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Peer Reviewed

Title: Talking the talk, walking the walk: Social network norms, communication patterns, and condom use among the male partners of female sex workers in La Romana, Dominican Republic.
Author: Barrington C; Latkin C; Sweat MD; Moreno L; Ellen J; Kerrigan D
Source: Social Science and Medicine. 2009 Jun;68(11):2037-2044.
Abstract: Male partners of female sex workers are rarely targeted by HIV prevention interventions in the commercial sex industry, despite recognition of their central role and power in condom use negotiation. Social networks offer a naturally existing social structure to increase male participation in preventing HIV. The purpose of this study was to explore the relationship between social network norms and condom use among male partners of female sex workers in La Romana, Dominican Republic. Male partners (N =318) were recruited from 36 sex establishments to participate in a personal network survey. Measures of social network norms included 1) perceived condom use by male social network members and 2) encouragement to use condoms from social network members. Other social network characteristics included composition, density, social support, and communication. The primary behavioral outcome was consistent condom use by male partners with their most recent female sex worker partner during the last 3 months. In general, men reported small, dense networks with high levels of communication about condoms and consistent condom use. Multivariate logistic regression revealed consistent condom use was significantly more likely among male partners who perceived that some or all of their male social network members used condoms consistently. Perceived condom use was, in turn, significantly associated with dense networks, expressing dislike for condoms, and encouragement to use condoms from social network members. Findings suggest that the tight social networks of male partners may help to explain the high level of condom use and could provide an entry point for HIV prevention efforts with men. Such efforts should tap into existing social dynamics and patterns of communication to promote pro-condom norms and reduce HIV-related vulnerability among men and their sexual partners.
Language: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | KAP SURVEYS | MULTIVARIATE ANALYSIS | SOCIAL NETWORKS | SEX WORKERS | WOMEN IN DEVELOPMENT | SEXUAL PARTNERS | MEN | CONDOM USE | HIV PREVENTION | PEER PRESSURE | PERCEPTION | MALE ROLE | MEN'S INVOLVEMENT | Developing Countries | Caribbean | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Friends and Relatives | Family and Household | Sociocultural Factors | Sex Behavior | Behavior | Economic Development | Economic Factors | Demographic Factors | Population | Risk Reduction Behavior | HIV Infections | Viral Diseases | Diseases | Psychosocial Factors | Psychological Factors | Social Behavior | Programs | Organization and Administration
Document Number: 331004

Peer Reviewed

Title: Effect of sexual intercourse on the absorption of levonorgestrel after vaginal administration of 0.75 mg in Carraguard gel: a randomized, cross-over, pharmacokinetic study.
Author: Brache V; Croxatto H; Kumar N; Sitruk-Ware R; Cochon L; Schiappacasse V; Sivin I; Munoz C; Maguire R; Faundes A
Source: Contraception. 2009 Feb;79(2):150-4.
Abstract: BACKGROUND: The Population Council studied a pre-coital contraceptive microbicide vaginal product containing levonorgestrel (LNG) as active component and Carraguard gel as a vehicle (Carra/LNG gel) for couples who engage in occasional unplanned intercourse. The objective of this study was to evaluate the effect of sexual intercourse after vaginal application of Carra/LNG gel on serum levels of LNG in women and to assess LNG absorption by the male partner. STUDY DESIGN: This was a randomized, cross-over, pharmacokinetic study including an abstinence arm and an arm in which couples engaged in sexual intercourse between 2 and 4 h after gel application. In each study arm, each woman received a single application of Carra/LNG gel (0.75 mg in 4 mL gel) followed by serial blood samples taken at 0, 1, 2, 4, 8, 24 and 48 h after gel application for LNG measurements. In the intercourse arm, LNG was measured in blood samples taken from the male partner before intercourse and at 4, 8 and 24 h after gel application in the female partner. RESULTS: Time concentration curves for serum LNG levels showed a mean C(max) of 7.8+/-5.5 and 8.3+/-5.7 nmol/L, a mean T(max) of 6.2+/-5.9 and 7.5+/-5.7, and comparable area under the curve for the intercourse and abstinence arm, respectively. Pharmacokinetic parameters presented large variability between subjects, but excellent reproducibility within each subject. LNG was undetectable in 10 out of 12 male partners. CONCLUSION: Sexual intercourse does not appear to interfere with vaginal absorption of LNG after application of a Carra/LNG gel. A vaginal pre-coital contraceptive gel is feasible.
Language: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | SEXUAL PARTNERS | SEXUAL INTERCOURSE | PHYSIOLOGY | LEVONORGESTREL | VAGINAL GEL | MICROBICIDES | TIME FACTORS | CONTRACEPTIVE EFFECTIVENESS | EMERGENCY CONTRACEPTION | Developing Countries | Caribbean | Americas | Research Methodology | Economic Development | Economic Factors | Sex Behavior | Behavior | Reproduction | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Vaginal Spermicides | Contraceptive Methods | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population
Document Number: 331015

