Volume 7, Number 16
7 May 2007

Note: The Pop Reporter Topical Category Changes

To better meet your information needs, starting May 7, 2007, The Pop Reporter will group research and news items under new topical categories. This will make it easier for us to provide you with relevant research and news.

The topical categories as of May 1, 2007 are:

Adolescent Health - will take the place of Youth Health;
Family Planning - will take the place of Family Planning/Reproductive Health;
Gender and Health - will take the place of Women's Health and Men's Health;
HIV/AIDS and STIs - will take the place of HIV/AIDS;
Law and Policy – will take the place of Family Planning/Reproductive Health Law and Policy;
Maternal and Child Health - will remain the same;
Population/Fertility/Demography - will take the place of Population.

Items will continue to be grouped under Research and News.

FAMILY PLANNING RESEARCH

Nurses' discourse in contraceptive prescribing: An analysis using Foucault's 'procedures of exclusion'
(Abstract; subscription needed for full text; Europe)
Journal of Advanced Nursing . 2007 May;58(4):358-367.
Hayter M
Related Report: Focus on...Improving Hormonal Method Continuation
(You need Adobe Acrobat Reader to access this document)
This paper is a report of an analysis of the discourse about contraceptive efficacy and side effects used by nurses when prescribing contraception. All women seeking contraception should be informed of the efficacy and potential adverse effects of the particular method they are considering. This information facilitates an informed choice. Women also require this information in order to monitor for any side effects. Paradoxically, side effects are also a key factor in reducing adherence with contraceptive regimens. However, there is no literature that explores specifically how this issue is addressed in clinical consultations, or places these practices in a theoretical context. Forty-nine consultations between nurses and women in sexual health clinics were audio-recorded during 2002. Data were subject to a discourse analysis using Foucault's 'procedures of exclusion' to explore the discursive construction of contraceptive efficacy and side effects. The nurses employed specific discursive strategies when discussing contraception. When addressing efficacy, discourse centred on medico-statistical facts, but side effects were described in lay terms that minimized their severity. Nurses contextualized contraceptive side effects within potential problems that women might experience in pregnancy, and also attempted to 'normalize' contraceptive-related problems. Discourse and its deployment play a key role in practitioner-client relationships that sexual health nurses need to become more aware of how they discuss clinical issues about contraception with women. Clinical data on contraceptive side-effects are present in the literature, and it is important that sexual health nurses use this to help women make truly informed decisions.

Tubal sterilization, all-cause death, and cancer among women in the United Kingdom: Evidence from the Royal College of General Practitioners' Oral Contraception Study
(Abstract; subscription needed for full text; Europe)
American Journal of Obstetrics and Gynecology. 2007 May;196(5):447.e1-447.e8.
Iversen L | Hannaford PC | Elliott AM
The purpose of this study was to examine the relationship between tubal sterilization and subsequent all-cause death and the risk of any gynecologic and breast cancer in women in the United Kingdom. A cohort study was conducted with 2801 sterilized women and 2801 nonsterilized women who were identified from the UK Royal College of General Practitioners' Oral Contraception Study. Adjusted hazard ratios and 95% CIs were calculated with Cox regression. Tubal sterilization was not associated with significantly altered risks of subsequent all-cause death or cancer. Tubal sterilization was associated with a nonsignificant reduced risk of subsequent gynecologic (adjusted hazard ratio, 0.84; 95% CI, 0.52-1.37) and breast cancer (adjusted hazard ratio, 0.88; 95% CI, 0.67-1.16). The absence of increased long-term death and cancer risk is reassuring, given that many women have chosen this method of contraception.

