Volume 7, Number 30
13 August 2007

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FAMILY PLANNING RESEARCH

Adolescent mothers' attitudes toward contraceptive use before and after pregnancy
(Abstract; subscription needed for full text; North America)
Journal of Pediatric and Adolescent Gynecology. 2007 Aug;20(4):233-240.
Lemay CA | Cashman SB | Elfenbein DS | Felice ME
The study objective was to understand attitudes and beliefs influencing use and nonuse of contraceptive methods pre- and postpartum among a group of adolescent mothers. A qualitative descriptive study utilizing focus groups was conducted between May 2005 and January 2006 in Central Massachusetts. The participants in the study were adolescent mothers attending a federally funded multi-professional medical program. Inclusion criteria included being at least one year postpartum. Forty-six mothers were eligible; 34 were successfully contacted via telephone. Twenty-two agreed to attend; 15 adolescent mothers attended one of four groups. Emergent themes were identified concerning adolescent mothers' attitudes and beliefs regarding contraception pre- and postpartum. Themes pertaining to nonuse of contraception prior to first pregnancy were: denial, not planning to have sex, not considering the consequences of unprotected sex, and wanting to become pregnant. Participants identified barriers to obtaining and utilizing contraception, including embarrassment discussing the topic, confidentiality, inability to obtain contraception without parental knowledge, and lack of knowledge regarding methods. Participants reported that convenience, perceived effectiveness, familiarity, and side effects were the primary reasons for selecting or changing a method of contraception postpartum and recommended several methods of promoting contraceptive use among adolescents. These included persuading health care providers to discuss the issue routinely with every adolescent patient, parental involvement, outreach by young mothers to at-risk teens, and media campaigns. Given the adverse consequences of adolescent pregnancy, understanding the attitudes and beliefs of postpartum adolescents regarding contraceptives is important for developing effective interventions. Focus groups conducted with adolescent mothers, a difficult population to engage, provide a venue for exploring this complex issue.

Family planning attitudes of medically underserved Latinas
(Abstract; subscription needed for full text; North America)
Journal of Women's Health. 2007 Jul;16(6):879-882.
Rivera CP | Mendez CB | Gueye NA | Bachmann GA
The objective was to evaluate the cultural and socioeconomic factors that may influence family planning decisions in Latinas attending a community health center. Contraceptive choices made by medically underserved Latinas attending a federally funded community health clinic were surveyed, and the societal, religious, economic, and community factors that affect their use were evaluated. In a cohort of 97 Latinas, almost one third were not using birth control, and those using birth control often chose nonhormonal methods. Early pregnancy was desired by this cohort, with 72 women (84%) reporting that 25 years or younger was an ideal age for a first pregnancy; 81 women (89 %) indicated having children was an extremely important goal for them. Contraceptive use was lower than the national average in this cohort of mainly Spanish-speaking Latinas, with most of the women using methods considered not as efficacious as hormonal ones. These data suggest that initial counseling for young Latinas, especially for those who may not be acclimated to U.S. culture as evidenced by their preference for counseling in Spanish, should focus on how to optimally prepare for planning and spacing of pregnancies rather than on how to prevent pregnancy. Counseling that emphasizes only birth control options and not pregnancy concerns should be employed after desired family size is reached.

FAMILY PLANNING NEWS

Manila promotes natural family planning
(News Article; Asia)
8 Aug 2007
Digal S, Asia News

China: Family planning signs banned as too crude
(News Article; Asia)
6 Aug 2007
Shanghai Daily

