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 6, Number 17
1 May 2006

Pop Reporter Tip: Tell your friends about The Pop Reporter. They'll appreciate it! Most subscribers tell us they learned about The Pop Reporter through a friend. Have you read a research or news item that you think your colleagues shouldn't miss out on? Use the "Email this item" link to send it. Or just tell a friend about The Pop Reporter.

Guest Editorials (free with every subscription)

The Patch Controversy: Should Health Care Providers Alter Their Practice?


Author: Anna V. Lyapis and Juan E. Vargas, MD

vargasj@obgyn.ucsf.edu

The new bolded product label of the Ortho Evra® patch approved by the US Food and Drug Administration (FDA) on November 10, 2005 states that women using the transdermal patch are exposed to 60% higher steady-state estrogen levels compared with women using a typical oral contraceptive (OC) containing 35 µg of estrogen. The warning further advises that this increased estrogen exposure may increase the risk of a serious adverse event, such as a venous thromboembolism (VTE) (blood clots in the veins) (1). This is not new information and has been on file with the FDA since approval of the patch. Clinicians should know that the FDA changed the label to include this difference in drug exposure but did not alter any safety or efficacy information in the package labeling. The new warning poses a challenge to health care providers when counseling current and prospective users of the Ortho Evra patch.

A recent study by Jick et al compared the risk of nonfatal VTE in first-time users of Ortho Evra with the risk in first-time users of OC's containing 35 µg of estrogen (norgestimate-35) (2). An estimated 147,323 women-years of current exposure to contraceptives were analyzed, identifying 68 total VTE cases—31 among patch users and 37 among OC users. These cases were matched with 266 controls by age and the duration of contraception use. The study demonstrated no difference in the risk of non-fatal VTE between patch and OC users. Patients were excluded from the study if they had important clinical risk factors for VTE. While this study controlled for the age and the overall duration of use, it failed to control for the effect of smoking on the risk of VTE.

Why is it that despite higher levels of estrogen we are not seeing a higher-than-expected risk of VTE among users of the patch? One reason might be that the patch has lower daily peak levels (about 25% lower) than the pill and avoids first pass metabolism through the liver. Ultimately, we do not know whether higher total hormone exposure is more important than peak levels (i.e., the levels seen by the liver). The bottom line, however, is that we are not seeing a higher incidence of thromboembolic complications among patch users based on data of more than 147,000 women-years studied.

Health care providers should not alter their practice of prescribing the Ortho Evra patch to patients who do not otherwise have health risks that make them ineligible for exogenous estrogen. Women who have a personal history of thromboembolic events, have migraines with aura, smoke and are over 35, or who will have prolonged immobility should instead consider progestin-only contraceptives. Thus, a 35-year-old woman with no factors to suggest estrogen contraindication can be prescribed Ortho Evra; whereas the same woman who smokes and has a history of migraines with aura is a better candidate for a progestin-only contraceptive (3).

Finally, it is important to consider the risks incurred by the use of contraception relative to those associated with pregnancy or unwanted pregnancy. The absolute risk of VTE in women using an OC containing estrogen is 3-4 per 10,000 women per year. Pregnancy and the postpartum period increase this risk of VTE to 6-12 per 10,000 women per year (4-6). Furthermore, the risk of dying due to pregnancy-related complications in the United States was 20 per 100,000 live births in the year 2000 (7). Thus, promoting the use of effective contraception based on the patient's preference and medical profile can be a life-saving strategy. Restricting the use of a contraception suitable and convenient for many women based on unfounded fear appears premature and ill advised.

Dr. Vargas is Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, and Chief of Obstetrics at San Francisco General Hospital. Ms. Lyapis is a 4th year medical student at UCSF.

