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I. PROGRAM RESOURCES
1. 2007 Indonesia Young Adult Reproductive Health Survey (IYARHS)
2. Doorways: Student, Community Counselor and Teacher Program to Reduce Gender-Based Violence in Schools
3. FHI Quality Improvement Guidelines for Care and Support Programs for Orphans and Other Vulnerable Children
4. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents
5. Healthy Youth, Productive Lives: Empowering Youth in the Fight against HIV/AIDS
6. Heroes and Villains: Teachers in the Education Response to HIV
7. Keeping the Promise: An Agenda for Action on Women and AIDS
8. Levels and Spread of HIV Seroprevalence and Associated Factors: Evidence from National Household Surveys
9. Sexual Behavior and Contraceptive Use among Youth in West Africa
10. Socio-Demographic Analysis of Youth in the Caribbean: A Three Country Case Study
II. RESEARCH SUMMARIES
1. Aborting and suspending pregnancy in rural Tanzania: an ethnography of young people's beliefs and practices
2. Age at first sex in rural South Africa
3. Alcohol use, intimate partner violence, sexual coercion and HIV among women aged 15-24 in Rakai, Uganda
4. Associations between premarital sex and leaving school in four sub-Saharan African countries
5. Comparative assessment of the quality of age-at-event reporting in three HIV cohort studies in sub-Saharan Africa
6. Effect of HSV-2 serostatus on acquisition of HIV by young men: results of a longitudinal study in Orange Farm, South Africa
7. HIV/AIDS education in Tanzania: the experience of at-risk children in poorer communities
8. Influence of timing of sexual debut and first marriage on sexual behaviour in later life: findings from four survey rounds in the Kisesa cohort in northern Tanzania
9. Knowledge of HIV, sexual behaviour and correlates of risky sex among street children in Kinshasa, Democratic Republic of Congo
10. Levels of change in adolescent sexual behavior in three Asian cities
11. Like parent, like child: intergenerational transmission of partner violence in Cebu, the Philippines
12. Measuring trends in age at first sex and age at marriage in Manicaland, Zimbabwe
13. Objective and perceived knowledge of oral contraceptive methods among adolescent mothers
14. Perceived risks of HIV/AIDS and first sexual intercourse among youth in Cape Town, South Africa
15. Pregnancy-related school dropout and prior school performance in KwaZulu-Natal, South Africa
16. Sexual behavior and emergency contraception among adolescents from public schools in Pernambuco State, Brazil
17. Social factors, social support, and condom use behavior among young urban slum inhabitants in southwest Nigeria
18. South African teachers' reflections on the impact of culture on their teaching of sexuality and HIV/AIDS
19. Sub-Saharan African university students' beliefs about condoms, condom-use intention, and subsequent condom use: a prospective study
20. Trends in age at first sex in Uganda: evidence from Demographic and Health Survey data and longitudinal cohorts in Masaka and Rakai
21. Trends in marriage and time spent single in sub-Saharan Africa: a comparative analysis of six population-based cohort studies and nine Demographic and Health Surveys
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I. PROGRAM RESOURCES
1. 2007 Indonesia Young Adult Reproductive Health Survey (IYARHS) (2009, 225 pages, 1.2 MB)
The IYARHS focuses on young women and men, ages 15-24, and covers topics including education, knowledge and attitudes about reproductive health and family planning, knowledge of HIV/AIDS and sexually transmitted infections, attitudes about sexual activity and marriage, smoking, and use of alcohol and drugs.
Organization: Macro International, Government of Indonesia
Contact: reports@macrointernational.com
2. Doorways: Student, Community Counselor and Teacher Program to Reduce Gender-Based Violence in Schools (2009)
Students (206 pages, 2.3 MB)
Community (203 pages, 2.3 MB)
Teachers (224 pages, 2.3 MB)
Doorways is a set of three manuals designed for teachers, students, and volunteer community counselors. The Doorways training program was developed to be easily implemented and adapted across the world to prevent and respond to gender-based violence in schools.
