Volume 7, Number 27
23 July 2007

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FAMILY PLANNING RESEARCH

Predictors of condom use among sexually active persons involved in compulsory national service in Ibadan, Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Health Education Research. 2007 Aug;22(4):459-472.
Sunmola AM | Olley BO | Oso GE
Migration is known to increase the risk of heterosexual transmission of human immunodeficiency virus (HIV) in sub-Saharan Africa, but little attention has been paid to fresh graduates of tertiary institutions who are on migration for compulsory national assignment in Nigeria. In July and August 2004, a survey was conducted on sexually active men (n = 344) and women (n = 373) to investigate determinants of condom use during national service. Sixty-eight percent of men and 41% of women reported condom use at last intercourse before the survey. For both men and women, condom use was common if they had one or more regular sex partners and if they were purchasing condoms. In addition, women's condom use was predicted by being single and having intention to use condoms in next intercourse. The findings further showed that there was high risk of HIV transmission in the sample population as consistent condom use was 15% for men and 4% for women. Twelve percent of men and 8% of women reported STI diagnoses in the last 12 months before the survey. Four percent of men and 2% of women reported they already had HIV diagnoses. Only 1% of men and 2% of women reported they would receive voluntary HIV test if offered free by the government. The study findings suggest the need to extend the existing condom social marketing services in the country to the youth on national service and promote condom education messages among them prior to commencing national service.

Contraceptive use among U.S. women with HIV
(Research Article; North America)
Journal of Women's Health. 2007 Jun;16(5):657-666.
Massad LS | Evans CT | Wilson TE | Golub ET | Sanchez-Keeland L
The objective was to describe trends in and correlates of use of contraception and sterilization among women with the human immunodeficiency virus (HIV). This was a longitudinal cohort study of HIV-infected and uninfected women at risk for pregnancy, including structured questions on contraceptive use every 6 months. Proportions of women using contraception were calculated. Multivariate generalized estimating equation models were applied, and correlates of use were determined using logistic regression. Sterilization was assessed using a Kaplan-Meyer plot. Across 26,832 visits among 2784 women from 1994 to 2005, barrier methods were used at 30.5%-36.3% of visits, sterilization at 21.8%-26.5%, hormones at less than 10%, and no contraception at great than 30%. Dual use of barrier and hormones or barrier and spermicide was uncommon. In multivariable analysis, HIV serostatus was not correlated with barrier use (OR 1.10, 95% CI 0.96-1.26, p = 0.18 compared with no method), but hormonal contraception was less likely in women with HIV (OR 0.73, 95% CI 0.60-0.89, p = 0.002). Among HIV-seropositive women, barrier use was more likely among women who had been pregnant (OR 1.37, 95% CI 1.03-1.83, p = 0.03) and among those with higher CD4 lymphocyte counts (OR 1.10, 95% CI 1.04-1.16, p = 0.0006), whereas hormone use was linked to higher CD4 counts (OR 1.12, 95% CI 1.03-1.23, p = 0.01). HAART use was not associated with barrier or hormone use. HIV serostatus was linked to sterilization in Cox analysis (HR 1.32, 95% CI 0.89-1.94, p = 0.17). Under-use of highly effective contraception and barriers leaves women with HIV at risk for unintended pregnancy and disease transmission.

FAMILY PLANNING NEWS

Chile: Condom use still limited
(News Article; South America)
18 Jul 2007
La Tercera, La Nacion

Malawi: Repositioning family planning - choice, not chance
(Commentary; Sub-Saharan Africa)
16 Jul 2007
The Chronicle Newspaper (Lilongwe)
Related Fact Sheet: Family Planning Success Stories in Sub-Saharan Africa

Guyana: Given a choice most men would not use condoms - study finds
(News Article; South America)
15 Jul 2007
Stabroek News

