Volume 7, Number 20
4 June 2007

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FAMILY PLANNING RESEARCH

Injectable progestin contraceptive use and risk of HIV infection in a South African family planning cohort
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Contraception. 2007 Jun;75(6):461-467.
Kleinschmidt I | Rees H | Delany S | Smith D | Dinat N
The objective was to investigate whether the incidence of HIV infection is higher among sexually active women using depot medroxyprogesterone acetate (DMPA) or noresthisterone enanthate (NET-EN) injections for contraception than among women using nonhormonal or no contraception. Five hundred and fifty-one initially HIV-negative women were followed up for a total of 491 person-years. Participants were interviewed, counselled, examined, tested for HIV and other STIs, and treated, at three monthly intervals for 1 year. There was no significant association between progestin contraceptive use and HIV infection (rate ratio 1.1, 95% CI 0.5 to 2.8; log-rank test, p=.73). In proportional hazards regression, the only significant hazard ratios for HIV acquisition were prevalent Neisseria gonorrhoea (5.2; 95% CI 1.1 to 23.7, p=.035) and Trichomonas vaginalis (4.8; 95% CI 1.0 to 22.8, p=.049); bacterial vaginosis was marginally significant (2.8; 95% CI 1.0 to 8.3, p=.057). The adjusted hazard ratios for NET-EN and DMPA were 1.76 (95% CI 0.64 to 4.84) and 0.46 (95% CI 0.06 to 3.79), respectively, relative to nonuse. Five hundred and twelve of 551 women had one or more confirmed STIs during the study. There is no evidence of an association between HIV infection and injectable contraceptives. Due to the limited power of this study and because similar studies have not included young women using NET-EN, we recommend that further research be carried out to focus on the use of NET-EN and HIV acquisition in high risk groups.

Desire for children and unmet need for contraception among HIV-positive women in Lesotho
(Report; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Calverton, Maryland, Macro International, MEASURE DHS, 2007 Mar. (DHS Working Papers No. 32)
Adair T
In Lesotho, where the HIV prevalence rate for women is 26.4%, there is high risk for mother-to-child transmission (MTCT) of HIV. Efforts to prevent MTCT can focus on reducing the fertility level of HIV-positive women. This paper examines the desire for children and unmet need for contraception to limit or space births among HIV-positive women age 15-49 years, using data from the 2004 Lesotho Demographic and Health Survey. Multivariate analysis of HIV-positive women, 83% of whom have never learned their HIV status, shows that the desire for children in the future does not differ by socioeconomic status. Unmet need for contraception is highest among women in the poorest households. Although these women have lower HIV prevalence, they have higher potential for MTCT. The multivariate results are similar for both HIV-positive and HIV-negative women because of low self-awareness of HIV status. Efforts to reduce the level of MTCT require improved access to family planning services for all women, especially the poorest, and an increase in HIV testing and counseling.

Contraceptive implants in Kenya: Current status and future prospects
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Contraception. 2007 Jun;75(6):468-473.
Hubacher D | Kimani J | Steiner MJ | Solomon M | Ndugga MB
Since introducing Norplant over 20 years ago in Kenya, demand for contraceptive implants has remained high and implant costs are dropping substantially. An assessment of the Kenyan experience with implants was conducted to understand level of demand, capacity to provide services and reproductive health impact of possible increased use. Interviews were conducted with 35 key Kenyan informants. By modeling increases in national implant use (at the expense of oral contraceptives), reductions in the annual number of unintended pregnancies were estimated. Kenya has an unmet need for implants and the current network of trained providers appears ready to increase the volume of services. If 100,000 users of oral contraceptives switch to implants, then an estimated 26,000 unintended pregnancies can be averted over a 5-year period. With increased purchases of implants by international donor agencies, Kenya can reduce reliance on short-term hormonal methods and reduce the 45% prevalence rate of unintended pregnancy.

