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Volume 3, Number 51
22 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

Prevalence and Risk Factors of STDs in Rural Haiti: Implications for Policy and Programming in Resource-poor Settings (research abstract)
The goals of this study were to (1) estimate the prevalence of STDs among women accessing services at a women's health clinic in rural Haiti and (2) identify risk factors for STDs in this setting. A case-control study was used to compare risk factors for women who demonstrated positive laboratory results for chlamydia and/or gonorrhoea to women who tested negative for both of these pathogens. The strongest risk factors for chlamydia and/or gonorrhoea were largely economic variables, with work as a domestic servant increasing the risk by four-fold. Working as a market vendor reduced a woman's risk of having an STD by approximately 45%. The authors suggest that one potential mechanism for reducing the risk of STDs, including HIV, would involve increasing economic opportunities for women in rural Haiti.

‘Failed’ Contraception in Rural South African Population (research abstract)
Researchers used a case-control study in a rural South African hospital to study whether the free availability of contraception affects the need for termination of pregnancy (TOP). The study groups were 3,095 TOP seekers and 439 non-pregnant controls. Less than one-third (28.6%) of TOP seekers claimed to be using contraception versus 85% of controls. Injectable contraception (IC) was preferred by the controls and oral contraception (IC) by TOP seekers. The reason for discontinuation of hormonal contraception was obtained from 31.2% of TOP seekers and 63.3% of controls; no reason for discontinuation was acknowledged by 30.1% of the former and 6.3% of the latter. Poor compliance and absence of an acknowledged reason for discontinuing hormonal contraception resulted in 173 unwanted pregnancies.

Informed Choice: The Timing of Postpartum Contraceptive Initiation (research abstract)
This study examined women’s preferences in South Africa regarding timing of postpartum injectable progestogen-only contraceptives (IPC) initiation, as well as women’s contraceptive and breast-feeding behaviors and pregnancy risk in the early postpartum period. A cross-sectional study was conducted among 200 antenatal clinic (ANC) attendees and 180 mothers attending a child health clinic (CHC). Most ANC women planed to use IPCs (92%) and to breast-feed (98%) after delivery. Most CHC mothers had used IPCs (91%) and had breast-fed (83%) after delivery. When women at the ANC were provided with appropriate information they made decisions about when to initiate IPC by balancing the theoretical risks of IPC to their infant against their personal risk of pregnancy and ability to return to a clinic in the early postpartum period.

Chlamydia Trachomatis Genital Infection in Apparently Healthy Adult Population of Tamil Nadu, India: A Population-based Study (research abstract)
This is the first Indian report on the prevalence of genital chlamydial infections in the general population. The authors enrolled adults aged 15-45 years, pre-identified from the selected households during medical camps conducted for a major study on community prevalence of STDs in Tamil Nadu, India. The prevalence of anti- C. trachomatis antibodies was 2.4%. The prevalence of genital chlamydial infection was 1.1%. The majority of the detected infections (68.8%) were asymptomatic.

'You Can't Tell by Looking': Pilot Study of a Community-based Intervention to Detect Asymptomatic Sexually Transmitted Infections (research abstract)
The authors designed an intervention, "You Can't Tell By Looking," which combined health promotion with testing for gonorrhoea and chlamydia using nucleic acid amplification technology and treatment and partner notification delivered in non-clinical settings. Forty-three percent of participants were from Black Caribbean or Black Other ethnic groups and 39% were Black African: 125 of 181 participants were sexually active and 109 of these (87%) provided a urine specimen. 10/109 (9.2%) samples were confirmed positive for Chlamydia trachomatis and two were also positive for Neisseria gonorrhoeae. The authors conclude that the intervention was both feasible and acceptable to young people, and that it could be tested in a wider variety of non-clinical settings and evaluated in a cluster randomized trial.

Risk of Venous Thromboembolism After Air Travel: Interaction with Thrombophilia and Oral Contraceptives (research abstract)
This study investigated whether individuals with thrombophilia and those taking oral contraceptives are more likely to develop venous thromboembolism during flights than those without these risk factors. The study sample consisted of 210 patients with venous thromboembolism and 210 healthy controls. In the month preceding thrombosis for patients, or the visit for controls, air travel was reported by 31 patients (15%) and 16 controls (8%). Thrombophilia was present in 102 patients (49%) and 26 controls (12%), and oral contraceptives were used by 48 patients and 19 controls (61% and 27% of those of reproductive age, respectively). After stratification for the presence of air travel and thrombophilia, the odds ratio for thrombosis in individuals with both risk factors was 16.1. Stratification for the presence of air travel and oral contraceptive use gave an odds ratio of 13.9 in women with both risk factors.