Peer Reviewed

Title: Understanding the HIV epidemic in the Dominican Republic: a prevention success story in the Caribbean?
Author: Halperin DT; de Moya EA; Perez-Then E; Pappas G; Garcia Calleja JM
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51 Suppl 1:S52-9.
Abstract: OBJECTIVE: To analyze the general dynamics and trends of the HIV epidemic in the Dominican Republic (DR). METHODS: Thorough review of available HIV seroprevalence and sexual behavioral data from the DR. RESULTS: Multiple sources of data suggest that the DR's HIV epidemic has generally declined. Between the mid-1990s and about 2002, HIV-1 prevalence fell among pregnant women in the capital, Santo Domingo, particularly among young women. Declines in prevalence were also observed over the same period among sexually transmitted infection clinic patients, blood bank donors, US entry visa applicants, and female sex workers. National household surveys found 1.0% (confidence interval: 0.9% to 1.1%) adult prevalence in 2002 and 0.8% (0.6% to 0.9%) in 2007. Among largely Haitian immigrant residents of the impoverished former "sugarcane plantations," prevalence was much higher but declined from 5.0% to 3.2% between 2002 and 2007. The DR's heterogeneous epidemic includes an important men-having-sex-with-men (MSM) and bisexual component. The proportion of reported AIDS cases among men remained constant from 1989 to 2006, accounting for about two thirds of both total cumulative and year 2006 cases. Some survey and qualitative data also suggest a considerable occurrence of MSM-related risk behaviors. HIV prevalence remains relatively high in MSM, with no evidence of significant decrease. CONCLUSIONS: As in several other developing countries that have succeeded in slowing HIV transmission, HIV reductions in the DR seem mainly due to changes in sexual behavior, particularly increased condom use, especially for sex work, and partner reduction in men. Similarly favorable HIV declines and reported behavior change have occurred in some other Caribbean countries, including neighboring Haiti. However, of concern is that anal sex, both male-male and heterosexual, remains a taboo yet apparently common practice largely ignored by existing prevention campaigns. And although the DR epidemic has generally stabilized, there is a danger of complacency, and some recent data suggest that HIV prevalence is no longer declining (and may even be increasing) in some populations.
Language: English
Keywords:
DOMINICAN REPUBLIC | CARIBBEAN | RESEARCH REPORT | MEN HAVING SEX WITH MEN | HETEROSEXUALS | HIV PREVENTION | HIV TRANSMISSION | ANAL SEX | Developing Countries | Americas | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases
Document Number: 341320

Title: Barriers and facilitators of HIV prevention with heterosexual Latino couples: beliefs of four stakeholder groups.
Author: Perez-Jimenez D; Seal DW; Serrano-Garcia I
Source: Cultural Diversity and Ethnic Minority Psychology. 2009 Jan;15(1):11-7.
Abstract: Although HIV prevention interventions for women are efficacious, long-term behavior change maintenance within power-imbalanced heterosexual relationships has been difficult. To explore the feasibility, content, and format of an HIV intervention for Latino couples, the authors conducted 13 focus groups with HIV/AIDS researchers, service providers, and heterosexual men and women in Puerto Rico, the Dominican Republic, and Mexico. Reasons that participants thought that men should be involved in prevention efforts included promotion of shared responsibility, creation of a safe environment for open conversation about sex, and increased sexual negotiation skills. Perceived barriers to men's involvement included cultural taboos, sexual conservatism associated with Catholicism and machismo, and power-imbalanced relationships. Participants stressed the need for recruitment of men within naturally occurring settings or by influential community leaders. Participants indicated that couples-level interventions would be successful if they used strong coed facilitators, included both unigender and mixed-gender discussion opportunities, and addressed personally meaningful topics. Implications of these findings are discussed.
Language: English
Keywords:
DOMINICAN REPUBLIC | PUERTO RICO | MEXICO | RESEARCH REPORT | COUPLES | HETEROSEXUALS | MEN | HIV PREVENTION | BELIEFS | Developing Countries | Caribbean | Americas | Developed Countries | North America | Family Characteristics | Family and Household | Sociocultural Factors | Sex Behavior | Behavior | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Culture
Document Number: 330815

Title: Improving contraceptive access with a simple job aid to help rule out pregnancy.
Author: Family Health International [FHI]
Source: [Research Triangle Park, North Carolina], FHI, 2008. [2] p. (Research Utilization Case StudiesUSAID Cooperative Agreement No. GPO-A-00-05-00022-0)
Abstract: Research consistently showed that menstruation requirements in several countries prevented women from accessing their desired methods of family planning. Using criteria endorsed by the World Health Organization (WHO), Family Health International (FHI) developed, introduced, and trained health care providers to use a simple checklist to help rule out pregnancy in women who are not menstruating. The evidence-based tool has been requested by health professionals in approximately 20 countries. At least seven ministries of health have endorsed the checklist, and it is being incorporated into family planning guidelines and national training materials to help improve contraceptive access.
Language: English
Keywords:
DOMINICAN REPUBLIC | DEVELOPING COUNTRIES | SUMMARY REPORT | WOMEN | MENSTRUATION | FAMILY PLANNING | PREGNANCY | CONTRACEPTION | PROGRAM ACCESSIBILITY | Caribbean | Americas | Demographic Factors | Population | Reproduction | Program Evaluation | Programs | Organization and Administration
Document Number: 331528

10.

Peer Reviewed

Title: The epidemiology of dependency among urban-dwelling older people in the Dominican Republic: a cross-sectional survey.
Author: Acosta D; Rottbeck R; Rodriguez G; Ferri CP; Prince MJ
Source: BMC Public Health. 2008 Aug 13;8:285.
Abstract: Demographic ageing, and the health transition will soon lead to large increases in the number of dependent older people in low and middle income countries. Despite its importance, this topic has not previously been studied. A cross sectional catchment area one-phase survey of health conditions, dependency, care arrangements and caregiver strain among 2011 people aged 65 years and over in Santo Domingo, Dominican Republic. 7.1% of participants required much care and a further 4.7% required at least some care. The prevalence of dependency increased sharply with increasing age. Dependent older people were less likely than others to have a pension and much less likely to have paid work, but no more likely to benefit from financial support from their family. Needing much care was strongly associated with comorbidity between cognitive, psychological and physical health problems. However, dementia made the strongest independent contribution. Among those needing care, those with dementia stood out as being more disabled, as needing more care (particularly support with core activities of daily living), and as being more likely to have paid caregivers. Dementia caregivers experienced more strain than caregivers of those with other health conditions, an effect mediated by behavioural and psychological symptoms. Dependency among older people is nearly as prevalent in Dominican Republic as in developed western settings. Non-communicable diseases, particularly dementia are the main contributing factors. Attention needs to be directed towards the development of age-appropriate healthcare, a long-term care policy, and mechanisms for ensuring the social protection of older persons.
Language: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | EPIDEMIOLOGY | URBAN AREAS | OLDER ADULTS | DEMOGRAPHIC AGING | HEALTH | DEPENDENCY BURDEN | Caribbean | Americas | Developing Countries | Research Methodology | Public Health | Geographic Factors | Population | Adults | Age Factors | Population Characteristics | Demographic Factors | Population Dynamics | Microeconomic Factors | Economic Factors
Document Number: 307986

11.

