Volume 7, Number 35
17 September 2007

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FAMILY PLANNING RESEARCH

Risk of thromboembolism in women taking ethinylestradiol/drospirenone and other oral contraceptives
(Abstract; subscription needed for full text; Global)
Obstetrics and Gynecology. 2007 Sep;110(3):587-593.
Seeger JD | Loughlin J | Eng PM | Clifford CR | Cutone J
The oral contraceptive ethinylestradiol 0.03 mg/drospirenone 3 mg contains a progestin component that differs from other oral contraceptives. Case reports and prescription event monitoring suggested that ethinylestradiol/drospirenone might be associated with an elevated risk of thromboembolism. The authors sought to estimate the association between ethinylestradiol/drospirenone and risk of thromboembolism relative to the association among other oral contraceptives. They identified ethinylestradiol/drospirenone initiators and a twofold larger group of other oral contraceptive initiators between June 2001 and June 2004 within a U.S. health insurer database. The comparison group was selected to have demographic and health care characteristics preceding oral contraceptive initiation that were similar to ethinylestradiol/drospirenone initiators. Thromboembolism during the follow-up of the cohorts was identified through claims for medical services, and only medical record-confirmed cases were included in analyses. The primary (as-matched) analysis used proportional hazards regression, whereas a secondary (as-treated) analysis accounted for changes in oral contraceptives during follow-up using Poisson regression. The 22,429 ethinylestradiol/drospirenone initiators and 44,858 other oral contraceptive initiators were followed for an average of 7.6 months, and there were 18 cases of thromboembolism in ethinylestradiol/drospirenone initiators and 39 in the comparators (rate ratio 0.9, 95% confidence interval 0.5-1.6). More than 9,000 women would need to be prescribed oral contraceptives to observe a difference of one case of thromboembolism. Results of the as-treated analysis were similar to those of the as-matched analysis. Ethinylestradiol/drospirenone initiators and initiators of other oral contraceptives are similarly likely to experience thromboembolism.

Contraceptive efficacy of a novel spermicidal microbicide used with a diaphragm: A randomized controlled trial
(Abstract; subscription needed for full text; Global)
Obstetrics and Gynecology. 2007 Sep;110(3):577-586.
Barnhart KT | Rosenberg MJ | MacKay HT | Blithe DL | Higgins J
Women need products that protect against both pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). The acid buffering gel is a nondetergent spermicide that may provide this dual protection by reinforcing normal vaginal acidity to inactivate both sperm and acid-sensitive sexually transmitted pathogens. The objective of this study was to assess the gel's contraceptive effects, safety, and acceptability. We conducted a multicenter, randomized, double-masked, noninferiority study at 11 centers, comparing 621 women who used an acid buffering gel plus diaphragm with 300 women who used a nonoxynol-9 spermicide plus diaphragm for 6 months. A double-masked study extension followed 234 women for an additional 6 months of use. The 6-month pregnancy rate per hundred women was 10.1% (95% confidence interval [CI] 7.1-13.1%) for acid buffering gel and 12.3 (95% CI 7.7-16.9) for nonoxynol-9 spermicide users. The difference in rates was -2.2% with a 95% CI -7.7 to 3.3%. Consistent and correct use 6-month pregnancy rates were 4.7% for acid buffering gel and 6.1% for nonoxynol-9 spermicide users, calculated from those cycles where diary entries indicated such use. Adverse events and acceptability were similar between the two groups. Pregnancy probabilities were similar between groups participating in the 12-month study extension. An acid buffering gel used with a diaphragm is a safe, acceptable contraceptive with efficacy comparable to that of a common commercial spermicide with diaphragm.

