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The Pop Reporter®

Volume 4, Number 15
12 April 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.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Reassessing the Level of Unintended Pregnancy and Its Correlates in Vietnam (research abstract)
This study reassesses the level of unintended pregnancy in Vietnam and its correlates, drawing on retrospective calendar data gathered for the Vietnam Demographic and Health Survey II. Data from 13,540 "segments" of outcomes and contraceptive practice were analyzed. Based on the calendar data, 40% of pregnancies during the 1994-97 period are estimated to have been unintended, a proportion 48% higher than the prevailing estimate calculated from the reported intendedness of live births. Unintended pregnancy was found to be associated with age, early marriage, spousal age difference, number of living sons, past unintended pregnancy, geographic region, contraceptive use prior to pregnancy, and the family planning supply environment.

Impact of Post-abortion Counselling in a Semi-urban Town of Western Nigeria (research abstract)
This study evaluated the impact of post-abortion counselling in bringing about changes in sexual behavior among patients who had treatment for an induced abortion and/or its complication. A structured questionnaire was administered to 108 patients, who formed part of 238 patients who had undergone induced abortion and who benefitted from the behavioral contract counselling technique. The results showed that the percentage of women using contraception increased from 30 (27.8%) to 53 (49.1%) at the time of interview. The number of subjects with multiple sexual partners fell from about 62 (58%) to 12 (11%). Major factors influencing contraceptive usage and change in behavior include suffering experienced at the time of termination 26 (49%) and knowledge of contraception 19 (36%).

Condom Use as a Dependent Variable: A Brief Commentary About Classification of Inconsistent Users (research abstract)
The authors state that transformation of nonnormally distributed measures of condom use frequency can be problematic for researchers. Distributions are typically dichotomized. They used data collected from 483 university undergraduates in the US in an anonymous, cross-sectional survey to illustrate the value of a screening analysis before dichotomization. Inconsistent condom users were compared to consistent users with respect to 14 measures. Subsequently, inconsistent users were compared to those who never used condoms with regard to the same 14 measures. Findings suggest that a screening analysis is a potentially important aspect of analyzing distributions that assess frequency of condom use.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

US: Survey Suggests Lack of Awarenes Heightens Risk for Sexually Transmitted Diseases (press release)
Related news article: Study Finds Half Don't Practice Safe Sex
New survey results suggest that lack of awareness may put Americans at risk for contracting STDs. While an overwhelming majority surveyed (84%) felt that they take the necessary precautions to protect themselves against STDs, many people do not use protection on a regular basis when they engage in sexual activities. Furthermore, more than half were unsure or had not been vaccinated against hepatitis A and hepatitis B, also known as vaccine-preventable hepatitis (VPH), which are the only STDs that can be prevented through immunization.

China Plans for Free Condoms (news article)
China plans to start handing out free condoms at all entertainment venues in a bid to stem the rapid spread of HIV/AIDS, state media reported today. The government will also distribute new syringes and methadone, a substitute drug used to treat morphine and heroine addiction.

Gender Choice Kit Set for UK Market (news article)
A US company that claims its gender selection kits can influence the sex of a child before conception is set to bring its product to the UK.

Australia: Birth Control Experts Cast Doubts on Updated Rhythm Method (news article)
Creators of a new take on the rhythm method of contraception say it is now a viable, natural, and reliable option for women, but Australian experts are not so enthusiastic.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

China Strives to Eliminate Discrimination against HIV/AIDS Patients (news article)
The amendment draft to China's 15-year-old law on contagious disease prevention and control has canceled forcible isolation of HIV/AIDS patients, an important legal step to eliminate bias against HIV/AIDS patients. The amendment draft dropped the AIDS prevention and control management standard from the highest level to the medium level, which does not require forcible isolation of HIV/AIDS patients any more.

The Philippines: MILF Rejects Fatwah on Reproductive Health (news article)
The central committee of the Moro Islamic Liberation Front (MILF) rejected Tuesday the recent fatwah on Reproductive Health and Family Planning program being implemented by the government. Muhammad Ameen, secretary-general of the MILF Central Committee, made the announcement as proponents of reproductive health and family planning claimed they have been sanctioned by a fatwah known as Tanzim Al-Usra.

South Korea: Military Recruits Will Receive AIDS Testing from 2006 (news article)
Military draftees will be subjected to mandatory testing for AIDS starting in 2006, the Ministry of Defense in South Korea said on Friday. A ministry official said that the government has decided to introduce AIDS testing in medical checkups for military recruits as the number of HIV or AIDS cases has been on the rise. He said that the decision was made especially when a growing number of teenagers are exposed to a high risk of contracting the disease through unprotected sex with AIDS virus carriers or blood transfusions.

