Johns Hopkins Bloomberg School of Public Health: The INFO Project

Your knowledge-sharing resource on family planning and reproductive health

Shopping Basket

The Pop Reporter®

Volume 4, Number 51
20 December 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

The HIV and Nevirapine Controversy in Africa

By: Ronald H. Gray, MBBS, MSc

rgray@jhsph.edu

Editorial Note:
This past week a controversy arose when it was reported in the media that testing of the drug nevirapine at Uganda's Mulago Hospital failed to meet international standards and that pregnant women who take the drug once to inhibit passing HIV to their babies may develop resistance to it that can limit drug therapies to combat the deadly disease. News articles were rife with headlines such as AIDS Drug Concerns Threaten S. Africa Program and Many Now Worry AIDS Drug Will Be Halted. In response, the National Institute of Allergy and Infectious Diseases issued this statement,
The HIVNET 012 Study and the Safety and Effectiveness of Nevirapine in Preventing Mother-to-Infant Transmission of HIV and also a Questions and Answers fact sheet: Questions and Answers: The HIVNET 012 Study and the Safety and Effectiveness of Nevirapine in Preventing Mother-to-Infant Transmission of HIV.

The following response to this controversy was written exclusively for The Pop Reporter by Dr. Ronald Gray, Robertson Professor of Reproductive Epidemiology, Johns Hopkins University, Bloomberg School of Public Health. Dr. Gray has published extensively in population and family health sciences and has a particular interest in the HIV epidemic in Africa.


Nevirapine and Prevention of Mother-to-child HIV Transmission in Africa: What Are the Facts?
A trial, published in 1999, showed that a single dose of nevirapine (NVP) provided as a tablet to the mother at onset of labor and as syrup to the infant within 72 hours of birth could halve the rate of perinatal mother-to-child HIV transmission (MTCT). The study also showed that this single-dose regimen was safe for the mother and child and that the reduction of infant HIV infections observed shortly after birth persisted for at least the first 18 months of life.

This trial (often called HIVNET012) revolutionized the prospects for pediatric HIV prevention in Africa and led to the widespread use of this drug regimen. Subsequent studies have demonstrated the feasibility of this procedure both in clinic and home settings and that mothers could provide the drug to themselves and their children.

Nothing, however, is perfect in the HIV world. Boehringer-Ingleheim, the manufacturer of NVP, submitted an application to the FDA, asking for approval for this single-dose use (NVP had been previously approved as part of Highly Active Anti-Retroviral Therapy [HAART]). The FDA refused approval, mainly because the trial had failed to adequately document possible adverse effects (e.g., did not track down hospital records) and because the investigators did not adhere to strict FDA procedures. The trial had been conducted under a FDA Investigational New Drug application, which mandates strict regulations, so administratively the investigators were at fault. The trial was supported and supervised by NIH, so they share responsibility for these shortcomings.

From a public health perspective it is important to note that the FDA review and disapproval, as well as multiple subsequent audits and reviews, did not question the efficacy of the drug for preventing pediatric HIV infection, nor did they demonstrate safety concerns.

The plot then thickened. It was known that the HIV virus rapidly mutates, and that resistant virus was a problem with NVP, especially if the drug was used alone (monotherapy). Such resistance was observed in the blood of both mothers and children in the 012 trial, but it appeared to fade over about one year. Nevertheless, there was concern that the resistant virus would remain in the lymph glands and would re-emerge if NVP was subsequently used for HAART therapy. This concern appears warranted, because a 2004 Thai study showed that women who had received NVP had a poorer response to subsequent HAART regimens containing NVP.

This conjunction of events, non-FDA approval and criticism of the trial and the problem of NVP, has generated a perfect storm of media attention. It is further exacerbated by claims that NIH did not communicate the information on NVP resistance when plans were being made for the Presidential Emergency Program for AIDS Relief (PEPFAR), which is the main US effort to provide drugs (including NVP) to the developing world. This accusation of withholding information on resistance is a canard, because the problem of NVP resistance was well documented and widely known.

