Volume 8, Number 18
5 May 2008

Free Gift for Completing Survey! If you use the HIV/AIDS and Sexual and Reproductive Health Integration Web site (http://www.hivandsrh.org), we invite you to complete a short on-line survey. Five respondents will be selected by a drawing to receive their choice of either: (1) Family Planning: A Global Handbook for Providers (English or Spanish); or (2) the World Health Organization's Medical Eligibility Criteria Wheel for Contraceptive Use. Complete the survey at: http://www.zoomerang.com/Survey/?p=WEB227QJNL6XPS

ADOLESCENT HEALTH NEWS

Cameroon: Centre -- Youths revise strategies to combat HIV
(News Article; Sub-Saharan Africa)
5 May 2008
Cameroon Tribune (Yaoundé)

ADOLESCENT HEALTH RESEARCH

Predictors of early sexual initiation among a nationally representative sample of Nigerian adolescents
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Public Health. 2008 Apr 25;8:136.
Fatusi AO | Blum RW
Early sexual debut among adolescents is associated with considerable negative heath and development outcomes. An understanding of the determinants or predictors of the timing of sexual debut is important for effective intervention, but very few studies to date have addressed this issue in the Nigerian context. The aim of the present study is to examine predictors of adolescent sexual initiation among a nationally representative sample of adolescents in Nigeria. Interviewer-collected data of 2,070 never-married adolescents aged 15-19 years were analysed to determine association between age of sexual debut and demographic, psychosocial and community factors. Using Cox proportional hazards regression multivariate analysis was carried out with two different models - one with and the other without psychosocial factors. Hazard ratio (HR) and 95% confidence interval (CI) were calculated separately for males and females. A fifth of respondents (18% males; 22% females) were sexually experienced. In the South 24.3% males and 28.7% females had initiated sex compared to 12.1% of males and 13.1% females in the North (p less than 0.001). In the first model, only region was significantly associated with adolescent sexual initiation among both males and females; however, educational attainment and age were also significant among males. In the second (psychosocial) model factors associated with adolescent sexual debut for both genders included more positive attitudes regarding condom efficacy (males: HR=1.28, 95% CI=1.07-1.53; females: HR=1.24, 95% CI=1.05-1.46) and more positive attitudes to family planning use (males: HR=1.19, 95% CI=1.09-1.31; females: HR=1.18, 95% CI=1.07-1.30). A greater perception of condom access (HR=1.42, 95% CI=1.14-1.76) and alcohol use (HR=1.90, 95% CI=1.38-2.62) among males and positive gender-related attitudes (HR=1.13, 95% CI=1.04-1.23) among females were also associated with increased likelihood of adolescent sexual initiation. Conversely, personal attitudes in favour of delayed sexual debut were associated with lower sexual debut among both males (males: HR=0.36, 95% CI=0.25-0.52) and females (HR=0.38, 95% CI=0.25-0.57). Higher level of religiosity was associated with lower sexual debut rates only among females (HR=0.59, 95% CI=0.37-0.94). Given the increased risk for a number of sexually transmitted health problems, understanding the factors that are associated with premarital sexual debut will assist programmes in developing more effective risk prevention interventions.

Internet influences on sexual practices among young people in Hanoi, Vietnam
(Abstract; subscription needed for full text; Asia)
Culture, Health and Sexuality. 2008 Jun;10 Suppl 1:S201-S213.
Ngo AD | Ross MW | Ratliff EA
While the influences of the Internet on adult sexuality are well recognized, research on the potential connection between the Internet and young people's sexuality is still limited. We conducted a qualitative study to examine how young people (aged 15-19 years) in Hanoi, Vietnam used the Internet to develop sexual practices and identities. Our analysis of texts from focus groups, in-depth interviews, chat scripts and field notes reveals how the Internet is used to assemble sexual information that was not available from other sources such as the family and school. Young people's narratives also show how they use the Internet as a medium for expressing sexual identities and desires. In the light of these findings, we suggest expanding sex education to include issues that are important to young people such as emotions and relationships, rather than simply focusing more narrowly on reproduction, public health and other interests of the state.

Reproductive health awareness among adolescent girls in rural Bangladesh
(Abstract; subscription needed for full text; Asia)
Asia-Pacific Journal of Public Health. 2008 Apr;20(2):117-128.
Uddin J | Choudhury AM
This article presents the status of rural Bangladeshi adolescent girls' awareness about reproductive health. Analysis of data revealed that a sizable proportion of adolescent girls had incorrect knowledge or misconceptions about the fertile period, reproduction, sexually transmitted diseases, and HIV/AIDS. Age, education either of adolescents or their mothers, residence, and exposure to mass media were the significant predictors of adolescent girls' knowledge about reproductive health. Strong efforts are needed to improve awareness and to clarify misconceptions about reproductive health. Improved access to mass media and education could improve rural Bangladeshi adolescent girls' awareness about reproductive health.

