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Africa Health |
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Africa Health provides the latest information on medical research of interest to physicians and other health professionals in Africa. It is the leading journal of continuing medical education for health professionals in Africa’s English-speaking countries. Established in 1978, the publication was known as Mera -- Medical Education Resource Africa -- from 2002 until recently, when it reverted to its original title. More than 12,000 copies of each issue are distributed throughout sub-Saharan Africa and the English-speaking world. The articles below, written by staff members of Family Health International, are reproduced with permission of Africa Health (editor@fsg.co.uk, www.fsg.co.uk).
During the past decade, HIV counseling and testing services have expanded in both urban and rural areas of sub-Saharan Africa, even becoming routine in some medical settings. With this expansion, more women who are infected with HIV are becoming aware of their status. As more HIV-infected women learn of their status, they will be able to make informed choices about their reproductive health — including whether to have children and how to prevent further transmission of the virus.
When a woman chooses a contraceptive method, effectiveness is often the most important characteristic she considers. Knowing the risks and benefits of each method, including its effectiveness, is necessary for a woman to make a truly informed decision. Yet, many women do not understand how well various methods protect against pregnancy.
Scientists around the world are working diligently to develop a topical microbicide that can prevent HIV and other sexually transmitted infections (STIs). Advocacy and support for microbicide research is strong, and the availability of an effective product — although likely years away — could help to relieve the HIV epidemic in Africa.
Many women and men are certain that they are finished with childbearing, never wish to have children, or would like to ensure a reasonable space between infants. Yet long-acting and permanent methods (LAPMs) of contraception — contraceptive implants, intrauterine devices (IUDs), and female and male sterilisation — are far less popular than short-acting methods, such as oral contraceptives, injectables, and barrier methods. In many African countries, fewer than 5% of the women who use contraception use an LAPM.
Although a direct causal relationship between sexual coercion and adverse effects on reproductive health has not been established, experts warn that nonconsensual sex contributes to some of the world's most tenacious and often life-threatening reproductive health problems: unintended pregnancy and its complications, sexually transmitted infections (STIs) that can cause cervical cancer and infertility, and HIV infection. How can physicians and other health professionals respond to this threat to reproductive health? Answers are beginning to emerge as more health professionals and programs begin to provide services for those who experience nonconsensual sex.
Studies show that a checklist developed and tested by Family Health International (FHI) is highly effective in ruling out pregnancy and can be used with confidence when laboratory tests are not available.
With the risk of teenage pregnancies on the rise, sexually active youth in Africa need safe, effective, and reliable contraception now more than they ever did before. As the HIV/AIDS epidemic continues to grow, young people must also find a way to protect themselves against HIV and other sexually transmitted infections (STIs). Healthcare providers should explore the reproductive health needs of young clients when they help them choose a contraceptive method. Providers must also consider the range of available options, the effectiveness of the methods, and their medical appropriateness.
Contraceptive implants are a highly effective, long-acting, reversible method of family planning that can be safely used by the majority of women who wish to space or limit their pregnancies. Yet despite the advantages of implants, far fewer than 1% of the women in sub-Saharan Africa (with the exception of Burkina Faso, Ghana, and Kenya) use the method. Although a lack of availability has been a major problem in the region, that situation could soon improve.
Concerns about infection and infertility have surrounded the use of the intrauterine device (IUD) for many years. Although recent rigorous studies have largely shown that these concerns are unfounded, health care providers in some parts of the world — especially where sexually transmitted infections (STIs) are common — have been reluctant to provide IUDs because of difficulties in testing or screening women for STIs. A simple, new algorithm may help providers identify women who live in areas of moderate to high STI prevalence, but who are at low risk of STIs, and therefore may be good candidates for IUD use. Although the algorithm was developed and validated based on data from a range of countries, it may not be perfectly suited for every setting. Local health officials may wish to tailor it to their local contexts, if resources are available.
There is now clear evidence that male circumcision reduces the transmission of HIV from women to men. In December 2006, the National Institutes of Health (NIH) in the United States halted two clinical trials, in Kenya and Uganda, on the grounds that it would be unethical not to offer circumcision to all the men taking part in the studies. Circumcised men in both trials had dramatically reduced rates of HIV infection — a reduction of 53% in Kenya and 48% in Uganda — compared to controls who were uncircumcised.
In most settings, family planning and HIV/AIDS services have traditionally been offered through separate, vertical programs. Family planning services have primarily targeted married women of reproductive age, while HIV/AIDS services have targeted men and women at high risk of HIV infection. But service integration has potential benefits, such as allowing more comprehensive services and expanding access to services.
Women with HIV have a right to decide whether they want to become pregnant and bear children. But if an HIV-infected woman chooses not to have children, or wants to space her family, she should be able to make informed, voluntary decisions about contraception and then receive her method of choice. Such use of contraception by HIV-infected women is an important way to reduce HIV-positive births. In addition, HIV-infected women using antiretroviral (ARV) therapy may want to use family planning until the effects of these drugs on maternal and child health are better understood.
In the midst of an unrelenting AIDS epidemic, attention is increasingly being paid to the prevention of HIV infection among the world's most vulnerable individuals: its newborns. Minimizing HIV-infected births will likely be best achieved through a combination of approaches that includes preventing unplanned pregnancies among HIV-infected women and preventing HIV infection among reproductive-age women.
Antiretroviral treatment of rape victims definitely or probably exposed to HIV during their assaults can be cost-effective in countries with high HIV prevalence. It also may be affordable in a middle-income country like South Africa, a modeling study conducted there suggests. However, the cost-effectiveness of such treatment, called postexposure prophylaxis (PEP), is critically dependent upon improving sexual services and providing an environment that encourages rape victims to both seek care in a timely manner and complete their PEP regimen. |
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Meeting the reproductive health needs of women with HIV
Helping women understand contraceptive effectiveness
