Morbidity and mortality patterns in HIV-1 seropositive/ seronegative women in Kampala and Harare during pregnancy and in the subsequent two years.

OBJECTIVE: To compare birth outcomes, hospital admissions and mortality amongst HIV-1 seropositive and HIV-1 seronegative pregnant women in Kampala, Uganda and Harare, Zimbabwe. DESIGN: In Kampala and Harare about 400 HIV-1 seropositive and 400 HIV-1 seronegative pregnant women were recruited at initial visit for antenatal care into a prospective study and followed for two years after delivery. The women were classified as HIV-1 seropositive at recruitment if initial and second ELISA tests were positive and confirmed by Western Blot assay. Data on demographic, reproductive, contraceptive and medical histories were obtained using a comprehensive questionnaire at entry, 32 and 36 weeks gestation, at delivery and at six, 12, and 24 months post delivery. In addition, a physical examination and various blood tests were performed at each antenatal and post natal visit. RESULTS: During the two years after delivery, HIV-1 seropositive women had higher hospital admission and death rates than HIV-1 seronegative women. HIV-1 seropositive mothers had a two-fold increase in risk of being admitted to hospital (Kampala: RR = 2.09; 95% CI = 0.95 to 4.59; Harare: RR = 1.98; 95% CI = 1.13 to 3.45). In the six weeks after delivery eight deaths occurred, six of which were among HIV-1 seropositive women and in the period from six weeks to two years after delivery, 53 deaths occurred, 51 of which were among HIV-1 seropositive women (Kampala: RR = 17.7; 95% CI = 4.3 to 73.2; Harare: RR = 10.0; 95% CI = 2.3 to 43.1). However, there was no difference in hospital admission rates between HIV-1 seropositive and seronegative women during pregnancy itself and there was only one death during that period (in a HIV-1 seronegative woman). There was no difference in the frequency of complications of delivery between HIV-1 seropositive and HIV-1 seronegative women and the outcome of births were also similar. CONCLUSIONS: A significant number of HIV-1 positive pregnant women presented at both Harare and Kampala although there was no difference in the number of hospital admissions or mortality between HIV-1 seropositive and HIV-1 seronegative women during pregnancy. Although there were no differences in complications during pregnancy or outcome at delivery, in the two years after delivery, HIV-1 seropositive women in both centres were at increased risk of being admitted to hospital and of dying.

Male knowledge of and attitudes and practices towards AIDS in Zimbabwe.

This paper presents findings from a survey on knowledge of and attitudes and practices towards AIDS among currently married Zimbabwean men conducted between April and June 1988. Findings indicated that knowledge was reasonably high: 89.7% reported having heard of AIDS. The young and middle-aged groups, the most educated, and the urban men were the most knowledgeable in identifying routes of transmission. However, 22% did not know that there could be asymptomatic carriers of the virus capable of transmitting the virus and infecting others. Furthermore, 38% did not know that all those affected with AIDS eventually die as a result, and only 55% knew that there is no cure for AIDS. Behavioral change in order to avoid contracting AIDS seems relatively low given this sample's history of sexually transmitted diseases and extramarital sexual relations during the year prior to the survey. Although condom use was the lowest percentage of the behavioral change categories, a high percentage reported ever using a condom.

Estimating HIV incidence from age-specific prevalence data: comparison with concurrent cohort estimates in a study of male factory workers, Harare, Zimbabwe.