FAMILY PLANNING NEWS

Uganda: Kyafu urges on family planning
(News Article; Sub-Saharan Africa)
30 Apr 2008
Bita G, New Vision

Philippines: PopCom promotes scientific natural family planning method use in WV
(News Article; Asia)
29 Apr 2008
The News Today

Solomon Islands: Family planning agency receives new health kits
(News Article; Oceania)
26 Apr 2008
Solomon Star

FAMILY PLANNING RESEARCH

Pharmacokinetics and pharmacodynamics of oral testosterone enanthate plus dutaseride for 4 weeks in normal men: Implications for male hormonal contraception
(Abstract; subscription needed for full text; Global)
Journal of Andrology. 2008 May-Jun;29(3):260-271.
Amory JK | Kalhorn TF | Page ST
Oral administration of testosterone enanthate (TE) and dutasteride increases serum testosterone and might be useful for male hormonal contraception. To ascertain the contraceptive potential of oral TE and dutasteride by determining the degree of gonadotropin suppression mediated by 4 weeks of oral TE plus dutasteride, 20 healthy young men were randomly assigned to 4 weeks of either 400 mg oral TE twice daily or 800 mg oral TE once daily in a double-blinded, controlled fashion at a single site. All men received 0.5 mg dutasteride daily. Blood for measurement of serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, dihydrotesterone (DHT), and estradiol was obtained prior to treatment, weekly during treatment, and 1, 2, 4, 8, 12, 13, 14, 16, 20, and 24 hours after the morning dose on the last day of treatment. FSH was significantly suppressed throughout treatment with 800 mg TE once daily and after 4 weeks of treatment with 400 mg TE twice daily. LH was significantly suppressed after 2 weeks of treatment with 800 mg TE, but not with 400 mg TE. Serum DHT was suppressed and serum estradiol increased during treatment in both groups. High-density lipoprotein cholesterol was suppresed during treatment, but liver function tests, hematocrit, creatinine, mood, and sexual function were unaffected. The administration of 800 mg oral TE daily combined with dutasteride for 28 days significantly suppresses gonadotropins without untoward side effects and might have utility as part of a male hormonal contraceptive regimen.

The effects of TCu-380A on cervicovaginal flora
(Abstract; subscription needed for full text; Europe)
Archives of Gynecology and Obstetrics. 2008 May;277(5):429-432.
Kanat-Pektas M | Ozat M | Gungor T
This study aims to identify the alterations in cervicovaginal flora after insertion of TCu 380A which is a popular type of copper IUD. Among the women who visited the Department of Family Planning in our hospital during 1 month, 100 subjects who preferred IUDs for contraception and who had no history of local or systemic antibiotic use were considered eligible candidates. Anaerobic colonies, especially Gram-positive cocci and Gram-negative bacilli were isolated at significantly higher rates after the insertion of TCu-380A. Aerobic colonies were isolated relatively less. It can be suggested that copper IUD causes the predominance of anaerobic species in the cervicovaginal flora, which is consistent with the literature. This clinically insignificant condition can be attributed to the copper content or threads of the IUDs. Yet there is no evidence that the prevalance of pelvic infections is influenced by the use of IUDs.

Fishing for families: Reproductive health and integrated coastal management in the Philippines
(Report; Asia)
Washington, D.C., Woodrow Wilson International Center for Scholars, Environmental Change and Security Program, 2008 Apr. 11 p. (Focus on Population, Environment, and Security No.)
Castro J | D'Agnes L
Life in the Philippines -- a nation of more than 7,000 islands -- is never far from the sea. Every Filipino lives within 45 miles of the coast, and every day, more than 4,500 new residents are born. The rapidly rising population has overwhelmed the fisheries that have traditionally supported the country, bringing grinding poverty and malnutrition to many coastal communities. But a new approach to conservation may save families along with the fish and their habitats. The Integrated Population and Coastal Resource Management (IPOPCORM) project seeks to improve life in communities dependent on the sea for their livelihoods, while conserving biodiversity and productivity in high-priority marine corridors. By integrating the delivery of family planning and conservation services, IPOPCORM found that it could improve reproductive health and coastal resource management more than programs that focused exclusively on reproductive health or the environment-and at a lower total cost.

