1.  Peer Reviewed Title: The national response to the HIV/AIDS epidemic in Peru: accomplishments and gaps--a review. Author: Caceres CF; Mendoza W Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51 Suppl 1:S60-6. Abstract: In Peru, after the first case of AIDS was reported in 1983, nearly 20,000 AIDS cases have been notified to date and between 20,000 and 79,000 persons are estimated to be living with HIV. Despite a relatively low HIV prevalence in the general population, the epidemic has importantly mobilized social actors and economic resources and has helped articulate a very active field within the Peruvian health sector. In recent years, the country has become the largest recipient of HIV funding from the Global Fund for AIDS, Tuberculosis, and Malaria in Latin America, for which a substantial national counterpart has been committed. Peru's predictable selection as one of the 12 focal countries for the 5-year impact evaluation of the Global Fund suggested that an analysis of the response to the HIV epidemic in Peru may provide significant lessons on the possibilities of international aid in the AIDS field, particularly in the Latin American context. This article presents an analysis of the impact of the HIV/AIDS epidemic and the nature of the response articulated by the State and civil society in Peru, based on the Universal Access Principles proposed by World Health Organization, UNAIDS, and others. Relying on a number of recent secondary sources, we focus not only on the impact of the epidemic on morbidity and death but also on the changes in society as a whole, particularly in social movements and their dynamic relationship with the State. We start with an epidemiological overview and move to describe the role of social actors in response to the epidemic and then propose a framework for the analysis of the scope and limitations of the national response and elaborate on potential courses of action that may lead to strengthen accomplishments and resolve remaining gaps. Language: English Keywords: PERU | RESEARCH REPORT | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | MORBIDITY | DEATH RATE | HEALTH POLICY | PUBLIC HEALTH | EPIDEMIOLOGY | EVALUATION | Developing Countries | South America, Western | South America | Latin America | Americas | Measurement | Research Methodology | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Policy | Political Factors | Sociocultural Factors | Health Document Number: 341319 |
2.  Peer Reviewed Title: Sexual behavior and drug consumption among young adults in a shantytown in Lima, Peru. Author: Galvez-Buccollini JA; DeLea S; Herrera PM; Gilman RH; Paz-Soldan V Source: BMC Public Health. 2009 Jan 19;9(23):[27] p. Abstract: Risky sexual behaviors of young adults have received increasing attention during the last decades. However, few studies have focused on the sexual behavior of young adults in shantytowns of Latin America. Specifically, studies on the association between sexual behaviors and other risk factors for sexually transmitted infections (STI) and HIV/AIDS transmission, such as the consumption of illicit drugs or alcohol are scarce in this specific context. The study participants were 393 men and 400 women between 18 and 30 years of age, from a shantytown in Lima, Peru. Data were obtained via survey: one section applied by a trained research assistant, and a self-reporting section. Logistic regression was used to estimate associations between use of any illicit drug, high-risk sexual behaviors and reported STI symptoms, adjusting for alcohol consumption level and various socio-demographic characteristics. Among men, age of sexual debut was lower, number of lifetime sexual partners was higher, and there were higher risk types of sexual partners, compared to women. Though consistent condom use with casual partners was low in both groups, reported condom use at last intercourse was higher among men than women. Also, a lifetime history of illicit drug consumption decreased the probability of condom use at last sexual intercourse by half. Among men, the use of illicit drugs doubled the probability of intercourse with a casual partner during the last year and tripled the probability of reported STI symptoms. Drug consumption is associated with high-risk sexual behaviors and reported STI symptoms in a Lima shantytown after controlling for alcohol consumption level. Development of prevention programs for risky sexual behaviors, considering gender differences, is discussed. Language: English Keywords: PERU | RESEARCH REPORT | OLDER ADULTS | RISK FACTORS | RISK BEHAVIOR | DRUG USE AND ABUSE | ALCOHOL USE AND ABUSE | SEX BEHAVIOR | SEXUALLY TRANSMITTED DISEASES | AIDS | HIV INFECTIONS | CONDOM USE | SIGNS AND SYMPTOMS | South America, Western | South America | Latin America | Americas | Developing Countries | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Biology | Behavior | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Risk Reduction Behavior Document Number: 329532 |
| 3. Peer Reviewed Title: Mortality profiles in a country facing epidemiological transition: An analysis of registered data. Author: Huicho L; Trelles M; Gonzales F; Mendoza W; Miranda J Source: BMC Public Health. 2009 Feb 2;9(47):39 p. Abstract: Sub-national analyses of causes of death and time-trends help to define public health policy priorities. They are particularly important in countries undergoing epidemiological transition like Peru. There are no studies exploring Peruvian national and regional characteristics of such epidemiological transition. We aimed to describe Peru's national and regional mortality profiles between 1996 and 2000. Registered mortality data for the study period were corrected for underregistration following standardized methods. Main causes of death by age group and by geographical region were determined. Departmental mortality profiles were constructed to evaluate mortality transition, using 1996 data as baseline. Annual cumulative slopes for the period 1996-2000 were estimated for each department and region. For the study period non-communicable diseases explained more than half of all causes of death, communicable diseases more than one third, and injuries 10.8% of all deaths. Lima accounted for 32% of total population and 20% of total deaths. The Andean region, with 38% of Peru´s population, accounted for half of all country deaths. Departmental mortality predominance shifted from communicable diseases in 1996 towards non-communicable diseases and injuries in 2000. Maternal and perinatal conditions, and nutritional deficiencies and nutritional anaemia declined markedly in all departments and regions. Infectious diseases decreased in all regions except Lima. In all regions acute respiratory infections are a leading cause of death, but their proportion ranged from 9.3% in Lima and Callao to 15.3% in the Andean region. Tuberculosis and injuries ranked high in Lima and the Andean region. Peruvian mortality shows a double burden of communicable and noncommunicable, with increasing importance of non-communicable diseases and injuries. This challenges national and sub-national health system performance and policy making. Language: English Keywords: PERU | RESEARCH REPORT | DEMOGRAPHIC TRANSITION | CAUSES OF DEATH | DEATH RATE | MORTALITY | AGE FACTORS | DISEASES | DEFICIENCY DISEASES | TUBERCULOSIS | ACCIDENTS AND INJURIES | South America, Western | South America | Latin America | Americas | Developing Countries | Population Dynamics | Demographic Factors | Population | Population Characteristics | Nutrition Disorders | Infections | Health Document Number: 329534 |