Gender Roles and HIV Sexual Risk Vulnerability of Roma (Gypsies) Men and Women in Bulgaria and Hungary: an Ethnographic Study (research abstract)
Researchers conducted in-depth interviews of 42 men and women aged 18-52 living in Roma community settlements in Bulgaria and Hungary to elicit information about sexual partnerships and sexual risk behavior practices occurring, use and perception of protection, knowledge and beliefs about AIDS and STDs, and sexual communication patterns. Findings showed that men have great sexual freedom before and during marriage, engage in a wide range of unprotected practices with multiple outside partners, and have relationship power and control. Women are expected to be virgins at marriage and sexually exclusive to their husbands. Condoms are not normally used and are thought of as contraceptives. Awareness of AIDS was common, but not perceived as a personal threat. Misconceptions about how HIV is transmitted are widespread. Women particularly had very little knowledge about STDs, HIV transmission, and protective steps.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

New Rapid Test Developed to Detect Chlamydia (news article)
An international team of scientists has developed an easy-to-use, rapid test for chlamydia, a sexually transmitted disease that affects men and women and is a leading cause of infertility. The "Firstburst" test gives results in less than 25 minutes and will cost as little as 70 U.S. cents in developing countries. "One of the key features of this test is that it is not just rapid and easy to perform but sample taking is very simple," Dr. Helen Lee, of the University of Cambridge, England, who headed the research team, said in an interview.

US: FDA-Approved, Reusable, Ovulation Management Test Now Available Nationwide (news article)
For women concerned about getting pregnant, there is now a new, affordable and reusable, at-home test available nationwide that can tell from a sample of a woman's saliva if she is ovulating. For less than $29, Ovulation Scope accurately predicts a woman's peak likelihood to become pregnant.

Oral Contraceptive Is Appropriate Delivery Vehicle for Folic Acid, Cmte. Says (news article)
Related news article: The Pill Plus Folic Acid May Reduce Birth Defects
An oral contraceptive combination product is an appropriate delivery vehicle for folic acid supplementation, FDA’s Reproductive Health Drugs Advisory Committee concluded last week. The committee voted unanimously that such an OC/folic acid product would be appropriate to prevent neural tube defects in infants born to woman who accidentally become pregnant on OCs or become pregnant shortly after discontinuing OC use. Folic acid supplementation is currently recommended for pregnant women.

India: New Microbicide to Undergo Tests in 4 Cities (news article)
A new dual purpose microbicide, to act as a contraceptive and providing protection against the transmission of STIs, in the form of gel or foaming tablets will undergo effectiveness test in four cities of the country from mid-2004. The cellulose sulphate based microbicide (also a spermicide), is developed by the Contraceptive Research and Development Centre, Arlington, Virginia, USA.

Canada: World's Largest Syphilis Outbreak in Vancouver at Risk of Spreading (news article)
A hand-drawn map of sexual relationships between Downtown Eastside hookers, pimps, and johns may be the best weapon health officials have in stopping the world's largest syphilis outbreak. But doctors say their approach has been about as effective as shooting a water gun at a fire. Since a case was imported in 1997, likely by a traveller, syphilis has spread through the city's slum where prostitution is rampant. It quickly mushroomed to the world's largest per capita outbreak of syphilis, a disease that was once close to being eliminated in North America.

Condom Cards Keep Chinese Women in the Pink (news article)
Beijing authorities plan to issue special cards to married women that will allow them to get condoms for free from vending machines placed throughout the city, state media reports. The machines, which will begin operating next month, will initially appear at 100 different locations in the city of 13 million people. At the start of the pilot project, 60,000 married women will be issued with cards that entitle them to 12 packs of condoms a year.

Singapore: Santarinas Hands Out 50,000 Condoms in Orchard Rd to Promote Safe Sex (news article)
This brief article describes a condom distribution campaign in Singapore and public reaction to it.

India: Adivasi Not Targeted for Sterilisation: Report (news article)
A Health Directorate inquiry has found that there is no truth in the reports alleging that the adivasi population in Kerala's Wayanad district had been targeted for mass sterilization campaign this year.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

FDA Panel Backs Easier Access to Morning-After Pill (news article)
Related news article: How 'Morning-After Pill' Will Affect Nation's Sex Habits
A US advisory panel last week voted to recommend allowing the Plan B "morning after" contraceptive pill to be sold without a prescription. The FDA will make the final decision, but the agency usually follows the advice of its advisory panels. The pill is intended for use by women within 72 hours after sexual intercourse. A follow-up article speculates that if, as expected, the so-called morning-after pill becomes widely available over the counter, it has the potential to revolutionize the debate about abortion and, some contend, sexual mores in the United States.