Peer Reviewed

Title: Micro-credit, women's groups, control of own money: HIV-related negotiation among partnered Dominican women.
Author: Ashburn K; Kerrigan D; Sweat M
Source: AIDS and Behavior. 2008 May;12(3):396-403.
Abstract: A sample of 356 members of women's groups, aged 18-49, in the Dominican Republic were interviewed by trained female interviewers. Data among 273 partnered women were analyzed. The dependent variable, a measure of HIV-related negotiation, was examined for associations with control of own money, level of women's group participation, and ever having received a loan through a micro-credit program. Findings suggest control of own money to be significantly associated with HIV-related negotiation. Ever having received a loan and level of women's group participation, however, were not significantly associated with HIV-related negotiation. Empowerment measured as control of own money may influence HIV protective behavior among partnered women in this setting. (author's)
Language: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | INTERVIEWS | CROSS SECTIONAL ANALYSIS | WOMEN'S GROUPS | MICROENTERPRISE DEVELOPMENT | HIV PREVENTION | WOMEN'S EMPOWERMENT | PARTNER COMMUNICATION | FEMALE ROLE | INEQUALITIES | Developing Countries | Caribbean | Americas | Data Collection | Research Methodology | Interest Groups | Political Factors | Sociocultural Factors | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Women's Status | Socioeconomic Factors | Economic Factors | Interpersonal Relations | Behavior | Social Behavior
Document Number: 325821

12.

Peer Reviewed

Title: A Phase I study of the functional performance, safety and acceptability of the BufferGel Duet.
Author: Ballagh SA; Brache V; Mauck C; Callahan MM; Cochon L
Source: Contraception. 2008 Feb;77(2):130-137.
Abstract: The purpose of this study was to assess the functional performance of the BufferGel Duet, a buffering microbicide and spermicide gel applied to the cervix and vagina by a novel applicator that also serves as a mechanical barrier. This was a noncomparative Phase I safety trial in 30 healthy couples, aged 20-50 years, at low risk for sexually transmitted infections, who agreed to use the gel-device combination twice in 1 week and respond to detailed questionnaires about their experience. The female participants were examined with colposcopy before and 6-18 h after using the second device. Based on written instructions alone, 25 women successfully placed and 28 women successfully removed the device. Three women reported feeling the device dislodge around the time of intercourse. The product was equally acceptable to both men and women. Most users concluded that intercourse was the same or better with the device than with no product. About 73% would choose Duet over male condoms, and no one preferred the standard diaphragm. Colposcopic findings were noted in 79% of women with external genital findings (9) or cervicovaginal peeling (18) predominating. Only one finding breached the epithelium. Most product-related adverse events were mild (10/11) and confined to the genitourinary tract. The successful placements and acceptability suggest that further product development is warranted and could target over-the-counter use. During increased duration of use or more frequent dosing, cervicovaginal monitoring is advised based on the extent of peeling and external colposcopic findings in this short-term study. (author's)
Language: English
Keywords:
DOMINICAN REPUBLIC | UNITED STATES OF AMERICA | CLINICAL TRIALS | WOMEN | BARRIER METHODS | VAGINAL GEL | MICROBICIDES | CONTRACEPTIVE SAFETY | USER COMPLIANCE | CONTRACEPTIVE METHOD ACCEPTABILITY | SIDE EFFECTS | Developing Countries | Caribbean | Americas | Developed Countries | North America | Clinical Research | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Vaginal Spermicides | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Safety | Public Health | Behavior | Contraceptive Usage
Document Number: 323986

13.

Peer Reviewed

Title: Perceived influence of an HIV vaccine on sexual-risk behaviour in the Dominican Republic.
Author: Barrington C; Moreno L; Kerrigan D
Source: Culture, Health and Sexuality. 2008 May;10(4):391-401.
Abstract: This study explored local perceptions regarding the potential influence of an HIV vaccine on sexual risk behaviours in Santo Domingo, Dominican Republic. Qualitative in-depth interviews were carried out with 25 participants, including 15 women and 10 men. Approximately half of the male study participants stated that they would increase their number of sexual partners and/or would not use condoms if they received an HIV vaccine. In contrast, women reported that they would be unlikely to change their own behaviour, but stated that an HIV vaccine would allow them to worry less about the sexual-risk behaviour of their male partners. Our findings suggest the need to utilize existing HIV prevention programmes to support future HIV vaccine research and distribution efforts and minimize increased risk behaviour. Such efforts should actively assess and address the role of culturally-defined gender norms on behavioural responses to the introduction of HIV vaccines. (author's)
Language: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | QUALITATIVE RESEARCH | INTERVIEWS | HIV | VACCINES | RISK BEHAVIOR | SEX BEHAVIOR | PERCEPTION | CONDOM USE | MULTIPLE PARTNERS | FEMALE ROLE | MALE ROLE | GENDER ISSUES | Developing Countries | Caribbean | Americas | Research Methodology | Data Collection | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior | Psychological Factors | Risk Reduction Behavior | Sexual Partners | Social Behavior | Sociocultural Factors
Document Number: 326897

14.

