Volume 7, Number 13
16 April 2007

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FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

The importance of discreet use of the diaphragm to Zimbabwean women and their partners
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS and Behavior. 2007 May;11(3):443-451.
Kang MS | Buck J | Padian N | Posner SF | Khumalo-Sakutukwa G
We conducted a 6-month acceptability study of diaphragms as a potential HIV/STI prevention method among Zimbabwean women. We examined partner involvement in diaphragm use, and importance of discreet use (use without partner awareness). Of the 181 women who completed the study, 45% said discreet use was "very or extremely important" and in multivariate logistic regression, women were more likely to value discretion if their partners: had other partners; drank alcohol; or were believed to prefer condoms to diaphragms. Qualitative data confirmed these findings. Both women and their partners reported that diaphragms can be used discreetly and saw this as advantageous, for both sexual pleasure and female control. However, many were concerned that use without partner approval could lead to marital problems. Discreet use should be considered in development of barrier methods and in diaphragm promotion, if proven effective against HIV/STI.

Social and behavioral determinants of consistent condom use among female commercial sex workers in Ghana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Education and Prevention . 2007 Apr;19(2):160-172.
Adu-Oppong A | Grimes RM | Ross MW | Risser J | Kessie G
This study investigated the social and behavioral predictors of consistent condom use among female commercial sex workers in Ghana. Four hundred fifty street commercial sex workers were interviewed in Accra, Kumasi, and Techiman. The level of condom education was very low (14%); however, consistent condom use (all the time) with clients was relatively high (49.6%). Two-hundred seventy-seven of the participants did not use condoms all the time.

Changes in weight with depot medroxyprogesterone acetate subcutaneous injection 104 mg/0.65 mL
(Abstract; subscription needed for full text; Global)
Contraception . 2007 Apr;75(4):261-267.
Westhoff C | Jain JK | Milsom I | Ray A
The study was conducted to assess the impact of depot medroxyprogesterone acetate subcutaneous injection 104 mg/0.65 mL (DMPA-SC 104) on body weight. Changes in weight from pretreatment were analyzed using data from two 1-year, noncomparative trials of DMPA-SC 104 (North/South American, N=722; European/Asian, N=1065) and a 3-year, randomized study (SC/IM) comparing DMPA-SC 104 (N=266) with the DMPA intramuscular injection 150 mg/mL (DMPA-IM 150). For each study, additional analyses were conducted for changes in body weight by age (less than 25, 25 to 35 and greater than 35 years) and body mass index (BMI) (less than or equal to 25, greater than 25 to less than or equal to 30 and greater than 30 kg/m2) subgroups. In both 1-year trials, the mean (+/-SD) weight gain at month 12 was less than 2 kg [1.7 kg (+/-4.5 SD) in the Americas trial and 1.4 kg (+/-3.6 SD) in the Europe/Asia trial]. In the SC/IM trial, mean weight changes were similar between DMPA-SC 104 and DMPA-IM 150 groups, with mean (+/-SD) gains at month 36 of 4.5+/-8.5 and 5.8+/-8.7 kg, respectively. Similar differences in weight gain were observed by age or baseline BMI in all studies. DMPA-SC 104 was associated with modest weight gain in most women.

Fertility preferences, contraceptive behaviors and unmet needs: A gap between urban and suburban parts of a city
(Abstract; subscription needed for full text; Europe)
European Journal of Contraception and Reproductive Health Care . 2007 Mar;12(1):86-94.
Dinc G | Eser E | Cihan UA | Ay S | Pala T
The purpose of this study was to explore the differences in unwanted fertility in different parts of a city. Data were obtained from the 1999 Manisa Demographic and Health Survey (MDHS) in Turkey. We collected information from a representative sample of 1728 ever married women aged 15-49 years on fertility, fertility preferences, unmet need for family planning, contraceptive discontinuation, and abortion. Data were analyzed using SPSS 10.0 for Windows. Of the persons studied, 1238 (71.6%) were living in urban settlements and 490 (28.4%) in suburban (gecekondu) settlements. The total fertility rate is higher among gecekondu women (2.42) than among urban women (2.14) although gecekondu women have a lower wanted fertility rate (1.54) than urban women (1.77). Married women in the urban area were currently using a contraceptive method more frequently (75.6%) than those living in the gecekondu area (61.7%) (OR 2.5; 95% CI 1.9-3.2; p less than 0.001). The unmet need percentage in gecekondu women (17.7%) is higher than in urban women (8.3%; p less than 0.001). The induced abortion rate is higher in urban women (14.8 per 1000 pregnancies) than in gecekondu women (7.1 per 1000 pregnancies; OR 2.1; 95% CI 1.4-3.1; p less than 0.001). There are inequalities in the achievement of fertility preferences and in accessibility to family planning services between urban and suburban parts of the city.

