Tuberculosis in Sub-Sahara Africa

Tuberculosis is only the second leading cause of death in the
world with AIDS/HIV being the first according to the World Health
Organization (WHO). What makes this infection so harmful to
sub-Saharan countries is that AIDS/HIV and Tuberculosis is found to
have a positive correlation with each other. (Cantwell, 1996)
Tuberculosis is a bacteria that can be easily passed through the air
from an infected individual. Because most of its symptoms are mild,
many people who are infected are unaware for months. Treatment
programs in these countries are in their teenage years with some
major kinks to work out, the larges being how drug interactions with
HIV/AID treatments cause one to be inefficient. The WHO and Global
health organizations such as The International Union against TB have
been in the forefront fighting this battle. Many individual countries
do not participate because many of these countries are poverty
stricken and have nothing that they would want, such as oil. As we
saw in the video clip from this weeks lecture material, a group of
four men had to bring TB treatments to countries because no one else
would due to the belief that they would die and it would not make a
difference. Major organizations have been working at enforcing laws
that cause people to be tested for TB before working in places such
as the coal mines. Sadly they found this to be inefficient as the
percentage of workers who had TB increased from 1% to 30% in a matter
of twenty years. (Corbett, et. Al, 2006) While the reasons as to how
the amount of infected persons increased so greatly with such high
standards are long and unknown, many organizations feel that
establishing preventative actions and some treatments cause more harm
that good.

In the article, “Barriers
and outcomes: TB patients co-infected with HIV accessing
antiretroviral therapy in rural Zambia”,
anthropologist
Chileshe followed a series of patients with TB and HIV and how easy
or hard it may be to get treatment. It was discovered that living in
the rural areas of Zambia made treating TB and HIV more difficult.
With having to foot the bill for transportation to the facilities and
then upon arrival learning that blood work was lost, the electricity
was off or lack of staffing prolonging treatment caused the
financially incapable to suffer even more. When the person was sick
or not feeling well some normal family roles were changed such as the
woman becoming the bread winner. In many cases the families were
ashamed to be acknowledged with having such a disease so they moved
further away from their communities. Having the illness caused the
same financial strain on the families as the funeral for the family
member. At the end of her year long studies of the seven individuals,
only three were taking the treatment and two were to start treatment,
the other two had already passes. Several months after leaving the
three that were on treatment when she left were the only survivors.
The lack efficient treatment options and accessibility for the
patients caused the mortality rates to decrease significantly
alongside with the inability to eat the proper foods. In conclusion,
treatments are only helpful if they can be given in a reasonable
amount of time and other factors do not exist such as lack of
transportation to hospitals and lack of nourishing food. It is only
when theses factors are eradicated that treatment can be effective in
these countries.

Sources

 

1. Cantwell, M. F., and N. J. Binkin. “Result Filters.” National Center for Biotechnology Information.U.S. National Library of Medicine, June 1996. Web. 10 Aug. 2012.
http://www.ncbi.nlm.nih.gov/pubmed/8758104.

2.Corbett E., Martson B., Churchyard G.J., De Cock K.M., “Tuberculosis
in sub-Saharan Africa: opportunities, challenges, and change in the
era of antiretroviral treatment” Lancet 2006; 367: 926–37

3.Muatale Chileshe, Virginia Anne Bond,
Barriers and outcomes: TB patients co-infected with HIV accessing antiretroviral therapy in rural ZambiaAIDS Care Vol.22, Iss. sup1,2010

4.Dye C, Harries AD, Maher D, et al. Tuberculosis. In: Jamison DT, Feachem
RG, Makgoba MW, et al., editors. Disease and Mortality in Sub-Saharan
Africa. 2nd edition. Washington (DC): World Bank; 2006. Chapter
13.Available from: http://www.ncbi.nlm.nih.gov/books/NBK2285/

5.”Tuberculosis.” WHO.
N.p., n.d. Web. 10 Aug. 2012.
<http://www.who.int/mediacentre/factsheets/fs104/en/>.

