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The Pop Reporter®

Volume 3, Number 47
24 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.

GUEST EDITORIAL

A Legal Approach to Female Circumcision/Female Genital Mutilation: What Does It Mean for Governments?

by Laura Katzive, JD, LLM

lkatzive@reprorights.org

Stopping the practice of female circumcision/female genital mutilation, a goal rarely discussed in international fora just 20 years ago, has emerged as a critical priority in United Nations and regional human rights bodies. The change can be attributed to the work of activists, government officials and others who made the case that FC/FGM is not a private matter beyond the reach of governments, but a reflection of broad disregard for women’s human rights (1).

Characterizing FC/FGM as a human rights violation is not merely a rhetorical tool. Rather, it is a statement about governments’ responsibility to stop the practice. In countries where FC/FGM is practiced, which primarily include 28 African nations and numerous countries that receive African immigrants (2), governments have a duty under international law to take effective measures to ensure that girls and women are safe from genital cutting.

One of the most concrete steps a government can take to stop FC/FGM is to adopt a legal measure prohibiting the practice. Many advocates have lobbied for this type of response (3), with substantial success. At least 15 African countries have one or more laws or regulations specifically addressing the practice. With some variations, most governments that have taken a legislative approach – including Burkina Faso, Ghana, Kenya, and Tanzania – have assigned criminal penalties to those who perform, assist or solicit FC/FGM (4).

While criminal legislation sends a powerful message of intolerance for FC/FGM and can create deterrents for the practice, advocates caution that criminal sanctions alone do not address the root causes of the practice. Others have questioned governments’ commitment to implementing and enforcing criminal laws. Some have gone further to argue that a legal approach to FC/FGM might undermine efforts to stop the practice by driving it underground.

These considerations should guide governments’ responses to FC/FGM, but not discourage them from taking a legal approach. It is unquestionably true that a criminal ban on FC/FGM will achieve little in the absence of broader measures to empower women and reduce demand for the practice. Many governments have recognized this and complemented criminal legislation with national plans of action to stop FC/FGM through outreach programs and community-based strategies. It should also be recognized, however, that criminal legislation is but one legal response approach to FC/FGM, and its effectiveness can be enhanced when reinforced by a broader legal strategy. Governments have a variety of legal tools at their disposal to guide individuals’ behavior and create accountability. For example, health ministries can issue a decree barring medical practitioners from performing FC/FGM in public facilities, as was done in Egypt and Mali (5). The judiciary, when asked, may intervene to prevent a girl from undergoing FC/FGM, as courts have done several times in Kenya (6). In some cases, monetary awards may be sought in civil court from practitioners of FC/FGM on behalf of girls and women who have undergone the procedure.

To maximize the effectiveness of government action to stop FC/FGM, therefore, outreach activities should be extended to government officials themselves. Sensitization and education are needed for employees in every government sector – including law enforcement agents, judges, health officials and providers, and teachers – who may be in a position to use the law to prevent an act of FC/FGM or to assist a girl or woman who has undergone it. The law is a versatile tool, offering avenues for protection and recourse. A legal approach to FC/FGM should reflect the law’s full potential for creating change.

References:

1. Rahman A and Toubia N. Female Genital Mutilation: A Guide to Laws and Policies Worldwide, 10-13; 2000.

2. World Health Organization, Factsheet: Female Genital Mutilation, No. 241 (June 2000), available at http://www.who.int/inf-fs/en/fact241.html.

3. See, for example, the Cairo Declaration for the Elimination of FGM, adopted at the Afro-Arab Expert Consultation on Legal Tools for the Prevention of Female Genital Mutilation, June 2003, available at http://www.stopfgm.org/stopfgm/FGMappeal/expert.jsp?idMenu=1,13&.

4. Center for Reproductive Rights, Factsheet: Female Circumcision/Female Genital Mutilation (FC/FGM): Legal Prohibitions Worldwide (June 2003), available at http://www.reproductiverights.org/pub_fac_fgmicpd.html.

5. Egypt: Rahman & Toubia, supra note 1, at 142; Mali: Khadidia Sidibe Aoudou Maiga, Etude de Cas: le Mali, prepared for the Afro-Arab Expert Consultation on Legal Tools for the Prevention of Female Genital Mutilation, June 2003, available at http://www.stopfgm.org/stopfgm/FGMappeal/prepDoc.jsp?idMenu=1,13&.

6. "Using the Law to Protect Kenya’s Young Women from FGM," Reproductive Freedom News, September 2002, Vol. XI, No. 9, http://www.reproductiverights.org/rfn_02_09.html#6.

Laura Katzive is a legal adviser for global projects at the Center for Reproductive Rights. She coordinates the Center’s research and advocacy on legal responses to FC/FGM.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Acceptability of Emergency Contraception in Brazil, Chile, and Mexico. 1 - Perceptions of Emergency Oral Contraceptives (research article)
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This article presents the results of a study on the acceptability of emergency contraception (EC) in Brazil, Chile, and Mexico. Opinions of potential users and possible providers were obtained through discussion groups and those of authorities and policy-makers through semi-structured interviews. Most participants had a positive opinion of EC, based on the view that it can help reduce unplanned pregnancy, adolescent pregnancy, and unsafe abortion. Several interviewees felt that all women should be informed about EC, while others viewed it as a method for special situations such as rape and unprotected first sexual intercourse. Concern was expressed that its introduction might be associated with a decrease in condom use, increase in sexually transmitted diseases, and irresponsible or promiscuous sexual behavior among adolescents.

