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Volume 4, Number 29
19 July 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

Mind the Gap: Responding to the Global Funding Crisis in Family Planning (PubMed abstract)
The widening gap between the cost of meeting family planning needs and the funding available for commodities and programmes is a concern among policymakers and reproductive health professionals. The gap could reach US$210 million by 2015. Its causes are clear; its solutions are not. While changes in programme method mix and cost shifting could address this gap, an often-overlooked alternative is the development and introduction of effective, low-cost methods.

Men's Influences on Women's Reproductive Health: Medical Anthropological Perspectives (PubMed abstract)
Reproductive health has emerged as an organizational framework that incorporates men into maternal and child health (MCH) programs. For several decades, medical anthropologists have conducted reproductive health research that explores male partners' effects on women's health and the health of children.The first half of the article begins by exploring reproductive rights, examining the concept from an anthropological perspective. The second half of the article then turns to a number of salient examples of men's relevance in the areas of contraception, abortion, pregnancy and childbirth, infertility, and fetal harm.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Controversy Erupts at AIDS Conference (news article)
Related news article: Europe Backs Condom Use in Battle Against AIDS
A controversy erupted at a global AIDS conference on Monday over whether abstaining from sex or using condoms is more effective to prevent the disease. The Ugandan President brought the issue into the open at the first full day of the AIDS conference by saying abstinence is the best way to stem the spread of the killer virus. The remarks by the Ugandan president, whose country is a rare success story in Africa's war on AIDS, are at odds with the views of health experts who back condoms as a frontline defense against the incurable disease.

Low-tech AIDS Defenses Studied: Role of Diaphragms, Male Circumcision, Microbicide Gels, Herpes Control Tested (news article)
With the quest for an AIDS vaccine coming up short, researchers--desperate to find a way to slow the global pandemic--are mining an array of low-tech solutions that hold surprising promise. At the 15th International AIDS Conference, now drawing to a close, these simpler technologies are being explored with an increasing sense of urgency. Unfortunately, most of these technologies require extensive testing, the results of which may not be known for three to five years.

Nigeria: Support Reproductive Health Programmes, Journalists Urged (news article)
Journalists in Bauchi State have been challenged to give adequate support to the promotion of reproductive health programmes as the only means to enhance reproductive health status of the citizenry. The Project Director of the National Association of Women Journalists (NAWOJ), and Vision Project Organisation, urged journalists in the state to continue to disseminate correct information on reproductive health, to enable people to make informed decisions.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

UK Policy on AIDS Leaves US Isolated (news article)
The UK yesterday signalled a major rift with the United States over its AIDS policies, publicly rejecting the Bush doctrine that sexual abstinence is the best way to stop the spread of the pandemic. The international development minister of the UK also made it clear the UK did not support the US over its reluctance to endorse the use of cheaper, generic drugs to fight the disease.

Clinical Trials in Sub-Saharan Africa and Established Standards of Care (research abstract)
The minimum standard of care required for participants in clinical trials conducted in resource-poor settings is a matter of controversy; international documents offer contradictory guidance. The objective of this study was to determine whether recently published trials conducted in sub-Saharan Africa met standards of care consistent with best current clinical standards for human immunodeficiency virus (HIV) treatment, tuberculosis treatment, and malaria prevention. Data from 73 different randomized clinical trials showed that only 12 trials provided care that met guidelines for both intervention and control patients. Only 1 of the 34 trials that enrolled patients with HIV disease provided antiretroviral treatment that conformed to guidelines. Conversely, all tuberculosis treatment trials provided tuberculosis therapy that conformed to guidelines. Twenty-one of 29 malaria prophylaxis trials tested interventions that met guidelines, but only 3 used any active prophylactic intervention in the control group. Conclusion: Rates of adherence to established clinical guidelines of care in randomized clinical trials of HIV treatment, tuberculosis treatment, and malaria prophylaxis varied considerably between disease categories.

