Infertility-related reproductive health knowledge and help-seeking behaviour in African countries

¹Correspondence address. E-mail: silke.dyer{at}uct.ac.za Data from African countries indicate that men and women attributeinfertility to traditional beliefs about health and diseaseas well as to biomedical causes, although appropriate knowledgeof the latter is frequently lacking. Infertility is a dreadedcondition and as a result help-seeking is often intense andpersistent. Most of the help-seeking is undertaken by womenand both traditional and modern biomedical health services areaccessed. There are, however, many barriers to effective andaffordable biomedical infertility care, many of which are relatedto poor resources and lack of infrastructure, and as a resultthe need for infertility treatment is often unmet. Advancesin the quality of care require greater commitment to the problemof infertility in African countries, the provision of healtheducation as an integral part of infertility management, theintegration of infertility services into reproductive healthcare programmes and defining the role of assisted reproductivetechnologies in low resource settings. At the same time theimportance of traditional health services in infertility managementshould be recognized.     

Infertility in developing countries: funding the project

³ Correspondence address. E-mail: hnsallam{at}link.net Assisting developing countries in establishing infertility servicesis not a uniform exercise and depends on the stage of developmentof each country. Three levels of assistance are suggested: providingbasic (level 1), advanced (level 2) or tertiary referral infertilityservices (level 3). At each of these levels, four activitiesare needed: equipping the clinics, training the staff, educatingthe public and running the services. Basic (level 1) clinicscan be equipped by international donors, whereas level 2 and3 clinics can be funded through a partnership between an internationalscientific body (WHO, ESHRE, etc.) and an international bank(World Bank, African Development Bank, etc.). Training of themedical and paramedical staff should be the responsibility ofthe non-profit organizations (NPOs) preferably in regional trainingcenters. An awareness campaign is necessary to educate the publicand inform them of the range of treatment available in theircommunity and can also be funded by NPOs. Finally, the runningcost of the services including the staff salaries, the costof the investigations and medication should be the responsibilityof the local government, although in many countries, this hasto come from out of pocket payments.     

Decision-Making Therapy in HIV/AIDS: The African Experience

The challenge of providing relevant and sophisticated counseling interventions to people with HIV/AIDS in Africa has greatly intensified. The task has shifted from what it was deemed to entail at the first decade of the disease. Then, it was understood to involve the process of bringing healing to the emotional situation of the client demoralized by the news of infection. In addition, at that time, the emphasis was on information and education as the most commanding weapon for preventing the spread of the AIDS pandemic. But professional experiences in the second decade of the disease has clearly shown that as we work for prevention we must also develop strategies for responding to the needs and problems of people already in contact with the disease, requiring that they be started on antiviral therapy. The present article is intended to highlight and discuss the critical issues that attend and challenge the decision-making therapy of people with HIV disease in Africa.     

Affordable assisted reproductive technologies in developing countries: pros and cons

¹ Correspondence address. E-mail: akandewole{at}yahoo.com Infertility in developing countries is pervasive and a seriousconcern. In addition to the personal grief and suffering itcauses, the inability to have children especially in poor communitiescan create broader problems, particularly for the woman. Infertilityservices in developing countries span the spectrum from preventionto treatment. From a societal and public health standpoint,prevention is cost–effective and is considered by manygovernments and public health care providers to be a priorityfor service delivery. While prevention remains paramount, takenalone it ignores the plight of infertile couples, includingthose with non-infectious causes of infertility. Two key argumentsare frequently used to challenge the development of new reproductivetechnologies in developing countries: overpopulation and limitedresources. Evidence supports the conclusion that there is acompelling need for infertility treatment beyond prevention.In many instances, assisted reproductive technologies (ART)are the last hope or the only means to achieve a child for couples.In an effort to make much needed ART to developing countriesaccessible and affordable, developing countries should lookto public–private partnerships. Governments have a responsibilityto ensure safe and effective services including the controlof standards for clinical procedures and the regulation of professionalpractice.     

