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Experiences from the field: HIV prevention among most at risk adolescents in Central and Eastern Europe and the Commonwealth of Independent States.
Geneva, Switzerland, UNICEF, Regional Office for Central and Eastern Europe and the Commonwealth of Independent States, .  p.This document shares experiences in an effort to support programmers, policymakers, and donors to carry out and strengthen further programming among most-at-risk-adolescents (MARA) and other vulnerable adolescents in the Central and Eastern Europe and the Commonwealth of Independent States Region and beyond. It presents programming experiences from Albania, Bosnia and Herzegovina, Moldova, Montenegro, Romania, Serbia, and Ukraine. The overarching goal of these programs has been to promote HIV prevention among MARA and to ensure their integration into national HIV / AIDS program strategies and monitoring and evaluation frameworks.
European Journal of Contraception and Reproductive Health Care. 2008 Mar; 13(1):58-70.Acceptance of sexual and reproductive health as fundamental to the sustainable development of societies has allowed for creation of new reproductive health programmes and policies. WHO sexual and reproductive health (SRH) strategies were developed in the WHO Regional Office for Europe (2001), as well as globally (2004). Adolescent SRH is important in both strategies. Despite these commitments, adolescents remain vulnerable to poor reproductive health. The goal of this paper is to analyse the current status of SRH of adolescents in Europe. Key reproductive health indicators were chosen. Information was obtained from published studies, databases and questionnaires sent to WHO reproductive health counterparts within the health ministries in the Member States of the WHO European Region. Pregnancy rate, age at first sexual intercourse, contraceptive use at first and last intercourse, contraceptive prevalence, HIV knowledge, and STI rates vary widely according to the population considered. Gender difference and lack of information pertaining to SRH of all adolescent populations are other key findings. While the SRH of most European adolescents is good, they remain a vulnerable population. Lack of standardized reproductive indicators and age specific aggregate data make it difficult to accurately assess the situation in individual countries or perform cross country comparison. (author's)
Report of the High-level consultation on improvement of sexual and reproductive health and rights of young people in Europe. Report on a WHO meeting, Copenhagen, Denmark, 11-12 December 2006.
Copenhagen, Denmark, WHO, Regional Office for Europe, 2007. 27 p. (EUR/07/5063690)Representatives nominated by the Ministries of Health from 23 Member States of the WHO European Region, the European Commission, the International Planned Parenthood Federation European Network (IPPF-EN) and Lund University attended a two day high-level consultation meeting to evaluate the midterm results of the project "The way forward: a European partnership to promote the sexual and reproductive health and rights of youth" (2004-2007). The situation on the trends in sexual and reproductive health status of young people in the European Union countries was analysed and tools developed by the WHO, IPPF EN and Lund University were presented. Country representatives discussed the draft policy framework on sexual and reproductive health and rights that will be presented in the final meeting of the project in October 2007 and many recommendations were received to prepare the document that would be an important tool for developing national policies and programs in the area of sexual and reproductive health of young people. (author's)
Copenhagen, Denmark, WHO, Regional Office for Europe, Sexuality and Family Planning Unit, 1986 May. 12 p.In 1965, the World Health Assemble gave the World Health Organization (WHO) a mandate to offer advice on family planning to member states and later states that family planning is an important part of basic health services. In 1884 the 33 members of the European region adopted a plan of action for a consolidated health policy. The goal of this plan and strategy, is for people to have access to health services that will make it possible to have socially and economically productive lives. There will be 4 main areas of effort including, promotion of healthy lifestyles, prevention medicine, better primary health care systems, and more effective political, managerial, technical, manpower, and research to ensure the above. There are ongoing studies to consider sexual health in a variety of cultures. These will assess changing sex roles, information interchange on lifestyle factors and demographic trends, ideas on childrearing styles, and recommendations on the development of healthy sexual relationships. There will be assessments of harmful sexual behavior and the reduction of sexually transmitted diseases. To improve basic health care systems, this program will help[ clarify concepts, investigate needs, analyze present services, get client input, compare information, and draw up guidelines. Methods will be examined to improve information exchange and the distribution of research and other pertinent material. There will be guidelines for legislative proposals in relation to lifestyles that promote better health by 1991. The development of ways to integrate family planning programs and services and connect them to key areas of society, is a goal to be reached by 1993. Also training programs to improve the various aspects of family planning and sexuality, including the attitudes of health professionals is needed.
