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The Pop Reporter®

Volume 7, Number 4
12 February 2007

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Guest Editorials (free with every subscription)

Hormonal Contraception and the Risk of Acquiring HIV


Author: Charles Morrison, PhD, Senior Epidemiologist, Family Health International

publications@fhi.org

Over 100 million women around the world use hormonal methods of contraception -- primarily combined oral contraceptives (COCs) and injectable progestin-only contraception. The use of these methods is especially common in regions such as sub-Saharan Africa, where the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) are widespread. This has been a cause for concern among some scientists and clinicians who have raised the possibility that the use of hormonal contraceptives may be associated with an increased risk of acquiring HIV. Conclusive evidence of such a link would have a profound impact on family-planning programs in areas with a high prevalence of the virus. To date, however, the findings have been contradictory.

We recently published a report -- the largest prospective study ever to address this question directly -- that sheds new light on the problem and brings scientists closer to a confident answer (AIDS January 2, 2007). The FHI-led investigation, which was based in Uganda, Zimbabwe and Thailand, found no overall association between women who use COC pills or the injectable progestin-based contraceptive, depot-medroxyprogesterone acetate (DMPA), and the risk of acquiring HIV.

This result was bolstered by another recent study, which found that older women (35-49 years) in South Africa who use COCs, DMPA or another injectable progestin-only contraceptive, norethindrone enanthate (NET-EN), do not have an increased risk of acquiring HIV (International Journal of Epidemiology, January 25, 2007).

Despite the positive results from both reports, scientists are still faced with some unanswered questions. For one thing, other STIs may also modify the risk associated with the use of hormonal contraception and the acquisition of HIV. The FHI study found an unexpected outcome among women who were infected with the herpes simplex virus type-2 (HSV-2). The use of a hormonal contraceptive increased the risk of HIV among women who were not infected with HSV-2, whereas the risk of HIV did not increase among hormonal contraceptive users who were infected with HSV-2. This finding is now being investigated by other researchers.

In addition, a woman’s age may modify the effects of hormonal contraception on the risk of acquiring HIV. In the FHI-led study, 18–24 year-old women who used COC and DMPA had an increased risk of HIV infection. In contrast, 25–35 year-old women who used hormonal contraceptives had a decreased risk of acquiring HIV.

There is clearly a need for more research concerning the potential modifying effects of hormonal contraception on the relationship between HIV acquisition and a woman’s age, and her status with respect to other STIs. Scientists must also determine whether other forms of hormonal contraception -- such as the progestin-only implants Jadelle and Implanon -- have different effects on the risk of acquiring HIV. Moreover, scientists should assess the risks and benefits of hormonal contraceptive use among women who are already infected with HIV. In particular, we need to understand whether hormonal contraceptive users who are infected with HIV are more infectious to a sex partner, whether they are more likely to have a rapidly progressive HIV infection, and whether they can safely use commonly prescribed anti-retroviral therapies compared to HIV-infected women who do not use hormonal contraception.

For more information see: http://www.fhi.org/

References:

Morrison CS, Richardson BA, Mmiro F, Chipato T, Celentano DD. Hormonal contraception and the risk of HIV acquisition. AIDS. 2007 Jan 2;21(1):85-95.

Myer L, Denny L, Wright TC, Kuhn L. Prospective study of hormonal contraception and women's risk of HIV infection in South Africa. International Journal of Epidemiology. 2007 Jan 25.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Herpes simplex virus type 2: epidemiology and management options in developing countries
(Abstract; subscription needed for full text; Global)
STI Online. 2007 Feb;Online access February 8, 2007. 83(1):16-22.
Paz-Bailey G | Ramaswamy M | Hawkes SJ | Geretti AM
Genital herpes simplex virus type 2 is highly prevalent worldwide. Continued transmission is facilitated by the large number of undiagnosed cases, the frequency of atypical disease, and the occurrence of asymptomatic shedding. The lack of easy, affordable diagnostic methods and antiviral treatment in countries with low and middle income is of great concern. Interventions are required to improve recognition of genital herpes, to prevent its spread and also to prevent its potential to promote HIV transmission in developing countries.