References:

1. FDA Updates Labeling for Ortho Evra Contraceptive Patch. FDA Press Release, November 10, 2005, http://www.fda.gov/bbs/topics/news/2005/NEW01262.html.
2. Jick SS, Kaye JA, Russmann S, Jick H. Risk of nonfatal venous thromboembolism in women using a contraceptive transdermal patch and oral contraceptives containing norgestimate and 35 microg of ethinyl estradiol. Contraception. 2006 Mar;73(3):223-8. Epub 2006 Jan 26.
3. Allais G, De Lorenzo C, Mana O, Benedetto C. Oral contraceptives in women with migraine: balancing risks and benefits. Neurol Sci 2004 25:S211–S21.
4. Kujovich JL. Hormones and pregnancy: thromboembolic risks for women. Br J Haematol. 2004 Aug;126(4):443-54.
5. Vandenbroucke JP, Rosing J, Bloemenkamp KW, Middeldorp S, Helmerhorst FM, Bouma BN, Rosendaal FR. Oral contraceptives and the risk of venous thrombosis. N Engl J Med. 2001 May 17;344(20):1527-35.
6. Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999;353:1258–1265.
7. Maternal mortality in 2000: estimates developed by WHO, UNICEF and UNFPA, http://www.who.int/reproductive-health/publications/maternal_mortality_2000/mme.pdf.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Communicating contraceptive effectiveness: A randomized controlled trial to inform a World Health Organization family planning handbook
(Abstract; subscription needed for full text; Global)
American Journal of Obstetrics and Gynecology. Online access April 19, 2006.
Steiner MJ | Trussell J | Mehta N | Condon S | Subramaniam S | Bourne D
This study compared three different approaches for increasing clients' understanding of contraceptive effectiveness. Researchers randomized 900 reproductive-age women in India and Jamaica to 1 of 3 charts presenting pregnancy risk. The most important reason for choosing a contraceptive was how well it prevents pregnancy (54%) followed by few side effects (17%). About half knew oral contraceptive pills are more effective than condoms (46%) and intrauterine devices are more effective than injectables (50%). All 3 charts improved knowledge significantly for these 2 questions. No chart improved knowledge better than any other.



Impact of an entertainment-education television drama on health knowledge and behavior in Bangladesh: an application of propensity score matching
(Abstract; subscription needed for full text; Asia)
Journal of Health Communication. 2006 April-May;11(3):301-325.
Do MP | Kincaid DL
This article demonstrates how a relatively new statistical technique, propensity score matching in conjunction with structural equation modeling, can be used to obtain an unbiased estimate of changes in health outcomes that can be attributed to exposure to an entertainment-education drama.



Reproductive health commodity security (RHCS) country case studies synthesis: Cambodia, Nigeria, Uganda and Zambia
(Report; Global)
(You need Adobe Acrobat Reader to access this document)
Department for International Development (DFID) Health Resource Centre (HRC) , 2006.
Druce N
This report, commissioned by the UK Department for International Development and the Netherlands Ministry of Foreign Affairs, analyses the key factors that influence the financing, procurement, forecasting, and supply of reproductive commodities and how national and international agents interface and co-ordinate their activities. Findings show that while there have been some successes to strengthen commodity supply, there are continued limitations in national capacity. They also highlight how the role of external agencies in financing and procurement tends to undermine ownership and discourage national government accountability.



The Babel effect: community linguistic diversity and extramarital sex in Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS and Behavior. Online access April 8, 2006.
Bishai D | Patil P | Pariyo G | Hill K
Researchers conducted a survey on rates of sexual contact in last 12 months among 1,709 respondents age 18–60 living in Uganda. Sexual contact was reported by 26% vs. 13% of unmarried women in multilingual vs. monolingual clusters, respectively. Extramarital sexual contact occurred for 29% vs. 16% for married men in multilingual vs. monolingual clusters, respectively. These results were robust to multivariate models, which included confounders such as urbanity, and cluster distance to market places, cinemas, and transportation. The authors state that their results suggest a robust association between residence in a multilinguistic community and higher rates of non-spousal sex.



