Migration,Marital Change,and HIV Infection in Malawi

Research on the relationship between migration and HIV infection in sub-Saharan Africa often suggests that migrants are at higher risk of HIV infection because they are more likely to engage in HIV risk behaviors than nonmigrants, and they tend to move to areas with a relatively higher HIV prevalence. Although migration may be a risk factor for HIV infection, I instead focus on the possibility that the HIV positive are more likely to migrate. Using a longitudinal data set of permanent rural residents and migrants from Malawi, I find that migrants originating from rural areas are indeed more likely than nonmigrants to be HIV positive and to have engaged in HIV risk behaviors. The increased HIV risk among migrants may be due to the selection of HIV-positive individuals into migration; I find that HIV-positive individuals are more likely to migrate than those who are HIV negative. The explanation for this phenomenon appears to be marital instability, which occurs more frequently among HIV-positive individuals and leads to migration after marital change.     

Designing appropriate intervention strategies for HIV/AIDS in southern Africa

This research was supported by the U.S. Agency for International Development.     

Designing an HIV counseling and testing program for bathhouses: the Seattle experience with strategies to improve acceptability

Bathhouses are important venues for providing HIV counseling and testing to high-risk men who have sex with men (MSM), yet relatively few bathhouses routinely provide this service, and few data are available to guide program design. We examine numerous logistic considerations that had been identified in the HIV Alternative Testing Strategies study and that influenced the initiation, effectiveness, and maintenance of HIV testing programs in bathhouses for MSM. Key programmatic considerations in the design of a bathhouse HIV counseling and testing program included building alliances with community agencies, hiring and training staff, developing techniques for offering testing, and providing options for counseling, testing, and disclosure of results. The design included ways to provide client support and follow-up for partner notification and treatment counseling and to maintain relationships with bathhouse management for support of prevention activities. Early detection of HIV infection and HIV prevention can be achieved for some high-risk MSM through an accessible and acceptable HIV counseling and testing program in bathhouses. Keys to success include establishing community prevention collaborations between bathhouse personnel and testing agencies, ensuring that testing staff are supported in their work, and offering anonymous rapid HIV testing. Use of FDA approved, new rapid tests that do not require venipuncture, centrifugation, or laboratory oversight will further decrease barriers to testing and facilitate implementation of bathhouse testing programs in other communities.     

Marital Processes, Arranged Marriage, and Contraception to Limit Fertility

An international transition away from familially arranged marriages toward participation in spouse choice has endured for decades and continues to spread through rural Asia today. Although we know that this transformation has important consequences for childbearing early in marriage, we know much less about longer-term consequences of this marital revolution. Drawing on theories of family and fertility change and a rural Asian panel study designed to measure changes in both marital and childbearing behaviors, this study seeks to investigate these long-term consequences. Controlling for social changes that shape both marital practices and childbearing behaviors, and explicitly considering multiple dimensions of marital processes, we find evidence consistent with an independent, long-standing association of participation in spouse choice with higher rates of contraception to terminate childbearing. These results add a new dimension to the evidence linking revolutions in marital behavior to long-term declines in fertility and suggest that new research should consider a broader range of long-term consequences of changing marital processes.     

The Importance of Fairness and Equity for the Marital Satisfaction of Older Women

ABSTRACT

In all societies, people are concerned with social justice. “It's just not right” is a fairly common lament. In these two studies, we interviewed 240 older women, who ranged in age from 50 to 82. We found that most older women (85%) considered their marriages to be fair and equitable. Older women were less concerned about existing inequities than their younger peers. Nonetheless, they were somewhat concerned with how rewarding and how fair and equitable their relationships were perceived to be. Those who felt over-benefited, for example, felt more guilty than did their less advantaged peers; those who felt under-benefited felt far more angry than did their privileged peers. Stressful life events—such as the arrival of children, retirement, serious illness, or the awareness impending death—often brought to awareness long simmering resentments over issues of fairness.     

