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1.
Title: Incidence and diagnoses of HIV infection - Puerto Rico, 2006.
Author: Centers for Disease Control and Prevention (CDC)
Source: MMWR. Morbidity and Mortality Weekly Report. 2009 Jun 5;58(21):589-91.
Abstract: In 2006, 33 U.S. states and five territories had confidential, name-based, human immunodeficiency virus (HIV) infection reporting; among territories, Puerto Rico had the second highest rate of HIV infection. To characterize the HIV epidemic in Puerto Rico in 2006 (the year with the most recent available data), the Puerto Rico Department of Health and CDC analyzed data on diagnoses of HIV infection (including infections that occurred in 2006 and in previous years) and used a stratified extrapolation approach developed by CDC to generate HIV incidence estimates (the number of persons newly infected with HIV in 2006). The results indicated that, in 2006, an estimated 1,440 persons aged >or=13 years were newly infected with HIV in Puerto Rico, resulting in an estimated incidence rate of 45.0 cases per 100,000 population, twice the rate for the 50 U.S. states and District of Columbia (DC). Males accounted for 65% of new HIV infections in Puerto Rico, and 38% of new HIV infections occurred among persons aged 30-39 years; 39% of new infections were associated with injection-drug use, and 37% with high-risk heterosexual contact. The results provide insight into HIV transmission patterns in Puerto Rico that can help guide allocation of resources and the planning, implementation, and evaluation of HIV prevention programs and other services.
Language: English
Keywords:
PUERTO RICO | SUMMARY REPORT | INCIDENCE | MEN | HISPANICS | IV DRUG USERS | MEN HAVING SEX WITH MEN | HIV INFECTIONS | PROGRAM EVALUATION | Caribbean | Americas | Developed Countries | Measurement | Research Methodology | Demographic Factors | Population | Ethnic Groups | Cultural Background | Population Characteristics | Drug Use and Abuse | Behavior | Sex Behavior | Viral Diseases | Diseases | Programs | Organization and Administration
Document Number: 341589

Title: The long wait: reproductive health care in Haiti.
Author: John Snow [JSI]. Research and Training Institute, Inc.
Source: Arlington, Virginia, JSI, Research and Training Institute, Inc., 2009. 22 p.
Abstract: The reproductive health status of Haiti's communities contributes to a life expectancy of 62.8 years for women in comparison to 75.5 years in neighboring Dominican Republic or 80.8 years for women in the U.S. According to Haiti's 2005-2006 Demography Health Survey, 37.5% of women have unmet family planning needs. Additionally, youth and rural area residents report greater unmet needs for family planning than the national average. Unmet family planning contributes to a high total fertility rate of 4.79 (5 in rural versus 2.8 in urban areas), a high infant morality (57 deaths per 1000 live births) and the highest maternal mortality rate in the western world-630 deaths per 100,000 live births. These alarming RH indicators prompted a team from JSI Research & Training Institute, Inc. (JSI) to visit Haiti in January 2009. The objectives of the study were: 1) to identify gaps in the availability and accessibility of comprehensive RH services including: Safer motherhood and emergency obstetric care (EmOC), Family planning, HIV/AIDS and sexually transmitted infections (STI) prevention, care and support, Gender-based violence (GBV) prevention, care and support, and Adolescent-focused RH programming for each of the above RH components. 2) to identify community-level responses and opportunities for strengthening the quality and availability of comprehensive RH services. This report presents the findings of this assessment.
Language: English
Keywords:
HAITI | SUMMARY REPORT | MOTHERS | SAFE MOTHERHOOD | REPRODUCTIVE HEALTH | HIV PREVENTION | AIDS PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | VIOLENCE AGAINST WOMEN | PREVENTION AND CONTROL | FAMILY PLANNING | HEALTH SERVICES | DELIVERY OF HEALTH CARE | PROGRAM ACCESSIBILITY | Developing Countries | Caribbean | Americas | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Maternal Health | Health | HIV Infections | Viral Diseases | Diseases | AIDS | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Domestic Violence | Crime | Social Problems | Program Evaluation | Programs | Organization and Administration
Document Number: 341307