Cancer risk among users of oral contraceptives: Cohort data from the Royal College of General Practitioner's oral contraception study
(Abstract; subscription needed for full text; Europe)
British Medical Journal. Online access September 11, 2007.
Hannaford PC | Selvaraj S | Elliott AM | Angus V | Iversen L | Lee AJ
Related Abstract; subscription needed for full text: Taking Contraceptive Pill May Reduce Risk Of Developing Cancer, Study Suggests
Related Abstract; subscription needed for full text: UK study finds net cancer benefit in oral contraceptive use
The objective of this study is to examine the absolute risks or benefits on cancer associated with oral contraception, using incident data. The main outcome measures included adjusted relative risks between never and ever users of oral contraceptives for different types of cancer, main gynaecological cancers combined, and any cancer. Standardisation variables were age, smoking, parity, social class, and (for the general practitioner observation dataset) hormone replacement therapy. Subgroup analyses examined whether the relative risks changed with user characteristics, duration of oral contraception usage, and time since last use of oral contraception. The main dataset contained about 339 000 woman years of observation for never users and 744 000 woman years for ever users. Compared with never users ever users had statistically significant lower rates of cancers of the large bowel or rectum, uterine body, and ovaries, tumours of unknown site, and other malignancies; main gynaecological cancers combined; and any cancer. The relative risk for any cancer in the smaller general practitioner observation dataset was not significantly reduced. Statistically significant trends of increasing risk of cervical and central nervous system or pituitary cancer, and decreasing risk of uterine body and ovarian malignancies, were seen with increasing duration of oral contraceptive use. Reduced relative risk estimates were observed for ovarian and uterine body cancer many years after stopping oral contraception, although some were not statistically significant. The estimated absolute rate reduction of any cancer among ever users was 45 or 10 per 100 000 woman years, depending on whether the main or general practitioner observation dataset was used. In this UK cohort, oral contraception was not associated with an overall increased risk of cancer; indeed it may even produce a net public health gain. The balance of cancer risks and benefits, however, may vary internationally, depending on patterns of oral contraception usage and the incidence of different cancers.

FAMILY PLANNING NEWS

India: Family planning scheme goes awry, man gives up kids
(News Article; Asia)
8 Sep 2007
Pushpak P, IBN-CNN

United States: New period-free Pill raises questions
(News Article; North America)
13 Sep 2007
Streicher L, Chicago Sun-Times
This has global relevance even though it was published in Chicago. JB

India: To encourage male participation in family planning, surgical camp held
(News Article; Asia)
8 Sep 2007
Express News Service

HIV/AIDS and STIs RESEARCH

Oral lesions as clinical markers of highly active antiretroviral therapy failure: A nested case-control study in Mexico City
(Abstract; subscription needed for full text; Central America and the Caribbean)
(You need Adobe Acrobat Reader to access this document)
Clinical Infectious Diseases. 2007 Oct;45(7):925-932.
Ramirez-Amador V | Ponce-de-Leon S | Anaya-Saavedra G | Ramirez BC | Sierra-Madero J
Clinical markers that may predict virological failure during highly active antiretroviral therapy (HAART) have not been evaluated adequately. The aim of the present study was to evaluate the usefulness of human immunodeficiency virus (HIV)-related oral lesions as clinical predictors of virological failure in HIV-infected patients receiving HAART. A nested case-control study was conducted within a cohort of 1134 HIV-infected patients receiving HAART who attended the AIDS Clinic of the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City during the period 1997-2005. Case patients were patients who, after achieving an undetectable viral load, had at least 1 viral load determination greater than or equal to 2000 copies/mL while receiving treatment. Control subjects were patients who, after achieving an undetectable viral load, continued to have undetectable viral loads during the follow-up period. There were 2-3 control subjects for each case patient, matched according to duration of follow-up. Oral examinations were blinded to viral loads and CD4+ lymphocyte counts. Analyses were performed with multivariate conditional logistic regression models, and associations were shown as odds ratios (ORs) with 95% confidence intervals (CI). Positive predictive values were calculated. The target cohort consisted of 431 HIV-infected individuals; 47 case patients and 132 control subjects underwent complete oral examinations and formed the basis of the analysis. At the visit at which an undetectable viral load was determined, case patients and control subjects showed a similar frequency of HIV-related oral lesions (21.3% vs. 17.4%) (OR, 1.39; 95% CI, 0.57-3.38; P = .47). At the visit at which virological failure was determined, case patients showed a higher risk for HIV-related oral lesions (OR, 14.5; 95% CI, 4.21-49.94; P less than .001) and oral candidosis (OR, 26.2; 95% CI, 3.34-205.9; P less than .001) than did control subjects. The positive predictive value of HIV-related oral lesions and oral candidosis to identify patients who experienced virological failure while receiving HAART was 80% and 83%, respectively. HIV-related oral lesions and, specifically, oral candidosis may be considered to be clinical markers of virological failure in HIV-infected patients receiving HAART.

