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Volume 3, Number 43
27 October 2003

"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs INFO Project When you click on any link below, your Internet browser will access a Web site not connected to "The Pop Reporter." Information accessed through these links and contained in this issue of "The Pop Reporter" does not necessarily state or reflect the views of the INFO Project, Johns Hopkins University, or the US Agency for International Development. All links were verified at the date of mailing. Your computer and/or network configuration regarding Java script, cookies, and other security issues may not allow you to view certain Web sites. Consult your computer technician if you are having problems.

GUEST EDITORIAL

New Survey Findings: The Reproductive Revolution Continues

Since 1990, 120 surveys of women (many also including men) have taken place in 71 countries as part of the Demographic and Health Surveys (DHS) and the Reproductive Health Surveys (RHS) programs. These surveys report on contraceptive use, child survival, and other key reproductive health topics. The INFO Project's complete report on its survey findings are available in the latest issue of Population Reports, "New Survey Findings: The Reproductive Revolution Continues," which is available online (http://www.infoforhealth.org/pr/m17/index.shtml) and in pdf format (http://www.infoforhealth.org/pr/m17/m17.pdf). Summary findings from this issue of Population Reports are presented here.

Fertility fell in almost all developing countries surveyed since 1990, as use of modern contraception rose. These trends continue a long-term change in attitudes and behavior. Findings from more than 100 surveys conducted since 1990 suggest that, as family planning programs have become widespread, more and more people want smaller families, and more succeed in having the size of family that they want.

Contraceptive use and fertility rates vary substantially among developing countries. In a few countries of Asia and Latin America, at least 75% of married women use a contraceptive method—levels equal to those in developed countries. In contrast, in some sub-Saharan African countries, less than 10% of married women use contraception. Fertility rates range from just 2.3 children per woman in Vietnam to 7.2 in Niger (1).

Although fertility is higher and contraceptive use less common in sub-Saharan Africa than elsewhere, surveys suggest that parts of Africa have started down the path already taken in other regions. Fertility fell by more than 1% per year in 9 of 16 sub-Saharan countries with more than one survey since 1990.

Use of contraception: Around the world, more than 600 million married women are using contraception—nearly 500 million in developing countries. Among married women, contraceptive use rose in all but two developing countries surveyed more than once since 1990 (2). Among unmarried sexually active women, contraceptive use rose in 21 of 25 countries. Four modern contraceptive methods—female sterilization, oral contraceptives, injectables, and IUDs—are the most widely used methods among married women in developing countries. Together they account for almost 75% of all contraceptive use. Male condoms rank just behind IUDs. Since 1990, use of injectables has increased substantially, and they have become the third most commonly used method in developing countries surveyed.

Reproductive intentions: A growing share of married women do not want any more children. Outside sub-Saharan Africa, nearly 60% of married women surveyed since 1990 want to end childbearing. As new reproductive attitudes spread, the family sizes that women consider ideal are falling (3).

Unmet need: An estimated 105 million married women, about 1 in every 5, have an unmet need for family planning—that is, they are sexually active and want to avoid pregnancy, but are not using contraception. The percentage of women with unmet need fell since 1990, but the number changed little because populations grew (4).

Unmarried youth: In many countries a growing share of unmarried women ages 15 to 24 are sexually active before marriage. These young women increasingly use contraception, and in particular, condoms. Still, many unmarried young women have unintended pregnancies, and many are at risk for HIV/AIDS and other sexually transmitted infections (5).

Child survival and health: Infant and child survival rates improved by nearly 30% in surveyed developing countries as a whole since 1990. But infant and child mortality increased in some sub-Saharan countries, particularly in those hardest hit by the HIV/AIDS epidemic. Few surveyed countries have met the goal set by WHO and UNICEF of immunizing at least 80% of children against the common childhood diseases by 2000 (6).

Maternal health care: In general, the percentage of married women who gave birth in a medical facility increased somewhat since 1990. Nevertheless, in much of North Africa and Asia and in some parts of sub-Saharan Africa, women are still much more likely to deliver at home than in a medical facility. One-fourth of women surveyed in developing countries received no antenatal care from a skilled attendant during their most recent pregnancy (7).