OBJECTIVE: To compare HIV incidence estimates from cross-sectional age-specific prevalence data with concurrent cohort estimates and to examine the sensitivity of the estimates to changes in age-categorization and survivorship assumptions. METHODS: Two previously described methods of estimating HIV incidence from cross-sectional prevalence data - the cumulative incidence and survival (CIS) and constant prevalence (CP) methods - are applied using data from a study of male factory workers in Harare, Zimbabwe. The methods are applied under two alternative groupings of the HIV prevalence data and under alternative survivorship assumptions: (a) Weibull distribution providing the best fit to the HIV prevalence data using the CIS method; (b) Weibull distribution matching data from an HIV natural history cohort study in Uganda; and (c) survivorship pattern as in (b) with survival periods reducing with increasing age at infection. Age-specific, age-standardized and cumulative HIV incidence estimates are calculated. The results are compared with concurrent longitudinal estimates from 3 years of follow-up of the Harare cohort (1993-1995). RESULTS: Age-standardized HIV incidence was estimated at 2.02 per 100 man years (95% CI, 1.57-2.47) in the cohort study. There was evidence of recent variability in HIV incidence in these data. Estimates from the cross-sectional methods ranged from 1.98 to 2.74 per 100 man years and were sensitive to changes in age-categorization of the HIV prevalence data and changes in survivorship assumptions. The cross-sectional estimates were higher at central ages and lower at older ages than the cohort estimates. The age-specific estimates from the CIS method were less sensitive to changes in age grouping than those from the CP method. CONCLUSIONS: HIV incidence remains high in Harare. Incidence estimates broadly consistent with cohort estimates can be obtained from single-round cross-sectional HIV prevalence data in established epidemics - even when the underlying assumption of stable endemic prevalence is not fully met. Estimates based on cross-sectional surveys should therefore be explored when reliable longitudinal estimates cannot be obtained. More data on post-HIV infection survivorship distributions in sub-Saharan Africa would facilitate the improvement of estimates of incidence based on cross-sectional surveys.

HIV seroincidence and correlates of seroconversion in a cohort of male factory workers in Harare, Zimbabwe.

OBJECTIVES: Given that health promotion messages on transmission of HIV and other sexually transmitted diseases (STD) have been widely publicized in Zimbabwe and elsewhere in the late 1980s, it is vital to analyse which risk events still expose individuals to infection. A cohort was established with the objectives of estimating HIV seroincidence, behavioural and biological determinants of infection, and ultimately, evaluating the impact of AIDS prevention interventions in the workplace. METHODS: HIV seroincidence was estimated in a prospectively followed cohort of male factory workers recruited in Harare, Zimbabwe during the period prior to a workplace AIDS prevention intervention. Correlates of HIV seroconversion were identified using Cox regression analysis. RESULTS: There were 51 seroconversions among 1607 HIV-negative participants following 1738 person-years (PY) of observation [seroincidence, 2.93 per 100 PY; 95% confidence interval (CI), 2.18-3.86]. The prevalence of HIV in the cohort was 19.1%. HIV seroincidence was significantly increased among men who were younger [hazard ratio (HR) per year, 0.96; 95% CI, 0.93-0.99], were single (HR, 3.29; 95% CI, 1.56-6.96), were married but resided separately from their wives (HR, 2.18; 95% CI, 0.99-4.80), reported having any STD (HR, 3.00; 95% CI, 1.53-5.86), reported having a genital ulcer (HR, 4.87; 95% CI, 2.18-10.91), and reported paying for sex (HR, 2.01; 95% CI, 1.06-3.77). Seroincidence also increased with the number of sex partners reported in the year preceding enrolment (HR per partner, 1.10; 95% CI, 1.01-1.21). In multiple Cox regression analysis, three independent associations with HIV seroconversion were reporting a genital ulcer (adjusted HR, 3.55; 95% CI, 1.52-8.29), number of sex partners (adjusted HR, 1.10; 95% CI, 1.01-1.21), and being married but residing separately from one's wife (adjusted HR, 2.21; 95% CI, 1.00-4.89). CONCLUSIONS: Innovative and sustained workplace-based interventions are needed to address the high risk of HIV infection in this economically productive population. The predictors of HIV seroconversion described in this study underscore the need for public health efforts to simultaneously address the biological, socioeconomic and behavioural factors that continue to place individuals at risk of HIV in general populations of Africa.