HIV/AIDS and STIs RESEARCH

Estimating the number of vertically HIV-infected children eligible for antiretroviral treatment in resource-limited settings
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Epidemiology. 2007 Jun;36(3):679-687.
Little K | Newell ML | Luo C | Ngongo N | Borja MC
With the gradual roll-out of antiretroviral therapy (ART) to delay progression of HIV disease in children in programmes across sub-Saharan Africa and resource-limited settings elsewhere, reliable information on the number of vertically infected children eligible for such treatment is urgently required. We present a model to estimate the number of vertically HIV-infected children by age who have progressed to moderate to severe disease (MSD) and as such are eligible for ART on the basis of clinical disease, allowing for: antenatal HIV prevalence, use of interventions to prevent mother-to-child transmission (PMTCT), infant feeding policies and availability of co-trimoxazole to prevent opportunistic infections that may hasten the onset of serious disease. The model assumptions were informed by published evidence and expert opinion; rates of progression to serious disease were inferred from mortality of infected and uninfected children of HIV-infected mothers; and mortality among children treated with ART was based on a study of treated children in Abidjan. To allow widespread use the model has been developed using the Excel spreadsheet software. With South Africa as a hypothetical example, published antenatal prevalence and demographic data, and assuming PMTCT coverage with single dose nevirapine of 11%, all exposed and infected children receive co-trimoxazole, and various infant feeding policy scenarios, estimated numbers of children eligible for ART are presented. This model is easy to implement and flexible and can be used in ART programmes at national and local level.

Antiretroviral treatment of HIV in Uganda: A comparison of three different delivery models in a single hospital
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007 Sep;101(9):885-892.
Larsson EC | Okong P | Thorson A | Ekstrom AM
This exploratory study examined health workers' perspectives and the type of HIV care received in three different delivery models of antiretroviral treatment (ART) at St Francis Hospital, Kampala, Uganda. Two of the clinics were financed by external donors and the third through out-of-pocket payments. Key informant interviews with health workers investigated potential challenges with ART care, and exit interviews with patients collected data on the care received. Despite the fact that all three clinics were located in the same hospital, services offered and quality of care varied extensively. Health staff at all ART clinics identified the lack of collaboration between different HIV programmes and low patient adherence as the main challenges. More women than men accessed ART through the externally financed programmes. These programmes provided more comprehensive care because of higher staff density and more frequent laboratory monitoring compared to the private clinic. Despite these shortcomings and the fact that prescriptions were often renewed without a preceding medical check-up at the private clinic, many chose to pay a monthly average equivalent of US$60 for ART in return for privacy and access to drugs without HIV disclosure requirements. Stigma and fear of abandonment were thought to be the main barriers for access to ART.

Trends in mortality from pulmonary tuberculosis and HIV/AIDS co-infection in rural South Africa (Agincourt)
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007 Sep;101(9):893-898.
Zwang J | Gareene M | Kahn K | Collinson M | Tollman SM
This study investigates trends and age-and-sex patterns of mortality in pulmonary tuberculosis (PTB) and PTB/HIV co-infection in a rural population of South Africa. The PTB/HIV mortality emerged in 1994, and has been rising ever since (men: P = 0.001; women: P = 0.020, test for trend). In the last 2 years, for both sexes combined, 63% (95% CI 51-74%) of PTB deaths were attributable to HIV/AIDS. PTB/HIV death rate was higher in men than in women for all ages combined (RRMH = 2.48, 95% CI 1.53-4.04, P less than 0.001). PTB/HIV death rate was also higher in younger individuals (less than 25 years) compared with PTB without HIV/AIDS (P = 0.033), and the median age at death from PTB/HIV in women (28 years) was lower than in men (38 years, P = 0.002). While mortality from PTB without HIV remained constant over time, HIV/AIDS explained the rise in PTB mortality. In the last 3 years, the HIV/AIDS epidemic has caused the number of persons dying of PTB to increase by +117%, with the mortality excess being higher in women (+164%) than in men (+103%, P = 0.001). Combined PTB and HIV programme activities need to be reinforced to respond to the increase in PTB mortality, particularly in women.

Self-reported mechanical problems during condom use and semen exposure: Comparison of two randomized trials in the United States of America and Brazil
(Abstract; subscription needed for full text; North Africa | South America)
Sexually Transmitted Diseases. 2007 Aug;34(8):557-562.
Chen MP | Macaluso M | Blackwell R | Galvao L | Kulczycki A
The objective was to compare self-reported condom use problems and objectively determined semen exposure in two populations. Two randomized crossover trials in the United States and Brazil compared the failure rates of the female condom (FC) and male condom (MC). Participants used both condom types, completed condom-specific questionnaires to report problems, and collected precoital and postcoital samples of vaginal fluid. Prostate-specific antigen (PSA) was detected by immunoassay. Problems with condom use were reported less frequently in the Brazilian study (rate difference: FC = 24%, P less than 0.0001, MC = 5%, P = 0.003). By contrast, the PSA detection rates were similar for both the FC and the MC (rate difference: FC = 2%, MC = 1%, not significant). These results suggest that the PSA detection rate was similar in the two study groups and that self-reported problems may be a less reliable measure of condom failure. Use of biomarkers of condom failure like PSA may help to strengthen the validity of studies promoting behavior change for the prevention of sexually transmitted diseases.

