Volume 7, Number 23
25 June 2007

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FAMILY PLANNING RESEARCH

Timeliness of contraceptive reinjections in South Africa and its relation to unintentional discontinuation
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Family Planning Perspectives. 2007 Jun;33(2):66-74.
Baumgartner J | Morroni C | Mlobeli R | Otterness C | Myer L | Janowitz B | Stanback J | Buga G
Research examining hormonal injectable contraceptive continuation has focused on clients' intentional discontinuation. Little attention, however, has been paid to unintentional discontinuation due to providers' management of clients who would like to continue use but arrive late for their scheduled reinjections. A cross-sectional survey of 1,042 continuing injectable clients at 10 public clinics was conducted in South Africa's Western and Eastern Cape provinces. Bivariate logistic regression analyses were used to identify associations between specific variables and the likelihood of receiving a reinjection, among clients who returned to clinics late but within the two-week grace period for reinjection. Of 626 continuing clients in the Western Cape, 29% were up to two weeks late and 25% were 2-12 weeks late for their scheduled reinjection; these proportions among 416 continuing clients in the Eastern Cape were 42% and 16%, respectively. Only 1% of continuing clients in the Western Cape who arrived during the two-week grace period did not receive a reinjection; however, 36% of similar clients in the Eastern Cape did not receive a reinjection. Among late clients in the Eastern Cape who did not receive a reinjection, 64% did not receive any other method. Few variables were significant in bivariate analyses; however, certain characteristics were associated with receiving reinjections among late clients in the Eastern Cape. It is common for clients to arrive late for reinjections in this setting. Providers should adhere to protocols for the reinjection grace period and have a contraceptive coverage plan for clients arriving past the grace period to reduce clients' risk of unintentional discontinuation and unintended pregnancy.

Constrained contraceptive choice: IUD prevalence in Uzbekistan
(Abstract; subscription needed for full text; Asia)
International Family Planning Perspectives . 2007 Jun;33(2):50-57.
Barrett J | Buckley C
Because individuals' and couples' needs vary, the availability of a variety of contraceptive choices is a key component of successful family planning programs. Most women in Uzbekistan rely on a single contraceptive method (the IUD), but it is unclear whether this reflects constraints on choice or simply a widespread preference. Nationally representative data from the 1996 Uzbekistan Demographic and Health Survey and the 2002 Uzbekistan Health Examination Survey were used to evaluate the relationship between demographic characteristics and knowledge and use of contraceptives among sexually active women. Separate multivariate regression analyses were performed for 1996 and 2002. Nearly all sexually active women knew about contraceptives, and in 2002 most reported that they had ever used the IUD (71%) or any modern method (77%). In both surveys, women with higher levels of wealth (odds ratios, 2.2-3.1) and education (1.9-2.5) were more likely than other women to know about contraceptive methods other than the IUD. Higher levels of wealth and education, as well as urban residence and non-Uzbek ethnicity, were also associated with the use of contraceptives other than the IUD, although these relationships were generally weaker in 2002 than in 1996. Despite the high prevalence of contraceptive use in Uzbekistan, the country's reproductive health program may be constraining method choice. Expanded programmatic efforts emphasizing choice from a range of methods are needed, especially among subgroups of women who have little knowledge or experience with methods other than the IUD.

FAMILY PLANNING NEWS

Children's parliament advocate family planning in Nigeria
(News Article; Sub-Saharan Africa)
17 Jun 2007
People's Daily Online

Pakistan: NWFP government to build 10 family planning centres
(News Article; Asia)
17 Jun 2007
Daily Times

India: Most men say no to birth control, women a big yes
(News Article; Asia)
21 Jun 2007
Sharma S, Ludhiana Newsline

Tanzania: Shadya calls for effective family planning
(News Article; Sub-Saharan Africa)
21 Jun 2007
Yussuf I, Daily News- TSN

United States: House OKs lifting contraception aid ban
(News Article; North America)
21 Jun 2007
Associated Press