In all the media hype, accusation and counteraccusation, release of documents under the Freedom of Information Act, personal attacks and acrimony, there seems to be little concern for preventing pediatric HIV infection. We have a dilemma of massive proportions: Millions of mothers are infected with HIV, particularly in Africa. The only affordable, simple and effective preventive measure available is the single-dose NVP regimen. Taking this drug will select resistant virus and likely compromise the response to later HAART therapy for the mother and child, if such therapy contains nevirapine or related drugs (called NNRTIs). Should we ban NVP because of an administratively imperfect trial and double the number of HIV infected infants? Should we withhold NVP to avoid drug resistance, so that these mothers and children will respond better to HAART at some time in the future when they become immunodeficient? Does the FDA's concerns about imperfect documentation of side effects in an efficacy trial outweigh the risk of infant HIV infection and death?

I think we need to get our priorities straight. NVP is an imperfect drug, it has toxicities, it has resistance problems, but it is the only regimen that can be used at time of delivery. Other regimens (e.g., short-course AZT) taken for the last weeks of pregnancy should be provided to women where possible, but since 80% or more of births in Africa occur at home without medical supervision, this is not a feasible option for most women. We need research, particularly on combination therapy during labor and delivery, but, while waiting for this research, we only have NVP to fall back on.

The media do children a grave disservice by promoting disinformation without considering the public health benefits. This disinformation could lead governments (such as South Africa) or donors to restrict access to this valuable drug, and infected children would pay the price for such misguided policy.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Oral Contraceptives and Cardiovascular Disease: Press Statement from Wayne State University and the Women’s Health Initiative (news article)
Related: news article: Birth Control Pill Study Flawed
Related: news article: Questions about Oral Contraceptives and Cardiovascular Disease
A few weeks ago a report on oral contraceptive use and cardiovascular disease was presented by Dr. Rahi Victory at a meeting of the American Society for Reproductive Medicine, and an associated abstract was published in the journal Fertility and Sterility by Dr. Victory and Wayne State University colleagues. This presentation and abstract have been quoted in the popular media worldwide as providing evidence that oral contraceptive use protects against subsequent heart disease, stroke, and other cardiovascular diseases. This statement, along with the Questions and Answers, clarifies the implications of the Women’s Health Initiative data that were used in this study.


USAID/W Technical Assessment of Recent Evidence on Depo-Provera and Bone Density - November 2004 (resource material)
From the summary: "The Pfizer company has been conducting 2 long-term studies to assess an ongoing concern about the effects of the injectable contraceptive Depo-Provera (DMPA) on bone density. The company recently released new data from the 2 studies in its drug labeling and strengthened its warning about the effect. While USAID/W takes the new findings seriously, we believe Pfizer's position is overly cautious. We await the scientific assessment by WHO's Medical Eligibility Criteria (MEC) before recommending any major changes."


The Unfinished Agenda: Meeting the Need for Family Planning in Less Developed Countries (report)
(You need Adobe Acrobat Reader to access this document)
This brief reviews the progress to date and challenges ahead in meeting the need for family planning in less developed countries. Rising contraceptive use and smaller family size have meant millions of lives saved and additional benefits for women and children who are healthier and can achieve greater levels of education and empowerment. Despite these gains, a large and persistent divide exists among countries in access to and use of contraception. Various factors intensify the challenges ahead, including population growth, a shortage of supplies, and inadequate funds.


The Prediction of Condom Use Intention among South African University Students (PubMed abstract)
In this study, from the School of Social Sciences, University of the North, Sovenga, Republic of South Africa, a questionnaire was administered to 294 sexually active, unmarried undergraduate students to investigate the role of social norms in the prediction of the intention to use condoms. Components of social cognitive theory and the theory of reasoned action and planned behavior were integrated with those of the Health Belief Model to predict future intention to use condoms with a new partner. Logistic regression analyses of selected risky sexual behaviors on the intention to use condoms showed that, among males, attitudes towards using condoms and the Health Belief Model component of perceived barriers predicted the intention to use condoms. Attitudes, subjective norms, and perceived self-efficacy were associated with female students' intention to use condoms.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Islamists Burn Posters, Videos in Northwest Pakistan (news article)
Authorities in a Pakistani province ruled by Islamists have torched thousands of confiscated condom posters, video cassettes and computer disks in a campaign against vulgarity. Watched by dozens of chanting people, Northwest Frontier province government officials destroyed what they desribe as material morally corrupting through obscene and sexually provocative pictures.


