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I. PROGRAM RESOURCES
1. Accelerating Education's Response to HIV and AIDS in Nigeria
2. Accelerating the Education Sector Response to HIV and AIDS in sub-Saharan Africa: A Rapid Situation Analysis of 34 Countries
3. Acting for Youth
4. Assessing your Risks: SMARTgirl Program Facilitator's Guide and Risk Assessment Cards
5. Impact of Youth Peer Education Programs: Final Results from an FHI/YouthNet study in Zambia
6. Kids Understand how other Kids Hurt: Children and Adolescents Speak Out about Sexual Exploitation
7. Long-term Evaluation of the MEMA kwa Vijana Adolescent Sexual Health Programme in Rural Mwanza, Tanzania: A Randomised Controlled Trial
8. Multisectoral Youth RH Interventions: The Scale-up Process in Kenya and Senegal
9. Perception of Children on Parenting Practices
10. Sexual and Reproductive Health Needs of Adolescents Perinatally Infected with HIV in Uganda
11. Supporting the Educational Needs of HIV-positive Learners: Lessons from Namibia and Tanzania
12. Youth-Friendly Services for Married Youth: A Curriculum for Trainers
II. RESEARCH SUMMARIES
1. Adapting a multifaceted U.S. HIV prevention education program for girls in Ghana
2. Behavioral and psychosocial predictors of condom use among university students in Eastern China
3. A community perspective on young people's knowledge of HIV/AIDS in three African countries
4. Impact of life skills training to improve cognition on risk of sexual behavior and contraceptive use among vocational school students in Shanghai, China
5. Knowledge of HIV survival on skin-piercing instruments among young adults in Nyanza Province, Kenya
6. Knowledge on HIV/AIDS and sexual behaviour among youths in Kibaha District, Tanzania
7. Street life and drug risk behaviors associated with exchanging sex among male street children in Lahore, Pakistan
8. Unmet needs for reproductive health knowledge among unmarried migrant youth
9. "When in the body, it makes you look fat and HIV negative": The constitution of antiretroviral therapy in local discourse among youth in Kahe, Tanzania
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1. Accelerating Education's Response to HIV and AIDS in Nigeria (2008, 12 pages, 1 MB)
In 2007, the Federal Ministry of Education, Nigeria, undertook a review in order to document how the Government of Nigeria and development partners worked together to build a systematic education sector response to HIV and AIDS. The review serves as a case-study for a wider review of education's response to HIV in sub-Saharan Africa called 'Accelerating the Education Sector Response to HIV and AIDS in sub-Saharan Africa: Five Years of Experience 2002-2007'. This document is a summary of the Nigeria review. The education sector has a central role to play in the multi-sectoral response to HIV and AIDS; in reducing stigma, promoting prevention, and providing access to care, treatment, and support for teachers and staff.
Organization: World Bank, Partnership for Child Development, Federal Ministry of Education, Action Health Incorporated
Contact: pcd@imperial.ac.uk
2. Accelerating the Education Sector Response to HIV and AIDS in sub-Saharan Africa: A Rapid Situation Analysis of 34 Countries (2008, 42 pages, 1 MB)
In recent years, the education sector in low-income countries has come to play an increasingly important role in the health of the school-aged child. The sector has a key role in providing young people, especially girls, a chance to a productive and AIDS-free life. In 2007, the Networks of Ministry of Education HIV and AIDS Focal Points led a rapid situation analysis to update their current understanding of the education sector responses of HIV and AIDS and School Health and Nutrition (SHN) in sub-Saharan Africa. It was considered that the identification of priority areas in SHN and HIV and AIDS in each country would enable government officials to concentrate resources and programming in these areas, and aid future planning both within each country and collectively across Networks. The findings would also serve as a baseline from which countries and Networks can measure their progress in coming years.
Organization: African Networks of Ministry of Education HIV and AIDS Focal Points
Contact: pcd@imperial.ac.uk
3. Acting for Youth (2009, 13 pages, 6.3 MB)
This edition of UNFPA's adolescent youth cluster newsletter features young people participating in development strategies for Malawi and El Salvador, building peer education programs in Eastern Europe, supporting adolescent girls, and contributing to recovery efforts in Haiti following hurricane season, among other stories.