Peer Reviewed

Title: Comparative acceptability of the SILCS and Ortho ALL-FLEX diaphragms among couples in the Dominican Republic.
Author: Coffey PS; Kilbourne-Brook M; Brache V; Cochon L
Source: Contraception. 2008 Nov;78(5):418-23.
Abstract: BACKGROUND: The SILCS diaphragm is a new, single-size contraceptive diaphragm. The objective of this crossover pilot study was to assess the fit and acceptability of the SILCS diaphragm compared to the Ortho ALL-FLEX diaphragm to validate the product design among parous women in a low-resource setting. STUDY DESIGN: Sexually active couples not at risk of pregnancy and at low risk of sexually transmitted infection were recruited and randomly assigned to one of two groups to determine order of device use. Couples used each device four times and provided feedback on key performance indicators via product-use questionnaires, a simple coital log and a gender-specific debriefing interview. RESULTS: Twenty couples provided data on a total of 160 product uses (80 for each device). Couples indicated that both diaphragms were acceptable with respect to ease of use, comfort and satisfaction with sex. At the end of the study, 19 of 20 women and 15 of 20 men reported preferring the SILCS diaphragm over the Ortho diaphragm (pLanguage: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | KAP SURVEYS | PILOT PROJECTS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | MEN | COUPLES | FAMILY PLANNING ACCEPTORS | VAGINAL DIAPHRAGM | CONTRACEPTIVE USAGE | SEX FACTORS | SATISFACTION | ACCEPTANCE PROCESS | Caribbean | Americas | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Demographic Factors | Population | Family Characteristics | Family and Household | Sociocultural Factors | Family Planning Programs | Family Planning | Vaginal Barrier Methods | Barrier Methods | Contraceptive Methods | Contraception | Population Characteristics | Psychological Factors | Behavior | Decision Making
Document Number: 329146

15.

Peer Reviewed

Title: Stigma, social inequality, and HIV risk disclosure among Dominican male sex workers.
Author: Padilla M; Castellanos D; Guilamo-Ramos V; Matiz Reyes A; Sanchez Marte LE
Source: Social Science and Medicine. 2008 Aug;67(3):380-388.
Abstract: Some quantitative behavioral studies in the USA have concluded that bisexually behaving Latino men are less likely than White men to disclose to their female partners that they have engaged in same-sex risk behavior and/or are HIV-positive, presumably exposing female partners to elevated risk for HIV infection. Nevertheless, very little theoretical or empirical research has been conducted to understand the social factors that promote or inhibit sexual risk disclosure among Latino men who have sex with men (MSM), and much of the existing literature has neglected to contextualize disclosure patterns within broader experiences of stigma and social inequality. This paper examines decisions about disclosure of sex work, same-sex behavior, and sexual risk for HIV among male sex workers in two cities in the Dominican Republic. Data derive from long-term ethnography and qualitative in-depth interviews with 72 male sex workers were used to analyze the relationships among experiences of stigma, social inequality, and patterns of sexual risk disclosure. Thematic analysis of interviews and ethnographic evidence revealed a wide range of stigma management techniques utilized by sex workers to minimize the effects of marginality due to their engagement in homosexuality and sex work. These techniques imposed severe constraints on men's sexual risk disclosure, and potentially elevated their own and their female partners' vulnerability to HIV infection. Based on the study's findings, we conclude that future studies of sexual risk disclosure among ethnic minority MSM should avoid analyzing disclosure as a decontextualized variable, and should seek to examine sexual risk communication as a dynamic social process constrained by hierarchical systems of power and inequality. (author's)
Language: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | CASE STUDIES | INTERVIEWS | MEN | SEX WORKERS | MEN HAVING SEX WITH MEN | HIV | RISK FACTORS | CONDOM USE | PARTNER COMMUNICATION | STIGMA | SOCIAL BEHAVIOR | INEQUALITIES | CULTURE | TABOO | Developing Countries | Caribbean | Americas | Studies | Research Methodology | Data Collection | Demographic Factors | Population | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Biology | Risk Reduction Behavior | Interpersonal Relations | Social Problems | Sociocultural Factors | Socioeconomic Factors | Economic Factors
Document Number: 327078

16.

Title: Situation analysis of the integration of family planning services in postpartum, postabortion and prevention of mother to child transmission programs in the Dominican Republic.
Author: Quiterio G; Molina M; Miric M; Vernon R; Rivero-Fuentes ME
Source: [Santo Domingo], Dominican Republic, Population Council, Frontiers in Reproductive Health, 2008 Mar. [42] p. (USAID Cooperative Agreement No. HRN-A-00-98-00012-00)
Abstract: A diagnostic study of the provision and use of contraception in postpartum, postabortion, and prevention of mother-to-child transmission (PMTCT) programs in the Dominican Republic was conducted with funding from USAID's Latin American and the Caribbean Bureau. The objectives of the study were to assess the contraceptive knowledge, attitudes, and behaviors of providers and clients, the degree to which information, counseling, and delivery are implemented in postpartum, postabortion, and PMTCT services, the quality of these services, and the readiness of postpartum, postabortion and PMTCT services to offer contraceptive services. Researchers visited and carried out service inventories at 59 hospitals and health centers of the Ministry of Health (MOH), the Dominican Social Security Institute, and Profamilia (the IPPF-affiliate). Interviews were held with 522 health providers (303 in Ob-Gyn wards and 219 in outpatient services), 2,965 women in antenatal care, 879 following their delivery, 162 in postabortion care, 1,421 in the six-month postpartum period, and 156 at HIV integral care units. In five facilities non-intrusive ethnographic observation were undertaken of the context where services were provided and structured observation of client-provider interactions. In-depth interviews were held with 21 providers and 20 users and three focus group discussions with women in the first six months postpartum. (excerpt)
Language: English
Keywords:
DOMINICAN REPUBLIC | EVALUATION REPORT | KAP SURVEYS | FOCUS GROUPS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | POSTPARTUM WOMEN | HEALTH PERSONNEL | POSTABORTAL PROGRAMS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | POSTPARTUM PROGRAMS | PROGRAM EVALUATION | HIV PREVENTION | USAID | ANTENATAL CARE | Developing Countries | Caribbean | Americas | Evaluation | Surveys | Sampling Studies | Studies | Research Methodology | Data Collection | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Puerperium | Reproduction | Delivery of Health Care | Health | Family Planning Programs | Family Planning | Disease Transmission Control | Prevention and Control | Diseases | Programs | Organization and Administration | HIV Infections | Viral Diseases | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services
Document Number: 326791