Organization: SafeSchools Program, USAID
Contact: devtech@devtechsys.com
3. FHI Quality Improvement Guidelines for Care and Support Programs for Orphans and Other Vulnerable Children (2009, 22 pages, 902 KB)
The guidelines are organized into nine areas of support that respond to the basic needs and human rights of children. They are also aligned with the core areas of support for programs for orphans and vulnerable children established by the U.S. government in the President's Emergency Plan for AIDS Relief (PEPFAR). The areas covered by the guidelines are cross-cutting issues, care coordination, health, food and nutrition, education, psychosocial support, shelter and care, protection, and household economic strengthening.
Organization: Family Health International
Contact: publications@fhi.org
4. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents (2009, 216 pages, 2.3 MB)
Major changes in the guidelines include 1) greater emphasis on the importance of antiretroviral therapy for the prevention and treatment of opportunistic infections (OIs), especially those OIs for which no specific therapy exists; 2) information regarding the diagnosis and management of immune reconstitution inflammatory syndromes; 3) information regarding the use of interferon-gamma release assays for the diagnosis of latent tuberculosis (TB) infection; 4) updated information about drug interactions that affect the use of rifamycin drugs for prevention and treatment of TB; 5) the addition of a section on hepatitis B virus infection; and 6) the addition of malaria to the list of OIs that might be acquired during international travel.
Organization: Centers for Disease Control
Contact: zud4@cdc.gov
5. Healthy Youth, Productive Lives: Empowering Youth in the Fight against HIV/AIDS (2008, 8 pages, 379 KB)
In 2006, the USAID-funded Malawi Teacher Training Activity created the Mphamvu Kwa Achinyamata ("Power to the Youth") clubs to support school-based HIV and AIDS prevention education in Malawi. This brochure highlights key aspects of the HIV/AIDS School Clubs Initiative, and it profiles just a few of the many successful club activities underway throughout Malawi.
Organization: American Institutes for Research (AIR)
Contact: fkadyoma@yahoo.com
6. Heroes and Villains: Teachers in the Education Response to HIV (2009, 266 pages 3.1 MB)
This book investigates, from the standpoint of the classroom teacher, how school-based education is addressing the global HIV epidemic. It synthesizes evidence from a variety of education systems; discusses lessons learned; and recommends steps to be taken by ministries of education, teachers unions, and development partners to strengthen the role of teachers in responding to HIV.
Organization: UNESCO-IIEP
Contact: info@iiep.unesco.org
7. Keeping the Promise: An Agenda for Action on Women and AIDS (2008, 32 pages, 1.9 MB)
AIDS is affecting women and girls in increasing numbers, yet current AIDS responses do not, on the whole, tackle the social, cultural, and economic factors that put women at risk of HIV and that unduly burden them with the epidemic's consequences. The world's governments have repeatedly declared their commitment to improve the status of women and acknowledged the linkage with HIV. In some areas, progress has been made. By and large, though, efforts have been small-scale and haphazard. Major opportunities to stem the global AIDS epidemic have been missed. This book describes the UNAIDS-led Global Coalition on Women and AIDS, which is calling for a massive scaling up of AIDS responses for women and girls.
Organization: Global Coalition on Women and AIDS, UNAIDS
Contact: womenandaids@unaids.org
8. Levels and Spread of HIV Seroprevalence and Associated Factors: Evidence from National Household Surveys (2009, 157 pages, 3.4 MB)
This report summarizes HIV prevalence and the associations between HIV serostatus and key characteristics and behaviors of adult women and men in 22 developing countries, primarily in sub-Saharan Africa. Among other factors, the report examines youth who were under age 18 at their first sexual encounter and found they had higher rates of HIV prevalence than other youth ages 15-24. With the exception of Lesotho, HIV prevalence is low among youth who have never had sex (primary abstinence) and also among youth who did not have sex in the 12 months preceding the survey (secondary abstinence).