Organization: UNFPA
Contact: http://www.unfpa.org/help/contact.htm
4. Assessing your Risks: SMARTgirl Program Facilitator's Guide and Risk Assessment Cards
Facilitator's Guide (2008, 36 pages, 1.2 MB)
Risk Assessment Cards (2008, 26 pages, 806 KB)
Family Health International's SMARTgirl program in Cambodia has developed colorful, well-designed risk assessment cards and an accompanying facilitator's guide which help entertainment service workers recognize their level of risk in different situations and take action to protect themselves from HIV, unplanned pregnancy, or sexual violence.
Organization: FHI Cambodia
Contact: info@fhi.org.kh
5. Impact of Youth Peer Education Programs: Final Results from an FHI/YouthNet study in Zambia (2009, 57 pages, 814 KB)
This study sought to determine the effect of youth peer education (YPE) programs on sexual and reproductive health behaviors among youth. Phase 1 (in Zambia and the Dominican Republic, summarized in Youth Research Working Paper No. 3) identified core elements believed to be important for effective and sustainable YPE programs. Phase 2, conducted only in Zambia, assessed the interrelationships among program inputs, outputs, exposure, and outcomes. Instruments developed in Phase 1 were used to measure inputs and outputs in five YPE programs in Zambia. Data gathered were linked with exposure to YPE programs and outcomes of these programs; exposure and outcomes were measured using population survey data and clinic-based data. The study found a chain of associations indicating that YPE in Zambia promotes HIV prevention behaviors. Findings indicate that appropriate referrals had been made by peer educators. And, findings indicated that the core components of YPE programming, as measured by the checklists developed in Phase 1, are equally important in terms of program quality.
Organization: Family Health International
Contact: publications@fhi.org
6. Kids Understand how other Kids Hurt: Children and Adolescents Speak Out about Sexual Exploitation (2008, 5 pages, 559 KB)
During 2007 and 2008, World Vision consulted over 400 boys and girls across the world involved in projects that address the sexual abuse and exploitation of children and adolescents. Young people aged ten to 21 from Africa, Europe, Asia, and Latin America shared stories of how they have dealt with and are already engaged in combating such abuses in their communities.
Organization: World Vision
Contact: worvis@wvi.org
7. Long-term Evaluation of the MEMA kwa Vijana Adolescent Sexual Health Programme in Rural Mwanza, Tanzania: A Randomised Controlled Trial (2008, 8 pages, 221 KB)
This technical briefing paper finds that the MEMA kwa Vijana intervention increased young people's knowledge, which is important in its own right. However, this did not reduce HIV or other sexually transmitted infections. The briefing concludes that other approaches need to be developed, implemented, and evaluated to find effective ways of preventing HIV among young people in sub-Saharan Africa.
Organization: MEMA kwa Vijana (MkV)
Contact: http://www.memakwavijana.org/contacts.html
8. Multisectoral Youth RH Interventions: The Scale-up Process in Kenya and Senegal (2008, 16 pages, 1.7 MB)
Young people account for about 25 percent of the population in many developing countries, and their welfare is thus of vital strategic importance. However, rapid social change exposes youth to numerous sexual and reproductive health risks, including unintended pregnancy, sexually transmitted infections including HIV, and sexual violence. Studies conducted by the FRONTIERS program (Population Council) on the feasibility of multisectoral interventions to improve youth reproductive health knowledge and behavior showed positive results in Kenya and Senegal. Both communities and the public ministries that participated in the interventions expressed strong interest in continuing and expanding the interventions, which took place in schools, communities, and health facilities. This program brief describes the process of institutionalizing and scaling up these interventions in Kenya and Senegal.
Organization: Population Council FRONTIERS
Contact: publications@popcouncil.org
9. Perception of Children on Parenting Practices (2008, 55 pages, 329 KB)
These are some of the findings from a study focused on parenting styles for children between 8-16 years, as parenting education is generally not provided for parents of girls and boys in this age range in South Asia. The focus of government programs on parenting education is generally on early childhood issues with specific focus on feeding, growth monitoring, language development and hygiene education. The knowledge gained from the current study will facilitate discussions on how to develop an effective parenting education program to increase parents' capacities to foster children's health, education, protection and participation in matters that affect them.
