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Volume 4, Number 44
1 November 2004

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FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Efficacy of the New TwoDay Method of Family Planning (research abstract)
Related: news article: 'TwoDay' Method Helps Women Avoid Pregnancy
This study tested the efficacy of the TwoDay Method, a new fertility awareness–based method of family planning that provides women with simple instructions to identify the days each cycle when they are most likely to become pregnant. Users avoid unprotected intercourse on days when cervical secretions are present on that day or on the day before, to prevent pregnancy. Study participants were followed for up to 13 cycles of method use. The first-year pregnancy rate was 3.5 (pregnancies per 100 women/years) with correct use of the method, 6.3 with use of a backup method on the fertile days, and 13.7 including all cycles and all pregnancies in the analysis. The TwoDay Method's efficacy compares well with that of other coitus-dependent family-planning methods.

Effectiveness of the Male Latex Condom: Combined Results for Three Popular Condom Brands used as Controls in Randomized Clinical Trials (research article)
This study looks at condom efficacy rates by combining the results from two randomized, controlled contraceptive efficacy trials that used commercial latex condoms brands(Ramses Sensitoltrade mark, LifeStylestrade mark, Trojan-Enztrade mark) in the control arms. The combined clinical breakage rate for the first five condom uses was 0.4% for the three latex brands and the combined clinical slippage rate was 1.1%. The combined six-cycle typical-use pregnancy rate for the latex condoms was 7%. The combined six-cycle consistent-use pregnancy rate was 1%. There were no differences in performance or efficacy among the three latex brands tested. The male latex condoms rarely broke or slipped off during intercourse and provided high contraceptive efficacy, especially when used consistently.

Peripartum Contraceptive Attitudes and Practices (research abstract)
In this study, currently pregnant and postpartum women were surveyed about their attitudes toward contraception, particularly in relation to the index pregnancy. Important contraceptive attributes for women included reliability, efficacy, and safety during breast-feeding, especially in the postpartum period. Over 80% of women surveyed were using contraception prior to pregnancy, but nearly 20% were not satisfied with the method used. Over 40% of peripartum women indicated a desire to change their contraceptive after delivery. The results indicate that childbirth has a profound effect on contraceptive priorities and desires, especially toward long-term methods.

Contraception by Ushercell™ (Cellulose Sulfate) in Formulation: Duration of Effect and Dose Effectiveness (research abstract)
This study evaluated contraception by formulated Ushercell, a uniquely high-molecular-weight form of cellulose sulfate. Variables included dose effectiveness, duration of effectiveness, and formulation excipients. A 6% gel is active for at least 18 h; partial activity is observed for at least 24 h. Findings show that formulated Ushercell is an effective, long-lasting contraceptive and is bioavailable when vaginally applied.

Effect of Etonogestrel Subdermal Contraceptive Implant (Implanon(R)) on Liver Function Tests - A Randomized Comparative Study with Norplant(R) Implants (research abstract)
The study aimed to assess the possible differences in effects of Implanon(R) and Norplant(R) implants on liver function over 2 years of use. In both the implant groups, the mean total and unconjugated bilirubin and the gamma-glutaryl transferase levels were significantly raised during implant use. For none of the subjects, at any sampling period, did the levels exceed the normal range in our population. There was no significant elevation of any other liver enzymes in either group.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

China: Cash Rewards for Family Planners (news article)
In an effort to promote voluntary birth control in rural areas, the Yunnan provincial government is granting annual pensions to compliant families.

UN Population Fund Signs New Accord with Nearly 80 Developing Countries (news article)
Seventy-nine member governments of the African, Caribbean and Pacific Group of States signed an agreement in Belgium with the United Nations Population Fund to work together to tackle problems of reproductive health, including HIV/AIDS.

Jamaica: 'Family Planning is More than Making Babies' (news article)
The National Family Planning Board is shooting for a fertility rate of two children per woman in a decade, having already eclipsed its 2005 target.

