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The Pop Reporter®

Volume 5, Number 5
31 January 2005

"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

Integrating Family Planning into VCT Services

By: Kerry Wright Aradhya, MS, ELS

kwright@fhi.org

As efforts begin to integrate family planning into HIV/AIDS services, voluntary counseling and testing (VCT) centers are emerging as primary targets for integration. Research from Africa and the Caribbean shows that such integration is feasible and acceptable, and large-scale integration efforts are being launched and expanded there.

VCT services have become one of the most common means of preventing, detecting, and improving access to care and support for HIV/AIDS. And VCT services are likely to greatly expand with support from the five-year U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which focuses on fighting the HIV/AIDS epidemic in 15 resource-poor countries, mostly in Africa and the Caribbean.

In terms of family planning, VCT centers offer a rare opportunity to reach many people with contraceptive needs who may not normally visit a family planning clinic. Women are the primary clients of family planning clinics, but VCT centers attract large numbers of women, men, and couples. At the centers, provision of or referral for contraceptive services can help prevent pregnancies among uninfected women who wish to postpone or space childbirth. And among HIV-infected women or women who may be at risk of infection, pregnancy prevention can ultimately help in the prevention of mother-to-child transmission of HIV. For male clients and couples, especially those whose HIV serostatus is discordant, counseling and provision of condoms alone or in combination with other, more effective contraceptives can provide dual protection against unintended pregnancy and HIV transmission.

Although international support for such integration is growing, the idea is still relatively new, and, generally, implementation is just beginning. In Kenya, for example, a large collaborative effort to develop and implement a national strategy to integrate family planning into VCT services is well under way.

Kenya is a promising setting for integration because its Ministry of Health (MOH) already has an ambitious program to expand VCT services and the government also recognizes the benefits of family planning. Formative research to identify opportunities and challenges for integration has also been influential. The MOH’s National AIDS and STD Control Programme (NASCOP) and Division of Reproductive Health, with technical assistance from Family Health International (who is helping facilitate the integration process) and partners, gathered information from 20 VCT centers throughout Kenya in 2002 (1). Data suggested that integration was acceptable but that only some of the centers were ready to implement it. The researchers concluded that decisions on whether and how much to integrate need to be made at the facility level—a finding that later became the basis of the national integration strategy.

This strategy—developed by a task force of VCT and family planning experts and already approved by the MOH and beginning to be implemented—identifies four potential levels of integration. It recommends that all VCT centers achieve at least the first level, which includes, in addition to the traditional VCT services, the provision of basic pregnancy risk assessment and counseling services and the availability of contraceptive pills and condoms on-site. Family planning services provided and the requirements needed to provide them increase with each level. The fourth level, in which all contraceptive methods are available on-site, is viewed as a long-term goal because it would require enormous additional resources for most centers (2).

In general, whether integration of services has a measurable impact on improving reproductive health remains unknown, and research to generate clear evidence of benefits is greatly needed. But the potential for positive impact of offering family planning services to VCT clients has been demonstrated in a VCT center in Port-au-Prince, Haiti.

The VCT center was established in 1985 by Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), a nongovernmental organization that works with the Haitian MOH to provide free HIV services. The center gradually integrated other services, such as care for AIDS and tuberculosis patients and management of sexually transmitted infections (STIs). And, in 1993, it finally added family planning services.

Data from an evaluation of the experiences of the VCT center from 1985 to 2000 showed that demand for services, in general, increased substantially and that the percentages of reproductive-age women, adolescents, symptom-free clients, and self-referred clients attending the center also increased after integration began (3). A separate study conducted from 1999 to 2001 showed that after an additional intervention to introduce family planning services into the STI and HIV clinic within GHESKIO, 16% of some 3,000 HIV-infected women attending the clinic began using contraceptives (4).

As in Kenya, efforts to integrate services in Haiti have enjoyed the support of the government, whose involvement in the outcome of integration activities can build consensus, ownership, and acceptance of the integration process. The MOH is working with GHESKIO and partners to increase the number of sites that offer VCT and integrated services. With assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria and from PEPFAR, they established 20 new centers throughout Haiti in 2003 and have continued to create more.

Ms. Aradhya is a senior science writer and editor, specializing in reproductive health issues, at Family Health International.