Long-term assessment of symptomatology and satisfaction of an extended oral contraceptive regimen
(Abstract; subscription needed for full text; North America)
Contraception . 2007 Jun;75(6):444-449.
Coffee AL | Sulak PJ | Kuehl TJ
The study was conducted to assess hormone withdrawal symptoms, patient acceptance and occurrence and management of bleeding with an extended oral contraceptive (OC) regimen. Subjects were placed on an OC containing 3 mg drosperinone (DRSP) and 30 micrograms ethinyl estradiol (EE), in the standard 21/7 fashion for two cycles, before converting to an extended pattern of OC for women who indicated they had menstrually related symptoms such as headaches, cramping and mood swings (52 weeks with phone-call follow-up 6 months later). Daily assessments of bleeding, headache, pelvic pain, mood and number of pain pills were recorded. Results are reported as means with S.E., and values were compared using analysis of variance with Dunnett's post hoc test for comparison with 21/7 cycle, Duncan's post hoc test for comparison of changes during the course of the extended regimen and Pearson's chi-square for comparison of proportions. Of the 111 women who began the extended OC regimen, 80 completed 1 year of use. Mood scores, headache scores and pelvic pain were all improved in the extended OC intervals, compared to the 21/7 cycle (p less than .001 for all comparisons). Improvement in symptoms persisted throughout the 1 year extended regimen. The findings indicated that 53.7% of subjects had no breakthrough bleeding or breakthrough spotting (BTB/BTS) during any given 28-day interval of the extended regimen. BTB/BTS decreased in the second half compared to the first half of the extended regimen. To manage BTB/BTS, instituting a 3-day hormone-free interval (HFI) was significantly more effective than continuing OCs (p less than .001). At the 6-month follow-up, most subjects had continued the extended regimen on their own with a high level of satisfaction. An extended OC regimen containing DRSP/EE significantly improved mood, headaches and pelvic pain scores throughout the 1 year of use, compared to a 21/7 cycle. Sustained BTB/BTS episodes occurred in 45 subjects (56%), decreasing in the second half of the study and effectively managed with a 3-day HFI.

FAMILY PLANNING NEWS

Indonesia needs 60,000 personnel of family planning programs
(News Article; Asia)
29 May 2007
Antara News, Indonesian National News Agency

Sex and childbearing after HIV diagnosis
(Commentary; Global)
25 May 2007
Boonstra H | Moody K | Pettitt F, OneWorld.net

HIV/AIDS and STIs RESEARCH

Clinical implications of HIV and hepatitis B co-infection in Asia and Africa
(Abstract; subscription needed for full text; North Africa | Asia | Sub-Saharan Africa)
Lancet Infectious Diseases. 2007 Jun;7(6):402-409.
Hoffmann CJ | Thio CL
Hepatitis B virus (HBV) is the leading cause of chronic liver disease and liver-related death worldwide, with the majority of these cases occurring in areas of Africa and Asia where HBV prevalence is high. Many of the countries that are affected by hepatitis B are also affected by a high HIV burden, leading to frequent HIV/HBV co-infection. The consequences of co-infection, including increased liver-related morbidity and mortality, increased hepatitis B viral replication, immune reconstitution to HBV in the setting of antiretroviral therapy, and hepatotoxicity from antiretroviral drugs, are especially important in regions with expanding antiretroviral programmes. Little data, however, are available on HIV/HBV co-infection from regions with high chronic hepatitis B prevalence. This Review discusses the epidemiology, natural history, pathogenesis, and management of HIV/HBV co-infection from these areas. Topics for future research relevant to HIV/HBV co-infection in Africa and Asia are also highlighted.

Men's extramarital sexuality in rural Papua New Guinea
(Abstract; subscription needed for full text; Oceania)
American Journal of Public Health. 2007 Jun;97(6):1006-1014.
Wardlow H
Married women in rural Papua New Guinea are at risk for HIV primarily because of their husbands' extramarital relationships. Labor migration puts these men in social contexts that encourage infidelity. Moreover, many men do not view sexual fidelity as necessary for achieving a happy marriage, but they view drinking and "looking for women" as important for male friendships. Although fear of HIV infection is increasing, the concern that men most often articulated about the consequences of extramarital infidelity was possible violent retaliation for "stealing" another man's wife. Therefore, divorced or separated women who exchange sex for money are considered to be "safe" partners. Interventions that promote fidelity will fail in the absence of a social and economic infrastructure that supports fidelity.

