International Public Health Commons^™

Patterns And Implications Of Male Migration For Hiv Prevention Strategies In Karnataka, India, Niranjan Saggurti, Ravi K. Verma, Pranita Achyut, Saumya Ramarao, Anrudh K. Jain

HIV and AIDS

Karnataka is one of the high HIV prevalence states in India. Results from the National Family Health Survey indicate that 0.69 percent of adults aged 15–49 were infected with HIV in 2005–06. According to sentinel surveillance system data, HIV prevalence among pregnant women receiving antenatal care (ANC) in Karnataka was 1.3 percent. Further, 18 of the state's 27 districts have recorded HIV prevalence of more than 1 percent among pregnant women receiving ANC in sentinel sites. Strong male migration patterns are evident in some of the state’s high HIV prevalence districts. According to the 2001 census, Karnataka ranks fourth in …

Building The Capacity Of Faith-Based Organizations To Promote Mutual Monogamy In South Africa, Waimar Tun, Nathi Sohaba, Unathi Malinzi, Matthew Nqono, Osborne Mzilikazi, Bonisiwa Mgujulwa, Moses Madywabe, Mbulelo Fatyeni, Christine Fontecchio

HIV and AIDS

In South Africa, where sex partnerships outside primary relationships are common even among church members, HIV-prevention programs focusing on mutual monogamy (MM) are needed. Church leaders, highly regarded by the community, may be effective in reaching congregation members with HIV-prevention messages. However, implementing programs that promote faithfulness pose several challenges. In response to a lack of research on effective strategies to promote MM, the Horizons Program, in partnership with the Eastern Cape Provincial Council of Churches and the South African Council of Churches, piloted an intervention to promote MM. A curriculum was developed covering topics including HIV transmission, personal relationships, …

Moving Forward: Tackling Stigma In A Tanzanian Community, Laura Nyblade, Kerry Macquarrie, Gideon Kwesigabo, Aparna Jain, Lusajo Kajula, Fausta Philip, William Henerico Tibesigwa, Jessie K. Mbwambo

HIV and AIDS

The International Center for Research on Women, the Muhimbili University College of the Health Sciences, the Population Council, and Family Health International conducted an evaluation of a community-based effort to reduce stigma surrounding HIV infections in a peri-urban community in Tanzania. Results presented a mixed, but hopeful, picture for a way forward in tackling stigma at the community level. Tackling stigma requires that the individuals tasked with doing this undergo personal change. Programs can start by focusing stigma-reduction efforts on a smaller, more manageable geographical area and adding specific anti-stigma components to their portfolio of activities. Engaging community opinion leaders …

Feasibility, Acceptability, Effect, And Cost Of Integrating Counseling And Testing For Hiv Within Family Planning Services In Kenya, Wilson Liambila, Charlotte E. Warren, Saiqa Mullick, Ian Askew, Rick Homan, Ibrahim Mohammed, Robert Ayisi, Margaret Gitau, Josephine Kibaru, Mary W. Gathitu, Judith Maua, Helton Jilo, Juma Mwangi, John Njoroge, Anthony K. Wanyoro, Peter Mohammed Njuguna, Andrew Mboche

Reproductive Health

FRONTIERS supported the Division of Reproductive Health and the National AIDS and STI Control Program of the Kenya Ministry of Health to design, implement, and compare two models of integrating counseling and testing (CT) for HIV within family planning (FP) services in terms of their feasibility, acceptability, cost, and effect on the voluntary use of CT, as well as the quality of FP services. The study demonstrated that both models were feasible and acceptable to providers and to clients as means of integrating and linking HIV prevention counseling, condom promotion, and counseling and testing with FP services, and are effective …

If You Build It, Will They Come? Kenya Healthy Start Pediatric Hiv Study: A Diagnostic Study Investigating Barriers To Hiv Treatment And Care Among Children, Karusa Kiragu, Katie D. Schenk, Julie Murugi, Avina Sarna

HIV and AIDS

In Kenya the proportion of eligible HIV-positive children receiving ART treatment is only 11 percent. This study explored and documented possible barriers in the community to accessing pediatric HIV testing and treatment, to guide the development of new interventions to encourage uptake. The study identified barriers such as cost, use of traditional healers, low knowledge of treatment options, attitudinal barriers, stigma, unique treatment issues, and dissatisfaction with available services. Additionally, healthcare workers missed opportunities to provide services and cited numerous service-side challenges. The study recommends prioritizing community awareness, mobile clinics, strengthening capacity of healthcare workers, supporting family-based HIV testing, and …

