To subscribe to Youth InfoNet (and other electronic notices of YouthNet publications and information), or to propose submissions to this newsletter, please send an email to youthnetpubs@fhi.org.
For copies of the publications, please contact the publisher, not YouthNet.
RESEARCH ARTICLES
Contraceptive Use
1. Access to contraceptive services among unmarried young people in the north-east of China
2. Contraceptive use in teens: a threat to bone health?
3. Depot medroxyprogesterone acetate, oral contraceptives and bone mineral density in a cohort of adolescent girls
4. Emergency contraception use is correlated with increased condom use among adolescents: results from Mexico
5. Fertility trend and pattern in a rural area of South Africa in the context of HIV/AIDS
6. Missed opportunities: emergency contraception utilisation by young South African women
Sexually Transmitted Infections/HIV
7. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial
8. High-risk behaviors and beliefs and knowledge about HIV transmission among school and shelter children in Eastern Europe
9. The influence of alcohol, drugs and substance abuse on sexual relationships and perception of risk to HIV infection among adolescents in the informal settlements of Nairobi
10. Methamphetamine users in northern Thailand: changing demographics and risks for HIV and STD among treatment-seeking substance abusers
11. Prevalence and determinants of genital infection with papillomavirus, in female and male university students in Busan, South Korea
12. Prevalence and risk behaviors for chlamydial infection in a population-based study of female adolescents in Brazil
13. Rich fools, spare tyres and boyfriends: partner categories, relationship dynamics and Ivorian women's risk for STIs and HIV
14. Risk for HIV infection among adolescents in the Border City of Tijuana, Mexico
15. Sexual exposure to blood and increased risks for heterosexual HIV transmission in Cape Town, South Africa
Research Issues
16. "A bit more truthful": the validity of adolescent sexual behaviour data collected in rural northern Tanzania using five methods
17. Consistency in the reporting of sexual behavior by adolescent girls in Kenya: a comparison of interviewing methods
***************
RESEARCH ARTICLES
Most of these articles are not available on-line without a subscription to the journal. To obtain the full article, you will need to contact the journal directly or through your organization's library.
Contraceptive Use
1. Access to contraceptive services among unmarried young people in the north-east of China. Zhang LY, Jejeebhoy S, Shah IH, et al. W. Eur J Contracept Reprod Health Care 2004;9(3):147-54.
To investigate factors associated with young people's access to contraceptive services, a study was conducted in 2001 in Changchun city among 1,227 unmarried young people aged 15-24 years (619 males and 608 females). It assessed risky sexual practices and the obstacles to accessing appropriate contraceptive and other services. The study included a community-based survey employing self-administered questionnaires, key informant interviews, focus group discussions and in-depth interviews. Results showed that 16% of young people had experienced premarital sexual intercourse and, among them, only 48% used contraceptive methods during the first sexual intercourse; 30% used a condom. Drug stores were the main source of contraceptives. Findings suggest that the hostile and judgmental attitudes of providers, as well as the lack of counseling and privacy, were the key obstacles that unmarried youth encountered in their search for contraceptive services. Findings suggest the need for a reorientation of the contraceptive services to focus on unmarried youth, and generally to make contraceptive services more accessible to young people.
2. Contraceptive use in teens: a threat to bone health? Gold MA, Bachrach LK. J Adolesc Health 2004;35(6):427-9.
This editorial appeared in the same journal issue that reported a negative impact of some hormonal methods to bone density of adolescents (see depot medroxyprogesterone acetate, DMPA, study below). The editorial addresses some of the methodological issues involved in the study and emphasizes the risk vs. benefit nature of these contraceptive methods. It emphasizes that DMPA and oral contraceptives have contributed to the decline in teen pregnancy in the past decade in the U.S., where the study was conducted. It concludes that the potential adverse effects of DMPA and low-dose oral contraceptives should be viewed in the context of risks and benefits of all contraceptive options and unintended pregnancy.
3. Depot medroxyprogesterone acetate, oral contraceptives and bone mineral density in a cohort of adolescent girls. Cromer BA, Stager M, Bonny A, et al. J Adolesc Health 2004;35(6):434-41.