PIP: Results of a prospective HIV testing and questionnaire response study of 1607 male factory workers in Harare, Zimbabwe, were used to identify demographic and behavioral characteristics associated with HIV seroconversion. Specifically, the objectives of this study were to estimate HIV seroincidence, identify behavioral and biological determinants of infection, and evaluate the impact of current AIDS prevention intervention programs presented in the workplace. This male cohort was followed from a pre-intervention program phase through the establishment of a workplace/post-intervention program. Results were compared. Correlates of HIV seroconversion were identified using Cox regression analysis. There were 51 (3.2%) seroconversions among the 1607 HIV-negative participants following 1738 person-years (PY) of observation (seroincidence, 2.93/100 PY; 95% confidence interval (CI), 2.18-3.86). The HIV prevalence in the cohort was 19.1%. HIV seroincidence was significantly increased among men who were younger (hazard ratio (HR) per year, 0.96; 95% CI, 0.93-0.99), were single (HR, 3.29; 95% CI, 1.56-6.96), were married but resided separately from their wives (HR, 2.18; 95% CI, 0.99-4.80), reported having an STD (HR, 3.00; 95% CI, 1.53-5.86), reported having a genital ulcer (HR, 4.87; 95% CI, 2.18-10.91), and reported paying for sex (HR, 2.01; 95% CI, 1.06-3.77). Seroincidence also increased with the number of sex partners reported from the preceding calendar year (HR per partner, 1.10; 95% CI, 1.01-1.21). The authors conclude that innovative and sustained workplace-based interventions are needed to address the high risk of HIV infection in this economically productive segment of the Zimbabwe population. The risk factors and predictors of HIV seroconversion described in this study underscore the great need for public health efforts designed to address the biological, socioeconomic, cultural, and behavioral factors surrounding the spread of HIV and STDs.

Birthweight patterns in Harare, Zimbabwe.

Few data on birthweight distributions are available for Zimbabwe. This paper reports a study of 2140 births in Harare, Zimbabwe, occurring in April 1986. Births took place in public facilities, which are estimated to serve 85% of the urban population. Mean birthweight for the entire sample is 2970 g, and for singleton livebirths 3059 g. These data suggest that the proportion of low birthweight in Harare attributable to prematurity falls between the patterns of developed and developing countries.

Human follicular fluid stimulates hyperactivated motility in human sperm.

Since human follicular fluid (FF) is known to enhance the acrosome reaction and capacitation, we investigated whether hyperactivated motility is stimulated by FF. Follicular fluid-treated sperm exhibited a threefold increase in hyperactivation compared with the controls. The use of fetal cord serum in the medium, instead of bovine serum albumin, supported the same high levels of hyperactivation, although the peak occurred at 3 hours rather than 5 hours of capacitation. When sperm were treated with a steroid-rich fraction of the FF, hyperactivation was stimulated to the same degree as with whole FF. In contrast, no stimulation occurred when sperm were treated with a FF fraction stripped of steroids. The FF enhancement of hyperactivation in vitro could augment the fertilizing capacity of subfertile sperm samples, providing also a glimpse of possible in vivo events as sperm traverse the FF-laden cumulus oophorus.

Serum hormone levels affect sperm function.

If hormone levels affect sperm motility during capacitation, then the serum added to samples prepared for artificial insemination could affect sperm fertilizability. We investigated various sperm functional movement characteristics (percent motile, progressive velocity, linearity, beat cross frequency, lateral head displacement, longevity, and hyperactivation) in specimens incubated with women's sera, as well as exogenous hormone preparations of estradiol (E2) and progesterone (P). Early follicular phase serum (low E2 and low P) maintained motility and longevity. Sperm in E2-treated medium exhibited higher progressive velocity, linear motility, and longevity. In contrast, the percent motility decreased as sperm exhibited hyperactivated motility with P.

The effect of the motility stimulants, caffeine, pentoxifylline, and 2-deoxyadenosine on hyperactivation of cryopreserved human sperm.