Reducing the risk of mother-to-child human immunodeficiency virus transmission: Past successes, current progress and challenges, and future directions
(Abstract; subscription needed for full text; Global)
American Journal of Obstetrics and Gynecology. 2007 Sep;197(3 Suppl 1):S3-S9.
Fowler MG | Lampe MA | Jamieson DJ | Kourtis AP | Rogers MF
Prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) in the United States and Europe has been a tremendous success, such that transmission rates of less than 2% have been achieved. Some key successes have also been demonstrated in resource-poor countries; however, the translation of successful interventions into public health policy has been slow because of a variety of factors such as inadequate funding and cultural, social, and institutional barriers. The issue of HIV and infant feeding in settings that lack culturally acceptable, feasible, affordable, safe, and sustainable nutritional substitutes for breast milk is a continuing dilemma. An effective preventive infant HIV vaccine would be an optimal approach to reduce HIV acquisition in the first year of life among breast-feeding infants. The challenges to eliminate new perinatal HIV infections worldwide will depend on both sustaining and expanding PMTCT interventions and effective primary HIV prevention for women, adolescents, and young adults.

Approaches for scaling up human immunodeficiency virus testing and counseling in prevention of mother-to-child human immunodeficiency virus transmission settings in resource-limited countries
(Abstract; subscription needed for full text; Global)
American Journal of Obstetrics and Gynecology. 2007 Sep;197(3 Suppl 1):S83-S89.
Bolu OO | Allread V | Creek T | Stringer E | Forna F
Prevention of mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT) programs have nearly eliminated mother-to-child transmission of HIV in developed countries, but progress in resource-limited countries has been slow. A key factor limiting the scale-up of PMTCT programs is lack of knowledge of HIV serostatus. Increasing the availability and acceptability of HIV testing and counseling services will encourage more women to learn their status, providing a gateway to PMTCT interventions. Key factors contributing to the scale-up of testing and counseling include a policy of provider-initiated testing and counseling with right to refuse (opt-out); group pretest counseling; rapid HIV testing; innovative staffing strategies; and community and male involvement. Integration of testing and counseling within the community and all maternal and child health settings are critical for scaling-up and for linking women and their families to care and treatment services. This paper will review best practices needed for expansion of testing and counseling in PMTCT settings in resource-limited countries.

HIV/AIDS and STIs NEWS

Africa: Effect of globalisation on HIV/Aids
(Commentary; Sub-Saharan Africa)
11 Sep 2007
Nanjakululu W, This Day (Lagos)

Angola: Creation of mutual help group for HIV positive defended
(News Article; Sub-Saharan Africa)
12 Sep 2007
Angola Press Agency (Luanda)

South Africa: Rural schools shoulder AIDS burden
(News Article; Sub-Saharan Africa)
11 Sep 2007
Thom A, Health-e (Cape Town)

Nigeria: Govt approves workplace policy on HIV/Aids
(News Article; Sub-Saharan Africa)
10 Sep 2007
This Day (Lagos)

South Africa: SANAC on course to meet health targets
(News Article; Sub-Saharan Africa)
11 Sep 2007
du Plessis J, BuaNews (Tshwane)

Uganda: Minister calls for HIV vaccine trial volunteers
(News Article; Sub-Saharan Africa)
10 Sep 2007
Nuwagira S, East African Business Week (Kampala)

