Ann E. Biddlecom

Migration sexual behavior and the risk of HIV in Kenya.

The association of migration with AIDS in sub-Saharan Africa is well documented, yet the social and behavioral mechanisms underlying this relationship remain poorly understood. Using data from the 1993 Kenya Demographic and Health Survey, this article examines whether migrants are more likely than nonmigrants to have multiple recent sexual partners and not use condoms with those partners. Results indicate that migration is a critical factor in high-risk sexual behavior and that its importance varies by gender and by the direction of movement. Independent of marital and cohabitation status, social milieu, awareness of AIDS, and other crucial influences on sexual behavior, male migrants between urban areas and female migrants within rural areas are much more likely than nonmigrant counterparts to engage in sexual practices conducive to HIV infection. In rural areas, migrants from urban places are more likely than nonmigrants to practice high-risk sex. Given the predominance of men in urban migration and the large volume of circulatory movement between urban and rural areas, these results have serious implications for HIV transmission throughout Kenya.

Sexual Behavior, Knowledge and Information Sources of Very Young Adolescents in Four Sub-Saharan African Countries

Adolescents are a key target group for HIV and pregnancy prevention efforts, yet very little is known about the youngest adolescents: those under age 15. New survey data from 12-14 year olds in Burkina Faso, Ghana, Malawi and Uganda are used to describe their sexual activity, knowledge about HIV, STIs and pregnancy prevention, and sources of sexual and reproductive health information, including sex education in schools. Results show that very young adolescents are already beginning to be sexually active and many believe their close friends are sexually active. They have high levels of awareness but little in-depth knowledge about pregnancy and HIV prevention. Multiple information sources are used and preferred by very young adolescents. Given their needs for HIV, STI and pregnancy prevention information that is specific and practical and considering that the large majority are attending school in most countries in Sub-Saharan Africa, school-based sex education is a particularly promising avenue for reaching adolescents under age 15.

Role of parents in adolescent sexual activity and contraceptive use in four African countries.

CONTEXT Parents have an influence on the sexual and reproductive health of adolescents, but evidence from Sub- Saharan Africa is limited. A better understanding of the relationship between different dimensions of parenting and recent sexual activity and contraceptive use is needed in the region. METHODS Data were collected in 2004 in nationally representative surveys of 12-19-year-olds in Burkina Faso, Ghana, Malawi and Uganda. Bivariate analysis compared gender differences for two outcomes among unmarried 15-19-year-olds-having had sexual intercourse in the last 12 months and, among those who had had sex in this period, contraceptive use at last sex. Multivariate logistic regression analysis identified associations between these outcomes and coresidence with parents or parent figures, parental monitoring and parent-child communication. RESULTS Unmarried adolescents reported moderate to high levels of parental monitoring and low levels of parent-child communication about sexual matters. In all countries, adolescent males who reported low monitoring were at elevated risk of having had sex in the last year (odds ratios, 2.4-5.4), as were their female counterparts in three of the countries (6.9-7.7). Communication with parents was positively associated with sexual activity among Malawian males and Ugandan females (2.2 and 1.5, respectively). Parental monitoring was not associated with contraceptive use at last sex, whereas parent-child communication was associated with such use among Ghanaian females (3.0) and among Ugandan adolescents of both genders (1.9-2.0). CONCLUSIONS Programs to improve adolescent sexual and reproductive health should include dimensions of parental involvement that can strengthen the programs specific behavior change goals.

Influence of social connectedness, communication and monitoring on adolescent sexual activity in Ghana.

This paper examines connectedness to, communication with and monitoring of unmarried adolescents in Ghana by parents, other adults, friends and key social institutions and the roles these groups play with respect to adolescent sexual activity. The paper draws on 2004 nationally-representative survey data and qualitative evidence from focus group discussions and in-depth interviews with adolescents in 2003. Adolescents show high levels of connectedness to family, adults, friends, school and religious groups. High levels of adult monitoring are also observed, but communication with family about sex-related matters was not as high as with non-family members. The qualitative data highlight gender differences in communication. Multivariate analysis of survey data shows a strong negative relationship between parental monitoring and recent sexual activity for males and females, and limited effects of communication. Creating a supportive environment and showing interest in the welfare of adolescents appear to promote positive sexual and reproductive health outcomes.

