Sexual violence among female high school students in Debark, north west Ethiopia.
A school-based cross-sectional survey was conducted to assess the prevalence, outcome and awareness of sexual violence among high school female students in Debark Town, northwest Ethiopia. 216 female high school students, grade 9-11 were included for the quantitative study. For the qualitative data, 16 individuals for the focus group discussion (10 well-recognized female figures in the town and 6 high school students) and head of the police department for in- depth interviews were enrolled. 62% of the respondents had heard of sexual violence committed on young females. Sexual violence was reported by 65.3% of the respondents. The prevalence of performed and attempted rape were 8.8% and 11.5%, respectively. The age range of performed rape victims was between 12 and 21 years. Of the 19 (8.8%) who reported rape being performed on them, unwanted pregnancy, suicide attempt, vaginal discharge and abortion were the consequences in 21%, 15.8%, 10.5% and 5.3%, respectively. Sexual violence is a major public health problem with high rates of underreporting. Sex education should be given on a regular basis and policy making bodies and the police be well aware of this high magnitude and take strong measures to reduce it. (author's)
The importance of culture in HIV / AIDS prevention in Grenada.
It has been reported that by the end of 1999, the AIDS epidemic has left behind the cumulative total of 11.2 million orphans, defined as children who have lost their mothers before reaching the age of 15. The WHO further estimates that 5.3 million people including 600,000 children under age of 15, became infected with the virus that causes AIDS this year. Specifically, the data coming out of the Caribbean region show that HIV/AIDS has been moving into younger and younger population groups. About 83% of AIDS cases are diagnosed in people between the ages of 15 and 54 and almost half of these are diagnosed in people 23-34 years old. Mindful of the links between health behavior and the context of family and culture, the authors maintain that intervention strategies in West Indian communities like Grenada must take into account the broader cultural context. The purpose of this article is twofold: to examine the impact of HIV/AIDS in Grenada and to introduce cultural behaviors in the context of Grenadian family structure and communication styles which impact HIV prevention and intervention strategies. The goal is to set the contextual framework for the development of culturally responsive HIV/AIDS education and prevention programs targeted to young people and adolescents. Specific strategies for working parents and adolescents from this cultural group are recommended. (author's)
Significant changes in the US population result from increasing numbers of immigrants who enter the country annually; people from Asian and Pacific Rim countries emigrate to the US more rapidly than any other group. The authors discuss changing population demographics, health-risk behaviors related HIV/AIDS, as well as linguistic and cultural characteristics of Asian Pacific Islander Americans that must be addressed in HIV/AIDS prevention education programs. (author's)
HIV risk behaviors in adolescent and young adult substance users undergoing treatment.
Among substance abusing youth, HIV remains a threat, due in part to the multiple risk factors often found in this population. Therefore, drug detoxification facilities are important sites in which to characterize the extent of drug and sexual co-occurring risk behaviors among patients. The authors distributed a self-administered, anonymous questionnaire to patients at two state-funded Rhode Island detoxification facilities to examine the HIV-related risk behaviors of adolescent and young adult substance abusers, and to examine the influence of gender on these behaviors. The authors found that 62% of all respondents reported injecting drugs in the past 6 months, and 67% of current injecting drug users (IDUs) reported sharing syringes in the past 6 months. 46% and 70% of sexually active youth reported never using condoms in the past 6 months for vaginal and anal sex, respectively. Females were significantly more likely to report a lifetime history of injecting drugs, exchanging sex for drugs or money, and having sex with an IDU. The high rates of sharing injection equipment and the prevalence of risky sexual activity underscore the need to develop interventions that specifically address the needs of young substance abusing males and females. (author's)
Correlates of casual sex among African-American female teens.
This study identified correlates of reporting voluntary sex with casual partner (VS-CP) among African American adolescent females. Sexually active African- American female teens (N = 522) were recruited from neighborhoods characterized by high rates of unemployment, substance abuse, violence, and sexually transmitted diseases (STDs). Of the 609 eligible adolescents, 522 (85.7%) agreed to participate in the study. VS-CP was reported by 15.9% of adolescents. Identified correlates of VS-CP were acquiescing to unwanted sex, living with a non-parent relative, never being pregnant, rejecting messages about the value of condoms for disease prevention, low parental supervision, and dissatisfaction with body image. These correlates may be important in the targeting and design of STD/HIV prevention programs for African-American adolescent females. (author's)
The African-American community and HIV / AIDS.
African-Americans have the highest AIDS case rate per 100,000 populations of all ethnic/racial groups, with 66.4/100,000 compared with 8.2 for Whites. It is noted that African-American males have an AIDS rate of 125.2, over 7 times the rate for White males; and African-American women have an AIDS case rate of 49.8, over 20 times the rate for White females. Such data on the incidence of HIV among gay Black men has introduced a whole new dimension and concern into the prevention picture. Speculations remain about the reasons for this situation, including the influence of the Black church in the Black community and the powerful message that is sent by how AIDS is, or is not, addressed by Black clergy. Overall, it is noted that while some schools are becoming more open in their acceptance of curriculum around HIV prevention that deals honestly with sexuality and drugs, and are more willing to consider providing condoms to students, this acceptance is not universal. The message from Black churches also needs to become more accepting of sexuality and homosexuality, specifically. Moreover, it is important to understand the effects on youth and young adult sexual attitudes and behaviors of music from the hip-hop culture.
Discussing sexuality fosters sexual health.
Violence, coercion, discrimination, fear, shame, guilt, false beliefs, and lack of knowledge about sexual issues are barriers to sexual health that many women throughout the world face. However, providers can help by discussing in a respectful manner with clients aspects of their lives that may impede optimal sexual health. Studies indicate that providing quality of reproductive health care is complex and involves an open dialogue between providers and clients about issues that traditionally may not have been discussed during medical consultations. This is because it is particularly difficult to explain to a married woman that she had a genital infection and how she might have acquired it, since such an explanation implied infidelity. A clear explanation by a medical professional of the source of sexually transmitted infections (STIs) is not sufficient to prevent infection, but it does serve as a foundation for the prevention of STIs, including HIV/AIDS. Research has also shown that women do not always have the power to make decisions about when they are going to have sex, how they are going to have sex, and what contraceptive method or disease- preventing method they are going to use.
Training providers to talk about sex.
In 1999, Population Council's Frontiers in Reproductive Health project conducted research in Egypt, which showed that sexuality counseling, could be successfully integrated into services at family planning clinics. Nurses and physicians from four Egyptian Ministry of Health and population clinics and two private clinics attended a 2-day contraception training session emphasizing barrier methods. Staff at three of these clinics received 3 additional days of training on sexuality, gender, and counseling. To evaluate the effects of the extra training, the study conducted exit interviews with 503 clients at both the control sites and the intervention sites where additional training had been given. Five focus group discussions were also conducted with clients. Results showed that medical practitioners who went through sexuality training were less inhibited about discussing sexuality-related issues with their clients. Despite the extra training, many clinicians reported that they still felt embarrassed to discuss sexual issues with clients and continued to think clients with sexual problems should be referred to specialists. Thus, it is recommended that providers be trained to manage simple sexual problems and to counsel women about how various contraceptive methods can affect sexual relations.
Life circumstances influence decisions.
Cultural and social factors strongly influence the reproductive health (RH) decisions of women in many settings throughout the world. Research has found, for instance, that social factors can influence a woman's access to RH care and limit her ability to make decisions about RH issues. A woman's position within her extended family has also been found to limit women's RH care choices. However, social factors do not always have a negative effect on women's RH since interpersonal communication through household kinship networks may facilitate the spread of information and kinship networks may provide greater economic resources with which to purchase modern contraceptive methods. Moreover, it is noted that cultural and social factors also influence women's knowledge and beliefs about contraception and reproduction, their self-esteem, and their feelings about sexuality, which, in turn, affect their RH decisions. Overall, it is emphasized that providers should not forget that many women are living in a context where they are not making unilateral decisions about their RH.
Gender stereotypes compromise sexual health.
Gender stereotypes of submissive females and powerful males may restrict access to health information, hinder communication, and encourage risky behavior among women and men in different ways. Ultimately, they increase vulnerability to sexual health threats such as violence, sexual exploitation, unplanned pregnancy, unsafe abortion, and sexually transmitted infections, including HIV. Women's low social and economic status throughout much of the world poses serious threats to their sexual health. Society's expectation that women defer to male authority supports many practices that are harmful to women's sexual health. On the other hand, men benefit from their privileged status in most societies, but traditional male roles also have their costs. Research shows that socialization of boys to repress emotion, use violence to resolve conflicts, and be independent at an early age has harmful effects on their health. Some experts believe that challenging traditional views of masculinity and femininity is essential to promoting sexual health. Several projects encourage men and women to question and change the assumptions about gender that govern sexual behavior.
Youth programs challenge stereotypes.
Many youth programs that focus on gender roles to improve reproductive health (RH) are similar in their approaches. Many of these programs address gender and sexual health issues in context, provoking reflection, discussion, and analysis with information and examples drawn from participants' experiences and local research; use creative, interactive methods to keep participants engaged, encourage them to think critically, and help them address sensitive issues; address sexual health broadly, rather than focusing on (RH) or preventing specific risk behaviors; identify and train facilitators who are open to new ideas and willing to question their own attitudes about sexuality, gender, and equality; work with parents, teachers, and others in a community to create a more supportive environment for youth who want to change their behavior; take a positive approach to sex and sexuality; and empower young people to act for themselves.
When partners talk, behavior may change.
Research conducted in Uganda has shown that while couples communicated with each other about whether or not to stop childbearing, they did so in indirect and ultimately ineffective ways. This resulted in both men and women overestimating each other's desire for additional children. Such couples are unable to communicate effectively over this issue because of several factors: religion, misinterpretations, imbalances in power relationships, differences in race and ethnicity, and embarrassment. Moreover, research is mixed about whether couples in close relationships are more likely to use condoms than are those in relationships that are more casual. It notes that because discussions between partners about sexuality, contraception, and safe sexual practices are likely to cause anxiety and even outright conflict, some experts argue that attention to interpersonal relations and communication should become part of the overall design of family planning sexually transmitted infections prevention programs. Recommended strategies for enhancing couple communication include attempts to enlist the cooperation of men by providing them with family planning, communication, and educational services. Another strategy is to directly empower women to discuss sexual health issues.
Dialogue tool promotes open, honest discussion.
Family Health International (FHI) has developed and is evaluating a tool to help men and women communicate openly with each other about sex and other issues affecting their sexual health. The "Dialogue" is a communication tool designed to facilitate group discussions, first presented in 1996 by the FHI AIDS Control Project Women's Initiative at a satellite meeting of the Eleventh International Conference on AIDS. In 1997, the Indian Institute of Health Management Research tested Dialogue among some 400 married men and women from one rural and one urban area of Jaipur district, India. Researchers trained to guide and record the Dialogue process conducted 60 focus group discussions, 12 of which involved men and women talking to each other. Main discussion points included: the role and responsibilities of men in the family, gender equity, virtues of a good man and a good woman, knowledge of symptoms, causes and prevention of sexually transmitted infections and HIV/AIDS, use of condoms, promiscuous sexual behavior of men, and safer sexual practices. Overall, results showed that Dialogue helped to create an enabling environment for a free and open discussion of sex and related issues, and its more important achievement was as much as a 100% increase in the use of condoms.
Traditional method use, communication sometimes linked.
Although modern methods of contraception prevent pregnancy more effectively than traditional methods, some women prefer traditional methods because their effective use requires a commitment by their partners to regulate fertility and demonstrates marital cooperation and communication. A study among 26 married Mexican women ages 15-50 living either in the US or in Mexico noted that 11 women who used the rhythm method or withdrawal explained that they liked doing so because the physical restraint required of their husbands confirmed a shared commitment to a non-reproductive sexual relationship. Those who used the rhythm method felt that its use built more egalitarian relationships. They were more likely than users of withdrawal to discuss sexual matters with their husbands and to value the quality of sex more than its frequency. However, women using either withdrawal or the rhythm method appreciated the fact that their husbands were endeavoring to protect them. Moreover, some women preferring traditional methods of contraception did so because they viewed their fertility as a precious resource that they shared with their husbands and feared that it might be endangered by use of a more modern method.