| 4. Title: Andean traditional midwifery in Peru. Author: Ingar C Source: Midwifery today With International Midwife. 2009 Spring;(89):57-9. Abstract: This article provides an overview of common characteristics of the "Andean tradition" regarding conception of the body, pregnancy, and birth. It discusses the birth as ritual and the importance of the figure of the Andean midwife in that ritual. The masculine role in childbirth is also explored, as is maternal care during pregnancy, birth, and after birth. Language: English Keywords: PERU | CRITIQUE | MIDWIVES AND MIDWIFERY | TRADITIONAL BIRTH ATTENDANTS | CHILDBIRTH | TRADITIONAL HEALTH PRACTICES | PREGNANCY | MATERNAL PHYSIOLOGY | KNOWLEDGE | Developing Countries | South America, Western | South America | Latin America | Americas | Health Personnel | Delivery of Health Care | Health | Pregnancy Outcomes | Reproduction | Culture | Sociocultural Factors | Physiology | Biology Document Number: 341185 |
| 5. Peer Reviewed Title: Retroviral infection in Peruvian men who have sex with men. Author: La Rosa AM; Zunt JR; Peinado J; Lama JR; Ton TG; Suarez L; Pun M; Cabezas C; Sanchez J Author: Peruvian HIV Sentinel Surveillance Working Group Source: Clinical Infectious Diseases. 2009 Jul 1;49(1):112-7. Abstract: We tested 2655 Peruvian men who have sex with men for the presence of retroviral infection. Human T cell lymphotropic virus type 1 (HTLV-1) was detected in 48 (1.8%) of the patients, HTLV-2 was detected in 28 (1.1%), and HTLV-1 and HTLV-2 were both detected in 5 (0.2%). Human immunodeficiency virus infection was detected in 329 (12.4%) of the patients; 24 (7.3%) had HTLV coinfection. Risk factors for HTLV-1 and HTLV-2 infection varied with sexual role. Language: English Keywords: PERU | RESEARCH REPORT | STATISTICAL REGRESSION | MEN HAVING SEX WITH MEN | VIRAL DISEASES | HIV INFECTIONS | HERPES GENITALIS | RISK FACTORS | PREVALENCE | SEX BEHAVIOR | LABORATORY PROCEDURES | ANAL SEX | TRANSMISSION | Developing Countries | South America, Western | South America | Latin America | Americas | Data Analysis | Research Methodology | Behavior | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Health | Measurement | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 342345 |
| 6. Peer Reviewed Title: Partner- and partnership-related risk factors for preterm birth among low-income women in Lima, Peru. Author: Paul K; Garcia PJ; Manhart LE; Holmes KK; Hitti JE Source: Social Science and Medicine. 2009 Apr;68(8):1535-40. Abstract: A woman's partner and the characteristics of their partnership can play an important role in the health of her pregnancy. Yet, with the notable exception of intimate partner violence, there has been little previous research addressing the associations between partner- or partnership-related factors and birth outcomes. This analysis tested the hypothesis that risk factors related specifically to partner or partnership characteristics increased the risk for preterm birth. Between 2003 and 2005, a total of 580 preterm cases (20-36 weeks gestational age at delivery) and 633 term controls (> or =37 weeks) were selected from women delivering at an obstetric hospital in Lima, Peru. Each woman completed a confidential, structured interview and provided biological specimens within 48 h after delivery. Multivariable logistic regression was used to assess associations between partner and partnership characteristics and preterm birth. After adjustment for behavioral, demographic, and obstetric risk factors, ever having had a partner with a history of drug use (aOR = 1.91, 95% CI 1.22-2.99), ever having had anal sex (aOR = 1.40, 95% CI 1.07-1.84), having a current partner with a history of visiting prostitutes (aOR = 1.69, 95% CI 1.22-2.33), and perceiving one's current partner as a "womanizer" (aOR = 1.34, 95% CI 1.02-1.77) were significantly associated with an elevated risk of preterm birth when tested in separate models. These four factors were then used to create a composite partnership risk score, which showed an increasing dose-response relationship with preterm birth risk (per additional partner risk factor: aOR = 1.31, 95% CI 1.16-1.49). These results highlight the importance of considering a broader set of risk factors for preterm birth, specifically those related to a woman's partner and partnership characteristics. Further research could clarify the specific mechanisms through which these partner and partnership characteristics may increase the risk of preterm birth. Language: English Keywords: PERU | RESEARCH REPORT | CONTROL GROUPS | LOW INCOME POPULATION | WOMEN | SEXUAL PARTNERS | PREMATURE BIRTH | RISK FACTORS | SEX BEHAVIOR | DRUG USE AND ABUSE | INTERVIEWS | Developing Countries | South America, Western | South America | Latin America | Americas | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Demographic Factors | Population | Behavior | Pregnancy Outcomes | Pregnancy | Reproduction | Health | Data Collection Document Number: 341690 |
| 7. Title: Prevalence, types, and pattern of intimate partner violence among pregnant women in Lima, Peru. Author: Perales MT; Cripe SM; Lam N; Sanchez SE; Sanchez E; Williams MA Source: Violence Against Women. 2009 Feb;15(2):224-50. Abstract: This study assesses the prevalence, types, and pattern of intimate partner violence (IPV) during lifetime and current pregnancy for 2,392 women in Lima, Peru. The reported lifetime prevalence of any IPV (physical, sexual, or emotional) is 45.1%. For women who experienced abuse, the prevalence of lifetime physical, emotional, and sexual IPV is 34.2%, 28.4%, and 8.7%, respectively. Older (>/= 30 years), unmarried, employed, and economically disadvantaged women and those with little education are more likely to experience lifetime and pregnancy IPV. Efforts at universal antepartum IPV screening and appropriate interventions are needed to reduce the burden of violence experienced by pregnant women. Language: English Keywords: PERU | RESEARCH REPORT | PREVALENCE | PREGNANT WOMEN | PHYSICAL ABUSE | DOMESTIC VIOLENCE | VIOLENCE AGAINST WOMEN | Developing Countries | South America, Western | South America | Latin America | Americas | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Violence | Behavior | Crime | Social Problems | Sociocultural Factors Document Number: 330547 |
| 8. Title: Incidence of induced abortions in Peru [letter] Author: Puccetti R Source: CMAJ. 2009 May 26;180(11):1133; author reply 1133-4. Abstract: Antonio Bernabé-Ortiz and colleagues misleadingly assert that, although access to induced abortion services is legally restricted in Peru, the incidence of induced abortion is "as high as, or higher than, the estimated incidence in many countries where induced abortion is legal and safe." The abortion rate (the number of abortions per 1000 women of reproductive age) is greatly influenced by a number of factors, namely contraceptive behaviour and fertility rates, and thus it is not a good measure to use to evaluate the impact of the legal status of abortion on the incidence of abortions in a particular jurisdiction. The estimated total fertility rate is 2.86 in Peru; in comparison, it is 2.04 in the United States and 1.66 in the United Kingdom. Therefore, it is not surprising that the abortion rate in Peru may be similar to the rates in the United States and United Kingdom. The legal status of abortion may strongly affect postconceptional attitudes concerning pregnancy termination; this effect is much better described by the abortion ratio (the number of abortions per 1000 live births). Of the approximately 8660 pregnancies reported by participants in the study by Bernabé-Ortiz and colleagues, 1127 ended in induced abortions and 996 in spontaneous abortions. This means that there were approximately 6538 live births and the abortion ratio was 172.3. The authors referred to a study with US data from 2001, in which there were 6.4 million pregnancies, 1.1 million spontaneous abortions and 1.3 million induced abortions. The corresponding abortion ratio was 325. More recent US data indicate that there were 1 206 200 abortions and 4 138 349 births in 2005. The corresponding abortion ratio was 291.5. In England and Wales, 193 737 induced abortions and 669 601 live births were registered in 2006, with a corresponding abortion ratio of 289.3. These data show that there is a lower incidence of abortion in Peru than in other countries where abortion is legal. (full-text) Language: English Keywords: PERU | CRITIQUE | COMPARATIVE STUDIES | MEASUREMENT | ABORTION LAW | ABORTION RATE | REPRODUCTIVE BEHAVIOR | TOTAL FERTILITY RATE | Developing Countries | South America, Western | South America | Latin America | Americas | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Fertility | Population Dynamics | Demographic Factors | Population | Fertility Rate | Birth Rate | Fertility Measurements Document Number: 341641 |
