1.  Peer Reviewed Title: Intentional condomless anal intercourse among Latino MSM who meet sexual partners on the Internet. Author: Balan IC; Carballo-Dieguez A; Ventuneac A; Remien RH Source: AIDS Education and Prevention. 2009 Feb;21(1):14-24. Abstract: Data on intentional condomless anal intercourse in risky contexts, also known as "barebacking," among ethnic minority MSM, whose rates of HIV infection continue to rise, are extremely limited. In this study, 31 Latino MSM who seek barebacking partners via the Internet underwent in-depth interviews about bareback sex and its association to pleasure, substance use, HIV concerns, and cultural identity. Participants reported engaging in bareback sex owing to the physical and emotional pleasure they experience. They expressed concern about HIV infection and took steps to reduce risk of infection. Although a majority of participants reported using alcohol or drugs in the context of bareback sex, substance use did not appear to propel the behavior. Crystal methamphetamine use, prevalent only among our HIV-positive participants, was related to very high HIV risk behavior. In this sample, culture did not seem to play a large role in barebacking. Language: English Keywords: NEW YORK | RESEARCH REPORT | KAP SURVEYS | MEN HAVING SEX WITH MEN | SEXUAL PARTNERS | ETHNIC GROUPS | ANAL SEX | CONDOM USE | INTERNET | RISK BEHAVIOR | SEX BEHAVIOR | PARTNER COMMUNICATION | DRUG USE AND ABUSE | HIV TRANSMISSION | PERCEPTION | Developed Countries | United States of America | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Behavior | Cultural Background | Population Characteristics | Demographic Factors | Population | Risk Reduction Behavior | Information Networks | Communication | Interpersonal Relations | HIV Infections | Viral Diseases | Diseases | Psychological Factors Document Number: 330344 |
| 2. Peer Reviewed Title: Antiretroviral adherence in rural Zambia: the first year of treatment availability. Author: Birbeck GL; Chomba E; Kvalsund M; Bradbury R; Mang'ombe C; Malama K; Kaile T; Byers PA; Organek N Author: RAAZ Study Team Source: American Journal of Tropical Medicine and Hygiene. 2009 Apr;80(4):669-74. Abstract: We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence. Language: English Keywords: ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | RURAL POPULATION | PERSONS LIVING WITH HIV/AIDS | SPOUSE | SOCIAL NETWORKS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | CLINIC VISITS | PARTNER COMMUNICATION | KNOWLEDGE | SEX FACTORS | SPOUSAL SUPPORT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Friends and Relatives | HIV | Behavior | Service Statistics | Program Activities | Programs | Organization and Administration | Interpersonal Relations | Microeconomic Factors | Economic Factors Document Number: 331277 |
| 3. Title: [Assessment of factors associated with patients' comprehension of treatment at the start of antiretroviral therapy] Evaluacion de factores asociados a la comprension del tratamiento en pacientes Author: Braga Ceccato MG; Acurcio Fde A; Vallano A; Comini Cesar C; Crosland Guimaraes MD Source: Enfermedades Infecciosas Y Microbiologia Clinica. 2009 Jan;27(1):7-13. Abstract: OBJECTIVE: The aim of this study was to evaluate factors associated with patients' comprehension of antiretroviral therapy (ART). METHOD: Cross-sectional analysis in which patients at 2 HIV/AIDS public referral centers (Belo Horizonte, Brazil) were interviewed after initiating ART. Information was recorded on variables related to the patient's characteristics, the treatment prescribed, and the healthcare professional involved. A score indicating the patients' level of comprehension regarding the medications prescribed was obtained using a latent trait model estimated by the item response theory. RESULTS: A total of 406 patients were interviewed. Mean (SD) age was 35 (10) years, 227 were men (56%), 302 of Afro-American ethnicity (77%), and 213 had <8 years of education (53%). The regression model determined that 52.25% of the variability of comprehension was explained by the individual's characteristics. Variables associated (P<0.05) with poorest understanding about ART were lower education (<8 years), lack of knowledge about treatment duration and clinical severity, inadequate information provided by physicians, inability to understand pharmaceutical information, daily number of tablets, and the ART regimen prescribed. CONCLUSION: Comprehension of information about the ART regimen prescribed varies considerably between individuals. Nonetheless, several factors were found to be associated with the level of understanding: characteristics of the patient (education, clinical severity), characteristics of treatment (daily number of tablets, ART regimen prescribed), and contribution of healthcare professionals (information from physicians and pharmacists). Strategies to reinforce information about ART should be a priority for patients with a low level of understanding. Language: Spanish Keywords: BRAZIL | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | INTERVIEWS | CLIENTS | ETHNIC GROUPS | PRESCRIPTIONS | EDUCATIONAL STATUS | KNOWLEDGE | TREATMENT | INFORMATION | PHYSICIAN-PATIENT RELATIONS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Data Collection | Program Activities | Programs | Organization and Administration | Cultural Background | Population Characteristics | Demographic Factors | Population | Distributional Activities | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Interpersonal Relations | Behavior Document Number: 341238 |
| 4. Peer Reviewed Title: Determinants of nonadherence to a single-dose nevirapine regimen for the prevention of mother-to-child HIV transmission in Rwanda. Author: Delvaux T; Elul B; Ndagije F; Munyana E; Roberfroid D; Asiimwe A Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):223-30. Abstract: OBJECTIVES: To describe experiences, and identify factors associated with nonadherence to a single-dose nevirapine (SD-NVP) regimen for the prevention of mother-to-child transmission (PMTCT) of HIV in Rwanda. METHODS: In April to May 2006, using a case-control design at 12 PMTCT sites, we interviewed HIV-infected women who did not adhere (n = 111) and who adhered (n = 125) to the PMTCT prophylaxis regimen. Nonadherence was defined as mother and/or infant not ingesting SD-NVP at the recommended time or not at all and adherence as mother-infant pairs who ingested it as recommended. RESULTS: Only 61% of nonadherent women had received SD-NVP during pregnancy or delivery. Among nonadherent women who received SD-NVP, 80% ingested it at the recommended time, representing 49% of all nonadherent women. Only 7% of their newborns ingested SD-NVP. Multivariate logistic regression showed that unmarried women, less educated women, women who made 2 or less antenatal care visits, and those offered HIV testing after their first antenatal care visit were more likely to be nonadherent to PMTCT prophylaxis. Not disclosing one's HIV status to someone aside from a partner was also associated with nonadherence in mother-infant pairs. CONCLUSIONS: Sociodemographic factors, health services delivery factors, and a lack of communication and social support contributed to nonadherence to PMTCT prophylaxis in Rwanda. Language: English Keywords: RWANDA | RESEARCH REPORT | KAP SURVEYS | MULTIVARIATE ANALYSIS | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | USER COMPLIANCE | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | ADMINISTRATION AND DOSAGE | PREVALENCE | EDUCATIONAL STATUS | ANTENATAL CARE | PARTNER COMMUNICATION | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Behavior | Disease Transmission Control | Prevention and Control | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Socioeconomic Status | Socioeconomic Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Interpersonal Relations Document Number: 330370 |