Prevalence of serum antibodies to human papilloma virus in patients with genital ulcer disease in an urban population of Tanzania
(Abstract; subscription needed for full text; Sub-Saharan Africa)
STI Online. 2007 Feb;Online access February 8, 2007 83(1):64-65.
Mbwana J | Viscidi R | Lyamuya E | Mhalu F | Chalamilla G | Liljeqvist JA | Lagergård T
In this study, sera of 200 patients of both sexes with genital ulcer disease (GUD) and sera of 60 male blood donors and 60 pregnant women were tested for antibodies to HPV to determine the cumulative seroprevalence of selected HPV types in order to evaluate exposure. The overall seroprevalence of HPV types for all patients with GUD was 83% for women and and 77% for men. Infections with the oncogenic HPV types 16, 18 and 52 are common among patients with GUD and pregnant women in urban Tanzania, emphasizing the need for appropriate HPV vaccine programs.



Use of modern contraception by the poor is falling behind
(Research Article; Global)
PLoS Medicine. 2007 Feb 6;Online access February 8, 2007. 4(2):e31 1-9.
Gakidou E | Vayena E
Demographic and Health Surveys from 55 developing countries were analyzed using wealth indices that allow the identification of the absolute poor within each country. This article explores the macro level determinants of the differences in the use of modern contraceptives between the poor and the national averages of several countries. Despite increases in national averages, use of modern contraception by the absolute poor remains low. Over time, the gaps in use persist and are increasing.



Religion, conscience, and controversial clinical practices
(Abstract; subscription needed for full text; North America)
The New England Journal of Medicine. 2007 Feb 8;356(6):593-600.
Curlin FP | Lawrence RE | Chin MH | Lantos JD
Related News Article: Many doctors stay mum on controversial care: study
Two thousand practicing US physicians were surveyed about their beliefs about their ethical rights and obligations when patients request a legal medical procedure to which they object for religious or moral reasons, including providing abortion and prescribing birth control to adolescents without parental approval. Most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients and that physicians are obligated to present all options and to refer the patient to another clinician.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Work, youth before babies for Chinese who freeze eggs
(News Article; Asia)
7 Feb 2007
Reuters
An increasing number of Chinese women are leaving nothing to chance and asking fertility institutes to freeze their eggs so they can postpone pregnancy to enjoy more of their career and youth. More than 260 couples in Shanghai had gone through a process to freeze their unfertilised eggs, a "notable rise" from the previous year.



Over-the-counter pill plan debate
(News Article; Europe)
5 Feb 2007
BBC News
The Medicines and Healthcare Products Regulatory Agency (MHRA), the drug regulating agency in the United Kingdom, is meeting to consider making the pill available over-the-counter without a doctor's prescription. Doctors warn that the MHRA should proceed with caution because of potential side effects of the pill.



Some birth control may raise clot risk
(News Article; North America)
6 Feb 2007
Newsday
A US advocacy group called Public Citizen filed a petition with the Food and Drug Administration that seeks to stop the sale of certain low-dose birth control pills. This group claims that certain low-dose birth control pills, or "third-generation" oral contraceptives that contain a type of progestin called desogestrel, increase a woman's risk of a potentially deadly blood clot more than others and should be pulled off the market.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Girl or boy? As fertility technology advances, so does an ethical debate
(Feature Article; Global)
6 Feb 2007
Grady D, New York Times
If people want to choose their baby’s sex before pregnancy, should doctors help? Some parents would love the chance to decide, while others wouldn’t dream of meddling with nature. The medical world is also divided. Professional groups say sex selection is allowable in certain situations, but differ as to which ones. Meanwhile, it’s not illegal, and some doctors are already cashing in on the demand.

HIV/AIDS RESEARCH

Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2007 Feb;83:29-34.
Simbayi LC | Kalichman SC | Strebe A | Cloete A | Henda N | Mqeketo A
Among the 903 HIV-positive male and female participants who were currently sexually active, 378 (42%) had sex with a person to whom they had not disclosed their HIV status in the previous 3 months. Participants who had not disclosed their HIV status to their sex partners were considerably more likely to have multiple partners, HIV-negative partners, partners of unknown HIV status and unprotected intercourse with non-concordant sex partners.



Is smoking tobacco an independent risk factor for HIV infection and progression to AIDS? A systemic review
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2007 Feb;83:41-46.
Furber AS | Maheswaran R | Newell JN | Carroll C
A systematic review was undertaken of studies to look at tobacco smoking as a risk factor for either HIV seroconversion or progression to AIDS. Six studies were identified with HIV seroconversion as an outcome measure. Five of these indicated that smoking tobacco was an independent risk factor after adjusting for important confounders with adjusted odds ratios ranging from 1.6 to 3.5. 10 studies were identified using progression to AIDS as an end point of which nine found no relation with tobacco smoking.



Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy
(Abstract; subscription needed for full text; Global)
The American Journal of Clinical Nutrition. 2007 Feb;Online access February 9, 2007. 85(2):333-345.
Drain PK | Kupka R | Mugusi F | Fawzi WW
In HIV-infected persons, low serum concentrations of vitamins and minerals, termed micronutrients, are associated with an increased risk of HIV disease progression and mortality. With broader access to highly active antiretroviral therapy (HAART), a better understanding of micronutrient deficiencies and the role of micronutrient supplements in HIV-positive persons receiving HAART is a priority. The provision of micronutrient supplements with HAART may have several benefits, such as an improvement in immune reconstitution.

HIV/AIDS NEWS

South Africa: Minister orders relook at anti-HIV gel trials
(News Article; Sub-Saharan Africa)
7 Feb 2007
Business Day (Johannesburg)
After shocking news that a microbicide trial was halted after early results suggested the microbicide might raise, not lower, the risk of HIV infection, South Africa's Health Minister has ordered the newly formed National Health Research Ethics Council to investigate all anti-HIV vaginal gel trials in the country.



S. Africa launches biggest AIDS vaccine trial
(News Article; Sub-Saharan Africa)
8 Feb 2007
Reuters
South Africa, burdened with one of the world's major HIV/AIDS epidemics, unveiled plans for its biggest AIDS vaccine trial. The government-backed South African AIDS Vaccine Initiative said the Phambili trial would be conducted on 3,000 HIV-negative people aged between 18 and 35. It will test whether the MRKAd5 HIV-1 vaccine developed by drug firm Merck & Co. either prevents HIV infection or lowers HIV levels in those who become infected. It will also measure the effectiveness of the drug on the C strain of HIV prevalent in South Africa.



Uganda: 25,000 children got HIV in 2006
(News Article; Sub-Saharan Africa)
7 Feb 2007
The Monitor (Kampala)
The country Director of the Elizabeth Glaser Paediatric Aids Foundation has said that 25,000 children in Uganda were infected with HIV last year. The majority of children with HIV were infected from their mothers, during pregnancy, childbirth, or breastfeeding.



AIDS group urges restart for S.Africa gel trials
(News Article; Sub-Saharan Africa)
7 Feb 2007
Chiahemen J
South African AIDS activists hope that clinical trials of a microbicide gel designed to help women protect themselves against HIV could restart after they were halted last month. Treatment Action Campaign, Africa's most influential AIDS lobby, praised US group CONRAD for halting the trials following reports that some of the women involved in the study had contracted HIV. But the group fears it is now almost impossible to restart the trials, even if a review of the data showed the gel was not the problem, rather the way it was being used.

MATERNAL AND CHILD HEALTH RESEARCH

Chloroquine prophylaxis against vivax malaria in pregnancy: a randomized, double-blind, placebo-controlled trial
(Abstract; subscription needed for full text; Asia)
Tropical Medicine & International Health. 2007 Feb;12(2):209-218.
Villegas L | McGready R | Paw MK | Pimanpanarak M | Arunjerdja R | Viladpai-nguen SJ | Greenwood B |White NJ | Nosten F
One thousand pregnant women were enrolled in a randomized, double-blind, placebo-controlled trial of chemoprophylaxis with chloroquine to assess the safety of chloroquine (CQ) as prophylaxis against Plasmodium vivax infection during pregnancy. The mothers were actively followed from inclusion to delivery and their infants until 12 months of age. CQ prophylaxis completely prevented P. vivax episodes and had no impact on maternal anaemia, birth weight, gestational age, development or growth of newborns, or neurological development in infants at 1 year of age.



Long-term effects of perinatal nutrition on T lymphocyte kinetics in young Gambian men
(Abstract; subscription needed for full text; Sub-Saharan Africa)
The American Journal of Clinical Nutrition. 2007 Feb;Online access February 9, 2007. 85(2):480-487.
Ghattas H | Wallace DL | Solon JA | Henson SM | Zhang Y | Ngom PT | et al
In rural Gambia, individuals born during seasonal nutritional deprivation are susceptible to mortality from infectious diseases in adult life. This study investigated the hypothesis that impaired immunocompetence in those born during nutritional deprivation results from an underlying defect in immunologic memory, which is likely to be reflected in the phenotype and kinetics of T lymphocytes in young adults. In healthy young Gambian men, T lymphocyte homeostasis is extremely robust, regardless of perinatal nutritional compromise.



