Ton van der Velden
Please find here some of the RH news from June 2008.
Excellent news but a no-brainer: The UN Security Council has unanimously voted in favor of a resolution opposing the use of rape as a weapon of war.
Well, the flap over UNAIDS and the importance of HIV in global health has not yet died down. Kevin deCock (Director of the HIV/AIDS dept in WHO) was quoted this month in the Independent, as saying that the threat of a generalized heterosexual AIDS epidemic outside Africa may be over. (See also The spread, treatment, and prevention of HIV-1: evolution of a global pandemic, which he co-authored) A few days later the same DeCock and Paul deLay (Director of the Department of Evidence, Monitoring and Policy, UNAIDS) had this to say: “AIDS remains the leading infectious disease challenge in global health. To suggest otherwise is irresponsible and misleading.” I must say I find the wording vague and disingenuous. Leading challenge? What is that? In what sense? Political? Scientific? Certainly not funding-wise…
John Bongaarts from the Population Council has also joined from a demographic perspective. He and colleagues ask in the June issue of Population and Development Review: Has the HIV Epidemic Peaked? And the answer seems to confirm deCocks earlier statement: Yes, it has. Meanwhile the 2008 high-level meeting on AIDS took place last month in the UN General Assembly. To the best of my knowledge the issue was not mentioned.
BTW this problem with disproportionate funding for HIV is not going to go away. Almost one million more people in poor countries with HIV/AIDS received ARVs in 2007 than in 2006, bringing the total to almost three million. But an estimated 6.7 million in need were still unable to access ARVs says the new UNAIDS/WHO report Towards Universal Access. So say we get the other 6.7 million on ARVs, and all newly infected people as well in the coming years. That means there is going to be a greater moral responsibility for not stopping these treatments (people have expectations that they will continue to receive ARVs) and that means even greater levels of funding are needed. Expect this debate to get more intense, not less so…
And undisturbed, the Global Fund Launches an additional funding round
OK, more on AIDS and morality: The Report of the Commission on AIDS in Asia noted that sex workers are part of the solution to preventing the spread of HIV, and advised countries to "avoid programs that accentuate AIDS-related stigma and can be counterproductive. Such programs may include ‘crack-downs' on red-light areas and arrest of sex workers." (A new study from New Zealand, for example, shows that decriminalisation of sex work has led to less exploitation with no increase in prostitution.) Ban Ki-Moon endorsed the report. That was March of this year. And low and behold, what does Cambodia do in June? It issues a law against prostitution and cracks down hard. Sex workers have been forcibly detained in rehabilitation centers where they have been raped and robbed by police and guards. Thousands of women have lost their livelihoods and HIV positive sex workers have great difficulty in accessing ARV's- both in and outside the detention centres. See here for a video report.
Consistent with the Bush government previous positions (eg in the anti-prostitution pledge requested by USAID), here is how the US responded to the Cambodian law..Even the US Ambassador to Cambodia, Joseph Mussomeli, has said he thinks it is likely that Phnom Penh has initiated the crackdown “just to keep the Americans off their back”. It has worked: The latest State Department report on trafficking, published a few days after the crackdown began, has upgraded Cambodia from the wicked to the less wicked category on its trafficking watch list.
In other parts of the world politicians are more sensible: Malaysia's deputy health minister urged every woman in the country to carry a condom to protect against HIV, and a Jamaican politician said sex work should be decriminalized. He is trying to sell it as a way to tax their income….Whoops! The Jamaican Prime Minister, Bruce Golding, has openly condemned the statement, assuring the public that his government has no such intentions. Golding also went a step further to warn that in the future, public officials can face serious sanctions if they make public statements that run "counter to Government policy."
The second clinical trial for a H5N1 vaccine was successful: See A Clinical Trial of a Whole-Virus H5N1 Vaccine Derived from Cell Culture. Read about the first trial here. The difference is that the first trial was done with virus grown in chicken eggs, and this one with vaccine grown in Vero cell culture: a much quicker way of producing vaccine in large quantities. Also, getting your hands on eggs for virus production when everyone is busy killing of chickens during an epidemic is maybe not the best bet…
And vaccine doses are getting lower and lower: An Adjuvanted, Low-Dose, Pandemic Influenza A (H5N1) Vaccine Candidate Is Safe, Immunogenic, and Induces Cross-Reactive Immune Responses in Healthy Adults.
