Volume 6, Number 15
17 April 2006

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Guest Editorials (free with every subscription)

SAVE: Christian Aid's New Strategy to Fight AIDS

Author: Rachel Baggaley, MD

rbaggaley@christian-aid.org

Christian Aid (CA) (www.christian-aid.org.uk/) has been aware for some time of limitations implicit in the ABC approach (Abstain from sexual activity, Be faithful, and Condom use) to combating HIV. Some messages used to slow the spread of HIV have had the unfortunate consequence of adding to the stigma surrounding it. ABC is sometimes one such message.

In a recent conference of CA HIV partner organizations from around the world, the degree to which these problems are a real barrier to our partners’ work, in high- and low-prevalence settings, became apparent. As a result, CA has adopted a new doctrine as the basis for a comprehensive approach to HIV: SAVE. SAVE, originally developed by CA partner ANERELA+ (the African Network of Religious Leaders Living with or personally affected by HIV and AIDS – www.anerela.org), is an acronym for:

• Safer practices
• Available medications
• Voluntary counselling and testing
• Empowerment.

HIV is a virus, not a moral issue. The response to HIV must be based on public health measures and human rights principles. ABC as a theory is not well-suited to the complexities of human life. If you or your partner have tested positive for HIV and still have unprotected sexual intercourse, then this puts the other person at risk of HIV infection. While abstinence may be appropriate at some stages of life, faithfulness is for many people the preferred choice. Unfortunately, it is not a guarantee against infection. ANERELA+ reports that approximately 60% of HIV-positive African women believed they were in a monogamous, faithful relationship.

According to the definitions of ABC, the use of a condom automatically puts a person in the category of one who cannot be faithful or does not want to abstain. This can fuel stigma, and precludes safer sexual practices.

Many faith-based organizations use HIV as a way to reinforce traditional views of sex and sin. CA’s faith-based partners believe that religious organizations can best protect people from HIV, and help those living with it, by extending Christian values of care and support and promoting safer lifestyles.

Following the launch of our SAVE document, we have had many responses from partners, staff, CA supporters, and the general public. Although the majority have been positive, a minority thought that, by adopting SAVE, we had somehow "abandoned" abstinence. It's important to be very clear here; the adoption of SAVE does not imply the abandonment of abstinence. The "S", for "safer practices", includes abstinence as a very important option alongside a wide range of evidence-based HIV prevention interventions.

Additionally, HIV prevention cannot be effective without a care component. The SAVE model combines prevention and care components, as well as providing messages to counter stigma:

"S" refers to safer practices covering all the different modes of HIV transmission. For example: safe blood transfusions; barrier methods for penetrative sexual intercourse; and sterile needles for injecting. Abstinence remains the most reliable method of avoiding exposure to sexually transmitted infections, but it must not be taught in isolation.

"A" refers to available medications. Antiretroviral therapy (ART) is by no means the only medical intervention needed by people living with AIDS (PLHAs). Long before it may be necessary, or desirable, for a person to commence ART, some HIV-associated infections will have to be treated. Treatment of these infections results in better quality of life, better health, and longer term survival. Every person needs adequate nutrition and clean water, and this is doubly true for PLHAs.

"V" refers to voluntary counselling and testing. Individuals who know their HIV status are in a better position to protect themselves from infection, and – if they are HIV-positive – from infecting others.

"E" refers to empowerment. It is not possible to make informed decisions about any aspect of HIV or sexual behavior without access to all the relevant facts on "S", "A", and "V". Inaccurate information and ignorance are two of the greatest factors driving HIV-related stigma and discrimination. Education also includes information on good nutrition, stress management, and the need for physical exercise.

Correct, non-judgmental information must be disseminated to all. This can only assist people to live positively – whatever their HIV status – and help to break down the barriers that HIV has erected between people and within communities. After all, we must not forget that HIV is just a virus; stigma has no place in an urgent matter of public health.