The Option for Vasectomy and Implications for Gender Relations (research abstract)
This was qualitative study designed to investigate the process that leads couples to decide for vasectomy; characterize the gender relations involved in this process; and identify sources of information on vasectomy. Semi-structured interviews were conducted with 20 couples who had requested vasectomy at the outpatient clinic of the Center for Integrated Women's Health Care in São Paulo, Brazil. Most couples opted for vasectomy as a last resort after attempting numerous other contraceptive methods, not always successfully. The emerging gender relations showed fluctuation between (1) a more rigid, quasi-patriarchal model characterized by male predominance in the family's decision-making and (2) a more ambiguous model in relation to reproductive decisions, whereby women assumed responsibility for contraception until the situation became untenable, at which point men faced up to the unavoidable necessity of sterilization.

Social and Proximate Determinants of Sexual Activity in Rural Nigeria (research abstract)
This study analyzes the social, physiological, and motivational determinants of sexual activity for 644 married women in rural areas of Osun State, Nigeria. The data come from the Fertility Awareness and Pregnancy Avoidance study conducted in 1993-94. Sexual activity was measured by three continuous variables: weekly frequency of (1) total sexual activity, (2) coital-only sex, and (3) both coital/non-coital sex. Results show that while many socioeconomic variables by themselves are significantly associated with sexual activity measures, the addition of physiological and motivational variables weakens their effects and lessens their original statistical significance. Additionally, the socioeconomic and demographic factors associated with frequency of sexual activity are not necessarily the same ones significantly associated with coital-only or combined coital/non-coital sex. The authors write that contraceptive protection was shown to be highly positively associated with all three of the sexual activity measures, empirically confirming the important relationship between contraception and both coital and non-coital forms of sexual activity.

Changes in Contraceptive Use in Vietnam (research abstract)
This analysis used data, primarily from the 1997 Vietnamese Demographic and Health Survey, to determine the changes in contraceptive use in Vietnam. The use of any contraceptive method and the use of modern methods increased from 1988 to 1997. The primary contraceptive method utilized is the IUD, and its use has increased substantially from 1988 to 1997. Younger women (aged 15-24) were less likely to use any contraceptive method. Women not desiring additional children were significantly more likely to use contraceptive methods than those desiring more children. Education has a clear impact on both contraceptive knowledge and use by women, with higher educated women being more likely to use a contraceptive method. Urban women are more likely than rural women to use contraception. Religion is not strongly related to the contraceptive behavior of women.

Nonlatex vs. Latex Male Condoms for Contraception: A Systematic Review of Randomized Controlled Trials (research abstract)
This review sought to evaluate nonlatex male condoms in comparison with latex condoms in terms of contraceptive efficacy, breakage, slippage, safety and user preferences. Two reviewers independently abstracted data from the 10 identified trials. Nonlatex condoms were associated with higher rates of clinical breakage than their latex comparisons, with statistically significant odds ratios of clinical breakage ranging from 2.6 (95% confidence interval [CI]: 1.6–4.3) to 5.0 (95% CI: 3.6–6.8). Few adverse events were reported. Substantial proportions of participants reported preferences for the nonlatex condoms. Despite higher rates of clinical breakage, nonlatex condoms still provide an acceptable alternative for those with allergies, sensitivities, or preferences that might prevent the consistent use of latex condoms.

Dual Protection against Sexually Transmitted Infections and Pregnancy in South Africa (research abstract)
This study reports on the prevalence and correlates of dual protection in South Africa. A cross-sectional survey of 929 sexually active women (aged 15–49 years) was conducted in 89 public primary health care clinics, with dual method use and use of condom alone at last sexual intercourse as outcomes. At last intercourse, 12% of women were protected from both STIs and pregnancy. In multivariate analysis, higher education, being unmarried, and multiple sex partnership in the past year were predictors of dual method use, while younger age, higher education, and awareness of the dual function of condoms were predictors of condom use alone. Dual protection is low in this population. The predominance of hormonal contraceptive use in South Africa means that increasing barrier method use among hormonal contraceptive users is an important strategy for increasing dual protection.

The Norplant Experience in Zaria: A Ten-Year Review (research abstract)
The aim of this review was to ascertain the response of family planning clients in Zaria to Norplant. The study showed that most of the clients were satisfied with the method. There was a progressive increase in the number of women using Norplant, with a significant decrease in the number of women undergoing sterilization.

