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Volume 3, Number 50
15 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

Analysis of Risk Factors Associated with Uterine Perforation by Intrauterine Devices (PubMed abstract)
This prospective follow-up study was conducted between 1996 and 2002 at the family planning clinic of a referral hospital in Turkey. All 8,343 women who had a copper T-380A IUD inserted underwent ultrasound examination after 1 year. Eighteen uterine perforations occurred during the study, giving an incidence of 2.2 per 1000 insertions. When the time elapsed after the last delivery until IUD insertion was considered, postplacental insertion and insertion after 6 months postpartum were found not to increase the risk of uterine perforation. However, IUD insertion 0 to 3 months postpartum increased the risk of uterine perforation as did insertions at 3 to 6 months postpartum. Increasing parity decreased the risk, and increasing number of abortions increased the risk. The authors conclude that it is safer to postpone IUD insertion until 6 months after delivery.

Intrauterine Device Insertion-related Complications: Can They be Predicted? (PubMed abstract)
The purpose of this retrospective case notes analysis (n=545) was to determine risk factors affecting the incidence of IUD insertion-related complications and failures and whether postcoital IUD insertions have a higher incidence of complications than routine IUD insertions. The incidence of complications at insertion, or up to 12 weeks after insertion, was determined and included failed insertion, cervical problems, syncope, bradycardia, convulsions, early perforation, and early expulsion. Fourteen potential risk factors were examined to determine the effect on incidence of complications. Failed insertions were statistically more likely in women who had never previously had a vaginal delivery and also when a less experienced doctor performed the insertion. Nulliparous women were at statistically increased risk of cervical problems and bradycardia. Cervical problems at insertion also increased significantly with age. Patients who were amenorrhoeic at insertion were more likely to suffer an early IUD expulsion.

Sperm from Stem Cells Fertilize Egg (research review)
Related press release: Mouse Embryonic Germ Cells and Male Gametes Created in the Lab
Mouse sperm grown from stem cells have successfully fertilized eggs. This could open the door to producing laboratory-grown human sperm. Earlier this year, fertile eggs were produced from stem cells. These advances could lead to alternative ways to help infertile couples conceive by in-vitro fertilization, and help parents who have genetic defects to give birth to normal children. Earlier this year Japanese researchers were the first to manufacture sperm in the laboratory, but Daley's group is the first to create male gametes, primitive male sperm, and to demonstrate that these sperm are fertile. Understanding how germ-cell formation works, and sometimes goes awry, may teach scientists about early developmental defects and some forms of male infertility.

Levonorgestrel and Mifepristone in Emergency Contraception (research review)
This paper reviews recent research and presents combined data from the authors' multinational trials and combined estimates of efficacy for mifepristone and for levonorgestrel separately. Data were available for 6,283 women in 10 mg mifepristone groups and 4,098 women in levonorgestrel groups. One of these studies compared the two methods, namely a randomized, double-blind trial in which they also investigated a single dose of 1.5 mg of levonorgestrel. The researchers concluded that both levonorgestrel and mifepristone are effective for emergency contraception and prevent a high percentage of pregnancies when used within a few days after coitus.

Prevalence of STDs Among Prostitutes in Czech Border Areas with Germany in 1997–2001 Assessed in Project "Jana" (research abstract)
This paper reports on the Czech-German project "Jana," based on a project umbrella network of the WHO, to prevent STDs, including HIV/AIDS, and assessment of STD prevalence in prostitutes. Of the 561 street girls registered in the project during 1997–2001, there was one HIV positive, every 11th prostitute had syphilis, and one in 93 had gonorrhoea. In the Czech Republic in 2001, incidence of syphilis was 10.2/100,000 and that of gonorrhoea 9.5/100,000 inhabitants. STD frequency revealed in project participants significantly exceeded the numbers of STDs in other inhabitants of the Czech Republic.