Organization: Macro International, MEASURE DHS
Contact: press@measuredhs.com
9. Sexual Behavior and Contraceptive Use among Youth in West Africa (2009)
This article examines data from the Demographic and Health Surveys conducted in Burkina Faso, Mali, and Senegal, and it explores the variation in sexual knowledge and practices among youth ages 15-24. With this information, policy-makers and program managers can develop programs that more effectively respond to the sexual and reproductive health needs of youth.
Organization: PRB
Contact: popref@prb.org
10. Socio-Demographic Analysis of Youth in the Caribbean: A Three Country Case Study (2008, 24 pages, 125 KB)
This study provides an analysis of 2000 census data from Antigua and Barbuda, Grenada, and Saint Lucia, with a focus on children, youth, and young families. Special attention is given to the description of their living arrangements and household composition, religion, health, well-being, migration, education and profession, economic activities, civil status, and reproductive patterns.
Organization: ECLAC
Contact: registry@eclacpos.org
II. RESEARCH SUMMARIES
1. Aborting and suspending pregnancy in rural Tanzania: an ethnography of young people's beliefs and practices. Plummer ML, Wamoyi J, Nyalali K, et al. Stud Fam Plann 2008;39(4):281-92.
This study presents findings on abortion practices and beliefs among adolescents and young adults in Tanzania, where abortion is illegal. From 1999 to 2002, six researchers carried out participant observations in nine villages and conducted group discussions and interviews in three others. Most informants opposed abortion as illegal, immoral, dangerous, or unacceptable without the man's consent, and many reported that ancestral spirits killed women who aborted clan descendants. Nonetheless, abortion was widely, if infrequently, attempted, by ingestion of laundry detergent, chloroquine, ashes, and specific herbs. Most women who attempted abortion were young, single, and desperate. Some succeeded, but they experienced opposition from sexual partners, sexual exploitation by practitioners, serious health problems, social ostracism, and quasi-legal sanctions. Many informants reported the belief that inopportune pregnancies could be suspended for months or years using traditional medicine. The authors conclude that improved reproductive health education and services are urgently needed in rural Tanzania.
2. Age at first sex in rural South Africa. McGrath N, Nyirenda M, Hosegood V, et al. Sex Transm Infect 2009;85(Suppl 1):i49-55.
The authors used longitudinal data from four rounds (2003-2007) of a prospective population-based HIV and sexual behavior survey in rural KwaZulu-Natal, South Africa to investigate the distribution and predictors of earlier first sex among young men and women (12-25 years) in a population with a high prevalence and incidence of HIV. Survival analyses were used, and each analysis considered men and women separately. Among the 4,724 women and 4,029 men who were virgins at the beginning of the period, the median age at first sex (AFS) was 18.5 and 19.2 years, respectively. In multivariable models, factors associated with earlier AFS across gender were periurban residence (vs. rural), ever use of alcohol, and knowing at least one person who had HIV, while school attendance had a significant protective effect. Other factors were important for one gender only. Maternal death was significantly associated with earlier AFS for women, in the same way that paternal death was for young men, while mother's membership of the same household significantly delayed AFS of young men. The analysis of early first sex confirmed the same factors to be important as in the overall analyses for men and women.
3. Alcohol use, intimate partner violence, sexual coercion and HIV among women aged 15-24 in Rakai, Uganda. Zablotska IB, Gray RH, Koenig MA, et al. AIDS Behav 2009;13(2):225-33.
In a sample of 3,422 women aged 15-24 from Rakai, Uganda, the authors use adjusted odds ratios (Adj OR) and 95% confidence intervals (95% CI) to examine the association between self-reported alcohol use before sex, physical violence/sexual coercion in the past, and HIV prevalence. During the previous year, physical violence (26.9%) and sexual coercion (13.4%) were common, and alcohol use before sex was associated with a higher risk of physical violence/sexual coercion. HIV prevalence was significantly higher with alcohol consumption before sex (Adj OR = 1.45, 95% CI: 1.06-1.98) and especially when women reported both prior sexual coercion and alcohol use before sex (Adj OR = 1.79, 95% CI: 1.25-2.56).