Report. European Parliamentarians' Forum on Child Survival, Women and Population: Integrated Strategies, February 12-13, 1986, the Hague, Netherlands.
[The Hague, Netherlands, European Parliamentarians' Forum on Child Survival, Women and Population, 1986.] 109 p.This report summarizes the consensus of the European Parliamentarians' Forum on Child Survival, Women, and Population. They have had the opportunity to examine integrated approaches to several of the world's most crucial issues of social development. Their co-sponsors, the World Health Organization, UNICEF, and the UN Population FUND, have been active in promoting integrated strategies to provide health for all, survival and well-being of mothers and children, family planning, and full and equal participation of men and women in the development process. But a great deal more remains to be done. The parliamentarians subscribe to the view that the effectiveness of the UN system will increase considerably in pursuit of commonly defined goals and objectives and action programs as defined in various conferences and meetings. Common action plans are available; the challenge now is to engage in a combined and concerted effort to implement these plans. Their role as parliamentarians is to implement the recommendations of today and to build up support, both within the governmental and the private sectors. Public perception tends to overlook the significant contributions the UN and related bodies are making to improve conditions of life and well-being the world over. The main tasks all have agreed on are 1) encouraging UN agencies and organizations concerned with social development to work together closely and to and enhance the effectiveness of their programs; 2) focusing public attention on the interrelatedness of issues relating to health, mother and child survival and care, the role and status of women, and freedom of choice for both men and women in family matters; 3) seeking greater support for social development programs of the UN, which ultimately strengthens the UN as a whole, through increased governmental contributions and better public understanding; and 4) maintaining and strengthening their own commitment through dialogues among themselves as parliamentarians.
[Unpublished] 1985. 114 p.This document is a practical guide to help those Planned Parenthood Associations which want to establish contraception and counseling services for young people. It draws its examples from the considerable experience of selected European countries in what can be controversial and difficult areas. In the section devoted to adolescent sexuality and contraception, contributors cover culture and subculture, health and sexuality, sexual behavior and contraceptive services, the adolescent experience, the question of opposition to services for adolescents, and statistical indices. 1 section is devoted to examples of contraceptive counseling services for adolescents in Sweden, Italy, France, the UK, and Poland. Another section summarizes service provision examples. The 5th section presents methodology for the establishment of adolescents services and the final section discusses methodology testing of new projects. This report contends that the case for the rapid development of contraceptive/counseling services, tailored to the needs and desires of young people, is justified on moral as well as on sociological, psychological, and health grounds. It rejects totally the argument that any measure which could facilitate the sexual debut of the unmarried or legally dependent adolescent should be resisted. It does recognize public concern about family breakdown and the potential health risks of sexual activity but considers the examples given as measures designed to combat rather than ignore these. Taking into account sociological, psychological, and medical evidence, the contributors to this report challenge the following presumptions: sexual activity among the young is always and necessarily morally unacceptable and socially destructive; adolescents will resort to promiscuous sexual activity in the absence of legal deterrents such as refusal of access to contraceptive/counseling services; the potential health risks of sexual activity and use of contraceptives during adolescence provide sufficient justification for deterrent measures, including refusal of contraceptive/counseling services; and the scale of sexual ignorance and prevalence of unplanned pregnancy among adolescents can only be reduced by disincentives and deterrents to sexual activity itself. The case for the provision of contraceptive/counseling services rests on their potential to help adolescents to recognize and resist repressive forms of sexual activity, which are destructive of humanmanships. Evidence suggests that it is not difficult to attract a large cross-section of an adolescent public to use contraceptive/counseling services, where established.
