Volume 7, Number 19
28 May 2007

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FAMILY PLANNING RESEARCH

Challenging the courtesy bias interpretation of favorable clients' perceptions of family planning delivery
(Abstract; subscription needed for full text; Global)
Evaluation Review . 2007 Feb;31(1):24-42.
Leon FR | Lundgren R | Huapaya A | Sinai I | Jennings V
Favorable client perceptions of provider's interpersonal behavior in contraceptive delivery, documented in clinic exit questionnaires, appear to contradict results from qualitative evaluations and are attributed to clients' courtesy bias. In this study, trained simulated clients requested services from Ministry of Health providers in three countries. Providers excelled in courteousness/ respect in Peru and Rwanda; in India, providers were less courteous and respectful when the simulated clients chose the pill. Privacy and two-way communication were less prevalent in all three countries. The findings challenge the courtesy bias interpretation. Global results from qualitative studies may have expressed the views of the minority of clients who are not treated well by providers.

Taking community empowerment to scale -- Lessons from three successful experiences
(Report)
(You need Adobe Acrobat Reader to access this document)
Baltimore, MD, Health Communication Partnership, Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs, May 2007. (Health Communication Insights)
Snetro-Plewman G | Tapia M | Uccelani V | Brasington A | McNulty M
The report describes three USAID-funded programs that used community empowering approaches to achieve public health impact at scale in three different settings -- Africa, Asia, and the Middle East. It also identifies the success factors common to all three programs.

Targeting access to reproductive health: Giving contraception more prominence and using indicators to monitor progress
(Abstract; subscription needed for full text; Global)
Reproductive Health Matters . 2007 May;15(29):186-191.
Bernstein S | Edouard L
Unmet need for contraception represents a major failure in the provision of reproductive health services and reflects the extent of access to services for spacing and limiting births, which are also affected by personal, partner, community and health system factors. In the context of the Millennium Development Goals, family planning has been given insufficient attention compared to maternal health and the control of sexually transmitted infections. As this omission is being redressed, efforts should be directed towards ensuring that an indicator of unmet need is used as a measure of access to services. The availability of data on unmet need must also be increased to enable national comparisons and facilitate resource mobilisation. Unmet need is a vital component in monitoring the proportion of women able to space and limit births. Unmet need for contraception is a measure conditioned by people's preferences and choices and therefore firmly introduces a rights perspective into development discourse and serves as an important instrument to improve the sensitivity of policy dialogue. The new reproductive health target and the opportunity it offers to give appropriate attention to unmet need for contraception will allow the entry of other considerations vital to ensuring universal access to reproductive health.

Birth control pill FAQ: Benefits, risks and choices
(Fact Sheet; Global)
22 May 2007
The Mayo Clinic
Frequently asked questions covered in this document include: How are pills that prevent your period different from regular birth control pills? Will taking the pill prevent menopause?

FAMILY PLANNING NEWS

FDA approves period suppression pill
(News Article; North America)
23 May 2007
Bridges A, Associated Press

China's child fines 'spark riot'
(News Article; Asia)
21 May 2007
BBC News

China: 72% of women students use contraception 'most of time'
(News Article; Asia)
23 May 2007
The China Post

HIV/AIDS and STIs RESEARCH

Impact of genotypic drug resistance mutations on clinical and immunological outcomes in HIV-infected adults on HAART in West Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2007 May 31;21(9):1157-1164.
Seyler C | Adje-Toure C | Messou E | Dakoury-Dogbo N | Rouet F
The objectives were to analyse the association between the presence of resistance mutations and treatment outcomes. The impact of HIV-1 drug resistance mutations in African adults on HAART has so far never been reported. In 2004 in Abidjan, Cote d'Ivoire, 106 adults on HAART had plasma viral load measurements. Patients with detectable viral loads had resistance genotypic tests. Patients were followed until 2006. Main outcomes were serious morbidity and immunological failure (CD4 cell count less than 200 cells/microl). At study entry, the median previous time on HAART was 37 months and the median CD4 cell count was 266 cells/microl; 58% of patients had undetectable viral loads, 20% had detectable viral loads with no major resistance mutations, and 22% had detectable viral loads with one or more major mutations. The median change in CD4 cell count between study entry and study termination was +129 cells/microl in patients with undetectable viral loads, +51 cells/microl in those with detectable viral loads with no mutations and +3 cells/microl in those with detectable viral loads with resistance mutations. Compared with patients with undetectable viral loads, those with detectable viral loads with resistance mutations had adjusted hazard ratios of immunological failure of 4.32 (95% CI 1.38-13.57, P = 0.01). One patient died. The 18-month probability of remaining free of morbidity was 0.79 in patients with undetectable viral loads and 0.69 in those with resistance mutations (P = 0.19). In this setting with restricted access to second-line HAART, patients with major resistance mutations had higher rates of immunological failure, but most maintained stable CD4 cell counts and stayed alive for at least 20 months.

