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Volume 3, Number 49
8 December 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

Unmet Need and Unintended Fertility: Longitudinal Evidence from Upper Egypt (research article)
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Women who participated in the 1995 Egypt Demographic and Health Survey in two governorates in Upper Egypt were followed for 2 years (N=2,444); in-depth data on their fertility preferences, contraceptive use, and births were gathered in 1996 and 1997. Transitions among contraceptive need categories from 1995 to 1997 were examined, and rates of unintended (mistimed and unwanted) births were calculated according to contraceptive need status at baseline. Unmet need increased by six percentage points, from 28% to 34%. This change was the net outcome of 14% moving out of unmet need and 20% moving into unmet need. The rate of unintended fertility was far higher among
women with unmet need at baseline than among contraceptive users in 1995. Women with unmet need made up about one-quarter of the baseline sample, but they contributed almost one-half of mistimed and unwanted births during the 2 years.

UK: Male Contraceptive Trial (news article)
Scientists at the University of Edinburgh want to recruit a group of men to help try out a ground-breaking new contraceptive. The invention is a hormone implant that tricks the body into stopping the production of sperm.

The Social Context of Reproductive Health in an Egyptian Hamlet: A Pilot Study to Identify Female Genital Schistosomiasis (news article)
This pilot study identified female genital schistosomiasis (FGS) in an Egyptian community setting. Schistosoma haematobium ova were found in 16.7% of women in the study. Half of the women who had a gynecological examination (43 of 86) had evidence of reproductive morbidity due to schistosomiasis. Community members recognized Schistosoma haematobium as a health problem, but did not believe that it affected reproductive health. There was little awareness of reproductive health and no discussion of any reproductive health issues between women and their spouses outside of fertility. The study identified factors that would affect the identification and treatment of FGS, and reproductive health care: (1) the neglect of women's health; (2) misconceptions about reproductive health and family planning; and (3) limited access to and use of formal health care.

Oral Contraceptives and Reproductive System Cancer (research abstract)
The authors write that extensive research during the last 20 years has shown that oral contraceptives (OCs) are safe. Several recent epidemiological studies have confirmed that combined oral contraceptives (COCs) provide substantial protection against endometrial and ovarian cancer, and this protection is long-lasting and may persist for 15 or more years after termination of OC use. In many studies COCs have been associated with an increased risk of cervical abnormalities and cervical cancer, but there might be alternative explanations for these epidemiological associations (COC users can start having sexual intercourse at an earlier age, they have more sexual partners, and they rarely use barrier methods of contraception), so OCs act as a promoter for HPV-induced carcinogenesis. Finally, women who are currently using COCs or have used them in the past 10 years are at a slightly increased risk of having breast cancer during the next 10 years, although the additional cancers diagnosed tend to be localized to the breast and they are less advanced clinically than the cancers diagnosed in those who have never used COCs.

Seventy-Five Microgram Desogestrel Minipill, A New Perspective in Estrogen-Free Contraception (research abstract)
The authors write about a new low-dose progestin-only minipill containing 75 µg desogestrel (DSG), which scored comparably in the Pearl index to indicies found in clinical trials of oral contraceptives. This minipill also allows for a 12-hour tolerance time in taking the pill. The high effectiveness of the DSG minipill is attributable to an almost constant inhibition of ovulation, as shown by the absence of elevated progesterone circulating levels and inhibition of follicular growth in the vast majority of cycles studied. Since irregular bleeding patterns are observed with all minipills, patterns experienced with DSG 75 µg have been compared to those obtained with levonogestrel 30 µg. As expected, the more pronounced ovarian inhibition produced wider bleeding variability with DSG, but also less bleeding overall.

Where Do Rural Women Obtain Postabortion Care? The Case of Uttar Pradesh, India (research article)
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The aim of this study was to collect information about where rural women seek care for abortion complications and about the quality of care they receive. Qualitative data were collected in 1999 in four villages in rural Uttar Pradesh. Postabortion care is widely available in the villages studied, largely from untrained or inappropriately trained providers. Because village-level providers are the front line of care for many women, abortion complications may be exacerbated rather than alleviated, appropriate care delayed, and the cost of treatment increased. Village-level postabortion care does not include family planning and contraceptive counseling services or links to reproductive and other health services.

