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Training Workshop Fellows
William K. Adih, M.D., Dr.P.H.
Social Interaction and Reproductive Behavior in Southern Ghana In collaboration with the Population Council in New York (John Casterline
and Mark Montgomery, Principal Investigators), the Demography Unit of the
University of Cape Coast (Ghana) is conducting a multi-year study of social
interaction and reproductive behavior in southern Ghana, with funding from
the U.S. National Institutes of Health and the Rockefeller Foundation.
The project is conducting a panel survey of women of reproductive age and
their partners residing in six purposively-selected dispersed communities
in three regions of southern Ghana. The first round was conducted
in Nov-Dec 1998, with 1221 women and 679 male partners interviewed.
The second round is underway and will run from May-July 1999, and the third
round is scheduled for Nov-Dec 1999. The questionnaires for each
round are lengthy, containing socioeconomic and demographic background
information and comprehensive measurement of reproductive attitudes and
behaviors. In addition, each round contains one or two social network
modules and a set of items on HIV/AIDS. With these various blocks
of information, it will be possible to analyze HIV/AIDS knowledge, attitudes,
and behaviors as a function of social network characteristics of the individual.
Further, the panel design will permit modeling of changes in knowledge,
attitudes and behaviors as a function of changes in social networks.
Priscilla Akwara
Multiple Partners and the Risk of HIV/AIDS among Women and Men in Kenya Although Kenya is experiencing rapid declines in fertility levels and
increases contraceptive use, there is a growing concern about the rapid
spread of HIV/AIDS and other sexually transmitted infections (STIs).
Using data already collected from one region considered to have high HIV/AIDS
prevalence in Kenya, the study will attempt to examine the proportion and
characteristics of women and men at risk of HIV infection because they
had multiple sexual partners and the proportion at risk because their partners
engaged in risky behavior.
Shelly Atherly-Trim, MPH
Social Diffusion Project Currently I am coordinating a research study in northern Ghana looking
at social networks and the diffusion of fertility behavior sponsored by
the New York Population Council in collaboration with the Navrongo Health
Research Center. The diffusion study was designed to observe the
social dynamics of the adoption of modern contraception using a micro longitudinal
data collection system. The overall aim of the diffusion study is
to investigate the role of social dynamics and diffusion as a component
of the fertility theory. The quantitative survey instrument was designed
to explore the influence of family planning adoption through different
levels of the socio-cultural and political structure among residents of
a rural community. This study may give insight into the role of diffusion
dynamics and its influence on traditional program implementation and evaluation,
as well as service delivery.
Aparna Basu
Mathematical modeling of HIV transmission in India I have been working in the area of mathematical modelling in S&T,
and have recently become interested in network analysis in connection with
my work on collaboration in Indian science. I have earlier used epidemiological
models for studying diffusion. The use of mathematical models is not very
widespread here except in the study of the economy and weather forecasting.
Any real anlysis will of necessity have to be an interdisciplinary effort
between medical professionals and those with a background in data handling.
Dr. Valentina Bodrova
Sexually Transmitted Diseases (STD) as the early stages of an epidemic of HIV/AIDS in Russia From February through May of 1996, a reproductive health survey was
carried out among women in three locations in Russia. USAID sponsored the
survey as part of its Russia Women’s Reproductive Health Project. This
project consists of a variety of components intended to expand and improve
the use of effective contraception, reduce the reliance on abortion as
a means of birth prevention, prevalence of STDs, knowledge about prevention
and health care and generally to improve the reproductive health of Russia
women.
Nicole M. Buono, MPH
Social Diffusion of Reproductive Control The Navrongo Health Research Centre in collaboration with the Population
Council has developed a proposal to investigate social diffusion of reproductive
control in the Kassena-Nankana District. The main aims of the project are:
(1) To assess the contribution of social diffusion to the spread of modern
contraception in rural areas; (2) To assess the ways in which existing
local social organization (formal and informal) facilitates and/ or constrains
the diffusion of new family planning behavior; (3) To develop strategies
for increasing the effectiveness of health and family planning operations
through exploiting the potential for positive diffusion effects through
social relationships. The study proposed for the Chiang Mai Conference
on Partnership Networks is part of this Diffusion Initiative and specifically
examines personal social networks of family planning users and non-users
to better understand the social interactions and influences on the adoption
of family planning innovations.
