IN THIS ISSUE
Current public health and social science research often focuses on populations characterized as being "at risk" of negative outcomes. Yet the conditions that make them vulnerable to these outcomes are frequently left unstated and may not apply to all members of the group in question. Adolescents, for example, are often considered a high-risk group simply because of their age, an assumption that does not take into account their family situation, the environment in which they live, their social and economic status or their actual behavior. If interventions are to be designed to help them avoid negative outcomes, we must know much more about the factors that put them at risk and how great that risk is.
According to Fatima Juarez and Teresa Castro Martín, the sexual health risks faced by male adolescents living in the urban shantytowns of Recife, Brazil, may not be nearly as high as one might think [see article]. About three-quarters of the nearly 1,500 males aged 13–19 interviewed in the study had had a partner in the previous two years, but fewer than half had had a sexual relationship and only 4% had had concurrent sexual partnerships. Moreover, 55% of the adolescents who had had at least one sexual partnership said they had always used contraceptive protection (mainly condoms). Overall, in the 25 months preceding the study, the participants had spent an average of only 2.8 months in a sexual partnership, of which just 1.1 months were not protected by contraceptive use.
Despite a widespread assumption that early marriage protects young women against the risk of contracting HIV, rates of infection in some countries are higher among married adolescents than among their unmarried peers. Using Demographic and Health Survey data for 29 countries in Africa and Latin America, Shelley Clark and colleagues examine the social and behavioral factors that contribute to this situation [see article]. First, they say, married adolescents have more frequent unprotected sex than their unmarried, sexually active counterparts. In addition, women who marry young tend to have considerably older husbands, who are more likely than adolescent boyfriends to be infected and who wield much greater power over their partners. Furthermore, adolescents who marry generally have less access to information about HIV, which their unmarried counterparts can obtain at school and through the media. And perhaps most important, neither abstinence nor condom use—the two most effective HIV prevention strategies—is a realistic option for most married adolescents.
Also in This Issue
•Almost all Pakistani women know of one or more contraceptive methods and where to obtain them; still, despite high levels of unwanted fertility, only about one in four women of reproductive age use a method. According to an analysis by Saima Hamid and Rob Stephenson [see article], providers bear some of the responsibility: Only 45% of women who visited health facilities in urban Pakistan to obtain family planning left with a method or a referral. However, women were more likely to receive services if they visited a facility that displayed educational materials about family planning, had higher proportions of normally offered methods in stock, more staff doctors and more staff who provided family planning.
•The risk of becoming pregnant after unprotected intercourse can be greatly reduced by use of emergency contraception, but the method is effective only when obtained in a timely manner and used correctly. For this to occur, health care providers need to be better informed about the method. Of a sample of 256 providers surveyed by Olufunke Margaret Ebuehi and colleagues in Lagos, Nigeria, nine in 10 had heard of emergency contraception [see article]. Fewer than one in 10 who had heard of the method said they always provided information about emergency contraception to clients, while more than six in 10 said they did so occasionally or only on request. Nearly six in 10 had provided clients with emergency contraceptive pills, but only one in 10 could correctly identify the drug, dose and timing of the first pill in the regimen.
•Fertility awareness–based methods of contraception are particularly unforgiving of incorrect use, but not all women who adopt these methods always abstain on fertile days or use a barrier method if they do have intercourse. Irit Sinai and colleagues examined data from efficacy trials of the TwoDay Method and the Standard Days Method for factors that might identify women who could benefit from additional counseling or should be advised to adopt a different method [see article]. Women using the TwoDay Method were less likely than those relying on the Standard Days Method to avoid unprotected intercourse on fertile days, possibly because the TwoDay Method's instructions are less clear cut. On the other hand, women who did not earn income and those with a higher housing quality index score were more likely than other women to abstain on fertile days.