Does knowledge about antiretroviral therapy and mother-to-child transmission affect the relationships between HIV status and fertility preferences and contraceptive use? New evidence from Nigeria and Zambia.

The increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009-2010 community-based surveys in Nigeria and Zambia, this study explores whether women's knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by women's HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media.

Women's and men's fertility preferences and contraceptive behaviors by HIV status in 10 sub-Saharan African countries.

This article draws on biomarker data from Demographic and Health Surveys (2003-2007) in 10 sub-Saharan African countries to examine differences in fertility preferences and contraceptive behaviors by HIV status for women and men, taking into account whether or not they probably know their HIV status. The objective is to determine if there are common patterns in the associations between these variables across several countries. Women's and men's fertility preferences and contraceptive behaviors are relatively similar across HIV status and probable knowledge of that status. However, two consistent differences emerge in some of the countries: HIV-positive women who probably know their status are less likely to want more children and are more likely to be using male condoms than women who are HIV-negative and probably know it. A similar association is observed for men for condom use but not for limiting childbearing. Other factors unrelated to HIV status seem to be shaping women's and men's unmet demand for contraception and use of methods other than the condom.

Is the internet filling the sexual health information gap for teens? An exploratory study.

At the same time that there was a decline in comprehensive school-based sex education, adolescents' use of the Internet became nearly universal. This study explores adolescents' use and evaluation of the Internet for sexual health information, with a focus on the issues of contraception and abstinence. The authors conducted 58 in-depth interviews with juniors and seniors in 3 public high schools in New York City and Indiana. Most of the adolescents used the Internet on a daily basis, but few considered it a main source of information about contraception or abstinence. Students were more likely to rely on and had greater trust in traditional sexuality education sources such as school, family members, and friends. Most of the adolescents the authors interviewed were wary of sexual health information on the Internet, and the authors describe strategies adolescents used to sort through the abundance of sex-related material. Formal and informal efforts to provide sexuality education to adolescents should include specific age- and content-appropriate Web sites because many teens are not actively searching on their own, and they express reservations about relying on the Internet as a source of sexual health information.

Social organization and the transition from direct to indirect consumption.

This paper presents a new theoretical framework for the study of environmental consumption at the micro-level by building on concepts from classical sociological theory and recent macro-level studies of the environment. The framework emphasizes the local community context as an important determinant of environmental consumption. We test this framework with unique micro-level data on consumption, household size, household affluence, and community context from Nepal, a setting in the midst of dramatic change in community organization, population size, and consumption behavior. The results of these tests are consistent with the hypothesis that local nonfamily organizations shift the consumption of environmental resources from direct to more indirect. We argue that the framework presented here is a useful early step toward more comprehensive micro-level models of environmental quality.

Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa.

Using national survey data collected in 2004 in Burkina Faso, Ghana, Malawi, and Uganda with 12-19 year olds, we examine the prevalence of sex in exchange for money or gifts in the 12 months prior to the survey and its association with adolescents' social and economic vulnerability and condom use. Receiving something in exchange for sex is very common among sexually active, unmarried female adolescents and there are no significant differences by household economic status, orphan status, level of schooling completed or age difference between partners. Condom use at last sex in the 12 months prior to the survey is not associated with receiving gifts or money. Qualitative data based on focus group discussions and in-depth interviews collected in 2003 with adolescents suggest that receiving money or gifts for sex is not necessarily a coercive force, but rather can be a routine aspect of dating.

Adolescents' views of and preferences for sexual and reproductive health services in Burkina Faso, Ghana, Malawi and Uganda.

Adolescents' views of and preferences for sexual and reproductive health services highlight promising directions and persistent challenges in preventing pregnancy and HIV and treating sexually-transmitted infections (STIs) in this population. Results from nationally-representative surveys of 12-19 year-olds in Burkina Faso, Ghana, Malawi and Uganda in 2004 show that contraceptive and STI services and HIV testing are still under-utilized. A substantial proportion of sexually-active adolescents do not know of any source to obtain contraception or get STI treatment, and social-psychological reasons (e.g., embarrassment or fear) and financial cost remain common barriers to getting services. Adolescents' preferences are overwhelmingly for public clinics, with strongly positive perceptions of confidentiality, accessibility and cost. Some gender and country differences exist, yet overall females and males' views are similar. Results highlight the need to inform youth about sources, increase availability of government health facilities and improve youth's access to them, especially by reducing social barriers.

Intergenerational transfers of resources between older persons and extended kin in Taiwan and the Philippines.

This study examines the extent to which older generations actively exchange resources with extended kin in Taiwan and the Philippines. It is critical to understand the position of older generations in the family, because population ageing and declines in family size spur concerns about the tenacity of family support. This research builds upon previous studies that have predominantly focused on parent-child relationships alone or on support received by older parents. Social-network measures are used to estimate overall levels of transfers of resources across generations, and the prevalence and patterns of pathways that link generations and types of kin. Our findings show that the availability of kin is similar in both settings but that transfer activity in the Philippines appears more broadly distributed across family relations, especially siblings, while in Taiwan transfers are more concentrated among lineal kin. These results confirm the importance and diversity of extended kin in systems of family support.

Transfers from older parents to their adult children in Taiwan and the Philippines.

This study examines the extent to which older parents provide material resources and services to their children in the Philippines and Taiwan, and the influence of coresidence on reported transfers between parents and their adult children. The data used in the analyses are from two nationally representative household surveys of persons aged 60 and older in the Philippines and Taiwan. Results show that almost half of older parents in the Philippines provide resources to non-coresident children and only 4 percent of older Taiwanese parents currently make such transfers. When transfers with coresident children are included, older parents show much greater involvement in family support: 69 and 14 percent of older parents in the Philippines and Taiwan, respectively, say they make transfers to children. The difference between the two measures diminishes with age, however, as overall levels of giving decline. Results from multivariate models show that while both measures are associated in similar ways with key factors such as age, health, gender, and economic resources, the association between living arrangements and intergenerational transfers varies across measures. These results suggest that older adults' in these countries tend to exhibit a preference for transfers to the children with whom they live, and that coresidence with grandchildren may be an indirect transfer of services to non-coresident adult children.