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I. PROGRAM RESOURCES

1. Adolescents, Social Support and Help-seeking Behaviour
2. Framework for Action on Adolescents and Youth. Opening Doors with Young People: 4 Keys
3. Emerging Answers – Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases
4. Engaging Men and Boys to Achieve Gender Equality: How Can We Build on What We Have Learned?
5. Exchange on HIV/AIDS, Sexuality and Gender
6. New Resources on HIV and Adolescents
7. Transport, (Im)mobility and Spatial Poverty Traps: Issues for Rural Women and Girl Children in Sub-Saharan Africa
8. Will You Listen? Young Voices from Conflict Zones
9. Young and Vulnerable: The Reality of Unsafe Abortion among Adolescent and Young Women
10. Young Adolescents' Sexual and Reproductive Health and Rights

II. RESEARCH SUMMARIES

1. Consent and coercion: examining unwanted sex among married young women in India
2. HIV risk perceptions and first sexual intercourse among youth in Cape Town South Africa
3. HIV seroprevalence in street youth, St Petersburg, Russia
4. Human papillomavirus detection by penile site in young men from Kenya
5. Identification of novel risks for nonulcerative sexually transmitted infections among young men in Kisumu, Kenya
6. Mental health and disclosure of HIV status in Zambian adolescents with HIV infection: Implications for peer-support programs
7. Outcome of teenage pregnancy
8. Predictors of sexual behaviors among Thai young adults
9. Predictors of sexual intercourse among Korean adolescents
10. Psychosocial predictors of adolescent sexual behavior
11. Rebel girls? Unplanned pregnancy and colonialism in highlands Papua, Indonesia
12. Sex, money, and premarital partnerships in southern Malawi

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I. PROGRAM RESOURCES

1. Adolescents, Social Support and Help-seeking Behaviour (2007)

This paper discusses both the sources of social support available to adolescents in their communities and whom adolescents actually turn to for support and why. The paper contains the findings of a literature review on the health-seeking behavior of adolescents, the results of consultations with 35 adolescent health programs, conclusions and recommendations for action, and a tool that can be used to carry out a rapid assessment of available social supports.
Organization: WHO
Contact: bookorders@who.int

2. Building a Gender Friendly School Environment: A Toolkit for Educators and their Unions (2007)

This toolkit was designed to help educators' unions create a healthy, safe environment in learning institutions for learners of all ages. The goal is to challenge and change negative gender stereotyping and gender inequalities in all aspects of learning institutions and to promote equal opportunities for female and male learners to develop a healthy gender identity and complete a quality basic education.
Organization: Education International, EDC, WHO
Contact: info@ei-ie.org

3. Emerging Answers – Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases (2007, PDF, 204 pages, 5.7 MB)

This book reviews research findings on the effectiveness of comprehensive and abstinence-only sex education programs in reducing teen pregnancy and sexually transmitted infections. It concludes that there is not sufficient evidence to justify the widespread dissemination of abstinence-only-until-marriage programs.
Organization: National Campaign to Prevent Teen and Unplanned Pregnancy
Contact: http://www.thenationalcampaign.org/contact-us/general-inquiries.aspx

4. Engaging Men and Boys to Achieve Gender Equality:How Can We Build on What We Have Learned? (2007, PDF, 28 pages, 2.1 MB)

This publication summarizes a May 2007 seminar organized by the International Center for Research on Women (ICRW) and Instituto Promundo to examine the current state of work with men and boys in the field of health care, especially reproductive and sexual health.
Organization: ICRW and Instituto Promundo
Contact: info@icrw.org

5. Exchange on HIV/AIDS, Sexuality and Gender (2007)

Topics covered in the newest issue of Exchange include comprehensive sexuality education and the realities of young people's lives, talking about sex using youth language in sexuality education, and sexuality of young people infected with HIV.
Organization: Royal Tropical Institute, SAfAIDS
Contact: exchange@kit.nl

6. New Resources on HIV and Adolescents (2007)
The Guttmacher Institute has released six new resources on adolescent sexual and reproductive health in Guatemala, Honduras, Nicaragua, Burkina Faso, Uganda, and Ghana.