Reprinted in revised format from “Network,” Volume 23, Number 3, 2004, courtesy of Family Health International.
References:

1. Reynolds HW, Liku J, Maggwa BN, et al. Assessment of Voluntary Counseling and Testing Centers in Kenya. Potential Demand, Acceptability, Readiness, and Feasibility of Integrating Family Planning Services into VCT. Research Triangle Park, NC: Family Health International, 2003.

2. Kenya Ministry of Health. Strategy for the Integration of HIV Voluntary Counseling and Testing Services and Family Planning Services. Nairobi, Kenya: National AIDS and STD Control Program and Division of Reproductive Health, 2004.

3. Peck R, Fitzerald DW, Liautaud B, et al. The feasibility, demand, and effect of integrating primary care services with HIV voluntary counseling and testing. Evaluation of a 15-year experience in Haiti, 1985-2000. J Acquir Immune Defic Syndr 2003;33(4):470-75.

4. Deschamps MM, GrandPierre R, Verdier RI, et al. Interventions to integrate HIV counseling testing and family planning (FP) and treatment to prevent mother to child transmission. Abstract: THPeD7653. XIV International AIDS Conference, Barcelona, Spain, July 7-12, 2002.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Towards an Understanding of Barriers to Condom Use in Rural Benin Using the Health Belief Model: A Cross Sectional Survey (research article)
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This study identifies barriers to condom use based on the Health Belief Model (HBM) in Benin, West Africa. The study was a cross-sectional survey conducted from June to July 2002. In spite of satisfactory knowledge on HIV/AIDS transmission, participants are still at high risk of contracting the infection; 63% of the interviewees reported being able to recognize infected people, and condom use during the last occasional intercourse was declared by only 36.8% of males and 47.5% of females. Based on the HBM, failure to use a condom was related to its perceived lack of efficacy and perceived quality.


Predictors of Diaphragm Use as a Potential Sexually Transmitted Disease/HIV Prevention Method in Zimbabwe (research abstract)
This study assessed diaphragm uptake and use over time in Zimbabwe and identified factors associated with self-reported consistent diaphragm use. Consistent diaphragm use was reported by 13% to 16% of the women, and in multivariate regression analysis, it was significantly associated with never using condoms. Other factors included discreet use, preferring diaphragms to condoms, timing of insertion, domestic violence, and contraception. Diaphragms were well accepted among women at risk for STDs/HIV.


Female Condom and Male Condom Failure Among Women at High Risk of Sexually Transmitted Diseases (research abstract)
This study examined the frequency and determinants of breakage and slippage during female and male condom use.
A 6-month prospective follow-up study of women attending 2 STD clinics was conducted. Breakage was less common for female condoms (0.1%) than for male condoms (3.1%). Slippage was more common for female condoms (5.6%) than for male condoms (1.1%). Rates significantly decreased with use and increased with number of previous failures.


Cost-Effectiveness and Contraceptive Effectiveness of the Transdermal Contraceptive Patch (research abstract)
This study examined implications of increased perfect use on the cost-effectiveness of the contraceptive patch compared with combination oral contraceptives (COCs). This study compared the patch with low-estrogen-dose COCs. It assumes that the risks of developing a medical condition during use are the same for both the patch and COCs. Differences in net cost and pregnancies avoided during use were modeled. With the use of a pharmacoeconomic model, both methods were compared with a hypothetical reference case of contraception nonuse. The base-case analysis showed that use of the patch resulted in a savings of $249 and 0.03 pregnancies per woman over 2 years compared with COCs.


Effectiveness of Syphilis Treatment Using Azithromycin and/or Benzathine Penicillin in Rakai, Uganda (news article)
This study assessed azithromycin and/or benzathine penicillin for treatment of syphilis in Uganda. Among 952 cases with syphilis, 18% received penicillin alone, 17% azithromycin only, and 65% dual treatment. The overall cure rate was 61%. Cure rates were lower in males compared with females. There was no significant differences in cure rates among HIV-positive and HIV-negative persons. Azithromycin alone or in combination with penicillin achieved higher cure rates than penicillin alone. In low-titer infections, the three drug combinations were equally effective.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Philippines: DOH Says No to Condoms in Population Control Drive (news article)
Health officials in this mostly Roman Catholic country say they will not endorse the use of condoms to stem the country’s galloping population growth.


Uganda: Rakai Condom Use Reaches 66% (news article)
The number of people using condoms in this Ugandan district had risen to 66% from 2% in 1992.