Nepal: reproductive health commodity pricing survey
(Report; Asia)
(You need Adobe Acrobat Reader to access this document)
Arlington, Va.: John Snow, Inc./DELIVER, 2005.
Rao R | Thapa D
This analysis informs Nepal's reproductive health (RH) commodity security decision makers (and others interested in the relationship between price and access) through examination of the price, price components, availability, and affordability of RH medicines.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Effect of male pill could be reversed in months
(News Article; Global)
28 Apr 2006
Reuters
Related Commentary: Is the male pill good for women?
Men given a hormone-based contraceptive, which could be available in the near future, can regain their fertility about four months after stopping the treatment, new research shows. Drug companies have been working on a male pill or injection to inhibit sperm production and give couples a greater choice of family planning methods. Scientists who analyzed studies involving men who had been given the contraceptives in trials found the treatments were highly effective but reversible.



China slow to awake to need for sex education
(Feature Article; Asia)
25 Apr 2006
Reuters
In pre-communist China, sex was less a taboo than it became under former leader Mao Zedong, whose own highly active -- and disease-ridden -- love life was chronicled by his doctor in a book banned in China. Under Mao, sex was officially a matter of doing one's reproductive duty for the state. He wanted a new labor force to build a new country, and the state encouraged high birth rates. Since then, the government has embarked upon a stern family planning policy to control a booming population -- the world's largest -- but official attitudes toward sex remain puritan, though they are changing slowly. They need to change faster, health experts say.



Too young to learn about sex
(News Article; Europe)
25 Apr 2006
Sheffield Today
A Sheffield infants school is at the center of a sex education controversy after furious parents claimed lessons for 5-year-olds will be too explicit. Worried parents of children have voiced concerns over the proposed classes, which will introduce the names of body parts such as "penis" and "clitoris" to Year 1 pupils.



Japan pins hopes on 'speed dates'
(News Article; Global | Asia)
26 Apr 2006
BBC
Speed dating parties, as such events are known, are proving increasingly common in many countries. In Japan, though, some are paid for by the government. The hope is that by encouraging people to date, marry, and start a family, the current demographic trend leading towards a shrinking population can be arrested.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Zambia and Swaziland mull wider circumcision policy
(News Article; Global | Sub-Saharan Africa)
29 Apr 2006
International AIDS Society
Swaziland's Health Ministry and surgeons in Zambia back wider use of circumcision to prevent HIV transmission. But the World Health Organization will not endorse circumcision until it sees more evidence.



HIV/AIDS: thinking through the politics of country responses
(Technical Report; Global)
(You need Adobe Acrobat Reader to access this document)
HLSP Institute, UK , March 2006.
Dickinson C
This technical approach paper considers how politics plays a role in country response to HIV and AIDS. It argues that greater analysis of the political dimensions of these responses can and should be used to understand how and why governments respond to HIV and AIDS, and how the design and implementation of interventions can be made more effective. The paper outlines how political analysis is important and uses country examples to highlight key political issues that have significant influence on HIV and AIDS responses at country level.



Still a matter of shame
(Commentary; Asia)
24 Apr 2006
The Telegraph
A new bill in India to protect children from sexual abuse does not address the issue of the sexual rights of a child, according to this commentator.



Nigeria: New bill puts human rights defenders of sexual rights at risk
(Press Release; Sub-Saharan Africa)
7 Apr 2006
The World Organisation Against Torture
The World Organisation Against Torture (OMCT) and the International Federation for Human Rights (FIDH), in the framework of their joint programme, the Observatory for the Protection of Human Rights Defenders, expressed their deep concern over a bill in Nigeria that would introduce criminal penalties for public advocacy or associations supporting the rights of lesbian and gay people, as well as for relationships and marriage ceremonies between persons of the same sex.