Health literacy and contraception: A readability evaluation of contraceptive instructions for condoms, spermicides and emergency contraception in the USA
(Abstract; subscription needed for full text; North America)
European Journal of Contraception and Reproductive Health Care. 2007 Mar;12(1):58-62.
El-Ibiary SY | Youmans SL
The purpose of this study was to assess readability of over-the-counter (OTC) contraceptive product instructions currently available, compare the results with previous studies from a decade ago, and review the implications for health care providers, in particular pharmacists counseling on OTC contraceptives. A sample of contraceptive instructions was submitted to a readability analysis using four standard readability formulas. Products included condoms, spermicides, and emergency contraception instruction pamphlets. Reading grade levels for condoms ranged from 6th to 12th grade. The average reading levels for the spermicides were 9th-10th grade and for the emergency contraceptives 10th-12th grade. These results were consistent with those of similar studies performed a decade ago. Consumers need to have at least a high school reading level in order to comprehend current product instructions. Very little has changed in the past decade regarding readability of OTC contraceptive patient instructions, despite calls to simplify written instructions. Healthcare providers, in particular pharmacists, must be aware of these disparities to enhance patient education and advocate for simpler reading materials.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Ethiopia: New strategy to tackle reproductive health issues
(News Article; Sub-Saharan Africa)
12 Apr 2007
IRIN
Related News Article: Ethiopia launches youth reproductive health strategy

Rwanda: Rulindo district to boost family planning
(News Article; Sub-Saharan Africa)
7 Apr 2007
Tasamba J, All Africa

Chile: President stands her ground on emergency contraception
(News Article; South America)
13 Apr 2007
Lowy M, Latin America Press

Men's and women's fertility facts--explained
(News Article; Global)
11 Apr 2007
Van Dusen A, Forbes

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

India 'to drop' menstrual forms
(News Article; Asia)
12 Apr 2007
BBC News

HIV/AIDS RESEARCH

Early adolescent peer leader development in HIV prevention using youth-adult partnership with schools approach
(Abstract; subscription needed for full text; Asia)
Journal of the Association of Nurses in AIDS Care. 2007 Mar-Apr;Online access April 12, 2007. 18(2):60-71.
Fongkaew W | Fongkaew K | Suchaxaya P
This article describes the development and evaluation of an HIV prevention program developed for early adolescents through participatory action research. The HIV prevention program included a curriculum that was delivered by trained younger youth leaders through a youth and adult partnership with 10 schools in Chiang Mai Province, Thailand. The curriculum used participatory learning experiences, "edutainment" approaches, and skills-building strategies for enhancing youth leaders' capacities. Results of the evaluation showed that the senior-junior peer education program was effective in leadership role preparation, in improving youth leaders' ability to share sexual and reproductive health knowledge, and in promoting positive attitudes toward themselves. Success also rested on the fact that adults took a critical role in providing the opportunities, assistance, and guidance so that young people could develop their leadership capacity in an atmosphere of trust and respect.

Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science and Medicine. 2007 May;Online access April 12, 2007. 64(9):1823-1831.
Simbayi LC | Kalichman S | Strebel A | Cloete A | Henda N
AIDS stigmas interfere with HIV prevention, diagnosis, and treatment and can become internalized by people living with HIV/AIDS. However, the effects of internalized AIDS stigmas have not been investigated in Africa, home to two-thirds of the more than 40 million people living with AIDS in the world. The current study examined the prevalence of discrimination experiences and internalized stigmas among 420 HIV-positive men and 643 HIV-positive women recruited from AIDS services in Cape Town, South Africa. The anonymous surveys found that 40% of persons with HIV/AIDS had experienced discrimination resulting from having HIV infection and one in five had lost a place to stay or a job because of their HIV status. More than one in three participants indicated feeling dirty, ashamed, or guilty because of their HIV status. A hierarchical regression model that included demographic characteristics, health and treatment status, social support, substance use, and internalized stigma significantly predicted cognitive-affective depression. Internalized stigma accounted for 4.8% of the variance in cognitive -- affective depression scores over and above the other variables. These results indicate an urgent need for social reform to reduce AIDS stigmas and the design of interventions to assist people living with HIV/AIDS to adjust and adapt to the social conditions of AIDS in South Africa.

Prevalence and correlates of condom use and HIV testing among female sex workers in Tashkent, Uzbekistan: Implications for HIV transmission
(Abstract; subscription needed for full text; Asia)
AIDS and Behavior. 2007 May;Online access April 12, 2007. 11(3):435-442.
Todd CS | Alibayeva G | Khakimov MM | Sanchez JL | Bautista CT
Little is known about sex work in Tashkent, Uzbekistan, despite rapid increases in HIV infection. Consistent client condom use and prior HIV testing are described among 448 female sex workers (FSW) completing a self-administered questionnaire, health provider interview, and HIV testing between April 2003 and March 2004. Participants were recruited through outreach workers using modified snowball sampling. Consistent client condom use was more likely for FSW who were married, knew condoms prevent HIV, and from countries in south Central Asia. Prior HIV testing was less likely for FSW younger than 21 years, who shared drugs with clients, initiated sex work at 18 years or less and had engaged in sex work less than 2 years. Low rates of condom use, particularly by those with risky drug behaviors, indicate that targeted risk-reduction interventions are urgently needed.

Perceptions of community HIV prevalence, own HIV infection, and condom use among teachers in KwaZulu-Natal, South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS and Behavior. 2007 May;Online access April 12, 2007. 11(3):453-462.
Chao LW | Gow J | Akintola O | Pauly M
A total of 120 teachers from KwaZulu-Natal, South Africa, underwent HIV/AIDS training. As part of the study, the teachers were surveyed, before and after the training, about their perceptions of HIV prevalences among pupils, other teachers, and community members, and about their perceptions of their own HIV status. Before the training, the teachers estimated average HIV prevalences among pupils, other teachers, and other community members to be 36%, 48%, and 61%, respectively. One-third of the teachers believed that they had a 50% or greater chance of currently being infected with HIV. Male teachers and teachers with a university degree gave lower HIV prevalence estimates for other people but not for themselves. Frequency of condom use was positively related to teachers' HIV prevalence estimates for other people. Teachers' estimates of HIV prevalence and perceived risk of own HIV infection increased significantly after the HIV/AIDS training.

A social cognitive model of health for HIV-positive adults receiving care in India
(Abstract; subscription needed for full text; Asia)
AIDS and Behavior. 2007 May;Online access April 12, 2007. 11(3):491-504.
Tarakeshwar N | Srikrishnan AK | Johnson S | Vasu C | Solomon S
In-depth interviews were conducted with 50 HIV-positive adults (23 women, 27 men) with access to care at a non-governmental organization in Chennai, India to gain a broad understanding of how they managed their HIV infection. Using a Social Cognitive Model of Health, we identified factors within the model's three domains -- Personal, Environmental, and Behavioral -- that are applicable to this socio-cultural context. The Personal domain's factors were a positive self-concept, family-focused goals, and treatment optimism; the Environmental domain comprised family-based support, treatment availability, access and quality, and HIV stigma and discrimination; and the Behavior domain's factors were medication adherence and health habits, sexual behavior, and social relationships and emotional well-being. Significant differences for many of the factors within the three domains were observed across married men and women, widowed women, unmarried men, and female sex workers. Implications for an enhanced intervention for HIV-infected individuals in similar treatment settings are discussed.

