Each year, more than 2 million women are diagnosed with breast or cervical cancer, yet where a woman lives, her socioeconomic status and agency largely determines whether she will develop one of these cancers and will ultimately survive. In regions with limited resources, fragile or fragmented health systems, cancer contributes to the cycle of poverty. There are proven and cost-effective interventions for both these common cancers, yet for so many women access to these is beyond reach. These inequities highlight the urgent need for sustainable investments in the entire spectrum of cancer control, from prevention to palliative care, and in the development of high-quality population-based cancer registries, in low-and middle-income countries. In this first Series paper we describe the burden of breast and cervical cancer with an emphasis on global and regional trends in incidence, mortality and survival, and the impact, particularly among socioeconomically disadvantaged women in different settings.

BackgroundAlthough many men who have sex with men (MSM) in Peru are unaware of their HIV status, they are frequent users of the Internet, and can be approached by that medium for promotion of HIV testing.MethodsWe conducted an online randomized controlled trial to compare the effect of HIV-testing motivational videos versus standard public health text, both offered through a gay website. The videos were customized for two audiences based on self-identification: either gay or non-gay men. The outcomes evaluated were ‘intention to get tested’ and ‘HIV testing at the clinic.’FindingsIn the non-gay identified group, 97 men were randomly assigned to the video-based intervention and 90 to the text-based intervention. Non-gay identified participants randomized to the video-based intervention were more likely to report their intention of getting tested for HIV within the next 30 days (62.5% vs. 15.4%, Relative Risk (RR): 2.77, 95% Confidence Interval (CI): 1.42–5.39). After a mean of 125.5 days of observation (range 42–209 days), 11 participants randomized to the video and none of the participants randomized to text attended our clinic requesting HIV testing (p = 0.001). In the gay-identified group, 142 men were randomized to the video-based intervention and 130 to the text-based intervention. Gay-identified participants randomized to the video were more likely to report intentions of getting an HIV test within 30 days, although not significantly (50% vs. 21.6%, RR: 1.54, 95% CI: 0.74–3.20). At the end of follow up, 8 participants who watched the video and 10 who read the text visited our clinic for HIV testing (Hazard Ratio: 1.07, 95% CI: 0.40–2.85).ConclusionThis study provides some evidence of the efficacy of a video-based online intervention in improving HIV testing among non-gay-identified MSM in Peru. This intervention may be adopted by institutions with websites oriented to motivate HIV testing among similar MSM populations.Trial registrationClinicaltrials.gov NCT00751192

Objectives: To measure the risk of preterm delivery, premature rupture of membranes, infant low birth weight and infant mortality, by a population-based retrospective cohort study using Washington State birth certificate data. Methods: All women diagnosed with Chlamydia trachomatis infection (n = 851), noted with a check box on the birth certificate from 2003, and a randomly selected sample of women not diagnosed with C trachomatis (n = 3404) were identified. To assess the RR between chlamydia infection and pregnancy outcomes, multivariable logistic regression analysis was used. Results: Women with chlamydia infection were younger, more likely to be non-white and had less years of education compared with women without chlamydia. Additionally, they were more likely to have inadequate prenatal care and coinfections with other sexually transmitted infections. After adjusting for age and education, chlamydia-infected women were at an increased risk of preterm delivery (RR 1.46, 95% CI 1.08 to 1.99) and premature rupture of membranes (RR 1.50, 95% CI 1.03 to 2.17) compared with non-infected women. However, no increased risk of infant death (RR 1.02, 95% CI 0.37 to 2.80) or low birth weight (RR 1.12, 95% CI 0.74 to 1.68) associated with chlamydia infection was observed. Conclusion: This study suggests that C trachomatis is associated with an increased risk of preterm delivery and premature rupture of membranes, but not with infant death and low birth weight. Routine screening and opportune treatment for C trachomatis should be considered a necessary part of prenatal care to reduce these adverse pregnancy outcomes. G enital chlamydial infection is recognised as one of the most common sexually transmitted infections (STIs) worldwide. In 1999, 92 of the 340 million new STI cases reported by the World Health Organization were due to this infection.1 Chlamydia trachomatis is also the most commonly reported notifiable disease in the US, and the leading cause of bacterial STI in industrialised countries.2 3 In the US, there are approximately four million new chlamydia infections per year. It is estimated that ,10% of these cases are diagnosed, resulting in an adverse impact, especially in women not treated for this infection. Infection with C trachomatis can lead to severe complications of the reproductive tract and adverse pregnancy outcomes. The common clinical manifestations of this infection include cervicitis, pelvic inflammatory disease and tubal factor infertility. [5][6][7] In pregnant women, chlamydia infection has been associated with an increased risk of ectopic pregnancy, preterm delivery, spontaneous abortions, low birth weight, premature rupture of membranes, perinatal mortality and postpartum endometritis.5 8-14 Because of these risks, screening of pregnant women at the first prenatal visit is recommended by the Centers for Disease Control and Prevention and US Preventive Services Task Force. Additionally, both organisations suggest testing pregnant women at increased risk a second time during the third trimes...