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The Pop Reporter®

Volume 4, Number 2
12 January 2004

"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs INFO Project When you click on any link below, your Internet browser will access a Web site not connected to "The Pop Reporter." Information accessed through these links and contained in this issue of "The Pop Reporter" does not necessarily state or reflect the views of the INFO Project, Johns Hopkins University, or the US Agency for International Development. All links were verified at the date of mailing. Your computer and/or network configuration regarding Java script, cookies, and other security issues may not allow you to view certain Web sites. Consult your computer technician if you are having problems.

GUEST EDITORIAL

Family Planning and the Prevention of Mother-to-child Transmission of HIV

by John Stover

j.stover@tfgi.com

High levels of HIV prevalence among women of childbearing age in many parts of the world carry a triple tragedy. Not only do HIV-positive women face the prospect of discrimination, illness and early death, but they may also pass the HIV infection to their children or leave their children behind as orphans when they die.

The United Nations agencies have outlined a four-pronged approach to address mother-to-child transmission. The strategy includes services to prevent women from becoming infected with HIV, prevention of unintended pregnancies among women who are HIV-positive, use of antiretroviral drugs, safe delivery practices and infant feeding options to reduce the transmission of HIV from mother to child, and care and support for HIV-positive mothers and their children and families.

Efforts are underway to rapidly expand programs to prevent adult HIV infections (through behavior change communications programs, voluntary counseling and testing and other prevention programs) and to improve treatment for those already infected. Programs are also focusing on expanding access to services to prevent mother to child transmission (PMTCT) of HIV. These programs offer the promise of preventing thousands of new infections and child deaths. The addition of family planning to these services could save even a greater number of lives.

Programs that counsel men and women about their sexual behavior also offer the opportunity to discuss family planning issues. Family planning can contribute to HIV/AIDS education efforts by providing HIV+ couples with an opportunity to prevent unintended pregnancies that may result in an HIV+ infant or an orphan. In addition, family planning has many other benefits for both HIV+ and HIV- mothers. Birth spacing can significantly reduce child and maternal mortality rates, saving many lives.

People attending PMTCT clinics are good candidates for family planning services. All are sexually active and are clearly fertile. The probability of a future pregnancy is high if family planning is not used. In spite of these benefits, family planning is not currently included in most policies or guidelines addressing PMTCT

The benefits of PMTCT programs alone are substantial. These programs can reduce transmission of HIV from mother to child by one-half or more, can provide counseling about HIV to many women of reproductive age, and can help more women to learn their HIV-status and seek appropriate care if they are infected. These benefits are further enhanced by the addition of family planning services. One analysis of the benefits of adding family planning to PMTCT services in 14 high-prevalence countries found that family planning can double the impact of PMTCT programs in reducing HIV+ births and can have an even larger impact on reducing child and maternal deaths (1). The cost of adding family planning to PMTCT services was estimated at only about $360 per child death averted.

As funding for HIV programs expands at a rapid pace and funding for family planning programs remains constant or declines, there is an inevitable shift of human and other resources from family planning to HIV/AIDS. This shift threatens to reduce the effectiveness of family planning programs in countries where family planning is not yet well established, as is the case for many countries in Africa with high HIV prevalence. The integration of family planning with PMTCT services is an effective approach to strengthening family planning programs and averting child HIV infections.


John Stover is Vice President, Futures Group, Washington, DC.

References:

1. Adding Family Planning to PMTCT Sites Increases the Benefits of PMTCT. USAID Issue Brief, Population and Reproductive Health, October 2003. Accessed January 6, 2004: http://www.usaid.gov/pop_health/pop/techareas/familyplanning/fppmtct.pdf.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Periodic Abstinence in Developing Countries: An Assessment of Failure Rates and Consequences (research abstract)
Using data from 15 national surveys in low and middle-income countries, this article assesses characteristics of periodic abstinence (PA) users, knowledge of the fertile period, accidental conceptions while using PA, and the reproductive consequences of these conceptions. Current users of PA (predominantly the simple calendar variant) tend to be more educated and urban than users of other methods. The method is preferred by young single women and older married women. The proportion of users with correct knowledge of the timing of ovulation ranges from 8% to 91% (median 62%). The median 12-month gross failure rate was 24 per 100 episodes. Couples who experienced PA failure were more likely than couples who experienced failure with another method to carry the pregnancy to term. Nevertheless, PA still contributes to one-sixth of all abortions (or miscarriages) following contraceptive failure.