References:

1. Zlidar, V.M., Gardner, R.. Rutstein, S.O, Morris, L, Goldberg, H.; and Johnson, K. New Survey Findings: The Reproductive Revolution Continues. Population Reports, Series M, No. 17. Baltimore, The Johns Hopkins Bloomberg School of Public Health, The INFO Project, Spring 2003. Available at: http://www.infoforhealth.org/pr/m17/m17chap2_2.shtml. Accessed October 22, 2003.
2. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap2.shtml. Accessed October 22, 2003.
3. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap2_4.shtml. Accessed October 22, 2003.
4. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap6_3.shtml. Accessed October 22, 2003.
5. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap7.shtml. Accessed October 22, 2003.
6. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap8.shtml. Accessed October 22, 2003.
7. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap9.shtml. Accessed October 22, 2003.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Defining the Components of "Performance" in Family Planning/Reproductive Health for Conceptual Clarity and Sounder Measurement (research article)
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In the family planning/reproductive health literature, the word “performance” is used to refer to different concepts. The authors attempt to standardize its definition and operationalize its measurement among international assistance organizations. In the field of Human Performance Technology, the definition of performance is both behavior or activities and the accomplishments produced by such behaviors/activities. They describe typical methodologies used to measure each component as well as particular challenges facing the measurement and reporting of performance.

Husband-wife Communication and Family Planning Practices among Malay Married Couples in Mukim Rusila, Terengganu (PubMed abstract)
This was a cross-sectional study of the role of husband-wife communication in the practice of family planning among the rural Malay couples in Mukim Rusila, Terengganu. A total of 193 (100.0%) wives and 74 (38.3%) husbands responded to a face-to-face interview. There was a significant association between husband-wife communication on family planning and the current practice of family planning, and the 'likelihood' that couples who had had good husband-wife communication to practice family planning was about 2.8 times higher compared to those couples with poor husband-wife communication.

STD Trends and Patterns of Treatment for STD by Physicians in Private Practice in Peru (research abstract)
This article describe trends in STD visits to physicians in private practice in Peru over a 15 year period and in the patterns of treatments used for STD. The number of first visits for pelvic inflammatory disease (PID) and trichomoniasis, and total visits for genital herpes increased from 1983–5 to 1996–7; while first visits for gonorrhoea and total visits for syphilis changed little in recent years. Treatment for gonorrhoea usually involved the use of spectinomycin or an aminoglycoside only. Treatments offered for PID were remarkably inadequate and for trichomoniasis often involved products not known to be effective for trichomoniasis or other causes of vaginal discharge.

Sex Differences in the Experience of Testing Positive for Genital Chlamydia Infection: A Qualitative Study with Implications for Public Health and for a National Screening Programme (research abstract)
Researchers used semistructured interviews with 24 heterosexual patients (12 men; 12 women) diagnosed with genital chlamydia infection, at a large sexual health clinic in central London, to explore men’s and women’s accounts of chlamydia testing, with a view to understanding sex differences in attitudes and in behaviors of public health importance. Participants’ expressions revealed important sex differences. Women felt anxious about their future reproductive health, feared stigmatization, and blamed themselves for contracting chlamydia; whereas men generally reported less concern, were unwilling to disclose their condition to sexual partners, and sometimes projected attributions of blame onto their partners. Delays in seeking care appeared to be related to perceptions of chlamydia as a relatively minor infection, particularly in men. The authors state that health promotion needs to reflect sex and age differences, emphasizing the negative consequences of delayed clinic attendance and exposure to repeat infections.

Cross-border Procurement of Contraception Estimates from a Postpartum Survey in El Paso, Texas (research abstract)
Along the US-Mexico border, US residents have the option of crossing to Mexico to purchase hormonal contraception sold over-the-counter at very low prices in pharmacies. This study investigated the prevalence of cross-border contraceptive procurement by way of a survey of 3,134 women who delivered in a large public hospital in El Paso, Texas, between 1996 and 1997. Pills, injectables, condoms, and IUDs were the most commonly used methods by women in the birth interval preceding delivery. Among multiparous women, 41% of pills and 54% of injectables were obtained in Mexico. However, almost all condoms were obtained in the US. In this largely Hispanic population, the prevalence of cross-border procurement was highest among women who were born and educated in Mexico.

Supplying Emergency Contraception via Community Pharmacies in the UK: Reflections on the Experiences of Users and Providers (research abstract)
This paper discusses findings from an evaluation of a program to provide free emergency hormonal contraception (EHC) via community pharmacies in the North-West of England. The benefits of the service, cited by both pharmacists and users, included enhanced access to EHC, at times when it was needed, and at no cost to the user. In particular, users noted a welcome absence of judgmental attitudes when accessing the service. Pharmacists too were positive about the service, not least because they believed that it conferred enhanced professional status. However, both users and pharmacists had a number of major concerns about the schemes, including the potential for misuse, changes in contraceptive behavior, and the impact on sexually transmitted infections.