Organization: Save the Children Sweden, Regional Office for South and Central Asia
Contact: rosca@sca.savethechildren.se
10. Sexual and Reproductive Health Needs of Adolescents Perinatally Infected with HIV in Uganda (2008, 31 pages, 839 KB)
This study involved qualitative research and a survey of 732 perinatally HIV-infected girls and boys aged 15-19 years in four districts of Uganda. Its aim was to better understand the reproductive health and sexuality (desires, experiences, beliefs, values, and practices) of this population group, and to identify anxieties or fears they have around growing up, love and loving, dating, pregnancy, fatherhood, motherhood, relationships and intimacy that could be addressed through programmatic solutions tailored to their unique needs.
Organization: Population Council, TASO
Contact: frontiers@pcdc.org
11. Supporting the Educational Needs of HIV-positive Learners: Lessons from Namibia and Tanzania (2008, 42 pages, 1.8 MB)
This report is a review of best practice as well as an exploratory study in two countries to understand how the education sector should support HIV-positive learners at school. The increase in the number of children and young people living with HIV poses new challenges to the education sector. The report identifies the specific challenges faced by the education system in responding to the needs of HIV-positive learners and develops a set of recommendations and guidelines about how best to support them.
Organization: UNESCO
Contact: aids@unesco.org
12. Youth-Friendly Services for Married Youth: A Curriculum for Trainers (2008, 190 pages, 190 pages, 1.1 MB)
This manual seeks to enhance health care providers' understanding of young married men and women's reproductive health needs and enable them to provide appropriate information, support, and services. Moreover, the manual encourages health care providers to reach out to community members and adults and help them create a supportive environment that meets the reproductive health needs of young married couples.
Organization: The ACQUIRE Project/EngenderHealth
Contact: info@acquireproject.org
II. RESEARCH SUMMARIES
1. Adapting a multifaceted U.S. HIV prevention education program for girls in Ghana. Fiscian VS, Obeng EK, Goldstein K, et al. AIDS Educ Prev 2009;21(1):67-79.
A U.S. HIV prevention program was adapted to address knowledge gaps and cultural pressures that increase the risk of infection in adolescent Ghanaian girls. The theory-based nine-module HIV prevention program combines didactics and games, an interactive computer program about sugar daddies, and tie-and-dye training to demonstrate an economic alternative to transactional sex. The abstinence-based study was conducted in a church-affiliated junior secondary school in Nsawam, Ghana. Of 61 subjects aged 10-14 in the prevention program, over two thirds were very worried about becoming HIV infected. A pre-post evaluation of the intervention showed significant gains in three domains: HIV knowledge (p = .001) and self efficacy to discuss HIV and sex with men (p < .001) and with boys (p < .001). Responses to items about social norms of HIV risk behavior were also somewhat improved (p = .09). Subjects rated most program features highly. Although short-term knowledge and self-efficacy to address HIV improved significantly, longer term research is needed to address cultural and economic factors placing young women at risk of HIV infection.
2. Behavioral and psychosocial predictors of condom use among university students in Eastern China. Ma Q, Ono-Kihara M, Cong L, et al. AIDS Care 2009;21(2):249-59.
The purpose of this study was to identify behavioral and psychosocial correlates of condom use among Chinese university students. A self-administered questionnaire survey with cross-sectional design was conducted among all classes of undergraduate students at two universities in one municipality of Eastern China, 2003. Data obtained from 1850 sexually active students who answered the question on condom use during the previous year were used for analysis. Frequent (always/often) condom use during the previous year was reported by only about 40% of both men and women. Multivariate analysis revealed that condom use during the first sexual experience, oral contraceptive use in the previous year and higher condom self-efficacy score in both genders were potent predictors of frequent condom use, while frequent condom use was less likely practiced by men who ever had non-vaginal sex, by those with higher risk-awareness for pregnancy/HIV/sexually transmitted diseases and by women with lower scores for perceived condom benefits. Safe sex education for Chinese students should be urgently introduced and should not be limited to knowledge provision but should also address psychosocial factors, such as condom self-efficacy and gender differences adequately to effectively encourage safer behavior.
