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I. MEETING PRESENTATIONS
The IYWG held its latest meeting in Washington, DC on June 25, 2009 to discuss the issue of young people most at risk for HIV/AIDS. The objectives of the meeting were: 1) To provide an overview of at-risk young people ages 10-24 and the unique needs of the three populations most-at-risk for HIV; 2) To provide program examples designed specifically to address most-at-risk behavior among young people and their related health needs; and 3) To identify next steps in addressing the needs of vulnerable and most-at-risk young people. For more information, and to download the presentations, click here.
II. RESEARCH SUMMARIES
1. Alcohol and illicit drug use and its influence on the sexual behavior of teenagers from Minas Gerais State, Brazil
2. Changes in sexual behavior following a sex education program in Brazilian public schools
3. Community factors shaping HIV-related stigma among young people in three African countries
4. Comportamentos de risco a saude em adolescentes no sul do Brasil: prevalencia e fatores associados [Health risk behaviors among adolescents in the south of Brazil: prevalence and associated factors]
5. Determinants of actual condom use among adolescents in Thailand
6. Development of leadership self-efficacy and collective efficacy: adolescent girls across castes as peer educators in Nepal
7. Evaluation of uptake and attitude to voluntary counseling and testing among health care professional students in Kilimanjaro region, Tanzania
8. Factors associated with HIV testing among sexually active South African youth aged 15-24 years
9. "If you don't abstain, you will die of AIDS": AIDS education in Kenyan public schools
10. Kenyan in-school youths' level of understanding of abstinence, being faithful, and consistent condom use terms: implications for HIV-prevention programs
11. Knowledge, practices, and attitudes regarding emergency contraception among students at a university in Ghana
12. Maternal acceptance of human papillomavirus vaccine in Malaysia
13. Milking the cow: young women's construction of identity and risk in age-disparate transactional sexual relationships in Maputo, Mozambique
14. Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study
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1. Alcohol and illicit drug use and its influence on the sexual behavior of teenagers from Minas Gerais State, Brazil. Bertoni N, Bastos FI, de Mello MB, et al. Cad Saude Publica 2009;25(6):1350-60.
This article summarizes the findings of a survey of 5,981 students from public schools in Minas Gerais State, Brazil. The analysis assessed the influence of drug use on sexual practices. Among the boys who stated having used illicit drugs and who were engaged in relationships with casual partners, 56% reported consistent condom use, as compared to 65% among those not reporting such habits. Among boys who reported illicit drug use and who were engaged in relationships with stable partners, consistent condom use was reported by 43%, versus 64% among those not reporting such habits. In the subgroup of boys engaged in stable relationships who did not report illicit drug use, consistent condom use was less frequent among those who used alcohol or cigarettes, compared to those who did not drink or smoke (61% versus 71%). Girls were less likely than boys to use condoms consistently, regardless of the nature of their relationships, without a noticeable influence of drug use. Policies to prevent drug abuse, sexually transmitted infections, and unplanned pregnancy should be fully integrated.
2. Changes in sexual behavior following a sex education program in Brazilian public schools. Andrade HH, de Mello MB , Sousa MH, et al. Cad Saude Publica 2009;25(5):1168-76.
This paper describes an evaluation of possible changes in sexual behavior in adolescents who participated in a school-based sex education program in selected public schools in four municipalities in the state of Minas Gerais, Brazil. The program, given within the context of reproductive rights, dealt with risks involved in unsafe sexual practices, and focused on the positive aspects of sexuality. A quasi-experimental design with pre- and post-tests and a nonequivalent control group was used to evaluate the intervention. A total of 4,795 questionnaires were included in this analysis. The program succeeded in more than doubling consistent condom use with casual partners and in increasing the use of modern contraceptives during last intercourse by 68%. The intervention had no effect on age at first intercourse or on adolescents' engagement in sexual activities. The sex education program was effective in generating positive changes in the sexual behavior of adolescents, while not stimulating participation in sexual activities.
3. Community factors shaping HIV-related stigma among young people in three African countries. Stephenson R. AIDS Care 2009;21(4):403-10.
Using nationally representative data on 15- to 24-year-olds in Burkina Faso, Ghana, and Zambia, the author examined the economic, demographic, and behavioral dimensions of community environments that shape HIV-related stigma among young people. The elements of the community that were significantly associated with HIV-related stigma were economic and behavioral aspects. There was no evidence of relationships between demographic patterns and HIV-related stigma. Behavioral change interventions must address HIV-related stigma in order to encourage behavior change, and must take into account the social, economic, and cultural environments in which young people live.
4. Comportamentos de risco a saude em adolescentes no sul do Brasil: prevalencia e fatores associados [Health risk behaviors among adolescents in the south of Brazil: prevalence and associated factors]. Farias JC, Nahas MV, de Barros MV, et al. Rev Panam Salud Publica 2009;25(4):344-52.