HIV/AIDS and STIs NEWS

Nigeria: Businesses should educate workforces about HIV and Aids - Nibucaa
(News Article; Sub-Saharan Africa)
7 Aug 2007
Ogundipe S, Vanguard (Lagos)

Botswana: More women than men on ARVs
(News Article; Sub-Saharan Africa)
6 Aug 2007
Chwaane T, Mmegi/The Reporter (Gaborone)

Africa: Falling HIV rates tell a complex story
(News Article; Sub-Saharan Africa)
5 Aug 2007
The Nation (Nairobi)

Kenya: Permanent secretary unveils plan on drafting of Aids policy
(News Article; Sub-Saharan Africa)
6 Aug 2007
The Nation (Nairobi)

Niger's religious leaders unite to fight AIDS
(News Article; Sub-Saharan Africa)
7 Aug 2007
Massalatchi A, Reuters

MATERNAL AND CHILD HEALTH RESEARCH

Infant feeding in the time of HIV: Assessment of infant feeding policy and programmes in four African countries scaling up prevention of mother to child transmission programmes
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Archive of Disease in Childhood. 2007 Aug 8;
Chopra M | Rollins N
To assess the infant feeding components of prevention of mother to child HIV transmission (PMTCT) programmes. Setting and Methods: Assessments were performed across four countries -- Botswana, Kenya, Malawi and Uganda. Districts offering PMTCT were selected by stratified random sampling with rural and urban strata. All health facilities in the selected PMTCT district were assessed. The facility level manager and the senior nurse in charge of maternal care were interviewed. Three hundred and thirty four health workers involved in the PMTCT programme in 29 health districts across the four countries were randomly selected and completed self-administered questionnaires. A total of 640 PMTCT counselling observations were conducted. Finally, 34 focus groups were conducted amongst men and women in communities across the four countries. Results: Most health workers (234/334, 70%) were unable to correctly estimate the transmission risks of breastfeeding. Exposure to PMTCT training made little difference to this. Infant feeding options were mentioned in 307 out of 640 (48%) observations of PMTCT counselling session and in only 35 (5.5%) were infant feeding issues discussed in any depth; of these 19 (54.3%) were rated as poor. A number of health workers also reported receiving free samples of infant formula in contravention of the International Code. National HIV managers stated that they were unsure about infant feeding policy in the context of HIV. Finally, there was an almost universal belief that a HIV positive mother who breastfeeds her child will always infect the child and intentional avoidance of breastfeeding by the mother indicates that she is HIV positive. Conclusion: These findings underline the need to implement and support systematic infant feeding policies and programme responses in the context of HIV programmes.

A comprehensive assessment of maternal deaths in Argentina: Translating multicentre collaborative research into action
(Research Article; South America)
Bulletin of the World Health Organization. 2007 Aug;85(8):615-622.
Ramos S | Karolinski A | Romero M | Mercer R
The objective was to perform a comprehensive assessment of maternal mortality in Argentina, the ultimate purpose being to strengthen the surveillance system and reorient reproductive health policies to prevent maternal deaths. Our multicentre population-based study combining qualitative and quantitative methodologies included a descriptive analysis of under-registration and distribution of causes of death, a case-control study to identify risk factors in health-care delivery and verbal autopsies to analyse social determinants associated with maternal deaths. A total of 121 maternal deaths occurred during 2002. The most common causes were abortion complications (27.4%), haemorrhage (22.1%), infection/sepsis (9.5%), hypertensive disorders (8.4%) and other causes (32.6%). Under-registration was 9.5% for maternal deaths (n = 95) and 15.4% for late maternal deaths (n = 26). The probability of dying was 10 times greater in the absence of essential obstetric care, active emergency care and qualified staff, and doubled with every 10-year increase in age. Other contributing factors included delays in recognizing "alarm signals"; reluctance in seeking care owing to desire to hide an induced abortion; delays in receiving timely treatment due to misdiagnosis or lack of supplies; and delays in referral/transportation in rural areas. A combination of methodologies is required to improve research on and understanding of maternal mortality via the systematic collection of health surveillance data. There is an urgent need for a comprehensive intervention to address public health and human rights issues in maternal mortality, and our results contribute to the consensus-building necessary to improve the existing surveillance system and prevention strategies.