 

 

 

 

HIV in Malawi

The global health problem I chose to discuss is HIV in Malawi. I just wrote a paper about AIDS for another class so I’m well caught up on the subject so that’s why I chose this topic. The first case of AIDS in Malawi was in 1985. Because of the poverty and famine in Malawi it continues to still be a problem today, and is actually the leading cause of death in adults. The government has formed many policies to help fend in the fight against HIV but the number of cases continue to grow despite the efforts. Not having a financially stable government means that money for ads and prevention programs fall short and are sacrificed for things that are more important in their eyes. There are programs to educate people on HIV/AIDS and to teach them to be cautious but with limited resources it is sometimes not possible to avoid a situation in which they could be infected because the need to survive is greater.

An anthropologist working in Malawi is Dr. Anat Rosenthal. She started out by hearing about the HIV/AIDS epidemic in Malawi from women who lived in Tel Aviv who were HIV+ and decided that she wanted to do something about it. She now aids in the effort to prevent the spread of HIV/AIDS. She researches the impact that HIV/AIDS has on communities and focuses most of her attention to the children. She looks at the health status of children who have been orphaned by HIV/AIDS and who will raise them after this has happened. She has done twelve months of field work, used participant observation, and has several interviews to help aid her in her work. She recently spoke at SMU (Southern Methodist University) in Texas to get word out about her efforts and to hopefully encourage people to follow in her steps and to realize the problems these people face.

http://www.avert.org/aids-malawi.htm#contentTable0

http://www.smudailymustang.com/?tag=anat-rosenthal

Famine/Malnutrition in Somalia

I wanted to talk about the famine of two thousand eleven in Somalia and the malnutrition in their country at all times. In Somalia tens of thousands of people dies from the famine caused by a serious drought. It was their worst drought in over sixty years. The largest group of people who died was children under five years old. The CBN article that was posted for our class said that during this drought parts of Somalia had the highest malnutrition levels in the world. The article went on to stats shocking facts about the devastation of this famine. The drought has affected eleven million Somalians and many people are fleeing to the surrounding countries of Kenya and Ethiopia (Gartenstein-Ross).

The people are trouble surviving this because they have reserves for food, but they were quickly used up and years of poor rain do not allow them to stock large reserves. Governments can try to help, but when your country has tough climate issues only so much can be done without receiving foreign food aid. Somalia had been receiving foreign aid but the Muslim group al-Shabaad (linked to the terrorism group Al-Qaeda) has been preventing the people of Somalia from receiving aid. They recently stopped during this horrible famine (Gartenstein-Ross). This terror group involvement is another problem that the government and political leaders need to address because these groups take advantage of poor and hungry people. They will join these groups in order to receive food and water. The United States assisted during Somalia’s civil war and the power of warlords is a problem throughout the region.

When people constantly struggle to have clean water and access to adequate food, overall health is severely affected. Africa in general is constantly in trouble with their ability for food and clean water. The climate is so extreme in the region and there is a constant battle for the people to survive. I read an article that referred to and said, “Professor David Himmelgreen has worked in the Department of Anthropology at the University of South Florida for more than a decade. He’s done extensive research in Africa dealing with food, nutrition, chronic disease, and security” (Fields). He and other anthropologist try and find solutions to Somalia’s problems and other African Nations. Vice-President Joe Biden’s wife has led the United States aid effort to help with the drought and famine. There are other programs that constantly help this region and the main one is UNICEF. They say, “640,000 children are acutely malnourished in southern Somalia alone. Their programs support 16 stabilization centers, 201 outpatient therapeutic programs, and 325 supplementary feeding programs” (Fields).

Referring back to the problem with terrorist and militant groups disrupting aid, “When a United Nations food shipment arrived on Friday in Mogadishu, a gunfight broke out and seven people were killed.  Himmelgreen says, “I think it will get better, but it won’t be before a lot more children die or get very sick”(Fields). Not only do these militants take aid away from the Somalians, but also they disrupt refugees from fleeing to surrounding countries. The article says that Somalia has seven million people and over three million people needed food, water, and health care due to malnutrition.

Anthropologists like Himmelgreen knew the situation in Somalia was getting worse. He says, “They have these early warning famine systems in place. The U.S. government has one so there are sets of indicators that they look at and they can tell months in advance if there’s an impending famine. But because of all the politics there was relative inaction”(Fields). It is unfortunate that politics can get in the way of what needs to happen. I think when a serious problem like this occurs people should act and let politics take place later on. The worst part is that children suffer the most. They have the least amount of representation.