The study conducted a longitudinal comparison of bone mineral density (BMD) in 370 adolescent girls, aged 12-18, comparing those who self-selected depot medroxyprogesterone acetate (DMPA) or an oral contraceptive (OC) containing 20 microg ethinyl estradiol/100 microg levonorgestrel, with girls who received no hormonal treatment (control group). Lumbar spine and femoral neck BMD measurements were obtained by dual energy x-ray absorptiometry at baseline and 12 months. Data were analyzed with repeated measures analysis of covariance methods. Over 12 months, lumbar spine BMD decreased in the DMPA group (n = 29), with a mean percent change of -1.4% (95% confidence interval [CI] -2.73, -0.10), and increased by a mean of 3.8% (95% CI 3.11, 4.57) in the control group [n = 107 (p < .001)]. The increase in mean percent change in lumbar spine BMD in the OC group (n = 79), 2.3% (95% CI 1.49, 3.18), was significantly smaller than in the control group (p = .03). Over 12 months, the mean percent change in femoral neck BMD was -2.2% (95% CI -3.95, -0.39) in the DMPA group, but increased 2.3% (95% CI 1.29, 3.27) in the control group (p < .001). The increase in mean percent change at the femoral neck in the OC group, 0.3% (95% CI -0.87, 1.41), was significantly lower than in the control group (p = .03). Our study contributes to an increasing body of knowledge indicating a negative impact of DMPA on bone health in young women. Additional findings suggest a potential adverse effect of an OC containing 20 microg ethinyl estradiol/100 microg levonorgestrel on bone health in adolescents.
4. Emergency contraception use is correlated with increased condom use among adolescents: results from Mexico. Walker DM, Torres P, Gutierrez JP, et al. J Adolesc Health 2004;35(4): 329-34.
To evaluate the association between knowledge about, or experience with, emergency contraception (EC), and condom use among school-attending adolescents in the state of Morelos, Mexico, we analyzed data from anonymously self-administered questionnaires (n = 10,918), from a cluster-randomized controlled trial among first year students from 40 (75%) public high schools in Morelos. The survey included specific questions about EC knowledge and experience as well as questions about perceived ability to negotiate and condition sexual relations on condom use; and condom use at first and last sexual intercourse. Overall, 61% (6,384) of students had heard of EC, and 36% (1,964) of girls and 39% (1,997) of boys had correct knowledge about EC. Correct knowledge was based upon knowing that EC is pills taken up to 3 days after unprotected sex to prevent pregnancy. Of 1,695 (16%) reporting lifetime sexual activity, 16% (275) reported they had tried to obtain EC and almost of all them (263) reported having used EC. The probability of a student reporting he/she is capable of interrupting sexual intercourse to use a condom was significantly higher for those who had correct EC knowledge, and a history of EC use was strongly correlated with condom use at last sexual intercourse. Experience with emergency contraception has no adverse effects on condom use, but rather is associated with an increased probability of condom use and an increased perceived capacity to negotiate condom use. Despite concern that information about, and access to, EC may encourage sexual risk taking, our results suggest the reverse is true. These data support the position that there is no justification to withhold EC information or access from adolescents.
5. Fertility trend and pattern in a rural area of South Africa in the context of HIV/AIDS. Camlin CS, Garenne M, Moultrie TA. Afr J Reprod Health 2004;8(2):38-54.
Various demographic and statistical techniques were used to examine fertility patterns in a population of 21,847 women in a rural KwaZulu-Natal (KZN) demographic surveillance area. These are compared with patterns seen in another South African rural population under demographic surveillance, and with data from the 1998 South Africa Demographic and Health Survey. Findings are interpreted in light of contraceptive use patterns and HIV prevalence in the population. In rural KZN, where national fertility levels are highest, fertility has declined rapidly for about two decades and would have reached below replacement level in 2003. While fertility has declined rapidly among all women over age 18 years, fertility levels among adolescents have not changed in decades. Although most adolescents in rural KZN were sexually active (60%), few had ever used contraception. High HIV seroprevalence appears to explain a small part of the fertility decline (12%); however, this effect is likely to grow in the near future as the HIV/AIDS epidemic continues in South Africa.
6. Missed opportunities: emergency contraception utilisation by young South African women. Mqhayi MM, Smit JA, McFadyen ML, et al. Afr J Reprod Health 2004;8(2):137-44.
Although contraceptives, including emergency contraceptives, are widely available free at public health facilities in South Africa, rates of teenage and unintended pregnancy are high. This paper analyzes awareness and utilization of emergency contraception amongst 193 young women (aged 15 to 24 years) attending public sector health facilities. Structured interviews were held at 17 and 14 primary health clinics in an urban and a rural area, respectively. Respondents were asked about their knowledge of contraceptive methods and use, and specifically about emergency contraceptive utilization. More sexually active young urban women (76%) were currently using a method of contraception, compared to the young rural women (53%). Only 17% had ever heard of emergency contraception, although significantly more in the urban area (p = 0.005) had heard of it. Only one woman from each site had ever used emergency contraception, although 39% had had unprotected intercourse in the previous year when they did not wish to conceive. Young South African women should be the focus of interventions aimed at improving awareness of the availability of emergency contraception and knowledge about its correct utilization.