Cost Efficiency in Maternal and Child Health and Family Planning Service Delivery in Bangladesh: Implications for NGOs (research abstract)
This paper analyzes costs of the NGO service delivery systems in Bangladesh for maternal and child health and family planning and identifies areas for increasing efficiency, especially through reducing labor costs and increasing service outputs. The findings demonstrated a significantly high proportion of personnel costs in field (outreach) service delivery systems, ranging between 70% to 85%. More than two-thirds of the working time of providers was spent on support activities, personal preoccupations, and idle time. Simulations of various cost reduction options showed that considerable efficiency gains were possible through the combined effects of lowering personnel costs for field activities, increasing service outputs at the clinics, and ensuring more efficient use of providers’ time.

India: Parliamentary Committee Seeks Draft Legislation on AIDS (news article)
The parliamentary committee has asked Lawyers’ Collective to prepare a draft legislation on HIV/AIDS. The goal for preparing the legislation is to create a comprehensive law which protects rights of people living with HIV/AIDS and provide anti-discrimination protections for other marginalised groups.

Chile: Stations Opposed to AIDS Campaign Accused of Double Standards (news article)
Scantily-clad models and actors telling off-color jokes are stars on the same TV channels in Chile that have refused to run government ads that encourage the use of condoms to prevent the spread of HIV/AIDS. The Unified Movement of Sexual Minorities has taken legal action against three TV stations that have refused to broadcast the spots produced as part of the latest government AIDS prevention campaign.

Moroccan King Bridges Divide on Marriage Law (news article)
Just 3 years ago, proposals to improve women's rights in marriage and divorce left public opinion divided in Morocco, where Islam is the state religion. Now, King Mohammed and his advisers appear to have found consensus with a package of reforms which has something for everyone. A revised package of reforms, drawn up by a royal commission, has ingeniously side-stepped the most thorny issues. The new law will spell out that decisions on children and family planning should be taken by both spouses together. A woman will no longer have the legal obligation of "obedience" toward her husband. However, polygamy will still be legal. King Mohammed told politicians, "I cannot, as Commander of the Faithful ... forbid what the Almighty has permitted."

AIDS Audit – HIV and Human Rights: An Australian Pilot (research abstract)
This article explores the Australian pilot of a human rights audit using ten indicators in the specific area of HIV/AIDS. The new methodology has three main roles: a monitoring device to measure human rights protection in a jurisdiction's legal system against international standards; an intervention to raise local dialogue and consciousness of rights-based legislation; and an advocacy tool to stimulate law reform. It uses a tripartite process balancing independent experts, government, and community representatives.

US: HIV-infected Woman Pleads Guilty Having Unprotected Sex (news article)
An HIV-infected woman from Jacksonville, Florida who had unprotected sex with more than 200 men pleaded guilty to a charge of criminal transmission of the virus that causes AIDS and was sentenced to just under 2 years in prison. In Florida, a person infected with HIV who has sex with a partner without first informing the partner is committing a third-degree felony which carries a maximum penalty of 5 years in prison.

HIV/AIDS RESEARCH

Accurate and Inaccurate HIV Transmission Beliefs, Stigmatizing and HIV Protection Motivation in Northern Thailand (research abstract)
Researchers interviewed 219 respondents In Chiang Rai, northern Thailand, using a structured questionnaire to assess accurate and inaccurate HIV transmission beliefs, emotional reactions towards people with AIDS (PWA), stigmatizing attitudes, and motivation to protect from HIV. Accurate beliefs about modes of HIV transmission were held by 47% of the respondents, while 26% held at least one inaccurate belief about transmission. Those who held inaccurate beliefs about HIV transmission reported more fear towards PWA, homosexuals and commercial sex workers, and more irritation towards PWA. They also reported more stigmatizing attitudes, perceived AIDS as less severe, perceived a lower vulnerability, and used less condoms. The authors write that their findings suggest that inaccurate beliefs about HIV transmission are related to fear and stigmatizing and undermine HIV prevention behavior.

Management of Antiretroviral Therapy in Neonates, Children, and Adolescents (report)
This report summarizes official National Institutes of Health guidelines for the prevention of perinatal HIV infection and the management of pediatric and adolescent HIV infection, and provides the most current updates on therapy, first-line therapy, changing therapy, salvage therapy, and management strategies.

Risk Factors for HIV Infection among Women in Carletonville, South Africa: Migration, Demography and Sexually Transmitted Diseases (research abstract)
A random sample of 834 women was recruited into a community-based cross-sectional study in an urban South African setting. HIV prevalence was 37.1% with higher prevalence among migrant women (46%) than non-migrant women (34.7%). The highest HIV prevalence (50.9%) was between ages 26 and 35 years. Having two or more lifetime partners increased the risk of HIV infection. Migration, age, marital status, alcohol use, syphilis, and gonorrhoea were independently associated with HIV infection.