A Comparative Analysis of the Modification of Sexual Desire of Users of Oral Hormonal Contraceptives and Intrauterine Contraceptive Devices (PubMed abstract)
This prospective observational study of 1,073 women using oral hormonal contraceptives (OCs) or an IUD in Alicante, Spain was conducted to compare the influence of OCs and the use of IUDs on the modification of sexual desire. A logistic regression analysis was undertaken which considered the factors of age adjustment, level of studies, family planning information, relationship with partner, age when sexual relationships were initiated, parity, contraceptive method previously used, and the duration of use of the contraceptive method. Researchers found that sexual desire does not vary in relation to the use of OCs or IUDs, yet it does decrease with age, in nulliparous women, and in those with an average or poor relationship with their partner.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

US: Debate on Selling Morning-After Pill Over the Counter (news article)
Related press release: Joint Meeting of the Nonprescription Drugs Advisory Committee and the Advisory Committee for Reproductive Health Drugs
Two panels for the Food and Drug Administration will consider this week whether to allow the so-called morning-after pill, now a prescription drug taken after intercourse to prevent pregnancy, to be sold over the counter.

In Haiti, Where Pleasures are Scarce, U.S.-funded Abstinence Campaign Gets Mixed Reviews (news article)
According to this news article, the abstinence message financed by the US government is getting mixed reviews in Haiti, where earthly pleasures are scarce and HIV has infected 5% of the 8 million people. Although HIV infection has leveled off in some age groups, it is increasing among Haitians aged 15 to 24. The country is one of the hardest-hit in the Caribbean, whose AIDS rate is second only to sub-Saharan Africa. "When the lights go out in Haiti, people have sex," said James Picard, 25, an AIDS educator. "And if you know anything about Haiti, the lights go out often."

Brazil Blasts Catholic Church's Opposition to Condom Use (news article)
The director of Brazil's national AIDS and sexually transmitted disease program last week sent an open letter to the Catholic Church criticizing the church's opposition to condom use to prevent HIV infections. Alexandre Grangeiro said he sent the letter because the church's attempts to discredit condom use "could not go unchallenged. We don't want to stir up controversy, but when the church tries to shut down discussion about condoms and claims to use scientific criteria to show they don't work, we have to clarify the facts."

Ghana: Pharmacists' Behaviour Disincentive to Patronage of Condoms (news article)
This news article from Ghana states that pharmacists and chemical store attendants have been accused of hindering the patronage of condoms and other contraceptives.

The Philippines: Muslims to be Taught Family Planning (news article)
Islamic teachings (fatwa) on family planning, including the use of some contraceptives, will be taught in mosques nationwide next year, the first attempt by Muslim religious leaders to address reproductive health among believers. The fatwa, which will start in Tawi-Tawi, was borne from consultations among 100 Islamic teachers on what the Q’uran says on family planning.

New Zealand: Safe Sex Ads Upset Church Leaders (news article)
Two New Zealand church leaders have attacked a Christmas safe-sex advertising campaign depicting a trio of jeans-wearing men with packets of condoms in their back pockets as Three Wise Men. The nationwide campaign by the Family Planning Association and condom maker Ansell is featured on billboards and the back of buses.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Kenya: Female Genital Mutilation: 3,000 Girls Undergo Alternative Rite (news article)
In keeping with the Kenyan Children’s Act, which prohibits circumcision in girls under 16, more than 3,000 girls around the country underwent an alternative to the practice of female genital mutilation.

HIV/AIDS RESEARCH

Measuring Quality of Life among HIV-Infected Women Using a Culturally Adapted Questionnaire in Rakai District, Uganda (research abstract)
Researchers culturally adapted a Lugandan version of the Medical Outcomes Survey-HIV to examine self-reported quality of life and health status of HIV-infected women with a comparison sample of HIV-uninfected women in rural Uganda. A cross-sectional survey among 803 women (239 HIV-positive and 564 HIV-negative) enrolled in a community study to evaluate maternal and child health in Rakai District, Uganda, was administered. HIV-positive women reported significantly poorer functioning and well-being than HIV-negative women, which led the authors to conclude that patient-reported measures of health status and related concepts may provide a feasible method to assess the impact of HIV/AIDS and future interventions to improve patient outcomes in rural Africa.