Hopefully in the future there can be improvements in famine prevention, but as bad as it sounds Africa seems to never truly benefit from aid. Everything that seems to be done there is just a small band-aid on a very large wound. There are many political and government issues that need to be worked out. The countries have governments, but warlords control many countries. The saddest part is that the people suffer and without the basic human necessities of clean water, quality food, and shelter the health of the country will not improve. The amount of people dying in Somalia also takes a toll on those who survive. The mental and physical health of these people is constantly in shambles. I think anthropologist, health care providers, and political leaders are all needed to fix this lingering problem.

Sources

Fields, Tammie. “29,000 Children Dead from Famine in Somalia.” Wtsp.com. N.p., 6 Aug. 2011. Web. 10 Aug. 2012. <http://www.wtsp.com/news/national/article/204731/81/29000-children-dead-from-famine-in-Somalia>.

 

Gartenstein-Ross, Daveed. “Thousands Dying from Malnutrition in Somalia.” Thousands Dying from Malnutrition in Somalia. Christian Broadcast News, 20 July 2011. Web. 10 Aug. 2012. <http://www.cbn.com/cbnnews/world/2011/July/Thousands-Dying-from-Malnutrition-in-Somalia/>.

Sexual Health in India: AIDS and HIV

India, currently being one of the most populous countries in the world is currently struggling with the vast spread of HIV and AIDS. This spread of this disease is of major concern since there are currently around 2.5 million HIV positive Indians and the spread has not slowed down. There are several problems that make this epidemic particularly hard to stop. The first is that there is simply not enough sexual education and aids awareness in the poverty stricken districts. This combined with the lack of condom use has resulted in the rapid spread of infections, especially among high risk groups such as sex workers, their customers and intravenous drug users. Another issue is the transmission of HIV from mothers to their infants. While this transference is preventable, it often occurs when the mother lacks knowledge of the disease, lacks funds to receive the anti-retroviral treatment, or is pressured not to take this action. A third major issue that interferes with the prevention of the transmission of aids is the culture itself. Many people see it as taboo to talk about sex related issues, and many are not willing to admit that sex occurs outside of marriages. Some of the organizations that are trying to help are the National AIDS Control Organization, which is a government run aids prevention program and UNAIDS, the Joint United Nations Program on HIV/AIDS. Both of these groups have attempted to raise AIDS awareness by increasing education and promoting safe sex habits (condoms).

An Anthropologist currently working in the field of AIDS and HIV study, particularly of that concerning childbirth transmission, is Cecilia Van Hollen of Syracuse University. She looks at the experiences of mothers throughout pregnancy, childbirth and nursing and how this is altered by HIV and AIDS. She also analyzes the transmission rates of HIV in India and how it often how negative cultural effects on the low class women.

 

http://www.avert.org/aidsindia.htm

http://www.unicef.org/india/hiv_aids.html

http://www.maxwell.syr.edu/faculty.aspx?id=6442451310

Infant Mortality in China

Infant mortality in China has been a problem in past years but it has recently been reduced to 33/1000 deaths, in which the article I have cited states is a measure of the health care level.  In the past, the rate was 300/1000 deaths before age one. Some causes could be related to difficult labors or disease. There has been an increased focus on vaccination to prevent infectious diseases. 

Socially and culturally, China may be modernizing and realizing its infants do need to be taken care of to survive and thrive.  They need vaccinations and to be born in a hospital.  The lower mortality rate indicates that China has progressed both politically and economically in line with other prominent nations in the world today.

Carol Berman, a medical anthropologist from the University of Buffalo, has done research on infant mortality in Tibet.  She has compared behavior and infant mortality.

The Chinese government has done an extensive amount of work in health promotion.  They have increased their rate of vaccinations and thus made a substantial reduction in the infant mortality rate in China.  There is still work to be done in this area but it is improving rapidly.  The infant mortality rate is higher in rural areas, which is to be expected.  There is less access to hospitals in these areas. The political climate has improved in China and the residents–infants included are benefiting from a new and improved China.  Economically the country is doing better and the people of China are culturally, politically, socially functioning much better than they have in the past.  Soon infant mortality, hopefully will become a problem from the past such as diseases that are no longer a problem today such as polio, tuberculosis, measles, things we have vaccinations for.  This is good news for the people of China. 