The unmet need for emergency obstetric care in Tanga region, Tanzania
(Research Article; Sub-Saharan Africa)
BMC Pregnancy and Childbirth. 2007 Aug 6;7(16)
Prytherch H | Massawe S | Kuelker R | Hunger C | Mtatifikolo F | Jahn A
Background: Improving maternal health by reducing maternal mortality constitutes the fifth Millennium Development Goal and represents a key public health challenge in the United Republic of Tanzania. In response to the need to evaluate and monitor safe motherhood interventions, this study aims at assessing the coverage of obstetric care according to the Unmet Obstetric Need (UON) concept by obtaining information on indications for, and outcomes of, major obstetric interventions. Furthermore, we explore whether this concept can be operationalised at the district level. Methods: A two-year study using the UON concept was carried out in three districts in Tanga Region, Tanzania. Data was collected prospectively at all four hospitals in the region for every woman undergoing a major obstetric intervention, including indication and outcome. The concept was adapted to address differentials in access to emergency obstetric care between districts and between rural and urban areas. Based upon literature and expert consensus, a threshold of 2% of all deliveries was used to define the expected minimum requirement of major obstetric interventions performed for absolute maternal indications. Results: Protocols covering 1,260 complicated deliveries were analysed. The percentage of major obstetric interventions carried out in response to an absolute maternal indication was only 71%; most major obstetric interventions (97%) were caesarean sections. The most frequent indication was cephalo-pelvic-disproportion (51%). The proportion of major obstetric interventions for absolute maternal indications performed amongst women living in urban areas was 1.8% of all deliveries, while in rural areas it was only 0.7%. The high proportion (8.3%) of negative maternal outcomes in terms of morbidity and mortality, as well as the high perinatal mortality of 9.1% (still birth 6.9%, dying within 24 hours 1.7%, dying after 24 hours 0.5%) raise concern about the quality of care being provided. Conclusions: Based on the 2% threshold, Tanga Region -- with an overall level of major obstetric interventions for absolute maternal indications of 1% and a caesarean section rate of 1.4% -- has significant unmet obstetric need with a considerable rural-urban disparity. The UON concept was found to be a suitable tool for evaluating and monitoring the coverage of obstetric care at district level.

MATERNAL AND CHILD HEALTH NEWS

Kenya: Women suffer abuse in public maternity facilities - report
(News Article; Sub-Saharan Africa)
6 Aug 2007
Center for Reproductive Rights
Related Abstract; subscription needed for full text: Failure to deliver: Violations of human rights in Kenyan health facilities

Philippines: 100 moms, babies in Quezon City to join global breastfeeding
(News Article; Asia)
7 Aug 2007
Ortiz M, The Inquirer Network

Nigeria: FG advised to formulate policies to stem maternal mortality
(News Article; Sub-Saharan Africa)
3 Aug 2007
This Day