Dr. Rachel Baggaley is Head of HIV Unit, Christian Aid, UK.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Ultramodern contraception: social class and family planning in India
(Abstract; subscription needed for full text; Asia)
Asian Population Studies. 2005 Nov;1(3):303-323.
Basu AM
Contraceptive use differentials in India suggest that in fact it is the most 'modern' women (those with a college education and living in urban areas) who are the most likely to use "traditional methods" of birth control and to use them very efficiently. This paper locates a counter-intuitive preference among urban, educated women in what may be called ‘ultramodern’ attitudes to the body and to modern medicine and tries to situate such modernization in the contemporary developmental paradigm. The paper also implies that population policy and contraceptive research may be unduly attributing contraceptive ineffectiveness to the users of traditional birth control today.

Strategies to improve adherence and acceptability of hormonal methods for contraception
(Abstract; subscription needed for full text; Global)
The Cochrane Database of Systematic Reviews. 2006;(1)(Art. No. CD004317)
Halpern V | Grimes DA | Lopez L | Gallo MF
The intent of this review was to determine if enhanced counseling improved adherence to, and continuation of, hormonal methods of contraception. Randomized controlled trials were examined for ways to help women use hormonal contraceptives. Quality varied among the six trials found. Some studies had small numbers of participants and several had high losses to follow-up. Only one trial of structured counseling found a significant benefit. Women who received repeated, structured information were more likely to continue with an injectable contraceptive one year later than the women who had routine counseling. Also, the women who had structured counselling were less likely to stop using the contraceptive due to menstrual changes.

Combination contraceptives: effects on weight
(Abstract; subscription needed for full text; Global)
The Cochrane Database of Systematic Reviews. 2006;(1)(Art. No.: CD003987)
Gallo MF | Lopez LM | Grimes DA | Schulz KF | Helmerhorst FM
This review examined trials of contraceptive pills or patches where the woman's weight was measured. In these trials, women using either the pill or the patch did not gain weight, and women were not more likely to stop using the contraceptive because of weight gain. The evidence was not strong enough to be sure that hormonal contraceptives do not cause some weight gain, but no major effect on weight was found.

Continuing communicable disease burden in Eritrea
(Abstract; Sub-Saharan Africa)
South African Medical Journal. 2006 Mar;96(3):221-224.
Mufunda J | Nyarango P | Kosia A | Ogbamariam A | Mebrahtu G | Usman A | Gebresillosie S | Goitom S | Araya E | Andemichael G | Gebremichael A
This retrospective study of the national health profile of Eritreans focused on acute respiratory tract infection (ARTI), tuberculosis (TB), diarrhoea, STDs, and HIV/AIDS. The disease burden from TB and STDs declined over the 6-year study period.

Prevalence of usage of different contraceptive methods in East Delhi-a cross sectional study
(Research Article; Asia)
(You need Adobe Acrobat Reader to access this document)
Indian Journal of Community Medicine. 2005 Apr;30(2):53-55.
Bhasin SK | Pant M | Metha M | Kumar S
Of 764 eligible couples from 250 families each in 4 neighborhoods in East Delhi, 75% were "ever users" of any contraceptive method and 59.8% were currently using any contraceptive method. Condom was the most common method (33.4%), followed by tubectomy (27.3%), oral pills (16.6%), and intrauterine device (15.7%). Awareness about contraceptive methods was very high (more than 90%) in all the groups. Eighty percent of the subjects approved of contraceptive methods. Amongst the subjects who were not using contraceptives, the most common reason for not doing so was the desire for more children (36.4%).

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Pakistan: Hijras caught in no man's land between two genders
(Feature Article; Asia)
12 Apr 2006
Integrated Regional Information Networks
The hijras, or transgender people as they are sometimes known, occupy an unusual position within South Asian society. They are considered social outcasts, existing in a strange, no man's land. This feature article focuses on Vision Pakistan, the first organization to take up the issue of male sex workers, using HIV/AIDS as the route.

Women urged to use extra protection
(News Article; Oceania)
11 Apr 2006
AAP
A new program launched in Sydney by Sexual Health and Family Planning Australia is called It Takes 2 to Tango and advises women to use both the contraceptive pill and condoms. The campaign is targeted at 16-25 year olds, who are at the highest risk of STDs and unplanned pregnancies.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Egypt: New paternity law stipulating DNA testing proposed
(News Article; North Africa)
13 Apr 2006
Integrated Regional Information Networks
Egypt's parliament is currently discussing a new law that would make DNA tests mandatory in paternity cases, in large part due to the recent case of a a high-profile paternity case a woman brought in 2004 against a famous actor.