Using Network Analysis to Understand Community-Based Programs: A Case Study from Highland Madagascar (research article)
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In 1999, a total of 159 women and men of reproductive age were interviewed in a village in highland Madagascar with an active community-based family planning program. Network analysis informed by chi-square tests and multiple regression analysis was used to test whether respondents’ communication with CBD agents and the location of their discussion partners were associated with their knowledge and use of family planning. The CBD agents were highly central in the village’s family planning network; 35% of women and 19% of men directly communicated with a CBD agent about family planning or were indirectly linked to an agent. Knowledge of family planning was associated with having either a direct or an indirect link to a CBD agent; use of a modern method was associated with discussing family planning only with someone outside the village (odds ratio, 12.6) or with discussing it in the village and communicating directly with a CBD agent (10.8).

Decentralization in Zambia: Resource Allocation and District Performance (research abstract)
This article examines quality of services following decentralization to districts in Zambia, and an analysis of data assessing allocation choices, as well as some indicators of the performance of the health systems under decentralization. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. Analysis of available indicators of performance, such as the utilization of health services, immunization coverage, and family planning activities, found little variation during the period 1995–1998 except for a decline in immunization coverage, which may have also been affected by changes in donor funding. Findings suggest that decentralization may not have had either a positive or negative impact on services.

Community Participation in Externally Funded Health Projects: Lessons from Cambodia (research abstract)
This article discusses lessons learned on establishing effective community participation in two externally funded, NGO health projects at the district level in Cambodia. The first project was implemented in accordance with the Cambodian national guidelines on community participation. The second worked with Buddhist pagoda volunteers. The community participation around pagoda volunteers was found to be more effective and sustainable than using new, externally established community structures with formally elected representatives. The pagoda volunteers offered effective leadership, local organization, resource mobilization and management. The article concludes that working with existing community-based organizations and agencies is more effective when undertaking any health initiatives. Using participatory research to identify the most appropriate local organization to lead such initiatives is recommended by the authors of this article.

Human Papillomavirus Cervical Infection in Guarani Indians from the Rainforest of Misiones, Argentina (research abstract)
Researchers conducted a cross-sectional cytological and HPV screening of sexually active Guarani women from nine Indian settlements, collecting demographic data, information about sexual behavior, and gynecological histories. Cervical specimens from 239 patients were collected, with 207 included in this study. The prevalence of cervical HPV infection in Guarani women was reported for the first time, with nearly all having some grade of cervical disease.

Miniature, Low-Dose, Intrauterine Drug-Delivery Systems (research abstract)
This paper addresses the various "frameless" and "framed" intrauterine systems currently being clinically evaluated. The authors write that they are less troublesome than the available intrauterine systems and could therefore be suitable for use in most women for contraception and treatment purposes (e.g., menorrhagia, hormone replacement). These systems require a single short office procedure, and have a low morbidity, which is undeniably linked with more invasive methods and systemic hormonal contraceptives. The authors conclude that miniature, low-dose, long-term intrauterine drug-delivery systems offer enhanced effectiveness, reduced side effects, and optimal user compliance.

Oral Contraception Over the Age of 40 (research abstract)
This article discusses the pros and cons of various oral contraceptives for women over the age of 40.

The Levonorgestrel Intrauterine System: A Clinical Perspective from the UK (research abstract)
This paper reviews the levonorgestrel intrauterine system. The author writes that adverse side effects are few and in general they are not in the "hazardous" category.

Fournier's Gangrene Complicating Vasectomy (PubMed abstract)
This paper presents two cases of Fournier's gangrene following vasectomy in previously healthy male adults in Malawi. It discusses their diverse management and results and explores the potential impact on the program in Malawi, in the context of adverse publicity on contraceptives. The possible operational factors for the complications are explored and preventive strategies proposed to ensure sustenance of the already registered gains in fertility control in Malawi.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

UK Women 'Ready to Lie' (news article)
More than 50% of women would not tell their partner a baby was not his if they wanted to stay with him, a survey revealed today. And a third of women (32%) would pretend to use contraception, like the pill, if they wanted to get pregnant but their partners did not want a child.

