Evaluation of Syracuse Healthy Start’s Program for Abnormal Flora Management to Reduce Preterm Birth Among Pregnant Women

Randomized trials of bacterial vaginosis (BV) treatment among pregnant women to reduce preterm birth have had mixed results. Among non-pregnant women, BV recurs frequently after treatment. Randomized trials of early BV treatment for pregnant women in which recurrence was retreated have shown promise in reducing preterm birth. Syracuse’s Healthy Start (SHS) program began in 1997; in 1998 prenatal care providers for pregnant women living in high infant mortality zip codes were encouraged to screen for abnormal vaginal flora at the first prenatal visit. Vaginal swabs were sent to a referral hospital laboratory for Gram staining and interpretation. SHS encouraged providers to treat and rescreen women with bacterial vaginosis or abnormal flora (BV). We abstracted prenatal and hospital charts of live births between January 2000 and March 2002 for maternal conditions and treatments. We merged abstracted data with local electronic data. We evaluated the effect of BV screening before 22 weeks gestation, treatment, and rescreening using a retrospective cohort study design. Among 838 women first screened before 22 weeks, 346 (41%) had normal flora and 492 (59%) women had BV at a mean of 13 weeks gestation; 202 (24%) did not have treatment documented and 290 (35%) received treatment at a mean of 15 weeks gestation; 267 (92%) of those treated were rescreened. Among pregnant women with early BV, 42 (21%) untreated women and 28 (10%) treated women delivered preterm (Odds Ratio [OR] 0.4, 95% confidence interval [CI] 0.2–0.7)). After adjustment for age, race, prior preterm birth and other possible confounders, treatment remained associated with a reduced risk of preterm birth compared to no treatment (aOR = 0.5, 95% CI 0.3–0.9); the aOR for women with normal flora was not significantly different. Conclusion: Screening, treatment, and rescreening for BV/abnormal flora between the first prenatal visit and 22 weeks gestation showed promise in reducing preterm births and deserves further study

Consistent Condom Use in South African Youth's Most Recent Sexual Relationships

Sexually active South African youth are at high risk for HIV infection but a low prevalence of condom use has been reported in this population. We examined correlates of consistent condom use with most recent sex partners among a nationally representative sample of youth 15-24 years old who reported having had sex in the previous 12 months (N = 6,649). Among men and women, having talked to a partner about using condoms was the most significant predictor of consistent condom use. However, youth who reported being in their most recent relationship for more than 1 year and who reported having had sex one or more times in the last month were more likely to report inconsistent condom use. HIV interventions should empower youth to talk about using condoms with their partners, encourage periodic testing for HIV, and reinforce condom use according to HIV status in long-term relationships

Parental Literacy and Infant Health: An Evidence-Based Healthy Start Intervention

Syracuse Healthy Start, a federally funded infant mortality prevention project in Onondaga County, New York, has undertaken a range of interventions to address parental low literacy as a risk factor for infant mortality. A growing number of studies advocate for health-related information that is easy to read, of a low literacy level, and culturally appropriate. Creation of an evidence-based public health intervention involves analyzing local data, reviewing published studies, assessing available materials, initiating programmatic interventions, and evaluating the outcomes. Preparing health educational materials that are clear, culturally sensitive, and at appropriate reading levels follows Paulo Freire’s lead in empowering the disadvantaged to positively affect their health and the health of their infants toward the reduction of infant mortality

Keep them in school: the importance of education as a protective factor against HIV infection among young South African women

Objective: To identify risk factors for HIV infection among young women aged 15–24 years reporting one lifetime partner in South Africa. Design: In 2003, we conducted a nationally representative household survey of sexual behaviour and HIV testing among 11,904 young people aged 15-24 years in South Africa. This analysis focuses on the subset of sexually experienced young women with only one reported lifetime sex partner (n = 1708). Methods: Using the proximate determinants framework and the published literature we identified factors associated with HIV in young women. The associations between these factors and HIV infection were explored in multivariable logistic regression models. Results: Of the young women, 15% reporting one lifetime partner were HIV positive. In multivariable analyses, young women who had not completed high school were more likely to be infected with HIV compared with those that had completed high school (AOR 3.75; 95% CI 1.34–10.46). Conclusions: Young South African women in this population were at high risk of HIV infection despite reporting only having one lifetime partner. Few individual level factors were associated with HIV infection, emphasizing the importance of developing HIV prevention interventions that address structural and partner level risk factors

A Tale of Two Countries: Rethinking Sexual Risk for HIV Among Young People in South Africa and the United States

Purpose: To compare the sexual behaviors of young people in South Africa (SA) and the United States (US) with the aim to better understand the potential role of sexual behavior in HIV transmission in these two countries that have strikingly different HIV epidemics. Methods: Nationally representative, population-based surveys of young people aged 18-24 years from SA (n = 7,548) and the US (n = 13,451) were used for the present study. Results: The prevalence of HIV was 10.2% in SA an