4. Associations between premarital sex and leaving school in four sub-Saharan African countries. Biddlecom A, Gregory R, Lloyd CB, Mensch BS. Stud Fam Plann 2008;39(4):337-50.
Using data from the 2004 National Survey of Adolescents conducted in Burkina Faso, Ghana, Malawi, and Uganda, the authors investigated the empirical association between premarital sex and leaving school among those who were enrolled in school at the outset of adolescence (age 12). Discrete-time logistic regression models show that, in general, girls are more likely than boys to leave school before completing secondary school, before completing primary school, and, among those completing primary school, before progressing to secondary school. Girls who complete primary school, however, do so at the same age as or a younger age than their male peers. Girls appear more vulnerable to leaving school once they engage in premarital sex. These findings can assist researchers, policy-makers, program managers, and educators in understanding and addressing the challenges to educational attainment posed by the increasing proportion of school-aged adolescents engaging in premarital sex.
5. Comparative assessment of the quality of age-at-event reporting in three HIV cohort studies in sub-Saharan Africa. Wringe A, Cremin I, Todd J, et al. Sex Transm Infect 2009;85(Suppl 1):i56-63.
The authors assessed inconsistencies in reported age at first sex (AFS) and age at first marriage (AFM) in three African cohorts and considered the implications for interpreting trends in sexual and marital debut. They analyzed data from population-based cohort studies in Zimbabwe, Uganda, and South Africa with 3, 10, and 4 behavioral survey rounds, respectively. Three rounds over a similar time frame were selected from each site for comparative purposes. The consistency of AFS and AFM reports was assessed for each site by comparing responses made by participants in multiple surveys. Respondents were defined as unreliable if less than half of all their age-at-event reports were the same. Kaplan-Meier functions were used to describe the cumulative proportion (1) having had sex and (2) married by age, stratified by sex, birth cohort and site, to compare the influence of reporting inconsistencies on these estimates. Among participants attending all three comparable rounds, the percentage with unreliable AFS reports ranged from 30% among South African women to 56% among Zimbabwean men, with similar patterns observed for AFM. Inclusion of unreliable reports had little effect on estimates of median age-at-event in all sites. The authors concluded that although reporting quality is unlikely to affect comparisons of AFS and AFM between settings, care should be taken not to overinterpret small changes in reported age-at-event over time within each site.
6. Effect of HSV-2 serostatus on acquisition of HIV by young men: results of a longitudinal study in Orange Farm, South Africa. Sobngwi-Tambekou J, Taljaard D, Lissouba P et al. J Infect Dis 2009;199(7):958-64.
The authors analyzed data collected during a male circumcision trial conducted in Orange Farm, South Africa. They estimated adjusted incidence rate ratios for HIV acquisition, using survival analysis and background characteristics, herpes simplex virus type 2 (HSV-2) status, male circumcision status, and sexual behavior as covariates. Results showed that HSV-2 has a substantial impact on HIV acquisition among young South African men. The study suggests that HSV-2 infection enhances HIV acquisition and is responsible for 25% of incident cases of HIV infection. However, the protective effect of male circumcision against HIV acquisition appears independent of HSV-2 serostatus.
7. HIV/AIDS education in Tanzania: the experience of at-risk children in poorer communities. Maro CN, Roberts GC, Sorensen M. Vulnerable Child Youth Stud 2009;4(1):23-36.