The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple's sexual behaviour during the fertile time: A prospective longitudinal study
(Abstract; subscription needed for full text; Europe)
Human Reproduction. 2007 May;22(5):1310-1319.
Frank-Herrmann P | Heil J | Gnoth C | Toledo E | Baur S | Pyper C | Jenetzky E | Strowitzki T | Freundl G
The efficacy of fertility awareness based (FAB) methods of family planning is critically reviewed. The objective was to investigate the efficacy and the acceptability of the symptothermal method (STM), an FAB method that uses two indicators of fertility, temperature and cervical secretions observation. This paper will recommend a more suitable approach to measure the efficacy. Since 1985, an ongoing prospective observational longitudinal cohort study has been conducted in Germany. Women are asked to submit their menstrual cycle charts that record daily basal body temperature, cervical secretion observations and sexual behaviour. A cohort of 900 women contributed 17 638 cycles that met the inclusion criteria for the effectiveness study. The overall rates of unintended pregnancies and dropout rates have been estimated with survival curves according to the Kaplan–Meier method. In order to estimate the true method effectiveness, the pregnancy rates have been calculated in relation to sexual behaviour using the 'perfect/imperfect-use' model of Trussell and Grummer-Strawn. After 13 cycles, 1.8 per 100 women of the cohort experienced an unintended pregnancy; 9.2 per 100 women dropped out because of dissatisfaction with the method; the pregnancy rate was 0.6 per 100 women and per 13 cycles when there was no unprotected intercourse in the fertile time. The STM is a highly effective family planning method, provided the appropriate guidelines are consistently adhered to.

Contraindications to oral contraceptive use among women in the United States, 1999–2001
(Abstract; subscription needed for full text; North America)
Contraception. 2007 May;75(5):355-360.
Shortridge E | Miller K
The prescription requirement for oral contraceptives (OCs) is designed to prevent women with contraindications from using OCs, but this system has never been evaluated. This analysis investigates OC use among women who have contraindications. The authors use National Health and Nutrition Examination Survey data to estimate the prevalence of contraindications among OC users and nonusers. They associate OC use with contraindication status, controlling for sociodemographic characteristics and access to health services. Overall, 16% of fecund women aged 20 to 51 years are contraindicated from OC use. The prevalence of contraindications among current OC users is 6%, as compared to 19% among nonusers. Regression results show that OC use is more strongly associated with age, race, marital status and health insurance coverage than with having a contraindication to OCs. The results suggest that under the prescription requirement, screening for contraindications to OCs may be working, but not perfectly. More research is needed to identify more effective and convenient screening methods.

Safety and acceptability with the use of a contraceptive vaginal ring after surgical or medical abortion
(Abstract; subscription needed for full text; North America)
Contraception. 2007 May;75(5):367-371.
Fine P | Tryggestad J | Meyers N | Sangi-Haghpeykar H
The study was conducted to determine if a contraceptive vaginal ring (CVR) is a safe and acceptable method of contraception when used in the proximate postabortion period following first-trimester surgical or medical abortion. A CVR was inserted within 1 week following a medical or surgical abortion. Participants were followed up for 3 months to determine safety and acceptability. Safety was measured by the absence of signs of infection or serious adverse events. Acceptability was assessed by the CVR satisfaction survey, completed at the 3-month follow-up visit. Of 81 participants enrolled in the study, 69 (85%) completed the first-month follow-up visit, and 54 (67%) completed the final 3-month follow-up visit. There were no serious adverse events and no signs of infection on physical exam. Most adverse events were mild and not specifically related to the CVR. Related adverse events were those commonly associated with hormonal contraception use. Eighty-nine percent of participants chose to continue the CVR as their birth control method. The CVR is potentially safe and has high acceptability when used in the proximate postabortion period following a first-trimester abortion.

FAMILY PLANNING NEWS

World Bank health plan passes with no objections
(News Article; Global)
2 May 2007
Wroughton L, Reuters

India: Mumbai institute study indicates women prefer bimonthly injectable contraceptive
(News Article; Asia)
30 Apr 2007
Daily India/Asia News International
Related Report: Expanding Services for Injectables

Uganda: Family planning still low- Okware
(News Article; Sub-Saharan Africa)
2 May 2007
Mwanje R | Nakakande S, The Monitor

Uganda: Bugiri offers condoms in toilets
(News Article; Sub-Saharan Africa)
1 May 2007
Nampala M, The New Vision

Uganda: Women initiate condom use - study
(News Article; Sub-Saharan Africa)
1 May 2007
Onyalla H, The New Vision