HIV/AIDS NEWS

AIDS drugs sales could top $10 billion by 2015
(News Article; Global)
12 Apr 2007
Reuters

AIDS-hit South Africa running out of burial plots
(News Article; Sub-Saharan Africa)
11 Apr 2007
Reuters

Thailand weighs offer for AIDS drugs
(News Article; Asia)
10 Apr 2007
Associated Press

Pacific told it can't ignore threat of Aids
(News Article; Asia | Oceania)
12 Apr 2007
New Zealand Herald

Swaziland: HIV hits hard on farmers
(News Article; Sub-Saharan Africa)
13 Apr 2007
The Swazi Observer

MATERNAL AND CHILD HEALTH RESEARCH

Rapid achievement of the child survival Millennium Development Goal: Evidence from the Navrongo experiment in Northern Ghana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Tropical Medicine and International Health. 2007 May;12(5):1-6.
Binka FN | Bawah AA | Phillips JF | Hodgson A | Adjuik M
The objective was to determine the impact of deploying nurses and volunteers to village locations on demographic and health outcomes. We implemented an experimental design that emphasizes the value of aligning community health services with traditional social institutions that organize village life. Data for this analysis come from the Navrongo demographic surveillance system, a longitudinal database that tracks fertility, mortality, and migration events over time. The experiment uses conventional demographic methods for estimating mortality rates from longitudinal demographic surveillance registers. Posting nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated attainment of the childhood-survival millennium development goal (MDG) in the study areas relative to trends observed in comparison areas. Results from the Navrongo experiment demonstrate that community health and family planning programmes can have an impact on childhood mortality. Posting nurses to communities can dramatically accelerate the pace of progress in achieving the childhood-survival MDGs. Community-volunteer approaches, however, have no additional impact, a finding that challenges the child survival value of international investment in volunteer-based health programmes. The total cost of the intensive arm of the project is less than $10 per capita per year. Navrongo research thus demonstrates affordable means of attaining the child survival MDG agenda with existing technologies.

Electric breast pump use increases maternal milk volume in African nurseries
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Tropical Pediatrics. 2007 Apr;53(2):125-130.
Slusher T | Slusher IL | Biomdo M | Bode-Thomas F | Curtis BA
Health experts worldwide recognize breastmilk as the superior infant food. Recommendations from the American Academy of Pediatrics and the World Health Organization (WHO) identify exclusive breastfeeding for the first half-year of life and continuation of breastfeeding into toddlerhood as offering maximum protection from illness, providing a substrate for immunological protection. Data from developed countries identify increasing morbidity and mortality rates for infants who have never received breastmilk in life and demonstrate that infants benefit from exclusive breastfeeding, especially, in areas of severe poverty. Preterm infants, most at risk for morbidity and mortality in developing countries, are identified as needing their own mother's milk for survival. Exclusive feeding of own mothers' milk (OMM) is associated with improved infant survival; however, inadequate maternal milk volume (MMV) often necessitates adding artificial feedings or exogenous substances to OMM. The objective of this study was to compare mean daily MMV for mothers of premature or sick infants in special care nurseries (SCN) using one of three methods of OMM expression: electric breast pump, non-electric pedal breast pump, and hand (manual) expression. We studied 65 mothers whose infants were cared for in two SCN in Africa (Kenya and Nigeria) and were unable to feed directly at the breast. In this randomized trial, mothers were randomly assigned to one of three milk expression groups at birth. MMV, the dependent variable, was measured for an average of 8.7 days. MMV for the electric and pedal pump and hand milk expression was 578 plus or minus 228 ml (n = 22), 463 plus or minus 302 ml (n = 24) and 323 plus or minus 199 ml (n = 19), respectively. Data were evaluated using a one-way ANOVA (p = 0.014). The Tukey revealed significant differences (p less than 0.01) between electric breast pump expression and hand expression but not between the electric and pedal pump or the pedal pump and hand expression. Findings revealed greater MMV with electric breast pumps than hand-expression for mothers of infants in African nurseries. This data has important implications for international policy if exclusive OMM feeding is to be achieved for the vulnerable infant.