Family Planning Groups Blast Denial of U.S. Contribution to UN Population Fund (press release)
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President George Bush has put election-year politics ahead of helping the world’s most vulnerable women. Relying on a discredited claim that UNFPA supports forced sterilization and abortion in China, the Administration has once again refused to release to the agency $34 million appropriated by Congress. In 2002, a hand-picked Administration fact-finding team found “no evidence that UNFPA has supported or participated in the management of a program of coercive abortion." In fact, UNFPA was found to help reduce such practices in China. But in 2004, re-election comes before reason.

HIV/AIDS RESEARCH

Single-Dose Perinatal Nevirapine Plus Standard Zidovudine to Prevent Mother-to-Child Transmission of HIV-1 in Thailand (research article)
Although zidovudine prophylaxis decreases the rate of transmission of the human immunodeficiency virus (HIV) type 1 substantially, a large number of infants still become infected. The authors hypothesized that the administration, in addition to zidovudine, of a single dose of oral nevirapine to mothers during labor and to neonates would further reduce transmission of HIV. A randomized, double-blind trial of three treatment regimens in Thai women who were receiving zidovudine therapy during the third trimester of pregnancy was conducted. Authors concluded that a single dose of nevirapine to the mother, with or without a dose of nevirapine to the infant, added to oral zidovudine prophylaxis starting at 28 weeks' gestation, is highly effective in reducing mother-to-child transmission of HIV.

Nevirapine and Zidovudine at Birth to Reduce Perinatal Transmission of HIV in an African Setting (research abstract)
Antenatal counseling and human immunodeficiency virus (HIV) testing are not universal in Africa; thus, women often present in labor with unknown HIV status without receiving the HIVNET 012 nevirapine (NVP) regimen (a single oral dose of NVP to the mother at the start of labor and to the infant within 72 hours of birth). The objective of this study was to determine risk of mother-to-child transmission of HIV when either standard use of NVP alone or in combination with zidovudine (ZDV) was administered to infants of women tested at delivery. Results showed that the mother-to-child transmission of HIV at birth was 8.1% in infants administered NVP only and 10.1% in those administered NVP plus ZDV. For infants not infected at birth and retested at 6 to 8 weeks, transmission was 6.5% in those who received NVP only and 6.9% in those who received NVP plus ZDV.

Management of the Coinfected Patient: Human Immunodeficiency Virus/Hepatitis B and Human Immuno Deficiency Virus/Hepatitis C (PubMed abstract)
Deaths from liver disease have increased in persons infected with human immunodeficiency virus (HIV) because of coinfection with chronic hepatitis B and C; consequently, all HIV-infected patients should be screened for hepatitis B and C, and all those susceptible should be vaccinated for hepatitis B. Hepatitis A vaccination is indicated for susceptible coinfected patients. Three oral agents, lamivudine, adefovir, and tenofovir, are active against hepatitis B infection. The need for highly active antiretroviral therapy and hepatitis B therapy should be addressed in a coordinated fashion, since two of these agents are active against both HIV and hepatitis B virus. Oral combination therapy for hepatitis B infection looks promising but needs further study. Combination therapy for chronic hepatitis C with pegylated interferon plus ribavirin is the most effective available therapy and the current standard of care.

HIV/AIDS NEWS

New 'Toaster Size' AIDS Test to Speed Diagnosis (news article)
Scientists at the University of Texas have developed a mobile HIV testing laboratory that experts say should speed up diagnosis and treatment of AIDS in remote regions of the world. The device, smaller than a toaster, measures the level of patients' immune system CD4 cells within 15 minutes and works on rechargeable batteries. It would be priced at less than $1,000, with each test costing under $5.

Generic Drugs Extend HIV Patients' Lives (news article)
A few years ago, HIV was like a death sentence for tens of thousands of Thais who couldn't afford expensive imported drugs. Then came hope, in the shape of a one-pill generic drug cocktail. When the Thai Government Pharmaceutical Organization started producing the three-drug pill in March 2002, monthly treatment for one person plummeted to $30 from $500-$750. Thailand is one of the few countries making generic anti-AIDS drugs after overcoming challenges by European and U.S. pharmaceutical giants in a global patent fight. According to the World Health Organization, only 8 percent of those in need now receive drugs that in rich countries have turned AIDS from a death sentence into a chronic disease.