RU486 available 'within months'
(News Article; Oceania)
13 Apr 2006
AAP
After an emotion-fuelled debate earlier this year, Australian parliament decided in a rare conscience vote to strip Health Minister Tony Abbott of his power to ban the drug. The vote handed control over the controversial pill to the Therapeutic Goods Administration (TGA). The TGA granted Cairns-based doctor Caroline de Costa and her colleague approval to prescribe RU486, paving the way for the drug to be used by patients within a few months.

Parent trap? Litigation explodes over paternity fraud
(News Article; Global | North America)
10 Apr 2006
The National Law Journal
According to this article in The National Law Journal, paternity fraud is rampant in the United States, triggering legislation and legal challenges in more than a dozen states. According to a recent study in New Hampshire, as many as 30% of those paying child support are not the biological fathers of the children being supported.

HIV/AIDS RESEARCH

Prevalence and correlates of human immunodeficiency virus infection among female sex workers in Tashkent, Uzbekistan
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Diseases. Online access April 4, 2006.
Todd CS | Khakimov MM | Alibayeva G | Abdullaeva M | Giyasova GM | Saad MD | Botros BA | Bautista CT | Sanchez JL | Carr JK | Earhart K
Women participating in this cross-sectional study completed a questionnaire and HIV testing between April 2003 and March 2004. Of 448 women, 10% (45) were HIV infected, which was associated with ever injecting drugs, street-based sex work, exchanging sex for drugs, and more STI treatments in the preceding 3 months.

HIV frequency among female sex workers in Imbituba, Santa Catarina, Brazil
(Research Article; South America)
Brazilian Journal of Infectious Diseases. 2005 Dec;9(6):500-505.
Trevisol FS | da Silva MV
examined HIV frequency and probable risk factors among female sex workers (n=90) in the port city of Imbituba, Southern Brazil. Six (6.7%) of the sex workers were HIV-positive; risk factors of significance were the daily number of clients, the use of inhaled illicit drugs by the sex workers and by their clients, and the lack of condom use in sexual relations. The HIV infection rate in these sex workers was higher than that in the general population and similar to that found in other studies made with Brazilian populations presenting the same characteristics.

Challenges to microbicide introduction in South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science & Medicine. Online access April 5, 2006.
Ornera P | Harriesa J | Coopera D | Moodleya J | Hoffmana M | Beckerb J | McGrory E | Dabashb R | Bracken H
The authors conducted qualitative research in South Africa to determine perceptions about intra-vaginal microbicides in order to better understand the socioeconomic, cultural, and structural contexts for the support of future introduction of this new HIV prevention method. They found that microbicides have the potential to meet diverse needs beyond that suggested by prior research. This included a desire for products that could protect against HIV infection following rape, sexual coercion and unplanned sex, and the finding that a wider range of people than previously suggested would potentially use microbicides.

Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti
(Abstract; subscription needed for full text; Central America and the Caribbean | Sub-Saharan Africa)
Sexually Transmitted Infections. 2006;82(suppl 1):i1-i8.
Hallett TB | Aberle-Grasse J | Bello G | Boulos L-M | Cayemittes MPA | Cheluget B | Chipeta J | Dorrington R | Dube S | Ekra AK | Garcia-Calleja JM | Garnett GP | Greby S | Gregson S | Grove JT | Hader S | Hanson J | Hladik W | Ismail S | Kassim S | Kirungi W | Kouassi L | Mahomva A | Marum L | Maurice C | Nolan M | Rehle T | Stover J | Walker N
A mathematical model was developed to explore the relation between HIV prevalence recorded at antenatal clinics (ANCs) and the pattern of incidence of infection throughout the population. Recent downturns in prevalence observed in urban Kenya, Zimbabwe, and urban Haiti, like Uganda before them, could only be replicated in the model through reductions in risk associated with changes in behavior. In contrast, prevalence trends in urban Cote d’Ivoire, Malawi, urban Ethiopia, and Rwanda show no signs of changed sexual behavior.