Counseling of couples facilitates HIV disclosure.
Reproductive health professionals have the responsibility to protect the confidentiality of their clients, even those who are HIV-positive. Disclosing the HIV status of an infected woman may lead to violence or abandonment by a partner. Such involuntary disclosure may also discourage both men and women from seeking HIV voluntary counseling and testing (VCT) services, which have been shown in a randomized controlled trial involving some 4000 participants in Kenya, Tanzania, and Trinidad to be highly effective in reducing sexual risk behavior. However, offering VCT to couples is one way to facilitate such communication. Thus, researchers who have studied the effectiveness of VCT services generally recommend that: VCT programs recruit couples or partners of individuals who come for HIV testing services; counseling sessions address sexual communication and decision-making, stigmatization of HIV-positive partners, and negative reactions leading to violence; counselors be specifically trained to conduct couple counseling; provision of additional support and counseling services to couples be encouraged; and VCT counselor be attentive to youth.
Increasing contraception reduces abortion.
Studies offer strong evidence of a widely supposed but difficult-to-demonstrate benefit of reproductive health (RH) services: that increasing the use of effective contraception leads to declines in induced abortion rates. The results of such studies can help dispel misconceptions about the relationship between family planning and abortion. They can also help policymakers, program managers, and providers identify ways to improve RH services. It is noted that demonstrating that increased contraceptive use leads to fewer abortions is particularly important in countries where unsafe abortion poses a serious threat to women's health and survival. Studies on trends in contraception and abortion can point to ways of improving RH services.
High-quality services keep down abortion.
Findings of a study based on data collected from 1979-98 on 147,753 pregnancy outcomes among women from two areas in Matlab found that easy access to high- quality family planning (FP) services kept induced abortion rates from rising in one area of Matlab, despite the increasing likelihood that unintended pregnancies among women there would end in abortion. It found that women in an area with enhanced FP services were more likely to use contraceptives and less likely to have unintended pregnancies than women in a similar area of Matlab who had access to regular government contraceptive services. It is noted that as part of the Maternal Child Health and FP Project, community health workers visited married women of reproductive age every 2 weeks to provide counseling about FP and to deliver injectable contraceptives, pills, and condoms. The differences in access and quality of services led not only to higher rates of contraceptive use in general, but to greater use of injectables among women served by the project. Moreover, the counseling and support women received from project staff may have helped them sustain injectable use. Although enhanced FP services helped prevent a rise in abortion rates in the project area, it is emphasized that the desire to limit family size may grow even stronger.
For most of the history of the Soviet Union, women relied primarily on induced abortion to control their fertility. Many believed that the Soviet "culture of abortion" was so ingrained that abortion rates would be slow to decline, regardless of the availability of contraceptives. However, the states in eastern and Central Europe and Central Asia during the past decade suggests otherwise. It is noted that since the late 1980s, modern contraceptives have been the main method of controlling fertility. As the use of modern contraceptives roughly doubled in Russia from 1988-97, abortion rates were cut in half. Since 1994, the number of abortions has dropped more sharply than the number of births, suggesting that women have been increasingly successful in preventing unplanned pregnancies. Moreover, results from reproductive health surveys in 1996 and 1999, as well as from other surveys conducted in former Soviet republics, cast doubt on the theory of a deeply entrenched "culture of abortion". Likewise, the assumption that many Russian providers prefer performing abortions to family planning counseling because abortions are more profitable has been overstated.
DOTS still only reaching 27% of tuberculosis patients.
According to a new WHO Report, the internationally recommended directly observed treatment, short course strategy is reaching only 27% of the world's tuberculosis (TB) patients. Public health officials estimate that $1 billion a year will be needed to treat patients and control the TB epidemic in 22 countries that account for 80% of the world's TB burden. WHO found that surprisingly the governments of these 22 low-income nations are already paying 70% of the cost of treatment and control of the disease. The Global fund to fight AIDS, TB and Malaria has failed to raise the significant funding that it was mandated to find. Moreover, veterinary scientists in Britain have announced a breakthrough in the search for a TB vaccine. The scientists discovered after sequencing the entire genome of the organism causing bovine TB that humans originally gave animals TB, rather the other way around as had been supposed. The discovery meant that a vaccine being developed to save cattle from TB would probably work on humans as the human and bovine forms of the disease are 99.9% identical.
South Africa: government's renewed commitment to AIDS.
The government of South Africa will scale up its program to fight HIV/AIDS. Now, sexual assault victims will be offered a comprehensive package of care, including voluntary counseling and testing. Plus, HIV-infected pregnant women will be given nevirapine to reduce the risk of HIV transmission to their infants. Greater assistance will also be given to families affected by HIV/AIDS and home and community-based care programs will be strengthened. South Africa has also allocated significant resources to fight the disease by increasing its budget.
Research conducted on river blindness suggests that cheap antibiotics could be used to treat the disease. As reported in the African Health news section, river blindness is treated with a drug which must be given annually to everyone living in an infected community for at least 15 years. It is noted that river blindness is transmitted by blackflies infected with the parasitic worm Onchocerca volvulus, which burrow into the skin reproducing and releasing millions of offspring. Scientists think that Wolbachia bacteria, carried inside the parasitic worm, is released when these offspring die causing the immune reaction. The common antibiotic doxycycline might be a possible treatment for the disease.
This brief paper, intended for health personnel, answers the clinical question “What is the best oral rehydration solution for children with diarrhea and dehydration?” It is also the first in a series of articles that introduces the concept of systematic reviews, which derive from evidence-based medicine.
The treatment of human visceral leishmaniasis. Part 1.
The WHO considers leishmaniasis one of the six major public health problems. The clinical evolution of the disease presents itself in multiple forms: visceral, localized or diffused cutaneous of mucocutaneous leishmaniasis. Before starting treatment of visceral leishmaniasis (VL) it is advisable to carry out and evaluate the state of the patient. Therapy should take place with the patient hospitalized whenever possible, carrying out check-ups on cardiac, hepatic, pancreatic, and renal functions during both the course of treatment and once it is completed (3 and 12 months later). The response to treatment is usually rapid. The most commonly used drugs are pentavalent antimonials; secondary drugs are amphotericin B (AmB), pentamidine, and paramomicine. Although the action mechanism of pentavalent antimonials is practically unknown, there is speculation about its influence on the energy metabolism or on certain metabolic routes. It also seems clear that they work mainly by blocking the formation of adenosine triphosphate and guanine triphosphate. Moreover, the action mechanism of AmB is based on the union of the antibiotic with the sterols existing in the cellular membrane, either to the ergosterol of the Leishmania and fungal cells or to the cholesterol of the mammal cells.
Paediatrics review. Management of severe malnutrition -- time for a change?
According to the WHO, Protein Energy Malnutrition (PEM) affects every fourth child worldwide: 150 million (26.7%) are underweight while 182 million (32.5%) are stunted. WHO's guidelines for the management of severe malnutrition form part of the Integrated Management of Childhood Illness initiative and are well known. However, two commentaries on the implementation of the guidelines in Africa highlight several problems. Manary doubts whether widespread use would dramatically reduce case fatality rates, and Briend stressed the need to simplify the protocol for easier and reliable implementation. Both commentators agree that careful implementation of the WHO guidelines will reduce mortality. It is also clear that the condition is difficult to manage especially as the diagnosis of some of the severe complications is complex. Although the guidelines for the management of severe malnutrition are promoted as not difficult, their implementation is beyond the resources of many health institutions in Africa. New approaches to the management of severe malnutrition during famine may offer some useful insights for the endemic situation. Community-based management may also result in improved coverage and socioeconomic and educational benefits.
This document presents epidemiological data on HIV/AIDS in Angola. As a result of years of political and civil unrest, little information is available on the HIV epidemic in the country. However, data presented in this paper indicates that HIV seroprevalence among pregnant women in Luanda has increased from less than 1% of infected women in 1986 to 3% in 1999. Similarly, an increase of HIV- positive among tested blood donors is noted, from 0.1% in 1987 to 3% in 1999. In Cabinda Province, HIV prevalence among blood donors has fluctuated around 6%. In 1991, 6% of donors were infected, while 7% were tested HIV-positive in 1995. Nevertheless, it is noted that infection levels have declined in provinces where blood donor data are available, like in Malange province where in infection level decline from 7% in 1991 to less than 1% in 1993.
This document presents epidemiological data on HIV/AIDS in Benin. It notes that based on sentinel surveillance, HIV seroprevalence increased among tested pregnant women in Porto Novo which ranged from less than 1% in 1991 and 1992 to 3% in 1998. Similarly, sentinel surveillance among pregnant women during the 1990s in selected areas of Benin showed an increase in prevalence. In Kouande, there was no evidence of infection in 1992, however, by 1998, 2% of tested pregnant women aging 14-24 years were noted to be HIV-positive. With regards to HIV seroprevalence among patients with sexually transmitted diseases, the highest levels of infection were found in Alphahoue at 32% overall and the lowest in Cotonou at 3% overall. In contrast, no evidence of infection was found among 15-19 year olds in Alphahoue, Cotonou, and Natitingou.
Botswana has the most severe epidemic in the world with an estimated 36% of adults HIV-positive. Annual sentinel surveillance surveys indicate that HIV seroprevalence has steadily increased among pregnant women of all ages in Gaborone. However, in 1999, sizeable declines in infection levels occurred with 28% drop among 15-19 year olds from 30-21% and a 36% drop among 20-24 year olds from 42-27% between 1998 and 1999. In contrast, the HIV prevalence in Chobe district rose from 38% in 1997 to 50% in 1999. Among male patients with sexually transmitted disease (STD), HIV prevalence has risen dramatically since the early 1990s in the two major cities. By 1999, Francistown had levels at or above 60% while Gaborone had 50% of the STD patients with HIV.
HIV / AIDS profile: Burkina Faso.
The HIV epidemics in West Africa are less severe when compared to other regions in sub-Saharan Africa, although high levels of HIV infection have been found among various population groups in Burkina Faso. In 1998, approximately 8% of pregnant women in Ouagdougou were infected with HIV while seroprevalence in Bobo Dioulasso range from 7-10% between 1995 and 1999. As indicated in this study, both HIV-1 and HIV-2 are present in Burkina Faso. Among pregnant women tested in Bobo Dioulasso in 1999, 6% were HIV-1 positive but less than 1% were either HIV-2 or dual positive. It is noted that pregnant women in the 25-29 year old age group have consistently had highest HIV prevalence since 1996. However, in 1998, 30-34 year olds had a slightly higher prevalence of 12%.
In Burundi, HIV seroprevalence remains high in urban areas; however, there has been a slow decline in seroprevalence among several groups over the years. It is noted that seroprevalence in blood donors has declined dramatically over the course of the last 10 years in Bujumbura from 9% in 1998 to less than 1% in 1997. In contrast, the seroprevalence among the pregnant women in Burundi continues to be higher at urban sites than rural ones. In 1997, HIV prevalence among pregnant women in Kiremba and Jenda ranged from 3-4%, while prevalence in Gitega and Muramvya ranged from 15-17%. Among pregnant women in Bujumbura, the two age groups with the highest seroprevalence are 25-29 and 30-34 year olds at nearly 30%.