HIV/AIDS and STIs RESEARCH

Do tests devised to detect recent HIV-1 infection provide reliable estimates of incidence in Africa?
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Acquired Immune Deficiency Syndromes (JAIDS). 2007 May 1;45(1):115-122.
Sakarovitch C | Rouet F | Murphy G | Minga AK | Alioum A
The objective of this study was to assess the performance of 4 biologic tests designed to detect recent HIV-1 infections in estimating incidence in West Africa (BED, Vironostika, Avidity, and IDE-V3). These tests were assessed on a panel of 135 samples from 79 HIV-1-positive regular blood donors from Abidjan, Cote d'Ivoire, whose date of seroconversion was known. The 135 samples included 26 from recently infected patients (less than or equal to 180 days), 94 from AIDS-free subjects with long-standing infection (greater than 180 days), and 15 from patients with clinical AIDS. The performance of each assay in estimating HIV incidence was assessed through simulations. The modified commercial assays gave the best results for sensitivity (100% for both), and the IDE-V3 technique gave the best result for specificity (96.3%). In a context like Abidjan, with a 10% HIV-1 prevalence associated with a 1% annual incidence, the estimated test-specific annual incidence rates would be 1.2% (IDE-V3), 5.5% (Vironostika), 6.2% (BED), and 11.2% (Avidity). Most of the specimens falsely classified as incident cases were from patients infected for greater than 180 days but less than 1 year. The authors conclude that none of the 4 methods could currently be used to estimate HIV-1 incidence routinely in Cote d'Ivoire but that further adaptations might enhance their accuracy.

Discordant responses to potent antiretroviral treatment in previously naive HIV-1-infected adults initiating treatment in resource-constrained countries: The antiretroviral therapy in low-income countries (ART-LINC) collaboration
(Abstract; subscription needed for full text; Global)
Journal of Acquired Immune Deficiency Syndromes (JAIDS). 2007 May 1;45(1):52-59.
Tuboi SH | Brinkhof MW | Egger M | Stone RA | Braitstein P
The objectives were to assess the frequency of and risk factors for discordant responses at 6 months on highly active antiretroviral therapy (HAART) in previously treatment-naive HIV patients from resource-limited countries. The Antiretroviral Therapy in Low-Income Countries Collaboration is a network of clinics providing care and treatment to HIV-infected patients in Africa, Latin America, and Asia. Patients who initiated therapy between 1996 and 2004, were aged 16 years or older, and had a baseline CD4 cell count were included in this analysis. Responses were defined based on plasma viral load (PVL) and CD4 cell count at 6 months as complete virologic and immunologic (VR+IR+), virologic only (VR+IR-), immunologic only (VR-IR+), and nonresponse (VR-IR-). Multinomial logistic regression was used to assess the association between therapy responses and clinical and demographic variables. Of the 3111 patients eligible for analysis, 1914 had available information at 6 months of therapy: 1074 (56.1%) were VR+IR+, 364 (19.0%) were VR+IR-, 283 (14.8%) were (VR-IR+), and 193 (10.1%) were VR-IR-. Compared with complete responders, virologic-only responders were older, had a higher baseline CD4 cell count, had a lower baseline PVL, and were more likely to have received a nonstandard HAART regimen; immunologic-only responders were younger, had a lower baseline CD4 cell count, had a higher baseline PVL, and were more likely to have received a protease inhibitor-based regimen. The frequency of and risk factors for discordant responses were comparable to those observed in developed countries. Longer follow-up is needed to assess the long-term impact of discordant responses on mortality in these resource-limited settings.

HIV prevention among travelers: Why do men not use condoms when they engage in commercial sex overseas?
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Diseases. 2007 Apr;34(4):237-244.
Wong ML | Chan RK | Koh D
We investigated factors associated with condom use among men patronizing female sex workers abroad and locally. We conducted a survey on 372 local men attending the only public sexually transmitted infections clinic in Singapore between 2001 and 2003. Condom use was higher among clients patronizing sex workers in Singapore than those patronizing sex workers abroad (87.5% vs. 54.4%, P less than 0.001). Condom use in both groups was associated with initiation of condom use by the sex workers (adjusted prevalence ratios: 1.67, 95% confidence interval: 1.11-2.49; 1.87, 1.21-2.90) but was not associated with clients' knowledge of disease, self-perceived risk, confidence in condom use, and dislike of condoms. Less sex workers abroad than in Singapore (32.7% vs. 75.6%, P less than 0.001) initiated condom use. Lower condom use among Singaporean travelers abroad was determined by extrinsic factors, whereby sex workers abroad were less likely to initiate condom use rather than by clients' factors.