| 9. Title: Confirming the presence of HTLV-1 infection and the absence of HTLV-2 in blood donors from Arequipa, Peru. Author: Quispe NC; Feria EB; Santos-Fortuna Ede L; Caterino-de-Araujo A Source: Revista Do Instituto De Medicina Tropical De Sao Paulo. 2009 Jan-Feb;51(1):25-9. Abstract: Epidemiological studies conducted in Peru disclosed HTLV-1 to be prevalent in different ethnic groups, and found HTLV-2 in some Amazonian Indians and in men who have sex with men. No data concerning HTLV-1/2 infection in blood donors from Arequipa, a highlands region in southern Peru, is available. We searched for the presence of HTLV-1 and HTLV-2 antibodies in 2,732 serum samples obtained from blood donors from this geographic area. HTLV-1/2-specific antibodies were detected using an enzyme-linked immunosorbent assay (ELISA) and were confirmed by Western blot (WB). Reactive sera had their blood bags discarded from donation, and the demographic characteristics of the donors were analyzed. Thirty-five sera (1.2%) were HTLV seroreactive by ELISA, and 25 were confirmed HTLV-1-positive by WB. One serum disclosed HTLV-positivity, and the remaining nine serum samples showed indeterminate results by WB; three of which had an HTLV-1 indeterminate Gag profile. The median age of HTLV-positive individuals was 34.6 years; 27 were male and eight were female. All individuals were from southern Peru: 27 from Arequipa, five from Puno, and three from Cuzco. HTLV co-positivity with hepatitis B (five sera) and syphilis (one serum) were detected. Previous transfusion and tattooing were observed in two and one individuals, respectively. No serum was positive for HTLV/HIV co-infection. This study confirmed, for the first time, HTLV-1 infection and the absence of HTLV-2 infection in blood donors from Arequipa, Peru and suggests vertical transmission as the major route of HTLV-1 transmission and acquisition in this geographic region. Language: English Keywords: PERU | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | BLOOD DONORS | RURAL POPULATION | PREVALENCE | BLOOD TRANSFUSION | HIV INFECTIONS | VIRAL DISEASES | TATTOOS | SYPHILIS | HEPATITIS | Developing Countries | South America, Western | South America | Latin America | Americas | Research Methodology | Diseases | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Characteristics | Demographic Factors | Population | Measurement | Treatment | Culture | Sociocultural Factors | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections Document Number: 331252 |
| 10. Peer Reviewed Title: High HIV and ulcerative sexually transmitted infection incidence estimates among men who have sex with men in Peru: awaiting for an effective preventive intervention. Author: Sanchez J; Lama JR; Peinado J; Paredes A; Lucchetti A; Russell K; Kochel T; Sebastian JL Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51 Suppl 1:S47-51. Abstract: BACKGROUND: In the Andean Region, HIV and sexually transmitted infections (STI) are most prevalent among men who have sex with men (MSM), but incidence estimates and associated factors have never been prospectively assessed. METHODS: A cohort of 1,056 high-risk HIV-negative MSM in Lima, Peru, were recruited during 1998-2000 (the ALASKA Cohort), and a nested case-control analysis was conducted between seroconverters and nonseroconverters, matched 1:3 by age and duration of follow-up for comparison of risk behaviors, acute retroviral symptoms, circumcision, and STI. RESULTS: During average follow-up of 335 days, 34 men seroconverted, providing a HIV incidence estimate of 3.5 per 100 person-years [95% confidence interval (CI): 2.3 to 4.7]. High syphilis (8.4 per 100 person-years, 95% CI: 6.7 to 10.1) and herpes simplex virus type 2 (HSV-2) infection (10.4 per 100 person-years, 95% CI: 8.6 to 11.9) incidence estimates were obtained. HIV seroconverters were more likely than men who remained seronegative to report fever >or=3 days (46% vs. 7%), to seek medical care (62% vs. 27%), and to have >or=1 casual partner (86.2% vs. 74.1%) since their last visit. HIV seroconverters also were more likely to have acquired syphilis or HSV-2 infection (31% vs. 8% among initially HSV-2-seronegative men) although they were less likely to be circumcised (4.2% vs. 20.6%, a nonsignificant difference). In multivariate analysis, incident syphilis or HSV-2 infection (odds ratio [OR]: 5.9, 95% CI: 1.5 to 22.7) and sex with any casual partner (OR: 4.8, 95% CI: 0.9 to 26.2) were associated with HIV seroconversion. CONCLUSIONS: STI that may cause anogenital ulcers are important risk factors for HIV acquisition among high-risk MSM in Lima, a population with a very high HIV incidence estimate. Synergistic interventions focusing in preventing both HIV and HSV-2, like male circumcision, are warranted to be assessed, especially in MSM populations with low levels of circumcision and high incidence estimates of ulcerative STI. Language: English Keywords: PERU | RESEARCH REPORT | INCIDENCE | MEN | HOMOSEXUALS | MEN HAVING SEX WITH MEN | SYPHILIS | HIV INFECTIONS | HIV | SEXUALLY TRANSMITTED DISEASES | INTERVENTIONS | Developing Countries | South America, Western | South America | Latin America | Americas | Measurement | Research Methodology | Demographic Factors | Population | Sex Behavior | Behavior | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Programs | Organization and Administration Document Number: 341321 |
| 11. Title: Expanding access to contraception: How ability to pay effects use and source of IUDs. Author: Abt Associates. Private Sector Partnerships One [PSP-One] Source: [Bethesda, Maryland], Abt Associates, PSP-One, [2008]. 2 p. (Global Research Brief. LAPM Brief 2USAID Contract No. GPO-I-00-04-00007-00) Abstract: This brief looks at where women get their IUDs and how source varies with ability to pay. Because NGOs generally subsidize services, this analysis disaggregates the private sector into its commercial and NGO components. (Excerpt) Language: English Keywords: PERU | COLOMBIA | BOLIVIA | EGYPT | SUMMARY REPORT | CONTRACEPTIVE PREVALENCE | WOMEN | IUD | HEALTH SERVICES | QUALITY OF HEALTH CARE | FAMILY PLANNING | Developing Countries | South America, Western | South America | Latin America | Americas | South America, Northern | South America, Central | Africa, North | Africa | Contraceptive Usage | Contraception | Demographic Factors | Population | Contraceptive Methods | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 331618 |
