An assessment of youth centres in South Africa

Within South Africa there is much interest in expanding youth center programs, particularly in the nongovernmental sector, in part because of recognition that the HIV/AIDS crisis is disproportionately affecting young South Africans. This study was designed to give implementing agencies and donors a broad view of how the youth centers function, who they reach, and the quality of information and services. The assessment underscored the importance of monitoring the performance of programs and understanding who is being reached with what interventions. Youth centers that focus on providing recreational facilities attract a large number of clients, often boys who are repeat visitors, however, linkages between providing recreation and positive health outcomes are not clearcut. Centers should not lose sight of their health objectives and should recognize that a significant proportion of young people are in need of quality reproductive health (RH) information and services. The report further recommends that attention be paid to the specific needs and circumstances of boys and girls in designing programs that satisfy their distinct RH needs

Implementing and scaling-up Stepping Stones in KwaZulu-Natal, South Africa: Lessons from working in informal settlements

KwaZulu-Natal (KZN), a major epicenter of the South African HIV epidemic, has large informal settlements where thousands of people live. The settlements are often underserved by municipal services and lack accessible health care. Given high rates of HIV, there is a critical need to assess the successes and challenges of implementing HIV prevention and treatment in this context. Stepping Stones is a widely used life-skills training intervention focused on curbing gender-based violence and reducing HIV risk. The program addresses issues such as communication about HIV, relationship skills, and assertiveness. The manual-based curriculum encourages participants to engage in critical reflection through role-playing and group dialogue. Previous evaluations of Stepping Stones in South Africa found significant reductions in intimate partner violence and herpes simplex virus-2, and improvements in couple communication and negotiation. Under Project SOAR, the Population Council and the MatCH Research Unit of the University of the Witwatersrand conducted program evaluations in 18 selected informal settlements in KZN. This brief focuses on the experiences, challenges, successes, and perceived effects of implementing (and scaling up) Stepping Stones in the informal settlement setting

Bone mineral density and use of depot medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN) and combined oral contraceptives

PhD, Faculty of Health Sciences, University of the WitwatersrandMany studies have shown a negative effect of depot-medroxyprogesterone acetate (DMPA) hormonal contraception on bone mineral density (BMD) in women. There is limited information on the effect of norethisterone enanthate (NET-EN) on BMD and the effect of combined oral contraceptives (COCs) on BMD is inconclusive, however emerging evidence is showing that low-dose COCs maybe detrimental to BMD in young women. The aim of this research was to evaluate, in a 5-year follow-up study, the possible effect of DMPA, NET-EN and COCs on BMD among young (15-19 years) and older (40-49 years) South African women. Method: This prospective study was conducted at the Commercial City Family Planning clinic in Durban, South Africa between 2000 and 2007. In the adolescent group women with no history of hormonal contraception who were initiating use of DMPA (n=115), NET-EN (n=115) or COCs (n=116) and 144 nonuser controls were recruited. In the older group, one hundred and twenty seven users of DMPA, 102 NET-EN users and 106 COC users of at least one year were compared to 161 nonuser controls. BMD was measured at the distal radius and midshaft of the ulna using dual x-ray absorptiometry. In the crosssectional component of the study conducted at the end of the longitudinal phase, BMD was measured at the hip, spine and femoral neck in a sub-group of 96 of the younger women. Results: In the longitudinal study of adolescents, BMD increased in all four groups during follow-up (p<.001). There was evidence for lower BMD increases per annum in NET-EN (p=.050) and COC (p=.010) users compared to nonusers but no difference between DMPA and nonusers (p=.76). In 14 NET-EN discontinuers, an overall reduction of 0.61% per year BMD was followed, upon cessation, by an increase of 0.69% per year (p=.066). The cross-sectional sub-study found that young women in the injectables-only user group had lower BMDs compared to the non-user group after adjusting for BMI at the spine (p=0.042), hip (p=0.025), and femoral neck (p=0.023). The mixed COC/injectable user group BMD values were lower than controls; however, they were not significant at any of the three sites. In the older women, there was no significant difference in radius BMD between the contraceptive user groups and the non-user controls (p=.26) with and without adjustment for age at baseline, or after two and a half years of follow-up (p=0.52). Conclusion: This study suggests that BMD increases in adolescents may be less in NETEN and COC users; however, recovery of BMD in NET-EN users was found in the small sample of adolescents followed post-discontinuation. The cross-sectional sub-study showed similar findings in long-term injectable users, but not when women had mixed injectable and COC use. There was no evidence that long-term use of DMPA, NET-EN and COCs affected BMD in the older women

Dual protection against sexually transmitted infections and pregnancy in South Africa