This paper presents the HIV/AIDS profile in Cameroon. According to sentinel surveillance, HIV infection generally increased among pregnant women in Yaounde, the capital, and Douala, during the 1990s. With an HIV prevalence of 1% in both cities in 1990, it increased to almost 6% in Yaounde in 1998 and 5% in Douala in 1996. In addition, 6% of the general population was HIV positive in 1997-98 in Yaounde. Based on a multi-centre study, results indicated that HIV seroprevalence was two times higher among female adults in Yaounde. 8% of females were HIV positive, while 4% of males were infected. It was noted that HIV infection levels among sex workers in Yaounde have fluctuated over time, remaining stable by the late 1990s. By 1998, 33% of sex workers tested were HIV positive. Moreover, it was noted that there was little difference between male and female HIV prevalence levels among patients seen at the Dispensaire Antivenerien (DAV) Hospital in Douala varied by sex. 14% of male patients and 17% of female patients were HIV positive. The overall rate was 16%.
HIV / AIDS profile: Central African Republic.
This paper presents the HIV/AIDS profile in Central African Republic (CAR). Available data on the HIV epidemic in CAR show ever increasing levels of infection among pregnant women in the capital and other urban areas. By 1996, anywhere from 12 to 20% of pregnant women were HIV positive. However, HIV sentinel surveillance carried out in the capital city, Bangui, show that HIV prevalence among pregnant women ranged from 5% in 1986 and 1987 to 16% in 1993, while data available covering 1996 indicated that 12% of pregnant women tested positive. In addition, according to the sentinel surveillance results, HIV prevalence among patients with sexually transmitted diseases (STD) in Bangui fluctuated during 1989-98. It was noted that in 1989 15% of patients tested were infected. The highest level was reached in 1993 with an HIV prevalence of 31%. In 1996, 19% of STD patients tested were HIV positive.
This paper highlights the HIV/AIDS profile in Chad. It is noted that the prevalence among pregnant women increased during the 1990s in N'Djamena and other urban areas while HIV infection was already established in prostitutes and STD patients. In N'Djamena, the capital of Chad, HIV prevalence more than doubled among pregnant women between 1995 and 1999. In 1995, 2% were infected; in 1999, 6% were HIV positive. In addition, it was noted that HIV prevalence among pregnant women in 1999 ranged from 4% in Abeche and Bongor to 6% in Sarh, according to sentinel surveillance data. These levels were higher than that detected in 1992, except for Moundou, where 9% were HIV positive in 1992. Overall, sentinel surveillance carried out among STD patients in 1999 in two towns of Chad uncovered similar levels of infection. In Bol, 23% were HIV positive while, in Faya, 21% were infected.
HIV / AIDS profile: Congo, Democratic Republic.
This paper presents the HIV/AIDS profile in the Democratic republic of Congo (DROC). It is noted that HIV prevalence among pregnant women in DROC, has remained at 10% or below in urban areas of the country since 1986. In the Kinshasa, the capital of DROC, HIV prevalence among pregnant women has ranged from 4 to 10% during the years 1986-99, according to sentinel surveillance. It was noted that HIV prevalence among pregnant women varies by city in the DROC. Sentinel surveillance data for 1997 indicated that Bunia, in the northeast close to the Uganda border, had a prevalence rate of 6% while in Mikalayi, located in Kasai-Oriental Province, less than 1% of pregnant women tested were HIV positive. Furthermore, HIV prevalence among blood donors in selected areas of the DROC varied by location in the mid to late 1990s. At Kasumbalesa, 3% of donors tested were HIV positive in 1997 while, in Mbuji-Mayi, data from all sentinel sites indicated that almost 6% tested positive in 1998.
HIV / AIDS profile: Congo (Brazzaville).
This article highlights the demographic indicators and epidemiologic data on HIV/AIDS in Congo. The HIV epidemic began in the early 1980s but like a handful of countries, HIV prevalence levels have remained relatively unchanged. HIV seroprevalence for pregnant women in Brazzaville remains relatively stable, hovering between 6 and 8%. However, sentinel surveillance of pregnant women in Pointe-Noire shows seroprevalence rates around 10% in the early 1990s. Although this information has not been updated, these figures continue to be higher than those for pregnant women in Brazzaville. Furthermore, HIV seroprevalence for pregnant women in Congo varied greatly by location between years 1991 and 1993. It was also noted that HIV seroprevalence among blood donors in Brazzaville declined slightly between 1985 and 1993. Finally, the levels of HIV infection for blood donors vary in location.
HIV / AIDS profile: Cote d'Ivoire.
This article presents the HIV/AIDS profile in Cote d'Ivoire and discusses the country's demographic indicators as well as the epidemiological data. It is noted that HIV epidemic in Cote d'Ivoire is the most severe in West Africa. In 1999, 13% of pregnant women were positive for HIV-1 and less than 1% tested positive for HIV-2. Some urban areas have seen a decline in seroprevalence among pregnant women. However, infection rates continue to increase in many other areas. Moreover, levels of HIV seroprevalence among blood donors in rural regions of Cote d'Ivoire show the epidemic developing at alarming levels. On the other hand, the percentage of commercial sex workers in Abidjan infected with HIV-1 or HIV-1 and HIV-2 has increased since 1986. Finally, among high- risk males, male sexually transmitted disease (STD) clinic patients provide the best opportunity to study HIV infection. A 1992 study in Abidjan found 14% of male STD patients infected with HIV-1.
This paper presents the HIV/AIDS profile in Djibouti. During the 1990s, there were increases in HIV prevalence among pregnant women, prostitutes, and sexually transmitted disease (STD) patients. The prevalence of HIV infection among pregnant women tested in Djibouti was stable between 1993 and 1996 after a sharp jump in 1995 to 9%. In addition, the average prevalence rate among blood donors was 2% during the 1990s. On the other hand, seroprevalence declined among prostitutes studied in a non-specified area of Djibouti between 1993 and 1998. However, seroprevalence among both prostitutes and barmaids increased dramatically between 1987 and 1993. Meanwhile, prevalence among STD patients increased between 1993 and 1996 in Djibouti. It was noted that prevalence among male STD patients in the capital increased dramatically between 1987 and 1993.
This article presents an HIV/AIDS profile of Egypt. It is noted that there is little information regarding HIV in Egypt. Despite low-level epidemic among sexually transmitted disease (STD) patients, the prevalence had already reached 8% in Cairo in 1994 due to another high-risk group, intravenous (IV) drug users. However, in 1993, 1994, and 1996, none of the IV drug users surveyed at a drug treatment center in Alexandria were HIV positive. In Egypt, there was no evidence of infection among men having sex with men in 1987-98. Moreover, between 1987 and 1993, HIV infection levels declined among male STD patients.
HIV / AIDS profile: Equatorial Guinea.
This paper presents the HIV/AIDS profile in Equatorial Guinea and provides information regarding its demographic indicators as well as its epidemiological data. HIV prevalence levels in Equatorial Guinea range from 1-3% infected in most groups tested in the country. In Malabo, the capital which is located on Bioko Island, HIV seroprevalence among pregnant women tested was 0.4%. During 1995-97, HIV prevalence remained below 1% in selected areas of Equatorial Guinea. Moreover, HIV prevalence rates among blood donors in Bata more than doubled between 1993 and 1996. However, in 1994, only 0.2% of blood donors were HIV positive in Equatorial Guinea. It was noted that 2% of sexually transmitted disease patients tested were HIV positive in 1994.
This document discusses the HIV/AIDS profile in Ethiopia. The existing information available on the status of the HIV/AIDS epidemic in Ethiopia shows a stabilization of the epidemic in some segments of the population. However, seroprevalence levels for some groups, such as prostitutes, continue to rise. It is noted that the seroprevalence for pregnant women in the capital, Addis Ababa, rose in the early 1990s, from 5% in 1989 to 20% in 1993. In 1999-2000, 15% of pregnant women tested were HIV positive. Moreover, the level of seroprevalence in urban areas in Ethiopia is generally higher than levels in rural areas. In 1994, from a random sample of 1200 households in Addis Ababa, HIV prevalence in the adult male and female populations was 6% for males and 7% for females. On the other hand, HIV seroprevalence data from the Ethiopian Red Cross Society blood banks show a stabilization of infection rates for blood donors, with infection levels fluctuating around 7%. Hence, this data show increasing HIV seroprevalence for sexually transmitted disease clinic patients in Addis Ababa.
HIV / AIDS profile: The Gambia.
Similar to other countries in West Africa, HIV2 is the dominant strain of virus in Gambia. Among pregnant women, seroprevalence had already reached an unacceptably high level by 1997. It was noted that HIV seroprevalence in 1997 among pregnant women attending antenatal clinics in the Gambia ranged from 1% in Basse to 4% in Sibanor. In the eight largest antenatal clinics in the country, HIV2 was the predominant strain among pregnant women tested during 1993-95. A serosurvey carried out in greater Banjul and three other areas found about 2% of a sample of adults infected with HIV2 but only 0.1% infected with HIV1. HIV infection among blood donors has remained under 1% as indicated by a study from Banjul. Among prostitutes in three urban towns in the Gambia, a 1993 study showed 21% were infected with HIV2 and 8% were infected with HIV1. Finally, in Banjul, a seroprevalence study of sexually transmitted disease patients found somewhat equal levels of infection in both sexes.
UNAIDS estimates that 4% of those 15-49 are HIV infected in Ghana. Sentinel surveillance revealed that, by 1998, anywhere from 2-12% of pregnant women were infected with HIV1 in the country. HIV2 infection levels ranged from no evidence of infection to 2%. This paper presents epidemiological data on HIV/AIDS prevalence in Ghana. Included are: HIV seroprevalence for pregnant women in Accra from 1995-98; HIV seroprevalence for pregnant women by age and site in Accra from 1997-98; HIV seroprevalence for pregnant women by region in urban sites in Southern Belt from 1994-98; HIV seroprevalence for pregnant women by region in rural and urban sites in Southern Belt from 1994-98; HIV seroprevalence for pregnant women by region in urban and rural sites in Northern Belt from 1994-98; HIV seroprevalence for pregnant women in urban and rural sites by age and belt in 1998; HIV seroprevalence for sexually transmitted disease (STD) patients in Accra in 1997 and 1998; HIV seroprevalence for STD patients by age in Accra in 1998; HIV seroprevalence for STD patients in Kumasi from 1994-98; and HIV seroprevalence for STD patients by age in Kumasi from 1994-96.
Although the HIV epidemic in Guinea is less severe when compared to those seen in other parts of sub-Saharan Africa, HIV infection levels continue to rise. In Conakry, HIV infection among pregnant women slowly increased from no evidence of infection in 1987-88 to 1.5% infected in 1996. A descriptive study carried out in 1995 among pregnant women at Koulewondy Health Center in Conakry, found that HIV infection levels were highest among those women age 30 and over. In various cities of Guinea, HIV prevalence among pregnant women has increased since 1990- 91. HIV seroprevalence for pregnant population in two areas in Guinea in 1992 is also included. Other data presented are: HIV seroprevalence for blood donors in Conakry from 1987-98; HIV seroprevalence for prostitutes in Conakry from 1985-94; HIV seroprevalence for sexually transmitted disease (STD) patients in Conakry in 1995; HIV seroprevalence for STD out-patients in five areas from 1990-91; and HIV seroprevalence for STD out-patients in six areas from 1990-91.
HIV / AIDS profile: Guinea-Bissau.
HIV2 is the dominant strain in Guinea-Bissau. However, HIV1 and dual infections were on the increase, particularly among pregnant women tested in Bissau, the capital of Guinea-Bissau. This paper presents the HIV/AIDS profile in the country. Epidemiological data indicate that in 1997, 2% of pregnant women tested in Bissau were HIV1 positive. However, it was noted that HIV1 and HIV1&2 infection levels were on the increase. Slightly over 1% had HIV1 while almost 1% were dual infected. There were no differences between the sexes in infection levels for HIV1 and dual infection. Moreover, age and sex data showed higher levels of HIV2 infection among women, 9%, than among men, 7%. Overall, HIV2 infected persons tended to be older than HIV1 infected persons. This was especially the case among women. The peak age group for infection among women was 45-54 while the highest level among men was found in the age 35-44 age group.