进城还是回村？——跨省婚迁者的空间选择

在经济社会转型、人口频繁流动的条件下,婚迁由乡到城的单向迁移转变成为城乡互动的双向流动。婚迁者留在城市还是回到乡村,要取决于多种条件。本研究通过测度跨省婚迁的性别比发现,自1990年来的20年间我国省际婚迁性别比下降近一半。全国省际婚迁性别比呈现城市-城镇-乡村两端大中间小的“微笑曲线”。在婚迁的空间选择上,男性以城市为主,女性则以乡村为主。进一步分析影响婚姻迁移的因素发现,经济变量中人均GDP对总婚迁和城市婚迁呈正向影响,城镇和乡村呈负向影响;居民收入和消费状况对婚姻迁移产生正向影响,但消费的城乡差别则对其产生负向影响;人口的城乡流动与迁移以及社会变量中各因素对跨省婚迁产生正向影响,而文化变量中的各因素则形成负向影响。     

Legal aspects of regulating bathhouses: cases from 1984 to 1995

Public health measures regulating or closing bathhouses and other businesses facilitating consensual sexual activity among strangers have generally been upheld by courts. Using standard legal research methods, this study sought (1) suits brought by government authorities to close a sex-facilitating business (SFB) based at least in part on health concerns, and (2) suits filed by SFBs to invalidate state laws or local ordinances banning closed booths or other architectural features that facilitate sexual activity. The research yielded eight published and unpublished trial or appellate opinions between 1984 and 1995 in which local health or other officials filed a law suit to close or otherwise interfere with sex at a bathhouse or other SFB. In seven of the eight cases, the state prevailed entirely or in large part in securing the relief it sued for. Factors influencing these results include the traditional deference of courts to public health officials, stigma, and limited legal recognition of a right to public sexual activity. Major questions include the extent to which coercive health measures increase stigma or social hostility towards gay men, whether closure actions "educate" at risk-individuals about the danger of anonymous unprotected sex, and what effect legal action has on the frequency of unsafe behavior.     

New strategies for slowing population growth

Growth of world population over the next 100 years, until the year 2100, will produce an estimated 11.5 billion people. The past focus on reducing rapid population growth exclusively through family planning has not been sufficient. Population policy needs to be broadened to include health care, education, and poverty reduction. The population policy recommendations of Population Council Vice-President John Bongaarts and Senior Associate Judith Bruce were to reduce unwanted pregnancies by expanding services that promote reproductive choice and better health, to reduce the demand for large families by creating favorable conditions for small families, and to invest in adolescents. The Population Council 1994 publication "Population Growth and Our Caring Capacity" outlined these issues. Another similar article by John Bongaarts appeared in the journal "Science" in 1994. In developing countries, excluding China, about 25% of all births are unwanted; 25 million abortions are performed for unwanted pregnancies. The provision of comprehensive family planning programs will go a long way toward achieving a reduction in unwanted pregnancies. In addition, changes are needed in male control over female sexuality and fertility and in cultural beliefs that are obstacles to use of contraception. Stabilization of population at 2 children per family will not occur unless there is a desire for small families. In most less developed countries, large family sizes are preferred. Governments have an opportunity to adopt policies that reduce economic and social risks of having small families. This can be accomplished through the widespread education of children, a reduction in infant and child mortality, improvement in the economic and social and legal status of women, and provision of equitable gender relations in marriage and child rearing. The rights of children to be wanted, planned, and adequately cared for need to be supported. These aforementioned measures will help to reduce fertility, provide support for small families, and justify investment in social development. Population momentum will keep population growing for some time even with replacement level fertility. Investment in adolescents through enhancement of self-esteem and promotion of later childbearing can lengthen the span between generations and slow population momentum. Population policies will be more effective when human rights are protected.     