Intergenerational transfers of resources between older persons and extended kin in Taiwan and the Philippines

This study examines the extent to which older generations actively exchange resources with extended kin in Taiwan and the Philippines. It is critical to understand the position of older generations in the family, because population ageing and declines in family size spur concerns about the tenacity of family support. This research builds upon previous studies that have predominantly focused on parent–child relationships alone or on support received by older parents. Social-network measures are used to estimate overall levels of transfers of resources across generations, and the prevalence and patterns of pathways that link generations and types of kin. Our findings show that the availability of kin is similar in both settings but that transfer activity in the Philippines appears more broadly distributed across family relations, especially siblings, while in Taiwan transfers are more concentrated among lineal kin. These results confirm the importance and diversity of extended kin in systems of family support.

women's and men's fertility preferences and contraceptiVe behaViors by hiV statUs in 10 sUb-saharan african coUntries

This article draws on biomarker data from Demographic and Health Surveys (2003-2007) in 10 sub-Saharan African countries to examine differences in fertility preferences and contraceptive behaviors by HIV status for women and men, taking into account whether or not they probably know their HIV status. The objective is to determine if there are common patterns in the associations between these variables across several countries. Womens and mens fertility preferences and contraceptive behaviors are relatively similar across HIV status and probable knowledge of that status. However, two consistent differences emerge in some of the countries: HIV-positive women who probably know their status are less likely to want more children and are more likely to be using male condoms than women who are HIV-negative and probably know it. A similar association is observed for men for condom use but not for limiting childbearing. Other factors unrelated to HIV status seem to be shaping womens and mens unmet demand for contraception and use of methods other than the condom.

Induced abortion in Colombia: new estimates and change between 1989 and 2008.

CONTEXT Although abortion was made legal in Colombia under selected circumstances in 2006, no national studies have examined whether the incidence of the procedure has changed since the previous estimate in 1989. METHODS Data on the number of women treated for abortion complications were obtained from a nationally representative survey of 300 public and private health facilities, and estimates of the likelihood that women obtaining abortions experience complications and receive treatment at a facility were obtained from a survey of 102 knowledgeable professionals. Indirect estimation techniques were used to calculate national and regional abortion measures for 2008, which were compared with previously published 1989 estimates. Numbers and rates of unintended pregnancy were also calculated. RESULTS In 2008, an estimated 93,300 women were treated for induced abortion complications in public and private health facilities. An estimated 400,400 induced abortions were performed, which translates to a rate of 39 per 1,000 women aged 15-44, a slight increase from 1989 (36 per 1,000). Rates varied widely across regions, from 66 in Bogotá to 18 in Oriental. Despite the new abortion law, only 322 legal abortions were performed in 2008. Between 1989 and 2008, the proportion of pregnancies ending in induced abortion increased from 22% to 29%, and the proportion of pregnancies that were unintended rose from 52% to 67%. CONCLUSION Improvements in provision of and access to contraceptive and legal abortion services are needed to meet the increased demand among women and couples to prevent unintended pregnancy and unsafe abortion.

Trends in sexual behaviours and infections among young people in the United States

Objectives: To describe trends over time in sexual behaviour, condom use, and sexually transmitted infections among female and male adolescents in the United States. Methods: A review was carried out of published studies using data from six surveys since the 1970s on sexual behaviour and surveillance data on sexually transmitted infections. Results: The proportion of adolescents who have ever had sexual intercourse increased for females and males through the 1980s and then declined for males through the 1990s. Some survey data showed that the level remained unchanged in the 1990s for adolescent females and other sources showed a decline by 2001. Condom use at first sexual intercourse and current condom use have increased over the past two decades for both male and female adolescents. Incidence rates for gonorrhoea and syphilis among adolescents declined over the 1990s and up through 2002, though new diagnoses of HIV/AIDS among adolescents remained relatively constant throughout the 1990s and into the new century. Conclusion: Although data sources are difficult to compare over time, trends in sexual behaviour, condom use, and sexually transmitted infections among adolescents from different data sources display generally similar directions towards declines in risk behaviours and outcomes, and increases in protective behaviours.

Vaccine for cervical cancer: reaching adolescents in sub-Saharan Africa

Mercks vaccine for cervical cancer is being reviewed as a priority by the US Food and Drug Administration (FDA) with a ruling due on June 8 and GlaxoSmithKline submitted an application for its vaccine in the European Union on March 9. The issue of how best to introduce these vaccines to young people before they become sexually active is now therefore a research priority. Vaccination against cervical cancer is especially important in developing countries where nearly 80% of cases are reported and where effective methods of diagnosis--such as the Pap smear--are rarely used. Modelling studies indicate that vaccines against human papillomavirus (HPV) could be effective in preventing cervical cancer provided all adolescents--not just those at high risk--are vaccinated before they become sexually active. The need to reach large numbers of adolescents with a series of three injections is a challenge however especially in sub-Saharan Africa. (excerpt)

Does knowledge about antiretroviral therapy and mother-to-child transmission affect the relationships between HIV status and fertility preferences and contraceptive use? New evidence from Nigeria and Zambia.

The increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009-2010 community-based surveys in Nigeria and Zambia, this study explores whether womens knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by womens HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media.