CHILD DEATHS IN AFRICA ARE INCREASINGLY AIDS-RELATED
The proportion of Sub-Saharan African children younger than five who die because of HIV/AIDS quadrupled over the last decade, rising from less than 2% in 1990 to 8% in 1999, according to estimates covering 39 countries.1 Using data gathered by the World Health Organization and the Joint United Nations Programme on HIV/AIDS, researchers estimate that 330,000 HIV-infected children younger than five died in the region in 1999. In five countries--Botswana, Namibia, Swaziland, Zambia and Zimbabwe--the mean rates of HIV-related mortality in this age-group were higher than 30 per 1,000 deaths in 1999. Rates were 10-25 per 1,000 in 16 countries and lower than 10 per 1,000 in 18 countries. The proportion of deaths among children attributable to HIV infection in 1999 ranged from 0.1% in Madagascar to 42% in Botswana; the largest proportions were in southern Africa. The investigators note that their estimates are probably lower than the actual HIV/AIDS-related child mortality rates because their estimates reflect only the direct effects of HIV/AIDS. They conclude that "Death of parents and school-teachers, loss of income and resulting poverty, and other social disruptions that accompany high rates of HIV seroprevalence could also lead to increased morbidity and mortality among children."
1. Walker N, Schwartländer B and Bryce J, Meeting international goals in child survival and HIV/AIDS, Lancet, 2002, 360(9329):284-289.
REFUGEES MAY FARE BETTER IN CAMPS THAN AT HOME
Women living in postemergency refugee camps appear to have better reproductive health outcomes than women in their country of origin, according to an analysis of data on 42 refugee camps in five countries in Asia and Africa.1 Data on female refugees from eight countries of origin--Bhutan, Burundi, Cambodia, Democratic Republic of the Congo, Myanmar, Rwanda, Somalia and Sudan--were collected from August 1998 to December 1999. The women were divided into nine groups on the basis of their country of origin and their camp location. Five of the groups had significantly lower crude birthrates than the national rate in their country of origin (13-40 vs. 34-52 live births per 1,000 people). All five of the groups for which comparison data on neonatal mortality were available had rates significantly lower than those in their country of origin (0-29 vs. 35-75 neonatal deaths per 1,000 live births). Maternal mortality data were compared for six groups; four of these had significantly lower rates than their country of origin (76-730 vs. 550-1,300 maternal deaths per 100,000 live births). The researchers conclude that "Better access...to preventative and curative health care services, and to food and nonfood items...may account for better reproductive health outcomes among" refugees in postemergency camps than among women and infants in their countries of origin.
1. Hynes M et al., Reproductive health indicators and outcomes among refugee and internally displaced persons in postemergency camps, JAMA, 2002, 288(5):595-603.
MAGNESIUM SULFATE SAFELY PREVENTS ECLAMPSIA
Women at risk of eclampsia, or pregnancy-induced high blood pressure, who are given magnesium sulfate have a significantly lower risk of convulsions and death than those who receive a placebo, according to a randomized study of more than 10,000 women.1 The study participants were from 33 countries in Africa (47%), the Americas (27%), Asia and the Pacific (15%) and Europe (10%). Women in the experimental group received doses of 5 g of magnesium sulfate over a 24-hour period. Compared with women who received a placebo, those treated with magnesium sulfate were 58% less likely to have convulsions and 45% less likely to die (relative risks of 0.4 and 0.6, respectively). These results were consistent across countries, regardless of national maternal perinatal mortality rates. However, 24% of women who received treatment experienced side effects such as nausea or vomiting, muscle weakness, respiratory problems and headache, compared with only 5% of women who received a placebo. The investigators note that although magnesium sulfate is relatively inexpensive, it is not readily available in some countries. They conclude that "removing barriers in the supply and use of magnesium sulfate should be a priority for those responsible for maternal health services in developing countries."
1. The Magpie Trial Collaborative Group, Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial, Lancet, 2002, 359(9321):1877-1890.
TURNING AIDS RESEARCH INTO ACTION
An estimated 15,000 AIDS researchers, service providers and activists gathered in Barcelona on July 7-12 for the 14th International AIDS Conference, which was dedicated to "knowledge and commitment for action."1 In previous years, the conference had focused almost entirely on biomedical issues, but the organizers of the Barcelona conference widened its scope of interest to include program interventions and implementation as well as advocacy and policy. The program interventions and implementation track, for example, included a session on integrating HIV with other health services, while the advocacy and policy track featured sessions on topics such as workplace issues and capacity and policy prerequisites for access to antiretroviral therapy. Among the highlights of the conference were speeches during the closing ceremony by former U.S. President Bill Clinton and former South African President Nelson Mandela, who are cochairs of the International AIDS Trust. Speaking of the high cost of defeating AIDS, Clinton drew cheers when he asserted that "developing countries have to determine how much they can pay and send the rest of us the bill for the difference." Mandela, following Clinton on the podium, closed the conference by issuing a call for community. "We are all human," he said, "and the HIV/AIDS epidemic affects us all in the end. If we discard the people who are dying from AIDS, then we can no longer call ourselves people."