Egyptian Paternity Suit Ignites National Scandal (news article)
The standard three-step program for any unmarried
upper-class Egyptian girl who becomes pregnant is an abortion, an operation to refurbish her virginity with a new hymen and then marriage to the first unwitting suitor the family can snare. But Hind el-Hinnawy, a vivacious 27-year-old costume designer, decided she was not going to playact her way through the virgin-marriage pageant. Instead she did the unthinkable here: she had the child and then filed a public paternity suit, igniting a major scandal and prompting a national debate over the clandestine marriage contracts that young couples are using to have sex in this conservative, religious society.

HIV/AIDS RESEARCH

Human Herpesvirus 8 (HHV-8) Infection in HIV/AIDS Patients from Santos, Brazil: Seroprevalence and Associated Factors (research abstract)
The study evaluated the seroprevalence of human herpesvirus 8 (HHV-8) infection among HIV-infected individuals at a AIDS Reference center in Santos, Brazil and the associated risk factors. Overall HHV-8 seroprevalence was 13.9%. HHV-8 coinfection was significantly more frequent in men (18.7%) than in women (7.8%). It was significantly higher in men who have sex with men when compared with the other groups and it was independently associated with sexual orientation. No significant risk factor for HHV-8 infection could be demonstrated for HIV-infected women in this cohort.


HIV Disease Progression in a Patient Cohort Treated Via a Clinical Research Network in a Resource Limited Setting (research abstract)
This study examined HIV disease progression in a cohort of adult patients treated with antiretroviral therapy (ART) via a clinical research network in Thailand. During 1677 person years of follow-up, 29 of 417 patients progressed; tuberculosis was the most common event defining progression. The rates of progression to combined endpoint or death alone were 1.7 and 0.7 per 10 person years respectively. HIV-infected patients who had access to ART, appropriate care, CD4 cell and viral load monitoring facilities via a clinical research network had progression rates comparable to those in developed countries.


Identifying Deaths from AIDS in South Africa (research abstract)
This study quantifed the HIV/AIDS deaths misclassified to AIDS-related conditions in South Africa through retrospective analysis of vital registration data. The increase in the age-specific death rates for HIV-related deaths showed a distinct age pattern. Out of the 22 potential causes of death investigated, there were nine that increased in the same distinct age pattern and could be considered AIDS-related conditions. These conditions accounted for 61% of the total deaths related to HIV/AIDS. When added to the deaths classified as HIV-related on the death certificate, the total accounts for 93% of estimates of the number of AIDS deaths in 2000.


The TREAT Asia HIV Observational Database: Baseline and Retrospective Data (research abstract)
Relatively little is known regarding HIV disease natural history and response to antiretroviral treatments among Asian people infected with HIV. The Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) is a recently established collaborative observational cohort study that aims to assess HIV disease natural history in treated and untreated patients in the Asia-Pacific region. Analyses of retrospective data in the TAHOD suggest that the overall response to HAART in Asian populations is similar to that seen in Western countries.


Predictors of HIV Serostatus among HIV Discordant Couples in Lusaka, Zambia and Female Antenatal Clinic Attendants in Kigali, Rwanda (research abstract)
Researchers conducted a cross-sectional study to define predictors of HIV status and assess their differences by gender and country in two African cohorts: 1,351 heterosexual couples recruited from a voluntary HIV counseling and testing center in Lusaka, Zambia, and 1,458 women recruited from antenatal and pediatric clinics in Kigali, Rwanda. HIV-positive Zambian men and women differed most with respect to prevalence of wasting syndrome (48.1% vs. 35.5%). Zambian women were more likely to have a disseminated adenopathy than Rwandan women (33.2% vs. 7.8%) and had a much higher median erythrocyte sedimentation rate (ESR) than either of the two other groups (78 mm/hr vs. 47 mm/hr, p less than 0.01). A history of tuberculosis adenopathy on examination, and an ESR of more than 65 mm/hr, were strongly predictive of HIV status in all groups.