Polymorphisms in IRF-1 associated with resistance to HIV-1 infection in highly exposed uninfected Kenyan sex workers
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2007 May 31;21(9):1091-1101.
Ball TB | Ji H | Kimani J | McLaren P | Marlin C
The objective was to determine the correlation between polymorphisms in the IL-4 gene cluster and resistance to HIV-1 infection. A cross-sectional genetic analysis of polymorphisms within the IL-4 gene cluster was conducted in a well-described female sex worker cohort from Nairobi, Kenya, known to exhibit differential susceptibility to HIV-1 infection. Microsatellite genotyping was used to screen six microsatellite markers in the IL-4 gene cluster for associations with HIV-1 resistance. Further analysis of the interferon regulatory factor 1 (IRF-1) gene was conducted by genomic sequencing. Associations between IRF-1 gene polymorphisms and the HIV-1 resistance phenotype were determined using the chi-square test and Kaplan-Meier survival analysis. The functional consequence of IRF-1 polymorphism was conducted by quantitative Western blot. Three polymorphisms in IRF-1, located at 619, the microsatellite region and 6516 of the gene, showed associations with resistance to HIV-1 infection. The 619A, 179 at IRF-1 microsatellite and 6516G alleles were associated with the HIV-1-resistant phenotype and a reduced likelihood of seroconversion. Peripheral blood mononuclear cells from patients with protective IRF-1 genotypes exhibited significantly lower basal IRF-1 expression and reduced responsiveness to exogenous IFN-t stimulation. Polymorphisms in the IRF-1 gene are associated with resistance to infection by HIV-1 and a lowered level of IRF-1 protein expression. This study adds IRF-1, a transcriptional immunoregulatory gene, to the list of genetic correlates of altered susceptibility to HIV-1. This is the first report suggesting that a viral transcriptional regulator might contribute to resistance to HIV-1. Further functional analysis on the role of IRF-1 polymorphisms and HIV-1 resistance is underway.

Directly observed highly active antiretroviral therapy for HIV-infected children in Cambodia
(Abstract; subscription needed for full text; Asia)
American Journal of Public Health. 2007 Jun;97(6):974-977.
Myung P | Pugatch D | Brady MF | Many P | Harwell JI
Antiretroviral medications are becoming available for HIV-infected children in resource-limited settings. Maryknoll, an international Catholic charity, provided directly observed antiretroviral therapy to HIV-infected children in Phnom Penh, Cambodia. Child care workers administered generic antiretroviral drugs twice daily to children, ensuring adherence. Treatment began with 117 late-stage HIV-infected children; 22 died of AIDS during the first 6 months. The rest were treated for at least 6 months and showed CD4 count increases comparable to those achieved in US and European children. Staffing cost for this program was approximately US $5 per child per month, or 15% more than the price of the medications. Drug toxicities were uncommon and easily managed. Directly observed antiretroviral therapy appears to be a promising, low-cost strategy for ensuring adherent treatment for HIV-infected children in a resource-limited setting.

Genital herpes and its management
(Abstract; subscription needed for full text; Global)
British Medical Journal (BMJ). 2007 May 19;334(7602):1048-1052.
Sen P | Barton SE
Genital herpes is an important public health disease and is the leading cause of genital ulcer disease worldwide. We present the latest evidence-based guidelines from the British Association for Sexual Health and HIV (BASHH), the Centers for Disease Control and Prevention (CDC), and other expert committees to provide an up to date account of genital infection with herpes simplex virus (HSV), its clinical features and diagnosis, and a practical approach to management of affected patients. Treatment regimens have largely been based on evidence obtained from randomised controlled trials, while certain new diagnostic tests are limited by lower levels of evidence obtained only from descriptive or case studies.

