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I. PROGRAM RESOURCES
1. Education and HIV/AIDS: A Sourcebook of HIV/AIDS Prevention Programs Volume 2: Education Sector-Wide Approaches
2. Factors Influencing Access and Retention in Primary Schooling for Children and Young People Affected by HIV and AIDS: Case Studies from Rural Malawi
3. Gender Equality, HIV, and AIDS: A Challenge for the Education Sector
4. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
5. HIV and AIDS School Club Initiative (HASCI) Assessment Report
6. HIV Preventive Education Information Kit for School Teachers
7. Home Truths: Facing the Facts on Children, AIDS, and Poverty
8. An International Human Right: Sexuality Education for Adolescents in Schools
9. Prevention is for Life. HIV/AIDS: Dispatches from the Field
10. Our Broken Dreams: Child Migration in Southern Africa
11. The Reproductive Rights of Adolescents: A Tool for Health and Empowerment
II. RESEARCH SUMMARIES
1. The effect of community-based reproductive health communication interventions on contraceptive use among young married couples in Bihar, India
2. The effects of a communication program on contraceptive ideation and use among young women in northern Nigeria
3. Factors influencing the timing of first sexual intercourse among young people in Nyanza, Kenya
4. How young is "too young"? Comparative perspectives on adolescent sexual, marital, and reproductive transitions
5. Introduction to the special issue on adolescent sexual and reproductive health in Sub-Saharan Africa
6. Predictors of risky sexual behavior among adolescents in Tanzania
7. The quality of HIV testing services for adolescents in Cape Town, South Africa: do adolescent-friendly services make a difference?
8. Reproductive health information for young women in Kazakhstan: disparities in access by channel
9. Sexual activity and contraceptive use among young female students of tertiary educational institutions in Ilorin, Nigeria
10. Sexual behavior and desires among adolescents perinatally infected with human immunodeficiency virus in Uganda: implications for programming
11. Sexual behavior and STI/HIV status among adolescents in rural Malawi: an evaluation of the effect of interview mode on reporting
12. Sexual behavior, pregnancy, and schooling among young people in urban South Africa
13. The start of the sexual transition in Mali: risks and opportunities
14. Young people's sexual partnerships in KwaZulu-Natal, South Africa: Patterns, contextual influences, and HIV risk
15. Young women's perceived ability to refuse sex in urban Cameroon
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I. PROGRAM RESOURCES
1. Education and HIV/AIDS: A Sourcebook of HIV/AIDS Prevention Programs Volume 2: Education Sector-Wide Approaches (2008, PDF, 270 pages, 1.6 MB)
This volume describes 10 school-based HIV prevention programs from the Dominican Republic, Eritrea, The Gambia, Ghana, Israel, Kenya, Namibia, and Nigeria. All of the programs involve teachers; target school-age children; are considered successful, well implemented, and innovative; and have the potential to be replicated and scaled up.
Organization: The International Bank for Reconstruction and Development/The World Bank
Contact: feedback@worldbank.org
2. Factors Influencing Access and Retention in Primary Schooling for Children and Young People Affected by HIV and AIDS: Case Studies from Rural Malawi (2008, PDF, 99 pages, 1.4 MB)
Recent literature suggests that in sub-Saharan Africa a disproportionate number of children who do not complete primary school are likely to have been orphaned or otherwise made vulnerable by HIV and AIDS. The research documented in this publication focuses on improving the access of children affected by HIV/AIDS to learning and increasing retention through strategies that complement conventional schooling.
Organization: University of London, Institute of Education
Contact: m.harri@ioe.ac.uk
3. Gender Equality, HIV, and AIDS: A Challenge for the Education Sector
Full text (2008, PDF, 242 pages, 956 KB)
Chapters
This book examines the roles that the education sector can play in transforming unequal gender relations, protecting young people against HIV and AIDS, and contributing to care for those affected and infected. The authors illustrate the importance of democratic learning environments that are informed by evidence-based policy.
Organization: Oxfam GB, ActionAid
Contact: http://www.oxfam.org.uk/contact/
4. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (2008, PDF, 146 pages, 1.5 MB)
This publication provides newly updated guidelines on the use of antiretroviral drugs to treat adults and adolescents. Topics covered include when to initiate therapy, which drug combinations are preferred and which should be avoided, and how to treat patients who have coinfections like hepatitis and tuberculosis.