Modifying Vasectomy Technique Can Increase Effectiveness (news article)
Global vasectomy experts agreed last week that modifying a simple ligation and excision technique commonly used in developing countries to perform male sterilization can increase its effectiveness. The experts reviewed a growing body of both published and unpublished vasectomy research during the first day of a 3-day expert consultation on vasectomy cosponsored December 3 to 5, 2003, by the Research Triangle Park, NC-based Family Health International and the New York City-based EngenderHealth. The organizations have recently completed a series of studies addressing the effectiveness of different vasectomy methods. Because post-vasectomy pregnancies are rare and difficult to study, these recent research findings are based on semen analysis rather than pregnancy data. Participants at the experts' meeting agreed that modifying ligation and excision by adding a technique called fascial interposition reduces the likelihood of vasectomy failure, as defined by semen analysis. Fascial interposition involves pulling the sheath that covers the vas over one severed end, then sewing it shut to create a natural tissue barrier.

One-child Policy Driving China Towards Gender Crisis (news article)
The one-child policy in China, where many couples have a marked preference for boys, is to blame for a potentially perilous imbalance between males and females in the population.

Guyana Official Proposes Condoms for Prisoners to Help Fight Spread of AIDS (news article)
Guyana's health minister said Friday that he will propose distributing condoms in the South American country's prisons to help control the spread of AIDS. Health Minister Leslie Ramsammy said he expects Cabinet will give quick approval in the next 2 weeks.

Central African Republic: Pygmies Seek Education on Condom Use (news article)
Pygmies in the village of Gbokila, 26 km from the Central African Republic capital, Bangui, have asked that pygmy women be trained on HIV/AIDS, especially on the importance of condom use as a means of prevention, a leader of the community has been reported as saying. "Whenever my wife sees a condom she destroys it saying she cannot allow me to throw children in the bush," Aubin Tikitiki told a visiting UN mission headed by the deputy representative of the UN Development Programme.

UK: 'Four-season' Pill to be Launched (news article)
A contraceptive pill that cuts the number of periods to four a year could come to the UK next year.

Philippines: Labor Groups to Continue Lobbying for Reproductive Health in Collective Bargaining Agreements? (news article)
According to the Trade Union Congress of the Philippines, some labor unions are integrating reproductive health services into their collective bargaining agreements. Meeting their demands, some Philippine companies have granted reproductive health benefits, like contraceptive provisions.

India: Classified Information (editorial)
The author argues that society in India is in denial about the sexuality of their teens, stating that adolescents have active sex lives before marriage which existing reproductive health services are not serving. Very little information about reproductive anatomy, physiology, sex, and contraception is available to adolescents. Parents, teachers, and the media are reluctant to deal with the subject and NGO’s have had to pull their informational materials for fear of being punished under the obscenities act. Consequently, teens are relying on other teens to pick up half-truths or no-truths about sex. Studies show that condom use is rare and irregular, HIV/AIDS doesn’t figure as a major concern, and there is a high prevalence of reproductive tract infections and gynecological morbidity among adolescent women.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Coordination of National Responses to HIV/AIDS: Guiding Principles for National Authorities and Their Partners (executive summary)
At the International Conference on AIDS and STIs in Africa (ICASA), held in Nairobi, Kenya, in September 2003, officials from national coordinating bodies and relevant ministries of African nations, major funding mechanisms, multilateral and bilateral agencies, NGOs and the private sector gathered to review principles for national-level coordination of the HIV/AIDS response. This document represents a set of guiding principles, identified through a preparatory process at global and country levels, initiated by UNAIDS in cooperation with the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Italian Town Offers $11,900 per Baby (news article)
Women in Laviano, a town southeast of Naples, are being offered a “baby bonus” to have children as the town population declines. Overall, Italian women are the least likely to have babies among European women. This trend causes governmental concern about future pension and healthcare responsibilities.

The Standard Days Method of Family Planning: A Response to Cairo (commentary)
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This article examines how the Standard Days Method, a new family planning method based on fertility awareness that is currently being introduced into programs worldwide, addresses ICPD policy issues, while responding to the family planning needs of people around the world.

Legal System Sympathetic to HIV/AIDS People (news article)
India is among the countries with the highest amount of HIV/AIDS-related litigation, however, its legal system has been praised for exhibiting sensitivity towards People Living with HIV/AIDS. In many cases, courts have passed orders of 'suppression' of identity so as to enable the concerned persons to take recourse to the legal system without fear of being identified and stigmatized.