Title: PRISM tools for assessing, monitoring, and evaluating RHIS performance.
Author: Aqil A; Lippeveld T
Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2009 Mar. [32] p. (MS-09-34USAID Cooperative Agreement No. GPO-A-00-03-00003-00)
Abstract: PRISM Framework and its tools applications have expanded since 2004. Now it has been applied in Pakistan, Uganda, South Africa, Mexico, Paraguay, Honduras, Haiti, China and Cote d'Ivore for assessment and evaluation. It has been applied in diverse countries of Africa, Asia, Latin America and Carribean continents. While these applications showed the strengths and appropriateness of PRISM Framework and its tools in identifying strengths and weaknesses of the routine information systems, they brought some challenges to attention. First, to make a distinction between RHIS performance indicators -accuracy, timeliness and completeness, from their counterpart processes. Second, to keep minimum variables in various tools for triangulation of information to avoid respondent's burden of filling the details. Third, better measurement of use of information. Thus, there was a need to revise the PRISM tools. Uganda PRISM evaluation in 2007 for testing its reliability and validity also helped to make the revisions. PRISM tools version 3.0 meets old and new challenges in assessing, monitoring and evaluation of RHIS.
Language: English
Keywords:
PAKISTAN | MEXICO | HONDURAS | HAITI | CHINA | PARAGUAY | SOUTH AFRICA | UGANDA | SUMMARY REPORT | EVALUATION | INFORMATION PROCESSING | DATA COLLECTION | MANAGEMENT | PROGRAM ACTIVITIES | Developing Countries | Asia, Southern | Asia | North America | Americas | Central America | Latin America | Caribbean | Asia, Eastern | South America, Central | South America | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Eastern | Information | Research Methodology | Organization and Administration | Programs
Document Number: 339994

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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

Title: The influence of early sexual debut and sexual violence on adolescent pregnancy: a matched case-control study in Jamaica.
Author: Baumgartner JN; Geary CW; Tucker H; Wedderburn M
Source: International Perspectives on Sexual and Reproductive Health. 2009 Mar;35(1):21-28.
Abstract: The authors conducted structured interviews with 15- to 17-year-old females-250 who were currently pregnant and 500 sexually experienced, but never-pregnant, neighborhood-matched controls. Bivariate and multivariate analyses were used to examine associations between adolescent pregnancy and early sexual debut, sexual coercion or violence, and sexual risk-taking behaviors. Greater proportions of pregnant youth than of their never-pregnant peers reported having had first sex by age 14 (54% vs. 41%), a first sexual partner who was five or more years older (33% vs. 20%), or multiple partners (63% vs. 50%). A greater proportion of never-pregnant youth had used contraceptives at first sex (88% vs. 80%). Almost half (49%) of all young women reported ever having experienced sexual coercion or violence. Compared with controls, pregnant youth had greater odds of having had an older partner at first sex and believing contraception is a woman's responsibility (odds ratios, 1.3 and 2.1, respectively), and had lower odds of ever having experienced sexual violence and thinking that it is important to protect oneself against pregnancy (0.5 and 0.2, respectively). An interaction between early sexual debut and multiple partners was found. Having had multiple partners was associated with pregnancy only for youth with early sexual debut. Encouraging adolescents to delay sexual debut and reduce their number of sexual partners may help prevent unintended pregnancies. Experiences of sexual coercion and violence were common among both groups, highlighting the need to address gender-based violence at the community level.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | CASE STUDIES | ADOLESCENTS, FEMALE | ADOLESCENT PREGNANCY | SEXUAL ABUSE | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Crime | Social Problems | Sociocultural Factors
Document Number: 315213

Peer Reviewed

Title: The persistence of induced abortion in Cuba: exploring the notion of an "abortion culture".
Author: Belanger D; Flynn A
Source: Studies in Family Planning. 2009 Mar;40(1):13-26.
Abstract: Cuba's annual induced abortion rate persistently ranks among the highest in the world, and abortion plays a prominent role in Cuban fertility regulation despite widespread contraceptive prevalence and state promotion of modern contraceptives. We explore this phenomenon using the concept of an "abortion culture," typically used in reference to Soviet and post-Soviet countries. We synthesize existing literature to provide a historical account of abortion and contraception in Cuba. We also provide a qualitative analysis of abortion and contraceptive use based on in-depth interviews conducted in 2005 in Havana with 24 women who have had an abortion and 10 men whose partners have had an abortion. Information gained from a focus-group discussion with medical professionals also informed the study. Our four principal findings are: (a) longstanding awareness of abortion, (b) the view of abortion as a personal decision, (c) the influence of economic constraints on the decision to induce an abortion, and (d) general skepticism toward contraceptives. We discuss our results on abortion in Cuba in relation to the notion of social diffusion, an approach commonly used to explain the spread of fertility control throughout a population.
Language: English
Keywords:
CUBA | RESEARCH REPORT | KAP SURVEYS | FOCUS GROUPS | WOMEN IN DEVELOPMENT | MEN | ABORTION RATE | CULTURE | COMMUNISM | PERCEPTION | ATTITUDES | KNOWLEDGE | MICROECONOMIC FACTORS | DECISION MAKING | CONTRACEPTIVE USAGE | Caribbean | Americas | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Collection | Economic Development | Economic Factors | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Sociocultural Factors | Socialism | Political Systems | Political Factors | Psychological Factors | Behavior | Contraception
Document Number: 341079