3. A community perspective on young people's knowledge of HIV/AIDS in three African countries. Stephenson R. AIDS Care 2009;21(3):378-83.
Individual, household and community-level influences on young people's (15-24) knowledge of HIV/AIDS in three African countries (Burkina Faso, Ghana and Zambia) are explored. The focus of the analysis is on the roles of demographic, economic and behavioral dimensions of the community environment in shaping knowledge of HIV/AIDS. Data from Demographic and Health Surveys, collected independently for males and females in each of the countries, are analyzed. There are clear pathways through which the community environment shapes knowledge, and the community influences on knowledge vary greatly by country and gender. For young women, residences in communities with demographic and behavioral patterns that are indicative of greater opportunities are associated with increased knowledge of HIV/AIDS. The results highlight community-level factors that can be harnessed in the development of community-based interventions to improve knowledge of HIV/AIDS among young people, and reinforce the need to focus on the community environment in designing behavioral change interventions.
4. Impact of life skills training to improve cognition on risk of sexual behavior and contraceptive use among vocational school students in Shanghai, China. Lou C, Wang X, Tu X, et al. Reprod Contracept 2008;19(4):239-51.
Three vocational schools of an urban district in Shanghai were selected as the research sites, with two schools as the intervention groups (group A and group B) and the other as the control (group C). Group A was provided life skills training with core of reproductive health plus peer education, while group B only provided life skills training. All the second grade students were recruited as the subjects. Baseline surveys were conducted in three schools before the implementation of the intervention, and similar surveys were conducted after two terms of the intervention to test the effectiveness of the intervention. In total, 1 612 subjects, including 810 males and 802 females, were recruited. The effects of the intervention on subjects' cognitions on sexual behavior and condom/contraceptive use were analyzed using mixed model with repeated measures. From pretest to posttest, there were significant increase of the proportions of perceiving risks in getting pregnant, infecting STDs and HIV, benefits by learning and using condom, and self-efficacy in contraceptive use, and decrease of the proportions of perceiving barriers for condom use in two intervention groups; while few similar changes in the control group. In mixed modeling analysis, interaction effects of group A × time and group B × time were found on the scores of perceived risks (P<0.000 1), perceived benefits (P<0.000 1), perceived barriers (P=0.001 2 for group A and P=0.003 4 for group B), and perceived self-efficacy (P<0.000 1). The significant difference of the effects between two interventions was only observed on perceived benefits (P<0.000 1). Life skills training using participatory approaches is effective in improving students' reproductive health cognition and could be used as an important method in educating young people about sex-related issues.
5. Knowledge of HIV survival on skin-piercing instruments among young adults in Nyanza Province, Kenya. Ounga T, Okinyi M, Onyuro S, et al. Int J STD AIDS 2009;20(2):119-22.
In countries with generalized HIV epidemics, people may be exposed to blood-borne HIV at their home as well as during health care and cosmetic services. We asked young adults from the Luo and Kisii ethnic groups in Nyanza Province, Kenya, how long HIV survives in blood and how to clean skin-piercing instruments. Only 21% thought that HIV could survive more than an hour in dry conditions (although it can survive for days), and only 24% thought it could survive more than a week in wet conditions (although it can survive more than four weeks). The Kisii, with lower HIV prevalence, were more knowledgeable than the Luo about HIV survival. Survey participants reported that barbers and other service providers often cleaned instruments by wiping with alcohol or bleach, a practice which does not reliably inactivate HIV. People we interviewed, at risk from blood-borne HIV, did not know enough to protect themselves.
6. Knowledge on HIV/AIDS and sexual behaviour among youths in Kibaha District, Tanzania. Lema LA, Katapa RS, Musa AS, et al. J Health Res 2008;10(2):79-83.
