Advancing Sexual and Reproductive Health and Rights
 
International Perspectives on Sexual and Reproductive Health
Volume 37, Number 1, March 2011
UPDATE


OVERVIEW OF U.S. AID FOR GLOBAL HEALTH

As part of the Obama Administration’s Global Health Initiative (GHI), the U.S. government in 2010 distributed $5.7 billion to 73 countries and 12 regions to assist in six health program areas, including HIV and AIDS, maternal and child health, and family planning and reproductive health, according to a new report by the Kaiser Family Foundation entitled The U.S. Global Health Initiative: A Country Analysis.1 The most commonly supported area was HIV and AIDS, accounting for 73% of funding; 64 countries received some support for HIV programs, whereas 43 received support for maternal and child health, and 38 for family planning and reproductive health. Africa received the vast majority of GHI funding (84%) and the greatest proportion of funding in each of the six program areas. With the exception of Haiti, all of the 10 countries that received the most GHI aid were located in Africa; Kenya received the most assistance overall ($600 million). The authors comment that “many GHI countries do not currently receive [maternal and child health] and/or [family planning and reproductive health] program funding; given the GHI’s emphasis on addressing the needs of women and girls, this may signal the need to pay particular attention to these countries moving forward.”

1. Michaud J, Kates J and Kaiser Family Foundation, The U.S. Global Health Initiative: A Country Analysis, Feb. 2011, <http://www.kff.org/globalhealth/upload/8140.pdf>, accessed Mar. 3, 2011.

TEXTING ENHANCES HIV TREATMENT PROGRAM

Text messaging can be effective in supporting participants’ adher¬ence to antiretroviral therapy (ART) in low-resource settings, according to an evaluation of an intervention conducted among HIV-infected adults at three Kenyan HIV clinics between May 2007 and October 2008.1 Of the 538 participants who were beginning ART and reported having “near-daily” access to a mobile phone and being able to communicate by its short message service function, half were randomly assigned to the control group to receive counseling and drug treat¬ment. The other half were assigned to the intervention group, whose members not only received counseling and ART, but were sent a weekly text message asking “How are you?” (“Mambo?”), to which they were instructed to respond that they were doing well (“Sawa”) or that they had a problem (“Shida”). Over the one¬year study period, health care workers sent 11,983 text messages, to which they re¬ceived 7,812 “Sawa” responses; if participants responded “Shida” (391) or did not respond within the 48¬hour time frame (3,780), health care workers followed up by phone. Overall, 62% percent of participants in the intervention group reported ART adherence (i.e., reported at six-and 12-month follow-ups that they had taken >95% of the prescribed doses from the prior 30 days), compared with 50% of those in the control group. The intervention group was less likely than the control group not to adhere to their treatment regimen (relative risk, 0.8). Fifty-seven percent of the intervention group partici¬pants and 48% of controls had a suppressed viral load (<400 copies/ml), as determined by a blood test at the one-year follow-up. Compared with controls, members of the intervention group had a lower likelihood of not having a suppressed viral load (0.9). No adverse events were attributable to the intervention. The authors comment that theirs is “the first effectiveness trial assessing the ability of a mobile health technology intervention to influence HIV outcomes in a resource¬limited setting.”

1. Lester RT et al., Effects of a mobile phone short message service on anti¬retroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial, Lancet, 2010, 376(9755):1838–1845.

CAUSES OF UNDER-FIVE MORTALITY IN INDIA

The causes of death among children younger than five in India are generally preventable and vary substantially by gender and region, according to an analysis of nationally representative child mortality data from 2001–2003 and data on deaths and live births in India in 2005.1 Of the 23,152 child deaths for which data were available, 10,892 occurred among children younger than one month (neonates) and 12,260 were among children aged 1–59 months. The overall child mortality rate was 85.8 per 1,000 live births; the overall rate was highest in central India (107.9) and higher for girls than for boys (90.2 vs. 81.8). Sixty-two percent of all child deaths were attributed to five causes: pneumonia, prematurity and low birth weight, diarrheal diseases, neonatal infections, and birth asphyxia and birth trauma. Three causes—prematurity and low birth weight, neonatal infections, and birth asphyxia and birth trauma—accounted for 78% of all neonatal deaths; the neonatal mortality rate was 20% higher among boys than girls (40.1 vs. 33.5). Pneumonia and diarrheal diseases caused half of all deaths among 1–59-month-olds; the child mortality rate was higher among girls than boys (56.7 vs. 41.7). When both region and gender were accounted for, girls aged 1–59 months in central India had five times the mortality rate from pneumonia among boys in south India and four times the mortality rate from diarrheal diseases among boys in west India. The authors comment that “each of the major causes of neonatal deaths can be prevented or treated with known, highly effective and widely practicable interventions.” They add that “at ages 1–59 months, girls in every region die more commonly than do boys, and inequities in access to care, rather than biological or genetic factors, are a more plausible explanation for these recorded differences between sexes.”

1. The Million Death Study Collaborators, Causes of neonatal and child mortality in India: a nationally representative mortality survey, Lancet, 2010, 376(9755):1853–1860.

