Volume 7, Number 32
27 August 2007

Pop Reporter Tip: Did you know? You can see what type an item is before you click on the title to go to the text. Below every item’s title is a description of what that item is: "News Article", "Research Article", "Report", "Abstract", and so on. Sometimes we are unable to link to full-text articles because a personal or institutional subscription is necessary. But the research is still important. We identify these items with "Abstract; subscription needed for full text" so that you know what you’ll be getting after you click the link.

FAMILY PLANNING RESEARCH

A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus
(Abstract; subscription needed for full text; Sub-Saharan Africa)
American Journal of Obstetrics and Gynecology. 2007 Aug;197(2):144.e1-144.e8.
Stringer EM | Kaseba C | Levy J | Sinkala M | Goldenberg RL
Related Abstract; subscription needed for full text: Hormonal contraception and the risk of HIV acquisition
Related Abstract; subscription needed for full text: Hormonal contraception and the risk of HIV acquisition. Authors' reply [letter]
The purpose of this study was to determine whether the intrauterine contraceptive device (IUD) is effective and safe among women who are infected with the human immunodeficiency virus (HIV). We randomly assigned 599 postpartum, HIV-infected women in Zambia to receive either a copper IUD or hormonal contraception and followed them for at least 2 years. Women who were assigned randomly to hormonal contraception were more likely to become pregnant than those who were assigned randomly to receive an IUD (rate, 4.6/100 vs 2.0/100 woman-years; hazards ratio, 2.4; 95% CI, 1.3-4.7). One woman who was assigned to the IUD experienced pelvic inflammatory disease (crude rate, 0.16/100 woman-years; 95% CI, 0.004-868); there was no pelvic inflammatory disease among those women who were assigned to hormonal contraception. Clinical disease progression (death or CD4+ lymphocyte count dropping below 200 cells/microL) was more common in women who were allocated to hormonal contraception (13.2/100 woman-years) than in women who were allocated to the IUD (8.6/100 woman-years; hazard ratio, 1.5; 95% CI, 1.04-2.1). The IUD is effective and safe in HIV-infected women. The unexpected observation that hormonal contraception was associated with more rapid HIV disease progression requires urgent further study.

Transdermal hormonal contraception: Benefits and risks
(Abstract; subscription needed for full text; Global)
American Journal of Obstetrics and Gynecology. 2007 Aug;197(2):134.e1-134.e6.
Burkman RT
Transdermal drug delivery systems have been available in the United States for greater than 20 years. Since the introduction of the first transdermal patch (scopolamine) for the treatment of motion sickness, greater than 35 transdermal patch products have been approved by the US Food and Drug Administration for a variety of indications that include hormone replacement therapy, nicotine replacement therapy, chronic pain (fentanyl), angina (nitroglycerin), hypertension (clonidine), and more recently, overactive bladder (oxybutynin), and contraception (ethinyl estradiol/norelgestromin). Clinical data demonstrated the efficacy and safety of the contraceptive patch; however, concerns regarding estrogen levels and reports of venous thromboembolism led to the development of 2 epidemiologic studies and, subsequently, revised product labeling. Despite this, the contraceptive patch may be an appropriate option for some patients.

FAMILY PLANNING NEWS

India: Family planning surgery, insurance cover on the anvil
(News Article; Asia)
23 Aug 2007
www.newindpress.com / Express Network Private Limited

India: Monetary incentives for family planning
(News Article; Asia)
16 Aug 2007
David R , New Delhi Television Limited (NDTV)

Cameroon: Female condom scares
(News Article; Sub-Saharan Africa)
22 Aug 2007
Yufeh B, Cameroon Tribune (Yaoundé)

Botswana: Female condoms not readily available
(News Article; Sub-Saharan Africa)
22 Aug 2007
Botswana Press Agency (BOPA)