GENDER and HEALTH NEWS

Nigeria: Violence - Women as Punch Bags
(News Article; Sub-Saharan Africa)
27 April 2008
Vanguard (Lagos)

GENDER and HEALTH RESEARCH

Women's perceptions and experiences of sexual violence in marital relationships and its effect on reproductive health
(Abstract; subscription needed for full text; Asia)
Health Care for Women International. 2008 May;29(5):468-483.
Hussain R | Khan A
In this article we explore women's perceptions and experiences of sexual violence in marital relationships and its effects on reproductive health. We conducted a qualitative study composed of key informant interviews, focus group discussions, and in-depth interviews in two low- to middle-income areas of Karachi, Pakistan. Results show sexual coercion and nonconsensual sex were common and not limited to abusive relationships. Difficulties in negotiating safe sex resulted in unwanted pregnancies, some leading to unsafe abortions. The women reported escalation of violence during pregnancy to be common. Social norms prevented disclosure of sexual violence leading to limited support or intervention or both. The link between women's social status, marital violence, and reproductive health is discussed.

Prevalence and correlates of bacterial vaginosis among young women of reproductive age in Mysore, India
(Abstract; subscription needed for full text; Asia)
Indian Journal of Medical Microbiology. 2008;26(2):132-137.
Madhivanan P | Krupp K | Chandrasekaran V | Karat C | Arun A
Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge among women of childbearing age and is associated with STI/HIV and adverse birth outcomes. The objective of this study was to determine the prevalence and correlates of BV among young women of reproductive age in Mysore, India. Between October 2005 and December 2006, 898 sexually active women of 15-30 years of age were enrolled from two reproductive health clinics in Mysore. The women underwent an interview followed by physical examination, HSV-2 serologic testing, endocervical culture for Neissera gonorrhoeae, and vaginal swabs for diagnosis of BV, Trichomonas vaginalis infection and candidiasis. Statistical analyses included conventional descriptive statistics and multivariable analysis using logistic regression. Of the 898 women, 391 (43.5%) were diagnosed with greater than or equal to 1 endogenous reproductive tract infection and 157 (17.4%) with greater than or equal to 1 sexually transmitted infection. Only 863 women had Gram-stained vaginal smears available, out of which 165 (19.1, 95% confidence interval [CI]: 16.3%-22.2%) were found to have BV and 133 (15.4, 95% CI: 12.9%-18.3%) were in the 'intermediate' stage. BV was related to concurrent infections with T. vaginalis (odds ratio [OR] = 4.07, 95% CI: 2.45-6.72) and HSV-2 seropositivity (OR = 2.22, 95% CI: 1.39-3.53). In this population, the prevalence of BV at 19% was relatively low. Coinfection with T. vaginalis, however, was common. BV was independently associated with concurrent T. vaginalis infection and partner's alcohol use. Muslim women had reduced odds BV as compared to non-Muslim women. Further research is needed to understand the role of T. vaginalis infection in the pathogenesis of BV and the sociocultural context surrounding the condition in India.

Efficacy and tolerability of vardenafil in Asian men with erectile dysfunction
(Abstract; subscription needed for full text; Asia)
Asian Journal of Andrology. 2008 May;10(3):495-502.
Tan HM | Chin CM | Chua CB | Gatchalian E | Kongkanand A
The aim was to evaluate the efficacy and tolerability of vardenafil, a phosphodiesterase type-5 (PDE-5) inhibitor, in men of Asian ethnicity with erectile dysfunction (ED). In this prospective, double-blind, multinational study, Asian men were randomized to receive vardenafil (10 mg) or placebo (4:1 ratio) for 12 weeks. The primary efficacy variables were the International Index of Erectile Function erectile function domain (IIEF-EF), and Sexual Encounter Profile (SEP) questions related to penetration and intercourse completion. Significant mean improvements were required in all three measures to show positive benefits of vardenafil treatment. Secondary efficacy variables included the Global Assessment Question (GAQ) on erection improvement. Least-squares mean baseline IIEF-EF domain scores (vardenafil 14.6, placebo 13.4) were consistent with moderate ED. After 12 weeks, vardenafil treatment was associated with significant increases from the baseline in IIEF-EF domain scores compared with the placebo (22.4 vs. 14.3; P less than 0.001). Vardenafil was associated with significant improvements from baseline in least squares (LS) mean success rates for SEP-2 (vardenafil 82.2 vs. placebo 43.6; P less than 0.001) and SEP-3 (vardenafil 66.1 vs. placebo 24.0; P less than 0.001). Positive GAQ responses were reported by 81.8% of vardenafil recipients vs. 24.3% of placebo recipients. Adverse events were reported by 25.4% of the vardenafil group, the majority mild and transient. Vardenafil (10 mg) is a highly effective and well-tolerated treatment for moderate ED in Asian men. These results add to the increasing amount of data demonstrating the safety and efficacy of vardenafil for the treatment of ED in a range of patient populations.