HIV/AIDS and STIs RESEARCH

Home-based self-sampling and self-testing for sexually transmitted infections: Acceptable and feasible alternatives to provider-based screening in low-income women in Sao Paulo, Brazil
(Abstract; subscription needed for full text; South America)
Sexually Transmitted Diseases. 2007 Jul;34(7):421-428.
Lippman SA | Jones HE | Luppi CG | Pinho AA | Veras MA
The objective of this study was to determine whether home-based screening for sexually transmitted infections (STIs) is acceptable, feasible, and increases the proportion of women screened among low-income women in Sao Paulo, Brazil. Eight hundred eighteen women were randomized to receive a clinic appointment or a kit for home-based STI self-collection and testing. All participants collected 2 vaginal swabs, one for polymerase chain reaction detection of chlamydia, gonorrhea, and trichomoniasis and another for a self-conducted rapid test for trichomoniasis. Slightly more women responded to the initiative within 2 weeks in the home group (80%) than in the clinic group (76%) with younger women showing improved response to home-based screening. Ninety-four percent of home group participants successfully completed self-collection and self-testing on their first attempt. Home-based self-collection and self-testing was acceptable, feasible, and resulted in a slightly higher response rate. Home sampling and testing provide promising alternatives to clinic-based STI screening across diverse contexts.

Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: A randomised controlled trial
(Abstract; subscription needed for full text; Sub-Saharan Africa)
The Lancet. Online access July 13, 2007.
Padian N | van der Straten A | Ramjee G | Chipato T | de Bruyn G | Blanchard K | Shiboski S | Montgomery E | Fancher H | Cheng H | Rosenblum M | van der Laan M | Jewell N | Mdntyre J
Related News Article: Diaphragms no extra help against AIDS, study finds
Related News Article: Africa: Contraceptive device fails to prevent HIV
Female-controlled methods of HIV prevention are urgently needed. We assessed the effect of provision of latex diaphragm, lubricant gel, and condoms (intervention), compared with condoms alone (control) on HIV seroincidence in women in South Africa and Zimbabwe. We did an open-label, randomised controlled trial in HIV-negative, sexually active women recruited from clinics and community-based organisations, who were followed up quarterly for 12-24 months (median 21 months). All participants received an HIV prevention package consisting of pre-test and post-test counselling about HIV and sexually transmitted infections, testing, treatment of curable sexually transmitted infections, and intensive risk reduction counselling. The primary outcome was incident HIV infection. This study is registered with ClinicalTrials.gov, number NCT00121459. Overall HIV incidence was 4.0% per 100 woman-years: 4.1% in the intervention group (n=2472) and 3.9% in the control group (n=2476), corresponding to a relative hazard of 1.05 (95% CI 0.84-1.32, intention-to-treat analysis). The proportion of women using condoms was significantly lower in the intervention than in the control group (54% vs 85% of visits, p less than 0.0001). The proportions of participants who reported adverse events (60% [1523] vs 61% [1529]) and serious adverse events (5% [130] vs 4% [101]) were similar between the two groups. We observed no added protective benefi t against HIV infection when the diaphragm and lubricant gel were provided in addition to condoms and a comprehensive HIV prevention package. Our observation that lower condom use in women provided with diaphragms did not result in increased infection merits further research. Although the intervention seemed safe, our findings do not support addition of the diaphragm to current HIV prevention strategies.

The evolving cost of HIV in South Africa: Changes in health care cost with duration on antiretroviral therapy for public sector patients
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Acquired Immune Deficiency Syndromes. 2007 Jul;45(3):348-354.
Harling G | Wood R
A retrospective costing study of 212 patients enrolled in a nongovernmental organization-supported public sector antiretroviral treatment (ART) program near Cape Town, South Africa was performed from a health care system perspective. t-Regression was used to analyze total costs in 3 periods: Pre-ART (median length = 30 days), first 48 weeks on ART (Year One), and 49 to 112 weeks on ART (Year Two). Average cost per patient Pre-ART was $404. Average cost per patient-year of observation was $2502 in Year One and $1372 in Year Two. The proportion of costs attributable to hospital care fell from 70% Pre-ART to 24% by Year Two; the proportion attributable to ART rose from 31% in Year One to 55% in Year Two. In multivariate analysis, Pre-ART and Year One costs were significantly lower for asymptomatic patients compared with those with AIDS. Costs were significantly higher for those who died Pre-ART or in Year One. In Year Two, only week 48 CD4 cell count and being male were significantly associated with lower costs. This analysis suggests that the total cost of treatment for patients on ART falls by almost half after 1 year, largely attributable to a reduction in hospital costs.

