SURVIVAL MEANS NEW RISKS
With highly active antiretroviral therapy prolonging the lives of people with HIV, growing numbers of teenagers who were infected at birth will become sexually active and conceive. The first available data on such young people--eight Puerto Rican women who had a total of 10 pregnancies in 1998-2002--suggest that they need to learn early in life about their infection and about how to reduce sexual risk.1 On average, the women had been told their HIV status at age 13; half were sexually active by the time they were 15, and half conceived by age 17. During interviews in 2002, when they were aged 15-22, six women reported having had multiple partners; two said they had had a sexually transmitted disease before conceiving. While five reported always discussing HIV with partners, only two said they used condoms consistently. Five women had not intended to conceive; two had been using condoms for birth control. Compared with these eight women, a similar group who had never been pregnant had learned of their HIV status slightly earlier and had become sexually active somewhat later; five women in the comparison group, but only two of the others, had discussed sexual activity, pregnancy or contraception with a family member. Altogether, 10 desired more reproductive health information. Analysts urge the development of "appropriately tailored health interventions" for teenagers who were infected with HIV at birth.
1. Centers for Disease Control and Prevention, Pregnancy in perinatally HIV-infected adolescents and young adults--Puerto Rico, 2002, Morbidity and Mortality Weekly Report, 2003, 52(8):149-151.
Researchers who study sexually transmitted diseases and whose work includes sex workers, men who sleep with men or individuals who engage in anal sex are well advised not to use the terms "sex workers," "men who sleep with men" and "anal sex" in applications for federal grants, according to scientists who say that federal health officials have warned them that certain "key words" may attract unfavorable attention.1 A spokesperson for the Department of Health and Human Services interviewed by The New York Times denied that grant applications are screened for politically controversial topics, but an official at the National Institutes of Health (NIH) said that NIH project officers advise researchers to steer clear of using "sensitive language." While this practice is not new for NIH, the official added, it has been followed much more strictly under the Bush administration than it was previously. The pressure to "cleanse" grant applications of sensitive language has created what one scientist called a "pernicious sense of insecurity" among researchers, who fear that the concerns of individual legislators are gaining influence.
1. Goode E, Certain words can trip up AIDS grants, scientists say, New York Times, Apr. 18, 2003, <http:www. nytimes.com/2003/04/18/national/ 18GRAN.html>, accessed Apr. 21, 2003.
As America's favorite pastime entered its current spring season, a group of former and current professional baseball players and executives threw out the first pitch in a "friendly fund-raising competition" to finance a "one-stop shopping educational center for pro-life individuals and organizations throughout America."1 The Battin' 1000 campaign revolves around "teams" of contributors in each of the 30 major league baseball markets; all it takes to become a team member is a minimum contribution of $1,000, and all team members receive a sporty souvenir with a baseball theme. Standings, based on contributions, are posted monthly on the campaign's Web site; division, league and World Series winners are determined in postseason playoffs. Big winners receive trophies--donated by a "pro-life award distributor," of course. Perhaps the season will be rained out. We can only hope.
1. American Life League, Battin' 1000--building America's Campus for Life, 2003, <http://www.all.org/battin1000/ index.htm>, accessed Apr. 29, 2003.
HOW WELL DO PHARMACIES SERVE TEENAGERS?
Pharmacists could be important providers of contraceptive information and supplies for teenagers, but many feel poorly trained to play this role.1 Of nearly 1,000 pharmacists surveyed in Indiana, more than half said that they did not feel adequately trained to deal with adolescent-specific issues, and a similar proportion considered themselves inadequately versed in relevant confidentiality issues. Three in five respondents reported that adolescents rarely or never ask them about prescription medications, and two-thirds said that young people seldom, if ever, ask about medical devices, including home pregnancy tests and condoms. Fifty-nine percent of those surveyed dispensed emergency contraception to adolescents, but the majority of those who did said that they were at least sometimes uncomfortable doing so. Respondents said that they would be more likely to dispense emergency contraception to a 17-year-old than to a 14-year-old, and that they would be less likely to contact an older teenager's than a younger teenager's parent or health care provider before providing the drug. The researchers conclude that if training for pharmacists focused greater attention on their role in adolescent health care, the result could be "decreased barriers to care and improved health outcomes" for young people.
1. Conard LAE et al., Pharmacists' attitudes toward and practices with adolescents, Archives of Pediatrics and Adolescent Medicine, 2003, 157(4):361-365.