Has the HIV/AIDS Epidemic Changed Sexual Behavior of High Risk Groups in Uganda? (research abstract)
Researchers investigated whether and why, as a consequence of the HIV/AIDS epidemic, there were changes of sexual behavior and practices among risky groups in Uganda. Focus group data, collected in 1999, from commercial sex workers, street children, long haul truck drivers, bar maids and adolescents in three towns in Uganda was used. Results showed that despite the HIV/AIDS epidemic, these groups had changed their sexual behavior little, and they reported to be continuing with multiple sexual partners. Adolescents and street children were under peer pressure; poverty was the reason commercial sex workers and bar maids attributed to their risky behavior; and truck drivers cited loneliness and the need for female company. All were aware that having multiple sexual partners put them at higher risk for contracting HIV. All said they adopted condom use as an HIV preventive strategy. They also observed that married people were at a high risk of contracting HIV due to non-use of condoms in marital relationships and in extramarital affairs.

HIV/AIDS in India (report)
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This chartbook, produced jointly by the Population Foundation of India and Population Reference Bureau, is intended to illustrate the threat that HIV/AIDS now poses to India in a clear and succinct format. It provides an overview and individual reports on HIV/AIDS in the Indian states of Karnataka, Nagaland, Tamil Nadu, Manipur, Maharashtra, and Andhra Pradesh. This report is written in English and Hindi.

Popular Opinion Leaders and HIV Prevention Peer Education: Resolving Discrepant Findings, and Implications for the Development of Effective Community Programmes (research abstract)
This article presents core elements of the popular opinion leader (POL) model; interpretations are made of possible reasons for the discrepant findings of the UK peer education and US POL interventions; and practical issues for applied program development are discussed.

Sexual Behavior among Injection Drug Users in 3 Indonesian Cities Carries a High Potential for HIV Spread to Noninjectors (research abstract)
Researchers examine the prevalence of injecting drug users (IDU) in Indonesia and examine the risk of sexual transmission of HIV from IDUs to noninjecting populations. IDU gathering places were mapped in 3 cities in 2002, and 650 IDUs were given interviews and questionnaires on injecting practices, sexual behavior, and HIV-related knowledge. Almost half (48%) of IDUs reported multiple sex partners, and 40% had sex with a female sex worker in the preceding 12 months with consistent condom use reported at 10%. Most injectors (85%) reported using a syringe previously used by another IDU in the previous week. Findings conclude that potential for the sexual spread of HIV from IDUs to noninjectors is extremely high in Indonesia.

Establishing Valid AIDS Monitoring and Research in Countries with Generalized Epidemics (research abstract)
This study presents guidelines for valid HIV/AIDS surveillance and epidemiologic research, and for clarification of uncertainties in transmission dynamics, particularly in countries with generalized epidemics.

Immunodeficiency Virus Type 1 in Southern Brazil (research abstract)
HIV subtype C, the most prevalent subtype in the world, has recently expanded in Brazil, particularly in the southernmost state of Rio Grande do Sul, Brazil. Researchers subtyped and genotyped 77 HIV-1-infected subjects. The prevalence of subtype C was shown to increase over the last 18 years of the epidemic, while subtype B decreased. Analysis of drug resistance mutations in viruses from treated subjects has shown some associations between subtypes and particular mutations. This population is one of the few in the developing world where a large number of HIV-1C-infected subjects are under antiretroviral treatment, making it useful for clinical, treatment, and vaccine trials.

HIV/AIDS NEWS

Fury as Price of AIDS Drug Soars 400% (news article)
A storm of protest has erupted in the US over a company’s decision to increase the US price of an important AIDS drug more than fourfold. Abbott Laboratories has defended the move, saying the treatment value and the cost of improving the drug’s formulation has increased sharply.

Palau to Promote Sexual Monogamy and Abstinence (news article)
The Palau Ministry of Health has started a 5-year STD-HIV/AIDS strategic plan that will aggressively promote monogamous relationships and abstinence among young people to prevent the spread of STDs on the islands. The ministry says having multiple sexual partners has been identified as the leading causes of the spread of STDs; thus, monogamous relationships among locals must be practised.

India: Microbicide Ready for Phase-III Trials (research article)
An Indian-made microbicide is currently being tested for its efficacy in protecting against HIV transmission during sex. Microbicides are used by women before sex as a protection against STDs, giving her more control as she does not have to negotiate its use. The gel-like substance is aimed at preventing harmful pathogens from invading the skin of the vagina or rectum, reducing the chances of transmission. The microbicide demonstrated approximately 80% protection from HIV during Phase II trials in a "sizeable target group." Efforts are underway to conduct Phase-III trials on a larger group.