GENDER and HEALTH RESEARCH

Differences in hospital admissions for males and females in northern Uganda in the period 1992 -- 2004: A consideration of gender and sex differences in health care use
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007 Sep;101(9):929-938.
Accorsi S | Fabiani M | Nattabi B | Ferrarese N | Corrado B
To inform our understanding of male and female health care use, we assessed sex differences in hospital admissions by diagnosis and for in-patient mortality using discharge records for 210 319 patients admitted to the Lacor Hospital in northern Uganda in the period 1992-2004. These differences were interpreted using a gender framework. The overall number of admissions was similar by sex, yet differences emerged among age groups. In children (0-14 years), malaria was the leading cause of admission, and the distribution of diseases was similar between sexes. Among 15-44 year olds, females had more admissions, overall, and for malaria, cancer and anaemia, in addition to delivery and gynaeco-obstetrical conditions (25.7% of female admissions). Males had more admissions for injuries, liver disease and tuberculosis in the same age group. In older persons (greater than or equal to 45 years), women had more admissions for cancer, hypertension, malaria and diarrhoea, while, as for the previous age group, males had more admissions for injuries, liver disease and tuberculosis. This study provides insight into sex- and gender-related differences in health. The analysis and documentation of these differences are crucial for improving service delivery and for assessing the achievement of the dual goals of improving health status and reducing health inequalities.

Beyond reproductive health: Listening to women about their health in disadvantaged Beirut neighborhoods
(Abstract; subscription needed for full text; Middle East)
Health Care for Women International. 2007 Aug;28(7):614-637.
Zurayk H | Myntti C | Salem MT | Kaddour A | el-Kak F
In this article, we aim to contextualize gynecological problems within a broader health and social context, expanding the lens beyond reproductive health. Questionnaires were administered to 1,869 ever-married women aged 15 to 59 that included questions on living, general health, and gynecological problems. These questions were open-ended, allowing women to respond in their own words. Women reported a multitude of health problems, indicating competing priorities. Musculoskeletal complaints emerged as the most prevalent and most important health problem. One in four women reported a gynecological problem, mainly reproductive tract infections (RTIs), when asked directly. Selected quotes provide clues about the complex relationship between women's lives and health.

"My heart is cut": Sexual violence by rebels and pro-government forces in Côte d'Ivoire
(News Article; Sub-Saharan Africa)
2007 Aug;19(11(a))
Higonnet E, Human Rights Watch
Related News Article: Cote d'Ivoire: Government urged to act over sexual abuse of women
Related News Article: Côte d'Ivoire: Peace process fails to address sexual violence
Since an armed conflict erupted in 2002 between the Ivorian government and northern-based rebel groups, girls and women in Côte d’Ivoire have been victims of brutal forms of sexual violence by armed men on both sides of the military and political divide. Human Rights Watch documented over 180 cases of sexual violence in Côte d’Ivoire, including individual and gang rape, sexual slavery, forced incest, and egregious sexual assault. The Forces Nouvelles ("New Forces" or FN) rebels and the Ivorian Government must shoulder the greatest responsibility for ending impunity and stopping ongoing abuses. The New Forces, the government, and aid agencies must improve medical assistance, provide free medical certificates to rape victims, launch a nationwide information campaign on the connection between sexual violence and HIV/AIDS (on prevention, counseling, testing and treatment), and prioritize the nationwide establishment of sexual and reproductive health programs for women and girls. Ivorian women should be active participants in the formulation and implementation of these programs.

GENDER and HEALTH NEWS

South Africa: SAPS renew efforts to protect women, children
(News Article; Sub-Saharan Africa)
8 Aug 2007
Sakoana T, BuaNews (Tshwane)

Jamaica: Women having less children, owning more businesses
(Feature Article; Central America and the Caribbean)
6 Aug 2007
The Jamaica Observer

Uganda: Women sexually harass circumcised men - FIDA
(News Article; Sub-Saharan Africa)
6 Aug 2007
Nsambu J, New Vision (Kampala)