Migration/Mobility And Vulnerability To Hiv Among Male Migrant Workers: Tamil Nadu 2007-08, Anjaneyalu Subbiah, S. Ramachandran, A.K. Ravi Shankar, Niranjan Saggurti, Ravi K. Verma, Anrudh K. Jain, Saumya Ramarao, Suvakanta N. Swain, Ajay Kumar Singh

HIV and AIDS

The present study was undertaken by the Population Council in partnership with Annamali University, Tamil Nadu, India to study the broad patterns and motivating forces driving migrant men’s mobility and the contexts that determine and influence their engaging in high-risk activities that increase their vulnerability to HIV. The results indicate large interdistrict movements of working men in Tamil Nadu with a little variation across districts and greater mobility among younger men. Research results suggest that further examination of the contract system under which many of the migratory laborers work is a potential focus for program intervention. Places of origin offer …

Consentimiento Informado En Ensayos De Prevención Del Vih: Aspectos Destacados De Un Taller Internacional, Population Council

HIV and AIDS

Resumen adaptado del informe del taller organizado conjuntamente por el Population Council y Family Health International en mayo de 2005. El resumen se centra específicamente en las herramientas y estrategias presentadas en el taller que se están usando en ensayos de prevención del VIH para facilitar el consentimiento informado, explicar conceptos difíciles, y evaluar la comprensión entre los participantes del ensayo. Se destacan ejemplos ilustrativos de ensayos concluidos y en curso. Este resumen será útil para una audiencia de investigadores locales, defensores y personal de ensayos clínicos.

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Brief adapted from the report of a workshop co-hosted by the Population …

Consentimento Informado Nos Ensaios De Prevenção Do Hiv: Pontos Altos Dum Workshop Internacional, Population Council

HIV and AIDS

Resumo adaptado do relatório do workshop organizado pelo Population Council e Family Health International em maio de 2005. O resumo se concentra especificamente nas ferramentas e estratégias apresentadas no workshop que estão sendo usadas em testes de prevenção do HIV para facilitar o consentimento informado, explicar conceitos difíceis e avaliar a compreensão entre os participantes do estudo. Exemplos ilustrativos de ensaios concluídos e em andamento são destacados. Este resumo será útil para um público de investigadores locais, advogados e equipe de ensaios clínicos.

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Brief adapted from the report of a workshop co-hosted by the Population Council and Family Health …

Imvume Unolwazi Ocwaningweni Lokuvimbela Igciwane Lesandulela Ngculaza, Population Council

HIV and AIDS

Brief adapted from the report of a workshop co-hosted by the Population Council and Family Health International in May 2005. The brief focuses specifically on tools and strategies presented at the workshop that are being used in HIV-prevention trials to facilitate informed consent, explain difficult concepts, and assess comprehension among trial participants. Illustrative examples from completed and ongoing trials are highlighted. This brief will be useful for an audience of local researchers, advocates, and clinical trial staff.

Patterns Of Migration/Mobility And Hiv Risk Among Female Sex Workers: Karnataka 2007-08, Shiva S. Halli, Raluca Buzdugan, Ravi K. Verma, Stephen Moses, James Blanchard, Anrudh K. Jain, Saumya Ramarao, Suvakanta N. Swain, Niranjan Saggurti

HIV and AIDS

In Karnataka, South India, HIV infection is spreading, with female sex workers (FSWs) a high-risk group. In an effort to gain control over the epidemic, the HIV/AIDS program has made substantial efforts in the last few years toward offering FSWs access to information about sexually transmitted infections/HIV/AIDS and to condoms, clinics, and other medical services. The present study was undertaken by the Karnataka Health Promotion Trust and the Population Council to determine the patterns and factors that drive mobility among FSWs and the association of mobility with HIV risk. The report’s findings—including mobility routes, sociodemographic profiles of FSWs, membership in …

Extending Prevention Of Mother-To-Child Transmission Through Postpartum Family Planning In Lesotho, Charlotte E. Warren, Semakaleng Phafoli, Bosielo Majara, Thato Tsukuluet