HIV/AIDS RESEARCH

Can fear arousal in public health campaigns contribute to the decline of HIV prevalence?
(Abstract; subscription needed for full text; Global)
Journal of Health Communication. 2006 April-May;11(3):245-259.
Green EC | Witte K
The authors provide overviews of the prevailing American expert view, African national views, and the most recent findings on the use of fear arousal in behavior change campaigns. Their analysis suggests that American, post-sexual-revolution values and beliefs may underlie rejection of fear arousal strategies, whereas a pragmatic realism based on personal experience underlies Africans' acceptance of and use of the same strategies in AIDS prevention campaigns.



Trends in antenatal HIV prevalence in urban Uganda associated with uptake of preventive sexual behaviour
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2006;82(suppl 1):i36-i41.
Kirungi WL | Musinguzi J | Madraa E | Mulumba N | Callejja T | Ghys P | Bessinger R
Researchers found that antenatal HIV seroprevalence in seven urban clinics in Uganda peaked around 1992 (15%–30%) followed by a steady decline by 2002 (5%–12%), most markedly among women aged 15–19 and 20–24 years. Premarital sex among women and multiple partnerships decreased between 1995 and 2000. There were no significant changes in reporting of extramarital sex among men. Ever use of condoms increased from 1% among women in 1989 and 16% among men in 1995 to 16% and 40% in 2000, respectively.



Current trends in Rwanda's HIV/AIDS epidemic
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2006;82(suppl 1):i27-i31.
Kayirangwa E | Hanson J | Munyakazi L | Kabeja A
This paper reviews the history of HIV serological and behavioural surveillance efforts in Rwanda, dating back to the early 1980s, synthesising findings from surveillance, research, and other relevant HIV programmatic data. Findings suggest that Rwanda may have experienced declines over the long term in HIV prevalence in urban areas, especially in Kigali, and may have stable or slightly rising HIV prevalence in rural areas. The limited behavioral data available suggest that, on the national level, Rwanda may benefit from a unique combination of low numbers of partners and late sexual debut, which may have had a mitigating effect on HIV prevalence.



Guidelines for managing the HIV/AIDS supply chain
(Teaching and Training Material; Global)
(You need Adobe Acrobat Reader to access this document)
Arlington, Va.: John Snow, Inc./DELIVER, 2005.
The Guidelines for Managing the HIV/AIDS Supply Chain is a set of references for managers working to ensure a continuous supply of quality HIV/AIDS commodities to programs. The Guidelines highlight lessons learned from JSI and DELIVER advisors’ experience designing, implementing, and improving HIV/AIDS supply chains in resource poor settings. The recommendations and tools presented in the Guidelines have been developed specifically for programs where supply chain implementation is occurring within the context described above. The authors recognize that as HIV/AIDS programs continue to evolve, so will supply chain solutions. The Guidelines will be updated accordingly.



Declaration of commitment on HIV/AIDS: five years later
(Report; Global)
(You need Adobe Acrobat Reader to access this document)
Secretary General, United Nations / United Nations (UN) Conference on Environment and Development (UNCED) , 2006.
This report, from the United Nations Secretary General, provides an update on progress in the global response to HIV and AIDS since the 2001 special session. The report is based on nearly 120 country progress reports from the Joint United Nations Programme on HIV/AIDS and more than 30 reports from civil society and national and global surveys. The report finds that, 5 yeas since the special session, many countries have failed to fulfil the key targets and milestones for 2005.



Expert patients and AIDS care
(Review/Synthesis; Global)
(You need Adobe Acrobat Reader to access this document)
Eldis HIV and AIDS Resource Guide, 2006.
Kober K | Van Damme W
This paper, published by the Institute of Tropical Medicine, reviews the literature on expert patient programmes for AIDS care in high-income countries, and explores their relevance for low-income countries with severe human resources shortages. The paper identifies human resources as a major bottleneck in scaling up the provision of antiretroviral therapy (ART) for AIDS, especially in southern Africa. Present ART models are very intensive in their use of skilled medical staff and projections suggest that they can only be used in countries where the human resources situation is less severe, such as South Africa.



