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By building up an integrated framework of political initiatives, distribution of specific knowledge, consulting, networking and tools for gender mainstreaming, the state of North Rhine Westphalia was successful in integrating a gender perspective into the health system from 2001 to 2006. The process developed in concentric circles--starting with women's rights initiatives, then reaching health politics--and has meanwhile reached health services. Important determinants for success were (1) statewide campaigns and offers of gender-specific consulting that distributed the topic to the city level and health services, (2) the linking of gender mainstreaming and the debate about quality in health services, (3) referring to specific health requirements or health problems of women or men and (4) a precise definition of 'sex' and 'gender'. A difficulty in implementing gender-sensitive approaches in the health system is seen in connecting specific medical or public health knowledge with the more general gender competence. To further promote gender sensibility, gender knowledge and gender-specific approaches to health and illness, an integration of gender mainstreaming tools into strategies and tools of project or quality management is proposed.

The 'Arbeitsgemeinschaft Gestose-Frauen e.V.' was founded in 1984 with a couple of sufferers and has advised more than 24,000 women so far. In addition to the care by the midwife and gynaecologist, this self-help organization offers the possibility to exchange experiences with other sufferers, but also to receive medical and psychological counselling.

Worldwide, 50% of all HIV-positive persons are female. The situation is particularly dismal in Africa and Asia, in South America and in the Caribbean. Germany is confronted with a high percentage of immigrants from countries in these parts of the world, and consequently must expect to see an increasing rate of HIV-positive women from these regions. This makes programs for the management of female HIV-positive victims an urgent necessity. The present article describes a multidisciplinary concept, whose aim it is, via comprehensive preventive measures, to avoid medium- and long-term complications.

Despite increasing numbers of heterosexually transmitted HIV-infected women and high numbers of female i.v.-drug users within HIV-infected population the subject of HIV-infection in women has been of low interest during the past years in Germany. This prospective study investigated the economic, social and psychological situation with regard to the special situation of this group. While there was no difference in clinical parameters we found a worse economic situation of HIV-positivity in women. Concerning the psychosocial situation there were few differences, but HIV-infected women sought help by voluntary workers more often. Specific education and socioeconomic support of HIV-infected women are conditions for the success of antiretroviral therapy of HIV-infection which has recently become more demanding and complex.

It is the declared aim of any national health policy to assist in the development of life styles and environments, in cooperation with other institutions, that would promote the overall health of the population. The Federal German provincial ("Land") governments and municipal as well as county administrations have been preparing health reports for this purpose during the last few years. The question is whether these reports adequately ensure the promotion of health among women in particular. Our conclusion is that this is not yet the case. The purpose of the following article is to describe and assess the present state of the problem and policy formulation. To this end we evaluated and synopsized 16 provincial and urban reports via document analysis. The health reports show that, although they do include problem definitions in relation to the health situation of women, they fail to formulate health targets for them. The reports are neither coordinated with health policy executives, nor do public health administrations cooperate with any other sectors of the administration to formulate and translate into reality a policy that would promote the health of women. On assessing the health reports in respect of their ranking within the Public Health Action Cycle for a health-promoting policy we must conclude that in their present form they are unsuitable both for defining health promotion problems and for formulating health policies with particular reference to women as an important target group. These health reports, as they are now being prepared and presented, lack clear definition and orientation with regard to appropriate action.

From 1976 to 1985 151 recurrent carcinomas of the uterine cervix were diagnosed and in 118 cases they have been treated at the Gynaecological Centre of the University of Freiburg. The recurrences were divided according to the localisation scheme of Munnell and Bonney. 55 patients (47%) received radiotherapy, 22 (19%) surgery, 12 (10%) combined therapy of surgery and radiotherapy and 13 women (11%) chemotherapy or hormone therapy. 16 patients (13%) received a different type of therapy. We found most of the recurrences three or four years after the primary therapy. There was no correlation between the point of time of diagnosis of the recurrences and the prognosis. The distribution of the histology was no parameter for the OAS. The operative procedure demonstrates better results than the radiotherapy at recurrences in the centre of the pelvis--but there is no significance. The radiotherapy achieves significant better results than the operative treatment when we have large recurrences in the whole pelvis. If there is an answer of the tumour to the therapy, the OAS gets better--in these cases we should use, in spite of the risk of more side effects, the whole therapeutic range.