Gates Foundation to Give $69 Million to Global Fund on AIDS (news article)
The Bill and Melinda Gates Foundation said today it will give an additional $69.18 million to a UN-sponsored global fund to fight AIDS, a day after the United States said it won't give the resource-short fund any more money. Yesterday, US global AIDS coordinator Randall Tobias rejected a call by the UN Secretary-General Kofi Annan for a $US1 billion contribution in 2005, saying the money it has already given is sufficient. The United States has given about $US580 million to Global Fund until now, and has proposed giving another $US200 million for 2005.

Novel Pfizer AIDS Drug Shows Promise in Trials (news article)
A novel AIDS pill designed to exploit the discovery that some people appear naturally resistant to HIV has produced good results in early-stage clinical trials. Pfizer's experimental compound belongs to a new class of medicines that block the virus before it can enter human cells, rather than fighting it once inside. Such drugs may keep patients healthy for longer with fewer side effects than conventional antiretroviral therapies and provide a new option for people who have developed resistance to conventional AIDS drugs.

MATERNAL AND CHILD HEALTH RESEARCH

Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants (report)
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Related news article: South Africa: WHO Issues Guidelines on Nevirapine
These guidelines present recommendations for the use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants in resource-constrained settings. It contains a summary of the scientific rationale and programmatic considerations for these recommendations. By addressing issues of efficacy, safety, drug resistance and feasibility the document is intended to guide the selection of antiretroviral regimens to be included in programmes to prevent mother-to-child transmission of HIV. Moreover, it is intended to support and facilitate antiretroviral treatment for pregnant women and women of reproductive age who have indications for treatment. The guidelines may also be useful for health service providers as specific recommendations are provided for the most frequently encountered clinical situations.

Timing and Magnitude of Increases in Levothyroxine Requirements During Pregnancy in Women with Hypothyroidism (research abstract)
Related news article: Pregnant Women Need to Monitor Their Thyroid
Hypothyroidism during pregnancy has been associated with impaired cognitive development and increased fetal mortality. During pregnancy, maternal thyroid hormone requirements increase. Although it is known that women with hypothyroidism should increase their levothyroxine dose during pregnancy, biochemical hypothyroidism occurs in many. In this prospective study, the authors attempted to identify precisely the timing and amount of levothyroxine adjustment required during pregnancy. The authors concluded that levothyroxine requirements increase as early as the fifth week of gestation. Given the importance of maternal euthyroidism for normal fetal cognitive development, they propose that women with hypothyroidism increase their levothyroxine dose by approximately 30 percent as soon as pregnancy is confirmed.

Status of Women and Infants in Complex Humanitarian Emergencies. (PubMed abstract)
Women and children bear the greatest burden in the midst of war and long-term disasters. Complex humanitarian emergencies are characterized by social disruption, armed conflict, population displacement, collapse of public health infrastructure, and food shortages. Humanitarian assistance for refugees and internally displaced populations requires particular attention to the common issues affecting morbidity and mortality in women and infants. Gender-based violence and reproductive health concerns are discussed within the context of populations affected by conflict and forced migration. Recommendations for midwives and women's health care providers engaging in care for women and children in complex humanitarian emergencies are discussed.

MATERNAL AND CHILD HEALTH NEWS

Djibouti: High Maternal Mortality Despite Improved Health Services (news article)
Djibouti has made significant progress in reducing maternal mortality over the past 10 years, but the number of women who die in childbirth is still high. According to the Djibouti government, the key causes of high maternal mortality were high fertility rates, poor emergency obstetric care, and the persistence of harmful practices such as excision, infibulation and the more severe types of female genital mutilation (FGM).

Angola: UN Recommends Special Focus on Women's Rights (news article)
After bearing the brunt of years of civil conflict, women in Angola require special attention and efforts to achieve equality. Angolan women suffered high levels of maternal and child mortality, malnutrition, illiteracy, poverty, violence, lack of resources and unemployment in both the formal and informal sectors; women also headed most households and were most affected by HIV/AIDS and other sexually transmitted diseases.