Update. 2001 Jun; 6-7.This paper presents an interview with Dr. Peter Piot, executive director of the Joint UN Programme on HIV and AIDS (UNAIDS), regarding the link between HIV/AIDS and drug abuse. Piot notes that sharing or using contaminated needles carries a very high risk of HIV infection. Anyone who shares a contaminated needle or who engages in high-risk sexual behavior under the influence of drugs can become infected with HIV. More and more countries are reporting cases of injecting drug use, with 114 of them reporting HIV cases as a direct result. Asia is undoubtedly the region with the largest number of HIV/AIDS cases associated with injecting drug use, due to the sheer size of both its population and its drug injecting population. Prevention of this mode of transmission requires preventing people from engaging in drug abuse, ensuring access to drug treatment, and reaching out to injecting drug users and engaging them in a comprehensive package of prevention interventions. The recently approved UN system position paper entitled “Preventing the transmission of HIV among drug abusers” demonstrates a clear and strong commitment to HIV prevention. Moreover, Piot indicated that although much has been achieved regarding this critical issue, there is still a need to overcome a range of barriers to prevention.
Youth and Reproductive Health in Countries in Transition: report of a European regional meeting, Copenhagen, Denmark, 23-25 June 1997.
New York, New York, UNFPA, 1997. vii, 70 p.A report of a European meeting is presented in this document. The youth and reproductive health meeting held in Copenhagen, Denmark, June 23-25, 1997, was one of the regional meetings organized by the UN Population Fund to enhance the active participation of young people in discussing issues and formulating reproductive and sexual health programs. 67 participants attended the meeting, representing the countries of central and eastern Europe, countries in the Commonwealth of Independent States and the Baltic States; government and nongovernmental organizations from the aforementioned areas; and the national youth organization. This document is subdivided into 6 parts: 1) introduction; 2) opening session; 3) summary of presentation, which includes challenges to adolescent reproductive health; 4) key issues in reproductive and sexual health, which includes unprotected sexual relations and their consequences, sexual abuse, exploitation and violence against young women, lack of clear policies and programs, inadequate social support system, lack of knowledge and skills, lack of sound and relevant information services, lack of human and financial resources, and concluding observations; 5) strategies for action, which include the framework, and the proposed interventions; and 6) concluding remarks.
Psychosexual aspects of natural family planning as revealed in the World Health Organization multicenter trial of the ovulation method and the New Zealand Continuation Study.
In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, DC, December 10-14, 1990, edited by John T. Queenan, Victoria H. Jennings, Jeffrey M. Spieler, Helena von Hertzen. Washington, D.C., Georgetown University, Institute for International Studies in Natural Family Planning, . 118-20.Successful natural family planning (NFP) use depends upon the day-to-day sexual decision making of users. Given the important role of psychosexual factors in this decision making, they are an important influence in both the effectiveness of natural methods as well as in their acceptability as a means of family planning. The World Health Organization (WHO) Multicenter Study of the ovulation method was conducted in Auckland, New Zealand; Bangalore, India; Dublin, Ireland; Manila, the Philippines; and San Miguel, El Salvador with the secondary objective of obtaining psychosexual information to identify factors leading to the successful use of NFP. Findings were reported in 1987. This paper reviews some of the WHO findings and compares them with some preliminary findings of the current study in New Zealand on continuation rates of NFP users following the symptothermal method with the goal of determining rates of continuation and reasons for acceptability. The WHO study found that the more satisfied people were with NFP and the less difficulty they reported with abstinence, the more likely they were to be successful users, as measured by their avoidance of pregnancy. The New Zealand Study, however, indicates that for many couples abstinence may not be the main difficulty in using NFP, and that long-term acceptance is not necessarily influenced by pregnancy. The authors notes that the two studies involved different NFP methods. The challenge for the future of NFP services is to learn more about what leads to acceptability in different countries and cultures, remembering that for a natural method of family planning, success depends very much upon the decisions, attitudes, and resulting behavior of the couple involved.