输卵管性不孕患者IVF助孕后自然妊娠--附13例临床分析

目的:探讨输卵管性不孕患者进行体外受精-胚胎移植(IVF-ET)后自然妊娠的可能性以及与发生自然妊娠相关的临床条件。方法:对1999年11月至2007年6月于本院生殖中心因输卵管因素不孕进行IVF的患者进行随访,回顾性分析IVF后发生自然妊娠的13例患者的临床特征、IVF助孕情况和自然妊娠情况。结果:13例输卵管因素不孕患者行IVF治疗时的年龄为31.8±4岁(27-41岁),不孕年限5.2±2.2年(2-8年)。行IVF治疗发生生化妊娠1例,流产1例,单胎足月分娩1例。11例患者在IVF后6月内发生自然妊娠,另2例分别在IVF后2年和8年发生自然妊娠。其中,2例有异位妊娠史的患者发生对侧输卵管妊娠,1例发生流产,7例已生育健康后代,3例正处于中孕期。结论:输卵管因素不孕患者行IVF后仍有可能发生自然妊娠,尤其是年轻(<35岁)患者。IVF失败或放弃IVF治疗后患者心理状态的变化,也可能有助于激发其生育潜能,促成自然妊娠的发生。     

Melanin and HIV in sub-Saharan Africa

HIV is common in sub-Saharan Africa. Sexually transmitted bacterial and fungal infections increase the chance of HIV infection. Melanin can prevent the penetration of skin and mucus membranes by microorganisms, and soluble melanin can inhibit HIV replication. We suggest that melanin may reduce the incidence of HIV infection through venereally acquired skin lesions, thus reducing the risk of sero-conversion and slow the progress to AIDS. Indigenous sub-Saharan peoples are highly melanized, but there is pigment variation between populations. We show that skin reflectance, a negative correlate of melanin, is positively associated with adult rate of HIV in sub-Saharan countries. There is no such relationship in populations outside sub-Saharan Africa. We suggest that melanin concentration in black people may correlate with resistance to HIV infection.     

Sacred Conceptions: Clinical Theodicies, Uncertain Science, And Technologies Of Procreation In India

This article argues that the rapid transfer of assisted conception technologies, such as in vitro fertilization, to India is not restricted merely to the modalities of offering potential biomedical resolution of infertility but includes, more crucially, how clinicians and infertile consumers assimilate the “Western technoscience” of conception. The article draws on a larger multisite ethnographic study of infertility and assisted conception in India’s five major cities and is principally based on narratives of clinicians and infertile couples and on clinic-based ethnographic observations. In this article I contend that the success or failure of assisted conception, when situated in the universe of Hindu faith, becomes a powerful critique of the “incompleteness” of the “Western” science of conception. Situating this contention in the broader context of a clinician’s faith, I assert that assisted conception—by conjoining seemingly disparate domains of the traditional and the modern, the sacred and the profane, the human and the superhuman, science and religion—produces clinical theodicies that help explain and contain the tentativeness permeating the conception technologies. The article concludes by arguing that this enchanted version of a thoroughly disenchanted worldview of biomedicine is part of a larger cultural process of indigenization of biomedicine in India.     

Molecular insights into the causes of male infertility

Infertility is a reproductive health problem that affects many couples in the human population. About 13–18% of couple suffers from it and approximately one-half of all cases can be traced to either partner. Regardless of whether it is primary or secondary infertility, affected couples suffer from enormous emotional and psychological trauma and it can constitute a major life crisis in the social context. Many cases of idiopathic infertility have a genetic or molecular basis. The knowledge of the molecular genetics of male infertility is developing rapidly, new “spermatogenic genes” are being discovered and molecular diagnostic approaches (DNA chips) established. This will immensely help diagnostic and therapeutic approaches to alleviate human infertility. The present review provides an overview of the causes of human infertility, particularly the molecular basis of male infertility and its implications for clinical practice.     