Mozambique: The Condom and Culture Clash (feature article)
Delegates to "Countdown 2015: Sexual and Reproductive Health and Rights for All" (which took place at the beginning of September) heard that on average, men in sub-Saharan Africa only have access to about three condoms a year. As condoms have long been acknowledged as a key part of efforts to contain the spread of AIDS, this limited supply of prophylactics would appear to have dire implications for Africa. In Mozambique – one of the poorest countries on the continent – an examination of condom availability offers cause for both hope and concern.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Mozambique: New National Plan Against AIDS Unveiled (news article)
The fight against HIV/AIDS "demands the collaboration of each and every one of us, as citizens of this country", declared Mozambican Prime Minister Luisa Diogo on Wednesday. She was speaking at a meeting to unveil the second National Plan for the Fight Against AIDS, covering the period 2005-2010. The plan was drafted by a group of doctors, sociologists, economists, and anthropologists, chaired by former health minister Helder Martins.

Zambia Bans Condom Handouts to Students (news article)
Zambia banned the free distribution of condoms in schools on the same day the United States began a $24-million program to fight AIDS by handing them out. A government official who declined to give his name said a circular had been sent round primary and secondary schools on Tuesday ordering condom programs mostly run by NGOs to be stopped.

HIV/AIDS RESEARCH

Gender and Monitoring the Response to HIV/AIDS Pandemic (research article)
The mechanisms, techniques, and data sources used to monitor and evaluate global AIDS prevention and treatment services may vary according to gender. The Joint United Nations Program on HIV/AIDS has been charged with tracking the response to the pandemic by using a set of indicators developed as part of the Declaration of Commitment endorsed at the UN General Assembly Special Session on AIDS in 2001. Statistics on prevalence and incidence indicate that the pandemic has increasingly affected women during the past decade. Women's biologic, cultural, economic, and social status can increase their likelihood of becoming infected with HIV.

Sexual Power and HIV Risk, South Africa (research article)
Researchers examine the relationship between lack of sexual power and the decreased likelihood of consistent condom use and increased risk for HIV infection among sexually experienced, 15- to 24-year-old women in South Africa. While limited sexual power was not directly associated with HIV, it was associated with inconsistent condom use: women with low relationship control were 2.1 times more likely to use condoms inconsistently, and women experiencing forced sex were 5.77 times more likely to use condoms inconsistently. Inconsistent condom use was, in turn, significantly associated with HIV infection.

Infant HIV Infection: Acceptability of Preventive Strategies in Central Tanzania (research abstract)
This article reports on research to explore factors that may influence the acceptability of mother to child transmission interventions. Data collection included in-depth interviews with 12 health workers and focus group discussions with five community groups. Findings seek to explain how new ideas and products are disseminated through a community. Respondents describe the factors that may help and hinder this process. They propose ways to maximize this diffusion, such as integrating HIV and antenatal services, encouraging male participation, community-wide education, offering free HIV testing, and training health workers as change agents.

The Sonagachi Project: A Sustainable Community Intervention Program (research abstract)
This article describes The Sonagachi Project, based in Calcutta, India, which has been associated with lower HIV rates among prostitutes as compared to other urban centers in India. The program defined HIV as an occupational health problem and included multifaceted, multilevel interventions addressing community, group, and individual factors. The Sonagachi Project's core concepts and strategies evolved as community needs were expressed and defined. In particular, the program was not initially conceptualized as a community empowerment project but emerged over time, allowing for project sustainability. Project components appear to be replicable across settings within India and worldwide.

HIV/AIDS Risk Among Brothel-Based Female Sex Workers in China: Assessing the Terms, Content, and Knowledge of Sex Work (research abstract)
This article examines variations in occupational control among brothel-based prostitutes in China and the relationship between the terms and content of this work and the risk of HIV/AIDS. Observation and in-depth interviews were conducted in 2000-01 with 158 female prostitutes from 45 brothels in 4 red light districts. Brothel-based female sex workers in China displayed considerable variability in the organization of life and work, relationships with managers and clients, ability to negotiate condom use, knowledge of STDs and HIV, and occupational identity, all of which may result in different risks of acquiring HIV. Results demonstrate the importance of prevention activities directed at the brothel managers and clients, as well as the sex workers.