8.
Peer Reviewed

Title: The persistence of induced abortion in Cuba: exploring the notion of an "abortion culture".
Author: Belanger D; Flynn A
Source: Studies In Family Planning. 2009 Mar;40(1):13-26.
Abstract: Cuba's annual induced abortion rate persistently ranks among the highest in the world, and abortion plays a prominent role in Cuban fertility regulation despite widespread contraceptive prevalence and state promotion of modern contraceptives. We explore this phenomenon using the concept of an "abortion culture," typically used in reference to Soviet and post-Soviet countries. We synthesize existing literature to provide a historical account of abortion and contraception in Cuba. We also provide a qualitative analysis of abortion and contraceptive use based on in-depth interviews conducted in 2005 in Havana with 24 women who have had an abortion and 10 men whose partners have had an abortion. Information gained from a focus-group discussion with medical professionals also informed the study. Our four principal findings are: (a) longstanding awareness of abortion, (b) the view of abortion as a personal decision, (c) the influence of economic constraints on the decision to induce an abortion, and (d) general skepticism toward contraceptives. We discuss our results on abortion in Cuba in relation to the notion of social diffusion, an approach commonly used to explain the spread of fertility control throughout a population.
Language: English
Keywords:
CUBA | RESEARCH REPORT | ABORTION RATE | CULTURE | CONTRACEPTION | AWARENESS | Caribbean | Americas | Developing Countries | Fertility Control, Postconception | Family Planning | Sociocultural Factors | Knowledge
Document Number: 341339

10.

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

11.

Peer Reviewed

Title: One versus multiple packs for women starting oral contraceptive pills: a comparison of two distribution regimens.
Author: Chin-Quee D; Otterness C; Wedderburn M; McDonald O; Janowitz B
Source: Contraception. 2009 May;79(5):369-74.
Abstract: BACKGROUND: Despite World Health Organization and International Planned Parenthood Federation recommendations to provide multiple pill cycles to new users, many programs in developing countries still give only one pill cycle to new acceptors. STUDY DESIGN: To compare provision of a single versus multiple packs of pills, new pill users in 20 matched public sector clinics in Jamaica were assigned to one of two pill regimens in which they received either one (then subsequently three) or four pill cycles at method initiation. The primary outcome was the proportion of women who used pills beyond 4 months. RESULTS: Among 655 women, those receiving one cycle of pills at initiation, followed by counseling and a three-pack resupply, were no more likely to be using pills after 4 months than women who received four packs at initiation (odds ratio=1.33; 95% confidence interval=0.88-2.0). In both pill regimen groups, returning late to the clinic for resupply was a problem. However, more women in the 1+3-pack regimen group returned late to study clinics to obtain their fifth cycle of pills than their counterparts in the 4-pack regimen group (53% vs. 28%). CONCLUSION: Our findings support the recommendation that pill users should be given more than one cycle to start, because an extra visit for resupply contributes to clinic and provider costs. Moreover, providing more pill cycles at initiation would decrease the likelihood that women experience a gap in pill use between cycles.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | CONTRACEPTIVE PREVALENCE SURVEYS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | CONTRACEPTIVE DISTRIBUTION | PACKAGING | ORAL CONTRACEPTIVES | TIME FACTORS | COUNSELING | USER COMPLIANCE | CONTRACEPTIVE PREVALENCE | CONTRACEPTION CONTINUATION | Caribbean | Americas | Developing Countries | Family Planning Surveys | Family Planning | Studies | Research Methodology | Economic Development | Economic Factors | Distributional Activities | Program Activities | Programs | Organization and Administration | Marketing | Contraceptive Methods | Contraception | Population Dynamics | Demographic Factors | Population | Clinic Activities | Behavior | Contraceptive Usage
Document Number: 330940

12.

Peer Reviewed

Title: Pilot trial of an intervention aimed at modifying drug preparation practices among injection drug users in Puerto Rico.
Author: Colon HM; Finlinson HA; Negron J; Sosa I; Rios-Olivares E; Robles RR
Source: AIDS and Behavior. 2009 Jun;13(3):523-31.
Abstract: Injection drug users (IDUs) contaminate preparation materials with blood-borne pathogens by using syringes as measuring and dispensing devices. In collaboration with IDUs, we developed a preventive intervention consisting of four new preparation practices aimed at avoiding the use of syringes in the preparation, and reducing the contamination of the materials. This report describes the results of a pilot trial introducing the new practices to ascertain their adoption potential and their potential efficacy in reducing contamination. Participants comprised 37 active IDUs among whom the new practices were promoted during 16 weeks. In addition to self-reported behaviors, the study collected cookers and plastic caps from shooting galleries and tested them for the presence of blood residues. Adoption rates were: (1) cleaning of skin area with hand sanitizer--65.6%; (2) directly pouring water with a dropper into the cooker--56.3%; (3) drawing drug solution with a preparation syringe and syringe filter--34.4%; and, (4) backload rinsing syringes--53.1%. Rates of blood residues detected in cookers and plastic caps were 41.7% prior to the trial, 28.6% at week 8, 24.6% at week 14, and 12.0% at week 18. We believe the results of the pilot trial are compelling and suggest that this intervention merits further formal testing.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | PILOT PROJECTS | IV DRUG USERS | CLIENTS | HIV PREVENTION | SANITATION | PARTICIPATION | BEHAVIOR | Caribbean | Americas | Developed Countries | Studies | Research Methodology | Drug Use and Abuse | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Public Health | Health | Social Behavior
Document Number: 342088

13.