| 5. Peer Reviewed Title: Beneficial effects of offering prenatal HIV counselling and testing on developing a HIV Preventive attitude among couples. Abidjan, 2002-2005. Author: Desgrees-Du-Lou A; Brou H; Djohan G; Becquet R; Ekouevi DK; Zanou B; Viho I; Allou G; Dabis F; Leroy V Source: AIDS and Behavior. 2009 Apr;13(2):348-355. Abstract: Prenatal HIV counselling and testing is mainly an entry-point to the prevention of mother-to-child transmission of HIV, but it may also play an important role in triggering the development of spousal communication about HIV and sexual risks and thus the adoption of a preventive attitude. In Abidjan, Coˆte d'Ivoire, we investigated couple communication on STIs and HIV, male partner HIV-testing and condom use at sex resumption after delivery among three groups of pregnant women who were offered prenatal counselling and HIV testing: HIVinfected women, uninfected women, and women who refused HIV-testing. The proportion of women who discussed STIs with their regular partner greatly increased after prenatal HIV counselling and testing in all three groups, irrespective of the women's serostatus and even in the case of test refusal. Spousal communication was related to more frequent male partner HIV-testing and condom use. Prenatal HIV counselling and testing proposal appears to be an efficient tool to sensitize women and their partner to safer sexual practices. Language: English Keywords: COTE D'IVOIRE | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | COUPLES | VOLUNTARY COUNSELING AND TESTING | HIV PREVENTION | ANTENATAL CARE | ATTITUDES | PARTNER COMMUNICATION | SPOUSAL SUPPORT | CONDOM USE | SEXUALLY TRANSMITTED DISEASE PREVENTION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Family Characteristics | Family and Household | Sociocultural Factors | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Psychological Factors | Behavior | Interpersonal Relations | Microeconomic Factors | Risk Reduction Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections Document Number: 340128 |
| 6. Title: Adolescent contraceptive care for the practicing pediatrician. Author: Duffy K; Wimberly Y; Brooks C Source: Adolescent Medicine. 2009 Apr;20(1):168-87, x. Abstract: Improved use of contraception has been intrinsic in the decline of teenaged pregnancies in the United States. Recent advances in contraception, including the development of new progestins and longer-acting reversible methods, have greatly increased the options available for adolescents. By frankly discussing adverse effects, offering clear explanations of noncontraceptive benefits, and developing strategies for improving compliance, providers can play a key role in facilitating successful contraceptive use in young patients. Language: English Keywords: GEORGIA | UNITED STATES OF AMERICA | RESEARCH REPORT | ADOLESCENTS | HEALTH PERSONNEL | ADOLESCENT HEALTH | HEALTH SERVICES | SEXUALLY TRANSMITTED DISEASE PREVENTION | CONTRACEPTION | CONFIDENTIAL INFORMATION | EMERGENCY CONTRACEPTION | ORAL CONTRACEPTIVES | PHYSICIAN-PATIENT RELATIONS | VAGINAL RING | INJECTABLES | IUD | COUNSELING | Developing Countries | Asia, Southwestern | Asia | Developed Countries | North America | Americas | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Family Planning | Ethics | Sociocultural Factors | Contraceptive Methods | Interpersonal Relations | Behavior | Clinic Activities | Program Activities | Programs | Organization and Administration Document Number: 341530 |
| 7. Peer Reviewed Title: Mobilizing men as partners: the results of an intervention to increase dual protection among Nigerian men. Author: Exner TM; Mantell JE; Adeokun LA; Udoh IA; Ladipo OA; Delano GE; Faleye J; Akinpelu K Source: Health Education Research. 2009 Apr 9; Abstract: This quasi-experimental, proof-of-concept study evaluated the effects of an intervention designed to help Nigerian men decrease risk for HIV/sexually transmitted infections and unintended pregnancy. The intervention was delivered in groups during two 5-hour workshops, with a monthly 2-hour check-in session. A comparison condition consisted of a group-based half-day didactic workshop. Based on recruitment area, 149 men were assigned to the intervention and 132 to the comparison. Men were evaluated at baseline and 3-month post-intervention. At follow-up, men assigned to the intervention were almost four times more likely than comparison men to report condom use at last intercourse (P < 0.001) and to report fewer unprotected vaginal sex occasions, greater self-efficacy for negotiation, a more egalitarian power dynamic in their primary relationship, more positive expectations for condom use and greater intention for future consistent condom use (all P values < 0.05). Findings suggest that this intervention is both feasible and effective. Language: English Keywords: NIGERIA | RESEARCH REPORT | KAP SURVEYS | CASE CONTROL STUDIES | MEN | SEXUAL PARTNERS | MEN'S INVOLVEMENT | HIV PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | CONDOM USE | CONTRACEPTIVE USAGE | WORKSHOPS | PARTNER COMMUNICATION | PROGRAM EVALUATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Sex Behavior | Behavior | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Risk Reduction Behavior | Contraception | Family Planning | Education | Interpersonal Relations Document Number: 341487 |