Building Dynamic Democratic Governance and HIV-Resilient Societies (Chinese translation) (report)
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This paper, presented in Chinese, shows that introducing democratic governance practices into development facilitates the building of a community's HIV resilience. From such a perspective, the author shows that governance issues are not a luxury for developed countries, but a means of survival and prosperity for developing countries. The Oslo Governance Centre hopes that the present paper, which has been reviewed by both governance and AIDS experts, will trigger new thinking on which to build effective and sustainable policies and programs to stem the spread of HIV/AIDS.

HIV/AIDS NEWS

Vietnam to Detect HIV/AIDS Infections in Army (news article)
Viet Nam will conduct annual HIV/AIDS testing among its soldiers and army officers. According to a new report, all soldiers and officers in the country will undergo tests for HIV/AIDS and drug on a regular basis and tests among recruits will receive special attention.

South Africa: People Can't Be Forced Onto AIDS Drugs - Health Minister (news article)
South African Health Minister Manto Tshabalala-Msimang has defended the poor uptake of the country's free AIDS drug rollout by saying she could not force people to use antiretrovirals.

Bangladesh: HIV/AIDS Patients May Increase: Less than 10% People Use Condom (news article)
Less than 10% of Bangladeshi people use a condom when they have sex. As a result, the risk of spreading HIV/AIDS is increasing, officials of the Health Directorate have said.

Disaster Report Warns of 'Social Calamity' (news article)
Related: news article: World Disasters Report 2004
Within the next 10 years, some southern African countries will lose half their working population, according to the International Federation of Red Cross and Red Crescent Societies. Last year alone, it is estimated, HIV/AIDS killed more than 3 million people worldwide - 2.2 million of them in sub-Saharan Africa.

Kyrgyzstan: Muslim Clerics Help Raise HIV/AIDS Awareness (news article)
The United Nations Development Program in Kyrgyzstan, the State Commission on Religious Affairs, and local Muslim clergy have launched a unique campaign that aims to inform religious leaders about HIV/AIDS.

Uganda: 'Include HIV/AIDS in Sermons' (news article)
The District Director of Health Services, Dr George Kabagambe, has asked religious leaders to campaign against HIV/AIDS in their sermons.

New, Free AIDS Clinics in Lesotho, Swaziland (news article)
The governments of Lesotho and Swaziland have announced that new medical centers focused on caring for children with HIV/AIDS will be built in Maseru, Lesotho and Mbabane, Swaziland.

MATERNAL AND CHILD HEALTH RESEARCH

Costing Nevirapine Delivery to Infants: A Zambian Case Study (research article)
(You need Adobe Acrobat Reader to access this document)
USAID invited the Partners for Health Reformplus to estimate costs associated with the packaging of infant doses of Nevirapine in Zambia. The costs of following four scenarios were examined in this exercise: 1) preparation and administration of Nevirapine by a nurse immediately after birth, 2) preparation of Nevirapine in batches prepared by either a nurse or nurse’s aide, 3) a semi-automated approach of pre-filled and packaged Nevirapine syringes, and 4) a fully automated approach using UnijectDP pre-filled with Nevirapine. Findings show that, at all dose levels, administration by a nurse after birth is the most cost-effective scenario. However, if other important factors, such as limited access to hospital facilities, are taken into consideration, then the semi-automated or Uniject approaches may be more suitable.

Maternal-Fetal Transfer and Amniotic Fluid Accumulation of Nucleoside Analogue Reverse Transcriptase Inhibitors in Human Immunodeficiency Virus-Infected Pregnant Women (research abstract)
This study was performed to investigate placental transfer of nucleoside analogue reverse transcriptase inhibitors (NRTIs) and their concentrations in amniotic fluid when given to HIV-infected pregnant women. A total of 100 HIV type 1-infected mothers receiving antiretroviral therapy at the time of delivery were enrolled and maternal blood samples and amniotic fluid were obtained during delivery or cesarean section. A significant relationship between concentrations in maternal and cord plasma samples was found for zidovudine, lamivudine, stavudine, and didanosine. These findings indicate that most NRTIs cross the placenta by simple diffusion and are concentrated in the amniotic fluid, probably through fetal urinary excretion. The efficacy or toxicity of NRTIs may vary according to placental transfer.

