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Factoring poverty and culture into HIV / AIDS campaigns: Empirical support for audience segmentation.

This article argues in favor of the selection of content and dissemination channels based on audience differences in HIV knowledge, perceptions and media preferences. Data were collected from low-income teenagers in Durban, South Africa. Key differences within this low-income group were found between Indians and blacks, and between boys and girls on what to communicate about HIV/AIDS and how to communicate. The argument for audience segmentation beyond income group demographics is supported. (author's) | Published in Gazette in 2001, this study observes the communication patterns of poor black and Indian teenagers in Durban, South Africa, to investigate the extent to which ethnic and cultural factors may influence the effectiveness of communication campaigns on HIV/AIDS. The study is theoretically guided by the idea of audience segmentation, which posits that desired goals of communication (e.g., behaviour change) are easier to achieve when messages are tailored to economically and culturally distinct sub-groups in the audience. By using this model, the authors challenge the "one-shoe-fits-all" communication strategy in AIDS campaigns that have been utilised in the developing world for decades. The study specifically answers questions regarding two components of AIDS-related communications: (1) what to communicate about HIV/AIDS, and (2) how to communicate about HIV/AIDS. The authors provide empirical evidence in support of audience segmentation in HIV/AIDS communication campaigns.

Family life, reproductive health, and population education: key elements of a health-promoting school.

Young people all over the world have common needs in order to achieve full and healthy development: a positive and stable family life; an understanding about their bodies, including the emotional and physical capacities that enable them to have sexual relations and reproduce; an awareness of population issues and how these issues will affect them; and the knowledge and skills to deal with these matters responsibly, now and in the future. With these assets, young people are more likely to succeed in school, have quality of life and relationships, and contribute to the economy and productivity of their countries. Without them, they face interrupted schooling, personal insecurities, ill health, and diminished economic opportunity. This document focuses on a range of family life, reproductive health, and population issues, and how they can be integrated into the components of a Health-Promoting School to improve the overall health, education, and development of children, families, and community members. This document makes the assumption that in almost every school there are boys and girls who: have inadequate understanding of the emotions and physiology of the human body and would benefit from preparation for social and emotional relationships, marriage, parenthood and adulthood; have not engaged in sexual intercourse; are currently engaging in sexual relations; have engaged in sexual relations but have stopped; are forced to engage in sexual relations (e.g., have been raped or forced by adults or peers to engage in sex in exchange for money or other favours). (excerpt)

The rights of migrant workers and members of their families: Nigeria.

While migration across international borders have always taken place, the formation of the Economic Community of West African States (ECOWAS) and agreements signed by the 17 member States on free movement within the sub-region have further increased the flow of legal and illegal migrants into Nigeria. As an important and committed member state of ECOWAS, it has been almost impossible for her to close her doors to sister States within the sub-region. Nigeria is simultaneously a country of origin and destination of migrants, with significant migrant worker population, although illegal immigrants that are largely not documented may make this virtually impossible to appreciate. Documented negative experiences of migrant workers and their families in different parts of Africa, including Nigeria range from xenophobia, forms of subtle and overt racism, social exclusion, demonstrating marked threats to their fundamental rights and physical safety in employer countries. Nigeria, like some other employer countries in Africa (such as South Africa and Gabon) was absent from the Convention, had neither signed nor ratified, nor expressed any reservations regarding the convention. Given that managing and integrating the rights (social, cultural, economic and political) and obligations of all migrants and their families have become global issues of growing concern, there is the need for more information on the position of Nigeria regarding the Convention and the status and situation of migrant workers and their families in the country. (excerpt)

Need and significance of HIV / AIDS preventive education in Pakistan. Trial edition.

Pakistan is a developing country. Like every developing country it has a host of challenges with comparatively less resources to overcome these. However, the Government of Pakistan is trying its level best to put the country on the track of the development and to provide better facilities in education, health and other social sectors. Education is an important base for economic and social development. The fast changing world of today demands a lot from the educational system to respond and to bring the desired changes especially positive attitudinal changes. The world of today is threatened with the fast growing menace of HIV/AIDS. Most of the people fall victims to this deadly infection because ignorance about the means of transmission of this infection. The new generation has to be informed about its challenges and the preventive measures to be adopted. It is through education that the youth and out future generation can be informed as well as equipped for adopting safe behavior, so as to protect themselves from the deadly infection. It is through education, both through formal and non-formal ways, that this message can reach every one. (excerpt)

Focusing on the forest, not just the tree: Cultural strategies for combating AIDS.

Most behavior change communication interventions for HIV prevention, care, and support have focused on individuals as the locus of change. Metaphorically-speaking, interventions have focused more on the tree, and not enough on the forest of which the tree is a part. The present article argues for the importance of focusing on the forest in designing and implementing culturally-sensitive communication interventions. Culture-based approaches to HIV/AIDS communication interventions must view culture as an ally, reconstruct cultural rites, employ culturally-resonant narratives, and create a culturally-based pedagogy of HIV prevention. (author's) | Published in the MICA Communications Review, this article challenges the reliance of behaviour change communication (BCC) interventions for HIV prevention, care, and support on individuals ("the tree") as the locus of change. Arvind Singhal's claim here is that attending to the "forest" of which individuals are a part - that is, locally-situated knowledge, including its cultural elements - can be an effective strategy in designing and implementing HIV/AIDS communication campaigns.

Singhal begins by describing the limitations of individual-directed BCC strategies, arguing that interventions drawing on these approaches have been "mixed at best, and generally dismal". He cites, and challenges, 4 mistaken assumptions on which these strategies are built: that all individuals are capable of controlling their context, that all persons are on an "even playing field", that all individuals make decisions of their own free will, and that all individuals make preventive health decisions rationally. Furthermore, he argues, such strategies are often anti-sex, anti-pleasure, and fear-inducing - centring around the individual as positioned against and threatened by the promiscuous and deviant behaviour of "others" (the high-risk group). The problem here relates, again, to the failure to see people as part of a "forest": as social creatures whose commitment to social constructions of "love" involves risk-taking, trusting, and giving may also put them at risk of HIV infection. In this case, context or "culture", broadly understood, can play a problematic role by contributing to HIV/AIDS, yet communication practitioners do not see this or address it; instead they tend to focus only on the individual (the "tree"), says Singhal.

For Singhal, attention to the social and cultural construction of sexuality is key to effective communication-centred programming, as illustrated by 2 research studies from Brazil and Kenya that he alludes to in his introductory remarks. Reflecting on this research, he lays out 4 core principles:

View culture as an ally - Several socio-cultural and spiritual dimensions of both Sengalese society and the Nguni people of Southern Africa have strengthened these communities' response to HIV/AIDS; for example, non-penetrative sex practices such as ukusoma could be drawn upon in BCC interventions. Singhal also points to the potential positive power of cultural practices such as familismo (family ties) in Latino culture and strong family bonds in India.
Reconstruct cultural rites - When anthropological research in the Nyanza Province in Western Kenya showed that the "widow-cleansing practice" with the late husband's relative to avoid a curse called chira often leads to HIV infection, discussions with community elders were conducted. Possibilities for replacing the rite with alternative ones emerged; such alternatives have also been developed in addressing female genital mutiliation (FGM) in Kenya ("Circumcision with Words").
Employ culturally resonant narratives - Rather than emphasising scientific/rational appeals, Singhal stresses the power of traditional oral communication channels, such as proverbs, adages, riddles, folklore, and storytelling. He highlights a diarrhoea prevention campaign in northern Nigeria to explain the importance of context-based explanations that match prevention messages with local magico-religious myths.
Create a culturally-based paedogogy of HIV prevention - Here, Singhal discusses several HIV/AIDS prevention programmes in Brazil which are inspired by the participatory approaches of the late educator Paulo Freire. He details in some depth an initiative carried out by Vera Paiva at the University of Sao Paulo which was based on "a deep understanding of the socio-cultural dimension of risk". The effort to create a new generation of "sexual subjects" (rather than passive objects of desire and the sexual scripts of others) drew on such approaches as face-to-face group interaction with girls and boys that incorporated creative techniques including role-playing, teamwork, psychodrama, games and art to make condoms erotic, and the molding of flour and salt paste to shape reproductive body parts. In this case "the pedagogy of prevention was based on an 'eroticization' of prevention'."

Singhal concludes that, while communication practitioners need to be mindful about the dangers of manipulating or subverting culture, community- and dialogue-based approaches can make important contributions to HIV/AIDS initiatives in a way that biomedical, individual-oriented strategies often cannot.

Migrants and their integration: contemporary issues and implications.