1. Proteger la salud sexual y reproductiva de la juventud guatemalteca (PDF, 8 pages, 278 KB)
   
2. Proteger la salud sexual y reproductiva de la juventud hondureña (PDF, 8 pages, 279 KB)
   
3. Proteger la salud sexual y reproductiva de la juventud nicaragüense (PDF, 8 pages, 257 KB)
   
4. Protéger la prochaine génération au Burkina Faso: Nouvelle évidence sur les besoins de santé sexuelle et reproductive des adolescents (PDF, 52 pages, 1.3 MB)
   
5. Protecting the Next Generation in Ghana: New Evidence on Adolescent Sexual and Reproductive Health Needs (PDF, 48 pages, 2.9 MB)
   
6. Qualitative Evidence of Adolescents' Sexual and Reproductive Health Experiences in Uganda (PDF, 60 pages, 749 KB)
   

Organization: Guttmacher Institute
Contact: buyit@guttmacher.org

7. Transport, (Im)mobility and Spatial Poverty Traps: Issues for Rural Women and Girl Children in Sub-Saharan Africa (2007, PDF, 18 pages, 148 KB)

This paper reflects on the experiences of women and girls with poor accessibility to services and markets, and inadequate transport in rural sub-Saharan Africa. It uses examples from field research to look at how these factors affect girls' education and access to health services.
Organization: Chronic Poverty Research Centre, Overseas Development Institute
Contact: publications@odi.org.uk

8. Will You Listen? Young Voices from Conflict Zones (2007)

The voices of young people from Afghanistan, Angola, Burundi, Colombia, Haiti, Iraq, and many other countries affected by conflict have been brought together in this report. It was compiled from the views and recommendations of some 1,700 children and young people in 92 countries, collected through a series of focus groups and an online questionnaire. The report is a companion to Children and Conflict in a Changing World, the 10-year strategic review of the landmark UN report, The Impact of Armed Conflict on Children, widely known as the Graca Machel study.
Organization: UNFPA
Contact: martinez@unfpa.org

9. Young and Vulnerable: The Reality of Unsafe Abortion among Adolescent and Young Women (2006, 12 pages, 893 KB)

This newsletter discusses gender and rights perspectives in health policies and programs in Asian countries. This latest issue specifically covers unsafe abortions among adolescents in the Asia Pacific, where data on the incidence of induced abortion among this group are sparse, unrepresentative, and incomplete, especially among unmarried women. The size of Asia's population means that the region accounts for just under half (45.7%) of the 7.2 million unsafe abortions among women aged 15-24 that occur each year in the developing world.
Organization: Asian-Pacific Resource & Research Centre for Women (ARROW)
Contact: arrow@arrow.po.my

10. Young Adolescents' Sexual and Reproductive Health and Rights (2007)

Adolescents 10-14 years old make up 9 percent of the world's population and as much as 15 percent in some low- and middle-income countries. However, programs and policies on sexual and reproductive health are typically designed for older adolescents. This series on young adolescents uses evidence on the sexual and reproductive knowledge and behaviors of 10- to 14-year-olds to argue for more responsive policies and programs regionally and globally. A global overview, Overlooked and Uninformed, was produced in early 2007. Four regional briefs have now been released as well.

1. Young Adolescents' Sexual and Reproductive Health and Rights: Latin America and the Caribbean (PDF, 4 pages, 156 KB)
   
2. Young Adolescents' Sexual and Reproductive Health and Rights: Middle East and North Africa (PDF, 4 pages, 144 KB)
   
3. Young Adolescents' Sexual and Reproductive Health and Rights: South and Southeast Asia (PDF, 4 pages 146 KB)
   
4. Young Adolescents' Sexual and Reproductive Health and Rights: Sub-Saharan Africa (PDF, 4 pages, 182 KB)
   

Organization: International Women's Health Coalition
Contact: communications@iwhc.org

II. RESEARCH SUMMARIES

1. Consent and coercion: examining unwanted sex among married young women in India. Santhya KG, Haberland N, Ram F, et al. Int Fam Plan Perspect 2007;33(3).
Few studies have looked at coerced sex within marriage in settings where early marriage is common, or at sex that may not be perceived as forced, but that is unwanted. A cross-sectional study, using both survey research and in-depth interviews, was conducted among 1,664 married young women in Gujarat and West Bengal, India. Descriptive data and multinomial logistic regression were used to identify the prevalence and risk factors for occasional and frequent unwanted sex. Qualitative data were analyzed to examine the context in which unwanted sex takes place. Twelve percent of married young women experienced unwanted sex frequently; 32% experienced it occasionally. The risk of experiencing unwanted sex was lower among women who knew their husband fairly well at the time of marriage, regularly received support from their husband in conflicts with other family members, or lived in economically better-off households. Frequent unwanted sex was associated with not yet having had a child or having become pregnant, with lower education, and with agreeing with norms that justify wife beating. Further research is required to determine the effects of unwanted sex on sexual and reproductive health outcomes and to help programs develop the best strategies for dealing with coerced sex within marriage.