Sexually transmitted infection management, safer sex promotion and voluntary HIV counselling and testing in the male circumcision trial, Rakai, Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Reproductive Health Matters. 2007 May;15(29):68-74.
Matovu JK | Ssempijja V | Makumbi FE | Gray RH | Kigozi G
If circumcised men believe that they are protected from HIV, there is a possibility that they will compensate for their perceived risk reduction by engaging in higher risk behaviours, thereby mitigating any benefit of circumcision in preventing HIV infection. Some observational studies have shown that circumcised men engage in higher risk behaviours than uncircumcised men, and the Orange Farm trial in South Africa found circumcised men to have slightly higher levels of risk compared to uncircumcised men. However, results from the other two randomised trials of male circumcision in Kisumu, Kenya and Rakai, Uganda, did not find any evidence of risk compensation in circumcised relative to uncircumcised men. This could have been due to intensive health education and access to risk-reduction HIV counselling and testing provided during the trials to minimise behaviour disinhibition. These findings are consistent with a cohort study conducted in Siaya and Bondo districts in Kenya which found that circumcised men did not engage in more risky sexual behaviours than uncircumcised men. In this article, we describe voluntary HIV counselling and testing (VCT), sexually transmitted infection (STI) management and safer sex promotion activities conducted as part of the male circumcision trial in rural Rakai district, south-western Uganda. Methods and results are described together following a short description of the overall study.

Roundtable: "just a snip"?: A social history of male circumcision
(Commentary; Global)
Reproductive Health Matters. 2007 May;15(29):15-21.
Aggleton P
Related Abstract; subscription needed for full text: Roundtable: Male circumcision and HIV prevention: Is there really enough of the right kind of evidence?
The last seven years have seen growing advocacy for male circumcision as a means of HIV prevention, commencing first among public health specialists working mainly in the USA, then among some of those working in international organisations, and more recently endorsed as part of a comprehensive package of measures supported by both the World Health Organization and UNAIDS. Opinions continue to differ sharply as to whether or not to implement this form of prevention -- or how quickly to do so -- although there appears to be growing consensus that, as with all HIV-related public health interventions, male circumcision must be promoted in a culturally appropriate, rights-based and gender sensitive way.

HIV/AIDS and STIs NEWS

Botswanan chosen as new UN envoy to tackle HIV/AIDS in Africa
(News Article; Sub-Saharan Africa)
21 May 2007
UN News Centre

Increased efforts needed to curb spread of HIV among migrant workers in Asia, group says
(News Article; Asia)
23 May 2007
Kaiser Network

Malaysia cannot promote condoms: Report
(News Article; Asia)
21 May 2007
AFP News brief

Low levels of HIV/AIDS awareness, stigma contributing to spread of disease in Pakistan
(News Article; Asia)
21 May 2007
Kaiser Network

AIDS support group rebukes detention of sex workers by police
(News Article; Central America and the Caribbean)
24 May 2007
Jamaica Gleaner

Swaziland: AIDS triggers wave of urban homeless
(News Article; Sub-Saharan Africa)
24 May 2007
IRIN

MATERNAL AND CHILD HEALTH RESEARCH

Flash-heat inactivation of HIV-1 in human milk: A potential method to reduce postnatal transmission in developing countries
(Abstract; subscription needed for full text; Global)
Jounal of Acquired Immune Deficiency Syndrome. Online Access May 17, 2007.
Israel-Ballard K | Donovan R | Chantry C | Coutsoudis A | Sheppard H | Sibeko L | Abrams B
Related News Article: HIV in breast milk killed by flash-heating, new study finds
Related News Article: Flash-heating kills HIV in breast milk
Background: Up to 40% of all mother-to-child transmission of HIV occurs by means of breast-feeding; yet, in developing countries, infant formula may not be a safe option. The World Health Organization recommends heat-treated breast milk as an infant-feeding alternative. We investigated the ability of a simple method, flash-heat, to inactivate HIV in breast milk from HIV-positive mothers. Methods: Ninety-eight breast milk samples, collected from 84 HIV-positive mothers in a periurban settlement in South Africa, were aliquoted to unheated control and flash-heating. Reverse transcriptase (RT) assays (lower detection limit of 400 HIV copies/mL) were performed to differentiate active versus inactivated cell-free HIV in unheated and flash-heated samples. Results: We found detectable HIV in breast milk samples from 31% (26 of 84) of mothers. After adjusting for covariates, multivariate logistic regression showed a statistically significant negative association between detectable virus in breast milk and maternal CD4T-lymphocyte count (P = 0.045) and volume of breast milk expressed (P = 0.01) and a positive association with use of multivitamins (P = 0.03). All flash-heated samples showed undetectable levels of cell-free HIV-1 as detected by the RT assay (P less than 0.00001). Conclusions: Flash-heat can inactivate HIV in naturally infected breast milk from HIV-positive women. Field studies are urgently needed to determine the feasibility of in-home flash-heating breast milk to improve infant health while reducing postnatal transmission of HIV in developing countries.