Peer Reviewed

Title: A feeding education program to prevent mother-to-child transmission of HIV in Haiti.
Author: Deschamps MM; Devieux JG; Theodore H; Saint-Jean G; Antillus L; Cadot I; Pape JW; Malow RM
Source: AIDS Care. 2009 Mar;21(3):349-54.
Abstract: In Haiti, as in most of the developing world, vertical transmission of HIV from infected mother to infant through postpartum breastfeeding remains a significant mode of transmission. As part of their prevention of mother-to-child transmission program, the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centers developed a feeding education program in which over 83% of the HIV-positive pregnant women who were eligible to participate, enrolled. Bivariate and adjusted multivariate logistic regression analyses were used to compare feeding choices of the 290 women who participated in the feeding education program to 58 who did not. Of those who participated, 91.7% chose to use replacement formulas for their newborns, while 75.9% of those who did not participate chose replacement feeding. After adjustment for socio-demographic variables, analyses revealed that the no education group was less likely to adopt replacement feeding and more likely to use mixed feeding (OR=0.31, p=0.004; and OR=2.74, p=0.05, respectively). This suggests that a targeted and culturally appropriate education program can be effective in encouraging replacement feeding, even in those countries where breastfeeding is the norm.
Language: English
Keywords:
HAITI | RESEARCH REPORT | CONTROL GROUPS | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HEALTH EDUCATION | BREASTFEEDING, EXCLUSIVE | WEANING | SUPPLEMENTARY FEEDING | ANTIRETROVIRAL THERAPY | Developing Countries | Caribbean | Americas | Research Methodology | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Education | Breastfeeding | Infant Nutrition | Nutrition | Health | HIV
Document Number: 341855

14.
Peer Reviewed

Title: Prevention of mother-to-child transmission of HIV in Haiti.
Author: Deschamps MM; Noel F; Bonhomme J; Devieux JG; Saint-Jean G; Zhu Y; Wright P; Pape JW; Malow RM
Source: Revista Panamericana de Salud P�blica / Pan American Journal of Public Health. 2009 Jan;25(1):24-30.
Abstract: OBJECTIVES: To describe the effectiveness of a program designed to reduce the rate of mother-to-child transmission (MTCT) of HIV at the primary HIV testing and treatment center in Haiti between 1999 and 2004. METHODS: All pregnant, HIV-positive women who attended the major HIV testing and treatment clinic in Port-au-Prince, Haiti, between March 1999 and December 2004 were asked to participate in an MTCT prevention program. Of the 650 women who participated, 73.3% received zidovudine (AZT), 2.9% received nevirapine (NVP), and 10.1% received triple-drug therapy when it became available in 2003 and if clinical/laboratory indications were met. Approximately 13.8% received no antiretroviral medication. All participants received cotrimoxazole prophylaxis and infant formula for their children. Kaplan-Meier survival analysis and the log rank test were used to evaluate program impact on child survival. RESULTS: Complete data were available for 348 mother-infant pairs who completed the program to prevent MTCT of HIV. The rate of MTCT in the study was 9.2% (95% CI: 6.14-12.24), in contrast to the historical mother-to-child transmission rate of 27% in Haiti. HIV-positive infants were less likely to survive than HIV-negative infants at 18 months of follow-up (chi(2) = 19.06, P < .001, log rank test). Infant survival improved with early pediatric diagnosis and antiretroviral treatment. CONCLUSIONS: The MTCT prevention program described proved to be feasible and effective in reducing vertical HIV transmission in Haiti. The authors emphasize the need to expand testing, extend services to rural areas, and implement early HIV diagnosis to reduce infant mortality.
Language: English
Keywords:
HAITI | RESEARCH REPORT | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTENATAL CARE | HIV TRANSMISSION | HIV INFECTIONS | PROGRAM EFFECTIVENESS | Developing Countries | Caribbean | Americas | Disease Transmission Control | Prevention and Control | Diseases | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Viral Diseases | Program Evaluation | Programs | Organization and Administration
Document Number: 341542

15.