OBJECTIVE: To determine if the motility stimulants, caffeine (7 mM), pentoxifylline (3 mM), 2-deoxyadenosine (3 mM), and a combination of the three would induce hyperactivated (HA) motility. DESIGN: Controlled laboratory study of stimulants using cryopreserved semen from 10 donors at three time points. SETTING: The study was performed in the Andrology Laboratory at Prince Henry's Institute of Medical Research Clayton, Victoria, Australia. INTERVENTIONS: Stimulants in doses maximally effective for stimulation of motility were incubated with suspensions of previously cryopreserved sperm. MAIN OUTCOME MEASURES: Motility characteristics (curvilinear velocity [VCL], linearity [LIN], and maximum amplitude of lateral head displacement [ALHmax]) were derived using the single cell track facility of the CellSoft computer-automated semen analyzer (Cryo Resources Ltd., Montgomery, NY). Videotapes were visually inspected, and 125 sperm cell trajectories exhibiting characteristic HA behavior were identified. The HA motility thresholds (5th or 95th centiles) were as follows: VCL > 74 microns/s, LIN < 74%, and ALHmax > 4.7 microns. Cells with motility characteristics outside these limits were regarded as HA. The significance of the effect of the stimulants on the proportion of sperm exhibiting HA was examined by Poisson regression analysis. RESULTS: Sperm washing (removal of the cells from the cryoprotectant) and swim-up caused significant changes in the VCL and straight line velocity and a twofold (5.6% to 11.9%) increase in the proportion of HA cells. In the presence of motility stimulants, the proportion of HA cells was significantly increased threefold (11.9% to 32.5%) above that seen in the control washed sperm. Hyperactivated motility declined after 1 to 2 hours, but 2-deoxyadenosine demonstrated a prolonged effect. CONCLUSION: These motility stimulants that affect adenosine 3':5' monophosphate in human sperm stimulate cyclic hyperactivation.

Maternal mortality in rural and urban Zimbabwe: social and reproductive factors in an incident case-referent study.

A community-based incidence case-referent study was undertaken in a rural and an urban setting in Zimbabwe in order to define risk factors associated with maternal deaths at family, community, primary and referral health care levels. Referent subjects were drawn from place or area of delivery for each consecutive maternal death. Using a multiple source confidential reporting network for all maternal deaths, the maternal mortality rate for the rural setting was 168/100,000 live births and that for the urban setting was 85/100,000 live births. A model for interacting factors contributing to maternal mortality was designed. Haemorrhage and abortion sepsis were the major direct causes while malaria was the leading indirect cause in the rural setting. In the urban setting, eclampsia, abortion and puerperal sepsis were the leading causes of maternal deaths. It was found that all situations associated with diminished, or absent social support, that is, being single (Odds Ratio = 4.7, 95% CI = 2.2-9.8) divorced, widowed, one of several wives, cohabiting, or self-supporting carried an increased risk for maternal mortality, especially in the rural area. Income and level of education for index and referent subjects were comparable, probably because of the limited part of the population under study that belonged to a more affluent class. Distribution of cases and referents by religious-affiliation was also comparable. Age > 35 years and parity > 6 were significant risk factors for maternal mortality in the rural setting, whereas bad reproductive history with reported stillbirth or abortion constituted a high risk both in the city and in the rural areas (Odds Ratios 4-6).(ABSTRACT TRUNCATED AT 250 WORDS)

Unplanned pregnancies in Harare: what are the social and sexual determinants?

