Advancing Sexual and Reproductive Health and Rights
 
International Perspectives on Sexual and Reproductive Health
Volume 38, Number 3, September 2012
UPDATE


U.S. PLAN TO FIGHT GLOBAL GENDER VIOLENCE UNVEILED


The United States has released its first-ever global strategy to prevent and respond to gender-based violence,1 which was accompanied by President Obama’s signing of an executive order directing all relevant agencies to implement the strategy. According to the executive order, gender-based violence “undermines not only the safety, dignity, and human rights of the millions of individuals who experience it, but also the public health, economic stability, and security of nations.”2 The strategy aims to prevent and respond to gender-based violence by increasing coordination of efforts among U.S. government agencies and with other stakeholders; enhancing integration of efforts into existing U.S. government work; improving collection, analysis and use of data and research to enhance efforts; and enhancing or expanding U.S. government programming that addresses gender-based violence.


1. United States Agency for International Development, United States Strategy to Prevent and Respond to Gender-Based Violence Globally, Aug. 10, 2012, <http://www.state.gov/documents/organization/196468.pdf>, accessed Aug. 22, 2012.


2. The White House Office of the Press Secretary, Executive Order: Preventing and Responding to Violence Against Women and Girls Globally, Aug. 10, 2012, <http://www.whitehouse.gov/the-press-office/2012/08/10/executive-order-preventing-and-responding-violence-against-women-and-gir>, accessed Aug. 22, 2012.


GLOBAL FUNDING FOR AIDS RETURNS TO HIGHER LEVEL


A recent report from the Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS found that funding for HIV and AIDS in low- and middle-income countries was US$7.6 billion in 2011—a return to 2008 and 2009 levels—
after a drop to US$6.9 billion in 2010.1 International investments accounted for two-thirds of HIV funding in Africa, which remains the continent with the greatest HIV and AIDS burden. The United States—the largest donor country—increased its investment by US$785 million over the previous year, which raised its funding back to its 2009 level. Of the total donor government investment, the six largest funders in 2011 were the United States (59%), the United Kingdom (13%), France (5%), the Netherlands (4%), Germany (4%) and Denmark (3%). In an analysis of each country’s “fair share” (based on resources standardized to the size of a nation’s economy), Denmark provided the highest level of funding, followed by the United Kingdom, the Netherlands, Ireland, Sweden and the United States.

1. Kates J et al., Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from Donor Governments in 2011, 2012, <http://www.kff.org/hivaids/upload/
7347-08.pdf>, accessed Aug. 23, 2012.

INSURANCE COVERAGE IN CHINA LINKED TO CESAREAN DELIVERY


Health insurance may promote the overuse of cesarean section in China, according to an analysis of data from surveys conducted in five rural counties between December 2008 and March 2009.1 Of the 3,550 women in the counties who gave birth during the study period and provided information about participation in China’s government-instituted rural health insurance program, 46% reported having delivered by cesarean—13%
had had emergency procedures and 33% had not. Half of women who had had a non-emergency cesarean reported that their doctor had recommended the procedure, and half that they had requested it themselves. The proportion of births by cesarean ranged by county, from 13% to 82%. In the three counties with rates in the middle of the range (28–63%), women with health insurance were more likely than those without to have had a cesarean and to have had a nonemergency cesarean (odds ratios, 0.8 and 2.2, respectively); no association was found in the counties with the highest and lowest rates. The authors suggest that “further studies are needed to develop appropriate interventions to reduce non-medically indicated [cesarean section], focusing on payment mechanisms, healthcare provider practice patterns, and maternal requests.”

1. Long Q et al., High caesarean section rate in rural China: is it related to health insurance (new co-operative medical scheme)? Social Science & Medicine, 2012, 75(4):733–737.


WORLD POPULATION GROWTH 
LED BY DEVELOPING COUNTRIES


The world’s population is nearing 7.1 billion, and almost all future growth will occur in less developed countries, according to the 2012 World Population Data Sheet.1 Worldwide, the total fertility rate was 2.4 children per woman of reproductive age; however, in the poorest countries, that rate was 4.4 children per woman, and in Sub-Saharan Africa, it was 5.1. Developing nations in Africa, Asia and Latin America accounted for 97% of the past year’s population growth—much of which is attributable to continued high birthrates and young populations.2 And by 2050, the population of the world’s less developed countries will make up 86% of the entire population. Developed countries will experience little growth in this century. Latin America and the Caribbean are predicted to have the lowest proportional growth among developing regions, driven in part by fertility declines in Brazil and Mexico.


1. Population Reference Bureau (PRB), 2012 world population data sheet, <http://www.prb.org/Publications/Datasheets/2012/world-population-data-sheet/data-sheet.aspx>, accessed Aug. 20, 2012.


2. Haub C, Fact sheet: world population trends 2012, July 2012, Washington, DC: PRB, <http://www.prb.org/Publications/Datasheets/ 2012/world-population-data-sheet/fact-sheet-world-population.aspx>, 
accessed Aug. 20, 2012.