Cost-effectiveness Analysis of Behavior Change Interventions: A Proposed New Approach and an Application to Egypt (research abstract)
This paper presents a new approach to cost analysis of family planning programs that focuses on behavior change of program clients as the final "output" rather than units of contraceptive services delivered (as does the familiar couple-years-of-protection index). The proposed approach rests on the familiar "steps to behavior change" paradigm and (1) develops a methodology for applying a client-behavior-change-centered cost analysis to program activities; (2) tests the methodology and concepts by applying them retrospectively to a case study of mass media interventions in Egypt; and (3) derives cost per unit of behavior changes for these Egyptian communications campaigns to demonstrate the workability of the approach.

Primary and Secondary Syphilis --- United States, 2002 (report)
Related news article: U.S. Syphilis Rates Climb for the Second Year
Overall, the syphilis rate rose in the United States by 9.1% between 2001 and 2002, according to new statistics released last week by the Centers for Disease Control and Prevention.

Female Condom Use among HIV-infected Women (research abstract)
This prospective descriptive study evaluated acceptability, adhesion, and experience with the use of the female condom (FC) in 76 HIV-infected women in Brazil. A structured questionnaire was used at 30, 60, and 90 days, along with a diary on sexual intercourse and use of the male condom (MC) and FC. Rate of continuity was 52% after 90 days. The use of FC in half the intercourses for each time period remained stable over the 90-day interval. There was a significant reduction in unprotected intercourses (from 14% to 6%), without use of FC or MC, at the end of the period.

An Assessment of the Quality of Information Available on the Internet about the IUD and the Potential Impact on Contraceptive Choices (research abstract)
This study analyzed data gathered from a survey of online information on the intrauterine device (IUD) to determine the content and quality of information available to consumers and providers. The authors found that information on the IUD is consistently available on websites providing information about birth control options, but there is a great deal of misinformation about the IUD on the Internet. For example, they found that a substantial percentage of sites, designed for both healthcare providers and consumers, state that the IUD increases risk of pelvic inflammatory disease, ectopic pregnancy, and infertility.

Reproductive Health Counseling at Pregnancy Testing: A Pilot Study (research abstract)
This paper reports on a pilot study of reproductive health counseling for women obtaining pregnancy testing in a managed-care setting who did not desire pregnancy. Of 85 women who completed counseling, 58 (68%) completed follow-up. Participants reported that counseling was useful at baseline (94%) and follow-up (83%). The staff found the intervention important (100%) and implementation feasible (100%). Forty-one percent of participants improved their use of contraception (from no use or from less effective use to more effective use). The authors conclude that these observed behavioral changes suggest that this intervention may be helfpul in increasing effective use of contraception.

Sexually Transmitted Infection Control with Sex Workers: Regular Screening and Presumptive Treatment Augment Efforts to Reduce Risk and Vulnerability (research abstract)
This paper reviews two STI treatment strategies that have proven effective with female sex workers and their clients: 1) Clinical services with regular screening and 2) presumptive treatment of sex workers, a form of epidemiologic treatment, which can be an effective short-term measure to rapidly reduce STI rates.

Gender Issues in the Prevention and Control of STIs and HIV/AIDS: Lessons from Awka and Agulu, Anambra State, Nigeria (research abstract)
This study examined perceptions, practices, and norms underlying sexuality and gender relations that constrain the prevention and control of STIs and HIV/AIDS. It was carried out among the Igbo of Awka and Agulu in Anambra State of Nigeria. Both quantitative and qualitative methods were used for data collection. Findings indicate that cultural practices that encourage the establishment of sexual networks by men persist. Some married women who are not able to achieve pregnancy with their husbands get involved in such networks to have children. Some parents who do not have male children encourage their unmarried daughters to have children out of wedlock so as to perpetuate the lineage. Inequality in gender relations and fear of repercussions constrain women from negotiating safe sex.

Fertility Intentions and Subsequent Fertility Behaviour in Matlab: Do Fertility Intentions Matter? (research abstract)
This study examines the extent of the interrelationship between future fertility intention and subsequent fertility behavior in rural Bangladesh. It confirms that fertility intention is an important predictor of subsequent fertility behavior for rural Bangladeshi women. Women wanting no more children are more than three times less likely to have a child during a 5-year follow-up than those wanting more children. A multivariate model using logistic regression shows that fertility intention is a useful indicator for fertility behavior when background and life-cycle variables are controlled. The authors conclude that the different patterns of fertility intentions by socioeconomic and demographic subgroups suggest that different program strategies should be designed for specific target groups.

Training Pharmacy Workers in Recognition, Management, and Prevention of STDs: District-randomized Controlled Trial (research article)
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This study determined the effectiveness of an intervention for pharmacy workers in improving their recognition and management of STD syndromes. The authors randomly selected 14 districts from the 24 districts of low socioeconomic status in Lima, Peru. They randomly assigned paired districts to receive training and support for management and prevention of STDs or a control intervention about management of diarrhoea. The STD intervention included interactive luncheon seminars on recognition and management of four STD syndromes (urethral discharge, vaginal discharge, genital ulcers, and pelvic inflammatory disease) and STD/HIV prevention counselling; monthly pharmacy visits by “prevention salespersons” who distributed materials that included “STD/HIV prevention packets” containing information, condoms, and cards given to patients for referral of their sex partners; and workshops for physicians on managing patients with STD syndromes referred from pharmacies. Standardized simulated patients visited pharmacies in intervention and control districts at 1, 3, and 6 months after training to assess outcomes. Standardized simulated patients reported significantly better recognition and management (appropriate antimicrobial regimens provided for discharge syndromes and referral to specially trained physicians for genital ulcers or pelvic inflammatory disease) by pharmacy workers of all four STD syndromes. They also reported significantly more frequent recommendations for use of condoms and treatment of partners at pharmacies in intervention districts than in control districts.