Understanding the reasons for decline of HIV prevalence in Haiti
(Abstract; subscription needed for full text; Central America and the Caribbean)
Sexually Transmitted Infections. 2006;82(suppl 1):i14-i20.
Gaillard EM | Boulos L-M | Cayemittes MPA | Eustache L | Van Onacker JD | Duval N | Louissaint E | Thimoté G
Following an epidemiological analysis of HIV prevalence among pregnant women and the general population in Haiti, three mathematical models were used to re-create the national epidemic, calculate HIV incidence, and confirm the decline of HIV prevalence. Although many factors have acted in synergy to halt the AIDS epidemic in Haiti, the main reasons for decline seem to point to mortality and blood safety intervention efforts in the early stages of the epidemic.



The price of adherence: qualitative findings from HIV positive individuals purchasing fixed-dose combination generic HIV antiretroviral therapy in Kampala, Uganda
(Abstract; subscription needed for full text; Global | Sub-Saharan Africa)
AIDS and Behavior. Online access April 25, 2006.
Crane JT | Kawuma A | Oyugi JH | Byakika JT | Moss A | Bourgois P | Bangsberg DR
The authors conducted qualitative interviews with patients purchasing low-cost, generic antiretroviral therapy to better understand the social dynamics underlying the near-perfect adherence to HIV antiretrovirals generally reported in sub-Saharan Africa. They found that concerns for family well-being motivate adherence, yet, the financial sacrifices necessary to secure therapy may paradoxically undermine family welfare.



Network of sexual contacts and sexually transmitted HIV infection in Burkina Faso
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Medical Virology. 2006;78(6):724-729.
Latora V | Nyamba A | Simpore J | Sylvette B | Diane S | Sylvére B | Musumeci S
The authors describe the results of a study measuring the degree distribution of the network of sexual contacts in Burkina Faso.



STD treatment: how can it improve HIV prevention in the South?
(Abstract; subscription needed for full text; Global)
Sexually Transmitted Diseases. Online access March 21, 2006.
Berman SM | Cohen MS
In this review of published literature, the authors found that community trials produced inconsistent results but still suggest that STD treatment can reduce HIV transmission in the United States. They write that treatment of symptomatic STDs among those with HIV-infection should reduce HIV infectivity. There is as yet only limited evidence that STD treatment can reduce HIV susceptibility, although promising studies addressing herpes simplex virus are under way.

HIV/AIDS NEWS

AIDS conference ends with appeals
(News Article; Global)
26 Apr 2006
Associated Press
An international AIDS conference ended Wednesday with impassioned appeals to political and pharmaceutical industry leaders to fund development of a virus-killing gel to protect women from the disease and so save millions of lives. Peter Piot, head of UNAIDS, said he was deeply disappointed that research into microbicides or vaginal gels was so slow.



Condom fight: The Vatican strikes back
(Feature Article; Global)
30 Apr 2006
TIME Europe
Suggestions that the Roman Catholic Church might condone the use of condoms in some circumstances are quickly withdrawn.



Circumcision, fidelity touted in AIDS fight
(News Article; Global | Sub-Saharan Africa)
23 Apr 2006
Chicago Tribune
The most promising way to stem Africa's worst AIDS epidemics appears to be encouraging male circumcision and faithfulness to a single partner at a time, not promoting condom use or abstinence, a new look at AIDS studies across the continent suggests. Condoms are rarely used by regular sex partners, who are involved in much of the spread of the disease in southern Africa, the region of the continent worst hit by AIDS, studies show. And abstinence campaigns appear to simply delay the infection of young people by a year or two, Daniel Halperin, a leading US AIDS prevention expert, said in a provocative speech in Johannesburg.



Figuring out which AIDS prevention programs work
(Feature Article; Global)
26 Apr 2006
Voice of America
Unprecedented amounts of money are going to prevent the spread of HIV and AIDS. But finding out which prevention programs work is often difficult.