HIV/AIDS and STIs RESEARCH

Coming back from the dead: Living with HIV as a chronic condition in rural Africa
(Abstract; subscription needed for full text; North Africa | Sub-Saharan Africa)
Health Policy and Planning. 2007 Sep;22(5):344-347.
Russell S | Seeley J | Ezati E | Wamai N | Were W
Scaling-up of anti-retroviral therapy (ART) in resource-poor settings has dramatically reduced mortality and morbidity for those with access, but considerable challenges remain for people who are trying to live with HIV as a manageable chronic condition. A return to 'normal life' for people on ART depends on the assurance of an uninterrupted, affordable and accessible supply of medication. However, many poor people also require economic support to re-establish their livelihoods, particularly where productive and financial assets have been depleted because of long-term illness. ART programmes need to seek convergence with economic programmes that have expertise in livelihood support and promotion, and with social protection initiatives. The future for those on ART depends not only on the provision of medicine but also on economic and social support for rebuilding lives and livelihoods.

Reduced risk of toxoplasma encephalitis in HIV-infected patients -- A prospective study from Gauteng, South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of STD and AIDS. 2007 Aug;18(8):555-558.
Hari KR | Modi MR | Mochan AH | Modi G
Toxoplasma seroprevalence was determined in 307 consecutive HIV-infected medical inpatients at the Helen Joseph Hospital, Johannesburg, South Africa, using an enzyme linked immunosorbent assay to detect immunoglobulin G (IgG) and IgM antibodies. The mean age of patients was 36 years, with a female to male ratio of 1.3 to 1. The mean CD4 count was 109 cells/mL. Toxoplasma antibodies were detected in 25 patients (8%). Twenty-two of these patients were IgG positive and IgM negative, i.e. reactivation toxoplasmosis. Only two patients (0.65%) had clinical manifestations of toxoplasmosis (one toxoplasma encephalitis and one retinitis). The risk for toxoplasma encephalitis (TE) was 0.33%. These results indicate that the toxoplasma seroprevalence and the TE risk in this population is low. The implication from this study is that in HIV-infected populations where the toxoplasma seroprevalence is low, the TE risk will be low and empiric treatment of focal brain lesions with anti-toxoplasma therapy may be inappropriate.

A negative association between condom availability and incidence of urethral discharge in a closed Malawian community
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of STD and AIDS. 2007 Aug;18(8):559-562.
Metcalfe D
This study explored the relationship between condom availability and sexually transmitted infection (STI) incidence in a closed Malawian community. An audit of clinic records charted the changing availability of condoms and the concurrent incidence of patients presenting with STI-associated urethral discharge (UD). When condoms first became available, their distribution steadily increased and the UD incidence declined. During a three-month period of unavailability, this previously uninterrupted decline was reversed and UD incidence increased. Once condoms again became available, UD incidence resumed its decline. This association was found to be statistically significant (Spearman's correlation coefficient, -0.499; P = 0.035). In a small community largely isolated from neighbouring towns, condom distribution appeared to negatively correlate with the number of patients presenting with UD.

Patient-led partner notification for syphilis: Strategies used by women accessing antenatal care in urban Bolivia
(Abstract; subscription needed for full text; South America)
Social Science and Medicine. 2007 Sep;65(6):1124-1135.
Klisch SA | Mamary E | Olavarrieta CD | Garcia SG
Maternal syphilis adversely affects close to one million pregnancies worldwide every year with consequences that may include spontaneous abortion, stillbirth, neonatal death, premature birth, neurological impairment and bone deformities of the neonate. In Bolivia, the maternal syphilis rate has been estimated at 4.3% among women with live births and 26% among women with stillbirths. Partner notification is critical to the prevention of maternal re-infection and vertical transmission of syphilis. Patient-led partner notification, also known as patient referral, is the recommended starting point for partner notification programs in resource-poor settings because it requires less infrastructure and provider involvement. Though patient referral requires a higher level of engagement on the part of individuals, few studies have examined, in depth, the process of patient-led notification. Further, we found no studies of this type conducted in Bolivia, a country where culturally acceptable and appropriate interventions are needed to control maternal syphilis. This study examined partner notification, for the first time, from the perspective of women accessing treatment for maternal syphilis in Bolivia. Semi-structured interviews were conducted with 18 women who had attempted or planned to attempt notifying their partner. The interview guide was designed to investigate the experience of patient-led partner notification for syphilis with particular emphasis on the strengths and capacities of the participants. Accordingly, we applied an existing theoretical model for individual empowerment in the analysis of the interviews with the participants. This emphasis on the positive, solution-finding capacities of the participants allowed us to investigate the ways in which participants took control over an aspect of concern to their health. More studies are needed which examine successful patient-led strategies for partner notification and their connections with long-term health outcomes.