Assessment of trends in biological and behavioural surveillance data: is there any evidence of declining HIV prevalence or incidence in Malawi?
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2006;82(suppl 1):i9-i13.
Bello GA | Chipeta J | Aberle-Grasse J
Researchers analyzed HIV prevalence trends in conjunction with other second generation surveillance data to describe trends in HIV prevalence and behaviors related to HIV transmission. The overall HIV prevalence for 19 antenatal clinic sentinel sites in 2003 was 19.8%. The available epidemiological and behavioral surveillance data show that HIV prevalence has declined in several urban and semi-urban areas, but some rural areas had evidence of an increasing trend in HIV prevalence.

A comprehensive sex education approach for HIV testing and counselling
(Abstract; subscription needed for full text; Global)
Sex Education: Sexuality, Society and Learning. 2006 Feb;6(1):47-59.
Colpin H
The author argues that effective counselling must be based on a comprehensive sex education approach.

HIV/AIDS NEWS

Africa: Continent must step up prevention efforts to stop HIV/AIDS - AU
(News Article; Sub-Saharan Africa)
12 Apr 2006
Integrated Regional Information Network
Africa, which has the highest number of HIV infections in the world, must scale up its prevention efforts to reverse this trend, said the president of the African Union Commission. He was speaking at the official launch of the year of "The Acceleration of Prevention of HIV Initiative in the African Region", an initiative of African health ministers aimed at stepping up the pace of HIV prevention on the continent.

'Public confused over condom use'
(News Article; Sub-Saharan Africa)
14 Apr 2006
The Herald Eastern Cape
Related Editorial: South Africa: Zuma's antics border on the absurd
The Southern African HIV Clinicians Society, which represents more than 12,000 HIV specialists in South Africa, claims to have been inundated with queries since former deputy president Jacob Zuma’s testimony that having a shower after sex could reduce the chances of getting HIV.

Intersecting epidemics: tuberculosis and HIV
(Feature Article; Global)
Apr 2006
Population Reference Bureau
As if the global AIDS pandemic alone were not enough, developing countries are beset with converging epidemics of HIV and tuberculosis, increasing the likelihood of premature death in these countries. This article from the Population Reference Bureau argues that the new solution to this convergence is to utilize the infrastructure developed for each disease to also combat the other disease. But challenges to this approach are pervasive.

From a distance: HIV interventions for out-of-school youth
(Feature Article; Sub-Saharan Africa)
31 Mar 2006
id21
Education is a key protective factor against HIV. But school dropouts are increasing in many affected countries. This feature article from id21 argues that new ways to deliver the 'education vaccine' are urgently needed.

Namibia: AIDS envoy Lewis hails progress, but underlines lack of capacity
(Feature Article; Sub-Saharan Africa)
13 Apr 2006
Integrated Regional Information Network
Namibia's efforts to combat the HIV pandemic have made good progress despite a shortage of funds and lack of capacity, said Stephen Lewis, UN special AIDS envoy for Africa. "The political commitment is there and excellent polices are in place - it is important now to implement them," Lewis told reporters as he wrapped up his four-day visit on Thursday. "Namibia cannot do it alone, and the lack of sufficient resources and human capacity is not only apparent in Namibia, but common to all developing countries."

Namibia: HIV/AIDS brings change in Himba communities
(News Article; Sub-Saharan Africa)
11 Apr 2006
Integrated Regional Information Networks
"Faithfulness to one partner is unheard of to the Himba," noted a Red Cross Society manager as she explained the difficulties AIDS workers faced in accessing the group. Many older men marry several young girls, and it is not uncommon to find married Himba women having up to three boyfriends on the side.

Iran's AIDS-prevention program among world's most progressive
(News Article; Middle East)
13 Apr 2006
Knight Ridder Newspapers
Iran's fight against the spread of HIV hinges on a delicate give-and-take between activists who talk frankly about sex and drugs and the ruling ayatollahs, who fiercely protect the Islamic Republic's puritan image. The combination has made Iran the Middle East leader in preventing HIV and AIDS.

Learning about HIV/AIDS and gender stereotypes in schools in southern Africa
(Feature Article; Sub-Saharan Africa)
3 Mar 2006
id21
Most young people learn about sexuality and HIV/AIDS in school. Giving teenage pupils space to explore, debate and ask questions is just as important as checking that they know how HIV is transmitted and avoided. What role might teachers play in the fight against AIDS and gender stereotypes?