Title: Knowledge, attitudes, and behaviors among a sample of HIV-positive and HIV-negative females visiting an urban VCT center in Haiti.
Author: Devieux JG; Deschamps MM; Malow RM; Jean-Gilles M; Saint-Jean G; Saint-Jean G; Marcelin A; Pape JW
Source: Journal of Health Care For the Poor and Underserved. 2009 May;20(2):554-68.
Abstract: The knowledge, attitudes, and behaviors of over 43,000 women attending the Groupe Hatien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centers in Haiti between 1999-2004 were examined. Comparative analyses were conducted for several sub-samples. Analyses revealed that across the entire sample, HIV-positive women appeared to engage in more risky behaviors than HIV-negative women (p< .01); however, as a group, pregnant HIV-positive women reported safer behaviors than non-pregnant HIV-positive women (p<.01). Women from all groups were generally knowledgeable about the risk of HIV transmission through dirty needles and mother to child. However, inaccurate information about transmission through supernatural means and mosquitoes was very common. These results suggest that knowledge and education are negatively associated with HIV status in this sample. Addressing gaps in knowledge and behavior and reducing the risky behaviors of HIV-positive individuals are important directions for future programs.
Language: English
Keywords:
HAITI | RESEARCH REPORT | KAP SURVEYS | WOMEN | RISK BEHAVIOR | VOLUNTARY COUNSELING AND TESTING | HIV INFECTIONS | KNOWLEDGE | ATTITUDES | SEX BEHAVIOR | Developing Countries | Caribbean | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Behavior | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Sociocultural Factors | Psychological Factors
Document Number: 341812

16.
Peer Reviewed

Title: High early mortality in patients with chronic acquired immunodeficiency syndrome diarrhea initiating antiretroviral therapy in Haiti: a case-control study.
Author: Dillingham RA; Pinkerton R; Leger P; Severe P; Guerrant RL; Pape JW; Fitzgerald DW
Source: American Journal of Tropical Medicine and Hygiene. 2009 Jun;80(6):1060-4.
Abstract: This case-control study examines whether chronic diarrhea at initiation of antiretroviral therapy (ART) affects survival of human immunodefiency virus-infected patients. Cases (288) were treatment-naive, non-pregnant, adults with self report of frequent loose stool for > 3 weeks at the time ART was initiated. One-third of patients had an enteric pathogen identified including Cryptosporidium spp., Giardia spp., Isospora belli, Cyclospora cayetanensis, and Entamoeba histolytica. Control patients (400) did not have diarrhea when initiating ART. At six weeks, mortality was 10% in the patients with diarrhea and 5% in the patients without diarrhea (P = 0.009). Chronic diarrhea in patients requesting ART in Haiti is associated with increased early mortality.
Language: English
Keywords:
HAITI | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | ADULTS | PERSONS LIVING WITH HIV/AIDS | AIDS | ANTIRETROVIRAL THERAPY | DIARRHEA | GASTROINTESTINAL EFFECTS | ANTIBIOTICS | MORTALITY | Developing Countries | Caribbean | Americas | Research Methodology | Program Activities | Programs | Organization and Administration | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics
Document Number: 341760

17.

Title: Haiti: Going to scale with a performance incentive model.
Author: Eichler R; Auxila P; Antoine U; Desmangles B
Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :165-188.
Abstract: Rewarding NGOs for increasing access to a package of basic services and paying them for achieving population-based performance targets can result in significant increases in essential services such as immunizations and assisted deliveries. Paying NGOs for results strengthens institutional capacity to deliver services from the bottom up. Changes in the design throughout the six years offer lessons for other contexts.
Language: English
Keywords:
HAITI | RESEARCH REPORT | PILOT PROJECTS | MATERNAL HEALTH | CHILD HEALTH | REPRODUCTIVE HEALTH | FAMILY PLANNING | MEASUREMENT | PERFORMANCE IMPROVEMENT | PROGRAM ACTIVITIES | NONGOVERNMENTAL ORGANIZATIONS | ORGANIZATION AND ADMINISTRATION | PROGRAM EVALUATION | MONITORING | Developing Countries | Caribbean | Americas | Studies | Research Methodology | Health | Management | Programs | Organizations | Political Factors | Sociocultural Factors | Evaluation
Document Number: 331456

18.

19.

Peer Reviewed

Title: High mortality among patients with AIDS who received a diagnosis of tuberculosis in the first 3 months of antiretroviral therapy.
Author: Koenig SP; Riviere C; Leger P; Joseph P; Severe P; Parker K; Collins S; Lee E; Pape JW; Fitzgerald DW
Source: Clinical Infectious Diseases. 2009 Mar 15;48(6):829-31.
Abstract: We analyzed mortality among 201 patients with AIDS and tuberculosis in Haiti. Patients who received a diagnosis of tuberculosis during the first 3 months after the initiation of antiretroviral therapy were 3.25 times more likely to die than were other patients with AIDS and tuberculosis. Failure to recognize active tuberculosis at initiation of antiretroviral therapy leads to increased mortality.
Language: English
Keywords:
HAITI | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | TIME FACTORS | ANTIRETROVIRAL THERAPY | AIDS | TUBERCULOSIS | COMPLICATIONS | DEATH RATE | Developing Countries | Caribbean | Americas | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Dynamics | Demographic Factors | Population | HIV | Infections | Mortality
Document Number: 330706

20.