The AIDS epidemic in Kenya began in the early 1980s among the prostitute population and it has since spread to most areas of the country. By 1997, some urban and rural areas had rates that were higher than rates in Nairobi among pregnant women. However, HIV prevalence levels remain highest in western Kenya. This paper presents the HIV/AIDS profile in Kenya. The epidemiological data presented include HIV seroprevalence for pregnant women during the period 1991- 97; HIV seroprevalence for pregnant women by age from 1996-97; HIV seroprevalence for pregnant women in urban areas by province from 1990-2000; HIV seroprevalence for pregnant women in Kajiado District from 1989-98; HIV seroprevalence for pregnant women by rural sites from 1994-2000; HIV seroprevalence for pregnant women by rural sites in four districts in 1997 and 1999; HIV seroprevalence for adults in Kismu in 1998; HIV seroprevalence for prostitutes in Nairobi from 1980-92; HIV seroprevalence for sexually transmitted disease (STD) patients in Nairobi from 1989-93; and HIV seroprevalence for STD patients in selected cities from 1990-92.
Lesotho lies in southern Africa, the area most severely hit by the HIV/AIDS pandemic. This paper presents the HIV/AIDS profile of this country. It notes that due to several factors including the young age of first sexual encounter, multiple sexual partners, continued migration of males for work related reasons and poor perception of actual risk, the epidemic continues to spread. Other data included in this paper are the following: HIV seroprevalence for pregnant women at four sentinel sites of Lesotho such as Leribe, Maluti, Mafeteng, and Quthing Health Service Areas (1999); HIV seroprevalence for pregnant women in four sentinel sites of Lesotho (1991-94); HIV seroprevalence for pregnant women in Maseru, Lesotho (1991-94); HIV seroprevalence for family planning clinic attendees in four sentinel sites in Lesotho (1999); HIV seroprevalence for adults in rural area of Lesotho (1995); HIV seroprevalence for blood donors in Lesotho in 1987-92; HIV seroprevalence for sexually transmitted disease (STD) clinic patients in Maseru, Lesotho in 1988-94; and HIV seroprevalence for STD clinic patients in four sentinel sites in Lesotho in 1991-94.
This paper presents the HIV/AIDS profile in Liberia. It is noted that due to unstable political environment, there is little to no recent information on HIV in this country. Prevalence data from blood donors tested between 1992 and 1997 suggests that the epidemic was on the increase among this group. Among the facts included in this paper are the following: HIV seroprevalence for pregnant women in Monrovia, Liberia in 1992-93; HIV seroprevalence for blood donors in Monrovia, Liberia in 1992-93; HIV seroprevalence for blood donors in various sites in Liberia in 1994-97; and HIV seroprevalence for sexually transmitted disease patients in Monrovia, Liberia in 1993.
HIV / AIDS profile: Madagascar.
This paper presents the HIV/AIDS profile in Madagascar. It notes that the HIV epidemic in this country remains low when compared to other countries in East and southern Africa. However, a high level of infection among sexually transmitted disease patients during the 1990s may signal future expansion of the disease in other sub groups of the population. The other significant data indicated in this paper include: HIV seroprevalence for prostitutes in Antsiranana Province, Madagascar (1992-98); HIV seroprevalence for prostitutes in two cities of Madagascar in 1995; HIV seroprevalence for prostitutes in various provinces in Madagascar in 1992-96; HIV seroprevalence for sexually transmitted disease (STD) patients in four provinces in Madagascar in 1990-98; HIV seroprevalence for STD patients in selected provinces of Madagascar in 1990- 98; and HIV seroprevalence for pregnant women in selected provinces in Madagascar in 1996.
This document focuses on the epidemiological data as well as the demographic indicators of the HIV/AIDS profile in Malawi. It is noted that in the late 1980s, the epidemic in this country began to spread. Infection rates among pregnant women continued to increase during the 1990s in the three major cities. Patterns in infection trends are less discernible in other locales though high prevalence rates are still evident. Some important facts are presented in this paper that include: HIV seroprevalence for pregnant women in three cities of Malawi in 1985-98; HIV seroprevalence for pregnant women by age in three cities of Malawi in 1997-98; HIV seroprevalence for pregnant women by age in 15 districts in Malawi (1997-98); HIV seroprevalence for pregnant women in urban sites by district during 1992-98. It also presents data on HIV seroprevalence for pregnant women in rural sites by district in Malawi during 1992-98; HIV seroprevalence for blood donors in Blantyre, Malawi in 1992-99; HIV seroprevalence for prostitutes in Malawi during 1994; HIV seroprevalence for sexually transmitted disease (STD) patients in three cities of Malawi in 1995; and finally, on HIV seroprevalence for STD patients in seven districts in Malawi during the period of 1995.
This paper discusses the HIV/AIDS profile of Mali. It notes that by 1994, there were already very high infection levels among prostitutes tested in Bamako and other major cities. Other data show that Mali has one of the more serious epidemics in West Africa. Several relevant data are also presented in this paper. These include: HIV seroprevalence for pregnant women in Bamako district, Mali (1997); HIV 1,2 seroprevalence for pregnant women by age in Bamako district during the period of 1997; HIV seroprevalence for pregnant women in four areas of Mali in 1994; and HIV seroprevalence for pregnant women in three areas of Mali in 1994. It also illustrates on HIV seroprevalence for general population in various regions of Mali (1992); HIV seroprevalence for male truck drivers and apprentices in three cities of Mali during 1994; HIV seroprevalence for blood donors in Bamako, Mali (1987-92); HIV seroprevalence for prostitutes in Bamako, Mali during 1987-99; HIV seroprevalence for prostitutes in Sikasso, Mali in 1999; HIV seroprevalence for prostitutes in Bamako, Mali (1997); HIV seroprevalence for prostitutes in three areas of Mali in 1994; and HIV seroprevalence for prostitutes in various regions in Mali during 1987-92.
HIV / AIDS profile: Mauritania.
In Mauritania, there is very little information about HIV infection levels and what is available is dated. This paper presents the HIV/AIDS profile in Mauritania and provides information of the country's demographic indicators as well as its epidemiologic data. In the mid 1990s, it was reported that prevalence among sexually transmitted disease (STD) patients was 1.7% in urban areas of Nouakchott, Nouakhibou, Kaedi, and Rosso. In 1993-94, almost 1% of STD patients with genital discharge were infected, irrespective of sex in Nouakchott, Mauritania. Among pregnant women attending the Centre National de Bienetre Familial, overall HIV prevalence was 0.5% in 1993-94. Moreover, the seroprevalence level among blood donors tested in Nouakchott between 1990 and 1992 was 0.4%.
HIV / AIDS profile: Mozambique.
This article presents the HIV/AIDS profile of Mozambique and provides information of the country's demographic indicators as well as its epidemiological data. The graphs illustrate the HIV seroprevalence among pregnant women in Maputo from 1988-98; HIV seroprevalence for pregnant women by age in Maputo (1996-980); and HIV seroprevalence for pregnant women in three areas in Mozambique from 1994-98. In 1998, the HIV seroprevalence for pregnant women in four areas of Mozambique varies. The other graphs also illustrate the HIV seroprevalence for blood donors; sexually transmitted disease (STD) patients; STD patients by sex; STD patients in four areas as well as HIV seroprevalence for STD patients in three areas of Quelimane, Pemba and Tete.
This paper discusses the HIV/AIDS profile of Namibia. Since the early 1990s, both urban and rural areas in Namibia have been experiencing an increase in HIV infection. Among pregnant women, the level of HIV infection has soared to more than five times what was in 1991-92 in Windhoek. By 1998, prevalence among pregnant women in both urban and rural areas has steadily increased. Sentinel surveillance data shows that pregnant women aged 20-24 and 25-29 were the most affected with 20% and 22%, respectively, testing positive in 1998. Data from the Blood Transfusion Service of Namibia show HIV seroprevalence levels among blood donors increased from 0% in 1989 to nearly 2% in 1998. In selected sites, both urban and rural, prevalence levels among sexually transmitted disease (STD) patients, in 1998, were high. Over time, HIV prevalence rates among STD patients have increased tremendously, especially in urban areas.
This paper focuses on the HIV/AIDS profile in Nigeria. It is noted that the national prevalence has been steadily increasing from 1.8% in 1990 to 5.4% in 1999. As a result, this country was ranked third after South Africa and Ethiopia as the nations in Africa with the largest number of HIV infected people. The graphs presented illustrate the HIV seroprevalence for pregnant women in the South-South; South-East; South-West; North-Central; North-East; and North-West states. In 1999, HIV seroprevalence among pregnant women in six zones of Nigeria ranged from 3% among 15-19 year olds in the North East zone to nearly 10% among 20-24 year olds in the North Central zone. Moreover, HIV seroprevalence for female sexually transmitted disease (STD) clinic patients is somewhat higher than for men. Among STD clinic patients in 13 states, adults ages 26-30 had the highest level of HIV infection, reaching 28% in 1995.
This document discusses the HIV/AIDS profile in Niger and provides information on the demographic indicators as well as on the epidemiological data. As early as 1987-88, HIV infection was reported among pregnant women in Niamey, Nigeria, wherein infection levels of HIV1 and HIV2 were 0.1% and the dual infection rate was 0.3%. However, in 1993, there was no evidence of HIV2 or dual infection among pregnant women. During the 1990s, seroprevalence among blood donors increased to 4%. In addition, infection levels by sex were similar among blood donors tested in 1997 at the National Hospital. Studies also reported moderately high HIV seroprevalence levels among sex workers. Finally, prevalence among sexually transmitted disease patients tested in Niamey changed very little between 1991 and 1992. It was noted that the overall rate of infection ranged from 5-6%, with 60% of infections attributable to HIV1 in both years.
This paper presents the HIV/AIDS profile in Rwanda. It notes that prior to the civil unrest in 1994, Rwanda had one of the older and more severe HIV epidemics. Seroprevalence among pregnant women in Kigali seems to have leveled off, although infection rates for pregnant women in rural areas continue to rise. As Rwanda's population is predominantly rural, education and prevention should be aimed at these areas. The facts included are focused on: HIV seroprevalence for pregnant women in Kigali, Rwanda for 1996 and 1997; HIV seroprevalence for pregnant women in selected areas of the country in 1996 and 1997; HIV seroprevalence for pregnant women by age in 1996; HIV seroprevalence for the general population in Kigali in 1997; HIV seroprevalence for the general population of three sites in Rwanda (Butare region, Umatara district, and Kibungo district) in 1997; HIV seroprevalence for adults by age and sex in 1997; HIV seroprevalence for sexually transmitted disease (STD) patients in 1996; and HIV seroprevalence for STD patients by sex in four sites of Rwanda in 1996.
This paper presents epidemiologic data on the HIV/AIDS profile in Senegal. It notes that although the Senegalese government has managed to keep the HIV epidemic from getting out of control, there are still high levels of HIV-2 found in the country. Data on the HIV seroprevalence for prostitutes in Dakar, Kaolack and Ziguinchor from 1990-98 are included. Other data focus on HIV seroprevalence for prostitutes in M'Bour and Thies from 1994-98; HIV seroprevalence for male sexually transmitted disease (STD) patients in Dakar from 1989-98; HIV seroprevalence for male STD patients in Kaolack and Ziguinchor from 1989-97; HIV seroprevalence for male STD patients in M'Bour and Thies from 1994-98; HIV seroprevalence for pregnant women in Dakar from 1989-97; HIV seroprevalence for pregnant women in Kaolack and Ziguinchor from 1989-98; HIV seroprevalence for pregnant women in selected cities from 1996-98; and HIV seroprevalence for the general population by sex in Kolda Region in 1995.
HIV / AIDS profile: Sierra Leone.