| 12. Title: A multi-tiered approach to meeting family planning needs of the poor in Peru. Author: Constella Futures. Health Policy Initiative Source: Washington, D.C., Health Policy Initiative, Futures Group International, 2008 Apr. 4 p. (USAID Contract No. GPO-I-01-05-00040-00) Abstract: More than half of Peru's population lives in poverty, with significant disparities evident between urban and rural areas and between indigenous and non-indigenous populations. Disparities in access to health services among income groups, and ethnic groups are found in family planning (FP) use as well. The USAID | Health Policy Initiative identified barriers that restrict poor women's access to and use of FP services, and then designed interventions to address barriers related to existing financing mechanisms. This brief summarizes a full report on the approach applied in Peru. Language: English Keywords: PERU | EVALUATION REPORT | EVALUATION | LOW INCOME POPULATION | GOVERNMENT AGENCIES | GOVERNMENT FINANCING | CONTRACEPTIVE DISTRIBUTION | FAMILY PLANNING PROGRAM EVALUATION | NATIONAL HEALTH SERVICES | REPRODUCTIVE HEALTH | PERFORMANCE IMPROVEMENT | INTEGRATED PROGRAMS | HEALTH INSURANCE | FAMILY PLANNING POLICY | South America, Western | South America | Latin America | Americas | Developing Countries | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Organizations | Political Factors | Sociocultural Factors | Financial Activities | Distributional Activities | Program Activities | Programs | Organization and Administration | Family Planning Programs | Family Planning | Health Services | Delivery of Health Care | Health | Management | Population Policy | Social Policy | Policy Document Number: 308946 |
| 13. Title: Offering the TwoDay Method within family planning services in Peru. Author: Georgetown University. Institute for Reproductive Health Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Feb. [98] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: This study was the first introducing the TwoDay Method (TDM) into regular reproductive health service delivery programs. It tested the feasibility of counseling for TDM use later in the menstrual cycle than the first week (the protocol at the time of the study) and determined if this affected correct use, continuation, acceptability, partner participation, user satisfaction, and management of fertile days. It also tested the protocol, training curriculum, and job aids supporting integration of the TDM into diverse settings. In conclusion, providers can offer the method equally well to clients at any point in their menstrual cycle and clients can use the method correctly, regardless of when they learned to use it. Continuation rates and satisfaction were not affected by the time in their cycle in which women were counseled. Results suggest that providers and clients liked the method. The one-day training workshop was sufficient, and job aids were appropriate. (Excerpts) Language: English Keywords: PERU | RESEARCH REPORT | CLIENTS | WOMEN | COUNSELING | FAMILY PLANNING | HEALTH SERVICES | DELIVERY OF HEALTH CARE | CONTRACEPTIVE USAGE | MENSTRUATION | SATISFACTION | CONTRACEPTIVE METHOD ACCEPTABILITY | PARTICIPATION | TRAINING ACTIVITIES | Developing Countries | South America, Western | South America | Latin America | Americas | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Clinic Activities | Health | Contraception | Reproduction | Psychological Factors | Behavior | Social Behavior | Training Programs | Education Document Number: 331602 |
| 14. Title: Assessing the impact of scaling-up the Standard Days Method in India, Peru, and Rwanda. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Feb. [225] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: This study was designed to assess the impact of integrating the Standard Days Method® (SDM) into existing services in India, Peru, and Rwanda. The method was introduced on a large scale and information was collected for two years through simulated clients, survey statistics, and household surveys in the intervention and control areas. Results of this study will help shape efforts to scale-up the SDM in various countries. The specific objectives of the study were to test the effect of SDM integration on provider behavior, client behavior and community perceptions, attitudes, and practices. The study spanned three years, beginning in the second half of 2004 and ending in early 2007. It was implemented in each country by local research organizations with supervision from the IRH local office and IRH-Washington. The intervention was tailored to each country and involved integrating the SDM into existing public health and family planning services in all facilities in the intervention areas, so that it became one of the family planning options available to couples. Integration included advocating at the national, regional, and local level, making CycleBeads® available in all area facilities, training providers and supervisors to provide the SDM, monitoring and supervising services, and extensive information, education and communication (IEC) activities. In some areas the SDM was also made available in selected non-governmental organizations and private facilities. (excerpt) Language: English Keywords: INDIA | PERU | RWANDA | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | INTEGRATED PROGRAMS | HEALTH SERVICES | NEEDS | PROVIDERS WITH CLIENTS | CLIENT-STAFF RELATIONS | QUESTIONNAIRES | Asia, Southern | Asia | Developing Countries | South America, Western | South America | Latin America | Americas | Africa, Central | Africa, Sub Saharan | Africa | Family Planning | Family Planning, Behavioral Methods | Programs | Organization and Administration | Delivery of Health Care | Health | Economic Factors | Interpersonal Relations | Behavior Document Number: 327613 |
| 15. Title: AWARENESS Project. Introducing the Standard Days Method into public sector services in Peru. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Feb. [24] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: After seeing the yet-unpublished results of the Standard Days Method® (SDM) efficacy trial, Peruvian Ministry of Health (MOH) decision-makers expressed interest in adding the method to their regular family planning (FP) services. A three-year pilot introduction project was carried out, designed to develop and test a service delivery model appropriate for the local context and for replication elsewhere in the country. A study component was superimposed on the pilot project to answer key questions the MOH had regarding the SDM's performance in non-study circumstances: 1) if there would be enough demand for the method, 2) whether the SDM would siphon clients from other methods, 3) if pregnancy rates would be in the range of those seen in the efficacy trial, and 4) whether offering and providing the SDM would represent an excessive burden to FP providers. The SDM was offered and provided to clients at MOH facilities in the Department of San Martín, initially in two provinces, then expanded to most of the department. A cross sectional survey of SDM clients was conducted 18 months after the method became available. Some 1200 women were contacted and interviewed (of 1254 reported as SDM users at the time the interviews were conducted). On average, they had received counseling in the SDM 10 months before. Although the project had initially been planned for two years, at the request of the local MOH, it was extended for another 12 months. At the end of the project SDM services were available at over 300 facilities throughout the department, offered by over 700 trained providers (most of whom were trained by the MOH using their own personnel and resources). (excerpt) Language: English Keywords: PERU | EVALUATION REPORT | PILOT PROJECTS | COMPARATIVE STUDIES | GOVERNMENT AGENCIES | WOMEN IN DEVELOPMENT | DELIVERY OF HEALTH CARE | UTILIZATION OF HEALTH CARE | FERTILITY AWARENESS | CONTRACEPTIVE METHODS CHOSEN | CONTRACEPTIVE EFFECTIVENESS | FAMILY PLANNING EDUCATION | South America, Western | South America | Latin America | Americas | Developing Countries | Evaluation | Studies | Research Methodology | Organizations | Political Factors | Sociocultural Factors | Economic Development | Economic Factors | Health | Health Services | Family Planning | Contraceptive Usage | Contraception | Education Document Number: 327644 |