Numbers of women circumcised in Africa: The production of a total
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Demographic and Health Research. March 2008;Calverton, Maryland, Macro International, MEASURE DHS, 2008 Mar. No. 3919 p. (Array)
Yoder PS | Khan S
The text provides a total number and accounts of its derivation for women 15 years old and older in African countries who have been circumcised. The estimates do not include girls younger than 15 years old, although Appendix A provides an estimate for girls 10-14 years old. Two types of data are needed for such calculations: a reliable estimate of the number of women 15 years old and older for each country, and a national prevalence rate for FGC for the same women. After a brief discussion of the importance of obtaining numbers as accurate as possible, the text describes the procedures used to estimate the numbers of women circumcised in countries with population-based national surveys. The next section describes how prevalence estimates were done for the countries without such data. The report concludes with a discussion of the assumptions made and the relative strength of the calculations used.

Male sexual health concerns in Muong Khen, Vietnam
(Abstract; subscription needed for full text; Asia)
Culture, Health and Sexuality. 2008 Jun;10 Suppl 1:S139-S150.
Phong VH
Male sexual health concerns are often construed in the medical literature as linked only to genital and reproductive difficulties and malfunctions. However, in reality, male sexual health concerns encompass a broader range of issues and should not be so narrowly conceived. This paper explores men's perceptions of sexual health concerns in Muong Khen, a rural town in northwestern Vietnam. Data were collected through observation, in-depth interviews and focus group discussions. Findings suggest that men's sexual health concerns are strongly related to worries about economic problems, excessive drinking, men's beliefs about how their bodies work and the hegemonic notion that a man should be responsible for his family's economic well-being.

South Africa: ‘I am at the lowest end of all’. Rural women living with HIV face human rights abuses in South Africa
(Report; Sub-Saharan Africa)
London, U.K., Amnesty International Publications, Mar 2008. (AI Index: AFR 53/001/2008)
This report provides an analysis of patterns of human rights abuses against women who are exposed to the risk of or are already living with HIV in rural contexts of widespread poverty and unemployment. It draws on the testimonies of 37 women who, to varying extents, had experienced incidents of violence from intimate partners or strangers, were unable to secure a stable income, faced periods of hunger, but were striving to maintain their access to health services and adhere to treatment despite the consequences of poverty, stigma and their low social status.

HIV/AIDS and STIs NEWS

Namibia: Namibia Ranks Top in HIV/Aids Care
(News Article; Sub-Saharan Africa)
30 Apr 2008
New Era/AllAfrica

South Africa: Q&A: Circumcision an opportunity to take great strides forward against HIV
(Interview; Sub-Saharan Africa)
30 Apr 2008
IPS

South Africa: New stats show millions more HIV positive
(News Article; Sub-Saharan Africa)
4 May 2008
Momberg E, Cape Argus (Cape Town)

HIV/AIDS and STIs RESEARCH

Female condom uptake and acceptability in Zimbabwe
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Education and Prevention. 2008 Apr;20(2):121-134.
Napierala S | Kang MS | Chipato T | Padian N | van der Straten A
As the first phase of a two-phase prospective cohort study to assess the acceptability of the diaphragm as a potential HIV/STI prevention method, we conducted a 2-month prospective study and examined the effect of a male and female condom intervention on female condom (FC) use among 379 sexually active women in Harare, Zimbabwe. Reported use of FC increased from 1.1% at baseline to 70.6% at 2-month follow-up. Predictors of FC uptake immediately following the intervention included interest in using FC, liking FC better than male condoms, and believing one could use them more consistently than male condoms. Women reported 28.8% of sex acts protected by FC in the 2 weeks prior to last study visit. Though FC may not be the preferred method for the majority of women, with access, proper education, and promotion they may be a valuable option for some Zimbabwean women.

Sexual pleasure, gender power and microbicide acceptability in Zimbabwe and Malawi
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Education and Prevention. 2008 Apr;20(2):171-187.
Woodsong C | Alleman P
Topical vaginal microbicides are being developed to reduce HIV infection in women for whom correct and consistent condom use is impossible or undesirable. Although microbicides have been heralded as a "women-initiated" method that requires no action of the male partner, gender norms for sexual relationships and sexual practices could impede acceptability and use. To facilitate development of microbicides and look ahead to their eventual introduction, it is necessary to understand couples' sexual dynamics, including power and pleasure. This article presents data from a study of microbicide acceptability ancillary to a microbicide clinical trial in Malawi and Zimbabwe. Female trial participants, male partners, health care professionals and community stakeholders were interviewed about norms for sexual decision-making, sexual pleasure, and associated intravaginal practices that ensure this pleasure. Even though acceptability of microbicides was found to be high, sexual intercourse is accompanied by issues of power and gender norms that place women, particularly those in stable union, at a disadvantage for enactment of risk reduction strategies. Although woman-initiated use is an important goal in development of microbicides, the need for men's cooperation or agreement must be addressed in strategies for future product introduction.

