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SEXUAL HEALTH EXCHANGE. 1998; (3):5-6.The Family Planning Association of Kenya (FPAK), together with the Population Council's Africa Operations Research/Technical Assistance Project I, developed a program in rural coastal Kenya to gain insight into the relative effectiveness of reaching men with family planning services. The program sent trained teams of men only, women only, and both sexes to 3 comparable sites in Kilifi District, Coast Province, an area with a contraceptive prevalence lower than the national average, to reach out to men in places where they tend to congregate, and to include them in family planning discussions during home visits. The community-based agents were local people recommended by community leaders and aged 30-40 years, married with children, and with at least primary school educations. The agents were trained in a 10-day course and the fieldwork program lasted 18 months. Subsequent program evaluation determined that husband-wife communication on family planning improved in all 3 sites, with the most communication between spouses occurring in the program with both male and female agents. The all-male team distributed the most condoms and also did well distributing female methods such as foam tablets and oral pills. The most reported behavior change among men in response to AIDS education was a move toward having sex with only one's wife. Some concern was expressed, especially among men, about male agents making home visits and men were more likely to respond to educational activities when they were specifically targeted to men. Men also reported greater current use of modern contraceptive methods than women and a major positive change in behavior in response to HIV/AIDS education.
In: Sexual behaviour and networking: anthropological and socio-cultural studies on the transmission of HIV, edited by Tim Dyson. Liege, Belgium, Editions Derouaux-Ordina, . 249-67.Using a modified form of the WHO partner relations survey questionnaire on a sample of 222 adults, the authors explore seasonal out-migration from the rural area of Mlomp, Senegal, as it relates to coital frequency. Generally low levels of coital frequency were revealed. Unmarried individuals had sex less often than those married. Among married couples, 19% had last intercourse 1-6 days previously and 20% had last intercourse more than 1 year previously. Eliminating those never having experienced sexual intercourse and those having last sex at least 1 year previously, mean duration in the group since last intercourse was about 2 months. A taboo against postpartum sex and the absence of married men during the dry season of palm wine harvesting partially account for these long periods of relative abstinence. Coital frequency is also probably influenced by the overlap of menstrual cycles, seasonal out-migration cycles, and pregnancy and lactation. The authors note that while men are away from their homes during seasonal harvests, however, they definitely partake of extramarital sex. Accordingly, efforts must be made to educate these men about condoms and the risks of unprotected sexual intercourse.
FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 29-30.AIDS and HIV infection are in the early stages in Indonesia. 21 AIDS cases have been reported, and 30 persons have tested HIV-seropositive. Given the relatively low number of cases, and the presumed slow spread of HIV in the population, the government may yet be able to react in timely fashion to thwart epidemic spread. A rigorous education campaign and early detection of infected individuals are elements central to such intervention. The World Health Organization set a 1992 budget of US$500,000 for AIDS efforts in Indonesia. Research is young, awareness is minimal, and the campaign has barely commenced. AIDS cases have emerged in Jakarta, Surabaya, Bandung, and Denpasar. It is especially in cities that the government is concerned over checking the spread of AIDS. In these populations, many engage in extramarital sex, visible transvestite communities exist, and commercial sex districts thrive. Low condom use among sex workers, and relatively high rates of untreated STDs prevail in the general population. From March, blood donated in 15 cities, including these 4, will be compulsorily screened for HIV. Socially, moral and religious attitudes must be recognized and accommodated in mounting an effective AIDS prevention and education campaign in Indonesia. While religious sensibilities may be offended by the discussion of sex and sexual practices, such discussion is necessary and must be supported by the well-organized religious groups in this overwhelmingly Muslim country. Hopefully, Indonesia will bring to bear against AIDS the same cultural pragmatism exhibited to effect population control in the 1970s and 1980s.
WORLDAIDS. 1992 Jan; (19):11.In 1991, researchers followed 212 mothers and infants who tested HIV-1 negative at delivery in Rwanda. Later 8 infants tested HIV positive. Both the infants and mothers became infected simultaneously. They ruled out other routes of infection and concluded that the colostrum and breast milk were possibly the route of infection for 4 infants and positively the route for 4 infants. They postulated that when one 1st becomes infected with HIV, one may have high levels of HIV in the blood and thus be more infectious in the time period between 1st contracting HIV and development of HIV antibodies. All the mothers were vulnerable to sexual exploitation because they were either unmarried or widowed or had absent husbands and unstable sexual partnerships. Thus the risk factor of economic and social instability enhanced their vulnerability to exposure to HIV. The researchers suggested that heal professionals should counsel HIV negative mothers who are at high risk about the possibility of transmitting HIV via breast milk if they happen to seroconvert. In some developing countries like Rwanda, no alternatives to breast feeding exist so the researchers advocated intervention studies to assess the efficacy and feasibility of alternative nutritional practices, such as wet nursing, for mothers at high risk of acquiring HIV after delivery. They did not conclude that already HIV infected mothers should not breast feed since research had not yet proved that infants acquire HIV from breast milk of infected mothers. In fact, other research showed that HIV positive infants who are breast fed live longer than bottle fed HIV infants. After publication of this study, WHO continued its commitment to promote, protect, and support breast feeding no matter what the HIV prevalence of a country is.