Mature Allover 30 Women
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In the US, it is virtually unheard of. Not that women who are over 30 are all married. Far from it. In the US, we consider it more important to mature in your own life before getting married. Most people are worried that their children will marry too young; certainly not too old. I got married when I was 23. She was 19. Everyone tried to discourage it. But, being in America, they left the choice up to us.
The priority to advance HIV awareness and HIV knowledge among all groups of people was already stressed in the 1994 Cairo International Conference on Population and Development (ICPD, 1994). In response to this programme services in China have started providing education on HIV/AIDS for rural women, young people, as well as for migrants (Fang & Kaufman, 2008). This was later reiterated in the UNFPA country programmes in China, which aimed to promote client-centred reproductive health and family planning services in China and to assess the state of reproductive health and family planning in the country, as well as to help design necessary interventions in order to achieve goals formulated at the ICPD. As a part of the intervention efforts, two surveys were conducted in 2003 and 2005 in 30 selected counties within 30 provinces across China under the Fifth Country Programme (CP5) (UNFPA, 2003). HIV prevention and improvement of the level of HIV awareness and knowledge among the general population were the core themes for the CP5 (UNFPA, 2003).
One of the recommendations from the CP5 Baseline report was that intervention measures should place an additional emphasis on issues related to HIV/AIDS (Li et al., 2004a). The evaluation report concluded that there was an urgent need to increase the level of HIV awareness and HIV knowledge among different strata of the Chinese population. Young people, both males and females, as well as women (especially those unmarried and currently married) from the Western region of the country (which is the least developed part of China), as well as those from the Central region, were identified as being least aware of HIV as 30% of them had never heard of HIV/AIDS (Li et al., 2004a). These lagging-behind groups of people were then specifically targeted in the areas covered by the CP5 interventions. A major focus of the CP5 interventions was the dissemination of standard education materials on HIV/AIDS prevention, including wall posters, leaflets, pamphlets and video materials explicitly focusing on prevention of HIV transmission and reducing stigma and discrimination and providing information about care and treatment of people living with HIV/AIDS. Health care providers, including doctors, nurses and community health workers, were provided with training sessions on HIV prevention and treatment compliance strategies, including partner referral and follow-up and counselling, as well as on emphasizing the relevance of reducing stigma and discrimination against those living with HIV/AIDS.
The 1997 survey used a two-stage sample: first 1041 communities were selected, then 15,213 women were selected within those communities (Jiang, 2000). The sample of women in this survey is self-weighted (Jiang, 2000). The quality of the data collected met all objectives the survey team had (Jiang, 2000).
The 2001 survey was conducted in the same 1041 communities that were selected for the 1997 survey (Pan et al., 2003). All women of reproductive age in these communities were interviewed for this survey. The sample of women in this survey is not self-weighted. The quality of data was also satisfactory according to the survey team (Pan et al., 2003).
In the 2005 survey a main change in sampling occurred: the sampling procedure was moved from the sample of individuals to the sample of households (Li et al., 2008). The 2005 survey used a stratified multi-stage sample of households (Li et al., 2008). Thirty counties were first stratified into the three regions (Eastern, Central and Western) and then regions were stratified by urban and rural areas. The sample size for each region was equal. Within each of the three regions, 50 townships were first selected (Li et al., 2008). Systematic random sampling with probabilities proportional to the number of households within each township was used for the selection of townships in the Endline survey (Li et al., 2008). Then within each township four communities were selected using systematic random sampling with probabilities proportional to the number of households within each community. In the final stage, a systematic random sample of fifteen households was selected for a list ordered by local geography, and all women of reproductive age were considered eligible for the survey in these households (Li et al., 2008). Women were asked similar question at two points of time (2003 and 2005), which allows trends to be studied over time in the context of the 30 selected counties. However, the surveys are cross-sectional in nature and different samples of women were selected for the two surveys.