10% of new HIV cases have virus mutation associated with antiretroviral resistance, researcher says at microbicide conference
(News Article; Global)
26 Apr 2006
Kaiser network.org
One in 10 newly diagnosed HIV-positive people have at least one "significant mutation" of the virus "associated with drug resistance," Mark Wainberg, director of the McGill AIDS Centre at the Jewish General Hospital in Montreal, Canada, said on Tuesday at the Microbicides 2006 Conference in Cape Town, South Africa.



Myanmar's hidden AIDS epidemic
(Feature Article; Asia)
25 Apr 2006
FRONTLINE/World
The story of AIDS in Myanmar is as much about human rights as it is about health. The true toll of AIDS in Myanmar may never be known. The country's AIDS epidemic is the least studied in the world, according to health experts. The most reliable data available, from a 2000 World Health Organization study, estimated that some 300,000 people were infected and some 48,000 people had died the previous year from AIDS. But for that same year, the military government reported only 850 deaths. This feature article details personal experiences of several people fighting the disease.



Jordan: National media to promote AIDS awareness
(News Article; Middle East)
1 May 2006
Integrated Regional Information Networks
Local journalists have been asked to participate with both government and non-government organizations in a national media campaign aimed at raising awareness about HIV/AIDS.



Botswana: Ravaged by AIDS, but fighting back
(Feature Article; Sub-Saharan Africa)
29 Apr 2006
CNN
This feature article from CNN relates Botswana's struggles fighting the AIDS epidemic.



Lesotho: Lack of healthcare workers a drain on new HIV/AIDS plan
(News Article; Sub-Saharan Africa)
27 Apr 2006
Integrated Regional Information Networks
As the Lesotho government prepares to launch a 'Know your HIV status' campaign, a shortage of qualified healthcare workers threatens to derail plans to increase access to AIDS treatment in the mountain kingdom. According a nurse at Queen Elizabeth Hospital, the country's main referral hospital, 70 nurses tend to around 3,400 patients – an average of close to 50 patients per nurse.



Imagining a world without AIDS
(Feature Article; Global)
28 Apr 2006
CNN
Dr. Sanjay Gupta previews a townhall discussion about AIDS, "The End of AIDS: A Global Summit with President Clinton".

MATERNAL AND CHILD HEALTH RESEARCH

Maternal mortality in St. Petersburg, Russian Federation
(Research Article; Asia)
(You need Adobe Acrobat Reader to access this document)
Bulletin of the World Health Organization. 2006 Apr;84(4):283-289.
Gurina NA | Vangen S | Forsen L | Sundby J
Researchers from the St. Petersburg Medical Academy of Postgraduate Studies Maternal found that mortality levels in St. Petersburg still exceed European levels by a factor of five. They conclude that improved management of abortion, emergency care for sepsis and haemorrhage, and better identification and control of infectious diseases in pregnancy are needed.



Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting
(Research Article; Global | Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Bulletin of the World Health Organization. 2006 Apr;84(4):314-319.
Molyneux E | Ahmad S | Robertson A
In this "Lessons from the Field" article, the authors describe their experience working in a busy paediatric outpatient clinic in a public tertiary care hospital in Blantyre, Malawi. The main changes they made were to train staff in emergency care and triage, improve patient flow through the department, and to develop close cooperation between inpatient and outpatient services. These changes led to a reduction in inpatient mortality from 10–18% before the changes were made (before 2001) to 6–8% after.



Vitamins C and E and the risks of preeclampsia and perinatal complications
(Abstract; subscription needed for full text; Global)
New England Journal of Medicine. 2006 Apr 27;354(17):1796-1806.
Rumbold AR | Crowther CA | Haslam RR | Dekker GA | Robinson JS
Researchers conducted a multicenter, randomized trial of nulliparous women between 14 and 22 weeks of gestation. Women were assigned to daily supplementation with 1000 mg of vitamin C and 400 IU of vitamin E or placebo until delivery. Primary outcomes were the risks of maternal preeclampsia, death, or serious outcomes in the infants. Baseline characteristics of the two groups were similar. There were no significant differences between the vitamin and placebo groups in the risk of preeclampsia, death, or serious outcomes in the infant.