Nada S. Chaya
Chiweni Ellerton Kible CHIMBWETE
Socioeconomic and demographic aspects of young people’s sexual behaviour and health in Malawi This is a study of social, cultural, and demographic factors affecting
sexual behaviour and the reproductive health (RH) patterns of young people,
in relation to childbearing, family planning and HIV/AIDS control, with
special emphasis on young females. Some of the specific objectives
are: to investigate the awareness and utilisation of reproductive health
services at community level; to explore sexual behaviour of young people;
and to study the knowledge and attitude towards HIV/STD infection risk,
among the adolescents and the adult population. The study uses
quantitative and qualitative data. Demographic and health surveys
conducted in 1992 and 1996 collected information on sexual behaviour and
childbearing. A qualitative study on the socio-cultural aspects of
reproductive behaviour and health was carried out by the researcher in
1997/98. At a community level, the study collected details of the
social norms, perceptions and cultural influences on young people's sexual
behaviour through focus group discussions involving the young people themselves.
Opinion leaders were also interviewed as there is need to expand our understanding
of most influential people in the community if effective measures to promote
behavioural change are to take place. The study also reviewed the
policy and the programmes of AIDS control, family planning, youth development
and family life education in Malawi.
Sophie Le Cœur
Socio-demographic characteristics associated with HIV-infection in pregnant women in Thailand Maternal HIV-1 infection is a major public health concern in Thailand
due to the high prevalence among women of childbearing age and the poor
prognosis for perinatally infected children. Interventions that use AZT
to reduce mother-to-child transmission are now being implemented throughout
the country. HIV seroprevalence-associated characteristics were studied
in a population of 23,091 pregnant women followed in 27 hospitals in northern
and central Thailand.
Wassana Im-Em
AIDS epidemic in Thailand An increasing number of people infected with HIV/AIDS are returning
home after they had developed the AIDS symptoms. Several PWHA in
the Upper-North region whose spouses had died decided to live together
to help supporting each other. Although Thailand is often cited to be the
country with great success in controlling the AIDS epidemic, the major
challenge for Thailand today is how to promote safe sex or to promote condom
use among the general population, not only among sex workers.
Monica Magadi
Social Networks and HIV Transmission in the Nyanza Province of Kenya Like in other Sub-Saharan Africa countries, the main mode of HIV transmission
in Kenya is through heterosexual contact. A greater part of the transmission
is fueled by casual sex. However, in some communities, the traditional
practises within formal marriage are likely to play an enormous role in
the HIV transmission. Polygamy is one such practise which is likely to
fuel the spread of HIV. In the 1993 KDHS, more than a quarter of women
in Coast, Western and Nyanza provinces reported having co-wives.
These are the same regions where the highest prevalence of HIV/AIDS in
the country have been reported. Among the Luo ethnic group which is the
predominant group in Nyanza, the pattern of re-marriage in the event of
a man dying further greatly encourages the HIV spread. Luo widows are expected
to re-marry within the family, usually to a younger brother of the deceased.
Hence, if the deceased died of AIDS, there are high chances of the disease
quickly spreading to the brother’s household. Such a scenario is already
apparent in some villages where the disease has wiped out groups of brothers
and their wives, leaving behind many orphans and elderly grandparents with
no one to care for.
Jacob R.S. Malungo
Qualitative And Quantitative Research Methodologies In Understanding Sexual Networking In The Era Of HIV/Aids In Sub-Saharan Africa: Zambia In Perspectives A number of researchers have raised concerns as to whether Demographers should utilise micro-level, ethnographic approaches, in addition to the “conventional” quantitative methods. Against this backdrop, I considered Fricke (1997:825)’s recommendation “for a self-conscious search for methodologies that will allow demographers to incorporate cultural meanings into their explanations of demographic processes”, and combined both approaches. The quantitative approach employed a sample of 1000 males and females randomly selected in the second half of 1998 from Southern Province of Zambia. Also, relevant data from the 1997 Zambia Demographic and Health Survey were utilized. To complement these data sets, qualitative data drawn from both within and outside the sample were obtained by various techniques, notably, area truncation, snowball sampling and “informal discussions”. The study observed three elements of sexual networking: pre-marital;
extra-nuptial and “commercialised” or “monetised” (as there are no legalized
brothels, but bars and other drinking and dancing places in Zambia) sexual
relations. Although marriage is near universal, pre-marital and extra-nuptial
sexual relations culturally not accepted, and “living together” very uncommon,
more than half of the married people have had sexual relations outside
their current marriages with single and married partners and prostitutes.