| 16. Title: AWARENESS Project. Peru country report, 2002-2007. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [24] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: Georgetown University's Institute for Reproductive Health (IRH), with support from USAID through the AWARENESS Project and the previous Natural Family Planning Project, has worked in Peru since the late 1980s, when it partnered with a faith-based organization (FBO) to promote natural family planning. In the mid-1990s, IRH facilitated the introduction of the Lactational Amenorrhea Method (LAM) into Ministry of Health (MOH) services. IRH tested both the Standard Days Method® (SDM) and the TwoDay Method® (TDM) in Peru to determine efficacy and feasibility. Peru has successfully introduced the SDM into existing services and is scaling up the program. It has been-and continues to be-the site of several important studies for both the SDM and TDM. The long-term goal of IRH's work in Peru is to make high-quality FAB services available in a sustainable manner as an option for couples throughout the country. Although IRH has worked with many private and public organizations in Peru, the MOH has always been its prime partner. Since 2000, the Instituto de Salud Reproductiva -Peru (ISR), a Peruvian nongovernmental organization (NGO) supported by IRH, has carried out all IRH's in-country activities. The country's strategic importance for USAID and its potential to increase the effective use of family planning by women using traditional periodic abstinence led to Peru's selection as one of the countries to introduce SDM to regular services. Peru sites have participated in many key SDM and TDM studies, which interested the MOH in the method and its potential in the national program. Also, IRH's experience in Peru with the introduction of LAM into public services in the mid-1990s provided a good starting point when advocating and negotiating with key decision-makers. This report highlights work done under the AWARENESS Project from 2002-20007. (excerpt) Language: English Keywords: PERU | SUMMARY REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | PROGRAM DESIGN | PROGRAM DEVELOPMENT | IMPLEMENTATION | CAPACITY BUILDING | FAMILY PLANNING TRAINING | AWARENESS | PROGRAM SUSTAINABILITY | PUBLIC SECTOR | DELIVERY OF HEALTH CARE | South America, Western | South America | Latin America | Americas | Developing Countries | Family Planning | Programs | Organization and Administration | Training Programs | Education | Knowledge | Sociocultural Factors | Macroeconomic Factors | Economic Factors | Health Document Number: 327641 |
| 17. Title: [Cultural adaptation of counseling in sexual and reproductive health] Adecuacion cultural de la orientacion / consejeria en salud sexual y reproductiva: documento tecnico. Author: Peru. Ministerio de Salud. Direccion General de Salud de las Personas. Estrategia Sanitaria Nacional de Salud Sexual y Reproductiva Source: Lima, Peru, Ministerio de Salud, 2008 Jun. :96 p.. (USAID Contract No. GPO-I-01-05-00040-00) Abstract: Produced by Peru's Ministry of Health with support from the USAID | Health Policy Initiative, Task Order 1 in Peru, the objective of this publication is to help improve the quality of reproductive health (RH) services by strengthening the patient-provider relationship through cultural adaptation and counseling. The manual establishes technical guidelines for taking cultural customs, practices, and expectations into consideration when implementing RH counseling in primary healthcare facilities. Language: Spanish Keywords: PERU | MANUAL | HEALTH PERSONNEL | PERFORMANCE IMPROVEMENT | REPRODUCTIVE HEALTH | COUNSELING | PRIMARY HEALTH CARE | HEALTH SERVICES | QUALITY OF HEALTH CARE | South America, Western | South America | Latin America | Americas | Developing Countries | Delivery of Health Care | Health | Management | Organization and Administration | Clinic Activities | Program Activities | Programs | Health Services Evaluation | Program Evaluation Document Number: 308943 |
| 18. Title: Additional zinc delivered in a liquid supplement, but not in a fortified porridge, increased fat-free mass accrual among young Peruvian children with mild-to-moderate stunting. Author: Arsenault JE; de Romana DL; Penny MH; Van Loan MD; Brown KH Source: Journal of Nutrition. 2008 Jan;138:108-114. Abstract: The exact mechanism whereby zinc influences growth is unknown, although it has been postulated that zinc may stimulate appetite and energy intake or enhance fat-free mass (FFM) accrual directly. We compared energy intake, reported appetite, and body composition of 6- to 8-mo-old Peruvian children with initial length-for-age Z-score (LAZ) < -0.5 SD who were randomly assigned to receive daily for 6 mo: 1) 3 mg/d zinc in a liquid supplement; 2) 3 mg/d zinc in a fortified porridge; or 3) no extra zinc in either the supplement or porridge. There were no group-wise differences in changes in dietary energy intakes or body composition or in the prevalence of reported poor appetite. However, among children with an initial LAZ less than the median (-1.1 SD), those who received zinc as a liquid supplement had a 0.41 kg greater increase in FFM than those who did not receive zinc (P < 0.05). We concluded that daily provision of 3 mg of supplemental zinc did not affect energy intake or reported appetite. Among children with initial mild-to-moderate stunting, those who received the zinc supplement had a greater increase in FFM than those who did not receive additional zinc. It is possible that the growth-restricted children were more likely to be zinc deficient and that FFM accrual may be an early growth response to supplemental zinc. Zinc supplements may be more efficacious than the same dose of zinc provided in fortified food; therefore, further research is needed on the optimal level of zinc fortification that will result in improved health outcomes in populations with high rates of zinc deficiency. (author's) Language: English Keywords: PERU | RESEARCH REPORT | COMPARATIVE STUDIES | CLINICAL RESEARCH | CHILDREN | ZINC | FOOD SUPPLEMENTATION | BODY WEIGHT | GROWTH | ADMINISTRATION AND DOSAGE | South America, Western | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Metals | Vitamins and Minerals | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Child Development | Drugs | Treatment | Medical Procedures | Medicine Document Number: 323233 |
| 19. Title: Expansion of HIV and syphilis into the Peruvian Amazon: a survey of four communities of an indigenous Amazonian ethnic group. Author: Bartlett EC; Zavaleta C; Fernandez C; Razuri H; Vilcarromero S; Vermund SH; Gotuzzo E Source: International Journal of Infectious Diseases. 2008 Nov;12(6):e89-94. Abstract: BACKGROUND: In 2004, cases of HIV and syphilis were reported in an indigenous community in the Peruvian Amazon. This study sought to determine the prevalence of HIV and syphilis in four remote communities of the same indigenous ethnic group located further from an urban center than the original community, and to identify risk factors for HIV and syphilis transmission. METHODS: Rapid and confirmatory tests for HIV and syphilis were performed. A questionnaire elicited demographic information, risk factors for sexually transmitted infections, and knowledge/beliefs about HIV/AIDS. RESULTS: We collected 282 blood samples and conducted interviews with 281 (99.6%) participants. The confirmed syphilis prevalence rate was 3.2% (9/282; 3.7% (5/135) for men and 2.7% (4/147) for women). The confirmed HIV prevalence rate was 0.7% (2/282), with both infections in men who had sex with men (MSM). Self-reported MSM activity was 39.7%. There was poor knowledge about HIV infection, transmission, and prevention, and low acceptance of known prevention methods. CONCLUSIONS: HIV and syphilis are now prevalent in remote Amazonian communities of an indigenous group in Peru. Expansion of the HIV epidemic into the Amazon requires an urgent public health response. Language: English Keywords: PERU | RESEARCH REPORT | PREVALENCE | ETHNIC GROUPS | INDIGENOUS POPULATION | MEN HAVING SEX WITH MEN | HOMOSEXUALS | SYPHILIS | HIV INFECTIONS | HIV | South America, Western | South America | Latin America | Americas | Developing Countries | Measurement | Research Methodology | Cultural Background | Population Characteristics | Demographic Factors | Population | Sex Behavior | Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Viral Diseases Document Number: 329708 |