2. HIV risk perceptions and first sexual intercourse among youth in Cape Town South Africa. Anderson KG, Beutel AM, Maughan-Brown B. Int Fam Plan Perspect 2007;33(3).
Health behavior models posit that the perceived level of risk of HIV infection is associated with the level of HIV risk behavior; however, there has been limited research in Sub-Saharan Africa on factors associated with perceived risk or on the relationship between perceived risk and risk behaviors. Longitudinal data collected in 2002 and 2005 from 3,017 black, colored, and white youth in Cape Town, South Africa, were analyzed using multivariate regression to examine whether a reciprocal relationship exists between sexual experience and perceived HIV risk. Independent variables taken from the 2002 survey were used to predict dependent variables taken from the 2005 survey. In 2005, most youth (82% of males and 83% of females) viewed themselves as being at no or small risk of HIV infection. A reciprocal relationship in which higher perceived HIV risk was associated with a delay in sexual debut (odds ratio, 0.8) and sexual experience was associated with higher perceived risk (1.4) was found for females, but not for males. Knowing someone who had died of AIDS was associated with sexual debut and with an elevated perceived HIV risk among females (1.7 and 1.3, respectively). The associations between race and perceived risk of HIV infection varied by gender. HIV/AIDS education and prevention programs should consider more carefully how gender and race may intersect to influence risk perceptions and risk behaviors. In addition, possible reciprocal relationships between risk behaviors and risk perceptions should be considered in education and intervention programs.

3. HIV seroprevalence in street youth, St Petersburg, Russia. Kissin DM, Zapata L, Yorick R, et al. AIDS 2007;21(17).
A cross-sectional assessment conducted during January–May 2006 included city-wide mapping of 41 street-youth locations, random selection of 22 sites, rapid HIV testing for all consenting 15- to 19-year-old male and female street youth at these sites, and an interviewer-administered survey. Adjusted odds ratios (AOR) were calculated using logistic regression, accounting for intracluster homogeneity. Of 313 participants, 117 (37.4%, 95% confidence interval 26.1-50.2%) were HIV infected. Subgroups with the highest seroprevalences included double orphans (64.3%), those with no place to live (68.1%), those previously diagnosed with a sexually transmitted infection (70.5%), those currently sharing needles (86.4%), and those currently using inhalants (60.5%) or injection drugs (78.6%), including Stadol (82.3%) or heroin (78.1%). Characteristics independently associated with HIV infection included injecting drugs (AOR 23.0), sharing needles (AOR 13.3), being a double or single orphan (AOR 3.3 and 1.8), having no place to live (AOR 2.4), and being diagnosed with an STI (AOR 2.1). Most HIV-infected street youth were sexually active (96.6%), had multiple partners (65.0%), and used condoms inconsistently (80.3%).

4. Human papillomavirus detection by penile site in young men from Kenya. Smith JS, Moses S, Hudgens MG, et al. Sex Transm Dis 2007;34(11).
Limited data are available on whether sampling from the penile shaft or urethra increases detection of penile HPV infection in men beyond that found in the glans and coronal sulcus. Within a randomized clinical trial, a validation study of penile sampling was conducted in Kisumu, Kenya. Young men (18-24 years) were invited to provide penile exfoliated cells using prewetted Dacron swabs to determine the best site for HPV detection. Beta-globin gene PCR and HPV DNA type GP5+/6+ PCR status were ascertained from three anatomical sites. A total of 98 young HIV-seronegative, uncircumcised men participated. Penile HPV prevalence varied by anatomical site: 50% in penile exfoliated cells from the glans, coronal sulcus, and inner foreskin tissue; 43% in the shaft and external foreskin tissue; and 18% in the urethra (P <0.0001). For each anatomical site, more than 87% of samples were beta-globin positive. Beyond that found in the glans/coronal sulcus, urethral sampling resulted in no increase in HPV positivity, and shaft sampling resulted in an additional 7.3% of overall HPV positivity. The prevalence of high-risk HPV positivity varied by anatomical site: 39% in glans/coronal sulcus, 31% in shaft, and 13% in the urethra (P <0.0001). HPV 16 was the most common type identified. These data will help inform studies on HPV transmission dynamics, and on the efficacy of HPV prophylactic vaccines on penile HPV carriage in men.