Estimation of Births Averted Due to Breast-feeding and Increases in Levels of Contraception Needed to Substitute for Breast-feeding (research abstract)
After contraceptive use, breast-feeding duration is the major determinant of the birth interval length. This study presents three methods of estimating births averted by breast-feeding and the increase in contraceptive use needed to substitute for breast-feeding. Method 1 simply utilizes Bongaarts’ Ci, and the other two are based on mean birth intervals with and without breast-feeding. Estimates for each method are derived for six countries with DHS surveys from the mid-1990s: Burkina Faso, Uganda, India, Indonesia, Brazil, and Peru. The estimated percentage of additional births that would occur if there were no breast-feeding ranged from 1% to 4% in Brazil to about 50% in Burkina Faso and Uganda, reflecting very low breast-feeding in Brazil and very high levels in the sub-Saharan African nations.

Improving Quality of Care and Use of Contraceptives in Senegal (research abstract)
This paper presents findings from a longitudinal survey of 1,320 Senegalese women who had sought family planning services at 10 public sector facilities (five reference centers and five health centers). Information was collected on the quality of care they received at the time they adopted family planning. Follow-up was 16 months later with 1,110 of the respondents. The first principal finding was that attendees at reference centers reported receiving relative better care than those who attended health centers. On average, clients at reference centers received 4.3 out of 5 units of care, compared to 3.8 units as reported by health center clients. Second, multivariate analyses indicated that quality of care received at the time of adopting a contraceptive has a significant influence on subsequent contraceptive use. Those who received good care were 1.3 times more likely to be using a method than others.

Effects of Polygyny and Consanguinity on High Fertility in the Rural Arab Population in South Jordan (research abstract)
Based on the authors’ interview survey with 608 randomly selected women of the rural Arab population in the South Ghor district of Jordan, this paper examined the effects of polygyny and consanguinity on high fertility. The prevalence of polygynous and consanguineous marriages was 28% and 58.1%, respectively, largely reflecting the population’s traditional marriage customs. The findings highlighted a significantly higher total marital fertility rate (TMFR) in the monogamous wives (10.5) than in the senior polygynous (8.1) and junior polygynous wives (8.6); the TMFR did not significantly differ among the wives of non-consanguineous, first-cousin and second-cousin marriages.

Miscommunication between Healthcare Providers and Patients May Result in Unplanned Pregnancies (research abstract)
The purpose of this study was to examine the impact of prior healthcare provider counseling on previous use of contraception and knowledge of emergency contraception (EC) in women seeking surgical abortion. The researchers performed a retrospective analysis of 342 patient charts from women seeking an office abortion in a private practice setting from January 1999 to June 2001. Patients were primarily white (69%) and unmarried (63%) and had private insurance that covered abortion services (72%). Only 19% of women were using a birth control method with no recognized potential failure. Twenty-two percent of women were using their birth control method correctly but experienced an event that put them at risk for pregnancy, 32% were using their birth control method incorrectly and 27% were using no birth control method at all. Miscommunication between patients and their healthcare provider(s) negatively affected use of a primary contraceptive method in 14% of patients. Of the 77% of women who did not know about EC, nearly two thirds had an identifiable event for which EC could have been used.

A Consensus Process to Adapt the World Health Organization Selected Practice Recommendations for UK Use (research abstract)
This paper reviews the process used (nominal group technique) for consensus development to consider the World Health Organization Selected Practice Recommendations for Contraceptive Use for adoption or adaptation in the United Kingdom.

Measurement of Condom Use as a Risk Factor for HIV Infection (research abstract)
This paper addresses the methodology used to assess condom use and HIV infection in a study population. The authors use one common indicator of condom use, the UNGASS indicator (condom use at last higher risk sex of those aged 15–24), to illustrate how changes in the proportion of people who report using condoms do not always explain changes in the size of the group who had high risk behavior. They propose that indicators based on the proportion of the whole population who have sex without using a condom would be better measures of the size of the group at highest risk of HIV infection.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

India: Sena Offer in UP: Have 10 Children, Get Rs 100,000 (news article)
"Have 10 children and get a reward of Rs 100,000". That is the latest slogan of the Shiv Sena in Uttar Pradesh, India's most populous state. The call may be in sharp contrast to the Indian government's emphasis to arrest its billion plus population, but the Shiv Sena is reaching out to Hindus here from its stronghold in Maharashtra with a specific purpose: to curb the number of Muslims.

Africans Resist Condom Message (news article)
Cultural views of intimacy are causing many Africans to reject condoms and risk contracting HIV, the BBC's Africa Live programs has found. Despite continued campaigning, expert advice about condom use is being ignored. According to the UN, only 3% of Africa's sexually active population use condoms.