ANTIBIOTICS AND CHEMOTHERAPY. 1991; 43:1-13.Delphi techniques used by the World Health Organization predict more than 6 million cases of AIDS and millions more to be infected with HIV by the year 2000. In the absence of quick solutions to the epidemic, one must prepare to work against and survive it. The modes of HIV transmission are constant and seen widely throughout the world. Transmission may occur through sexual intercourse and the receipt of donated semen; transfusion or surgically-related exposure to blood, blood products, or donated organs; and perinatally from an infected mother to child. There are, however, 3 patterns of transmission. Pattern I transmission is characterized by most cases occurring among homosexual or bisexual males and urban IV-drug users. Pattern II transmission is predominantly through heterosexual intercourse, while pattern III of only few reported cases is observed where HIV was introduced in the early to mid-1980s. Both homosexual and heterosexual transmission have been documented in the latter populations. Significant case underreporting exists in some countries. Investigators are therefore working to find incidence rates of both infection and AIDS cases to better estimate actual present and future needs in the fight against the epidemic. Surveillance data does reveal a rapidly rising and marked number of reported AIDS cases. The cumulative number reported to the World Health Organization increased over 15-fold over the past 4 years to reach 141,894 cases by March 1, 1989. Large, increasing numbers of cases are reported from North and Latin America, Oceania, Western Europe, and areas of central, eastern and southern Africa. 70% of all reported cases were from 42 countries in the Americas. 85% of these are within the United States. Increases in the proportion of IV-drug users who are infected with HIV are noteworthy especially in Western Europe and the U.S. The epidemic in Italy is also specifically discussed.
[Unpublished] 1989.  p. (WHO/GPA/INF/89.21)In October 1989, WHO and the International Labour Office (ILO) organized a consultation on AIDS and seafarers. Participants included shipowners, public health professionals, physicians, seafarer organizations, and government representatives. They concluded that seafarers were not at particular risk since they work and live basically on ships for extended periods of time. Nevertheless conditions do exist that warrant special attention. For example, they are a geographically mobile young population living and working in a mixed cultural environment. This environment restricts their accessibility to health facilities and timely information and HIV and AIDS. Further, the nature of their profession limits social interaction on board ship and on shore. Therefore the consultation stated aims and objectives to help prevent HIV transmission and to promote the health of HIV positive seafarers on the job. Shipping owners and seafarer organizations should develop strategies together, and where appropriate, with governmental and other agencies to achieve these goals. The consultation recommended that WHO and ILO provide guidance AIDS health promotion, encourage its integration into overall health promotion, and support any regional pilot projects on AIDS health promotion. They should also establish a resource center and a network to disseminate resource packages with culturally sensitive material, such as video tapes and posters. In addition, these international organizations should reexamine current occupational health and safety regulations and medical guides for ships and the manner in which they are applied. Accordingly they should develop a seafarer's manual for physician use. WHO and ILO should widely distribute the consultation statement to relevant organizations. Finally, they should encourage national AIDS committees to tie in with individuals working on HIV/AIDS issues for seafarers.