A little help from my friends: caring for premature babies in a war zone
(Research Article; Sub-Saharan Africa)
International Breastfeeding Journal. 2007 Feb 3;2(3)
Harris H
This paper is a narrative of some aspects of the author's work as a midwife with Medecins Sans Frontieres in an isolated north-western regional hospital of Cote d'Ivoire in an area under rebel military control in 2004-2005 during the civil war. This is a short account of methods used to care for premature babies in a resource-poor setting. Equipment was basic, necessitating a creative use of available resources. Providing warmth, oxygen, and adequate feeding were often sufficient for a successful outcome for many premature babies.



Revealing the burden of maternal mortality: a probabilistic model for determining pregnancy-related causes of death from verbal autopsies
(Research Article; Sub-Saharan Africa)
Population Health Metrics. 2007 Feb;Onlince access February 9, 2007. 5(1)
Fottrell E | Byass P | Ouedraogo TW | Tamini C | Gbangou A | Sombie I | et al
Verbal autopsy (VA) can elicit circumstances of maternal death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death. VA represents a potentially valuable new tool for measuring maternal mortality. It could become a routine tool in research and service settings where levels and changes in pregnancy-related deaths need to be measured.



Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries
(Abstract; subscription needed for full text; Global)
International Journal of Gynecology and Obstetrics. 2007 Feb;Onlince access February 9, 2007 96(2):139-146.
McClure EM | Goldenbergb RL | Bann CM
Using data provided by the WHO from 188 developed and developing countries, correlations and linear regression analyses between maternal mortality and stillbirth rates and cesarean section rates, skilled delivery attendance, and more than 4 prenatal visits were developed. Stillbirth was significantly associated with maternal mortality. Both stillbirth and maternal mortality were similarly related to all three measures of obstetric care. An increase in cesarean sections was associated with sharp decreases in both maternal mortality and stillbirths.

MATERNAL AND CHILD HEALTH NEWS

Stanford team repairs India's smallest hearts
(News Article; Asia)
8 Feb 2007
San Francisco Chronicle
In most industrial nations, technology and medical expertise can detect heart maladies before birth. More than 75 percent of infants born with congenital heart disease survive beyond the first year. Yet despite India's recent inroads in space and computer technology, it has been unable to keep pace with such medical advances and it is highly evident in pediatric medicine. In countries like India, only a tiny proportion of children with heart defects receive appropriate treatment.



Spring conception may up risk of preterm birth
(News Article; North America)
8 Feb 2007
Rausher M, Reuters
Researchers have found that women who conceive in the springtime may be more likely to deliver before 37 weeks gestation than women who conceive at other times of the year. After analyzing the records of 75,399 women who delivered over the 10-year period 1995 to 2005, researchers found that the rate of preterm birth was 8.4 percent for summer conception, 8.8 percent for fall conception, 9.1 percent for winter conception, and 9.2 percent for spring conception.

MEN'S HEALTH RESEARCH

Sexual function in men and women with neurological disorders
(Abstract; subscription needed for full text; Global)
The Lancet. 2007 Feb 10;Online access February 8, 2007. 369(9560):512-525.
Rees P | Fowler C | Maas C
The advent of non-invasive functional brain imaging has clarified which regions of the brain are recruited during sexual arousal. Injuries to those regions, and to the spinal cord and peripheral nerves that link genitalia to limbic and cognitive centres, can profoundly influence sexual well-being. Sexual consequences of epilepsy, stroke, multiple sclerosis, Parkinson's disease, and other common neurological disorders are discussed as well as management of sexual dysfunction from both disease and treatment.



‘I had a guilty conscience because I wasn't going to marry her’: Ethical dilemmas for Mexican men in their sexual relationships with women
(Abstract; subscription needed for full text; Central America and the Caribbean)
Sexualities. 2007 Feb;Online access February 9, 2007. 10(1):61-81.
Amuchástegui A | Aggleton P
In Mexico's predominantly Catholic culture, the enjoyment of sexual rights faces challenges at the political and the personal level. Although often connected, the meanings of sexuality and reproduction are fundamentally different and so, correspondingly, are possibilities for the exercise of reproductive rights versus sexual rights. Drawing on in-depth research conducted among young Mexican men in rural communities, this article examines the ‘ethics’ implicit in men's accounts when talking about sexual desires, pleasures and practices with women.