HIV/AIDS and STIs NEWS

Condom Nations
(Feature Article; Global)
(You need Adobe Acrobat Reader to access this document)
Sep/Oct 2007
Fontes M | Roach P, Foreign Policy

Sex now primary cause of China HIV spread: Report
(News Article; Asia)
20 Aug 2007
Reuters

Uganda: 'Washing after sex may raise HIV risk'
(News Article; Sub-Saharan Africa)
22 Aug 2007
The Monitor (Kampala)

Uganda: Hospital runs out of HIV test kits
(News Article; Sub-Saharan Africa)
22 Aug 2007
Kirunda KA, The Monitor (Kampala)

Uganda: Doctors speak out on failed Aids trials
(News Article; Sub-Saharan Africa)
18 Aug 2007
Lirri E, The Monitor (Kampala)

Health-Asia: HIV and AIDS take on a woman's face
(News Article; Asia)
21 Aug 2007
Ebrahim Z, IPS/TerraViva

MATERNAL AND CHILD HEALTH RESEARCH

Blood pressure dynamics during pregnancy and spontaneous preterm birth
(Abstract; subscription needed for full text; Global)
American Journal of Obstetrics and Gynecology. 2007 Aug;197(2):162.e1-162.e6.
Zhang J | Villar J | Sun W | Merialdi M | Abdel-Aleem H
The objective of the study was to examine whether blood pressure in early pregnancy and its rise in the second half of gestation are associated with spontaneous preterm birth in healthy, normotensive, nulliparous women. We included 5167 women with singleton gestation who participated in the World Health Organization Calcium Supplementation for the Prevention of Preeclampsia Trial. Systolic, diastolic, and mean arterial blood pressure and pulse pressure at baseline (12-19 weeks of gestation) and at the midthird trimester (30-34 weeks) were calculated. Rise in blood pressure was the difference between the midthird trimester and baseline. Preterm birth was defined as early preterm (less than 34 completed weeks) and late preterm birth (34-36 weeks). Women experiencing early or late preterm birth had over 10 mm Hg and 3 mm Hg higher rise, respectively, in systolic, diastolic, and mean arterial blood pressure than women delivering at term. A rise in systolic pressure over 30 mm Hg or diastolic pressure over 15 mm Hg was associated with a statistically significant 2- to 3-fold increase in risk of spontaneous preterm birth. An excessive rise in either systolic or diastolic blood pressures from early pregnancy to the midthird trimester is associated with spontaneous preterm birth in a dose-response pattern.