The essentials of antiretroviral therapy for health care and program managers
(Technical Report; Global)
Watertown, Massachusetts, Pathfinder International, April 2007 (Technical Guidance Series No. 5)
Hope R | Israel E
Seventy percent of people needing Antiretroviral Therapy (ART) live in Africa, but until recently, only 10 percent of those in need have been able to access treatment. With the current, unprecedented global mobilization of resources for the fight against HIV and AIDS, people living in resource-limited settings are slowly beginning to access ART. This guidance paper provides basic information and practical guidance on ARI and wider care and treatment issues for program implementers and health care managers as well as addressing people's wider care, support, and treatment needs from the time they are diagnosed as HIV positive, before ART is needed, and after commencing ART. It discusses the community participation and services essential for mobilizing the wide range of resources that people living with HIV and their families need to optimize their quality of life and increase their use of facility-based services. The final section discusses end-of-life care for people whose disease does not respond to available drugs.

Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: A systematic review
(Research Article)
BMC Public Health. 2007 Apr 25;7(1):63.
Muula AS | Ngulube TJ | Siziya S | Makupe CM | Umar E
HIV and AIDS are significant and growing public health concerns in southern Africa. The majority of countries in the region have national adult HIV prevalence estimates exceeding 10 percent. The increasing availability of highly active antiretroviral therapy (HAART) has potential to mitigate the situation. There is however concern that women may experience more barriers in accessing treatment programs than men. A systematic review of the literature was carried out to describe the gender distribution of patients accessing highly active antiretroviral therapy (HAART) in Southern Africa. Data on number of patients on treatment, their mean or median age and gender were obtained and compared across studies and reports. The median or mean age of patients in the studies ranged from 33 to 39 years. While female to male HIV infection prevalence ratios in the southern African countries ranged from 1.2:1 to 1.6:1, female to male ratios on HAART ranged from 0.8: 1 to 2.3: 1. The majority of the reports had female: male ratio in treatment exceeding 1.6. Overall, there were more females on HAART than there were males and this was not solely explained by the higher HIV prevalence among females compared to males. In most Southern African countries, proportionally more females are on HIV antiretroviral treatment than men, even when the higher HIV infection prevalence in females is accounted for. There is need to identify the factors that are facilitating women's accessibility to HIV treatment. As more patients access HAART in the region, it will be important to continue assessing the gender distribution of patients on HAART.

HIV/AIDS and STIs NEWS

South Africa: Activists launch new AIDS plan
(News Article; Sub-Saharan Africa)
30 Apr 2007
Bobb S, Voice of America

South Africa: HIV prevention services miss rape survivors
(News Article; Sub-Saharan Africa)
1 May 2007
IRIN

African countries lag behind in fight against HIV/AIDS
(News Article; Sub-Saharan Africa)
30 Apr 2007
Kaberia J, Capital FM (Nairobi, Kenya)

Male circumcision - the new frontier in the fight against HIV/AIDS
(News Article; Global)
2 May 2007
Jamaica Gleaner

HIVMA opposes The Gambia's unproven AIDS remedy
(Press Release; Sub-Saharan Africa)
30 Apr 2007
Baragona S, EurekAlert

Thailand: AIDS test results to be aired in July
(News Article; Asia)
1 May 2007
Thai News Agency/MCOT
Related News Article: Results from Thai HIV/AIDS vaccine trial scheduled to be released in July

Uganda: STDs, HIV/AIDS counselling, testing centre inaugurated
(News Article; Sub-Saharan Africa)
30 Apr 2007
Uganda Press Agency
Related News Article: Angola: STDs, HIV/AIDS counselling, testing centre inaugurated

South Africa: Life's better in jail, say ex-prisoners hit by AIDS
(News Article; Sub-Saharan Africa)
30 Apr 2007
Munnion C, Daily Telegraph

Arrest call over Uganda Aids fund
(News Article; Sub-Saharan Africa)
1 May 2007
BBC News

'First India condom disco' opens
(News Article; Asia)
02 May 2007
Jolly A, BBC News