Metformin in Polycystic Ovary Syndrome: Systematic Review and Meta-analysis (research article)
The research assesses the effectiveness of Metformin in improving clinical and biochemical features of polycystic ovary syndrome through a systematic review and meta-analysis of 13 trials, including 543 women with polycystic ovary syndrome that was defined by using biochemical or ultrasound evidence. Based on the findings, the researchers conclude that Metformin is an effective treatment for anovulation in women with polycystic ovary syndrome.

A Review of Psychosocial Interventions in Infertility (research abstract)
In this review, the authors determine whether psychosocial interventions improved well-being and pregnancy rates and identify the kinds of interventions that were most effective. The researchers found that pregnancy rates were unlikely to be affected by psychosocial interventions. It was also found that group interventions that had emphasized education and skills training (eg, relaxation training) were significantly more effective in producing positive change across a range of outcomes than counseling interventions that emphasized emotional expression and support and/or discussion about thoughts and feelings related to infertility.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Plan B Emergency Contraceptive OTC Switch Will Get Committee Review Dec. 16 (news article)
FDA’s Nonprescription Drugs and Reproductive Health Drugs Advisory Committees will jointly review the proposed OTC switch of Barr/Women’s Capital Corporation’s Plan B (levonorgestrel) emergency contraceptive during a Dec. 16 meeting. WCC’s April 21 sNDA included 39 studies on nearly 11,000 women, including a label comprehension study, an actual use study, and several clinical and behavioral trials. The label comprehension study, published in December 2002, found that 96% of women understood that the regimen’s two 0.75 mg tablets should not be taken at the same time and that 86% of women understood that the pills should be taken at a 12-hour interval.

The Philippines: Muslim Religious Leaders Discuss Family Planning and Reproductive Health (news article)
Muslim religious leaders from all over Mindanao gathered to engage in a dialogue on the formulation of a national fatwah (a religious edict) on reproductive health and family planning. While some call for responsible parenthood, others maintain that family planning is not allowed by the Koran.

China Outlines Its Reproductive Health Product Plans (news article)
China is working hard to become a major exporter of reproductive health technology and products in 5 to 10 years. According to the article, China's reproductive health industry has the potential to play a significant role in helping to meet the need for such technology and products, especially from developing countries.

Home Abortions Soar in Iraq as Unwanted Pregnancies Rise (news article)
This article reports that women in Baghdad are turning to backstreet abortionists to avoid the risk of family honor killings.

Indo-US Team to Make Male Pill a Reality (news article)
Indian and American scientists are working closely in the field of male contraception to produce a sperm-based vaccine. Last week, scientists representing nine institutions in the US and 16 in India exchanged notes on the ongoing research on the subjects in both countries. This was part of the Indo-US Programme on Contraceptive and Reproductive Health Research, ongoing since 1997.

Half of Indian Population Unaware of Contraceptive Methods (news article)
This news articles quotes a local expert who states that a lack of awareness about contraception keeps more than half of the Indian population from taking any birth control measures.

UK: Contraception and Sexual Behavior (news article)
The article provides and summarizes recent statistics on contraception and sexual behavior patterns in England. In 2002/03, 74% of women in England (aged 16 to 49) used some form of contraception. The pill continued to be the most common method of contraception, used by 25% of women, followed by the male condom (20%). The type of contraception which women used varied with their age. Women aged under 30 were more likely to use the contraceptive pill than older women, while the likelihood of a women having been sterilized or having a partner who had had a vasectomy rose with age.

US: 'It's a Boy' is Still What Parents Hope to Hear (news article)
Despite growing equality for girls and women, Americans continue to want sons over daughters. In a new Gallup Poll, 38% of respondents say they would prefer a boy if they could have only one child. Twenty-eight percent would choose a girl. Slightly more than a quarter express no preference. The rest have no opinion.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Belgium to Subsidise Costs of Contraception to Teenagers (news article)
In a bid to reduce the number of unwanted pregnancies, the Belgian government is planning to provide hundreds of thousands of teenagers with monthly vouchers (beginning January 1 next year) to help pay for the costs of contraception. Each voucher will be worth (US$3.5), the monthly cost of the second generation pill, and will be available to about 372,000 young men and 357,000 young women aged 15 to 20 years. But the starting age may be raised to 16, the current age of consent in Belgium.