This cross-sectional study aimed to investigate the determinants of high-risk sexual behaviors among youths in Kibaha District, Tanzania. Data was collected using a structured questionnaire. The survey gathered data pertaining to the sexual healthy behaviors among youths, including condom use, number of sexual partners, age at first sexual involvement and knowledge on sexually transmitted diseases and HIV/AIDS. A total of 322 individuals aged 15-24 years were involved in the study. More than 69% had sex at least once in their life time. Only about one-third (32.3%) of the youths reported to have used condom during the first sexual intercourse and 37% during the last sex. About 21.7% of the respondents acknowledged having more than one sexual partner in the last 12 months. The majority (98.4%) of the respondents have heard of HIV/AIDS. About three quarters (74.8%) of the respondents knew where to get HIV testing services but only a small proportion (28.9%) had tested for HIV infection. Of those not yet tested, 38.2% admitted that they were ready to do so. Although 317 (98.4%) respondents were aware of HIV/AIDS, and majority, 65.2% mentioned condom as the method used to prevent its transmission, only 117 (36.3%) acknowledged using them. In conclusion, despite good knowledge on transmission of HIV among youths in Kibaha district, only a small proportion of them practices safe sex. Education programs on safe sex practices should be strengthened to provide skills that could be effective in changing and maintaining safe sex behaviors among youths in Tanzania.
7. Street life and drug risk behaviors associated with exchanging sex among male street children in Lahore, Pakistan. Towe VL, ul Hasan S, Zafar ST, et al. J Adolesc Health 2009;44(3):222-8.
The study examined HIV risk behaviors and factors associated with exchanging sex among male street children in Lahore, Pakistan. The survey was conducted from August 2003 to March 2004 among 565 registrants, ages 5-19, of Project Smile, a program that aimed to enhance the lives of street children in Lahore. We analyzed the frequency and correlates of recent (past 3 months) sex exchange for money, drugs, or goods. Multivariate log-binomial regression was used to evaluate the independent effect of covariates on exchange sex. Approximately 40% of participants reported having exchanged sex during the past 3 months. We found high rates of sex exchange among a sample of street children in Lahore, Pakistan. The finding that children who have heard about HIV/AIDS are more likely to exchange sex suggests that children at HIV risk talk about HIV, but accuracy of their conversations is unclear. Street children in Pakistan are in great need of HIV education and safe alternatives for generating income.
8. Unmet needs for reproductive health knowledge among unmarried migrant youth. Zhao S, Gao E, Zabin LS. J Reprod Contracept 2008;19(4):227-38.
Qualitative research method was used with in-depth interview as the major approach to collect data. The results showed that lack of formal sexual education and the special social status were deep reason for their knowledge lack. Very few of them had received sex education in school. Before falling in love and beginning to date, most girls and some boys have no interest in sexual related knowledge. The knowledge they have usually come first from peer communication and are full of mistakes. As growing up, mass media, like TV and magazines begin to be their major knowledge sources. But many get the information from TV dramas, novels or advertisements, and few from formal educational programs. Working long hours each day, with little leisure time and living isolated in cities, migrant people rarely benefit from the ongoing education activities in cities. Special sexual and reproductive health education programs are needed urgently among unmarried migrant youth, particularly female.
9. "When in the body, it makes you look fat and HIV negative": The constitution of antiretroviral therapy in local discourse among youth in Kahe, Tanzania. Ezekiel MJ, Talle A, Juma JM, et al. Soc Sci Med 2009;68(5):957-64.
In this article we examine how ART is constituted within local discourses about treatment and healing. Based on 21 focus group discussions with young people aged 14-24 years in a rural area (Kahe), we examine how local terms and descriptions of antiretroviral therapy relate to wider definitions about the body, health, illness and drug efficacy. Findings illustrate how local understandings of ART draw on a wider discourse about the therapeutic functions of medicines and clinical dimensions of HIV/AIDS. Therapeutic efficacy of antiretroviral medication appeared to overlap and sometimes contradict locally shared understandings of the clinical functions of medicines in the body. Implications of ART on bodily appearance and HIV signs may influence conceptions about sick role, perpetuate stigma and affect local strategies for HIV prevention. Structural inequities in access, limited information on therapeutic efficacy of ART and perceived difficulties with status disclosure appear to inform local conceptions and possible implications of ART. Policy and programme interventions to foster public understanding and acceptability of ART should emphasize treatment education about the benefits and limitations of therapy and increased access to ART in rural areas, and should integrate voluntary status disclosure and HIV prevention.