5. Identification of novel risks for nonulcerative sexually transmitted infections among young men in Kisumu, Kenya. Mehta SD, Moses S, Ndinya-Achola JO, et al. Sex Transm Dis 2007;34(11).
The authors analyzed baseline data from a randomized trial of male circumcision. Participants were interviewed for sociodemographic and behavioral risks. Neisseria gonorrhoeae (NG) and chlamydia trachomatis (CT) were diagnosed by polymerase chain reaction assay and trichomonas vaginalis (TV) by culture. The outcome for logistic regression analysis was infection with NG, CT, or TV. Among 2,743 men, 214 (7.8%; 95% CI: 6.8%-8.8%) were infected with any STI. In multivariable analysis, statistically significant risks for infection were living one's whole life in Kisumu (OR = 1.50; 95% CI: 1.12-2.01), preferring "dry" sex (OR = 1.47; 95% CI: 1.05-2.07), HSV-2 seropositivity (OR = 1.37; 95% CI: 1.01-1.86), and inability to ejaculate during sex (OR = 2.04; 95% CI: 1.15-3.62). Risk decreased with increasing age and education, and cleaning one's penis less than 1 hour after sex (OR = 0.51; 95% CI: 0.33-0.80). Understanding how postcoital cleaning, "dry" sex, and sexual dysfunction relate to STI acquisition may improve STI and HIV prevention.

6. Mental health and disclosure of HIV status in Zambian adolescents with HIV infection: Implications for peer-support programs. Menon A, Glazebrook C, Campain N, et al. J Acquir Immune Defic Syndr 2007;46(3).
This study used a cross-sectional survey of 127 HIV-positive adolescents aged 11 to 15 years recruited through clinics in the Lusaka region. Mental health was assessed using the youth report version of the Strengths and Difficulties Questionnaire (SDQ). Caregivers completed the parent SDQ. Sixty-two participants were invited for a semi-structured interview, which probed views on attending a peer support group. Compared to a British community sample, participants had increased mental health problems (OR, 2.1), particularly emotional symptoms (OR = 3.6) and peer problems (OR = 7.1). The majority of children (n = 94) were receiving antiretroviral (ARV) treatment, but only 48 children (37.8%) had their HIV status disclosed. Those who had not had their HIV status disclosed were younger (P < 0.001) and less likely to be receiving ARV treatment (P < 0.001). Of 38 interviews transcribed, content analysis showed that only three children were opposed to participation in a peer-group program, with the majority (23/38) expressing reasoned and positive responses, regardless of disclosure status. High rates of emotional and peer problems were found in this sample but disclosure of HIV status did not have a negative effect on mental health. Interventions to promote disclosure could facilitate access to emotional and peer support.

7. Outcome of teenage pregnancy. Kumar A, Singh T, Basu S, et al. Indian J Pediatr 2007;74(10).
This study evaluated the obstetric, fetal, and neonatal outcomes of teenage pregnancy in a tertiary care teaching hospital. A retrospective case control study was performed over five years. Data were retrieved from hospital records. All teenage mothers (aged 13-19 years) delivering in the University Hospital were taken as cases. Next, three consecutive deliveries in the age group of 20- to 30-year-olds were selected as controls for each case. For statistical analysis the cases were further subdivided into two groups, 17 years (Group A) and 18 – 19 years (Group B). Groups were compared for obstetric complications and neonatal outcome. Statistical analysis was done by software package SPSS 10. The incidence of teenage deliveries in hospital over the last five years was 4.1%. Majority of the teenagers were primigravida (83.2% vs. 41.4%, p< 0.01). Complications like pregnancy-induced hypertension (PIH) (11.4% vs. 2.2%, p< 0.01), pre-eclamptic toxemia (PET) (4.3% vs. 0.6%, p< 0.01), eclampsia (4.9% vs. 0.6%, p< 0.01), and premature onset of labor (26.1% vs. 14.6%, p< 0.01) occurred more commonly in teenagers compared to controls. Teenage mothers also had increased incidence of low birth weight (LBW) (50.4% vs. 32.3%, p< 0.01), premature delivery (51.8% vs. 17.5%, p< 0.01), and neonatal morbidities like perinatal asphyxia (11.7% vs. 1.9%, p< 0.01), jaundice (5.7% vs. 1.2%, p< 0.01), and respiratory distress syndrome (1.9% vs. 0.3%, p< 0.05). Teenage pregnancy was also associated with higher fetal (1.9% vs. 0.3%, p< 0.05) and neonatal mortality (3.8% vs. 0.5%, p< 0.05). The study concludes that the younger teenager group (17 years) was most vulnerable to adverse obstetric and neonatal outcomes.