Kenya: Policy on Norplant Worrying Women (research article)
This article describes the controversial and sometimes misunderstood government policy decisions in Kenya regarding the distribution of Norplant.

UK: Female Mutilation Curbs Set to Become Law (news article)
A bill curbing the practice of female genital mutilation completed its passage through Parliament last week. The Female Genital Mutilation Bill, which extends the scope of the existing ban by making it unlawful to take girls abroad for such practices, was given an unopposed third reading in the Lords. It is set to receive royal assent and become law on October 30.

UK: Man Convicted of Grievous Bodily Harm for Infecting Two Women with HIV (news article)
In the first successful prosecution of its kind in England and Wales, a London man was convicted last week of grievous bodily harm for infecting two women with HIV.

UK: Disabled Mother Whose Sterilisation Failed Cannot Claim the Extra Costs of Bringing Up a Child (news article)
In the UK, the House of Lords last week ruled that any disabled woman who gives birth to a normal, healthy child after a negligently performed sterilisation operation is not entitled to sue for the extra childcare costs she incurs because of her disability.

ABC of Subfertility: Assisted Conception and the Law in the United Kingdom (policy brief)
Along with advances in technology comes the need for government guidelines and laws to ensure that those technologies are used safely and responsibly. The article covers the development of the rules in the United Kingdom that govern assisted conception, and the implications of these rules for day to day clinical practice.

HIV/AIDS RESEARCH

Psychosocial Needs, Mental Health, and HIV Transmission Risk Behavior among People Living with HIV/AIDS in St. Petersburg, Russia (research abstract)
This article reports on the social, psychological, behavioral, and health care service access of persons living with HIV in Russia.

AIDS Knowledge and Educational Needs of Technical University Students in Turkey (research abstract)
The aim of this research is to determine the Turkish university students knowledge, sexual risk behavior, attitude towards AIDS and educational needs concerning AIDS. One thousand four hundred and twenty-seven university new registrants from the Middle East Technical University participated and answered a 32-item self-administered questionnaire. The response rate was 84%. Two hundred and seventy-one (19%) participants had sexual intercourse. Eighty-one (30%) participants reported condom use during the last sexual encounter. Seven hundred and twenty-four (51%) stated they knew "very much" about AIDS. Television was reported as the major source of information about AIDS, and almost all students stated that there should be a course on AIDS in their curriculum.

Epidemiological and Demographic HIV/AIDS Projections: South Africa (research abstract)
Related news article: South Africa AIDS Epidemic Peaked in 2002
Related news article: Academics Cast Doubt on New Aids Survey
A study released last week indicated that South Africa may finally be winning the battle to bring the killer AIDS disease under control. After developing a model based on data from HIV-prevalence surveys conducted in South African prenatal clinics, the study authors said South Africa's AIDS epidemic likely peaked in 2002 and would level off as fewer new infections were recorded. However, in a related news article, two of South Africa's leading HIV/AIDS academics have cast their doubts on the study findings. The new findings fly in the face of previous research, showing HIV prevalence rates were highest in Free State and Gauteng and not KwaZuluNatal and Mpumalanga. University of Natal epidemiologist Prof. Quarraisha Abdool Karim was quoted in the news article as saying: "The [new] study has not been through a peer-review process. There are a number of flaws in the study, and in the interpretation and data analysis that have not been addressed the use of these data to calibrate a new model questions the validity of the model." The news article also states that the researchers have refused other academics access to their data or the questionnaires.

Behaviour and Communication Change in Reducing HIV: Is Uganda Unique? (research abstract)
In this paper, the authors assess the epidemiological and behavioural data on Uganda compared to other African countries and then analyze data from other populations where HIV has declined. They found that, in Uganda, HIV prevalence declined from 21% to 9.8% from 1991–1998; there was a reduction in non-regular sexual partners by 65%; and greater levels of communication about AIDS and people with AIDS through social networks, unlike the comparison countries. The authors also found evidence of a basic population level response initiated at the community level to avoid risk, reduce risk behaviors, and care for people with AIDS. The basic elements — a continuum of communication, behaviour change, and care — were integrated at the community level. The researchers identify a similar, early behavior and communication response in other situations where HIV has declined: Thailand, Zambia, and the US Gay community.

