Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 38, Number 1, March 2006
FYI


SAME DATA SET, BUT…

Contrary to results of earlier work based on the same data set, an analysis of data from the National Longitudinal Survey of Youth has found no evidence that women who have an abortion to terminate an unintended first pregnancy are at greater risk of clinical depression than their counterparts who carry to term.1 In the more recent analysis, the two groups of women did not differ either when scores on a commonly used depression scale were examined according to a standard cutoff indicating risk of depression or when scores were examined continuously. The analysts attribute the discrepancies between their findings and the earlier ones mainly to differences in coding of the data. Additionally, the analysts explored the possible indirect effects of abortion on depression. They found that on average, women who terminated a pregnancy had more education, higher incomes and smaller families than those who carried to term; all of these factors were associated with a reduced risk of depression. In conclusion, the analysts write that “if the goal is to reduce women's risk for depression, research should focus on how to prevent and ameliorate the effect of unwanted childbearing.”

1. Schmiege S and Russo NF, Depression and unwanted first pregnancy: longitudinal cohort study, BMJ, 2005, 331(7528):1303–1307.

WHAT DO DOCTORS KNOW?

Women may take it for granted that their primary care physicians know how to manage STDs, but they may be wrong.1 In a sample of primary care physicians in Pennsylvania who answered a mailed questionnaire in 1998, the average number of correct answers to eight questions designed to measure knowledge about STD diagnosis and treatment was 5.7. Only 61% of the sample (which was made up of obstetrician-gynecologists, internists, pediatricians and family practitioners) gave at least six correct answers, which the researchers considered the threshold marking “good knowledge.”In analyses controlling for demographic and professional characteristics, the likelihood that physicians' STD knowledge was good was significantly elevated among women (odds ratio, 2.1), doctors aged 40 and younger (2.3), those practicing in cities (1.7) and those who said they were familiar with the federal treatment guidelines (2.0). The researchers characterize physicians' knowledge of STD management as “too often poor”and emphasize the need for continuing education programs to focus on this area of care.

1. Wiesenfeld HC et al., Knowledge about sexually transmitted diseases in women among primary care physicians, Sexually Transmitted Diseases, 2005, 32(11):649–653.

HIV TESTS FOR RAPISTS: WHOSE CALL?

Under a proposal by Massachusetts Governor Mitt Romney, individuals who have been indicted for or formally charged with rape or sexual assault would have to be tested for HIV and other STDs if the prosecutor or victim requested it.1 Opponents of the bill contend that it would violate the constitutional rights of individuals who have not been proven guilty but would have little benefit for victims, who generally undergo a month of prophylactic treatment that must begin in less time than it usually takes for an alleged assailant to be identified and apprehended. The bill's supporters, however, praise its potential to give victims “significant psychological relief and a clearer understanding of the totality of their circumstances."2 Massachusetts is one of only a handful of states with no law requiring HIV testing for rape suspects.

1. Mishra R, Romney urges HIV test in rapes, Boston Globe, Jan. 6, 2006, <http://www.boston.com/news/local/massachusetts/articles/2006/01/06/romney_urges_hiv_test_in_rapes/>, accessed Jan. 13, 2006.

2. Executive Department, Commonwealth of Massachusetts, Romney files bill to protect rights of sexual assault victims, news release, Jan. 5, 2006, <http://www.mass.gov/portal/site/massgovportal/menuitem.a77edd600cd731c14db4a11030468a0c/?pageID=gov2homepage&L=1&L0=Home&sid=Agov2>, accessed Jan. 2. Executive Department, Commonwealth of Massachusetts, Romney files bill to protect rights of sexual assault victims, news release, Jan. 5, 2006, <http://www.mass.gov/portal/site/massgovportal/menuitem.a77edd600cd731c14db4a11030468a0c/?pageID=gov2homepage&L=1&L0=Home&sid=Agov2>, accessed Jan. 17, 2006.

THE LATEST ON HIV DIAGNOSES

The 33 states that had name-based HIV surveillance systems in 2001–2004 reported more than 150,000 HIV diagnoses to the Centers for Disease Control and Prevention during that period.1 Seven in 10 infected persons were male, the majority of whom (61%) acquired the virus through sexual contact with other men; among women, the most common route of infection was high-risk sexual contact (accounting for 76% of diagnoses). Overall, 51% of infections were among blacks; the proportion was even higher among women (68%). Although the rate of diagnosis among blacks declined by an average of 5% annually between 2001 and 2004, the 2004 rate (76 diagnoses per 100,000 population) was nearly four times the overall average and more than eight times the rate among whites. Eighteen percent of infections were among Hispanics; the infection rate for this group was somewhat above average and showed no significant change over the period. Although the data are not nationally representative, they demonstrate that “the epidemic has continued to concentrate in groups that traditionally have had limited access to prevention services, medical care, and effective therapies.”

1. Espinoza L, Hall HI and Campsmith ML, Trends in HIV/AIDS diagnoses—33 states, 2001–2004, Morbidity and Mortality Weekly Report, 2005, 54(45):1149–1153, <http:// www.cdc.gov/mmwr/preview/mmw/ html.mm5445a1.htm>, accessed Jan. 6, 2006.