Policies and projects:
The Gates Foundation has decided to throw its support behind the development of new forms of family planning. Representatives from the Foundation introduced the Global Health Program's new Reproductive and Maternal Health strategy at several conferences last month. The development of new contraceptive technologies is one of their five major reproductive health grant making priorities. The Foundation’s website describes this priority as “improving contraceptive methods through the discovery, development, and clinical testing of methods that are more acceptable to potential users, easier to use, more effective, and better suited for use in resource-limited settings.”
Unexpected? CIA Director Gen. Michael Hayden recently identified population growth as one of three top destabilizing trends currently facing the world.
And then the science:
Very interesting: Meta-Analysis of Intrauterine Device Use and Risk of Endometrial Cancer suggest that non-hormonal IUD use may be associated with a decreased risk for endometrial cancer
Occurrence of menses or pregnancy after cessation of a continuous oral contraceptive
Emergency Contraception: Overestimated Effectiveness and Questionable Expectations
Advances in Male Contraception
And related: Evaluation of the potential of synthetic peptides of 80 kDa human sperm antigen (80 kDaHSA) for the development of contraceptive vaccine for male
Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it
Effects of two low-dose combined oral contraceptives containing drospirenone on bone turnover and bone mineral density in young fertile women: a prospective controlled randomized study
Inverse association of NSAID use and ovarian cancer in relation to oral contraceptive use and parity
Other family planning research is here, here, and here.
UNICEF released the State of the World’s Children: Child Survival.
Mortality rates from malaria in children under 5 fall sharply in 10 countries
This makes painful but obligatory reading: No One to Turn To - The under-reporting of child sexual exploitation and abuse by aid workers and peacekeepers
Effect of 50 000 IU vitamin A given with BCG vaccine on mortality in infants in Guinea-Bissau: randomised placebo controlled trial showed that Vitamin A supplementation given with BCG vaccine at birth had no significant benefit in this African setting
Urine dipstick as a screening test for urinary tract infection
The use of hand washing, masks, gloves, and gowns alone or in combination were effective in preventing the spread of respiratory virus infections according to Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review
How odd: Differential Gender Response to Respiratory Infections and to the Protective Effect of Breast Milk in Preterm Infants shows that breastfeeding decreased the risk for severe acute lung disease in very preterm girls but not in boys.
School-based drama interventions in health promotion for children and adolescents: systematic review
Pregnancy and injecting drug use
Peter Piot is stepping down after 13 years as head of UNAIDS
Coinfection of tuberculosis and HIV poses global threat
Children and AIDS: Second Stocktaking Report, 2008 from UNICEF, UNAIDS, and WHO addresses OVC, treatment, and PMTCT, as well as funding and monitoring.
Securing our Future, Report of the Commission on HIV/AIDS and Governance in Africa (careful 5.6MB) says many cultural factors, including gender inequalities, wife inheritance and some sexual practices, that influence the AIDS epidemic and response are specific to the continent and must be better understood and changed.
‘I am at the lowest end of all’ - Rural women living with HIV face human rights abuses in South Africa from Amnesty International 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.
Asia Pacific Civil Society and 2008 UNGASS on HIV and AIDS Some 25 countries from Asia and the Pacific submitted their country’s 2008 AIDS Progress Report. This publication provides a review of 25 country’s AIDS progress Reports, other related literature and key contacts’ feedback.
Women, Ink, a program of the International Women’s Tribune Centre, has compiled a collection of materials entitled “HIV/AIDS and Women: Resources to Support Policy and Advocacy
Involving Young People in Efforts to Combat HIV and AIDS in Africa: the Importance of Income-Generating Strategies, 2007 from Education Development Center, International Youth Foundation, and Rotary emphasizes strategies to involve young people in income-generating activities to fight HIV/AIDS in sub-Saharan Africa.
Preventing HIV/AIDS among Adolescents through Integrated Communication Programming, from UNFPA guides program managers for evidence-based communication programming for HIV prevention among adolescents.
ICAP has prepared 2 PMTCT infant feeding technical guides: Infant Feeding in the Context of HIV Infection and HIV and Infant Feeding – ICAP Approach to Improving HIV-free Survival
The Extending Service Delivery Project launched Mobilizing Muslim Religious Leaders for RH/FP at the Community Level: A Training Manual (see the box on the left), a 5-day training curriculum designed to equip male and female Muslim Religious Leaders with information and skills to better understand, accept, and support the provision of MCH/RH/FP information and services, presenting a perspective consistent with the teachings of Islam.
Management of Chronic Hepatitis C Virus Infection in HIV-Infected Patients
Nutrition and Tuberculosis: A review of the literature and considerations for TB control programs reviews scientific literature on the role of nutrition in TB disease, summarizes key findings and knowledge gaps, and investigates related programmatic experience.