What Women Believe about Oral Contraceptives and the Effect of Counseling (research abstract)
This study evaluated Canadian women's (n=649) knowledge of the risks, benefits, and side effects of oral contraceptives (OCs) and the effect of counseling. Survey respondents recorded whether or not they had discussed 12 separate issues about OC use with their healthcare provider. More than 80% of the women selected the optimal response for the questions relating to dysmenorrhea, leg pain, and co-medication. Less than half of survey respondents identified the optimal response for nausea, breakthrough bleeding, breast tenderness, acne, headaches and weight change. Counseling made a significant impact on selection of the optimal response for 7 of the 12 questions. Fifty-two percent indicated that they did not know what they were told about the risk of uterine and ovarian cancer when on the pill.

Incidence of Acute Hepatitis B --- United States, 1990--2002 (research summary)
To characterize the epidemiology of acute hepatitis B in the United States, CDC analyzed national notifiable disease surveillance data for 1990-2002. This report summarizes the results of that analysis, which indicated that, during 1990-2002, the incidence of reported acute hepatitis B declined 67%. This decline was greatest among children and adolescents, indicating the effect of routine childhood vaccination. The decline was lowest among adults, who accounted for the majority of cases; incidence increased among adults in some age groups. To reduce HBV transmission further in the United States, hepatitis B vaccination programs are needed that target men who have sex with men (MSM), injection-drug users (IDUs), and other adults at high risk.

Minimum Effectiveness of the Levonorgestrel Regimen of Emergency Contraception (research abstract)
The authors used data from two published randomized trials of the levonorgestrel and Yuzpe ECP regimens to calculate the minimum effectiveness of the levonorgestrel regimen. Conservatively assuming that the Yuzpe regimen was entirely ineffective in these trials, they estimate that the levonorgestrel regimen prevented at least 49% of expected pregnancies (95% confidence interval: 17%, 69%). They write that because physiologic data suggests that the Yuzpe regimen does, in fact, have some efficacy, the effectiveness of the levonorgestrel regimen is likely to be higher than their minimum estimate.

Respondent Perspectives on Self-report Measures of Condom Use (PubMed abstract)
This study used semistructured interviews to elicit the perspectives of women who had participated in a microbicide clinical trial in which self-reports of condom use were included. Women were asked about their comprehension of the questions, how they remembered their condom use, and their sensitivity to the expectations of the interviewer, and how this affected their answers. Although most women believed they were accurate in their answers about condom use, a number of women admitted to exaggerating their condom use or believed other women did, citing concerns related to interviewers' expectations of them as the primary reason. Most women did not believe that comprehension or memory was a problem and a number were able to articulate strategies for remembering their condom use.

Use of Erythromycin for Nonsurgical Female Sterilization in West Bengal, India: A Study of 790 Cases (research abstract)
The purpose of this study was to determine if erythromycin is an effective agent for achieving occlusion of the Fallopian tube for nonsurgical female sterilization. A readily available marketed tablet preparation containing 500 mg of the estolate salt of erythromycin was used for the trial. In one study locale, the tablet was crushed before placing in a copper-T IUD inserter for placement at the fundus. In the other study locale, crushed tablets were processed into 50 mg pellets of the same diameter as standard quinacrine pellets and 10 pellets were inserted at the fundus using aseptic precautions. At 12 months of use, the failure rate of the sterilization procedure for the crushed 500 mg tablets was 35.8% with 417 women at risk. At 12 months of use, the failure rate for the erythromycin pellets was 28.6% with 43 women at risk. The authors conclude that the failure rate in this study is unacceptably high for erythromycin to be used as a sterilization method.