Promotion of simultaneous protection against sexually transmitted infections (STIs) and unintended pregnancy, referred to as dual protection, represents an important public health intervention. We investigated its prevalence and correlates in South Africa. A cross-sectional survey of 929 sexually active women, aged 15-49 years, was conducted in 89 public primary health care clinics, with dual method use and use of condom alone at last sexual intercourse as outcomes. At last intercourse, 12% of women were protected from both STIs and pregnancy. In multivariate analysis, higher education, being unmarried, and multiple sex partnership in the past year were predictors of dual method use, while younger age, higher education and awareness of the dual function of condoms were predictors of condom use alone. Dual protection is low in this population. The predominance of hormonal contraceptive use in South Africa means that increasing barrier method use among hormonal contraceptive users is an important strategy for increasing dual protectio

Dual protection in sexually active women

Objective. To determine the prevalence and co-factors associated with the practice of dual protection against sexually transmitted infections (STis) and unwanted pregnancy in a cross-sectional sample of South African women.Design. Secondary analysis of cross-sectional household survey data.Methods. Statistical analysis of responses by sexually active women to the question, 'Was a condom used on the last occasion you had sex?' were obtained from the women's questionnaire of the South African Demographic and Health Survey in relation to a number of other variables.Results. (i) 10.5% of all sexually active women aged 15- 49 years used a condom at last sex and 6.3% used a condom as well as another contraceptive method; (it) condom use is more likely among younger, more educated, more affluent, and urban women, and among women who change partners more frequently; (iii) reasons for not using condoms are more likely to be associated with the personal attitudes of women or their partners than with poor knowledge of or lack of access to condoms; (iv) women who have no need or desire to prevent pregnancy are less likely to use condoms; and (v) there is a minority of sexually active women, characterised by social disadvantage, who have difficulty obtaining condoms.                                                                                                                                               Conclusions. There is an urgent need for targeted programmes that increase dual protection with condoms

Ever and repeat HIV testing rates among male and female clients: Findings from a reproductive health services integration project in South Africa

Background. HIV testing rates have increased in recent years. Repeat testing is recommended to identify and treat new HIV infections timeously. However, there are limited data on repeat HIV testing, especially in South Africa (SA).Objectives. To provide data on repeat HIV testing rates in males and females in a district in SA.Methods. A sexual and reproductive health (SRH) service integration model was implemented in seven healthcare facilities in eThekwini District, KwaZulu-Natal Province, SA, between 2009 and 2011. HIV testing data were collected from male and female clients attending these facilities, prior to (baseline) and after the implementation (endline) of the 3-year health services integration intervention.Results. There were 230 clients at baseline (195 female, 35 male) and 200 at endline (169 female, 31 male). High ever-tested rates were reported at baseline (females 95.4%, males 74.3%) and endline (females 91.7%, males 87.1%), with large increases in male testing rates over time. In addition, high increases were seen between baseline and endline among those who had tested more than once and more than twice in their lifetime. Increases between baseline and endline testing rates were highest in HIV testing services (HTS) (37.0 - 93.3% for clients who had tested more than once, and 11.1 - 53.3% for those who had tested more than twice).Conclusions. HIV testing and repeat testing increased over time, especially in males and in HTS. Promotion and integration of SRH services are critical to facilitate improved health-seeking behaviour and HIV testing of both male and female clients. They are also important for continued access to HTS at multiple service delivery points

Acceptability of the female condom in different groups Of women in South Africa-A Multicentred study to inform the national female condom introductory strategy

Objectives. To assess the acceptability of the female condom to different groups of women and their partners in South Africa.Design. Descriptive, cross-sectional study.Setting. Multicentre study conducted in five sites.Subjects. The study recruited 678 women from five centres to an acceptability trial of the female condom. Acceptability and successful use varied between the centres. Outcome measures. Factors affecting successful use and willingness and intention to use the method again.Results. In total, 209 women used the condom at least once. Discontinuation rates were high, with partner reluctance to try the method as the main reason given for discontinuation at all sites. Women who had previous experience with the male condom or who received a more intensive training session generally found the device easier to use. The main issues concerning women were over-lubrication (27%) and concern that the device was too large (28%). The majority of women said that they would be interested in using the method again (86%) and would recommend it to friends (95%).Conclusions. Overcoming partner opposition is an important issue to address when introducing the method. The study was used to address the national introductory strategy of the female condom, which began in 1998

Acceptability of the female condom in different groups of women in South Africa - A multicentred study to inform the national female condom introductory strategy