Sexually Transmitted Infections/HIV
7. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Harper DM, Franco EL, Wheeler C, et al. Lancet 2004;364(9447):1757-65.
Vaccination against the most common oncogenic human papillomavirus (HPV) types, HPV-16 and HPV-18, could prevent development of up to 70% of cervical cancers worldwide. We did a randomised, double-blind, controlled trial to assess the efficacy, safety, and immunogenicity of a bivalent HPV-16/18 L1 virus-like particle vaccine for the prevention of incident and persistent infection with these two virus types, associated cervical cytological abnormalities, and precancerous lesions. We randomised 1,113 women between 15 to 25 years of age to receive three doses of either the vaccine formulated with AS04 adjuvant or placebo on a 0 month, 1 month, and 6 month schedule in North America and Brazil. Women were assessed for HPV infection by cervical cytology and self-obtained cervicovaginal samples for up to 27 months, and for vaccine safety and immunogenicity. In the according-to-protocol analyses, vaccine efficacy was 92% (95% CI 64.5-98.0) against incident infection and 100% against persistent infection (47.0-100) with HPV-16/18. In the intention-to-treat analyses, vaccine efficacy was 95% (63.5-99.3) against persistent cervical infection with HPV-16/18 and 93% (70.0-98.3) against cytological abnormalities associated with HPV-16/18 infection. The vaccine was generally safe, well tolerated, and highly immunogenic. The bivalent HPV vaccine was efficacious in prevention of incident and persistent cervical infections with HPV-16 and HPV-18, and associated cytological abnormalities and lesions. Vaccination against such infections could substantially reduce incidence of cervical cancer.
8. High-risk behaviors and beliefs and knowledge about HIV transmission among school and shelter children in Eastern Europe. Goodwin R, Kozlova A, Nizharadze G, et al. Sex Transm Dis 2004;31(11):670-5.
This study examined sexual behavior, injecting drug use, knowledge and representations of HIV transmission among adolescents in Russia, Georgia, and the Ukraine. It included semi-structured interviews on sexual behavior and structured inventories assessing knowledge of HIV transmission, sexual behavior and drug use, and social representations of the epidemic. Shelter children are more likely than school children to have had sex and injected drugs. Georgian school children are more likely than the other school children to have sex and inject drugs. Shelter children and Georgians are the most likely to hold mistaken representations about the epidemic. Particular groups (Russian and Ukrainian shelter children, Georgian school children) urgently require education about the risks of HIV/AIDS.
9. The influence of alcohol, drugs and substance abuse on sexual relationships and perception of risk to HIV infection among adolescents in the informal settlements of Nairobi. Mugisha F, Zulu EM. J Youth Stud 2004;7(3):279-93.
This study explores the impact of alcohol, drug, and substance abuse on HIV-related sexual risk behavior and the risk perception of HIV infection among the adolescents of Nairobi slums. Using the Nairobi Cross-sectional Slum Survey, a representative sample of adolescent boys and girls from Nairobi slums, the results suggest that alcohol and drugs have a positive effect on having been forced or having forced anyone to have sexual intercourse, having a boyfriend/girlfriend, and risk perception of HIV infection. In addition, boys are at increased risk of forcing others to have sexual intercourse, while girls are at increased risk of being forced. Being in school is protective, and those in school perceive themselves less at risk of HIV infection. Increasing urbanization, with the majority living in the slums and without substantial investment in addressing factors that predispose the adolescents to alcohol and drugs, is likely to increase the proportion of the population at increased risk of HIV infection.
10. Methamphetamine users in northern Thailand: changing demographics and risks for HIV and STD among treatment-seeking substance abusers. Beyrer C, Razak MH, Jittiwutikarn J, et al. Int J STD AIDS 2004;15(10):697-704.