Czech Republic: Condom Regulation Creates Confusion (news article)
The Minister of Health was criticized last week for the resurrection of an old regulation that would make it impossible to buy a condom at the corner store, gas station, or supermarket, the places they're now sold in abundance. The Ministry of Health reissued a regulation in September that included condoms among "medical goods," like thermometers and sterile bandages, which can be sold only by people with special education or long experience.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Australia: $10,000 a Year to be a Mum (news article)
Mothers should be paid up to $10,000 a year by the federal government as part of a strategy to halt Australia's falling birth rate, a study by Liberal Party think tank the Menzies Research Centre has found. The report's author said that existing incentives, such as the Family Tax Benefit and Government-funded child care places, should be replaced by the annual payment to women with children aged under five.

Pakistan: National Youth Policy Soon for Welfare of Youths (news article)
This article reports that a comprehensive National Youth Policy is being drafted with the consensus of experts and could be implemented soon.

India: Blood Test Before Nuptial Knot: Ignorance about HIV, Thalassaemia Prods Law Shift (news article)
The government of Calcutta, worried about the “appalling lack of awareness” in the city about the spread of HIV and thalassaemia, is moving towards enacting a piece of legislation making it mandatory for every bride and groom to run a blood test for both conditions.

HIV/AIDS RESEARCH

The Impact of a Mass Media Campaign on Personal Risk Perception, Perceived Self-Efficacy and on Other Behavioural Predictors (research abstract)
Household survey data were collected from 2,213 sexually experienced male and female Kenyans, aged 15-39, to determine whether an AIDS prevention mass media campaign influenced risk perception, self-efficacy, and other behavioral predictors. Logistic regression analysis was used to determine the impact of exposure to mass media messages to measure behavior change. A higher exposure to advertising was associated with more positive outcomes, while exposure to generic advertising messages was less frequently associated with positive health beliefs. Branded mass media campaigns that promote condom use are likely to contribute to the development of perceptions that are conducive to the adoption of condom use.

Safer Sex and Reproductive Choice: Findings from "Positive Women: Voices and Choices" in Zimbabwe (research abstract)
This article presents selected findings from the Zimbabwe research report on "Positive Women: Voices and Choices," an advocacy-research project developed by the International Community of Women Living with HIV/AIDS to explore the impact of HIV/AIDS on women's sexual and reproductive lives, challenge the violation of their rights, and advocate improvements in policy and services. Findings show that HIV-positive women were unaware they were at risk before an HIV diagnosis, and that gender norms and economic dependence on husbands/partners restricted women's ability to control their sexual and reproductive lives. Prejudices that HIV-positive women should not be sexually active or have children meant women did not disclose their status to health workers, making it difficult for their needs to be acknowledged or addressed.

HIV/AIDS in the Shadows of Reproductive Health Interventions (commentary)
The commentator uses her experience in Tanzania to illustrate why AIDS and reproductive health programs are still thought of and implemented through separate channels, to the detriment of both. She writes that historically competing bureaucracies in maternal and child health/family planning and gender and development are not easily unified with a vertical HIV/AIDS control program under the umbrella of "reproductive health". She also argues that HIV/AIDS cannot merely be inserted into existing family planning programs and renamed as "reproductive health" programs. She concludes that, as the AIDS epidemic is transformed through new technologies, reproductive health policy and priorities will be called into question and force us to look at the state of the African health care system, networks of care-giving, and how individuals and communities fail when there is no socio-economic safety net.

The Extent of Bisexual Behaviour in HIV-Infected Men and Implications for Transmission to Their Female Sex Partners (research abstract)
This study examined HIV-infected persons who participated in a cross-sectional interview project. Issues of sexual identity and bisexual behavior in men were explored. The study also determined the proportion of women who knew their partner was a bisexual male. Data suggested that bisexual activity was relatively common among black and Hispanic HIV-infected males who have sex with men, that few identify themselves as heterosexual, and their female partners may not know of their bisexual activity.

Pregnant Women's Decisions on Antenatal HIV Screening in Hong Kong (research abstract)
This cross-sectional study examines the decisions of pregnant Hong Kong Chinese women to undergo antenatal HIV screening and the reasons for their choices. Among 191 pregnant women studied, 147 (77%) indicated they would opt for antenatal HIV screening if offered. Fourteen (7.3%) would decline the test, because they have one stable sexual partner and felt that HIV infection was not a concern to them.

The Influence of Psychosocial Difficulties on Women's Attrition in an HIV/STD Prevention Program (research abstract)
Attrition from an HIV/STD group counselling intervention was examined by quantitative analyses of the entire sample (n=287) and structured interviews of a subset of 30 women with low attendance to determine what the difficulties to attending were. Study findings suggest that in interventions for women at HIV/STD risk, it is not enough to ensure cultural relevance and to provide food, childcare, and transportation. To increase retention, interventionists should consider the use of strategies to support attendance and intervention formats that are brief, matched to participants' stage of change, population-specific, and maximum accessibility.