| 8. Peer Reviewed Title: Adapting a multifaceted U.S. HIV prevention education program for girls in Ghana. Author: Fiscian VS; Obeng EK; Goldstein K; Shea JA; Turner BJ Source: AIDS Education and Prevention. 2009;21(1):67-79. Abstract: A U.S. HIV prevention program was adapted to address knowledge gaps and cultural pressures that increase the risk of infection in adolescent Ghanaian girls. The theory-based nine-module HIV prevention program combines didactics and games, an interactive computer program about sugar daddies, and tie-and-dye training to demonstrate an economic alternative to transactional sex. The abstinence-based study was conducted in a church-affiliated junior secondary school in Nsawam, Ghana. Of 61 subjects aged 10-14 in the prevention program, over two thirds were very worried about becoming HIV infected. A pre-post evaluation of the intervention showed significant gains in three domains: HIV knowledge (p = .001) and self efficacy to discuss HIV and sex with men (p < .001) and with boys (p < .001). Responses to items about social norms of HIV risk behavior were also somewhat improved (p = .09). Subjects rated most program features highly. Although short-term knowledge and self-efficacy to address HIV improved significantly, longer term research is needed to address cultural and economic factors placing young women at risk of HIV infection. (author's) Language: English Keywords: GHANA | UNITED STATES OF AMERICA | EVALUATION REPORT | THEORETICAL MODELS | KAP SURVEYS | ADOLESCENTS, FEMALE | WOMEN IN DEVELOPMENT | SEX WORKERS | HIV PREVENTION | SEX EDUCATION | KNOWLEDGE | COMPUTER PROGRAMS AND PROGRAMMING | SELF ESTEEM | RISK BEHAVIOR | PARTNER COMMUNICATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Developed Countries | North America | Americas | Evaluation | Research Methodology | Surveys | Sampling Studies | Studies | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Education | Sociocultural Factors | Information Processing | Information | Psychological Factors | Interpersonal Relations Document Number: 325287 |
| 9. Title: Conflicting accountabilities: doctor's dilemma in TB control in rural India. Author: Fochsen G; deshpande K; Ringsberg KC; Thorson A Source: Health Policy. 2009 Feb;89(2):160-167. Abstract: The aim of this study was to analyse how the implementation strategy of direct observed treatment short course (DOTS) has shaped and influenced patient-provider encounters in a district tuberculosis centre (DTC) in a rural district of India. Method: Qualitative methods, combining observations and interviews, were carried out in a DTC focusing on the medical encounters between a TB doctor and his patients. Results: The findings showed that the TB doctor seemed to be working with a dilemma, defined as conflicting accountabilities, in the medical encounters. In an organization perceived as inefficient and resource-constrained, the doctor struggled to find a balance between meeting the obligations of the DOTS programme and meeting the needs and expectations of the patients. Strategies to deal with these conflicting accountabilities were identified as limiting patients' involvement, struggling to maintain authority, and transferring responsibility. Conclusion: Professional involvement and patient participation were seen as part of a linked process in this study, and the importance of empowering doctors and health care workers who are implementing DOTS is emphasized. The development of DOTS guidelines needs to be based on the actual process of health care delivery, and staff empowering efforts should also include strengthening of public health care infrastructure. Language: English Keywords: INDIA | RESEARCH REPORT | RURAL POPULATION | PHYSICIAN-PATIENT RELATIONS | CLIENTS | TUBERCULOSIS | DIRECTLY OBSERVED THERAPY SHORT-COURSE (DOTS) | Developing Countries | Asia, Southern | Asia | Population Characteristics | Demographic Factors | Population | Interpersonal Relations | Behavior | Program Activities | Programs | Organization and Administration | Infections | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330192 |
| 10. Peer Reviewed Title: Micronutrient supplementation affects maternal-infant feeding interactions and maternal distress in Bangladesh. Author: Frith AL; Naved RT; Ekstrom EC; Rasmussen KM; Frongillo EA Source: American Journal of Clinical Nutrition. 2009 Jul;90(1):141-8. Abstract: BACKGROUND: Good maternal-infant interaction is essential for optimal infant growth, health, and development. Although micronutrient malnutrition has been associated with poorer interaction, the effects of maternal micronutrient supplementation on interaction are unknown. OBJECTIVES: We examined differences in maternal-infant feeding interaction between 3 maternal pre- and postpartum micronutrient supplementation groups that differed in iron dose and inclusion of multiple micronutrients and determined whether any differences observed were mediated by maternal distress. DESIGN: A cohort of 180 pregnant women was selected from 3300 women in the randomized controlled trial Maternal Infant Nutritional Interventions Matlab, which was conducted in Matlab, Bangladesh. At 8 wk of gestation, women were randomly assigned to 1 of 3 groups to receive a daily supplement of micronutrients (14 wk gestation to 12 wk postpartum): 60 or 30 mg Fe each with 400 microg folic acid or multiple micronutrients (MuMS; 30 mg Fe, 400 microg folic acid, and other micronutrients). A maternal-infant feeding interaction was observed in the home when infants were 3.4-4.0 mo of age, and maternal distress was assessed. RESULTS: Compared with 30 mg Fe, 60 mg Fe decreased the quality of maternal-infant feeding interaction by approximately 10%. Compared with 30 mg Fe, MuMS did not improve interaction but reduced maternal early postpartum distress. Distress did not mediate the effects of micronutrient supplementation on interaction. CONCLUSION: For pregnant and postpartum women, micronutrient supplementation should be based on both nutritional variables (eg, iron status) and functional outcomes (eg, maternal-infant interaction and maternal distress). Language: English Keywords: BANGLADESH | RESEARCH REPORT | DOUBLE-BLIND STUDIES | PREGNANT WOMEN | VITAMINS AND MINERALS | FOOD SUPPLEMENTATION | BONDING | MATERNAL HEALTH | DEFICIENCY DISEASES | IRON | FOLIC ACID | ANXIETY DISORDERS | DEPRESSION | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Interpersonal Relations | Behavior | Nutrition Disorders | Diseases | Metals | Psychological Factors | Mental Disorders Document Number: 341995 |