How do Africans View the Impact of HIV? A Report from a Ugandan Community (report)
Little has been written about how societies affected by the HIV epidemic perceive its effects; particularly in sub-Saharan Africa. In this study, 50 residents (28 female, 22 male) from 30 villages in southwest Uganda were interviewed about the problems affecting their communities as a result of HIV, particularly (1) lack of able-bodied adults, (2) lack of care for children, and (3) mental and social problems. The authors discuss the interrelatedness of these categories in the context of communities that are struggling to recover from the effects of HIV.

HIV Testing Attitudes, AIDS Stigma, and Voluntary HIV Counselling and Testing in a Black Township in Cape Town, South Africa (research abstract)
This study examined the relation between HIV testing history, attitudes towards testing, and AIDS stigmas in men (n = 224) and women (n = 276) living in a black township in Cape Town, South Africa. Only 47% of participants had been tested for HIV. Risks for exposure to HIV were high and comparable among people tested and not tested. Comparisons on attitudes toward voluntary HIV antibody counselling and testing, controlling for demographics and survey venue, showed that individuals who had not been tested for HIV and those tested but who did not know their results held significantly more negative testing attitudes than individuals who were tested, particularly people who knew their test results. Compared to people who had been tested, individuals who were not tested for HIV demonstrated significantly greater AIDS related stigmas; ascribing greater shame, guilt, and social disapproval to people living with HIV. Knowing test results among those tested was not related to stigmatizing beliefs.

Enabling Households to Support Successful Migration of AIDS Orphans in Southern Africa (research abstract)
Qualitative research conducted with children and guardians in Lesotho and Malawi examines orphans' migration experiences to assess how successful migration might best be supported. AIDS policy in southern Africa places the burden of care on the extended family. Failed attempts to resettle orphans results in another move with further trauma. Failed placement usually results from orphans feeling ill-treated in their new families or from changes in guardians' circumstances. Reducing the economic costs of caring for children (particularly school-related costs) would allow children to stay with relatives who are best able to meet their non-material needs and reduce resentment of foster children in impoverished households.

Exploring the Relationship of Conspiracy Beliefs about HIV/AIDS to Sexual Behaviors and Attitudes among African-American Adults (research article)
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This study examined the relationship of HIV/AIDS conspiracy beliefs to sexual attitudes and behaviors in 71 African-American adults (aged 18–45; 61% female) in the United States. The authors used a national, cross-sectional telephone survey. Results indicated significant associations between endorsement of a general HIV/AIDS government conspiracy and negative beliefs regarding condoms and greater numbers of sexual partners. Endorsement of HIV/AIDS treatment conspiracies was related to positive attitudes about condoms and greater condom use intentions. The authors conclude that findings in their study suggest that conspiracy beliefs have implications for HIV prevention in African-American communities.

HIV/AIDS NEWS

AIDS Moves Beyond 'High Risk' Groups in India (feature article)
Densely populated India has become a key battleground in the fight against AIDS. While the virus is far from under control among high-risk drug users and sex workers, it is now also on the rise among the wider population and in rural areas.

Indonesia: Mega Calls for Action on AIDS (news article)
President Megawati Sukarnoputri of Indonesia announced that the government will soon provide subsidized anti-retroviral drugs for sufferers of HIV/AIDS to help combat the growing problem. According to the World Health Organization (WHO) and the United Nations, an estimated 130,000 Indonesians are living with HIV/AIDS, up from 110,000 last year. WHO and UNAIDS announced a program to provide generic anti-retroviral drugs to three million people in developing countries worldwide. Indonesia’s National Agency for Drug and Food Control has assigned a local pharmaceutical company to manufacture the generic drugs Hiviral, Reviral, Duviral, Neviral and Triviral. UNAIDS has urged Indonesia to combat the spread of the disease by: promoting safer sex behavior, promoting and distributing condoms, prevention and treatment of sexually transmitted infections, safe blood transfusions, treatment and care of people with AIDS, and introduction of supporting laws and regulations.