RECENT STD TREND DATA

Since reaching an all-time low in 2000, the rate of primary and secondary syphilis has climbed steadily, according to the Centers for Disease Control and Prevention; it rose by 8% between 2003 and 2004, reaching 2.7 cases per 100,000 population.1 The change has been driven mainly by increases among men—a near doubling since 2000 and a 12% rise between 2003 and 2004. For the first time in a decade, the syphilis rate did not increase among women in 2003–2004. Meanwhile, with a 2% decline from 2003 to 2004, the rate of gonorrhea infection has reached a record low of 114 cases per 100,000. The overall rate masks dramatic variations among racial groups: 21 per 100,000 among Asians and Pacific Islanders, 33 among whites, 71 among Hispanics, 118 among American Indians and Alaskan Natives, and 630 among blacks. The most commonly reported infectious disease in the United States is chlamydia, which occurred at a rate of 320 cases per 100,000 population in 2004, 6% higher than the previous year's rate. Although the analysts attribute the increase to improved screening and diagnosis, they also believe that reported infections represent only about one-third of the total.

1. Centers for Disease Control and Prevention (CDC), Trends in Sexually Transmitted Diseases in the United States, 2004, Atlanta: CDC, 2005.

WHEN DOES HIGH OCCUPANCY BEGIN?

Last November, a Phoenix police officer pulled a driver over for improper use of a carpool lane. The officer said the driver was the only one in the car; the driver, who was pregnant, said she was not, because her unborn child was with her. The woman appealed her fine, contending that Arizona traffic laws do not define when life begins. Early this year, a municipal court judge ruled against her; “common sense,”he held, suggests that given the purpose of high-occupancy vehicle lanes, an individual passenger must occupy a “separate and distinct”space in the car.1 As far as FYI has determined, there has been no response from the Vatican.

1. Associated Press, Judge: don't count fetus for carpool quota, Jan. 11, 2006, <http://www.nytimes.com/ aponline/national/AP-Fetus-Carpool. html?pagewanted=print>, accessed Jan. 12, 2006.

PROTECTING SEX WORKERS

Arguing that designated zones for prostitution do not protect sex workers from rape or violence, the British government has decided against establishing such zones but announced alternative plans meant to enhance the safety of the roughly 80,000 women who work as prostitutes in the country.1 Whereas current law allows only one prostitute to work out of an apartment, a new rule will allow for two plus a receptionist, to increase security. The government also plans to help prostitutes find other work and address the problem of international trafficking of women. A British-based advocacy group had argued that decriminalizing prostitution is the best way to protect sex workers because it would reduce the stigma of the profession and keep prostitutes off the streets.

1. Reuters, Britain rejects European-style prostitution zones, New York Times, Jan. 17, 2006, <http://www.nytimes.com/reuters/international/international-britain-prostitutes.html?pagewanted=print>, accessed Jan. 18, 2006.

DRUG-RESISTANT HIV IN THE UK

The prevalence of drug-resistant HIV in the United Kingdom is high and appears to be rising, according to an analysis of national data for 1996–2003.1 During the study period, 14% of HIV-positive individuals who were tested for drug resistance before beginning treatment had a strain of the virus that would not respond to at least one antiretroviral drug used to treat the infection; the prevalence rose from 11% in 1996–1997 to 19% in 2002– 2003. Drug-resistant virus was more common in recently infected individuals than in those whose duration of infection was unknown (22% vs. 14%); other clinical factors, as well demographic characteristics, were at best only marginally associated with the prevalence of resistance. The researchers note that “by limiting the therapeutic options for a significant number of patients, the secondary epidemic of drug resistant HIV represents a major clinical and public health problem.”

1. UK Group on Transmitted HIV Drug Resistance, Time trends in primary resistance to HIV drugs in the United Kingdom: multicentre observational study, BMJ, 2005, 331 (7529):1368–1373.

OLD MEASURE, NEW APPROACH

Measurement of socioeconomic status is a fairly standard component of public health and social science research; how socioeconomic status is defined and measured, however, is anything but. After examining standard approaches to measuring socioeconomic status, and their flaws, one group of researchers concludes that “health research could be improved significantly with a more conceptually and empirically sound approach."1 Such an approach would be geared to specific outcomes and social groups, and would involve considering causal mechanisms, gathering as much socioeconomic data as possible, being clear about the specific measures assessed and carefully considering the potential importance of unmeasured socio-economic factors.

1. Braveman PA et al., Socioeconomic status in health research: one size does not fit all, Journal of the American Medical Association, 2005, 294(22):2879–2888.

TEA MAY WARD OFF CANCER

The more tea women drink, the lower their risk of ovarian cancer may be, according to findings from a population-based study in Sweden.1 In a large cohort of women followed for an average of 15 years, those who drank two or more cups of tea daily had a 46% lower risk of ovarian cancer than those who seldom or never drank tea. And for every cup of tea a woman drank per day, her risk of ovarian cancer declined by 18%. The researchers acknowledge that the relatively high level of health consciousness found among women in the cohort who drank two or more cups a day may help explain the findings, but they add that the robustness of the associations in age-adjusted analyses argues against such confounding.

1. Larsson SC and Wolk A, Tea consumption and ovarian cancer risk in a population-based cohort, Archives of Internal Medicine, 2005, 165(22):2683–2686.