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A prodrug strategy for sustained release of lactic acid from silicone elastomer vaginal rings
No full textLactic acid is the most abundant organic weak acid in the healthy human vagina and plays a pivotal role in maintaining an acidic vaginal environment protective against exogenous bacteria and viruses. However, in dysbiotic or non-optimal vaginal environments, significantly decreased concentrations of lactobacilli result in reduced lactic acid production, increased vaginal pH, and enhanced risk of sexually transmitted infections (including human immunodeficiency virus), and bacterial vaginosis. Various gel-based products are marketed to administer lactic acid vaginally for the treatment of bacterial vaginosis and non-hormonal contraception, and there is interest in developing vaginal ring products for sustained/controlled release of lactic acid. However, lactic acid is not compatible with the most common addition-cure type of silicone elastomer used to manufacture vaginal rings; the carboxylic acid group inhibits the hydrosilylation reaction used to cure the elastomer system. Here, we report that DL-lactide—a racemic mixture of (R,R)-D-lactide and (S,S)-L-lactide, in which the dilactide molecules are cyclic lactones derived from esterification of two molecules of lactic acid—can be successfully incorporated into and released from addition-cure medical grade silicone elastomer vaginal rings. Following release of lactide from the rings into an aqueous medium, the lactide molecule rapidly hydrolyses to produce only lactic acid. We demonstrate that lactic acid (i) is formed f release of lactide from the rings; (ii) inhibits sperm motility, (iii) inhibits replication of HIV-1 and HSV-2, and (iv) is active against Gardnerella vaginalis (one of the causative organisms responsible for bacterial vaginosis) but not lactobacillus (associated with optimal human vaginal health). The results support the inclusion of lactide as a lactic acid prodrug in next-generation multipurpose contraceptive silicone elastomer vaginal rings
Governmental influence on childbearing: What\u27s really at stake?
No full textOn the sidelines of CSW 69, the Population Council held a thought-provoking discussion on pronatalist policies and their implications for the lives of women and girls.
A growing number of countries seek to increase childbearing to achieve economic and cultural objectives. Speakers explored social, health, economic, and legal impacts of these policies in diverse settings including in China, across North America, and in Indigenous communities.
Speakers and Commentators:
Dr. Rana Hajjeh, President of the Population Council provided introductory remarks and perspective on the Council\u27s work on this issue.
Ms. Yiping Cai, PhD candidate at University of California Irvine, and member of the DAWN Executive Committee spoke on the transition of China’s population policy and how its challenges offer an opportunity to reconfigure social policies centered on justice and equality.
Dr. Joan Kaufman, Senior Director for Academic Programs for the Schwarzman Scholars Program and Lecturer on Global Health at Harvard Medical School, amplified observations with reference to China.
Ms. Judith Bruce, Senior Advisor, Population Council (Moderator)
Professor Shelley Clark, James McGill Professor of Sociology at McGill University, highlighted the impact of pronatalist policies for urban and rural women in the United States, drawing on her own research.
Dr. Kelly Hallman, Founder and Executive Director of the Indigenous Justice Circle, and an enrolled member of the Cherokee nation, centered her remarks on implications of both antinatalist and pronatalist policies for Indigenous girls and women.
Dr. Vladimira Kantorova, Chief of the Fertility and Population Ageing Section of the Population Division, Department of Economic and Social Affairs, United Nations whose research has focused on fertility, reproductive health and family dynamics addressed the demographic foundations—especially in Europe—and the effectiveness (and fairness) of population policies
Cytokine concentration and T cell subsets in the female genital tract in the presence of bacterial vaginosis and \u3ci\u3eTrichomonas vaginalis\u3c/i\u3e
No full textTrichomonas vaginalis (TV) and bacterial vaginosis (BV) are highly prevalent vaginal infections. Both are associated with pelvic inflammatory disease and HIV acquisition and transmission, though the underlying mechanisms are incompletely understood. We characterized the effect of TV and BV infection on inflammatory markers in the vagina among reproductive-aged women in Atlanta, Georgia. Cervicovaginal lavage specimens were collected from HIV seronegative women at a baseline visit and again three months later. Eighteen individual cytokines, 17 T cell subsets, BV, and TV were measured at both timepoints. After natural log transformation, the median cytokine concentration and number of T cells were compared by infection status statistically using the Kruskal-Wallis test. A cytokine inflammation score and a T cell score were created using principal components analysis. The scores were then used as outcomes in separate linear mixed regression models with a random intercept. Sixty women had baseline data and 43 were seen for follow-up. The median age was 30 years, 78% self-reported Black race. TV and BV prevalence at the baseline visit was 15% and 37%, respectively. The concentration of 16 out of 18 cytokines differed by infection status. In multivariable modeling, neither TV nor BV were associated with cytokine score. Most CD4+ T cell subsets (7 out of 9) differed by infection status. In a multivariable model, TV infection was associated with a higher T cell score (1.54; 95%CI 0.00, 3.08). BV was not associated with a higher T cell score. Increased concentration of vaginal mucosal T cells may explain the observed association between TV infection and HIV risk
Strengthening community health systems to improve uptake of Possible Serious Bacterial Infections (PSBI) services in the context of COVID-19 in Busia and Migori Counties, Kenya
No full textUsing a mixed-method approach, this study sought to assess the fidelity, adoption, acceptability, and sustainability of Possible Serious Bacterial Infections management in the context of COVID-19 in Busia and Migori counties in Kenya
What about well-being? Measuring what we really care about in sexual and reproductive health