The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil
(Abstract; subscription needed for full text; South America)
AIDS. 2007 Jul 11;21(11):1441-1448.
Golub JE | Saraceni V | Cavalcante SC | Pacheco AG | Moulton LH
Tuberculosis is a common complication and leading cause of death in HIV infection. Antiretroviral therapy (ART) lowers the risk of tuberculosis, but may not be sufficient to control HIV-related tuberculosis. Isoniazid preventive therapy (IPT) reduces tuberculosis incidence significantly, but is not widely used. We analysed tuberculosis incidence in 11 026 HIV-infected patients receiving medical care at 29 public clinics in Rio de Janeiro, Brazil, between 1 September 2003 and 1 September 2005. Data were collected through a retrospective medical record review. We determined rates of tuberculosis in patients who received neither ART nor IPT, only ART, only IPT, or both ART and IPT. The overall tuberculosis incidence was 2.28 cases/100 person-years (PY) [95% confidence interval (CI) 2.06-2.52]. Among patients who received neither ART nor IPT, incidence was 4.01/100 PY. Patients who received ART had an incidence of 1.90/ 100 PY (95% CI 1.66-2.17) and those treated with IPT had a rate of 1.27/100 PY (95% CI 0.41-2.95). The incidence among patients who received ART and IPT was 0.80/ 100 PY (95% CI 0.38-1.47). Multivariate Cox proportional hazards modeling revealed a 76% reduction in tuberculosis risk among patients receiving both ART and IPT (adjusted relative hazard 0.24; P less than 0.001) after adjusting for age, previous tuberculosis diagnosis, and CD4 cell counts at baseline. The use of both IPT and ART in HIV-infected patients is associated with significantly reduced tuberculosis incidence. In conjunction with expanded access to ART, the wider use of IPT in patients with HIV will improve tuberculosis control in high burden areas.

HIV/AIDS and STIs NEWS

HIV patients build normal immune strength in study
(News Article; Global)
18 Jul 2007
Dunham W, Reuters

Syphilis emergency in Madagascar
(News Article; Sub-Saharan Africa)
18 Jul 2007
Hogg J, BBC News

Botswana: Harvard man hails Botswana for HIV treatment
(News Article; Sub-Saharan Africa)
13 Jul 2007
Chwaane T, Mmegi/The Reporter (Gaborone)

Rwanda: Govt maps out strategic plan in HIV/Aids fight
(News Article; Sub-Saharan Africa)
16 Jul 2007
Hitimana B, East African Business Week (Kampala)

Nigeria: Military laments HIV/Aids scourge
(News Article; Sub-Saharan Africa)
16 Jul 2007
Daily Champion (Lagos)

Angola: Bengo - Paul Gasol appeals for solidarity towards HIV positive
(News Article; Sub-Saharan Africa)
15 Jul 2007
Angola Press Agency (Luanda)

Botswana: HIV prevalence rates go down
(News Article; Sub-Saharan Africa)
10 July 2007
Chwaane T, Mmegi/The Reporter (Gaborone)

MATERNAL AND CHILD HEALTH RESEARCH

Pregnancy rates and birth outcomes among women on Efavirenz-containing highly active antiretroviral therapy in Botswana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Acquired Immune Deficiency Syndromes. 2007 Jul;45(3):269-273.
Bussmann H | Wester CW | Wester CN | Lekoko B | Okezie O
Millions of HIV-infected women in developing countries are in need of safe and highly effective antiretroviral therapy. Pregnancy rates are usually high in developing countries, and efavirenz (EFV) use in women of childbearing age is of concern because of its potential teratogenicity. As part of a prospective study comparing 6 initial highly active antiretroviral therapy (HAART) regimens, 3 of which contained EFV, pregnancy and birth outcomes were evaluated among female participants enrolled in a randomized clinical trial in Botswana. Before enrollment, all female participants indicated a willingness to avoid pregnancy for the 3-year duration of the study. Monthly urine pregnancy testing and regular contraceptive education and counseling were given to all women on study. Four hundred fifty-one (69.4%) of 650 enrolled study participants were female and experienced 71 pregnancies, for a rate of 7.9 per 100 person-years during the study. The mean time from HAART initiation to time of first pregnancy was 385 days. The median birth weight of babies was 2950 g (interquartile range: 2700-3250 g); the gender of babies (24 female and 15 male) and occurrence of early pregnancy loss (42%) and stillbirths (3%) did not differ between EFV- and non-EFV-exposed pregnancies (P = 0.7). First-trimester EFV exposure occurred in 38 (53.5%) of the 71 pregnancies; 22 (57.9%) of these 38 pregnancies resulted in live births. One infant (4.5%) of the 22 EFV-exposed live births had a congenital abnormality with right limb shortening that was assessed to be unrelated to EFV exposure. The restoration of health and longevity in many HAART-treated women is often accompanied by childbearing, as evidenced by the large fraction of women in our cohort who became pregnant despite their initial statements of intent to avoid pregnancy. Of 22 first-trimester EFV-exposed live births, 1 neonate was found to have a major congenital abnormality; however, this defect was unrelated to EFV exposure. The small sample size is insufficient to estimate accurately the underlying risk of congenital malformation after exposure to EFV in early pregnancy, underscoring the importance of reporting to the existing international Antiretroviral Pregnancy Registry. In addition to accessing safe and effective HAART regimens, HIV-infected women require access to comprehensive family planning services, including contraception and procreation counseling.