Increased Infertility With Age in Men and Women (research abstract)
This prospective fecundability study was conducted in a sample of 782 couples recruited from seven European centers for natural family planning. The percentage infertility was estimated at 8% for women aged 19 to 26 years, 13% to 14% for women aged 27 to 34 years and 18% for women aged 35–39 years. Starting in the late 30s, male age was an important factor, with the percentage failing to conceive within 12 cycles increasing from an estimated 18% to 28% between ages 35 and 40 years. The estimated percentage of infertile couples that would be able to conceive after an additional 12 cycles of trying varied from 43% to 63%, depending on age.

A Comparison of the Fertile Phase as Determined by the Clearplan Easy Fertility Monitor™ and Self-assessment of Cervical Mucus (research abstract)
This study compared the fertile phase of the menstrual cycle as determined by the Clearplan Easy Fertility Monitor (CPEFM) with self-monitoring of cervical mucus. One-hundred women (mean age 29.4 years) observed their cervical mucus and monitored their urine for estrogen and luteinizing hormone metabolites with the CPEFM on a daily basis for 2 to 6 cycles and generated 378 cycles of data. The beginning of the fertile window was, on average, day 11.8 by the monitor and day 9.9 by cervical mucus. The average first day of peak fertility by the monitor was 16.5 and by cervical mucus 16.3. The mean length of the fertile phase by the monitor was 7.7 days and by cervical mucus 10.9 days. The peak in fertility as determined by the monitor and by self-assessment of cervical mucus is similar but the monitor tends to underestimate and self-assessment of cervical mucus tends to overestimate the actual fertile phase.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

China: Nation's First Human Sperm Bank Opens for Deposits (news article)
China's first human sperm bank, in central China's Hunan Province, started a new service this week to help men aged 25-45 to deposit sperm for later use.

In Brazil, Church, Health Officials Clash Over Free-condom Program (feature article)
Brazil has South America's highest AIDS rates, almost 238,000 documented cases since 1980, a number believed far lower than actual infection rates. Many Brazilians refuse to seek AIDS testing and die from AIDS-related illnesses that are never classified as such. Church leaders have drawn the line at expanding condom giveaway programs, which last year provided 317,000 condoms to teens, along with sex education, in four interior cities and Sao Paulo, the country's largest metropolis. Next month, the Health Ministry plans to expand its efforts to give away condoms in public high schools.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

India: HIV Test Made Mandatory for City Cops (news article)
Alarmed at the increasing number of HIV positive cases in the force, the Mumbai police has decided to make it mandatory for each of the 38,000 constables and officers up to the rank of inspector to undergo a HIV test every 6 months. As many as 450 police personnel have tested HIV positive since 1991.

HIV/AIDS RESEARCH

HIV/AIDS Kowledge, Beliefs, and Behavior among Women of Childbearing Age in India (PubMed abstract)
This study investigated the relationships of health beliefs and HIV/AIDS knowledge with frequency of condom use among women of childbearing age in four major Indian cities. Surveys were completed by 210 women attending six primary health care centers. Among the sexually active women (n = 139), 68% noted rare or no use of condoms during intercourse. Perceived benefits and normative efficacy in requesting condom use were related to a greater frequency of condom use. About 54% of women knew that breast milk could transmit HIV, but fewer than a third were aware that an HIV-positive mother does not always infect her infant at delivery. Most participants endorsed HIV testing for women prior to pregnancy. Approximately three fourths of participants advocated abortion for HIV-seropositive pregnant women.

Mobility, Sexual Behavior, and HIV Infection in an Urban Population in Cameroon (research abstract)
In this study, the authors examined the relationship between mobility, sexual behavior, and HIV infection in an urban population of Cameroon. A representative sample of 896 men and 1,017 women were interviewed and tested for HIV infection and other STIs in Yaoundé in 1997. Mobile and nonmobile people were compared with respect to sociodemographic attributes, risk exposure, condom use, and prevalence of HIV infection. Seventy-three percent of men and 68% of women reported at least one trip outside of Yaoundé in the preceding 12 months. Among men, the prevalence of HIV infection increased with time away from town. Men who declared no absence were 5 times less likely to be infected than were those away for more than 31 days (1.4% vs. 7.6%, respectively). Furthermore, mobile men reported more risky sexual behaviors (ie, more partners). For women, the pattern was less clear: differences in the prevalence of HIV infection were less marked for nonmobile than for mobile women (6.9% vs. 9.8%, respectively). Results of thiss study suggest that characteristics of male mobility may be an important feature of the HIV epidemic in Cameroon.