Considering the continuing political and social upheaval in Sierra Leone, there is no prevailing information on the HIV epidemic in the country. Prevalence among blood donors in the early 1990s were noted to range from 1-4%. However, there is little information pertaining to pregnant women. In this regard, this paper presents epidemiological data on the prevalence of HIV/AIDS in Sierra Leone. Data presented include: HIV seroprevalence for pregnant women from 1990- 92; HIV1 seroprevalence for general population in a rural area for 1993; HIV seroprevalence for adults by sex and age in a rural area for 1993; HIV seroprevalence for blood donors in Freetown, Sierra Leone from 1987-91; HIV seroprevalence for blood donors in various regions from 1990-91; HIV seroprevalence for prostitutes in Freetown for 1995; and HIV seroprevalence for sexually transmitted disease patients in Freetown from 1998-92.
HIV / AIDS profile: South Africa.
Although the HIV/AIDS epidemic in South Africa began much later than it did in other countries in Africa, infection rates increased tremendously. It is noted that South Africa is facing one of the most serious HIV epidemics in the world. This paper presents an HIV/AIDS profile of South Africa. Data presented include: HIV seroprevalence of pregnant women from 1991-99; HIV seroprevalence of pregnant women by age from 1991-99; HIV seroprevalence of pregnant women by province from 1990-99; HIV seroprevalence of pregnant women in selected areas from 1988-98; HIV seroprevalence of pregnant women by age in Hlabisa District in 1997; HIV seroprevalence for adults in Hlabisa District in 1995; HIV seroprevalence for prostitutes in KwaZulu/Natal from 1996-98; HIV seroprevalence for sexually transmitted disease (STD) patients in Johannesburg from 1988-94; and HIV seroprevalence for STD patients by age and sex in Hlabisa District from 1996-97.
HIV / AIDS profile: Swaziland.
During the 1990s, Swaziland has seen an extraordinary rise in HIV prevalence among pregnant women and sexually transmitted disease patients. It is noted that by 1998, one-third of pregnant women were HIV positive with one-quarter of those aged 15-19 HIV positive. This paper presents the HIV/AIDS profile of Swaziland. Data included are focused on: HIV seroprevalence for pregnant women from 1992-98; HIV seroprevalence for pregnant women by age from 1992-98; HIV seroprevalence for pregnant women in four regions (Hhohho, Lubombo, Manzini, and Shiselweni) in Swaziland from 1992-98; HIV seroprevalence for blood donors from 1988-92; HIV seroprevalence for sexually transmitted disease (STD) patients by sex in the four regions of Swaziland from 1992-98; and HIV seroprevalence for STD patients by age and sex from 1992-98.
In Tanzania, like much of East Africa, the HIV epidemic began in the early 1980s. This paper presents demographic indicators and epidemiological data on HIV/AIDS in Tanzania. It is noted that a steady increase in infection levels among pregnant women in many areas of the country occurred up through the mid 1990s. However, in the Dar es Salaam, the capital of Tanzania, the HIV seroprevalence has remained stable at 14% based on a HIV sentinel surveillance system. In both the rural and urban areas of Mbeya Region, on the Zambian border, the seroprevalence has increased among pregnant women with 20% and 30%, respectively in both areas. In contrast, the seroprevalence among pregnant women in the lakeside town of Bukoba has fallen to 28% in 1992 to 13% by 1996.
This article presents the HIV/AIDS profile in Togo. It is noted that available information suggests a fairly stable epidemic among various risk groups. However, Kara Region has shown an increase in prevalence among pregnant women tested as part of the sentinel surveillance system. Among pregnant women attending two antenatal clinics in Lome, the capital of Togo, prevalence has fluctuated around 7% during the 1995-97 time period. In the rural area around Dapong, HIV seroprevalence levels among blood donors fluctuated around 2% between 1991 and 1993 while the prevalence among patients with sexually transmitted diseases declined from nearly 10% in 1991 to 7% in 1993.
This article presents demographic indicators and epidemiological data on HIV/AIDS in Uganda. With strong prevention campaigns, it is noted that the country's estimated prevalence rate declined down to 8% from peak of 14% in the early 1990s. In the capital of Kampala, a surveillance of pregnant women in two hospitals and an antenatal clinic indicated that the prevalence rates have declined 50% since 1993. Among blood donors in Nakasero, Kampala, and available data revealed that HIV seroprevalence has declined substantially. Similarly, HIV prevalence continues to decline among blood donors in the central regions of Uganda. It noted that blood donor clubs have been organized in rural areas to create a continuous voluntary safe blood supply. In addition, these clubs also educate local communities about the importance of safe sex.
This paper presents the HIV/AIDS profile in Zambia. It is noted that there has been a marked decline in HIV prevalence among 15-19 year old women due to behavior change but there is little sign of change in overall prevalence among adult women. Among pregnant women, prevalence continued to rise throughout the 1990s, even in some rural areas. In general, though, rural areas had lower prevalence rates among pregnant women than in urban areas, ranging from 8-13% in 1998. It is also noted that seroprevalence among blood donors in Lusaka had fallen throughout the 1990s from 16% to 6%. The overall decline throughout the early to mid 1990s is most likely attributable to prescreening of donors.
In Zimbabwe, the HIV epidemic has become severe and widespread by 1990. This paper presents demographic indicators as well as epidemiological data regarding HIV/AIDS in the country. It is noted that high levels of infection are found not only in high-risk groups, such as patients with sexually transmitted diseases, but in pregnant women as well. Studies of pregnant women attending antenatal clinics in Harare show that HIV seroprevalence increased rapidly from 18% in 1990 to 39% in 1996. Among blood donors, a drop in HIV seroprevalence was noted from of 3% in 1986 to 1.3% in 1996. In contrast, prostitutes in Harare have very high levels of HIV infection at 86% in 1994-95.
[Population and development in Tunisia: the metamorphosis]
Discussing the complex subject of population and development in Tunisia, this text is comprised of the following chapters: the settling of Tunisia from its origins to Independence, natural population dynamics since independence, health determinants and mortality declines, marital and family changes, fertility determinants, Tunisia’s family planning program experience during 1956-96, socioeconomic factors of migration, population age structure changes, population distribution and urbanization, Tunisia’s population in the 21st century, education policies, employment and economic activity, housing and living conditions in the context of population growth, changing housing consumption patterns, women’s rights and changing male-female relations since independence, social disparities and anti-poverty programs, population and environment, Tunisia’s innovative population policy, international cooperation in the population arena, lessons learned from Tunisia’s experience, Tunisian demographic and social statistics sources and history, and annotated legal texts on Tunisian population policy. Furthermore, case studies are presented upon changes in southern Tunisia, the growth of Grand Tunis, urban growth in the Sahel, labor market disequilibria and the role of the informal sector, Tunisia’s experience with tourism, and the promotion of women’s income in rural Sers.
[STD management guide. Module 1: Epidemiology, importance and control strategies for STD]
STDs are a priority public health problem, with ever-rising incidence and prevalence. They are major causes of disease due to the serious and sometimes deadly complications that can result. Such complications particularly affect women and newborns. Moreover, adverse associations have been clearly established between STDs and HIV. Available statistics indicate that STDs continue to pose many problems in Senegal. A study conducted in Dakar in 1990 demonstrated a rather elevated STD prevalence among prostitutes and pregnant women; 46% of prostitutes and 0.30% of pregnant women were infected with trichomoniasis, 16% and 2% with gonorrhea, 20% and 13% with chlamydia, and 29% and 7% with syphilis, respectively. As for HIV and AIDS in Senegal, the data indicate a relatively stable predominance of HIV-2 infection, but with progressively growing HIV-1 prevalence. 1994 data show that HIV prevalence remains low among pregnant women, but is elevated among prostitutes. This paper demonstrates the importance and scope of STDs, and introduces strategies to promote against such diseases. Health personnel, populations, and health policy planners all need to be aware of STDs’ impact upon the morbidity and mortality of reproductive-aged individuals. This paper offers recent and prospective data upon HIV/AIDS and STD trends, their scope and determinant factors, and the strategies best suited for implementation in developing countries.
[Support project to the campaign against AIDS (IEC-SIDA). Compendium of IEC experiences in Senegal]
Financed by the Canadian Agency for International Development (CAID), executed by Desjardins International Development (DID), and implemented through close collaboration with community organizations and government institutions, the Support Project against AIDS (IEC-AIDS) launched its activities in Senegal in 1992. It has thus far implemented more than 100 micro-interventions. This report of Senegal’s experiences is divided into 3 parts, with the first one focused upon the description and analysis of the approach and how micro-interventions were selected. The second part describes experiences by type of strategy. Three experiences per strategy are described taking into account the intervention axis, population reached, message communicated and activities undertaken, strategies employed, results obtained, and short- and medium-term impacts upon target population, intervention region, environment, and requesting organization. The third part of the report consists of a broader analysis of results obtained by exploring the experiences of involved parties, as well as the relationships established with their surroundings, including government institutions. From this analysis, the authors draw key lessons and recommendations for future STD/AIDS interventions using information, education, and communication as means of intervening to arrive at desired behavioral change. The report’s chapters discuss the context of AIDS prevention, young people, women, prostitution, migration, mass media, and religious leaders.
[Situation analysis of the Benin family planning program. Preliminary report]
Family planning (FP) activities have existed in Benin since 1971 despite the absence of official population policy and the existence of the 1920 legislation. Since 1983, FP activities in Benin have been officially integrated into maternal-child health services with the creation of the Family Well-Being Project. A situational analysis was conducted of Benin’s FP program to address organizational questions and identify current program problems. Specifically, the study aimed to describe the functional capacity and performance of service delivery points, then assess the quality of FP services delivered. Data were collected through structured interviews, non-participative observations, and through inventories of infrastructure, equipment, and service statistics among a representative sample of the country’s healthcare facilities. These data come from program documentation, interviews with senior Ministry of Health personnel, FP service providers, and maternal-child health and FP clients. Aimed at Senegal’s planners, directors, and FP program service providers, as well as the FP program’s partners, these study results facilitated the identification of Benin’s FP program strengths and weaknesses.
The authors traveled to Lome, Togo, during April 14-18, 1998, to help conduct the final phase of adapting the Integrated Management of Childhood Illness (IMCI) approach. Approximately 50 people, including representatives from the Ministry of Health and the University School of Medicine and Pharmacy, participated in a mid-term, follow-up workshop involving the development of national consensus upon the adaptation of generic IMCI materials. Upon its return from Niger, the Togo team decided to establish a new technical group and use materials from Niger rather than generic World Health Organization (WHO) and UNICEF materials in a bid to speed the process. Groups presented the results of their activities for discussion. Discussions held with the technical group following the workshop were drawn from Togo’s experience adapting the strategy. There was insufficient information exchange and communication between the new technical group and the technical committee. Workshop recommendations included finalizing other field research, field-testing the management of children 0-7 days old, and incorporating findings in the chart and modules as adaptations. People met during the visit, activity schedule, and participant list are presented as annexes.
The authors traveled to Bamako, Mali, for several days in July 1996, to help with a training seminar upon the Integrated Management of Childhood Illness (IMCI) approach. The seminar was held to inform decisionmakers and other involved parties about the IMCI strategy, to describe planning and program implementation-related constraints, to reach consensus upon how to introduce the IMCI approach, to identify contributing factors and obstacles to effective strategic implementation, and to develop an implementation plan for measures designed to remove obstacles and effectively adapt the World Health Organization’s generic model. To realize these goals, 3 presentations were made before sending participants off to working groups. Factors favoring IMCI implementation in Mali, problems identified, and solutions proposed are noted, as well as the training seminar evaluation and conclusions. Coordination is one of the most significant problems identified. Objectives and scheduling, opening comments, participants’ list, problem identification and potential solutions, implementation schedule, training seminar programming, and the roundtable of partners are presented in annexes.