About one in five of the people in both urban and rural areas have discovered
that their spouses have extra-nuptial relations and a significant proportion
of those widowed have acquired new sexual partners. A variety of reasons
surrounding the observed sexual networking just like how the different
methodological components were conceived and articulated are elucidated
in this discourse.
Soori E. A. Nnko
Sexual Networking in Kisesa TANESA is involved in a multisite UNAIDS study on sexual networking
in Kisesa ward. The study involve qualitative and quantitative data source.
The collection of quantitative data on sexual networking was started way
back in November 1996 alongside serological surveys. The survey on
sexual networking have been followed by a qualitative study which looked
at partnering including sexual mixing patterns and the sequences of partner(s)
replacement and change. The qualitative study involved in depth interviews,
observation, and informal talks with key informants. The in depth interviews
asked for concurrent and serial partnering. Apart from involving
in the UNAIDS multisite, during 1999 TANESA is conducting more research
on the sexual networking among vulnerable groups including prisons and
mines.
Constance Nyamukapa
Sexual Behaviour Patterns and the Rapid Rise in Age-Specific HIV-1 Prevalence among Young Women in Rural Zimbabwe A population survey of HIV and associated patterns of sexual behaviour is currently in progress in rural areas of Manicaland Province, Zimbabwe. Early results indicate that HIV prevalence increases very rapidly between the ages of 16 and 25 in women but more slowly and at later ages among men. A part of the explanation for the contrasting age-pattern of infection lies in higher male-female than female-male HIV transmission probabilities. However, differences in patterns of sexual behaviour between young men and young women could be a further contributing factor. Our objectives are to describe the sexual activity and sexual mixing
patterns of young men and women in rural Manicaland, and to investigate
the extent to which these patterns of sexual behaviour could explain observed
gender differentials in HIV prevalence at young adult ages.
Susan M. Rogers
Measures of Sexual Networks and Individual STD Risk The proposed study of sexual networks builds upon a recently completed
survey of the health and STD-related risk behaviors among adults residing
in Baltimore City, MD. The Baltimore STD and Behavior Study (BSBS) combined
urine-based diagnostic tests for gonorrhea (GC) and chlamydial infection
(CT) with a population-based survey. An important feature of this
study was the ability to differentiate currently infected individuals from
individuals providing a self-reported history of infection.
We suspect that the currently infected individuals had partners who engaged
in ‘high-risk’ behaviors and/or circulated in different sexual networks.
Unfortunately, the BSBS collected limited information on respondents’ sexual
partners. A preliminary investigation of sexual networks will be
incorporated into a pilot study of STD clinic patients in Baltimore.
Of particular methodological interest for this investigation are: (1) selection
of an appropriate sexual network sampling method (respondents and their
partners), (2) determining the relevant sexual network variables (partners’
attributes, behavior, and infection status) to be collected in modeling
STD risk, and (3) utilization of appropriate methods of analysis for network
data, i.e., when the study design focuses not on the individual but the
sexual partnership. In order to address issue #2, in-depth interviews with
patients will be organized around a series of open-ended questions addressing
the following issues from the patients’ perspectives: why should all sexual
partners be notified of a patient’s positive infection status; what is
risked and what is gained in revealing the identity of a sexual partner(s);
what are the advantages of clinic vs personal notification techniques;
how much do/should individuals know of their partners’ (regular, casual)
sexual activities and histories.