Ravages of AIDS Threaten Thailand's Children (news article)
This article states that HIV/AIDS has fallen off the political radar screen in Thailand. Politicians are no longer talking openly about the problem, and aggressive condom campaigns targeting sex workers are gone. Thailand also struggles to care for more than 300,000 children orphaned by AIDS and has 670,000 people infected; the largest number of AIDS cases in Southeast Asia. Thailand fought AIDS aggressively in the 1990s and became a role model for the developing world, but complacency has set in. The country is faced with rising infection rates and the enormous problem of caring for the offspring of some of the 450,000 AIDS patients who have died.

Guinea Bissau: Country's First AIDS Treatment Centre Opens in Renovated Hospital (news article)
Guinea-Bissau has opened its first treatment center for people living with HIV/AIDS in a newly refurbished hospital, which will provide antiretroviral therapy free of charge. Situated in the 116-bed Raoul Follerau hospital in the capital Bissau, the center reopened on Thursday after being completely destroyed during the 1998-99 civil war.

Enraged S. Africa Rapists Kill HIV-positive Victim (news article)
South African police have arrested two men on charges they gang-raped an AIDS activist and then kicked her to death in fury when she told them she was infected with the disease, according to officials.

Viet Nam: Mobile Clinic Reaches Out to People with HIV/AIDS (news article)
Ho Chi Minh city's first mobile health clinic targeting people at high-rish for HIV/AIDS and hepatitis has been put into operation. The clinic is a 3-year project aimed at reducing the spread of HIV and hepatitis transmission in the general community and improving the health and quality of life for patients and their families.

MATERNAL AND CHILD HEALTH RESEARCH

Improving Skilled Attendance at Delivery: A Preliminary Report of the SAFE Strategy Development Tool (research abstract)
This paper reports on the SAFE Strategy Development Tool, which was field tested in five collaborating countries: Bangladesh, Ghana, Jamaica, Malawi, and Mexico. The methods employed by the tool were found to be feasible and produced evidence that will be useful in the formulation of maternal health programs. Application of the tool can be completed in 3 to 5 months and was estimated to cost between US$12,938 and US$15,627 for applications at district or subdistrict level.

A Multistage Model for Maternal Morbidity During Antenatal, Delivery and Postpartum Periods (research abstract)
This study uses data from a prospective survey on Maternal Morbidity in Bangladesh, employing a multistage model that involves transitions at different stages to complications. A total of 1,020 pregnant women were followed during pregnancy, delivery and 90 days after delivery. Slightly more than half of the women suffered from at least one of the major complications (hemorrhage, excessive vomiting, edema, and fits/convulsion) during pregnancy. The authors also found that if a woman suffers from one or more of the major complications during pregnancy, then it is more likely that she will suffer from complications during delivery.

Motherhood in the Context of Maternal HIV Infection (research abstract)
In this paper, metasummary and metasynthesis techniques were used to integrate findings pertaining to motherhood in 56 reports of qualitative studies conducted with HIV-positive women. Motherhood in the context of maternal HIV infection entailed work directed toward the illness itself and the social consequences of having HIV infection in the service of two primary goals: the protection of children from HIV infection and HIV-related stigma and the preservation of a positive maternal identity. The study found that motherhood both intensified and mitigated the negative physical and social effects of HIV infection. HIV-positive mothers engaged in a distinctive kind of maternal practice - virtual motherhood - to resist forces that disrupted their relationships with and ability to care for their children, as well as their identities as mothers.

The Effect of Integrated Management of Childhood Illness on Observed Quality of Care of Under-fives in Rural Tanzania (research abstract)
This paper presents results of a survey conducted in August 2000 in stratified random samples of government health facilities to compare the quality of case-management and health systems support in Integrated Management of Childhood Illness (IMCI) and comparison districts. The results indicate that children in IMCI districts received better care than children in comparison districts: their health problems were more thoroughly assessed, they were more likely to be diagnosed and treated correctly as determined through a gold-standard re-examination, and the caretakers of the children were more likely to receive appropriate counselling and reported higher levels of knowledge about how to care for their sick children. The authors write that this study suggests that IMCI, in the presence of a decentralized health system with practical health system planning tools, is feasible for implementation in resource-poor countries and can lead to rapid gains in the quality of case-management.

Infant Mortality in Brazil During Recent Periods of Economic Crisis (research abstract)
This time-series study was based on the Ministry of Health's Mortality Information System and analyzed time trends in infant mortality in Brazil during a recent period of economic crisis (1980-1998). Infant mortality showed a declining trend (-59.3%) and a strong correlation with most of the indicators analyzed. However, only correlations between infant mortality rate and total pregnancy and birth rates presented a significant difference between the two decades.

