Women and AIDS in Africa: demographic implications for health promotion

The population pyramid in most African countries is symmetricalwith a broad base. However, in urban areas, one finds a prominentone-sided bulge caused by the migration of young males (aged18–35) into the cities for employment. The prevalenceof HIV infection in urban populations in Africa is highest inthe 25–35 year old age-group in males and in the 15–25year old age-group in females. This difference is due to thefact that on average, sexual partnerships are formed betweenolder men and younger women. The distortion of the urban populationprofile caused by male migration results in an overall 1:1 female:maleprevalence ratio of infection. However, as the epidemic spreadsinto the larger rural population, the absolute size of the mostseverely affected younger female population is larger than thesize of the older male population, which eventually resultsin a higher number of infections in women. This excess of female morbidity from HIV infection has importantimplications for the social and the economic role of women insociety. It also adds fuel to an emerging epidemic of paediatricAIDS. Health promotion strategies to address this issue shouldinclude: (1) public policies designed to narrow the male:femaleage-gap of sexual partnership formation; (2) policies addressingthe economic migration patterns of the male work force and;(3) policies to narrow the base of the general population pyramid.     

Oral Contraception,Circulating Immune Complexes,Antiethinylestradiol Antibodies,and Thrombosis*

ABSTRACT: Circulating immune complexes were detected in women on oral contraceptives (OC) by a simple antigen nonspecific method using precipitation of serum in 25% saturated ammonium sulfate (CIC-AS). A significant correlation was found between the presence of CIC-AS and the OC vascular risk. A radioimmunoassay with tritiated ethinylestradiol indicated that CIC-AS contained antiethinylestradiol antibodies (anti-EE Ab) in a number of OC users, but indicated also that 1) anti-EE Ab may be found in cases with no detectable CIC-AS, 2) CIC-AS containing no anti-EE Ab are found in nonusers, and 3) even in OC users the CIC-AS may contain antibodies to other ligands than EE. The study demonstrated also that, in OC users with a vascular complication, anti-EE Ab were more frequently detected (78% of cases) than CIC-AS (60%). Moreover, among OC users with CIC-AS, anti-EE Ab were found in 95% of women with a vascular complication and only 37% of current healthy users. The detection of anti-EE Ab appears to be more predictive, with regard to the vascular risk of OC, than the detection of CIC-AS.