ICRH Belgium Newsletter
13th of September, 2010
PROJECTS AND EVENTS
ICRH exposition: Beyond figures, snapshots from research of sexual and reproductive health
ICRH projects are about real people and their struggle for sexual health. This reality sometimes get hidden from sight by the scientific research approach. A photo exhibition and a book aim to bring the human and societal side of the ICRH work under the attention of a broad public.
Researchers are mainly busy with "objectively verifiable data." So do we, at the ICRH. Worldwide we are studying aspects of sexual and reproductive health. We try to think objectively and rationally for our publications and analyses. But our job also has another angle. We are working with people. We meet, observe, interview, talk and teach. Pure reason often fails and then we have to continue with our gut feeling. However, in scientific articles you cannot even read this gut feeling between the lines. Now we are presenting our work in a different way. Liesbet Christiaen explains with sensitive pictures. The ICRH staff members Kristien, Dirk and Peter wrote warm-hearted stories. Photos and texts were combined to a photo exhibition and a book. The photo exhibition can be visited for the first time from 20 September until 2 October 2010 in the UFO building of Ghent University (Sint-Pietersnieuwstraat 33), and will be travelling afterwards. The book (Dutch and English version can be ordered at icrh@ugent.be ( 20Euro). The official launch of the exhibition and the book will take place on Friday 24 September 2010 at 8pm.
More information: peter.decat@ugent.be or http://www.icrh.org/news/039beyond-figures039-book-amp-exposition-from-september-20-till-october-1-2010-in-ghent-ufo-bui
Seminar ‘Prevention of sexual & Gender-based Violence in the European Reception & Asylum Sector’: 10 September in Brussels
Within the European reception facilities; asylum seekers, unaccompanied minors as well professionals reveal to be vulnerable to sexual and gender-based violence (SGBV). Yet, no specific prevention tools, codes of conduct nor standard operating procedures in prevention and response of SGBV in this sector exist.
At the Seminar: “Senperforto: Prevention of sexual & Gender-based Violence in the European Reception & Asylum Sector” we wish to take the prevention of SGBV in the European Asylum & Reception sector forward. First, we introduce the major challenges. Second, we highlight the research results of a Knowledge, Attitude and Practice-Study we conducted among professionals and residents in the reception structures. Subsequently we present the Senperforto Framework in SGBV Prevention. In four workshops we want to discuss and formulate policy and practice recommendations on the implementation of the Senperforto framework as a European Standard. Finally, we discuss these challenges and recommendations with a panel of policy makers on European, national and regional level. With all participants we wish to make a commitment: Prevention of Sexual and Gender-based Violence should be part of the minimum reception standards.
The seminar will take place on Friday, 10th of December 2010, in Brussels.
For registration, please send an e-mail to ellen.taets@ugent.be. She will send you the registration form in return. The subscription fee is € 60. Registration should be finalized before November 15th.
More information: ines.keygnaert@ugent.be
Conference on ‘Post-Abortion Contraception’ in Shanghai
The first China Obstetrics & Gynecology Hospital President Forum on the theme of ‘Post-Abortion Contraception’ (PAC) was held in Shanghai on 28th September 2010. This Forum was organized in collaboration between ICRH and Society of Family Planning, Chinese Medical Association, China. 
Near 40 Presidents of Hospitals from all over China attended the Forum. Prof. Marleen Temmerman and Dr. Wei-Hong Zhang from ICRH presented the results of the PAFP study (Post Abortion Family Planning services in China) which was an EU funded FP6 project coordinated by ICRH and carried out between 2006-2009 in three large cities in China.
China’s abortion rate has remained at high levels during the last decade, with on average 8 million cases per year, which is much higher than most European developed countries. The PAFP study showed that the abortion and repeat abortion rates have significantly decrease by providing post-abortion family planning services. The aim of the Forum is to share experiences between participants and prepare the implementation of Post-Abortion Family Planning services at national level in China.
More information: weihong.zhang@ugent.be or http://www.icrh.org/files/ChineseMedia-PAC%2028thOct2010event.pdf
‘Integrated Network for the Fight against HIV/AIDS’ presented at the 18th International AIDS Conference
The project ‘Integrated Network for the Fight against HIV/AIDS in Tete Province, Mozambique’, in which ICRH is one of the implementing partners, participated with two presentations at the 18th International AIDS Conference in Vienna, Austria, between 18 and 23 July 2010.