Development of a proxy wealth index for women utilizing emergency obstetric care in Bangladesh
(Abstract; subscription needed for full text; Asia)
Health Policy and Planning. 2007 Sep;22(5):311-319.
Pitchforth E | van Teijlingen E | Graham W | Fitzmaurice A
There are increasing concerns regarding inequities in access to health care, and hence calls for routine data collection to improve monitoring. For many developing countries, such as Bangladesh, increasing the availability and uptake of emergency obstetric care (EmOC) is vital in improving maternal health. It is crucial, however, that women of all socio-economic status benefit from this. This paper describes the development and validation of a proxy wealth index for assessing women's socio-economic status in Bangladesh as they are admitted to hospital. Existing poverty assessment tools are unsuitable for use in this context as they are too lengthy or need to be administered at household or community level. We sought to develop a tool with a limited number of indicators to allow quick administration and avoid interference with treatment. We also aimed to develop a pragmatic tool to be able to calculate a score in the field. The steps, involving selecting and weighting indicators, assigning a proxy wealth score and validating the score, are outlined. Indicators were selected from the Bangladeshi Demographic and Health Survey (DHS) data, which allowed comparison of socio-economic status between women using EmOC and those in the wider population. The tool proved quick and easy to use and was acceptable to women and their families. The validity of the tool was established by means of factor analysis. Our comparison with DHS data suggested that women using EmOC were significantly wealthier than women in the wider population. The implications of this, as well as the strengths and limitations of the proxy wealth index, are discussed. The proxy wealth index offers potential as a pragmatic and quick means of assessing poverty status in a busy hospital setting. Such a tool may enable monitoring of equity in access to treatment and identification of those least able to afford treatment, to enable any mechanisms in place to pay for care to be applied in a timely fashion, so avoiding delays in treating life-threatening complications.

Cost-effectiveness of a folic acid fortification program in Chile
(Abstract; subscription needed for full text; South America)
Health Policy. 2007 Oct;83(2-3):295-303.
Llanos A | Hertrampf E | Cortes F | Pardo A | Grosse SD
Periconceptional intake of folic acid reduces the risk of neural tube defects (NTDs), a frequent birth defect that can cause significant infant mortality and disability. In Chile, fortification of wheat flour with folic acid has resulted in significant reduction in the risk of anencephaly and spina bifida. We investigated the cost-effectiveness implications of this policy. We conducted an ex-post economic analysis of this intervention. Estimates of the effect of fortification in decreasing NTDs and deaths were derived from a prospective evaluation. The costs of fortification and provision of medical care to children with spina bifida in Chile were based on primary data collection. The intervention costs per NTD case and infant death averted were I$ 1200 and 11,000, respectively. The cost per DALY averted was I$ 89, 0.8% of Chile's GDP per capita. Taking into account averted costs of care, fortification resulted in net cost savings of I$ 2.3 million. Fortification of wheat flour with folic acid is a cost-effective intervention in Chile, a middle income country in the post-epidemiological transition. This result supports the continuation of the Chile fortification program and constitutes valuable information for policy makers in other countries to consider.

MATERNAL AND CHILD HEALTH NEWS

Breastfeeding reduces infant deaths
(News Article; Global)
22 Aug 2007
The Daily Observer
Related Abstract; subscription needed for full text: Delayed breastfeeding initiation increases risk of neonatal mortality

Ghana: First baby fair launched
(News Article; Sub-Saharan Africa)
17 Aug 2007
Hagan E, Public Agenda

Cameroon: Alleviating women's plight as beasts of maternal slavery
(News Article; Sub-Saharan Africa)
16 Aug 2007
Nsom K, The Post

Nigeria: One out of five children will die before age five - Prof. Njokanma
(News Article; Sub-Saharan Africa)
15 Aug 2007
Eleweke T, Daily Champion

GENDER and HEALTH RESEARCH

Negotiating state and NGO politics in Bangladesh: Women mobilize against acid violence
(Abstract; subscription needed for full text; Asia)
Violence Against Women. 2007 Aug;13(8):857-873.
Chowdhury EH
This note showcases the story of Nurun Nahar, a survivor of acid violence in Bangladesh, to demonstrate that, despite protective measures, state, medical, and legal institutions continually fail to adequately respond to violence against women systematically and deny women rights to state protection, which are affirmatively embodied in law. The failure of state institutions to ensure appropriate care has been somewhat mitigated by nongovernmental organizations (NGOs), particularly women's groups, which are albeit heavily constrained because of the volume of demand yet scarcity of expertise, infrastructure, and funds. In addition, this note offers some thoughts on how nonstate actors, namely, women's NGOs, have created alternative strategies and visions for victimized women's recovery and empowerment.