MEN'S HEALTH NEWS

Men's testicles 'HIV hiding spot'
(News Article; Global)
4 Feb 2007
BBC
HIV can dodge destruction by powerful antiretroviral drugs by hiding out in the testicles. Work in the American Journal of Pathology suggests the gonads provide an ideal environment for the AIDS virus to replicate itself. Evidence shows even the best antiretrovirals find it difficult to penetrate the testes. This may explain why HIV can still be found in the semen of men on drugs that successfully clear their blood of it.



United Kingdom: HIV man challenged over safe sex
(News Article; Europe)
06 Feb 2007
BBC News
A chef accused of knowingly giving a former partner HIV and Hepatitis C has been challenged over claims that he always wore a condom during sex.

POPULATION RESEARCH

Return of the population growth factor: Its impact upon the Millenium Development Goals
(News Article; Global)
(You need Adobe Acrobat Reader to access this document)
2007 Jan;
United Kingdom All-Parliamentary Group on Population, Development and Reproductive Health
Related News Article: Viewpoint: Poverty reduction stymied by population growth
A report from the United Kingdom’s All-Parliamentary Group on Population, Development and Reproductive Health says the world will fail to achieve the targets set in the landmark Millennium Development Goals unless population growth is curbed. The report’s findings underscore the fact that access to family planning and reproductive health services is not only a fundamental right but also essential to achieving a wide-range of commonly shared goals, including eradicating poverty and hunger, reducing maternal and infant death, and combating HIV/AIDS.



Socio-economic status, permanent income, and fertility: a latent-variable approach
(Abstract; subscription needed for full text; Global)
Population Studies. 2007 March;61(1):15-34.
Bollen A | Glanville J | Stecklov G
This paper examines how permanent income and other components of socio-economic status (SES) are related to fertility in less developed countries. A latent-variable method was used as permanent income cannot be measured directly. Data from Ghana and Peru show that permanent income has a large, negative influence on fertility and that research must take the latent nature of permanent income into account to uncover its influence.

POPULATION NEWS

Rent-a-womb in India fuels surrogate motherhood debate
(News Article; Asia)
6 Feb 2007
Reuters
The practice of surrogate motherhood services in India are far cheaper than in the West. India has no laws regulating the fertility industry, but specialists say they have set their own criteria: only childless couples who cannot have a successful pregnancy themselves. For the surrogates, usually lower middle class housewives, money is the primary motivator. For their clients, it's infertility or as some claim, educated working women turning to hired wombs to avoid a pregnancy affecting careers.



Kenya: Minister warns over population growth
(News Article; Sub-Saharan Africa)
6 Feb 2007
The Standard
Kenya's finance minister warned that the surge in the population growth rate poses a threat to the realization of Kenya's Vision 2030 targets. He said the annual growth rate of 2.2 per cent could see the population rise from the current 30 million to 50 million by 2030.

WOMEN'S HEALTH RESEARCH

Psychological and biological markers of stress and bacterial vaginosis in pregnant women
(Abstract; subscription needed for full text; Global)
British Journal of Obstetrics and Gynaecology. 2007 Feb;114(2):216-223.
Harville E | Savitz D | Dole N | Thorp J | Herring A
This study was undertaken to determine whether stress is associated with risk of bacterial vaginosis (BV) in pregnant women. 897 women were seen at a prenatal clinic that sees mostly government-insured and uninsured women, and a physicians' clinic that sees mostly those with private health insurance. No clear pattern of association was seen between stress hormones and BV. Few associations between stress and BV were seen after adjustment for confounders.



A health inequalities perspective on violence against women
(Abstract; subscription needed for full text; Global)
Health & Social Care in the Community. 2007 Feb;Online access February 9, 2007. 15(2):120-127.
Humphreys C
Ths paper argues that the physical and mental health consequences of gender-based violence constitute a major public health problem and a source of significant health inequality. The concept of violence against women is explored alongside brief examples of the mental and physical health impact of this violence. While the impact on women's health is relatively uncontested, the extent to which social divisions such as poverty, class and minority ethnic status create specific vulnerabilities to violence are more controversial.