Correlates of depressive symptomatology during the second trimester of pregnancy among Hong Kong Chinese
(Abstract; subscription needed for full text; Asia)
Social Science and Medicine. 2000 May;64(9):1802-1811.
Lau Y | Keung DW
The study investigated the correlates of antenatal depressive symptoms among Hong Kong Chinese women during their second trimester of pregnancy. A total of 2178 women were recruited at five regional public hospitals in Hong Kong to participate in a study with a cross-sectional design. Associations were examined between depressive symptoms (using the Edinburgh Postnatal Depression Scale) and socioeconomic, obstetric, and Chinese family relations. Logistic regression analysis revealed that younger age, a personal or family psychiatric history, an unplanned pregnancy, a history of menstruation discomfort or premenstrual mood change, high marital conflict, and high mother-in-law conflict were found to be associated with more severe depressive symptoms. Antenatal depression is important because of its association with risk of adverse consequences for mothers and their families. There is a consensus that depression is most treatable when detected early. These findings therefore provide important information for the prevention of antenatal depressive symptoms among the Hong Kong population, amongst whom depression is rarely talked about. The implications and limitations of these findings and directions for future research are discussed.

MATERNAL AND CHILD HEALTH NEWS

Zero infant mortality, Cuba region
(News Article; Central America and the Caribbean)
2007 Apr 11;
Prensa Latina
Related News Article: Cuba with lowest Latin American infant mortality rate

Ghana: Assembly moves to curb maternal mortality
(News Article; Sub-Saharan Africa)
2007 Apr 11;
Ghana News Agency

Nepal: More than 600,000 women suffer uterine prolapses
(Feature Article; Asia)
10 Apr 2007
IRIN

MEN'S HEALTH RESEARCH

Acceptability of male circumcision for prevention of HIV/AIDS in sub-Saharan Africa: A review
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS and Behavior. 2007 May;11(3):341-355.
Westercamp N | Bailey RC
Based on epidemiological, clinical and experimental evidence, male circumcision (MC) could have a significant impact on the HIV epidemic in selected areas. We reviewed studies of the acceptability of MC in sub-Saharan Africa to assess factors that will influence uptake of circumcision in traditionally non-circumcising populations. Thirteen studies from nine countries were identified. Across studies, the median proportion of uncircumcised men willing to become circumcised was 65% (range 29-87%). Sixty-nine percent (47-79%) of women favored circumcision for their partners, and 71% (50-90%) of men and 81% (70-90%) of women were willing to circumcise their sons. Because the level of acceptability across the nine countries was quite consistent, additional acceptability studies that pose hypothetical questions to participants are unnecessary. We recommend pilot interventions making safe circumcision services available in conjunction with current HIV prevention strategies and evaluating the safety and acceptability of circumcision.

Male circumcision to prevent HIV transmission and acquisition: What else do we need to know?
(Abstract; subscription needed for full text)
AIDS and Behavior. 2007 May;11(3):357-363.
Muula AS
There is growing interest and controversy regarding the promotion of male circumcision (MC) for the prevention of HIV transmission in Africa. Three randomized controlled studies have so far been stopped prematurely as evidence accumulated that showed that circumcision was superior to no circumcision in preventing HIV acquisition among sexually active men in Africa. To some people, the evidence is overwhelming and MC should be promoted aggressively. Others suggest cautious decision making. This paper attempts to review a continuum of perceptions and suggest that the decision to scale-up male circumcision cannot just be based on randomized controlled trial results.

