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I. PROGRAM RESOURCES
1. Adolescent Marriage and Childbearing in India: Current Situation and Recent Trends
2. Advocating for Sexual Abuse Free Classrooms
3. Analyzing the Cost-effectiveness of Interventions to Benefit Orphans and Vulnerable Children: Evidence from Kenya and Tanzania
4. Evaluating the Impact of Community-based Interventions on Schooling Outcomes among Orphans and Vulnerable Children in Lusaka, Zambia
5. Exchange on HIV, Sexuality and Gender: HIV and AIDS Information for Young People
6. Family Health Research: Evidence-based Interventions for Youth
7. Momentum: HIV and Children
8. Reaching Out to Teen Mothers in Malawi
9. Reaching Youth Through Community Strategies
10. Sexual and Reproductive Health of Women and Adolescent Girls Living with HIV: Guidance for Health Managers, Health Workers and Activists
11. Situational Analysis of Orphaned and Vulnerable Children in Eight Zimbabwean Districts
12. Supporting Highly Vulnerable Children: Progress, Promise and Partnership
13. Their Protection is in Our Hands - The State of Global Child Trafficking for Sexual Purposes
II. RESEARCH SUMMARIES
1. Access to sexual and reproductive health for young people: bridging the disconnect between rights and reality
2. Adolescent childbearing in Nicaragua: a quantitative assessment of associated factors
3. Adolescent sexual and reproductive health in developing countries: an overview of trends and interventions
4. Condom use amongst out of school youths in a local government area in Nigeria
5. Correlates of misperceptions in HIV knowledge and attitude towards people living with HIV/AIDS (PLWHAs) among in-school and out-of-school adolescents in Ghana
6. Early coital debut and associated HIV risk factors among young women and men in South Africa
7. Exposure to information and communication about HIV/AIDS and perceived credibility of information sources among young people in northern Tanzania
8. Gender differences in intention to remain a virgin until marriage among school pupils in rural northern Tanzania
9. Health discourse, sexual slang and ideological contradictions among Mozambican youth: implications for method
10. Patterns and trends in adolescents' contraceptive use and discontinuation in developing countries and comparisons with adult women
11. Premarital romantic partnerships: attitudes and sexual experiences of youth in Delhi, India
12. Premarital sexual behavior among male college students of Kathmandu, Nepal
13. Readiness of youth in rural Ethiopia to seek health services for sexually transmitted infections
14. Risk and protective factors that affect adolescent reproductive health in developing countries: a structured literature review
15. Role of parents in adolescent sexual activity and contraceptive use in four African countries
16. Youth as research fieldworkers in a context of HIV/AIDS
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I. PROGRAM RESOURCES
1. Adolescent Marriage and Childbearing in India: Current Situation and Recent Trends (2009, 32 pages, 427 KB)
Over the last decade and a half, little progress has been made in reducing the proportion of adolescents in India who become brides. While a range of socioeconomic and cultural factors may influence when a young woman gets married, past research has shown that areas where girls achieve higher levels of education have lower rates of early marriage. Keeping girls in school longer has also been found to delay early childbearing, which is rare outside of marriage in India.
Organization: Guttmacher Institute
Contact: info@guttmacher.org
2. Advocating for Sexual Abuse Free Classrooms (2009, 11 pages, 893 KB)
This booklet is part of a series that looks critically at the current risk factors for sexual abuse of children. The booklet proposes recommendations for government and other organizations involved in supporting children and communities affected by high rates of sexual abuse.
Organization: Childhope UK
Contact: info@childhope.org.uk
3. Analyzing the Cost-effectiveness of Interventions to Benefit Orphans and Vulnerable Children: Evidence from Kenya and Tanzania (2009, 28 pages, 407 KB)
To provide insight on the success of programs providing services to orphans and vulnerable children (OVC), this paper analyzes cost-effectiveness of four programs in Kenya and Tanzania by comparing intervention costs to program outcomes. These results provide some evidence that investments in OVC programs -- particularly (1) school-based HIV education and counseling for children and (2) savings and internal lending committees for guardians -- can help improve the well-being of OVCs at a fairly low cost per beneficiary.