Effect of Maternal HIV and Malaria Infection on Pregnancy and Perinatal Outcome in Zimbabwe (research abstract)
The authors investigate the effect of infection with malaria and HIV on pregnancy and neonatal outcome by collecting data on pregnant women admitted during the rainy seasons in the obstetric division of a hospital in northern Zimbabwe in 2000 and 2001. HIV-infected women were more likely to develop malaria attacks during pregnancy than seronegative women, as well as an increased risk of stillbirth, increased risk of low birth weight, and fetal growth restriction.

Some Considerations on Sexuality and Gender in the Context of AIDS (research abstract)
This paper argues that there are four issues central to our understanding of how the HIV pandemic moves and develops that are not necessarily best understood through an analysis that uses gender alone, namely: women's vulnerability, men's culpability, young people's sexual interests, and marginalized sexual cultures. The paper proposes using sexuality as a framework for analyzing these issues and seeks to utilize developments in critical sexuality research to add to gender as a way to increase the capacity to respond to the HIV/AIDS crisis.

Women's Acceptability and Husband's Support of Rapid HIV Testing of Pregnant Women in India (research abstract)
This study examined acceptability among pregnant women and their husbands for HIV testing within the antenatal clinic and delivery room of a government hospital in Pune, India in 2001. Acceptance of HIV counselling and testing was high. Data collected indicated that the majority of women agreed to be tested independently without the need for further consultation with family members. This view was strongly supported in this sub-sample by accompanying husbands.

Men and Women–Still Far Apart on HIV/AIDS (commentary)
The commentator addresses the gay-feminist alliance in Latin America regarding its response to the AIDS epidemic. The author argues that this alliance is more rhetorical than real, citing published published articles and his own experience in HIV/AIDS work in Chile.

Pill Taking 'Routinization': A Critical Factor to Understanding Episodic Medication Adherence (research abstract)
Factors that lead to episodic nonadherence to highly active antiretroviral therapy were examined in this study. Episodic adherence refers to whether an individual took a particular dose on a particular date. Interviews were conducted with a sample of 27 participants who had missed at least one dose of antiretroviral medication during the past 2 days. Qualitative analysis revealed that routinization of pill regimens and factors associated with the participant's ability to maintain these routines play an important role in successful adherence. Other psychosocial factors such as psychological distress, substance abuse, and active and unpredictable social lives are also barriers to adherence.

HIV/AIDS NEWS

Brazil Says It Obtains Record Discount on AIDS Drugs (news article)
Bristol-Myers Squibb Co. has agreed to sell the new AIDS drug, Atazanavir, to Brazil at a 76% discount, demonstrating that it is possible to provide health inputs in developing countries in line with their socioeconomic situation.

Pakistan Launches AIDS Programme (news article)
Pakistan has launched a big program to tackle AIDS after denying that the country has a problem. Recorded cases of AIDS and HIV infection are small compared to Pakistan's neighbor, India. Until recently many government and religious leaders argued that was because of the moral and ethical values enshrined in the Muslim way of life. Now they are waking up to the possibility that prevalence could sky-rocket, like in other Muslim countries.

Victory over AIDS Remains Elusive Dream (news article)
Two and a half years ago, UN Secretary General Kofi Annan made conquering AIDS one of his primary goals for the world body. Since then, he has been at the forefront of efforts to keep global attention focused on battling the deadly virus. But as the world prepares to mark World AIDS Day on December 1 - the third since the UN declaration of war on AIDS - progress has been maddeningly slow, with victory still a distant dream.

China's "Far West" Faces Up to AIDS (feature article)
One of the fastest growing AIDS problems in China is hidden from view in the far north-western province of Xinjiang. This feature article from the BBC describes how people in this area are coming to terms with the disease.

Asia Looks to Thailand's AIDS Success Story (feature article)
Thailand is emerging as a learning center for developing countries in Asia, where AIDS is spreading rapidly. Its nationwide prevention campaign, launched in the early 1990s, has dramatically cut the spread of the disease. As a result, the number of people testing positive for HIV, the virus linked to AIDS, fell last year to 23,676, down 83% from a peak in 1991 of 142,819, according to the Thai government.

Botswana: Reluctance to Face Tests Slows Botswana AIDS Fight (news article)
Botswana health officials together with the CDC, will employ a new initiative: giving HIV tests as a routine part of checkups in public and private clinics in an effort to overcome reluctance to be tested for AIDS because of the associated stigma.

Selling Condoms for AIDS Sake (feature article)
The creative brains of one of the world's top advertising agencies were hired to combat HIV in three countries where the virus is on the very cusp of running out of control. This feature article tells the story of the ad campaign to increase the use of condoms in India, China, and Russia.

Russia's AIDS Timebomb (feature article)
This feature article describes a new phase Russia is entering in dealing with AIDS. Test centers are reporting an increasing number of new infections contracted through sexual contact. Experts judge that the virus is now spreading to the wider population along a well-studied model.

Uganda: Africa's AIDS Fight Aims High (news article)
A new "executive wing" at an AIDS clinic in Uganda is geared toward VIPs, who are often reluctant to seek help. It is the first of its kind in Uganda, and its goal is to reach a class of African society that has long confounded health workers battling AIDS: the elite.

