THE NEWLY INFECTED ARE MOST LIKELY TO TRANSMIT HIV

The risk of heterosexual HIV transmission per coital act is highest for people who have a newly acquired infection, according to a study conducted among 235 monogamous, HIV-discordant couples in Rakai, Uganda.1 By analyzing data collected from the couples between 1994 and 1999, researchers estimated that the overall rate of HIV transmission was 1.2 cases per 1,000 coital acts. People in the earliest stage of infection (i.e., the first 2.5 months after becoming HIV-positive) transmitted the infection to their partners at the highest rate—8.2 cases per 1,000 coital acts. The rate decreased to 0.7–1.5 cases per 1,000 coital acts among people with established infections, but then increased to 3.6 cases per 1,000 coital acts among those with late-stage infections (i.e., 6–25 months before death). In a multivariate analysis adjusted for age, viral load and genital ulcer disease, people with early- and late-stage infections had significantly higher risks of HIV transmission than did those with established infections (rate ratios, 5.0 and 3.5, respectively). The researchers comment that "measures that prevent primary HIV infection or reduce early viremia are likely to have a greater effect than antiretroviral therapy on the spread of HIV."

1. Wawer MJ et al., Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda, Journal of Infectious Diseases, 2005, 191(9):1403–1409.

CONTRACEPTIVE KNOWLEDGE MAY NOT LEAD TO USE

Among postpartum adolescents in El Salvador, education and literacy predict contraceptive knowledge, but neither literacy nor contraceptive knowledge predicts contraceptive use, according to a study conducted in October 2002 in an urban public hospital.1 Of the 50 13–18-year-olds interviewed, all but two reported that their current pregnancy was unintended. Three-quarters were able to name at least one contraceptive method, but fewer than one-fifth (18%) had ever used a method. And in spite of the high level of unintentional pregnancy, only 58% intended to practice contraception in the future. In univariate analyses, higher levels of education and literacy predicted contraceptive knowledge. However, neither these factors nor contraceptive knowledge predicted contraceptive use. On the other hand, having a partner and living with a partner did predict use. The authors conclude that their finding that contraceptive knowledge does not predict contraceptive use highlights "the importance of incorporating family planning research and interventions into the social context in which adolescents exist."

1. Newmann SJ et al., Predictors of contraception knowledge and use among postpartum adolescents in El Salvador, American Journal of Obstetrics and Gynecology, 2005, 192(5):1391–1394.

HIV RISK ELEVATED AMONG BAR PATRONS IN ZIMBABWE

The risk of HIV infection is greater among men and women who visit beer halls than among those who do not, according to a study conducted in the Manica- land province of Zimbabwe between July 1998 and January 2000.1 The study used data from a population-based survey that collected information on social and demographic characteristics, sexual behavior and beer hall visits; in addition, blood specimens were collected for HIV testing. Of the more than 9,000 participants, 50% of males and 4% of females reported visiting a beer hall in the last month. Visiting a beer hall was associated with sexual activity: For example, among 17–24-year-olds, men and women who had recently been to a beer hall were more likely than those who had not to be sexually active (odds ratios, 4.9 and 3.2, respectively). Furthermore, beer hall visitors had significantly greater mean numbers of lifetime partners, partners in the last year and new partners in the last year. In logistic regression analyses adjusted for age and marital status, men and women who had recently been to a beer hall had elevated odds of being HIV-positive (1.6 and 2.1, respectively); in addition, male bar patrons had elevated odds of ever having experienced urethral discharge or genital sores (1.6 and 1.4, respectively), and their female counterparts had elevated odds of ever having experienced vaginal discharge (1.5). The authors comment that "beer halls may be an important focus for prevention efforts," although they add that "the ability and willingness of intoxicated individuals to absorb and retain these important messages is unclear."

1. Lewis JJ et al., Beer halls as a focus for HIV prevention activities in rural Zimbabwe, Sexually Transmitted Diseases, 2005, 32(6):364– 369.

THE COST OF SAVING CHILDREN’S LIVES

The universal provision of 23 basic health interventions—such as measles vaccination and vitamin A supplementation—that could save the lives of millions of children each year is both feasible and affordable.1 According to a cost-estimate study, 42 countries have 90% of the world’s child deaths. It would take approximately $5.1 billion in new resources each year to provide these proven preventive and treatment interventions to all children younger than five who did not receive such services in 2000 in these coun-tries.1 That comes out to about $1.23 per person per year living in those countries, or an average cost of $887 per child life saved. The authors comment that "this cost should be affordable for governments in even the poorest countries." They point out, however, that "donor inputs and donor convergence are needed to scale up the health systems." When this occurs, they conclude, "countries will be able to sustain these achievements, once they are attained."