South Africa: HIV/AIDS Threatens to Undermine Democracy (news article)
HIV/AIDS may pose a serious threat to South Africa's young democracy in elections to come, according to a study just released by the Governance and AIDS Programme of the Institute for Democracy in South Africa.

HIV/AIDS RESEARCH

Condom Promotion for AIDS Prevention in the Developing World: Is It Working? (research abstract)
The authors perform a literature review in order to determine the effectiveness of condoms in AIDS prevention in developing countries. They found that condoms are about 90% effective for preventing HIV transmission and have produced substantial benefit in countries like Thailand, where both transmission and condom promotion are concentrated in the area of commercial sex. They write that the public health benefit of condom promotion in settings with widespread heterosexual transmission, however, remains unestablished. In countries like Uganda that have curbed generalized epidemics, reducing the number of individuals' sex partners appears to have been more important than promoting the use of condoms.

Assessing the Potential of Condom Use to Prevent the Spread of HIV: A Microsimulation Study (research abstract)
In this study, a microsimulation model is used to assess the potential impact of condom use on women's lifetime risk of acquiring HIV in rural southern Malawi. The model draws on survey data for information on sexual activity, marriage and divorce, and on the biomedical literature for input parameters governing the transmission and spread of HIV and other STDs. The researchers show that lifetime risk could be as high as 42% with no condom use and as low as 8% if everyone consistently uses condoms with nonmarital partners. They also examined the impact of more realistic, intermediate strategies of condom use, varying men's propensity to use a condom with nonmarital partners, varying the per-coitus probability of condom use, varying probabilities of slippage or breakage, and finally, examining the effect of condom use in the presence of STD symptoms. They demonstrate profound effects of consistent condom use and of condom use prompted by symptomatic STDs.

Partner Reduction is Crucial for Balanced "ABC" Approach to HIV Prevention (research article)
Related news article: Promiscuity 'Fuelling HIV Spread'
In this "Education and debate" article from the British Medical Journal, the authors write that the key to preventing the spread of HIV, especially in epidemics driven mainly by heterosexual transmission, is through changing sexual behavior. Interest has been growing in an "ABC" approach in which A stands for abstinence or delay of sexual activity, B for be faithful, and C for condom use. Although "be faithful" literally implies monogamy, it also includes reductions in casual sex and multiple sexual partnerships (and related issues of partner selection) that would reduce higher risk sex. While most of the often polarised discussion surrounding AIDS prevention has focused on promoting abstinence or use of condoms, the authors argue that partner reduction remains the neglected component of ABC.

Transactional Sex is the Driving Force in the Dynamics of HIV in Accra, Ghana (research abstract)
The aim of this study was to delineate the population attributable fraction (PAF) of transactional sex in prevalent cases of HIV infection in the male adult population of Accra, Ghana. HIV prevalence was 4.9% (8/162) among clients of mobile sex workers (SWs), 15.8% (53/335) among clients of home-based SW, 17.5% (10/57) among personnel, and 32.1% (9/28) among boyfriends. A condom was used in 90% of intercourses, according to clients. Non-use of a condom was clustered in selected locations and independently associated with older age of client, frequency of intercourse with SW in the last year, and current urethritis. Among the male population of Accra aged 15-59 years, 84% of prevalent cases of HIV were attributable to transactional sex.

Universal Nevirapine Upon Presentation in Labor to Prevent Mother-to-child HIV Transmission in High Prevalence Settings (research abstract)
Researchers assessed the uptake of and adherence to nevirapine to prevent mother-to-child HIV transmission among women of unknown HIV serostatus presenting in labor in Zambia. In the group of women studied (n=1,591), nevirapine without HIV testing upon presentation in labor was accepted by two-fifths of women. Because therapy is directly observed, the authors state that adherence is nearly perfect. They conlude that labor ward dosing to enhance nevirapine coverage should be considered as an adjunct to antenatal nevirapine administration for prevention of mother-to-child transmission of HIV.

Zimbabwe: Asssessing the Cost of Transporting HIV/AIDS Commodities: A Case Study in Financial Analysis (report)
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This case study examines lessons learned from an assessment of transport costs for HIV/AIDS commodities in Zimbabwe conducted by the DELIVER project in July 2002. The case study discusses the purpose and design of the transport assessment, as well as methods for data collection and analysis. The case then describes the findings and how they were used, drawing insights for logistics and financial analysis.