Reproductive Health

Recognizing the need to improve the care and follow up of mothers and infants in the postpartum period, the Lesotho Ministry of Health and Social Welfare (MOHSW), with technical support from the Frontiers in Reproductive Health (FRONTIERS) of Population Council and funding from PEPFAR/RHAP/USAID, carried out an operations research project to strengthen the existing postpartum care services. This study had a specific focus on strengthening linkages with existing PMTCT follow-up and family planning services during the postpartum period by changing the number, timing, and content of postpartum consultations that a woman and her newborn should receive. The key findings indicated …

Patterns Of Migration/Mobility And Hiv Risk Among Female Sex Workers: Tamil Nadu 2007-08, Niranjan Saggurti, Ravi K. Verma, Suvakanta N. Swain, Hanimi Reddy Modugu, Ajay Kumar Singh, Saumya Ramarao, Anrudh K. Jain

HIV and AIDS

In past years, considerable research has been undertaken on the role of female sex workers (FSWs) in the transmission of HIV infection. FSWs have been seen as a major “source” of infection, and consequently, have been extensively targeted to prevent its spread. There is, however, a gap in our understanding of the dynamics of sex work, sex workers' patterns of mobility, and the relationship of such mobility with risk of HIV infection and gender-based violence. The Population Council collaborated with its local partner, TNS, to carry out a study in Tamil Nadu to examine the patterns of mobility of FSWs …

Strategies For Implementing The New International Health Regulations In Federal Countries, David P. Fidler, Kumanan Wilson, Christopher Mcdougall, Harvey Lazar

Articles by Maurer Faculty

The International Health Regulations (IHR), the principal legal instrument guiding the international management of public health emergencies, have recently undergone an extensive revision process. The revised regulations, referred to as the IHR (2005), were unanimously approved in May 2005 by all Member States of the World Health Assembly (WHA) and came into effect on 15 June 2007. The IHR (2005) reflect a modernization of the international community’s approach to public health and an acknowledgement of the importance of establishing an effective international strategy to manage emergencies that threaten global health security.

The success of the IHR as a new approach …

Meeting The Family Planning Needs Of Postpartum Women, Ricardo Vernon

Reproductive Health

The first days, weeks, and months after a delivery represent a period of substantial information and service needs for both mother and child, including treatment of hemorrhage and infections, breastfeeding information and support, nutritional complements and micronutrients, immunizations for children and mothers, counseling for managing intimate partner violence and depression, and, most importantly, contraception. In areas of high HIV prevalence, contraceptives and antiretroviral therapy are especially critical elements of postpartum care. Yet despite its strategic importance, few organizations have made it a priority to address women's reproductive health and fertility needs during the year following delivery. The situation is compounded …

Manual For Building Capacity Of Trainers And Program Managers In Emergency Contraception, Sharif M.I. Hossain, M.E. Khan, Mary Philip Sebastian, Sohini Roychowdhury

Reproductive Health

This manual equips trainers with appropriate knowledge on emergency contraceptive pills (ECPs). Emergency contraception (EC) refers to any method of contraception that can be used by a woman to prevent an unwanted pregnancy within three days of unprotected intercourse or a contraceptive accident such as condom leakage. This manual discusses ECPs and the provision of related services. After a day’s training, trainers have the knowledge and skills necessary to train service providers and workers on ECPs. The manual is divided into four sessions. The first provides an overview of the demographic and reproductive health (RH) situation in South and South …

Dominican Republic, Haiti, Nicaragua: Promoting Family Planning During The Postpartum Period Can Increase Contraceptive Acceptance, Population Council

Reproductive Health

The World Health Organization recommends that women receive information on family planning (FP) during antenatal care (ANC), immediately after birth, and during postpartum and well-baby care. However, few studies have assessed the effect of information during each of these stages on women’s use of contraceptive methods. Data collected by FRONTIERS in the Dominican Republic, Haiti, and Nicaragua have been analyzed to answer this question. Use of maternal care services, exposure to FP information, and use of postpartum contraception varies among countries. All women interviewed in the Dominican Republic attended ANC services and delivered in a facility; ANC use and institutional …

Highlighting Marital Hiv Risk And Promoting Premarital Vct In Nyanza Province, Kenya, Ben Ochieng, Annabel Erulkar

Reproductive Health

This report describes a project undertaken in Kenya by the Population Council, in collaboration with PATH and Kendu Adventist Hospital, whose objectives were: 1) to design and implement educational strategies to raise awareness of the risks of HIV and early marriage; 2) to promote voluntary counseling and testing (VCT) for couples; and 3) to support and empower newly married girls through community-based clubs. The report notes that the strong technical support and leadership provided by the partners led to successful implementation of most project activities. The partnership enabled scarce resources to be shared, and has ensured that the comparative advantages …