| 20. Peer Reviewed Title: Policies around sexual and reproductive health and rights in Peru: Conflict, biases and silence. Author: Caceres C; Cueto M; Palomino N Source: Global Public Health. 2008;3(S2):39-57. Abstract: This study is aimed at examining how subsequent Peruvian governments, since 1990, have addressed reproductive rights, HIV/AIDS prevention and treatment, and sexual diversity rights, as well as the drastic policy shifts and its many contradictions. Abortion and contraception consistently generated the deepest public controversies and debates, which made progress in reproductive rights difficult. HIV/AIDS was often portrayed as having the potential to affect everyone, which allowed advocates and activists to achieve some success in advancing HIV/AIDS-related rights. Sexual diversity rights, perceived as a demand made by "others", were generally trivialised and disdained by politicians, officials, and the general population. Positive changes occurred as long as the issue was given a low political and institutional profile. The analysis of policy-making and programme implementation in these three areas reveals that: (1) Weaknesses in national institutional frameworks concerning reproductive health made it possible for governments to adopt two very different (even contradictory) approaches to the issue within the past 15 years; (2) Policies were presented as rights-based in order to garner political legitimacy when, in fact, they evidenced a clear disregard for the rights of individual citizens; and (3) By favouring low-profile "public health" discourses, and marginalising "the sexual" in official policies related to sexuality, advocacy groups sometimes created opportunities for legal changes but failed to challenge conservative powers opposing the recognition of sexual and reproductive rights and the full citizenship of women and sexual minorities. (author's) Language: English Keywords: PERU | REPRODUCTIVE HEALTH | REPRODUCTIVE RIGHTS | HIV INFECTIONS | HIV PREVENTION | AIDS | GOVERNMENT AGENCIES | POLITICAL SYSTEMS | ADVOCACY | BIAS | PUBLIC OPINION | South America, Western | South America | Latin America | Americas | Developing Countries | Health | Human Rights | Political Factors | Sociocultural Factors | Viral Diseases | Diseases | Organizations | Communication | Error Sources | Measurement | Research Methodology | Attitudes | Psychological Factors | Behavior Document Number: 327684 |
| 21. Peer Reviewed Title: New populations at high risk of HIV / STIs in low-income, urban coastal Peru. Author: Caceres CF; Konda KA; Salazar X; Leon SR; Klausner JD Source: AIDS and Behavior. 2008 Jul;12(4):544-551. Abstract: The HIV epidemic in Peru is concentrated primarily among men who have sex with men. HIV interventions have focused exclusively on a narrowly defined group of MSM and FSW to the exclusion of other populations potentially at increased risk. Interventions targeting MSM and FSW are insufficient and there is evidence that focusing prevention efforts solely on these populations may ignore others that do not fall directly into these categories. This paper describes non-traditional, vulnerable populations within low-income neighborhoods. These populations were identified through the use of ethnographic and epidemiologic formative research methods and the results are reported in this publication. Although the traditional vulnerable groups are still in need of prevention efforts, this study provides evidence of previously unrecognized populations at increased risk that should also receive attention from HIV/STI prevention programs. (author's) Language: English Keywords: PERU | RESEARCH REPORT | FORMATIVE RESEARCH | INTERVIEWS | FOCUS GROUPS | LOW INCOME POPULATION | URBAN POPULATION | HIV | SEXUALLY TRANSMITTED DISEASES | RISK FACTORS | South America, Western | South America | Latin America | Americas | Developing Countries | Research Methodology | Data Collection | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Biology Document Number: 327542 |
| 22. Peer Reviewed Title: Assessing debt-to-health swaps: a case study on the Global Fund Debt2Health Conversion Scheme. Author: Cassimon D; Renard R; Verbeke K Source: Tropical Medicine and International Health. 2008 Sep;13(9):1188-95. Abstract: The Debt2Health Conversion Scheme of the Global Fund to Fight AIDS, Tuberculosis and Malaria is used to reassess a range of recent initiatives that propose debt relief in exchange for spending in the health sector. The experience with debt swaps in the mid 1990s was far from positive, and recent improved insight in the economics of debt relief suggests extreme caution. We argue that the recent spade of debt swap proposals, even if targeting countries and debt titles that fall outside current major international debt relief mechanisms, share most of the design faults of previous initiatives. Proposals such as Debt2Health do not constitute efficient vehicles to increase net transfers to poor countries, to reduce the economic disadvantages of indebtedness, or to strengthen public health systems of partner countries. For debt relief to constitute a valuable mechanism to provide aid, it should be designed as a large-scale and comprehensive operation, with spending earmarked to broad country-established priorities, and reinforce rather than undermine national implementation systems. Language: English Keywords: INDONESIA | KENYA | PAKISTAN | PERU | RESEARCH REPORT | HUMANITARIAN ASSISTANCE | DEVELOPMENT PLANNING | HIV PREVENTION | AIDS PREVENTION | TUBERCULOSIS | MALARIA | FUNDS | INTERNATIONAL AGENCIES | Asia, Southeastern | Asia | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Asia, Southern | South America, Western | South America | Latin America | Americas | Financial Activities | Economic Factors | HIV Infections | Viral Diseases | Diseases | AIDS | Infections | Parasitic Diseases | Organizations | Political Factors | Sociocultural Factors Document Number: 328615 |
| 23. Peer Reviewed Title: Effect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with men: a randomised, double-blind, placebo-controlled trial. Author: Celum C; Wald A; Hughes J; Sanchez J; Reid S Source: Lancet. 2008 Jun 21-27;371(9630):2109-2119. Abstract: Across many observational studies, herpes simplex virus type 2 (HSV-2) infection is associated with two-fold to three-fold increased risk for HIV-1 infection. We investigated whether HSV-2 suppression with aciclovir would reduce the risk of HIV-1 acquisition. We undertook a double-blind, randomised, placebo-controlled phase III trial in HIV-negative, HSV-2 seropositive women in Africa and men who have sex with men (MSM) from sites in Peru and the USA. Participants were randomly assigned by block randomisation to twice daily aciclovir 400 mg (n=1637) or matching placebo (n=1640) for 12-18 months, and were seen monthly for dispensation of study drug, adherence counselling and measurement by pill count and self-reporting, and risk reduction counselling, and every 3 months for genital examination and HIV testing. The primary outcome was HIV-1 acquisition and secondary was incidence of genital ulcers. Analysis was by intention to treat. This study is registered with Clinicaltrials.gov, number NCT00076232. 