Uganda: New Import Measures Lead to Condom Shortage (news article)
New rules requiring that condoms be tested before and after shipment to Uganda have caused a shortage of the rubber prophylactic, which the east African country credits for curbing the spread of HIV.


China: Experts Call for More Use of Condoms (news article)
Chinese university students should learn more about condoms to help prevent HIV/AIDS instead of blushing and refusing to talk about it, say experts, warning that the epidemic is still spreading.


Canada: STDs on the Rise (news article)
The "safe-sex" message is out there, but it's not being heard, says a University of Alberta infectious disease expert. A recent explosion in new confirmed cases of syphilis in the Capital Health region suggests people are tuning out repeated warnings about sexually transmitted diseases and engaging in risky behaviors.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Transatlantic Divide in Publication of Content Relevant to Developing Countries (research article)
Although 112 countries now receive 2,200 medical journals free or at reduced prices, 90% of the US$70bn spent annually on health research is focused on the diseases of 10% of the world's population. Researchers in eight industrialized countries produce almost 85% of the world's leading science; 163 countries, including most of the developing world, account for less than 2.5%. Less than 8% of articles published in the six leading tropical medicine journals in 2000-2002 were generated exclusively by scientists from developing countries. The objective of this study is to review the relevance of the contents of four leading medical journals to developing countries, compare the journals, and observe trends.


U.S.: One-Child Abuses Rampant in China (news article)
Related: news article: Arthur E. Dewey, Assistant Secretary for Population, Refugees and Migration Testimony before the House International Relations Committee
Despite some changes, China's one-child family planning program remains a source of coercion, forced abortions, infanticide and perilously imbalanced boy-girl ratios, State Department officials said Tuesday. Testimony before the House International Relations Committee focused on a Shanghai woman who, since her second pregnancy in the late 1980s, has been assigned to psychiatric wards, coerced into an abortion, and removed from her job. She is reportedly subject to torture in a labor camp. In testimony before the Committee, Arthur E. Dewey, Assistant Secretary for Population, Refugees and Migration, said, "China’s birth planning law and policies retain harshly coercive elements in law and practice. Forced abortion and sterilization are egregious violations of human rights, and should be of concern to the global human rights community, as well as to the Chinese themselves. Unfortunately, we have not seen willingness in other parts of the international community to stand with us on these human rights issues."


Spain Changes Law on Genital Mutilation (news article)
Spain is to modify legislation to enable the judiciary to penalise immigrants for female genital mutilation (FGM) operations performed in their home countries. Parliament agreed unanimously on Tuesday to make FGM an extra-territorial crime like genocide, terrorism or child abuse. The judiciary has hitherto been unable to prosecute African immigrants who have their daughters circumcised during holidays in their home countries. People practising female circumcision in Spain, however, face up to 12 years in prison.

HIV/AIDS RESEARCH

Antenatal Couple Counseling Increases Uptake of Interventions to Prevent HIV-1 Transmission (research abstract)
This paper examines the effect of partner involvement and couple counseling on uptake of interventions to prevent HIV-1 transmission. Women attending a Nairobi antenatal clinic were encouraged to return with partners for voluntary HIV-1 counseling and testing (VCT) and offered individual or couple posttest counseling. Nevirapine use was reported by 88% of HIV-infected women who were couple counseled, 67% whose partners came but were not couple counseled, and 45% whose partners did not present for VCT. HIV-1-seropositive women receiving couple counseling were five times more likely to avoid breastfeeding.