Title: Knowledge about breastfeeding among a group of primary care physicians and residents in Puerto Rico.
Author: Leavitt G; Martinez S; Ortiz N; Garcia L
Source: Journal of Community Health. 2009 Feb;34(1):1-5.
Abstract: Physicians have an essential role in promoting, protecting, and supporting breastfeeding as the ideal method of infant feeding. They are in an important position to promote breastfeeding but report difficulty in advising mothers with lactation problems. The purpose of this study is to assess knowledge about breastfeeding among primary care physicians and residents and identify potential barriers to its promotion. One hundred seventy-seven residents and physicians answered an anonymous questionnaire. The participants recognized breastfeeding benefits but 26% did not encourage exclusive breastfeeding. Mastitis, breast abscess, and the use of medications by the mother were considered contraindications to breastfeeding. Temporary breastfeeding discontinuation and bilirubin levels measurement were the preferred recommendations for the jaundiced infant. Most physicians received training in breastfeeding benefits although they report fair knowledge in myths, techniques, and contraindications. Physicians demonstrated to recognize breastfeeding benefits, but formal education is needed to eliminate barriers to breastfeeding promotion and support.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | PHYSICIANS | KNOWLEDGE | PRIMARY HEALTH CARE | HEALTH FACILITIES | BREASTFEEDING | HEALTH EDUCATION | MATERNAL HEALTH | Caribbean | Americas | Developed Countries | Health Personnel | Delivery of Health Care | Health | Sociocultural Factors | Health Services | Infant Nutrition | Nutrition | Education
Document Number: 330862

21.

22.

Title: Can we reduce the number of low-birth-weight babies? The Cuban experience.
Author: Lopez NB; Choonara I
Source: Neonatology. 2009;95(3):193-7.
Abstract: Low-birth-weight (LBW) infants have a significantly greater mortality than other babies, not only within the neonatal period but also in infancy and early childhood. Babies are LBW either because they are preterm or they have experienced intrauterine growth retardation. Reducing the prevalence of LBW babies is important in reducing child and infant mortality. Risk factors for prematurity and intrauterine growth retardation are well established. Socioeconomic conditions and nutrition during pregnancy are two key factors. Interventions to reduce the prevalence of LBW infants in developed countries have usually been unsuccessful. A few studies in developing countries have, however, achieved positive results. Cuba has managed to reduce the prevalence of LBW infants and their model of healthcare in relation to achieving this is described. Key features of the Cuban healthcare system are that it is both free and universal, and additionally there is a strong emphasis on primary healthcare. It is likely that a similar approach in both developing countries and disadvantaged communities in developed countries would reduce the prevalence of LBW babies. This would have a major impact in relation to reducing infant mortality rates.
Language: English
Keywords:
CUBA | RESEARCH REPORT | LOW BIRTH WEIGHT | PREMATURE BIRTH | INTRAUTERINE GROWTH RETARDATION | MORTALITY | PREVENTION AND CONTROL | Caribbean | Americas | Developing Countries | Birth Weight | Body Weight | Physiology | Biology | Pregnancy Outcomes | Pregnancy | Reproduction | Congenital Abnormalities | Neonatal Diseases and Abnormalities | Diseases | Population Dynamics | Demographic Factors | Population
Document Number: 341366

23.

Title: Effects of a culturally adapted HIV prevention intervention in Haitian youth.
Author: Malow RM; Stein JA; McMahon RC; Devieux JG; Rosenberg R
Source: Journal of the Association of Nurses in AIDS Care. 2009 Mar-Apr;20(2):110-121.
Abstract: This study assessed the impact of an 8-week community-based translation of Becoming a Responsible Teen (BART), an HIV intervention that has been shown to be effective in other at-risk adolescent populations. A sample of Haitian adolescents living in the Miami area was randomized to a general health education control group (n = 101) or the BART intervention (n = 145), which was based on the information- motivation-behavior (IMB) model. Improvement in various IMB components (i.e., attitudinal, knowledge, and behavioral skills variables) related to condom use was assessed 1 month after the intervention. Longitudinal structural equation models using a mixture of latent and measured multi-item variables indicated that the intervention significantly and positively impacted all IMB variables tested in the model. These BART intervention-linked changes reflected greater knowledge, greater intentions to use condoms in the future, higher safer sex self-efficacy, an improved attitude about condom use, and an enhanced ability to use condoms after the 8-week intervention. (author's)
Language: English
Keywords:
HAITI | RESEARCH REPORT | YOUTH | ADOLESCENTS | HIV PREVENTION | RISK BEHAVIOR | SEX BEHAVIOR | Developing Countries | Caribbean | Americas | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Behavior
Document Number: 328102