Timeliness of care for eclampsia and pre-eclampsia in Benin, Ecuador, and Jamaica
(Abstract; subscription needed for full text; Central America and the Caribbean | South America | Sub-Saharan Africa)
International Journal of Gynecology and Obstetrics;97(3):209-214.
Edson W | Burkhalter B | McCaw-Binns A
Cases meeting diagnostic criteria for severe pre-eclampsia or eclampsia were reviewed in three countries to determine timeliness and effectiveness of care. Cases were retrospectively selected from 11 emergency obstetric care facilities and medical records reviewed by trained obstetricians. Of 91 cases (Benin, 28; Ecuador, 25; Jamaica, 38), 74% were correctly treated with anticonvulsant and 77% with antihypertensive therapy. The median interval to treat eclampsia (anticonvulsant, 28 min; antihypertensive, 77 min) was shorter than for severe pre-eclampsia (anticonvulsant, 45 min; antihypertensive, 85 min). Two in three cases (65%) received anticonvulsant but only 41% received antihypertensive therapy within 60 min of diagnosis. While 74% of eclamptics had been delivered within 12 h, only 39% of severe pre-eclamptics were delivered within 24 h. Timeliness can be studied in developing countries. Its objective measurement is a first step towards improving this component of care.

Zinc supplementation reduced cost and duration of acute diarrhea in children
(Abstract; subscription needed for full text; Global | Asia)
Journal of Clinical Epidemiology. 2007 Jun;60(6):560-566.
Gregorio GV | Dans LF | Cordero CP | Panelo CA
The objective was to determine whether zinc with oral rehydration solution (ORS) is more cost effective than ORS alone in the treatment of acute diarrhea. Study Design and Setting: Cost-effectiveness analysis among patients consulting the emergency room of a government institution. Cost of treatment and outcome of participants of a randomized trial of zinc + ORS vs. ORS alone for acute diarrhea were investigated. Included were subjects 2-59 months with diarrhea less than 7 days and no dehydration. The direct medical, nonmedical and indirect costs were obtained, using the societal perspective. The incremental cost-effectiveness ratio (ICER) was calculated. Sixty patients were given zinc + ORS and 57 were given ORS alone. Mean duration of diarrhea was 17 hours shorter and mean total cost of treatment was 5% cheaper in the zinc than ORS group .The ICER showed that with use of zinc, the society saves $ 2.4 per day of diarrhea less than 4 days and spends $ 0.03 per case of diarrhea averted less than 4 days from consult, although the confidence interval included the null value of zero. Use of zinc with ORS reduced the total cost and duration of acute diarrhea. The ICER suggests cost effectiveness of zinc supplementation but there is a need to further assess the role of zinc supplementation in a larger population.

99%: The proportion of maternal deaths that occur in developing countries
(Fact Sheet; Global)
2007 May 21;
UNICEF
It is estimated that each year more than half a million women – roughly one woman every minute – die as a result of pregnancy complications and childbirth. Some 99 per cent of all maternal deaths occur in developing countries, with over 90 per cent of those in Africa and Asia. Many of these women’s lives could be saved if they had access to basic health care services, including skilled attendants at all births and emergency obstetric care for women who develop complications.

The commodification of obstetric ultrasound scanning in Hanoi, Viet Nam
(Abstract; subscription needed for full text; Asia)
Reproductive Health Matters. 2007 May;15(29):163-171.
Gammeltoft T | Hanh Thi Thuy Nguyen
Growing numbers of pregnant women across the world now routinely have ultrasound scans as part of antenatal care, including in low-income countries. This article presents the findings of anthropological research on the use of obstetric ultrasonography in routine antenatal care in Hanoi, Viet Nam. The findings come from observation, a survey and interviews with women seeking ultrasound scans at a main maternity hospital and interviews with doctors providing ultrasound there. We found a dramatic overuse of ultrasound scanning; the 400 women surveyed had had an average of 6.6 scans and 8.3 antenatal visits during pregnancy, while one-fifth had had ten scans or more. Doctors considered obstetric ultrasound an indispensable part of modern antenatal care. For two-thirds of the women, the main reason for frequent scans was reassurance of normal fetal development. However, the women often also said their doctor had recommended the scans. This overuse must be seen in the context of growing commercialisation in the Vietnamese health care system, where ultrasound provides an important source of revenue for both private and public providers. There is an urgent need in Viet Nam for policy and practice guidelines on the appropriate use of ultrasonography in pregnancy and how best to combine it with essential antenatal care, and information dissemination to women.