MATERNAL AND CHILD HEALTH RESEARCH

Nutrition of young children and mothers in Mozambique: findings from the 2003 Mozambique Demographic and Health Survey
(Tool; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Calverton, Maryland, ORC Macro, March 2006.
The MEASURE DHS Nutrition Chartbooks are a compilation of nutrition-related data on children and women based on DHS surveys conducted in African countries. Findings from the Mozambique 2003 DHS survey, the second DHS conducted in that country, indicate that over 40% of the children are considered stunted, or too short for their age. This is a sign of chronic malnourishment. A child’s nutritional status was found to be strongly related to his or her mother’s level of education. Stunting affects only 15% of children whose mothers have a secondary education or higher, compared with 49% among those whose mothers have no education. Half of children received a vitamin A supplement in the 6 months before the survey. Vitamin A supplementation was most common in Maputo City (77% of children between the ages of 6 and 59 months) and least common in Niassa (36% of children 6-59 months). The 2003 Mozambique DHS also collects information on women’s nutritional status. The survey found that 8% of women are considered thin (body mass index of less than 18.5) while 12% of women are overweight (BMI greater than 25). Three in five pregnant women took iron supplements during pregnancy, but of those, only 24% took them for 90 days as recommended.

The effect of number of births on women's mortality: Systematic review of the evidence for women who have completed their childbearing
(Abstract; subscription needed for full text; Global)
Population Studies. 2006 Mar;60(1):55-71.
Hurt LS | Ronsmans C | Thomas SL
Mortality in women who have completed their childbearing may increase with the number of births experienced because of maternal depletion or a trade-off between reproduction and mortality. This study reports a systematic review of the evidence on this association. Mortality declined with increasing numbers of births in twelve historical cohorts, but in eight contemporary cohorts the highest mortality was seen in the nulliparous and in women with more than four births. All effects seen were small and there were few statistically significant results. Studies examining the relationship in other ways (such as by linear trends or by mean number of births by age at death) found inconsistent associations.

Determinants of HIV-1 mother-to-child transmission in Southern Brazil
(Research Article; South America)
Anais da Academia Brasileira de Ciências. 2006 Mar;78(1):113-121.
Martínez AMB | da Hora VP | dos Santos AL | Mendoza-Sassi R | Von Groll A | Soares EAJM | D'Ávila N | Silveira J | Leal RG | The HIV/AIDS Unit, HU-FURG | TanuriII A | Soares MA
In this study, 102 children born from HIV-1-infected mothers between 1998 and 2004 in the city of Rio Grande, Brazil were analyzed for potential risk factors associated with mother-to-child transmission (MTCT). Seventy two percent of the mothers were infected by subtype C viruses. Twelve (11.8%) newborns were HIV-1-positive. There was no association between infecting HIV-1 subtype and increased risk for MTCT.

Barriers for HIV testing during pregnancy in Southern Brazil
(Research Article; South America)
Revista de Saúde Pública. 2006 Apr;40(2)
RosaI H | GoldaniI MZ | ScanlonII T | da SilvaIII AAM | GiuglianiI EJ | AgranonikI M | Tomkins A
A total of 1,642 mothers were interviewed in Porto Alegre, Southern Brazil, to assess HIV testing rate and determine risk factors for not have been tested during pregnancy. Of them, 94.3% reported being offered HIV testing before or during pregnancy or during labor; 89 mothers (5.4%) were not tested or did not know if they were tested. Attending fewer than six prenatal visits, being single, and age less than 18 years were relevant barriers preventing HIV testing.

Congenital syphilis campaigns evaluation in the city of Rio de Janeiro based on a theoretical logical model
(Abstract; South America)
Revista Brasileira de Saúde Materno Infantil. 2005 Dec;5(suppl 1):s33-s41.
Saraceni V | Vellozo VRO | Leal MC
The authors of this paper evaluated congenital syphilis elimination campaigns launched in the city of Rio de Janeiro between 1999 and 2000 to identify successes and failures during and following the proposed intervention. The full text of this article is available in Portuguese.