Is poverty a driver for risky sexual behaviour? evidence from national surveys of adolescents in four African countries
This is reassuring: Risk Compensation Is Not Associated with Male Circumcision in Kisumu, Kenya: A Multi-Faceted Assessment of Men Enrolled in a Randomized Controlled Trial or, in other words, men who have been circumcised do not engage in riskier behavior. Previous trials – all observational, not prospective- have shown different results..m
The Safety of Adult Male Circumcision in HIV-Infected and Uninfected Men in Rakai, Uganda
Two important studies on preventing early death and HIV infection among breastfeeding infants of HIV+ mothers in poor countries. Effects of Early, Abrupt Weaning on HIV-free Survival of Children in Zambia found that early weaning does not improve the rate of HIV-free survival among children born to HIV+ mothers in a low-resource setting. Extended Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission concluded that extended prophylaxis with nevirapine or with nevirapine and zidovudine for the first 14 weeks of life significantly reduced postnatal HIV-1 infection in 9-month-old infants.
A gaggle of studies (For example this one) have shown that people with HSV-2 are more likely to get infected with HIV, in part because they are more likely to have ulcers that open the door to HIV. So it was perfectly logical to think that if we suppressed the herpes, we’d have fewer new HIV infections. The first study, among high risk women in Tanzania, was not encouraging. Now a much larger study among women in South Africa, Zambia and Zimbabwe and gay men in Peru and North America have confirmed the gloom. Apparently treating herpes has no effect on acquiring HIV. Prevention of HIV by treating HSV is still possible in the context of labor and delivery though. See Maternal herpes simplex virus type 2 coinfection increases the risk of perinatal HIV transmission: possibility to further decrease transmission?
Carbon monoxide aids shift from active infection to a drug-resistant dormant TB
Australia has seen a significant drop in breast cancer according to Decrease in breast cancer incidence following a rapid fall in use of hormone replacement therapy in Australia. FYI, the drop in HRT prescriptions came after this article was published in JAMA in 2002.
Community Pathways to Improved Adolescent Sexual and Reproductive Health aims to enhance efforts to improve ASRH program outcomes by presenting an intervention framework for changing community norms and practices as well as enhancing even amplifying individual and structural interventions. And somewhat on the same topic: See also Science & Success in Developing Countries: Holistic Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Oh, and Youth InfoNet 46 is out..
Reproductive Health and Rights - Reaching the Hardly Reached brings together a public health and human rights focus on the reproductive health and rights of women and men who are the most disadvantaged and underserved: the "hardly reached."
Marital Violence: Is it a Factor Affecting the Reproductive Health Status of Women?
Safety of screening with Human papillomavirus testing for cervical cancer at three-year intervals in a high-risk population: experience from the LAMS study
Management Strategies for Premenstrual Syndrome/Premenstrual Dysphoric Disorder
Selective Serotonin Reuptake Inhibitors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder
Medical Students for Choice's Reproductive Health Externships: impact on medical students' knowledge, attitudes and intention to provide abortions
Comparison of two doses and two routes of administration of misoprostol after pre-treatment with mifepristone for early pregnancy termination
The METEX study: methotrexate versus expectant management in women with ectopic pregnancy: a randomised controlled trial.
Migraine in pregnancy
Severe vaginal tears occur during childbirth in up to 20 percent of women, but those receiving antibiotics in this study had a third as many infections or other healing complications two weeks after the tears were surgically repaired following the delivery. See Antibiotic Prophylaxis for Prevention of Postpartum Perineal Wound Complications
Episiotomy and Increase in the Risk of Obstetric Laceration in a Subsequent Vaginal Delivery shows episiotomy at first vaginal delivery increases the risk of spontaneous obstetric laceration in the subsequent delivery. “Based on these findings, for every four episiotomies not performed one second-degree laceration would be prevented” Use this article to convince people to restrict routine episiotomy use!
Decreasing the Incidence of Anal Sphincter Tears During Delivery. Slowing the delivery of the infant’s head and instructing the mother not to push while the head is delivered decreased the incidence of anal sphincter tears significantly from 4.03% to 1.17%.
The 82-year-old founder of Republicans for Choice, Harriet Stinson, is throwing in the towel on her own party and re-registering as a Democrat because of John McCain's views on reproductive rights.
The Bronx, a borough of New York that is home to 1.3 million people, has decided that it is going to try to test all adults for HIV over the next three years, according to The New York Times.