Current HIV/AIDS End-of-life Care in Sub-Saharan Africa: A Survey of Models, Services, Challenges and Priorities (research article)
Researchers surveyed end-of-life care programs, addressing the domains of service aims and configuration, barriers to pain control, governmental endorsement and strategies, funding, monitoring and evaluation, and research. Although 85% of programs reported government endorsement, end-of-life and palliative care national strategies were largely absent. Still, data from 48 programs in 14 countries with a mean annual funding of US $374,884 demonstrated integrated care delivery across diverse settings.

HIV/AIDS NEWS

Hidden from the World, a Village Dies of AIDS while China Refuses to Face a Growing Crisis (feature article)
This article relates the grim tale of Xiongqiao village, Henan province, known as ground zero of China's AIDS epidemic. Up to a million people have been infected in this single province through a vast, largely unregulated blood-selling operation. A reporter for the British newspaper The Guardian gained rare access to the village and has spoken to HIV-positive villagers who have been arrested and beaten for trying to draw attention to their plight; to health officials who have been harassed, sued and kept under surveillance for speaking out; and to local newspaper reporters who have been fired for trying to publish the truth.

AIDS Plan Would Cut Drug Costs for Poor (news article)
The Washington Post reports that the World Health Organization (WHO) will disclose this week the first details of a global AIDS strategy to bring low-cost drugs to 3 million people in poor countries, a plan that top officials said will eventually include endorsement of pills that combine three HIV drugs in a single tablet. The endorsement of the three-in-one pills is expected to be controversial because they could violate a variety of patents. Only about 300,000 people are receiving AIDS medicine in the regions targeted by WHO. The strategy is also expected to call for treating patients at the first sign of symptoms, rather than waiting for tests to confirm infection by HIV, and to allow nurses and community organizations to dispense the medicines. As a first step, WHO will issue a list next week of the "first line" medicines to be used in poor countries.

Ghana: Is Voluntary Testing and Counseling (VCT) the Key to Behavioral Change? (news article)
Voluntary Counseling and Testing (VCT) may be an effective avenue to promote behavioral change related to preventing and managing the HIV/AIDS. The advantages of such an approach is beginning to be looked at more carefully in Ghana, where several VCT centers currently operate.

Zimbabwe: Virginity Tests Return to Fight HIV/AIDS (news article)
With the HIV/Aids epidemic devastating the country, virginity testing is seen as a logical move by some. Critics of virginity tests say the practice is not only degrading to the girls but could also make them targets for HIV/AIDS positive men who believe sleeping with a virgin is the cure for HIV infection.

Annan Welcomes Pact on Lowering AIDS Drug Prices in Developing Countries (news article)
United Nations Secretary General Kofi Annan last week welcomed an agreement between former President Bill Clinton's foundation and four pharmaceutical companies in developing countries to halve the price of anti-retroviral drugs used to treat HIV/AIDS, and he said he hoped other drug manufactures would follow suit.

AIDS in Asia Spreading Rapidly (news article)
One million people in Asia and the Pacific acquired HIV in 2002, bringing the number of people now living with the virus to an estimated 7.2 million — a 10% increase since 2001. According to the article, a further 490,000 people are estimated to have died of AIDS in the past year. About 2.1 million young people (aged 15-24) are living with HIV.

MATERNAL AND CHILD HEALTH RESEARCH

Is Antenatal Syphilis Screening Still Cost Effective in Sub-Saharan Africa (research abstract)
Researchers assessed the economic costs of adding on-site antenatal syphilis screening and treatment in Mwanza, Tanzania, to routine antenatal care. The economic cost of the intervention is $1.44 per woman screened, $20 per woman treated, and $187 per adverse birth outcome averted. The cost per DALY saved is $110 with low birth weight as the only adverse outcome. When including stillbirth, this estimate improves 10-fold to $10.56 per DALY saved. The cost per DALY saved from all syphilis screening studies ranged from $3.97 to $18.73. Syphilis screening is shown to be at least as cost effective as prevention of mother to child transmission of HIV screening, and more cost effective than many widely implemented interventions. The authors recommend scaling up syphilis screening and treatment in high prevalence areas.