17.

Peer Reviewed

Title: Antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission [letter]
Author: Roman-Poueriet JA; Kley NC; Beck-Sague CM
Source: New England Journal of Medicine. 2008 Oct 23;359(17):1845; author reply 1846-8.
Abstract: As professionals working in a resource-limited country to prevent the transmission of the human immunodeficiency virus (HIV) from mother to child and to promote child survival and the use of highly active antiretroviral therapy (HAART), we read with interest the articles about abrupt weaning and prophylaxis regimens in infants by Kuhn et al. and Kumwenda et al. (July 10 issue).1,2 Harm-reduction alternatives for HIV-infected mothers who breast-feed are essential. However, in the study by Kuhn et al., the risk of mother-to-child transmission or death among breast-fed infants, whether they were abruptly weaned or not, was more than 30%.1 Extended antiretroviral prophylaxis was superior to singledose nevirapine, but 8.0% of infants were infected at birth; postnatal mother-to-child transmission related to breast-feeding added a 5.2% or 6.4% risk of infection.2 Alternatives should be considered, including HAART (which is now available to HIV-infected persons in Zambia,3 Malawi,4 and the Dominican Republic5), formula, and improved access to potable water. From 1999 to 2005, the rate of mother-to-child transmission of HIV among our patients, most of whom have low levels of both income and education, was 3.3% with the use of multidose antiretroviral treatment and exclusive formula-feeding; 2.8% of uninfected infants died. Pregnant women in developing countries can use HAART, prophylaxis regimens for infants, formula, and home-purified water. The cost is significant, but the savings (in lives, orphan care, and treating infected children) are also significant. (full-text)
Language: English
Keywords:
DOMINICAN REPUBLIC | CRITIQUE | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | MOTHERS | INFANT | PERSONS LIVING WITH HIV/AIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL THERAPY | BREASTFEEDING | EDUCATIONAL STATUS | INCOME | Caribbean | Americas | Developing Countries | Research Methodology | Economic Development | Economic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | HIV | Infant Nutrition | Nutrition | Health | Socioeconomic Status | Socioeconomic Factors
Document Number: 329068

18.

Peer Reviewed

Title: Sexual risk behaviour among HIV-positive patients at an urban clinic in Santiago, Dominican Republic.
Author: Sears D; Cabrera-Rodriguez C; Ortiz-Mejia F; Anderson B; Stein M
Source: AIDS Care. 2008 Feb;20(2):191-197.
Abstract: More than one percent of adults in the Dominican Republic are HIV-infected and most infections are acquired sexually. We studied sexual risk behaviours in a group of HIV-positive patients treated in Santiago, Dominican Republic. Interviews were conducted with 129 participants seen in May 2006 at one of the country's largest public hospital HIV clinics. Questions included demographics, sexual history, condom use and focused on patients' last sexual encounter. Most patients (72.4%) had been sexually active since their HIV diagnosis. Following their diagnosis, 72.8% of sexually active patients used condoms more frequently, 21.7% used condoms with the same frequency and 5.4% used condoms less often. The most common reason cited for not using a condom after HIV diagnosis differed by gender; men cited decreased sexual pleasure (70.0%) and women reported that their partner had refused to use a condom (71.8%). Sexually active patients who believed that their partner did not have HIV were much more likely to report using a condom at their last sexual encounter than those who did not know their partner's HIV status (OR_16.9). HIV-positive patients reported using condoms more frequently following their HIV diagnosis and were more likely to use a condom if they believed their partner did not have HIV. Increased HIV testing may lead to reduced sexual risk behaviour in the Dominican Republic. (author's)
Language: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | CLIENTS | PSYCHOLOGICAL FACTORS | AIDS | CARE AND SUPPORT | HIV INFECTIONS | RISK BEHAVIOR | SEX BEHAVIOR | CONDOM USE | TREATMENT | Developing Countries | Caribbean | Americas | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Behavior | Health Services | Delivery of Health Care | Health | Risk Reduction Behavior | Medical Procedures | Medicine
Document Number: 324876