24.
Peer Reviewed

Title: Descriptive epidemiology of mortality and morbidity of health-indicator diseases in hospitalized children from western Jamaica.
Author: McCarthy JE; Evans-Gilbert T
Source: American Journal of Tropical Medicine and Hygiene. 2009 Apr;80(4):596-600.
Abstract: The objectives of our study were to describe the epidemiology of child-health indicator diseases in western Jamaica, examine differences in indicator diseases between sex and age, and generate hypotheses about causes of disease burden. International Classification of Disease, 10th Revision, coded discharge diagnoses were collected from consecutive admissions for 2003-2005 from a public tertiary care hospital. Mortality data were not coded. Perinatal disease was the most common cause of mortality, with hyaline membrane disease the primary cause. Younger children, particularly males, are disproportionately affected by all indicator diseases (P < 0.001) and more likely to die from acute respiratory tract infections and infectious diseases (P < 0.05). Sickle cell disease was the fourth most common diagnosis. Children in western Jamaica are most affected by diseases of prematurity. These children experience disease burden similar to that of children in other developing countries, but fewer neonatal sepsis and insect-borne infections, and more hematologic illness.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | EVALUATION INDEXES | CLASSIFICATION | CHILDREN | INFANT | PREVALENCE | HEALTH STATUS INDEXES | CHILD HEALTH | CHILD MORTALITY | CAUSES OF DEATH | SEX FACTORS | RESPIRATORY INFECTIONS | Caribbean | Americas | Developing Countries | Research Methodology | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Health | Mortality | Population Dynamics | Infections | Diseases
Document Number: 331278

25.

Title: Trends in HIV/TB coinfection in Trinidad and Tobago for the period 1998-2007.
Author: Mungrue K; Beharry A; Kalloo J; Mahabir S; Maraj T; Ramoutar R; Ramsaroop K; Solomon V
Source: Journal of the International Association of Physicians in AIDS Care. 2009 May-Jun;8(3):170-5.
Abstract: OBJECTIVES: The aim of this study was to extend the description of the epidemiologic pattern of human immunodeficiency virus (HIV)/tuberculosis (TB) coinfection from 1998 to 2007 in a high HIV/AIDS prevalence country. DESIGN AND METHODS: This study utilized registry data to determine yearly TB incidence and HIV coinfection. Mortality rates for coinfected patients were calculated and compared with patients receiving highly active antiretroviral therapy (HAART). RESULTS: From a TB population of 2010 registered patients, data was collected on the 466 patients with HIV/TB coinfection. The coinfection rate was found to be 23.6% for the study period. Patients on HAART were twice as likely to survive. DISCUSSION AND CONCLUSIONS: The incidence of TB and HIV/TB coinfection rates continues to be major challenges in the developing world. Demographic, socioeconomic trends as well as risk factors remain unchanged. Increased HIV screening and HAART coverage offers hope for the future.
Language: English
Keywords:
TRINIDAD AND TOBAGO | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | HIV INFECTIONS | TUBERCULOSIS | INCIDENCE | PREVALENCE | ANTIRETROVIRAL THERAPY | ANTIBIOTICS | CASE FATALITY RATE | Developing Countries | Caribbean | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | Measurement | HIV | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Death Rate | Mortality | Population Dynamics | Demographic Factors | Population
Document Number: 342459

26.

Peer Reviewed

Title: The effect of sympathy on discriminatory attitudes toward persons living with HIV/AIDS in Puerto Rico: a hierarchical analysis of women living in public housing.
Author: Norman LR; Abreu S; Candelaria E; Sala A
Source: AIDS Care. 2009 Feb;21(2):140-9.
Abstract: As the number of persons living with HIV/AIDS (PLWHA) continues to increase in Puerto Rico, it becomes increasingly important to address the issues of stigma and other discriminatory attitudes. Therefore, the objective of the present study is to examine the attitudes toward PLWHA of a large sample of women living in public housing in Puerto Rico, including sympathy and support for PLWHA in the workplace and in school. A total of 1138 women completed a self-administered 218-item survey made up of questions that measured HIV-related knowledge, attitudes and behaviors. Levels of sympathy varied depending upon the target group, with HIV-infected drug users receiving the least sympathy. Most women reported that HIV-positive teachers should be allowed to teach and that HIV-positive children should be allowed to attend school. However, a significantly lower percentage reported that HIV-infected nurses should be allowed to continue working. Women who were more sympathetic toward PLWHA were more tolerant of PLWHA in the workplace and school, while those with inaccurate knowledge concerning HIV transmission were less tolerant. Also, those who knew a PLWHA were more tolerant. Levels of discriminatory attitudes in Puerto Rico are high and warrant both individual- and societal-level interventions.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | DATA ANALYSIS | WOMEN | PERSONS LIVING WITH HIV/AIDS | LOW INCOME POPULATION | HIV INFECTIONS | AIDS | STIGMA | SOCIAL DISCRIMINATION | ATTITUDES | Caribbean | Americas | Developed Countries | Research Methodology | Demographic Factors | Population | Viral Diseases | Diseases | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Social Problems | Sociocultural Factors | Psychological Factors | Behavior
Document Number: 330811