8. Predictors of sexual behaviors among Thai young adults. Rasamimari A, Dancy B, Talashek M, et al. J Assoc Nurses AIDS Care 2007;18(6).
To identify correlates of sexual behaviors among Thai young adults between 18 and 24 years, the authors used a cross-sectional survey of 405 young adults from eight randomly selected Thai urban and rural vocational schools. The young adults completed self-report questionnaires. Logistic regressions were used to determine the correlates between a Thai young adult's ever having had sexual intercourse and the correlates of the number of sexual partners and consistent condom use among those who were sexually active. The independent variables were age, gender, socioeconomic status, geographic residence, parental residence, parental-young adult communication, HIV knowledge, and negotiation for safer sex. The results showed that geographic residence and negotiation for safer sex were related to a young adult's ever having had sexual intercourse; gender, HIV knowledge, and negotiation for safer sex were related to the number of sexual partners; and geographic residence was related to condom use. HIV prevention programs should incorporate HIV knowledge and negotiation skills for both genders and for all geographical areas.

9. Predictors of sexual intercourse among Korean adolescents. Ryu E, Kim K, Kwon H. J Sch Health 2007;77(9).
A descriptive survey was used to identify the predictors of sexual intercourse among Korean adolescents. Data were collected from students attending 10 senior high schools in two cities and three provinces in Korea. A total of 1,012 students were chosen by convenience sampling, with 50 excluded because they did not respond properly. Logistic regression analysis of the data showed that gender, socialization traits, and disinhibition were the statistically significant individual factors, and that parental living arrangement, career track, school record, having a boyfriend/girlfriend, and sexual permissiveness with a boyfriend/girlfriend were the statistically significant environmental factors associated with sexual intercourse by adolescents.

10. Psychosocial predictors of adolescent sexual behavior. Lakshmi PV, Gupta N, Kumar R. Indian J Pediatr 2007;74(10).
This study enrolled 11th class students from six randomly selected schools in Chandigarh Union Territory of India. A pre-tested questionnaire containing 83 items was administered after ensuring privacy and confidentiality. Socio-economic status, residence, gender, grade in the class, religion, acculturation level, self esteem, social support, and coping behavior were considered independent explanatory variables; physical sexual contact (which included kissing, hugging, and sexual intercourse) was the dependent variable. The mean age of the 257 students enrolled for the study was 17 years. The prevalence of sexual activity was 20% (95% CI: 13.6%-28.1%) among males and 6% (95% CI: 1.3%-18.8%) among females. Four percent of males and 1% of females reported sexual intercourse. The main reason students reported for not having sexual physical contact was societal norms. After adjusting for confounders in multivariate analysis, male gender (OR: 3.5; 95%CI: 1.5-8.1) and modern attitudes (OR: 0.77; 95%CI: 0.6-0.98) were found to be the risk factors for initiation of sexual activity in adolescence. The authors conclude that cultural norms rather than the individual/psychological factors tend to govern adolescent sexual behavior in Indian society.

11. Rebel girls? Unplanned pregnancy and colonialism in highlands Papua, Indonesia. Butt L, Munro J. Cult Health Sex 2007;9(6).
Case studies from highlands Papua, Indonesia, which has undergone rapid social change under a colonial system of governance, offer insights into the ways a political context of colonial domination limits options and choices for young women who have children born out of wedlock. In particular, this paper describes how the "settler gaze" — omnipresent colonial norms and judgments — creates regulatory effects in the realm of reproduction.

12. Sex, money, and premarital partnerships in southern Malawi. Poulin M. Soc Sci Med 2007;65(11).
In this paper, the author argues two main points. First, in premarital, sexual partnerships in rural Malawi, the purpose of money exchange extends beyond the alleviation of female partners' economic constraints, and, second, by clarifying this broader purpose, it becomes possible to recognize where women exert control over their sexual selves. These findings come from field observations and a rich set of in-depth interviews (N=54), bolstered on occasion by survey data, conducted with young women and men, aged 15-24 years, in the Balaka district in the southern region of the country. This research demonstrates that, contrary to typical expectations, money and gift transfers in sexual partnerships are part and parcel of the courting practices of young Malawian women and men. Transfers are as much about the expression of love and commitment as they are about meeting the financial needs of women or the acquisition of sex for men. These findings offer a new perspective that broadens usual interpretations of transactional sex, the understanding of which is critical in fighting AIDS.