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2. Contraception use and pregnancy among 15-24-year-old South African women: a nationally representative cross-sectional survey. MacPhail C, Pettifor AE, Pascoe S, et al. BMC Med 2007;5(Article No. 31).

Participants completed a questionnaire on sexual behavior and provided an oral fluid sample for HIV testing. Analysis of the data was restricted to women (n = 6217), particularly those who reported being sexual active in the last 12 months (n = 3618). Univariate and multivariate analyses were conducted to explore factors associated with contraceptive use. The survey found that two-thirds of all women reported having ever been sexually active, and among these, 87% were sexually active in the past 12 months. Among women who reported currently being sexually active, 52.2% reported using contraceptives. There was evidence of association between contraceptive use and being employed or a student (vs. unemployed); fewer sex partners; type of last sex partner; having talked to last partner about condom use; and having ever been pregnant. The authors conclude that specific emphasis must be placed on encouraging young women to use contraceptive methods that offer protection against pregnancy and STIs/HIV. Consistent finding of a relationship between discussing condom use with partners and condom use indicates the importance of involvement of male partners in women's contraceptive decisions.

 

3. Contraceptive use by 15-year-old students at their last sexual intercourse: results from 24 countries. Godeau E, Nic Gabhainn S, Vignes C, et al. Arch Pediatr Adolesc Med 2008;162(1).
Data were collected in 2002 by self-report questionnaire from a cluster sample of 33,943 students aged 15 years from 24 countries in this cross-national, cross-sectional survey. The percentages of students reporting having had sexual intercourse ranged from 14.1% in Croatia to 37.6% in England; 82.3% of those who were sexually active reported that they used condoms and/or birth control pills at last intercourse. Condom use only was most frequent and ranged from 52.7% in Sweden to 89.2% in Greece. Dual use of condoms and contraceptive pills was also relatively frequent, ranging from 2.6% in Croatia to 28.8% in Canada. The use of contraceptive pills was most frequent in Northern and Western Europe. No contraceptive use at last intercourse was reported by 13.2% of students. A substantial minority of 15-year-olds have engaged in sexual intercourse. Condom use is the most frequent method of contraception reported by the sexually active respondents, followed by the dual use of condoms and contraceptive pills and then by contraceptive pills only. The proportions of poorly protected and unprotected youth remain high, and attention to international policy and practice determinants of young sexual behavior and contraceptive use is required.

4. Differences in young people's reports of sexual behaviors according to interview methodology: a randomized trial in India. Jaya, Hindin MJ, Ahmed S. Am J Public Health 2008;98(1).
The authors compared reports of sexual behaviors given in standard face-to-face interviews with reports given in audio computer-assisted self-interviews (ACASIs) and culturally specific interactive interviews among adolescents in India. They sought to determine which of the interview methods leads to higher reporting of sexual behaviors among economically disadvantaged 15- to 19-year-olds in urban India. They conducted a randomized trial in which each participant (583 boys and 475 girls) was assigned to two interview methods: face-to-face interview and ACASI or interactive interview. They used matched case-control analyses to assess differences in the individuals’ reporting on the two methods. Female participants consistently reported fewer sexual behaviors in ACASIs than in face-to-face interviews, whereas male participants' reports differed according to type of sexual behavior and interview mode. Both male and female participants reported more sexual behaviors during interactive interviews than during face-to-face interviews. Twenty-eight percent of male participants reported having engaged in heterosexual intercourse in interactive interviews, as compared with 20% in face-to-face interviews (P< .01); the corresponding percentages for female participants were 7% and 2% (P<.01). Results showed that young people were more likely to report sexual behaviors in culturally specific interactive interviews than in face-to-face interviews. By contrast, ACASIs did not uniformly lead to higher reporting levels than did face-to-face interviews.

5. Ethical and human rights perspectives on providers' obligation to ensure adolescents' rights to privacy. Ringheim K. Stud Fam Plann 2007;38(4).
The rights of adolescents to privacy and confidentiality as stipulated in international human rights conventions are poorly protected in reproductive health-care settings. Fear that their private information will become known, particularly to a parent, has been shown to be a major factor in adolescents' failure to seek the services they need. The tension between parental interests in guiding the development of children and public interest in maintaining a healthy population is considered in light of the ethical principles that bear upon these decisions. In practice, health-care workers are the intermediaries who must ensure that the privacy rights of adolescent clients are protected. They are bound through obligations engendered in human rights conventions as well as by ethical principles to provide the young with information and confidential services, skills that must be acquired through training. Enhancing the survival of adolescents promotes the greater social good.