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Mortality in the Islamic Republic of Iran, 1964-2004
(Research Article; Middle East)
(You need Adobe Acrobat Reader to access this document)
Bulletin of the World Health Organization. 2007 Aug;85(8):607-614.
Khosravi A | Taylor R | Naghavi M | Lopez AD
Reliable information on the pattern, level and trend of mortality is essential for evidence-based policy to improve health. Various sources of mortality data in the Islamic Republic of Iran have not been critically assessed. This paper aims to document and evaluate the completeness of the different data sources on mortality and to estimate the level and trends of mortality over the past 40 years according to various mortality indices such as child mortality, adult mortality and life expectancy. The study undertook a systematic review of all available studies on infant mortality from 1964 to 2004 and estimated the most probable trend in child mortality. Death registration data from between 1992 and 2004 were assessed for completeness to estimate the level of adult mortality. Life tables for 2004 were constructed for the Islamic Republic of Iran based on these data, corrected for under-registration of death. Infant mortality decreased from an estimated 154 deaths per 1000 live births in 1964 to 26 in 2004. The risk of adult mortality in 2004 was estimated to be 0.124 and 0.175 for females and males respectively. According to adjusted death registration data, life expectancy at birth in 2004 was 71.2 for females and 68.7 for males. The average completeness of death registration for ages 5 years and older across all systems was 76% for the period 2001-2004. There has been a general decline in child mortality in the Islamic Republic of Iran over the past three decades. Adult mortality levels also have declined, but less substantially. Mortality information systems have improved, yet serious concerns remain regarding the completeness and quality of data.

Cohort profile: Mandela's children: The 1990 birth to twenty study in South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Epidemiology. 2007 Jun;36(3):504-511.
Richter L | Norris S | Pettifor J | Yach D | Cameron N
The late 1980s were a period of profound sociopolitical change in South Africa. It was clear that the Apartheid state was crumbling and, amongst acts of civil disobedience which characterized 'the struggle', Black Africansy began to disregard restrictive legislation that constrained where they lived and worked. Very rapid unplanned urbanization began, and shanty towns mushroomed around formerly White cities and towns. It was anticipated that this rapid urbanization, with urban growth estimated at the time to be 3.5% per year. would have profound effects on children's health and development. While improved access to health care, education and employment in urban areas could decrease preventable childhood morbidity and mortality, the inability of government to establish and maintain services to meet the needs of the growing urban population could exacerbate existing infectious diseases, such as HIV/AIDS and tuberculosis. Non-infectious conditions related to the interaction of lifestyle, urban stressors and socio-cultural changes-for example, childhood injuries, substance use and obesity-were predicted to increase. In 1988, as a result of discussions on these issues, Noel Cameron at the University of the Witwatersrand, and Derek Yach at the South African Medical Research Council (MRC) approached the then MRC President, Andries Brink, for funds to begin a birth cohort study in Soweto-Johannesburg with Lucy Wagstaff, also from the University of the Witwatersrand. The aim was to track a group of urban children for 10 years, not knowing at the time, that these children would also be the first cohort born into a democratic South Africa. At the start, the study was called Birth to Ten (BT10), but changed to Birth to Twenty (BT20) in 2000 when we reached the 10-year follow-up goal and resolved to continue the study to age 20. The children came to be known colloquially as Mandela's Children because they were born in the 7 weeks following Nelson Mandela's release from prison on the February 11, 1990, an event that heralded in radical social and political changes. Linda Richter was part of the original investigator group. Shane Norris has been the Project Manager since 2001. With seed funding, we undertook several pilot studies to determine, amongst other things, the seasonality of births in the area and the optimum months for recruitment into a birth cohort study; the nature and accuracy of routinely collected health service data; and follow-up rates of children from birth to six months. The date for enrolling the birth cohort was set for February, but a national hospital strike delayed enrollment, which occurred from April 23 to June 8, 1990.

The impact of family policies on fertility in industrialized countries: A review of the literature
(Abstract; subscription needed for full text; Global)
Population Research and Policy Review. 2007 Jun;26(3):323-246.
Gauthier AH
This paper examines the theoretical propositions and empirical evidence linking policies and fertility. More specifically, the analysis presented in this paper draws attention to the complex mechanisms that theoretically link policies and demographic outcomes: mechanisms that involve imperfect information and decisions that are rationally bound by very specific circumstances. As to the empirical evidence, studies provide mixed conclusions as to the effect of policies on fertility. While a small positive effect of policies on fertility is found in numerous studies, no statistically significant effect is found in others. Moreover, some studies suggest that the effect of policies tends to be on the timing of births rather than on completed fertility.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Trinidad and Tobago: Fertility rates, births decreasing
(News Article; Central America and the Caribbean)
6 Aug 2007
Browne J, Trinidad News