Young black women who spend a lot of time watching rap music videos may be at increased risk of poor health outcomes.1 Virtually all 522 women in a study of 14-18-year-olds in Birmingham, Alabama, reported watching rap videos, particularly gangsta rap, which often glorifies drug use, violence and sex. Results of multivariate analyses showed that over a 12-month period, women who had high levels of exposure to rap videos were significantly more likely than those with less exposure to have multiple sexual partners (odds ratio, 2.0) and acquire a sexually transmitted disease (1.6). Increased exposure to rap also was associated with elevated odds of using drugs or alcohol (odds ratio, 1.6 for each), hitting a teacher (3.0) and being arrested (2.6). The researchers urge public health practitioners "to educate communities, schools, and advocacy groups about the potential public health risks associated with [black teenage women's] exposure to rap music videos."
1. Wingood GM et al., A prospective study of exposure to rap music videos and African American female adolescents' health, American Journal of Public Health, 2003, 93(3):437-439.
A NEW TACK ON HIV PREVENTION EFFORTS
In response to increasing HIV incidence in some communities and stabilizing rates of HIV-related morbidity and mortality, the Centers for Disease Control and Prevention (CDC) has announced a new initiative aimed at preventing spread of the disease.1 With an emphasis on reducing barriers to early diagnosis and expanding access to quality services, the initiative consists of four key strategies: The CDC will work with medical associations and health departments to promote the inclusion of HIV testing as part of routine medical care; fund and establish new projects offering HIV testing in nonclinical settings, including correctional facilities; develop materials and collaborate with other agencies to help infected individuals change their risk-related behavior or maintain changes they have already made; and promote efforts to reduce the incidence of mother-to-child HIV transmission. The initiative is intended to give "every HIV-infected person...the opportunity to be tested and have access to state-of-the-art medical care and to the prevention services needed to prevent HIV transmission."
1. Centers for Disease Control and Prevention, Advancing HIV Prevention: New Strategies for a Changing Epidemic--United States, 2003, Morbidity and Mortality Weekly Report, 2003, 52(15): 329-332.
HOW'S THE BABY?
All states require that newborns be screened for disorders that could, in the absence of early intervention, cause severe illness or death, but there is little consistency in which disorders states' programs include.1 The majority of programs screen for six or fewer disorders; a few screen for about 30. While most states provide information on their screening program to parents and health care providers, many do not make parents aware of their option to obtain screening for disorders that are not part of the program. Criteria for deciding whether to screen for a given disorder typically include how often it occurs in a population, whether it is treatable and whether an effective screening test exists. A government-funded expert group is being convened to develop a list of disorders for which all states should screen newborns.
1. General Accounting Office (GAO), Newborn Screening: Characteristics of State Programs, Washington, DC: GAO, 2003.
MORE HARM THAN GOOD
Evidence continues to accumulate that there is no good reason for most women to take combined hormones after menopause. New analyses from the Women's Health Initiative, which previously found that postmenopausal use of estrogen plus progestin is associated with several health risks, indicate that hormone therapy has no beneficial effects on health-related quality of life.1 The randomized, placebo-controlled study, involving nearly 17,000 postmenopausal women, provided an opportunity to explore possible benefits of combined hormone use for which earlier research had produced inconsistent findings. Results showed no significant associations between hormone therapy use and general health, vitality, mental health, depressive symptoms or sexual satisfaction. After one year, women using combined hormones had small improvements in sleep disturbance, bodily pain and physical functioning; however, these associations were not clinically meaningful, and they were no longer significant after three years. "For most women," the investigators conclude, "these small benefits do not outweigh the risks of heart attack, stroke, blood clots, and breast cancer associated with combined hormone therapy."
1. Hays J et al., Effects of estrogen plus progestin on health-related quality of life, New England Journal of Medicine, 2003, 348(19):1839-1854.
YOUNG WOMEN AND PAP SMEARS
Eight in 10 sexually experienced women seen at a hospital-based adolescent clinic in 1998-1999 intended to return as instructed for Pap smears or follow-up appointments after abnormal results, but after 15 months, only three in 10 had done so.1 The 490 women, with an average age of 18, completed questionnaires that measured their knowledge and beliefs about Pap smears, perceived risk, communication with health care providers, impulsivity, risk-related behaviors and outcomes, family history of cervical cancer and background characteristics. According to results of multivariate analyses, women's odds of returning for recommended screening or follow-up were significantly elevated if they did not consider themselves impulsive (odds ratio, 1.7), they believed that the test is not painful (1.7) and prevents cervical cancer (1.8), and they expected the doctor to be honest with them (4.1); the odds of returning were reduced if women had cervical cancer in their family (0.3). The researchers suggest that these findings may be used in the development of interventions to increase young women's compliance with recommendations for obtaining Pap smears.
1. Kahn JA et al., Predictors of Papanicolaou smear return in a hospital-based adolescent and young adult clinic, Obstetrics & Gynecology, 2003, 101(3):490-499.