The authors sought to determine the prevalence of health risk behaviors and to analyze factors associated with exposure to such behaviors among adolescents in the state of Santa Catarina in the south of Brazil. Adolescents attending 240 high school classes at the state's public schools answered a questionnaire that collected demographics (sex, age, area of residence, and day versus night classes); social and economic data (working status and monthly family income); and information on health risk behaviors. The completed questionnaires of 5,028 adolescents (2,984 females and 2,044 males) 15-19 years of age were considered valid. The most prevalent health risk behaviors were insufficient levels of physical activity (36.5%), low intake of fruits and vegetables (46.5%), and irregular use of condoms (38.3%). Approximately 7 of 10 adolescents (64.7%) were exposed to two or more risk behaviors simultaneously. The following risk subgroups were identified: male adolescents, adolescents 18-19 years of age, living in urban areas, studying at night, and having a higher family income. The percentage of adolescents exposed to health risk behaviors was high, especially when simultaneous exposure to different behaviors was considered.
5. Determinants of actual condom use among adolescents in Thailand. Khumsaen N, Gary FA. J Assoc Nurses AIDS Care 2009;20(3):218-29.
This study examined the relationships among attitudes toward condom use, personal characteristics, condom use self-efficacy, and actual condom use among Thai adolescents. Predictors of condom use were also investigated. The sample consisted of 270 Thai vocational students aged 18 to 21 years. Multiple regressions were used to estimate the correlates between the independent study variables and condom use among Thai adolescents. The results showed that self-reported history of alcohol or drug use, attitudes toward condom use, and condom use self-efficacy were related to actual condom use.
6. Development of leadership self-efficacy and collective efficacy: adolescent girls across castes as peer educators in Nepal. Posner J, Kayastha P, Davis D, et al. Glob Public Health 2009;4(3):284-302.
Local nongovernmental organizations developed a peer education program in three districts of Nepal that paired girls from different castes and different educational levels. The program sought to increase peer educators' (PE) leadership and collective efficacy for informing peers and adults about the effects that menstrual restrictions and HIV awareness and prevention have on women and girls. In total, 504 girls were selected and trained as PEs. They conducted targeted discussion sessions with other girls and organized mass awareness events, reaching 20,000 people. Leadership self-efficacy, which was a central theoretical construct for the program, provided a strong predictor of both increased HIV knowledge and of practicing fewer menstrual restrictions. The project demonstrated that girls from different castes and educational backgrounds are able to work together to change individual behavior and to address socio-cultural norms that affect their lives and well-being within their communities.
7. Evaluation of uptake and attitude to voluntary counseling and testing among health care professional students in Kilimanjaro region, Tanzania. Charles MP, Kweka EJ, Mahande AM, et al. BMC Public Health 2009;9(Article No.128):9p.
A structured questionnaire was used among health care professional students aged 18-25 years who were enrolled in degree, diploma, and certificate courses at Kilimanjaro Christian Medical College and all other allied health schools. A total of 309 students were recruited; among these 197 (63.8%) were females. All respondents were aware of the benefits of voluntary counseling and testing (VCT). Only 107 (34.6%) of students had previously gone to VCT. Risk perception among the students was low (37.2%) even though they were found to have higher risk behaviors that predisposed them to becoming infected with HIV.
8. Factors associated with HIV testing among sexually active South African youth aged 15-24 years. MacPhail C, Pettifor A, Moyo W, et al. AIDS Care 2009;21(4):456-67.
The authors explored the correlates of HIV testing using data from youth aged 15-24 years old who reported being sexually experienced during a national survey conducted in South Africa in 2003 (N=7,665). Among sexually experienced youth, 32.7% of females and 17.7% of males reported having been tested for HIV. In multivariable analysis, ever being pregnant, ever starting a conversation about HIV/AIDS, and urban residence were independent correlates of HIV testing among sexually experienced females. Among sexually experienced males, HIV-positive status, personally knowing someone that died of AIDS, being aged 20-24 years, and having completed high school were independent correlates of HIV testing. The following factors were significantly associated with HIV testing among both men and women: ever talking to parents about HIV/AIDS, ever participating in a loveLife program, a higher frequency of visits to a clinic in the past 12 months, and non-black race (p<0.05).
9. "If you don't abstain, you will die of AIDS": AIDS education in Kenyan public schools. Njue C, Nzioka C, Ahlberg B-M, et al. AIDS Educ Prev 2009;21(2):169-79.