Prospective evaluation of the learning curve for holmium laser enucleation of the prostate
(Abstract; subscription needed for full text; Global)
Journal of Urology. 2007 Apr;177(4):1468-1474.
Shah HN | Mahajan AP | Sodha HS | Hegde S | Mohile PD
In a prospective manner we evaluated the learning experience of an endourologist inexperienced with holmium laser prostate enucleation and its impact on surgical outcome. We also reviewed the literature to document technical features of holmium laser prostate enucleation at different institutions. Patient demographic, perioperative and followup data were analyzed. To assess the impact of the learning curve on postoperative outcome patients were divided into group 1 -- patients 1 to 50, group 2 -- 51 to 100 and group 3 -- 101 to 162. The effect of the learning curve and weight of resected tissue on enucleation and morcellation efficiency was studied. Holmium laser prostate enucleation was successfully completed in 93.82% of patients. Eight patients required conversion to transurethral prostate resection. Enucleation and morcellation efficiency was 0.49 and 2.75 gm per minute, respectively. Enucleation efficiency attained a plateau after 50 cases. Postoperative outcome was compared in the 3 patient groups. There was a higher incidence of capsular perforation and stenotic urethral complications in group 1. In the literature a mean of 57.09% of tissue (range -9.6 to 81.9%) was retrieved after holmium laser prostate enucleation and mean efficiency was 0.52 gm per minute (range -0.11 to 1.09). Efficiency increased proportionally with resected prostate weight. An endourologist inexperienced with holmium laser prostate enucleation can perform the procedure with reasonable efficiency after about 50 cases with an outcome comparable to that of experts, as described in the literature. During the learning curve conversion to transurethral prostate resection can be done without any harm to the patient.

MEN'S HEALTH NEWS

Anti-malaria pesticide affects male fertility
(News Article; Sub-Saharan Africa)
12 Apr 2007
Carnie T, The Mercury/Independent Online
Related Research Article: Impaired semen quality associated with environmental DDT exposure in young men living in a malaria area in the Limpopo Province, South Africa

Testicular cancer survivors have increased risk of noncancer deaths
(News Article; Global)
8 Apr 2007
Medical News Today

Myths about manhood keep teen boys from sexual health care
(News Article; Global)
11 Apr 2007
Medical News Today
Related News Article: Masculine beliefs, parental communication, and male adolescents' health care use

New York Health Department plans to promote male circumcision to help reduce spread of HIV
(News Article; Global)
9 Apr 2007
Medical News Today

POPULATION RESEARCH

Sub-Saharan Africa: Beyond the health worker migration crisis?
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science and Medicine. 2007 May;64(9):1876-1891.
Connell J | Zurn P | Stilwell B | Awases M | Braichet JM
Migration of skilled health workers from sub-Saharan African countries has significantly increased in this century, with most countries becoming sources of migrants. Despite the growing problem of health worker migration for the effective functioning of health care systems there is a remarkable paucity and incompleteness of data. Hence, it is difficult to determine the real extent of migration from, and within, Africa, and thus develop effective forecasting or remedial policies. This global overview and the most comprehensive data indicate that the key destinations remain the USA and the UK, and that major sources are South Africa and Nigeria, but in both contexts there is now greater diversity. Migrants move primarily for economic reasons, and increasingly choose health careers because they offer migration prospects. Migration has been at considerable economic cost, it has depleted workforces, diminished the effectiveness of health care delivery and reduced the morale of the remaining workforce. Countries have sought to implement national policies to manage migration, mitigate its harmful impacts and strengthen African health care systems. Recipient countries have been reluctant to establish effective ethical codes of recruitment practice, or other forms of compensation or technology transfer, hence migration is likely to increase further in the future, diminishing the possibility of achieving the United Nations millennium development goals and exacerbating existing inequalities in access to adequate health care.