A hospital-based study was undertaken in Harare, Zimbabwe to estimate the proportion of unplanned or unintended pregnancy among mothers who delivered at the referral hospital and to analyse their socio-demographic pattern and sexual relationships. A case-referent study design was used with systematic sampling of maternity records of mothers who had delivered. Interviews were performed before discharge using a semi-structured questionnaire. Mothers who reported that the index pregnancy was unplanned or unintended constituted the cases, and the referents were those reporting the pregnancy as planned. Out of 923 deliveries, 41% were unplanned and 9% unwanted. The mean age of the mothers was 25 years and women aged 19 or below [Odds Ratio (OR) = 2.2, 95% CI = 1.5-3.2] and 35 or above (OR = 2.8, 95% CI = 1.7-4.6) were significantly more likely to present with unplanned pregnancy. Nulliparous women (OR = 2.4) and mothers with five or more pregnancies (OR = 8.2) had a significantly increased likelihood of the pregnancy being unplanned. Level of education in the mothers studied had no independent association to planning of pregnancy. Unemployed (OR = 14) and single (OR = 7.8), or divorced/separated/widowed (OR = 5.1) women as well as those with low income (OR = 2.1) and whose partner earned no income (OR = 2.2), were more at risk of unplanned pregnancy. Those living with their own parents despite being pregnant were also more likely to report an unplanned pregnancy. In conclusion, there are documentable social and reproductive factors underlying unwanted pregnancy. Risk factors for unplanned pregnancy form a pattern similar to those for maternal mortality. Thus unplanned pregnancy is a major indicator of the presence of factors known to increase the risk of maternal death. Policy makers and health education should address factors contributing to unplanned pregnancy and its prevention in order to prevent reproductive mortality and morbidity. The presence of those factors associated with unplanned pregnancy at booking or delivery should also alert service providers to the need for appropriate contraceptive counselling as part of post delivery care.

Effects of a randomized health education intervention on aspects of reproductive health knowledge and reported behaviour among adolescents in Zimbabwe.

Unwanted teenage pregnancy and the attendant morbidity and mortality necessitate an understanding of the factors influencing adolescent sexuality and the implementation of programmes designed to improve their knowledge and reproductive behaviour. A randomized controlled study on reproductive health knowledge and behaviour was undertaken among adolescent pupils drawn from a multi-stage random cluster sample. A self-administered questionnaire was used to assess aspects of reproductive health knowledge and behaviour at baseline followed by a health education intervention, except for control schools. Results are based on 1689 responses made up of 1159 intervention and 530 control respondents. There was a significant increase in correct knowledge about aspects of menstruation in intervention as compared with control schools [odds ratio (OR) = 4.5, 95% confidence interval (CI) = 3.4-6.1). Significantly, (OR = 2.0, 95%CI = 1.1-3.9) more pupils from intervention than control schools scored correctly on practice relating to menstruation. Pupils from intervention schools were more likely (P < 0.001) to know that a boy experiencing wet dreams could make a girl pregnant and that a girl could get pregnant at her first sexual intercourse (OR = 1.4, 95%CI = 1.1-1.9). Knowledge of family planning was low in both groups at baseline but was high at five months follow-up in the intervention schools. The findings point to the need for early school-based reproductive health education programmes, incorporating correct information on reproductive biology and the subsequent prevention of reproductive ill health.

Hyperprolactinemic infertile men.

Clinical descriptions of prolactin in states of oversecretion are presented in 49 patients that presented for infertility investigation. Radiological assessment did not reveal microadenomas in these patients. Erectile dysfunction or deficient semen parameters could be early manifestations of hyperprolactinemia in some infertile men.

Generational differences in male sexuality that may affect Zimbabwean women's risk for sexually transmitted diseases and HIV/AIDS.

OBJECTIVE: To determine generational differences in male sexuality, which could predispose men's female sexual partners to STDs/HIV. DESIGN: Cross-sectional study. SETTING: Harare, Zimbabwe. SUBJECTS: Three hundred and ninety seven male adults aged eighteen years and above. MAIN OUTCOME MEASURES: Number of sexual partners, condom use, likelihood of sharing information on HIV status with wife or with other sexual partners, preference for women with dry vaginas prior to sex and discussion about sexual satisfaction with wife or with girl friend. RESULTS: Fewer men in the 27-39 year age group when compared to men aged 18-26 years (22.2% versus 28.9%) had two or more sexual partners. The greatest proportion of ever condom users were men aged 27-39 years, but this proportion was not significantly different from the proportion of ever condom users aged 18-26 years (76.5% versus 69.5%; Odds Ratio[OR] = 1.42, 95% Confidence interval [CI] 0.81-2.51). Men aged > or = 40 years (43.8%, OR = 0.34, 95% CI 0.20-0.84) were significantly fewer than men aged 18-26 years in ever use of condoms. In the event that they contracted HIV, 79.5%, 82.4% and 85.9% of men aged 18-26, 27-39 and 40 years and above respectively indicated that they would disclose their HIV status to their wives. On the other hand, men aged 18-26 years (56.8%), 27-39 years (54.0%) and > or = 40 years (53.1%) indicated that they would disclose their HIV status to girl friends or other sexual partners. Significantly, more men aged 40 years (OR = 2.23; 95% CI 1.19-4.18) and 27-39 years (OR = 1.82; 95% CI 1.00-3.32) in comparison to 18-26 year old men indicated their preference for women with dry vaginas prior to sex. The greatest proportion of men who discussed sexual satisfaction with their wives (85.7%) and girl friends or other sexual partners (23.5%) were aged 27-39 years. CONCLUSION: It is recommended that public health and behavioural scientists in Zimbabwe devote more time to understanding the intricacies of male sexual behaviour at different stages of life. This would provide the important insight needed to develop effective targeted interventions to reduce the spread of STDs/HIV in Zimbabwe.