Hormonal Contraception during Lactation: Systematic Review of Randomized Controlled Trials (research abstract)
This is a review of randomized controlled trials to determine the effect of hormonal contraception on lactation. Seven reports from five randomized controlled trials met the inclusion criteria of the authors. Most of the five trials did not specify their method used to generate a random sequence, method of allocation concealment, blinding of treatments or use of an intention-to-treat analysis. Additionally, high loss-to-follow-up rates invalidated at least two trials. The findings from two trials comparing oral contraceptives to placebo during lactation were conflicting. Another trial found no inhibitory effects on lactation from progestin-only contraceptives. Finally, the World Health Organization trial found a statistically significant decline in breast milk volume in women using combined oral contraceptives compared to women using progestin-only pills. However, infant growth for the two groups did not differ. The authors write that the limited evidence from randomized controlled trials on the effect of hormonal contraceptives during lactation is of poor quality and insufficient to establish an effect of hormonal contraception, if any, on milk quality and quantity. At least one properly conducted randomized controlled trial of adequate size is urgently needed to make recommendations regarding hormonal contraceptive use for lactating women.

Infant Health Among Puerto Ricans --- Puerto Rico and U.S. Mainland, 1989--2000 (report)
This report compares trends during the previous decade in infant mortality rates (IMRs) and major determinants of these rates such as low birthweight (LBW), preterm delivery (PTD), and selected maternal characteristics among infants born to Puerto Rican women on the US mainland (50 states and the District of Columbia) with corresponding trends among infants born in Puerto Rico. The findings indicate that despite having lower prevalence of selected maternal risk factors, Puerto Rico--born infants are at greater risk for LBW, PTD, and infant death than mainland-born Puerto Rican infants. This report also highlights a persistent disparity in IMRs and an emerging disparity in LBW and PTD rates between Puerto Rico--born infants and mainland-born Puerto Rican infants.

MATERNAL AND CHILD HEALTH NEWS

Nigerian Muslims Skeptical of Polio Plan (news article)
An emergency drive to vaccinate Nigerians against polio as a spreading outbreak threatens worldwide efforts to eradicate the disease faces suspicions among Muslim fundamentalists. Health workers launched the drive on Friday, racing to immunize 15 million African children at immediate risk a four-day effort impeded by rumors among Muslim fundamentalists that the vaccine was part of a US plot to spread AIDS and render Muslims infertile. Three predominantly Muslim states in northern Nigeria Kano, Kaduna and Zamfara have either delayed or refused permission for the vaccination drive, with Zamfara demanding proof the vaccine is safe, something UN officials say has been repeatedly supplied.

Sudan: Avoidably High Maternal Death Rates (news article)
The article describes the high maternal death rates by region in Sudan. Women have a one-in-30 chance of dying in childbirth in northern Sudan, with higher rates in areas of the south. Despite inconsistent reporting, some localized studies have been done which reveal death rates of between 400 and 800 deaths per 100,000 births.

Uganda: Mothers Reject Free HIV Drugs (news article)
This article describes the troubling link between HIV testing, treatment, and a mother’s wish to continue breastfeeding. Because HIV testing is required prior to receiving drugs to prevent mother-to-child transmission of HIV, many women refuse due to the implications for breastfeeding.

MEN'S HEALTH RESEARCH

Sexually Transmitted Infections in Male Clients of Female Sex Workers in Benin: Risk Factors and Reassessment of the Leucocyte Esterase Dipstick for Screening of Urethral Infections (research abstract)
Male clients of female sex workers (n=404) were recruited on site at prostitution venues in Cotonou, Benin, to assess risk factors for urethral infections and to study the validity of LED testing of male urine samples compared to a highly sensitive gold standard (PCR) for the diagnosis of urethral infections. STI prevalences were: C trachomatis, 2.7%; N gonorrhoeae, 5.4%; either chlamydia or gonorrhoea 7.7%; T vaginalis 2.7%; HIV, 8.4%. The overall sensitivity, specificity, positive, and negative predictive values of the LED test for detection of either C trachomatis or N gonorrhoeae were 48.4%, 94.9%, 44.1%, and 95.7%, respectively. In symptomatic participants (n=22), all these parameters were 100% while they were 47.4%, 94.7%, 37.5%, and 96.4% in asymptomatic men (n=304).

Male Circumcision and HIV Heterosexual Transmission (research article)
This article is in Portuguese and the abstract is in English. This article reviews African studies on the association between male circumcision and HIV infection, the origin of circumcision practices in human societies, potential prepuce mechanisms for increasing male vulnerability to heterosexual HIV infection, its association with other infectious and neoplastic diseases, controversies on the convenience of male circumcision as an HIV control strategy in Africa, the scarce Brazilian literature on male circumcision, and perspectives of future research.