Eric A. Roth
STD/HIV In Northern Kenya Due to the area’s poor infrastructure and resulting logistic difficulties, northern Northern Kenya and its largely pastoralist populations are routinely omitted from Kenyan national surveys (e.g. Republic of Kenya 1994). As a result today there are no data pertaining to STD and/or HIV knowledge, prevalence or transmission risks, for this region. Funded by a Canadian International Development Agency micro-grant in 1998 we initiated pilot studies in one sedentary community of Rendille pastoralists with the goals of: 1) determining community knowledge of STD and HIV transmission, symptoms and intervention, 2) delineating Ariaal sexual culture and, 3) identifying high risk behaviour. We now wish to expand this research to incorporate three Rendille communities, Karare (n. households = 560), Kitiruni (n. households= 256), and Songa n. households= 480). With the goal of developing a culturally appropriate STD/HIV education
and intervention program our proposed research has three main foci. The
first will be to delineate traditional and modern elements of Ariaal sexual
culture through the use of focus groups and key informant interviews. This
will be followed by whole community surveys designed to identify sexual
networks and high-risk behaviour (c.f. Orubuloye et al. 1994). Particularly
important here is the role of Ariaal sexual traditions, including nykeri
and dumassi. In the former unmarried males, or warriors, bead adolescent
girls, initiating long-term premarital sexual relationships with young
girls who may be sexually shared with the warrior’s age-mates (Roth et
al. 1999) The second refers to and “open lover institution” (Sato 1998)
by which men may initiate sexual relationships with his elder brothers’
wife(ves) and her/their sisters. The final focus will consist of the construction
and delivery of a peer education and counseling program guided by the findings
from the first two studies. While based specifically on the Ariaal, it
is hoped that this study will provide a framework for STD/HIV programs
across northern Kenya, appropriate for other pastoralist peoples, e.g.
Turkana, Boran, Somali, Rendille, of the region.
Mukta Sharma
Why are HIV/AIDS rates so high in Manipur and how effective and appropriate are HIV/AIDS prevention and care policies, both in the governmental and non-governmental sectors? HIV/AIDS infection rates in the North-Eastern Indian state of Manipur
are extraordinarily high. The National AIDS Control Organisation of India,
in its annual country Report, 1998 has indicated a seropositivity rate
of 177.1 per 1000. Although Manipur makes only 0.2% of India’s population
it contributes 16% of the HIV/AIDS burden. In the first instance, the epidemic
broke out amongst the 30,000 or so injecting drug users in the state (
with seroprevalence rates of 73%) but it has now entrenched itself deeply
amongst the general population as well.
Mohan Singh
Sexual Networking and HIV AIDS in Singapore: An Explorative Study The spread of HIV infection is dramatic in South and South East Asia. Poverty coupled with fragile health care systems has exacerbated the epidemic in this part of the world. While considerable attention has been paid to countries such as India, China and Thailand, there is very little focus on the disease in other South and South East Asian countries. Lack of attention in these countries has led to lack of understanding of HIV and AIDS thereby has restricted programmes to curb the disease. In Singapore the clinical data suggest that increasing number of HIV
cases are heterosexuals. But there is no clear evidence to show how did
these heterosexual people contract the virus. The available data on the
HIV and AIDS careers only provides information on their sex and age. There
is lack of detail about their sexual habits, sexual networking, sexual
behaviour, socio-economic characteristics, circumstances that led to their
contracting the virus. This study focuses on sexual networking among
various types of population groups such as Singaporean males and females,
and foreign males and females working in Singapore. The study assumes that
recent regionalization drive as well as increasing affluence among Singaporeans
has exacerbated the HIV infection. Furthermore, study also seeks to address
the sexual and health behaviour among foreign domestic worker (maids) and
foreign construction workers. The study will extended to Thailand and Indonesia
where every year many Singaporeans visit for pleasure and which are also
important sources of workers in Singapore's domestic and construction industries.