Zimbabwean teenagers' knowledge of AIDS and other sexually transmitted diseases.

A cross sectional anonymously administered questionnaire was used amongst 1689 secondary school girls and boys to determine their knowledge of AIDS and other sexually transmitted diseases (STDs). Their knowledge was found to be very low. While 80% could name an STD in an open question, only 16% could recognise the important symptoms of the common and treatable diseases such as gonorrhoea and syphilis. This finding is worrying in view of the fact that these common STDs facilitate transmission of HIV/AIDS. The awareness of AIDs was high but when it came to the mode of transmission of AIDS the large majority were not aware of the risk of intercourse with an infected person. Furthermore, despite an intensive AIDS awareness campaign programme mounted by the government of Zimbabwe a large number of students thought that one can contract HIV/AIDS by shaking hands, sharing a toilet and witchcraft. Misconceptions on transmission abound. The data show that there is a need to review strategies of disseminating information to teenagers regarding STD, including AIDS, reproductive biology, sexuality and contraception. The best strategy may be the introduction of a reproductive health education curriculum in all schools starting at an early age.

Gender dynamics and the challenges for HIV prevention.

Information on the transmission of the human immunodeficiency virus (HIV), leading to acquired immunodeficiency syndrome (AIDS), has been widely disseminated since the early 1980s, and yet curbing new infections remains a major public health dilemma. In response to the global challenge of HIV/AIDS, most control and prevention interventions have targeted "core groups' with messages which include:- 1. Reduction of individual risk through responsible sexual behaviour or behaviour change, such as, delayed sexual debut, abstinence, monogamy and condom use. 2. Communal (as a society) adoption of a risk reduction strategy e.g. reduced rate of sexual partner change and avoiding multiple partners. 3. Improved, early and aggressive STD treatment programmes. However, data from sub-Saharan Africa and elsewhere shows how the epidemic, in the general population, appears to thrive unabatted. Large proportions of women and some men, in none of the traditional high risk core groups, are increasingly becoming infected with HIV. Most of the women appear to be at risk of infection not so much because of their own behaviour, but that of their partners of husbands. In this continuum, our response has been fragmented and non-strategic. Few programme activities have been developed that address men as a critical core group potentially propagating or sustaining the epidemic. The preoccupation with female sex workers and other core groups (e.g. truck drivers) could have overshadowed the need for programmes and interventions that make men, in general, aware of HIV risk and less likely to infect their sexual partners. Challenges posed by HIV require innovative strategies that foster behavioural and social change in the situation of men at risk and their partners.

PIP: Checking the spread of HIV infection remains a public health challenge. Most HIV/AIDS control and prevention interventions have targeted core groups thought to be at high risk of infection, such as female prostitutes and truck drivers. Data from sub-Saharan Africa and elsewhere, however, indicate that despite the implementation of targeted prevention and control interventions, HIV infection continues to spread without challenge. Large proportions of women and some men in no traditional high risk core group are increasingly becoming infected with HIV. Most of the women seem to be at risk of infection as a result of their partners' or husbands' risk behavior. The preoccupation with targeting female prostitutes and other core groups has meant that the need to focus upon men overall as a risk group has been largely ignored. Only few program activities have been developed to make the broad male population aware of HIV risk and less likely to infect their sex partners.