Rapid scaling-up of antiretroviral therapy in 10,000 adults in Cote d'Ivoire: 2-year outcomes and determinants
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2008 Apr 23;22(7):873?882.
Toure S | Kouadio B | Seyler C | Traore M | Dakoury-Dogbo N
The objective was to assess the rates and determinants of mortality, loss to follow-up and immunological failure in a nongovernmental organization-implemented program of access to antiretroviral treatment in Cote d'Ivoire. In each new treatment center, professionals were trained in HIV care, and a computerized data system was implemented. Individual patient and program level determinants of survival, loss to follow-up and immunological failure were assessed by multivariate analysis. Between May 2004 and February 2007, 10 211 patients started antiretroviral treatment in 19 clinics (median preantiretroviral treatment CD4 cell count, 123 cells/ml; initial regimen zidovudine-lamivudine-efavirenz, 20%; stavudine-lamivudine-efavirenz, 22%; stavudine-lamivudine-nevirapine, 52%). At 18 months on antiretroviral treatment, the median gain in CD4 cell count was +202 cells/microl, the probability of death was 0.15 and the probability of being loss to follow-up was 0.21. In addition to the commonly reported determinants of impaired outcomes (low CD4 cell count, low BMI, low hemoglobin, advanced clinical stage, old age and poor adherence), two factors were also shown to independently jeopardize prognosis: male sex (men vs. women: hazard ratio = 1.52 for death, 1.27 for loss to follow-up, 1.31 for immunological failure); and attending a recently opened clinic (inexperienced vs. experienced centers: hazard ratio = 1.40 for death, 1.58 for loss to follow-up). None of the three outcomes was associated with the drug regimen. In this rapidly scaling-up program, survival and immune reconstitution were good; women and patients followed up in centers with longer experience had better outcomes; outcomes were similar in zidovudine/stavudine-based regimens and in efavirenz/nevirapine-based regimens. Decreasing the rate of loss to follow-up should now be the top priority in antiretroviral treatment rollout.

Sexual responses to living with HIV/AIDS in Lome, Togo
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Culture, Health and Sexuality. 2008 Apr;10(3):287-296.
Moore AR | Amey F
A qualitative study of sexual behaviour among 88 people living with HIV was conducted in Lome, Togo. Data were collected by means of open-ended interviews. Three separate sexual-behaviour patterns were identified: people who reported not having sex at all; people who reported using condoms consistently; and people who reported not using condoms at all or using them inconsistently. Reasons given to explain these behaviours were analysed. Findings reveal the need for different programmes and policy approaches to dealing with problems of HIV and AIDS in Lome, Togo.

HIV prevention and low-income Chilean women: Machismo, marianismo and HIV misconceptions
(Abstract; subscription needed for full text; South America)
Culture, Health and Sexuality. 2008 Apr;10(3):297-306.
Cianelli R | Ferrer L | McElmurry BJ
Socio-cultural factors and HIV-related misinformation contribute to the increasing number of Chilean women living with HIV. In spite of this, and to date, few culturally specific prevention activities have been developed for this population. The goal of the present study was to elicit the perspectives of low-income Chilean women regarding HIV and relevant socio-cultural factors, as a forerunner to the development of a culturally appropriate intervention. As part of a mixed-methods study, fifty low-income Chilean women participated in a survey and twenty were selected to participate in prevention, in-depth interviews. Results show evidence of widespread misinformation and misconceptions related to HIV/AIDS. Machismo and marianismo offer major barriers to prevention programme development. Future HIV prevention should stress partner communication, empowerment and improving the education of women vulnerable to HIV.

Outcomes from monitoring of patients on antiretroviral therapy in resource-limited settings with viral load, CD4 cell count, or clinical observation alone: A computer simulation model
(Abstract; subscription needed for full text; Global)
Lancet. 2008 Apr 26;371(9622):1443-1451.
Phillips AN | Pillay D | Miners AH | Bennett DE | Gilks CF
In lower-income countries, WHO recommends a population-based approach to antiretroviral treatment with standardised regimens and clinical decision making based on clinical status and, where available CD4 cell count, rather than viral load. Our aim was to study the potential consequences of such monitoring strategies, especially in terms of survival and resistance development. A validated computer simulation model of HIV infection and the effect of antiretroviral therapy was used to compare survival, use of second-line regimens, and development of resistance that result from different strategies - based on viral load, CD4 cell count, or clinical observation alone-for determining when to switch people starting antiretroviral treatment with the WHO-recommended first-line regimen of stavudine, lamivudine, and nevirapine to second-line antiretroviral treatment. Over 5 years, the predicted proportion of potential life-years survived was 83% with viral load monitoring (switch when viral load greater than 500 copies per mL), 82% with CD4 cell count monitoring (switch at 50% drop from peak), and 82% with clinical monitoring (switch when two new WHO stage 3 events or a WHO stage 4 event occur). Corresponding values over 20 years were 67%, 64%, and 64%. Findings were robust to variations in model specification in extensive univariable and multivariable sensitivity analyses. Although survival was slightly longer with viral load monitoring, this strategy was not the most cost effective. For patients on the first-line regimen of stavudine, lamivudine, and nevirapine the benefits of viral load or CD4 cell count monitoring over clinical monitoring alone are modest. Development of cheap and robust versions of these assays is important, but widening access to antiretrovirals -- with or without laboratory monitoring -- is currently the highest priority.