The present paper begins by briefly summarising some of the major contemporary developments in international population movement and the most pressing issues the movements pose. It then addresses some of the major issues relating to the integration of movers in destinations. The paper subsequently moves on to discuss some of the policy implications of these issues from the perspectives of sending and receiving countries, focusing especially on their responsibilities. The role of international instruments is then discussed with reference to existing instruments. Finally, barriers to greater acceptance of international instruments are discussed and some strategies designed to increase the extent to which these instruments are adopted and operationalised are put forward. (excerpt)

Breastfeeding is priceless; No substitute for human milk. A CIMS fact sheet.

The World Health Organization, health care associations, and government health agencies affirm the scientific evidence of the clear superiority of human milk and of the hazards of artificial milk products. The World Health Organization recommends that mothers exclusively breastfeed their infants for at least the first six months, continuing breastfeeding for two years and beyond. Human milk provides optimal benefits for all infants, including premature and sick newborns. The American Academy of Pediatrics encourages pediatricians to promote, protect, and support breastfeeding in their individual practices as well as in hospitals, medical schools, communities, and the nation. Although more US mothers are initially breastfeeding their infants, in 2001 less than half of mothers who initiated breastfeeding did so exclusively (without supplementing with artificial milk or cow's milk) and less than one in five were breastfeeding exclusively at 6 months. A Healthy People 2010 goal is to have three-quarters of mothers initiate breastfeeding at birth, half of them breastfeed until at least the fifth or sixth month, and one-fourth to breastfeed their babies through the end of the first year. (excerpt)

Identification of the obstacles to the signing and ratification of the UN Convention on the Protection of the Rights of All Migrant Workers: the Asia-Pacific Perspective.

The overall aim of this report is to investigate ways to gain wider acceptance of the ICMR in the specific context of the Asia Pacific region. This report: investigates why a sample of major sending and receiving countries in the Asia Pacific region have not ratified the Convention, and develops recommendations to encourage more ratifications in this region and beyond. The main research methods employed were semi-structured interviews with key informants in seven selected countries in the Asia Pacific region. Informants were sought from among the following groups: politicians and/or governmental officials (at national and local level), NGO representatives (migrant support groups and human rights groups), academics, embassy staff (labour attaches), lawyers (bar associations), trade unions and employers/industry organizations, and National Human Rights Commissions (see Appendix I for more details). Interviews were arranged with the assistance of local coordinators, most of whom are members of the APMRN. The actual interview schedule was designed to test the obstacles and opportunities created by ratifying the Convention from a legal, social and political perspective. This also included an examination of the role the media are playing in the acceptance of human rights for migrants. Other materials informing the report comes from websites, and from newspaper clippings and copies of legal and semi-legal documents provided by the country coordinators. (excerpt)

Implementation process review of the "Training of Teachers Manual on Preventive Education against HIV / AIDS in the School Setting".

At a recent review workshop in Uzbekistan and elsewhere concerns have been raised that the manual is too strictly focused on transferring biomedical knowledge and does not pay enough attention to reducing vulnerability to HIV/AIDS by promoting lifeskills. It is also believed that the HIV information in the manual needs to be updated, and that the inclusion of teaching of more participatory training techniques could be considered. In addition, in some countries, a strict focus on HIV/AIDS is not realistic - embedding HIV/AIDS in a wider school-health approach should be considered. Before expanding to other countries, UNESCO decided then to do a review of the progress implementation of the "Preventive Education against HIV/AIDS in the School Setting" project and a review of the manual. The particular interest of this review is to look at the way that the project was implemented and to review the manual based on the comments generated by the targeted countries. Its overall aim is to generate recommendations both on the content of the manual and the implementation process, before expanding to other countries covered by UNESCO Bangkok. (excerpt)

Gender sensitive IEC materials and empowering HIV / AIDS prevention strategies.

HIV/AIDS prevention work usually aims at enabling women and men to act responsibly towards themselves and others, and concretely to avoid infection with the virus. This requires promotion of learning processes that deal with medical, social, political, cultural and economic facts and circumstances. The gender dimension is key to HIV prevention work in all world regions. Without addressing gender questions the desired changes regarding awareness, sensitivity and behaviour will remain rudimentary and rootless. The need to apply a gender perspective and to use gender-sensitive approaches and materials in prevention work has been underlined frequently. (excerpt)

Gender and violence in schools.

This analytical review will consider the evidence of gender-based violence in schools in developing countries and summarise the measures taken to address them. A central problem in identifying the nature and scope of the review is the fact that many forms and incidents of gender violence in schools are not reported as such. Most often, gender violence is not considered differently from other forms of school violence. Identification of gender-based violence in schools as a barrier to increased educational participation, in particular of girls, in the poorer countries of the world, is recent and our understanding of its causes and consequences is not well developed. As a result, the appropriate gender-sensitive framework required to observe and to intervene does not exist, so that these least desirable aspects of school life are either left unreported or unrecognised as gender violence. There is no doubt, however, that this is not an isolated phenomenon, as studies directed at investigating a range of problems in education in developing countries such as underachievement, high pupil drop-out, poor quality of teaching and low levels of teacher professionalism, hint at its presence in schools. There is therefore a need to explore and categorise its manifestations within an explicit gender framework and to examine its impact on the school experience and student learning. Without this, it will be impossible to identify effective system-wide strategies to address it. (excerpt)

Women's changing roles in the context of the demographic transition.

This paper presents a review of the evidence on the consequences of the demographic transition for women. Although we make frequent references to relevant material from developed countries, our main focus is on developing countries. We begin by presenting evidence that women gain from demographic progress, and that gender differentiation is reduced. However, we then show that this is by no means the end of the story. We discuss some of the evidence that suggests that there is not always a straightforward link from demographic progress to improvements in women's status and gender equality. (excerpt)

Women's roles in keeping AIDS orphans in Gwanda.

This booklet is one of an ever-growing series of easy-to-read materials produced at a succession of UNESCO-ADEN workshops. The workshops are based on the appreciation that gender-sensitive literacy materials are powerful tools for communicating messages on gender issues, women rights and farming issues to poor rural people particularly illiterate rural women farmers and out-of-school girls. The workshop focused on a number of topics covering the life of these Rural Women Farmers (RWF). The questions of gender, the rights, appropriate technology to lighten the rural women's daily workload, were dealt with. One the issue of rights, the discussions allowed these RWF to have a deeper understanding to the rights they currently enjoy and the work which remains to be done. On the other issues, these RWF became aware that there is technology available which cannot only permit them to lighten their tasks, but also improve their productivity. (excerpt)

Workshop report: Appraising HIV / AIDS Prevention Curricular Materials and Teaching-Learning Resources, Geneva, Switzerland, 9-11 June 2003.

The IBE organized this workshop as part of UNESCO's common effort to make existing curriculum documents and teaching-learning materials for HIV/AIDS education easily accessible, and to identify and disseminate good practices and lessons learned, with the aim of improving the overall success of education as principal means of combating the epidemic. Three objectives have been identified for this workshop: discuss and improve the set of appraisal criteria prepared by the IBE to assess curricular materials and teaching-learning resources for HIV/AIDS prevention in schools; apply the proposed appraisal criterial to analyze concrete curriculum materials and teaching learning resources brought by the participants and identify good practices and lessons learned; formulate follow-up actions and recommendations for future collaboration among participants for identification and promotion of promising approaches and good practice. Presentations of the participants the first day and discussions on important issues and challenges that the education sector faces in designing and implementing HIV/AIDS prevention in schools provided valuable information, but also crucial questions on how to continue the work. (excerpt)

Strangers in foreign lands: Diversity, vulnerability and the rights of migrants.

Globalization and increased population flows across borders have created a daunting challenge for the international community: the need to address the particular vulnerability of migrants. While migrant workers often make significant contributions to the economies and societies of the State in which they work and of their State of origin they remain, from a legal point of view, more vulnerable than many other groups who have the benefit of clearer and more wide-ranging international and regional legal protections. This is because the development and acceptance - especially from more developed States - of international legal standards to protect migrants' rights has been very slow, with the UN Convention on the Protection of all Migrant Workers and Members of their Families only entering into force in 2003. The rights contained in the Migrant Workers' Convention are human rights. They are indicators as to how governments may protect migrants and better manage the problems and opportunities of international migration. This may also help avoid the dangers of racism, intolerance and xenophobia which may result when there is not a balanced view of both positive and negative aspects of migration movements and their effects on the economies and societies of both host States and States of origin. The global challenge which international migration represents calls for a global approach. UNESCO - as part of its role in the field of migration, social integration and cultural diversity - has been bringing together researchers, policy-makers, NGOs and other interested parties to deal with various facets of this challenge, including the adoption of the Universal Declaration on Cultural Diversity and the launch of a much needed campaign for the ratification of the Migrant Workers' Convention. (author's)

Population-related policies in Estonia in the 20th century: Stages and turning points.