JAMA. 1988 Apr 1; 259(13):1917-9.The largest number of AIDS cases (55,167) are in the US. The World Health Organization reports a total of 81,433 cases in 133 other countries, of which 10,770 are in Europe. However, the statistics are not reliable from many parts of the world, and the World Health Organization estimates that there will be 1 million AIDS cases by 1990. In France and Brazil the number of cases doubled between 1987 and 1988, to 3073 and 2325 respectively; in Uganda, they quadrupled to 2369 cases. AIDS in the Third World was a subject for discussion at the Boston meeting of the American Association for the Advancement of Science. In central and southern Africa, AIDS is spreading rapidly, by heterosexual transmission, especially in the cities, causing some observers to worry that it will deplete the educated elite in African countries. AIDS educational campaigns in Africa are hampered by the number of different languages spoken and by the attitude that AIDS is "just another white man's sexually transmitted disease." Educational campaigns, on the other hand, have been very successful in the Dominican Republic, where the level of knowledge about AIDS is very high, partly due to fear engendered by the country's proximity to Haiti and partly to the tacit support of the Catholic Church. Condom use among young men in Santo Domingo has doubled. In Brazil, where sexual mores are lax, there are expected to be 75,000 AIDS cases within 5 years. Brazil does not have the resources to deal with the epidemic. The people are so poor that many cannot afford even the expense of a condom, and there is widespread selling of blood. The average 20-day hospitalization of an AIDS patient costs $17,000; this is almost 3 times the average yearly income of a physician in Brazil. Japan does not recognize AIDS as a national problem, and since seropositive people are reported by name, people resist testing. The Soviet Union reports no deaths from AIDS and a total incidence of 33 cases, 18 of which were reportedly infected by foreigners.
London, England, Bodley Head, 1984. 286 p.This biography of the British family planning pioneer Helena Wright, who lived from 1887-1981, is based on her books, letters, and papers and on a series of personal interviews, as well as on the recollections and writings of her friends, colleagues, and critics. Considerable attention was given to her background and early life because of their strong influence on her later works and attitudes. Wright was the only physician among the small group of women who founded the British Family Planning Association, and was a founder and officeholder of the International Planned Parenthood Federation. She helped gain acceptance of the principle of contraception from the Anglican clergy and the medical establishment, and was an early worker in the field of sex education and sex therapy. Among Wright's books were works on sexual function in marriage, sex education for young people, contraceptive methods for lay persons and for medical practitioners, and sexual behavior and social mores. This biography also contains extensive material on the history of contraception and of the birth control movement, including the development of the British Family Planning Association and the International Planned Parenthood Federation, as well as important early figures in the movement.
[Voluntary sterilization in France and in the world] La sterilisation volontaire en France et dans le monde.
Paris, Masson, 1981. 277 p.This monograph, directed not only to medical and paramedical personnel but to sterilization seekers as well, touches upon all aspects of voluntary sexual sterilization. The history of sterilization is follwed by a review of female and male anatomy and physiology, and of present available and reversible methods of contraception. All surgical, laparoscopic, tubal, electrocoagulation, culdoscopic, or hysteroscopic methods of female sterilization are described, and results, including morbidity and mortality, complication rates, side effects, and failure rates are presented. This part of the monograph is illustrated with clear and schematic drawings. Problems related to demand for reversal of sterilization are discussed. The same is done for male sterilization, its techniques and complications. The monograph discusses the ever increasing demographic problem in the world , and the role and the extent of voluntary sexual sterilization in industrialized countries and in third world countries, stressing the efforts of those international agencies, such as WHO, IPPF, the Population Council, the European Council, UNFPA, and the World Federation of Associations for Voluntary Sterilization, which promote sterilization around the world, and offer sterilization services. The authors then investigate the role of the physician in the decision to recur to sterilization as a permanent contraceptive method, and in deciding the proper surgical technique. A special chapter discusses the psychological conflicts related to sterilization, especially those which arise before the intervention, and which may very well represent the strongest contraindication to sterilization. A final chapter is devoted to France and to the sociocultural aspects which make sterilization more or less acceptable, the existing legislation, and the professional problems linked to sterilization interventions.
IPPF Regional Information Bulletin 8(2):12. April 1979.An English speaking, subregional working group of the IPPF meet in London on March 6-7 to discuss obstacles to contraception and agreed to limit the discussion to problems involved in adolescent sexual education. Points brought out in the discussion were 1) parents should be provided with sex education information since they are able to transmit this information to their children in a more individualized manner, taking into account the maturity and sexual experience of the child, than is possible in the age-graded, sex education programs presented in classroom settings; 2) adults frequently equate sex with coitus and fail to take into account noncoital sexuality; 3) health personnel, responsible for imparting contraceptive information, must be aware of the profit-oriented motives of contraceptive manufacturers; and 4) the legitimacy of some obstacles to contraceptives, such as medical contraindications, must be recognized. The working group will present a full report at the Regional Council meeting in May, 1979.