Organization: U.S. Department of Health and Human Services, Henry J. Kaiser Family Foundation
Contact: ContactUs@aidsinfo.nih.gov
5. HIV and AIDS School Club Initiative (HASCI) Assessment Report (2008, PDF, 49 pages, 720 KB)
This report assesses a school-based anti-AIDS campaign in Malawi. The project focused particularly on school-community and intergenerational dialogue about prevention of HIV and AIDS, with an emphasis on abstinence and faithfulness.
Organization: Miske Witt & Associates, American Institutes for Research
Contact: inquiry@air.org
6. HIV Preventive Education Information Kit for School Teachers (2008, PDF, 101 pages, 2.5 MB)
This kit provides teachers with basic information on teaching young people about HIV and AIDS. The materials cover challenges of teaching about HIV and AIDS in the school setting, countering community resistance to HIV/AIDS education, addressing stigma and discrimination, and reducing risk behaviors.
Organization: UNESCO Bangkok
Contact: Bangkok@unesco.org
7. Home Truths: Facing the Facts on Children, AIDS, and Poverty (2009, PDF, 84 pages, 2 MB)
This report summarizes two years of research and analysis of AIDS-related policies, programs, and funding sources and their effectiveness in addressing the needs of children. It calls for greater emphasis on strengthening families and communities to enable them to give children the care and support they are uniquely suited to provide. The report also recommends new approaches to address the simultaneous impacts of HIV, poverty, food insecurity, and social inequality that many countries confront today.
Organization: Joint Learning Initiative on Children and HIV/AIDS
Contact: info@jlica.org
8. An International Human Right: Sexuality Education for Adolescents in Schools (2008, PDF, 7 pages, 172 KB)
This document discusses governments' obligation under international human rights law to provide school-based sexuality education that is scientifically accurate and objective and free of prejudice and discrimination.
Organization: Center for Reproductive Rights
Contact: publications@reprorights.org
9. Prevention is for Life. HIV/AIDS: Dispatches from the Field (2008, PDF, 27 pages, 2.7 MB)
This advocacy booklet provides real-life examples to illustrate how HIV prevention can save lives in diverse cultural and geographical settings. It includes chapters on youth and HIV, promoting and distributing male and female condoms, protecting women and girls, linking HIV prevention with other sexual and reproductive health care, and empowering populations who are at particular risk. The booklet features stories from Belize, China, Egypt, Ethiopia, Nigeria, the Russian Federation, and Tajikistan.
Organization: UNFPA
Contact: martinez@unfpa.org
10. Our Broken Dreams: Child Migration in Southern Africa (2008, PDF, 134 pages, 7 MB)
In this book, children tell their own stories of the dangers they faced crossing borders alone in Mozambique and across southern Africa. Children were interviewed in Mozambique, South Africa, Zimbabwe, and Swaziland, where in some cases the numbers of unaccompanied child migrants has reached alarming levels.
Organization: Save the Children UK/Save the Children Norway
Contact: MozFO@savechildren.org
11. The Reproductive Rights of Adolescents: A Tool for Health and Empowerment (2008, PDF, 25 pages, 430 KB)
This paper outlines the general framework of adolescents' reproductive and sexual rights. It focuses on sexuality education, access to confidential health care, child marriage and lack of educational opportunity, sexual violence, and female genital mutilation. The authors list recommendations about how governments, youth advocates, and health care providers can help ensure that adolescents have the ability to make and act on informed reproductive decisions.
Organization: Center for Reproductive Rights
Contact: publications@reprorights.org
II. RESEARCH SUMMARIES
1. The effect of community-based reproductive health communication interventions on contraceptive use among young married couples in Bihar, India. Daniel EE, Masilamani R, Rahman M. Int Fam Plan Perspect 2008;34(4):189-97.
