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Volume 3, Number 46
17 November 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.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Application of Simple Fertility Awareness-Based Methods of Family Planning to Breastfeeding Women (research abstract)
Researchers determined the potential efficacy of two simple fertility methods of family planning, the Standard Days Method and the TwoDay Method, among 73 breastfeeding women in Australia, Britain, and Canada, who were followed starting 42 days postpartum, until they had at least two potentially fertile cycles. Results indicated that these two methods may be appropriate for different groups of breastfeeding women at different times. The Standard Days Method may be appropriate after cycle regularity is established, whereas the TwoDay Method may be a more effective option earlier in the postpartum period.

Effect of Oral Contraceptives and Intrauterine Devices on Midcycle Myometrial Contractions (research abstract)
Researchers determined the effects of oral contraceptives and intrauterine devices (IUDs) on midcycle myometrial contractions. They found that oral contraceptives dramatically suppressed midcycle contractility. Uncoordinated contractions in IUD bearing women indicate that the foreign body reaction of the IUD affects the normal physiology of these contractions.

Does Contraception Benefit Women? Structure, Agency, and Well-being in Rural Mexico (research abstract)
The authors of this paper examine Amartya Sen's contributions to the concept of human well-being from a gender perspective and argue that this concept is particularly useful for explaining women's decisions on contraceptive use. The study draws on data collected in six rural communities of Chiapas, Mexico. It emphasizes the ways in which public discourse articulates the apparent benefits of having small families; the context of the household and community in which rural women make reproductive decisions; and the impact of family planning programs on women's sense of subjective well-being. In particular, it questions the assumption that reduced fertility through contraception necessarily enhances women's well-being and points to the importance that women attach to being a party to reproductive decisions.

Preventing Sexually Transmitted Infections and Unintended Pregnancy, and Safeguarding Fertility: Triple Protection Needs of Young Women (research abstract)
This paper argues for the notion of "triple protection" to include the safeguarding of fertility, as infertility and STIs are often connected. Building on efforts to promote dual protection, an opportunity exists to include prevention of infertility into safer sex messages and to address the fragmentation of reproductive health and HIV/AIDS programs.

Pregnant or Positive: Adolescent Childbearing and HIV Risk in KwaZulu Natal, South Africa (research abstract)
Cross-sectional survey data from KwaZulu Natal, South Africa, was analyzed to explore whether an association exists between the desire for pregnancy and perceptions of HIV risk among 1,426 adolescents in 110 local communities. The analysis suggests that, for some adolescents, the danger of HIV infection is becoming part of the calculus of the desirability of a pregnancy.

The Right to Love: The Desire for Parenthood among Men Living with HIV (research article)
This paper reports a study that investigated issues of sexuality and reproduction with 250 Brazilian men living with HIV in São Paulo. The researchers asked whether the men wished to have children and whether health professionals in HIV/AIDS treatment clinics that they attended were supportive of their wishes. Health professionals were not considered by most participants to be supportive enough or even impartial about HIV-positive people having children, and paid little attention to men's fathering role. For example, few of the men received information about treatment options that would protect infants. The authors conclude that the rights of those with HIV to found a family depend as much on curing the ills of prejudice and discrimination, including among health professionals, as on medical interventions.

Father Absence, Parental Care, and Female Reproductive Development (research abstract)
This study examines female reproductive development from an evolutionary life history perspective. Retrospective data are for 10,847 U.S. women. Results indicate that timing of parental separation is associated with reproductive development and is not confounded with socioeconomic variables or phenotypic correlations with mothers' reproductive behavior. Divorce/separation between birth and 5 years predicted early menarche, first sexual intercourse, first pregnancy, and shorter duration of first marriage. Separation in adolescence was the strongest predictor of number of sex partners. Multiple changes in childhood caretaking environment were associated with early menarche, first sex, first pregnancy, greater number of sex partners, and shorter duration of marriage.

Developmental Toxicology Studies of WHI-07, a Novel Nucleoside Analogue-Based Dual-Function Microbicide, Administered Intravaginally to Rabbits (research abstract)
The findings in this rabbit model indicate that WHI-07 shows unique clinical potential to become the active ingredient of a new female-controlled topical microbicidal vaginal contraceptive for women who are at high risk of acquiring HIV/AIDS.