1. Bryce J et al., Can the world afford to save the lives of 6 million children each year? Lancet, 2005, 365(9478):2193– 2200.

OVER-THE-COUNTER EC FINDS LITTLE FAVOR IN HONG KONG

Chinese women have poor knowledge about and conservative attitudes toward emergency contraception, suggesting that efforts to make the method available over the counter may be premature.1 According to survey data collected from 1,405 female clients of Hong Kong birth control clinics and youth health care centers between November and December 2003, 64% reported having heard of emergency contraception, and 52% knew that the method should be used within 72 hours of unprotected sex; awareness and correct knowledge were positively correlated with younger age, higher education, having never given birth and being single. Sixteen percent of women had ever used emergency contraceptives. Approximately half (49%) said that they supported doctors providing emergency contraception in advance, and about a quarter (26%) supported the method being sold over the counter. The most commonly cited reasons for opposing more liberal provision of emergency contraception were side effects, possible misuse of the method and the belief that it would promote irresponsible sex. In light of their findings, the authors conclude that efforts to make emergency contraception available in Hong Kong without a prescription would be unwarranted at this time. Instead, they suggest focusing on improving acceptance of advance provision of the method by enhanced public education and continuing medical education for doctors.

1. Wan RSF and Lo SST, Are women ready for more liberal delivery of emergency contraceptive pills? Contraception, 2005, 71(6):432–437.

GESTATIONAL LENGTH AND MATERNAL WEIGHT

The gestational age of a newborn may be associated with the mother’s prepregnancy weight, according to a study using weight data and birth records from three Gambian villages.1 The region in which these rural farming villages are located experiences an annual rainy season, causing regular intervals of hunger and abundance. Women’s average weights fluctuate with the food supply, with their lowest weights occurring between September and November each year. Of the 2,977 live births delivered in the villages between 1978 and 2003, the records of 1,918 included gestational ages assessed by medical doctors within five days of birth. Overall, the average gestational age was 38.9 weeks; mean gestational ages were lower for infants born between June and December, with the lowest value occurring in July (38.1). When the researchers superimposed gestational age by month of birth against women’s mean weight at the time of conception, there was a correlation between the two; there was no such correlation between gestational age and women’s mean weight change at time of conception. In further analyses, births conceived between September and November were delivered significantly earlier than those conceived in other months. The researchers comment that their results "suggest a possible link between low maternal energy stores at conception and shortened gestation," but caution that "other seasonally variable events… might play a role."

1. Rayco-Solon P, Fulford AF and Prentice AM, Maternal preconceptional weight and gestational length, American Journal of Obstetrics and Gynecology, 2005, 192(4):1133–1136.

PREGNANCY BECOMES LESS RISKY FOR EGYPTIAN WOMEN

In Egypt, the maternal mortality ratio decreased by 52% from the early 1990s to the end of the decade, in part due to improvements in care by health providers and to reduced delays in recognizing problems and seeking medical care.1 Between March 1992 and February 1993, the Ministry of Health and Population conducted a survey of health bureaus in 21 governates; a similar survey of 27 governates was conducted by the ministry between January and December 2000. In 1992–1993, 174 women died of pregnancy-related causes for every 100,000 live births; the ratio for 2000 was 84—a 52% reduction. The ratio decreased for all regions, but the largest decreases occurred in Egypt’s urban areas (233 to 48) and in the less developed parts of the South (217 to 89). The most common cause of maternal death—hemorrhage—was the same during both survey periods, accounting for 30% of deaths in each. There were substantial reductions, however, in the number of deaths due to certain avoidable causes, such as substandard care by obstetricians, poor antenatal care, and delay in recognizing problems and seeking medical care. The analysts conclude that the "reduction in [the ratio] over a relatively short time demonstrates the collective effect of an integrated national Safe Motherhood programme aimed at making improvements at the community, health-care delivery site and health-care professional levels."

1. Campbell O et al., National maternal mortality ratio in Egypt halved between 1992–93 and 2000, Bulletin of the World Health Organization, 2005, 83(6):462– 471.

IN BRIEF

•The Population Reference Bureau has released its 2005 World Population Data Sheet, which shows that more than half of the world’s people live below the internationally defined poverty line of less than $2 a day and that 99% of the world’s population growth occurs in the developing world. The data sheet is available at <http://www. prb.org/pdf05/05WorldDataSheet_Eng.pdf>.

•The Swedish International Development Cooperation Agency–sponsored training program in sexual and reproductive health is now open to obstetricians, midwives and policymakers from 23 Sub-Saharan African countries. More information about the program, which is free of charge and includes one month of training in Sweden and a final seminar in South Africa, can be found at <http://www.lu.se/o.o.i.s/3225&gt;.