WOMEN'S HEALTH NEWS

Parents turn to clinics for genital mutilation: U.N.
(News Article; Global)
5 Feb 2007
Reuters
The U.N. Population Fund warns that more parents are turning to medical clinics to perform genital mutilation, wrongly assuming that it spares girls physical and psychological damage. The trend has been spotted in Egypt, Kenya, Somalia, Djibouti and Yemen.



FDA OKs test to predict breast cancer return
(News Article; Global)
6 Feb 2007
Reuters
U.S. health officials approved a genetic test that can give women with early breast cancer an estimate of whether the disease is likely to return in five to 10 years. Officials cautioned, however, that the test was not perfect and should be used with additional information to help doctors and patients decide how aggressively to treat an early tumor.



South Africa: Group calls for more research on sexual violence
(News Article; Sub-Saharan Africa)
5 Feb 2007
IRIN
According to the Pretoria-based Sexual Violence Research Initiative little is understood about sexual violence because it is so often overlooked as an area of research. Data suggests that sexual violence is pervasive throughout the world. In some countries, one in four women has been sexually assaulted by an intimate partner, according to the World Health Organisation. The WHO's World Report on Violence and Health in 2002 also finds that in some countries as many as one in three young women report being forced into their first sexual experience.



UNFPA renews call to end FGM
(News Article; Sub-Saharan Africa)
6 Feb 2007
Angola Press
The United Nations Population Fund (UNFPA) renewed its call for intensified global efforts to save the 3 million girls who still face the risk of female genital mutilation or cutting every year. The UNFPA executive director pledged to increase support for efforts to prevent female genital mutilation or cutting, and advance gender equality and human rights, including the right to sexual and reproductive health.

YOUTH HEALTH RESEARCH

Does setting adolescent-friendly standards improve the quality of care in clinics? Evidence from South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal for Quality in Health Care. 2 Feb 2007;Onlince access February 9, 2007.
Dickson KM | Ashton J | Smith JM
This study determined whether setting and implementing adolescent-friendly standards improves the quality of adolescent services in clinics. The authors found that intervention clinics with adolescent-friendly services performed better than regular clinics on most criteria. Setting and implementing standards and criteria improves the quality of adolescent services in clinics. Best results are achieved when a facilitator trained in quality improvement methodologies supports clinics.



Perinatal outcomes and risk factors of Turkish adolescent mothers
(Abstract; subscription needed for full text; Europe)
Journal of Pediatric and Adolescent Gynecology. 2007 Feb;20(1):19-24.
Keskinoglu P | Bilgic N | Picakciefe M | Giray H | Karakus N | Gunay T
This study determined obstetric and neonatal outcomes and risk factors in adolescent pregnant women and compared perinatal outcomes among teen age groups and between adolescent and adult women. A relation was observed between the rate of adolescent pregnancy and social, economic, and cultural factors. In developing countries, alterations of the social and cultural factors that may be the cause for early marriages are difficult and slow. Obstetric and perinatal complications could be significantly reduced by effective family planning.

YOUTH HEALTH NEWS

Brazil vows to install condom machines in schools
(News Article; South America)
7 Feb 2007
Reuters
Brazil's health ministry vowed to proceed with plans to put condom vending machines in schools and sought to defuse criticism with new data showing that parents in the world's largest Roman Catholic nation approve of the idea. Brazil's health ministry has been offering free condoms and sex education for more than a decade in some schools as part of an AIDS-prevention program that has been recognized worldwide for its success in avoiding an epidemic of the sexually transmitted disease.



Bahamas: Youth report “troubling”
(News Article; Central America and the Caribbean)
6 Feb 2007
The Bahama Journal
Details of a crucial report on the socioeconomic situation of youth in The Bahamas emerged recently. The document contained was compiled by Inter American Development and contained some troubling findings, including that almost half of all male secondary school students and 20 percent of all female students are sexually active by the time they are 15.



Qatar: Doctors back sex education in schools
(News Article; Middle East)
9 Feb 2007
The Peninsula
Following a recent statement made by former Dean of Qatar University about the need to introduce sex education as a subject in schools, several doctors have said it would be a good idea. Most doctors felt that failure to introduce the subject to youngsters aged 10 and up could lead to them getting into trouble at a later age, including unwanted pregnancies and deviant sexual activity.

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