Male Contraception: Mechanical, Hormonal and Non-hormonal Methods (research abstract)
This article reviews recent approaches toward the development of new male contraceptives.

POPULATION RESEARCH

Russian Mortality Trends for 1991-2001: Analysis by Cause and Region (research article)
Researchers found that mortality increased substantially after Russia's economic crisis in 1998, with life expectancy falling to 58.9 years among men and 71.8 years among women by 2001. Most of these fluctuations were due to changes in mortality from vascular disease and violent deaths (mainly suicides, homicides, unintentional poisoning, and traffic incidents) among young and middle aged adults. Similar trends were found in all parts of Russia. Alcohol consumption is strongly implicated in being at least partially responsible for many of these trends.

POPULATION NEWS

US Census: Record Number of Women Childless (feature article)
Related resource material: US Census Bureau: Fertility of American Women
This article reports that a record number of US women (nearly 44%) aged 15 to 44 are childless. The latest numbers reflect the well-established trend of more women going to college and entering the work force, then delaying motherhood or deciding not to have children. The article relates how childless couples are often incorrectly tagged as "kid-haters," when all they are really interested in is maintaining their lifestyle choices.

Aged Chinese to Increase by 3.2% Yearly (news article)
The elderly population of China is forecast to grow by 3.2% every year in China. China reports a high growth of its aged population and has already moved into an aging society in step with many other countries. China has about 134 million people older than 60, or 10% of the country's total population, among whom 94 million are over 65 and 13 million over 80.

WOMEN'S HEALTH RESEARCH

Baseline Survey of Sexually Transmitted Infections in a Cohort of Female Bar Workers in Mbeya Region, Tanzania (research abstract)
The purpose of this study was to determine baseline prevalence of STIs and other reproductive tract infections (RTI) and their association with HIV, as well as sociodemographic and behavioural characteristics, in a newly recruited cohort of female bar workers in Mbeya Region, Tanzania. Female bar workers (600) were recruited from 17 different communities. HIV-1 seroprevalence was 68%. Prevalences of STI/RTI were high titre syphilis, 9%; herpes simplex virus 2 antibodies, 87%; chlamydia, 12%; gonorrhoea, 22%; trichomoniasis, 24%; and bacterial vaginosis, 40%.

Disruption of the Upper Female Reproductive Tract Epithelium by Nonoxynol-9 (research abstract)
In this laboratory study in a mouse model, the authors state that their results demonstrate for the first time that N-9 has a deleterious effect on uterine epithelium. A similar disruption of the upper reproductive tract epithelium in women by N-9 may facilitate HIV infection and serve as an unrecognized portal of human HIV transmission.

Combined Oral Contraceptives and the Risk of Myocardial Infarction (research abstract)
This article reviews studies on the combined oral contraceptive (COC) pill and myocardial infarction. The authors state that a reasonable conclusion is that the COC pill causes a two-fold increase in the risk of myocardial infarction. There is a marked interaction with smoking. The pill causes coagulation changes and affects lipoprotein and carbohydrate metabolism, and these changes provide a plausible explanation for its effect. However, there are dangers in using these surrogate end-points to predict which pills carry the greatest risk. This must depend on an assessment of the epidemiology, and at present third generation pills have not convincingly been shown to be safer in this regard. The risk of causing myocardial infarction in non-smokers is small, but they caution against prescribing the pill to smokers over 34 years old and especially to smokers over 39 years old.

Knowledge Aadequacy on Contraceptives among Women in Brazil (research abstract)
An analysis of secondary data was carried out to evaluate the knowledge adequacy on contraceptives and its association with socioeconomic and demographic characteristics. The sample consisted of 472 women from the city of Campinas, São Paulo, Brazil. Less than half of the women (47.6%) showed an adequate knowledge of contraceptives. A higher level of education and better socioeconomic status were associated with higher scores of knowledge.

WOMEN'S HEALTH NEWS

Health Needs of Women Who Have Sex with Women (editorial)
Women who have sex with women form a small but important group and have specific health needs. A lack of awareness among healthcare professionals about these needs may lead to ill-informed advice and missed opportunities for the prevention of illness. High-risk types of genital human papillomavirus are associated with developing high-grade cervical intraepithelial neoplasia, and sexual intercourse with men is a powerful risk factor for cervical cancer. According to the report, it is important to counter the erroneous assumption that women who have sex with women are not at risk of catching human papillomavirus. Around one in five women who have never had heterosexual intercourse have human papillomavirus.