Our objective was to determine sociodemographic, sexual, and drug-use-related risk factors among methamphetamine (MA) users presenting for drug treatment in northern Thailand. Patients admitted for drug detoxification for MA and other drugs were studied cross-sectionally for risk factors associated with substance abuse and blood-borne and sexually transmitted pathogens. In all, 1,865 (200 women) patients treated for MA, opiate, and mixed substance abuse between 1 February 1999 and 31 January 2000 completed all study procedures. Among 1,865 participants, 750 (40%) were admitted for MA detoxification and 1,115 (60%) for opiate (heroin, opium, or both) treatment. MA users were significantly younger, better educated, more likely to be Thai than highland ethnic minorities, and had significantly different sexual risks and sexually transmitted disease rates, including lower syphilis seropositivity and higher chlamydial prevalence, than persons admitted for opiate or mixed drug treatment. For those who reported MA use only, use by injection was rare and HIV infections significantly less common than among all other drug users. Thailand is undergoing an epidemic of MA use. These young users are a strikingly different population from opiate/heroin users in northern Thailand. MA users had lower HIV rates than injecting drug users, but still elevated. MA use is a serious public health problem in Thailand and both improved prevention and treatment methodologies are urgently needed.
11. Prevalence and determinants of genital infection with papillomavirus, in female and male university students in Busan, South Korea. Shin H-R, Franceschi S, Vaccarella S, Roh J-W, et al. J Infect Dis 2004;190(3):468-76.
Little is known about the prevalence of human papillomavirus (HPV) infection in young adults in Asia. We invited female and male students in Busan, South Korea, to participate in a survey that included, for females, self-collection of vaginal cells and, for males, physician-performed collection of exfoliated genital cells. The prevalences of 25 HPV types were evaluated, by a polymerase chain reaction-based assay, in 672 female students (median age, 19 years) and in 381 male students (median age, 22 years). HPV DNA was detected more frequently in female students (15%) than in male students (9%); in both sexes, high-risk HPV types were predominant. Among sexually active students, HPV prevalence was 39% in females and 11% in males. In female students, currently smoking cigarettes and having multiple lifetime sex partners were the strongest risk factors for HPV infection; in male students, associations between HPV prevalence and sexual habits were similar to those in female students but never attained statistical significance. Young women in South Korea start having penetrative sexual intercourse relatively late (median age, 18 years), but, once they begin, HPV prevalence quickly rises to levels comparable with those found in university students in the United States and in northern Europe. The high rate of participation in our study suggests that trials of new vaccines against HPV may be feasible among university students in South Korea.
12. Prevalence and risk behaviors for chlamydial infection in a population-based study of female adolescents in Brazil. Miranda AE, Szwarcwald CL, Peres RL, et al. Sex Transm Dis 2004;31(9):542-6.
The objective of this study was to identify demographic, behavioral, and clinical factors for STIs and to determine the prevalence of Chlamydia trachomatis infection (CT) among female adolescents in Vitoria, Brazil. We performed a cross-sectional study among female adolescents (15 to 19 years) served by the Health Family Program. Participants were screened for CT and Neisseria gonorrhoeae (GC) using ligase chain reaction applied to urine and answered a face-to-face questionnaire to assess demographic, behavioral, and clinical factors. All participants and their parents signed the informed consent; 464 young women were sampled. The prevalence of CT was 9%; among sexually active women, CT and gonorrhea prevalence were 12% and 2%, respectively. Previously diagnosed STI was reported by 13%. Women who reported regular condom use and having condoms at home were significantly less likely to have CT, and having never purchased condoms was significantly associated with a positive CT result. A high prevalence of CT was found in this population, and behavioral risk was high despite readily available STI prevention information. Women who reported positive condom use behaviors were less likely to have CT. These results demonstrate the need for ongoing STI prevention activities, including STI screening and continued successful risk reduction activities such as condom use.
13. Rich fools, spare tyres and boyfriends: partner categories, relationship dynamics and Ivorian women's risk for STIs and HIV. Longfield K. Cult Health Sex 2004;6(6):483-500.
This study describes partner categories common to young women in Abidjan, Cote d'Ivoire, the underlying domains of their sexual partnerships, and relationship dynamics that contribute to their risk for STIs and HIV. Data from free lists and pile sorts underwent dichotomous variable testing to create comprehensive partner categories. Interview transcripts were analyzed to examine common themes and differences among categories. Findings suggest that young people describe sexual partners with at least 79 terms, which can be divided into nine categories. Social, sexual, emotional, and monetary expectations differ for each category, with women giving priority to relationships that contain the greatest amount of sentiment. Study data reveal the contribution of partner characteristics and relationship dynamics to women's risk for STIs and HIV in more detail than provided by conventional categories such as regular and occasional partners. Including details about partner characteristics and relationship dynamics in future STI/HIV prevention work can help program planners target relationships common to young women in which risk-taking behavior is high but STI/HIV risk perception may be low.