6. HIV/AIDS vaccination in adolescents would be efficient and practical when vaccine supplies are limited. Johnson LF, Bekker L-G, Dorrington RE. Vaccine 2007;25(43).
The first HIV/AIDS vaccines are likely to be expensive and limited in supply, and developing countries with generalized HIV/AIDS epidemics will need to distribute the limited vaccine stock in a manner that is both efficient and practical. This analysis compares seven strategies for distributing an HIV/AIDS vaccine in different South African sub-populations, using a mathematical model. If vaccination is not coupled with HIV screening, vaccination of 16-year-olds in school is likely to be the most efficient strategy for averting HIV infections in the short term. If coupled with screening, vaccination of sex workers and patients seeking STI treatment would be more efficient, but these gains in efficiency would have to be weighed against the practical challenges associated with vaccinating “high-risk” groups and conducting screening.

7. Household and community income, economic shocks and risky sexual behavior of young adults: evidence from the Cape Area Panel Study 2002 and 2005. Dinkelman T, Lam D, Leibbrandt M. AIDS 2007;21(Suppl 7).
The objective of the study was to describe recent trends in adolescent sexual behavior in Cape Town, South Africa, and to determine whether household and community poverty and negative economic shocks predict risky sexual behavior. The authors found a statistically significant increase in condom use and a decrease in the incidence of multiple sexual partners between 2002 and 2005 for young women aged 17-22 years. Young women in households with 10% higher income were 0.53% less likely to debut sexually by 2005; young men in communities with a 10% higher poverty rate were 5% less likely to report condom use at last sex. Negative economic shocks are associated with a 0.04% increase in the probability of multiple partnerships for young women. Education is positively correlated with sexual debut for young women and with multiple partnerships for both sexes. Trends in sexual behavior between 2002 and 2005 indicate significant shifts toward safer practices. There is little evidence of a relationship between negative economic shocks, household and community poverty, and risky behavior. The authors hypothesize that the unexpected positive relationship between education and sexual debut may be driven by peer effects in schools with substantial age mixing.

8. Inclusion of adolescents in preventive HIV vaccine trials: public health policy and research design at a crossroads. Jaspan HB, Cunningham CK, Tucker TJ, et al. J Acquir Immune Defic Syndr 2008;47(1).
Several promising candidate HIV vaccines are in advanced clinical development. To date, however, no trial has included adolescents, one of the most important target groups for any preventive HIV vaccine. To license a vaccine for use in this age group, efficacy data or, at a minimum, bridging safety and immunogenicity data in this population are needed. To accomplish this, several critical issues and special challenges in the development and implementation of HIV vaccine trials in adolescents must be addressed, including regulatory considerations, potential differentials in safety and immunogenicity, alternative trial design strategies, recruitment and retention challenges, community involvement models, and approaches to informed consent/assent. This article examines these issues and proposes specific next steps to facilitate the routine inclusion of this high-priority population in preventive HIV vaccine trials as early and seamlessly as possible.

9. The influence of disclosure of HIV diagnosis on time-to-disease progression in a cohort of Romanian children and teens. Ferris M, Burau K, Schweitzer AM, et al. AIDS Care 2007;19(9).  This article reports on an investigation of the effect of disclosure of a child's own HIV infection status on death and CD4 decline in a cohort of 325 HIV-infected Romanian children receiving highly active antiretroviral therapy (HAART). A retrospective database analysis was conducted. Data from a nearly three-year period were examined. Children who were aware of their HIV diagnosis were compared with those who were not aware. The authors found significant associations between not knowing the HIV diagnosis and death, and not knowing the HIV diagnosis and disease progression defined as either death or CD4 decline. The results imply that in the context of HAART, knowledge of one's own HIV infection status is associated with delayed HIV disease progression.

10. Influence of institutionalization on time-to-HIV-disease progression in a cohort of Romanian children and teens. Ferris M, Burau K, Constantin AM, et al. Pediatrics 2007;120(6).
A retrospective database analysis was conducted. Data from a nearly three-year period were examined with Kaplan-Meier survival analysis and Cox regression analysis models. Subjects all received primary and HIV specialty care and treatment at the Romanian American Children's Center in Constanta, Romania. Children in one group resided with their biological families and the other children resided in "family home"-style institutions. There was no difference between groups for death during the follow-up period, although there was a trend for survival advantage for children in institutional care. There was no statistically significant difference between the study groups in terms of CD4 decline, although there was a trend toward greater decline among children who resided with their biological families. Children with their biological families were more likely to experience disease progression through either death or CD4 decline than were children in institutions. The authors conclude that a family home-style institution may prove to be a replicable model for the safe and appropriate care of HIV-infected orphaned and abandoned children and teens.