MATERNAL AND CHILD HEALTH RESEARCH

Prospects of Safe Motherhood in Botswana: Midwifery Training and Nurses' Ability to Complete the Botswana Obstetric Record (research abstract)
This paper examines several key factors that determine nurses' ability to complete the Botswana Obstetric Record (BOR), an instrument that should help with early diagnosis of problems during pregnancy, labor, delivery, and the puerperium. Using a national sample of 309 nurses, the study found that a nurse's ability to complete the BOR was significantly related to midwifery training, level of basic nursing training, age group, level of income, job satisfaction, adequacy of equipment, attendance of refresher courses, overall level of in-service training, reliance on workshops and seminars, peer reliance, and self-reliance for information on new nursing practices.

The Provision and Use of Progestogen-only Contraceptives Amongst Antenatal and Postpartum Women in a Rural Area of the Eastern Cape (report)
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This report presents findings from research amongst 346 women attending the child health clinic (CHC) and amongst 346 women attending the antenatal clinic (ANC) at St Patrick's Hospital, in Bizana in the Eastern Cape. The results of the survey were as follows: Most women were able to access health services without difficulty. Contraceptive use was low, at 29%. Six percent of women may be at risk of becoming pregnant, as they were not exclusively breastfeeding and were sexually active within the first six weeks postpartum. Seventy-eight percent and 75% at the CHC and ANC, respectively, lacked good knowledge about the time they were most fertile. Most women did not regard exclusive breastfeeding as a reliable method of contraception (40% and 47%, at the CHC and ANC respectively).

Utilization of Care During Pregnancy in Rural Guatemala: Does Obstetrical Need Matter? (research abstract)
This study examines the extent to which complications in an ongoing or previous pregnancy affect a woman's decisions to seek care in Guatemala. Findings suggest that obstetrical need, as well as demographic, social, and cultural factors, are more important predictors of pregnancy care than availability and access to health services. Results also suggest the importance of unobserved variables such as quality of care in determining women's decisions about pregnancy care.

Preventing Mother-to-Child HIV Transmission in a Developing Country: The Dominican Republic Experience (research abstract)
This paper presents the results of a large-scale program to prevent mother-to-child transmission in a developing country.

Treatment of Trichomonas in Pregnancy and Adverse Outcomes of Pregnancy: A Subanalysis of a Randomized Trial in Rakai, Uganda (PubMed abstract)
The purpose of this study was to assess the association of presumptive Trichomonas vaginalis treatment during pregnancy and birth outcomes. A community-randomized trial of presumptive STD treatment during pregnancy was conducted between 1994 and 1999 in Rakai district, Uganda. Children of 94 women with Trichomonas who were treated had increased low birth weight, preterm birth rate, and 2-year mortality rate, compared with children of 112 women with Trichomonas who were not treated. The authors conclude that treatment of Trichomonas vaginalis during pregnancy may be deleterious, and they infer that this may be due to metronidazole.

Infant and Young Child Feeding: A Tool for Assessing National Practices, Policies and Programmes (report)
This tool, jointly developed by the WHO and LINKAGES, is designed to assist users in assessing the status of infant and young child feeding practices, policies, and programs in their country. The purpose of such an assessment is to identify strengths and possible weaknesses, with a view to improving the protection, promotion, and support of
optimal infant and young child feeding.

Barriers to Accessing Safe Motherhood and Reproductive Health Services: The Situation of Women with Disabilities in Lusaka, Zambia (research abstract)
Researchers examined how well Lusakan health services met the safe motherhood and reproductive health care needs of women with disabilities, using in-depth tape-recorded interviews with 24 women with disabilities and 25 safe motherhood service providers. Social, attitudinal, and physical barriers to accessing safe motherhood and reproductive health services in this particular setting were experienced by the women, such as assumption among reproductive health service providers that women with disabilities will not be sexually active and will not require reproductive health services. Beliefs about transmission of disabilities were also experienced, and nurse-midwives' feared delivery complications in women with physical impairments.

Maternal Literacy and Health Behavior: A Nepalese Case Study (research abstract)
Researchers explored the question of whether literacy could mediate the relationships of schooling to maternal health behavior in populations undergoing demographic transition. The literacy skills of 167 urban and rural mothers of school-aged children in the Kathmandu Valley of Nepal were tested for reading comprehension, academic language proficiency, health media skills and health narrative skills. Regression analysis of the data indicates the retention of literacy skills in adulthood and their influence on health behavior.