19.
Peer Reviewed

Title: Antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission [letter]
Author: Waweru C
Source: New England Journal of Medicine. 2008 Oct 23;359(17):1845-6; author reply 1846-7.
Abstract: The article by Kumwenda et al. provides invaluable insight into the reduction of postnatal transmission of HIV in resource-poor settings. However, the authors did not discuss one important facet of their study: the ascertainment of the infants' HIV status at birth. For obvious reasons, only infants who were not HIV-infected were included in the study. Unfortunately, in resource-poor countries, the HIV status of a child - unless the child is symptomatic - often remains unknown until 18 months of age. Unlike adults, children require specialized diagnostic tests for HIV; these tests are not routinely available in many developing countries because of exorbitant costs.1 A 2007 study in 77 developing countries (71% of all developing countries) showed that only 8% of infants had been tested for HIV within the first 2 months after birth.1 Therefore, a policy of antiretroviral prophylaxis in infants, although theoretically plausible, is likely to be impeded by programmatic and infrastructural barriers. This sad reality is the reason why research into challenges in developing countries should try to mirror the reality on the ground as much as possible. (full-text)
Language: English
Keywords:
DOMINICAN REPUBLIC | RECOMMENDATIONS | CLINICAL RESEARCH | INFANT | WOMEN IN DEVELOPMENT | MOTHERS | HUMAN MILK | BREASTFEEDING | ANTIRETROVIRAL THERAPY | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | WEANING | POVERTY | EDUCATIONAL STATUS | ADMINISTRATION AND DOSAGE | Caribbean | Americas | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Lactation | Maternal Physiology | Physiology | Biology | Infant Nutrition | Nutrition | Health | HIV | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Socioeconomic Factors | Socioeconomic Status | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 329065

20.

Title: Achieving the MDGs: the contribution of family planning. Dominican Republic.
Author: Futures Group International. Health Policy Initiative
Source: Washington, D.C., Futures Group International, Health Policy Initiative, [2007]. [2] p.
Abstract: The Millennium Development Goals (MDGs) -- a set of eight important, time-bound goals ranging from reducing poverty by half to providing universal primary education -- represent a blueprint for global development agreed to by member states of the United Nations and international development institutions. However, achieving them will be a major challenge for the Dominican Republic and many other developing countries that are not "on track" to meet the goals by the target date of 2015. As stated by former United Nations Secretary-General Kofi Annan, it will take time and commitment to mobilize the necessary resources, train the required personnel, and establish the needed infrastructure to meet the MDGs. In the Dominican Republic and other Latin American countries, one major factor contributing to the challenge is the continued rapid growth of the population. The number of people in need of health, education, economic, and other services is large and increasing, which, in turn, means that the amountof resources, personnel, and infrastructure required to meet the MDGs is also increasing. In light of this fact, development efforts in support of the MDGs should not overlook the importance and benefits of slowing population growth. This brief looks at how one strategy -- meeting the need for family planning -- can reduce population growth and make achieving the MDGs more affordable in the Dominican Republic, in addition to directly contributing to the goals of reducing child mortality and improving maternal health.
Language: English
Keywords:
DOMINICAN REPUBLIC | SUMMARY REPORT | GOALS | FAMILY PLANNING | CHILD MORTALITY | MATERNAL HEALTH | POVERTY | NEEDS | DISEASE PREVENTION | EDUCATION | PREVENTION AND CONTROL | Developing Countries | Caribbean | Americas | Planning | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Health | Socioeconomic Factors | Economic Factors | Diseases
Document Number: 331539

21.

Peer Reviewed

Title: Local understanding of an HIV vaccine and its relationship with HIV-related stigma in the Dominican Republic.
Author: Barrington C; Moreno L; Kerrigan D
Source: AIDS Care. 2007 Aug;19(7):871-877.
Abstract: The purpose of this study was to explore local perceptions and experiences regarding vaccines in general and HIV vaccines and vaccine trials in the Dominican Republic. In-depth interviews were carried out with 25 participants representing two study groups: (1) individuals considered at high risk for HIV infection including female sex workers and male STI clinic attendees and (2) individuals considered at low risk of HIV infection including women and men recruited at a general outpatient clinic. Across the groups, participants often characterized vaccines in general as having both preventive and curative properties. In turn, one of the most salient concerns regarding the receipt of an HIV vaccine was the fear that one would be labelled 'HIV positive' and stigmatized, as the vaccine may be perceived as a cure for those already infected. These findings suggest the importance of individual and community level education to clarify the nature and mechanisms of the given HIV vaccine being tested. Social support and counselling services should also accompany HIV vaccine trials and distribution plans to assist individuals in determining if and how they communicate their participation and/or receipt of an HIV vaccine to others and manage potential negative social reactions. (author's)
Language: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | KAP SURVEYS | CLINICAL TRIALS | TARGET POPULATION | SEX WORKERS | WOMEN IN DEVELOPMENT | HIV PREVENTION | IMMUNIZATION | STIGMA | VACCINES | PERCEPTION | FEAR | HEALTH EDUCATION | COUNSELING | Caribbean | Americas | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Clinical Research | Program Design | Programs | Organization and Administration | Sex Behavior | Behavior | Economic Development | Economic Factors | HIV Infections | Viral Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Social Problems | Sociocultural Factors | Medical Procedures | Medicine | Psychological Factors | Emotions | Education | Clinic Activities | Program Activities
Document Number: 319463

22.