Time to listen: strategies to improve hospital-based postnatal care

BACKGROUND: In Australia and internationally, women report high levels of dissatisfaction with hospital-based postnatal care. AIM: To design and implement strategies to improve hospital-based postnatal care at a Sydney metropolitan hospital. METHOD: This was an Action Research study. In Phase One, midwives considered the literature and participated in group discussions and interviews to determine their perceptions of postnatal care and the factors that facilitate or hinder the provision of quality care. In Phase Two, midwives participated in 12 working group meetings to design strategies to improve care. RESULTS: Several important principles of postnatal care were described, including building a relationship with women, meeting their individual needs, being flexible in approach and providing continuity of care. 'Listening to women', 'being there,' and 'normalising experiences and expectations' were believed to be critical to achieving these principles. A key strategy 'One to One Time' was designed to provide women with an uninterrupted period of time each day with a midwife who was available to listen to their needs and concerns and discuss issues related to their health and that of their baby. CONCLUSION: Midwives designed and implemented strategies that they believed would improve in-hospital postnatal care.     

Innovative strategies for comparative aging research

"After introductory comments on the theme of ?ageing east and west', this paper looks at trends in ageing and responses to ageing over time, with particular reference to European experience. The evidence is reviewed in historical, cultural, religious, political and ?social political' perspective. Attention is drawn to the different patterns of experience and of policy responses characteristic of the different countries and regions within Europe both past and present. The paper concludes with a review of [the] latest trends and prospects in ?community care', which could signal a seeming point of convergence between east and west."     

Changing Residence: Comparative Perspectives on its Relationship to Age,Sex, and Marital Status

Change of usual dwelling unit (house, flat, etc.) during a fixed period of time is the common denominator to measuring the amount of spatial mobility within different countries. Around 1980 or 1981, the percentage of population who moved from one dwelling unit to another in one year was over 19 per cent in New Zealand, 17–18 per cent in the United States, Canada, and Australia, 9–10 per cent in Great Britain, Sweden, Japan and France, 7–8 per cent in the Netherlands and Belgium, and 6 per cent in Ireland. Evaluation of ‘age schedules’ of local and non-local movement reveals especially high mobility among U.S. children, and a narrowing of mobility differences for older people between countries, particularly over local distances. Life-table techniques help to quantify the amount of mobility associated with different marital statuses, and bring into focus some of the sequelae of these statuses for men and women in different countries.     

Marital fertility control among the Qing nobility: implications for two types of preventive check

Demographers, as early as Malthus, have assumed that the preventive checks, delayed marriage and celibacy, were absent in traditional China. In this paper on the Qing (1644-1911) imperial lineage, we demonstrate that, instead, there may have been a different, more 'modern' preventive check: fertility control within marriage. Marital fertility of lineage couples during the eighteenth and nineteenth centuries was low to moderate. Such low fertility was the product of three behavioural mechanisms: late starting, early stopping and, most significantly, long spacing. Couples apparently regulated their fertility according to their economic resources and the sex of their surviving children. Moreover, they did so, we suggest, by regulating their coital frequency. Deliberate fertility control, in other words, was already within the 'calculus of conscious choice' for some Chinese well before this century. the speed of contemporary sinitic fertility transitions may accordingly be attributed to the fact that they did not require a change in attitudes, only the diffusion of new incentives and effective technologies.     

Marital Fertility Control Among the Qing Nobility: Implications for Two Types of Preventive Check

Demographers, as early as Malthus, have assumed that the preventive checks, delayed marriage and celibacy, were absent in traditional China. In this paper on the Qing (1644–1911) imperial lineage, we demonstrate that, instead, there may have been a different, more ‘modern’ preventive check: fertility control within marriage. Marital fertility of lineage couples during the eighteenth and nineteenth centuries was low to moderate. Such low fertility was the product of three behavioural mechanisms: late starting, early stopping and, most significantly, long spacing. Couples apparently regulated their fertility according to their economic resources and the sex of their surviving children. Moreover, they did so, we suggest, by regulating their coital frequency. Deliberate fertility control, in other words, was already within the ‘calculus of conscious choice’ for some Chinese well before this century. The speed of contemporary sinitic fertility transitions may accordingly be attributed to the fact that they did not require a change in attitudes, only the diffusion of new incentives and effective technologies.     