Knowledge of Men and Women about Reproductive Tract Infections and AIDS in a Rural Area of North India: Impact of a Community-Based Intervention (PubMed abstract)
This study of a community-level health-education intervention on reproductive tract infections (RTIs)/STDs was conducted in three villages of Haryana in north India. The study was aimed at increasing awareness among men and women of reproductive age about the prevention and treatment of RTIs, modes of HIV/AIDS transmission, and methods of prevention. Results revealed that there was an improvement in the median total knowledge score of women from 0 to 6, whereas it remained at 5 for men both at baseline and follow-up. Knowledge about RTI/STIs increased among both groups from 0 to 2 and from 0 to 3, respectively. The median knowledge score on HIV/AIDS declined among men from 4 to 2 but increased from 0 to 3 among women. Clinic attendance for RTI/STI cases showed an eight-fold rise.


Incidence and Risk Factors for Rash in Thai Patients Randomized to Regimens with Nevirapine, Efavirenz or Both Drugs (research abstract)
This study examined the incidence and risk factors for rash in Thai patients taking four different non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. Of 202 patients, 47% and 34.2% developed a rash from all reasons and from NNRTI, respectively. Thai patients had a high incidence of NNRTI-related rash when treated with NVP + EFV or NVP once daily. NVP if used twice daily had the same rash incidence as EFV for rash of all grades. Females, and persons with earlier HIV disease or with a large rise in CD4+ cell count after starting therapy are at greater risk for NNRTI-related rash.

HIV/AIDS NEWS

Study Finds Some African-Americans Avoid Condoms Due to Conspiracy Beliefs (news article)
Related: press release: Study by Rand and Oregon State University Finds Conspiracy Beliefs among African Americans Deter Condom Use
Related: research abstract: Are HIV/AIDS Conspiracy Beliefs a Barrier to HIV Prevention Among African Americans?
Researchers conducted a national telephone survey of a scientifically selected random sample of 500 African-Americans, ages 15-44, from around the United States. Those surveyed were asked a series of questions about whether they agreed or disagreed with specific HIV/AIDS myths. More men than women believe in the conspiracy theories, the study found. The survey also found that about 59% agreed with the statement that "a lot of information about AIDS is being held back from the public"; 53% agreed that "there is a cure for AIDS, but it is being withheld from the poor"; nearly 27% agreed that "AIDS was produced in a government laboratory"; about 16% agreed that AIDS was created by the government to control the black population; and about 15% agreed that AIDS is a form of genocide against African-Americans.


Chirac Calls for Global Tax to Fight AIDS (news article)
French President Jacques Chirac called for a tax to finance the global fight against AIDS, as new figures showed a modest rise in the number of patients receiving life-saving drugs in poor nations.


FDA Public Health Advisory for Nevirapine (Viramune) (resource material)
This public health advisory informs health care providers and patients about recent safety-related changes to the nevirapine (Viramune) label (package insert) and about appropriate use of HIV triple combination therapy containing nevirapine, which is one treatment option in the United States and which is increasingly being used globally.


'Morning After' Treatment Advised to Prevent AIDS (news article)
A "morning after" treatment for the AIDS virus can help prevent infection after a rape, contact with a contaminated needle or even a night of passion without a condom, U.S. health officials have said.


Nepal: Focus on the Plight of Rural People Living with HIV/AIDS (news article)
A large number of people living with HIV/AIDS in Nepal are unable to buy food or basic medicine. Their situation is becoming more desperate as many NGOs based in the capital, Kathmandu, are withdrawing their HIV/AIDS support programs from villages due to fear of the Maoist insurgents who have been waging an increasingly vicious armed rebellion for the last nine years.


Condom Shortage, Thailand Warned of AIDS Spread (news article)
The UN has warned that the HIV/AIDS virus may quickly spread across Thailand's tsunami-affected coastline due to increasing prostitution and condom shortage.


Poor Countries Left Behind on AIDS Treatment (news article)
The number of AIDS sufferers in the developing world receiving drug treatment has nearly doubled over the past year but some poor countries need sharply to increase their efforts, according to official agencies involved in combating the disease.


Ethiopa: New Strategy Launched to Combat HIV/AIDS (news article)
Ethiopia is beginning to turn the tide in the war against HIV/AIDS, but the virus is still devastating the country.


Nigeria: MSF to Expand HIV/AIDS Treatment Scheme (news article)
Medecins Sans Frontieres (MSF) has said it planned to sharply increase the number of people living with HIV/AIDS who receive comprehensive treatment and counselling for free in Lagos, Nigeria's largest city.