User Fees at a Public Hospital in Cambodia: Effects on Hospital Performance and Provider Attitudes (research abstract)
This report describes the effects of introducing user fees at the National Maternal and Child Health Center (NMCHC) of Cambodia, on patient utilization, revenue and expenditure, quality of hospital services, provider attitudes, low-income patients, and the government, by reviewing hospital data, patient and provider surveys, and provider focus group discussions. Patients' utilization of the NMCHC was found to increase after the introduction of user charges. Noticeable improvement in staff service and operational quality, including drug and medical supplies and the establishment of an exemption policy for low-income patients, increased the attractiveness of services to users at the facility. The study’s findings suggest that in creating a user-fee program in developing counties, donors improve hospital services, make them sustainable, and provide financial and management support.

The Maternal Depletion Transition in Northern Kenya: the Effects of Settlement, Development and Disparity (research abstract)
Malnutrition depletion syndrome results from dietary inadequacy, heavy workloads, and too many pregnancies, and has been determined to be an important predictor of maternal and child health. This study examines the nutritional status and dietary intakes of 912 Rendille women in one nomadic and four settled communities in northern Kenya, testing the hypothesis that settlement of nomadic pastoral peoples results in improved diet and nutrition. Findings showed that long and short-term reproduction-related changes in triceps skin fold and upper arm muscle area were examined in relation to parity, age, and socioeconomic factors. Community comparisons revealed improvements in dietary adequacy and nutritional health only among women residing in the District capitol, Marsabit. Data also revealed that economic disparity increased in the process of settlement.

A Pilot Study to Evaluate the Safety and Feasibility of the Administration of AZT/3TC Fixed Dose Combination to HIV Infected Pregnant Women and Their Infants in Rio de Janeiro, Brazil (research abstract)
This study evaluated the safety and feasibility of zidovudine and lamivudine (AZT/3TC) given to HIV infected pregnant women and their infants in Rio de Janeiro, Brazil. Treatment of the 40 HIV infected antiretroviral women included fixed dose AZT 300 mg/3TC 150 mg by mouth every 12 hours until labor; AZT 300 mg by mouth every 3 hours until delivery; in the infants: AZT 4 mg/kg every 12 hours plus 3TC 2 mg/kg every 12 hours for 6 weeks. Thirty nine women tolerated treatment (one was lost to follow-up). All 39 babies were uninfected.

MATERNAL AND CHILD HEALTH NEWS

Obstetric Fistula is a Widespread Problem in South Asia, Says UNFPA (press release)
Obstetric fistula, the most devastating of all pregnancy-related disabilities, affects hundreds of thousands of girls and women in South Asia, said UNFPA, at the first South Asia Conference for the Prevention and Treatment of Fistula, held in Dhaka, Bangladesh last week. Over 400,000 women are estimated to be living with the condition in Bangladesh alone. The three-day meeting included 50 health experts who discussed the extent of the problem in the region and measures to address it.

MEN'S HEALTH RESEARCH

Men's Use of Sexual Health Services (research abstract)
This paper uses various data sources to describe the level of, and trends in, men's use of sexual health services in England. The authors found that the number of male clients attending family planning clinics has increased by 160% during the 1990s. Most of this increase is due to more men obtaining condoms. The ages of these clients are unknown, but data show an increase among younger men. The one service for which male and female use is approximately equal is genitourinary medicine (GUM). Male cases of sexually transmitted infections and other treatments have increased over the 1990s, although not at the same rate as female cases. Use of GUM clinics by homosexually active men is much greater than by all men.

POPULATION RESEARCH

United Nations Expert Meeting on World Population in 2300 (resource material)
Related news article: U.N. Says 9 Billion Will Share Planet in 300 Years
After several fluctuations, the world's population will swell to 9 billion people by 2300, according to new projections by the United Nations.

POPULATION NEWS

Iran's Population to Increase by One Million Next Year (news article)
This article reports that Iran's population is expected to increase by one million to 67,500,000 in the next Iranian year (to start on March 20) from 66,500,000 this year.