This article is about the experience of population-related policies in Estonia. During the recent decade much has been published on this theme, usually with an analysis of currently enforced regulations. Repeated amendments of legal norms and procedures, which are inevitable in a period of fundamental reforms, however, tend to limit their value quite rapidly. Against such a background, this paper applies a longer perspective with an attempt to cover the main stages and turning points in the development of population-related policies in the country since the establishment of statehood in 1918. In the interwar period, the efforts to build up a modern nation included setting up relevant institutions and regulations in the field of population-related policies. These undertakings have been seldom discussed in the recent publications. Somewhat similarly, the postwar decades are frequently regarded as fairly distant and of little relevance to present challenges. To understand the developments, however, the longer view should not be neglected. Today's concerns are rooted in the arrangements and disarrangements of the past, and no less importantly, such continuity is strengthened by the nature of population development and the flow of cohorts which absorb the influences of the societal environment and carry them along through their lifetime. The article is structured in four sections focusing on the development of marriage and the family, children and fertility, the pension system and social welfare, and the health care system. In each section, the aim is to outline successive policy regimes and their main characteristics in terms of objectives and methods of regulations. Understandably, limited space does not allow coverage of minor changes and technicalities, so for more specific information the article provides further reference to various source materials. (author's)

Sexual development, social oppression, and local culture.

This article reviews some of the factors that have created and reproduced intellectual, historical, political, and disciplinary barriers to understanding the contribution of social oppression as a force in the development of young people's sexuality. Social oppression in sexual development is common in many places and times and creates an impact on childhood sexual subjectivities and behaviors that has typically been ignored in research and policy. I argue in this paper for the expansion of the study of childhood sexuality through biopsychosocial approaches that are more inclusive of cross-cultural and intra-cultural diversity and subjectivity. Finally, optimal sexual development is viewed here as being more dependent upon the environment than previously suggested by theorists, and such a revised view places increased emphasis upon the importance of sexual health research that will better inform and help to shape the best practices and policies related to sexuality. (author's) | Published in Sexuality Research & Social Policy, this paper reviews some of the factors that have created and reproduced intellectual, historical, political, and disciplinary barriers to understanding the role of social oppression in the development of young people's sexuality. In it, author Gilbert Herdt argues for, and delineates, a new research and policy framework to understand how severe social oppression - or "structural violence" resulting from poverty, racism, heterosexism, religious persecution and anti-Semitism, homophobia and anti-gay violence, the diaspora of transgender people, xenophobic bias against immigrants, ageism, and discrimination against individuals with disabilities - impacts young people's sexuality around the world.

Herdt (an anthropologist) emphasises the need for context-based research on social oppression in sexual development, which he claims is "common in many places and times and creates an impact on childhood sexual subjectivities and behaviors that has typically been ignored in research and policy." To support this hypothesis, he explores analytical paradigm shifts that have taken place in the past 20 years in the social and health sciences. In short, while historically, sexuality research as well as policy consistently emphasised the individual rather than the culture, theories of sexuality have been reassessed - such that thinkers have incorporated the contributions of culture and society to sexual development and of the expanding role played by social meaning systems and social practices as defining features of sexual cultures. The idea is that sociocultural theory can help to embed research on young people's sexuality within real-world contexts, "wherein social suffering, and even 'survival sex,' are a part of daily life constraining the choices and life circumstances widely experienced by young people globally."

Herdt moves on to focus in greater depth on these theories and shifts, exploring such topics as the following: sexual essentialism and individual difference theories, the influence of Freudian developmentalism, "what individual difference theory left out", the over-reliance of biopsychosocial theories of individual differences on normative development on middle-class European and American populations, and social difference theories of childhood sexuality. The HIV epidemic was one factor that influenced researchers' thinking, making it evident that researchers must no longer take the Western middle class norm as the baseline for all childhood sexual development, especially in situations of radical and swift social change.

In short, culture-specific and socially-sensitive research is the key strategy Herdt endorses. In one portion of the document, he explains that narratives and observations can be critical approaches "where sexuality is silenced by shame and secrecy", and when there is a "need to know who has the power to silence, who feels shame, and what is at stake in adhering to or breaking the rules..."

To that end, in the Conclusion section Herdt opens up a number of research avenues. For instance, he notes that research on "survival sex" - e.g., studies looking into the process of development of those whose sexuality is outside of the norm (especially for those in situations of social oppression) - has been insuffienct to date. In addition, if optimal sexual development is indeed more dependent upon context than previously suggested by theorists, sexual health research can, the author suggests, better inform and help to shape the best practices and policies related to sexuality in communities and populations continually impacted by oppression and adversity. In short, by taking into account cultural and social factors impacting sexuality in health communication research, policymaking, and programming, "we can increase the sense of inclusion and belonging...by creating, through the best research and thoughtful social policies, the means for people to achieve a better voice in their own sexual and social development and destinies."

State of the private health sector wall chart.

Meeting healthcare needs in developing countries is an enormous challenge. Though developing country governments provide health products and services, declining or variable funding levels may limit access to and quality of care for the general population. The private health sector can succeed in responding to these unmet healthcare needs. Moreover, consumers in several developing countries are willing to pay for healthcare in the private sector in order to obtain better or more accessible health products and services. As economies develop and incomes rise, many more consumers will have the financial means to purchase healthcare goods and services. With growing awareness among consumers that the private sector is a viable source for healthcare and products, the time is right to encourage greater private sector involvement in health to meet public heath goals. (excerpt)

Health concerns of "invisible" cross-border domestic maids in Thailand.

With the rising number of sex venues along the Thai-Burmese border and the perceived links between migration and the HIV epidemic, the Thai authorities and NGOs have begun concerning themselves with health problems of immigrant workers and seeking effective social welfare programmes for them. However, this paper argues that formal service programmes targeting specific groups may not be enough and notes a need to call attention to officially invisible migrants, particularly domestic maids from Burma who are more vulnerable precisely because they are 'invisible'. The 'maid trade' from Burma to Thailand is statistically invisible firstly because domestic work is not recognized as a formal occupation either by the employers or the employees and therefore, they fail to be registered in census data. Burmese female domestic workers in Thailand are normally recruited through informal channels facilitated by regional trans-national networks that also engage in human smuggling. Domestic workers remain invisible in Thailand also because most of them are live-in and tend to work for one family for lengthy periods of time. They are normally out of reach of labour unions, religious organizations, non-governmental organizations and public health services. The fear of being caught as 'illegal workers' by the authorities further hinders their contact with the public. This paper also attributes the migrants' invisibility to the tradition of 'domestic servitude' in Thai society. Using three detailed case studies, the paper demonstrates how the invisibility has contributed to the health vulnerability of these women in their daily lives. (author's)

The economics of consanguineous marriages.

The institution of consanguineous marriage - a marriage contracted between close biological relatives - has been a basic building block of many societies in different parts of the world. This paper argues that the practice of consanguinity is closely related to the practice of dowry, and that both arise in response to an agency problem between the families of a bride and a groom. When marriage contracts are incomplete, dowries transfer control rights to the party with the highest incentives to invest in a marriage. When these transactions are costly however, consanguinity can be a more appropriate response since it directly reduces the agency cost. Our model predicts that dowry transfers are less likely to be observed in consanguineous unions. We also emphasize the effect of credit constraints on the relative prevalence of dowry payment and consanguinity. An empirical analysis using data from Bangladesh delivers robust results consistent with the predictions of the model. (author's)

Living with migration: Experiences of left-behind children in the Philippines.

In the Philippines, large-scale overseas migration has raised concerns about left-behind children, who are perceived to be most affected by the absence of fathers, mothers or both. Without their 'real' parents (especially mothers) to rear and guide them, left-behind children are perceived to bear the brunt of the social costs of migration. Based on data collected from a 2003 nationwide study, this article examines how left-behind children (specifically those aged 10-12 years old and adolescents) cope without their migrant parents. Three questions are explored: (1) how children are raised in the absence of one or both migrant parents; (2) how children (re)configure family, family life and family practices; and (3) what roles children have, if any, in how the family unit copes with the migration of one or both parents. Although migration creates emotional displacement for migrants and their children, it also opens up possibilities for children's agency and independence. (author's)

Five myths about the HIV epidemic in Asia.

