Advancing Sexual and Reproductive Health and Rights
 
International Perspectives on Sexual and Reproductive Health
Volume 39, Number 4, December 2013
UPDATE


ORAL HPV INFECTION UNCOMMON IN MEN

In a cohort of men followed for up to four years, the incidence of new oral human papillomavirus (HPV) infection was low, and most infections cleared within a year.1 The 1,626 participants were part of a larger cohort recruited in Brazil, Mexico and the United States beginning in 2005; at enrollment, they were 18–70 years old, were HIV-negative and reported no history of cancer of the anus or genitals. Follow-up interviews and testing for oral HPV were conducted every six months; the median duration of follow-up was 13 months. During the first year, 4% of men acquired an oral HPV infection—2% acquired a strain of the virus related to cancer, and 3% one not associated with cancer. Half of all infections cleared within seven months; the median duration of infection was six months for cancer-related strains of HPV and eight months for other strains. Incidence did not differ by country, age-group or reported sexual behavior. Observing that “the natural history of HPV infection differs across anatomical sites,” the researchers stress the need for further work on correlates of oral HPV infection and clearance to inform prevention efforts.

1. Kreimer AR et al., Incidence and clearance of oral human papillomavirus infection in men: the HIM cohort study, Lancet, 2013, 382(9895):877–887.

BRINGING PREGNANCY TESTS TO WOMEN IN RURAL NEPAL

Community health volunteers trained to provide pregnancy tests, as well as reproductive health counseling and referrals, appear to be successful in providing such services to rural women, according to a pilot program conducted in Nepal in 2009–2010.1 In follow-up interviews about eight months after receiving training, 80% of 1,492 female community health volunteers reported that they had performed a urine pregnancy test for a client. The mean number of tests performed by volunteers was 3.1. Fifty-three percent of women tested for pregnancy received a positive result; volunteers referred two-thirds of pregnant women for antenatal care services and one-third for abortion services. All women with a negative pregnancy test result received family planning counseling; 24% also received oral contraceptive pills, 20% condoms and 10% other contraceptive methods. The authors conclude that “community health workers…are a promising channel for early pregnancy detection and referral to reproductive health services in low-resource settings.”

1. Andersen et al., Early pregnancy detection by female community health volunteers in Nepal facilitated referral for appropriate reproductive health services, Global Health: Science and Practice, 2013, doi: 10.9745/GHSP-D-12-00026, accessed Nov. 13, 2013.

HIV PREVALENCE IN RURAL SOUTH AFRICA

HIV prevalence in rural South Africa is high, and is substantially higher among women than men, according to a survey conducted in 2010–2011 among 4,362 adults aged 15 and older living in the Agincourt Health and Socio-Demographic Surveillance site.1 Overall, HIV prevalence was 19%; however, the rate among women was more than double that among men (24% and 11%, respectively). For both genders, prevalence peaked at ages 35–39 (45% for men and 46% for women). In general, rates were comparable to those found in KwaZulu-Natal and in Swaziland, although prevalence in those regions peaked at younger ages. The researchers note that “it is unknown whether older individuals contracted HIV at earlier ages and survived for long periods, or whether they acquired HIV at older ages,” and conclude that “consideration must be given to expanding prevention activities to older adults.”

1. Gómez-Olivé FX et al., Prevalence of HIV among those 15 or older in rural South Africa, AIDS Care, 2013, 25(9):1122–1128.

EMERGENCY CONTRACEPTION ACCESS VARIES GLOBALLY

International and country-level efforts to promote emergency contraception over more than a decade have yielded results, according to a review of data from the International Consortium for Emergency Contraception online database and other sources.1 Since 2000, donor and nongovernmental organizations have purchased more than 20 million doses of levonorgestrel-containing emergency contraceptive. In addition, an emergency contraceptive pill has been registered in 144 countries, and the method is currently included on the essential medicines lists of 59 countries and the World Health Organization. However, some 65 countries do not have a registered product. And of 42 low-resource countries surveyed, emergency contraception was offered in the public sector in only 23; similarly, only one-third of social marketing family planning programs currently offer a product. Moreover, knowledge and use of emergency contraceptive remains low in most low-income countries: According to Demographic and Health Survey data from 45 countries in four regions, knowledge among women ranged from 11% in East Asia to 35% in Latin America, whereas ever-use among sexually experienced women ranged from less than 1% in East Asia to 4% in Latin America. The authors comment that “governments…should commit to ensuring full access to emergency contraception among their population, including through the public sector.” They add that “raising the correct knowledge of emergency contraception among the general public is critical and will lead women to seek it out for themselves.”

1. Westley E et al., A review of global access to emergency contraception, International Journal of Gynecology and Obstetrics, 2013, 123(1):4–6.

