Pacific women and AIDS: dilemmas, options, choices and vulnerability.
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The authors make out a statement about HIV infection in French Polynesia at the date of 1991 December 31. 96 cases all together of seropositive and AIDS infected people were recorded. These patients are young generally (78 p.c. between 21 and 40 years old) sexually contaminated (72 out of 96) and live in Tahiti island (94 p.c.). Sex-ratio is 2.8 male/1 female. Among them, we noted 55 p.c. of Europeans, 38 p.c. of Polynesians and 7 p.c. of Asiatic people. Epidemiological monitoring of the infection was made easy because of a set of laws and possibilities of detection highly favourable. Progress of the infection is constant, with 20 new cases detected each year with a prevalence of 150 cases of AIDS per 1 million of inhabitants, French Polynesia could be classified as the 5th or 6th region of France as far as the importance of the disease. Clinical, biological and epidemiological taking of charge of patients is detailed as well as the prevention campaign.
The present U.S. abortion law, Roe v Wade, is based on the trimester/viability concept. However, both concepts seem to be biologically ill founded and are likely to contribute to confusion regarding abortion laws. A survey of the abortion laws in individual states revealed a lack of uniformity. The time limit for abortion upon request varies from 13 to 28 weeks; nine states have no specific abortion law. This confusion also exists in other countries. Standards are lacking regarding requests for the dates of the last menstrual period, fertilization and implantation. Some states do not allow termination of pregnancy for maternal indications after 24 weeks, and the definition of maternal endangerment has rarely been addressed and remains vague. Only a few states have provisions for fetal malformation. Such terms as trimester and viability are not biologically founded and are likely to contribute to the confusion. The terminology should be clarified so abortion, contraception, birth control and other such terms are uniform.
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Data on fertility and contraception in Micronesian women in the Marshall Islands were collected during a women's health survey in 1985. High total fertility rates were found. The reproductive pattern of many Marshallese women is one that has been associated with adverse health consequences: pregnancies in teenagers and in women over 39 years, high parities of four or more births, and short birth intervals. The practice of breastfeeding is declining in younger women. The prevalence of contraceptive use is low, and the availability of reversible methods is limited. Most contraceptive nonusers would like to practice contraception, but are inhibited by the lack of information about family planning. It is suggested that more attention needs to be given to family planning services in the Marshall Islands, in particular to improving the availability of reversible methods of contraception and of information about family planning. Further research is also needed on how family planning services might best be organized to maximize participation by women and their partners who wish to use such services.
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This report is an analysis of mortality in the population of Niue Island over the years 1978-82. The overall level of mortality in Niue is low. Life expectancy at birth is correspondingly high (66.5 years). Because of the extensive migration of Niueans during the period of study the death rate may be underestimated and the life expectancy correspondingly overestimated. Infant mortality has dropped from over 200 deaths per 1000 live births during the 1940s to around 10 per 1000 during the period under study. The major causes of premature mortality in Niuean males were injury/poisoning followed by cardiovascular disease. In females infection, injury/poisoning and neoplasia were the major causes of mortality. The 1980 epidemic of dengue fever had an appreciable effect on mortality in this small population. Except for dengue fever, the pattern of mortality in Niue is similar to that in many developed countries. Preventive efforts against metabolic and cardiovascular disease (including hypertension and diabetes) should continue in order to control mortality from these causes, Mosquito programmes, and emergency measures if epidemics threaten, are required so that deaths from haemorrhagic dengue are prevented.
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A dengue type 1 epidemic occurred in Fiji between July 1989 and July 1990. Virus isolation in C6/36 cell cultures and Toxorhynchites mosquitos yielded 36 strains. Of the 3686 cases recorded by the Ministry of Health, 60% involved indigenous Fijians and 37%, Indians. A house-to-house survey revealed that a large majority of patients had classical dengue symptoms and 8% reported haemorrhagic manifestations. Among the children and adults hospitalized for dengue, 43% had haemorrhagic manifestations, including epistaxis, gingival bleeding, haematemesis, melaena and haematuria. A total of 15 patients with haemorrhagic manifestations and/or shock died, 10 of whom were aged 0-15 years; the diagnoses were confirmed in four cases by virus isolation or serology.
Community health programmes can be one of the most important and most available forms of education for the total community. This article outlines health programmes and health education initiatives, as well as approaches to participatory training, in several South Pacific countries.
The relationship between female age and infertility is examined using a single-island Micronesian population case. Demographic data, derived primarily from reproductive history interviews, show that a significant age-associated decline in marital reproductive performance is absent before women reach their late thirties in this population but a substantial decline is present once women reach their forties. Ethnographic data support the demographic inference that couples are maintaining relatively high levels of conjugal coital activity with both advancing female age and increasing marital duration. Thus coital activity levels appear to be an important factor in the maintenance of fertility in this group before the mid-thirties but decreases in fecundability after this age are due primarily to reductions in fecundity, not to declines in coital activity. The description of the Butaritari case lends support to Underwood's (1990) suggestion that a "Micronesian pattern" of reproductive performance may exist for the region's atoll-based populations and underscores the promise of further investigations of these special cases in the fields of demography and reproductive ecology.