HIV/AIDS and STIs RESEARCH

Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings: Informing urgent policy changes
(Abstract; subscription needed for full text; Global)
Lancet. 2007 Jun 16;369(9578):2042-2049.
Getahun H | Harrington M | O'Brien R | Nunn P
The HIV epidemic has led to large increases in the frequency of smear-negative pulmonary tuberculosis, which has poor treatment outcomes and excessive early mortality compared with smear-positive disease. We used a combination of systematic review, document analysis, and global expert opinion to review the extent of this problem. We also looked at policies of national tuberculosis control programmes for the diagnosis of smear-negative pulmonary tuberculosis to assess their coverage, identify the diagnostic difficulties, and find ways to improve the diagnosis of this type of tuberculosis, with a focus on resource-constrained settings with high HIV infection rates. We propose that the internationally recommended algorithm for the diagnosis of smear-negative pulmonary tuberculosis should be revised to include HIV status, severity of AIDS and tuberculosis, and early use of chest radiography in the decision tree. Increased use of promising methods of diagnosis such as sputum liquefaction and concentration and increased availability of fluorescence microscopy should be explored and encouraged. Culturing of sputum in resource-constrained settings with high HIV infection rates should also be encouraged, existing facilities should be made full use of and upgraded, and effective quality-assurance systems should be used. Innovative ways to address human resources issues involved in addressing the diagnostic difficulties are also needed. The development of rapid, simple, and accurate tuberculosis diagnostic tools with applicability at point of care and remote location is essential. To achieve these goals, greater political commitment, scientific interest, and investment are needed.

Prevalence of HIV and factors associated with risk behaviours among Chinese female sex workers in Hong Kong
(Abstract; subscription needed for full text; Asia)
AIDS Care. 2007 Jul;19(6):721-732.
Lau JT | Ho SP | Yang X | Wong E | Tsui HY
The study examined the HIV prevalence and factors associated with risk behaviours among Chinese female sex workers (FSW) in Hong Kong. Unlinked anonymous HIV antibody testing and interviews, using structured questionnaires, were conducted for 293 FSW. None was tested HIV positive. In the last six months, 13.7% self-reported having contracted STD, 50.7% were not using condoms with their male clients consistently; 73.3% and 22.6% respectively had had unprotected sex with boyfriends and one-night-stand partners. Believing that condom use with a boyfriend is a mistrust and the perception that one did not have full control over condom use decisions, would agree not to use condoms if being paid more, and could not refuse to have unprotected sex with clients were significantly associated with condom use with various types of sex partners (OR = 1.95 to 4.83). FSW has low HIV prevalence but high prevalence of risk behaviours. Bridging effects exist. Empowerment of FSW is warranted.

Violence against wives, sexual risk and sexually transmitted infection among Bangladeshi men
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Infections . 2007 Jun;83(3):211-215.
Silverman JG | Decker MR | Kapur NA | Gupta J | Raj A
The objective was to assess the relationship between men's reported violence against wives and their sexual risk behaviours and sexual health. Cross-sectional analyses of a survey of a nationally representative household-based sample of married men in Bangladesh (n = 3096). Physical and sexual violence against wives during the previous 12 months was assessed and examined for relations to men's extramarital sexual behaviours and sexually transmitted infection (STI) symptoms or diagnosis during this same period, as well as to men's disclosure of such infection to wives and condom use while infected. More than 1 in 3 (36.84%) married Bangladeshi men reported physically and/or sexually abusing their wives in the past year. Men perpetrating such violence were more likely to report both premarital and extramarital sex partners (OR/adjs 1.80-3.45; 95% CI 1.20 to 8.23); those reporting physical violence were more likely to report STI symptoms or diagnosis in the past year (OR/adjs 1.68-2.52; 95% CI 1.24 to 3.73). Men perpetrating physical violence and contracting an STI were somewhat more likely to fail to disclose infection status to wives (OR/adj 1.58; 95% CI 0.93 to 2.70) than infected men not reporting such abuse. Violence against wives is common among Bangladeshi men. Men who perpetrate such abuse represent increased risk regarding their wives' sexual health because they are more likely to both participate in extramarital sexual behaviour and contract an STI compared with non-abusive husbands. Given the growing epidemic of HIV infection among monogamous South Asian women based on intercourse with infected non-monogamous husbands, research and intervention regarding men's violence in marriage and implications of such behaviour for women's sexual health should be prioritized.