| 11. Peer Reviewed Title: Association Between Testing for Human Immunodeficiency Virus and Changes in Risk Behaviors Among Injecting Drug Users in Southern China. Author: Jin X; Smith K; Sun Y; Ding G; Yao Y; Xu J; Chang D; Wang G; Zhu Y; Wang N Source: Sexually Transmitted Diseases. 2009 May 18; Abstract: BACKGROUND:: There is growing need for research in China regarding posttest risk behavior differences among injecting drug users that explores the effect of various testing modes (nonvoluntary vs. voluntary) and other related factors on changes in posttest risk behaviors. METHODS:: One hundred seventy-two study subjects self-reported human immunodeficiency virus (HIV)-related personal risk behaviors including condom use rates and needle-sharing habits. Fisher exact test and multivariate regression analysis compared the impact of HIV testing mode on ongoing risk behaviors for HIV transmission. RESULTS:: The study found that those who received positive test results were 5.37 times more likely to increase condom use with regular sexual partners, that men were 8.8 times more likely than women to increase posttest condom use in commercial sexual activities. Needle-sharing behavior was significantly lower for subjects who tested HIV-positive (odds ratio [OR]: 4.5), who notified sexual partners of test results (OR: 0.03), and who had tested voluntarily (OR: 0.04). CONCLUSION:: Based on the study results this report concludes that voluntary HIV testing and encouragement of partner notification of test results should be incorporated into China's national testing strategy. Language: English Keywords: CHINA | RESEARCH REPORT | KAP SURVEYS | MULTIVARIATE ANALYSIS | IV DRUG USERS | SEX WORKERS | HIV TESTING | RISK REDUCTION BEHAVIOR | HIV TRANSMISSION | CONDOM USE | NEEDLE SHARING | SEX FACTORS | VOLUNTARY COUNSELING AND TESTING | NOTIFICATION | PARTNER COMMUNICATION | Asia, Eastern | Asia | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Drug Use and Abuse | Behavior | Sex Behavior | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Risk Behavior | Population Characteristics | Demographic Factors | Population | Political Factors | Sociocultural Factors | Interpersonal Relations Document Number: 341498 |
| 12. Peer Reviewed Title: Change and stability in parent-child contact in five western countries. Author: Kalmijn M; de Vries J Source: European Journal of Population. 2009 Aug;25(3):257-276. Abstract: Although much is known about changes in the conjugal family, little is known about trends in contact between parents and adult (independently living) children. Using unique survey data, we study changes in contact with the mother and the father in five western countries over a 15-year period (Austria, West Germany, Great Britain, the United States, and Italy). We describe changes and we examine the role of compositional changes in the trend. We find no evidence for a decline in intergenerational contact, in contrast to notions of individualism. In two countries, there has been an increase in contact with the mother and in three countries no net trend is observed. Contact with the father has not changed. Other forms of contact (e.g., telephone contact) have increased. Some compositional changes have had a downward pressure on the trend, leading to a decline in contact (i.e., rising education, declining church attendance), but these pressures have been compensated by counteracing compositional changes (declining sibsize) and by behavioral changes. Language: English Keywords: UNITED KINGDOM | UNITED STATES OF AMERICA | GERMANY | AUSTRIA | ITALY | RESEARCH REPORT | PARENTS | CHILDREN | FAMILY LIFE | BONDING | CHANGES | BEHAVIOR CHANGE | Developed Countries | Europe, Western | Europe | North America | Americas | Europe, Central | Europe, Southern | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Interpersonal Relations | Behavior | Social Change Document Number: 339897 |
| 13. Title: Influencing risk behavior of sexually transmitted infection clinic visitors: efficacy of a new methodology of motivational preventive counseling. Author: Kuyper L; de Wit J; Heijman T; Fennema H; van Bergen J; Vanwesenbeeck I Source: AIDS Patient Care and STDs. 2009 Jun;23(6):423-31. Abstract: A quasi-experimental study was conducted at a Dutch sexually transmitted infection (STI) clinic to compare the effects of educational counseling and motivational interviewing (MI)-based HIV/STI counseling on determinants of condom use and partner notification at 6-month follow-up. It also examined the feasibility of MI-based counseling in a busy real-life clinic. The counseling approaches were historically compared: respondents in the control condition were recruited between April and July 2005, those in the experimental condition between September and December 2005. The study involved 428 participants. These were all high-risk clients of the STI clinic. Their mean age was 33.7 years, and 39.6% were female. The study showed that MI-based counseling had a more positive effect on self-efficacy, intentions to use condoms with casual partners, and long-term condom use with steady partners. It had no adversarial outcomes on other social cognitions or behaviors compared to educational counseling. Furthermore, MI-based counseling is experienced as a more respectful and structured way of counseling. MI-based counseling was relatively easily implemented into the current clinic procedures. In addition to the implementation of the training, neither specialized staff nor additional or longer client visits were needed. However, some nurses indicated that the new method required more personal investment and effort. Limitations of the current study are the low response rates, the high educational level of most participants, and the small sample size regarding partner notification. Nonetheless, we conclude that MI-based counseling was a more effective approach to preventive counseling compared to educational counseling and feasible in the busy real-life setting. Language: English Keywords: NETHERLANDS | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | NURSES AND NURSING | COUNSELING | SAFER SEX | HIV PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | CONDOM USE | HEALTH EDUCATION | MOTIVATION | PARTNER COMMUNICATION | Europe, Western | Europe | Developed Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Health Personnel | Delivery of Health Care | Health | Clinic Activities | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Risk Reduction Behavior | Education | Psychological Factors | Interpersonal Relations Document Number: 342409 |
| 14. Peer Reviewed Title: Sexual risk behaviour for women working in recreational venues in Mwanza, Tanzania: considerations for the acceptability and use of vaginal microbicide gels. Author: Lees S; Desmond N; Allen C; Bugeke G; Vallely A; Ross D Source: Culture, Health and Sexuality. 2009 May 14;:1. Abstract: Qualitative research was conducted to explore the social context of sexual-risk behaviour among women working in recreational occupations, during a feasibility study in preparation for the Phase III clinical trial of vaginal microbicides in Mwanza, Tanzania. Participant observation was conducted in 68 recreational venues. Six focus group discussions were conducted with women working in recreational occupations and two with male customers at these venues. Findings revealed that these women are at risk of HIV due their dependence on sexual transactions to improve their economic circumstances, which take place in environments and relationships where condom use is difficult. However, the findings revealed that, in spite of constraints, women did take actions to prevent HIV by negotiating for condom use or avoiding perceived risky practices or partnerships, in particular moving to more casual partnerships where condom negotiation is more acceptable. This indicates that, given their perception of their own risk, women working in recreational occupations will welcome an effective microbicide. However, sustained use will depend on how formulations overcome the difficulties women currently experience with condom negotiation and the specific environments and relationships in which they engage in sex. Language: English Keywords: TANZANIA | RESEARCH REPORT | FOCUS GROUPS | WOMEN IN DEVELOPMENT | WORKERS | PARKS AND RECREATIONAL FACILITIES | MICROBICIDES | VAGINAL GEL | CONDOM USE | HIV PREVENTION | SEX BEHAVIOR | RISK ASSESSMENT | PERCEPTION | PARTNER COMMUNICATION | SELF-PERCEPTION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Economic Development | Economic Factors | Labor Force | Human Resources | Natural Resources | Environment | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Vaginal Spermicides | Contraceptive Methods | Contraception | Family Planning | Risk Reduction Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Evaluation | Psychological Factors | Interpersonal Relations Document Number: 341493 |