MATERNAL AND CHILD HEALTH NEWS

Due to malnutrition, anemia threatens maternal health in Yemen
(News Article; Middle East)
2007 May 21;
Yemen Times

South Africa: Northern Cape educates communities on health
(News Article; Sub-Saharan Africa)
2007 May 21;
Dlamini N, BuaNews

Nigeria: Motherhood kills
(Commentary; Sub-Saharan Africa)
2007 May 20;
Shettima K, This Day

GENDER and HEALTH RESEARCH

Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia
(Abstract; subscription needed for full text; Global)
International Journal of Gynecology and Obstetrics. 2007 Jun;97(3):190-194.
Kriplani A | Singh BM | Lal S | Agarwal N
The objective was to evaluate the efficacy, acceptability, and possible side effects of a levonorgest-relreleasing intrauterine system for menorrhagia. Sixty-three women with menorrhagia but without uterine enlargement, endometrial hyperplasia with atypia, or endometrial carcinoma were enrolled in this prospective, open, nonrandomized clinical trial. An intrauterine system releasing 20 microg/day of levonorgestrel (LNG-IUS; Mirena, Shering, Finland) was inserted in the postmenstrual phase. Menstrual pattern, number of bleeding days, and subjective and objective estimation of menstrual blood loss using a pictorial blood loss assessment chart (PBAC) were recorded before insertion and at specific intervals for 4 years. Hemoglobin levels and endometrial thickness were evaluated at baseline and at 12 months. Treatment continuation and hysterectomy rates were noted as well as side effects. The device was expelled spontaneously in 6 patients (9.52%) and removed prematurely in 9 patients (14.3%); 3 patients (4.8%) were lost to follow-up; and 45 patients (71.4%) continued with the LNG-IUS. Menorrhagia was cured in 35 (77.7%) of these 45 patients at 3 months and in all patients at 36 months. There was a significant decrease in the mean number of bleeding days (P=0.01) and PBAC score (P=0.00) at 1 month, and the decrease continued with treatment duration. The subjective blood loss reduction was considerable as well, and at 12 months the mean plus or minus SD rise in hemoglobin concentration was 1.06 plus or minus 1.7 g/dL (P=0.000). Endometrial thickness was decreased by 3.4 plus or minus 3.53 mm (P=0.0001) at 12 months. The most common side effect was intermenstrual spotting during the first 6 months, and 18 patients (28.57%) developed amenorrhea. Using the LNG-IUS is an effective and well-accepted option overall for the medical management of menorrhagia.

Legislating against sexual violence in Kenya: An interview with the Hon. Njoki Ndungu
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Reproductive Health Matters. 2007 May;15(29):149-154.
Association for Women's Rights in Development
Sexual violence is rampant in Kenya and the law was not adequately dealing with it. This is an interview by the Association for Women's Rights in Development (AWID) with the Hon. Njoki Ndungu, a Member of the Kenyan Parliament. It is about the history of the development and passage of the Sexual Offences Act, which came into law in Kenya in July 2006. The law contains 14 offences; it has created minimum sentences and criminalised sexual harassment. The media and radio stations had a big role in getting everyone talking about the issues, and support was widespread. Women's organisations and women's rights advocates played an important role, including lobbying members of Parliament, but there were some disagreements about tactics, such as whether demonstrations to support the bill were a good idea or not. The opposition claimed the bill would encourage women to make false rape allegations. As a way to discredit it, they also falsely claimed that it would legalise same-sex relations and abortion. Work is now in progress on a curriculum for training the police, public administration and judiciary on the new Act and its application, as well as a public awareness programme aimed at encouraging people to report incidents of sexual violence.