The effects of individual- and community-level knowledge, beliefs, and fear on stigmatization of people living with HIV/AIDS in China
(Abstract; subscription needed for full text; Asia)
AIDS Care. 2007 May;19(5):666-673.
Chen J | Choe MK | Chen S | Zhang S
This paper assesses the effects of individual- and community-level knowledge of HIV transmission, beliefs and fear of infection on individual attitudes toward and willingness to interact with people living with HIV/AIDS in China. Data are from a sample survey of 12,270 men and women age 15-49 from seven provinces/municipalities. The survey was conducted by the Population and Family Planning Commission in December 2003. Multilevel regression analyses show that stigmatization of people living with HIV/AIDS is strongly associated with community-level HIV knowledge and fear, even after taking into account HIV knowledge and fear at the individual level. The findings suggest that individual attitudes are partially shaped through social learning and social influence. Public-health interventions aimed at eliminating stigmatization of people living with HIV/AIDS will need to pay special attention to social and community influences while continuously working to enhance HIV knowledge and reduce inaccurate beliefs and fear.

Congenital syphilis: A continuing but neglected problem
(Abstract; subscription needed for full text; Global)
Seminars in Fetal and Neonatal Medicine. 2007 Jun;12(3):198-206.
Walker GJ | Walker DG
Congenital syphilis was rare in most affluent countries but there has been a slight resurgence recently in several European countries. In large parts of the world and particularly sub-Saharan Africa congenital syphilis is a significant public health problem. The cornerstone of congenital syphilis control is antenatal screening and treatment of mothers with penicillin, which is a cost-effective intervention. In affluent countries it should be strengthened among those at high risk. Clinicians should be more vigilant for the possibility of babies being born with congenital syphilis, which is often asymptomatic. In developing countries not only does antenatal care screening need to be strengthened by implementing point-of-care decentralised screening and treatment but alternative innovative approaches to controlling congenital syphilis should be explored. There is an urgent need for international health agencies to support focused approaches to tackling the tragedy of continuing congenital syphilis. This could be a part of a pro-poor strategy to meet the Millennium Development Goals.

HIV
(Abstract; subscription needed for full text; Global)
Seminars in Fetal and Neonatal Medicine. 2007 Jun;12(3):174-181.
Thorne C | Newell ML
Mother-to-child transmission (MTCT) is almost entirely preventable with a combination of interventions - antiretroviral prophylaxis during pregnancy, intrapartum and neonatally, elective caesarean section and avoidance of breastfeeding. In resource-rich settings new paediatric human immuno-deficiency virus (HIV) infections have reached an all-time low due to broad application of these interventions, particularly the widespread use of highly active antiretroviral therapy and no breastfeeding. However, most HIV-infected pregnant women live in developing countries where less than 10% of them have access to preventative interventions. Although MTCT rates in developed countries are now around 1-2%, rates in developing countries remain very much higher. Although the vast majority of infants born to HIV-infected mothers can thus be protected from acquisition of infection, they would then be exposed to antiretroviral drugs for which there is only limited information on toxicity and long-term safety. However, based on current knowledge, the immense benefits of antiretroviral prophylaxis in reducing MTCT risk far outweigh the potential for adverse effects.

HIV/AIDS and STIs NEWS

Zambia bans untested AIDS cures
(News Article; Sub-Saharan Africa)
27 May 2007
Kaunda D, Voice of America (VOA)

India alarm over HIV in new areas
(News Article; Asia)
30 May 2007
Raman S, BBC News
Related Research Article: A population-based study of human immunodeficiency virus in south India reveals major differences from sentinel surveillance-based estimates
(You need Adobe Acrobat Reader to access this document)

Malaysia: Negri makes pre-marital HIV test a must for Muslims
(News Article; Asia)
29 May 2007
Star Publications (Malaysia) Bhd

Coca-Cola to distribute HIV and AIDS prevention playing cards among Chinese migrant workers
(News Article; Asia)
29 May 2007
Kaiser Network