Genital Human Papillomavirus Genotyping by HPV Oligonucleotide Microarray in Korean Commercial Sex Workers (research abstract)
Because of the diversity in human papillomavirus (HPV) distribution, according to the population and region, detailed investigations of HPV genotypes and subtypes are important in designing more effective HPV vaccines for any given country. The prevalence of HPV in Korean commercial sex workers in this study was found to be 47%, with HPV-16 and HPV-51 as the dominant genotypes. The authors write that this molecular epidemiological study of genital HPV will be useful for the development of a favorable strategy to prevent the spread of this potentially serious infection.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

U.S. Clears Bristol-Myers Chewable Contraceptive (news article)
Related press release: FDA Approves Ovcon 35 as the First Chewable Oral Contraceptive Tablet for Women
US regulators have approved the first chewable oral contraceptive for women, a spearmint-flavored tablet called Ovcon 35. It contains progestin and estrogen, the hormones used in standard birth control pills to prevent pregnancy, the FDA said.

FDA Grants Fast Track Designation for 1.0% C31G Vaginal Gel for Reduction of HIV Transmission (news article)
Biosyn, Inc. announced that the US Food and Drug Administration (FDA) has granted Fast Track designation for the development program of 1.0% C31G vaginal gel for the reduction of HIV transmission. In granting the Fast Track designation, the FDA recognized that HIV infection is a serious and life-threatening condition, there is an unmet need for a female controlled method to reduce the sexual transmission of HIV, and 1.0% C31G has the potential to address this unmet medical need.

Nigeria: Plateau to Introduce Sex Education In Schools (news article)
Plateau State Governor, Chief Joshua Dariye, has said that it had become compelling for government to introduce and include sex education in the curriculum of post-primary institutions. He also called on the federal government to formulate a national policy concerning reproductive health for Nigerian youths and allocate resources.

Caribbean Countries Reaffirm Vow to Women’s Health and Gender Equality – UN (news article)
Representatives from Caribbean countries met in Trinidad and Tobago to review their progress in reaching the goals set by the 1994 International Conference on Population Development in Cairo on Friday. Issues key to discussions were reproductive health, gender equality,the empowerment of women, reducing infant and maternal deaths, access to reproductive health services for all, and increased
funding for programs to fight HIV/AIDS.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

South Africa HIV/AIDS Spending to Rise Fourfold (news article)
In an apparent shift in government policy on HIV/AIDS, South Africa is set to almost quadruple its spending on efforts to combat the disease, allocating $1.7 billion over the next 3 years.

Botswana Lauded In Washington as Model in HIV/AIDS War (news article)
Botswana's President Mogae has developed a multisectoral response campaign to encourage safe sex, AIDS awareness and education, as well as to improve testing and treatment efforts, with good results.

India Considers Childbirth Bill to Curb Population (news article)
India is considering a national bill to limit the family size of politicians and legislators to two children. The measure is to set an example for the general population in an effort to curb skyrocketing population. At least six states have adopted laws mandating two-child norm for members of village councils. Other incentives for reducing family size may also be offered.

Jamaica: Cabinet Considers Controversial Sex Policy for Children Under 16 (news article)
Jamaica's cabinet is considering a controversial policy that would make sex education and contraception information easily available to Jamaican children under the age of 16, without parental consent, according to the Health Minister.

Scotland: Sex Health Strategy Unveiled (news article)
A sexual health strategy for Scotland has been published, which aims to reduce the rates of teenage pregnancy and sexually transmitted disease. The Scottish Executive document has taken 4 years to prepare due to disagreement on the expert panel tasked with drawing up the strategy.

HIV/AIDS RESEARCH

HIV/AIDS in the Shadows of Reproductive Health Interventions (commentary)
The author analyzes why she rarely heard about AIDS during her 25 months spent in maternal and child health/family planning clinics in Tanzania. She states that HIV/AIDS cannot be merely inserted into existing family planning programs, re-named "reproductive health" programs. As the AIDS epidemic is transformed through new technologies, reproductive health policy and priorities will be called into question, forcing a closer look at the African health care system, networks of care-giving, and how individuals and communities fail when there is no socio-economic safety net.

Traditional Birth Attendants in Developing Countries Cannot Be Expected to Carry Out HIV/AIDS Prevention and Treatment Activities (research abstract)
The author is suggesting that policymakers, researchers, and service providers in reproductive health and HIV/AIDS, especially those in prevention of mother-to-child transmission of HIV, establish what expertise other groups working in the field have and integrate knowledge and services in a more effective way. The article voices concerns that there are worrying signs that specialists in both camps are making inappropriate policy and service delivery recommendations based on too little knowledge of each others' work.

Rape and HIV Post-Exposure Prophylaxis: Addressing the Dual Epidemics in South Africa (research article)
This paper compares the conditions for providing HIV PEP (post-exposure prophylaxis)in Europe and North America with the conditions faced by two initiatives in South Africa, one serving a primarily rural base, and one urban. It is based on a review of the literature on sexual violence in South Africa and use of PEP following occupational and non-occupational exposure. Delays in accessing PEP caused by the public justice system and lack of training for service providers constitute significant obstacles to effective implementation. Attention to reform and strengthen existing services for post-rape care and to link attention to the epidemic of sexual violence to HIV/AIDS prevention is necessary.