HIV/AIDS RESEARCH

AIDS Epidemic Update - December 2003 (report)
Related press release: UNAIDS: Global AIDS Epidemic Shows No Sign of Abating; Highest Number of HIV Infections and Deaths Ever
Related news article: Nigeria Has Highest Number of Orphans in West Africa
This new UN report states that an estimated 40 million people are living with HIV worldwide,including 2.5 million children under the age of 15. Sub-Saharan Africa is the most severely affected region of the world with women being hit disproportionately.A new wave of HIV epidemics is predicted in China, India, Indonesia, and Russia, Nigeria and Ethiopia where it is anticipated that the number of HIV/AIDS cases in these countries may double or triple by 2010.

Integrating Prevention of Mother-to-Child HIV Transmission into Antenatal Care: Learning from the Experiences of Women in South Africa (research abstract)
In South Africa in 1999, a Mother-to-Child HIV Transmission prevention program was implemented at the routine primary care level. A total of 264 women attending prenatal care in these clinics were interviewed using a standardized questionnaire in Xhosa, and 95% accepted HIV testing. Women who had not been tested before were four times more likely to believe that the community rejects HIV-positive women. Of women who tested, 19% were HIV positive and 83% had told their partner that they had taken the test. HIV-positive women who had not disclosed testing to their partners were three times more likely to believe that partners are violent towards HIV-positive women; and 86% stated that they would have taken AZT if found to be HIV positive. Only 11% considered that the use of formula feeding indicated that a woman was HIV positive.

Training Outreach Workers for AIDS Prevention in Rural India: Is It Sustainable? (research abstract)
The activity described in this paper was part of a larger AIDS education project that aimed at creating awareness and promoting risk-reducing behaviors in the community. This paper describes efforts of the project to identify and train peer educators during its implementation phase and discusses strategies used to facilitate sustainability. The authors evaluate the impact of these efforts by conducting an analysis in the project area 2 years after the end of the project. The findings reveal generalized interest among rural communities in HIV prevention issues. The authors present a conceptual model based on these findings to help future projects plan for and achieve sustainability.

Social, Cultural and Sexual Behavioral Determinants of Observed Decline in HIV Infection Trends: Lessons from the Kagera Region, Tanzania (research abstract)
Interviews, focus group discussions, field observations, and ethnographic assessments were used to collect the required data for this study. Findings suggest there have been significant changes in sexual behaviors, norms, values, and customs considered to be high-risk in HIV transmission. Condom use, abstinence, sticking to one sexual partner, and HIV testing have increased, while traditional polygamy, widow inheritance, high alcohol consumption, and sexual networking have decreased.

Assessing the Impact of Orphanhood on Thai Children Affected by AIDS and their Caregivers (research abstract)
This longitudinal study presents preliminary findings of the circumstances and welfare of Thai youth who have lost one or both parents to AIDS. Based on interviews and focus groups, most of the AIDS orphaned children were being cared for by members of their extended family. Many caregiving households were experiencing financial hardship, which could have negative implications for the children's long-term well-being. There was a lack of available childcare for AIDS-affected children, requiring many to be placed in the care of elderly relatives.

HIV Incidence and Risk Behaviors after Voluntary HIV Counseling and Testing among Adults Aged 19-35 Years Living in Peri-urban Communities around Chiang Mai City in Northern Thailand, 1999 (research abstract)
Researchers evaluated HIV incidence following participants utilization of HIV voluntary counseling and testing (VCT) and examined its effect on risk behaviors among northern Thai adults. A total of 924 men and 1,327 women, 19-35 years of age, took place in the study. Subjects were counseled and interviewed for socio-demographic placement, HIV risk behavior, and HIV testing history. They were tested for HIV infection at baseline and at 6 months follow-up. The effects of VCT on risk behaviors among the study participants could not be determined, but the HIV incidence after VCT among this study population was substantial.

Feasibility and Acceptability of a Specialist Clinical Service for HIV-Infected Mineworkers in South Africa (research abstract)
A specialized clinic was established in a mining hospital in the Free State, South Africa, with the aim of delivering preventive therapy for HIV-infected workers. The clinic was designed for minimizing stigma, protecting confidentiality, monitoring side effects, supporting adherence, and identifying prophylaxis failure. Most of the 1,773 patients who were tested in April 1999 were HIV-infected; 99% of persons are still attending after a median time of 13 months. The clinic has already been successfully replicated in two other regions of the mining health service in South Africa and provides a model for workplace HIV clinical services.