This article explores the constraints of implementing AIDS education in public schools in Kenya. The authors conducted 60 interviews with teachers and 60 focus group discussions with students in 21 primary and nine secondary schools. System and school-level constraints included lack of time in the curriculum, limited reach of secondary-school students (because AIDS education is embedded in biology, which is not compulsory), and disapproval of openness about sex and condoms by the Ministry of Education and parents. Alternative strategies to teach about AIDS had their own constraints. Teachers lacked training and support and felt uncomfortable with the topic. They were not used to interactive teaching methods and sometimes breached confidentiality. Teachers' negative attitudes constrained students from seeking information. The authors conclude that training interventions should be provided to teachers to increase their self-confidence, foster more positive attitudes, and stimulate interactive teaching methods. The Ministry of Education needs to have a clear policy toward the promotion of condoms.
10. Kenyan in-school youths' level of understanding of abstinence, being faithful, and consistent condom use terms: implications for HIV-prevention programs. Lillie T, Pulerwitz J, Curbow B. J Health Commun 2009;14(3):276-92.
Kenyan in-school youth ages 13-19 years (N = 1,375) were surveyed before an HIV-prevention intervention was implemented. As part of the survey, students wrote their definitions of the terms "abstinence," "being faithful," and "consistent condom use." These definitions were qualitatively analyzed by determining recurrent themes, developing a codebook, and having two coders code the responses. The entire definition was assigned an overall code of fully comprehended, partly comprehended, did not comprehend, or no response in comparison to the conventional definition of the term. Overall, 48% fully comprehended abstinence, 20% fully comprehended being faithful, and 7% fully comprehended consistent condom use.
11. Knowledge, practices, and attitudes regarding emergency contraception among students at a university in Ghana. Addo VN, Tagoe-Darko ED. Int J Gynaecol Obstet 2009;105(3):206-9.
An anonymous, self-administered, 39-item questionnaire was sent to 3,200 students. The sample size was stratified, and 2,292 students were randomly selected. Of the 71.6% of students who responded, 51.4% had heard of emergency contraception (EC). Among those, 19.4% thought EC consisted of contraceptive pills, 19.1% of "morning-after pills," and 12.8% of an intrauterine device. Only 4.2% had ever used EC, but 73.9% wished it were provided on campus. Of all the respondents, 90.9% called for the establishment of a reproductive health counseling center on campus.
12. Maternal acceptance of human papillomavirus vaccine in Malaysia. Sam IC, Wong LP, Rampal S, et al. J Adolesc Health 2009;44(6):610-12.
Acceptability rates of human papillomavirus (HPV) vaccination by 362 Malaysian mothers were 65.7% for daughters and 55.8% for sons. Younger mothers, and those who knew someone with cancer, were more willing to vaccinate their daughters. If the vaccine was routine and cost free, acceptability rate was 97.8%.
13. Milking the cow: young women's construction of identity and risk in age-disparate transactional sexual relationships in Maputo, Mozambique. Hawkins K, Price N, Mussa F. Glob Public Health 2009;4(2):169-82.
This study employed peer ethnography to explore young women's construction of social identity and risk within age-disparate transactional sexual relationships in Maputo, Mozambique. Peer ethnography is a rapid approach based upon training members of the target group to carry out in-depth qualitative interviews with their peers. The study highlighted young women's perception of agency and power in these relationships. Through a strategy of using their sexuality to extract financial and material resources from men, young women construct a positive identity and esteem linked to perceptions of modernity and consumption and their ability to access consumer goods. Current behavior change HIV prevention messages have little meaning in relation to young women's perceived goals, in a context in which conditions offer few opportunities and limited hope for a secure economic future.
14. Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study. Raj A, Saggurti N, Balaiah D, et al. Lancet 2009;373(9678):1883-9.
The authors assessed the prevalence of child marriage -- i.e., before 18 years of age -- in young adult women in India, and the associations between child marriage and women's fertility and fertility-control outcomes. Data from the National Family Health Survey-3 (2005-06) were limited to a sample of Indian women aged 20-24 years (n=22,807), of whom 14,813 had been or were presently married (ever-married). Prevalence of child marriage was estimated for the whole sample. They used regression models adjusted for demographics, and models adjusted for demographics and duration of marriage to estimate odds ratios for the associations between child marriage and both fertility and fertility-control outcomes, in the ever-married subsample. About 45% of women aged 20-24 years were married before age 18 years, 22.6% were married before age 16 years, and 2.6% were married before age 13 years. Child marriage was significantly associated with no contraceptive use before first childbirth, high fertility (three or more births), a repeat childbirth in less than 24 months, multiple unwanted pregnancies, pregnancy termination, and female sterilization. The association between child marriage and high fertility, a repeat childbirth in less than 24 months, multiple unwanted pregnancies, pregnancy termination, and sterilization all remained significant after controlling for duration of marriage. The authors conclude that increased enforcement of existing policies is crucial for preventing child marriage. Improved family-planning education, access, and support are urgently needed for women married as children, their husbands, and their families.