AIDS Among Infants Close To Being Wiped Out In US (news article)
AIDS among infants is close to being eliminated in the United States, according to public health officials. A report in the New York Times says about 2,000 babies born in 1990 were infected with HIV, the virus responsible for AIDS. However, now, the report says, that number has been reduced to just over 200.

MATERNAL AND CHILD HEALTH RESEARCH

Evaluating Programs to Prevent Mother-to-Child HIV Transmission in Two Large Bangkok Hospitals, 1999-2001 (research abstract)
The two largest maternity hospitals in Bangkok implemented comprehensive programs to prevent mother-to-child HIV transmission in 1998. Medical records of women and their newborns were reviewed. The HIV diagnosis was first known before pregnancy for 61 (13%) women, during pregnancy for 357 (73%) women, during labor for 22 (5%) women, and shortly after delivery for 48 (10%) women. Antenatal zidovudine (ZDV) was used by 347 (71%) women, and intrapartum ZDV was used by 372 (76%) women. Although uptake of services was high, inconsistent antenatal care, fear of stigmatization, and difficulty in disclosing HIV status prevented some women from using services.


Free Does Not Mean Affordable: Maternity Patient Expenditures in a Public Hospital in Bangladesh (research article)
(You need Adobe Acrobat Reader to access this document)
This study investigated a) the amount and types of out-of-pocket expenditures by patients for nominally free services in a large public hospital in Bangladesh, b) the factors influencing these expenses, and c) the impact of these expenses on household income. All interviewees incurred substantial out-of-pocket expenditures. The median total per-patient expenditure was equivalent to 7% of annual household income. Half of all patients reported that their families had to borrow to pay for care at interest rates of 5%-30% per month. A third of these families reported selling jewelry, land, or household items to moneylenders. The rural patients reported more difficulty in paying for care than the urban patients.


Mixed Success Involving Men in Maternal Care Worldwide (report)
In most locales around the world, men are little involved in their partners’ health care during pregnancy. Research has shown, however, that women would like their partners to be more involved and that, in many cases, men are interested in being involved. The Population Council’s Frontiers in Reproductive Health program conducted two “Men in Maternity” studies in disparate settings—one in India and the other in South Africa—to engage male partners in health services during the antenatal and postpartum periods. This brief reports on the findings.


Maternal Health Education Needed in Pakistan (report)
In July and August 2000, researchers conducted five focus-group discussions and in-depth interviews on maternal health in Pakistan. Women in the focus-group discussions and those who were interviewed were young and older postpartum mothers, those who had many children and those who had only one, and trained and untrained traditional birth attendants. From August to November 2000, the researchers also conducted a survey among 525 Muslim women who were 6 to 8 weeks postpartum in five impoverished settlements in Karachi, Pakistan. The findings of this research are reported in this population brief from the Population Council.

MATERNAL AND CHILD HEALTH NEWS

Tajikistan: Infant Mortality on the Rise in North (news article)
The infant mortality rate is going up in northern Tajikistan, health officials say, citing poor socioeconomic conditions in the country.

MEN'S HEALTH RESEARCH

Young Men and HIV Prevention (report)
(You need Adobe Acrobat Reader to access this document)
The December 2004 Horizons Report, the biannual newsletter of the Horizons Program, focuses on young men and HIV prevention, and includes findings from operations research on gender-based approaches in Brazil, India, and Tanzania.


Homosexuality and HIV/AIDS Prevention: The Challenge of Transferring Lessons Learned from Western Europe to Central and Eastern European Countries (research abstract)
This study examines the rapidly growing HIV/AIDS epidemics in Eastern Europe and the potential transfer of prevention know-how and experience from Western European countries. These include similarities regarding sexual attitudes and HIV prevention needs. In terms of practice, the successes of instituting country-level structures while also working within the gay community are to be emphasized. Shortcomings are evident in terms of reaching men of lower socio-economic status, cultural minorities, and sex workers.

MEN'S HEALTH NEWS

New Zealand: Sly DNA Tests Show 1 in 3 Dads Duped (news article)
Hundreds of Kiwi men are paying out almost $900 for secret tests in Australia to determine whether they are really a dad. And the company which runs the tests says that in one in three cases, the man finds he's been duped.

POPULATION RESEARCH

World Fertility Report 2003 (news article)
Related: news article: Developing World Births 'Falling'
Women in the developing world now give birth to fewer than four children on average, according to a major United Nations study on fertility. The average number of births has fallen from 5.9 children in the 1970s to 3.9 in the 1990s, it says. In 20 countries, births have now fallen beneath the number needed to maintain current population levels. The UN Population Division's World Fertility Report says improved contraception is behind the fall.