MATERNAL AND CHILD HEALTH RESEARCH

Nxwisen, ntzarrin or ntzo'lin? Mapping children's respiratory symptoms among indigenous populations in Guatemala
(Abstract; subscription needed for full text; Central America and the Caribbean)
Social Science and Medicine. 2007 Oct;65(7):1337-1350.
Thompson L | Diaz J | Jenny A | Diaz A | Bruce N| Balmes J
Estimating the prevalence of asthma is an epidemiologic challenge, particularly in rural areas of lesser-developed countries characterized by low literacy and poor access to health care. To avoid under or over reporting of symptoms, questionnaires must use terminology familiar to participants and that accurately describes the triad of cough, wheeze and breathlessness characteristic of asthma. In preparation for a large longitudinal cohort study entitled Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter (CRECER) that will examine the effects of variable early lifetime woodsmoke exposure on the respiratory health of Mam-speaking children residing in communities in the western highlands of Guatemala, we conducted individual interviews (n = 18) and five focus groups (n = 46) with indigenous women from 17 of these communities to elicit and define local Mam and Spanish terms for common respiratory symptoms used to describe their own and their children's respiratory symptoms. Focus group participants were also shown an International Study of Asthma and Allergies in Childhood (ISAAC) video of wheezing children and adults. The authors developed a conceptual framework that can be used as an efficient model for future studies investigating health and/or disease terminology in isolated communities, an integral step in the development of standardized questionnaires. Among this Mam-speaking population, wheeze was best described as nxwisen or ntzarrin, "breathing sounds that are heard in the neck but come from the chest." The variation in understanding of terms between women with and without children with a history of wheeze (such that for those without wheezing children some terms were virtually unrecognized), has important implications for large-scale population surveys within countries and comparative surveys such as ISAAC. It is important to use linguistically and culturally appropriate terminology to describe wheeze in prevalence studies of asthmatic symptoms among relatively isolated communities in lesser-developed countries.

The impact of pregnancy intention on breastfeeding duration in Bolivia and Paraguay
(Abstract; subscription needed for full text; South America)
Studies in Family Planning. 2007 Sep;38(3):198-205.
Shapiro-Mendoza CK | Selwyn BJ | Smith DP | Sanderson M
Research has demonstrated that prolonged duration of breastfeeding promotes child survival. This study examines the impact of unintended-mistimed or unwanted-pregnancy on breastfeeding duration. The authors use data from the 1990 Paraguay and 1994 Bolivia Demographic and Health Surveys and restrict our analysis to last-born, surviving children younger than 36 months from singleton births. To assess the association, unintended and intended pregnancies are compared by calculating incidence rates and adjusted hazard ratios (aHR) using survival analysis. Most children (approximately 95 percent) were breastfed initially, but the median duration of breastfeeding in Bolivia was five months longer than that in Paraguay (19 versus 14 months). A greater proportion of pregnancies were described as intended in Paraguay than in Bolivia (74 percent versus 45 percent). In adjusted analyses, unwanted and mistimed pregnancies were associated with slightly longer duration of breastfeeding (aHR = 0.9) than were intended pregnancies, but the association was not statistically significant. In this study, therefore, pregnancy intention was not an important factor in duration of breastfeeding in Bolivia or Paraguay.

Ethnographic study of factors influencing compliance to intermittent preventive treatment of malaria during pregnancy among Yao women in rural Malawi
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007 Oct;101(10):980-989.
Launiala A | Honkasalo ML
In Africa today one of the main strategies to reduce malaria infection during pregnancy is the promotion of intermittent preventive treatment (IPT). To date only a few studies have investigated the factors affecting compliance to IPT. This medical anthropology study aims to describe these factors from the perspective of pregnant women in rural Malawi. The study examine women's knowledge and perceptions about the use of medication in pregnancy and the timing and motivation concerning use of antenatal clinic (ANC) services. In addition, the circumstances and interaction at the ANC and the IPT implementation process are described. The data were collected by applying an ethnographic approach, including focus group discussions (n = 8), in-depth interviews (n = 34), drug identification exercises, participant observation and a 'knowledge, attitudes and practices' survey (n = 248). This study discovered several factors affecting IPT. These were: unclear messages about IPT with sulfadoxine-pyrimethamine (SP) from nurses; timing of SP-1; periodic shortages of SP; women's limited understanding of IPTSP; tendency for late enrolment; and nurses' underperformance. The results of this study show that understanding of the multiple contexts affecting malaria prevention is important, and that ethnographic research is useful for discovering and solving problems beyond the scope of many other research approaches.