Controversies in the use of nevirapine for prevention of mother-to-child transmission of HIV
(Abstract; subscription needed for full text; Global)
Expert Opinion on Pharmacotherapy. 2006 Apr;7(6):677-685.
McIntyre JA
The author, Executive Director of the Perinatal HIV Research Unit, University of the Witwatersrandloof, Johannesburg, South Africa, reviews controversies in the use of nevirapine for prevention of mother-to-child transmission of HIV.

MATERNAL AND CHILD HEALTH NEWS

World Health Organization releases new Child Growth Standards
(Press Release; Global)
27 Apr 2006
WHO
New international Child Growth Standards for infants and young children released today by the World Health Organization provide evidence and guidance for the first time about how every child in the world should grow.



Burundi: Nkurunziza announces free maternal healthcare, pay rise for workers
(News Article; Global | Sub-Saharan Africa)
1 May 2006
Integrated Regional Information Networks
Free maternal healthcare, a 15% salary increase for workers in the public service, and the setting up of anti-corruption bodies are some of the measures Burundian President Pierre Nkurunziza announced in a message to the nation on the eve of Labour Day, marked worldwide on 1 May.



Beijing reports higher Caesarean birth rate
(News Article; Asia)
1 May 2006
Xinhua
Beijing has seen rapid increase in Caesarean births in the past two decades and more, with the highest rate reaching 60% in some hospitals.

POPULATION RESEARCH

Evidence for population level declines in adult HIV prevalence in Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2006;82(suppl 1):i21-i26.
Cheluget B | Baltazar G | Orege P | Ibrahim M | Marum LH | Stover J
Nationally, the adult prevalence of HIV in Kenya has declined from 10% in the late 1990s to under 7% today. This paper discusses the evidence for this decline.



Measuring trends in prevalence and incidence of HIV infection in countries with generalised epidemics
(Abstract; subscription needed for full text; Global)
Sexually Transmitted Infections. 2006;82(suppl 1):i52-i56.
Ghys PD | Kufa E | George MV
This paper reviews recent data and practice to derive guidance on questions relating to the measurement and analysis of trends in HIV prevalence and incidence.



A comparison of cluster and systematic sampling methods for measuring crude mortality
(Research Article; Global)
(You need Adobe Acrobat Reader to access this document)
Bulletin of the World Health Organization. 2006 Apr;84(4):290-296.
Rose AMC | Grais RF | Coulombier D | Ritter H
This paper compares the results of two different survey sampling techniques (cluster and systematic) used to measure retrospective mortality on the same population at about the same time.

POPULATION NEWS

French exception: Experts ponder high birth rate
(Feature Article; Global | Europe)
26 Apr 2006
Reuters
Experts say France's high birth rate (women have an average of 1.9 children) is probably due to the government's long-term policy of rewarding those who have children, offering medals, financial incentives and favorable work rules.



Germany headed for demographic disaster?
(News Article; Global | Europe)
26 Apr 2006
Reuters
Related News Article: German women take the rap for declining birth rate
Germans are living longer, having fewer children and, according to demographic experts, heading for economic decline and a pension crisis. Fewer children were born in Germany in 2005 than in any year since World War Two, government data released last month showed. A new report reveals that the roots of the problem lie with the nation's women. Not only are they reluctant to have children, they could also be working a whole lot harder.



Pope: lack of love and hope explains low births
(News Article; Global)
28 Apr 2006
Zenit News Agency
Benedict XVI says the lack of love and hope is the cause of the decline in the birthrate that is leading to the aging of societies, especially in developed countries.



Pushing for babies: Singapore fights fertility decline
(Feature Article; Asia)
27 Apr 2006
Reuters
Singapore's ruling People's Action Party has often used financial incentives and other methods to influence its citizens' behavior -- from who they marry and when, to how many children they have, and where they live. But it's the ruling PAP's policies on marriage and babies, with their whiff of eugenics, that have proved most controversial.