[Demographic and Health Survey, Cote d'Ivoire, 1998-1999]
This second Demographic and Health Survey initiated by the government of Cote d’Ivoire was conducted in 1998-99 by the National Institute of Statistics with technical support from ORC Macro. Fieldwork occurred during September-November 1998 and February-March 1999. Return to the field in 1999 among approximately 40% of the sampling clusters helped improve survey data quality, especially in rural areas. This study was conducted to provide decisionmakers, program managers, and other users with detailed data upon fertility, maternal-child health, infant-child mortality, family planning, nutrition, STDs and AIDS, and harmful traditional practices, in addition to other information. The first part of the report describes the country’s characteristics, such as its geography, history, economy, population, health status, and health and population policies. Survey methodology is then presented. The report continues by presenting data upon the following characteristics of individuals and households sampled: population age and sex structure, household size and composition, population educational status, household characteristics and goods possessed, individual sociodemographic characteristics, couples’ characteristics, media access, and economic activity. Subsequent chapters describe results upon fertility, family planning, nuptiality and exposure to pregnancy risk, fertility preferences, maternal-child health, feeding practices and maternal-child nutritional status, under-5 child mortality, genital mutilation, and STDs and AIDS. Sampling strategy and errors, a table to assess data quality, DHS personnel, and questionnaires are presented as annexes.
[Access to treatment in poor countries: to each his responsibility]
20% of the world’s population currently consumes 80% of the world’s medicines. However, at the same time, 20% of the world’s poorest population accounts for 56% of all deaths by malaria, 53% of diarrhea- related mortality, 42% of AIDS deaths, and will also soon suffer diseases typically found in wealthier countries, such as diabetes. Given this context, a 3-way partnership is called for between developing countries, private industry, and industrialized countries. A population cannot develop devoid of proper health, yet essential medicines are needed to ensure populations’ good health. Measures must be taken to enable developing countries to benefit from medical laboratory discoveries. Some pharmaceutical firms are already working to help the world’s poorest populations. In effect, there currently exist about 20 research and development projects designed to develop products against developing country diseases in need of therapy. Moreover, 68 countries currently benefit from preferential drug pricing policies. However, none of these initiatives can succeed unless developed countries recognize the price of innovation and prevent the reimportation to the north of products distributed in the south. Violence can be expected if nothing is done to provide all people with access to therapeutic drugs.
[Is West Africa undergoing "rurbanization"?]
Although the world’s population is increasingly urbanizing, recent works published by the French Center upon Population and Development (CEPED) challenge the notion of a dominant rural exodus over the past 40 years. In 1950, less than one-third of the world’s population lived in urban areas. Now more than half of the world’s population is urban, with expectations of the urban resident percentage to increase to more than two-thirds in barely over 20 years. Therefore, in 2025, 5 billion people will live in urban areas, of whom 4 billion will reside in developing country cities, condemned to living in overpopulated slums, without access to public services, without property rights, and without guaranteed housing. In this context, there nonetheless exists the surprising trend of urban outmigration toward rural areas, especially among young city dwellers having difficulty adapting to urban life. There remains considerable rural-to-urban population flows, but urban emigration currently dominates. Natural population growth continues to swell urban populations, even if the pace of urbanization is slowing. Urban migrants’ youth frustrates their access to employment, housing, and marriage opportunities. 6% of young migrants are seeking work, compared to 2% for the overall rural population; young migrants often live with a parent; and most are unmarried due to the inability to amass dowries. Urbanization is therefore not exclusive to industrialized countries.
[Developing countries face the challenge of a growing need for contraceptives]
Current global population already includes more than 1 billion people 15-24 years old. Working from this figure, among others, revised projections from the UN’s Population Division indicate that world population size could increase by 50% by 2050. A 36% increase in the number of reproductive-aged women is also projected among the 87 countries studied over the period 2000-15. The number of modern contraception users should increase by 79% over the same period. This growth in the reproductive-aged population and its level of contraceptive demand will be most marked in Asia and Africa. At the same time, the demand for family planning services grows and increasingly outpaces available supply. By 2005, a 20% gap should develop between financing needed to fund the demand for subsidized products and available resources. Therefore, if donors maintain current levels of support, the real funding gap could grow to 210 million dollars annually. Such inadequate funding could result in serious consequences for entire populations, but particularly young people, in terms of their risk of contracting STDs and experiencing undesired pregnancy. While contraceptive products and services are growing in both quality and quantity, funding levels several hundred millions of dollars below demonstrated need could compromise or even reverse reproductive health progress made since the 1994 Cairo International Conference on Population and Development. Better funding is needed. The author notes the possibility of integrating reproductive health products and services with primary healthcare services.
[A network of NGOs of young Africans is woven on the Web]
Overcoming obstacles to gaining Internet access in Western Africa, 5 nongovernmental organizations (NGO) in Benin, Cote d’Ivoire, Mali, Niger, and Senegal have successfully established a Web site designed to help create and maintain a network of Francophone youth for sustainable human development. Participating NGOs presented projects implemented by youth associations according to themes including health, education, employment, environment, and development. Proposals, discussions, and general mutual enrichment should result from this exchange of successful projects. The site will enable users to learn from others’ experiences, thereby ultimately benefiting regional development by enhancing the capacity of young Francophone Africans to effectively address sustainable human development concerns. This Web site must now collect information to synthesize into site content. The CeRADIS association, which provides and maintains the site’s platform in Benin, is heavily invested in the project. It has contacted all of the participating youth NGOs and organized several meetings with interested parties. This Web site is a fine example of the successful use of new technology in Africa, but the project’s sustainability nonetheless depends upon the ongoing shared interest of partnered associations to enrich and use this space reserved for them upon the Web.
[Microfinance. Alternative strategies for women]
African women contribute greatly to their countries’ economies without reaping any benefit. Excluded from decisionmaking and generally ignored by banks, millions of women worldwide, 80% of whom are illiterate, are implementing their business ideas and income-earning management abilities in the informal sector thanks to microfinance structures through which they have access to small loans, savings, and investments. With UNDP assistance, UNIFEM developed a microcredit and microenterprise support program to encourage technique cooperation between developing countries. The program is comprised of 3 phases, including inter-African experience sharing on the one hand and cooperation between Africa, Asia, and Latin America on the other, as well as the creation of a regional network of microcredit organizations and the strengthening of network members’ technical capacities. The first phase of the program involved organizing a strategic planning seminar and implementing a regional microcredit and microenterprise network targeted to African women. That seminar took place in Dakar during January 20-24, 1997. Microfin-Afrique, a microfinance and microenterprise support network, aims to spread awareness about African NGOs’ experiences with microfinance, increase awareness of their activities upon the continent, defend the group’s interests, and advocate for structural, legal, and legislative changes. Microfin- Afrique is working to increase and strengthen poor women’s access to economic resources, as well as their levels of productivity and negotiating power.
Some believe that campaigns to denounce female genital mutilation (FGM) are the concern of Western women, particularly feminists. Others, in agreement with international bodies, believe that FGM constitutes the worst form of discrimination and one of the most pressing health problems for women in Africa. They argue the need to lead sustained awareness campaigns to eradicate these unjustifiable, barbaric practices. Despite years of increasing awareness, an estimated 130 million women as of 1997 had undergone some form of FGM, while at least 2 million young girls annually risk mutilation. These latter militants are convinced that FGM harms girls’ and women’s physical and spiritual integrity, and prevents them from fully enjoying their rights and freedom. FGM is a violation of human rights and basic freedoms, and imposes major risks and consequences to human health. Now, after 2 decades of campaigns against FGM, more and more people support the need to intensify efforts against FGM. Across Africa, traditional FGM practitioners are abandoning their practices, parents are deciding to no longer mutilate their children, religious leaders are explaining that religious faiths do not recommend FGM, and political and opinion leaders are affirming their opposition to FGM.
[Malicounda Bambara turns its back on excision]
Thanks in large part to an education program jointly conducted over the past 10 years by the nongovernmental organization TOSTAN, UNICEF, and the Senegalese government, women of Malicounda Bambara village decided to abandon female genital mutilation (FGM). These women have abandoned the annual festivals traditionally marking the moment village girls enter into womanhood, completely turning their backs upon FGM. The education program encouraged village women to reflect for the first time upon previously taboo subjects. They tried, bit by bit, to together confront some of their FGM-related problems and resolve them. The women studied individual human rights in an education module upon women’s health, focusing upon women’s health and their rights to freely enjoy and preserve the physical integrity of their bodies. This knowledge then challenged the notion that every girl in the community should undergo FGM. By tradition, non-mutilated girls became the laughing-stock of the community, especially among mutilated girls. An unmutilated girl in Malicounda Bambara was considered soiled and unsuited to fix meals for others and serve those studying the Koran. However, that said, these women nonetheless recognized the existence of FGM-related complications and inconveniences. The women first decided in class to abandon FGM, then began discussing the possibility with the town’s traditional and religious leaders, as well as with their husbands.
[In Casamance also, traditional excisors against excision. Interview with Fatou Badji Aris]
Like elsewhere in Senegal, Casamance, comprising the southern part of the country, is concerned with female genital mutilation (FGM). For a number of years, the Regional Committee against Female Genital Mutilation has worked with ENDA Tiers-Monde, a nongovernmental organization based in Dakar, to increase awareness against the practice. The nurse-midwife who heads the regional committee explains the different educational activities undertaken by her committee. The committee director believes her organization’s anti-FGM message is well received by women. The committee’s awareness efforts continue with the goal of making everyone equally aware of FGM’s negative consequences. The Regional Committee against Female Genital Mutilation helped develop a national action plan to eradicate FGM in Senegal, as well as a regional women’s development plan. Senegal needs to coordinate its activities to at least assess the current FGM situation and better target eradication measures.
[An appeal to legislators, March 8]
In Senegal, more than 20% of the female population in the Senegal River Valley, Upper and Lower Casamance, and the eastern part of the country have undergone female genital mutilation (FGM). Almost 80% of Toucouleurs and Mandés practice FGM, as well as about 60% of Peuhls and Diolas. Well-established in rural areas, FGM is also known in urban centers due to the high rate of rural exodus towards cities. Condemnable and open to challenge, FGM was never advised by Islam. UNIFEM celebrated International Women’s Day upon the theme of sexual mutilation by organizing film screenings, student sketches, and panel debates. Furthermore, on March 8, 1997, a major information and awareness campaign against FGM was launched in Senegal. UNIFEM will therefore support all associations and organizations fighting against the most gratuitous forms of violence such as FGM. This campaign particularly targets young people. In addition to awareness and education campaigns, public powers should become more involved in efforts against FGM, taking steps to completely eradicate the practice. Research should also be conducted into the scope and evolution of the practice across Senegal.
[Islam does not recommend excision]
Each year, 2 million young girls and girls suffer female genital mutilation (FGM). Depending upon the periods and places considered, different reasons have been evoked to justify practicing various forms of FGM. Above and beyond tradition and religion, some people try to legitimize FGM as a purification process, preventive therapy, or corrective surgery. However, in all cases, FGM is in keeping with the aim of controlling and compromising women’s sexual activity. Anticipated results from FGM include preserving girls’ chastity, inhibiting women’s sexual desires, and making sexual relations impossible. In Senegal, very serious forms of FGM continue to be practiced among certain ethnic groups. While FGM is practiced by many Islamic populations, it is not prescribed by Islam. Rather than being an Islamic practice, FGM should be seen as a custom observed by Muslims. Islam gives high regard to individual sexuality, strongly affirming the right to enjoy sexual pleasures. In both religion and its worldview, Islam celebrates “the natural state.” FGM has no valid historical or religious foundation. Only myths and culture sustain the practice.
[Mantoulaye Guene: perseverance and dynamism rewarded]
Created in 1987, in honor of the former Minister of Women’s Status, the “Mantoulaye Guène” group quickly made a name for itself through its successful seafood processing operations. In 1996, the group processed 4298 tons of seafood for a commercial value totaling 326,783,800 francs CFA. This success is due largely to the round-the-clock efforts of women working during the fishing season. In 1997, the group was awarded the Head of State’s Grand Prize for women’s promotion in Senegal in recognition of its activities processing fish, fruit, and vegetables. Worth 5 million francs CFA, this award encourages the group’s efforts, while inviting its participants to persevere in their efforts supporting the country’s economic and social development. With this prize, all of Kayar, as well as its partners like UNIFEM, feel honored. The project aims to valorize local production while increasing the year-round availability of food stocks; increasing women’s incomes by creating smallholders to process fruit, vegetables, and seafood; strengthening women’s organizational capacity through proper training; and raising responsibility to better commercialize and sustain accomplishments. This project involved the towns of Kayar, Fass Boye, and Keur Mousseu.