Participants were 800 youths aged 12-15 years within three youth subgroups in poorer communities: those children attending school; children who were not attending school but who were still residing within their communities; and children who were street children (more than 50% of them being orphans). Participants responded to questionnaires. In general, all youths showed low levels of HIV knowledge, experience with condom use, and intention to use condoms. They exhibited moderate perceived behavior control in using condoms and positive subjective norms about the use of condoms, the value of sexual abstinence, and having an exclusive sexual partner. Contrary to expectations, there were no significant differences between those in-school and those out-of-school with regard to HIV knowledge, intended condom use, subjective norms about condom use, and abstinence. Indeed, the in-school children were more at risk for HIV infection, in that they reported the lowest condom experience and perceived behavioral control in condom use. There were systematic gender differences, in that girls scored lower than boys on all variables. The authors concluded that the policy of basing HIV/AIDS education within the schools of Tanzania has not been as effective as desired.
8. Influence of timing of sexual debut and first marriage on sexual behaviour in later life: findings from four survey rounds in the Kisesa cohort in northern Tanzania. Zaba B, Isingo R, Wringe A, et al. Sex Transm Infect 2009;85(Suppl 1):i20-6.
The authors evaluated reports on age at first sex (AFS) and age at first marriage (AFM) from a Kisesa cohort study, 1994 to 2004, for consistency and for trends in median age-at-event and time spent single but sexually active in different birth cohorts. The association of these variables with marital stability and numbers of partners at later ages was explored using statistical regression techniques. Age at first sex and AFM were inconsistently reported by 32% and 33% of respondents, respectively, but there was no general tendency to report lower or higher ages at a later report date. In 10-year birth cohorts born between 1950-1959 and 1980-1989, male median AFS declined from 18.1 to 17.0 years and female median AFM rose from 16.2 to 16.6 years. Young people of both sexes currently spend longer time sexually active but unmarried than previously. Early marriage is statistically associated with remarriage and polygamy; longer time between sexual debut and marriage is associated with higher numbers of partners at later stages of life. Inconsistent reporting of age-at-event introduces noise but does not bias estimates of population-level indicators. Lengthening time spent single and sexually active suggests that men and women entering first marriage will have been exposed to increased numbers of non-marital partners. Successful youth interventions may also influence adult behavior.
9. Knowledge of HIV, sexual behaviour and correlates of risky sex among street children in Kinshasa, Democratic Republic of Congo. Kayembe PK, Mapatano MA, Fatuma AB, et al. East Afr J Public Health 2008;5(3):186-92.
The authors sought to determine knowledge of HIV (transmission and prevention means), sexual activity, and exposure to HIV-prevention services, and to identify correlates of risky sexual behavior (not having used a condom at first or last sexual encounter and/or having multiple sexual partners over a 12-month period) among street children in Kinshasa. At the time of the survey, most participants (86%) were sexually experienced and 56% had their first sexual intercourse when they were already living on the streets. The median age at first sexual activity was 14.3 years for males and 13.5 years for females. Compared to males (median number of sexual partners = 1), females tended to be more involved with multiple sexual partners (median = 12). The pattern of condom use depended on the type of sexual partners (61% at last sexual encounter with a paid/paying partner and 23% at last sexual encounter with a non-paid/non-paying partner). In males, sleeping in a shelter provided by a nongovernmental organization and having had the first sexual intercourse while living on the streets were protective of risky sexual behavior, while a history of drug use and being aged 20-24 years increased the likelihood of displaying risky sexual behavior. In females, not knowing where to get a condom, having started sexual activity when living on the streets, and not having an income-generating activity were protective of risky sexual behavior. The potential benefit of providing homeless youth with night-shelters should be explored more since this could be an opportunity to integrate risk-reduction programs that take into account all problematic behaviors such as risky sexual behavior and drug use.
10. Levels of change in adolescent sexual behavior in three Asian cities. Zabin LS, Emerson MR, Nan L, et al. Stud Fam Plann 2009;40(1):1-12.