MATERNAL AND CHILD HEALTH RESEARCH

Socioeconomic determinants of infant mortality: A worldwide study of 152 low-, middle-, and high-income countries
(Abstract; subscription needed for full text; Global)
Scandinavian Journal of Public Health. 2007;35(3):288-297.
Schell CO | Reilly M | Rosling H | Peterson S | Ekstrom AM
To reach the Millennium Development Goals for health, influential international bodies advocate for more resources to be directed to the health sector, in particular medical treatment. Yet, health has many determinants beyond the health sector that are less evident than proximate predictors. The aim was to assess the relative importance of major socioeconomic determinants of population health, measured as infant mortality rate (IMR), at country level. National-level data from 152 countries based on World Development Indicators 2003 were used for multivariate linear regression analyses of five socioeconomic predictors of IMR: public spending on health, GNI/capita, poverty rate, income equality (Gini index), and young female illiteracy rate. Analyses were performed on a global level and stratified for low-, middle-, and high-income countries. In order of importance, GNI/capita, young female illiteracy, and income equality predicted 92% of the variation in national IMR whereas public spending on health and poverty rate were non-significant determinants when adjusted for confounding. In low-income countries, female illiteracy was more important than GNI/capita. Income equality (Gini index) was an independent predictor of IMR in middle-income countries only. In high-income countries none of these predictors was significant. The relative importance of major health determinants varies between income levels, thus extrapolating health policies from high- to low-income countries is problematic. Since the size, per se, of public health spending does not independently predict health outcomes, functioning health systems are necessary to make health investments efficient. Potential health gains from improved female education and economic growth should be considered in low- and middle-income countries.

Day-care management of children with severe malnutrition in an urban health clinic in Dhaka, Bangladesh
(Abstract; subscription needed for full text; Asia)
Journal of Tropical Pediatrics. 2007 Jun;53(3):171-178.
Ashraf H | Ahmed T | Hossain MI | Alam NH | Mahmud R
Management of severely malnourished children with associated complications relies on hospital-based treatment. Implementation of a standardized protocol at the Dhaka Hospital, ICDDR,B reduced case fatality approximately 50%. We developed and prospectively evaluated a day-care clinic approach that provided antibiotics, micronutrients and feeding during the day with continued care by parents at home at night as an alternative to hospitalization. Severely malnourished children aged 6-23 months denied admission to hospital were enrolled at Radda Clinic, Dhaka and received protocolized management with antibiotics, micronutrients and milk-based diet from 8:00 am to 5:00 pm each day, while mothers were educated on continuation of care at home. They were transitioned to the day-care nutrition rehabilitation (NR) unit of Radda Clinic following resolution of acute illness, received NR diet (Khichuri, halwa and milk-based) daily until children attained 80% weight-for-length. From February 2001 to November 2003, 264 children were enrolled; 52% were boys and 78%, 21% and 1% had marasmus, marasmus-kwashiorkor and kwashiorkor, respectively. Only 13% had severe malnutrition alone while 35% had pneumonia, 35% had diarrhea and 17% had both pneumonia and diarrhea. The mean (SD) duration of acute and NR phases were 8 (4) and 14 (13) days, respectively. Children gained weight [mean (SD) g/kg day] more rapidly during acute 10 (7) than NR phase 6 (5). Successful management was possible in 82% (95% CI 77-86%) children, 12% discontinued treatment and 6% referred to hospitals. Only one child died during NR phase. Severely malnourished children can be successfully managed at existing day-care clinics using a protocolized approach.