Setting priorities for safe motherhood program evaluation: A participatory process in three developing countries
(Abstract; subscription needed for full text; Asia | Sub-Saharan Africa)
Health Policy. 2007 Sep;83(1):94-104.
Madi BC | Hussein J | Hounton S | D'Ambruoso L | Achadi E | Arhinful DK
A participatory approach to priority setting in programme evaluation may help improve the allocation and more efficient use of scarce resources especially in low-income countries. Research agendas that are the result of collaboration between researchers, programme managers, policy makers and other stakeholders have the potential to ensure rigorous studies are conducted on matters of local priority, based on local, expert knowledge. This paper describes a process involving key stakeholders to elicit and prioritise evaluation needs for safe motherhood in three developing countries. A series of reiterative consultations with safe motherhood stakeholders from each country was conducted over a period of 36 months. In each country, the consultation process consisted of a series of participatory workshops; firstly, stakeholder's views on evaluation were elicited with parallel descriptive work on the contexts. Secondly, priorities for evaluation were identified from stakeholders; thirdly, the evaluation-priorities were refined; and finally, the evaluation research questions, reflecting the identified priorities, were agreed and finalised. Three evaluation-questions were identified in each country, and one selected, on which a full scale evaluation was undertaken. While there is a great deal written about the importance of transparent and participatory priority setting in evaluation; few examples of how such processes could be implemented exist, particularly for maternal health programmes. The authors' experience demonstrates that the investment in a participatory priority-setting effort is high but the process undertaken resulted in both globally and contextually-relevant priorities for evaluation. This experience provides useful lessons for public health practitioners committed to bridging the research-policy interface.

Effects of interpregnancy interval and outcome of preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh
(Abstract; subscription needed for full text; Asia)
BJOG: An International Journal of Obstetrics and Gynaecology. 6 Jul 2007;:1-9.
DaVanzo J | Hale L | Razzaque A | Rahman M
Objective: To estimate the effects on pregnancy outcomes of the duration of the preceding interpregnancy interval (IPI) and type of pregnancy outcome that began the interval. Design: Observational population-based study. Setting: The Maternal Child Health-Family Planning (MCH-FP) area of Matlab, Bangladesh. Population: A total of 66 759 pregnancy outcomes that occurred between 1982 and 2002. Methods: Bivariate tabulations and multinomial logistic regression analysis. Main outcome measures: Pregnancy outcomes (live birth, stillbirth, miscarriage [spontaneous fetal loss prior to 28 weeks], and induced abortion). Results: When socio-economic and demographic covariates are controlled, of the IPIs that began with a live birth, those less than 6 months in duration were associated with a 7.5-fold increase in the odds of an induced abortion (95% CI 6.0-9.4), a 3.3-fold increase in the odds of a miscarriage (95% CI 2.8-3.9), and a 1.6-fold increase in the odds of a stillbirth (95% CI 1.2-2.1) compared with 27- to 50-month IPIs. IPIs of 6-14 months were associated with increased odds of induced abortion (2.0, 95% CI 1.5-2.6). IPIs greater than or equal to 75 months were associated with increased odds of all three types of non-live-birth (NLB) outcomes but were not as risky as very short intervals. IPIs that began with a NLB were generally more likely to end with the same type of NLB. Conclusions: Women whose pregnancies are between 15 and 75 months after a preceding pregnancy outcome (regardless of its type) have a lower likelihood of fetal loss than those with shorter or longer IPIs. Those with a preceding NLB outcome deserve special attention in counselling and monitoring.