POPULATION NEWS

Poor Health, Murders Fuel Russia Population Crisis (news article)
A tiny birthrate, alcoholism, smoking, and lethal violence meant the number of Russians who died in 2004 outstripped the number born at a pace that could spell disaster for the future of the world's biggest country.

WOMEN'S HEALTH RESEARCH

Visual Inspection with Acetic Acid for Cervical Cancer Screening Outside of Low-resource Settings (research article)
(You need Adobe Acrobat Reader to access this document)
Related: news article: Wider Use of Simpler Cervical Cancer Screening Could Benefit Women in Developing Countries
An easy, inexpensive method using ordinary vinegar in screening women for cervical cancer could be applied in more situations in developing countries around the world, thus increasing the number of women whose disease is caught early and treated.


The Appropriateness of Core Group Interventions Using Presumptive Periodic Treatment Among Rural Zimbabwean Women Who Exchange Sex for Gifts or Money (research abstract)
This study maps the characteristics of rural based sex workers in Zimbabwe with regard to demographics, mobility, behavior, HIV and STI prevalence, to explore the appropriateness and feasibility of presumptive periodic treatment (PPT) for bacterial STIs as an HIV prevention intervention among these women, and to compare tolerability of two PPT regimens. Women were randomly assigned to receive a single dose of one of two PPT regimens and then followed to assess rates of side effects and reinfection. The overall prevalence of antibody to HIV was 55.7% and that of HSV-2 was 80.8%. The prevalence of bacterial STIs was low, suggesting that PPT may not be an appropriate intervention in this setting.


Cunnilingus and Vaginal Intercourse Are Risk Factors for Herpes Simplex Virus Type 1 Acquisition in Women (research abstract)
This study identified demographic and behavioral variables in women associated with the prevalence and acquisition of HSV-1. At enrollment, HSV-1 serum antibodies were detected in only 38% of women less than or equal to 20 years of age. In longitudinal analyses, women who had vaginal intercourse were more likely than sexually inactive women to acquire HSV-1. Similarly, women who only had receptive oral sex, without vaginal intercourse, were also more likely than sexually inactive women to acquire HSV-1.


Sexually Transmitted Infections Among Brothel-Based Sex Workers in Bangladesh: High Prevalence of Asymptomatic Infection (research abstract)
This study determined the prevalence of STIs/reproductive tract infections (RTIs) among brothel-based sex workers (SWs) in Bangladesh. A total of 439 SWs were enrolled and 49.6% had genital symptoms. Among all SWs, 17.5% were positive for N. gonorrhea; 15.5% for C. trachomatis; 7.5% for T. vaginalis, and 6.6% had active syphilis. A total of 67.4% SWs were positive for at least one cervical and/or vaginal infection.

WOMEN'S HEALTH NEWS

400,000 Nigerian Women Suffer VVF Disease (news article)
United Nations Population Fund (UNFPA) has said that more than 400,000 women in the country are infected by the pregnancy-related ailment Vesico Vaginal Fistula (VVF).


Abused, Poor Women often Shun Marriage (news article)
Poor women who experience sexual or physical abuse, especially during childhood, often find it difficult to marry or form long-term relationships with men.


Cameroon: Clinical Trial of Anti-HIV Drug on Sex Workers in Question (news article)
The government of Cameroon has said it may stop the clinical trial of an anti-AIDS drug being tested on 400 sex workers in the port city of Douala following allegations that the women are receiving inadequate counselling and medical care.


Africa: Gender-Based Violence Continues to Plague Conflict Zones (news article)
Human rights violations against women and children will continue to increase, particularly in conflict-ridden areas of Africa, unless the international community steps up its efforts to combat gender-based violence (GBV), according to UN officials.


Uganda: Hope After Fistula (news article)
Thousands of women countrywide live as social outcasts with untreated fistula. Yet more than 90% of VVF are preventable and treatable.

YOUTH HEALTH RESEARCH

Treating Opportunistic Infections Among HIV-Exposed and Infected Children: Recommendations from CDC, the National Institutes of Health, and the Infectious Diseases Society of America (report)
This report released by the Centers for Disease Control, the National Institutes of Health, and the Infectious Diseases Society of America provides guidelines for the proper evaluation and treatment of HIV-related opportunistic infections in youth.