Race and Pregnancy-related Care in Brazil and South Africa (research abstract)
This study examines racial difference in women's use of prenatal and delivery care in Brazil and South Africa, two multiracial societies with very different histories of race-related legislation that could affect medical care utilzation. Findings suggest that although state-sanctioned racism may help to explain the greater racial inequality in stunting in South Africa than in Brazil, reducing the disadvantage for non-Whites in South Africa and Brazil will depend on reducing fundamental inequalities in the distribution of socioeconomic resources and medical services that characterize many nations.

MATERNAL AND CHILD HEALTH NEWS

UK: Midwives to Ask All Pregnant Women: Does Your Husband Beat You Up? (news article)
Doctors and midwives are to ask all pregnant women if they have been beaten by their partners as part of a crackdown on domestic violence, ministers said. Mothers-to-be will be discreetly questioned by healthcare staff during ante-natal check-ups. The Department of Health hopes to implement the policy next year.

MEN'S HEALTH RESEARCH

A Comparison of Vas Occlusion Techniques: Cautery More Effective than Ligation and Excision with Fascial Interposition (research article)
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The objective of this analysis was to compare early failure rates, sperm concentrations, and time to success between two techniques for vas occlusion: intraluminal cautery versus ligation and excision with fascial interposition. Vasectomy with cautery was associated with a significantly more rapid progression to severe oligozoospermia and with significantly fewer early failures (1% versus 5%). Limitations of this comparison include (a) the variety of surgical techniques in the cautery study and differences in methods of fascial interposition between the two studies, (b) the uncertain correlation between sperm concentrations after vasectomy and the risk of pregnancy, and (c) the use of historical controls and different study sites.

Intratesticular Testosterone Concentrations Comparable With Serum Levels Are Not Sufficient to Maintain Normal Sperm Production in Men Receiving a Hormonal Contraceptive Regimen (research abstract)
This study examined the relationship between intratesticular fluid and serum testosterone at baseline and during treatment with a contraceptive regimen known to suppress spermatogenesis and measured intratesticular fluid androgenic bioactivity.

Sexually Transmitted Disease Management in Uganda's Private-for-Profit Formal and Informal Sector and Compliance With Treatment (research abstract)
The objective of this study was to investigate the management of STDs in the Ugandan private sector clinics and drug shops. Men with urethral discharge who had consulted clinics or drug shops for treatment in 5 districts were interviewed. 77% of patients sought treatment within 1 week of onset of symptoms but only 7% were properly managed. The reported cure rate was 47% and only 9% were treated according to National Guidelines. Eighteen percent of patients used condoms during treatment, 36% persuaded their partner to go for treatment, and 87% completed the recommended treatment course. Quality of STD management by private providers overall was found to be poor.

MEN'S HEALTH NEWS

China: Experts Urge Men to Care for Health (news article)
Medical experts have called for men to take better care of their health and become more aware of family planning issues and AIDS prevention.

POPULATION RESEARCH

Rapid Fertility Decline in the Maldives: An Assessment (research article)
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Recent evidence suggests the beginning of a fertility decline in Maldives from 6.4 children per woman during the early 1990s, to 5.7 in 1995 to a further drop in the total fertility rate to 2.8 in 2000. The assessment of the data quality and indirect estimates of fertility support the view that the fertility decline reported in the censuses of Maldives is fairly accurate. While the absence of a fertility survey in Maldives does not permit the analysis of the proximate determinants of fertility, some evidence of the positive socio-economic changes occurring in Maldives, such as the increased use of contraception, schooling opportunities in the rural areas and political endorsement of family planning at the highest level, provides an explanation for the rapid fertility decline occurring in the islands.

POPULATION NEWS

Viet Nam: Population Surge in 2004 Could Undermine Decade of Progress (news article)
The sudden increase in the Vietnamese birth rate this year is undermining the country's significant achievements in birth control over the past 10 years, said former director of the National Committee for Population, Family and Children.

India: Dip in Population Growth of 0-4 Years Age Group: Census (news article)
The share of children aged below 4 years in India's overall population has dropped from 12.55% in 1981 to 12.17% in 1991 and, further, sharply to 10.73% in 2001.

Pakistan: Population Growth Rate Still High at 1.9% (news article)
Pakistan still has a relatively high population growth rate of 1.9% per annum, said the State Bank of Pakistan in its annual report 2003-2004.