ICRH has been implementing the ‘Integrated Network’ project in Tete since 2004, together with the Provincial Health Directorate of Tete, Doctors without Borders-Belgium, and the Institute for Tropical Medicine in Antwerp, Belgium. The project aims to build a strong capacity in Tete’s Provincial Health Directorate to provide high quality prevention, treatment and care of HIV/AIDS in the Mozambican province. Delegates from three of the four project partners participated in the AIDS Conference in Vienna. Dr Azelia Ernesto Novela (Provincial Health Directorate) and Dr Tom Decroo (Doctors without Borders-Belgium) realized an oral presentation on their experiences with empowerment of HIV-positive patients on HAART, involving them actively in the promotion and monitoring of adherence to treatment, through their organisation in small groups. Early results showed an excellent adherence and very low mortality.
Mr Élder Chissale (Provincial Health Directorate) and Dr Diederike Geelhoed (ICRH) presented a poster on the intermediate results of an ongoing study into the viability of integrated care to mother and child under the age of five years, and its effects on the follow-up of HIV-exposed infants. Integrated mother and child care was found to be viable, especially in small and medium sized healthcentres. Integrated care was also very positively received by all participating health personnel. The effect on follow-up of HIV-exposed infants was not yet conclusive, although there appeared to be an increase in the number of HIV tests done in HIV-exposed infants in the healthcentres offering integrated care. However, health system constraints, such as frequent stock-outs of necessary HIV testing supplies or medication and absenteeism of staff, hindered the effective delivery of mother and child care in all participating health centres. Final results of the study are expected towards the end of 2010.
More information: geelhoed.d.w@gmail.com
PUBLICATIONS
Sexual violence, HSV-2 and HIV are important predictors for infertility in Rwanda
Based on a case-control study, Nathalie Dhont et al. examined potential predictors and their population attributable fraction for various infertility types including lifestyle factors, sexual behaviour and reproductive tract infections (RTIs).
Sexually active women aged 21–45 year presenting with infertility problems at the infertility clinic of the Kigali University Teaching Hospital (n = 312), and fertile controls who recently delivered (n = 283) were surveyed together with their male partners. Participants were interviewed about socio-demographic characteristics, sexual behaviours and lifestyle factors, and were tested for HIV and RTIs. Variables significantly associated with tubal infertility were history of sexual violence [adjusted odds ratio (AOR) 2.41; 95% CI 1.36–4.25]; positive HIV (AOR 2.41; 95% CI 1.36–4.25), herpes simplex virus type 2 (HSV-2; AOR 1.67; 95% CI 1.03–2.71) and Chlamydia trachomatis serology (AOR 1.78; 95% CI 0.99–3.21), and current bacterial vaginosis by Amsel criteria (AOR 1.97; 95% CI 1.12–3.47). Among men, male factor infertility was associated with positive HIV (AOR 2.43; 95% CI 1.31–5.23) and HSV-2 serology (AOR 1.71; 95% CI 1.02–2.87) and current urologic abnormalities (AOR 2.38; 95% CI 1.01–5.31). Positive HSV-2 serostatus carried the greatest PAF% (26%) for tubal infertility, followed by positive HIV serostatus (20%) and history of sexual violence (17%).
The authors conclude that although temporal relationships are difficult to ascertain, history of sexual violence, HSV-2 infection and HIV infection are important predictors of infertility in Rwanda.
N. Dhont, J. van de Wijgert, S. Luchters, C. Muvunyi, J. Vyankandondera and M. Temmerman; Sexual violence, HSV-2 and HIV are important predictors for infertility in Rwanda; Hum. Reprod. (2010) doi: 10.1093/humrep/deq189 - First published online: August 4, 2010
http://humrep.oxfordjournals.org/content/early/2010/08/03/humrep.deq189.full.pdf+html
More information: dhontnathalie@gmail.com
CHIMACA discussion papers
Two discussion papers have recently been published within the framework of the project “Structural Hinders to and Promoters of Good Maternal Care in Rural China” (CHIMACA) which was financed by the European Commission INCO Programme and coordinated by the National Institute for Health and Welfare (Helsinki) and in which the ICRH was a partner. 
The first paper describes the designs of community-based maternal health care interventions in three provinces in rural China (Anhui, Chongqing and Shaan´xi), conducted between 2007 and 2008; and evaluates the process of implementing the interventions by the qualitative study conducted in 2009. The investigation methods included key informant interviews, in-depth interviews and focus group discussions.
Townships of the selected counties were allocated into one of the 4 intervention or control groups: a financial intervention in antenatal and postnatal care; training of healthcare providers on health education at township or village levels; training of healthcare providers on clinical skills at township level; and control group (current practice). The qualitative study showed mixed views about the impact of the financial intervention on maternal health care utilisation. Generally, it was perceived to have only little contribution due to the small amount of the subsidy. Most respondents perceived that knowledge, skills and work attitudes were improved by health education and clinical skills training, but the intervention effects varied by province.