Mortality and Progression to AIDS after Starting Highly Active Antiretroviral Therapy (research abstract)
Related news article: AIDS Therapy Best if Given Early and Nonstop
New research suggests that an HIV-infected patient's chances of being alive 5 years later are highest if highly active antiretroviral therapy is given soon after infection and used continuously.

HIV/AIDS NEWS

Thailand's HIV Vaccine Trials Ends in Failure (news article)
Related press release: VaxGen Announces Results of its Phase III HIV Vaccine Trial in Thailand: Vaccine Fails to Meet Endpoints
A major trial in Thailand of a potential vaccine for HIV has ended in failure. VaxGen, the US-based company that developed the candidate vaccine known as AIDSVAX, announced that it did not prevent HIV infection or slow the progress of the disease.

Nearly 5 Million Indians Infected with HIV, Bill Gates-Funded Study Says (news article)
A study funded last month by the Bill & Melinda Gates Foundation states that although approximately 610,000 Indians contracted HIV last year, bringing the number of infected up to about 4.5 million, the second-highest total in the world, India is doing everything right to tackle the problem. The biggest challenge is getting out to the 640,000 villages spread across such a large country. The study's findings differ from the common perception that promiscuous truck drivers and needle-sharing drug users were spreading HIV.

Burundi: HIV/AIDS Patients May Get Free Drugs by December (news article)
Plans are underway to provide HIV/AIDS patients in Burundi with antiretroviral drugs free of charge by December.

China's AIDS Time Bomb (news article)
China is on the brink of an AIDS catastrophe and could have up to 10 million victims by the end of the decade.

Ghana: Banks Demanding Proof of HIV/AIDS Test from Customers (news article)
Some banks and credit-lending institutions in the country now demand proof of HIV/AIDS test from customers before approving their loan applications.

MATERNAL AND CHILD HEALTH RESEARCH

Anemia During Pregnancy in a Chinese Population (research abstract)
Prevalence, risk factors, and birth outcomes of anemic pregnant women in China were examined in this study. Results showed that anemia during early pregnancy was not associated with increased risk of adverse perinatal outcomes, but anemia in later pregnancy was inversely associated with preterm birth and low birth weight.

Explaining the Association of Maternal Age with Cesarean Delivery for Nulliparous and Parous Women (research abstract)
Cesarean delivery has been widely reported to rise with increasing maternal age. Future research needs to focus on unmeasured risk indicators for Cesarean delivery such as the management of labor and diagnosis of dystocia in nulliparas, as well as on the personal preferences of nulliparous women for Cesarean delivery. Results suggest that older women and their obstetricians should be the target of future efforts to control Cesarean rates.

Pregnancy-related Mortality among Women Aged 35 Years and Older, United States, 1991–1997 (research abstract)
Related news article: Pregnancy-related Deaths Increase with Age
US women age 35 and older face an increased risk of dying from a pregnancy complication, new research reports. The odds that a woman in the US will die during pregnancy or shortly after delivery are low: from 1991 to 1997, fewer than 800 such deaths among women age 35 and up were reported to the Centers for Disease Control and Prevention (CDC). Still, the long-standing increased risk for women in this age group remains, and it appears true for all major pregnancy-related causes of death, CDC researchers found. Women ages 35 to 39 were more than twice as likely as those in their 20s to die of a pregnancy-related cause, such as hemorrhage, infection or exacerbation of an existing medical condition. The risk for women age 40 and up was five times that of young women.

MATERNAL AND CHILD HEALTH NEWS

Childbirth in Afghanistan like Russian Roulette (feature article)
This article details new accounts of giving birth in Afghanistan.

Nepal: Maternal Mortality (feature article)
Despite some improvements in the health infrastructure of this country, a large number of women still do not receive minimum health facilities during pregnancy. At a time when the country’s basic health facilities are severely disrupted by the growing violence in the rural hinterland, a large number of women are denied basic treatment. The limited achievements of the last five decades do not prevent Nepal from turning into a country with the highest mortality rate in the world. Among observers from the prime minister to donors, there is growing realization of the need to improve the present situation. The question remains of how to make women’s lives safe.

POPULATION RESEARCH

Elaboration of the Coale-McNeil Nuptiality Model as the Generalized Log Gamma Distribution: A New Identity and Empirical Enhancements (research article)
(You need Adobe Acrobat Reader to access this document)
This paper shows that recognition of the identity of the
Coale-McNeil nuptiality model as the generalized log gamma distribution model should expand its possibility of application. Examples include development of country specific standard first marriage schedule, and incorporation of covariates with and without competing risk framework. The study also enhances the model ability to trace trajectory of lifetime first marriage schedule by incorporating empirical model of residual pattern
so as to ensure precise predictions even for cohorts that have not completed the processes. Illustrative application for estimation of cohort lifetime measures of first marriage
of Japanese women is presented. An application for fertility projection applying the model for fertility schedule by birth order is also proposed.