Sharing Experiences With Comprehensive Responses To Adolescent Reproductive Health Needs In Africa, Nafissatou J. Diop, Anta Fall Diagne

Reproductive Health

In 1999, the Population Council’s USAID-funded Frontiers in Reproductive Health (FRONTIERS) project, began a three-year collaboration in Senegal on an adolescent reproductive health (ARH) pilot project that showed that a multisectoral, multidisciplinary approach can increase knowledge, enhance attitudes, and foster positive behaviors for reproductive health. Following requests from several neighboring countries, and given the long collaboration with WHO, FRONTIERS initiated efforts in 2007 to enable utilization of these findings in other African countries. The purpose of this report is to promote the utilization of multisectoral approaches for improving ARH programming by governments, donors, and national and international agencies in francophone …

A Situation Analysis Of Care And Support For Rape Survivors At First Point Of Contact In India And Bangladesh, M.E. Khan, Aruna Bhattacharya, Ismat Bhuiya, Aditi Aeron

Reproductive Health

A situation analysis of post-rape care services available at the first point of contact was conducted in three cities in India and four cities in Bangladesh. The aim of this investigation was to gather information that could be used in the development of a comprehensive care and support system for the rape survivor. Secondarily, the study field-tested sensitive and practical tools that could be used in the future for large-scale situation analyses of the rape survivor services. The results demonstrated that there is no uniform service provision protocol to follow for managing rape survivors at health facilities in India or …

Sexual And Gender Based Violence In Africa: Key Issues For Programming, Population Council

Reproductive Health

The Population Council is supporting a multisectoral and multicountry network of partners dedicated to strengthening sexual and gender-based violence (SGBV) services. Initiated in 2006, the network aims to promote a comprehensive approach to preventing and managing SGBV throughout the region. The implementing partners aim to develop feasible, effective, and efficient models for a comprehensive response to the needs of SGBV survivors; strengthen services that address the health, psychological, and criminal justice consequences of violence; and reduce the determinants of violent behavior within communities. This brochure summarizes the key points of a literature review by the Population Council on SGBV designed …

Factsheet: Youth In India: Situation And Needs Study—Key Indicators, 2006-2007: Bihar, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

This factsheet provides selected key indicators for the state of Bihar, drawn from the Youth in India: Situation and Needs Study (Youth Study) 2006–07. The main goal of the Youth Study was to provide information on the situation of youth in India and the life choices available to them on a broad range of sexual and reproductive health issues, including both behaviors and their antecedents, through a population-based study. Findings are expected to inform evidence-based programming to address the health and other needs of young people. The subnational Youth Study was undertaken in six states: Andhra Pradesh, Bihar, Jharkhand, Maharashtra, …

Factsheet: Youth In India: Situation And Needs—Key Indicators, 2006-2007: Andhra Pradesh, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

This factsheet provides selected key indicators for the state of Andhra Pradesh, drawn from the Youth in India: Situation and Needs Study (Youth Study) 2006–07. The main goal of the Youth Study was to provide information on the situation of youth in India and the life choices available to them on a broad range of sexual and reproductive health issues, including both behaviors and their antecedents, through a population-based study. Findings are expected to inform evidence-based programming to address the health and other needs of young people. The subnational Youth Study was undertaken in six states: Andhra Pradesh, Bihar, Jharkhand, …

Youth In India: Situation And Needs 2006-2007, Maharashtra, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

The Youth in India: Situation and Needs Study (Youth Study) is the first-ever subnationally representative study conducted to identify key transitions experienced by married and unmarried youth in India. While today’s youth are healthier, more urbanized, and better educated than earlier generations, social and economic vulnerabilities persist. In the course of the transition to adulthood, young people face significant risks related to sexual and reproductive health, and many lack the knowledge and power to make informed sexual and reproductive choices. Several national policies and programs formulated since 2000 have underscored a commitment to addressing the multiple needs of this group …

Factsheet: Youth In India: Situation And Needs—Key Indicators, 2006-2007: Rajasthan, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