27.
Title: Impact of relationship dynamics and gender roles in the protection of HIV discordant heterosexual couples: an exploratory study in the Puerto Rican context.
Author: Orengo-Aguayo R; Perez-Jimenez D
Source: Puerto Rico Health Sciences Journal. 2009 Mar;28(1):30-9.
Abstract: BACKGROUND: Most of the HIV/AIDS prevention efforts have not taken into consideration the context of the relationship and the gender constructs that influence relationship dynamics. These efforts have failed to view HIV prevention as a collaborative process between partners. Therefore, it is important to explore how relationship dynamics and gender constructs influence how men and women involved in an HIV discordant heterosexual relationship, visualize their role in the protection of their partners in order to design more effective prevention interventions. METHODS: Five Puerto Rican HIV discordant heterosexual couples were interviewed via a qualitative semi-structured interview. The taped interviews were transcribed and analyzed using content analysis according to a set of defined categories. RESULTS: Women visualized their role as one of convincing their partners to use protection as well as being strong and firm in the demand of its use. Men viewed their role as one of being more supportive and willing to use protection, but recognized their resistance towards the use of condoms. Relationship dynamics such as communication and support promoted protection. CONCLUSIONS: Traditional and non-traditional gender roles were assumed by both men and women. Traditional gender roles inhibited protection but were also used in positive ways to promote it. Men showed a greater initiative to break with traditional gender norms. A positive relationship, marked by communication and support could serve as a facilitator in the protection and in the transformation of traditional gender norms. This points out to the need of viewing HIV/AIDS prevention as a collaborative rather than individualistic process.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | COUPLES | SPOUSE | HETEROSEXUALS | GENDER RELATIONS | HIV INFECTIONS | SPOUSAL SUPPORT | SEX FACTORS | CONDOM USE | PARTNER COMMUNICATION | Caribbean | Americas | Developed Countries | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Family Characteristics | Family and Household | Sociocultural Factors | Family Relationships | Sex Behavior | Behavior | Gender Issues | Microeconomic Factors | Economic Factors | Population Characteristics | Demographic Factors | Population | Risk Reduction Behavior | Interpersonal Relations
Document Number: 341066

28.

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

29.

30.
Title: Symptoms and quality of life of people living with HIV infection in Puerto Rico.
Author: Rivero-Mendez M; Portillo C; Solis-Baez SS; Wantland D; Holzemer WL
Source: Puerto Rico Health Sciences Journal. 2009 Mar;28(1):54-9.
Abstract: BACKGROUND: People living with HIV infection are confronted with physical and psychological symptoms that impact their quality of life. This study explored the symptom experience of people living with HIV infection in Puerto Rico and its correlation with quality of life. METHODS: A cross-sectional descriptive design was used to survey 44 men, women, and transgender people living with HIV infection. Measures included a demographic questionnaire, sign and symptom checklist, and a quality of life instrument. RESULTS: The sample was 50% male with a mean age of 42.1 years; the participants had been living with HIV infection an average for 9.8 years. The top five symptoms reported by the sample included: muscle aches (81.8%), depression (77.2%), weakness (70.5%), fear/worries (70.5), and difficulty concentrating (65.9%). Symptom frequency was significantly related to four dimensions of quality of life: overall function (r = -0.58), life satisfaction (r = -0.59), health worries (r = 0.32) and HIV medication worries (r = 0.59). The symptom experience was not related to financial worries, disclosure worries, or sexual functioning. Individuals who reported taking HIV medications reported significantly fewer symptoms than those not taking HIV medications (t = 3.061, df=42, p < 0.01). CONCLUSIONS: These results suggest that people living with HIV infection in Puerto Rico experience a wide array of physical and psychological symptoms and that these symptoms have a correlation with their perceived quality of life. Better management of symptoms may have an impact on perceived quality of life for people living with HIV infection.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | EVALUATION INDEXES | PERSONS LIVING WITH HIV/AIDS | QUALITY OF LIFE | SIGNS AND SYMPTOMS | HIV INFECTIONS | PSYCHOLOGICAL FACTORS | DEMOGRAPHIC FACTORS | HEALTH STATUS INDEXES | DEPRESSION | PAIN | ANTIRETROVIRAL THERAPY | Caribbean | Americas | Developed Countries | Surveys | Sampling Studies | Studies | Research Methodology | Quantitative Evaluation | Evaluation | Viral Diseases | Diseases | Social Welfare | Economic Factors | Behavior | Population | Health | Mental Disorders | HIV
Document Number: 341065


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