HIV ESTIMATES OFTEN FORGET OLDER ADULTS

Estimates of the number of people living with HIV and of the prevalence of HIV in Sub-Saharan Africa often fail to account for individuals older than age 49. In an analysis of data from Demographic and Health Surveys and other sources for 43 Sub-Saharan African countries, an estimated three million people older than 49 were living with HIV in the region in 2007— 14% of the 21 million people over the age of 15 estimated to be living with HIV.1 HIV prevalence among the 74 million people in Sub-Saharan Africa older than 49 was 4%, compared with 5% among 15–49-year-olds. Of the countries included in the study, South Africa had the most older people living with HIV (679,700) and Zimbabwe had the highest prevalence of HIV among older people (20%). The authors comment that “the need to better understand the various HIV¬related challenges faced by older adults will increase as the HIV+ population ages. Research should be aimed at understanding the specific vulnerabilities and challenges faced by this group.”

1. Negin J and Cumming RG, HIV infection in older adults in SubSaharan Africa: extrapolating prevalence from existing data, Bulletin of the World Health Organization, 2010, 88(11):847–853.

MOM’S RELATIONSHIPS AFFECT BABY’S WEIGHT

A child’s birth weight is associated with its mother’s relationship with and access to its father at the end of pregnancy, according to a study of data on 3,993 children born between 2000 and 2003 in one district of KwaZulu-Natal, South Africa.1 On average, the infants in the sample weighed 3,110 grams at birth; fewer than 10% were low-birth-weight (<2,500 grams). Sixteen percent of mothers lived with their child’s father during pregnancy; 17% of mothers were married at the time of the child’s birth, and 22% had no partner. In analyses adjusted for socio-economic and maternal characteristics, infants whose parents lived together at the time of birth were born an average of 59 grams heavier than those whose father lived elsewhere; there was no difference between the birth weight of children whose father did not reside with their mother and that of children whose father was deceased. Children born to mothers with a partner were heavier at birth than those born to mothers without a partner, with the difference varying by partner type (180 grams for a married partner, 122 grams for a coresident partner who was considered a member of the house¬hold, 107 grams for a nonresident-household partner and 84 grams for a nonresident-non-household partner). The authors comment that their results illustrate that “relationships may be supportive in some circumstances but not in others.” They add that “an improved understanding of the ways in which family members provide support can inform policies to promote and enhance positive family support to mothers and children.”

1. Cunningham SA et al., Prenatal development in rural South Africa: relationship between birth weight and access to fathers and grandparents, Population Studies, 2010, 64(3):229–246.

DRUGS CAN PREVENT HIV AMONG MEN AT HIGH RISK

Antiretroviral therapy (ART) given prophylactically can offer individuals at high risk some protection against HIV, according to a study of HIV-negative adult males who have sex with men recruited from 11 study sites in six countries (Peru, Ecuador, South Africa, Brazil, Thailand and the United States) between July 2007 and December 2009.1 Of the 2,499 partic¬pants, half were randomly selected to receive antiretroviral drugs to take once daily, and half were selected to receive a placebo; men were followed, on average, for 1.2 years, during which they underwent HIV testing every four weeks. Mean self¬-reported adherence to the pill regimen at the first and second follow¬ups was lower among the intervention group than among controls (89% vs. 92% and 93% vs. 94%, respectively), but the same thereafter (95%); the sexual practices of the two groups were similar at all time points. Over the study period, 100 men became infected with HIV—36 in the intervention group and 64 in the control group—representing a 44% relative reduction in HIV incidence among those taking prophylactic ART. Plasma HIV RNA levels and CD4+ T-cell counts in those who seroconverted were similar in the two groups, suggesting that the ART regimen was not effective at slowing the progression of infe¬tion. Nausea and weight loss were more likely in the intervention group than among controls, but there was no difference groups in the rates of serious adverse events.

1. Grant RM et al., Preexposure chemo¬prophylaxis for HIV prevention in men who have sex with men, New England Journal of Medicine, 2010, 363(27):2587–2599.

IN BRIEF

•The Population Reference Bureau has released its latest data on a wide variety of indicators on the socioeconomic status of women and girls in more than 180 countries. The World’s Women and Girls 2011 Data Sheet, which focuses on demography, reproductive health, education, work and public life—is available at <http://www.prb.org/pdf11/worldwomengirls2011datasheet.pdf>.

•In Children and AIDS: Fifth Stocktaking Report, 2010, UNICEF examines the progress made in the prevention of mothertochild HIV transmission, the provision of care to and treatment of children with HIV, the prevention of HIV among youth, and the protection and support of children affected by HIV and AIDS. The report outlines concrete actions that would further benefit children affected by HIV and is available at <http://www.unicef.org/publications/files/ Children_and_AIDSFifth_Stocktaking_Report_2010_ EN.pdf>.

•WHO has released new guidelines on how to protect people with HIV from tuberculosis (TB) with lowcost preventive medication. Central to the recommendations are “The Three I’s”: isoniazid (antiTB drug) preventive treatment, intensified case finding for active TB and TB infection control. The new guidelines are available at <http:// whqlibdoc.who.int/publications/2011/ 9789241500708_ eng.pdf>