It is widely recognised that the huge population sizes of many Asian countries mean that although national HIV prevalence levels are still very low, very large absolute numbers of people are being infected each year with HIV. Urgent responses are required; the effective responses by countries such as Thailand and Cambodia have shown how much can be done. As implementers who have worked with HIV/AIDS programmes in several countries in the region, we recognise the public health and welfare costs of the epidemic in Asia, and we respond to the need to "act now". We are concerned, however, about a number of misinformed beliefs, or myths, about the epidemic - myths that are widely circulating in Asia, disseminated in both public and professional discourse, and often dominating policy and political debate. We believe that these myths, if allowed to underpin and influence policy and programming and guide immediate action, have the potential to seriously jeopardise exactly the kind of focused, coherent, evidence-based programme being called for in Asia and the Pacific. In this Essay, we set out five myths that are commonly held with regard to HIV in Asia. We also suggest areas of policy that require greater clarity. (excerpt) | It is widely recognized that the huge population sizes of many Asian countries mean that although national HIV prevalence levels are still very low, very large absolute numbers of people are being infected each year with HIV. Urgent responses are required; the effective responses by countries such as Thailand and Cambodia have shown how much can be done. Perhaps the biggest challenge is lack of organizational and institutional capability to deliver effective prevention and care services at grass-roots level. | Published in PLoS Medicine, this essay offers the perspective of implementers who have worked with HIV/AIDS programmes in several countries in the region - personnel who "are concerned...about a number of misinformed beliefs, or myths, about the epidemic - myths that are widely circulating in Asia, disseminated in both public and professional discourse, and often dominating policy and political debate." They explore 5 such myths, suggesting areas of policy related to each one that they feel need attention in order to guide focused, coherent, evidence-based HIV/AIDS programming in Asia and the Pacific.

The authors outline and then debunk these myths, which include:

"There is a major risk that the epidemic in many Asian countries will have the same disastrous 'development impact' as in sub-Saharan Africa, but on a much worse scale, given the huge population sizes of much of Asia." - In reality, in Asia-Pacific (unlike Africa), the epidemic is concentrated in identifiable high-risk situations, and women's sexual risk is curtailed by socio-cultural factors. Rather than attending to mythical generalised developmental challenges, practitioners might consider honing in on the challenges of developing targeted intervention programmes and ensuring effective, equitable services for vulnerable groups.
"The 'Three Ones' are an essential framework for an expanded and strengthened response." - The idea that 1 national coordinating authority, 1 strategic plan, and 1 monitoring and evaluation system is relevant to this region (click here to learn more) is "a troubling myth". The authors explain why this approach may be understood as important for donors, but argue that "simply establishing national coordinating bodies may often create more problems than it solves". What is important, they claim, is "ownership".
"Most of the progress made in controlling the epidemic in Asia has been made by non-governmental organisations [NGOs]; the governmental contribution has been limited, clumsy, and hesitating." - In fact, the authors suggest, the work of NGOs is almost always on a small scale. "Where governments choose to be pragmatic about the legality of high-risk behaviours, and work directly with high-risk groups, or in explicit partnership with NGOs, much larger-scale coverage can be achieved."
"The Global Fund to Fight AIDS, Tuberculosis and Malaria has recently made a very significant contribution towards controlling the epidemic by making large amounts of funding easily available." - For various reasons delineated here, monies from the Global Fund are "very difficult to use", especially in the Asia-Pacific context. For instance, as explored here, the Fund's agenda privileges responses that focus on building partnerships, involving civil society and those affected directly by the diseases. However, in much of Asia, countries tend not to plan and manage in partnership with civil society, and so new, costly, and inefficient mechanisms have needed to be set up...
"The 'expanded multisectoral response', beyond the health sector, is essential for effective control of the epidemic in Asia." - In reality, "The emphasis on multi-sectorality may be appropriate in situations where prevalence rates are so high as to seriously affect labour productivity, availability of human resources, and social infrastructure and institutions (as in parts of Africa); but nowhere in the Asia-Pacific region is prevalence so high, or likely to become so high..."
In conclusion, the authors stress that - to be effective - the response to HIV/AIDS in this region "must be based on good evidence of each country's specific epidemiological needs, proven and working mechanisms for developing programmes and channeling funds, and frankness, openness, and clarity of purpose and process."

Migration and the well-being of the "left behind" in Asia: Key themes and trends.

This paper serves as an introduction to the three substantive papers in this themed section on the impact of migration on the well-being of the 'left behind' in Asia. In the light of recent migration trends such as the 'feminization' of migration and 'brain-drain' of health workers in the region, the paper provides a brief review of the existing scholarly literature on the vulnerability of different groups of the 'left behind', particularly women, children and the elderly. It argues that a multidimensional approach is needed, taking into consideration not only the economic impact of remittances but also factors such as social networks and gender effects. (author's)

The path to below replacement fertility in the Islamic Republic of Iran.

This article aims to review the phenomenal fertility change which occurred in the Islamic Republic of Iran during the period 1972-2003 and to discuss the pathways by which the below replacement-level fertility have been achieved in this country. Mean age at first marriage and age at the first and last birth are analysed. Progression to second and third birth are also examined. Finally, the future prospects for fertility as well as their policy implications are discussed. (excerpt)

Vietnamese aging and marital sexual behavior in comparative perspective.

This study examines marital sexual activity in relation to age and its significance for marital relationships in Vietnam with particular attention to older persons. Results are compared with Thailand and the US. Two regional surveys provide the first quantitative assessment of marital sex in Vietnam. As elsewhere, marital sexual activity declines with age. At older ages, substantial proportions of married Vietnamese are sexually inactive. Levels of activity among older Vietnamese and Thais are remarkably similar and substantially lower than in the US. Contrary to US studies, the frequency of sexual activity shows little relationship to marital satisfaction and harmony in Vietnam. Possible explanations for these differences are discussed in terms of biases in the data, differences in health and living arrangements, and societal, cultural and normative contexts. We speculate that a main reason underlying the differences is a lesser societal emphasis on sex in general and on the importance of sexual and physical intimacy in marital relationships in Vietnam and Thailand than in the US. (author's)

Prioritizing second-line antiretroviral drugs for adults and adolescents: a public health approach. Report of a WHO working group meeting, World Health Organization, HIV Department, Geneva, Switzerland, 21-22 May 2007.

Antiretroviral therapy has dramatically improved the survival of HIV infected individuals and is critically needed to save millions of lives. As resource-limited countries rapidly expand their HIV/AIDS treatment programmes, increasingly countries are faced with the need to make second-line ART regimens available. The 2006 WHO ARV treatment guidelines outline the strategic approaches that should inform updated national treatment guidelines for first- and second-line therapies, and outline which agents should be considered for use in first line and second line. National programmes, however, are requesting additional operational guidance on the composition of their 2nd line ART formularies based on programmatic efficiencies and costs. As the ARV formulary is generally limited in developing countries, there is an increasing and urgent need for principles and criteria by which to prioritize ARV options. Regulatory bodies both nationally and internationally (e.g. the WHO pre-qualification project) are also requesting guidance on how to select the most needed therapeutic ARV agents for rapid appraisal. WHO therefore convened an expert meeting to review the scientific evidence and programmatic data available, in order to develop guidance for national programmes, regulatory authorities and implementing partners on selection, prioritization and planning for second-line ARV drugs. (excerpt)

Differential mortality among pacific island countries and territories.

The purposes of the present article are to: (a) document levels of uncertainty in mortality estimates in Pacific island countries, (b) identify the major quality and analytical problems affecting estimates of mortality in Pacific island countries, and (c) provide best possible estimates based on an assessment of published data and application of demographic techniques. The scope of the current exercise is limited to total mortality levels from the 1990s to 2005 and is an update of previously published studies. A similar assessment of causes of death data and causes of death estimates is essential to help determine the need for priority health programmes. The present study focuses on: Melanesia which refers commonly to Fiji, New Caledonia, Papua New Guinea, Solomon Islands, Vanuatu; Micronesia: Federated States of Micronesia, Guam, Kiribati, the Marshall Islands, Nauru, the Northern Mariana Islands, and Palau; Polynesia: American Samoa, Cook Islands, French Polynesia, Niue, Samoa (formerly Western Samoa), Tokelau, Tonga, Tuvalu, Wallis and Futuna. (excerpt)

Broadband revolutionizes education on remote Maldives atolls.

In a historical event for the Maldives today, the country is launching 20 broadband-enabled, child-friendly learning centres, which link 20 of the country's atolls. Supported by UNICEF, the connected Teacher Resource Centres (TRCs) will create a virtual learning environment accessible throughout the Maldives. Because this Indian Ocean archipelago is made of 1,200 small islands - 200 of which are inhabited - up to 80 per cent of teacher-training costs are related to transportation. As a result, many teachers remain untrained. The TRCs will greatly alleviate these logistical problems, reaching teachers and children that are otherwise hard to reach. "It's down to basics. Transport is costly, making it expensive and often dangerous for children to travel between islands to get a better education and for teachers to upgrade their skills," said UNICEF Representative in the Maldives Ken Maskall. (excerpt)

Trafficking in human beings and the 2006 World Cup in Germany.