Estimating the Net Effect of HIV on Child Mortality in African Populations Affected by Generalized HIV Epidemics (research abstract)
Researchers developed a mathematic procedure to estimate the mortality of infected children from indirect data sources and obtained net HIV mortality patterns for each study population in Africa. The fitted curve that would be expected if HIV were the only effective cause of death shows 67% net survival at 1 year and 39% at 5 years. The curve also predicts 13% net survival at 10 years using constraints based on survival of infected adults.


Discord, Discordance, and Concurrency: Comparing Individual and Partnership-Level Analyses of New Partnerships of Young Adults at Risk of Sexually Transmitted Infections (research abstract)
This study examined if STI risk within partnerships is associated with discordance and concurrency using the partnership as the unit of analysis. 192 individuals, in 96 new partnerships, underwent a computer-assisted interview; were tested for chlamydia, gonorrhea, and trichomonas; and their medical records were reviewed. STI was detected in 22% of partnerships; discordance for demographics or relationship commitment was reported in 40% to 50%; and partner concurrency in 26%. Discordance and concurrency are associated with STI at the partnership level and may reflect bridging between high- and low-risk STI networks.


Nutritional Status and Birth Outcomes of Adolescent Pregnant Girls in Morogoro, Coast, and Dar es Salaam Regions, Tanzania (PubMed abstract)
This study examined the nutritional status and birth outcomes of pregnant adolescent girls from rural and urban areas of three regions in Tanzania. Pregnant adolescent girls (n=180) ages 15 to 19 years were recruited and interviewed, and their nutritional status measurements were taken. The height of about 54% of the subjects was shorter than 151 cm, suggestive of short maternal height. Severe wasting was observed in 27% of subjects. No significant differences were observed between rural and urban settings. About 48% of infants had low birth weight (less than 2500 g) and only 14% of infants had birth weight greater than 3000 g. The nutritional status of pregnant adolescent girls in the study areas was poor and resulted in poor pregnancy outcome.

YOUTH HEALTH NEWS

Botswana: Raising Youth AIDS Awareness Like 'Trying to Fight a Dead Animal' (news article)
Young people are swimming in a pool of information, but none of this automatically translates into behavior change in the fight against HIV/AIDS.


Kenya: Maasai Girls Are Not Yet Out of the Woods (news article)
Three years of Kenyan law enforcement and aggressive campaigns have produced a formidable resistance in rebels, determined to preserve female genital cutting practices. To cheat the law and escape the curiosity of activists, they now cut girls at a much younger age and have done away with the elaborate ceremonies that traditionally went with the rite.


Ghana: Young Women Refuse to Use Female Condoms (news article)
Young women in the East Akim District are not using female condoms because they say the condoms are just too big, according to the East Akim district co-ordinator of the National Youth Council, speaking at the 2004 Performance Review Meeting of the district health directorate at Kyebi.

BOOKS/BOOK REVIEWS

Childbearing Trends and Prospects in Low-Fertility Countries (book)
This book argues that low fertility, one of the critical issues in the contemporary world, will persist in the foreseeable future. The present study applies the cohort analysis approach to detailed data covering over half of the 20th century for populations of 35 countries. In distinction to most previous studies, that approach is put to use not only for elucidating past trends, but also to capture salient aspects of contemporary fertility patterns. And, beyond that, it is utilized to suggest possible near-term future trends in fertility behavior.

SPECIAL REPORTS/PROFILES/RESOURCES

"3 by 5" Progress Report, December 2004 (news article)
Related: news article: WHO's '3 by 5' Plan Gains Momentum
Related: news article: 700,000 AIDS Patients Get Drugs, Funds Short -- UN
On World AIDS Day 2003, WHO and UNAIDS set an ambitious target that 3 million people living with HIV/AIDS in developing and transitional countries would be receiving antiretroviral therapy by 2005. This report reflects the progress made by the end of 2004 as well as continuing challenges for the future.


Global Health Atlas (an Interactive World Map) (resource material)
The Global Health Atlas is an interactive world map where you decide what indicators for a particular country you would like to display. For example, in the health category, you can find out the child mortality rate under five, the number of teenage pregnancies, how many doctors are in a country, number of malaria and tuberculosis cases, etc.

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