| 15. Peer Reviewed Title: Managing men: women's dilemmas about overt and covert use of barrier methods for HIV prevention. Author: Macphail C; Terris-Prestholt F; Kumaranayake L; Ngoako P; Watts C; Rees H Source: Culture, Health and Sexuality. 2009 May 27;:1. Abstract: Women in sub-Saharan Africa are at high risk of HIV infection and may struggle to negotiate condom use. This has led to a focus on the development of female-controlled barrier methods such as the female condom, microbicides and the diaphragm. One of the advantages of such products is their contribution to female empowerment through attributes that make covert use possible. We used focus groups to discuss covert use of barrier methods with a sample of South African women aged 18-50 years from Eastern Johannesburg. Women's attitudes towards covert use of HIV prevention methods were influenced by the overarching themes of male dislike of HIV and pregnancy prevention methods, the perceived untrustworthiness of men and social interpretations of female faithfulness. Women's discussions ranged widely from overt to covert use of barrier methods for HIV prevention and were influenced by partner characteristics and previous experience with contraception and HIV prevention. The discussions indicate that challenging gender norms for HIV prevention can be achieved in quite subtle ways, in a manner that suits individual women's relationships and previous experiences with negotiation of either HIV or pregnancy prevention. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | KAP SURVEYS | FOCUS GROUPS | WOMEN IN DEVELOPMENT | SEXUAL PARTNERS | URBAN POPULATION | HIV PREVENTION | BARRIER METHODS | ATTITUDES | PARTNER COMMUNICATION | PERCEPTION | GENDER RELATIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Data Collection | Economic Development | Economic Factors | Sex Behavior | Behavior | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Contraceptive Methods | Contraception | Family Planning | Psychological Factors | Interpersonal Relations | Gender Issues | Sociocultural Factors Document Number: 341491 |
| 16. Peer Reviewed Title: The role of religion in HIV-positive women's disclosure experiences and coping strategies in Kinshasa, Democratic Republic of Congo. Author: Maman S; Cathcart R; Burkhardt G; Omba S; Behets F Source: Social Science and Medicine. 2009 Mar;68(5):965-70. Abstract: Literature from the U.S. has documented the importance of spirituality on the psychological health of people living with HIV/AIDS; however there is little published data on the ways in which people living with HIV/AIDS in Africa turn to religion for support. We conducted 40 in-depth interviews with HIV-positive women who were pregnant or had recently given birth in Kinshasa, Democratic Republic of Congo to inform the development of a comprehensive family-centered HIV treatment and care program. Women described how they relied upon their faith and turned to church leaders when they were diagnosed with HIV and prepared to share their diagnosis with others. The women used prayer to overcome the initial shock, sadness and anger of learning their HIV diagnosis. They turned to their church leaders to help them prepare for disclosing their diagnosis to others, including their partners. Church leaders were also important targets for disclosure by some women. Women's faith played an important role in their long-term coping strategies. Conceptualizing their infection as a path chosen by God, and believing that God has the power to cure their infection comforted women and provided them with hope. In settings like the Democratic Republic of the Congo, where there is a strong foundation of faith, we need to recognize how individuals draw upon their different health belief systems in order to develop and implement coherent and effective prevention, treatment and care strategies. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | URBAN POPULATION | PREGNANT WOMEN | INFLUENTIALS | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | PARTNER COMMUNICATION | HIV INFECTIONS | PSYCHOLOGICAL FACTORS | RELIGIOUS ASPECTS | LEADERSHIP | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Knowledge Sources | Communication | Puerperium | Reproduction | Economic Development | Economic Factors | Interpersonal Relations | Behavior | Religion | Sociocultural Factors | Organization and Administration Document Number: 341170 |
| 17. Title: Contraceptive practices and sexual initiation among young people in three Brazilian State capitals. Praticas contraceptivas e iniciacao sexual entre jovens de tres capitais brasileiras. Author: Marinho LF; Aquino EM; de Almeida M Source: Cadernos Saude Publica. 2009;25(Sup 2):S227-S239. Abstract: This study investigated contraceptive use during first sexual intercourse among 2,790 young men and women. Researchers used the GRAVAD household survey to interview a probabilistic sample in three Brazilian capital cities. A hierarchical logistic regression analysis was used. The prevalence of contraceptive use was 68.3% for women and 65.3% for men. Among women, contraception use was associated with per capita monthly family income, color/race, and the use of women's magazines as a source of information on pregnancy and contraception. For both genders, use was more frequent when partners discussed pregnancy prevention before intercourse, when sexual initiation was delayed and in a motel, and when the partner was patient. The interval between the start of the relationship and sexual initiation appeared to be associated with use during first sex for men. Language: English Keywords: BRAZIL | RESEARCH REPORT | SAMPLING STUDIES | STATISTICAL REGRESSION | YOUTH | CONTRACEPTIVE USAGE | FIRST INTERCOURSE | SOCIOECONOMIC STATUS | INFORMATION SOURCES | PARTNER COMMUNICATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Data Analysis | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Sex Behavior | Behavior | Socioeconomic Factors | Economic Factors | Information | Interpersonal Relations Document Number: 339906 |