MATERNAL AND CHILD HEALTH RESEARCH

Health aid and infant mortality
(Research Article; Global)
(You need Adobe Acrobat Reader to access this document)
Washington, D.C., International Monetary Fund, 2007 (International Monetary Fund Working Paper WP/07/10)
Mishra P | Newhouse D
This paper examines the relationship between health aid and infant mortality, using data from 118 countries between 1973 and 2004. Health aid has a statistically significant effect on infant mortality: doubling per capita health aid is associated with a 2 percent reduction in the infant mortality rate... Although past studies have failed to document robust evidence that aid encourages economic growth, there remains hope among academics, policy makers, and the media that aid serves a critical role by saving lives. This hope is consistent with micro-level evidence of the success of specific public health intervention programs. In addition, economic growth plays a limited role in explaining changes in health outcomes, implying that focusing exclusively on the effect of aid on growth may overlook important health benefits from aid.

Hospital-based study of the economic burden associated with rotavirus diarrhea in Taiwan
(Abstract; subscription needed for full text; Asia)
Vaccine. 2007 May 22;25(21):4266-4272.
Chen KT | Fan SF | Tang RB | Huang YF | Lee PI
Rotavirus infection is the most important cause of diarrheal illness in small children in both developed and developing countries. In addition to causing morbidity and mortality in children, the treatment of rotavirus gastroenteritis is a major economic burden on the health care system and families. The purpose of this study was to estimate the economic burden associated with rotavirus infection in Taiwan. To do this, we combined data on the disease burden of a rotavirus-associated hospital admission with detailed cost data for a sample of 2,600 children with diarrhea who were admitted to the hospital. The annual total social and hospital costs for rotavirus-associated admission calculated from data collected during April 1, 2001 to March 31, 2003 was US $13.3 million and US $10.4 million, respectively. On average, families spent US $294 when their child's admission was associated with rotavirus infection; this cost represents about 40% of the monthly salary of an unskilled or service worker. In conclusion, these data emphasize the potential for a safe and effective rotavirus vaccine to reduce the economic burden associated with rotavirus disease.

Caesarean sections and maternal mortality in Sao Paulo
(Abstract; subscription needed for full text; South America)
European Journal of Obstetrics and Gynecology and Reproductive Biology . 2007 May;132(1):64-69.
Kilsztajn S | do Carmo MS | Machado LC Jr | Lopes ES | Lima LZ
The objectives were to evaluate caesarean section in both public and private sectors; maternal mortality associated with mode of delivery in the public sector (Sistema Unico de Saude, SUS) in Sao Paulo State, Brazil 610,630 births in both public and private sectors for 2003; 1,153,034 deliveries and 314 maternal deaths in the public sector for 2001-2003. The study estimated caesarean section rates and odds ratios for caesarean section in association with maternal characteristics in both public and private sectors; maternal mortality associated with mode of delivery in the public sector, adjusted for hypertension, other disorders, problems and complications, as well as maternal age. The caesarean section rate was 32.9% in the public sector, and 80.4% in the private sector. The odd ratio for caesarean section was 2.6 (95% CI: 2.6-2.7) for women with 12 or more years of education. The odd ratio for maternal mortality associated with caesarean section in the public sector was 3.3 (95% CI: 2.6-4.3). Sao Paulo presented high caesarean section rates. Caesarean section compared to vaginal delivery in the public sector presented higher risk for mortality even when adjusted for hypertension, other disorders, problems and complications, as well as maternal age.

Determinants of exclusive breastfeeding duration in Xinjiang, PR China
(Research Article; Asia)
Asia Pacific Journal of Clinical Nutrition. 2007 Jun;16(2):316-321.
Xu F | Binns C | Zheng S | Wang Y | Zhao Y | Lee A
Objective: To document exclusive breastfeeding duration and factors associated with duration in Xinjiang, PR China. Methods: A cohort of 1219 mothers in Xinjiang, PR China was recruited to study their infant feeding practices. The mothers who delivered babies during 2003 and 2004 were contacted in hospital and again at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months postpartum, or until they ceased to breastfeed. Interviews were conducted using a structured questionnaire. Survival analysis was used to calculate the mean of exclusive breastfeeding and explore factors affecting exclusive breastfeeding duration. Results: The average exclusive breastfeeding duration in Xinjiang was 1.8 months. Factors negatively associated with exclusive breastfeeding duration were mother's going to work and using pacifier. Factors positively associated with exclusive breastfeeding duration were whether the maternal mother breastfed her children and deciding exclusive breastfeeding before delivery. Conclusions: Exclusive breastfeeding duration in Xinjiang, PR China was short. The study identified some factors associated with exclusive breastfeeding duration. The results suggested an education program aimed to correct traditional inappropriate breastfeeding perceptions and promote exclusive breastfeeding in Xinjiang.