Young infant sepsis: Aetiology, antibiotic susceptibility and clinical signs
(Abstract; subscription needed for full text; Global)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007 Oct;101(10):959-966.
Newton O | English M
Globally, young infant mortality comprises 40% of the estimated 10.8 million child deaths annually. Almost all (99%) of these deaths arise in low- and middle-income countries (LMICs). Achievement of the Millennium Development Goal for child survival, however, requires a significant improvement in the management of infections in young infants. The authors have reviewed current evidence from LMICs on one major cause of young infant mortality, severe infection, and have described the range of pathogens, reported antibiotic susceptibility and value of clinical signs in identifying severe bacterial illness. Evidence from the reviewed studies appears to show that common pathogens in young infant infections change over time and vary within and across settings. However, there are few good, large studies outside major urban settings and many reports describe infections of babies born in hospital when most young infant infections probably occur in the majority born at home. Yet what knowledge there is can aid in instituting prompt and appropriate therapy, and perhaps thus minimize the emergence of multidrug-resistant bacteraemia, a major threat at least in hospital settings. Improved country level data on pattern of microorganisms, resistance and antibiotic use are required to help reduce mortality through development of local, evidence-based clinical guidelines.

MATERNAL AND CHILD HEALTH NEWS

Nigeria: Curbing the tide of maternal mortality
(Feature Article; Sub-Saharan Africa)
13 Sep 2007
Obi C, Daily Champion

Botswana: PMTCT children HIV/Aids free - Tlou
(News Article; Sub-Saharan Africa)
10 Sep 2007
Maganu P, Mmegi/The Reporter (Gaborone)

Child deaths fall below 10 million for first time
(Press Release; Global)
13 Sep 2007
UNICEF

GENDER and HEALTH RESEARCH

Women and HIV/AIDS in China: Gender and vulnerability
(Abstract; subscription needed for full text; Asia)
Health Care for Women International. 2007 Sep;28(8):680-699.
Lin K | McElmurry BJ | Christiansen C
A comprehensive literature review was conducted to determine if there was a research gap between women's vulnerability to HIV and research addressing that vulnerability in China. Turmen's article Gender and HIV/AIDS served as a framework for examining the eight determinants placing women and adolescent girls at greater risk of HIV infection than men. Eighty-eight research reports were retrieved and categorized by general characteristics and the eight determinants. Women were found to be more vulnerable than men to HIV infection in China and worldwide. While researchers reported a considerable amount of research regarding women's HIV/AIDS-related issues in China, there is insufficient attention to some risk determinants. Investigators are encouraged to take advantage of political commitment and policy changes in China to conduct more research focusing on female vulnerability and to address the effects of violence, laws, stigma, and discrimination in female HIV prevention.

The fortunes and misfortunes of women rice producers in Ndop, Cameroon and the implications for gender roles
(Research Article; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Journal of International Women's Studies. 2007 May;8(4):133-147.
Fonjong LN | Athanasia MF
In most communities in Cameroon, traditional norms mandate that rural women fulfill the reproductive roles of child bearing, home management and food provision for the family. Thus, these women are unable to exercise any influential economic voice - they can hardly earn income. Cash agriculture like rice production provides a possible outlet for the empowerment of these women in rice producing areas. However, this agricultural work would solve one problem for the women and create another. Any attempt to encourage these women to work outside their homes may increase their workload. This paper examines the situation of female rice farmers in Ndop, Cameroon and argues that although rice production may have been beneficial to women and the society as a whole, it has implications for gender roles that go beyond the purview of women's empowerment.

