Kerry Richter

Factors Associated With Use of the Female Condom in Zimbabwe

CONTEXT Because women can initiate use of the female condom, the method is believed to make it easier for women to protect themselves against sexually transmitted infections (STIs), including HIV infection. Evidence is lacking about factors associated with trying the female condom and using it consistently. METHODS A sample of 1,740 sexually active consumers visiting retail outlets in urban Zimbabwe that sell male or female condoms were surveyed in 1998, one year after a social marketing campaign had begun. Logistic regression analyses were conducted to assess factors associated with ever-use of the female condom and consistent use (always or often) with marital and regular non-marital partners. RESULTS Perceived ease of use and affordability of the product and prior use of the male condom were associated with mens and womens ever-use. Consistent use with marital partners was negatively associated with reporting multiple partners in the past year (odds ratio, 0.3) and positively associated with using the device for pregnancy prevention (5.4) and previously using the male condom (8.0). Consistent use with regular non-marital partners was associated with numerous variables, including perceived ease of use (1.9) and effectiveness for STI prevention (3.8), low HIV risk perception (2.4), and use for pregnancy (2.9) and STI (2.3) prevention. CONCLUSIONS Perceived affordability and ease of use may encourage couples to try the female condom but may not lead to consistent use. Because the reasons for use can vary between marital and non-marital relationships, the female condom may need to be positioned differently for different target populations.

Community‐based interventions that work to reduce HIV stigma and discrimination: results of an evaluation study in Thailand

HIV stigma and discrimination are major issues affecting people living with HIV in their everyday lives. In Thailand, a project was implemented to address HIV stigma and discrimination within communities with four activities: (1) monthly banking days; (2) HIV campaigns; (3) information, education and communication (IEC) materials and (4) “Funfairs.” This study evaluates the effect of project interventions on reducing community‐level HIV stigma.

Union patterns and children’s living arrangements in Latin America

This article analyzes how union patterns in Mexico and Colombia affect the lives of children. The proportion of children affected by a disruption by the age of 15 is estimated by using life table methods. The factors that contribute to a child’s risk of experiencing a disruption are investigated by using proportional hazard models. Finally, the living arrangements of children by the mother’s marital status, the urban status, and the mother’s educational attainment are explored. The findings indicate that about one-fifth of Mexican children and one-third of Colombian children spend some time with an unmarried mother by the age of 15. In addition, those who experience a disruption or are born outside of a union spend a considerable length of time in the single-parent state. Most children of an unmarried mother live in an extended-family household, often with a grandparent.

The Impact of Parental Migration on the Mental Health of Children Left Behind

This study aims to examine the impact of parental international migration on the mental health of children left behind. Data for this paper were taken from the “Child Health and Migrant Parents in South-East Asia, Thailand, 2008” project. A total of 1,030 children (519 from emigrant parents and 511 from non-migrant parents) were covered. Data were collected from the caregivers of children using the Strength and Difficulties Questionnaire. Multivariate analyses were performed to determine the association between parental migration and the mental health status of children left behind. Several factors were significantly associated with children’s mental health. Our study did not find any association between current parental migration status and mental health status of the children left behind. The study found, however, that mother’s earlier migration history had a significant, independent association with mental health problems of the children left behind. Therefore, effective strategies to prevent such mental health problems among children are warranted.

Trust, Caution, and Condom Use with Regular Partners: An Evaluation of the Trusted Partner Campaign Targeting Youth in Four Countries

Research suggests that youth do not use condoms because they trust their partner. This article describes the Trusted Partner regional behavior change communication campaign and uses data from Lesotho, Mozambique, Uganda, and Zambia to evaluate the impact of the campaign. Cross-sectional surveys of youth aged 15 to 24 were conducted in each country before and after the campaign. The surveys measured elements related to trust and condom use with a regular partner. Multivariate logistic regressions were used to investigate the determinants of condom use and whether exposure to the campaign was associated with condom use. The evaluation of the campaign showed mixed results. The percent of youth recalling the campaign varied among countries: 32% in urban Lesotho, 54% in urban Mozambique, 16% in Uganda, and 39% in urban Zambia. In all 4 countries, sexual caution with a partner had a positive relationship with condom use. However, exposure to the campaign was only associated with condom use in Mozambique. These results from Mozambique indicate that more intense exposure may be necessary to achieve impact. Regional campaigns appear to be a cost-effective way to reach large numbers of youth, but more detailed measures of exposure should be pursued to improve program evaluations.

Effectiveness of a multi-country workplace intervention in sub-Saharan Africa

This paper examines whether a multi-country workplace peer education HIV prevention program is effective in influencing knowledge, attitudes and behavior in a highly educated and technically skilled workforce. Self-administered surveys were used to measure change among N=993 male and female workers exposed to a comprehensive and culturally-appropriate program. Most knowledge indicators and all attitude indicators showed significant improvement between baseline and post-intervention. The odds ratio was 2.48 for reporting confidence in using condoms correctly after exposure to the program compared with the baseline survey. The results on changes in practice were mixed; while respondents were more likely to report being tested for HIV post-intervention, they were also more likely to self-report risky behavior. The findings suggest that peer education prevention programs in the workplace may create a climate of open discussion about sexual issues that increases self-reporting of risk behavior. Reinforcement of the messages contained in the program is therefore extremely important for influencing future behavior change.

The impact of parental absence on early childhood development in the context of Thailand

This analysis investigates the impact of parental absence on early childhood development in Thailand, using the Denver II screening tool, based on a study conducted in 2013–2014. Children aged 36 months and younger were included (n = 923). Results reveal that the crucial factor for delayed development in early childhood is the mother’s presence in the household. Children who were cared for by others were not at higher risk of delayed development as long as their mother was present, while the father’s absence did not make a difference. This study raises concern for the large number of children living separately from their mothers, and also raises questions about the long-term effects of parental migration for this generation of Thai children.

Myanmar mortality registration: an assessment for system improvement

BackgroundThe vital registration system in Myanmar has a long history and geographical coverage is currently high. However, a recent assessment of vital registration systems of 148 countries showed poor performance of the death registration system in Myanmar, suggesting the need for improvement. This study assessed the quality of mortality data generated from the vital registration system with regard to mortality levels and patterns, quality of cause of death data, and completeness of death registration in order to identify areas for improvement.MethodsThe study used registered deaths in 2013 from the vital registration system, data from the 2014 Myanmar Population and Housing Census, and mortality indicators and COD information for the country estimated by international organizations. The study applied the guidelines recommended by AbouZahr et al. 2010 to assess mortality levels and patterns and quality of cause of death data. The completeness of death registration was assessed by a simple calculation based on the estimated number of deaths.ResultsFindings suggested that the completeness of death registration was critically low (less than 60%). The under-registration was more severe in rural areas, in states and regions with difficult transportation and poor accessibility to health centers and for infant and child deaths. The quality of cause of death information was poor, with possible over-reporting of non-communicable disease codes and a high proportion of ill-defined causes of death (22.3% of total deaths).ConclusionThe results indicated that the vital registration system in Myanmar does not produce reliable mortality statistics. In response to monitoring mortalities as mandated by the Sustainable Development Goals, a significant and sustained government commitment and investment in strengthening the vital registration system in Myanmar is recommended.