MATERNAL AND CHILD HEALTH NEWS

Kenya: ARVs inaccessible to children, says Nyikal
(News Article; Sub-Saharan Africa)
19 Jul 2007
Oywa J, East African Standard

UN officials urge male involvement in maternal health to save women's lives
(News Article; Global)
11 Jul 2007
UN News Center

Botswana: Minister says pregnancy deaths can be avoided
(News Article; Sub-Saharan Africa)
12 Jul 2007
Chwanee T, Mmegi

Gambia observes world population day: Maternal death at 730 per 100,000 live births
(News Article; Sub-Saharan Africa)
11 Jul 2007
The Daily Observer

Namibia: World Population Day targets men
(News Article; Sub-Saharan Africa)
11 Jul 2007
All Africa

Namibia: Pregnant women sleep under trees at Engela
(News Article; Sub-Saharan Africa)
17 Jul 2007
Shivute O, The Namibian

GENDER and HEALTH RESEARCH

Comparability of self-collected vaginal swabs and physician-collected cervical swabs for detection of human papillomavirus infections in Rakai, Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Diseases. 2007 Jul;34(7):429-436.
Safaeian M | Kiddugavu M | Gravitt PE | Ssekasanvu J | Murokora D
The objective of this study was to compare human papillomavirus (HPV) DNA testing between self-administered vaginal swabs and physician-administered cervical swabs in women from rural Rakai District, Uganda. Between 2002 and 2003, women from a population-based cohort participated in an HPV study. Women collected self-administered vaginal swabs and were also offered a pelvic examination, which included physician-collected cervical samples. Methods: Hybrid-capture 2 was used to determine carcinogenic HPV status. Polymerase chain reaction was used to determine HPV genotypes. Unweighted k statistics were used to determine agreement. Compliance with self-collected swabs was greater than or equal to 86%; however, only 51% accepted a pelvic examination. Carcinogenic HPV prevalence was 19% in self-collected and 19% in physician-collected samples. Agreement among paired observations was 92% with a k of 0.75. Kappa between self- and physician-collected samples was similar in HIV strata (k = 0.71 and 0.75 for HIV-positive and HIV-negative, respectively). In this community-based setting, detection of carcinogenic HPV was comparable among self- and physician-administered samples. Self-collection is a feasible and accurate means of obtaining HPV samples from women in resource-poor settings or persons reluctant to undergo a pelvic examination.

Effect of statin therapy on early return of potency after nerve sparing radical retropubic prostatectomy
(Abstract; subscription needed for full text; Global)
The Journal of Urology. 2007 Aug;178(2):613-616.
Hong SK | Han BK | Jeong SJ | Byun SS | Lee SE
We prospectively investigated whether postoperative statin use would contribute to earlier recovery of erectile function in men who underwent bilateral nerve sparing radical retropubic prostatectomy for clinically localized prostate cancer. A total of 50 potent men without hypercholesterolemia undergoing bilateral nerve sparing radical retropubic prostatectomy for clinically localized prostate cancer were prospectively randomized into 2 equal groups. Group 1 patients were instructed to ingest only 50 mg sildenafil per day if needed following hospital discharge after radical retropubic prostatectomy. Group 2 patients were prescribed atorvastatin at a dose of 10 mg daily from postoperative days 1 to 90 and they were also instructed to ingest sildenafil, as in group 1. Patient status regarding potency and adverse events were assessed 6 months after surgery. The 2 groups demonstrated no significant differences regarding various baseline factors, including International Index of Erectile Function-5 scores. Group 2 had a significantly higher postoperative International Index of Erectile Function-5 score than group 1 at 6 months postoperatively (p = 0.003). Meanwhile, as judged by a preset definition, the incidence of potent patients 6 months after prostatectomy was 26.1% in group 1 and 55% in group 2 (p = 0.068). Also, 17.4% and 40% of the men reported achieving intercourse by vaginal penetration without a phosphodiesterase 5 inhibitor in groups 1 and 2, respectively (p = 0.172). No serious adverse events associated with medication were reported. Postoperative treatment with atorvastatin in men who report normal erectile function preoperatively may contribute to earlier recovery of erectile function after nerve sparing radical retropubic prostatectomy.