HIV/AIDS and STIs NEWS

HIV-infected women rise 100 percent in Nepal
(News Article; Asia)
20 Jun 2007
Xinhua

PNG health minister urges caution on HIV checks
(News Article; Oceania)
19 Jun 2007
Parnell S, The Australian

Barred HIV-positive kids allowed back to school in India
(News Article; Asia)
18 Jun 2007
Jacob J, Agence France-Press (AFP)

MATERNAL AND CHILD HEALTH RESEARCH

Association between maternal infections and preeclampsia: A systematic review of epidemiologic studies
(Abstract; subscription needed for full text; Global)
Maternal and Child Health Journal. Online access June 19, 2007.
Rustveld LO | Kelsey SF | Sharma R
Objectives: A growing body of evidence suggests an association between maternal infection and preeclampsia. To examine the strength of this association, we conducted a comprehensive review of studies published in peer-reviewed journals. Methods: Data collection for this review involved Medline, Embase, and Cochrane data base searches of published studies since 1964 on the relationship between maternal infection and preeclampsia. Data were abstracted according to predefined inclusion and exclusion criteria. Study population included women with preeclampsia and normotensive mothers with and without bacterial or viral infections. Altogether, thirty two original studies were identified and evaluated for methodological quality, preeclampsia diagnosis and adjustment for well-known preeclampsia confounders. Pooled odds ratios and 95% confidence intervals, according to infection status, were calculated using DerSimonian-Laird random-effects models. Publication bias was assessed with a funnel plot and Egger's regression asymmetry test. Results: Sixteen of the 32 studies evaluated were selected for inclusion in the meta-analysis. These studies showed that women with either a bacterial or viral infection were at higher risk of developing preeclampsia, compared to women without infection. Combined results for the 16 studies yielded an OR of 2.1 (95% CI 1.6-2.7). Separate pooled estimates for prospective (OR 2.3, 95% CI 1.7-3.0), case control and retrospective studies combined (OR 2.0, 95% CI 1.4-2.9) yielded similar results. Heterogeneity was significant across overall pooled estimates, case control and retrospective studies (Q(df=20) of 45.7, P = .001; Q(df=10) of 38.7, P less than .005, respectively), but not prospective studies (Q(df=9) of 6.5 P = .69). Conclusions: In our analysis, any infection (bacterial or viral) was associated with a two-fold higher risk of preeclampsia. This association may provide a potential explanation for preeclampsia-related inflammation.

Emergency obstetric care in the southernmost provinces of Thailand
(Abstract; subscription needed for full text; Asia)
International Journal for Quality in Health Care. Online access June 15, 2007.
Liabsuetrakul T | Peeyananjarassri K | Tassee S | Sanguanchua S | Chaipinitpan S
Objective: To assess the accessibility, utilization and quality of emergency obstetric care in the five southernmost provinces of Thailand. Methods: A descriptive study was conducted in the five southernmost provinces of Thailand including fifty-six government hospitals and the admitted obstetric women. The accessibility of hospitals that provided emergency obstetric care was assessed over a 3-month period. The utilization and quality of emergency obstetric care were reviewed using the data of obstetric women admitted in a 6-month period. The admitted women with major obstetric complications were identified by the hospital reports. The accuracy of the hospital reports was checked using Lot Quality Assurance Sampling. The accessibility, utilization and quality of emergency obstetric care services, as defined by the United Nations (UN) indicators. Results: There were 8.4 basic and 1.8 comprehensive emergency obstetric care hospitals per 500 000 population. The proportion of births in hospitals was 89.5%, and the adjusted percentage of women with major obstetric conditions treated in the hospitals was 95.5%. The caesarean section rate was 17.8%, and the case fatality rate caused by postpartum haemorrhage was 0.7%. Delays in seeking, reaching and receiving good care were detected in the causes of maternal deaths. Over-reporting due to double-counting and under-reporting of complications were found in the hospital reports. Conclusions. Emergency obstetric care in Southern Thailand met UN guidelines; however, there was a problem of delays in seeking treatment in some maternal deaths. Improvement of over- and under-reporting of obstetric conditions in the hospitals is needed.