MATERNAL AND CHILD HEALTH NEWS

Sierra Leone: Fatal mix claims the lives of Sierra Leone's mothers
(News Article; Sub-Saharan Africa)
2007 Apr 30;
United Nations Office for the Coordination of Humanitarian Affairs - Integrated Regional Information Networks

Ghana: Stakeholders call for improved quality care to stem maternal deaths
(News Article; Sub-Saharan Africa)
2007 Apr 30;
Orhin IG, Public Agenda

Gambia: Gov't committed to equip TBAs
(News Article; Sub-Saharan Africa)
2007 May 2m;
Dibba LM, Daily Observer

GENDER and HEALTH RESEARCH

Mannose-binding lectin gene polymorphism, vulvovaginal candidiasis, and bacterial vaginosis
(Abstract; subscription needed for full text; Global)
Obstetrics and Gynecology. 2007 May;109(5):1123-1128.
Giraldo PC | Babula O | Goncalves AK | Linhares IM | Amaral RL
The objective was to evaluate associations between polymorphisms in the gene coding for mannose-binding lectin (MBL) and the diagnosis of acute or recurrent vulvovaginal candidiasis and bacterial vaginosis. Women at two outpatient clinics in Brazil filled out a questionnaire and were examined for the presence of vulvovaginal candidiasis or bacterial vaginosis. A buccal swab was blindly tested for codons 54 and 57 MBL2 gene polymorphisms by polymerase chain reaction and endonuclease digestion. A total of 177 women were enrolled. Vulvovaginal candidiasis was identified in 78 (44.1%) women, 33 (18.6%) had bacterial vaginosis, and 66 (37.3%) were normal controls. Recurrent vulvovaginal candidiasis was present in 50 (64.1%) of the women with vulvovaginal candidiasis; 20 (60.6%) of the bacterial vaginosis patients had recurrent disease. Vulvovaginal candidiasis was associated with white race (P = .007), bacterial vaginosis was associated with nonwhite race (P = .05), and both were associated with a history of allergy (P = .02) and having sexual intercourse at least three times a week (P less than .001). Carriage of the variant MBL2 codon 54 allele B was more frequent in women with recurrent vulvovaginal candidiasis (25.0%) than in the women with acute vulvovaginal candidiasis (17.9%) or controls (10.6%) (P = .004). Allele B was also more prevalent in women with recurrent bacterial vaginosis (22.5%) than in those with acute bacterial vaginosis (0%) (P = .009). The MBL2 codon 57 polymorphism was infrequent and not associated with vulvovaginal candidiasis or bacterial vaginosis. The incidence of vulvovaginal candidiasis and bacterial vaginosis differs by ethnicity in Brazilian women. The MBL2 codon 54 gene polymorphism is associated with both recurrent vulvovaginal candidiasis and recurrent bacterial vaginosis.

Radical cystectomy with preservation of sexual function and fertility in patients with transitional cell carcinoma of the bladder: New technique
(Abstract; subscription needed for full text; Global)
International Journal of Urology . 2007 Apr;14(4):294-298.
Salem HK
Radical cystectomy is the standard treatment for patients with invasive bladder carcinoma. Preservation of sexual function and fertility are important for surgery acceptance in young patients with this disease, and part of the prostate is generally preserved for this reason; however, this may compromise the radical nature of the surgery. Herein a novel technique of radical cystectomy with preservation of the vas deferens only is described aimed at preservation of sexual function and better cancer control. Between March 2002 and February 2004, four potent male patients with muscle invasive transitional cell carcinoma of the bladder underwent nerve-sparing radical cystectomy with urinary diversion. The bladder, prostate with prostatic urethra, regional lymph nodes and seminal vesicles were removed while the vas deferens was preserved until its terminal end and anastomosed (in the perineum) to the bulbar urethra (end to side). The diversion was ureterocolic in three patients and ileal conduit in one patient. The median age of the patients was 45.0 years (range 35-55). The mean follow-up was 35.5 months (range 23-46 months). There was no mortality. All patients were free of the disease (no local or distant recurrence) at the last follow-up. All patients reported adequate sexual function with normal erections and satisfactory intercourse similar to that reported before surgery. Two patients maintained antegrade ejaculation allowing procreation in one case. This technique allows preservation of sexual function in nearly all cases with better oncological outcome than any other techniques of radical cystectomy aimed at preservation of sexual function.