Human Population: The Next Half Century (research abstract)
Related news article: Population Expected to Boom by 2050
A new report shows the world's population is expected to grow from where it stands today at 6.3 billion, to 8.9 billion by 2050. And that's only if we continue to slow down our rate of reproduction from current levels; if fertility remained at present levels, the future population would likely reach 12.8 billion by 2050.

WOMEN'S HEALTH NEWS

The Jordanian Town that Still Circumcises Women (feature article)
Tucked away in a valley bounded by steep ridges of mountains and stretching from the Red Sea port city of Aqaba to the escarpment of the Southern Ghor of the Dead Sea is the town of Rahmah. From the outside, the nondescript ramshackle town of over 500 residents, whose Arabic name means “mercy,” appears little different from any other, with the exception of an ancient ritual performed there: that of circumcision, a practice otherwise unheard of in the conservative Hashemite Kingdom.

YOUTH HEALTH RESEARCH

Cervical Cytology Screening in Teens (research abstract)
New guidelines for the initiation of cervical cancer screening now recommend that screening be initiated within 3 years of the onset of vaginal intercourse but no later than 21 years of age. The new recommendations will assist in the over-referral and overtreatment of adolescents with HPV.

A Quantitative Survey of Knowledge of Reproductive Health Issues of 12-14-year-old Girls of Different Ethnic and Religious Backgrounds in Iran: implications for education (research abstract)
A quantitative research study was conducted to examine the knowledge of girls aged 12-14 years regarding reproductive health in five cities in Iran with different ethnic and cultural majorities. A cross-sectional study using a self-administrated questionnaire was conducted among guide school (middle school) pupils. Overall, knowledge level was unsatisfactory. An association between age and knowledge about reproductive health was found. The findings suggest that reproductive health education initiatives that involve mothers may be most appropriate in terms of cultural and religious sensitivities and be in keeping with the wishes of the girls themselves.

BOOKS/BOOK REVIEWS

HIV and AIDS in Africa: Beyond Epidemiology (book)
HIV and AIDS in Africa: Beyond Epidemiology is a collection that seeks to further understanding of AIDS by shifting the predominant understandings generated by biomedical and epidemiological research. The book brings together international contributors, including often overlooked African scholars and activists, from across the social sciences to examine HIV and AIDS from angles previously unexplored. By presenting on-the-ground evidence and ethnographic cases, the book emphasizes that HIV transmission in sub-Saharan Africa is a complex and regionally specific phenomenon rooted in local economies, deepening poverty, migration, gender, war, global economies, and cultural politics. The book also recognizes that AIDS in Africa cannot be stemmed until social, gender, and economic inequities are addressed in meaningful ways.

Rethinking AIDS Prevention: Learning from Successes in Developing Countries (book)
From an editorial review: "This is not another book about how AIDS is out of control in Africa and Third World nations, or one complaining about the inadequacy of secured funds to fight the pandemic. Edward C. Green, a member of President's Advisory Committee on HIV/AIDS, looks objectively at countries that have succeeded in reducing HIV infection rates...along with a worrisome flip side to the progress. This book is a bellwether in the escalating controversy, offering persuasive evidence in support of the ABC approach and exposing the fallacies and motivations of its opponents."

SPECIAL REPORTS/PROFILES/RESOURCES

Ask the Experts: Interview with Peter Piot, Executive Director, UNAIDS 11/18/2003 (resource material)
Ask the Experts: Interview with Peter Piot, Executive Director, UNAIDS, Tuesday, November 18, 2003. During this live webcast, Peter Piot, executive director, UNAIDS, will answer your questions about the state of the global HIV/AIDS epidemic and address recent efforts to expand access to treatment, lower drug costs, and step up prevention activities. The LIVE show begins at 2:00 pm ET, on Tuesday, November 18. Call toll-free at 1-888-KAISER8 (524-7378) during the show or submit your questions to ask@kaisernetwork.org before and during the discussion.

Problems and comments can be addressed to rjacoby@jhuccp.org. Archives available at http://www.infoforhealth.org/popreporter/ Subscribe at http://prds.infoforhealth.org/signup.php. Modify your account at http://prds.infoforhealth.org/modify.php. Have an item to contribute for consideration in The Pop Reporter? E-mail the URL and description to rjacoby@jhuccp.org. Forward this message to a friend who could benefit from INFO project activities! Sincerely, Robert Jacoby, rjacoby@jhuccp.org Editor, The Pop Reporter Johns Hopkins Center for Communication Programs

Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 3, Number 4617 November 2003