Premarital Childbearing in Thamaga Village, Botswana (research abstract)
This paper examines the diminished importance of marriage as a setting for childbearing in Botswana. It uses qualitative data gathered in Thamaga Village to explore the cultural basis of this development. Marriage practices and traditional attitudes to marriage, childbearing, and sexual relations are reviewed, and factors identified as having undermined them are discussed. Rational adaptation theory and social disorganization theory then provide a framework within which forces encouraging premarital childbearing in Thamaga are investigated.

Composition of Gestational Weight Gain Impacts Maternal Fat Retention and Infant Birth Weight (research abstract)
Related news article: Proper Pregnancy Weight Gain Benefits Mom, Baby
A newborn's birth weight and a mother's weight after pregnancy is influenced not just by how much weight she gains during pregnancy, but by the source of her excess weight, as well, according to new research. Women who gain weight during pregnancy add on both fat and lean mass, including weight from water and protein. But although women need to gain enough weight during pregnancy to produce a healthy-sized infant, US investigators found that only increases in lean mass, and not fat mass, appeared to influence infant size.

MATERNAL AND CHILD HEALTH NEWS

Ethiopia: Interview with Dr. Pascal Villeneuve, UNICEF Director of Health (interview)
Dr. Pascal Villeneuve, director of health with the UN Children's Fund (UNICEF) at its headquarters in New York, recently visited Ethiopia and conducted an interview to discuss what he feels lies lie at the root of millions of preventable child deaths each year: poor health systems.

Ghana: Stop Taunting Pregnant Women, Doctor Appeals to Nurses (news article)
At the launch of "Safe Motherhood Week," a regional director of the Ghana Health Service has urged nurses to resist the temptation to taunt women who come to give birth at the hospitals for being too young or as husband snatchers. "You are health workers, not moralists, treat your patients as a business," he said. "When you enter a medical facility, please leave your religion at the gate."

MEN'S HEALTH RESEARCH

Effects of Age on DNA Double-strand Breaks and Apoptosis in Human Sperm (research abstract)
Related news article: ...But Older Dads' Sperm Getting More Damaged
The older men get, the more damaged their sperm are genetically. Findings from this study show that older men are more likely to father children with birth defects, as well as to be less fertile than younger men. DNA tests showed that older men had more sperm with highly damaged DNA than younger men. And older men's sperm was less likely to undergo a cleansing process which gets rid of damaged cells. It is thought that age and environmental damage affect the sperm.

Internet Use and Early Syphilis Infection Among Men Who Have Sex with Men --- San Francisco, California, 1999--2003 (report)
Related press release: STD Directors Call for Internet Service Providers to Address Concern Over Spread of STDs via Internet
In response to the growing concern among many state and local STD public program directors over the Internet's impact on the spread of sexually transmitted diseases, including HIV, the National Coalition of STD Directors (NCSD) is calling on Internet Service Providers to help take measures to reduce HIV and STD transmission. NCSD's concern over the growing effect the Internet is having on the spread of sexually transmitted diseases is supported by the December 19, 2003 Morbidity and Mortality Report, which shows an increasing association between gay and bisexual men meeting sexual partners online and early syphilis infection. In just 2 years, the number of gay or bisexual men in San Francisco who reported meeting sexual partners through the Internet jumped from 12.2% to 37.4%, an increase of more than 200%. The men interviewed reported that they now meet nearly one-third of their sexual partners online, more than through any other single venue.

MEN'S HEALTH NEWS

Reproductive Health Programs Need to Involve Men (interview)
Despite increased recognition that conflicting interests and inequities between men and women pose serious obstacles to good health, reproductive health programs that attempt to overcome these inequities have been few. Traditional family planning and other programs have focused almost solely on women, often failing to involve men because of negative stereotypes about male attitudes and behavior toward childbearing and childrearing. Margaret E. Greene of George Washington University's Center for Global Health notes that, since the ICPD, many in the international health arena have been taking a fresh look at reproductive health programs. In an interview with the Population Reference Bureau, Greene notes, however, that despite agreement that promoting fairness in the distribution of services and in women's and men's responsibilities is the most effective approach, confusion about the objectives of involving men has spurred a number of programs that are not always consistent with the Cairo recommendations.

India: Brakes on Male Contraceptive 25 Years in the Making (news article)
A 25-year-old project for developing a new reversible male contraceptive was stopped by India's health ministry during final trials. Work on the contraceptive, touted as the best thing to have happened to medical science in 25 years, stopped in July 2002 after concerns that the injection was toxic. Researchers developing the new contraceptive state that swelling side effects disappear in a few weeks. The new drug is a one-time injection which is said to be effective for at least 10 years. When injected into the vas deferens (the vessel that carries sperms), it immobilises the sperms without obstructing flow. Unlike vasectomy, the male duct is not blocked and no portion of it is surgically removed. The project was funded by WHO, the Indian Council for Medical Research, and the Drug Controller General of India.