GENDER and HEALTH NEWS

Analysis: Egypt women's rights still an uphill climb
(News Article; North Africa)
4 May 2007
Frykberg M, Middle East Times

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Determinants and consequences of internal and international migration: The case of rural populations in the south of Veracruz, Mexico
(Research Article; Central America and the Caribbean)
(You need Adobe Acrobat Reader to access this document)
Demographic Research. 2007 Apr 24;16(10):287-314.
Poveda A
This paper analyzes the current migration in rural population in the south of Veracruz state (Mexico). We identify three different spaces of migration, traditional markets, the northern border and the United States. Applying a three-level multinomial logistic model and taking into account individual, family, and local characteristics of the migrants, we find different determinants in each space. These determinants are related to the objectives, needs and means of the migrants and their families. Otherwise, each space involves different consequences to the family in terms of the relationships between migrants and the rest of their relatives.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Four laureates awarded UN Population Fund's highest honour
(News Article; Global)
05 May 2007
UN News Center

Afghanistan: Infant mortality data improve
(News Article; Asia)
28 Apr 2007
New York Times

Pakistan: Population ministry's work plan approved
(News Article; Asia)
29 Apr 2007
Business Recorder Pakistan

ADOLESCENT HEALTH RESEARCH

Reproductive health of adolescent girls perinatally infected with HIV
(Abstract; subscription needed for full text; Global)
American Journal of Public Health. 2007 Jun;97(6)
Brogly SB | Watts DH | Ylitalo N | Franco EL | Seage GR | Oleske J | Eagle M | Van Dyke R
Related News Article: Cervical abnormalities common in HIV-infected girls
Objectives: We describe the reproductive health of adolescent girls perinatally infected with HIV. Methods: The incidence of first pregnancy, genital infections, and abnormal cervical cytology was estimated for 638 girls aged 13 years and older in the Pediatric AIDS Clinical Trials Group protocol 219C. Results: Thirty-eight girls became pregnant, for a first pregnancy rate of 18.8/1000 person-years; 7 of these girls had additional pregnancies (95% confidence interval [CI]=13.3, 25.7). Thirty-two pregnancies resulted in live births. All girls received antiretroviral therapy during pregnancy. One infant was HIV infected, 29 were uninfected, and 2 had unknown infection status, for a rate of mother-to-child transmission of HIV in infants with known infection status of 3.3% (95% CI=0.1, 18.6). Condylomata and trichomoniasis were the most frequent genital infections. Forty-eight (47.5%) of 101 girls with Papanicolaou test examinations had abnormal cervical cytology, including atypical cells of undetermined significance (n=18), low-grade squamous intraepithelial lesions (SIL; n=27), and high-grade SIL (n=3). Many abnormalities persisted despite intervention. Conclusions: Pregnancy rates were lower and cervical abnormalities higher than among HIV-uninfected adolescents. These findings underscore the importance of Papanicolaou tests and promotion of safer sexual practices in this population.