This factsheet provides selected key indicators for the state of Rajasthan, drawn from the Youth in India: Situation and Needs Study (Youth Study) 2006–07. The main goal of the Youth Study was to provide information on the situation of youth in India and the life choices available to them on a broad range of sexual and reproductive health issues, including both behaviors and their antecedents, through a population-based study. Findings are expected to inform evidence-based programming to address the health and other needs of young people. The subnational Youth Study was undertaken in six states: Andhra Pradesh, Bihar, Jharkhand, Maharashtra, …

Marriage Considerations In Sending Girls To School In Bangladesh: Some Qualitative Evidence, Sajeda Amin, Lopita Huq

Poverty, Gender, and Youth

This working paper analyzes parents’ decisions about girls’ schooling in the context of marriage through in-depth exploration of case studies in two rural areas of northern Bangladesh. The villages are sites of a long-term community study from 1991 and 2002, a time when significant changes were underway, partly as a result of new school incentive programs introduced in 1994. The data show that the rise of dowry demands, a relatively recent practice that is barely a generation old among Muslims in these areas, asserts an important and independent influence on marriage decisions and indirectly influences decisions about schooling. The influence …

Has The Hiv Epidemic Peaked?, John Bongaarts, Thomas Buettner, Gerhard Heilig, Francois Pelletier

Poverty, Gender, and Youth

This working paper reviews the highly diverse regional and country patterns of HIV epidemics and discusses possible causes of the geographic variation in epidemic sizes. The main finding of this analysis is that the HIV epidemic reached a major turning point over the past decade. The peak years of HIV incidence rates are past for all regions, and the peaks of prevalence rates are mostly in the past except in Eastern Europe, where it is expected to peak in 2008. But owing in part to the life-prolonging effect of antiretroviral therapy and to sustained population growth, the absolute number of …

Sexual Behavior And Sti/Hiv Status Among Adolescents In Rural Malawi: An Evaluation Of The Effect Of Interview Mode On Reporting, Barbara Mensch, Paul C. Hewett, Richard Gregory, Stephane Helleringer

Poverty, Gender, and Youth

This paper presents the results from an interview-mode experiment conducted by the Population Council with unmarried young women in rural southern Malawi. To collect data on sexual behavior and the dynamics of HIV transmission, respondents were randomly assigned to either an audio computer-assisted self-interview (ACASI) or a conventional face-to-face (FTF) interview. Clear evidence indicates that the mode of interviewing and probing concerning various sexual partnerships affects respondents’ reporting of their sexual activity, yet the results are not always in accordance with expectations. Reporting for “ever had sex” and “sex with a boyfriend” is higher in the FTF mode, whereas, when …

Fertility Transitions In Developing Countries: Progress Or Stagnation?, John Bongaarts

Poverty, Gender, and Youth

Over the past quarter century fertility has declined rapidly in many developing countries. Projections typically assume that this trend will continue until the replacement level is reached. However, recent evidence suggests that ongoing fertility declines may have slowed or stalled in a number of countries in transition. This Population Council study examines the pace of fertility change in developing countries that have multiple DHS surveys to determine whether ongoing transitions are decelerating or stalling. The main findings are that in sub-Saharan African countries, the average pace of decline in fertility is lower around 2000 than in the mid-1990s, and more …

Empowering Married Young Women And Improving Their Sexual And Reproductive Health: Effects Of The First-Time Parents Project, K.G. Santhya, Nicole Haberland, Arup Das, F. Ram, R.K. Sinha, Usha Ram, S.K. Mohanty

Poverty, Gender, and Youth

The Population Council, in partnership with Child In Need Institute in Kolkata, Deepak Charitable Trust in Vadodara, and International Institute for Population Sciences, Mumbai, initiated the First-time Parents Project in India to develop and test an integrated package of health and social interventions to improve married young women’s reproductive and sexual health knowledge and practices, enhance their ability to act in their own interest, and expand their social support networks. The project was formulated on the hypothesis that the periods immediately following marriage and surrounding the first pregnancy and birth offer a unique and powerful entry point for improving the …

How Early Marriage Compromises Girls' Lives, Maharashtra, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

The policy and program discourse around early marriage has increased significantly over the last decade in India. For example, several national-level policies formulated since 2000, including the Prohibition of Child Marriage Act 2006, have advocated special program attention to delay age at marriage and to enforce existing laws against child marriage. Also, programmatically several initiatives have been launched to prevent early marriage. Despite these commitments, substantial proportions of girls continue to marry in adolescence. As recently as 2005–06, 47 percent of women aged 20–24 were married by 18 years nationally. While the situation of married young women in India has …