A Research-based Tool for Identifying and Strengthening Culturally Competent and Evaluation-ready HIV/AIDS Prevention Programs (PubMed abstract)
This article surveys the various ways that the concept of cultural competence has been studied, extends the concept to the field of HIV/AIDS prevention, and presents a simple-to-use instrument that operationalizes the concept for use with HIV/AIDS prevention programs. The article also explores the idea of evaluation readiness among HIV/AIDS prevention programs in the hope of eventually enlarging the pool of minority-focused HIV/AIDS programs demonstrated as effective.

Trends in HIV and Sexual Behaviour in a Longitudinal Study in a Rural Population in Tanzania, 1994-2000 (research abstract)
Researchers used an open community cohort study with demographic surveillance and surveys of all consenting adults to describe the trends in HIV transmission and sexual behaviour in a rural population in Africa. The prevalence of HIV among adults aged 15-44 years increased gradually from 5.9% in 1994-1995 to 6.6% in 1996-1997 and 8.1% in 1999-2000. In spite of a modest increase in knowledge during the study period, most individuals continued to feel that they were not at risk of HIV, and sexual risk behavior remained largely unchanged, except for a small increase in condom use.

A, B and C in Uganda: The Roles of Abstinence, Monogamy and Condom Use in HIV Decline (report)
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Abstinence, monogamy, and condom use all contributed to Uganda's success between 1989 and 1995, when HIV rates fell steeply. Ugandans became less likely to have multiple sexual partners and more likely to use condoms. During this same period, according to this report, Ugandan adolescents increasingly delayed first sex; however, there was no change in sexual activity among those who had already had sex. The report concludes that, particularly in the late 1980s and early 1990s, positive changes in all three areas targeted by interventions in Uganda together contributed to the country's success in turning the tide of the HIV/AIDS epidemic and maintaining lower levels of infection. Young people delayed sexual initiation (or Abstinence), fewer people had multiple sexual partners (Be faithful, or monogamy) and Condom use increased among people who were sexually active. During the latter half of the 1990s, as HIV prevalence rates fell more slowly, condom use continued to rise while, in general, changes in abstinence and monogamy were mixed.

Higher Risk Behaviour and Rates of Sexually Transmitted Diseases in Mwanza Compared to Uganda May Help Explain HIV Prevention Trial Outcomes (research abstract)
The objective of this study was to determine to what extent the higher impact of treatment for STDs on HIV incidence in Mwanza, Tanzania than in Rakai and Masaka, Uganda might be explained by baseline differences between the trial populations. The researchers performed a re-analysis of baseline data from the three trial populations comparing demography, sexual risk behavior, and HIV/STD epidemiology. They found higher sexual risk behaviors, including younger age of sexual debut, higher numbers of recent partners, and lower frequency of condom use, in Mwanza compared to Masaka and Rakai. High-titre serological syphilis, gonorrhoea, chlamydia infection and trichomoniasis were all more prevalent in Mwanza, except for chlamydia infection in males. The authors conclude that differences between trial populations probably relate to previous reductions in risk behavior in Uganda and may explain, at least in part, the contrasting results of the trials.

Inconsistent Condom Use among HIV-infected Patients with Alcohol Problems (research abstract)
This US-based study examined the association between alcohol consumption level (abstinent, moderate, at-risk) and inconsistent condom use in a cohort of HIV-infected individuals with a history of alcohol problems. Subjects (n=345) had up to seven structured interviews over 36 months. Identical questions on alcohol consumption and inconsistent condom use were asked at each interview. At baseline, 132 (38%) participants reported inconsistent condom use. There was a significant interaction between alcohol consumption and injection drug use variables. Inconsistent condom use was more common among women, those believing condoms to be 'a hassle', and persons living with a partner.

