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M LV HEALTH INTERNATIONAL, VOL. 18 NO.3, SPRING 1998 NewsBriefs TIME 0 FONSET'. F<;>k"'C; p~h~~~ti9!l" Both studies, sup AIDS CASE FROM OC STROKE RISK 'M~i'::.8 8Q~ l~,;:·'p~r.~~tfbYFFn P RaG Est.J N'i . and published in 1959 VERY Low ~ ~ :i,:' t\',':_ " :;':: tn~~F ebruary issue ofFertility Decentstudies su~g~s,i:\hit)t~;)an~~~~~~lt9" focused only on '" cientists recently verified '" '. omen taking oralcontra the earliest known case of ,.' '. ceptives, especiallypills ~:~~~:;~~:::e;~:~'~. £/ ~~~:~~~~~~~.~~~i~c~ofa ~ ta ,;; AIDS, an African man who W., with higher levels ofestro- acetate (DMPA) and Norplant sperm penetration ~t day three died in 1959. The discovery " gen, ha~e an increased risk of provide effecti~e preg~~ncy pro- in this one subject was unex- suggests the virus first infected suffering a blood clot-induced tection more rapidly after injec- pected, and suggests the need people during the 1940s or early stroke than women not using tion or insertion than previously for more research to determine 1950s. them, but that risk is very low, thought, probably within three better the risk ofpregnancy if In a study published in the according to a study published days for most women. backup methods are not used for February 5 issue ofNature, re in the December 1997 British Current international seven days," says Dr. Petta. By searchers looked for signs of Medical Journal. guidelines recommend that the seventh day, all subjects in HIVin 1,213 blood sanlples The low-dose combined couples use a backup method for his study had cervical mucus gathered between 1959 and oral contraceptive pills com seven days after administration scores indicating contraceptive 1982 in Africa, where the virus is monly used today carry an even ofthese progestin-only methods, efficacy. .' believed to have originated. One smaller risk than the earlier ifa woman receives the implant In the study ofDMPA sample from a Bantu man who higher-dose pills. The results or injection after the seventh day (Depo-Provera brand), con- lived in Kinshasa, Congo (then from this study, which involved ofher active menstrual cycle. ducted by researchers fronl FHI called Leopoldville) clearly con 220 European women ages 16 to Some national guidelines rec- and the Universidade Estadual tained HIVgenetic fragments. 44 who had a stroke, and 775 ommend using a backup for the de Campinas, Campinas, Brazil, The scientists compared others who did not, were consis remainder ofthe menstrual 30 Brazilian women ages 18 to the 1959 HIV genetic fragments tent with results from a similar cycle. 40 were injected with the con- with genes from currentver 1996 study by the World Health Using condoms or another traceptive between days eight sions ofHIV, ofwhich there are Organization. backup method for less time and 13 oftheir menstrual cycle. 10 distinct subtypes, lettered A "Only first generation would save money for the user One day after injection, 90 per- through J. The researchers oral contraceptives'(high-dose and may encourage better com- cent.of the subjects display~d . found that the 39-year-old HIV estrogen) seem to be associated pliance, thus reducing preg- cervIcal mucus scores that IndI- sample was an ancestor ofsub with a higher risk," says Lothar nancy risks. (No backup method cated effective contr~ception types Band D. Subtype Bis the Heinemann ofthe Center for is necessary when the recipient had already been achIeved. dominant strain in the United Epidemiology and Health Re is within the first seven days of Asimilar study anlong 42 States and Europe, while subtype search in Berlin, principal author the menstrual cycle.) wonlen using Norplant in the D is most common in Africa. ofthe study. Oral contraceptive "We believe couples should Dominican Republic - This evolutionary continu use may cause about three strokes continue to use a backup for conducted by FHI, Asociaci6n ity suggests that all HIV sub annually per 100,000 women ages seven days until more research Dominicana Pro Bienestar de la types mutated from one form of 16 to 44, the study says. The very can examine this issue," says Dr. Familia (Profamilia), Johns HIV introduced into people, small increase in risk associated Carlos Petta ofBrazil,a former Hopkins Bayview Medical Cen- probably from monkeys or other with pills, the scientists noted, FHI fellow and principal author ter and Duke University- primates. Discovery ofthis early could be controlled ifdoctors did ofthe DMPA study. He notes indicated contraceptive effec- form ofHIVnlay help experts not prescribe pills to women with that one ofthe 30 subjects in his tiveness by the third day for all predict how the virus will evolve such cardiovascular risk factors as study did not appear to achieve women. "Backup methods