A Comparison of HIV/AIDS Knowledge and Attitudes of STD Clinic Clients in St. Petersburg, Russia and Milwaukee, WI, USA (research abstract)
This study compared HIV/AIDS knowledge, attitudes toward condoms, perceived vulnerability to HIV, and attitudes towards HIV testing in samples of 400 Russian and 401 American STD clinic patients. Participants in both samples exhibited knowledge deficits. Overall, Russians had less accurate HIV transmission knowledge, fewer sources of HIV-relevant information, and lower perceived vulnerability to HIV/AIDS. In both countries, a desire to be tested for HIV was related to perceived vulnerability to the disease.


Surveillance and Modelling of HIV, STI, and Risk Behaviours in Concentrated HIV Epidemics (research abstract)
This paper reviews methodological obstacles in conducting surveillance with population subgroups in concentrated HIV epidemics, elaborates on recent advancements that partially overcome these obstacles, and illustrates the importance of modelling integrated HIV, STI, and behavioral surveillance data.


Nevirapine and Prevention of Mother-to-child HIV Transmission in Africa: What Are the Facts? (commentary)
This commentary was written by Dr. Ronald Gray, Robertson Professor of Reproductive Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, in response to the controversy that arose last week in the media over HIV and nevirapine use in Africa.

HIV/AIDS NEWS

Nigeris: Restocked Rollout Expanded (news article)
As Nigeria, faced with one of the world's largest HIV-positive populations, expands its subsidized antiretroviral (ARV) program, concern is mounting about how funds are being spent.


Questions on AIDS Prevention Spending (resource material)
(You need Adobe Acrobat Reader to access this document)
Related: news article: The Waxman Goofeth
In this letter to the US Government Accountability Office, Rep. Henry Waxman (D-Calif.) requests a full investigation of the President's Emergency Plan for AIDS Relief (PEPFAR). This stems from his examination of domestic abstinece programs, which were found to be inaccurate and misleading. However, a newspaper columnist points out alleged errors in Waxman's initial report on abstinence education because his report "ignores evidence from the National Longitudinal Study of Adolescent Health that teen sexual activity entails a greater suicide risk. It asserts that there is no proof that abstinence programs work, while at least four studies in peer-reviewed journals show just that."


Worldwide Appeal for Free AIDS Treatment (news article)
Nearly 600 health experts, economists, and policy-makers have joined an appeal for free AIDS treatment for all people living with HIV/AIDS in the developing world.


Cardinal Says Cut Through Condom Debate (news article)
The cardinal chosen by Pope John Paul to head a new Vatican foundation to help AIDS victims has said too much time is spent arguing over the Catholic Church's opposition to condoms while too many people were dying. "I don't care about the condoms yes, condoms no, debate," Cardinal Javier Lozano Barragan, told a news conference. "What concerns me is that these people are dying and I have to help them." The Vatican said the new foundation, called Good Samaritan, would take donations from individuals, groups and governments and channel them to Catholic charities and other organisations helping AIDS victims, particularly in Africa.


Africa: HIV/AIDS Prevalence Rate Drops in Delta (news article)
Delta State Commissioner of Health Dr. Ifeanyi Okowa has disclosed that 1 out of every 20 Deltans are likely to be HIV positive, just as he put its prevalence rate in the state at 5% as against 5.8% in 2001.


Postage Stamps Reach Audiences beyond Mass Media (news article)
Several governments have shown their support in the fight against HIV/AIDS by putting prevention messages on specially-designed postage stamps. Three such stamps in Tanzania, Zimbabwe and Chad have featured Population Services International (PSI) products or services. Another special sticker issued by the Nepal Ministry of Communication's Department of Postal Services featured the message "Protect yourself and others from HIV/AIDS" and a PSI campaign logo, and was placed on every piece of mail domestic and international for six months, motivating healthy behavior far beyond the reach of mass media.