The PRACHAR Project, an ongoing intervention in Bihar, India, uses communication interventions in an attempt to increase contraceptive use for delaying and spacing births. The aim of this study was to determine the project's effects. Random samples of married women younger than 25 with no more than one child were surveyed in 2002-2003, before PRACHAR was implemented (N=1,995), and in 2004, 21-27 months after implementation (N=2,080). Contraceptive demand and use, and related attitudes and knowledge, were assessed in the two surveys in both intervention areas and comparison areas. Logistic regression was used to assess the effect of the interventions on these indicators. The surveys revealed that contraceptive use was very low (2%-6%) at baseline in both comparison and intervention areas. Demand for contraception increased from 25% at baseline to 40% at follow-up in intervention areas but remained virtually unchanged in comparison areas. At follow-up, contraceptive use had risen in both areas, but the adjusted odds of use in intervention areas were 3.8 times those in comparison areas. Women in intervention areas had elevated odds of knowing that fertility varies during the menstrual cycle, and of agreeing that early childbirth can be harmful and that contraceptive use is necessary and safe for delaying first births.
2. The effects of a communication program on contraceptive ideation and use among young women in northern Nigeria. Babalola S, Folda L, Babayaro H. Stud Fam Plann 2008;39(3):211-20.
This study assesses the effects of a communication campaign designed to encourage young people in northern Nigeria to use modern family planning methods to avoid unwanted pregnancies. The analyses are based on a sample of 819 sexually experienced women. Using multivariate probit regression, the authors attempted to correct for possible endogeneity among campaign exposure, contraceptive ideation, and contraceptive use. Their analysis reveals that the direct effect of campaign exposure on the probability of contraceptive use is only marginally significant, but the effect of exposure on contraceptive ideation is robust, as is the effect of contraceptive ideation on contraceptive use. The findings demonstrate not only the success of the program but also the relevance of incorporating ideation into analytic models assessing the effects of communication campaigns.
3. Factors influencing the timing of first sexual intercourse among young people in Nyanza, Kenya. Tenkorang EY, Maticka-Tyndale E. Int Fam Plan Perspect 2008;34(4):177-88.
Survey data collected in October 2003 from 8,183 students aged 11-17 in 160 schools in Nyanza Province, Kenya were used to understand the factors that influence the timing of first sexual intercourse. Both males and females who rejected myths about HIV transmission, who experienced less sexual pressure, and who did not know anyone who had died of AIDS, as well as males who had a stronger belief in their ability to abstain, were more likely to postpone sexual intercourse than were young people who lacked those characteristics. Although lower levels of perceived HIV risk were associated with early sexual initiation, adolescents who felt they were at no risk of HIV infection were most likely to postpone initiation. The pattern of associations across gender suggests that males are pressured into very early sexual activity to prove their maturity, although males who had confidence that they could abstain were more likely to do so. Females, however, were not able to translate belief in their ability to abstain into abstinence and were influenced to engage in intercourse by social and environmental pressures.
4. How young is "too young"? Comparative perspectives on adolescent sexual, marital, and reproductive transitions. Dixon-Mueller R. Stud Fam Plann 2008;39(4):247-62.
This study suggests three criteria for assessing the extent to which the timing of sexual, marital, and reproductive transitions among male and female adolescents could be considered "too young": (1) the physiological maturation of the body; (2) the cognitive capacity for making safe, informed, and voluntary decisions; and (3) institutionalized concepts of "old enough" for consent to sexual intercourse and marriage as reflected in legal frameworks and international standards. The author proposes expanding the age grouping of adolescence, from the customary 15-19, into three age categories -- early adolescence (ages 10-14, or 10-11 and 12-14), middle adolescence (15-17), and late adolescence (18-19) -- to better capture the age-specific variations in the trajectories of male and female sexual, marital, and reproductive events. An application of the three adolescent development criteria to the timing of transitions observed in Demographic and Health Surveys in 64 developing countries leads the author to conclude that boys and girls aged 14 and younger are universally "too young" to make safe and consensual transitions; that 15- to 17-year-olds may or may not be too young, depending on their circumstances; and that 18-year-olds are generally "old enough." Policies and programs should focus on building capacity and creating an enabling environment for making safe and voluntary transitions among all age groups, but particularly among 10- to 14-year-olds, whose sexual and reproductive health and rights are at stake.