Orphans’ Household Circumstances and Access to Education in a Maturing HIV Epidemic in Eastern Zimbabwe (research abstract)
As the cumulative impact of high morbidity and mortality from HIV takes its toll on the adult population, levels and patterns of orphanhood will change, along with the impact on child development. In the area of Zimbabwe examined, orphans are found disproportionately in rural, female-, elderly-, and adolescent-headed household, each a risk factor for extreme poverty. The over-representation in rural areas could reflect urban-rural migration around the time of death of the parent due to loss of income and the high cost of living in towns. Over-representation in female-, elderly-, and adolescent-headed households could reflect the predisposition of men to seek employment in towns, estates, and mines; the reluctance of second wives to take responsibility for their predecessors' children; and stress in the extended family system. The death of the mother was found to have a strong detrimental effect on a child's chances of completing primary school education, the strength of effect increasing with time since maternal death. The death of the father had no detrimental effect, despite the fact that paternal orphans were typically found in the poorest households.

Costing of HIV/AIDS Treatment in Mexico (report)
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This study documents the Mexican experience in HIV/AIDS treatment in three different health subsystems: the Ministry of Health, the Social Security Institutes, and the National Institutes of Health. The study provides donors and policy makers the information necessary to guide planning and scaling up of comprehensive HIV/AIDS treatment. The study consisted of a multicenter, retrospective patient chart review and the collection of complementary cost data to describe the utilization of services and to estimate costs of care for adult (18 years of age and above) HIV+ patients in the public sector who had at least one visit to a health facility between January 1, 2000, and December 31, 2001. Researchers found that since antiretroviral drugs are the greatest single component within treatment cost, even a small reduction in drug costs would have a measurable impact on the overall cost of therapy. Other findings highlight several improvements that can be made in the quality of care patients are receiving.

HIV/AIDS and Child Labour: A State-of-the-art Review with Recommendations for Action (report)
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This 75-page report synthesizes rapid assessments of child labor and HIV in South Africa, Tanzania, Zambia, and Zimbabwe, incorporating other data and highlighting the impact on young girls. It makes policy and programmatic recommendations and identifies research gaps and areas of collaboration by international organizations. Separate papers on each country are also available for downloading.

HIV/AIDS NEWS

Survey: Kenya HIV Rates Overestimated (news article)
Related executive summary: Preliminary Report of the 2003 Kenya Demographic and Health Survey
Related news article: Controversial HIV/AIDS Survey In Kenya
Preliminary findings of a government survey show that Kenya may have a lower HIV prevalence rate than previously thought. Planning and National Development Minister Anyang' Nyon'go said researchers found that 6.7% of Kenyans are HIV positive compared to a Health Ministry 2003 estimate of 9.4%.

India’s Treatment Programme for AIDS is Premature (news article)
The announcement by India’s health minister, on the eve of world AIDS day in December, that from 1 April 2004 the government will provide free antiretroviral drugs to 100,000 HIV-positive people in six states with high prevalence of the infection has left the bureaucracy and AIDS experts confused and in a state of shock. The poor infrastructure, few facilities, and lack of training have prompted serious apprehension among those working in the field.

Nigeria: 'More Men Take Care of HIV/Aids Patients Than Women' (news article)
More men than women are willing to care for an HIV-infected relative, be they male or female, according to the results of the National HIV/AIDS & Reproductive Health Survey conducted by the Federal Ministry of Health. Even though women are perceived to be more caring than men, less women than men across the country declared a willingness to care for an HIV-infected relative. The survey revealed that it did not matter whether the relative was male or female, the attitude remained the same.

Bush to Boost AIDS Funding, But Not Enough for Some (news article)
President Bush plans to propose $2.7 billion in his fiscal 2005 budget for AIDS initiatives, disappointing some activists who had hoped for a bigger commitment.

USAID HIV/AIDS E-Newsletter (December 2003) (resource material)
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The USAID HIV/AIDS E-Newsletter provides monthly updates on USAID's Office of HIV/AIDS and partner activities to prevent and mitigate HIV/AIDS across the developing world. Topics include briefings on recent and upcoming global events, conferences, workshops, and forums; announcements of newly released publications and online resources; and links to HIV/AIDS-related documents, resources, and USAID partners' Web sites.