Prior to the World Cup in Germany in 2006, there was considerable international concern that this event would contribute to a sharp increase in trafficking for sexual exploitation. Media reports suggested that prostitution would increase and that up to 40,000 women might be trafficked. This report investigates whether the number of victims of human trafficking for sexual exploitation increased during the World Cup 2006 in Germany. The study also examines the measures taken by the authorities and the NGO community in Germany before and during the World Cup. The study was conducted between June and September 2006. Research included a systematic review of media and statistical sources, an analysis of previous large-scale events and their impact on trafficking, and in-depth interviews with representatives of key agencies responsible for combating human trafficking in Germany. Sixteen in-depth interviews were conducted in total with six experts from the relevant departments of German Lander Criminal Police Offices or the City Police Offices of selected World Cup cities, and ten in-depth expert interviews with civil society organizations (street work and assistance to victims of trafficking). In addition to the analysis of the situation in Germany, information on trends in connection with the World Cup was gathered in cooperation with IOM missions. (excerpt)

Income, aging, health and wellbeing around the world: Evidence from the Gallup World Poll.

During 2006, the Gallup Organization collected World Poll data using an identical questionnaire from national samples of adults from 132 countries. This paper presents an analysis of the data on life-satisfaction (happiness) and health satisfaction and their relationships with national income, age, and life-expectancy. Average happiness is strongly related to per capita national income, with each doubling of income associated with a near one point increase in life satisfaction on a scale from 0 to 10. Unlike previous findings, the effect holds across the range of international incomes; if anything, it is slightly stronger among rich countries. Conditional on national income, recent economic growth makes people unhappier, improvements in life-expectancy make them happier, but life-expectancy itself has little effect. Age has an internationally inconsistent relationship with happiness. National income moderates the effects of aging on self-reported health, and the decline in health satisfaction and rise in disability with age are much stronger in poor countries than in rich countries. In line with earlier findings, people in much of Eastern Europe and in the countries of the former Soviet Union are particularly unhappy and particularly dissatisfied with their health, and older people in those countries are much less satisfied with their lives and their health than are younger people. HIV prevalence in Africa has little effect on Africans' life or health satisfaction; the fraction of Kenyans who are satisfied with their personal health is the same as the fraction of Britons and higher than the fraction of Americans. The US ranks 81st out of 115 countries in the fraction of people who have confidence in their healthcare system, and has a lower score than countries such as India, Iran, Malawi, or Sierra Leone. While the strong relationship between life-satisfaction and income gives some credence to the measures, the lack of such correlations for health shows that happiness (or self-reported health) measures cannot be regarded as useful summary indicators of human welfare in international comparisons. (author's)

Save the Children. Child Survival 18 - Vietnam. Building Partner Capacity for Child Survival of Vietnamese Ethnic Populations, Dakrong and Huong Hoa Districts, Quang Tri Province, North Central Region, Vietnam. Cooperative Agreement Number: ...

Building Partner Capacity for Child Survival of Vietnamese Ethnic Minority Populations was a five-year (2002-2007) Child Survival-18 (CS-18) project conducted by Save the Children (SC) in Dakrong and Huong Hoa Districts, Quang Tri Province, North Central Region, Vietnam. The project site predicated in the proposal and in the DIP included all 34 communes in the two rural mountainous districts, with a population, at baseline, of 87,070, including 13,931 children under five years of age and 20,897 women of reproductive age. The project scope expanded to include a total of 36 communes over the life of the project, due to government redistricting. The population of these communities increased to 99,253 over the life of the project. Some of the service sites are geographically located in urban/peri-urban areas (15.7%); the majority (84.3%) are in rural settings. A community profile is provided in Appendix F of this report. The goal of the project was to achieve sustained reductions in maternal and under-five mortality. Key objectives of the project were to: increase use of maternal, newborn and child care services; increase practice of key household behaviors; increase service delivery; improve service quality; and improve sustainability of all activities through development and further strengthening of the key project partners. (excerpt)

Poverty and pro-poor policies for Pacific Island countries.

Although generalizations can be misleading given the diversity of Pacific island countries' situation, the overall trend is that the Polynesian countries have been performing relatively well, the Micronesian countries of the north Pacific have been struggling to maintain gains already made, while Melanesian countries, notably those that have been impacted by natural disasters or where there has been conflict or civil/political tension, a reversal of earlier development progress is being witnessed. The result is that many countries in the Pacific are off-track to achieve at least five or more of the eight Millennium Development Goals. Weak fiscal situations, the impact of global externalities, concern over the future impact of climate change, and high levels of domestic rural/urban migration are all factors which are adversely affecting the ability and commitment of Governments in the Pacific to implement the policy initiatives necessary to realize significant achievements towards the Millennium Development Goals. Indeed the impact of oil price rises, climate change and demography, including the consequences of labour mobility and the growing threat of HIV/AIDS, are having profound affects on the likely long-term sustainability of some small island States. These issues therefore set very challenging policy agendas for human development in the Pacific islands. (excerpt)

Experimental studies on cyclooxygenase-2 inhibitor induced cervical cancer hela cell apoptosis and its molecular mechanism.

The objective was to investigate the Hela cells growth inhibition and apoptosis possible molecular mechanisms. Hela cells were treated with various concentrations (100 micromol/L,200 micromol/L, 300 micromol/L,400 micromol/L) of NS-398 (selective for COX-2 inhibition). Cell growth was measured by MTT (Thiazolyl blue). Apoptosis was detected by double staining flow cytometry (FCM). Levels of PGE2 were measured by radioimmunoassay. The expressions of COX-2 protein were also examined by Western blot analysis. After treated with different concentrations of NS-398, the growth of Hela cells was suppressed significantly in a dose-and time-dependent manner (P less than 0.01). The NS-398 can induce apoptosis with the apoptosis rates at 8.53%-43.46% by FCM in a dose-dependent manner. The release of PGE2 was reduced in Hela cells with the values of 69.26 plus or minus 2.13, 47.46 plus or minus 2.18, 28.15 plus or minus 1.64 and 17.01 plus or minus 1.12, respectively, there was significant difference compared with control group (83.78 plus or minus 1.11) (P less than 0.01). The NS-398 could inhibit the activity and expression of COX-2 in a dose-dependent manner and down-regulated the expression of COX-2 protein greatly. NS-398 could inhibit the proliferation and increase apoptosis in human Hela cells. These effects may be depended on the inhibition of the expression of COX-2 and PGE2 by NS-398. (author's)

Declining fertility in Japan: Its mechanisms and policy responses.

This article seeks to analyse the fertility transformation in post-war Japan. The following section discusses how the demographic mechanism of Japan's postwar fertility decline varied over time, while the ensuing section examines what factors contributed to such demographic shifts. Subsequently, a number of the policies and programmes to raise fertility that the Government of Japan has formulated and implemented over the past decade are discussed, and their limitations briefly considered. The final section discusses aspects of Japan's postwar experience which may be relevant for developing countries in Asia, particularly with regard to the first "demographic dividend" yielded by fertility reduction. (excerpt)

The Straight Talk campaign in Uganda: impact of mass media initiatives. Full report.

This report presents the findings of an evaluation of the Straight Talk Foundation's (STF) mass media communication programs which have been implemented in Uganda since 1993. The programs largely comprise three synergistic materials: i) Straight Talk (ST) radio programs broadcast to various districts in English and 11 other Ugandan languages, aimed at in- and out-of-school youth; ii) ST newspapers in English and six other Ugandan languages, primarily aimed at secondary school students; and iii) an English language Young Talk (YT) newspaper primarily aimed at primary school students. STF also implements a complementary array of school-based activities to engender a supportive school environment. It has invested in many community activities such as health fairs, and has worked to support youth-friendly health care services. The evaluation described here employed several strategies including a cross-sectional household survey of never-married adolescents, the main subject of this report. Other components included a household survey of parents, an assessment of the school environment, and a cost study. Results from the adolescent household survey are based on interviews with 2,040 males and females between the ages of 10 and 19 years. It was conducted in six districts: Apac, Arua, Ntungamo, Soroti, Kisoro, and Kamuli. While STF has been active in all six districts, it has been particularly active in the first four, broadcasting local language radio programs and providing cross-fertilizing local language ST newspapers. Thus STF has more intensive "conversations" with its audience in those districts. On the other hand, low intensity districts mostly received radio broadcasts and newspapers in English language. The study therefore assessed the impact of STF activities by level of intensity. Using multivariate methods, the study also conducted dose response analysis, i.e., impact of incremental exposure to STF activities on specific outcomes. (excerpt)

HIV and TB in the context of universal access: What is working and what is not? Report of an international open consultative meeting held in conjunction with the XVI International AIDS Conference, Toronto, Canada, 12-13 August 2006.