5. Introduction to the special issue on adolescent sexual and reproductive health in Sub-Saharan Africa. Juarez F, LeGrand T, Lloyd CB, et al. Stud Fam Plann 2008;39(4):239-44.
This special issue of Studies in Family Planning is divided into three main sections: "Sexual and Reproductive Transitions," "HIV Risk," and "Schooling and Adolescent Sexual Behavior."
6. Predictors of risky sexual behavior among adolescents in Tanzania. Masatu MC, Kazaura MR, Ndeki S, et al. AIDS Behav 2009;13(1):94-9.
The authors conducted a survey among in- and out-of-schools adolescents to measure prevalence of sexual behavior variables, including risky sexual behavior and associated factors. Risky sexual behavior was defined as having first sex before 16 years, using condoms inconsistently, and having multiple sexual partners. About 30% of adolescents reported being sexually active (a higher proportion being among males than females), and 25% of sexually active adolescents reported having multiple sexual partners. More males (37%) reported having multiple sexual partners than females (26%). Nearly 48% of unmarried sexually active adolescents reported having used a condom during the most recent sexual intercourse. Predictors of risky sexual behavior were being male, young (10-14 years), and in school.
7. The quality of HIV testing services for adolescents in Cape Town, South Africa: do adolescent-friendly services make a difference? Mathews C, Guttmacher SJ, Flisher AJ, et al. J Adolesc Health 2009;44(2):188-90.
The authors used adolescents posing as clients to evaluate whether HIV testing services in clinics participating in an adolescent-friendly initiative in Cape Town were superior to regular clinic services. The research revealed improved accessibility to HIV testing but no impact on adolescents' experience of negative attitudes from health workers and confidentiality breaches.
8. Reproductive health information for young women in Kazakhstan: disparities in access by channel. Buckley C, Barrett J, Adkins K. J Health Commun 2008;13(7):681-97.
Using 1995 and 1999 Kazakhstan Demographic and Health Surveys, the authors investigated access to reproductive health knowledge among young women (ages 15-24) during the development of wide-scale reproductive health programs in Kazakhstan throughout the 1990s. Their analysis revealed consistently high proportions of young women without family planning information access. Among young women with access to information, few received information from channels most strongly linked to knowledge and behavioral changes (family and medical professionals). Mass media sources and peer information networks remained the most often used channels. Urban residence, non-Kazakh ethnicity, older age (20-24), and higher education significantly increased the odds of accessing family planning information, and these same factors were especially important in terms of the relative odds of accessing medical and parental channels. While overall contraceptive knowledge and prevalence rose in Kazakhstan during the 1990s, knowledge varied by the information channel accessed. Findings also indicate that young women, regardless of marital status, possessed consistently low levels of reproductive health knowledge at the decade's end.
9. Sexual activity and contraceptive use among young female students of tertiary educational institutions in Ilorin, Nigeria. Abiodun OM, Balogun OR. Contraception 2009;79(2):146-9.
A valid and reliable semistructured questionnaire was self-administered to a sampled population of 600 female students aged 15 to 24 years. Of the 600 students, 562 (94%) completed the questionnaire. Most (99%) of the respondents were unmarried, 78% reported having had sexual intercourse, 68% unwanted pregnancy, and 64% an induced abortion. All the respondents were aware of contraceptives, but only 25% had ever used any contraceptive method. The most common sources of information about contraception among the respondents were friends and relatives (74%). Fear of side effects of modern contraceptives was the most common reason (78%) for nonuse.
10. Sexual behavior and desires among adolescents perinatally infected with human immunodeficiency virus in Uganda: implications for programming. Birungi H, Mugisha JF, Obare F, et al. J Adolesc Health 2009;44(2):184-7.
Counseling programs for adolescents living with HIV encourage abstinence from sex and relationships. This Uganda study, however, found that many of these adolescents are sexually active or desire to be in relationships but engage in poor preventive practices. Programs for HIV and AIDS programs need to strengthen preventive services to this group.
11. Sexual behavior and STI/HIV status among adolescents in rural Malawi: an evaluation of the effect of interview mode on reporting. Mensch BS, Hewett PC, Gregory R, et al. Stud Fam Plann 2008;39(4):321-34.