WOMEN'S HEALTH RESEARCH

How safe is safer sex? High levels of HSV-1 and HSV-2 in female sex workers in London
(Abstract; subscription needed for full text; Global | Europe)
Epidemiology and Infection. Online access March 29, 2006.
Fox J | Taylor GP | Day S | Parry J | Ward H
Female sex workers in Europe have low levels of STIs, attributable to condom use. This paper describes the seroepidemiology of HSV-1 and HSV-2 in female sex workers in London by using a 15-year prospective study of 453 sex workers. The seroprevalence of HSV-1 was 74.4% and independently associated with birth in a 'transitional country'. The seroprevalence of HSV-2 was 60% and declined over time; it was also independently associated with time in sex work and birth in a 'developing country'.



Human papillomavirus infection among women attending health facilities in the Kingdom of Bahrain
(Abstract; subscription needed for full text; Middle East)
Saudi Medical Journal. 2006;27(4):487-491.
Hajjaj AA | Senok AC | Al-Mahmeed AE | Issa AA | Arzese AR | Botta GA
The authors investigated the occurrence of human papillomavirus (HPV) infection and the associated risk factors in Bahrain's female population. Of 100 women studied, 11 (11%) with normal cytology were HPV-positive. Polygamy, smoking and hormonal contraception was not identified as risk factors, but positive women showed higher parity.

WOMEN'S HEALTH NEWS

Pakistan: Acid burn victims smile again
(Feature Article; Asia)
24 Apr 2006
Integrated Regional Information Networks
A premier beauty salon in Pakistan has teamed up with the Italian charity "Smile Again" to set up a program for acid-burn victims.

YOUTH HEALTH RESEARCH

Condom use among South African adolescents: developing and testing theoretical models of intentions and behavior
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS and Behavior. Online access April 25, 2006.
Bryan A | Kagee A | Broaddus MR
Researchers developed and tested models of intentions to use condoms and sexual behavior among adolescents from Cape Town, South Africa.



Towards a definition of orphaned and vulnerable children
(Abstract; subscription needed for full text; Global | Sub-Saharan Africa)
AIDS and Behavior. Online access April 26, 2006.
Skinner D | Tsheko N | Mtero-Munyati S | Segwabe M | Chibatamoto P | Mfecane S | Chandiwana B | Nkomo N | Tlou S | Chitiyo G
Researchers conducted focus group interviews to extend the definition of orphaned and vulnerable children.

YOUTH HEALTH NEWS

Text-mailing used to teach sex health
(News Article; Global | North America)
26 Apr 2006
United Press International
San Francisco health officials are starting a new program to get sex education advice to young people by sending them text messages. The city's Department of Public Health began a program this week, the first of its kind in the United States, offering automated sex education and health advice to people via their cell phones.



In Peruvian jungle city, church works to help child prostitutes
(Feature Article; South America)
25 Apr 2006
Catholic News Service
Child prostitution is on the rise in the tropical city of Iquitos, Peru. It's complicated by social attitudes and the economy. A local nonprofit organization that works with at-risk children said that many girls are lured into prostitution by a family member -- sometimes even a parent -- or a neighbor with the promise of quick cash.

SPECIAL REPORTS/PROFILES/RESOURCES

Reporting on children in the context of HIV/AIDS: a journalist's resource
(Teaching and Training Material; Global)
(You need Adobe Acrobat Reader to access this document)
Children's Institute, University of Cape Town; Centre for Social Science Research, University of Cape Town; Media Monitoring Project; HIV/AIDS and the Media Project, Journalism Programme and the Perinatal HIV Research Unit, University of the Witwatersrand / Children's Institute, University of Cape Town, 2005.
This resource provides reference information to assist journalists in reporting on children in the context of HIV/AIDS.

---

"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs INFO Project. When you click on any link, 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.

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!

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.