| 18. Peer Reviewed Title: Predictors of early first sexual intercourse among adolescents in Cape Town, South Africa. Author: Mathews C; Aaro LE; Flisher AJ; Mukoma W; Wubs AG; Schaalma H Source: Health Education Research. 2009 Feb;24(1):10 p. Abstract: The authors used a social cognition theoretical framework to investigate the predictors of young adolescents' transition to first intercourse. The analyses were based on a longitudinal study of students in schools allocated to the control arm of a cluster-randomized controlled trial to investigate the effect of a school-based HIV prevention program. The study involved 2,360 Grade 8 students in Cape Town. Of the 1,440 students who were virgins at baseline, 1,144 remained virgins 15 months later, and 296 (20.6%) reported having had their first sexual intercourse. Transition to first sexual intercourse was more likely among males, among older students, and among students with a lower socio-economic status. Transition to first sexual intercourse was significantly associated with intentions to have sexual intercourse, poor self-efficacy to negotiate delayed sex, and intimate partner violence. The model predicted 35% of the variance in intentions and 16% of the variance in transition. These findings indicate some of the factors that influence young people to have first sex and that need to be addressed when designing effective interventions. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | LONGITUDINAL STUDIES | ADOLESCENTS | URBAN POPULATION | FIRST INTERCOURSE | AGE FACTORS | RISK FACTORS | PSYCHOSOCIAL FACTORS | SEX FACTORS | SOCIOECONOMIC STATUS | PARTNER COMMUNICATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Sex Behavior | Behavior | Biology | Socioeconomic Factors | Economic Factors | Interpersonal Relations Document Number: 329524 |
| 19. Peer Reviewed Title: Young unmarried men's understanding of female hormonal contraception. Author: Merkh RD; Whittaker PG; Baker K; Hock-Long L; Armstrong K Source: Contraception. 2009 Mar;79(3):228-35. Abstract: BACKGROUND: A better understanding of men's attitudes, norms and behaviors regarding women's use of hormonal contraception is needed. STUDY DESIGN: We conducted contraceptive life-history interviews with 41 ethnically diverse males ages 18-25 years which detailed up to six heterosexual relationships, focusing on knowledge, attitudes, norms and behaviors regarding hormonal contraception use, decision making and communication. RESULTS: Men's attitudes, norms and behaviors associated with hormonal contraceptive decisions and use varied greatly across participants and their relationships. Findings suggest a mixture of attitudes and practices regarding the importance of communication around contraception influenced by sexual experiences, age and relationship type. Many men demonstrated limited knowledge about contraceptives and identified improving contraceptive knowledge as an essential step in facilitating contraceptive communication. CONCLUSIONS: Increased awareness about young men's understanding of and perceived roles regarding hormonal contraception will help in designing services that address contraceptive adherence, contraceptive communication and incorrect or inadequate contraceptive knowledge. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | EVENT HISTORY ANALYSIS | UNMARRIED | MEN | KNOWLEDGE | CONTRACEPTION | CONTRACEPTIVE AGENTS | HORMONES | ATTITUDES | VALUE ORIENTATION | SEX BEHAVIOR | DECISION MAKING | PARTNER COMMUNICATION | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Analysis | Marital Status | Nuptiality | Demographic Factors | Population | Sociocultural Factors | Family Planning | Endocrine System | Physiology | Biology | Psychological Factors | Behavior | Interpersonal Relations Document Number: 330054 |
| 20. Title: Couples' communication on sexual and relational issues among the Akamba in Kenya. Author: Miller AN; Golding L; Ngula KW; Wambua M; Mutua E; Kitizo MN; Teti C; Booker N; Mwithia K; Rubin DL Source: African Journal of AIDS Research. 2009 Apr;8(1):51-60. Abstract: A large portion of HIV transmission in sub-Saharan Africa occurs among married couples, yet the majority of research on safer-sex communication has focused on communication between couples in casual relationships. This paper explores how committed Kamba couples in Machakos District, Kenya, communicate about sensitive relational issues. The findings from focus group discussions with five groups of males and five groups of females are presented. The couples freely shared their thoughts about daily and economic issues and certain aspects of family planning and sexuality. Methods for raising sensitive issues with partners included monitoring the spouse's mood, gradual or indirect revelation, mentioning topics during sex, and use of third-party intermediaries. Interference by extended family members, especially husbands' mothers, and male authoritarian roles emerged as hindrances to effective communication between couples. The implications for HIV prevention regarding gender differences and the role of families in couples' communication are discussed. Language: English Keywords: KENYA | RESEARCH REPORT | FOCUS GROUPS | ETHNIC GROUPS | COUPLES | HIV PREVENTION | PARTNER COMMUNICATION | GENDER ISSUES | SAFER SEX | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Cultural Background | Population Characteristics | Demographic Factors | Population | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Interpersonal Relations | Behavior | Sex Behavior Document Number: 341287 |
| 21. Peer Reviewed Title: Iron deficiency and child and maternal health. Author: Murray-Kolb LE; Beard JL Source: American Journal of Clinical Nutrition. 2009 Mar;89(3):946S-950S. Abstract: BACKGROUND: Iron deficiency is most commonly found in women of reproductive age and infants worldwide, but the influence of maternal iron deficiency on infant development is underexplored. OBJECTIVE: The objective was to examine the relation between maternal iron status and mother-child interactions in a randomized, double-blind, intervention trial conducted in South Africa. DESIGN: Women were recruited into the study from a health clinic at 6-8 wk postpartum and were classified as either iron-deficient anemic (IDA) or iron-sufficient after blood analysis. IDA mothers received iron supplements of 125 mg FeSO(4) (IDA-Fe; n = 34) or placebo (IDA-PL; n = 30) daily from 10 wk to 9 mo postpartum. The control group (n = 31) consisted of iron-sufficient mothers. Free-play mother-child interaction sessions were videotaped in the clinic at 10 wk (n = 80) and 9 mo (n = 66) postpartum and coded per the Emotional Availability Scales (4 maternal scales: sensitivity, structuring, nonintrusiveness, and nonhostility; 2 infant scales: responsiveness and involvement). RESULTS: At 10 wk, scores for maternal sensitivity and child responsiveness were significantly greater in the control group than in the IDA groups (P = 0.028 and 0.009, respectively). At 9 mo, the control and IDA-Fe groups no longer differed. These 2 groups scored significantly better on the maternal sensitivity, structuring, and nonhostility scales and on the child responsiveness scale than did the IDA-PL group (P = 0.007-0.032), whose iron status remained low. CONCLUSION: These data indicate that maternal iron deficiency negatively affects mother-child interactions and that iron supplementation protects against these negative effects. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL TRIALS | DOUBLE-BLIND STUDIES | WOMEN IN DEVELOPMENT | INFANT | MOTHERS | CHILD DEVELOPMENT | SERUM IRON LEVEL | DEFICIENCY DISEASES | MATERNAL NUTRITION | FOOD SUPPLEMENTATION | ADMINISTRATION AND DOSAGE | BONDING | PARENTAL INVOLVEMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Studies | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Biology | Hemic System | Physiology | Nutrition Disorders | Diseases | Nutrition | Health | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Drugs | Treatment | Medical Procedures | Medicine | Interpersonal Relations | Behavior | Child Rearing Document Number: 330708 |
| 22. 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 |
| 23. Peer Reviewed Title: An event-level analysis of condom use as a function of mood, alcohol use, and safer sex negotiations. Author: Schroder KE; Johnson CJ; Wiebe JS Source: Archives of Sexual Behavior. 2009 Apr;38(2):283-9. Abstract: Daily self-reports of condom-protected intercourse were analyzed as a function of emotional states, alcohol consumption, and safer sex negotiations in a sample of single, low-income Hispanic students. The sample included 15 women and 17 men who reported a minimum of four sexual episodes as well as inconsistent condom use over a 3-month self-reporting period. The analyses focused on 829 days out of 2,586 daily self-reports on which sexual intercourse was reported. Hierarchical linear modeling was used to predict condom-protected intercourse as a function of mood states, substance use, and safer sex negotiations. Safer sex negotiation was the strongest positive predictor of condom use. Contrary to expectation, unprotected intercourse was less likely to occur in episodes characterized by greater negative affect and more likely in episodes in which greater positive mood was reported. No main effect of alcohol consumption on safer sex was observed; however, an interaction between alcohol consumption and positive mood emerged, indicating that unprotected intercourse was most likely to occur when positive mood was combined with alcohol consumption. The results contradict the assumption that emotional distress predicts engagement in more risky sexual behavior and indicate that safer sex negotiations are likely to outweigh any effects of mood or alcohol consumption on subsequent condom use. Language: English Keywords: TEXAS | RESEARCH REPORT | KAP SURVEYS | EVENT HISTORY ANALYSIS | LINEAR REGRESSION | HISPANICS | STUDENTS | CONDOM USE | PARTNER COMMUNICATION | ALCOHOL USE AND ABUSE | SAFER SEX | EMOTIONS | STRESS | RISK BEHAVIOR | SEX BEHAVIOR | Developed Countries | United States of America | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Analysis | Statistical Regression | Data Analysis | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Education | Risk Reduction Behavior | Behavior | Interpersonal Relations | Psychological Factors Document Number: 330970 |
| 24. Title: Informed consent for IUD fitting [letter] Author: Stillwell S; Searle S Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):132-3. Abstract: Perforation of the uterus is a rare complication of intrauterine device (IUD) fitting. It is quoted as occurring in up to 2 in 1000 IUD fittings. Risk factors for perforation include previous caesarean section and postpartum insertion up to 6 months after delivery. Perforation may occur during the sounding of the uterus or the device itself may perforate the uterus. This can lead to the device being free in the abdominal cavity, necessitating removal by laparoscopy or laparotomy. Faculty Guidance tells IUD fitters that they should explain the risk of perforation to women considering an IUD and document this discussion in the clinical record. This fits with General Medical Council (GMC) guidance on informed consent. I dealt with a complaint from a woman who had a perforation of the uterus following an IUD change; this lady required laparoscopy to remove a missing IUD. The perforation was diagnosed at her IUD check, when the threads were found to be missing. Despite a clinical record showing "perf" followed by a tick this lady alleged that she had not been made aware of the risk of perforation and that if she had been aware she would not have had an IUD fitted. Dealing with this complaint led me to review my own clinical practice and to seek the opinions of other IUD fitters. Using a questionnaire, 15 instructing doctors were asked about the manner in which they (1) explain perforation risk to women and their confidence doing this and (2) assess their patients' understanding of the risk of perforation. These doctors all explained the risk of perforation to all women on their first IUD fitting but only 80% did on subsequent fittings. They commonly used an explanation along the lines of: "There is a small chance -1 in a 1000 -of perforation. This means making a hole in the wall of the womb. This is not serious but if the IUD goes into the tummy outside the womb it has to be removed with keyhole surgery". An explanation such as this would meet GMC consent guidance (i.e. you must tell patients if an investigation or treatment might result in a serious adverse outcome, even if the likelihood is very small). Although 50% of doctors found perforation easy to explain only 20% felt that their patients had understood the risk of perforation. If this is the case then this would not meet guidance that "you should check that a patient understands the terms that you use, particularly when describing the seriousness, frequency and likelihood of an adverse outcome". No doctor felt that patients were deterred from having an IUD fitted by the risk of perforation. More than 50% of the doctors felt that they would like further training in the discussion of risk of perforation of the uterus and of explanation of risk in general. It sometimes takes a review of everyday practice to identify a learning need. In this case it was prompted by a complaint from a woman who unfortunately did experience uterine perforation following an IUD change. All the doctors questioned did discuss the risk of perforation at a first IUD fitting but not all did at a subsequent IUD change. We should not assume that a woman will remember the potential complications of IUD fitting from a previous consultation. The management of this particular complaint and the results of this survey have changed the way in which I discuss perforation risk with women, and I now incorporate this into a fuller explanation of how the device is introduced and why a problem might occur potentially leading to perforation. (full-text) Language: English Keywords: UNITED KINGDOM | SUMMARY REPORT | CASE HISTORIES | INFORMED CONSENT | IUD COMPLICATIONS | INSERTION | UTERINE PERFORATION | PHYSICIAN-PATIENT RELATIONS | Developed Countries | Europe, Western | Europe | Data Collection | Research Methodology | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Perforations | Diseases | Interpersonal Relations | Behavior Document Number: 341646 |