The HIV epidemic in China: history, response, and challenge

INTRODUCTION One-quarter of the world’s population, 1.3 billion people, live in China. The majority of the population is Han Chi- nese (91.9%), while the rest are a mix of different minor- ity groups living primarily in southern and western China [1]. The GDP per capita is $5,600 per year, but at least 10% of the population lives below the poverty line. Just less than 15% of the GDP is in agriculture, with the re- mainder in industry/construction and services. The total health expend…     

The HIV epidemic in China: history, response, and challenge

The first case of AIDS was reported in 1985 in China, but by the early 21st century, the government estimated that there were 840,000 citizens living with HIV/AIDS. The number is increasing rapidly. The major risk groups are injection drug users (IDUSs; 43%) and former plasma donors (27%), but rates among heterosexual groups are rising rapidly.Sentinel surveillance was initiated in 1986, and now includes IDUs, men-who-have-sex-with-men, sexually transmitted disease clinic attendees, antenatal women, long-distance truck drivers, and .sex workers. Although the government was slow to respond to the epidemic in the late 20th century, it has made a vigorous response in the early 21st century.Components of that response include implementation and evaluation of harm reduction programs for IDUs, education to increase knowledge and reduce stigma, treatment and social support for rural and poor HIV/AIDS patients, widespread testing, and increased funding for HIV/AIDS programs. International agencies have been generous in their support of the government initiatives. To successfully combat the epidemic, China needs to develop and train the necessary infrastructure to implement its intervention programs, particularly in the rural areas, to vigorously combat stigma and discrimination, support research especially in the universities and research institutions other than the China Centers for Disease Control, develop a system for efficient exchange of research and program information, and update legislation to reflect the current situation.     

On transient effects in the HIV/AIDS epidemic

During the initially exponential spread of the human immunodeficiency virus (HIV—the causative agent of AIDS) the growth rate of the number of AIDS cases decreases from plus infinity to the growth rate of HIV infections. A sensitivity analysis shows that for all reasonable values of the parameters of the HIV epidemic (incubation period, initial doubling time, etc.) the effect of this positive transient becomes negligible when the annual number of AIDS cases reaches a few dozen. Necessary and sufficient conditions are given for the growth rate of the number of AIDS cases to be monotonically decreasing during the positive transient. A mildly pathological density function for the incubation period of AIDS provides an example of a growth rate of AIDS that does not decrease monotonically, even though HIV is spreading exponentially. A negative transient occurs when the growth rate of HIV begins to decrease. In this context a somewhat surprising result emerges under the assumption that the growth rate of HIV is non-increasing: the growth rate of AIDS is at all times larger than the growth rate of HIV. A logistic HIV epidemic illustrates this result, and implications for the growth of the HIV epidemic in the United States and Europe are discussed. In particular, it is shown that the positive transient must have passed by 1982 in the United States and by 1986 or 1987 for the five European countries with the largest caseloads.     

The challenges of modelling antibody repertoire dynamics in HIV infection

Antibody affinity maturation by somatic hypermutation of B-cell immunoglobulin variable region genes has been studied for decades in various model systems using well-defined antigens. While much is known about the molecular details of the process, our understanding of the selective forces that generate affinity maturation are less well developed, particularly in the case of a co-evolving pathogen such as HIV. Despite this gap in understanding, high-throughput antibody sequence data are increasingly being collected to investigate the evolutionary trajectories of antibody lineages in HIV-infected individuals. Here, we review what is known in controlled experimental systems about the mechanisms underlying antibody selection and compare this to the observed temporal patterns of antibody evolution in HIV infection. We describe how our current understanding of antibody selection mechanisms leaves questions about antibody dynamics in HIV infection unanswered. Without a mechanistic understanding of antibody selection in the context of a co-evolving viral population, modelling and analysis of antibody sequences in HIV-infected individuals will be limited in their interpretation and predictive ability.     