Reproductive and sexual health: a research and developmental challenge.

There is a growing awareness of the burden and implications of reproductive ill health as contributed by unsafe motherhood (during pregnancy, childbirth, abortion), reproductive tract infection (RTIs) and cancer, sexually transmitted infections (STIs) including the human immunodeficiency virus (HIV), poorly regulated fertility, infertility, unwanted pregnancy and adolescent/teenage sexuality and pregnancy. Sexual health further entails a state of well-being in expression of sexuality, prevention of unwanted pregnancies, prevention of STIs and AIDS and freedom from sexual abuse and violence. Reproductive health is increasingly being recognized as one of the corner stones of health and a major determinant and indicator of human social development. It is central to general health as it reflects health in childhood and adolescence and sets the stage for health and life expectancy beyond the reproductive years. It is affected by other health aspects such as nutrition and environment, low birth weight, neonatal and perinatal mortality and morbidity. According to the WHO, reproductive health problems account for more than one third of the total burden of disease in women and more than 10 pc of that in men. The challenges posed by the subordinate status of women, the exclusion of men in reproductive health programmes and the need for shaping adolescents' sexual knowledge and behaviour are viewed against today's poor reproductive and sexual health outcomes in the context of Africa. Education systems, employers and policy makers are challenged to provide adequate STI/HIV education and on-site (school, work, satellite, drop in) control services. Prevention interventions, disease and health trends and their outcome require systematic research in order to impact on policy. Reproductive health education should be universal, especially for adolescents, and its impact assessed against appropriate monitoring criteria such as reproductive morbidity, STI prevalence and abortion complications.

Condom acceptance and HIV prevention in reproductive health: the challenges.

PIP: The AIDS epidemic weighs heavily on the already burdened health care delivery systems of developing countries especially in central Africa. AIDS not only incurs high morbidity and mortality but has a severe impact on productivity, economic infrastructures, and development in those countries which need them the most. HIV is mainly spread through heterosexual intercourse in central Africa. Vertical transmission of HIV and breast feeding are other means. The key vehicle of HIV transmission in the US is still homosexual intercourse. Sexually transmitted diseases (STDs) facilitate HIV transmission via intercourse. Research shows that subsequent infection by other STDs hastens the development of AIDS in HIV-infected people. Some evidence indicates that pregnancy increases the risk of developing AIDS in a woman who is positive for HIV. The main means to prevent HIV transmission is the condom. Yet, in Rwanda, only 7% of women had ever used condoms despite the high rate (32%) of HIV-positive serology. The University of Zimbabwe Medical School believes adolescents are the most appropriate starting point for AIDS prevention since they tend to experiment with sexual behaviors. Its youth counseling program involves education and prevention messages within and outside educational settings through youth meeting places, youth workers, and other mass media. It hosts workshops at meeting places which use the problem solving approach to risk reduction behavior. The program invites schools, churches, and other educational settings to form Anti-AIDS Clubs. It advocates use of drama and music to promote AIDS awareness. The program has also branched out into community counseling where it works to eliminate the stigma and guilt associated with talking about sexual transmission of AIDS. Governments must learn who the STD and HIV transmission high risk groups are and then target them with information, education, and communication AIDS prevention programs.^ieng

Condom use and acceptance: a survey of male Zimbabweans.

In addition to their traditional contraceptive role, condoms have moved to a crucial and central position in the strategy for prevention of sexual transmission of the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). As a cure for AIDS remains out of sight, condom use, celibacy and extensive health education remain the immediate sole weapons for controlling HIV infection. A stratified cluster sampling design of 722 Zimbabwean men reported 35.7 percent ever use of condoms while only 4.9 percent reported current condom use. 32.4 percent had unprompted knowledge of condom use for contraception. Circumstances during which condoms were used are discussed. Asked if the men would use condoms if asked by either wife or partner, only 30.0 percent of men who had not previously used condoms indicated that they would. Reasons given by the 64 percent with no previous use of condoms are discussed. Health education to promote acceptance and use of condoms is proposed.