Title: Contraceptive security committees: their role in Latin America and the Caribbean.
Author: Betancourt VS
Source: Washington, D.C., Constella Futures, Health Policy Initiative, 2007 Sep. 34 p. (USAID Contract No. GPO-I-01-05-00040-00) This report is also available in Spanish: Los comités para la disponibilidad asegurada de insumos anticonceptivos: su aporte en América Latina y el Caribe at http://www.healthpolicyinitiative.com/index.cfm?ID=publications&get=pubID&pubID=447
Abstract: Contraceptive security exists when all individuals are able to choose, obtain, and use high-quality contraceptives when they need them. This report summarizes portions of four case studies about the innovative regional strategies that LAC countries have been implementing since 2003 to achieve contraceptive security. In numerous countries, locally formed contraceptive security committees have been spearheading and coordinating these CS efforts, generally operating at a technical level. The objective of this study was to analyze the experience of six committees and assess their role in working to achieve contraceptive security. The study focused on the activities of CS committees in Bolivia, the Dominican Republic, El Salvador, Honduras, Nicaragua, and Paraguay from 2003 to early 2007. According to the results of the analysis, these committees played a key role in making progress toward contraceptive security. Several other LAC countries made significant political and legislative progress without establishing CS committees.
Language: English
Keywords:
BOLIVIA | DOMINICAN REPUBLIC | EL SALVADOR | HONDURAS | NICARAGUA | PARAGUAY | TECHNICAL REPORT | CASE STUDIES | PUBLIC SECTOR | NEEDS | CONTRACEPTIVE SECURITY | ADVOCACY | FINANCIAL ACTIVITIES | LEADERSHIP | POLICY DEVELOPMENT | REPRODUCTIVE HEALTH | FAMILY PLANNING | Developing Countries | South America, Central | South America | Latin America | Americas | Caribbean | Central America | Studies | Research Methodology | Macroeconomic Factors | Economic Factors | Contraceptive Availability | Contraception | Communication | Organization and Administration | Planning | Health
Document Number: 323049

23.

Peer Reviewed

Title: Effect of a single vaginal administration of levonorgestrel in Carraguard gel on the ovulatory process: A potential candidate for “dual protection” emergency contraception.
Author: Brache V; Croxatto H; Sitruk-Ware R; Maguire R; Montero JC
Source: Contraception. 2007 Aug;76(2):111-116.
Abstract: The study was conducted to evaluate the effect of Carraguard vaginal gel containing 0.75 mg of levonorgestrel (CARRA/LNG gel) administered in a single dose at different stages of follicle development over subsequent follicle rupture and hormonal levels. Randomized, blinded, cross-over study comparing the effects of a single administration of CARRA/LNG gel or Carraguard (CARRA) gel. Twenty-four healthy women were enrolled in two centers. The gels were administered when the follicle had reached diameters of 12-14, 15-17 and >/= 18 mm in eight women each. Volunteers were followed for one treatment, one washout cycle and a second treatment cycle. Follicle rupture or nonrupture was assessed by transvaginal ultrasound. Luteinizing hormone, estradiol and progesterone levels were measured daily for 5 days following treatment, and three times per week until menses. No follicular rupture within the 5-day period following administration was observed in 74% and 30% of the CARRA/LNG and CARRA gel treatment cycles, respectively, while ovulation was documented in 4% and 61%, respectively. The overall proportion of cycles with lack of follicular rupture or ovulatory dysfunction (follicle rupture preceded by an inadequate LH surge) was 96% for CARRA/LNG and 39% in the CARRA gel cycles. Single vaginal administration of 0.75 mg LNG in CARRA gel in the late follicular phase is effective for interfering with the ovulatory process. (author's)
Language: English
Keywords:
CHILE | DOMINICAN REPUBLIC | RESEARCH REPORT | PROSPECTIVE STUDIES | DOUBLE-BLIND STUDIES | WOMEN | VAGINAL GEL | LEVONORGESTREL | ADMINISTRATION AND DOSAGE | OVULATION | EMERGENCY CONTRACEPTION | CONTRACEPTIVE USE-EFFECTIVENESS | Developing Countries | South America, Southern | South America | Latin America | Americas | Caribbean | Studies | Research Methodology | Demographic Factors | Population | Vaginal Spermicides | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Contraceptive Effectiveness
Document Number: 318907

24.

Title: The safety and efficacy of tenofovir DF in combination with lamivudine and efavirenz through 6 years in antiretroviral-naive HIV-1-infected patients.
Author: Cassetti I; Madruga JV; Suleiman JM; Etzel A; Zhong L
Source: HIV Clinical Trials. 2007 May-Jun;8(3):164-172.
Abstract: Study 903 is a phase 3 trial with a completed 144-week, double-blind phase comparing tenofovir DF (TDF) to stavudine (d4T) in combination with lamivudine (3TC) and efavirenz (EFV) and an ongoing additional 336-week open-label extension phase. Patients in Brazil, Argentina, and the Dominican Republic who completed the 144-week double-blind phase on TDF were eligible to roll over to the extension phase (weeks 144-480). Results from an interim week 288 analysis are presented. Eighty-six patients (62% male, 70% white) initially randomized to the TDF arm continued treatment with TDF. At the end of the 144-week, double-blind phase, 85 of the 86 had HIV-1 RNA <400 copies/mL, of whom 84% maintained virologic suppression through week 288. CD4 counts continued to improve with a mean increase of 135 cells/mm3 from entry into the open-label extension to week 288. No patient discontinued due to renal adverse events. Small changes in bone mineral density at the lumbar spine and hip were seen in the first 48 weeks but were nonprogressive through 288 weeks. Mean limb fat increased from 8.0 kg at week 96 to 8.8 kg at week 288. Through 288 weeks, once-daily TDF+3TC+EFV demonstrated sustained antiretroviral activity with continued immunologic recovery. TDF treatment was not associated with renal adverse events or limb fat loss in antiretroviral-naive patients. (author's)
Language: English
Keywords:
BRAZIL | ARGENTINA | DOMINICAN REPUBLIC | RESEARCH REPORT | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | SAFETY | South America, Eastern | South America | Latin America | Americas | Developing Countries | South America, Southern | Caribbean | Clinical Research | Research Methodology | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Public Health
Document Number: 320614