[Bokk Ndeye project: Chickens against poverty]
In 1996, UNIFEM’s regional office financed an aviculture support project to benefit Pikine’s “Bokk Ndèye” women’s group, help it increase its production of plump chickens, and diversify its activities to include the raising of egg-laying hens. The short-term goal was to strengthen the group’s avicultural activities, but over the long-term, UNIFEM hoped to implement a global support strategy to promote aviculture as a sector in which women from outlying neighborhoods do not hesitate to invest to earn income. However, the midterm project evaluation, conducted at the end of 1996, revealed that Bokk Ndèye suffered organizational problems related to production and management, particularly regarding chicken distribution and commercialization. To address these problems, a day of reflection was organized by UNIFEM in collaboration with the African Center of Female Entrepreneurs (CAEF) on March 13, 1997, at Dakar’s Training and Improvement Center, to enhance the performance of the women’s operations. Approximately 20 Pikine women’s groups involved in aviculture participated. These women, who convened together for the first time, were able to discuss their problems and jointly consider strategic directions toward a unified support approach UNIFEM can propose to interested parties. A network encompassing the body of Pikine’s women’s groups involved in aviculture was developed from this 1-day conference. This network will exist to foster true avicultural entrepreneurship among women’s groups.
[How to establish a female leadership]
The authors present results from a national study of migratory dynamics, urban insertion, and the environment in Burkina Faso jointly conducted in 2000-01 by the University of Montreal’s Demography Department, CERPOD, and UERD within the framework of the Sahel’s Population and Development Program. The study was conducted to better understand reproductive strategies implemented by populations in Burkina Faso. The first part of the report outlines the study’s theoretical underpinnings, illustrating different aspects of the reproductive strategy concept with the help of examples drawn from work in Burkina Faso. The second part presents study objectives and sampling methodology, and describes information collected at the individual, household, community, regional, and national levels of analysis. For each level, the authors note data collection obstacles, survey innovations, and its analysis potential. Data collection lasted 4 months during March-July 2000. Overall, data were collected upon 22,999 individuals belonging to 3517 households, for 8644 completed individual histories. These data will enable the reconstruction of individual trajectories with regard to key aspects of personal life histories. They also facilitate the analysis of complex interactions between different trajectories. In effect, they permit an assessment of the influence of important individual life characteristics upon their residential, professional, and familial trajectories.
[Constance Yai: Women's rights, "Certain Ivoirian laws need to be changed"]
The Ivorian Association in Defense of Women’s Rights (AIDF) was established in 1992 out of the efforts of women of all ages and diverse backgrounds and outlooks who decided to join forces to determine how to increase community awareness upon women’s rights. AIDF has since promoted gender equity in Côte d’Ivoire. Among its efforts, the association works to enforce the texts of existing laws favoring women and to sensitize populations about the conditions and challenges of young urban and rural girls. Constance Yaï, AIDF president, describes her organization’s current challenges, as well as her views upon women’s rights. Since Côte d’Ivoire inherited French legislation predating the country’s independence, contradictions often exist between Côte d’Ivoire’s national laws and international accords favoring women. AIDF is currently waging a battle to revisit all existing legislation upon real estate, women’s rights within the family, and controlling adultery. The association denounces customs adversely affecting the health of women and young girls. Specifically, AIDF successfully created the National Committee against Harmful Traditional Practices (CNLP). Mrs. Yai describes AIDF’s current efforts to improve women’s situation in Côte d’Ivoire. She believes awareness in the country has affected populations’ behavior, while she also remains optimistic about the involvement of men and religious leaders.
[International cooperation in population]
From the first years of Tunisia’s independence, Tunisian authorities have given priority to cooperating with regard to development-related problems caused by rapid population growth in the context of limited natural resources. Foreign aid had to support national efforts to bolster social development, to which a large proportion of the government’s budget has always been dedicated. Tunisia launched its national family planning program in 1966. Over the past 3 decades, the program has complemented overall governmental measures within the framework of national priorities and action programs defined by international population conferences convened in Bucharest in 1974, in Mexico in 1984, and in Cairo in 1994. Benefiting from ongoing political support over the years, Tunisia’s population program has realized impressive results. It is a fine example of South-South cooperation in the field. The authors describe cooperation prior to launching the family planning program during 1956-61; cooperation and launching of the national family planning program during 1962-1974; population program implementation during 1974-84; population program strengthening during 1984-92 with bilateral, multilateral, and nongovernmental organization cooperation; and the period 1992-96. Over the past 40 years, cooperation has been a constant element of Tunisia’s efforts to control population characteristics and integrate population concerns into its development program, which has always emphasized social programs, and to which almost 40% of the government’s budget is currently dedicated.
Tunisia enjoys a certain wealth of natural resources, but except for its northern maritime fringe, the country is largely arid. This climate-derived aridity can be either encouraged or minimized depending upon prevailing soil types and their use by humans. Natural resources exploitation has marked the countryside and large forests formerly covering much of the territory, but which have now disappeared to make way for crop growth. The extent to which desertification has spread in the country, particularly in the center-south, demonstrates how much Tunisia is plagued by human activity and the notion of an irreversible environmental degradation process. At the end of last century, the country’s population was smaller than 2 million inhabitants, but population growth, especially robust during the 1950s and 1960s, led to the overexploitation of natural resources to meet agricultural and industrial needs, as well as those of other tertiary, emerging activities. 40% of Tunisia’s almost 10 million inhabitants currently reside in rural areas of the country. The authors consider the effects of urbanization upon the environment, population growth and agriculture, water as the major stake in the relation between population and environment, migration and environment, and family dynamics and the environment. Current environmental problems facing Tunisia are less associated with population growth than with changes in how its population lives, feeds itself, reproduces itself socially and at the family level, and how society responds to these trends.
[Women's rights and evolution of men-women relationships since independence]
Changes in gender relations since Tunisia’s independence are seen through legal reforms effected since the advent of the Personal Status Code. These reforms were undertaken with the aim of fostering greater equality between the sexes. Changing relations are also seen in the relationship between parents and their children, with the bolstering of child rights, and in Tunisia’s 1995 code upon child rights. This legislation conforms to the principle of equality between the sexes, a foundation of modern Tunisia incorporated within the country’s Constitution. However, all of these reforms cannot by themselves explain changes observed in gender relations. Recognizing the principle of equality, one must note the important role of many parties’ individuation and independence, such as among women themselves. This paper explores socioeconomic rights, including equality, sexual division within the workplace, and women in agriculture, public administration, higher education, and the media. It continues with consideration of illiteracy and education, coeducation in schools, the role of the media, women’s political rights, and women’s status among family and at home. Upon this latter subject, the authors examine women’s rights to a name, health, as infants and adolescents, and within marriage.
[Internal and external migration since independence]
Both international and internal migrations in Tunisia have played important roles in the country’s population dynamics over the past 40 years. Throughout its history, Tunisia has known many waves of immigration, of variable importance and diverse origins. Tunisia has therefore long been a host country for immigrants. During the first half of the century, the country, existing as a French protectorate, received a steady, intense flow of French colonists on the heels of very heavy Italian immigration at the close of the preceding century. At the time of the February 1, 1956 census conducted just prior to independence from France, Tunisia’s population totaled 3.783 million inhabitants, including 341,000 foreigners, of whom 180,000 were French and 67,000 Italian. Until World War II, migration within Tunisia either increased or decreased changes in population distribution across the country. Over time, coastal regions, and particularly those in the Tunis district, attracted more and more people from the interior and northwestern regions. Considering migration within Tunisia, the author discusses the effect of internal migration upon regional population growth, migrants’ profiles, migration and educational level, and migration, labor force participation, and unemployment. Regarding international migration, Tunisia’s foreign population since independence, Tunisia’s population and emigration, Tunisian expatriates, income transfer among Tunisians, and the future of Tunisian emigration to foreign countries are explored.
[Determinants of health and of decrease in mortality]
Mortality decline in Tunisia is the result of not only measures implemented at the health policy level, but also at the broader level of Tunisian social change across many levels. This study of health and mortality determinants in Tunisia is divided into the 3 following sections: the evolution of health policy across different plans since 1961, healthcare services, and health policy results upon child mortality trends and determinants. The section upon healthcare services provision explores the increase in health sector expenditures, medical and paramedical personnel, and healthcare equipment, while the third part of the paper examines neonatal, postneonatal, infant, and child mortality; child nutritional status; disease prevention and treatment; and prenatal and postnatal consultations and child delivery care. Maternal birth characteristics, living conditions, maternal educational status, and gender are also discussed within the context of sociocultural factors and ongoing inequalities. Tunisia has made considerable efforts in health since independence, both with regard to healthcare infrastructure and training of medical and paramedical personnel. Tunisia runs health education and prevention campaigns, while also redistributing health services across the country, but positive healthcare sector and mortality outcomes are especially due to progress realized in many other areas of economic and social development.
[Transformations of marriage and the family]
Marriage is a very important rite of passage among Tunisian families. Among the events marking each family’s history in the country, marriages are implicitly appreciated as a religious obligation. In Tunisian society, unmarried individuals are considered abnormal. Marriage still remains a deeply rooted tradition among social practices even if a minority of the population remains single less by choice than as a result of difficulties finding a spouse. Marriage ceremonies hold symbolic importance among families in Tunisia, involving family honor and presenting the opportunity for families to affirm their social status. If it exists, cohabitation outside of marriage is not recognized and remains illegal. This discussion of marital and familial changes is divided into the following 3 parts: union formation as family affairs or individual choice, the evolution of nuptiality, and familial changes within Tunisia. In the first part, the authors discuss the choice of spouse and marital rites, continuities, and adaptations. The second section includes parts upon changes in age at first marriage, a reasonable decrease in age gap between spouses upon marriage, marriage age and population distribution, and marital cycles. The final section then examines lifestyles among those in union with regard to residential freedom and the couple concept, family and household sizes, new types of familial relations and roles, child worth in societies moving toward lower fertility, unmarried lifestyles, and caring for the elderly.
[The experience of the Tunisian family planning program, 1956-1996]
Tunisia’s family planning program is a central component of the country’s overall population policy, which aims to achieve equilibrium between population growth and economic development. During the past 4 decades, this program reflects the country’s social evolution in a modernization process in which religious and cultural taboos have progressively yielded to pragmatic and rational positions. This study examines Tunisia’s family planning strategy in the context of emerging population and family planning policy during 1956-71, the development of population policy and the national family planning program during 1972-97, and the development of the national program both during the early period of 1966-73 and post-1973. Results are presented upon changes in public and private healthcare resources, increases in the number of family planning and reproductive health consultations over the years, contraceptive practice, demographic indicators, and family planning program impact. Government persistence and determination to control Tunisia’s population growth were decisive elements in ensuring success of the country’s national family planning program. These key factors were always adjusted to the particular demands of different stages of national development.
[Socioeconomic factors of migration]
When unforced, migration facilitates economic and social changes. Migration results from either individual or familial decisions based upon a comparison between two different situations. The quality and quantity of available information, means of communication, and the availability of transportation determine migration’s intensity and rhythm. Migration results from a tension between countries, regions, and settings, depending primarily upon an international tension between the needs of populations ignored by the colonial system and possibilities offered in neighboring, wealthier countries. Internal migration becomes increasingly complex in the context of Tunisia’s intense social changes. The author examines migratory flows in Tunisia, external emigration in response to demographic constraints, social collapse, collectivization and rural outflows, emigration to find employment, professional life-related mobility, securing housing, income and living condition disparities and migration, familial and personal problems, workplace proximity, school and schooling availability for children, women and family migration, business-related migration, schooling and migration, professional training and migration, lifestyle and facilities, social structures and solidarity, and property and landholding structures. The transition from patriarchal to nuclear families, especially in urban areas, imbalances between training programs and the labor market, and spread of increasingly individualistic lifestyles experienced in Tunisia over more than 2 decades encourage population movements.