The main interest of this study was to decompose the total change in the proportions of women being aware of HIV at different points in time (1997 and 2001; 2003 and 2005) into the change due to difference in population structure and due to the change in HIV awareness that is influenced by the external or environmental factors such as interventions and political commitment. Detailed decomposition analysis was conducted in order to establish which sub-groups experienced the larger changes in effect sizes, or in other words which variables contribute most to the total change in relationship or effect sizes between HIV awareness and characteristics of women. If no interventions are implemented or interventions are not effective, similar changes in probabilities are expected to be observed across different groups of women. However, if interventions are effective, larger changes are expected within the groups that were targeted by specific interventions.
Figure 2 presents the predicted probabilities obtained by applying the two different logistic regression equation coefficients (2003 and 2005) to the 2005 sample. It shows change in effect sizes between 2003 and 2005 for different subpopulations defined by ten main characteristics of Chinese women in 30 purposefully selected counties in China. The figure shows that between 2003 and 2005 there was a substantial change in HIV awareness for rural women (Fig. 2a), women who belong to minorities (Fig. 2b), those with no education (large change of 22 percentage points) and with only primary education (Fig. 2c), as well as for women residing in Central and Western regions (Fig. 2f). For example, Fig. 2f shows the change in size effects between 2003 and 2005 by regions. The larger change in effect sizes can be seen in the Western region as well as in the Central region, which might be attributed to the effectiveness of different prevention governmental and non-governmental programmes and campaigns, including the UNFPA interventions, as special attention was directed to women from Central and Western parts of the country. With time, lower awareness groups are catching up and the gaps between the groups are closing.
Confidence intervals for differences in mean predicted probabilities between two points in time, which were obtained using the bootstrap method, suggest that all differences in probabilities of being aware of HIV between 1997 and 2001, as well as between 2003 and 2005, are significant, with the exception of widowed or divorced women for both sets of surveys, women who were in the age group below 20 years for the years 1997 and 2001 and women who reported having a professional job for the years 2003 and 2005.
A smaller part of the observed change in HIV awareness over time is attributed to change in population structure, in other words to demographic change, but a larger part is due to changes in environment such as in political commitment, successful interventions and health promotion campaigns. However, part of the change in HIV awareness between the two sets of consecutive surveys is also due to the differences in representativeness levels of surveys and designs, which are different for different surveys used for the analysis. With time, lower awareness groups are catching up and gaps between groups with initially different awareness levels are closing. The joint efforts of interventions and programmes introduced in the whole of China and in 30 counties, including the UNFPA interventions, have been effective in closing the gaps between groups between 2003 and 2005, as suggested by the larger increase in HIV awareness in specific groups of women between 2003 and 2005 than between 1997 and 2001. The increases observed between 1997 and 2001 are more evenly spread between groups of women with different demographic characteristics, whereas between 2003 and 2005 increases are more pronounced among the groups that were targeted by different interventions and programmes, including the UNFPA interventions.
The main limitation of the results obtained through the decomposition analysis is the limited number of variables that were available for the analysis for Models 1 and 2. It is possible that there are other factors that could explain variation in the response variable but were not included in the logistic regression models because of lack of data. However, despite this limitation the results yielded a better understanding of evolution of HIV awareness in China. Also, decomposition analysis is a good technique that allows the separation of different components that contribute to the total change in HIV awareness between different points in time. Data only being available for women represents another limitation of the study. However, this limitation is also observed in other countries' data. Yet another limitation of the present analysis is that the results of the decomposition analysis between 2003 and 2005 cannot be generalized to the whole country, but are indicative of the possibility that if the right interventions are in place, the level of HIV awareness can be substantially improved within a short period of time. The analysis also could not establish any causal associations because of the cross-sectional nature of the data available for the analysis. The analysis would have benefited from including a study that collected information about all HIV awareness and HIV knowledge-related interventions that took place in China before 2005. This would have helped to control for the environment, e.g. interventions and programmes. It would also have helped to identify if there are specific interventions in place in China targeting groups such as MSM (men who have sex with men), which might be excluded from the provision performed through family planning services. Unfortunately, such a study has not been conducted. The results of this type of study would help to isolate specific effects of the interventions, including UNFPA interventions, which were implemented in China between 2003 and 2005, and to assess the effectiveness of these interventions rather than just speculate about their potential effectiveness. Finally, another limitation of the study is that it is not possible to isolate the specific effects of the UNFPA interventions due to the limitations of data such as absence of control observations. 59ce067264
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