| 25. Peer Reviewed Title: A Mixed Methods Evaluation of the Effect of the Protect and Respect Intervention on the Condom Use and Disclosure Practices of Women Living with HIV/AIDS. Author: Teti M; Bowleg L; Cole R; Lloyd L; Rubinstein S; Spencer S; Aaron E; Ricksecker A; Berhane Z; Gold M Source: AIDS and Behavior. 2009 Apr 9; Abstract: This mixed methods study evaluated the efficacy of an intervention to increase HIV status disclosure and condom use among 184 women living with HIV/AIDS (WLH/A). Participants were recruited from an HIV clinic and randomly assigned to: (1) a comparison group, who received brief messages from their health care providers (HCPs), or; (2) an intervention group, who received messages from HCPs, a group-level intervention, and peer-led support groups. Participants completed risk surveys at baseline, 6-, 12-, and 18-months. Quantitative analyses using hierarchical generalized linear models within a repeated measures framework indicated that intervention participants had significantly higher odds of reporting condom use with sexual partners in months 6 and 18. Grounded Theory-based qualitative analyses suggested that the opportunity to discuss the social context of their lives in addition to HIV/AIDS, including continued stigma and fear related to disclosure, are also essential components of a prevention strategy for WLH/A. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | CASE CONTROL STUDIES | PERSONS LIVING WITH HIV/AIDS | WOMEN | PEER EDUCATORS | WOMEN'S GROUPS | SEXUAL PARTNERS | CONDOM USE | PARTNER COMMUNICATION | HIV PREVENTION | STIGMA | FEAR | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Demographic Factors | Population | Education | Interest Groups | Political Factors | Sociocultural Factors | Sex Behavior | Behavior | Risk Reduction Behavior | Interpersonal Relations | Social Problems | Emotions | Psychological Factors Document Number: 331003 |
| 26. Peer Reviewed Title: Indicators for sexual HIV transmission risk among people in Thailand attending HIV care: the importance of positive prevention. Author: Tunthanathip P; Lolekha R; Bollen LJ; Chaovavanich A; Siangphoe U; Nandavisai C; Suksripanich O; Sirivongrangson P; Wiratchai A; Inthong Y; Eampokalap B; Ausavapipit J; Akarasewi P; Fox KK Source: Sexually Transmitted Infections. 2009 Feb;85(1):36-41. Abstract: BACKGROUND: Almost half of all new HIV infections in Thailand occur among low-risk partners of people infected with HIV, so it is important to include people infected with HIV in prevention efforts. METHODS: Risk for HIV transmission was assessed among people with HIV attending routine care at the National Infectious Disease Institute in Thailand. Sexual risk behaviour, sexually transmitted infection (STI-syphilis, gonorrhoea, chlamydia, trichomoniasis and genital ulcers) prevalence and HIV disclosure status were assessed. Patients were provided with STI care, risk-reduction and HIV disclosure counselling. RESULTS: Baseline data were assessed among 894 consecutive people with HIV (395 men and 499 women) from July 2005 to September 2006. Unprotected last sex with a partner of unknown or negative HIV status (unsafe sex) was common (33.2%) and more likely with casual, commercial or male-to-male sex partners than with steady heterosexual partners (p = 0.03). People receiving antiretroviral treatment were less likely to report unsafe sex (p<0.001). Overall, 10.7% of men and 7.2% of women had a STI (p = 0.08). More women than men had disclosed HIV status to their steady partners (82.5% vs 65.9%; p = 0.05). CONCLUSION: Indicators for HIV transmission risk were common among people attending HIV care in Bangkok. Efforts need to be strengthened to reduce unsafe casual and commercial sex and to increase HIV disclosure from men to their partners. A strategy for STI screening and treatment for people with HIV in Thailand should be developed. Language: English Keywords: THAILAND | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | MEN HAVING SEX WITH MEN | SEX WORKERS | HIV TRANSMISSION | HIV PREVENTION | SEX BEHAVIOR | RISK BEHAVIOR | ANTIRETROVIRAL THERAPY | SEXUALLY TRANSMITTED DISEASES | CONDOM USE | PARTNER COMMUNICATION | SEX FACTORS | Developing Countries | Asia, Southeastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Behavior | HIV | Reproductive Tract Infections | Infections | Risk Reduction Behavior | Interpersonal Relations | Population Characteristics | Demographic Factors | Population Document Number: 330967 |
| 27. Peer Reviewed Title: Women's perceptions about seeing the ultrasound picture before an abortion. Author: Wiebe ER; Adams L Source: European Journal of Contraception and Reproductive Health Care. 2009 Apr;14(2):97-102. Abstract: OBJECTIVES: To gain a better understanding of women's perceptions and experiences of viewing the ultrasound (US) before an abortion. METHODS: This mixed-methods study included questionnaires and interviews. Women presenting for medical and surgical abortion at two urban abortion clinics completed questionnaires asking if they wished to view the US image and those women who had done so answered questions about their perceptions. A randomly selected ten women were interviewed six weeks later about their perceptions. The interviews were audio-taped, transcribed and analysed for salient themes. RESULTS: The 350 participants had a mean age of 27.6 years, 0.68 births, and were at a mean of 49.1 days gestation at the time of the procedure. Most women (254/350, 72.6%) chose to view the US and 179/219 (86.3%) found it a positive experience. Older women and those who had children were less likely to want to view the US image (p = 0.001). All ten interviewees recommended that this choice be offered to every woman and recommended more communication between care providers and patients at the time of the US. None of the women changed her mind about having the abortion after having seen the US. CONCLUSIONS: Offering the choice to view the ultrasound is both feasible and beneficial to women having abortions. Our findings support those of the only other study published on the subject. Language: English Keywords: CANADA | RESEARCH REPORT | QUALITATIVE RESEARCH | |