[The evolution of the age structure of the population]
A population’s age structure has a dual relationship. On the one hand, it is progressively shaped over time by changing population growth factors such as fertility, mortality, and migration. However, at the same time, a population’s age structure influences the expression of such factors. Two populations with different age structures subjected to identical fertility, mortality, and migration factors will experience different crude birth, death, and migration rates, and therefore different growth rates. The authors consider the evolution of Tunisia’s population age structure, population sex ratio, geographic variation in the country’s age and sex structures, and Tunisia’s situation compared to other regional groupings. Data are presented upon Tunisia’s age pyramids from the 1966 and 1994 censuses, improving age reporting, transforming age pyramids in the context of transition during 1946-94, and the golden age of demography. Regarding gender equilibrium, the authors describe overall parity and age-related disparities.
[Spatial distribution of the population and urbanization]
Tunisia, particularly eastern Tunisia, is very open to both the sea and foreign countries. Except in extreme southern Sahara, no region of Tunisia is more than 250 km from the sea. This geography has long helped concentrate both populations and economic activity upon the eastern face of the country. This trend became particularly strong under French colonialism beginning in 1881. Harbor development, together with development of the capital city, irrigated agriculture, tourism, and industrial capacity along eastern coastal areas have exacerbated regional imbalance between a humid, active, dynamic, and heavily populated eastern Tunisia and the interior of the country, which is mountainous in the north and semi-arid in the center and south, of primarily rural, agricultural character largely devoid of cities, industry, and tourism. Population distribution changes during 1931-94 demonstrate this process, while the map of population concentrations by delegation in 1975 demonstrates regional population imbalances. The author describes population density and accelerating urbanization in Tunisia.
[Selected and annotated legal texts on the population policy of Tunisia]
Many different government texts govern population policies. Both international and domestic instruments are among these texts. International legal guidelines include international accords adopted by the UN General Assembly and resolutions upon plans, programs of action, and declarations adopted during recent UN international conferences upon human rights, population and development, and women. National legal texts consist of a body of laws, decrees, and circulars defining the population field from independence and especially those governing families, women, and reproductive and sexual health. Some of these texts, adopted since 1956, remain in force despite various modifications effected over the years. Others arose following the government of Tunisia’s adoption of a population policy and address particular aspects of policy. In Tunisia’s case, the author describes the legal organization of family life and women’s rights within the family regarding marital consent and the rights of married women. Regarding rights associated with the organization and protection of human life, the text explores individual civil status, contraception and abortion rights, and socioprofessional rights of pregnant women and young mothers.
Gender issues in social security policy of developing countries: Lessons from the Kerala experience.
This paper is based on the premise that labour market conditions are critical in shaping access to social security benefits. Women's entitlement to long-term social security is in many respects different from that of men on account of the assumptions which pervade the system about gender roles, labour market conditions, and outcomes. The Indian state of Kerala has made great strides in formulating various schemes for workers in the informal sector, but gender concerns in social security are in want of attention in the light of demographic pressures, fiscal constraints and changes in the global economy. (author's)
[Contraception during lactation]
Breastfeeding a newborn has proven advantages in terms of the health of the child, and it is universally accepted that breast milk contains the very best nutritional components in comparison with other substitutes. Moreover, breast milk plays a decisive factor in the survival of newborns in developing countries. In light of the above, there is a great deal of importance to the contraceptive that is chosen for use during breastfeeding, in order to reduce the effects on the milk and on the newborn. Article discusses factors in the selection of a contraceptive for a nursing mother. The article reviews the various forms of contraceptives that are available to nursing mothers, weighing the advantages and disadvantages of each such method. The methods are listed below. (excerpt)
[Which contraception to choose for the diabetic woman?]
Low-dose oral contraceptives can be used by a great number of women with IDDM or a previous gestational diabetes mellitus. Others hormonal contraceptives (progestogen-only preparations) are less convenient and the compliance is poor with an increasing risk of gynaecologic side effects. The safety of this contraceptives as regards vascular diabetic complications is not evaluated well. Nulliparous patients with progressive complications can use barrier methods of contraception after education. Macroprogestative contraception is a adequate choice for women within forties. For multiparous diabetic women, intra-uterine devices represent the first choice. (author's)
Delivering health education messages for part-time farmers through local employers.
Fifty-nine percent of principal farm operators in Kentucky work at jobs off the farm. These job settings can be a conduit for dissemination of health education and injury prevention messages. The Community Partners for Healthy Farming Project initialed a tractor Roll Over Protective Structure (ROPS) promotion campaign and through employers disseminated materials on the risks of tractor over turns and benefits of ROPS. Eight businesses participated in this effort. A case report describes one employer's activities in detail. (author's)
This note discusses the trend in People's Republic of China programs, international standards of human rights, legislative trends, and the United States budget for fiscal years 2000 and 2001 as they apply to family planning programs. Specifically, this discussion shows why Congress should condition funding of these programs based on assurances of compliance with human rights standards. Part I presents an overview of the P.R.C. programs. Part II reviews internationally accepted standards of human rights concerning reproduction and population control, as well as China's violations of these rights. Part III describes UNFPA funding of the P.R.C.'s programs, emphasizing their latest 4-year program. Part IV discusses the legislative trend since 1985 of limiting or halting funding to the programs, and the current state of the federal budget regarding these appropriations. Part V discusses the global gag rule and the necessity of its removal. Part VI considers recently proposed legislation regarding funding family planning. Finally, the conclusion proposes a possible solution to the family planning dilemma in the face of both the continuing need for assistance and the continued existence of human rights abuses. (excerpt)
Contraception in primary care.
Educational objectives: Demonstrate the process of helping each individual patient choose an appropriate contraceptive method. Summarize the risks and benefits of various contraceptive methods. Key questions: 1. What are the important features of the history and physical examination that will guide contraceptive choice? 2. What are the options available for reversible contraception? 3. What does the primary care provider need to tell patients about the risks and benefits of oral contraceptives? 4. What are the options available for permanent contraception? 5. What are the overall costs of various contraceptive methods? (excerpt)
[Low-dose oral contraception and bone density]
Oral contraceptives (OC) with 20 or 30 mcg Ethinyl-Estradiol (EE) inhibit bone remodeling in all age groups investigated until today as far as the biochemical parameters are considered. In perimenopausal women, OC with 20 or 30 mcg EE reduce the decrease in bone density and may, depending on the starting point, induce an increase in bone density. OC with 20 mcg EE might impede the formation of a physiological peak bone mass in very young women (probably women less than 20 years of age) by a reduction of bone metabolism. This possibility provoked a certain insecurity. However, it should not lead to the consequence that a safe contraceptive method is refused to young women. Unfortunately, there is still a lack of reliable studies allowing a final statement on the effect of low-dose OC on bone density in teenagers. Such studies are urgently needed so that we are able to guarantee in very young women that a reasonable contraception has not to be payed by a long-term risk for the skeletal health. The administration of a progestagen-only pill might be an alternative method for contraception in adolescence. A preparation containing 30 mcg of Levonorgestrel, nearly out of use today, could be of particular interest. A British study has shown that during regular per oral administration of 30 mcg Levonorgestrel per day, mean serum estradiol concentration decreased only slightly, from 653 to 500 pmol/l. This Estradiol concentration should still allow a normal bone metabolism and therefore a normal formation of the peak bone mass. However, the data actually available do not point convincingly to the conclusion that OC with 20 mcg EE or less might result in an insufficient estrogen concentration for normal bone metabolism. To reach peak bone mass, other factors than estrogens only are needed, such as Calcium, Vitamin D and physical activity. (author's)
Review of the complications and medicolegal implications of vasectomy.
Litigation against secondary care practitioners, mainly urologists and general surgeons undertaking vasectomy in the hospital setting or in private practice, is also highly prevalent. Neither the Royal College of Surgeons of England nor the Joint Committee for Higher Training in Urology mentions vasectomy in their curricula. The most common reason for complaint is that the operation failed to render the patient sterile, but failure to warn patients of possible complications such as pain, hematoma, and infection are also prominent causes of patient dissatisfaction. In this article we outline the potential pitfalls in offering a vasectomy service and suggest ways of avoiding them. In so doing we aim to provide guidance for best clinical practice in this litigious area. (excerpt)
Sexuality, difference, and the ethics of sex education.
Sex educators do not intend to harm their students, but this is exactly what they do, according to some perspectives in the study of sexuality. Sex educators are not willfully evil, but most are blissfully ignorant of this moral challenge to their work. They do not defend themselves against this challenge, because they appear not to know it has been mounted. This article will argue that it is wrong for sex educators to ignore the diversity of views about sexuality. It is wrong because some of these views might be correct, and by ignoring them educators risk doing unintended harm to their students. Teaching in ignorance of possibly correct views, which views claim that one's teaching does harm to students, is wrong regardless of whether those views are correct. This is a major charge to mount against a whole field of educational practice. The charge is worth making, because the damage potentially done to students by current sex education practice could be profound. Recognizing this potential for harm first requires understanding some aspects of the debate over the nature of sexuality. The following sections will explore the two broad approaches to defining sexuality: views that tie sexuality to reproductive differences and accounts that divorce sexuality from such differences. The purpose of these sections will be not to establish the correctness of either approach, but to describe the conflict and show its ethical significance to education. Subsequent sections will explore the moral responsibility of sex educators in the face of the contested nature of sexuality. (excerpt)
Health education and cholera in rural Guinea-Bissau.
Objective: The study was undertaken to explore local ideas about cholera and the diffusion of official health educational messages for cholera prevention and to assess whether such messages contributed to changed behavior in the population. Methods: During the ongoing cholera epidemic in 1994 in Guinea-Bissau, West Africa, a roster of all adult residents in a rural community was established. From this roster of 458 adults, 53 of 60 randomly chosen residents were interviewed for qualitative data on cholera and its prevention. Results: Local preventive rituals performed contributed to high awareness of the epidemic. Radio and word-of-mouth communication were the most important sources of information on cholera, whereas posters and television did not effectively reach the population. All persons with cholera rapidly sought care. Thirty-four (64%) of 53 participants recalled at least one preventive measure; specifically, treatment of water with lemon was mentioned by 21 (40%) of respondents. None of the respondents could explain how cholera is transmitted to humans. Conclusions: To improve compliance with recommended preventive measures, these should take local conceptions of diseases into account and be few in number, practical, and effective. The impact of the radio could be increased if those who hear the message are urged to spread the recommendation, especially to women who take care of food, water, and general hygiene in the household. (author's)
Female genital mutilation and its psychosexual impact.
Two hundred and fifty women, randomly selected from the patients of Maternal and Childhood Centers in Ismailia, were examined gynecologically and interviewed to investigate their psychosexual activity. Results showed that the 80% who were circumcised, complained more significantly of dysmenorrhea (80.5%), vaginal dryness during intercourse (48.5%), lack of sexual desire (45%), less frequency of sexual desire per week (28%), less initiative during sex (11%), being less pleased by sex (49%), being less orgasmic (39%), and less frequency of orgasm (25%), and having difficulty reaching orgasm (60.5%) than the uncircumcised women. However, other psychosexual problems, such as loss of interest in foreplay and dyspareunia, did not reach statistical significance. The study suggests that circumcision has a negative impact on a woman's psychosexual life. (author's)
A diabetic survey: report of a working party appointed by the College of General Practitioners.
The introduction of enzyme tests has greatly simplified the task of urine testing and made it possible to conduct surveys on large n