A meeting was co-organized by the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the International AIDS Society, the Treatment Action Group and the Forum for Collaborative HIV Research on behalf of the Global TB/HIV Working Group of the Stop TB Partnership in conjunction with the XVI International AIDS Conference in Toronto, Canada, on 12-13 August 2006. The objective of the meeting was to accelerate an effective and joint response to the epidemic of HIV-related tuberculosis (TB) by facilitating the sharing of information and experiences, networking and strengthening the partnership between TB and HIV (human immunodeficiency virus) communities in a forum environment. Lively and interactive discussion was promoted by a very successful marketplace, where participants presented and promoted their experiences, results, views, opinions and country-level findings in poster and display formats. The meeting was attended by almost 300 participants, mainly representing the HIV community, who were also attending the International AIDS Conference. A tribute was paid to Dr Lisa Onyemobi, WHO TB/HIV National Professional Officer in Nigeria, who died suddenly earlier in 2006. The meeting was followed by a TB/HIV satellite symposium on the afternoon of 13 August 2006, which was held as part of the International AIDS Conference. The International AIDS Society, Forum for Collaborative HIV Research, co-organized the satellite symposium with the Stop TB and HIV Departments of WHO. (excerpt)

Rich-poor gap in maternal care: The case of northeast India.

This paper examines the rich-poor gap in antenatal and delivery care in Northeast India on the basis of household economic well-being index constructed from household amenities, housing quality, consumer durables owned and assets. The study uses data on frequency of antenatal checks, iron folic supplementation, receiving two doses of tetanus toxoid injection and skill of delivery attendant from the Indian National Family Health Survey-II (1998-99). The finding reveals an unimaginably low level of maternal care in the region. Besides, there is evidence of concentration of women without adequate maternal care amongst the poorest economic strata. The need for region specific equitable maternal care services is suggested for the inaccessible northeastern region of India. (author's)

Low fertility in China: Trends, policy and impact.

China currently is the country with the largest population in the world. The Fifth National Population Census in 2000 reports that the total population of mainland China stands at 1.27 billion, while the 1 Percent National Population Sample Survey (mini-census) carried out in November 2005 reports the total population to be at 1.31 billion (National Statistics Bureau (NSB), 2006). China is also the country with the most stringent and government-directed family planning programme and fertility policy, having experienced a dramatic decline in fertility from 5 to 6 children per woman in the 1950s to less than 2 in recent years. The 2000 census reports China's total fertility rate (TFR) to be at 1.4. The rapid changes occurring in China's population dynamics call for a review of the fertility transition in China in terms of trends, policy and impact. This article will first discuss the population dynamics ongoing in China in terms of growth, birth rate and fertility and then examine the fertility policy implemented by the Government of China, before exploring the impact of fertility decline in terms of population ageing, gender equality, sex ratio at birth and labour supply. (excerpt)

Action of the International Conference on Population and Development and the Millennium Development Goals in the Pacific.

The sociocultural and demographic heterogeneity of Pacific island countries and territories, whose populations range from 6.3 million in Papua New Guinea to 1,200 people in Niue, adds to the complexity of monitoring progress towards achieving the MDGs in the Pacific. The difficulty of determining whether valid data exist for relevant indicators and the ambiguity of interpretation of certain indicators and targets within the context of very small populations poses significant challenges to monitoring progress towards the achievement of the MDGs. Furthermore, the reporting of summary statements with average figures does not adequately capture the disparities that exist across socio-economic groups, rural/urban groups or main island versus outer islands. To further complicate the issue, there is no single set of SRH indicators that would appear appropriate for the Pacific; the relatively conservative sociocultural setting poses some problems to the measurement of sexual behaviour; routine health information systems do not capture the needed community-based data; and national demographic health surveys have not been previously undertaken in many countries in the region. In addition, information on access to care is largely unavailable for the region. The status of sexual and reproductive health and prospects for achieving the MDGs, as outlined in this article, was written bearing in mind these aforementioned constraints. (excerpt)

Antioxidant activity and lipid peroxidation in preeclampsia.

Epidemiologic studies demonstrate a relation between preeclampsia and an increased risk of future maternal coronary heart disease. The pathophysiology of the underlying mechanism is unknown. Disorders of lipoprotein metabolism may contribute to endothelial dysfunction. Oxidative stress and decreased antioxidant defense enhances free radical-mediated membrane lipid peroxidation and possibly vascular endothelial damage. The aim of this study was to elucidate the possible relation between lipidemic status, lipid peroxidation and albumin with total antioxidant activity (AOA) that may contribute to atherogenicity in preeclamptic women. Twenty-five women with preeclampsia and 25 normal pregnant women who were matched for maternal and gestational age were selected for the study. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), atherogenic index (AI), malondialdehyde (MDA), a marker of lipid peroxidation, AOA and albumin levels were measured. MDA, TC and AI were significantly elevated (p less than 0.001), and HDL-C, AOA and albumin levels were significantly decreased (p less than 0.001) in preeclamptic patients compared to the control group. We conclude that hypercholesterolemia leads to excessive lipid peroxidation. Coexistent diminution in antioxidant activity leads to an imbalance between prooxidants and antioxidants, resulting in oxidative stress. Oxidative stress and elevated AI may contribute to atherogenicity in preeclampsia. (author's)

Lowest-low fertility in the Republic of Korea: Causes, consequences and policy responses.

Lowest-low fertility appeared quite suddenly in the Republic of Korea although fertility has consistently declined for several decades. Demographers in the mid-1990s could not have predicted that fertility would fall so rapidly to such levels. Interestingly, the pace of the decline accelerated after the region-wide economic crisis in 1997. Not only did fertility but also other indicators related to fertility and the family adjusted suddenly and significantly after the country had passed through the crisis. The present article aims to explain why lowest-low fertility appeared in the Republic of Korea in the late 1990s. The author approaches the recent fertility decline from a broader perspective that considers the traditional and cultural legacies which affect the everyday life of ordinary citizens. Finally, this article presents and discusses the latest population policies proposed by the Government of the Republic of Korea. (excerpt)

Where do tuberculosis patients go for treatment before reporting to DOTS clinics in southern Nigeria

Health-seeking patterns of persons with tuberculosis (TB) before reporting at the Directly Observed Treatment Short-course (DOTS) clinic for diagnosis and treatment were analysed. A total of 221 persons registered in the DOTS programme in 12 randomly selected rural and urban Local Government Areas in southern Nigeria were interviewed using a semi-structured questionnaire. Perceived causes of TB influenced first choice of treatment. Patients re-evaluated initial choices and shop for alternatives in persistent TB. Chemists were the first port of call for most patients. Those with unscientific causative theories of tuberculosis such as witchcraft engaged more in multiple health-seeking than those who indicated bacterial infection (P less than 0.0001). The respondents had a median diagnostic-delay of 90 days. Delay in commencement of DOTS treatment was attributable to ignorance among patients and poor attitude of health workers. In conclusion, delay exists between recognition of symptoms and initiation of treatment in DOTS clinics partly because of ignorance among patients. Health workers' attitude to patients reporting at health clinics also discouraged the use of DOTS facilities. Consequently, it is recommended to address such delay through social mobilization of communities and through engaging Chemists in TB service delivery in this area. (author's)

Civil society perspectives on HIV / AIDS policy in Nicaragua, Senegal, Ukraine, the United States, and Vietnam. Overview.

National governments and international agencies attempting to address HIV/AIDS continue to exclude or ignore marginalized groups that are disproportionately affected by the epidemic. In countries ranging from the United States, with some of the world's best medicine and health care technology, to Senegal, where more than 50 percent of the population lives below the poverty line, marginalized groups-injecting drug users, sex workers, men who have sex with men, prisoners, and ethnic minorities-are frequently excluded from the design, implementation, and evaluation of national HIV/AIDS policies and programs. The Open Society Institute's Public Health Watch HIV/AIDS Monitoring Project has documented the varying degrees and different forms that stigma and discrimination against marginalized groups can take in five developed and developing countries: Nicaragua, Senegal, Ukraine, the United States, and Vietnam. The results of this research, which are highlighted in this overview and available in five separate country reports, have made it clear that national governments and international agencies must collaborate more effectively with these groups in order to hear their concerns and address their needs. It will only be through the active and meaningful participation of these marginalized, most affected groups that countries will be able to achieve universal access to HIV/AIDS prevention, treatment, care, and support and to halt the progress of the HIV epidemic. (excerpt)

Availability, accessibility and utilization of pacific island demographic data -- issues of data quality and user relevance.