Africa AIDS Fight Not All Gloom and Doom (commentary)
The write of this viewpoint, a freelance journalist from Uruguay, has worked for the UN World Food Programme and NGOs in southern Africa, and is now based in Pretoria, South Africa. She says the AIDS pandemic is prompting communities all over Africa to defy stereotypes and make changes for the better.

MATERNAL AND CHILD HEALTH RESEARCH

Perinatal Mortality Associated Factors in a General Hospital of Chiapas, Mexico (research abstract)
identify socioeconomic, gynecological-obstetric and fetal factors associated with perinatal mortality in a general hospital of Chiapas, Mexico. A total of 99 cases and 197 controls were studied. Mean maternal age was 24.82 years and mean newborn age was 37.78 weeks gestation with an average birth weight of 2,760 grams. Factors associated with perinatal mortality were: father's occupation as a farmer, high obstetric risk index, cesarean birth , five or more prenatal visits, and preterm fetal maturity indices. These risk factors, the authors write, are consistent with the findings reported in the international literature.

Pregnancy-reducing Maternal Deaths and Disability in Sri Lanka: National Strategies (research abstract)
This article reviews the national strategies implemented by Sri Lanka, which resulted in a decline in maternal mortality from the 1930s to the late 1990s.

Safe Motherhood: A Brief History of the Global Movement 1947-2002 (research abstract)
This article reviews the global safe motherhood movement in the latter half of the 20th century.

Association of In Utero Exposure to Maternal Smoking with Reduced Semen Quality and Testis Size in Adulthood: A Cross-Sectional Study of 1,770 Young Men from the General Population in Five European.. (research abstract)
Related news article: Maternal Smoking Linked to Low Sperm Counts
Findings in this study suggest smoking during pregnancy could reduce the fertility of baby boys when they grow up. The adult sons of women who smoked during pregnancy were more likely to have lower sperm counts and smaller testes than other men.

Women’s Knowledge About Treatment to Prevent Mother-to-Child Human Immunodeficiency Virus Transmission (research abstract)
In a nationally representative sample of U.S. childbearing-aged women, 59% were aware of treatments to prevent mother-to-child human immunodeficiency virus transmission.

MATERNAL AND CHILD HEALTH NEWS

More U.S. Mothers Use Midwives (news article)
Births attended by midwives have doubled in the United States in the last decade, according to a report in American Baby magazine.

MEN'S HEALTH RESEARCH

Educational Differentials in Male Mortality in Russia and Northern Europe (research article)
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This study compares educational differentials in male mortality in Russia with those in two western populations, the inhabitants of Helsinki (capital of Finland) and Oslo (capital of Norway).

Prevalence and Risk Behaviors of Chinese Men Who Seek Same-sex Partners Via the Internet in Hong Kong (PubMed abstract)
A telephone survey of 15,230 Hong Kong Chinese men aged 18-60 was conducted to examine the prevalence of Internet sex networking among men who have sex with men (MSM) and risk behaviors associated with the behavior. Of the 283 active MSM (having engaged in some MSM behaviors in the last 6 months) identified (0.018%), 17.7% had networked for MSM partners via the Internet in the last 6 months. Independent predictors of Internet sex networking were younger age and being an anal-sex MSM.

MEN'S HEALTH NEWS

Specialists Concerned at Sperm Count Fall (news article)
The largest British study into sperm counts has found that they have fallen by almost 30% in 14 years, researchers announce today. The survey, based on almost 16,000 semen samples taken between 1989 and 2002, lends weight to concerns that sperm counts are falling.

POPULATION RESEARCH

Population Movement and HIV/AIDS: The Case of Ruili, Yunnan, China (report)
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This paper examines movements of people and their possible implications on HIV prevention policies and programs.

POPULATION NEWS

Experts to Examine European Population Trends and Policies at the European Population Forum 2004 in Geneva, Jan. 12-14 (press release)
International experts on population and reproductive health will meet at the Palais des Nations in Geneva from 12-14 January 2004 to examine key issues in Europe and North America, their causes, consequences and policy responses. The European Population Forum 2004 will consider challenges posed by current and emerging demographic trends in the European region, including countries in transition, and will assess progress in implementing the 1994 International Conference on Population and Development (ICPD) Programme of Action and related agreements.