25.
Peer Reviewed

Title: Microbicide applicators: Understanding design preferences among women in the Dominican Republic and South Africa.
Author: Cohen JA; Steele MS; Urena FI; Beksinska ME
Source: Sexually Transmitted Diseases. 2007 Jan;34(1):15-19.
Abstract: The objectives of this study were to prioritize applicator design attributes among women in the Dominican Republic and South Africa, and to determine how preferences differed based on sociodemographic variables. The goal was to identify acceptable microbicide applicator designs in 2 low-resource settings. We surveyed 895 women, randomly sampled from clinics in the Dominican Republic (n = 449) and South Africa (n = 446), with questions on sociodemographics, applicator attribute preferences, and price/design tradeoffs. Single-use design was the most valued attribute, and reusable design and low price were the least valued attributes in both populations. Preference for single-use design was associated with concern about reusable applicators spreading germs, secondary or higher education, older age, having children, and perception of moderate to high HIV risk. Acceptability factors related to microbicide delivery mechanisms should continue to be evaluated among potential microbicide users to directly inform product development and introduction of microbicides. (author's)
Language: English
Keywords:
SOUTH AFRICA | DOMINICAN REPUBLIC | RESEARCH REPORT | CROSS-CULTURAL COMPARISONS | KAP SURVEYS | WOMEN IN DEVELOPMENT | DEMOGRAPHIC FACTORS | MICROBICIDES | PRICES | PERCEPTION | ATTITUDES | EDUCATIONAL STATUS | AGE FACTORS | HIV INFECTIONS | RISK ASSESSMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Caribbean | Americas | Comparative Studies | Studies | Research Methodology | Surveys | Sampling Studies | Economic Development | Economic Factors | Population | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Commerce | Macroeconomic Factors | Psychological Factors | Behavior | Socioeconomic Status | Socioeconomic Factors | Population Characteristics | Viral Diseases | Diseases | Evaluation
Document Number: 310727

26.

27.

Title: Iodine deficiency, iodine content of salt and knowledge of iodine supplementation in the Dominican Republic [letter]
Author: Malasanos T; Chaudhari M; Selman-Almonte A; Pino S; Previti M
Source: Journal of Tropical Pediatrics. 2007 Jun;53(3):214-216.
Abstract: In 2003, WHO estimated that 36% of the global population lived in areas of iodine deficiency (ID) and Dunn estimated that 100 000 children were born with cretinism each year. Because of the serious developmental effects of ID disease (IDD), the United Nations and other agencies pledged in 1990 to work toward the elimination of ID by 2000. Iodized salt is the simplest and most effective way to provide iodine in the diet. In 1993, 74.2% of 837 Dominican Republic (DR) school children had ID [mean urinary iodine (UI) concentration was < 7 mcg/dl]. In 1994, the Minister of Health legislated that salt be iodinated at a level of 30-100 ppm. No studies were done to determine efficacy, although such monitoring is important for elimination of IDD. This study was undertaken during a medical student outreach program serving 1800 people in traveling clinics in the mountains of DR at elevations of 690-1200m. One hundred thirty-three subjects aged 2-75 years (53% < 16 years) were randomly selected, who were not related, ill, malnourished, treated for thyroid problems, or with obvious goiter noted on triage. The study, and informed consent and assent were approved by the University of Florida IRB. Questionnaires explored salt use and knowledge of iodination importance. (excerpt)
Language: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | SAMPLING STUDIES | DEFICIENCY DISEASES | FOOD SUPPLEMENTATION | PROGRAM EFFECTIVENESS | KNOWLEDGE | GOITER | MONITORING | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Nutrition Disorders | Diseases | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Sociocultural Factors | Thyroid Effects | Endocrine Effects | Endocrine System | Physiology | Biology | Evaluation
Document Number: 317059

28.

Title: Operations research study to improve postabortion care (PAC) services among adolescents in the Dominican Republic.
Author: McCarraher DR; Oronoz T; Grey T; Tucker H; Chen M
Source: Research Triangle Park, North Carolina, Family Health International [FHI], YouthNet Program, 2007. 35 p. (Youth Research Working Paper No. 7USAID Cooperative Agreement No. GPH-A-00-01-00013-00FHI Working Paper Series No. WP07-02)
Abstract: Counseling postabortion care (PAC) patients on family planning and facilitating their access to family methods can help prevent future unwanted pregnancies and repeat abortions. In many countries, adolescent PAC patients constitute a significant proportion of patients seeking PAC services. Recent qualitative work suggests that adolescents seeking PAC services may be more marginalized than older women seeking the same services. Public PAC services in the Dominican Republic (DR) need improvement. One area of particular concern is the lack of contraceptive counseling and access to family planning methods for PAC patients. A small qualitative study among adolescent PAC patients accessing public services in the DR found that the majority of patients did not want to be pregnant at the time they became pregnant but were not using a contraceptive method to prevent pregnancy. These patients also lacked accurate information about contraceptive methods, and some doubted that methods were effective at preventing pregnancy. We designed an operations research study to improve the PAC counseling and contraceptive uptake among adolescent PAC patients seeking public services in the DR. Among PAC patients, the main study goal was that 60% of patients who wished to delay pregnancy be discharged with a contraceptive method. We also examined patients' reports on the counseling they received related to their immediate risk of pregnancy, contraception, HIV / STI risk, and postabortion complications. We evaluated changes in providers' PAC counseling knowledge and practices, and attitudes towards working with adolescent patients, prior to and after implementing the intervention. (Excerpt)
Language: English
Keywords:
DOMINICAN REPUBLIC | SUMMARY REPORT | OPERATIONS RESEARCH | CLIENTS | ADOLESCENTS | POSTABORTION CARE | COUNSELING | REPRODUCTIVE HEALTH | ABORTION | TREATMENT | KNOWLEDGE | INFORMED CONSENT | Developing Countries | Caribbean | Americas | Research Methodology | Program Evaluation | Programs | Organization and Administration | Program Activities | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Clinic Activities | Fertility Control, Postconception | Family Planning | Medical Procedures |