MEN'S HEALTH RESEARCH

Prostate Carcinoma Among Men with Human Immunodeficiency Virus Infection (research abstract)
To determine the incidence of prostate carcinoma in men with HIV infection, the researchers initiated a prostate carcinoma screening program in a large HIV clinic. All men with prostate carcinoma in this population over the last 2 years were reviewed. Demographic data (age, ethnicity), duration of HIV infection, laboratory values (CD4 counts and HIV viral load), and medication use were determined by medical record review. The researchers concluded that prostate carcinoma screening identified abnormal PSA values in 3.2% of the HIV-positive cohort, many associated with prostatitis. Prostate carcinoma was common in older men and was associated with duration of HIV infection. As the life expectancy of men with HIV infection increases, prostate carcinoma screening will become increasingly important in this population.

Infertility Among Male UK Veterans of the 1990-1991 Gulf War: Reproductive Cohort Study (research article)
The objective of this study was to examine the hypothesis that exposure to toxicants of the type present in the Gulf war could affect spermatogenesis, which might be observed as increased levels of infertility. A retrospective reproductive cohort analysis was conducted with Male UK Gulf war veterans matched with a comparison group of non-deployed servicemen. Results showed that risk of reported infertility was higher among Gulf war veterans than among non-Gulf veterans. This small effect was constant over time since the war and was observed whether or not partners of the men had become pregnant before the war.

MEN'S HEALTH NEWS

Casseroles May Offer Best Prostate Cancer Protection - Study (news article)
Eating broccoli and tomatoes together may offer better protection against prostate cancer than eating either vegetable alone, cancer researchers reported. Their study, done in rats, supports the idea that the mixtures of compounds in foods work together to preserve health. It also suggests that supplements alone may not work to prevent cancer.

AIDS Campaigners Say Africa's "Sugar Daddies" Behind Alarming HIV Rates (news article)
They have lost their youth, but gained enough wealth to buy the company of many young consorts. These "sugar daddies" of sub-Sahara African are a hot topic with researchers trying to explain the region's alarmingly high HIV rates for teenage girls. Many AIDS experts believe liaisons between married, middle-aged men and their clandestine lovers, age 14 to 20, help explain why teenage girls in southern Africa are five times more likely to be HIV-infected than teenage boys. It remains unclear how closely the infection rates are tied to cross-generational sex, however, or even how prevalent the "sugar daddy" phenomenon really is. Some researchers suggest that high infection rates among young women have more to do with their sexual anatomy being more susceptible to abrasions that can allow HIV to enter the body.

POPULATION RESEARCH

Projecting the Demographic Consequences of Adult HIV Prevalence Trends: The Spectrum Projection Package (research abstract)
This paper describes the software package Spectrum, a modular program used to examine the consequences of current trends and future program interventions in reproductive health. Spectrum is used to determine the consequences of the HIV/AIDS epidemic, including the number of people living with HIV/AIDS by age and sex, the number of AIDS deaths, and the number of orphans as a result of AIDS, as well as other demographic indicators of interest, such as life expectancy and <5 mortality.

A Framework for Modelling Fertility Motivation in Couples (PubMed abstract)
The authors present a theoretical framework that organizes individual-level fertility motivations into a couple-level model. One feature of this framework is the Traits-Desires-Intentions-Behaviour (TDIB) sequence through which the fertility motivations of individuals produce instrumental behaviours that are designed to promote or prevent childbearing. A second feature of this framework is the cognitive capacity of individuals to perceive a partner's motivational structure. The authors also discuss the framework and consider its implications for population surveys, family planning services provision, and for a theory of reproductive psychology.