Birthrate among Bulgarian Youngsters Reached 0.04% (news article)
The birthrate among underage Bulgarian girls is higher than that in any other country in Central and Eastern Europe, according to a survey of the UN. Some 0.04% of all female Bulgarians give birth to their first child when they are aged 15 to 19.

WOMEN'S HEALTH RESEARCH

And then I Became a Prostitute ... Some Aspects of Prostitution and Brothel Prostitutes in Dakar, Senegal (research abstract)
This paper describes some characteristics of prostitution in brothels and prostitutes in Dakar, Senegal, and shows that young African women are vulnerable to HIV infection because sexual relations with men are an important means to achieve social and economic status, and for some women they are necessary for survival. In addition, these data show that Senegalese prostitutes, because of their high HIV prevalence, represent a reservoir of HIV infection and a core group for HIV transmission into Senegalese society. This suggests that in spite of information and free condoms, a number of prostitutes engage in unprotected sex. Clandestine and minor prostitutes are at major risk because they are not targeted for condom interventions.

YOUTH HEALTH RESEARCH

Patterns of HIV Risk Behavior and Condom Use Among Youth in Yaoundé and Douala, Cameroon (research abstract)
This study describes the levels of sexual risk behavior and condom use among Cameroonian urban youth in order to evaluate the need for reproductive health programs targeting youth and to inform the design of such programs. Researchers used data from a survey conducted in July–August 2000 among a representative sample of 1,956 unmarried youth aged 15–24 years. The data show that in urban Cameroon, first intercourse often occurs at an early age. Despite the HIV epidemic, a substantial fraction of youth, particularly males, continue to have high rates of partner change. A substantial fraction of youth consistently use condoms with casual partners. However, consistent condom use in regular relationships remains low, even though many youth have multiple regular partners. The authors conclude that their findings illustrate the need for youth-targeted reproductive health programs in urban Cameroon.

Behavioral Interventions to Reduce Incidence of HIV, STD, and Pregnancy among Adolescents: A Decade in Review (research abstract)
The authors reviewed adolescent sexual risk-reduction programs that were evaluated using quasi-experimental or experimental methods and published in the 1990s. They identified 101 articles, and 24 met their inclusion criteria. The majority of studies included randomized controlled designs and employed delayed follow-up measures. The most commonly measured outcomes were delay of initiation of sexual intercourse, condom use, contraceptive use, and frequency of sexual intercourse. Programs ranged from 1 to 80 sessions, most had adult facilitators, and commonly included skills-building activities about sexual communication, decision-making, and problem solving. The programs included a wide range of strategies for content delivery such as arts and crafts, school councils, and community service learning. Their analysis of these programs suggested four overall factors that may impact program effectiveness including the extent to which programs focus on specific skills for reducing sexual risk behaviors; program duration and intensity; what constitutes the content of a total evaluated program including researchers' assumptions of participants' exposure to prior and concurrent programs; and what kind of training is available for facilitators.

Clinic Assessment of Youth-Friendly Services: A Tool for Improving Reproductive Health Services for Youth (report)
Related news article: A Rapid Assessment of Youth Friendly Reproductive Health Services
This tool helps program managers and clinicians determine the extent to which current reproductive health services are youth-friendly. Results from the tool can be used to tailor services to better meet the needs and preferences of young people. The accompanying report contains assessments using the clinic assessment tool in Botswana, Ghana, Tanzania, and Uganda.

Too Young to Wed: The Lives, Rights, and Health of Young Married Girls (report)
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This report examines issues related to early marriage and offers policy and programmatic recommendations to end the practice, which is widespread despite laws and agreements forbidding it. Child marriage deprives girls of basic rights, subjects them to discrimination and serious health risks, and contributes to deepening poverty, since young married girls lacking a formal education and jobs skills are less likely to participate in the workforce.

SPECIAL REPORTS/PROFILES/RESOURCES

IPPF Medical Bulletin (Volume 37 Number 6 December 2003) (resource material)
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This edition of the IPPF Medical Bulletin presents two article: "Sexual violence" and "When will we have an effective vaccine against HIV?"