GENDER and HEALTH NEWS

South Africa's virginity testing
(News Article; Sub-Saharan Africa)
22 May 2007
Kaminju A, BBC

Zimbabwe: From School Teacher to Sexworker
(News Article; Sub-Saharan Africa)
21 May 2007
UN Integrated Regional Information Networks

South Africa: Gender activists welcome approval of sexual offences bill
(News Article; Sub-Saharan Africa)
23 May 2007
Dlamini N, BuaNews (Tshwane)

Kenya: First ever global conference on Women and AIDS
(Press Release; Sub-Saharan Africa)
22 May 2007
World YWCA (Geneva)

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Indonesia's social capacity for population health: The educational gap in active life expectancy
(Abstract; subscription needed for full text; Asia)
Population Research and Policy Review . 2007 Apr;26(2):219-234.
Hidajat MM | Hayward MD | Saito Y
In this paper lays the initial groundwork for anticipating Indonesia's future burden of disease by developing a demographic model of population health. The model was developed within the analytic framework of a Markov-based multistate life table model to calculate an important indicator of the burden of disease, the expected years of active life of elderly Indonesians. The magnitude of the gap points to the potential consequences of improvements in the nation's educational level for the future burden of disease. The results show that having some education increases life expectancy but it also expands the expected years with a major functional problem. Overall educational attainment levels, however, are very low, indicating that Indonesia's elderly are at the leading edge of improvements in the nation's social capacity for health. The life tables suggest that at the early stages of development, longer life is accompanied by an expansion of morbidity.

The metrics and correlates of physician migration from Africa
(Research Article; North Africa | Sub-Saharan Africa)
BMC Public Health . 2007 May 17;7(1):83.
Arah OA
Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration. Ranking and correlational analyses were conducted on African physician migration data adjusted for bilateral net flows, and supplemented with developmental, economic and health system data. The setting was the 53 African birth countries of African-born physicians working in nine wealthier destination countries. Three metrics of physician migration were used: total number of physician émigrés; emigration fraction defined as the proportion of the potential physician pool working in destination countries; and physician migration density defined as the number of physician émigrés per 1000 population of the African source country. Rankings based on any of the migration metrics differed substantially from those based on the other two metrics. Although the emigration fraction and physician migration density metrics gave proportionality to the migration crisis, only the latter was consistently associated with source countries' workforce capacity, health, health spending, economic and development characteristics. As such, higher physician migration density was seen among African countries with relatively higher health workforce capacity (0.401 less than or equal to r less than or equal to 0.694, p less than or equal to 0.011), health status, health spending, and development. The perceived magnitude of physician migration is sensitive to the choice of metrics. Complementing the emigration fraction, the physician migration density is a metric which gives a different but proportionate picture of which African countries stand to lose relatively more of its physicians with unchecked migration. The nature of health policies geared at health-worker migration can be expected to depend on the choice of migration metrics.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Uganda on course to achieving MDG goals
(News Article; Sub-Saharan Africa)
21 May 2007
Oluka BH, The East African

Qatar: Migration big challenge for Gulf states
(News Article; Middle East)
22 May 2007
The Peninsula

Childhood years impact fertility
(News Article; Asia)
20 May 2007
The International News

India: Prime time for health schools
(News Article; Asia)
22 May 2007
The Times of India

ADOLESCENT HEALTH RESEARCH

The impact of female genital cutting on health of newly married women
(Abstract; subscription needed for full text; North Africa)
International Journal of Gynecology and Obstetrics. 2007 Jun;97(3):238-244.
Elnashar A | Abdelhady R
The objective was to detect the rate of female genital cutting among a sample of newly married women in Benha city, and make a comparison between circumcised and non-circumcised women regarding long-term health problems. Randomly selected (264) newly married women were the subjects of this work. Circumcised group constitutes 75.8% of the sample. All non-circumcised women were living in an urban area. Dysmenorrhea was more common among circumcised rather than non-circumcised, with statistically significant difference (P less than 0.01). Marital problems (dyspareunia, loss of libido, failure of orgasm and husband's unsatisfaction) had statistically different levels of significance among circumcised women. Obstetric problems such as tears, episiotomy and consequently distressed babies were more events among circumcised mothers with statistical significance. Circumcised females had significant mental problems such as somatization, anxiety and phobia (P less than 0.001). Female genital cutting remains a widely practiced custom in our society. Grave complications of circumcision may last throughout women's life particularly the time of consummation of marriage and the time of childbirth.