Stall in fertility decline in Eastern African countries: regional analysis of patterns,determinants and implications

We use data from the Demographic and Health Surveys to examine the patterns of stall in fertility decline in four Eastern African countries. Contrary to patterns of fertility transition in Africa that cut across various socio-economic and geographical groups within countries, we find strong selectivity of fertility stall across different groups and regions in all four countries. In both Kenya and Tanzania where fertility decline has stalled at the national level, it continued to decline among the most educated women and in some regions. While fertility has remained at pre-transition level in Uganda over the past 20 years, there are signs of decline with specific groups of women (especially the most educated, urban and those in the Eastern region) taking the lead. For Zimbabwe, although fertility has continued to decline at the national level, stall is observed among women with less than secondary education and those in some of the regions. We link these intra-country variations to differential changes in socio-economic variables, family planning programme environment and reproductive behaviour models. The results suggest that declines in contraceptive use, increases in unmet need for family planning, increasing preferences for larger families, and increases in adolescent fertility were consistently associated with stalls in subgroup fertility across all four countries. These results are consistent with models that emphasize the role of declines in national and international commitments to family planning programmes in the premature stall in sub-Saharan fertility transition.     

Modeling the joint epidemics of TB and HIV in a South African township

We present a simple mathematical model with six compartments for the interaction between HIV and TB epidemics. Using data from a township near Cape Town, South Africa, where the prevalence of HIV is above 20% and where the TB notification rate is close to 2,000 per 100,000 per year, we estimate some of the model parameters and study how various control measures might change the course of these epidemics. Condom promotion, increased TB detection and TB preventive therapy have a clear positive effect. The impact of antiretroviral therapy on the incidence of HIV is unclear and depends on the extent to which it reduces sexual transmission. However, our analysis suggests that it will greatly reduce the TB notification rate.     

The interface between medically assisted reproduction and genetics: technical, social, ethical and legal issues*

¹⁹ To whom correspondence should be addressed at: Department of Medical Genetics, University of Turku, Kiinamyllykatu 10, FIN-20520 Turku, Finland. E-mail: hkaaria{at}utu.fi^* Reprinted from European Journal of Human Genetics (2006) 1–58 with permission. The views expressed in this study do not necessarily reflect those of the European Commission (EC). The interface between assisted reproductive technologies (ART)and genetics comprises several sensitive and important issuesthat affect infertile couples, families with severe geneticdiseases, potential children, professionals in ART and genetics,health care, researchers and the society in general. Geneticcauses have a considerable involvement in infertility. Geneticconditions may also be transmitted to the offspring and hencecreate transgenerational infertility or other serious healthproblems. Several studies also suggest a slightly elevated riskof birth defects in children born following ART. PGD has becomewidely practiced throughout the world for various medical indications,but its limits are being debated. The attitudes towards ARTand PGD vary substantially within Europe. The purpose of thisarticle was to outline a framework for development of guidelinesto be issued jointly by European Society of Human Genetics (ESHG)and European Society of Human Reproduction and Embryology (ESHRE)for the interface between genetics and ART. Technical, social,ethical and legal issues of ART and genetics will be reviewed.     

Chinese NGOs in action against HIV/AIDS

Chinese nongovernmental organizations （NGOs） have played a significant role in the battle against AIDS in the People＇s Republic of China. This article provides a brief overview of the structure of these organizations, as well as an analysis of their principle accomplishments. Of great significance in this analysis is the fact that Chinese NGOs have effectively dealt with many sensitive health education areas that government authorities have felt reluctant to handle directly. As such, they have provided an indispensable component in the HIV/AIDS prevention and control calculus on the mainland.     

Chinese NGOs in action against HIV/AIDS

Chinese nongovernmental organizations (NGOs) have played a significant role in the battle against AIDS in the People‘s Republic of China. This article provides a brief overview of the structure of these organizations, as well as an analysis of their principle accomplishments. Of great significance in this analysis is the fact that Chinese NGOs have effectively dealt with many sensitive health education areas that government authorities have felt reluctant to handle directly. As such, they have provided an indispensable component in the HIV/AIDS prevention and control calculus on the mainland.     

Chinese NGOs in action against HIV/AIDS

INTRODUCTION The AIDS epidemic continues its seemingly inexorable spread throughout the world. It is now very clear that the virus represents not only a medical problem, but also a challenging and multifaceted social problem. Because of this fact, it is imperative that nongovernmental organiza- tions outside of, or tangential to, the medical arena be- come involved in prevention and control efforts. The Chinese government is supportive of the development of such organizations on the mai…