Burden of Infection among Heads and Non-Head of Rural Households in Rakai, Uganda (research abstract)
This study objective was to determine HIV prevalence among heads and non-heads of household adults in order to assess the burden of HIV on households. It was a community study of 11,536 adults aged 15-59, residing in 4,962 households in 56 villages, Rakai district, Uganda. Interviews were used to determine socio-demographic/behavioral characteristics. HIV prevalence was 16.9% in the population; and 21.5% of households had at least one HIV-infected person. HIV prevalence was higher among heads than non-heads of households. HIV disproportionately affects heads of households, particularly males. Mortality due to AIDS is likely to increase the proportion of female-headed households.

HIV Infection of Women in African Countries (research abstract)
This paper discusses literature reviewed on HIV infection of women in Africa with reference to Ghana, West Africa. The paper provides an epidemiological overview of HIV infection of women in Ghana and Africa and the potential risk for vertical transmission and associated contributing factors.

The Dynamics of the Human Immunodeficiency Virus Epidemics in the South of Brazil: Increasing Role of Injection Drug Users (research abstract)
Changes in HIV infection among injection drug users (IDUs) are provoking a shift in the pattern of the HIV/AIDS epidemic in some regions of Brazil. IDUs living in 2 cities (Porto Alegre and Itajaí) in southern Brazil were contacted, interviewed, and tested for HIV. In 1998, 187 IDUs were surveyed and, in 2000, 352 IDUs. In Porto Alegre, HIV seroprevalence, age, and duration of injection history increased significantly over time. In contrast, a trend toward decline was observed in Itajaí. Homelessness, joblessness, and prison incarceration, as well as lifetime needle sharing, also increased over time in Porto Alegre. At the time of the study, at both sites, rates of needle sharing and condom use were similar, but use of syringe exchange programs, health and drug treatment, and HIV testing had increased over time.

HIV/AIDS NEWS

Soaring HIV Infections Going Unreported in Japan (news article)
According to this article, the number of HIV cases in Japan could be four times higher than the Ministry of Health, Labor and Welfare's reported figure.

China's Secret Plague (feature article)
Dr. David Ho, the New York City-based virologist named TIME's 1996 Person of the Year for his pioneering work on the drug therapies that have largely quelled the AIDS epidemic in the U.S. and Europe, is confronting the AIDS virus in its most populous stronghold. Up to 1 million Chinese are HIV positive, and that number could easily grow to 10 million by 2010, according to the Joint U.N. Program on AIDS. If current trends continue for another decade or so, China could overtake Africa, where 29 million people have been infected with the virus. In this in-depth feature analysis, TIME reports on the activities of Dr. Ho and his team's work in China.

Malaysia: One in Four Found to Have AIDS (news article)
One out of every four people who turned up voluntarily for HIV/AIDS counselling and screening at health clinics nationwide were found to be afflicted with the disease last year.

MATERNAL AND CHILD HEALTH RESEARCH

Costs of Near-miss Obstetric Complications for Women and their Families in Benin and Ghana. (research abstract)
This paper estimates the total cost associated with a spontaneous vaginal delivery and five types of obstetric complication in Benin and Ghana, and determines affordability in relation to household cash expenditure. Medical costs made up the largest share of total costs; these were mostly drugs and medical supplies in Ghana and costs of the delivery and any surgical intervention in Benin. Payments resulting from a spontaneous vaginal delivery amounted to at least 2% of annual household cash expenditure in both countries. In the case of severe obstetric complications, costs incurred reached a high of 34% of annual household cash expenditure in Benin. Researchers concluded that the economic burden of hospital-based delivery care in Ghana and Benin was likely to deter or delay women’s use of health services.

Perinatal Mortality in Rural China: Retrospective Cohort Study (research article)
Perinatal mortality in rural China is higher than in other developing countries, and is higher in second children than first children, and in girls. In this retrospective cohort study, the authors analyzed data collected by the Chinese family planning system on 3,697 pregnancies. Perinatal mortality was 69 per 1,000 births, and stillbirths and miscarriages were three times as common in second births than first births. The overall risk of death in the first months was twice as high for girls as for boys, mainly because of mortality in second births. This may result from the family planning policy and the preference for sons in China, the authors say.