Desire for a Future Pregnancy Among Women in Zimbabwe in Relation to Their Self-Perceived Risk of HIV Infection, Child Mortality, and Spontaneous Abortion (research abstract)
The authors investigated the desire for a future pregnancy among women in Zimbabwe in relation to (1) self-perceived risk of HIV infection, (2) child mortality, and (3) spontaneous abortion. A random cross-sectional sample of 2,250 ever-married women aged 15–49 years was selected from 6,828 households in rural and urban Zimbabwe. Overall, 54% of the participants desired to get pregnant in future; 55% perceived themselves at high risk for HIV infection; 6% reported the death of at least one child less than the age of 5 years in the last 5 years; and 12% reported at least one spontaneous abortion in the last 5 years. High self-perceived risk for infection with HIV was not associated with a lower desire for a future pregnancy among women in Zimbabwe in a high-prevalence area. In fact, the researchers write that their data suggest an increased desire for future pregnancy to replace childhood deaths or spontaneous abortions that may result from HIV infection.

An Assessment of HIV/AIDS Risk in Higher Education Students in Yerevan, Armenia (research abstract)
This study assessed HIV/AIDS knowledge and risk behaviors among higher education students in Yerevan, Armenia. Researchers found that knowledge of HIV transmission through sexual intercourse was markedly higher than that on intravenous transmission and prevailing myths; however, HIV/AIDS knowledge was not related to risk behaviors. Students reported risky sexual behaviors, including inconsistent condom use, casual sex, and multiple partners. In addition to descriptive statistics delineating gender differences across the target behavioral domains, bivariate and multivariate statistical analyses were used to understand factors that contributed to increased risk, including early age of initiation and the relationship between substance use and risky sexual activity.

Where Are the Gaps? The Effects of HIV-prevention Interventions on Behavioral Change (research abstract)
This study presents the results of an extensive effort to develop a matrix to relate coverage of key HIV/AIDS-prevention services to changes in behavior among different risk groups and to describe the gaps that exist in the literature.

HIV/AIDS NEWS

Only 6,000 Zambians on ARVs (news article)
Only 6,000 people out of an estimated population of 800,000 Zambians living with HIV/AIDS have been availed with anti-retroviral (ARVs) drugs since last year. Health Minister Brian Chituwo said this in Lusaka yesterday when he received a consignment of ARVs worth K55 million donated by the Indian government. Chituwo said the government had also adopted the three-by-five HIV/AIDS initiative, which aims at scaling up the provision of ARVs to at least 100,000 people living with HIV/AIDS by the 2005.

MATERNAL AND CHILD HEALTH RESEARCH

Higher Rates of Post-partum Complications in HIV-infected than in Uninfected Women Irrespective of Mode of Delivery (research abstract)
In this study involving in 13 European centers, researchers found that HIV-infected pregnant women are at increased risk of post-partum complications regardless of mode of delivery, but modification of clinical practice, particularly use of prophylactic antibiotics, would reduce this risk.

Timing of Birth After Spontaneous Onset of Labor (research abstract)
Related news article: Afternoon Births Are Most Common
Researchers studying the occurrence of spontaneous births find that they most commonly occur in the early afternoon and during the fall months.

MATERNAL AND CHILD HEALTH NEWS

Iraq: Focus on Maternal and Infant Healthcare in Baghdad (feature article)
This feature article, from the Integrated Regional Information Networks, part of the UN Office for the Coordination of Humanitarian Affairs, relates in statistics and individual stories how mothers and infants are coping in today's Iraq.

MEN'S HEALTH RESEARCH

Ejaculation Frequency and Subsequent Risk of Prostate Cancer (research abstract)
Related news article: Study Disputes Sex-Prostate Cancer Link
Contrary to some research, frequent sexual activity does not increase the risk of developing prostate cancer and might even reduce the danger, a study of nearly 30,000 men found. Some previous studies have suggested that men who have frequent ejaculations, whether through sex or masturbation, might be more prone to prostate cancer. One theory is that lots of sex exposes men to various germs and viruses that somehow lead to prostate cancer. The latest study should be "reassuring to those men who may be more active than others," said Dr. Durado Brooks, prostate cancer director for the American Cancer Society.