Medical evidence exposes US use of torture
Viet Nam interest
Medical Committee Netherlands – Vietnam (MCNV) in collaboration with the Vietnam Women’s Union have published “Expanding livelihood choices for women and their families affected by HIV/AIDS: A Manual on Micro – Enterprise Support”. Copies can be ordered at Ms. Nguyen Hai Ha,
Where Is Credit Due? Legal Institutions, Connections, and the Efficiency of Bank Lending in Vietnam
Participatory village and commune development planning (VDP/CDP) and its contribution to local community development in Vietnam
Health insurance reform in Vietnam: a review of recent developments and future challenges
Sexual coercion within marriage in Quang Tri, Vietnam.
Strategies for the prevention and treatment of reproductive tract infections among women in Vietnam.
Drugs, sex and AIDS: sexual relationships among injecting drug users and their sexual partners in Vietnam.
Dengue risk factors and community participation in Binh Thuan Province, Vietnam, a household survey.
Dealing with a positive result: routine HIV testing of pregnant women in Vietnam.
HIV drug resistance threshold survey using specimens from voluntary counselling and testing sites in Hanoi, Vietnam.
Internet influences on sexual practices among young people in Hanoi, Vietnam.
Male sexual health concerns in Muong Khen, Vietnam.
Femininity and sexual agency among young unmarried women in Hanoi.
Economic reform in Vietnam.
Seroprevalence of Toxoplasma gondii antibody in Vietnamese villagers.
Teaching paediatric resuscitation skills in a developing country: introduction of the Advanced Paediatric Life Support course into Vietnam.
Drug resistance and HIV co-infection among pulmonary tuberculosis patients in Haiphong City, Vietnam.
These two are interesting given the commotion 10 years ago when FHI used quinacrine for sterilization in Viet Nam: Contraceptive effectiveness of two insertions of quinacrine: results from 10-year follow-up in Vietnam. And Safety of quinacrine contraceptive pellets: results from 10-year follow-up in Vietnam.
Nigeria 2003: Results from the Demographic and Health Survey.
Geographical information system and predictive risk maps of urinary schistosomiasis in Ogun State, Nigeria.
Adolescent Reproductive Health in Nigeria
Does female schooling reduce fertility? Evidence from Nigeria
Using Drama for School-Based Adolescent Sexuality Education in Zaria, Nigeria
Geographical variations and contextual effects on age of initiation of sexual intercourse among women in Nigeria: a multilevel and spatial analysis.
Missed treatment opportunities for schistosomiasis mansoni, in an active programme for the treatment of urinary schistosomiasis in Plateau and Nasarawa states, Nigeria.
Awareness of warning signs among suburban Nigerians at high risk for stroke is poor: A cross-sectional study.
Reducing child mortality in Nigeria: A case study of immunization and systemic factors.
A qualitative study of the feasibility and community perception on the effectiveness of artemether-lumefantrine use in the context of home management of malaria in south-west Nigeria.
Validation of the World Health Organization's Rapid Assessment method for urinary schistosomiasis in southeastern Nigeria.
Perceptions and home management practices of malaria in some rural communities in Abeokuta, Nigeria.
Morbidity from diarrhoea, cough and fever among young children in Nigeria.
Controlling Schistosomiasis: Significant Decrease of Anaemia Prevalence One Year after a Single Dose of Praziquantel in Nigerien Schoolchildren
Community action for preventing HIV in Cambodia: evaluation of a 3-year project
Forensic Science for Cambodian Justice
Efavirenz replacement by immediate full-dose nevirapine is safe in HIV-1-infected patients in Cambodia.
The insecticide resistance status of malaria vectors in the Mekong region.
Access to artemisinin combination therapy for malaria in remote areas of Cambodia.
Integration of comprehensive abortion-care services in a Maternal and Child Health clinic in Cambodia.
Differential Diagnosis of Disorders of Sex Development in Egypt.
Practices of Rural Egyptian Birth Attendants During the Antenatal, Intrapartum and Early Neonatal Periods
Psychiatric morbidity following hysterectomy in Egypt
Simplified Age-Weight Mortality Risk Classification for Very Low Birth Weight Infants in Low-Resource Settings.
A Clinical Decision Aid for Triage of Children Younger Than 5 Years and With Organophosphate or Carbamate Insecticide Exposure in Developing Countries.
Characteristics of women in consanguineous marriages in Egypt, 1988 -- 2000
Central obesity among adults in Egypt: prevalence and associated morbidity.
The impact of community level treatment and preventative interventions on trachoma prevalence in rural Ethiopia
The cost of Child Health Days: a case study of Ethiopia's Enhanced Outreach Strategy (EOS).
More than 100,000 children in Ethiopia need therapeutic feeding.