 

 

 

 

http://chinaperspectives.revues.org/1120#tocto1n2

http://www.china.org.cn/english/19012.htm

 http://anthropology.buffalo.edu/people/faculty/berman/

 

 

 

 

 

 

 

 

 

 

 

http://www.china.org.cn/english/19012.htm

 

http://www.china.org.cn/english/19012.htm

 

Bipolar Disorder in Italy

*Bipolar disorder has been seen throughout the years.  As early as 300 to 500 AD persons with bipolar were euthanized.  These ill individuals were seen as crazy and were said to be possessed by the devil.  They were restrained, chained, and their blood was ‘let out’.  It was not until the 18th and 19th centuries that a healthier approach to mental disorders was adopted.  (Stephens; 2007)  In fact, the term mania and melancholia were coined by the ancient Greeks and Romans.  In order to treat agitated or euphoric patients they even used waters of northern Italian spas and even believed that lithium salts would aid in treatment.  The term manic-depressive psychosis was termed in 1875 due to the work of Jean-Pierre Falret.

In Italy, as well as elsewhere in the world, patients suffering from bipolar disorder do not normally attend the clinic of their primary care physician during euphoric periods.  They usually see these periods to be more of a phase of well-being or depressive remission.  This social stigma makes it extremely difficult for health care professionals to accurately diagnose bipolar disease.  (Carta et al; 2011)

Proven throughout the medical community is the fact that the response of the use of antidepressants is often unsatisfactory.  However, a preliminary study performed in Italy found that approximately 20% of bipolar patients were receiving only traditional antidepressants as treatment.  These cultural and medical factors severely decrease the effectiveness of treatment of bipolar disorder in Italy.   It was also discovered that 21.3% of patients in Italy who had been prescribed an antidepressant for depression actually had bipolar disorder.  (Hirschfeld et al; 2005)

As bipolar patients are more likely to seek medical attention during a depressive state than a euphoric one, it is offered that physicians should always consider bipolar disorder for patients presenting with depression.  (Carta et al; 2011)  Patients suffering from bipolar disorder are also turning to alternative and complementary medicines for treatments, a few of which include omega-3 fatty acids, St. John’s wort, and acupuncture.  Researchers are greatly advising that people be informed of the possible risks of alternative treatments.  (bphope.com 2007)  REAC-lithium (a radioelectric asymmetric brain stimulation device with lithium) is also being tested as a possible treatment for bipolar disorder; it has shown impressive results. (Mannu et al; 2011)

*Emily Martin is an anthropologist that wrote about and has experience with bipolar disorder.   She argues that “mania and depression have a cultural life outside the confines diagnosis, that the experiences of people living with bipolar disorder belong fully to the human condition, and that even the most so-called rational everyday practices are intertwined with irrational ones.”  (Martin; 2009)  Martin pulls a lot of her knowledge on bipolar disorder from her own experiences with it.

References

Carta, Mauro; et al.  The Lifetime prevalence fo bipolar disorders and the use of antidepressant drugs in bipolar depression in Italy. October 24, 2011. http://za2uf4ps7f.search.serialssolutions.com.proxy2.cl.msu.edu.proxy1.cl.msu.edu/directLink?&atitle=The+lifetime+prevalence+of+bipolar+disorders+and+the+use+of+antidepressant+drugs+in+bipolar+depression+in+Italy.&author=Carta%2C+Mauro+Giovanni%3BAguglia%2C+Eugenio%3BBalestrieri%2C+Matteo%3BCalabrese%2C+Joseph+R.%3BCaraci%2C+Filippo%3BDell%27Osso%2C+Liliana%3BDi+Sciascio%2C+Guido%3BDrago%2C+Filippo%3BFaravelli%2C+Carlo%3BLecca%2C+Maria+Efisia%3BMoro%2C+Maria+Francesca%3BNardini%2C+Marcello%3BPalumbo%2C+Gabriella%3BHardoy%2C+Maria+Carolina&issn=01650327&title=Journal+of+Affective+Disorders&volume=136&issue=3&date=2012-02-01&spage=775&id=doi:10.1016%2Fj.jad.2011.09.041&sid=ProQ_ss&genre=article.  Accessed August 10, 2012.

Caution urged on bp alternative treatments. 2007. www.bphope.com/Item.aspx/443/researchline 2007.  Accessed August 10, 2012.