Factors associated with survival of very-low-birth-weight infants in a Brazilian fee-paying maternity in the 1990s
(Abstract; subscription needed for full text; South America)
Journal of Tropical Pediatrics . 2007 Jun;53(3):153-157.
de Mello FB | de Almeida MF | dos Santos AM | de Paula Fiod Costa H | Miyoshi MH
This study describes intra-hospital survival rates of very-low-birth-weight infants, as well as factors present at birth associated with survival, during a period of 10 years. This is a Retrospective cohort study performed in a 3rd level nursery at Santa Joana Maternity Hospital, a fee-paying institution in Sao Paulo, Brazil. From January 1991 to December 2000, 963 live-born infants with a birth weight of 500-1499 g, without congenital anomalies, were followed until discharge. Survival was studied according with year of birth, and stratified by birth weight and gestational age. Factors present at birth associated with survival were analyzed by logistic regression. Patient characteristics were: birth weight 500-999 g (38%), gestational ages less than or equal to 27 weeks (32%), prenatal care (100%), small for gestational age (39%), multiple gestation (22%), male (52%) and C-section (68%). According to birth weight 500-749, 750-999, 1000-1249 and 1250-1499 g, survival rate in 1991 was, respectively, 0, 6, 60 and 80% and increased to 15, 71, 93 and 96% in 2000. Regarding gestational age of 24-25 weeks, 26-27 weeks and 28-31 weeks, intrahospital survival in 1991 was 0, 0 and 57%, and in 2000, improved to 44, 74 and 82%. Survival was associated with increasing birth weight (OR 0.996; CI 95%: 0.995-0.997) and gestational age (OR 0.73; CI 95%: 0.67-0.80), female gender (OR 1.52; CI 95%: 1.04-2.22) and year of birth (OR 0.70; CI 95%: 0.65-0.76). In the 1990s, survival rates among very-low-birth-weight infants improved according to year of birth, mainly in female patients with birth weight great than or equal to 750 g, and gestational age greater than or equal to 26 weeks.

MATERNAL AND CHILD HEALTH NEWS

Nepal child, maternal survival rates up despite war
(News Article; Asia)
2007 May 27;
Sharma G, Reuters

Volunteers and helpline join forces to reduce maternal mortality in rural India
(Feature Article; Asia)
2007 May 29;
Okafor A, UNICEF

In search of safer childbirth practices
(News Article; Central America and the Caribbean)
2007 May 28;
Jamaica Observer

GENDER and HEALTH RESEARCH

Bacterial vaginal flora in relation to changing oestrogen levels
(Abstract; subscription needed for full text; Global)
International Journal of STD & AIDS. 2007 May;18(5):308-311.
Wilson JD | Lee RA | Balen AH | Rutherford AJ
Hormonal changes may be important in the onset and clearance of bacterial vaginosis. We studied vaginal flora and serum oestradiol levels of 55 women at baseline and during hormonal treatment. None developed bacterial vaginosis (BV) from normal vaginal flora, 69% of women had normal flora at baseline increasing to 91% following hormonal treatment. The mean oestradiol level with BV was 39.07 ng/L compared with 176.41 ng/L with normal flora. Non-smokers had a mean oestradiol level of 173.95 ng/L compared with 118.67 ng/L in smokers. Recombinant follicle-stimulating hormone resulted in a mean oestradiol rise of 113.9 ng/L. The mean rise was 330.4 ng/L with improved vaginal flora but only 15.1 ng/L in persistently abnormal or worsening flora. A rise in oestradiol in this group of women was associated with a significant reduction of abnormal flora. Reversion from BV to normal flora was associated with a greater rise in oestradiol than where abnormal flora persisted or worsened. This study supports a possible hormonal influence in the natural history of BV. The lower oestradiol levels in smokers may help explain their increased risk of BV.

Self-concept and menopause among mid-life women: A survey in southern Taiwan
(Abstract; subscription needed for full text; Asia)
Maturitas. 2007 Jun 20;57(2):132-138.
Shu BC | Luh WM | Li SM | Lu SY
The purpose of this study was to understand the self-concept of community women in southern Taiwan during mid-life and its relationship with menopause symptoms. Women between 45 and 55 years of age were selected by simple cluster random sampling process from a name list obtained from the Household Registrar Office in one city of southern Taiwan. A total of 266 women were enrolled. The Chinese version of the Tennessee Self-Concept Scale and Greene Climacteric Symptom Scale were used for assessment. Results: (1) (a) 92.5% of women's total self-concept scores were within normal range; (b) the scores of the physical self-concept, psychological self-concept, and academic attainment self-concept in women with higher educational levels were significantly higher than those in women with lower educational levels; (c) among six subscales, only the score of the psychological self-concept of those women with a history of using hormone replacement therapy (HRT) was significantly lower than that in women who had never taken any. (2)Women with chronic disease history and with a history of using HRT (no. 54) showed significantly more menopause symptoms (physiological and psychological). (3) (a) Stepwise regression analysis showed that the physical self-concept, family self-concept and academic attainment self-concept were the best predictors for menopause symptoms (both psychological and physiological) for pre-menopausal women; (b) for peri- and post-menopausal women, only physical self-concept could significantly predict psychological and physiological symptoms. Our findings suggest that self-concept is an important factor for mid-life women to adjust to their menopause.