Country AIDS Policy Analysis Project (resource material)
The Country AIDS Policy Analysis Project is managed by the AIDS Policy Research Center at the University of California San Francisco. It is designed to inform planning and prioritizing of effective and equitable HIV/AIDS prevention and treatment interventions through multidisciplinary research on HIV/AIDS. The project develops and disseminates comprehensive, independent, multisectoral, fully referenced, peer-reviewed, readily accessible analyses of HIV/AIDS in 12 countries: Ethiopia, Kenya, Malawi, Senegal, South Africa, Uganda, Tanzania, Zambia, Zimbabwe, Brazil, Cambodia, and India. Each analysis is linked with national strategic plans for HIV/AIDS prevention, care, and support. Each is also accompanied by a comparative table of key indicators, part of a database comprising 70 HIV/AIDS and socioeconomic indicators for 168 countries and 13 regions that the AIDS Policy Research Center conceptualized and developed.

Education and HIV/AIDS: Sourcebook of HIV/AIDS Prevention Programmes (resource material)
This Sourcebook aims to support efforts by countries to strengthen the role of the education sector in the prevention of HIV/AIDS. It was developed in response to numerous requests for a simple forum to help countries share their practical experiences of designing and implementing programs that are targeted at school-age children. The Sourcebook seeks to fulfil this role by providing concise summaries of programs, using a standard format that highlights the main elements of the programs and makes it easier to compare the programs with each other. For many countries, HIV/AIDS is a newly recognized challenge to the education sector, and as a result, very few programs have been in place long enough to be formally evaluated. Rather than delaying access to program information until success was confirmed, the Sourcebook combines two approaches to offer some assurance of program quality. First, the programs were selected by national experts because they show promise where they have been implemented. Second, all the programs were benchmarked against criteria that the Joint United Nations Programme on HIV/AIDS (UNAIDS) Inter-Agency Task Team (IATT) for Education considers to be sound programming practice. This provides a framework for exploring the strengths and weaknesses of the program design, pending more conclusive evaluation. The Sourcebook has been developed rapidly to fill an important gap in information on programming within the education sector. It is a work in progress, and the content will be expanded and refined in use.

Family Planning/HIV Integration: Technical Guidance for USAID-Supported Field Programs (resource material)
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Building upon USAID’s previously distributed publication, "Integration of Family Planning/MCH with HIV/STD Prevention: Programmatic Technical Guidance", this guidance includes new suggestions and findings regarding effective integration approaches for both FP and HIV/AIDS program managers. The document includes technical insights regarding FP/HIV integration and should be used in conjunction with USAID’s "Guidance on the Definition and Use of the Child Survival and Health Programs Fund" for information regarding appropriate use of USAID funds.

Continuous Identification of Research Evidence (CIRE) Related to Family Planning Guidance

Kiddugavu M, Makumbi F, Wawer MJ, Serwadda D, and Sewankambo NK. Hormonal contraceptive use and HIV-1 infection in a population-based cohort in Rakai, Uganda. AIDS. 2003 Jan 24;17(2):233-240. (CIRE)
Findings in this article have been found relevant to WHO Method: Progestogen-Only Injectables and Condition: HIV infection/AIDS

Mercorio F, De Simone R, Di Spiezio Sardo A, Cerrota G, and Bifulco G. The effect of a levonorgestrel-releasing intrauterine device in the treatment of myoma-related menorrhagia. Contraception. 2003 Apr;67(4):277-280. (CIRE)
Findings in this article have been found relevant to WHO Method: Levonorgestrel IUDs and Condition: Vaginal bleeding patterns

Evans BA, Kell PD, Bond RA, MacRae KD, and Slomka MJ. Predictors of seropositivity to herpes simplex virus type 2 in women. International Journal of STD and AIDS. 2003 Jan;14(1):30-36. (CIRE)
Findings in this article have been found relevant to WHO Method: Combined OCs and Condition: Sexually transmitted disease (STDs)

Smith JS, Green J, Berrington de Gonzalez A, Appleby P, and Peto J. Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet. 2003 Apr 5;361(9364):1159-1167. (CIRE)
Findings in this article have been found relevant to WHO Method: Combined OCs and Condition: Cervical cancer (awaiting treatment)

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