Why do mothers die in Dakahlia, Egypt?
(Abstract; subscription needed for full text; North Africa)
Journal of Obstetrics and Gynaecology Research. 2007 Jun;33(3):283-287.
Abdel-Hady ES | Mashaly AM | Sherief LS | Hassan M | Al-Gohary A
The aim was to investigate the causes of maternal mortality in the Dakahlia Governorate in Egypt. A confidential enquiry for each case of maternal mortality during the years 2004-2005 was carried out. One hundred and seventy-nine maternal deaths were reported, giving a maternal mortality rate (MMR) of 71.3/100 000 live births. 140 (78.2%) women died due to direct obstetric causes, 24 (13.4%) due to indirect causes and 15 (8.4%) due to accidental or unexplained causes. 44 (24.6%) women died during or following delivery by cesarean section and 91 (50.8%) during labor or within 24 h following delivery. Complications during cesarean delivery, postpartum hemorrhage and hypertensive disorders were the leading causes of maternal mortality. Death due to substandard care was encountered in 85% of cases. Obstetricians were responsible for 51% of causes of avoidable maternal death. Maternal mortality in Dakahlia, although declining, is still relatively high. To further reduce maternal mortality, deliveries should be conducted at well-equipped hospitals.

MATERNAL AND CHILD HEALTH NEWS

Jamaica: Unhealthy sexual behaviour in children
(Commentary; Central America and the Caribbean)
17 Jun 2007
Simms G, Jamaica Gleanor

Pakistan: Maternal mortality in Balochistan nearly double national average
(News Article; Asia)
18 Jun 2007
Integrated Regional Information Networks

Tanzania: Activists vow to control maternal deaths in Isles
(News Article; Sub-Saharan Africa)
17 Jun 2007
Yussuf I, Daily News-TSN

Why Botswana's children are dying
(News Article; Sub-Saharan Africa)
Konopo J, Mail & Guardian

GENDER and HEALTH RESEARCH

Why males in Bangladesh do not participate in reproductive health: Lessons learned from focus group discussions
(Abstract; subscription needed for full text; Asia)
International Quarterly of Community Health Education. 2007;26(1):45-59.
Shahjahan M | Kabir M
The article explores male perception, attitude, and knowledge on reproductive health issues and their opinions on how men's participation in reproductive health could be increased. Data were obtained from six focus groups' sessions organized among the men aged 18-59. The participants indicated that males are not motivated to be involved in reproductive health issues in Bangladesh. The participants feel that men also have unmet reproductive and sexual health needs. Their needs are not addressed and traditionally they are not encouraged to participate in reproductive health services. In Bangladesh poor interaction between husband and wife often makes it difficult to understand reproductive health problems of women. Because of prevailing culture and myth, men do not visit health facilities with their wives; they do not feel comfortable taking their wives to the health facility because they do not like to discuss sexual reproductive health issues with the service providers. The analysis suggests that a complex web of social and cultural factors impedes spousal communication regarding reproductive health issues and that discourages them from taking their wives to health clinics. In the focus group discussions, men said that they do not feel comfortable in discussing sexually transmitted diseases with their wives. Generally women come to the health facility for the treatment of RTIs/STDs. Men do not bring their wives to the health facility because they feel shy discussing such diseases with service providers. In order to increase male participation in reproductive health, males suggested introduction of male workers like the present female workers and visiting at the household level to counsel and mobilize them to participate in reproductive health. The analysis indicates that male involvement will be an important strategy to reach demographic goals in Bangladesh.