Intercom 6(7):11. July 1978.Service-Oriented Research in Adolescent Fertility in Europe was the theme of a recent meeting sponsored by WHO in the Eastern European city of Warnemunde, German Democratic Republic (GDR). Representing formal recognition of the reality of premarital adolescent fertility and the societal problems associated with unintended and unwanted pregnancies in both developed and developing European countries, the gathering drew participants from all major regions of Europe, the U.S., and WHO's Geneva headquarters. Cosponsors included the GDR Society for Marriage and the Family, Joint Center for the Study of Health Programs Institute, University of Copenhagen, and the Transnational Family Research Institute, whose director, Henry P. Davis, presented the keynote address. An immediate follow-up meeting held in WHO's Copenhagen offices dealt with the application of research findings to the development of teen fertility programs, and country-specific priorities for research are expected to evolve from continuing consultations. Among the recommendations was a plea that the service providers, policymakers, and knowledgeable youth be brought into the planning process from the very beginning. A combined report of papers, discussions, and recommendations will be published in English, French, German, and Russian by WHO, which is expected to strengthen its role in providing information and technical consultation.(FULL TEXT)
Family Planning Perspectives. November-December 1977; 9(6):286-292.When Margaret Sanger initiated the American birth control movement in the early twentieth century, she stressed female and sexual liberation. Victorian views on morality have since combined with the compromises necessitated to achieve legitimacy for the movement to lead to a desexualization of the birth control movement. The movement's communication now concentrates on reproduction and ignores sex; it emphasizes family planning and population control but does not mention sexual pleasure. Taboos against publicity concerning contraceptives are more powerful even than laws restricting the sale or distribution of contraceptives themselves in many countries. The movement must recover its earlier revolutionary stance.
San Francisco, San Francisco Press, 1974. 292 p.Despite its high effectiveness, lack of side effects, ease of use, and low cost, condom utilization has declined in the U.S. from 30% of contracepting couples in 1955 to 15% in 1970. The present status of the condom, actions needed to facilitate its increased availability and acceptance, and research required to improve understanding of factors affecting its use are reviewed in the proceedings of a conference on the condom sponsored by the Battelle Population Study Center in 1973. It is concluded that condom use in the U.S. is not meeting its potential. Factors affecting its underutilization include negative attitudes among the medical and family planning professions; state laws restricting sales outlets, display, and advertising; inapplicable testing standards; the National Association of Broadcasters' ban on contraceptive advertising; media's reluctance to carry condom ads; manufacturer's hesitancy to widen the range of products and use aggressive marketing techniques; and physical properties of the condom itself. Further, the condom has an image problem, tending to be associated with venereal disease and prostitution and regarded as a hassle to use and an impediment to sexual sensation. Innovative, broad-based marketing and sales through a variety of outlets have been key to effective widespread condom usage in England, Japan, and Sweden. Such campaigns could be directed toward couples who cannot or will not use other methods and teenagers whose unplanned, sporadic sexual activity lends itself to condom use. Other means of increasing U.S. condom utilization include repealing state and local laws restricting condom sales to pharmacies and limiting open display; removing the ban on contraceptive advertising and changing the attitude of the media; using educational programs to correct erroneous images; and developing support for condom distribution in family planning programs. Also possible is modifying the extreme stringency of condom standards. Thinner condoms could increase usage without significantly affecting failure rates. More research is needed on condom use-effectiveness in potential user populations and in preventing venereal disease transmission; the effects of condom shape, thickness, and lubrication on consumer acceptance; reactions to condom advertising; and the point at which an acceptable level of utilization has been achieved.