14. Risk for HIV infection among adolescents in the Border City of Tijuana, Mexico. Martinez-Donate AP, Blumberg EJ, Hovell MF, et al. Hispanic J Behav Sci 2004;26(4):407-25.
This study examines the prevalence of HIV risk practices and psychosocial correlates among 370 high school students in the border city of Tijuana, Mexico, by gender and age group. The results indicate substantial risk for HIV infection among Tijuana youth due to unprotected sexual practices, lifetime rates of pregnancy and sexually transmitted infections, and needle-sharing practices, mostly related to tattooing and body piercing. These findings suggest the need for HIV prevention programs for Tijuana adolescents. These programs must be culturally sensitive and tailored to meet the needs of the different age and gender groups in this region.
15. Sexual exposure to blood and increased risks for heterosexual HIV transmission in Cape Town, South Africa. Kalichman SC, Simbayi LC. Afr J Reprod Health 2004;8(2):55-8.
A total of 224 men and 276 women living in a Black township in Cape Town, South Africa, were interviewed using a structured questionnaire on demographic characteristics and sexual behaviors over the three months preceding the interview, including engaging in sexual contact that involved blood, lifetime history of STI diagnoses and STI symptoms, and HIV prevention knowledge. Thirty six percent of the men and 28% of women experienced sexual contact involving blood in the past three months. Sexual blood contact was associated with the number of sex partners, unprotected intercourse, and sexually transmitted infections. Sexual exposure to blood is prevalent and may be a facilitating factor for HIV transmission in South Africa.
Research Issues
16. "A bit more truthful": the validity of adolescent sexual behaviour data collected in rural northern Tanzania using five methods. Plummer ML, Ross DA, Wight D, et al. Sex Transm Infect 2004;80 Suppl 2:ii49-56.
To assess the validity of sexual behavior data collected from African adolescents using five methods, 9,280 Tanzanian adolescents participated in a biological marker and face-to-face questionnaire survey and 6,079 in an assisted self-completion questionnaire survey; 74 participated in in-depth interviews, and 56 person weeks of participant observation were conducted. Only 58% of males and 29% of females with biological markers consistently reported sexual activity in both 1998 questionnaires; 38% of males and 59% of females reporting sexual activity did so in only one of the two questionnaires. Nine of 11 (82%) in-depth interview respondents who had had biological markers provided an invalid series of responses about sex in the survey and in-depth interview series. Only one of six female in-depth interview respondents with an STI reported sex in any of the four surveys, but five reported it in the in-depth interviews. In this low-prevalence population, biological markers on their own revealed that a few adolescents had had sex, but in combination with in-depth interviews they may be useful in identifying risk factors for STIs. Self-reported sexual behavior data were fraught with inconsistencies. In-depth interviews seem to be more effective than assisted self-completion and face-to-face questionnaires in promoting honest responses among females with STIs. Participant observation was the most useful method for understanding the nature, complexity, and extent of sexual behavior.
17. Consistency in the reporting of sexual behavior by adolescent girls in Kenya: a comparison of interviewing methods. Hewett PC, Mensch BS, Erulkar AS. Sex Transm Infect 2004;80 Suppl 2:ii43-8.
To investigate in a district in Kenya the level and consistency of reporting of sexual behavior among adolescent girls, the study randomly assigned girls to two modes of survey interview: face-to-face interview and audio computer assisted self-interview (ACASI). The analysis is based on a subsample of over 700 never married girls aged 15 to 21 years in Kisumu, Kenya, drawn from a population-based survey of over 2,100 respondents. A questionnaire with 69 questions was used, two-thirds of which were considered sensitive, including questions about risky sexual behavior, alcohol and drug use, contraceptive practice, pregnancy, induced abortions, and births. ACASI produced significantly higher reporting of sex with a relative, stranger, or older man, and higher reporting of coerced sex. However, differences by mode for ever had sex and sex with a boyfriend were not significant. Relative to ACASI, the interviewer-administered mode produced highly consistent reporting of sexual activity, both within the main interview and between the main and exit interviews. Both the mode of survey administration and the probing for various behaviors significantly affect the observed prevalence of sexual activity. The ACASI results suggest that adolescent girls in Kenya have more complex and perilous sex lives than traditional face-to-face surveys of sexual activity indicate. The level of consistency in the interviewer mode is argued to be suspect, particularly given the much lower levels of reporting, relative to ACASI, for types of sexual partners and coerced sexual activity.