Introducing Criteria Based Audit into Ugandan Maternity Units (research article)
The authors set up a pilot program to introduce criteria based audit into Ugandan maternity units. The audit training was made adaptable so that it would be relevant to the audience irrespective of whether they were rural health workers with little formal education or postgraduate medical trainees. Didactic teaching about criteria based audit followed by practical work in own units, with ongoing support and follow up workshops. Improvements were seen in many standards of care. Staff showed universal enthusiasm for the training; many staff produced simple, cost-free improvements in their standard of care. The authors write that, because the method is simple and can be used to provide improvements even without new funding, it has the potential to produce sustainable and cost effective changes in the standard of health care.

Community-based Antenatal Education in Istanbul, Turkey: Effects on Health Behaviours (research abstract)
This article describes the implementation and evaluation of a community-based antenatal education program for first-time expectant mothers carried out in Istanbul, Turkey.

MEN'S HEALTH RESEARCH

Hyperactivated Sperm Motility Driven by CatSper2 is Required for Fertilization (research abstract)
Related news article: Sperm Genes Hint at Male Contraception
The discovery of a sperm gene's role in fertilization could lead to fast-acting male contraceptives with minimal side effects. Researchers at the University of Texas Southwestern Medical Center at Dallas made the discovery while studying male infertility. They found that disrupting a gene called CatSper2 prevents sperm movement called hyperactivation that normally occurs near fertilization. The effects are very specific, leaving normal sperm cell production and movement intact.

Making Males Mindful of Their Sexual and Procreative Identities: Using Self-Narratives in Field Settings (commentary)
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This article reviews concepts of community- and school-based initiatives that draw upon a framework to promote men’s self-awareness of their sexual and procreative identities. The challenge for health care providers and educators is to develop, expand, and refine strategies that enable young males to become more aware of their sexuality and more responsible about their power to create human life.

Man2Man: A Promising Approach to Addressing the Sexual and Reproductive Health Needs of Young Men (report)
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This report describes the evolution of a promising program in Philadelphia, Pennsylvania: Man2Man. Four goals that have informed the development, implementation, and evaluation of this program are: to improve knowledge and attitudes regarding men’s health issues, and strengthen intentions to engage in responsible reproductive health behavior; to enhance personal values, life skills, family interactions and self-sufficiency; to increase personal responsibility by developing relationships with adult male role models; and to expand utilization of, and access to, primary and reproductive health care services.

MEN'S HEALTH NEWS

India: Mayor Wants to Sterilise All Mumbai Men! (news article)
Initiatives to provide vasectomy have been so successful in the city of Mumbai that the mayor hopes future drives will be even better.

POPULATION RESEARCH

Demography in a New Key: A Theory of Population Theory (research article)
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The author writes in this paper that the widespread opinion that demography is lacking in theory is based in part on a particular view of the nature of scientific theory, generally known as logical empiricism [or positivism]. A newer school of philosophy of science, the model-based view, provides a different perspective on demography, one that enhances its status as a scientific discipline. From this perspective, the author argues, much of formal demography can be seen as a collection of substantive models of population dynamics [how populations and cohorts behave]; in short, theoretical knowledge. And many theories in behavioral demography, often discarded as too old or too simplistic, can be seen as perfectly good scientific theory, useful for many purposes, although often in need of more rigorous statement.

POPULATION NEWS

Estonia Fights for Its Survival (news article)
The thinly-populated Baltic state of Estonia is literally fighting for its survival as a low birthrate raises the prospect of extinction. Although the country of 1.4 million raced ahead economically after restoring independence from the Soviet Union in 1991, today, 5 months from European Union membership, its leaders say the success could be short-lived unless Estonians start to have babies.

WOMEN'S HEALTH RESEARCH

Female Circumcision in Indonesia (report)
The specific aims of this study were to provide research-based information on female circumcision (FC) customary practices and their socio-cultural determinants, and if possible, to assess the immediate and long-term physical and psychological consequences of the practices on women’s sexuality, reproduction, and reproductive rights. The study used multiple data sources, including literature review, indepth qualitative interviews with FC providers, community leaders, religious leaders, and mothers, and a household survey with a sample of 1,694 mothers of female children under age 19. In addition, empirical on-site observations of FC procedures were recorded. Study findings indicate that in general Muslim communities support the continuation of FC practice, because they perceive it as both a societal custom or tradition, and a religious duty. Religious leaders want the practice of FC to continue indefinitely, because of their common interpretations that FC is required act of faith, although when being probed, they admitted that the law varies from one mazhab to another, from “wajib”
(obligatory) to sunnah (recommended but optional), while some placed it an even lower level of religious duty. Around 92% of the families visited for the survey expressed support for the continuation of FC not only for their girl children but also for future grandchildren.