Vaccine for Breast Cancer Shows Promise (news article)
The article describes a potentially effective treatment which stimulates the immune system to fight recurring cancer cells. The early results in 14 vaccinated survivors of advanced breast cancer suggest hope of preventing returning cancers.

Fertility Treatment Safe for Breast Cancer Patients (news article)
Researchers in Israel report that ovarian stimulation with tamoxifen, a drug that both stimulates ovarian function and protects the breast against cancer, is safe and effective for treatment of infertility in women with breast cancer. Ovarian stimulation as part of an in-vitro fertilization treatment is generally contraindicated in women with breast cancer because high estrogen levels can also promote malignant tumors.

YOUTH HEALTH RESEARCH

Sexual Behaviour among School Adolescents in Cordoba (research article)
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This article is in Spanish and the abstract is in English. The authors used an anonymous self-rated survey about sexual behaviour and uses of contraceptives methods in 893 randomly selected high school students in Cordoba. The average for first sexual relations was 16 years, with no difference between gender; 22% had had sexual relations, and girls more frequently had sexual relations. Eighty-two percent of those surveyed used a contraceptive method at their first sexual relation; the condom was the method most frequently used.

Contraceptive Use among Adolescents at Public Schools in Brazil (research abstract)
This article is in Portuguese and the abstract is in English. The authors used a cross-sectional study, by means of self-applied questionnaires, among 4,774 students ranging from 11 to 19 years of age to investigate factors associated with the use of contraceptive methods among female and male adolescent students. Among the 1,664 students who reported being sexually active, the factors positively associated with the consistent use of contraceptive method among male students included a) postponing their first experience of sexual intercourse and interaction with a stable partner, b) the family as a potential supplier of contraceptive methods, and c) access to health services. Among female students, factors positively associated with the consistent use of contraceptive methods included a) recent sexual initiation and b) having a father as their source of information regarding sexuality, contraception, and STD/AIDS prevention.

YOUTH HEALTH NEWS

Sexual Health Center for Young People Opens in E China (news article)
A sexual health center for young people has opened in Qingdao, a coastal city in east China's Shandong Province. The center, called "You and Me," will mainly offer free consultations on reproductive health.

Teens Want Relationship Help along with Sex Health Info (news article)
According to this article, when it comes to sexual health, teens have more questions about relationships than condoms or sexually transmitted infections. That was one of the conclusions reached by Planned Parenthood Federation of America researchers who sorted through 1,219 questions sent to the “Ask the Experts” section of their Web site for teens. Most of the questions posted to the site focused primarily on bodily symptoms such as bleeding or pain after sex, pregnancy and relationships and sexual identity. Fewer site visitors asked specifically about contraception and sexual behaviors. Sexually transmitted infections generated the smallest number of questions to the site. Researchers were concerned about the lack of questions on contraception and sexually transmitted infections, since recent studies suggest that “teens do not have crucial information” on these topics.

Adolescents: AIDS and Sexually Transmitted Diseases on the Rise in Italy (news article)
AIDS, gonorrhea, and syphilis are on the rise among adolescents, according to research presented at the conference of the Italian Society of Adolescent Medicine. Other illnesses, such as gonorrhea and syphilis, are also increasing among young people. Such an increase remains troubling, particularly given adolescents misconceptions that oral contraceptives will protect them from such diseases.

BOOKS/BOOK REVIEWS

Letting Them Die: Why HIV/AIDS Prevention Programmes Fail (book)
Related feature article: Why HIV/AIDS Prevention Programs Can Fail
Today in South Africa, HIV/AIDS kills about 5 in 10 young people. Many of the victims are miners and commercial sex workers who ply their trade in mining communities. In this critique of government-sponsored and privately funded HIV/AIDS prevention programs in South Africa, Catherine Campbell exposes why it has been so difficult to stop the HIV/AIDS epidemic. Campbell's research focuses on local vectors of the disease such as what people believe about the spread and prevention of AIDS, what measures they take to prevent disease, and whether they are likely to seek treatment at local AIDS clinics. "Letting Them Die" is not just an investigation into sexuality, social relations, health, and medicine; it is also a sharp review of the kinds of programs that are becoming the standard method of HIV/AIDS intervention throughout Africa.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 3, Number 4327 October 2003