POPULATION NEWS

Donors must help improve maternal, child health, women's education to reduce population pressures in developing countries, report says
(News Article; Global)
2007 Apr 6;
Medical News Today
Related News Article: The shape of things to come: Why age structure matters to a safer, more equitable world
(You need Adobe Acrobat Reader to access this document)

Governments must take advantage of demographic shift, UN meeting told
(News Article; Global)
09 Apr 2007
UN News Centre

Fertility rate in Pakistan declining fast
(News Article; Asia)
13 Apr 2007
Hasan K, Daily Times

Croatia: Low birth rate – the result of a lack of marriages
(News Article; Europe)
10 Apr 2007
JAVNO

WOMEN'S HEALTH RESEARCH

An exploration of attitudes toward female genital cutting in Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Population Research and Policy Review. 2007 Feb;26(1):69-83.
Freymeyer RH | Johnson BE
Female genital cutting (FGC) continues to be widespread, particularly in sub-Saharan African countries. We use data from the 1999 Nigeria Demographic and Health Survey to consider factors that influence attitudes toward this procedure held by Nigerian women aged 15-49. We test four models: model 1 explores whether attitudes are consistent with a view of FGC as a social convention associated with marriage-ability of women. Model 2 examines the impact of modernization factors such as education and urbanization. In model 3, the influence of media and community activities are considered. Model 4 includes all of the factors in the three previous models. We find strong support for considering FGC a social convention. Modernization has minimal impact on attitudes about FGC mainly through its influence on the social convention.

Gender and the gynecological examination: Women's identities in doctors' narratives
(Abstract; subscription needed for full text; Global)
Qualitative Health Research. 2007 Apr;17(4):477-488.
Galasinski D | Ziólkowska J
The authors explore the constructions of gender in male doctors' narratives of gynecological examinations. Focusing on the ways in which gender identities are constructed in the stories of the medical encounter, they argue, first, that gender is more flexible during the visit with a gynecologist than has been suggested. Gendered identities are assumed and put aside as the interaction progresses, with its final stage -- the pelvic examination -- being constructed with gender removed. Second, they argue that undressing is invested with a special status during the examination. It is a gendered rite of passage between the two different ungendered subject positions of the doctor and the patient. They conclude that contrary to the assumptions in the literature on gynecological interactions, it is the genderization of undressing that is most conducive to securing the least face-threatening gynecological examination for the woman.

WOMEN'S HEALTH NEWS

Staining 'spots cervical cancer': A cell-staining technique could help scientists in developing countries detect cervical cancers more accurately, a study has found
(News Article; Global)
9 Apr 2007
BBC News
Related Research Article: MCM immunocytochemistry as a first line cervical screening test in developing countries: a prospective cohort study in a regional cancer centre in India

Culture a barrier to Pap tests for Mexican women
(News Article; Central America and the Caribbean)
6 Apr 2007
Reuters
Related Research Article: Cervical cancer: A qualitative study on subjectivity, family, gender

Mexico: Activists cheer new anti-violence law: New legislation seeks to curb endemic violence against women
(News Article; Central America and the Caribbean)
12 Apr 2007
Lorraine Orlandi, Latin America Press

YOUTH HEALTH RESEARCH

Global perspectives on the sexual and reproductive health of adolescents: Patterns, prevention, and potential
(Abstract; subscription needed for full text; Global)
Lancet. 2007 Apr 7;Online access April 12, 2007. 369(9568):1220-1231.
Bearinger LH | Sieving RE | Ferguson J | Sharma V
Worldwide, societal shifts and behavioural patterns exacerbated by unique developmental vulnerabilities create a confluence of factors that place today's adolescents at heightened risks for poor health outcomes. Country-level data show that continued investment in effective prevention and treatment strategies is essential to protect adolescents' sexual and reproductive health. Whereas strategies must be tailored to the developmental needs of this age group and their social contexts, effective approaches are multifaceted. All adolescents need access to quality youth-friendly services provided by clinicians trained to work with this population. Sex education programmes should offer accurate, comprehensive information while building skills for negotiating sexual behaviours. Girls and boys also need equal access to youth development programmes that connect them with supportive adults and with educational and economic opportunities. Although progress has been made since the 1994 International Conference on Population and Development, adolescents continue to be disproportionately burdened by threats to their sexual and reproductive health.