Ties of dependence: AIDS and transactional sex in rural Malawi
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Studies in Family Planning. 2007 Sep;38(3):147-162.
Swidler A | Watkins SC
In sub-Saharan Africa, the exchange of sex for material support-labeled "transactional sex" by Western observers-is claimed by some to be a major driver of the AIDS pandemic. Transactional sex is described as akin to prostitution, a degraded form of sexual expression forced on vulnerable women by economic desperation. Using evidence from rural Malawi, we demonstrate that patron-client ties and a moral obligation to support the needy, which are fundamental to African social life, are central elements of transactional sex. We argue that the exchange of sex for money is better understood as one of the many ties of unequal exchange in which Malawians and other Africans engage, an exchange in which the patrons are as important as the clients.

GENDER and HEALTH NEWS

Nepal: Declaration on rights of girl child
(News Article; Asia)
7 Sep 2007
A staff reporter, The Rising Nepal

Ghana: Abused Women Lack Safe Shelter
(News Article; Sub-Saharan Africa)
11 Sep 2007

UNICEF chief calls for end to female genital cutting, 'honour crimes,' child marriage
(News Article; Global)
7 Sep 2007
UN News Center

Pakistan: Stopping violence against women: WRCP calls for men's bigger role
(News Article; Asia)
13 Sep 2007
Mirza I, Business Recorder

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

The association of childhood socioeconomic conditions with healthy longevity at the oldest-old ages in China
(Abstract; subscription needed for full text; Asia)
(You need Adobe Acrobat Reader to access this document)
Demography. 2007 Aug;44(3):497-518.
Yi Z | Gu D | Land KC
Based on unique data from the largest-ever sample of the Chinese oldest-old aged 80 and older, our multivariate logistic regression analyses show that either receiving adequate medical service during sickness in childhood or never/rarely suffering from serious illness during childhood significantly reduces the risk of being ADL (activities of daily living) impaired, being cognitively impaired, and self-reporting poor health by 18%-33% at the oldest-old ages. Estimates of effects for five other indicators of childhood conditions are similarly positive but mostly not statistically significant. Multivariate survival analysis shows that better childhood socioeconomic conditions in general tend to reduce the four-year period mortality risk among the oldest-old. But after additional controls for 14 covariates are put into the model, the effects are not statistically significant, thus suggesting that most of the effects of childhood conditions on oldest-old mortality are indirect-at least to the point of affecting current health status at the oldest-old ages, which itself is strongly associated with mortality. While acknowledging limitations of the present analyses due to a lack of information on childhood illness, the oldest-olds' recollection errors, and other data problems, we conclude, based on this and other studies, that policies that enhance childhood health care and children's socioeconomic well-being can have large and long-lasting benefits up to the oldest-old ages.

Guinea 2005: Results from the demographic and health survey
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Studies in Family Planning. 2007 Sep;38(3):206-211.
The Guinea Demographic and Health Survey 2005, or Enquete Demographique et de Sante Guinea (EDSG-III), was conducted by the Direction Nationale de la Statistique, with technical assistance from ORC Macro. Data for the nationally representative EDSG-III were collected from 6,282 households, and complete interviews were conducted with 7,954 women aged 15-49 and 3,174 men aged 15-59. The fieldwork took place from 1 February to the end of June 2005. The summary statistics presented were taken from the Guinea country report, with exceptions as noted.

Senegal 2005: Results from the demographic and health survey
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Studies in Family Planning. 2007 Sep;38(3):212-217.
The Senegal Demographic and Health Survey 2005, or Enquete Demographique et de Sante Senegal 2005 (EDS-IV), was conducted by the Centre de Recherche pour le Developpement Humain on behalf of the Ministere de la Sante et de la Prevention Medicale, with technical assistance from ORC Macro. Data for the nationally representative EDS-IV were collected from 7,412 households, and complete interviews were conducted with 14,602 women aged 15-49 and 3,761 men aged 15-59. The fieldwork took place from 1 February to 10 June 2005. The summary statistics presented were taken from the Senegal country report, with exceptions as noted.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Russia: In one region, a special day for family planning
(News Article; Asia)
11 Sep 2007
Arnold C, Radio Free Europe/Radio Liberty

Birth rates improves: Russian health minister
(News Article; Asia)
10 Sep 2007
Russia Today