POPULATION NEWS

Population of India to Overtake China's Within 30 years (news article)
India's population will overtake China's as the world's largest in 30 years despite the continued assault on the female population in a society in which bearing male offspring is still paramount. By 2035 India's population is projected to soar to 1.46 billion. taking it ahead of its northern neighbour, China. In India, the sex ratio for children up to six years has slipped from 945 females per 1,000 males in 1991 to just 927 females 10 years later, indicating that despite government measures, such as a ban on sex determination tests, female foeticide is still widely prevalent. Many girls are also killed in infancy. According to recent research, 90% of the estimated 3.5 million abortions in India each year are to eliminate females. Until now, it was believed that the bias against girls was especially acute in the countryside, where the high child mortality rate, combined with the prestige gained from having a male child, the need for wage earners and the prohibitive cost of marrying a daughter heavily tilted the scales in favour of sons. But the census has come up with a startling statistic--the sex ratio in the national capital region of Delhi has plummetted to just 865 girls per 1,000 boys, well below the national average. In one district in Delhi, it has dropped below 800.

Adding Muscle to Woman Power (editorial)
World Population Day came and went on Saturday with hardly any fanfare, at least in the Philippines. It’s disheartening that a country with a population incresing by 2.36 percent annually--one of the highest in the region--has not been more enthusiastic in celebrating such an auspicious event. The population issue has never established a firm foothold in the national consciousness. The government has not been aggressive enough in promoting a family-planning program, despite prodding from financial institutions like the World Bank, which equate economic advancement with manageable population growth. Past administrations have avoided going full blast in pushing a population agenda, fearing a backlash from the Catholic Church, which has never wavered from its position against artificial methods of contraception. Because of this lukewarm attitude, one aspect of the population issue has not been getting the boost it so badly needs: women's empowerment.

WOMEN'S HEALTH RESEARCH

Hormonal Factors and the Risk of Invasive Ovarian Cancer: A Population-Based Case-Control Study (PubMed abstract)
Related news article: Late Childbirth Cuts Ovarian Cancer Risk
The purpose of this study was to examine the influence of hormone-related factors on the risk of invasive epithelial ovarian cancer. Researchers conducted a population-based case-control study using in-person interviews. Results showed that compared with nulliparous women, women whose only (last) birth was after age 35 had an estimated 51% reduction in risk. If this birth occurred earlier, the reduction in risk was progressively less. Additional (earlier) births reduced the risk further. Oral contraceptive use also reduced risk.

Selected Food Intake and Risk of Endometriosis (PubMed abstract)
To offer data on the relationship between diet and risk of pelvic endometriosis, researchers analysed data collected in the framework of two case-control studies. Results showed that compared to women in the lowest tertile of intake, a significant reduction in risk emerged for higher intake of green vegetables, whereas an increase in risk was associated with high intake of beef and other red meat. Consumption of milk, liver, carrots, cheese, fish and whole-grain foods, as well as coffee and alcohol consumption, were not significantly related to endometriosis.

Microbiological/Clinical Characteristics and Validation of Topical Therapy with Kanamycin in Aerobic Vaginitis: A Pilot Study (PubMed abstract)
The term 'aerobic vaginitis' defines a 'new' vaginal pathology that is neither classifiable as specific vaginitis nor as bacterial vaginosis. Researchers studied a sample of 30 women with a clinical and microbiological diagnosis of aerobic vaginitis and compared the efficacy and tolerability of kanamycin and meclocycline, two products commercially available in Italy in the form of vaginal pessaries. At the first follow-up carried out immediately at the end of therapy, the percentage of normalisation of clinical signs and symptoms was increased independently of the type of treatment in the case of moderate grade aerobic vaginitis, while kanamycin produced a better effect in the group with severe aerobic vaginitis. at the second follow-up, a direct correlation with recovery of vaginal homeostasis was demonstrated by the normalisation of the vaginal pH and by the presence of lactobacilli, only in kanamycin treated group.