This study explored the dimensions and context of changes in romantic and sexual behaviors of Asian young people at three sites at different stages of modernization: Hanoi (early), Shanghai (intermediate), and Taipei (later stage). The authors conducted a survey of 17,016 males and females aged 15-24 in urban and rural settings in three large metropolitan areas. Survival analysis and Cox regressions were performed to explore ages of respondents at key transitions and the significance of differences between two age cohorts: 15-19 and 20-24. The authors found significant differences in levels of sexual and other transitions, even within the narrow time span reflected by the age cohorts. The findings highlight the differential impact of modernization on adolescent sexual behavior as traditional societies undergo social change, and they underline the importance of context in exploring youthful transitions.
11. Like parent, like child: intergenerational transmission of partner violence in Cebu, the Philippines. Fehringer JA, Hindin MJ. J Adolesc Health 2009;44(4):363-71.
The authors used 1994, 2002, and 2005 data from 472 married or cohabiting young adults from the Cebu Longitudinal Health and Nutrition Survey in Cebu, the Philippines. This is a longitudinal data set following more than 2,000 Filipino women and their index children since the child's birth in 1983-1984. They sought to determine the prevalence of partner violence perpetration and receipt among a sample of young men and women, as well as the relationship between witnessing interparental violence during childhood and current violence in partnerships. Prevalence of partner violence perpetration was 55.8% for female and 25.1% for male respondents. Prevalence of victimization was 27.7% for females and 30.5% for males. In all, 45% of females and 50% of males reported having witnessed their parents or caretakers physically hurt one another during childhood. Multinomial logistic regression analysis showed that witnessing interparental violence significantly predicted report of violent act victimization and reciprocal violent acts. Greater parental joint decision making and being male were independently associated with a lower risk of report of both reciprocal violent acts and violent act victimization. Duration of marriage or cohabitation was associated with report of violent act victimization and reciprocal violent acts. There were gender interaction effects for several factors, including mother's church attendance and household purchase of alcohol at age 11 years.
12. Measuring trends in age at first sex and age at marriage in Manicaland, Zimbabwe. Cremin I, Mushati P, Hallett T, et al. Sex Transm Infect 2009;85(Suppl 1): i34-40.
The authors analyzed longitudinal data from three rounds of a population-based cohort in eastern Zimbabwe. Reports of age at first sex and age at marriage from 6,837 individuals attending multiple rounds were classified according to consistency. Survival analysis was used to identify trends in the timing of first sex and marriage. In this population, women initiate sex and enter marriage at younger ages than men but spend much less time between first sex and marriage. Among those surveyed between 1998 and 2005, median ages at first sex and first marriage were 18.5 years and 21.4 years for men and 18.2 years and 18.5 years, respectively, for women aged 15-54 years. High levels of reports of both age at first sex and age at marriage among those attending multiple surveys were found to be unreliable. Excluding reports identified as unreliable from these analyses did not alter the observed trends in either age at first sex or age at marriage. Tracing birth cohorts as they aged revealed reporting biases, particularly among the youngest cohorts. Comparisons by birth cohorts, which span a period of >40 years, indicate that median age at first sex has remained constant over time for women but has declined gradually for men. Although many reports of age at first sex and age at marriage were found to be unreliable, inclusion of such reports did not result in artificial generation or suppression of trends.
13. Objective and perceived knowledge of oral contraceptive methods among adolescent mothers. de Sousa MC, Gomes KR. Cad Saude Publica 2009;25(3):645-54.
The authors conducted a cross-sectional study with 278 teenage mothers (15-19 years) admitted to four maternity hospitals in Teresina, Brazil in 2006. Logistic regression provided the basis for the statistical analysis. Nearly 98% of the adolescent mothers showed low objective and perceived knowledge of oral contraceptives. High parity was the only predictor of increased objective knowledge of oral contraceptives. The adolescents' low level of objective and perceived knowledge on use of oral contraceptives emphasized their susceptibility to risky sexual behavior. The findings emphasize the need for a more interactive approach with adolescents to reduce the occurrence and repetition of unwanted teenage pregnancy and its negative consequences for the lives of these young mothers and their children.