Men's condom use in higher-risk sex: Trends and determinants in five Sub-Saharan countries
(Report; Sub-Saharan Africa)
Calverton, Maryland, Macro International, MEASURE DHS, 2008 Apr. 29 p. (Array)
Adair T
This paper examines men's condom use at last higher-risk sex (i.e., nonmarital, noncohabiting partner) in five sub-Saharan countries: Burkina Faso, Cameroon, Kenya, Tanzania, and Zambia. The two most recent Demographic and Health Surveys (DHS) in each country are analyzed to show trends in various indicators. Condom use is an important way to prevent the transmission of HIV, the virus that causes AIDS. Encouragingly, use of condoms has increased substantially in Burkina Faso, Cameroon, and Tanzania, with smaller increases in Kenya and Zambia. At the same time, levels of higher-risk sex have declined in four of the five countries, although use of a condom at last higher-risk sex remains below 50 percent in Kenya and Zambia. Multivariate analysis shows that higher education is a consistently strong, positive predictor of condom use at last higher-risk sex, whereas higher wealth status is not significant in most surveys. Knowledge that use of condoms can reduce the risk of HIV transmission is a consistently strong, positive predictor of condom use, but urban-rural residence and region are significant only in some surveys. Comparing the two most recent DHS surveys in each of the five countries, there are no clear patterns of change in the predictive strength of explanatory variables. However, there is evidence of widening gaps in condom use by level of education in Cameroon and by urban-rural residence in Kenya. One important policy finding that emerged from this study is that low wealth status is not a barrier to condom use in most countries, but lack of education is.

Population and HIV/AIDS 2007
(Chart; Global)
New York, New York, United Nations, Department of Economic and Social Affairs, Population Division, 2008 Mar. [2] p. (ST/ESA/SER.A/270)
The Wall chart on Population and HIV/AIDS 2007 provides the most recent information on HIV/AIDS for all countries in the world. The Wall chart includes information on Government measures implemented in response to the HIV/AIDS epidemic, the number of people living with HIV, adult HIV prevalence, the number of deaths due to AIDS and the number of AIDS orphans. Additional data include life expectancy at birth and total population in 2015 with and without AIDS, condom use and antiretroviral coverage.

MATERNAL AND CHILD HEALTH NEWS

Gambia: Male brainstormed on safe-motherhood
(News Article; Sub-Saharan Africa)
29 Apr 2008
Jawo LS, The Daily Observer (Banjul)

Kenya: Pregnant? Malaria is your greatest enemy
(News Article; Sub-Saharan Africa)
25 Apr 2008
Kweyu D, The Nation (Nairobi)

Ghana: More Women Die During Child Birth
(News Article; Sub-Saharan Africa)
25 April 2008
Public Agenda (Accra)

Africa: Countdown to 2015 -- Critical health care fails to reach most women and children
(Press Release; Sub-Saharan Africa)
16 April 2008
United Nations Children's Fund (New York)

Liberia: MSF/MOF Hold Confab On Violence Against Women, Children
(News Article; Sub-Saharan Africa)
30 April 2008
The Inquirer (Monrovia)

Uganda: ARVs Give HIV Postive Children, Women Hope
(News Article; Sub-Saharan Africa)
26 April 2008
The Monitor (Kampala)

Iraq must spend more on basic services, particularly for children, says UN envoy
(News Article; Middle East)
30 April 2008
UN News Center

Philippines: House bill filed extending 60-day maternity leave to 120
(Abstract; subscription needed for full text; Asia)
29 Apr 2008
Ager M, INQUIRER.net (Manila)