of during the coming decades. high blood pressure. contraceptive protection by th~ contraception such as condoms More than 30 million people "Any small risks associated third day. need not be used for more than worldwide are infected with with the use ofOCs certainly are Like other progestin-only three days after [Norplant] in- HIV. Before the discovery ofthe outweighed by the clear benefits methods,both DMPA and sertion, even when the implants 1959 sample, the earliest uncon they provide to women ofrepro Norplant provide contraception are inserted close to ovulation," tested cases ofAIDS were inthe ductive age," says Dr. Pamela by inhibiting ovulation and by the authors concluded. late 1960s among members ofa Schwingl, an FHI epidenliolo causing cervical mucus to Norwegian family. gist who has studied this associa thicken, thus preventing sperm tion. "Risks associated with complications ofpregnancy and childbirth are far greater." 2 NETWORK Spring 1998 ·.Ni~if;i~lllibI1sl1eajq~~IT~!lyur~~~I1;jj/j··/ .··.~:tia:lJ~~~;:~~~~~r~···· ·i'j,j ':.:':::: 0 0 0 FAMILY HEALTH INTERNATIONAL, VOL. 18 NO.3, SPRING 1998 1[\1 THIS ISSUE MEN AND REPRODUCTIVE HEALTH MALE RESPONSIBILITY FOR REPRODUCTIVE HEALTH •••••••••••••••• 4 MEN'S REPRODUCTIVE HEALTH RISKS ••••••••••••••••••••••••••••••••••••• 7 MALE CIRCUMCISION AND HIV RISK •••••••••••••••••••••••••••••••••••••••• 9 MALE PARTICIPATION IN REPRODUCTIVE HEALTH ••••••••••••••••••• 11 MEN INFLUENCE CONTRACEPTIVE USE •••••••••••••••••••••••••••••••••• 13 REPRODUCTIVE HEALTH PROGRAMS FOR MEN •••••••••••••••••••••••• 28 , ..:::::.:; .. CONTRACEPTIVE METHODS FOR MEN EXPERIMENTAL MALE METHODS INHIBIT SPERM ••••••••••••••••••••• 16 .:·AR.T!~&\;PROriUCTiONEDITOR: ,;:, "....:.... CONDOM USE INCREASING •••••••••••••••••••••••••••••••••••••••••••••••••••• 20 ':.t;;i"!!l;!!(~f~lt:"Didk~tsoIl:· :. :'. ..' '. BEHAVIOR AFFECTS CONSISTENT USE ••••••••••••••••••••••••••••••••••• 22 Do CONDOM CHARACTERISTICS INFLUENCE USE? ••••••••••••••••••• 23 REASONS TO HAVE CONFIDENCE IN CONDOMS •••••••••••••••••••••••• 24 ATTRACTING MEN TO VASECTOMy •••••••••••••••••••••••••••••••••••••••••• 26 DEPARTMENTS NEWS BRIEFS •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 2 RESOURCES ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 32 .·:~~n£yfor:ffitemationiFI>eve1opment~·:--..·.:·,,:: '; Encouraging male responsibility for family planning requires services that protect the reproductive health ofboth men and women. An Ecuadorian farmer, photographed by Carlos D. Conde for Inter-American Development Bank, appears on the cover. NETWORK Spring 1998 3 Male.Responsib,ilitylor Reproductive Health The objective istopronzote gender equality in all spheres oflife, indudi!lgfamily and community life, and to encourage and enable men to take responsibilityfor their sexual and reproductive behavior and their social andfamily roles. ," " - Programme ofAction, UN International Conference on Population and Development, 1?94 efore the sexual revolutioninitiated which has pioneered services for nlen since by the pill, menwere a more integral 1985, when its first clinics formen opened. part offamily planning and" other Today, PROFAMILIA"clinics offer a range, reproductive health concerns than ofmale reproductive health services, in ad they are today. Ifa couple wished to dition to providing such male contraceptive use contraception, their options were lim~ "options as vasectonlies. "We never have been itedpfimarily to methods requiring a man's interested in subtracting from our services participation - withdrawal, periodic absti what we need is to do more. We do this by lienee or condoms. looking into what we have, what we can use Hormonal me'thods for wonlen, begin better, where the empty space is,"and how to ning with the first oral contraceptives in usewhat we now have more costefficiently 1960, and thesubsequent development of and with more client~orientation. The first intrauterine devices and modern surgical thing is toask clientS what they want." sterilization, led to the development of a While PROFAMILIA and a fewothe~ family planning services community focused successful progranls have found ways to on women, often to theexc1usion"ofmen. encourage nlale partidpation,"ahuge gap Today's challenge, as expressed by the 1994 remains between the rhetoric ofpromoting International Conference on Population and male involvement and "the realities offemale Development (ICPD) held in Cairo, is to oriented reproductive health programs," says enhance male responsibility for family plan Errol Alexis ofthe New York-based Margaret ning by expanding services in ways that pro Sanger CenterInternational, who has tect the reproductive health of both nlen and worked with men and youth for20yearsih women,

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