MOVING MAY PROTECT YOUNG WOMEN FROM PREMARITAL SEX


The number and timing of changes of residence experienced by youth between the ages of 12 and 18 are associated with a reduced likelihood of premarital sex among females, but not among males. According to an analysis of 2007 relationship calendar data from 389 young women and men aged 18–24 living in the Kenyan city of Kisumu, 64% had first had premarital sex between the ages of 12 and 18, and 45% had experienced a change in residence between those ages; a greater proportion of females than males had moved (50% vs. 41%).1 Among those who had changed residen-
ces, the mean number of moves experienced was 3.9; on average, females had moved a greater number of times than males (4.2 vs. 3.6). Twenty-six percent had experienced their last move 1–3 months prior to their interview, 17% had last moved 4–6 months prior and 57% had last moved seven or more months prior. In multivariate analyses, number of moves was negatively associated with adolescent premarital sex in females (hazard ratio, 0.7), and young women who had moved 1–3 months prior to being interviewed were less likely than those who had never moved to have had premarital sex (0.4); no relationship was found between number or timing of moves and premarital sex among young men. The authors conclude that “familial and community control accompanying residential change may be stronger or more effective for girls,” and suggest that “future research should identify which aspects of migration…
support (or hinder) successful and healthy transitions to 
adulthood.”


1. Luke N et al., Migration experience and premarital sexual initiation in urban Kenya: an event history analysis, Studies in Family Planning, 2012, 43(2):115–126.

SEX WORKERS AND CONDOM USE WITH STEADY PARTNERS


An intervention promoting the use of condoms among female sex workers in Mexico was successful in decreasing unprotected sex with clients, but not with steady noncommercial partners. According to a study conducted between January 2004 and March 2006 among 362 female sex workers in Tijuana and Ciudad Juarez who participated in a brief behavioral intervention, 80 reported having a steady noncommercial partner both in the baseline survey before the intervention and in the six-month follow-up survey.1 In this subgroup, the ratio of unprotected sex acts (anal or vaginal) to total sex acts with clients in the past month was 0.4 at baseline and 0.2 six months later; however, the ratio of unprotected to total sex acts with steady partners in the past month was high at baseline (0.9) and remained unchanged at follow-up. In negative binomial regression analysis, a measure for the interaction between partner type (steady vs. client) and time (baseline vs. follow-up) was significant (rate ratio, 0.5). The authors suggest that there is a “need for specialized prevention materials and intervention strategies that address HIV/STI risk between [female sex workers] and their steady partners.”


1. Ulibarri MD et al., Condom use among female sex workers and their non-commercial partners: effects of a sexual risk intervention in two Mexican cities, International Journal of STD & AIDS, 2012, 23(4):229–234.

TEXTS SPEED DELIVERY OF HIV TEST RESULTS IN ZAMBIA


In Southern Zambia, an automated notification system utilizing text messaging via mobile telephone reduced the time required to transmit infant HIV test results from central laboratories back to point-of-care health facilities and then to infants’ caregivers, according to an evaluation of a pilot project implemented at 10 study sites in July 2011.1 In the 19 months before implementation of the pilot study, blood samples were collected from 1,009 infants, and the mean turnaround time from sample collection to the health facility’s receipt of test results via courier was 44 days. Over the subsequent 7.5-month study period, blood samples were collected from 406 infants, and the mean time to the health facility’s receipt of results by automated text message dropped to 27 days. In addition, the mean time until caregivers received results decreased from 67 days before implementation of the pilot study (when caregivers received results on their next facility visit after results were received) to 35 days after implementation (when facilities attempted to contact caregivers to notify them when results were available). Fewer than 1% of texted results differed from the original paper versions. The authors conclude that a text message–based system “can overcome some of the challenges inherent in the delivery of test results in a resource-constrained context such as Zambia.”


1. Seidenberg P et al., Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results, Bulletin of the World Health Organization, 2012, 90(5):348–356.

REFERRAL OF SEX WORKERS’
CLIENTS TO STI CLINICS


High proportions of female sex workers with an STI reported that they would refer their sexual partners—especially their regular partners—to a clinic for care, according to a study conducted in southern Guatemala.1 Of 116 female sex workers who had received a positive STI diagnosis at one of three STI clinics in Escuintla province, 98% said that it was likely or very likely that they would refer their current regular partner (husband or boyfriend) to the clinic within the next month; 83% intended to refer an occasional partner (nonpaying partner other than a regular partner); and 63% intended to refer their last paying client. In multivariate analyses, a female sex worker’s intention to refer her last client was associated with her having a positive attitude toward partner notification, believing that people she respected would think that it was important to refer him and believing that partner notification prevents transmission of infection from a pregnant woman to her fetus or baby (odds ratios, 3.8–18.6). Women believed that the best notification method was for them to talk directly to the partner and inform him that he might have an STI (77%) or that he needed to contact the clinic (85%). The authors conclude that “STI/HIV prevention programs should integrate partner notification as an essential component, and health staff should consistently assist index patients in notification.”


1. Sabidó M et al., Notification for sexually transmitted infection and HIV among sex workers in Guatemala: acceptability, barriers, and preferences, Sexually Transmitted Diseases, 2012, 39(7):504–508.