The timing of natural menopause in Poland and associated factors
(Abstract; subscription needed for full text; Europe)
Maturitas. 2007 Jun 20;57(2):139-153.
Kaczmarek M
The outcome of interest was the assessment of age at natural menopause and the variables hypothesized as covariates of age at menopause were indicators of demographic and social status, characteristics of the reproductive history and lifestyle behaviour. Seven thousand one hundred and eighty-three women from all social strata of non-clinical population, and aged between 35 and 65 years were investigated in a cross-sectional survey across Poland in 2000-2004. The demographic, social, lifestyle behaviour and reproductive history aspects of the menopause-specific questionnaire were examined. The nonparametric Kaplan-Meier cumulative survivorship estimates were used to assess the timing of natural menopause. Univariate and multivariate Cox proportional hazards regression models were used to assess the association of age at natural menopause with factors of interest and to estimate relevant relative risk (the hazard ratio) for earlier age at menopause. The overall median age at natural menopause was 51.25 years; 25th percentile 49; 75th percentile 54 years. Temporal changes in age at menopause were not demonstrated in the sample (p = 0.9 for differences among age cohorts). Univariate Cox models were first fitted to the age at natural menopause for all covariates singly. The findings revealed that marital status, living environment, employment, BMI, age at first live birth delivered by a woman, breastfeeding, physical activity, smoking amount, and consumption of alcohol were not associated with age at menopause (p greater than 0.05). The multiple Cox model revealed that early menarche, short menstrual cycle length, smoking cigarettes, a low level of education, and a negative health perception were associated with younger age at menopause (p less than 0.01). Use of oral contraceptives and parity were associated with later menopause (p less than 0.01). The present study provides an estimate of median age at natural menopause in Poland that may be used as a measure of health for the growing number of Polish women whose survival is calculated at 30 years after menopause. This study has revealed that the pattern of relationship between age at menopause and the study factors reflects its population-specific character for its social and cultural backgrounds, socio-economic status, and social behaviours.

GENDER and HEALTH NEWS

Southern Africa: Discrimination against women fuels HIV/AIDS, report
(News Article; Sub-Saharan Africa)
28 May 2007
IRIN
Related Report: Epidemic of Inequality: Women's Rights and HIV/AIDS in Botswana & Swaziland

Senegal, Gambia villages give up female circumcision
(News Article; Sub-Saharan Africa)
29 May 2007
Middle East Times

Burundi: Study says coffee harvest linked to increase in gender-based violence
(News Article; Sub-Saharan Africa)
25 May 2007
IRIN

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Birth-spacing patterns in Huaning County, Yunnan Province, PRC: Is the adoption of a small family norm sustainable?
(Abstract; subscription needed for full text; Asia)
Scandinavian Journal of Public Health . 2007;35(3):257-264.
Lofstedt P | Ghilagaber G | Johansson A
China's family planning programs have emphasized delayed marriage and longer spacing between births. Since 1970, the fertility has declined from 6 to 1.8 births and the mean age at first marriage has gone up but the recommended spacing intervals have not been fully realized. Despite the fertility decline it is being debated among scholars whether China has completed a sustainable demographic transition or not, especially in rural areas. The aim of this study was to analyze trends in the timing and patterns of marriage and childbearing in relation to successive family planning policies. A cluster random sample of 1,336 women aged 15-64 at the time of the survey (2000) was selected in one rural county in Yunnan province. Life-table techniques were used to analyze the cumulative proportion of women marrying and having a certain number of births. Cox's hazard regression model was used to estimate the effects of various covariates on the "hazard" for a woman to have a second birth. Our findings demonstrate how childbearing patterns have changed in the direction of delayed marriage, a decreased interval between first marriage and first child, and significantly longer spacing between the first and second child. This transformation of childbearing patterns corresponds well with the requirements of the policies. Considering the characteristics of Yunnan, it seems likely that the changing fertility behavior has been more influenced by a strictly enforced family planning policy than by societal changes leading to the adoption of a new, smaller family norm.