Singapore Birth Rate Drops to 26-year Low (news article)
Singapore is headed for its lowest birth rate in 26 years, unless there is a massive baby boom in the year's final 2 months.

WOMEN'S HEALTH RESEARCH

A Population Based Study of Herpes Simplex Virus 2 Seroprevalence in Rural Costa Rica (research abstract)
Researchers determined seroprevalence and determinants of herpes simplex virus 2 (HSV-2) seropositivity in a random sample of a population based cohort of 10,049 women of Guanacaste, Costa Rica. Overall age adjusted HSV-2 seroprevalence was 38.5%, and it was strongly associated with increasing age. A greater number of lifetime sexual partners increased the risk of seropositivity, with a 28.2% seroprevalence among monogamous women and 75%seroprevalence for those with four or more partners. Barrier contraceptive use was negatively associated with HSV-2 seropositivity.

Prevalence and Determinants of Chlamydia Trachomatis Infections in Women from Bogota, Colombia (research abstract)
Researchers performed a cross sectional study in Bogota, Colombia, where cervical cancer rates are high, to determine the prevalence and determinants of C trachomatis infection, and in particular its association with human papillomavirus (HPV). Low-income, sexually active women (n=1,829) were interviewed and tested. The overall prevalence of C trachomatis was 5%; this did not differ substantially between women with normal and those with abnormal cervical cytology. Women infected with any HPV type (15.1%) had a slightly increased risk of being simultaneously infected with C trachomatis. This association was stronger when multiple HPV infections were present.

Coercive Sex in Rural Uganda: Prevalence and Associated Risk Factors (research abstract)
This study presents findings from a community-based survey of 4,279 reproductive-aged women in partnerships in Uganda carried out in 1998–99. One in four women reported having experienced coercive sex with their current male partner, with most women reporting its occasional occurrence. Behavioral risk factors, such as the younger age of women at first intercourse and alcohol consumption before sex by the male partner, were strongly related to the risk of coercive sex. Women who perceived their partner to be at highest HIV risk experienced almost three times the risk of coercive sex. Analysis of 1-year longitudinal data provided additional support for this hypothesis. Sexual violence prevention programs in settings like Uganda and the possible importance of incorporating sexual and physical violence within current HIV prevention programs are proposed by the authors, as little is known about the issue of coercive sex in developing countries.

WOMEN'S HEALTH NEWS

Uganda: Sabiny Now Circumcise Married Women (news article)
Health workers report that girls who were saved from the knife in their adolescence are now falling victims upon marriage.

YOUTH HEALTH RESEARCH

The 1st South African National Youth Risk Behaviour Survey (report)
Related news article: Teens Say They Force Others to Have Sex
More than 8% of 10,699 pupils in grade eight to 11 who participated in a nationwide survey reported having forced someone to have sex with them. There was no significant difference in the prevalence among boys and girls, according to the first Youth Risk Behaviour Survey. Almost 10% of the respondents said they had been forced to have sex at some stage. Just over 40% (about half of boys and a third of girls) reported having had intercourse, with 14.4% saying they had their first experience before they were 14 years old. Of those sexually active, 54% said they had had two or more partners. Almost 29% said they always used a condom.

Assessment of Youth Reproductive Health Programs in Nicaragua (report)
This report provides an assessment on field activities in Nicaragua on youth reproductive health programs.

SPECIAL REPORTS/PROFILES/RESOURCES

The State of the World's Children 2004 (report)
Related news article: Girls Education Vital in Fighting Poverty - UNICEF
The 2004 UNICEF State of the World's Children report says that 121 million children worldwide are out of school, 9 million more girls than boys. UNICEF considers the education of girls to be essential to reducing child mortality, HIV/AIDS, and other diseases. Educated women are more likely to have healthy children and are more likely to ensure that their children complete school. Education can provide life skills for women which have a lasting effect, particularly in family planning and disease protection. In sub-Saharan Africa, 24 million girls did not go to school in 2002, an increase of 4 million since 1990, reflecting in part a sharp drop in foreign aid.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 3, Number 5015 December 2003