MEN'S HEALTH RESEARCH

Hormonal approaches to male contraception: Approaching reality
(Abstract; subscription needed for full text; Global)
Molecular and Cellular Endocrinology. Online access March 31, 2006.
Wu FCW
In this paper, the author explains that public-funded research has reached a stage where realization of male hormonal contraception is within our reach, and the pharmaceutical industry is beginning to embark on the necessary steps leading to product development. A progestogen/androgen combination is most likely to be the first product to be marketed.

Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis
(Abstract; subscription needed for full text; Global)
Sexually Transmitted Infections. 2006;82(2):101-110.
Weiss HA | Thomas SL | Munabi SK | Hayes RJ
This paper presents findings of a systematic review and meta-analyses of the associations between male circumcision and infection with herpes simplex virus type 2 (HSV-2), Treponema pallidum, or Haemophilus ducreyi. Most syphilis studies reported a substantially reduced risk among circumcised men, although there was significant between study heterogeneity. The reduced risk of HSV-2 infection was of borderline statistical significance. Circumcised men were at lower risk of chancroid in six of seven studies.

POPULATION RESEARCH

Making the link in the Philippines: population, health and environment
(Chart; Asia)
(You need Adobe Acrobat Reader to access this document)
Population Reference Bureau, 2006.
This new wallchart from the Population Reference Bureau collects national, regional, and provincial data for 15 indicators in the Philippines and highlights the connections among population trends, natural resource use, and the health and well-being of Filipinos.

The stall in mortality decline in Ghana: further analysis of demographic and health surveys data
(Report; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Calverton, Maryland, ORC Macro, 2005.
Johnson K | Rutstein S | Govindasamy P
This report summarizes the results of an in-depth study of mortality trends based on the Demographic and Health Surveys conducted in Ghana in 1988, 1993, 1998 and 2003. According to the GDHS, infant and childhood mortality rates declined steadily between 1988 and 1998, but then appeared to plateau or even rise slightly in 2003. This analysis suggests that while the mortality decline in Ghana has stagnated, the uptick seen in 2003 appears to be mostly a function of the underestimation of mortality in the previous survey. The paper suggests that the continuing problems in childhood nutrition and the low levels of women receiving tetanus toxoid injection and the low percentage of women receiving skilled assistance at delivery may be associated with the stagnation in mortality decline.

Modelling the spread of HIV/AIDS in China: the role of sexual transmission
(Abstract; subscription needed for full text; Asia)
Population Studies. 2006 Mar;60(1):1-22.
Merli MG | Hertog S | Wang B | Li J
This paper presents an exploration of the implications of patterns of sexual behavior for the spread of HIV in China using a bio-behavioural macrosimulation model. The results highlight the primacy of the levels and distribution of sexual activity in the population. They offer some guidelines for understanding and interpreting the potential implications of current and prospective changes in sexual behaviour for the spread of HIV/AIDS in the world's largest population.

POPULATION NEWS

By 2050 Brazil's population will rise to 260 million
(News Article; South America)
13 Apr 2006
Brazil-Arab News Agency
Estimates by the government statistical bureau (IBGE) are that the Brazilian population, at 182.1 million in the 2004 census, will rise to 260 million in just over 45 years. Although that may seem like a sharp increase, the IBGE reports that, following a worldwide trend, since the 1970s population growth in Brazil has slowed significantly due to a drop in the birth rate and the average number of children women are having.

The importance of sex
(Feature Article; Global)
12 Apr 2006
The Economist
This article from The Economist argues that girls are a better investment than boys. Girls get better grades at school than boys, and in most developed countries more women than men go to university. Women will thus be better equipped for the new jobs of the 21st century, in which brains count a lot more than brawn. In Britain far more women than men are now training to become doctors. In developing countries where girls are less likely to go to school than boys, investing in education would deliver huge economic and social returns. The article concludes: "It used to be said that women must do twice as well as men to be thought half as good. Luckily that is not so difficult."

Reducing poverty by integrating population, health, and environment
(Feature Article; Global)
Apr 2006
Population Reference Bureau
The Population Reference Bureau's Roger-Mark De Souza writes that crowding, pollution, and uncertain rural supplies of water and food are compromising the well-being of communities globally. But policymakers can change these dynamics through an integrated approach to development.