Vaginal douching and development of bacterial vaginosis among women with normal and abnormal vaginal microflora
(Abstract; subscription needed for full text; Global)
Sexually Transmitted Diseases. 2007 Sep;34(9):671-675.
Hutchinson K | Kip K | Ness R
Objectives: To evaluate the relationship between douching and bacterial vaginosis (BV) among women with and without prior abnormal vaginal flora. Study Designs: 1193 women had vaginal swabs obtained for Gram stain for BV, culture for vaginal microflora, and DNA amplification for Neisseria gonorrhoeae and Chlamydia trachomatis at baseline and 6, 12, 24, and 36 months. Self-reported douching was queried every 6 months. Results: In cross-sectional analyses, douching at least once per month was associated with BV among women who had BV at the immediately preceding visit but not among women with normal or intermediate flora. In prospective analyses, douching increased the risk of acquisition for BV among women with intermediate flora (adj. HR 1.5, 95% CI 1.1-2.4) but not among women with normal flora. Conclusions: Douching appeared to be associated with BV among women with already imbalanced flora but not among women with normal flora.

GENDER and HEALTH NEWS

Uganda: Involve us in AIDS gel trials - sex workers
(News Article; Sub-Saharan Africa)
21 Aug 2007
Issa A, The Monitor (Kampala)

Uganda: Female Victims Demand Justice
(News Article; Sub-Saharan Africa)
19 Aug 2007
Wacha J, Institute for War & Peace Reporting (London)

Genital surgery helps Burkina's mutilated women
(Feature Article; Sub-Saharan Africa)
22 Aug 2007
Schwarz N, Reuters

Anti-AIDS program to fund circumcision; U.S. initiative targets African men
(News Article; Sub-Saharan Africa)
20 Aug 2007
Timberg C, Washington Post Foreign Service

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

World Population Ageing 2007
(Report; Global)
2007;
United Nations
Related News Article: Aging Global Population is "Profound" and "Irreversible": UN Report
As a result of the transition from high to low fertility and the continuous reduction of adult mortality, the population of most countries of the world is ageing. This unprecedented demographic change, which started in the developed world in the nineteenth century and is more recent in developing countries, is already transforming many societies. The ageing process is expected to accelerate in the near future, particularly in developing countries. Because they have a shorter time to adapt to the changes associated with population ageing, it is urgent that the Governments of developing countries begin taking steps to face the challenges and make the best of the opportunities that population ageing brings. This report provides the demographic basis for ascertaining the extent and depth of population ageing today and in the years to come in each country of the world.

Youthquake: Population, fertility and environment in the 21st century
(Report; Global)
(You need Adobe Acrobat Reader to access this document)
London, Optimum Population Trust, 2007
Guillebaud J
Every country -- not merely those in the developing world -- would benefit from a national population policy that takes environmental sustainability into account. The planet faces the biggest generation of adolescents and teenagers in its history -- a "youthquake", with major social, political and demographic implications. This report argues that in the UK, for example, policies should cover initiatives to reduce teenage pregnancies, resistance to calls for an increase in the birth rate, and national recognition that continuous population growth is highly undesirable and, ultimately, impossible. Far from panicking about baby shortages, almost every country can welcome fertility rates at or slightly below replacement level. A "stop at two" children or "one child less" guideline for couples in the UK should be introduced by the government, promoted in schools and in the media and backed by environmental groups. This should be promoted as part of a greener lifestyle and as an example to couples worldwide, encouraging them to limit their own family size to protect the environment.