No full textThe well-being of individuals and communities is increasingly recognized as a core objective of economic and global development policies and programs. However, existing measures of well-being neglect sexual and reproductive experiences, which are core dimensions of people\u27s lives. While there has been increasing attention to the concept of sexual well-being, measures of sexual and reproductive health are predominantly deficit-based and ignore whether people are having positive experiences. To consider the development of a measure of sexual and reproductive well-being, a multidisciplinary and geographically diverse group of experts was convened. Outcomes of this meeting included endorsement of a draft definition of sexual and reproductive well-being, demonstrated enthusiasm and commitment to the development of a measure capturing this construct, and delineation of core considerations in the measure development process. These included considering the diversity of normative and political contexts around sexuality and reproduction, and the critical nature of meaningful community engagement when developing this measure. A pathway for measuring development was defined, with the goal of creating a concise measure assessing people\u27s holistic experiences of sexuality and reproduction that can draw attention to and monitor the extent to which people are having the sexual and reproductive lives they wish to have
Contraception today and family planning: A comprehensive review and position statement on the ethical, medical, and social dimensions of modern contraception
No full textIn a society whose needs are constantly changing, family planning plays a central role for women, men, and sustainable development. This comprehensive review and position statement summarises the proceedings of a meeting on contraception held in Rome in March 2024, supported by major scientific societies in the field. The aim is to inform the medical community about current medical and ethical issues of contraception use. First, the review addresses the complex ethical, religious, and social dimensions of contraceptive use and access; second, it provides a comprehensive analysis of traditional and modern contraceptive methods, discussing their safety and effectiveness; third, it examines current knowledge about male hormonal contraception. When prescribing a contraceptive method, medical indications or contraindications must be integrated to women’s religious beliefs, the geopolitical context in which they live, the risk of violence, their need for self-determination and their right to make decisions for themselves. If a partner is involved, the couple’s dynamics and shared needs must be considered. Healthcare providers are responsible for providing them with all the information they need to make informed choices, while ensuring individual autonomy. This position statement provides recommendations on how to guide contraceptive choice and identifies knowledge gaps about contraception today
Preventing the preventable: Assessing the burden of incessant caesarean deliveries in select Indian states using NFHS-5
No full textThe World Health Organization (WHO) recommends that life-saving Caesarean sections (CS) should account for 10–15% of deliveries. Southern states of India have good obstetric facilities and better public health systems than other parts of India. However, CS rates in select states are considerably higher. This study examines the prevalence and determinants of preventable CS among mothers in select Indian states, specifically the states that have high institutional deliveries (\u3e95%) viz. Andhra Pradesh, Kerala, Karnataka, and Tamil Nadu. It further compares the complications faced by CS and vaginal delivery cases. Data has been derived from a cross-sectional survey, the National Family Health Survey-5. Bivariate and Logistic regression analyses were used. The main outcome measured is Preventable C-sections, defined as per conditions in Robson’s criteria of 10-group classification based on obstetric characteristics for a woman. Results show that the preventable CS rates in these selected states were much higher than at the national level. Key correlates were higher education and middle socioeconomic status. The study highlights the need for policy reforms, maternal education, and healthcare system improvements to reduce unnecessary CS in select states of India, where the health system is exceptionally good but have another health burden in form of demand for unnecessary caesarean deliveries
Comparison of sexual risk behaviors among Zambian adolescent girls and young women living with and without HIV
No full textBackground: We sought to identify commonalities and variations in sexual risk behaviors between adolescent girls and young women living with and without human immunodeficiency virus (HIV) in Zambia. Our goal was to understand the specific needs of these populations to inform the design of interventions to support the sexual health by age group and HIV status. Methods: As a part of baseline survey Data collected for a cluster-randomized controlled, we surveyed a sample of 650 women aged 16–22 residing in Lusaka, Zambia between May and September 2021. We used bivariate statistical methods to determine whether sexual behavior and contraceptive use differed among participants living with and without HIV, by age group. Statistical significance was defined at P ≤ 0.10. Results: We found that among the younger participants (aged 16–18), those living with HIV were less likely to have ever had sex or be currently sexually active, and reported fewer casual and serious sexual partners in the last three months compared to those living without HIV. Among participants aged 19–22, we did not see a difference in sexual debut or number of casual sexual partners by HIV status. However, those living with HIV reported fewer recent serious sexual partners and were less likely to be currently having sex in this older age group. There was also evidence that those living with HIV in this older age group were more likely to be using condoms with sexual partners than their counterparts without HIV. Conclusions: Future HIV interventions should be tailored by age group and HIV status. For example, those living with HIV may require support to confidently engage in safe sexual relationships
La vida social del programa Abriendo Oportunidades® en Guatemala: Tres décadas habilitando espacios comunitarios y cívicos para niñas y mujeres indígenas
No full textDesde 2004, Abriendo Oportunidades® (AO®) surgió como un programa social transformador de género dirigido a niñas y mujeres jóvenes indígenas en el contexto de posguerra en Guatemala. Siguiendo un enfoque basado en evidencia y anclado en las comunidades, AO® comenzó como un programa y ha evolucionado hasta convertirse en un movimiento social. AO® ha demostrado continuamente su impacto en la reducción de la exposición de las niñas a la violencia de género y fue pionero en la educación alternativa mediante un modelo de mentoras como tutoras. Con el tiempo, AO® ha alcanzado a más de 25,000 niñas y adolescentes indígenas en más de 500 comunidades rurales de Guatemala y ha construido un camino de oportunidades profesionales para las jóvenes mentoras que lideran el programa. AO® es un ejemplo vivo del liderazgo del Population Council en Guatemala y en la región mesoamericana, ya que este trabajo ha dejado una huella significativa en Belice, República Dominicana, Honduras y México. Este informe forma parte de la Serie: El legado de Abriendo Oportunidades®, que celebra y destaca 20 años de implementación programática con impacto