11. Invisible and vulnerable: adolescent domestic workers in Addis Ababa, Ethiopia. Erulkar A, Ab Mekbib T. Vulnerable Child Youth Stud 2007;2(3).
The article describes a population-based study of adolescents aged 10 to 19 years old in low-income and slum areas of Addis Ababa, Ethiopia. Descriptive analysis was conducted to compare female domestic workers with other adolescent girls and boys in terms of background, working patterns, self-esteem, and social connections, and exposure to HIV and adolescent programs. Fifteen percent of the female adolescent population were domestic workers, most of whom had migrated from rural areas. Domestic workers were less likely to be educated or to live with parents compared to other categories of adolescents. They worked extremely long hours for low pay, with a mean income of US$6 per month. Domestic workers appeared to have lower self-esteem and fewer friends than other adolescents, as well as lower levels of HIV knowledge and minimal participation in existing adolescent programs. Adolescent domestic workers are highly vulnerable yet largely invisible, even despite their large numbers in some urban settings. Greater programmatic attention and awareness-raising need to be devoted to this large, at-risk group of adolescent girls.

12. Reduction in human immunodeficiency virus risk among youth in developing countries. Deveaux L, Stanton B, Lunn S, et al. Arch Pediatr Adolesc Med 2007;161(12).
The objective of this study was to address the 6-month efficacy of a human immunodeficiency virus (HIV) prevention intervention targeted to youth and delivered with and without a parental monitoring intervention. The study was a randomized, controlled, 3-cell intervention trial with a 6-month post-intervention follow-up with a total of 1282 Bahamian sixth-grade students (and 1175 parents) in 15 schools. Youth and parents were randomized at the level of the school to receive the following interventions: (1) Focus on Youth in the Caribbean (FOYC) plus Caribbean Informed Parents and Children Together (CImPACT), (2) FOYC plus an attention control for parents (Goal for It [GFI]), or (3) an attention control for the youth (Wonderous Wetlands [WW]) plus the GFI. The 10-session FOYC or WW curriculum was delivered as part of the elementary school curriculum. The GFI or CImPACT was delivered to parents in the evenings or on weekends. Compared with the WW, the FOYC significantly increased knowledge, condom use skills, protective perceptions, and intentions to engage in safer behaviors. Among youth, no differences were found in knowledge or condom use skills based on parent intervention; among parents, those receiving the CImPACT demonstrated superior condom use skills after the intervention. The authors conclude that protective knowledge, skills, perceptions, and intentions of youth can be significantly improved by youth intervention delivered through the schools. Longer follow-up is needed to determine if risk behaviors will be reduced and how long protective results will be sustained.

13. Responses to VCT for HIV among young people in Kampala, Uganda. Rassjo E-B, Darj E, Konde-Lule J, et al. Afr J AIDS Res 2007;6(3).
Attitudes toward voluntary counseling and testing (VCT) for HIV among young men and women in a slum area of Kampala, Uganda were studied through 22 individual semi-structured interviews and 5 focus group discussions. Attitudes ranged from having no problem with the procedure to being very reluctant. Despite fear of stigma, the participants perceived “positive living” after HIV testing as realistic. VCT was regarded as an important step to avoiding HIV infection, but informants expressed the need for the service to be more accessible in terms of cost, time, and quality of pre- and post-test counseling. The authors argue that counseling without HIV testing should be available for those who are reluctant to test. Poverty and gender power imbalances appeared to limit youths’ possibility of making rational decisions about sexual behavior and accessing VCT. The importance of considering the context in which such issues are being negotiated and decided is highlighted.