Uzbek People Have No Wide Access to AIDS Information (news article)
The Uzbek population does not have enough information on HIV/AIDS, while mass media are not widely covering this issue, a World Health Organization representative has said.


Ethiopia to Begin Distributing Antiretroviral Drugs with PEPFAR Funding (news article)
Ethiopia in 2005 will use $43 million in funding from the Bush administration's 5-year, $15 billion President's Emergency Plan for AIDS Relief to distribute antiretroviral drugs at no cost to as many as 15,000 HIV-positive people in the country.

MATERNAL AND CHILD HEALTH RESEARCH

Applying the BEHAVE Framework: Workshop Guide (resource material)
In 2002, the CORE Group’s Social and Behavior Change Working Group set out to identify tools and to offer capacity-building opportunities that would enable private voluntary organization (PVO) staff to incorporate the best of behavioral science into their child survival projects plans. Teaming up with the CHANGE Project of the Academy for Educational Development, the SBC Working Group offered several brief sessions on different aspects of behavior change during CORE annual meetings. The tools and concepts developed during this time are presented here.


Are Domestic Violence and the Excessive Use of Alcohol Risk Factors for Preterm Birth? (research abstract)
In this study from the Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, South Africa, 229 patients were interviewed regarding their experience of domestic violence: 99 in the low-risk (LR) group and 130 in the preterm labor (PTL) group. The PTL group experienced significantly more violence throughout their lives than the LR group. Experiences of violence within the last year or during the pregnancy were also higher for the PTL group. This group smoked significantly more cigarettes per day, used more alcohol, and had a higher incidence of syphilis than the LR group.


Breastfeeding Knowledge Among Health Workers in Rural South Africa (research abstract)
The setting of this study was a rural area of KwaZulu Natal, with a population of 220,000 people. At the time of the study approximately 36% of pregnant women were HIV-infected and no program was in place to prevent mother-to-child transmission. A convenient sample of 71 healthcare workers (14 doctors, 25 professional nurses, 16 staff nurses, and 16 community health workers) were included. More than 50% of respondents had given breastfeeding advice to clients over the previous month. However, there were significant discrepancies in breastfeeding knowledge compared to WHO recommendations. Ninety-three per cent (n=13) of doctors knew that breastfeeding should be initiated within 30 minutes of delivery, but 71% (n=10) would recommend water, and 50% (n=7) solids to breastfed infants under 6 months of age. Fifty-seven per cent (n=8) considered glucose water necessary for neonatal jaundice, constipation, and for infants immediately after delivery. Only 44% (n=7) of staff nurses and 56% (n=14) of professional nurses knew that breastfeeding should be on demand.

MATERNAL AND CHILD HEALTH NEWS

Uzbekistan: Infant Mortality Rate Decreasing (news article)
The rate of infant mortality is decreasing in Uzbekistan, with more than 1,000 newborns saved every year since 2000 in the most populous Central Asian country.


Abandoned Africa HIV Orphans Struggle with Stigma (news article)
UNICEF estimates that by 2010 more than 18 million African children will have lost one or more parents to AIDS unless swift action is taken. But the prejudice that casts AIDS as a curse will slow any response to the crisis, experts say.


Singapore Hospitals Begin HIV Testing on Pregnant Mothers (news article)
Singapore hospitals have begun testing pregnant women for HIV following a directive from the government concerned about the rising number of AIDS cases, the Ministry of Health said recently.


UK: More Women Have a Late Pregnancy (news article)
The number of women who are leaving it late to have children is increasing, statistics show. Office of National Statistics figures show the fertility rate in all age groups, except the under 20s, has risen. But in 2003 the largest increases in fertility rates were recorded in women aged 35-39 and 40 and over.

MEN'S HEALTH NEWS

Nearly a Quarter of China Gays Have 100 Partners and No AIDS Knowledge (news article)
At least 80% of China's estimated 5 to 10 million gays believe they are safe from HIV/AIDS, according to the country's first ever survey of the homosexual group. The survey, conducted by the center of AIDS control and prevention under the Chinese Center for Disease Control and Prevention in collaboration with its branch office in northeast China's Heilongjiang Province, found 80.6% of gay men are totally ignorant of their exposure to the virus or underestimate the risk. According to the survey, 31.7% have one to 10 partners and 22.2% have more than 100 partners.