Hirschfeld, Robert; et al. Screening for Bipolar Disorder in Patients Treated for Depression in a Family Medicine Clinic. August 2005. http://www.jabfm.com/content/18/4/233.full.pdf+html accessed August 10, 2012.

Mannu, Piero; et al.  Long-term treatment of bipolar disorder with a radioelectric asymmetric conveyor. June 2011. http://www.dovepress.com/long-term-treatment-of-bipolar-disorder-with-a-radioelectric-asymmetri-peer-reviewed-article-NDT-MVP.  Accessed August 10, 2012.

Martin, Emily.  Bipolar Expeditions: Mania and Depression in American Culture. 2009. http://press.princeton.edu/titles/8502.html.  Accessed August 10, 2012.

Stephens, Stephanie. Through the ages, it’s been there. 2007-2012 http://www.bphope.com/Item.aspx/162/through-the-ages-its-been-there.  Accessed August 10, 2012.

Infant Mortality in China

There are a number of causes to the infant mortality rate in China. Overpopulation is a huge problem in China, with the country being the home to over 1.344 billion people. This causes many problems it self, such as a deep economic disparity and an enormous number of people living in extreme poverty. The economic divide also causes a great number of the population to not have access to quality health care at all. Some citizens may have never even gone to any kind of health care center in their life. For this reason, plus the Chinese culture placing women secondary to men, means that maternal health care is very rare and a persistent issue. Lack of access to affordable health care for mothers is a leading cause for infant mortality in China because it means that many mothers are giving birth in non sterile locations which can lead to many neonatal infections and infant death. Looking at the results of authors Xu, Rimpela, Jarvelin and Nieminen, the infant mortality rate is higher in female infants than in males, and even though there has been a decrease in the rate, the rate has been notably decreased more in males than in females. One explanation for this lies both in cultural norms as well as public policy. Because of the population issues, the government set regulations that each family could only have one child, and because the culture focuses more on having male children, some families may purposefully choose to allow the death of a female child so that they may have a male child. The government is working towards making health care more accessible for women so that there may be less deaths for infants, there is also huge amount of adoption agencies so that infants can be placed with families that can take care of them.

 

I had a difficult time finding out too much biographical information about anthropologists working in this area of study, but there are many papers I saw written out of the Department of Public Health in China that worked with a couple different areas of the topic. It’s definitely something that is a growing area of study and work though, especially in China itself.

 

Population, China – www.google.com/publicdata

Sex differences of infant and child mortality in China. – http://www.ncbi.nlm.nih.gov/pubmed/7716434

Infant mortality among various nationalities in the middle part of Guizhou, China. – http://www.ncbi.nlm.nih.gov/pubmed/9257395

Infant Mortality in Afghanistan

Afghanistan is one of the most dangerous places in the world to be a pregnant woman or a young child. Infant mortality rates are the third highest in the world as of 2010, and one in 10 children in Afghanistan dies before they are five years old. The origins of such high infant mortality rates are a combination of complicated issues ranging from three continuous years of drought, lack of clean water, lack of proper medicines and treatment, lack of access to education and health care for women, estimated 10 million land mines (roughly one for every child), and only 10 percent of pregnant women receive maternal care. With the country being in war for decades, it has taken a toll on all of their resources, and the drought has made it even more complicated for mothers and their children. By improving the health of the mother, then the health of the children can be improved. Infants whose mothers die in childbirth are 3 to 10 times more likely to die before their second birthday. Many children never go to school because they must help their family make a living at a young age. With living situations difficult for an adult to live in, how could it be possible that a child survive past the age of five?

The country must first be stabilized on an international and local level. War has been going on in Afghanistan for decades with foreign countries and even war amongst their own ethnic groups. Safety and security must come first, which should be provided by the Afghanistan government. Long term goals and development are critical for the country’s long-term survival as it will help the country to become self-sufficient and sustainable. Outside of Afghanistan, it has been proven that the education of women prove to have significant success in the development of a country. Many organizations are coming in to help improve the lives of children by providing essentials such as food and safe drinking water. A supply of vaccines and antibiotics are also being brought into help treat illnesses such as pneumonia, diarrheal diseases, measles, diphtheria, and polio.

Dr. Patricia A. Omidian is an applied anthropologist in Afghanistan and has worked with women, children, and refugees in mental health programs, rescue committees, health programs, and children organizations. Her job is to help the Afghanistan and US/NATO military to understand local communities and reduce deaths. She firmly believes in her research and the people she studies, hoping to protect and provide a better future within the constant imbalance of power in Afghanistan and in the global setting.