PIP: In addition to their traditional contraceptive role, condoms have moved to a crucial and central position in the strategy for prevention of sexual transmission of the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). As a cure for AIDS remains out of sight, condom use, celibacy and extensive health education remain the immediate sole weapons for controlling HIV infection. A stratified cluster sampling design of 722 Zimbabwean men reported 35.7% ever use of condoms while only 4.9% reported current condom use. 32.4% had unprompted knowledge of condom use for contraception. Circumstances during which condoms were used are discussed. Asked if the men would use condoms if asked by either wife or partner, only 30.0% of men who had not previously use condoms indicated that they would. Reasons given by the 64% with no previous use of condoms are discussed. Health education to promote acceptance and use of condoms is proposed. (Author's).

Male fertility regulation: a study on acceptance among men in Zimbabwe.

Both traditional and modern methods of family planning widely practised currently in most countries, especially in sub-Saharan Africa, focus solely on the woman. There is hardly data on male directed methods of fertility regulation, or indeed whether, or not, such contraceptive options are acceptable. Contraception, whether for spacing, avoiding unintended pregnancy or limiting family size, is almost always a female prerogative. This, in certain circumstances, is despite the available female method being contraindicated. Acceptance of male sterilisation (vasectomy), condom use and male contraceptive pill were investigated in a representative sample of 711 Zimbabwean men. Only 14 pc of men considered vasectomy an acceptable method of contraception and none of the men had current or previous use of this method. Seventeen percent of the men had prompted knowledge of this method, compared to 53 pc who had prompted knowledge of female sterilisation. Only six percent of respondents reported current use of condoms and amongst condom non-users, 58.9 pc would not use the method if asked by a wife or partner. Surprisingly, 31.7 pc of the male respondents reported that they would consider a male contraceptive pill or injection if available. Should husband want no more children, 42.2 pc of men said they would agree to wife sterilisation and 19.5 pc could consider vasectomy. Previous use of condoms was reported by 33.8 pc of the men. Eighty eight (88 pc) percent of respondents had some formal education, although acceptance rates decreased with less education and older ages. Circumstances during which a male method could be considered, reasons and socio-economic determinants for acceptance of male fertility regulatory methods are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS related knowledge and sexual behaviour among commercial farm residents in Zimbabwe.

OBJECTIVE: To describe sexual behaviour among residents of commercial farms in Zimbabwe, their gender-specific differences; to examine implications of these for HIV/AIDS transmission. DESIGN: A cross sectional descriptive study. SETTING: Three commercial farming communities near Harare, Zimbabwe. SUBJECTS: Convenience sample of 218 adult (age 18+, or ever married) farm residents. MAIN OUTCOME MEASURES: Number of sexual partners, secondary sexual relationships outside marriage, condom ever-use, first sexual partner, sexually transmitted disease (STD) experience, unprompted knowledge of HIV. RESULTS: Knowledge of HIV transmission was high, with eight to 88% of respondents reporting various correct means of transmission. Males reported engaging in riskier behaviour than females, with 60% of currently married males (n = 81) reporting extra marital affairs compared to 4% of currently married females (n = 91) (OR: 4.02; 95% CI: 1.8 to 9.04). Males were more likely than females to report a second or further marriage (OR: 37.9; 95% CI: 16.01 to 92.1). Females were more likely than men to report first sexual partner as spouse. Fourteen percent of respondents had children of various ages outside their current union. Reported STD experiences under various circumstances were negligible with no differences by sex. CONCLUSION: While HIV/AIDS prevention measures largely rely on individual behavioural change, preventive efforts should also encompass differences in sexual behaviour between categories like male and female. Importantly, this will determine composition of preventive policy, but also allow a clearer determination of trends based on the gender-specific behaviours. There is also need for more research work that attends to determinants of reporting behaviour beyond aspects of reported behaviour per se.