POPULATION RESEARCH

The Security Demographic: Population and Civil Conflict After the Cold War (report)
Related press release: New Report Finds Demographic Clues to Risk of Civil Conflicts Findings Could Help Predict and Prevent Wars
High proportions of young adults, rapidly growing cities, scarcities of cropland and water, and HIV/AIDS prevalence may contribute significantly to the risk of deadly civil conflict, according to a new report from Population Action International (PAI). Among the implications of these findings is that sound population policies, centered around provision of reproductive health services for all who want them, can play an important role in advancing global security.

Critical Links: Population, Health, and the Environment (report)
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This issue of Population Bulletin from Population Reference Bureau highlights the results of research, community projects, and public policies to examine three critical questions about population, health, and environment relationships. First, what is the nature of these relationships? Second, how do these relationships affect human wellbeing and the environment? And finally, what can researchers, local communities, and policymakers do to address these impacts?

Births: Final Data for 2002 (report)
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Related news article: American Women Waiting Longer to Have First Child, CDC Says
The average age at which American women are having their first child has climbed to an all-time high of 25.1, according to a new CDC report. The rise reflects a drop in teen births and an increase in the number of women who are putting off motherhood until their 30s and 40s.

POPULATION NEWS

US: Nation's Population Nears 300 Million (news article)
The US population grew by 2.8 million in the past year and is edging toward 300 million, a threshold that should be reached within 4 years.

Germany: Fertile Village Breeds Interest (feature article)
The tiny German village of Laer has become a "symbol of hope" for population growth in a country facing a rapid population decline for the past two decades. The village is in the grip of a baby boom that has pushed its birth rate to 13.5 babies per 1,000 people, more than 60% above the national average. Elsewhere in Europe, policymakers and politicians are realizing the cultural shift started by feminism in the 1960s and 1970s - fed by economic instability, later marriage (if at all), and the desire for greater life choice on the part of women - is having a dire impact on population trends. Unless the tendency is reversed, many European societies may have too few new taxpayers to prop up pensions, health care, and economic growth.

In Bolivia, Smaller Families Spur Higher Hopes (feature article)
This feature article continues a series on world health challenges and the solutions, focusing on Bolivia.

WOMEN'S HEALTH RESEARCH

Cervical Human Papillomavirus Infections in Commercial Sex Workers: Risk Factors and Behaviours (research abstract)
The authors investigated the prevalence of, and risk factors for, cervical human papillomavirus (HPV) infection in commercial sex workers (CSWs) and controls attending the same sexual health clinics in Sydney, Australia. A self-administered "risk factor" questionnaire was completed and a Pap smear and a specimen for HPV detection and typing were taken. Results from the 288 CSWs and 266 controls were assessed by univariate and multivariate analyses. No significant difference in the rates of cervical HPV infection in CSWs (31.6%) and controls (24.4%) was found, but HPV related cytological abnormalities were more common on the CSWs. In both groups, factors independently associated with HPV infection were the use of non-barrier contraception, cytological abnormalities, age under 36, and the number of non-paying sexual partners.

Prevention of Cervical Cancer in Africa: A Daunting Task? (commentary)
This commentator writes that vaccination against HPV is the most promising strategy for the prevention of cervical cancer, but a wider variety of HPV types than currently being investigated must be considered for the development of the multivalent vaccine preparations required in Africa. He suggests that alternative strategies should be promoted in parallel.

Dual Protection in Sexually Active Women (research abstract)
The purpose of this study was to determine the prevalence and co-factors associated with the practice of dual protection against STIs and unwanted pregnancy in a cross-sectional sample of South African women. Statistical analysis of responses by sexually active women to the question, "Was a condom used on the last occasion you had sex?" were obtained from the women’s questionnaire of the South African Demographic and Health Survey in relation to a number of other variables. Study findings included: (1) 10.5% of all sexually active women aged 15-49 years used a condom at last sex and 6.3% used a condom as well as another contraceptive method; (2) condom use is more likely among younger, more educated, more affluent, and urban women, and among women who change partners more frequently; (3) reasons for not using condoms are more likely to be associated with the personal attitudes of women or their partners than with poor knowledge of or lack of access to condoms; (4) women who have no need or desire to prevent pregnancy are less likely to use condoms; and (5) there is a minority of sexually active women, characterised by social disadvantage, who have difficulty obtaining condoms.

Serum Antibody Response to the Heat Shock Protein 60 of Chlamydia Trachomatis in Women with Developing Cervical Cancer (research abstract)
Related news article: Chlamydia Linked to Cervical Cancer Risk
Women with persistent chlamydial infection are at increased risk for developing cervical cancer, new research suggests. Chlamydia is a common sexually transmitted infection that can cause fertility problems for women, but oftentimes it doesn't cause symptoms. The latest findings, coupled with other emerging evidence, suggest that "cervical cancer should be listed as one of the potential long-term (consequences) of genital chlamydial infection."