Barriers to Sexual and Reproductive Health Programming for Adolescents Living with HIV in Uganda

Despite revising their reproductive health policies in line with the 1994 International Conference on Population and Development (ICPD) Programme of Action, a major challenge facing many developing countries is the inability to fully implement the policies owing to lack of funds, bureaucratic delays, and limited awareness among various stakeholders. In some countries, the policies fail to adequately address sexual and reproductive health (SRH) needs of vulnerable groups. This study examines the barriers to SRH programming for adolescents living with HIV from the perspectives of key stakeholders involved in SRH issues in Uganda. The data are from qualitative interviews conducted in 2007 with 23 key informants from bilateral institutions, government ministries, and civil society organizations. The study findings confirm that policy and programmatic gaps exist in addressing the SRH needs of HIV-positive adolescents. This is attributable to: (1) lack of clear guidelines on how to address the SRH of HIV-positive adolescents; (2) challenges of dealing with adolescent SRH in general; (3) HIV/AIDS treatment, care, and support services that are either pediatric- or adult-oriented; and (4) limited institutional and provider capacity to offer SRH services to HIV-positive adolescents despite recognizing that this is an emerging area that requires intervention. These results suggest the need for: (1) clear guidelines on dealing with SRH of HIV-positive adolescents; (2) establishing transition clinics or youth-friendly corners to cater for the needs of adolescents who cannot fit in either pediatric or adult clinics; and (3) providing training and reorientation on SRH of HIV-positive adolescents to service providers/counsellors.     

The Retrenchment of Marriage: Results from Marital Status Life Tables for the United States, 1995

Marital status life tables were calculated using 1995 US rates of marriage, divorce, and mortality. Compared to figures for 1988, the proportion of persons surviving to age 15 who ever marry remained fairly steady at about five‐sixths of all men and seven‐eighths of all women. The average age at first marriage rose substantially: to 28.6 years for men and 26.6 years for women. The probability of a marriage ending in divorce changed little and was .437 for men and .425 for women. It is likely that no US period or cohort will ever have half of all marriages end in legal divorce, though the highest cohort may reach 47 percent. Patterns of marriage and divorce observed since 1970 show the effect that cohabitation continues to have on the American family, where it is delaying, but not replacing, marriage.     

Developing strategies for deriving small population fertility rates

Many agencies require population estimates and projections by ethnic group. These projections need ethnic-specific, age-specific fertility rates (ASFRs) but their inclusion is challenging since ethnicity is not recorded at birth registration. In this paper maternity data are used in a case study of electoral wards in Bradford, West Yorkshire, to develop fertility rates for small populations for a 1991 based projection. The challenge is to capture local variations in fertility by ethnic group when data are sparse. Small areas were grouped together using cluster analysis to define combinations with similar sociodemographic and fertility experiences so that sparse data could be aggregated to estimate reliable ethnic-specific fertility rates. For comparison, the data were aggregated into the 1991 Office for National Statistics area type classification. Fertility rates by single year of age for all area types were smoothed using the Hadwiger function. For the White ethnic group there were sufficient births to create ethnic-specific, ward-level ASFRs. For other ethnicities grouping of areas was necessary. The accuracy of the ASFRs in predicting births was assessed using mean absolute percentage error. Results show that for some minority groups district-level ethnic-specific fertility rates produced the most accurate birth estimates even though they were based on a larger area. This implies that rates created may be informative about the local area for White ethnic type but not in the same way for smaller ethnic groups. In terms of grouping strategies we recommend that existing classifications are assessed to determine how well variations in rates are stratified before embarking on a custom scheme. Where population sub-groups are small in some areas, it may be more reliable to use rates derived for larger areas and apply these to local populations. Inevitably, the rates used in a projection are a compromise but hopefully will still capture important dimensions of population change.     

Recruitment strategies for conducting research on women's retirement

Currently, little information is available to inform new or returning researchers about designing and conducting research on the topic of women and retirement. Few published studies describe how to access non-probability samples of retired women, yet preliminary evidence suggests women possess distinctive characteristics that affect their retirement as well as complicate the recruitment process. In this article, certain challenges and benefits of conducting research with women in retirement are presented. Next, important issues to consider prior to sampling retired women are described. Finally, specific strategies for identifying and recruiting community-dwelling retired women are presented and discussed.