In Vietnam, concern is rising that young men who have unprotected intercourse with sex workers or other high-risk partners before marriage could acquire HIV and later transmit it to their wives. In surveys conducted with men and women in three marriage cohorts in northern Vietnam (the Red River Delta area) and southern Vietnam (Ho Chi Minh City), almost one-third of the male respondents in both areas who had married during 1992–2000 reported that they had had premarital sex. In the North, 45% of men who had engaged in premarital sex had done so only with their future spouse, compared with 29% in the South. According to Sharon Ghuman and colleagues, their findings indicate that of the men who had had premarital sex, those in the South were more likely than those in the North to have placed their wives at some level of risk [see article]. They recommend that more information be collected about young men's sexual networks and their sexual contacts with high-risk groups, so that interventions can be created to help lower the risk that HIV will spread from these groups into the general population.
Also in This Issue
•Nigerian couples on average want fewer children than they did 15 years ago. Still, only 7% of married Nigerian women were using a modern method in 2003, leading to high rates of unplanned pregnancy. According to a survey conducted by Gilda Sedgh and colleagues among almost 3,000 women in eight Nigerian states, 28% of respondents reporting having had at least one unwanted pregnancy , and 44% had attempted to end their last such pregnancy [see article]. In all, 78% of the women who had sought an abortion had not been practicing contraception when they conceived; of these, 44% said they were not aware of a contraceptive method, and 22% said they were afraid of side effects, did not know where to obtain a method or could not afford one. On the basis of these findings, the authors recommend efforts "to increase awareness of, access to and use of contraceptives among Nigerian women."
•Women with unmet need are often the primary group targeted for promotion of family planning services. In some countries, however, large proportions of contraceptive nonusers who say they want to limit childbearing have a birth within a few years, and many of those births are reported as wanted. To explore this seeming contradiction, Ilene Speizer analyzed data from Demographic and Health Surveys in three African countries (Burkina Faso, Ghana and Kenya) where women who said they wanted to delay or end childbearing were asked how much of a problem it would be if they became pregnant in the next two weeks [see article]. In Kenya, more than four in 10 women said pregnancy would be no problem or a small problem, compared with one in four women in Burkina Faso and Ghana. According to the author, the considerably higher prevalence of such ambivalent responses in Kenya suggests that as a country's fertility transition advances, increasing proportions of women may follow the trend toward smaller families without feeling strongly committed to it. In such situations, she argues, programs might find it useful to focus on the subset of women with unmet need who have the strongest desire to delay or limit births.
•According to risk reduction theory, knowledge of AIDS is a pre-requisite to protective changes in behavior; however, this theory is not always supported by research findings. To determine whether other factors mediate the relationship, Ndola Prata and colleagues used data from a population-based survey among 15–24-year-olds in Mozambique to compare self-assessed risk of HIV infection with an assessment based on their current and past sexual behavior [see article]. Among respondents who considered themselves at no risk or a small risk of infection, 80% of men and 27% of women were actually at moderate or high risk. In multivariate analyses, men and women who correctly assessed their HIV risk were 17% and 16% more likely, respectively, to have used a condom at last sex than were those who did not. The authors recommend that risk reduction campaigns should focus on helping men and women assess their HIV risk accurately and encouraging behavior change based on that self-assessment.
•Intimate partner violence has been linked to numerous poor health outcomes for women and their children, but little attention has been paid to its association with gynecologic morbidity. Using data from men's and women's surveys conducted in Uttar Pradesh, in northern India, Rob Stephenson, Michael Koenig and Saifuddin Ahmed constructed a sample of matched husbands and wives and compared the husbands' reports of domestic violence in the last year with their wives' reports of gynecologic morbidity [see article]. In all, 12% of husbands said they had committed physical violence only, 17% sexual violence only and 9% both physical and sexual violence. Thirty-four percent of wives reported at least one gynecologic symptom. Compared with women whose husbands reported no violence, those whose husbands reported sexual violence only or both physical and sexual violence were significantly more likely to experience gynecologic problems. The authors recommend that reproductive health services either incorporate support services for abused women or link them to other agencies that provide such services.