MATERNAL AND CHILD HEALTH RESEARCH

Estimating vertically acquired HIV infections and the impact of the prevention of mother-to-child transmission program in Zimbabwe: Insights from decision analysis models
(Abstract; subscription needed for full text; Sub-Saharan Africa)
JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 May;48(1):72-81.
Dube S | Boily MC | Mugurungi O | Mahomva A | Chikhata F | Gregson S
The World Health Organization recommends a single-dose nevirapine (NVP) regimen for prevention of mother-to-child transmission (PMTCT) of HIV in settings without the capacity to deliver more complex regimens, but the population-level impact of this intervention has rarely been assessed. A decision analysis model was developed, parameterized, and applied using local epidemiologic and demographic data to estimate vertical transmission of HIV and the impact of the PMTCT program in Zimbabwe up to 2005. Between 1980 and 2005, of approximately 10 million children born in Zimbabwe, a cumulative 504,000 (range: 362,000 to 665,000) were vertically infected with HIV; 59% of these infections occurred in nonurban areas. Mother-to-child transmission (MTCT) of HIV decreased from 8.2% (range: 6.0% to 10.7%) in 2000 to 6.2% (range: 4.9% to 8.9%) in 2005, predominantly attributable to declining maternal HIV prevalence rather than to the PMTCT program. Between 2002 and 2005, the single-dose NVP PMTCT program may have averted 4600 (range: 3900 to 7800) infections. In 2005, 32% (range: 26% to 44%) and 4.0% (range: 2.7% to 6.2%) of infections were attributable to breast-feeding and maternal seroconversion, respectively, and the PMTCT program reduced infant infections by 8.8% (range: 5.5% to 12.1%). Twice as many infections could have been averted had a more efficacious but logistically more complex NVP + zidovudine regimen been implemented with similar coverage (50%) and acceptance (42%). The decline in MTCT from 2000 to 2005 is attributable more to the concurrent decrease in HIV prevalence in pregnant women than to PMTCT at the current level of rollout. To improve the impact of PMTCT, program coverage and acceptance must be increased, especially in rural areas, and local infrastructure must then be strengthened so that single-dose NVP can be replaced with a more efficacious regimen.

Reduced mortality associated with breast-feeding-acquired HIV infection and breast-feeding among HIV-infected children in Zambia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 May;48(1):90-96.
Fox MP | Brooks D | Kuhn L | Aldrovandi G | Sinkala M | Kankasa C | Mwiya M | Horsburgh R | Thea D
In developing countries, where mother-to-child transmission of HIV through breast-feeding is common, little is known about the impact of postpartum transmission on child survival. This study assessed whether children infected postpartum have longer survival from time of infection versus those infected during gestation or delivery. The author used a prospective cohort study to analyze data from 213 HIV-infected children enrolled in a breast-feeding intervention trial in Lusaka, Zambia (2001 to 2004). Methods: The author compared mortality 1 year after HIV infection in children stratified by age of infection: 0 to 3 days (intrauterine (I/U) group), 4 to 40 days (intrapartum/early postpartum [IP/EPP] group), and greater than 40 days (postpartum [PP] group). A total of 61, 71, and 81 children were infected in the I/U, IP/EPP, and PP groups, respectively. Children with intrauterine or intrapartum/early postpartum transmission had higher mortality over the first 12 months after infection than children with postpartum transmission (P = 0.001 and P = 0.006, respectively); no differences were detected between children with intrauterine and intrapartum/ early postpartum transmission. Nearly 20% of the I/U and IP/EPP groups died by 100 days after infection, whereas nearly 10% of the PP group had died by this time. After adjusting for birth weight, maternal CD4 cell count, breast-feeding, and maternal death, children infected postpartum had one quarter the mortality rate (hazard ratio [HR] = 0.27, 95% confidence interval [CI]: 0.15 to 0.50) of those infected in utero. Stopping breast-feeding increased mortality in infected children (HR = 3.1, 95% CI: 1.8 to 5.3). This study demonstrates a survival benefit among children infected postpartum versus children infected during pregnancy or delivery and a benefit to increased breast-feeding duration among infected children. Testing children for HIV early may provide a means to allow for earlier intervention.

Promotion of WHO feeding recommendations: A model evaluating the effects on HIV-free survival in African children
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Human Lactation. 2008 May;24(2):140-149.
David S | Abbas-Chorfa F | Vanhems P | Vallin B | Iwaz J | Ecochard R
In Africa, HIV and feeding practices deeply affect child mortality. To prevent mother-to-child transmission, the World Health Organization recommends exclusive breastfeeding for 6 months and replacement feeding when acceptable, feasible, affordable, and sustainable. Determining the proportion and number of children saved with exclusive breastfeeding and replacement feeding is essential to design and implement crucial nationwide policies. Using data on 31 sub-Saharan countries and a decision tree for risk assessment, the authors estimated the number of children's lives potentially saved according to 6 scenarios that combine exclusive breastfeeding for 6 months or replacement feeding with 3 promotion strategies. Among all HIV-negative children born to HIV-positive mothers who die in sub-Saharan Africa per year, 52 315 (9.6%) would be saved yearly with exclusive breastfeeding versus 21 638 (4.0%) with replacement feeding. Promotion support would double these numbers (110 625 vs 45 330; ie, 20.3% vs 8.3%), and with additional prenatal group education, 132 633 versus 54 192 lives would be saved (24.3% vs 9.9%). Wherever replacement feeding is not possible, exclusive breastfeeding with promotion support and prenatal group education would save 1 of 4 exposed children.