Controversies in sexual medicine: Male circumcision and HIV prevention
(Abstract; subscription needed for full text; Global)
The Journal of Sexual Medicine. 2007 Jul;4(4i):838-843.
Verdi Y | Sadeghi-Nejad H | Pollack S | Aisuodionoe-Shadrach OI | Sharlip ID
Growing evidence has linked circumcision with some protection against HIV infection. Should nations with a high HIV infection rate encourage male circumcision? Four people with expertise and/or interest in the area of circumcision and HIV were asked to contribute their opinions. The main outcome measure was to provide food for thought, discussion, and possible further research in a poorly discussed area of sexual medicine. Three clinical trials in Africa showed the benefit of circumcision in reducing HIV incidence in men. Sadeghi-Nejad cites these, but balances this with the pandemic in India, and the cultural implications of circumcision. Pollack cites these studies as well, but reinforces the World Health Organization and UNAIDS recommendations that male circumcision should not replace safe sex. As a Nigerian, Aisuodionoe-Shadrach discusses the indirect ways in which circumcision can reduce the spread of HIV, and advocates the surgery, although he proposes infant circumcision may be wiser. Ira Sharlip, President of the International Society for Sexual Medicine, explains some of the physiology involved while again citing the three recent African studies. He questions who would be circumcised and who would perform the procedure if pro-circumcision policies were adopted. While three clinical trials in Africa were halted after it became evident that circumcision was beneficial in protecting against HIV, further information on the health risks and benefits of male circumcision is needed. Ethical decisions need to be made and medical recommendations developed before circumcision can be considered for HIV prevention.

GENDER and HEALTH NEWS

UNICEF hails moves by Egypt to eliminate female genital mutilation
(News Article; North Africa)
3 Jul 2007
UN News Centre
Related Abstract; subscription needed for full text: Death of 12-Year-Old Circumcised Girl Shocks Egypt, Prompts Ban on Rite

Angola: Government official worried about domestic violence
(News Article; Sub-Saharan Africa)
17 Jul 2007
Angola Press Agency (Luanda)

Congo: Men called on to support reproductive health issues
(News Article; Sub-Saharan Africa)
17 Jul 2007
IRIN

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Towards long-term population decline: A discussion of relevant issues
(Abstract; subscription needed for full text; Global)
European Journal of Population. 2007 Jun;23(2):189-207.
Reher DS
This paper contains thoughts on the process of imminent population decline under way in much of the developed world and quite possibly in other world regions as well. We are witnessing the beginnings of a vast trend change which promises to bring to a close a period of population growth that has lasted for several centuries. It can be shown that this great change is a byproduct of the demographic transition that unleashed a number of the forces leading to where we are today. The extent to which much of the developing world will follow the reproductive trends of the developed world, with their social and economic implications, is discussed. The decades ahead for much of the world will lead us into mostly uncharted territory that bears few similarities with past periods of population decline. The purpose of this paper is to stimulate reflection and debate on a subject that looms as perhaps the key social issue of the twenty-first century.

Estrogen receptor alpha polymorphisms and fertility in populations with different reproductive patterns
(Abstract; subscription needed for full text; Global)
Molecular Human Reproduction. 2007 Aug;13(8):537-540.
Corbo RM | Ulizzi L | Piombo L | Martinez-Labarga C | De Stefano GF
The estrogen receptor (ER) plays an important role in mediating estrogen action on target tissues. ER-alpha, the most abundant, is found in all human reproductive tissues and studies on alpha-ER knockout mice have highlighted its role in reproduction. ER-alpha gene (ESR1) polymorphisms have been associated with a variety of disorders including human infertility. In this study, we examined the association of ESR1 PvuII and XbaI polymorphisms with fertility in two populations with different reproductive patterns and precisely in a sample of healthy Italian men and women (n = 178) and in a sample of healthy African-Ecuadorian women (n = 57). ESR1 xx and ppxx genotypes among the Italian men were found to be associated with an above-median number of children (P = 0.01 and P = 0.004, respectively). ESR1 pp genotype among the Italian women showed a tendency to be associated with a lower number of abortions (P = 0.04), whereas ESR1 pp and ppxx genotypes among African-Ecuadorian women were associated with a higher number of children (P = 0.02 and P = 0.03, respectively). These results are consistent with previous observations indicating a role of ESR1 genotypes in human infertility and give insight into the complex interactions between genotypes and reproductive behaviours in human populations.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