Singapore: New HIV Cases Up by over 6% in First 10 Months: Health Ministry (news article)
The latest statistics released by the Health Ministry reveal that, in the first 10 months of this year, the number of Singaporeans detected with HIV, the virus that can cause AIDS, was more than 6% higher than the average during the same period in the past 3 years.

Africa: Sex Traditions Spreading HIV (feature article)
A number of traditional sexual practices may be significantly assisting the spread of AIDS cases across Africa, experts say.

MATERNAL AND CHILD HEALTH RESEARCH

Between Personal Wishes and Medical "Prescription": Mode of Delivery and Post-Partum Sterilisation among Women with HIV in Brazil (research abstract)
This article presents some of the factors that affect mode of delivery and access to post-partum sterilization and their implications. Antenatal and post-partum interviews with HIV-positive pregnant women from Brazil reveal misleading medical advice, and perceptions and misconceptions of ceasarian section and sterilization, making medical choices confusing.

Prevalence of Sexually Transmitted Diseases Among Pregnant Women in Ilorin, Nigeria (PubMed abstract)
In this cross-sectional study, undertaken in the year 2000, 230 pregnant women attending an antenatal clinic in Nigeria were screened randomly to determine the prevalence of common STDs. Levels were high, indicating the importance of routine STD screening in pregnancy, especially among the young and illiterate. The authors recommend routine screening for STDs be incorporated into antenatal care.

Voluntary HIV Counseling and Testing During Prenatal Care in Brazil (research article)
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Researchers assessed characteristics of HIV testing and identified factors associated with HIV counseling and testing. A cross-sectional study was carried out comprising 1,658 mothers living in Porto Alegre, Brazil. Biological, reproductive, and social variables were obtained from mothers by means of a standardized questionnaire. Of 1,658 mothers interviewed, 1,603 (96.7%) underwent HIV testing, and 51 (3.1%) were not tested. Four (0.2%) refused to undergo testing after counseling. Of 51 women not tested in this study, 30 had undergone the testing previously. Of 1,603 women tested, 630 (39.3%) received counseling, 947 (59.2%) did not, and 26 (1.6%) did not inform. Low income, lack of prenatal care, late beginning of prenatal care, use of rapid testing, and receiving prenatal in the public sector were variables independently associated with a lower probability of getting counseling about HIV testing.

Factors Associated with HIV Risk Perception among Hospital Postpartum Women (research abstract)
The authors assessed factors associated with perception of HIV infection risk among 384 postpartum women admitted to two charitable maternity hospitals in the city of São Paulo, Brazil. They found that nearly 29% of postpartum women considered themselves at risk for HIV infection. They were single, had prior STDs, and believed "married men enjoy himself in the same way as single men do". The authors conclude that women's knowledge on AIDS seems to affect their individual risk perception.

A Method for the Evaluation of Primary Health Care Units' Practice in the Promotion, Protection, and Support of Breastfeeding: Results from the State of Rio de Janeiro, Brazil (research abstract)
Primary health care (PHC) units in Rio de Janeiro, Brazil, were examined to determine their effectiveness in enabling mothers to breastfeed with a tool developed for accreditation of baby-friendly hospitals. A scoring system assessed the extent to which procedures known to be effective at extending breastfeeding duration were applied within PHC units. Thirteen PHC units showed a fair performance; 11 performed poorly. Twice as many pregnant women and mothers in fair performance units were satisfied with the support provided for breastfeeding than in poor performance units. The association found between structure, process, and outcomes support the validity of the method.

Breastfeeding and the Nutritional Transition in the Latin American and Caribbean Region: A Success Story? (research article)
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This paper examines recent breastfeeding duration trends in Latin America and the Caribbean to document: (a) rural-urban differentials, (b) differences in educational levels, and (c) changes in breastfeeding duration across time. Secondary data analyses were conducted with 23 Demographic and Health Surveys collected between the mid-1980s and mid-1990s. Results indicate that median breastfeeding duration is still greater in rural (as compared to urban) areas and among less (versus more) educated women, although these differentials are decreasing with time. In five of the six countries examined for secular trends, breastfeeding duration continues to increase in both rural and urban areas. Breastfeeding duration improved more among women with the highest and declined among those with the lowest levels of education. Results indicate that breastfeeding duration has increased in Latin America and the Caribbean at a time when the opposite was predicted, given the region’s increased urbanization. Breastfeeding protection policies and promotion programs may explain part of the increase in breastfeeding duration.

Do Childhood Vaccines have Non-specific Effects on Mortality? (review article)
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The authors reviewed 782 English language articles on vaccines and childhood mortality and found only a few whose design met the criteria for methodological rigor. They write that the data reviewed suggest that measles vaccine delivers its promised reduction in mortality, but there is insufficient evidence to suggest a mortality benefit above that caused by its effect on measles disease and its sequelae.