Jordan: Total Population Stands at 5.29m — Census (news article)
Jordan's total population at the start of this month stood at 5.29 million, according to the initial results of the General Population Census, conducted earlier this month by the Department of Statistics.

WOMEN'S HEALTH RESEARCH

Steps for Preventing Infectious Diseases in Women (research article)
This study examines the rate of infectious diseases among various populations of women in Latin America and the Caribbean and the steps needed to develop effective interventions.

Sex Workers in Vietnam: How Many, How Risky? (research abstract)
This paper assesses the number and risks of sex workers in Nha Trang City, Vietnam. An estimated 444 women worked on the streets and beach (“direct” sex workers) and 486 worked in bars and restaurants or other facilities (“indirect” sex workers). Direct sex workers had more clients, were less likely to report always using condoms (67% vs. 81%), more likely to report a prior sexually transmitted infection (19% vs. 16%), and more likely to have clients who inject drugs (16% vs. 13%). This assessment has implications for planning programs to reduce sex work and its risks in Vietnam and potentially other countries.

Breaking New Ground: Livelihood Choices, Opportunities and Tradeoffs for Women and Girls in Rural Bangladesh (report)
This report discusses the type and nature of changes that Bangladeshi rural women and girls perceive as the most important for their health and economic well-being. The report, based on field analysis, finds that women and girls are participating in and in many cases driving changes in rural areas of Bangladesh.

Self-Reported Symptoms of Reproductive Tract Infections Among Rural Women in Hainan, China: Prevalence Rates and Risk Factors (research article)
The goal of this study was to examine risk of reproductive tract infections (RTIs) among women in rural China, including prevalence, influence of sociodemographic characteristics, knowledge, hygienic practices, attitudes, and behaviors related to premarital and extramarital sex, and abortion. Overall, 39% of women interviewed reported at least 1 RTI symptom in their lifetime and 20% during the past 6 months. Having had premarital sex, having sex during menstruation, belonging to an ethnic minority, being knowledgeable about RTIs, and living in a village at medium economic level were all related to having RTI symptoms.

Improving the Health Sector Response to Gender-Based Violence: A Resource Manual for Health Care Professionals in Developing Countries (training manual)
(You need Adobe Acrobat Reader to access this document)
Based on the experiences of an IPPF/WHR regional initiative to integrate services for victims of gender-based violence into reproductive health programs, this manual provides tools and guidelines for program managers working in developing countries.

Pregnancy Weight Gain and Breast Cancer Risk (research article)
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Results from this study suggest that high pregnancy weight gain increases later breast cancer risk, independently from body weight at the time of diagnosis.

WOMEN'S HEALTH NEWS

Sudan: For Raped Women in Darfur, Access to Reproductive Health Services Limited (news article)
Janjaweed militias and government police continue to attack and rape women in Darfur. But the few clinics that do have services for rape survivors are not seeing recent cases because women are unable and unwilling to use health services.

Congo's 40,000 War Rape Victims Face HIV Epidemic (news article)
Related: report: Democratic Republic of Congo: Mass Rape - Time for Remedies
More than 40,000 women and girls were raped by soldiers and used as sex slaves in the six-year civil war in the Democratic Republic of Congo and desperately need medical care, according to a recent report.

YOUTH HEALTH RESEARCH

Girl Child Labor in Agriculture, Domestic Work and Sexual Exploitation: Rapid Assessments on the Cases of the Philippines, Ghana and Ecuador (Volume 1) (research article)
(You need Adobe Acrobat Reader to access this document)
This study analyses the situation of girl child labor in three areas: agriculture, domestic work and sexual exploitation. Through a series of Rapid Assessments in the Philippines, Ghana and Ecuador, the study presents 1) assessment of the local magnitude of girl children in the three target sectors 2)description of the work processes, conditions and arrangements involved in the sectors 3)identification of policies, programs or initiatives that address the concerns of working girl-children and 4)recommendations toward the formulation of appropriate policies and programs.