14. Perceived risks of HIV/AIDS and first sexual intercourse among youth in Cape Town, South Africa. Tenkorang EY, Rajulton F, Maticka-Tyndale E. AIDS Behav 2009;13(2):234-45 .
The "Health Belief Model" (HBM) identifies perception of HIV/AIDS risks, recognition of its seriousness, and knowledge about prevention as predictors of safer sexual activity. Using data from the Cape Area Panel Survey and hazard models, the authors examined the impact of risk perception (considered the first step in HIV prevention), within the context of the HBM and socioeconomic, familial, and school factors, on the timing of first sexual intercourse among youth aged 14-22 in Cape Town, South Africa. Of the HBM components, female youth who perceive their risk as "very small" and males with higher knowledge, experience their sexual debut later than comparison groups. For both males' and females' socioeconomic and familial factors also influence timing of sexual debut, confirming the need to consider the social embeddedness of this sexual behavior as well as the rational components of decision making when designing prevention programs.
15. Pregnancy-related school dropout and prior school performance in KwaZulu-Natal, South Africa. Grant MJ, Hallman KK. Stud Fam Plann 2008;39(4):369-82.
This study examined the factors associated with schoolgirl pregnancy and subsequent educational pathways. The authors found that prior schooling discontinuities -- defined as instances of non-pregnancy-related grade repetition or temporary withdrawals from school -- are strongly associated with a young woman's likelihood of later becoming pregnant while enrolled in school, dropping out of school if she becomes pregnant, and not returning to school following a pregnancy-related dropout. Young women who are the primary caregivers to their children are also significantly more likely to leave school than are those who have help with their childcare responsibilities. Given the increasing importance of female school participation in sub-Saharan Africa, programs must be designed to reach girls and their families early to increase incentives for ensuring their timely progression through school and to increase their access to reproductive health information and services.
16. Sexual behavior and emergency contraception among adolescents from public schools in Pernambuco State, Brazil. de Araujo MS, Costa LO. Cad Saude Publica 2009;25(3):551-62.
This study examined knowledge and use of emergency contraception among 4,210 adolescents (14-19 years) enrolled in public schools in Pernambuco State, Brazil. The authors collected information with the Global School-Based Student Health Survey, previously validated. Knowledge, frequency, and form of use of emergency contraception were investigated. Independent variables were classified as sociodemographic and those related to sexual behavior. Most adolescents reported knowing and having received information about the method, but among those who had already used it, only 22.1% had done so correctly. Adjusted regression analysis showed greater likelihood of knowledge about the method among girls and the sexually initiated, while rural residents were 68% less knowledgeable. Rural residents showed 1.68 times higher odds of incorrect use, while girls showed 71% lower likelihood of incorrect use.
17. Social factors, social support, and condom use behavior among young urban slum inhabitants in southwest Nigeria. Adedimeji AA, Heard NJ, Odutolu O, et al. East Afr J Public Health 2008;5(3):215-22.
This study explored condom use behavior, specifically the extent to which beliefs, self efficacy, risk perception, and perceived social support act as predictors of use or non-use of condoms among sexually active young people aged 15-24 years. Data were obtained from 448 and 338 sexually active boys and girls, respectively, who were selected through multistage sampling techniques. Generally, there was widespread knowledge and low levels of condoms use, despite high levels of risky sexual behavior. Although half of boys and one third of girls reported ever using condoms, a considerably lower proportion of male and female adolescents regularly used condoms. Logistic regression models showed that among girls, those who perceived social support from peers and non-parental figures were more likely to use condoms while among boys, earning an income, high risk perception, and self efficacy were associated with higher odds of condom use.
18. South African teachers' reflections on the impact of culture on their teaching of sexuality and HIV/AIDS. Helleve A, Flisher AJ, Onya H, et al. Cult Health Sex 2009;11(2):189-204.