WOMEN'S HEALTH NEWS

Kenya: MPs must push for women's access to health services
(News Article; Sub-Saharan Africa)
12 Sep 2007
Integrated Regional Information Networks (IRIN)

ADOLESCENT HEALTH RESEARCH

Risks and benefits of multiple sexual partnerships: Beliefs of rural Nigerian adolescent males
(Abstract; subscription needed for full text; Sub-Saharan Africa)
American Journal of Men's Health. 2007 Sep;1(3):197-207.
Izugbara CO | Modo FN
Drawing on interview data from rural Nigeria, the article explores male youth perceptions of the risks and benefits of multiple sexual partnerships. Participants associated having multiple sexual partners with several harmful health and nonhealth outcomes, including sexually transmitted infections, and frequently confirmed that the practice also bolsters their sense of maleness and boosts their acceptance and ranking among peers. Young males' involvement in multiple sexual partnerships should not be seen as always consequent on their ignorance of and/or indifference to the risks inherent in the behavior. It could also result from the integrality of the behavior to the social processes through which male youths validate their masculinity, mark their transition from boyhood to malehood, and configure their identities to gain acceptance into a local male peer community. Sexuality education curricula that ignore adolescents' understandings of the benefits of their sexual practices may not deliver expected objectives.

Knowledge of HIV and AIDS among tertiary students in Bangladesh
(Abstract; subscription needed for full text; Asia)
International Quarterly of Community Health Education.. 2007;26(3):271-285.
Hossain MB | Kabir MA | Ferdous H
To examine the levels and predictors of knowledge on HIV and AIDS, a survey was conducted among 392 tertiary level students in the University of Dhaka, Bangladesh. Students demonstrated a high knowledge of transmission and prevention of HIV and AIDS yet with considerable misconception. All students said that unprotected sex with an HIV-positive man or woman can transmit the HIV virus to a negative man or woman but at the same time 43.6% of students believed that there is a preventive vaccine for HIV and 39.8% understood that HIV can be cured if it is diagnosed early. Multivariate regression analysis indicated that the students who had more knowledge on HIV and AIDS were: older boys, fathers having more income, business or service as father's occupation, having more mass media exposure, being senior students, living in a university dormitory, and being students of faculty of arts, social sciences, and science. The findings of this study suggest that a special course on health education, including risk perceptions of HIV and AIDS and issues related to sexual and other high risk behavior, should be included in the course curricula irrespective of disciplines at tertiary levels.

The influence of parents' marital relationship and women's status on children's age at first sex in Cebu, Philippines
(Abstract; subscription needed for full text; Asia)
Studies in Family Planning. 2007 Sep;38(3):173-186.
Upadhyay UD | Hindin MJ
This study examines the intergenerational effects of parents' marital relationship and the status of women on children's age at first sexual intercourse in Cebu, Philippines. Matched longitudinal data for 1,661 mothers and their children are analyzed. The mothers were interviewed in 1994, when their children were aged 9 to 11, about sociodemographic characteristics, their marital relationships, and women's status. Cox proportional hazards models are used to assess unmarried children's age at first sex as reported by the children in 2005 at ages 20 to 22. After multivariate adjustment, the analysis indicates that when parents make household decisions jointly, sons report delaying first sex. In households in which mothers have higher status, daughters report delayed first sex. The results demonstrate that long-term positive effects on children, particularly delaying first sex, occur in families in which parental decision-making is cooperative and in which women have high status.

Contraceptive use patterns across teens' sexual relationships: The role of relationships, partners, and sexual histories
(Abstract; subscription needed for full text; Global)
(You need Adobe Acrobat Reader to access this document)
Demography. 2007 Aug;44(3):603-621.
Manlove J | Ryan S | Franzetta K
By using data from the National Longitudinal Study of Adolescent Health, we examine how adolescent relationship characteristics, partner attributes, and sexual relationship histories are associated with contraceptive use and consistency, incorporating random effects to control for respondent-level unobserved heterogeneity. Analyses show that teens' contraceptive use patterns vary across relationships. Teens with more-homogamous partners, with more-intimate relationships, and who communicate about contraception before sex have greater odds of contraceptive use and/or consistency. Teens in romantic relationships, and who are older when engaging in sex for the first time, have greater odds of ever using contraceptives but reduced odds of always using contraceptives. Teens continue habits from previous relationships: teens with experience practicing contraceptive consistency and females who previously have used hormonal contraceptive methods are better able to maintain consistency in subsequent relationships. Also, relationship and partner characteristics are less important for females who previously used hormonal methods.