High-Risk Behaviors and Beliefs and Knowledge About HIV Transmission Among School and Shelter Children in Eastern Europe (research abstract)
The goal of this study was to determine sexual behavior, injecting drug use, knowledge and representations of HIV transmission among adolescents in Russia, Georgia, and the Ukraine. Semistructured interviews on sexual behavior and structured inventories assessing knowledge of HIV transmission, sexual behavior and drug use showed that shelter children are more likely than school children to have had sex and injected drugs. Georgian school children are more likely than the other school children to have sex and inject drugs. Shelter children and Georgians are also the most likely to hold mistaken representations about the epidemic.

Girl Child Labor in Agriculture, Domestic Work and Sexual Exploitation: Rapid Assessments on the Cases of the Philippines, Ghana and Ecuador (Volume 2) (research article)
(You need Adobe Acrobat Reader to access this document)
Volume Two of this study is a comparative analysis of gender sensitive assessments undertaken in the Ghana, Ecuador and the Philippines focusing on agriculture, domestic labor and prostitution. It analyses underlying factors of gender disparities in child labour and the consequences of those differences. The aim of the study is to inform policy and contribute to a fuller picture of child labor in general, and girl child labor in particular.

YOUTH HEALTH NEWS

Mozambique: Youth Health Targeted (news article)
As HIV infection continues to climb among Mozambican youth, initiatives are underway to address their specific health concerns.

Jamaica: Abstinence Increasingly Popular among Adolescents (news article)
Between 1993 and 2002 sexual activity among adolescents under 19 decreased by 10%, and within the same time period, the number of adolescents using prophylactics at the time of first sexual intercourse has increased from 43% to 68%.

Uganda: 75% of Kayunga Girls Have Sex Before 12 Yrs (news article)
About 75% of girls below 12 years of age in the district engage in early sex, the District Director of Health Services has said. Quoting statistics from HIV/AIDS testing centers in the district, 40% of the females who tested have HIV/AIDS compared to 10% of the males.

Bangladesh: Adolescents Now Aware of AIDS, STDs (news article)
Talking about reproductive health issues at the family level is taboo in Bangladesh's conservative society, but the situation is changing in some regions of the country.

BOOKS/BOOK REVIEWS

Strategic Communication in the HIV/AIDS Epidemic (book)
This book promotes the use of strategic communication to fight against the HIV//AIDS epidemic. Focusing on strategic communication for positive and measurable behavior change, the authors elaborate on a wide range of issues, including the importance of advocacy and community mobilization; comprehensive approaches to prevention and the use of communication in reducing stigma; the role of communication in support of clinical and social services; and a host of others.

The Impact of AIDS (book)
This report documents the wide-ranging impacts of HIV/AIDS: on population size and growth and national mortality levels; on families and households; agricultural sustainability; business; the health sector; education, and economic growth. It also shows that the AIDS epidemic will continue to have devastating consequences for decades to come for virtually every sector of society. Divided into two parts, part one is an attempt to provide a comprehensive survey of available studies on the impact of AIDS while part two presents summaries of selected studies, with particular attention to the methodology and scope of each study.

SPECIAL REPORTS/PROFILES/RESOURCES

Living in a World with HIV and AIDS (report)
The "Action Against HIV/AIDS in the UN System" Project is a benchmark for a best practice workplace model in respect to the implementation of appropriate HIV/AIDS workplace policies and the promotion of HIV/AIDS as a workplace issue. This toolkit is designed to help find ways of promoting a workplace that is supportive to people who are HIV infected or affected. It is a guide to assist UN Theme Groups and beyond, design appropriate workplace HIV/AIDS training practices that meet the needs of employers and employees alike.

Network: Integrating Services, 2004, Volume 23, Number 3 (resource material)
In most settings throughout the world, family planning services and HIV services traditionally have operated separately with little or no integration. Family planning services primarily target married women of reproductive age. HIV services primarily target individuals at high risk of HIV infection. Integrating family planning and HIV services potentially can maximize the use of existing services and minimize the number of people who do not obtain the health care they need. But much remains unknown about how best to integrate services and what impact such integration will have on reproductive health outcomes, such as preventing HIV infection and unintended pregnancy. This issue of Network, an overview of current thinking about integration, is the first of a series of publications, supported by USAID, intended to encourage health professionals to ask questions or share their experiences in regard to service integration.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 4, Number 44 1 November 2004