Bilateral testicular germ cell tumors in Turkey: Increase in incidence in last decade and evaluation of risk factors in 30 patients
(Abstract; subscription needed for full text; Europe)
Journal of Urology. 2007 Jul;178(1):129-133.
Bulent A | Taner DR | Tolga T | Sertac Y | Celik T
The relative risk of germ cell testicular tumor is significantly higher in patients with a testicular tumor history. We reviewed histological and clinical features in 30 patients with bilateral tumors treated at 2 academic centers in Turkey. Of 987 patients with testicular germ cell tumors, 30 (3.0%) were diagnosed with bilateral disease. Data on clinical information, histopathology and follow-up records were reevaluated. Contralateral testis biopsy was not performed in any patient at initial orchiectomy. Of 30 patients, 24 had sequential tumors at a median interval of 75 months (range 3 to 260), and 6 (20.0%) had synchronous tumors. Mean age at presentation was 32.3 and 26.7 years, respectively. The second tumor occurred within 2 and 5 years in 20.8% and 41.7% of patients, respectively. Patients with seminoma were at significantly higher risk for bilateral disease (4.5% vs 2.3%), whereas patients with nonseminoma had more advanced disease at presentation. Synchronous tumors had similar tumor histology on each side and more advanced stage at presentation than metachronous tumors. Most patients with metachronous tumors had stage 1 disease, including 81% originally and 95.2% subsequently. Primary tumors were significantly larger than secondary tumors (4.78 vs 2.59 cm). Median time after the first and second germ cell tumors was 128 and 47 months, respectively. At last follow-up, all patients had no evidence of disease. The risk of contralateral testicular germ cell tumor in patients with seminoma was 2 times higher than in those without a history of tumor. Synchronous tumors present at advanced stage and have similar histology on each side. Clinical outcome is excellent with appropriate treatment. Contralateral testis biopsy at initial diagnosis is not mandatory.

Perceptions and attitudes toward the menopause among middle aged women from Guayaquil, Ecuador
(Abstract; subscription needed for full text; South America)
Maturitas. 2007 Jul 20;57(3):233-238.
Leon P | Chedraui P | Hidalgo L | Ortiz F
Studies reporting the perspective of Latin American women, Ecuador, included, regarding the menopausal phenomena are scarce or lacking. The objectives were to obtain information regarding the perception and attitudes toward the menopause among middle aged women of Guayaquil, Ecuador. Women aged 40 or more, nursing staff members of two major associated teaching hospitals of the Universidad Catolica de Santiago de Guayaquil, Ecuador, were surveyed with a structured questionnaire containing items intended to assess women's perception and attitudes toward the menopause. Secondarily level of information related to the menopause was explored. During the study period, 349 women were surveyed of which mean age was 48 plus or minus 6.8 years. A 41.3% were postmenopausal, 55% premenopausal and 3.7% had a history of hysterectomy with conserved ovaries. Women more frequently perceived the menopause as a positive event as they agreed that it is a normal (93.7%) and important event (73.6%), that it gives more confidence and maturity (78.8%), that they may fully enjoy sexual relations (74.8%), that there is a relief as the risk of becoming pregnant is null (65.3%) and that life becomes easier and calmer (60.7%). A relatively high rate demonstrated a preoccupying attitude toward the menopause as 79.4% responded to be concerned about it indicating that seeking medical attention was important, moreover, 77.9% responded that health during this phase be taken care of and life styles changed. Less than 50% of surveyed women considered having enough information regarding the menopause whereas a high rate indicated wanting to receive educational sessions related to the menopause. Married and lower educated women were not concerned about the menopause in a higher rate than their counterparts. Despite the fact that women perceived the menopause as a positive event, displaying a concerned attitude toward it, their related knowledge was low.