Association between condom use at sexual debut and subsequent sexual trajectories: A longitudinal study using biomarkers
(Abstract; subscription needed for full text; Global)
American Journal of Public Health. 2007 Jun;97(6)
Shafii T | Stovel K | Holmes K
Objectives: We compared subsequent sexual behaviors and risk of sexually transmitted infections among adolescents who did and did not use a condom at their sexual debut. Methods: We derived data from the National Longitudinal Study of Adolescent Health, which followed a sample of 4018 sexually active adolescents between 1994 and 2002. During waves I, II, and III, of the study, data on sexual behavior were gathered, and at wave III urine specimens were collected to test for sexually transmitted infections. Results: Among interviewed adolescents, those who reported condom use at their debut were more likely than those who did not use condoms at their debut to report condom use at their most recent intercourse (on average 6.8 years after sexual debut), and they were only half as likely to test positive for chlamydia or gonorrhea (adjusted odds ratio=0.50; 95% confidence interval=0.26, 0.95). Reported lifetime numbers of sexual partners did not differ between the 2 groups. Conclusions: Adolescents who use condoms at their sexual debut do not report more sexual partners, are more likely to engage in subsequent protective behaviors, and experience fewer sexually transmitted infections than do adolescents who do not use condoms at their sexual debut.

REAL Men: A Group-Randomized Trial of an HIV Prevention Intervention for Adolescent Boys
(Abstract; subscription needed for full text; Global | North America)
American Journal of Public Health. 2007 Apr 26;97(6)
Diiorio C | McCarty F | Resnicow K | Lehr S | Denzmore P
Objectives: We tested the efficacy of an intervention among 11- to 14-year-old adolescent boys to promote delay of sexual intercourse, condom use among those who were sexually active, and communication on sexuality between fathers (or father figures) and sons. Methods: Sites were randomly assigned to the intervention and control groups. Assessments were conducted prior to the intervention and at 3-, 6-, and 12-month follow-up interviews. Results: A total of 277 fathers and their sons completed baseline assessments. Most participants were African American, and most fathers lived with their sons. Significantly higher rates of sexual abstinence and condom use and of intent to delay initiation of sexual intercourse were observed among adolescent boys whose fathers participated in the intervention. Fathers in the intervention group reported significantly more discussions about sexuality and greater intentions to discuss sexuality than did control-group fathers. Conclusions: The study demonstrates that fathers can serve as an important educator on HIV and sexuality for their sons.

Long-term follow-up of 414 HIV-infected Romanian children and adolescents receiving Lopinavir/Ritonavir-containing highly active antiretroviral therapy
(Abstract; subscription needed for full text; Europe)
Pediatrics. 2007 May;119(5):e1116-e1120.
Kline MW | Rugina S | Ilie M | Matusa RF | Schweitzer AM
There are no published reports of the long-term safety and effectiveness of highly active antiretroviral therapy for children and adolescents living in resource-limited settings or of large cohorts of HIV-infected children and adolescents treated long-term (greater than 48 weeks) with lopinavir/ritonavir-containing highly active antiretroviral therapy. The purpose of this work was to evaluate the long-term outcomes of treatment of HIV-infected children and adolescents with lopinavir/ritonavir-containing highly active antiretroviral therapy in a resource-limited setting. We studied an inception cohort of 414 HIV-infected children receiving lopinavir/ritonavir-containing highly active antiretroviral therapy between November 2001 and August 2006 at the Romanian-American Children's Center in Constanta, Romania. The center provides comprehensive primary and HIV specialty care and treatment to all known HIV-infected children and adolescents living in Constanta. We measured safety and effectiveness by the percentage of children remaining on treatment, rates of mortality, and changes in plasma HIV RNA concentrations and CD4+ lymphocyte counts. The study population consisted predominantly of antiretroviral drug-experienced older children and adolescents with advanced HIV disease. Treatment was well tolerated, with 337 children (81%) remaining on therapy after a median duration of greater than 4 years. Thirty-seven deaths occurred; the death rate compared favorably to prospectively collected historical data. The most recent on-treatment plasma HIV RNA concentration was less than 400 copies per milliliter in 192 of 265 children tested. The mean baseline CD4+ lymphocyte count was 292 cells per microliter (n = 299); the mean change from baseline was +266 (n = 284), +317 (n = 260), +343 (n = 176), and +270 cells per microliter (n = 121) after 1, 2, 3, and 4 years of treatment, respectively. Highly active antiretroviral therapy can be administered safely and effectively to children and adolescents in resource-limited settings. Lopinavir/ritonavir-containing highly active antiretroviral therapy is a safe, effective, and durable treatment option for antiretroviral drug-experienced older children and adolescents with advanced HIV disease.

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Volume 7, Number 16 7 May 2007