Prevalence and correlates of sexual behaviors among Karen villagers in northern Thailand
(Abstract; subscription needed for full text; Asia)
AIDS and Behavior. 2007 Jul;11(4):611-618.
Kobori E | Visrutaratna S | Kada A | Wongchai S | Ono-Kihara M
A cross-sectional survey was conducted in two mountainous villages of the Karen, a major ethnic minority in Thailand. The participants were 566 villagers aged 15-54 years (371 in Village A, 195 in Village B; response rate=81.9%). Premarital/extramarital sex was experienced by 10-20% of the sexually active respondents and sex with a female sex worker (FSW) by 12.6% of males. Premarital sex was independently associated with being a Christian and occupational experience in town; extramarital sex was associated with Village A and drug use; sex with a FSW was associated with being unmarried, a nonfarmer, and occupational experience in town. Approximately 80% of the married participants never used a condom with their spouse, and nearly one-third never did so with a boy/girlfriend or a FSW. A history of sexually transmitted infections (STIs) was associated with sex with a FSW. These findings suggest that nontraditional sexual practices are prevalent and could potentially threaten Karen communities with the spread of HIV.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

SA families getting smaller
(News Article; Sub-Saharan Africa)
28 May 2007
News24.com

India: Injections to check population boom
(Commentary; Asia)
31 May 2007
Bhatnagar RK, Asian Tribune
Related News Article: Expanding Services for Injectables: How Family Planning Programs and Providers Can Meet Clients' Needs for Injectable Contraceptives

Estonia's population decline slows - official statistics
(News Article; Europe)
29 May 2007
Russian News and Information Agency

ADOLESCENT HEALTH RESEARCH

Bone mineral density in adolescents using norethisterone enanthate, depot-medroxyprogesterone acetate or combined oral contraceptives for contraception
(Abstract; subscription needed for full text; Global | Sub-Saharan Africa)
Contraception. 2007 Jun;75(6):438-443.
Beksinska ME | Kleinschmidt I | Smit JA | Farley TM
Most studies have shown a negative effect of depot-medroxyprogesterone acetate (DMPA) on the bone mineral density (BMD) of adolescents. There is no information available on the effect of norethisterone enanthate (NET-EN) on BMD in adolescents and the effect of combined oral contraceptives (COCs) on adolescent BMD is inconclusive. The aim of this longitudinal study was to investigate BMD in adolescent (aged 15-19 years) new users of hormonal contraception (DMPA, NET-EN and COCs). New users of DMPA (n = 115), NET-EN (n = 115), COCs (n = 116) and 144 nonuser controls were recruited. BMD was measured at the distal radius and midshaft of the ulna using dual X-ray absorptiometry. In total, 275 women were included in this interim analysis and total follow-up time was 553 person-years. There was no significant difference in radius BMD between users of different contraceptive methods at baseline (p = .40). Overall, an increase in radius BMD of 0.00522 per person-year was observed. This result was similar when adjusting for BMI in the random effects regression model (p = .88). The regression model showed that BMI was significantly associated with radius BMD, with each unit increase in BMI corresponding to an increase of 0.0029 g/cm2 in BMD (95% CI 0.0023 to 0.0036, p less than .001). Interaction between contraceptive method and follow-up time adjusted for BMI was not significant (p = .07). The increase in BMD for NET-EN users of 0.0013 g/cm2 per person-year (95% CI -0.0017 to 0.0043) was significantly lower than that of nonusers (p = .017). For DMPA and COC users, the increase in BMD was not significantly different compared to the nonusers. This study suggests that NET-EN users had lower increase in BMD over time compared to the other user groups.