Objectives. To assess the acceptability of the female condom to different groups of women and their partners in South Africa. Design. Descriptive, cross-sectional study. Setting. Multicentre study conducted in five sites. Subjects. The study recruited 678 women from five centres-to an acceptability trial of the female condom. Acceptability and successful use varied between the centres. Outcome measures. Factors affecting successful use and willingness and intention to use the method again. Results. In total, 209 women used the condom at least once. Discontinuation rates were high, with partner reluctance to try the method as the main reason given for discontinuation at all sites. Women who had previous experience with the male condom or who received a more intensive training session generally found the device easier to use. The main issues concerning women were over-lubrication (27%) and concern that the device was too large (28%). The majority of women said that they would be interested in using the method again (86%) and would recommend it to friends (95%). Conclusions. Overcoming partner opposition is an important issue to address when introducing the method. The study was used to address the national introductory strategy of the female condom, which began in 1998

Dual protection in sexually active women.

OBJECTIVE: To determine the prevalence and co-factors associated with the practice of dual protection against sexually transmitted infections (STIs) and unwanted pregnancy in a cross-sectional sample of South African women. DESIGN: Secondary analysis of cross-sectional household survey data. METHODS: Statistical analysis of responses by sexually active women to the question, 'Was a condom used on the last occasion you had sex?' were obtained from the women's questionnaire of the South African Demographic and Health Survey in relation to a number of other variables. RESULTS: (i) 10.5% of all sexually active women aged 15-49 years used a condom at last sex and 6.3% used a condom as well as another contraceptive method; (ii) condom use is more likely among younger, more educated, more affluent, and urban women, and among women who change partners more frequently; (iii) reasons for not using condoms are more likely to be associated with the personal attitudes of women or their partners than with poor knowledge of or lack of access to condoms; (iv) women who have no need or desire to prevent pregnancy are less likely to use condoms; and (v) there is a minority of sexually active women, characterised by social disadvantage, who have difficulty obtaining condoms. CONCLUSIONS: There is an urgent need for targeted programmes that increase dual protection with condoms

Dietary assessment in Whitehall II: comparison of 7d diet diary and food-frequency questionnaire and validity against biomarkers

The aim of the present cross-sectional study was to examine the agreement and disagreement between a 7 d diet diary (7DD) and a self-administered machine-readable food-frequency questionnaire (FFQ) asking about diet in the previous year, and to validate both methods with biomarkers of nutrient intake. The subjects were an age- and employment-grade-stratified random subsample of London-based civil servants (457 men and 403 women), aged 39–61 years, who completed both a 7DD and a FFQ at phase 3 follow-up (1991–1993) of the Whitehall II study. Mean daily intakes of dietary energy, total fat, saturated, monounsaturated and polyunsaturated fatty acids, linoleic acid, total carbohydrate excluding fibre, sugars, starch, dietary fibre, protein, vitamin C, vitamin E (as α-tocopherol equivalents), folate, carotenes (as total β-carotene activity), Fe, Ca, Mg, K and alcohol were measured. Serum cholesteryl ester fatty acids (CEFA), plasma α-tocopherol and β-carotene were also measured as biomarkers. Estimates of mean energy intake from the two methods were similar in men, and some 10 % higher according to the FFQ in women. Compared with the 7DD, the FFQ tended to overestimate plant-derived micronutrient intakes (carotenes from FFQ v. 7DD men 2713 (SD 1455) V. 2180 (sd 1188) μg/d, women 3100 (sd 1656) v. 2221 (sd 1180) μg/d, both differences P<0·0001) and to underestimate fat intake. Against plasma β-carotene/cholesterol, carotene intake was as well estimated by the FFQ as the 7DD (Spearman rank correlations, men 0·32 v. 0·30, women 0·27 v. 0·22, all P≤0·0001, energy-adjusted data). Ranking of participants by other nutrient intakes tended to be of the same order according to the two dietary methods, e.g. rank correlations for CEFA linoleic acid against FFQ and 7DD estimates respectively, men 0·38 v. 0·41, women 0·53 v. 0·62, all P≤0·0001, energy-adjusted % fat). For α-tocopherol there were no correlations between plasma level and estimated intakes by either dietary method. Quartile agreement for energy-adjusted nutrient intakes between the two self-report methods was in the range 37–50 % for men and 32–44 % for women, and for alcohol, 57 % in both sexes. Disagreement (misclassification into extreme quartiles of intake) was in the range 0–6 % for both sexes. The dietary methods yielded similar prevalences (about 34 %) of low energy reporters. The two methods show satisfactory agreement, together with an expected level of systematic differences, in their estimates of nutrient intake. Against the available biomarkers, the machine-readable FFQ performed well in comparison with the manually coded 7DD in this study population. For both methods, regression-based adjustment of nutrient intake to mean dietary energy intake by gender appears on balance to be the optimal approach to data presentation and analysis, in view of the complex problem of low energy reporting