 

“Infant and under-five mortality in Afghanistan: current estimates and limitations.” World Health Organization. Web. 10 Aug. 2012. <http://www.who.int/bulletin/volumes/88/8/09-068957/en/>.

“Afghanistan, Children in crisis.” Save the Children. Web. 10 Aug. 2012. <http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/afghanistan_children.pdf>.

“Patricia Omidian, Applied Antrhopologist in Afghanistan, on the Human Terrain System.” Zero Anthropology. Web. 10 Aug. 2012. <http://zeroanthropology.net/2009/08/05/patricia-omidian-applied-anthropologist-in-afghanistan-on-the-human-terrain-system/>.

 

 

Malaria in Ethiopia

The global health problem that I chose to look at is Malaria inEthiopia.  Malaria inEthiopiahas been a problem for nearly 50 years and is one of the leading causes of death in this country.  This is a problem in this country because it is a poor developing country were many people live in close proximity of each other.  Another thing is thatEthiopiais a part ofAfrica, and there can be large rainfall one day, followed by a large drought the next, which is were the real danger of malaria come in.  Malaria is transmitted through mosquito bites, and mosquitoes generally nest in areas of standing water, which are easy to find after rains inAfrica.  In an effort to try and help people who have contracted malaria, there are community nurses who go from house to house in a community and check on people and give them shots and medication.  Another thing is some of the people have mosquito nets to try and keep the mosquitoes away, but this does not work for long because the nets get holes in them from use and then are unable to be used by people.

Source

http://www.globalissues.org/article/588/global-health-overview (Video)

http://www.ethiodemographyandhealth.org/MedVectoredDiseasesMalaria.pdf

An anthropologist working on this problem is Dr. Rory Nefdt.  He is working with UNICEF and other researchers to help the fight against malaria inEthiopia.  What he and many others have been doing is helping to distribute medication and other supplies like mosquito nets to the people ofEthiopia.  One problem is that the medication available does not have a very long shelf life than the previous drug used.  Researchers like Dr. Rory are trying to figure out a ways to elongate the expiry on these drugs so that they last longer so patients can use them before they expire.  Another problem facing this country is there are not enough of the mosquito nets, so they ordered 10 million more nets, but the firm inVietnamwhere the nets are expected from is saying they need more time to manufacture the products.

Source

http://www.panapress.com/Ethiopia-faces-challenges-in-fight-against-malaria–13-480355-18-lang4-index.html

Sexual Health in India

There has been many issues regarding sex in India. One problem in particular is HIV. The rates of HIV are extremely high in India. Not only is this a concern, it is a major concern for the age group in which HIV is spreading. HIV is rapidly spreading in young people between the tender ages of 15-24. There are several reasons why HIV is spreading among Indians and research scientists continue to search for answers.

One major problem among the Indian population is condom usage. A lot of Indians do not use condoms. Condom size is a major problem for Indian males. It is found that the size of Indian males’ penises are 2 inches too short in size for the condoms that are in local stores. For a further 30 percent, the difference was at least 2 inches. A poor fit meant the prophylactics often didn’t do the job they were bought for, and led to some tearing or slipping off during use (msnbc.msn.com).

From reading the article, they did not mention a solution or even a possible solution to this problem. Personally, I think a perfect solution to this problem would be to make condoms specifically for Indian men. This way, the rate of the spread of HIV will slow down and people will not have to worry about the condom slipping off all the time.

It is also said that many Indian men are embarrassed to ask for condoms because of their penis size. By making customized condoms specifically for Indian men, I think that they will be less embarrassed to ask for them or less embarrassed to go purchase them. I have not witnessed any article or anthropologist in an article to try to solve this problem.

The problem is talked about a lot but not the solutions. In the Indian culture, a lot of them are also against teaching sexual education because they do not consider it education. I think that the Indian culture should be more open to this because if more people were educated, there would be less HIV going around.

Sources

http://www.popcouncil.org/pdfs/wp/seasia/seawp19.pdf. August 10, 2012.

http://www.msnbc.msn.com/id/16157113/ns/health-sexual_health/t/condoms-big-problem-men-india/#.UCWTh51lTlY. August 10, 2012.