Staphylococcus Aureus Transmission Between Healthy, Lactating Mothers Without Mastitis and their Infants by Breastfeeding Using Both Bacteriological and Molecular-Epidemiological Methods (research abstract)
The authors investigated eight healthy, lactating mothers without clinical signs of mastitis and their infants of less than 3 months old for Staphylococcus aureus transmission between healthy, lactating mothers without mastitis and their infants using bacteriological and molecular-epidemiological methods. There was a 50% transmission rate of aureus between the pairs. The results suggest that methicillin-resistant S. aureus or methicillin-sensitive S. aureus may be transmitted between healthy, lactating mothers without mastitis and their infants by breastfeeding.

Current Concepts Regarding Vaginal Birth After Cesarean Delivery (research abstract)
This review of literature on vaginal birth after cesarean delivery examines its efficacy and safety. Current information suggests that the rate of major maternal and neonatal complications with vaginal birth after cesarean delivery is low, and this option should be offered to women with a single prior cesarean.

MEN'S HEALTH RESEARCH

A Polymeric Mini-stent Designed to Facilitate the Vasectomy Reversal Operation. A Rabbit Model Study (research abstract)
This study demonstrates the feasibility of the mini-stent, which was based on the hypothesis that it can facilitate and accelerate vasovasostomies (vasectomy reversals), which are technically demanding. A mini-stent device was tested with 28 rabbits, which were divided over two equal groups. In one group, the vasa deferentia were dissected and reattached surgically. In the other group, the vasa deferentia were dissected and reattached through implantation of the mini-stent. Sperm counts revealed 100% patency in both groups, i.e., all vasovasostomies were successful, but the operation was easier and faster with the mini-stent, which keeps the lumens of both vas ends exactly in line during suturing.

POPULATION RESEARCH

Health Expectancy in the Russian Federation: A New Perspective (research article)
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This paper compares life expectancy and healthy life expectancy in the Russian Federation and in countries of Eastern and Western Europe. The authors used WHO mortality data and data on self-reported health from the World Values Survey and the Russian Longitudinal Monitoring Survey. They found that the probability of remaining alive and healthy declines faster in the Russian Federation than in Western Europe, with the gap between Eastern Europe and the Russian Federation widening at older ages. In the Russian Federation, this rapid decline is due mainly to the high probability of death or of poor health for men and women, respectively.

Coexistence of Pathogens in Sexually-transmitted Disease Models (research abstract)
The researchers present a STD model for two strains of pathogen in a one-sex, heterogeneously-mixing population, where the dynamics are of SIS (susceptible/infected/susceptible) type, and there are two different groups of individuals. They analyze all equilibria for the case where contacts are modeled via proportionate (random) mixing. They found that both strains may under suitable circumstances coexist, and that it is the heterogeneous mixing that creates refuges for each strain as each population group favors one particular strain.

YOUTH HEALTH RESEARCH

Violent Relationship in Young People and STD/AIDS Risk (research abstract)
Researchers conducted a survey among youth 14 to 22 years of age to verify whether affective relationships involving violence are associated with increased risk of STDs, including AIDS. The study population resided in two low-income communities in Rio de Janeiro, Brazil; a qualitative methodology with focal groups and individual interviews was used. The authors write that violence is part of the routine among these youth in both their community and families. The following factors were associated with violence in interpersonal relations: lack of money, unemployment, drug and alcohol use, jealousy, and infidelity. The young people reported that condom use is not negotiated with violent partners, resulting in increased risk of STD/AIDS.

Parents’ Attitudes to Adolescent Sexual Behaviour in Lesotho (research abstract)
This study investigated the knowledge, attitudes, and opinions of parents on various aspects of adolescents’ sexual and reproductive health in Lesotho. The study used a qualitative methodology. Findings reveal that parents are aware that male and female adolescents engage in sexual relationships. Some parents believe that adolescents are too young to initiate sexual activities while others said they don’t mind older unmarried adolescents having sex. In addition, parents felt that adolescents do not face discrimination in obtaining family planning services. In relation to passing sexual and reproductive health knowledge to adolescents, there seems to be a dilemma on who should take the responsibility.

Reproductive Health Knowledge, Attitude and Practice among High School Students in Bahir Dar, Ethiopia (research abstract)
This study investigated the reproductive health knowledge, attitude, and practice of high school students in Bahir Dar, Ethiopia. Data were collected using self-administered questionnaire and focus group discussions. The study revealed that the students had high level knowledge of contraceptives and where to obtain contraceptive services; however, level of use was low. Some of the reasons given for not using contraceptives include lack of access to services, carelessness, unplanned sexual intercourse, and pressure from sexual partner.

Program Developed with Adolescents in a Health Center: Acquired Knowledge about the Themes Studied by a Multidisciplinary Staff (research abstract)
This paper presents results from a small study to verify the orientation program developed in conjunction with adolescents at Santo Amaro University, Brazil.

YOUTH HEALTH NEWS

Ghana: Traditions Die Hard: Can Arrests Stop Female Genital Mutilation? (news article)
The first arrest in Upper West Ghana was made for performing female genital mutilation (FGM) on three girls. She received a prison sentence of five years. Now that FGM is illegal, it is being done to younger children, even infants, so it will not be noticed.

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