Research brief: Sexual communication and knowledge among Mexican parents and their adolescent children
(Abstract; subscription needed for full text; Central America and the Caribbean)
Journal of the Association of Nurses in AIDS Care. 2007 Mar-Apr;Online access April 12, 2007. 18(2):28-34.
Gallegos EC | Villarruel AM | Gomez MV | Onofre DJ | Zhou Y
This study describes the sexual knowledge and communication of Mexican parents and adolescents. Preintervention data were analyzed from 829 high school students (ages 14-17) and one of the parents of each. Differences were found between parents and adolescents in sexual knowledge (M = 16.16 vs. M = 14.92; t = 7.20, p less than .001); specifically, parents had higher knowledge related to sexually transmitted diseases, HIV/AIDS, and condom use. Parents perceived more general communication (t [787] = 6.33, p less than .001), and less discomfort talking about sex (t [785] = 4.69, p less than .001) than adolescents. Parents with higher education levels scored higher in HIV knowledge and general communication. Fathers had higher total sexual knowledge, whereas mothers perceived higher sexual communication than fathers. There were no differences in knowledge and communication by parental socioeconomic level. Results suggest health care providers need to assist parents in developing specific knowledge and skills to support their adolescents' sexual decision-making.

Sexual stigma, sexual behaviors, and abstinence among Vietnamese adolescents: Implications for risk and protective behaviors for HIV, sexually transmitted infections, and unwanted pregnancy
(Abstract; subscription needed for full text; Asia)
Journal of the Association of Nurses in AIDS Care. 2007 Mar-Apr;Online access April 12, 2007. 18(2):48-59.
Kaljee LM | Green M | Riel R | Lerdboon P | Le Huu Tho
As rates of HIV increase in Vietnam, there is a need for data on social relations and sexual risk and protective behaviors among Vietnamese adolescents in a context of rapid social and economic changes. The authors report results from qualitative interviews with 159 Vietnamese adolescents living in Hanoi, Nha Trang City, and Ninh Hoa District and a survey of 886 adolescents in these same three sites. In the qualitative interviews, youths report a strong adherence to ideals and values regarding abstinence outside of marriage. Youths reported low rates of engagement in vaginal, anal, and/or oral sex with a significant difference in reported behaviors between males (29/469, 6.2%) and females (7/416, 1.7%; p = .000). A total of 15 of 32 (46.9%) sexually active youths reported rarely or never using condoms. Females had significantly higher scores for perceived sexual stigma than males (t = -10.22 [95% confidence interval (CI); -3.72 to -2.52; p = .000) whereas males scored significantly lower than females on a scale of perceived self-efficacy for abstinence (t = 5.31 [95% CI; .27 to .59]; p = .000). The stigmatization of sexual relations outside of marriage particularly for young women reinforces abstinence; however, these same values decrease adolescents' ability to obtain accurate information about sexuality and HIV and sexually transmitted infections and engage in safer sex.

Culture-specific factors contributing to HIV risk among Jamaican adolescents
(Abstract; subscription needed for full text; Central America and the Caribbean)
Journal of the Association of Nurses in AIDS Care. 2007 Mar-Apr;Online access April 12, 2007. 18(2):35-47.
Hutchinson MK | Jemmott LS | Wood EB | Hewitt H | Kawha
The purpose of this article is to describe the results from an elicitation research study addressing the multisystem-level factors that contribute to HIV risk among Jamaican adolescents. Focus group and survey data were determined from parents, adolescents, and teachers in Kingston, Jamaica, from 2004 and 2005. Guided by an ecological extension of the Theory of Planned Behavior, focus groups and survey questionnaires identified cultural factors at the individual, family, and societal levels that significantly influence Jamaican adolescents' behavioral, normative, and control beliefs related to sexual behaviors that contribute to risk for HIV and other sexually transmitted infections. Although some factors were similar to those reported among adolescents living in the United States, others were culture-specific influences and beliefs that were unique to Jamaica. Results from the current study could contribute to the development of theory-based, culture-specific HIV risk-reduction interventions for use with Jamaican adolescents.

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Volume 7, Number 1316 April 2007