The population conundrum
(Commentary; Global)
8 Aug 2007
The Economic Times

ADOLESCENT HEALTH RESEARCH

Sexual attitudes, pattern of communication, and sexual behavior among unmarried out-of-school youth in China
(Research Article; Asia)
BMC Public Health. 2007 Jul 31;7(1):189.
Wang B | Li X | Stanton B | Kamali V | Naar-King S
In recent years, more adolescents are engaging in premarital sex in China. However, only a limited number of studies have explored out-of-school youth's sexual attitudes and behaviors, critical for prevention intervention development. Using data from the baseline survey of a comprehensive sex education program that was conducted in a suburb of Shanghai in 2000-2002, this study describes sexual attitudes, patterns of communication on sexual matters, and premarital sexual behavior among 1,304 out-of-school youth. Multivariate logistic regression analysis was conducted to examine the factors associated with youth's premarital sexual initiation. The majority (60%) of out-of-school youth held favorable attitudes towards premarital sex. Males were more likely to have favorable attitudes compared with females. Male youth generally did not communicate with either parent about sex, while one-third of female youth talked to their mothers about sexual matters. Both males and females choose their friends as the person with whom they were most likely to talk about sexual matters. About 18% of the youth reported having engaged in sexual intercourse. One-fifth of sexually active youth had always used a contraceptive method, and one-quarter had been pregnant (or had impregnated a partner). There were no gender differences in rate of premarital sex or frequency of contraceptive use. Multivariate analysis revealed that age, education, family structure, parent's discipline, and attitudes towards premarital sex, pattern of communication and dating were significantly associated with youth premarital sex. A substantial proportion of out-of-school youth engage in risky sexual behaviors. Prevention programs that empower communication and sexual negotiation skills, and promote condom use should be implemented for this vulnerable group.

Behaviour change in generalised HIV epidemics: Impact of reducing cross-generational sex and delaying age at sexual debut
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2007;83 Suppl 1:i50-i54.
Hallett TB | Gregson S | Lewis JJ | Lopman BA | Garnett GP
Sexual behavioural change is essential to prevent HIV infections in Africa and statistical analysis of risk factors at the individual-level may be used to design interventions. The importance of reducing cross-generational sex (young women having sex with older men) and delaying age at first sex on the spread of HIV at the population-level has been presumed but not scientifically investigated and quantified. A mathematical model of heterosexual spread of HIV was developed to predict the population-level impact of reducing cross-generational sex and delaying sexual debut. The impact of behaviour change on the spread of HIV is sensitive to the structure and reaction of the sexual network. Reducing cross-generational sex could have little impact on the risk of infection unless it is accompanied by a reduction in the number of risky sexual contacts. Even peer-to-peer sexual mixing can support high endemic levels of HIV. The benefit of delaying sexual debut is comparatively small and is reduced if males continue to prefer young partners or if young women spend more time unmarried. In Manicaland, Zimbabwe, if older men were to use condoms as frequently as young men, the reduction in risk of infection could exceed that generated by a two-year delay in first sex. At the individual-level avoiding sex with older partners and delaying sexual debut can decrease the risk of infection but at the population-level these interventions may do little to limit the spread of HIV without wider-ranging behavioural changes throughout the sexual network.

ADOLESCENT HEALTH NEWS

Nigeria: Compulsory HIV test a 'breach of human rights'
(News Article; Sub-Saharan Africa)
8 Aug 2007
This Day

Swaziland: HIV education through theatre
(News Article; Sub-Saharan Africa)
8 Aug 2007
The Swazi Observer

Nepal: Youth day theme: "be seen, be heard"
(News Article; Asia)
8 Aug 2007
The Rising Nepal

Trinidad: Sex ed for family life studies
(News Article; Central America and the Caribbean)
8 Aug 2007
Trinidad and Tobago's Newsday

LAW AND POLICY

China: Pregnant students can stay on
(News Article; Asia)
4 Aug 2007
Jia G, Shanghai Daily

Philippines: Solon drums up support for reproductive health bill on Family Planning Day
(News Article; Asia)
3 Aug 2007
The News Today

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Volume 7, Number 3013 August 2007