Experiences of sex trafficking victims in Mumbai, India
(Abstract; subscription needed for full text; Asia)
International Journal of Gynecology and Obstetrics. 2007 Jun;97(3):221-226.
Silverman JG | Decker MR | Gupta J | Maheshwari A | Patel V
The objective was to explore mechanisms and contexts related to sex trafficking victimization among South Asian women and girls rescued from brothels in Mumbai, India. Records of residents at a major non-governmental organization providing rescue, shelter and care of minor girls and of women held against their will in brothels in Mumbai were systematically reviewed (n=160). Descriptive statistics were calculated, and demographic differences in trafficking mechanisms and pre-disposing contexts were explored. The majority of victims (51.9%) were trafficked as minors and by individuals previously known to them (59.7%). Traffickers most commonly lured victims via promises of economic opportunity (55.0%) or kidnapped individuals via use of drugs or force (26.3%). Victims were most often trafficked from public settings (e.g., markets, train stations; 50.9%) and via public transportation (94.9%). Almost half (49.4%) reported some type of family disruption as directly leading to their being trafficked; violence involving husbands or other family members (38.0%) and marital separation or abandonment (32.9%) were the most common forms of disruption reported. Differences in experiences of trafficking were identified based on age, nationality, education, and marital status; no differences were found based on religion. The interaction of poverty and gender-based mistreatment of women and girls in families heightens the risk of sex trafficking; further empirical research is needed on this critically understudied issue. Prevention efforts should work to improve economic opportunities and security for impoverished women and girls, educate communities regarding the tactics and identities of traffickers, as well as promote structural interventions to reduce trafficking.

Improving U.S. global AIDS policy for young people: Assessing the President's Emergency Plan for AIDS Relief
(Report; Global | Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Washington, D.C., Advocates for Youth, 2007 May 44 p.
Dhingra N
This report discusses the implications of U.S. government policies such as the 33 percent abstinence-until-marriage funding mandate as well as various guidance directives from the Office of Global AIDS Coordinator (OGAC) and incorporates findings from field research in South Africa, Kenya, and Malawi. The report identifies three major shortcomings of the President's Emergency Plan for AIDS Relief (PEPFAR) in addressing HIV/AIDS and young people: 1) Ideology has trumped science in PEPFAR's HIV prevention strategy for young people; 2) PEPFAR resists linking HIV prevention with reproductive health care and services; 3) PEPFAR does not pay adequate attention to HIV-positive adolescents as a vulnerable population.

ADOLESCENT HEALTH NEWS

Vietnam: Ministry introduces new model to address teen health, wellness issues
(News Article; Asia)
2007 May 22;
Vietnam News

India's underage brides wedded to tradition
(Feature Article; Asia)
2007 May 15;
Bhalla N, The Boston Globe

St. Kitts/Nevis: Delayed parenting aids national development
(Commentary; Central America and the Caribbean)
2007 May 23;
Charles-Gumbs I, Sun St. Kitts/Nevis

Calendar of Events

See All Events

August 5, 2007 - August 9, 2007
HIV and Alcohol, Gender Norms and Gender-Based Violence : A Strategic Communication Perspective
Registration deadline: 30th June 2007; Participants: Communication practitioners and interested individuals managing or implementing HIV and AIDS communication programs in Africa. The practicum registration form can be downloaded at AfriComNet website at: http://www.africomnet.org/events/africomnetRefPracticum.doc or can be requested by email from AfriComNet secretariat information desk: infodesk@africomnet.org. The purpose of the workshop is to familiarize participants with the situation regarding the underlying social factors that influence prevention, care and treatment practices, such as gender norms, gender-based violence and alcohol and drug abuse in the region, as well as communication approaches to address them. With funding from the Regional Outreach Addressing AIDS through Development Strategies (ROADS) Project, AfriComNet proposes to bring together 60-80 communication practitioners from across the continent to participate in this practical exercise to synthesize and document strategies that may have wider application. The overall aim is to enable participants to integrate alcohol, gender norms and gender-based violence into HIV and AIDS community outreach, advocacy, media, and client education and counseling programs. This will improve the effectiveness of HIV prevention, care and treatment programs in the region. The practicum is organized by the African Network For Strategic Communication In Health And Development (AfriComNet).
E-Mail: infodesk@africomnet.orgEvent Location: Addis Ababa – Ethiopia

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The Pop Reporter--Delivering thought-provoking global health news to your desktop.

Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 7, Number 1928 May 2007