Provision and use of maternal health services among urban poor women in Kenya: What do we know and what can we do?
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Urban Health. 2008 May;85(3):428-442.
Fotso JC | Ezeh A | Oronje R
In sub-Saharan Africa, the unprecedented population growth that started in the second half of the twentieth century has evolved into unparalleled urbanization and an increasing proportion of urban dwellers living in slums and shanty towns, making it imperative to pay greater attention to the health problems of the urban poor. In particular, urgent efforts need to focus on maternal health. Despite the lack of reliable trend data on maternal mortality, some investigators now believe that progress in maternal health has been very slow in sub-Saharan Africa. This study uses a unique combination of health facility- and individual-level data collected in the slums of Nairobi, Kenya to: (1) describe the provision of obstetric care in the Nairobi informal settlements; (2) describe the patterns of antenatal and delivery care, notably in terms of timing, frequency, and quality of care; and (3) draw policy implications aimed at improving maternal health among the rapidly growing urban poor populations. It shows that the study area is deprived of public health services, a finding which supports the view that low-income urban residents in developing countries face significant obstacles in accessing health care. This study also shows that despite the high prevalence of antenatal care (ANC), the proportion of women who made the recommended number of visits or who initiated the visit in the first trimester of pregnancy remains low compared to Nairobi as a whole and, more importantly, compared to rural populations. Bivariate analyses show that household wealth, education, parity, and place of residence were closely associated with frequency and timing of ANC and with place of delivery. Finally, there is a strong linkage between use of antenatal care and place of delivery. The findings of this study call for urgent attention by Kenya's Ministry of Health and local authorities to the void of quality health services in poor urban communities and the need to provide focused and sustained health education geared towards promoting use of obstetric services.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Uganda: Population pressure affecting AIDS fight
(News Article; Sub-Saharan Africa)
29 Apr 2008
New Vision (Kampala)

Uganda: Darkness cited for high population
(News Article; Sub-Saharan Africa)
27 Apr 2008
New Vision (Kampala)

Evacuees returning to ‘peaceful, progressive’ Muslim Mindanao
(News Article; Asia)
1 May 2008
Llanto J, ABS CBN News

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

What can we learn from indirect estimations on mortality in Mongolia, 1969 - 1989?
(Abstract; subscription needed for full text; Asia)
Demographic Research. 2008 Apr 18;18(10):285-310.
Spoorenberg T
The closure of Mongolia to the international community during the 20th century resulted in a dearth of available data and analytic demographic studies. In the absence of mortality analysis during the socialist period, this paper proposes the use of indirect census-based techniques to estimate mortality levels and trends of the last two socialist decades (1969-1989). Due to census data quality and choice of model life table, results are not homogeneous. The respective effects of these two components are discussed in order to understand the results. However, despite these shortcomings, it is shown that during the last socialist decades in Mongolia, the health conditions of the population deteriorated. The Mongolian pattern is relatively similar to the situation documented for the ex-socialist republics. Causes of this similarity are discussed.

The quantity-quality trade-off of children in a developing country: Identification using Chinese twins
(Abstract; subscription needed for full text; Asia)
Demography. 2008 Feb;45(1):223-243.
Li H | Zhang J | Zhu Y
Testing the trade-off between child quantity and quality within a family is complicated by the endogeneity of family size. Using data from the Chinese Population Census, we examine the effect of family size on child educational attainment in China. We find a negative correlation between family size and child outcome, even after we control for the birth order effect. We then instrument family size by the exogenous variation that is induced by a twin birth and find a negative effect of family size on children's education. We also find that the effect of family size is more evident in rural China, where the public education system is poor. Given that our estimates of the effect of having twins on nontwins at least provide the lower bound of the true effect of family size, these findings suggest a quantity-quality trade-off for children in developing countries.

Climatic change and Chinese population growth dynamics over the last millennium
(Abstract; subscription needed for full text; Asia)
Climatic Change. 2008 May;88(2):131-156.
Lee HF | Fok L | Zhang DD
The climate-population relationship has long been conceived. Although the topic has been repeatedly investigated, most of the related works are Eurocentric or qualitative. Consequently, the relationship between climate and population remains ambiguous. In this study, fine-grained temperature reconstructions and historical population data sets have been employed to statistically test a hypothesized relationship between temperature change and population growth (i.e., cooling associated with below average population growth) in China over the past millennium. The important results were: (1) Long-term temperature change significantly determined the population growth dynamics of China. However, spatial variation existed, whilst population growth in Central China was shown to be responsive to both long- and short-term temperature changes; in marginal areas, population growth was only sensitive to short-term temperature fluctuations. (2) Temporally, the temperature-population relationship was obscured in some periods, which was attributable to the factors of drought and social buffers. In summary, a temperature-population relationship was mediated by geographic factors, the aridity threshold, and social factors. Given the upcoming threat posed by climate change to human societies, this study seeks to improve our knowledge and understanding of the climate-society relationship.

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Volume 8, Number 18 5 May 2008