1. Henry J. Kaiser Family Foundation, Clinton and Mandela close the XIV International AIDS Conference, July 2002, <http://www.kaisernetwork. org/aids2002/webcast_12_a.cfm>, accessed Aug. 13, 2002.
U.S. WITHDRAWS SUPPORT FOR FAMILY PLANNING
The Bush administration has announced that it will withhold the $34 million U.S. contribution to the United Nations Population Fund (UNFPA) approved by Congress for the current fiscal year.1 The administration's decision is based on its determination that "UNFPA's support of, and involvement in, China's population-planning activities allows the Chinese government to implement more effectively its program of coercive abortion." The decision contradicts the report of an independent assessment team sent to China by Secretary of State Colin Powell, which concluded there is "no evidence that UNFPA has knowingly supported or participated in the management of a program of coercive abortion or involuntary sterilization in [China]."2 The Bush administration has said that it will redirect the $34 million to the U.S. Agency for International Development's Child Survival and Health Program Fund, which operates in approximately 60 countries, compared with the 142 countries in which UNFPA operates. Two days after the U.S. announcement, the European Commission announced that its member states had approved $32 million for a partnership with UNFPA and to fill in a "decency gap" left by the United States.3 An additional response came from United Nations ambassadors from more than 50 African countries. In a letter to the Bush administration, the ambassadors protested the administration's decision, saying it will impede their countries' efforts to "prevent HIV/AIDS, promote family planning and improve the lives of children."4
1. Powell CL, Letter to the Subcommittee on Foreign Operations, Committee on Appropriations, U.S. Senate, Washington, DC, July 21, 2002.
2. Brown WA, Glick BL and Tong TG, Summary findings and recommendations regarding the question "Does the UNFPA support or participate in the management of a program of coercive abortion or involuntary sterilization in China?" Report to The Honorable Colin L. Powell, Washington, DC, May 29, 2002.
3. EU ups family planning cash to fill gap left by US, Reuters Health, July 24, 2002.
4. United Nations Population Fund (UNFPA), UNFPA welcomes Africa's support, recommits to saving lives in developing world, press release, New York: UNFPA, Aug. 8, 2002.
EDUCATION CHANGES BEHAVIOR OF CHINESE SEX WORKERS
Chinese sex workers are more than twice as likely to use condoms consistently with clients after receiving information about HIV and other sexually transmitted diseases (STDs) and education on skills related to condom use.1 From March 1998 to October 1999, 966 female sex workers in Guangzhou were recruited for an intervention that included STD testing and treatment, as well as group counseling on reproductive health, STDs and condom use skills. After the initial visit, women were asked to return for three bimonthly follow-up visits; 52% made all three visits. Compared with all women who entered the study, those who made a third follow-up visit were significantly more likely to provide correct answers to nine questions measuring knowledge about HIV and AIDS (99% vs. 4%) and to five questions about condom use (80% vs. 24%). They were also significantly more likely to rate themselves as "very capable" on three measures of insistence on condom use with clients (96% vs. 32%). Likewise, 81% of sex workers interviewed at their third visit said they had always used condoms with clients during the previous two months, compared with 30% of the baseline sample. In addition, women who returned for all three visits were significantly less likely to have new chlamydia and trichomoniasis infections. According to the investigators, their findings suggest that "preventive education and STD care [are] likely to reduce unprotected sexual behavior and STD incidence" among Chinese sex workers.
1. Ma S et al., Decreasing STD incidence and increasing condom use among Chinese sex workers following a short term intervention: a prospective cohort study, Sexually Transmitted Infections, 2002, 78(3):110-114.
• The U.S. Agency for International Development has produced an interactive CD-ROM about the lactational amenorrhea method of contraception for breastfeeding women. Designed to help family planning program managers integrate the method into their programs, the CD-ROM contains training modules, educational materials and a bibliography with abstracts. To view, download or order free copies, visit <http://www.linkagesproject.org>.
• Interested in conducting qualitative research on sexual and reproductive health in developing countries? A field guide from Family Health International (FHI) covers such topics as basic principals of qualitative research methodology, study design and data collection and analysis. It also offers guidelines for managing focus group discussions and provides sample consent forms and budgets. To obtain a copy (free to researchers in developing countries), download the order form from FHI's web site at < http://www.fhi.org >.
• A curriculum for training health managers, planners and policymakers to develop policies and programs that promote gender equity and reproductive rights is available from the World Health Organization. The curriculum is designed to be used in courses on research and programming in sexual and reproductive health. To request a free copy of the curriculum, send an e-mail to [email protected].