Break the Silence: HIV/AIDS Knowledge, Attitudes, and Educational Needs among Arab University Students in United Arab Emirates
(Abstract; subscription needed for full text; Middle East)
Journal of Adolescent Health. 2007 Jun;40(6):572e.1-572e.8.
Ganczak M | Barss P | Alfaresi F | Almazrouei S | Muraddad A | Al-Maskari F
Purpose: In light of increasing spread of human immunodeficiency virus (HIV) in the Middle East, we assessed knowledge, attitudes, and educational needs of young people in United Arab Emirates (UAE), a modern and moderately conservative Islamic country. Methods: A cross-sectional survey among randomly selected first-year, gender-segregated Arab students at the national university in Al Ain in 2005 was conducted using an adaptation of an anonymous self-administered World Health Organization questionnaire. Knowledge and attitudes were scored. Results: Response was 89%; 119 males and 148 females. Knowledge scores about HIV/AIDS were low for 75%, moderate for 24%, high for less than 1%. Although 90% knew main routes of infection, there were misconceptions about transmission, and only 31% knew there is no vaccine and 34% no cure. Religion was stated as a reason to avoid extramarital relationships by 91% and sexually transmitted diseases (STDs) by 38%; 94% favored premarital testing. Attitudes toward people living with HIV (PLH) were neither friendly nor tolerant, including 97% who felt all people entering UAE should be tested, 53% that PLH should be forced to live apart, and only 27% who felt children with HIV should be allowed to attend school. Ninety-six percent stated that young people should be taught how to protect themselves and 57% that teaching at school was insufficient. Main information sources were books/media; preferred sources were media, schools, and health professionals. Males scored higher on knowledge and were more susceptible to fear of STDs, society, and family; females showed greater compassion and interest in premarital testing and education to protect themselves. Conclusions: Alarming gaps in knowledge about transmission and curability put young Arabs at risk of contracting HIV. Fear and intolerant attitudes toward PLH were prevalent. HIV/AIDS education designed to raise knowledge and change attitudes, and respectful of community values, is urgently needed from media, schools, and health professionals.

Attitudes of mothers in Da Nang, Vietnam toward a human papillomavirus vaccine
(Abstract; subscription needed for full text; Asia)
Journal of Adolescent Health. 2007 Jun;40(6):559-563.
Dinh TA | Rosenthal SL | Doan ED | Trang T | Pham VH
The purpose was to describe attitudes and acceptability toward a human papillomavirus (HPV) vaccine among mothers in Da Nang, Vietnam and examine factors that may influence HPV vaccine uptake. Women who were the primary caregiver of a girl 10-18 years old ("mothers") were eligible to participate. Mothers were recruited face-to-face from Da Nang General Hospital. Participants completed a survey addressing general vaccine attitudes, attitudes toward an HPV vaccine, beliefs about sexuality, recommendations from others, and likelihood of having their daughter vaccinated against HPV. A total of 194 surveys were returned; 181 (93%) contained analyzable data. Eleven percent of mothers were aware of an HPV vaccine. Ninety-four percent believed that the HPV vaccine will be effective and 90% disagreed that their daughter would have sex early if she was vaccinated. Beliefs regarding premarital sex, such as "girls who have sex before marriage are not respected" and "it would be hard to find a husband" were held by 76% and 62% of mothers, respectively. Despite this, over 90% were in favor of their daughter receiving the HPV vaccine. Ninety-five percent indicated that a recommendation from their doctor would be very important in their decision-making, and 78% indicated that the media would be very important. Initial responses to the HPV vaccine for girls in Vietnam appear favorable. Beliefs regarding negative social consequences for girls who engage in premarital sex are prevalent but unassociated with HPV vaccine acceptability. Accurate and consistent recommendations from doctors and media sources will be important for vaccination efforts.

ADOLESCENT HEALTH NEWS

Kenya: Catch them young
(News Article; Sub-Saharan Africa)
2007 May 28;
Oronje R, The East African
Related Research Article: Adolescent sexual and reproductive health in Malawi: Results from the 2004 National Survey of Adolescents
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Related Research Article: Risk and protection: Youth and HIV/AIDS in Sub-Saharan Africa
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Jamaica: Teen births rising again: Advocates blame poor education, flawed justice system
(News Article; Central America and the Caribbean)
2007 May 27;
Manning G, Jamaica Gleaner News

ROC launches DVD on sexual violence among teens
(News Article; South America)
2007 May 30;
Stabroek News

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Volume 7, Number 20 4 June 2007