Causality chains in the international migration systems approach
(Abstract; subscription needed for full text; Global)
Population Research and Policy Review. 2007 Aug;26(4):411-436.
Jennissen R
Research into international migration lacks a commonly accepted theoretical framework, which would facilitate the accumulation of knowledge. This article aims to be a first attempt to construct such a framework and to incorporate causalities in the international migration systems approach. The author presents a theoretical framework in which four groups of factors acting on international migration are distinguished: economic, social, political and "linkages." The causalities in this framework are derived from different international migration theories. The various positions of these whole theories within the framework are shown as causality chains. In a way, these causality chains form the time dimension of an international migration system.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Burkina Faso: Census shows population growth rising
(News Article; Sub-Saharan Africa)
22 Aug 2007
Integrated Regional Information Networks (IRIN)

WHO ties rising population, new diseases
(News Article; Global)
23 Aug 2007
Bulman E, Associated Press

ADOLESCENT HEALTH RESEARCH

Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: Prevalence, predictors, and associations with gender-based violence
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science and Medicine. 2007 Sep;65(6):1235-1248.
Dunkle KL | Jewkes R | Nduna M | Jama N | Levin J
We explored the prevalence and predictors of transactional sex with casual partners and main girlfriends among 1288 men aged 15-26 from 70 villages in the rural Eastern Cape province of South Africa. Data were collected through face-to-face interviews with young men enrolling in the Stepping Stones HIV prevention trial. A total of 17.7% of participants reported giving material resources or money to casual sex partners and 6.6% received resources from a casual partner. Transactionally motivated relationships with main girlfriends were more balanced between giving (14.9%) and getting (14.3%). We constructed multivariable models to identify the predictors for giving and for getting material resources in casual and in main relationships. Each model resulted in remarkably similar predictors. All four types of exchange were associated with higher socio-economic status, more adverse childhood experiences, more lifetime sexual partners, and alcohol use. Men who were more resistant to peer pressure to have sex were less likely to report transactional sex with casual partners, and men who reported more equitable gender attitudes were less likely to report main partnerships underpinned by exchange. The most consistent predictors of all four types of transaction were perpetration of intimate partner violence and rape against women other than a main partner. The strong and consistent association between perpetration of gender-based violence and both giving and getting material goods from female partners suggests that transactional sex in both main and casual relationships should be viewed within a broader continuum of men's exercise of gendered power and control. HIV prevention interventions need to explicitly address transactional sex in the context of ideas about masculinity, which place a high emphasis on heterosexual success with, and control of, women.

Emerging adulthood in Europe: Common traits and variability across five European countries
(Abstract; subscription needed for full text; Europe)
Journal of Adolescent Research. 2007 Sep;22(5):439-443.
Buhl HM | Lanz M
The fact that there is a specific age marking the emergence of adulthood in the United States has been well documented. The starting point for the studies included in this special issue is the assumption that the same can be said for European countries. Thus, a comparison of characteristics of emerging adulthood between different European countries was performed. In this special issue, contributions of scholars from five different European countries are taken as representative of different regions: Spain, Italy, Finland, Germany, and the Czech Republic. The efforts of the research are twofold. The first is to look at how the traditional markers of adulthood have changed and how the concept of adulthood is seen in the different countries. The second is to highlight the influence that the entrance into the working world and romantic partnership have on emerging adults and to detect the impact of the timing of entering adulthood on identity achievement. The results are presented here as different pathways that emerging adults follow to reach the same goal of mature adulthood.

ADOLESCENT HEALTH NEWS

The great Indian sex debate
(Feature Article; Asia)
20 Aug 2007
BBC World News
Related News Article: India: Imparting critical life skills early on
Related News Article: India:Teachers protest sex education in schools

Youth education network launched in Oman
(News Article; Middle East)
19 Aug 2007
Vaidya S, Gulf News

Uganda: Districts asked to use scouts in fighting Aids
(News Article; Sub-Saharan Africa)
20 Aug 2007
Nafula J, The Monitor

The 'Hayate Ahla' weekly segment on the 'Yawm Jadeed' show on Jordan television
(Press Release; Middle East)
22 Aug 2007
AME Info

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Volume 7, Number 3227 August 2007