FREE PREGNANCY TESTS HELP CONTRACEPTIVE PROVISION

Supplying family planning clinics with pregnancy tests to be provided for free or at low cost may reduce the proportion of female clients denied services because of providers’ uncertainty about their pregnancy status, according to a 2009–2010 study conducted at 10 clinics in Zambia—five randomly selected to receive free pregnancy tests and five selected as controls.1 Over the three months prior to the intervention, the proportion of female clients who did not receive a contraceptive method because they were not menstruating at the time of their visit (thus preventing their provider from determining if they were currently pregnant) was similar at clinics selected to participate in the intervention and control clinics (15% and 17%, respectively). Over the three-month intervention, however, the proportion of nonmenstruating clients denied service remained unchanged at control clinics, but dropped substantially at the clinics able to provide free pregnancy tests (4%). Compared with intervention group clients, control clients had more than four times the odds of being denied service (odds ratio, 4.4). A similar study in Ghana produced inconclusive results. The authors comment that “while the inconclusive results from Ghana preclude an unqualified recommendation, results from Zambia suggest that availability of free or low-priced pregnancy tests in family planning clinics may make strong public health sense in developing countries where service denial to non-menstruating clients remains a problem.”

1. Stanback J et al., Does free pregnancy testing reduce service denial in family planning clinics? A cluster randomized experiment in Zambia and Ghana, Global Health: Science and Practice, 2013, doi: 10.9745/GHSP-D-13-00011, accessed Nov. 13, 2013.

ONLINE HIV EDUCATION FOR YOUTH IN UGANDA

An Internet-based HIV prevention program developed for adolescents in Sub-Saharan Africa seems to be feasible to implement and acceptable among target youth. According to an initial assessment of CyberSenga, an HIV education program conducted in Uganda, researchers successfully set up “mobile cafés” (laptop computers and an Internet router—all independently powered by a car battery) in selected schools for students to use.1 During the intervention—which consisted of five weekly, one-hour modules of HIV, condom and healthy relationship information completed online by high school students—no interruptions in Internet service were experienced. Of the 182 male and female adolescents (mean age, 16.1 years) who participated in the program, 95% completed all five modules. Most of the feedback given by participants at follow-up interviews was positive: More than 90% reported that they had learned a lot from the program, found it easy to use and acquired skills that they needed to keep themselves healthy. In addition, 92% of males and 100% of females said that they would recommend the program to friends. However, 69–93% reported that the program talked too much about sex or condoms and had too many lessons. The authors comment that the negative feedback “may mean that the program exposed youth to things they have not done themselves or were uncomfortable thinking about” and did not necessarily suggest poor acceptability.

1. Ybarra ML et al., Acceptability and feasibility of CyberSenga: an Internet-based HIV-prevention program for adolescents in Mbarara, Uganda, AIDS Care, 2013, doi: 10.1080/09540121.2013.841837, accessed Nov. 14, 2013.

HEALTH WORKERS IN KENYA CAN SAFELY PROVIDE THE INJECTABLE

Injectable contraceptives can be safely provided by community health workers in Kenya, according to a pilot study implemented between August 2009 and September 2010.1 Over the yearlong study period, the 31 health workers—who had each completed three weeks of classroom and practical training on injectable provision and two weeks of supervised clinical experience prior to study initiation—provided services to 1,210 female clients. More than two-thirds of women served by health workers either initiated or continued use of the injectable; 75% of women who had previously received the injectable from a health facility opted to receive a reinjection from a health worker instead of returning to that facility. The one-year continuation rate among injectable clients—68%—was comparable to those from other studies. In total, health workers provided 2,452 injections without a single report of an injection-site infection or a needle-stick accident. In addition to providing the injectable, community health workers referred 34 women to health facilities for the IUD, the implant or female sterilization. Overall, family planning use in the study area increased from 9% to 46% over the study period; injectable use increased from 6% to 38%. The authors comment that as a result of their study and of subsequent advocacy efforts, “the [Ministry of Health] in November 2012 issued an official policy statement allowing provision of [the injectable] by trained [community health workers] in hard-to-reach areas.”

1. Olawo AA et al., “A cup of tea with our CBS agent…”: community provision of injectable contraceptives in Kenya is safe and feasible, Global Health: Science and Practice, 2013, doi: 10.9745/GHSP-D-13-00040, accessed Nov. 13, 2013.

IN BRIEF

•The Communist Party of China announced on Nov. 15 its decision to relax the country’s long-standing one-child policy. Couples will now be allowed to have two children if one of the parents is an only child; previously, couples were allowed two children if both parents were only children. [China to ease one-child policy, Xinhuanet, Nov. 16, 2013, <http://news.xinhuanet.com/english/photo/2013-11/16/c_132892920.htm>, accessed Nov. 19, 2013.]

•The United Nations Population Division has released its annual model-based estimates and projections of contraceptive prevalence, unmet need for family planning, total demand for family planning and percentage of demand for family planning among married or in-union women. The revision—which incorporates recently available data and extends the projection period from 2015 to 2030—is available at .