WOMEN'S HEALTH NEWS

Double Discrimination for Women in Dominican Republic (news article)
Rosa Polanco was in a hospital in the Dominican Republic, being treated for a liver disease, when she was illegally tested without her consent for HIV, the AIDS virus. The worst thing about it was not finding out that she was living with HIV, but how she was informed and the consequences of the disclosure of her status to her family. Polanco, 34, lost her job and was thrown out of her home by her mother, who would not let her touch her own daughters. She now lives alone in a wooden shack without sanitation, water or electricity in a slum neighbourhood on the outskirts of the city of Santiago in the northern part of this Caribbean nation. Women as well as men living with HIV suffer stigmatisation and discrimination in Dominican society due to ignorance regarding the transmission of the AIDS virus and the myths surrounding the disease. However, women suffer doubly, because they are often blamed for infecting their partners, who abandon them. They are also frequently the victims of domestic violence.

Women's Issues Crucial in AIDS Fight (news article)
The global fight against HIV will fail without serious progress in addressing the plight of women in the developing world, including ways they can protect themselves from infection without their partners knowing, advocates say. Nearly half of all people living with HIV now are women, and their infection rates in many regions are climbing much faster than men's. According to experts, as the AIDS epidemic around the world continues to unfold, the disparity between male and female infection rates will further increase unless radical steps are taken.

Screening Saved 100,000 British Women from Cervical Cancer (news article)
About 100,000 women have been saved from premature death by the National Health Service cervical cancer screening programme, according to a study for Cancer Research UK. Experts argue that the "remarkably successful" programme, launched in 1988, has saved Britain from an epidemic of the disease after a three-fold increase in deaths of women under-35 in the two decades before screening began.

YOUTH HEALTH RESEARCH

Efficacy of an HIV Prevention Intervention for African American Adolescent Girls (research abstract)
African American adolescent girls are at high risk for human immunodeficiency virus (HIV) infection, but interventions specifically designed for this population have not reduced HIV risk behaviors. The objective of this study was to evaluate the efficacy of an intervention to reduce sexual risk behaviors, sexually transmitted diseases (STDs), and pregnancy and enhance mediators of HIV-preventive behaviors. The intervention emphasized ethnic and gender pride, HIV knowledge, communication, condom use skills, and healthy relationships. The comparison condition emphasized exercise and nutrition. Results showed that adolescents in the intervention were more likely to use a condom at last intercourse, less likely to have a new vaginal sex partner in the past 30 days, and more likely to apply condoms to sex partners and had better condom application skills, a higher percentage of condom-protected sex acts, fewer unprotected vaginal sex acts, and higher scores on measures of mediators. Promising effects were also observed for chlamydia infections and self-reported pregnancy.

Children on the Brink 2004 (report)
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Related news article: Southern Africa: Households Burdened by an Increasing Number of AIDS Orphans
Millions of children are growing up without parents. Millions more are in households with family members sick or dying from AIDS. Children in sub-Saharan African have been hardest hit. Children on the Brink 2004 presents the latest statistics on past, current and projected numbers of children under 18 who have been orphaned by AIDS and other causes. This edition of the biannial report underscores the changing needs of this vulnerable group as they progress through adolescence and calls for the urgent development and expansion of family and community support.

YOUTH HEALTH NEWS

UNICEF Calls for Broader Assistance to AIDS Orphans in Uganda (press release)
Related news article: Uganda: UN Agency Calls for Better Access to Services for War-Affected Children
With the global release today of a biennial report on orphans, UNICEF in Uganda says that current measures for the care and support of children whose parents die of AIDS are inadequate compared to the scale of the problem in the country. The UN agency for children urges all stakeholders involved in Uganda’s response to the HIV/AIDS pandemic to aim for all children--including the most marginalised children living in the conflict-affected northern and eastern districts--to realise their rights to access basic services and to live in a caring environment.

Africa: Aids Drug Manufacturers Forget Children (news article)
The failure to adapt diagnostic HIV/AIDS tests and drugs to the needs of children is hampering treatment of HIV-positive youngsters in developing countries, according to an international health NGO. Medecins Sans Frontieres (MSF) noted that there are no reliable tests available to detect HIV in children under 18 months, and while fixed-dose drugs for adults cost around US $200 per person per year, the same drugs for children cost about $1,300. Research shows that little or no child-friendly AIDS medicines have been developed, despite many children having trouble swallowing the bad-tasting pills and syrups that are available.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 4, Number 2919 July 2004