Excluding pregnancy among women initiating antiretroviral therapy: efficacy of a family planning job aid.

BACKGROUND: Guidelines for initiating ART recommend pregnancy testing, typically a urine test, as part of the basic laboratory package. The principal reason for this recommendation is that Efavirenz, a first-line antiretroviral medication, has the potential of causing birth defects when used in the first trimester of pregnancy and is therefore contraindicated for use by pregnant women. Unfortunately, in many African countries pregnancy tests are not routinely provided or available in ART clinics, and, when available outside clinics, are often not affordable for clients.Recently, the World Health Organization added a family planning job aid called the 'pregnancy checklist,' developed by researchers at Family Health International, as a recommended tool for screening new ART clients to exclude pregnancy. Although the checklist has been validated for excluding pregnancy among family planning clients, there are no data on its efficacy among ART clients.This study was conducted to assess the clinical performance of a job aid to exclude pregnancy among HIV positive women initiating ART. METHODS: Non-menstruating women eligible for ART were enrolled from 20 sites in four provinces in Zambia. The pregnancy checklist was administered followed by a urine pregnancy test as a reference standard. Sensitivity, specificity, and positive and negative predictive values were estimated. RESULTS: Of the 200 women for whom the checklist ruled out pregnancy, 198 were not pregnant, for an estimated negative predictive value of 99%. The sensitivity of the checklist was 90.0%, and specificity was 38.7%. Among the women, 416 out of 534 (77.9%) did not abstain from sex since their last menses. Only 72 out of the 534 women (13.4%) reported using reliable contraception. Among the 416 women who did not abstain, 376 (90.4%) did not use reliable contraception. CONCLUSION: The pregnancy checklist is effective for excluding pregnancy in many women initiating ART, but its moderate sensitivity and specificity precludes its use to completely replace pregnancy testing. Its use should be encouraged in low resource settings where pregnancy tests are unavailable or must be rationed. Family planning methods should be available and integrated into ART clinics.

Zambian male adolescents' perceptions about premarital sexual relationships.

The role adolescent boys play in premarital sexual activities, gender power relations, and the reproductive health risks they are exposed to, has received little attention in research. This qualitative study has aimed to explore Zambian male adolescents' perceptions and expectations about premarital sexual relationships. Seven focus group discussions were conducted between November 2000 and May 2001, in George and Chimwemwe compounds, with 53 boys aged 15 to 19. The findings reveal that adolescent premarital sexual relationships are common and considered by many boys as a prerequisite to achieving an adult male's autonomy and status. The boys viewed themselves as the privileged gender, with greater freedom than girls, and were the major decision-makers on sexual matters in relationships. The results indicate that traditional values and stereotypical gender roles continue to influence Zambian boys' male identity. However, a sense of ambiguity among the boys on issues of gender imbalance in premarital relationships indicates a potential and preparedness to break with traditional trends - a true challenge for public health priorities and interventions.

"I am happy that God made me a boy": Zambian adolescent boys' perceptions about growing into manhood.

Adolescence is a period of transition during which a person is neither considered a child nor an adult. As little is known about adolescent boys' perceptions, norms, role models and gender relations that influence their male identity and behaviour, this qualitative study was conducted. Data were drawn from seven FGDs and twelve mails of adolescent boys (15-19 years old) residing in two townships outside Lusaka and Kitwe in Zambia. Findings show that growing up to a man entails a certain level of ambiguity and contradictory perceptions in terms of supposedly appropriate social and sexual behaviour but indicates a few alternatives. Based on the findings, we recommend that the information gap, misconceptions and anxiety among boys regarding their male identity should be addressed. The respondents suggested that an educational programme that will pay due attention to their needs and answer their questions should be designed and implemented with active involvement of male adolescent peers.