Wei-Hong Zhang, Joanna Raven, Touhong Zhang, Yuan Shen, Kun Huang, Qian Long, Reija Klemetti, Marleen Temmerman, Elina Hemminki and the CHIMACA study group. Implementation of interventions in the CHIMACA project. THL Discussion paper 13/2010, THL, Helsinki University Print, Helsinki, Finland.
The publication can be downloaded at http://www.thl.fi/thl-client/pdfs/682e76d7-c16e-45a7-ab61-6ba2dc611405
The second report describes the method and presents the basic results of the new mothers’ survey in maternal health care in three provinces in rural China: Anhui, Chongqing and Shaanxi, conducted in 2008.The aims of the survey sere to collect data on the use of maternal health care, hinders in using care, content of and satisfaction with received care.
In each province, one or two poor counties were selected and all townships (n=104) from the selected counties were included. Villages were included using the criteria of distance to the nearest township hospital and population size. Data were collected by interviewing women (n=3673) or their relatives (n=285) using a structured questionnaires included questions related to the women’s and her partner’s background, family’s situation, previous pregnancies and the experiences of using prenatal, delivery and postnatal care.
Many women were migrants and 18 percent reported the pregnancy to be illegal. About 46 percent had stopped working completely during pregnancy and almost all gad prenatal visits. Overall, 54 percent gave birth at county or higher-level hospitals. Caesarean section was almost as common as a vaginal birth. Overall, only 44 percent of women had had postnatal visits. In Anhui, the number of illegal pregnancies was lowers, but, the caesarean section rat was higher than in Shaanxi and Chongqing.
Klemetti Reija, Regushevskaya Elena, Zhang Wei-Hong, Raven Joanna, Long Qian, Huang Kun, Shen Yuan, Wu Zhuochun, Hemminki Elina. New mothers' survey in 2008 in rural China: a CHIMACA report. THL report 23/2010, THL, University print, Helsinki, Finland.
The publication can be downloaded at http://groups.stakes.fi/NR/rdonlyres/E4C55881-5B94-4962-A428-74E6D3C6D671/0/RAP023_2010.pdf
More information: weihong.zhang@ugent.be
Gender differences and factors associated with treatment-seeking behaviour for infertility in Rwanda
Nathalie Dhont et al. examined perceptions of infertility causes, treatment-seeking behaviour and factors associated with seeking medical care in an urban infertile population in Rwanda, as well as the response of health providers.
Between November 2007 and May 2009 a hospital based survey was conducted among 312 women and 254 male partners in an infertile relationship. Infertility causes based on a medical diagnosis were mentioned by 24% of women and 17% of men. Male infertility awareness was low in both sexes with 28% of men and 10% of women reporting male-related causes. Seventy-four per cent of women and 22% of men had sought care for their infertility in the past. Seeking treatment in the formal medical sector was associated with higher income, being married and infertility duration of more than 5 years in both sexes. In women, higher education and being nulliparous and in men blaming oneself for the infertility was also associated with seeking formal medical care. Participants reported a wide array of treatments they received in the past, often including ineffective or even harmful interventions. The authors conclude that health authorities should invest in improving information, education and counselling on issues pertaining to causes and treatments of infertility, and in drawing up guidelines for the management of infertility at all levels of health care.
Dhont N; Luchters S; Ombelet W; Vyankandondera J; Gasarabwe A; van de Wijgert J; Temmerman M
Gender differences and factors associated with treatment-seeking behaviour for infertility in Rwanda.Human reproduction (Oxford, England) 2010;25(8):2024-30
More information: dhontnathalie@gmail.com
WHO guidelines on Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants: recommendations for a public health approach, 2010 version.
The World Health Organization (WHO) recently published the 2010 guidelines on antiretroviral interventions for pregnant women and the prevention of mother-to-child HIV transmission (MTCT) to provide international standards, primarily for low- and middle income settings, in support of the global scale-up of more effective interventions.ICRH professor Stanley Luchters was one of the authors.
These revised recommendations emphasize the need to have a unified approach to preventing MTCT throughout pregnancy, labour and delivery, the postpartum, and the breastfeeding period. It contains a summary of the scientific rationale and programmatic considerations for these recommendations. By addressing issues of efficacy, safety, drug resistance and feasibility, the document is intended to guide the selection of antiretroviral regimens to be included in programmes to prevent MTCT. Moreover, it is intended to support and facilitate antiretroviral treatment for pregnant women and women of reproductive age who have indications for treatment. The guidelines may also be useful for health service providers as specific recommendations are provided for the most frequently encountered clinical situations.
Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants: recommendations for a public health approach 2010 version, WHO, Reference Number: ISBN 92 4 159209 5
The guidelines can be downloaded at http://www.who.int/hiv/pub/mtct/en/arvdrugswomenguidelinesfinal.pdf
More information: stanley.luchters@ugent.be
Sport and HIV prevention in Kenya
Wim Delva et al. conducted a cross-sectional survey assessing sexual behaviour and the determinants thereof among youth of a sports association in Kenya.
Sport has become a popular tool for HIV prevention, based on claims that it can foster life skills that are necessary to translate knowledge, attitudes and behavioural intentions into actual behaviour. Empirical evidence of the effectiveness of sport-based HIV prevention programmes is, however, sorely lacking. The authors conducted a cross-sectional survey assessing sexual behaviour and the determinants thereof among 454 youth of the Mathare Youth Sport Association (MYSA) in Kenya and a control group of 318 non-MYSA members. Multiple (ordinal) logistic regression models were applied to measure the association between MYSA membership and attitudes, subjective norms and self-efficacy related to condom use as well as sexual experience, age at sexual debut, condom use, history of concurrent relationships and number of partners in the last year. MYSA members were more likely to use condoms during the first sex act (odds ratio (OR)=2.10; 95% CI: 1.10-3.99). Consistent condom use with the current/last partner was 23.2% (36/155) among MYSA members vs. 17.2% (17/99) among the control group. Even after adjusting for media exposure - a factor associated with both MYSA membership and higher frequency of condom use - MYSA members were still found to use condoms more frequently with their current/last partner (adjusted OR=1.64; 95% CI: 1.01-2.68). Nevertheless, levels of condom use remain disturbingly low. More rigorous evaluations of sport programmes for HIV prevention are needed. When possible, programmes should be preceded by baseline assessments, trends in risk behaviour of the intervention group should be compared with those of a control group, and protocols for data collection and analysis should include measuring of and adjusting for potentially confounding factors.
Wim Delva; Kristien Michielsen; Bert Meulders; Sandy Groeninck; Edwin Wasong; Pauline Ajwange; Marleen Temmerman; Bart Vanreusel HIV prevention through sport: the case of the Mathare Youth Sport Association in Kenya . AIDS Care, Volume 22, Issue 8 August 2010 , pages 1012 - 1020
More information: wim.delva@ugent.be
Barriers to HIV testing in Europe
Jessica Deblonde at al. conducted a systematic review of literature on HIC testing barriers in Europe and identified critical information gaps.
In the European Union (EU) and neighbouring countries, HIV/AIDS, of all infectious diseases, has one of the highest morbidity and mortality rates. An estimated 30% of people living with HIV are unaware of their infection, and may therefore not benefit from timely treatment or may transmit HIV to others, unknowingly. Evidence shows that opportunities are being missed to diagnose HIV infections in EU Member States, particularly in regular health care settings. A systematic review of literature on HIV testing barriers in Europe was conducted, applying a free text strategy with a set of search terms. A total of 24 studies published in international peer-reviewed journals and meeting the review's eligibility criteria were identified. Fourteen studies report on barriers at the level of the patient; six on barriers at health care provider level and seven on institutional barriers referring to the policy level. The barriers described are centralized around low-risk perception; fear and worries; accessibility of health services, reluctance to address HIV and to offer the test; and scarcity of financial and well trained human resources. The authors conclude that some barriers to HIV testing and counselling have been illustrated in the literature. Nevertheless, there is lack of structured information on barriers considering (i) legal, administrative and financial factors, (ii) attitudes and practices of health care providers and (iii) perception of patients. Such data is critical to improve effectiveness of HIV testing and counselling.
Deblonde Jessika; De Koker Petra; Hamers Françoise F; Fontaine Johann; Luchters Stanley; Temmerman Marleen. Barriers to HIV testing in Europe: a systematic review. European journal of public health 2010;20(4):422-32
More information: jessika.deblonde@ugent.be
"Legislative Reform to Support the Abandonment of Female Genital Mutilation/Cutting (FGM/C)"
This paper recently published by UNICEF presents key features of a comprehensive legislative framework to support the abandonment of FGM/C. It also provides specific guidance on the content of the legislation, and its relationship to the process of social change that it is meant to support.
The paper is available on the UNICEF Legislative Reform webpage at http://www.unicef.org/policyanalysis/files/UNICEF_-_LRI_Legislative_Reform_to_support_the_Abandonment_of_FGMC_August_2010.pdf