Factors Associated with Non-epithelial Ovarian Cancer among Mexican Women: A Matched Case-control Study (PubMed abstract)
The purpose of this study was to identify risk factors associated with the development of non-epithelial ovarian cancer in Mexican women. A case-control study was carried out on women registered with the Mexican Institute of Social Security in Mexico City over a period of 2 years (1995-97). Twenty-eight new cases were recruited from the Gynecology and Obstetrics Hospital no. 4 and were matched by age with 84 controls selected randomly. Eighteen (64.3%) cases of germ cell tumors and 10 (35.7%) stromal sex cord tumors were found. The number of full term pregnancies was associated inversely to development of stromal sex cord tumors with lower risk in women with more than three full term pregnancies compared to nulliparous women. No associations were found respecting to germ cell tumors. Parity was inversely associated to development of stromal sex cord tumors, probably as a result of the endocrine system's influence on the ovaries.

Sexual Practices of Women within Six Months of Childbirth in Mulago Hospital, Uganda (PubMed abstract)
This study established the sexual practices and their associated morbidity among women within 6 months of childbirth in Kampala Uganda. Two hundred and seventeen eligible mothers took part. Sexual intercourse was resumed by 66.4% of the women within 6 months of childbirth. Of the mothers who resumed sexual intercourse, 22.2% had sexual problems, including vaginal pain (62.5%), discharge (18.8%), bleeding (15.6%), and bruises or tears (3.1%). Of those who had sexual intercourse and had problems only 59.4% sought medical assistance.

Knowledge and Practice about Cervical Cancer and Pap Smear Testing among Patients at Kenyatta National Hospital, Nairobi, Kenya (research abstract)
The objective of this study was to assess knowledge and practice about cervical cancer and Pap smear testing among cervical cancer and noncancer patients using a structured questionnaire to obtain information. Fifty-one percent of the respondents were aware of cervical cancer while 32% knew about Pap smear testing. There were no significant differences in knowledge between cervical cancer and noncancer patients. Health care providers were the principal source of information about Pap testing (82%). Only 22% of all patients had had a Pap smear test in the past, and patients aware of cervical cancer were more likely to have had a Pap smear test in the past.

Profiles of Infertility in Southern Nigeria: Women’s Voices from Amakiri (research abstract)
This paper advances understanding of the consequences of female infertility in sub-Saharan Africa on the individual level. It illustrates how local meanings of infertility are shaped by the social and cultural context and how they influence the life experiences and coping behaviors of infertile women in an Ijo community in the Niger Delta.

WOMEN'S HEALTH NEWS

PAHO Prepared to Help Caribbean Reduce High Cervical Cancer Rate (press release)
A PAHO-supported report presented to the Caribbean Caucus of Ministers said that well-organized programs can save lives of many women in the Caribbean, a region that suffers one of the world's highest rates of cervical cancer.

Getting Cut: A Woman Speaks Out on Female Genital Mutilation (feature article)
In this feature article, a woman from Ghana relates her experience with undergoing female genital mutilation.

The Gambia: Women, Girls Still Vulnerable to Female Genital Mutilation (news article)
According to this news article, a situational analysis of female genital mutilation (FGM) in The Gambia, commissioned by UN agencies such as the WHO, UNFPA, and UNICEF revealed embarrassing details of a report suggesting that 80% of Gambian women and girls are still prone to the practice. The report blamed the government for the lack of media access for anti-FGM activists, saying it is particularly to blame for recent setbacks in the drive to discourage the tendency, which is still widespread.

YOUTH HEALTH RESEARCH

Calcium Absorption is Significantly Higher in Adolescents during Pregnancy than in the Early Postpartum Period (research abstract)
Related news article: Teen Pregnancy Increases Osteoporosis Risk
The more than 500,000 US teenaged girls that give birth each year are at risk of early onset of osteoporosis, according to new research. The Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health examined the impact of early childbearing on calcium absorption in teens. The study, conducted with a group of teenage girls ages 13 to 18 in Baltimore, showed that one-third of the young mothers had a bone mass that meets the definitions of osteoporosis or osteopenia, the precursor condition to osteoporosis, shortly after pregnancy.

SPECIAL REPORTS/PROFILES/RESOURCES

The World Health Report 2003 - Shaping the Future (report)
Related news article: AIDS Pandemic Reduces Life Expectancy in Africa by Twenty Years
According to this year's report, life expectancy in some African countries has fallen by 20 years in the past decade, mainly due to the HIV/Aids crisis. Child and adult mortality rates in more than a dozen sub-Saharan countries have increased in the past 10 years, even as life expectancy in developed countries is improving.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 3, Number 5122 December 2003