In the news: the Nigerian census
(Feature Article; Sub-Saharan Africa)
Apr 2006
Population Reference Bureau
Protest, boycotts, charges of fraud, and deaths accompanied Nigeria's headcount last month, the country's first in 15 years.

Japan eyes discount shopping to boost births
(News Article; Asia)
13 Apr 2006
Reuters
Alarmed by its sliding birth rate and rapidly aging population, Japan is hoping the prospect of lower shopping bills will encourage couples to go for bigger families. The government is considering issuing identity cards to families with children which would give discounts at stores cooperating with the program. The size of the discounts would be decided by the stores, which would also be expected to fund the system in return for favorable publicity surrounding the plan. The government is also considering tax rebates as a way of reducing the economic burden on parents of young children, which is seen as one reason for the declining birth rate.

WOMEN'S HEALTH RESEARCH

Factors affecting female age at marriage in South Asia
(Abstract; subscription needed for full text; Asia)
Asian Population Studies. 2005 Nov;1(3):283-301.
Caldwell BK
This paper examines early marriages in Bangladesh, where age at marriage is very early, and Sri Lanka, where it is much later. A particular examination is made of the way in which changes in the arrangement of marriage affect age at marriage.

WOMEN'S HEALTH NEWS

Gender and equity in access to health care services in the Middle East and North Africa
(Feature Article; North Africa | Middle East)
Population Reference Bureau
Despite improvements, significant inequities in access to health care services and overall health status persist for the women in the Middle East and North Africa (MENA), especially in the area of reproductive health. One of the important factors affecting reproductive health disparities in the MENA region is the socially assigned gender roles endemic there. A pervasive culture of silence influences the way MENA women perceive their bodies and their health. And this culture also circumscribes their "health-seeking behaviors"—whether and where they look for health services.

Syria: Study notes, condemns domestic abuse of women
(News Article; Middle East)
13 Apr 2006
Integrated Regional Information Networks
One in four married women in Syria is a victim of domestic violence, notes a report released last week by the state-run Syrian General Union of Women.

YOUTH HEALTH RESEARCH

A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador
(Research Article; Central America and the Caribbean)
(You need Adobe Acrobat Reader to access this document)
BMC International Health and Human Rights. Online access April 11, 2006.
Springer AE | Selwyn BJ | Kelder SH
Sixteen schools and 982 students aged 12-20 years participated in this study, which examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains--aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors--among public secondary school students in central El Salvador. Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%).

Disclosure of HIV infection from the perspective of adolescents living with HIV/AIDS and their parents and caregivers
(Abstract; South America)
Cadernos de Saúde Pública. 2006 Mar;22(3):619-629.
Marques HHS | Silva NG | Gutierrez PL
Researchers used in-depth interviews and focus group to identify relevant issues in the disclosure of HIV-positive status in children and adolescents in São Paulo and Santos, Brazil. The main reasons for disclosure were poor treatment adherence, sexual maturity, adolescent's request, and inadequate procedures by medical staff. The full text of the article is available in Portuguese.

Youth InfoNet 23 - March 2006
(Newsletter; Global)
Family Health International, March 2006.
This issue of the electronic newsletter features 29 Web sites that host collections of resources designed to assist adults working with youth on reproductive health and HIV issues.

Perceptions of sexual risk behaviours and substance abuse among adolescents in South Africa: a qualitative investigation
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Care. 2006 Apr;18(3):215-219.
Morojele NK | Brook JS | Kachieng'A MA
The study examined South African adolescents' beliefs and attitudes regarding drug use, sexual risk behavior, and relationships between the two behaviors. The findings suggest that adolescent HIV intervention programs should address the risks posed by drug use on sexual behavior.

BOOKS/BOOK REVIEWS

HIV, health, and your community: a guide for action
(Book; Global)
Granich R | Mermin J
The book is meant for people who are searching for answers to questions about HIV prevention, epidemiology, diagnosis, and treatment. Each chapter begins with a fictional story; where useful boxes with text or illustrations have been added to highlight key points. At the end of each chapter the authors answer questions raised by the story, hoping at the same time to answer some of the reader’s questions. The fourth printing took place in 2006.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 6, Number 1517 April 2006