This study summarizes the results of an interview-mode experiment conducted with unmarried young women aged 15-21 in which respondents were randomly assigned to either an audio computer-assisted self-interview (ACASI) or a conventional face-to-face (FTF) interview. In addition, biomarkers were collected for HIV and three STIs: gonorrhea, chlamydia, and trichomoniasis. Before collecting the biomarkers, nurses conducted a short face-to-face interview in which they repeated questions about sexual behavior. Reporting for "ever had sex" and "sex with a boyfriend" was higher in the FTF mode. When the authors asked about other partners and multiple lifetime partners, however, the reporting was consistently higher with ACASI, in many cases significantly so. The FTF mode produced more consistent reporting of sexual activity between the main interview and a subsequent interview. The association between infection status and reporting of sexual behavior is stronger in the FTF mode, although in both modes a number of young women who denied ever having sex tested positive for HIV or other STIs.
12. Sexual behavior, pregnancy, and schooling among young people in urban South Africa. Marteleto L, Lam D, Ranchhod V. Stud Fam Plann 2008;39(4):351-68.
The authors analyzed data from a recently collected longitudinal survey of young adults and their families in metropolitan Cape Town. More than 50% of African women who were pregnant at age 16 or 17 were enrolled in school the following year. Male and female students who performed well on a literacy and numeracy exam administered in 2002 were less likely than those who performed poorly to become sexually active and less likely to drop out of school by 2005. Youth aged 14 to 16 who had completed more grades in school in 2002 were more likely than those who had completed fewer grades to have become sexually active by 2005. This finding could indicate peer effects resulting from the wide dispersion in age per grade in South African schools.
13. The start of the sexual transition in Mali: risks and opportunities. Sauvain-Dugerdil C, Gakou B, Berthe F, et al. Stud Fam Plann 2008;39(4):263-80.
Analysis of data from a questionnaire survey of 2,000 young Malians undertaken by the authors in 2002 demonstrates that, even in underprivileged urban and rural populations, changes in sexual behavior are emerging. Among women, first sex and motherhood are taking place slightly later, and a minority is now dissociating sexuality and procreation. The data confirm the considerable impact of female education on this transition. Girls' sexual activity before procreation is also influenced by lower religiosity. Among men, in contrast, in a traditional context of late sexual debut and fatherhood, the trend is toward earlier sexual activity and procreation. Fatherhood is delayed, however, among better-educated, wealthier, and less religious urban men, who therefore experience a longer period of sexual activity before they begin to build their own families.
14. Young people's sexual partnerships in KwaZulu-Natal, South Africa: Patterns, contextual influences, and HIV risk. Harrison A, Cleland J, Frohlich J. Stud Fam Plann 2008;39(4):295-308.
Using household survey and qualitative data, this study examines partnership dynamics and characteristics in the context of HIV risk, including number of partners, age differences, partnership duration and concurrency, and frequency of contact among young people aged 15-24 in rural KwaZulu-Natal, South Africa. One-third of the men surveyed reported multiple or concurrent partnering, and one-fourth of the women had partners who were five years older than they were. Nonparticipation in civic organizations or school was correlated with higher-risk partnerships for women but not for men. On average, relationships lasted more than a year for the women and men surveyed, and were frequently characterized as "serious." Qualitative findings pointed to the sequential and overlapping nature of relationships, however, with distance and mobility being important influences.
15. Young women's perceived ability to refuse sex in urban Cameroon. Hattori MK, DeRose L. Stud Fam Plann 2008;39(4):309-20.
This study draws upon data from the 2002 Cameroon Adolescent Reproductive Health Survey to analyze the determinants of young women's perceived ability to refuse sex in urban Cameroon. Findings are consistent with predictions of social exchange theory: young women's status characteristics predict their vulnerability differently under different circumstances. Overall, young women report having a lower ability to refuse sex in their relationships with men who offer to pay their school fees than in their relationships with men in positions of power over them. The costs and benefits of sexual exchanges made in order to continue one's education increase simultaneously in a context of declining enrollments and spreading HIV infection. When educational aspirations exceed opportunities, policy supporting access to education could reduce young women's need to employ their sexual resources in order to invest in their future.