The authors investigated how teachers respond to perceived cultural differences between the local community and the content of their teaching. Data were collected through interviews with teachers who taught students in grades 8 or 9 in public high schools. The teachers expressed differing viewpoints on the rationale for teaching about HIV/AIDS and sexuality. Many teachers saw teaching these topics as a response to declining moral standards, while others suggested that they were teaching issues that parents failed to address. The teachers were more concerned about young people's sexual behavior than about preventing HIV/AIDS. They perceived that cultural contradictions between what was taught and local cultural values were an issue to which they needed to respond, although they differed in terms of how to respond. Some took an adaptive approach to try to avoid conflicts, while others claimed the moral neutrality of their teaching. Teaching about sexuality was perceived to be challenging in terms of language and communication norms. Teaching about HIV/AIDS was perceived as challenging because teachers often needed to convince students about the reality of AIDS.
19. Sub-Saharan African university students' beliefs about condoms, condom-use intention, and subsequent condom use: a prospective study. Heeren GA, Jemmott JB III, Mandeya A, et al. AIDS Behav 2009;13(2):268-76.
This study examined whether certain behavioral beliefs, normative beliefs, and control beliefs predict the intention to use condoms and subsequent condom use among 320 undergraduates at a university in South Africa. The students completed confidential questionnaires on two occasions separated by three months. Participants' mean age was 23.4 years, 47.8% were women, 48.9% were South Africans, and 51.1% were from other sub-Saharan African countries. Multiple regression revealed that condom-use intention was predicted by hedonistic behavioral beliefs, normative beliefs regarding sexual partners and peers, and control beliefs regarding condom-use technical skill and impulse control. Logistic regression revealed that baseline condom-use intention predicted consistent condom use and condom use during most recent intercourse at three-month follow-up.
20. Trends in age at first sex in Uganda: evidence from Demographic and Health Survey data and longitudinal cohorts in Masaka and Rakai. Slaymaker E, Bwanika JB, Kasamba I, et al. Sex Transm Infect 2009;85(Suppl 1):i12-9.
This study sought to derive the best possible estimates of trends in age at first sex (AFS) among successive cohorts of Ugandan men and women based on all the data available from the Demographic and Health Surveys (DHS) and cohort studies in Masaka and Rakai districts. The authors analyzed the datasets from the DHS, Masaka cohort, and Rakai cohort separately. Survival analysis methods were used to estimate median AFS for men and women born in the 1950s-1980s and to compute hazard ratios for first sex, comparing later cohorts with earlier cohorts. The DHS and Masaka data showed an increase in age at first sex (AFS) in women in the more recent birth cohorts compared with those born before 1970, but this was less apparent in the Rakai data. Successive male cohorts in Masaka appeared first to have an increased AFS which subsequently decreased, a trend that was also apparent (but not significant) in the DHS data. Younger men in Rakai had an earlier AFS than those born before 1980. Women in Uganda who were born after 1970 have, on average, had sex at a later age than those born earlier. For men, AFS has not changed consistently over the period in question. Differences between Masaka and Rakai may reflect socioeconomic differences. Most of the change in AFS occurred too late to have contributed to the initial decline in the incidence of HIV.
21. Trends in marriage and time spent single in sub-Saharan Africa: a comparative analysis of six population-based cohort studies and nine Demographic and Health Surveys. Marston M, Slaymaker E, Cremin I, et al. Sex Transm Infect 2009;85(Suppl 1):i64-71.
The authors analyzed cohort data from Uganda, Tanzania, South Africa, Zimbabwe, and Malawi and Demographic and Health Survey (DHS) data from Uganda, Tanzania and Zimbabwe. Life table methods were used to calculate median age at first sex (AFS), age at first marriage (AFM), and time spent single. In each study, two surveys were chosen to compare marital status by age and identify changes over time. Median AFS, AFM, and time spent single vary considerably among these populations. These three measures are underlying determinants of sexual risk and HIV infection, and they may partially explain the variation in HIV prevalence levels among these populations.