POPULATION RESEARCH

What Have We Learned Studying Income Inequality and Population Health? (report)
Epidemiologists and social scientists around the world have long been interested in studying the relationship between income distribution and health. This report, from the Canadian Institute for Health Information, synthesizes the research on income inequality and health. The report reviews the chronology of studies on income inequality and health, explores some of the differences between countries, and examines research gaps. The report concludes with a summary and discussion of policy implications as identified by the author.

POPULATION NEWS

Korea: Government to Spend 7 Trillion Won to Raise Birth Rate (news article)
The South Korean government will spend 7 trillion won (US$6.6 billion) over the next 3 years to counter a growing concern about the falling birth rate and the aging of society, officials said.


The Philippines: 6 Cities Face Grave Problems Due to Overpopulation (news article)
The Commission on Population (Popcom) has warned that six cities in the country face the danger of draining their resources with the huge growth in their respective population.

WOMEN'S HEALTH RESEARCH

ACCP Strategies for Supporting Women With Cervical Cancer: Cervical Cancer Prevention Issues in Depth #2 (report)
(You need Adobe Acrobat Reader to access this document)
This report provides an overview of current issues relating to cancer treatment in developing countries and descriptions support provided to cancer patients in countries where the Alliance for Cervical Cancer Prevention (ACCP) has worked. The report outlines recommendations, based on ACCP experiences, for the provision of basic assistance at the national or local level to women with cervical cancer, within the context of a prevention-based intervention in low-resource settings.


Women's Stories, Women's Lives: Experiences with Cervical Screening and Treatment (resource material)
(You need Adobe Acrobat Reader to access this document)
This publication is a collection of stories based on interviews with women in developing countries who participated in Alliance for Cervical Cancer Prevention programs. These women's stories illustrate the unnecessary suffering cervical cancer can cause women and their families and how prevention programs can save women's lives.


Sexuality & Arab Women (resource material)
This link will take you to the index page of the Fall 2002/2003 issue of AL-RAIDA, a special issue on "Sexuality & Arab Women". Articles are accessible as pdf files through a required and free registration screen. Articles include "Premarital female sexuality in Morocco", "Women, sexuality and social change in the Middle East and the Maghreb", and "The importance of genital mutilations to gender power politics".


Chlamydial Infection in Women Along the US-Mexico Border (research abstract)
This binational project investigated the prevalence of, and risk factors for, C. trachomatis among women along the Arizona, US-Sonora, Mexico border. In 2,270 women, C. trachomatis prevalence overall was 8.2% as measured by hybrid capture and 2.6% by enzyme immunoassay. Infection was associated with young age, a history of new sexual partner(s) in the previous three months, HPV infection, and proximity of clinic to the international border. Antibiotic use in the previous 30 days was associated with decreased odds of infection.

WOMEN'S HEALTH NEWS

Amnesty: Two-thirds of Liberians Suffered Sexual Violence During '99-'03 war (news article)
Some two-thirds of Liberia's population may have suffered sexual abuse during the west African nation's 1999-2003 civil war, with women and girls the main targets but men and boys also falling prey.


UK: 96% of Women are Liars, Honest (news article)
The results of a survey that questioned 5,000 women (average age 38) across Scotland, England, Wales, and Northern Ireland found that 42% would lie about contraception in order to get pregnant (no matter the wishes of their partner) and 31% said they would not tell a future partner if they had a sexual disease (65% among single women). Half of the women said that if they became pregnant by another man but wanted to stay with their partner, they would lie about the baby’s real father.


China: 90% Women Students Approve Premarital Sex: Survey (news article)
Nearly 90% of female postgraduates at an east China university said premarital sex is acceptable, according to a recent survey on the campus. The survey was carried out by the students' union of Xiamen University in east China's Fujian Province and covered 312 female postgraduates, all of whom are not married.