‘Maletela (Miss) TUOANE
Partnership Networks Among Labour Migrants and their Partners in Lesotho: Exposure to the Risk of Sexually Transmitted Infections Sexually Transmitted Diseases (STDs) have long been a serious health problem in Lesotho, being the number one cause of out-patient morbidity among adults in Lesotho. The risk of contracting an STD is related to the chance of having intercourse with a partner who has an STD. This can depend upon the partner’s sexual behaviour (including his or her number of sexual contacts and the likelihood that they are infected) or upon other types of behaviour, such as needle sharing, if the partner is an intravenous drug user. In a study of 15 countries by Carael (1995), Lesotho had the highest level of multiple partnerships for both men and women. In the same study, 39 per cent of Basotho women reported more than one regular partner. This was attributed to very high labour migration to the mines in the Republic of South Africa (RSA) which affects more than half of the adult male population, resulting in the weakening of marriage and a rise in open concubinage. Levels of HIV infection are particularly high amongst migrant workers in sub-Saharan Africa. The large number of men living away from their homes may place them
and their families at risks of family dissolution and/or diseases.
It is, therefore, important to examine the partnership networks of labour
migrants and their partners in Lesotho, and the implications on the transmission
of diseases. In this way, prevention messages and programmes can
be targeted to specific behaviours which put them at the risk of sexually
transmitted infections.
Mark Vanlandingham
Sexual Networking in Thailand and Vietnam My research is in the fields of demography and medical sociology and focuses largely on the AIDS epidemic in Southeast Asia. The sexual networking project that I am planning will analyze the ongoing changes in sexual networking patterns occurring in both Thailand and Vietnam. One major hypothesis is that in Vietnam, these networks are increasingly including women drawn into sex work, while in Thailand, these networks increasingly include women who are not sex workers. These differences in networking patterns will have very different implications for the AIDS and STD epidemics currently underway in these two countries. A second project I have underway compares health beliefs, strategies,
and outcomes for Vietnamese nationals and immigrants. An examination of
the migration and information networks that contribute to these differences
will be critical to this study.
Kristin Velyvis
Sexual and social networks of migrant women in Senegal The literature on sexual networks of African women primarily uses individual
attributes to explain higher risk sexual networks, including work as a
trader, migration status and economically vulnerability (see Omorodion
1993; Oppong 1995; Niang 1995; Lurie et al. 1997). However, this
paradigm does not explain the lack of high risk networks among some groups
of women with these same high risk attributes. For example, in Senegal,
migrant women of the Serere ethnic group, who are extremely economically
vulnerable, and many of whom work as traders, do not have the numbers nor
kinds of sexual partners the literature would predict (Velyvis 1998).
My research will compare the sexual networks of migrant Serere women with
the sexual networks of another group of migrant women in Senegal, and will
try to determine contextual factors that shape their sexual behavior.
Nashid Kamal Waiz
Matching verbal diagnosis with physician's diagnosis and laboratory tests of STD/RTI and investigate sexual networking and treatment and cure of STD/RTIs among women in the urban slums of Dhaka city, Bangladesh This study is based on women of reproductive ages living in fourteen
different urban slums of Dhaka city. A previous study has documented detailed
socio-economic and environmental factors as a baseline study. This study
will use random sampling to select those respondents who have reported
more than three RTI/STD symptoms in the last study. Trained field workers
will locate these women, whose names and addresses are available. The field
workers will counsel the women to accompany them to the Bangladesh Medical
College for diagnosis and treatment by qualified doctors (included as Co
PIs in this study). This study has three important contributions
to the field of public health. Firstly, the GOB has plans to employ non-medic
health workers to diagnose and treat RTI/STD symptoms in one-stop health
centres in Bangladesh. The degree of matching of diagnosis based on verbal
diagnosis with actual lab tests will show the reliability of such methods.
It may also provide a guideline for diagnosing various RTI/STDs using verbal
diagnosis which may then be used by non-medics in the field. Secondly,
this study will look at the behavioural pattern regarding adherence to
treatment in the urban slums for RTI/STD. Finally, the sexual networking
of this population will be evident from the study which will also show
some indicators of AIDS awareness in an urban population. These findings
will have major policy implications for the one-stop health centre planned
by the Government of Bangladesh, termed HAPP-5.
Other Participants in the Training Workshop: Tom Zhuwau, Zambia
Contact Information:
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Abstracts must be sent via fax or Email to Renee Latour at IUSSP by March 30, 1999. Fax +32 4 222 38 47. Email: latour@iussp.org