14. Sexual behaviors and their correlates among young people in Mauritius: a cross-sectional study. Nishimura YH, Ono-Kihara M, Mohith JC, et al. BMC Int Health Hum Rights 2007;7(Article No. 8).
The authors conducted a cross-sectional survey in January 2003 to assess the prevalence of HIV-related sexual behaviors and their correlates among young people aged 15-24 years in Mauritius. They identified 1200 participants using two-stage cluster sampling. Demographic, social, sexual, and knowledge of HIV/AIDS data were obtained in face-to-face interviews using a structured questionnaire administered by trained interviewers. The prevalence of sexual behaviors was described in relation to gender, and the correlates of ever having had sex and nonuse of condom at last sex were analyzed using logistic regression. In the target population, 30.9% of males and 9.7% of females reported a history of sexual intercourse. Of the currently sexually active participants, 50.6% of men and 71.2% of women did not use condoms at their last sexual encounter. Logistic regression revealed that work experience and marijuana use were significantly associated with men's sexual experience, whereas being out of school and drinking experience were significantly associated with women's sexual experience. For both men and women, being Christian and visiting nightclubs were associated with having ever had sexual intercourse (P < 0.05). In addition, not using a condom at the first sexual encounter and lack of exposure to a nongovernmental organization (NGO) dealing with HIV/AIDS were associated with the nonuse of condoms at the last sexual encounter (P < 0.05). The authors conclude that young people in Mauritius are at risk of a future HIV epidemic because behaviors predisposing to HIV infection are prevalent among sexually experienced youth. A focused prevention program targeting young people should be reinforced as part of the National AIDS Control Program, taking into account the predictors of sexual behaviors identified here.

15. Sexual behaviour and contraceptive use among youth in the Balkans. Delva W, Wuillaume F, Vansteelandt S, et al. Eur J Contracept Reprod Health Care 2007;12(4).
A standardized questionnaire was self-administered by 2150 urban high school students. Multiple logistic regression analyses accounting for within-class correlation were applied to identify determinants of sexual behavior and the use of contraception and sexual and reproductive health (SRH) care. In this group of youth with a mean age of 16.7 years, 41.3% of the boys and 20.8% of the girls had already experienced sexual intercourse. Mean age at sexual debut differed between sexually active boys (15.5) and girls (16.3). A condom was used at first sex by 73.7% of the boys and by 69.0% of the girls. Condoms were consistently used during sexual intercourse with the current or last partner by 64.3% of the boys and 48.5% of the girls. Oral contraception was used by 0.0% (Macedonia) to 10.6% (Bosnia) of sexually active girls. One-third of sexually active girls and 18.0% of sexually active boys had ever refrained from seeking medical advice on SRH despite feeling the need for it, mainly because of feelings of shame, fear, and insecurity. Television or radio and friends were mentioned most often as useful sources of information on contraceptives. The authors conclude that age at sexual debut and the proportion of sexually active youth in these Balkan states do not differ from those in other parts of Europe. However, declining condom use after sexual initiation is not compensated by for by use of other contraceptive methods, as seen in some Western European countries. The role of mass media in dissemination of information and tackling barriers to SRH care should be explored.

16. A survey instrument for evaluating psychological variables and risky sexual behavior among young adults at two university centers in Mexico. Pina Lopez  JA, Robles Montijo S, Rivera Icedo BM. Rev Panam Salud Publica 2007;22(5).
This paper reports on a cross-sectional study of a sample of 1346 university students in Mexico. The study took place in Hermosillo during the month of October 2006 and in Tlalnepantla from January to March 2006. The survey had 11 questions on sociodemographics, 7 on risky sexual behaviors, 22 on related motives, 8 on social context, and 6 on physical status prior to sexual relations. The survey was evaluated in terms of how well the questions were understood, its conceptual validity, and reliability. The final version of the survey instrument was composed of 44 questions. The reliability analysis produced an overall Cronbach alpha value of 0.821, taking into account all the variables combined and grouped by factor. Three factors were found that together accounted for 38.36% of the total variance: reasons for not using a condom in the first sexual relationship or throughout life, reasons for inconsistent use of a condom with a casual sex partner, and willingness to become sexually active and to engage in casual sex. The authors conclude that the psychometric attributes of this survey instrument were satisfactory. Those interested in using this instrument should become familiar with the theoretical model on which it is based, since understanding the results depends on properly defining the historical and context variables, and their interaction.

17. Ties of dependence: AIDS and transactional sex in rural Malawi. Swidler A, Watkins SC. Stud Fam Plann 2007;38(3).
Using evidence from rural Malawi, the authors demonstrate that patron-client ties and a moral obligation to support the needy, which are fundamental to African social life, are central elements of transactional sex. We argue that the exchange of sex for money is better understood as one of the many ties of unequal exchange in which Malawians and other Africans engage, an exchange in which the patrons are as important as the clients.