YOUTH HEALTH RESEARCH

"A Bit More Truthful": The Validity of Adolescent Sexual Behaviour Data Collected in Rural Northern Tanzania Using Five Methods (research abstract)
This study assesses the validity of sexual behavior data collected from African adolescents using five methods: biological marker and face to face questionnaire survey, assisted self-completion questionnaire survey, in-depth interviews and 56 person weeks of participant observation. 38% of males and 59% of females reporting sexual activity did so in only one of the two 1998 questionnaires. Biological markers in combination with in-depth interviews may be useful in identifying risk factors for STIs. Participant observation was the most useful method for understanding the nature, complexity, and extent of sexual behavior.


Consistency in the Reporting of Sexual Behaviour by Adolescent Girls in Kenya: A Comparison of Interviewing Methods (research abstract)
This analysis, based on a subsample of over 700 never married girls aged 15–21 years in Kisumu, Kenya, found that both the mode of survey administration and the probing for various behaviors significantly affect the observed prevalence of sexual activity.

YOUTH HEALTH NEWS

Pakistan: The Challenge of Integrating HIV/AIDS Awareness into the School Curriculum (news article)
HIV/AIDS awareness needs to be taught in the context of wider health education, according to practitioners in Pakistan.


Kenya: Shock as More Teenagers Become Infected with AIDS (news article)
Shocking revelations have emerged about the sexual behavior of children under 14 years in Nyanza Province. The number of such teenagers engaging in unprotected sex is alarming, according a recent study by Kenya Medical Research Institute (Kemri). At the same time, the study shows that the highest increase in the number of HIV/AIDS infection was among teenage girls aged between 16 and 17. The study reveals that up to 33% of children below 14 years have engaged in sex and most probably unprotected.


US: Teens Say Parents Most Influence Their Decisions About Sex (press release)
(You need Adobe Acrobat Reader to access this document)
Teens say their parents (37%) influence their decisions about sex more than friends (33%), the media (5%), or siblings (6%), according to a new nationally representative survey released today by the National Campaign to Prevent Teen Pregnancy. Adults, however, mistakenly believe that friends (47%) are more influential than parents (28%).

BOOKS/BOOK REVIEWS

Growing Up Global: The Changing Transitions to Adulthood in Developing Countries (book)
Related: news article: Study Finds Children Worldwide Taking More Time to Grow Up
This report finds that, compared to the situation 20 years ago, young people are entering adolescence in better health and reaching puberty earlier. They are also more likely to attend school, more likely to postpone entering the labor force, and more likely to delay marriage and childbearing. These broad statements, however, capture only the average tendencies for young people in developing countries. Despite dramatic progress in certain areas, many young people still lack adequate schooling and good health, both of which are essential for ensuring their productivity and well-being.

SPECIAL REPORTS/PROFILES/RESOURCES

Addressing the Needs of Women Affected by Armed Conflict: An ICRC Guidance Document (resource material)
This guidance document aims to provide an operational tool for ensuring that humanitarian programs and services adequately address women's needs. Designed for quick reference, the guidance document is divided into specific themes that can be consulted separately. These themes, which revolve around the needs of beneficiaries, include: personal safety, sexual violence, displacement, freedom of movement, food and essential household items, water, health religious and cultural practices and shelter.

---

Problems and comments can be addressed to rjacoby@jhuccp.org. Archives available at http://www.infoforhealth.org/popreporter/. Subscribe at http://prds.infoforhealth.org/signup.php. Modify your account at http://prds.infoforhealth.org/modify.php. Have an item to contribute for consideration in The Pop Reporter? E-mail the URL and description to rjacoby@jhuccp.org. Forward this message to a friend who could benefit from INFO project activities! Sincerely, Robert Jacoby, rjacoby@jhuccp.org Editor, The Pop Reporter

Disclaimer: The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development, the U.S. Government or The Johns Hopkins University.