3172 participants (1358 women, 1814 MSM) were included in the primary dataset (1581 in aciclovir group, 1591 in control group). The incidence of HIV-1 was 3.9 per 100 person-years in the aciclovir group (75 events in 1935 person-years of follow-up) and 3.3 per 100 person-years in the placebo group (64 events in 1969 person-years of follow-up; hazard ratio 1.16 [95% CI 0.83-1.62]). Incidence of genital ulcers on examination was reduced by 47% (relative risk 0.53 [0.46-0.62]) and HSV-2 positive genital ulcers by 63% (0.37 [0.31-0.45]) in the aciclovir group. Adherence to dispensed study drug was 94% in the aciclovir group and 94% in the placebo group, and 85% of expected doses in the aciclovir group and 86% in the placebo group. Retention was 85% at 18 months in both groups (1028 of 1212 in aciclovir group, 1030 of 1208 in placebo group). We recorded no serious events related to the study drug. Our results show that suppressive therapy with standard doses of aciclovir is not effective in reduction of HIV-1 acquisition in HSV-2 seropositive women and MSM. Novel strategies are needed to interrupt interactions between HSV-2 and HIV-1. (author's) Language: English Keywords: SOUTH AFRICA | ZIMBABWE | ZAMBIA | UNITED STATES OF AMERICA | PERU | RESEARCH REPORT | DOUBLE-BLIND STUDIES | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | WOMEN | MEN HAVING SEX WITH MEN | HERPES GENITALIS | HIV INFECTIONS | ANTIVIRAL DRUGS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Developed Countries | North America | Americas | South America, Western | South America | Latin America | Studies | Research Methodology | Clinical Research | Viral Diseases | Diseases | Demographic Factors | Population | Sex Behavior | Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 327473 |
| 24. Peer Reviewed Title: Multi-country analysis of the effects of diarrhoea on childhood stunting. Author: Checkley W; Buckley G; Gilman RH; Assis AM; Guerrant RL Source: International Journal of Epidemiology. 2008 Aug;37(4):816-830. Abstract: Diarrhoea is an important cause of death and illness among children in developing countries; however, it remains controversial as to whether diarrhoea leads to stunting. We conducted a pooled analysis of nine studies that collected daily diarrhoea morbidity and longitudinal anthropometry to determine the effects of the longitudinal history of diarrhoea prior to 24 months on stunting at age 24 months. Data covered a 20-year period and five countries. We used logistic regression to model the effect of diarrhoea on stunting. The prevalence of stunting at age 24 months varied by study (range 21-90%), as did the longitudinal history of diarrhoea prior to 24 months (incidence range 3.6-13.4 episodes per child-year, prevalence range 2.4-16.3%). The effect of diarrhoea on stunting, however, was similar across studies. The odds of stunting at age 24 months increased multiplicatively with each diarrhoeal episode and with each day of diarrhoea before 24 months (all P<0.001). The adjusted odds of stunting increased by 1.13 for every five episodes (95% CI 1.07-1.19), and by 1.16 for every 5% unit increase in longitudinal prevalence (95% CI 1.07-1.25). In this assembled sample of 24-month-old children, the proportion of stunting attributed to 55 diarrhoeal episodes before 24 months was 25% (95% CI 8-38%) and that attributed to being ill with diarrhoea for 52% of the time before 24 months was 18% (95% CI 1-31%). These observations are consistent with the hypothesis that a higher cumulative burden of diarrhoea increases the risk of stunting. (author's) Language: English Keywords: BANGLADESH | GUINEA-BISSAU | BRAZIL | GHANA | PERU | RESEARCH REPORT | DIARRHEA | GROWTH | CHILD DEVELOPMENT | LONGITUDINAL STUDIES | Developing Countries | Asia, Southern | Asia | Africa, Western | Africa, Sub Saharan | Africa | South America, Eastern | South America | Latin America | Americas | South America, Western | Diseases | Biology | Studies | Research Methodology Document Number: 327851 |
| 25. Title: [Association between alcohol consumption and human immunodeficiency virus infection] Asociacion entre el consumo de alcohol y la infeccion por virus de inmunodeficiencia humana. Author: Chincha LO; Samalvides CF; Bernabe-Ortiz A; Kruger PH; Gotuzzo HE Source: Revista Chilena de Infectologia. 2008 Feb;25(1):49-53. Abstract: Several factors have been associated with HIV infection, but alcohol consumption has not been studied completely. The purpose of this study is to evaluate the association between alcohol consumption and HIV infection. A case-control study was undertaken with HIV-positive and HIV-negative patients, matched by sex and age (+or- 2 years). Latin-American Alcoholism Test (long version) was used to evaluate alcoholism diagnosis. A total of 198 cases were matched with 198 controls: 38.9% of cases were diagnosed as alcoholics, and only 22.7% of controls (p < 0.001). The multivariate model showed that economic income (p < 0.001), sexual orientation (p < 0.001), and alcoholism diagnosis (p < 0.001) were associated with HIV infection. This study demonstrates an association between alcohol consumption, homosexual practices between men and economic income with the prevalence of HIV infection. (author's) Language: Spanish Keywords: PERU | RESEARCH REPORT | CASE CONTROL STUDIES | HIV INFECTIONS | PERSONS LIVING WITH HIV/AIDS | ALCOHOL USE AND ABUSE | HOMOSEXUALS | MEN HAVING SEX WITH MEN | INCOME | South America, Western | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Viral Diseases | Diseases | Persons Living With HIV/AIDS | Behavior | Sex Behavior | Socioeconomic Factors | Economic Factors Document Number: 325203 |
| 26. Peer Reviewed Title: Prevalence of HIV, herpes simplex virus-2, and syphilis in male sex partners of pregnant women in Peru. Author: Clark JL; Konda KA; Munayco CV; Pun M; Lescano AG Source: BMC Public Health. 2008 Feb 19;8:65. Abstract: Sexually active heterosexual men may represent an important risk factor for HIV infection and STI transmission to their female partners and unborn children, though little is known about the prevalence of STIs in this population. We sought to determine the prevalence of HIV, herpes simplex virus type 2 (HSV-2), and syphilis infection and associated risk behaviors among male sex partners of pregnant women in Peru. Survey and seroprevalence data were collected from 1,835 male partners of pregnant women in four cities in Peru. Serum was tested for antibodies to HIV, HSV-2, and syphilis. Among the 1,835 male participants, HIV prevalence was 0.8% (95% CI = 0.5-1.4%), HSV-2 16.0% (95% CI = 14.3-17.8%), and syphilis 1.6% (95% CI = 1.0-2.2%). Additionally, 11.0% reported a lifetime history of intercourse with men, and 37.1% with female sex workers. Unprotected intercourse with men during the previous year was reported by 0.9% and with female sex workers by 1.2%. Pregnant women's sex partners reported lifetime sexual contact with core risk groups, had an elevated prevalence of HSV-2, and demonstrated the potential to spread HIV and other STIs to their partners. Though the prevalence of HIV in the population was not significantly higher than observed in other samples of heterosexuals in Peru, the risk of HIV transmission to their female partners may be exacerbated by their increased prevalence of HSV-2 infection. Further study of heterosexual populations is necessary to fully understand the epidemiology of HIV/STIs in Latin America. (author's) Language: English Keywords: PERU | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SEXUAL PARTNERS | PREGNANT WOMEN | HIV INFECTIONS | HERPES GENITALIS | SYPHILIS | PREVALENCE | RISK FACTORS | TRANSMISSION | SEX BEHAVIOR | South America, Western | South America | Latin America | Americas | Developing Countries | Research Methodology | Behavior | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Measurement | Biology Document Number: 324653 |