While ensuring that data are available, and available on time it is imperative to en sure also that they are of good quality - reliable (of sound quality) and valid (meaning that they do measure what they are meant to). This requires skilled and experienced staff in place, right through out Pacific island countries and territories' national statistical systems, and not merely at the level of section or agency head. (author's)

Children's health and nutritional status. A new look at data from the 2005 Ethiopia Demographic and Health Survey (EDHS).

The 2005 Ethiopia Demographic and Health Survey (EDHS) is the second in a series of national surveys conducted in Ethiopia. It is designed to measure levels, patterns, and trends in demographic and health indicators. In the 2005 EDHS, a nationally representative sample of 14,070 women and 6,033 men from 13,721 households were interviewed. Overall, 96 percent of women and 89 percent of men who were selected in the sample agreed to be interviewed. This sample provides estimates for Ethiopia as a whole, for urban and rural areas of the country, for each of the nine regions, and for the two Administrative Council Areas of Addis Ababa and Dire Dawa. The Ethiopia DHS provides data on fertility, family planning, maternal and child health, nutrition, malaria, HIV, and women's status. The background characteristics of women and men are also collected, allowing their health and demographic indicators to be compared to their age, residence, wealth, and educational level. Women interviewed in the EDHS were asked questions about the health of their young children (those under five). This booklet looks exclusively at children's health and nutritional status in Ethiopia. (excerpt)

The demographic impact of the HIV / AIDS epidemic in Papua New Guinea, 1990 - 2030.

The first case of human immunodeficiency virus (HIV) infection in Papua New Guinea was detected in the capital in 1987. After a relatively short period during which the epidemic was concentrated in certain "high-risk" groups, the disease spread throughout the country and by 2005 had become a "generalized epidemic" - with a 1 per cent HIV prevalence rate among adults aged 15-49. The most recent (2007) estimates suggest that the adult prevalence rate has risen to 1.6 per cent, confirming that the epidemic is continuing to grow rapidly. The scale of the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) epidemic in the country has reached the point where future demographic patterns are likely to be affected, possibly severely. Among the demographic impacts to be expected based on the experience of other countries with generalized epidemics are an increase in the number of deaths, particularly among young adults leading in turn to reduced life expectancy. The rate of population growth will drop as a higher death rate reduces the rate of natural increase. The number of births can also be expected to decline owing to the impaired fecundity of HIV positive women. Changes to the age structure follow from the concentration of excess AIDS mortality in the young adult age groups. (excerpt)

The impact of education on health outcomes. A new look at data from the 2005 Ethiopia Demographic and Health Survey.

The 2005 Ethiopia Demographic and Health Survey (EDHS) is the second in a series of national surveys conducted in Ethiopia. It is designed to measure levels, patterns, and trends in demographic and health indicators. In the 2005 EDHS, a nationally representative sample of 14,070 women and 6,033 men from 13,721 households were interviewed. Overall, 96 percent of women and 89 percent of men who were selected in the sample agreed to be interviewed. This sample provides estimates for Ethiopia as a whole, for urban and rural areas of the country, for each of the nine regions, and for the two Administrative Council Areas of Addis Ababa and Dire Dawa. The Ethiopia DHS provides data on fertility, family planning, maternal and child health, nutrition, malaria, HIV, and women's status. The background characteristics of women and men are also collected, allowing their health and demographic indicators to be compared to their age, residence, wealth, and educational level. This booklet looks exclusively at the relationship between education and demographic and health indicators. (excerpt)

Banking options for children in situations of vulnerability, compounded by HIV / AIDS. Outcomes of a study conducted in Delhi, Andhra Pradesh and Tamil Nadu.

This study has been built on the successful existing initiatives of the Lead Partners (the intermediary non-governmental organisations) of Alliance India, their implementing NGOs and other NGOs out side the Alliance partners' network to promote savings schemes for children orphaned by AIDS and made vulnerable to HIV and AIDS. The results of this study aim to facilitate further discussion with various key stakeholders on the feasibility of banking for orphans and vulnerable children (both below 14 years of age who are prohibited to work but are engaged in work & earning money and below 18 years of age who can not access banking services without a guardian). Within the context of orphans and vulnerable children, this study aimed to: explore the need for institutional banking facilities for those children who have no fixed address, guardian or parent; review the existing legal and banking barriers for orphans and vulnerable children; recommend policy and legal changes that may facilitate the provision of banking options for orphans and vulnerable children. (excerpt)

Improved microscopy diagnosis of pulmonary tuberculosis using sodium hypochlorite concentration technique in Tanga, Tanzania.

Pulmonary tuberculosis diagnosis commonly relies on the bacteriological examination of sputum. A cross-sectional hospital-based study was carried out to compare on "on the spot" sputum staining using sodium hypochlorite (bleach method) and routine Ziel-Neelsen (ZN) staining technique. Study candidates included individual patients presenting with cough less than 3 weeks (Group I) and greater than or equal to 3 weeks (Group II). Sensitivity and specificity of the bleach method was calculated and compared at 100% using the ZN staining technique as the standard. A total of 171 patients (94 males, 77 females) with mean age 34.9 years (SD plus or minus 12.9) were recruited. Fifty-eight patients had coughed for less than 3 weeks while 113 had coughed for greater than or equal to 3 weeks. Smear-positive TB in Group I was 13.8% (95% CI = 5-23) while in Group II was 25.7% (95% CI = 21-29). Using the bleach method, the prevalence of smear-positive TB in Group II was 28.3% (CI 95% = 20-36). This was an increase in smear-positivity rate of 15.6% as compared to the ZN technique. These results suggest that the use of bleach technique "on the spot" improve the sensitivity of tuberculosis diagnosis among patients with a history of coughing of over three weeks. However, further studies in different settings are recommended to validate the technique. (author's)

Stagnation in fertility levels in Pakistan.

Finally, at the turn of the century and after decades of stagnancy, there was definite evidence of a decline in fertility in Pakistan. Fertility in Pakistan probably began to decline in the early 1990s or even in the late 1980s. Significantly, all estimates for the 1990s for the first time fell below 6.0 births per woman to a little less than five. This is in contrast to numerous surveys that indicated that the TFR remained above six births per woman in the 1980s. Furthermore the last census held finally in 1998, indicated that the average population growth rate for the period 1981-1998 was 2.6 per cent per annum, a decline from previous intercensal rates, consistent with a decline in fertility in the 1990s. While this trend in fertility decline has continued - even touted as one of the "fastest declines in Asia" - the latest Pakistan Demographic and Health Survey (PDHS) indicates a stall in fertility at four children per woman. (excerpt)

Senegal final report, October 2000 - September 2001; June 2004 - September 2006 for USAID's Implementing AIDS Prevention and Care (IMPACT) Project.

IMPACT/Senegal began in 2001 under USAID/Senegal's new country program with a mandate to implement activities in the domains of HIV prevention, care and treatment, surveillance and capacity development, and to cover six of Senegal's 11 regions, including Dakar. In partnership with 14 local organizations, including three MOH institutions, IMPACT/Senegal targeted individuals, communities, and service delivery personnel in a comprehensive approach to contribute to USAID's Strategic Objective # 3 to increase access to, and use of, reproductive health services and information. The key results under this strategic objective were: increased access to STI/HIV/AIDS services; increased demand for STI/HIV/AIDS services; increased knowledge of the importance of STI/HIV/AIDS services. (excerpt)

Fertility decline in Asia: The role of marriage change.

In dealing with fertility decline in Asia, the present article needs to strike an appropriate balance, examining the role of marriage change without exaggerating its role. The first section summarizes current trends in fertility in some Asian countries, particularly where fertility has reached very low levels. Changes in marriage (particularly delays in marriage) in those countries are discussed in the second section. Available evidence of the disaggregation of fertility decline into marriage change and marital fertility decline is then summarized. The fourth section examines the factors influencing marriage and those influencing fertility within marriage, considering the extent to which they are interlinked or separate. A brief discussion of policy on marriage change for fertility reduction rounds out the substantive scope, followed by the final section that draws some conclusions. (excerpt)

Delays in the diagnosis and treatment of tuberculosis patients in Vietnam: A cross-sectional study.

