Articles- Reproductive and Sexual Health Among Young Adults in Uzbekistan
Cynthia Buckley is Associate Professor of Sociology, and Jennifer Barrett is a graduate student, Department of Sociology, University of Texas at Austin, A1700 343 Burdine Hall, Austin, TX 78712. E-mail: cbuckley@mail.la.utexas.edu. Yakov P. Asminkin is Director, Tahlil Center for Social Research, Tashkent. Since 1991, contraceptive use has risen significantly in Uzbekistan while reliance on abortion has declined; yet reproductive health improvements have not translated into better conditions for sexual health. The prevalence of sexually transmitted diseases increased significantly in the 1990s, and UNAIDS currently identifies the Central Asian region as a high HIV-growth zone. Structural, institutional, and attitudinal factors have contributed to the disconnection between reproductive and sexual health in Uzbekistan, even though family planning programs have been well established during the HIV pandemic. Integrating state statistics, Demographic and Health Survey data, and focus-group-discussion results, we highlight the ways in which a heavily centralized program focusing on reproductive health did little to better sexual health, especially among young adults. The example of Uzbekistan reveals pathways by which reproductive health efforts may continue to be compartmentalized, decreasing their potential contributions to sexual health, especially among young adults. (Studies in Family Planning 2004; 35[1]: 1–14)
- Reassessing the Level of Unintended Pregnancy and Its Correlates in Vietnam
Linh Cu Le is Head, Department of Demography, Hanoi School of Public Health, 138 Giang Vo Street, Hanoi, Vietnam. E-mail: lcl@hsph.edu.vn. Robert Magnani is Chair, and Ilene Speizer is Lecturer, Department of International Health and Development; Janet Rice is Lecturer, Department of Biostatistics; and William Bertrand is Director, Payson Center for International Development and Technology Transfer, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. Despite rapidly increasing contraceptive use and rapidly declining fertility, unintended pregnancy and induced abortion remain common in Vietnam. This study reassesses the level of unintended pregnancy in Vietnam and its correlates, drawing on retrospective calendar data gathered for the Vietnam Demographic and Health Survey II. Data from 13,540 “segments” of outcomes and contraceptive practice were analyzed. Based on the calendar data, 40 percent of pregnancies during the 1994–97 period are estimated to have been unintended, a proportion 48 percent higher than the prevailing estimate calculated from the reported intendedness of live births. When concealment of pregnancies ending in induced abortions is taken into account, the unintended pregnancy rate in Vietnam is likely to approach levels found only in developing countries. Unintended pregnancy was found to be associated with age, early marriage, spousal age difference, number of living sons, past unintended pregnancy, geographic region, contraceptive use prior to pregnancy, and the family planning supply environment. The findings suggest that broadening the method mix at the community level, targeting high-risk and underserved groups, and expanding postabortion counseling and services are likely to have a dramatic impact on the unintended pregnancy rate in Vietnam. (Studies in Family Planning 2004; 35[1]: 15–26)
- Where Are the Gaps? The Effects of HIV-prevention Interventions on Behavioral Change
Lori Bollinger is Senior Economist and John Stover is Vice President, The Futures Group, 80 Glastonbury Boulevard, Glastonbury, CT 06033. E-mail: l.bollinger@tfgi.com. Katharine Cooper-Arnold is Protocol Manager, Klein Management Systems, Nanuet, NY. As more funding becomes available for HIV/AIDS programs in developing countries, an understanding of how prevention interventions lead to behavioral change and how behavioral change leads to reductions in HIV prevalence is crucial. This study presents the results of an extensive effort to develop a matrix to relate coverage of key HIV/AIDS-prevention services to changes in behavior among different risk groups and to describe the gaps that exist in the literature. Many studies could not be included in the matrix because they did not meet the necessary criteria. Evaluation of interventions targeting abstinence programs, workplace programs, and certain groups at high risk of infection would prove invaluable. (Studies in Family Planning 2004; 35[1]: 27–38)
Reports - Condom Promotion for AIDS Prevention in the Developing World: Is It Working?
Norman Hearst is Professor, University of California, Box 0900, 500 Parnassus Avenue MU3E, San Francisco, CA 94143. E-mail: nhearst@itsa.ucsf.edu. Sanny Chen is Epidemiologist, San Francisco Department of Health. Two decades of experience and research provide new insights into the role of condoms for AIDS prevention in the developing world. This literature review and synthesis is based on computerized searches of the scientific literature and review of conference presentations, publications of national and international organizations, and popular media. Condoms are about 90 percent effective for preventing HIV transmission, and their use has grown rapidly in many countries. Condoms have produced substantial benefit in countries like Thailand, where both transmission and condom promotion are concentrated in the area of commercial sex. The public health benefit of condom promotion in settings with widespread heterosexual transmission, however, remains unestablished. In countries like Uganda that have curbed generalized epidemics, reducing the number of individuals’ sex partners appears to have been more important than promoting the use of condoms. Other countries continue to have high rates of HIV transmission despite high reported rates of condom use among the sexually active. The impact of condoms may be limited by inconsistent use, low use among those at highest risk, and negative interactions with other strategies. Recommendations include increased condom promotion for groups at high risk, more rigorous measurement of the impact of condom promotion, and more research on how best to integrate condom promotion with other prevention strategies. (Studies in Family Planning 2004; 35[1]: 39–47)
- Assessing the Potential of Condom Use to Prevent the Spread of HIV: A Microsimulation Study
Michael Bracher and Gigi Santow are independent researchers, 45 Kareela Road, Cremorne, NSW 2090, Australia. E-mail: mbracher@bigpond.net.au. Susan Cotts Watkins is Professor, Department of Sociology, Population Studies Center, University of Pennsylvania, Philadelphia. In this study, a microsimulation model is used to assess the potential impact of condom use on women’s lifetime risk of acquiring HIV in rural southern Malawi. The model draws on survey data for information on sexual activity, marriage and divorce, and on the biomedical literature for input parameters governing the transmission and spread of HIV and other sexually transmitted diseases (STDs). We show that lifetime risk could be as high as 42 percent with no condom use and as low as 8 percent if everyone consistently uses condoms with nonmarital partners. Next, we examine the impact of more realistic, intermediate strategies of condom use, varying men’s propensity to use a condom with nonmarital partners, varying the per-coitus probability of condom use, varying probabilities of slippage or breakage, and finally, examining the effect of condom use in the presence of STD symptoms. We demonstrate profound effects of consistent condom use and of condom use prompted by symptomatic STDs. (Studies in Family Planning 2004; 35[1]: 48–64)
Data - Gabon 2000: Results from the Demographic and Health Survey
- Uganda 2000–2001: Results from the Demographic and Health Survey
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