Women's douching practices and related attitudes in eastern Turkey
(Abstract; subscription needed for full text; Europe)
Journal of Obstetrics and Gynaecology Research. 2007 Jun;33(3):353-359.
Ege E | Timur S | Zincir H | Egri M | Reeder BS
Vaginal douching is a common hygiene practice for many women all over the world, but it is associated with several health risks. Little is known about the beliefs and attitudes that promote and maintain douching practices. Therefore, the objective of the present study was to evaluate the status of vaginal douching practices of women in the Malatya province of eastern Turkey. This was a cross-sectional study. A sample of 465 Muslim women was interviewed to ascertain the status of vaginal douching practices. All participants were between 15 and 49 years of age and all were married. Data were collected by using a questionnaire in the process of conducting face-to-face interviews in June 2004. Data analysis included descriptive statistics and logistic regression modeling. The present study revealed that the frequency of douching was 61.5% among women. The participants were frequently douching for feminine hygiene (47.6%). Vaginal douching practices were associated with several factors including education level (odds ratio [OR] = 1.991, 95% confidence interval [CI] = 1.154-3.434), family income (OR = 0.996, 95% CI = 0.994-0.998), marital age (OR = 0.402, 95% CI = 0.223-0.715), frequency of sexual intercourse (OR = 2.335, 95% CI = 1.532-3.554), and presence of genital syndromes/infections (OR = 1.813, 95% CI = 1.215-2.739). This study provides preliminary information about women's douching practices and attitudes in the Malatya region of Turkey. It may also provide information to health-care practitioners in their efforts to educate women on the adverse effects of vaginal douching.

GENDER and HEALTH NEWS

Ghana: FGM now a big crime
(News Article; Sub-Saharan Africa)
15 Jun 2007
Accra Mail

Rwanda: 'Culture hindering use of female condoms'
(News Article; Sub-Saharan Africa)
17 Jun 2007
New Times (Kigali)

Swaziland: Are there any good men?
(News Article; Sub-Saharan Africa)
15 Jun 2007
UN Integrated Regional Information Networks

Kenya: Sex slavery - U.S. says govt doing least in East Africa
(News Article; Sub-Saharan Africa)
19 Jun 2007
Kelley KJ, East African (Nairobi)

Fine-touch pressure thresholds in the adult penis
(News Article; Global)
18 Jun 2007
Medical News Today

Uganda: Genital mutilation legal - AG
(News Article; Sub-Saharan Africa)
20 Jun 2007
Afedraru L, The Monitor (Kampala)

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Sex, breastfeeding, and marital fertility in pretransition China
(Abstract; subscription needed for full text; Asia)
Population and Development Review . 2007 Jun;33(2):289-320.
Lavely W
The present study addresses the debate over low marital fertility in pre-demographic transition China. The debate, long-running and spirited, began when Princeton demographers, led by George Barclay, derived fertility estimates from John Lossing Buck's Chinese Farm Survey of 1929-31 and concluded that pretransition China had a natural fertility regime at very low levels relative to historical European populations. Incredulous that a society so manifestly pronatal could have such low marital fertility, Arthur Wolf (1984) questioned the quality of the historical fertility data, while Ansley Coale (1984) defended it. The debate might have ended there, except that James Lee, Wang Feng, and Cameron Campbell, in a series of books and articles, proposed that low marital fertility in China could be explained in part by "marital restraint," a term that subsumes both customary low coital frequency and deliberate restraint from coitus. Wolf (2001) objected vigorously, proposing that poverty and malnutrition, but certainly not spousal volition, might explain low fertility. The "revisionists" mounted further defense of their thesis (Lee, Campbell, and Wang 2002), even declaring deliberate control to be "the most distinctive feature of Chinese marital fertility".

Conservation and family planning in Tanzania: The TACARE experience
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Population & Environment. 27 Apr 2007;Online access April 27, 2007.
Mavanza M | Grossman A
Community-based distribution (CBD) programs present an alternative way of effectively reaching people in rural areas of developing countries where conventional methods of delivery do not exist or fail. This paper reviews the experience and findings from the Jane Goodall Institute’s (JGI) TACARE program in the Kigoma region of Tanzania. It focuses on the family planning CBD program and its integration within the TACARE program to meet the broader mission of JGI’s conservation efforts. Both qualitative and survey data suggest that the CBD program meets the needs for contraception in participating rural communities and is a complementary and acceptable strategy to ultimately contribute to reduce population pressure on the villages around Gombe National Park.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Niger gets aid for population control
(News Article; Sub-Saharan Africa)
20 Jun 2007
United Press International

Saudi Arabia - demographic trends to watch for
(News Article; Middle East)
18 Jun 2007
AME Info