World Population Moving More Toward Urban Areas
(News Article; Global)
10 Jul 2007
Voice of America

Congo: Government responds to population growth concerns
(News Article; Sub-Saharan Africa)
19 Jul 2007
IRIN Africa

ADOLESCENT HEALTH RESEARCH

Increased risk of chlamydial and gonococcal infection in adolescent sex workers in Madagascar
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Diseases. 2007 Jul;34(7):475-478.
Pettifor AE | Turner AN | Damme KV | Hatzell-Hoke T | Rasamindrakotroka A
The goal was to examine and compare young sex workers' risk of acquisition of sexually transmitted infections (STIs) with the risk among their older counterparts. The objective was to evaluate the effect of young age-16-19 years vs. 20 years and older-on risk of incident infection with Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT). A randomized controlled trial of 1,000 sex workers in Madagascar was conducted. STI testing was conducted at baseline, 6, 12, and 18 months. About 13% of the cohort (n = 134) was composed of young women aged 16-19 years. STI incidence rates in this group over the 18-month study period were high: 51.9/100 woman-years (WY) for GC and 47.4/100 WY for CT compared to 27.4/100 WY and 19.1/100 WY for sex workers over age 20, respectively. In multivariable models, young sex workers were at significantly higher STI risk compared with their older peers: The adjusted risk ratio (aRR) for GC comparing younger to older women was 1.50 (95% confidence interval (CI): 1.20, 1.88); for CT, the aRR was 1.72 (95% CI: 1.35, 2.19) and for GC or CT combined, the aRR was 1.42 (95% CI: 1.22, 1.66). This exploratory analysis suggests that additional research is warranted to identify effective and acceptable prevention strategies that benefit young women, and interventions already proven effective among adolescents should be given high priority for scale-up.

Health information seeking among Mbararan adolescents: Results from the Uganda Media and You survey
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Health Education Research. 2007 Jul 16;Online access July 16, 2007. :[10] p.
Ybarra ML | Emenyonu N | Nansera D | Kiwanuka J | Bangsberg DR
To maximize scarce intervention dollars, pediatricians and other adolescent health professionals must position health promotion efforts in mediums that most effectively reach youth. This may be especially true in resource-limited settings where access to primary health care and medications is limited. To improve the efficiency and impact of disease prevention and health promotion efforts in resource-limited settings, we examine sources of health information cited by adolescents in Mbarara Uganda. Participants in the Uganda Media and You survey were students aged 12-18 (n = 500) randomly identified in five secondary schools in Mbarara municipality, Uganda. Ninety-three percent of eligible and invited youth completed the cross-sectional, pencil-and-paper survey. Four in five adolescents (81%) indicated they turned to parents, teachers, and other adults while around half read a book/went to the library (56%) or turned to siblings and friends (50%) for information about health and disease. More than one in three (38%) indicated that they used the computer and Internet to search for health information. Older versus younger respondents tended to rely upon siblings and friends for all types of health questions. On the other hand, younger versus older youth were significantly more likely to turn to parents, teachers, and other adults for their questions about sexual health. Adults may be an important component of effective disease prevention and health promotion campaigns. Multiple delivery methods may be especially effective for reaching older adolescents. Technology also may be an important health promotion tool in resource-limited settings.

ADOLESCENT HEALTH NEWS

Sudan: Empowering girls to prevent teen pregnancies
(Feature Article; North Africa)
19 Jul 2007
IRIN Africa

Sex education creates storm in AIDS-stricken India
(News Article; Asia)
14 Jul 2007
Mukherjee K, Reuters
Related News Article: Renuka chowdhury speaks up in favour of sex education
Related News Article: NACO to review sex education module

Congo: HIV prevalence rate reaches 5.4 pct among uneducated youths
(News Article; Sub-Saharan Africa)
18 Jul 2007
African Press Agency

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Volume 7, Number 2723 July 2007