WOMEN'S HEALTH NEWS

Nicaragua: "Violence Against Women Is an Issue of Power and Control" (interview)
Over the last 10 years, Nicaragua has seen organized and systematic activities to combat violence against women. Particularly outstanding is the work of consciousness-raising carried out by the Network of Women Against Violence, whose actions are aimed at making public and denouncing intra-family and sexual violence. Created in 1992, the network is made up of 150 women representing different groups nationwide as well as around 100 individuals. To mark International Day of the Fight Against Violence Towards Women on Nov. 25, Elsa Chanduví Jaña interviewed Matilde Lindo, member of the network’s executive secretariat, who talks about the organization’s achievements and challenges.

YOUTH HEALTH RESEARCH

Adolescent Reproductive Health and Awareness of HIV among Rural High School Students, North Western Ethiopia (research abstract)
There is little information on the knowledge, attitudes, and practices of adolescents in Ethiopia concerning HIV, STDs, and preventive measures. Researchers conducted a cross-sectional study among 260 students from two rural high schools in North Western Ethiopia and found that general awareness of HIV was high, but only 44% of adolescent boys and 41% of adolescent girls had correct knowledge of the virus and its modes of transmission. Use of condoms among sexually active single male students was higher than among adolescents in many other African settings. Knowledge of STDs was generally low. Almost 20% of sexually active males in the study had previously experienced an STD; most after visiting a commercial sex worker.

Community Sex Education among Adolescents in Rural Uganda: Utilizing Indigenous Institutions (research abstract)
Traditionally in Uganda, it was the (father's sister) or senga, who was the traditional channel for socializing adolescent girls about sex and marriage. This paper discusses the implementation and community acceptability of 'modern' sengas who are trained to provide HIV-related counseling to adolescent girls. These sengas provide traditional services (such as advice on and assistance with labial elongation) as well as modern health and sex education, providing a middle road between tradition and modernity. Their activities were supported by the community and they proved to be an effective intervention.

Intentions to Use Condoms in Rwandan Secondary School Students (research abstract)
A survey was conducted among 474 students (213 female and 261 male) with a mean age of 21 years in three secondary schools in rural Rwanda in order to evaluate their attitudes towards condoms. Male students and those with sexual experience had more favorable attitudes towards condom use than female students and those without prior sexual contacts. Regular use of condoms was reported by 73 students. Having more than one sexual partner was reported by 42, of whom 20 claimed to regularly use a condom.

The Psychosocial Context of Young Adult Sexual Behavior in Nicaragua: Looking Through the Gender Lens (research article)
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A representative cross-sectional survey was conducted in six departments in the Pacific region of Nicaragua in 1998. A total of 552 never-married women and 289 never-married men aged 15–24 were interviewed about their perceptions of social pressure to engage in premarital sex; perceived social approval of and attitudes toward premarital sex and premarital pregnancy; perceived sexual activity among peers and siblings; communication with parents on sexuality issues; the psychosocial context of sexual debut; and preferred sources of information on sexuality issues. Most young men (83%) reported that they had received direct encouragement from at least one person in the last year to engage in premarital sex, and at least half perceived that their father, siblings, other relatives, and friends approved of premarital intercourse. A significantly greater proportion of men than of women reported that curiosity or gaining experience motivated their sexual debut (61% vs. 21%). Men perceived themselves to have a higher risk of unplanned and unprotected sex than did women. In contrast, women held more negative attitudes toward premarital sex and were more often discouraged by parents or siblings from engaging in sex.