Dracunculiasis, Onchocerciasis, Schistosomiasis, and Trachoma
Association of smoking and khat (Catha edulis Forsk) use with high blood pressure among adults in Addis Ababa, Ethiopia, 2006.
Immunity against HIV/AIDS, Malaria, and Tuberculosis during Co-Infections with Neglected Infectious Diseases: Recommendations for the European Union Research Priorities.
Improving retention and performance in civil society in Uganda
Acceptability of evidence-based neonatal care practices in rural Uganda -implications for programming
Health Services for Survivors of Gender-Based Violence in Northern Uganda: A Qualitative Study
Understanding home-based neonatal care practice in rural southern Tanzania
Nutritional indicators of adverse pregnancy outcomes and mother-to-child transmission of HIV among HIV-infected women
Randomized, double-blind, placebo-controlled trial of selenium supplements among HIV-infected pregnant women in Tanzania: effects on maternal and child outcomes
Sociodemographic variations in communication on sexuality and HIV/AIDS with parents, family members and teachers among in-school adolescents: A multi-site study in Tanzania and South Africa
Sociocultural Barriers and Malaria Health Care in Tanzania.
Vouchers for scaling up insecticide-treated nets in Tanzania: Methods for monitoring and evaluation of a national health system intervention.
Malignant lymphomas (ML) and HIV infection in Tanzania.
alpha(+)-Thalassemia Protects against Anemia Associated with Asymptomatic Malaria: Evidence from Community-Based Surveys in Tanzania and Kenya.
Prevalence of reverse transcriptase and protease mutations associated with antiretroviral drug resistance among drug-naive HIV-1 infected pregnant women in Kagera and Kilimanjaro regions, Tanzania.
Surveillance of transmitted HIV drug resistance among women attending antenatal clinics in Dar es Salaam, Tanzania.
Potential use of birthweight indicators in rural Tanzania for monitoring malaria control in pregnancy.
Newborn care practices in Pemba Island (Tanzania) and their implications for newborn health and survival.
Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs.
The prevalence of Parkinson's disease in rural Tanzania.
The role of partnership dynamics in determining the acceptability of condoms and microbicides.
Anticysticercal and antitoxocaral antibodies in people with epilepsy in rural Tanzania.
HIV, HSV-2 and syphilis among pregnant women in a rural area of Tanzania: Prevalence and risk factors.
Health and survival of young children in southern Tanzania.
Pesticides use by smallholder farmers in vegetable production in Northern Tanzania.
Markets, voucher subsidies and free nets combine to achieve high bed net coverage in rural Tanzania.
Circumcision among adolescent boys in rural northwestern Tanzania.
Gender inequality increase women’s risk of HIV infection in Moshi, Tanzania
Serological response to hepatitis B virus vaccine in HIV-infected children in Tanzania.
Modeling the Financial and Clinical Implications of Malaria Rapid Diagnostic Tests in the Case-management of Older Children and Adults in Kenya
HIV-1 Proviral Hypermutation Correlates with CD4 Count in HIV Infected Women from Kenya
Placebo found Equivalent to Amoxicillin for Treatment of Acute Bronchitis in Nairobi, Kenya: A Triple-Blind Randomized Equivalence Trial
The Epidemiology of Human Rotavirus Associated with Diarrhoea in Kenyan Children: A Review
Effectiveness of web-based education on Kenyan and Brazilian adolescents' knowledge about HIV/AIDS, abortion law, and emergency contraception: Findings from TeenWeb.
Risk compensation is not associated with male circumcision in Kisumu, Kenya: a multi-faceted assessment of men enrolled in a randomized controlled trial.
No HIV stage is dominant in driving the HIV epidemic in sub-Saharan Africa.
HIV, hepatitis B and hepatitis C coinfection in Kenya.
Intimate partner violence in Kenya: expanding healthcare roles.
Family planning and safer sex practices among HIV infected women receiving prevention of mother-to-child transmission services at Kitale District Hospital.
Perceptions of children with HIV/AIDS from the USA and Kenya: self-concept and emotional indicators.
Modeling the financial and clinical implications of malaria rapid diagnostic tests in the case-management of older children and adults in Kenya.
Impact of two rounds of mass treatment with diethylcarbamazine plus albendazole on Wuchereria bancrofti infection and the sensitivity of immunochromatographic test in Malindi, Kenya.
Perspectives of Somali Bantu refugee women living with circumcision in the United States: A focus group approach.
Evaluation of a measles vaccine campaign by oral-fluid surveys in a rural Kenyan district: interpretation of antibody prevalence data using mixture models.
Single dose filgastrim in cytotoxic-induced neutropaenia in children.