Treatment delay is an important indicator of access to tuberculosis diagnosis and treatment. Analyses of patient delay (i.e. time interval between onset of symptoms and first consultation of a health care provider) and health care delay (i.e. time interval between first consultation and start of treatment) can inform policies to improve access. This study assesses the patient, health care provider and total delay in diagnosis and treatment of new smear-positive pulmonary tuberculosis patients, and the risk factors for long delay, in Vietnam. A cross-sectional survey of new patients treated by the National Tuberculosis Control Programme was conducted in 70 randomly selected districts in Vietnam. All consecutively registered patients in one quarter of 2002 were interviewed using a pre-coded structured questionnaire. Median (range) delay was 4 weeks (1-48) for total, 3 (1-48) weeks for patient and 1 (0-25) week for health care delay. Patients with long total delay (greater than or equal to 12 weeks, 15%) accounted for 49% of the cumulative number of delay-weeks. Independent risk factors (p less than 0.05) for long total delay were female sex, middle age, remote setting, residence in the northern or central area, and initial visit to the private sector. For long patient delay (greater than or equal to 6 weeks) this was female sex, belonging to an ethnic minority, and living at greater than 5 km distance from a health facility or in the northern area. For long health care delay (greater than or equal to 6 weeks) this was urban setting, residence in the central area and initial visit to a communal health post, TB hospital or the private sector. Analyses of patient and treatment delays can indicate target groups and areas for health education and strengthening of the referral system, in particular between the private sector and the NTP. (author's)

Post-election violence in Kenya particularly hard on HIV patients

Human exposure to endocrine disrupters and semen quality

Reproductive pathology in the male represents about 20% of infertility cases. Male infertility may be attributed to a number of causes, including genetic and congenital abnormalities, infection, multisystemic diseases, varicocele, and others; however, a significant number of cases are idiopathic. Global declines in semen quality were suggested to be associated with enhanced exposure to environmental chemicals that act as endocrine disrupters as a result of our increased use of pesticides, plastics, and other anthropogenic materials. A significant body of toxicology data based upon laboratory and wildlife animals studies suggests that exposure to certain endocrine disrupters is associated with reproductive toxicity, including (1) abnormalities of the male reproductive tract (cryptorchidism, hypospadias), (2) reduced semen quality, and (3) impaired fertility in the adult. There is, however, a relative paucity of studies designed to measure exposure to endocrine disrupters on semen quality parameters (sperm concentration, motility, morphology). An overview of the human semen quality literature is presented that examines the role of endocrine disrupters including organochlorines (OC), dioxins, phthalates, phytoestrogens, and chemical mixtures (pesticides and tobacco smoke).

Ghana: Anaemia among women contributes 20 percent maternal deaths

HIV prevention and low-income Chilean women: Machismo, marianismo and HIV misconceptions

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.

South Africa: New stats show millions more HIV positive

Kenya: Govt Adopts Circumcision Policy to Fight HIV

Domestic violence surveillance system: A model

The objective was to develop a domestic violence surveillance system. The strategies included implementation of a standard digitalized reporting and analysis system along with advocacy with community decision makers, strengthening inter-institutional attention networks, consultation for constructing internal flow charts, sensitizing and training network teams in charge of providing health care in cases of domestic violence and supporting improved public policy prevention initiatives. A total of 6 893 cases were observed using 2004 and 2005 surveillance system data. The system reports that 80% of the affected were women, followed by 36% children under 14 years. The identified aggressors were mainly females' partners. The system was useful for improving victim services. Findings indicate that significant gains were made in facilitating the attention and treatment of victims of domestic violence, improving the procedural response process and enhancing the quality of information provided to policy-making bodies.

Reproductive health awareness among adolescent girls in rural Bangladesh

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.

Perspectives on domestic violence: Case study from Karachi, Pakistan

There is no adequate profile of domestic violence in Pakistan although this issue is frequently highlighted by the media. This case study used qualitative and quantitative methods to explore the nature and forms of domestic violence, circumstances, impact and coping mechanisms amongst selected women victims in Karachi. Violence was a continuum: all the women reported verbal abuse, often escalating into physical, emotional, sexual and economic abuse. The husband was the most common perpetrator. Women suffered in silence due to sociocultural norms, misinterpretation of religious beliefs, subordinate status, economic dependence and lack of legal redress. Besides short-term local measures, public policy informed by correct interpretation of religion can bring about a change in prevailing societal norms.

Uganda: Kyafu urges on family planning

Trends in youth reproductive health in Ethiopia, 2000 and 2005

The data for this study come from the 2000 and 2005 Ethiopia Demographic and Health Surveys (EDHS). The report is based on an in-depth analysis of 6,570 women and 1,008 men age 15-24 interviewed in the 2000 EDHS and 5,813 women and 2,399 men age 15-24 interviewed in the 2005 EDHS. These youth are a subgroup of a nationally representative sample of 15,367 women age 15-49 and 2,607 men age 15-59 interviewed in the year 2000 and 14,070 women age 15-49 and 6,033 men age 15-59 interviewed in the year 2005. There are many positive developments for youth in Ethiopia. Nonetheless, there remains room for substantial improvement. Overall, youth are more highly educated than their older peers. However, educational attainment among youth remains low, with half of young women and one-fourth of young men having no education. On all levels, young men are more educated than young women. The proportion of young respondents with no education decreased between 2000 and 2005, while the proportion of youth attending all levels of education increased during the period. Literacy levels among youth increased dramatically between 2000 and 2005. However, literacy levels among female youth remained substantially lower than levels among male youth. Young women are less likely to be employed than young men. Seven in ten young men were currently employed at the time of the 2005 EDHS, but only about three in ten young women were. Both young women and young men are less likely to be employed than their older counterparts. Youth in Ethiopia have more exposure to mass media than older people do. Over time, this exposure has been increasing although levels are still low-in 2005, seven in ten persons age 15-24 did not have weekly exposure to any form of mass media.

Sexual pleasure, gender power and microbicide acceptability in Zimbabwe and Malawi

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.

Starting young: Sexual initiation and HIV prevention in early adolescence

The rising numbers of new HIV infections among young people ages 15�24 in many developing countries, especially among young women, signal an urgent need to identify and respond programmatically to behaviors and situations that contribute to the spread of HIV and other sexually transmitted infections in early adolescence. Quantitative and qualitative studies of the sexual knowledge and practices of adolescents age 14 and younger reveal that substantial numbers of boys and girls in many countries engage in unprotected heterosexual vaginal intercourse��by choice or coercion��before their 15th birthdays. Early initiation into male�male or male�female oral and/or anal sex is also documented in some populations. Educational, health, and social programs must reach 10�14-year-olds as well as older adolescents with the information, skills, services, and supplies (condoms, contraceptives) they need to negotiate their own protection from unwanted and/or unsafe sexual practices and to respect the rights of others.

Africa: 'God should be so kind that I can have contraceptives'

India: Dial M for Malthus

South Africa: �I am at the lowest end of all�. Rural women living with HIV face human rights abuses in South Africa

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.

Trends in stillbirths, early and late neonatal mortality in rural Bangladesh: The role of public health interventions

Trends were examined in a cohort study of stillbirths and early and late neonatal deaths in Matlab, a rural area of Bangladesh between 1975 and 2002, using routinely collected demographic surveillance data. Main outcome measures were stillbirths per 1000 births, early neonatal deaths per 1000 livebirths, and late neonatal deaths per 1000 children surviving after 1 week. The authors performed a logistic regression examining trends over time and between two areas in the three outcome measures, controlling for the effects of parental education, religion, time, geography, parity, maternal age and birth spacing. There was a marked decline in stillbirths, early and late neonatal mortality over time in both areas, though the pace of decline was somewhat faster in the ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) service area. Stillbirths declined by 24% overall in the ICDDR,B service area (crude OR comparing 1996-2002 with 1975-81: 0.76 [95% CI 0.68, 0.84]), compared with 15% in the Government service area (crude OR comparing 1996-2002 with 1975-81: 0.85 [0.76, 0.94]). The overall reduction in early and late neonatal mortality comparing the same periods was 39% and 73%, respectively, in the ICDDR,B area, compared with 30% and 63%, respectively, in the Government service area. Adjusting for socio-economic or demographic factors did not substantially alter the time or area differentials. The dramatic decline in neonatal mortality was, in large part, due to a fall in deaths from neonatal tetanus. The pace of decline was faster in the area receiving intense maternal and child health and family planning interventions, but stillbirths, early and late neonatal deaths also declined in the area not receiving such intense attention, suggesting that factors outside the formal health sector play an important role.

Dueling protests target morning-after pill distribution ban in Chile

Uganda: ARVs Give HIV Postive Children, Women Hope

Female condom uptake and acceptability in Zimbabwe

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.