The Other Half of the Equation: Serving Young Men In a Young Women’s Reproductive Health Clinic (research article)
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Efforts to improve reproductive health typically target women. This paper presents the results after a family planning clinic in San Francisco, serving primarily young women, opened a male clinic as part of a male involvement program that included education and outreach components. Client volume was assessed by reviewing billing data. New male clients completed questionnaires on their demographic characteristics, sexual and health-seeking behavior, and reason for clinic visit. Before and after the male clinic opened, female clients completed questionnaires assessing their satisfaction with services and their attitudes on males’ being served at the clinic. In the first year of the male clinic, the number of adolescent and adult male clients served at the facility increased by 192% and 119%, respectively, over the previous year. Among 110 males making first visits, 88% came for STD testing or treatment. Three-quarters had learned of the clinic by word of mouth from a sexual partner (37%), friend (29%) or sibling (6%) rather than directly from outreach efforts. The proportion of female respondents very or mostly satisfied with their care was similarly high before (98%) and after (92%) the male clinic opened. The authors conclude that increasing capacity within the female reproductive health model to serve males is feasible.

The Young Men’s Clinic: Addressing Men’s Reproductive Health and Responsibilities (report)
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This report describes the Young Men's Clinic, a component of a reproductive health program jointly operated by the Center for Community Health and Education at Columbia University’s Mailman School of Public Health and New York–Presbyterian Hospital. The target age range for the clientele of the Young Men’s Clinic is 13–30. Seventy-five percent of patients are 20–29, and 46% are 20–24 (the male age-group with the highest rates of gonorrhea and chlamydia). Ninety-five percent are Hispanic (the majority of whom identify themselves as Dominican); 3% are black.

Pre/post Assessment of an HIV Infection Prevention Intervention Targeted at Teenagers in Southern Tarragona, Spain (research abstract)
This study assessed the effectiveness of a preventive intervention at the Secondary Schools in the Baix Ebre and Montsià areas of the Tortosa Healthcare District aimed at reducing the risk of HIV transmission and furthering the knowledge of this disease. Twelve schools agreed to participate, a total of 896 answers having been gotten for the pre-test and 805 answers for the post-test. A statistically significant increase was found for 52% (10/19) of the items regarding the correct answers on the post-test. A statistically significant improvement was found in four of the five items (80%) related to attitudes, and in five of the eight (62.5%) items related to overall knowledge of this infection following the intervention. A statistically significant improvement regarding prevention-related knowledge was found solely in one of the six items (16.6%). The authors conclude that preventive activities in the form of participational workshops are a good way of furthering the knowledge and improving the attitudes regarding HIV/AIDS of the participating teenagers.

YOUTH HEALTH NEWS

Chinese Youth in Urgent Need of Sexual Knowledge (feature article)
The era when those who had sex before marriage in China could face severe punishment, including being locked in a bamboo cage and sunk into a river, are gone. Chinese people are marching towards sexual freedom rapidly, and a well-known sociologist predicts that the Chinese people will match the West in terms of sexual attitudes in no more than 20 years. But a lack of relevant sex education will result in certain social problems, such as an increase in the number of single mothers, the spread of sexually transmitted diseases, and the forming of an unhealthy philosophy of love.

The Philippines: Youth Still Value Virginity, but Premarital Sex is Rising (news article)
While the number of Filipino youths practicing premarital sex have increased over the years, most of them, especially women, still value virginity, according to the second part of the State of Philippine Population 2003 prepared by the Commission on Population.

SPECIAL REPORTS/PROFILES/RESOURCES

Africa’s Orphaned Generations (report)
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Related news article: Report Predicts 20 Million AIDS Orphans in Africa by 2010
This report predicts that the number of AIDS orphans will rise from an estimated 11 million in 2001 to 20 million in 2010 as a result of the high proportion of adults with HIV or AIDS and the failure to deliver antiretroviral treatment to sub-Saharan Africa. Many affected countries still have no national policy to tackle the growing needs of AIDS orphans. Poor households are becoming poorer with the increased burden of caring for orphans. Botswana, Lesotho, and Swaziland, which have some of the world's highest prevalence rates of AIDS and HIV, and Zimbabwe are expected to have the most AIDS orphans. The report said that one fifth of children in these countries are likely to be AIDS orphans in 2010.

Client-provider Communication CD-ROM: Successful Approaches and Tools (resource material)
Client-provider communication is often considered the centerpiece of quality of care. This CD-ROM, from the Johns Hopkins University Center for Communication Programs, is based on knowledge gained while implementing quality improvement projects around the world since the mid 1990s. It highlights best practices and promising innovations for improving the quality of client-provider communication. The multimedia disc contains program descriptions that demonstrate various approaches and tools. It was developed as an effort to share lessons learned and best practices with reproductive health organizations working globally to improve quality of care in developing country heath care facilities.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 3, Number 49 8 December 2003