Pakistan: Population welfare programmes achieve success
(News Article; Asia)
18 Jun 2007
Associated Press of Pakistan

ADOLESCENT HEALTH RESEARCH

Attitudes toward condom use among high school and university students in Zimbabwe
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Quarterly of Community Health Education. 2007;26(1):61-72.
Cort MA | Modeste NN
Utilizing a sample of students (N = 504) from Matabeleland, Zimbabwe, Africa, this study investigated the extent to which knowledge of AIDS and two components of the Health Belief Model are related to: 1 ) attitude toward condom use, and 2) intentions to use a condom in future sexual encounters. Results indicated that knowledge of AIDS is not significantly related to any of the two dependent variables. However, belief in the efficacy of condoms, and lack of barriers to the use of condoms were significantly related to both dependent variables. Discussion focused on the role of religion and SES in influencing attitudes and decisions about condom use.

HIV/AIDS-related knowledge, attitudes and sexual behaviors as predictors of condom use among young adults in Croatia
(Abstract; subscription needed for full text; Europe)
International Family Planning Perspectives . 2007 Jun;33(2):58-65.
Stulhofer A | Graham C | Bozicevic I | Kufrin K | Ajdukovic D
Although Croatia is still in an early stage of HIV infection, the rising rates of infection in other central and eastern European countries suggest the need to understand HIV knowledge, attitudes and sexual behaviors among young adults in Croatia. Data from a multistage probability sample of 1,093 Croatians aged 18-24 surveyed in 2005 were used in regression models that examined the associations between HIV-related knowledge, attitudes and sexual behavior and predictors of condom use at first and last sexual intercourse and condom use consistency. For both men and women, condom use at first intercourse and positive attitudes toward condom use were the most robust predictors of condom use at last intercourse and consistent condom use. In addition, for women, having peers with less traditional attitudes regarding sexuality was associated with consistent condom use (odds ratio, 1.3). Risky sexual behaviors are common among young adults in Croatia. Pragmatic and comprehensive sex education programs should target young people before they become sexually active.

How effective are street youth peer educators? Lessons learned from an HIV/AIDS prevention programme in urban Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Health Education. 2007;107(4):364-376.
Mitchell K | Nyakake M | Oling J
This paper explores "lessons learned" resulting from a process evaluation of a peer-led HIV/AIDS prevention programme targeting street children and youth in urban Uganda. The purpose was to explore aspects of implementation that either enhanced or hindered the effectiveness of the peer educator (PE) role. The process data derive from three reviews conducted throughout the project lifespan. The reviews engaged participatory evaluation methods such as focus groups (four) and workshops (three), as well as drawing on monitoring data such as activity evaluations. The street youth in this project made effective peer educators. We suggest that letting the target group choose their peers and focusing on street youth undergoing rehabilitation engendered ownership of PEs by the target group and accountability among PEs themselves. The role was highly coveted and the PEs became powerful role models. The most useful work of the PEs lay in helping their peers to leave the risky environment of the streets, hence reducing their vulnerability to HIV/AIDS. By defining the role broadly and situating peer education activities within a broader strategy of capacity building and advocacy, we were able to remain sensitive to the context in which street youth make "choices" about their sexual behaviour. This paper contributes significantly to our understanding of the effective implementation of the PE method in this setting. It will be particularly helpful to practitioners in the design stage of similar peer-led programmes.

ADOLESCENT HEALTH NEWS

Uganda: UN agency gives youth Sh62m to fight AIDS
(News Article; Sub-Saharan Africa)
16 Jun 2007
Emorut F, ALL AFRICA

Ghana: Condom use booms in Sunyani
(News Article; Sub-Saharan Africa)
16 Jun 2007
MyJoyOnline

India: Karnataka to teach ‘life skills’ instead of sex education
(News Article; Asia)
16 Jun 2007
Khaleej Times

Vietnamese project wins global development marketplace competition
(News Article; Asia)
15 Jun 2007;19 Jun 2007
Vietnam Net Bridge

India: Punjab says no to sex education
(News Article; Asia)
20 Jun 2007
Bariana P, CNN-IBN

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Volume 7, Number 2325 June 2007