| 27. Peer Reviewed Title: Risk factors for the spread of HIV and other sexually transmitted infections among men who have sex with men infected with HIV in Lima, Peru. Author: Clark JL; Konda KA; Segura ER; Salvatierra HJ; Leon SR; Hall ER; Caceres CF; Klausner JD; Coates TJ Source: Sexually Transmitted Infections. 2008 Nov;84(6):449-54. Abstract: OBJECTIVES: To assess the prevalence of sexually transmitted infections (STIs), the frequency of sexual risk behaviours, and the relation between knowledge of HIV infection status and sexual risk behaviour among men who have sex with men (MSM) infected with HIV attending an STI clinic in Peru. METHODS: We recruited a convenience sample of 559 MSM from a municipal STI clinic in Lima, Peru. Participants completed a survey and provided blood for HIV, syphilis and HSV-2 antibody testing, and urine for gonorrhoea and chlamydia nucleic acid testing. RESULTS: Among 124 MSM with HIV, 72.6% were aware that they were infected with HIV. Active syphilis (RPR> or =1:8) was diagnosed in 21.0% of men infected with HIV, HSV-2 in 79.8%, urethral gonorrhoea in 1.6% and chlamydia in 1.6%. Among 41 participants reporting insertive anal intercourse with their last sex partner, 34.2% did not use a condom. Of the 86 participants reporting receptive anal intercourse, 25.6% did not use a condom. At least one episode of insertive unprotected anal intercourse (UAI) with a partner uninfected with HIV during the past 6 months was reported by 33.6% (35/104) of participants, and receptive UAI with a partner uninfected by HIV was reported by 44.6% (45/101). There was no difference in frequency of UAI with partners infected or uninfected with HIV observed between men who knew their serostatus compared with those who were previously undiagnosed (all p values >0.05). CONCLUSIONS: MSM with HIV in Peru engaged in high-risk behaviours for spreading HIV and STIs. Knowledge of whether someone was infected with HIV was not associated with a decreased frequency of UAI. Additional efforts to reduce risk behaviour after the diagnosis of HIV infection are necessary. Language: English Keywords: PERU | RESEARCH REPORT | PREVALENCE | MEN HAVING SEX WITH MEN | HIV INFECTIONS | SEXUALLY TRANSMITTED DISEASES | RISK FACTORS | TESTING | Developing Countries | South America, Western | South America | Latin America | Americas | Measurement | Research Methodology | Sex Behavior | Behavior | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Health Document Number: 330518 |
| 28. Peer Reviewed Title: Association of intimate partner physical and sexual violence with unintended pregnancy among pregnant women in Peru. Author: Cripe SM; Sanchez SE; Perales MT; Lam N; Garcia P Source: International Journal of Gynecology and Obstetrics. 2008 Feb;100(2):104-108. Abstract: The objective was to examine the associations between lifetime physical and/or sexual intimate partner violence (IPV) with pregnancy intent among pregnant women in Lima, Peru. A total of 2167 women who delivered at the Instituto Nacional Materno Perinatal, Lima, Peru were interviewed during the postpartum recovery period. Logistic regression was used to estimate multivariable adjusted odds ratios and 95% confidence intervals. Lifetime physical or sexual violence (40.0%) and unintended pregnancies (65.3%) were common in the study population. Compared with non-abused women, abused women had a 1.63-fold increased risk for unintended pregnancy. Unintended pregnancy risk was 3.31-fold higher among women who experienced both physical and sexual abuse compared with non-abused women. The prevalence and severity of physical violence during pregnancy was greater among women with unintended pregnancies compared with women with planned pregnancies. The findings indicate the need to include IPV screening and treatment in prenatal care and reproductive health settings. (author's) Language: English Keywords: PERU | RESEARCH REPORT | INTERVIEWS | CROSS SECTIONAL ANALYSIS | PREGNANT WOMEN | VIOLENCE AGAINST WOMEN | PREGNANCY, UNPLANNED | CONTRACEPTIVE USAGE | South America, Western | South America | Latin America | Americas | Developing Countries | Data Collection | Research Methodology | Population Characteristics | Demographic Factors | Population | Domestic Violence | Crime | Social Problems | Sociocultural Factors | Reproductive Behavior | Fertility | Population Dynamics | Contraception | Family Planning Document Number: 308609 |
| 29. Title: Treatment of cryptococcal meningitis in Peruvian AIDS patients using amphotericin B and fluconazole. Author: Dammert P; Bustamante B; Ticona E; Llanos-Cuentas A; Huaroto L Source: Journal of Infection. 2008 Sep;57(3):260-5. Abstract: OBJECTIVES: To describe the mycologic and clinical outcomes and factors associated with failure in Peruvian patients with AIDS-associated cryptococcal meningitis (CM) treated with amphotericin B deoxycholate (Amph B) followed by fluconazole. METHODS: Patients were treated with intravenous Amph B 0.7 mg/kg/day for 2 or 3 weeks followed by oral fluconazole 400mg/day for 7 or 8 weeks. Clinical and laboratory evaluations including cerebrospinal fluid (CSF) studies were performed at baseline and at weeks 2 and 10. RESULTS: The CSF cultures were negative in 25% and 68% of 47 patients at weeks 2 and 10, respectively. In the univariate analysis, baseline low body mass index (BMI), hyponatremia, low serum albumin, positive blood culture and CSF antigen titers >or=1024 were associated with a positive CSF culture at week 2. Baseline positive urine culture, positive blood culture, any positive extraneural culture and CSF opening pressure at week 2 >or=300 mm H2O were associated with a positive CSF culture at week 10. In the multivariate analysis no association was found. CONCLUSIONS: Therapy with Amph B and fluconazole, combined with aggressive management of elevated intracranial pressure (ICP), results in low CSF sterilization rates at week 2 and acceptable CSF sterilization rates at week 10 when compared with other series. Language: English Keywords: PERU | RESEARCH REPORT | CLINICAL RESEARCH | MULTIVARIATE ANALYSIS | PERSONS LIVING WITH HIV/AIDS | MENINGITIS | AIDS | ANTIBIOTICS | COMPLICATIONS | ADMINISTRATION AND DOSAGE | TIME FACTORS | BODY WEIGHT | PROTEINS | South America, Western | South America | Latin America | Americas | Developing Countries | Research Methodology | Data Analysis | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population Document Number: 328844 |
| 30. Title: Compensated sex and sexual risk: Sexual, social and economic interactions between homosexually- and heterosexually-identified men of low income in two cities of Peru. Author: Fernandez-Davila P; Salazar X; Caceres CF; Maiorana A; Kegeles S Source: Sexualities. 2008 Jun;11(3):352-374. Abstract: This study describes the complex dynamics of the sexual, economic and social interactions between a group of feminized homosexual men and men who have sex with men and self-identify as heterosexual ('mostaceros'), in lower-income peripheral urban areas of Lima and Trujillo, Peru. The study examined sexual risk between these two groups of men, and the significance of the economic exchanges involved in their sexual interactions. Using a Grounded Theory approach, 23 individual interviews and 7 focus groups were analyzed. The results reveal that cultural, economic and gender factors mold sexual and social relations among a group of men who have sex with men in Peru. Compensated sex is part of the behaviors of these men, reflecting a complicated construction of sexuality based on traditional conceptions of gender roles, sexual identity and masculinity. Several factors (e.g. difficulty in negotiating condom use, low self-esteem, low risk perception, alcohol and drug consumption), in the context of compensated sex, play a role in risk-taking for HIV infection. (author's) Language: English Keywords: PERU | RESEARCH REPORT | SOCIOMETRICS | MEN HAVING SEX WITH MEN | LOW INCOME POPULATION | URBAN POPULATION | HOMOSEXUALS | HETEROSEXUALS | TRANSACTIONAL SEX | RISK BEHAVIOR | SOCIOECONOMIC FACTORS | SEXUALITY | South America, Western | South America | Latin America | Americas | Developing Countries | Measurement | Research Methodology | Sex Behavior | Behavior | Social Class | Socioeconomic Status | Economic Factors | Population Characteristics | Demographic Factors | Population | Personality | Psychological Factors Document Number: 326813 |
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