Male Views of Contraceptive Methods in a Rural Community in Bahia State, Brazil (research article)
The full text of this article is available only in Portuguese. This study aimed to determine men's knowledge of contraceptive methods in a rural community in Bahia State, Brazil. Mean age of interviewees was 40 years. Avoiding unwanted pregnancy was reported as a responsibility of the couple by 39.7% of the male interviewees (n=71) and as the man's responsibility by 26.8%. The most widely known methods were condoms (98.9%) and the pill (96.6%). Condoms (22.9%), female sterilization (21.2%), and the pill (12.8%) were the most widely used methods. Most of the interviewees (56.4%) reported that they "always" use some method. The men chose the method in 45.6% of the couples.

Hormonal Contraception in Chinese Men: Variations in Suppression of Spermatogenesis with Injectable Testosterone Undecanoate and Levonorgestrel Implants (research article)
Researchers in China explore the causes of the differences in spermatogenic suppression between responders and non-responders in Chinese men treated with levonorgestrel implants plus a testosterone undecanoate injectable.

POPULATION RESEARCH

Transitions in World Population (report)
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This report from Population Reference Bureau states that world population was transformed in the 20th century as technological and social changes brought steep declines in birth and death rates. Europe's population is aging and declining; all future growth will be in developing countries among the world's poorest groups.

The Surprising Global Variation in Replacement Fertility (research abstract)
This paper, from the Office of Population Research, Princeton University, cautions against the assumption that the value of replacement-level fertility is an average of 2.1 lifetime births per woman worldwide. The authors point out that the global variation in replacement fertility is substantial, ranging by almost 1.4 live births from less than 2.1 to nearly 3.5. This range is due almost entirely to cross-country differences in mortality, concentrated in the less developed world. The authors caution policy makers to be sensitive to own-country replacement rates because failure to do so could result in fertility levels that are below replacement and lead to long-run population decline.

The Changing Institutional Context of Low Fertility (research abstract)
Using data for 1960–97 for 22 low fertility countries, the authors document a dramatic change in the association of fertility levels to women's levels of labor force participation. Until the 1980s, the association had been strongly negative. However, during the 1980s it became positive, and since 1990 strongly positive. They also document an emerging positive association of the country-level total fertility ratio (TFR) and nonmarital ratio (eg, the proportion of births to unmarried women). They argue that these transformed associations reflect societal level responses that, in some contexts, have eased the incompatibility between mother and worker roles and loosened the link between marriage and childbearing. These arguments imply that societal responses to mother/worker incompatibility exert substantial influence on fertility levels in low fertility countries.

An Analysis of Fertility Differentials by Religion in Kerala State: A Test of the Interaction Hypothesis (research abstract)
This paper examines the interaction between religion and other socioeconomic factors, that is, whether the effect of religion on fertility remains constant across other factors. The analysis is based on data from the National Family Health Survey-1 in Kerala State, India. The analysis found that large Hindu-Muslim fertility differences at a low level of education do not persist at higher levels. For contraceptive use, wider gaps are found at a middle level of education and at a medium level of standard of living than at lower and higher levels. The author writes that this indicates that couples at different socioeconomic settings make different decisions in spite of belonging to the same religion. The fact that fertility of Muslims at higher levels of socioeconomic status is low, and not much different than the fertility of other religions, suggests that the observed fertility gap between Hindus/Christians and Muslims is a passing phenomenon.

YOUTH HEALTH RESEARCH

HIV and Sexual Behaviour Among Young South Africans: A National Survey of 15-24 Year Olds (report)
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Related press release: Largest Youth Survey Results Released
Nearly one in four South African women aged between 20 and 24 is infected with the AIDS virus, but broad HIV infection rates among youth appear to be stabilizing, a national survey released last week said.

Reproductive and Sexual Health Among Young Adults in Uzbekistan (research abstract)
In this paper, the authors use state statistics, Demographic and Health Survey data, and focus-group-discussion results to highlight the ways in which a heavily centralized program focusing on reproductive health did little to better sexual health, especially among young adults. They argue that the example of Uzbekistan reveals pathways by which reproductive health efforts may continue to be compartmentalized, decreasing their potential contributions to sexual health, especially among young adults.

YOUTH HEALTH NEWS

China: High Schoolers Sexually Active: Survey (news article)
Sex before marriage may no longer be taboo in conservative China, but health officials are worried that a growing number of high school students in Shanghai could be getting too frisky, state media reported last week. Following a study of 25 high schools over the past two years, health officials discovered that nearly one-third of high school students had a partner, and had engaged in either hugging, kissing, or petting. Three percent of those surveyed said they had already had sex, the report said.

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