ADOLESCENT HEALTH NEWS

Uganda: Nnabagereka launches anti-sugar daddy campaign
(News Article; Sub-Saharan Africa)
13 Sep 2007
New Vision (Kampala)

Continuous Identification of Research Evidence (CIRE) Related to Family Planning Guidance

Bahamondes L, Espejo-Arce X, Hidalgo MM, Hidalgo-Regina C, and Teatin-Juliato C. A cross-sectional study of the forearm bone density of long-term users of levonorgestrel-releasing intrauterine system. Human Reproduction. 2006;21(5):1316-1319
(CIRE)
There are concerns about the effect of hormonal contraceptives on bone mineral density (BMD), but there is currently no information available on the effect of the levonorgestrel-releasing intrauterine system (LNGIUS) on BMD. The objective of this study was to compare the BMD of LNG-IUS users with that of controls using the TCu380A intrauterine device (IUD). A cross-sectional study paired 53 women, aged 25â€“51 years, who had been using the LNG-IUS for 7 years, with 53 IUD users, according to age (plus or minus 1 year) and body mass index (BMI; kg/m2) (plus or minus 1). BMD was evaluated at the midshaft of the ulna and the distal radius of the nondominant forearm using double X-ray absorptiometry. Mean age of women was 34 years. BMI was slightly over 25 in both groups. Estradiol was normal. Mean BMD was 0.469 plus or minus 0.008 and 0.467 plus or minus 0.009 and 0.409 plus or minus 0.009 and 0.411 plus or minus 0.009 at the midshaft of the ulna and distal radius in LNG-IUS and IUD users, respectively, without significant differences. Women aged 25â€“51 years, using the LNG-IUS for 7 years, had a mean BMD similar to that of the control group of TCu380A IUD users.

Link to CIRE evidence: http://www.infoforhealth.org/cire_pub.pl?cire_input=L-IUD.Age..2992.4119.Y

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

Link to CIRE evidence: http://www.infoforhealth.org/cire_pub.pl?cire_input=POI.Age..3260.4512.Y

Clark MK, Sowers MF, Levy BT, and Nichols S. Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate. Fertility and Sterility. 2006 Nov;86(5):1466-1474
(CIRE)
The objective was to compare changes in bone mineral density (BMD) during 48 months between first-time depot medroxyprogesterone acetate (MPA) users, during use and after discontinuation, to controls. Design: Longitudinal study. Setting: Academic community. Patient(s): Women 18â€“35 years, newly initiating depot MPA (n = 178) and controls (n = 145) not using hormonal contraception. Main Outcome Measure(s): The BMD of the hip and spine, measured at 3-month intervals, by dual energy roentgen absorptiometry. Hip and spine BMD declined during 48 months of depot MPA use by 7.7% plus or minus 0.11% (mean plus or minus SE) and 6.4% plus or minus 0.36%, respectively. The BMD of controls declined = 1.6% plus or minus 0.30%. Hip and spine BMD loss slowed to less than 0.6% after 48 months of depot MPA use. After discontinuation, BMD increased from 0.3% to 2.0% per year depending on length of depot MPA use and bone site. The longest depot MPA users remained 4.7% and 2.9% lower than hip and spine baseline values, respectively, 18 months after discontinuation. Depot MPA-related BMD loss is substantial but occurs mostly during the first 2 years of DMPA use. Therefore, longer use may not substantially increase the risk of osteoporosis. The prolonged recovery time suggests the need to consider timing of use in relation to menopause or other factors that may impede bone remodeling.

Link to CIRE evidence: http://www.infoforhealth.org/cire_pub.pl?cire_input=POI.Age..3131.4348.Y

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Volume 7, Number 3517 September 2007