Organization: Carolina Population Center
Contact: measure@unc.edu
4. Evaluating the Impact of Community-based Interventions on Schooling Outcomes among Orphans and Vulnerable Children in Lusaka, Zambia (2009, 42 pages, 347 KB)
This paper evaluates the impact of a community-based program implemented by a Zambian nongovernmental agency on educational outcomes among orphans and vulnerable children in Lusaka, Zambia. These outcomes included school enrollment and being at the correct age-for-grade.
Organization: Carolina Population Center
Contact: measure@unc.edu
5. Exchange on HIV, Sexuality and Gender: HIV and AIDS Information for Young People (2008, 16 pages, 3.1 MB)
This issue of Exchange magazine focuses on innovative behavior change communication and approaches that ensure that young people have the knowledge, skills, self-esteem, and support to make appropriate and responsible sexuality decisions that can empower them to avoid HIV infection.
Organization: Royal Tropical Institute and SAfAIDS
Contact: exchange@kit.nl
6. Family Health Research: Evidence-based Interventions for Youth (2009, HTML and PDF)
This newsletter explores how research results can be used to prevent unintended pregnancies and HIV infection among youth. It discusses existing evidence on successful programs and interventions, curriculum-based programs that reduce sexual risk-taking, and ways that community can bolster behavioral interventions.
Organization: Family Health International
Contact: familyhealthresearch@fhi.org
7. Momentum: HIV and Children (2009, 9 pages, 2.9 MB)
This issue of Momentum describes initiatives to increase access to low-cost, life-saving treatments to prevent mother-to-child transmission of HIV, help communities mobilize resources to assist families affected by HIV, train grandmothers to encourage HIV testing for orphans, and build a bank of evaluation data to guide programs and service delivery. The focus is on children 15 years of age and under.
Organization: Population Council
Contact: development@popcouncil.org
8. Reaching Out to Teen Mothers in Malawi (2009, 8 pages, 2.7 MB)
This case study describes a project implemented by Save the Children in Malawi that addresses the needs of adolescent mothers. The project goal was to improve the health of these girls, particularly related to family planning. However, the project also worked to address other needs of teen mothers, including physical, mental, and social support. Some activities included peer-to-peer support, community mobilization, and activities to support girls' return to school.
Organization: USAID and Save the Children
Contact: http://www.flexfund.org/about/who_we_are.cfm
9. Reaching Youth Through Community Strategies (2009, 5 pages, 334 KB)
This brief discusses the role that communities play in supporting and improving youth sexual and reproductive health. It includes steps for designing programs for youth in a community setting, strategies to reach youth through community members, links with larger community mobilization efforts, and additional technical resources.
Organization: USAID
Contact: http://www.flexfund.org/about/who_we_are.cfm
10. Sexual and Reproductive Health of Women and Adolescent Girls Living with HIV: Guidance for Health Managers, Health Workers and Activists (2009, 56 pages, 3.3 MB)
This manual offers recommendations for creating programs that protect and promote the sexual and reproductive health and rights of women and girls living with HIV and AIDS. Based on experiences in Brazil, the publication offers recommendations in four key areas: creating a political and social environment for promotion of sexual and reproductive rights; strengthening health systems to improve the availability of comprehensive sexual and reproductive health services; ensuring participation of adolescent girls and women living with HIV and AIDS in public policies and rights initiatives; and strengthening support available to them.
Organization: EngenderHealth
Contact: info@engenderhealth.org
11. Situational Analysis of Orphaned and Vulnerable Children in Eight Zimbabwean Districts (2009, 280 pages; document can be downloaded whole or in chapters)
In response to the AIDS epidemic and poverty, the Zimbabwean government and other organizations are implementing various programs aimed at assisting orphans and vulnerable children. However, the efforts of these agencies are being hampered by various challenges. This report highlights these challenges and also provides a set of recommendations for overcoming them.
Organization: HSRC
Contact: http://www.hsrcpress.ac.za/help.php?section=contactus&mode=update
12. Supporting Highly Vulnerable Children: Progress, Promise and Partnership (2009, 52 pages, 2.3 MB)
This report summarizes activities that U.S. Government agencies are undertaking together to improve programming for highly vulnerable children around the world. Key agencies implementing these programs include the U.S. Departments of Agriculture, Defense, Health and Human Services, Labor, State, the U.S. Agency for International Development (USAID), and the Peace Corps.
Organization: USAID
Contact: docorder@usaid.gov
13. Their Protection is in Our Hands - The State of Global Child Trafficking for Sexual Purposes (2009)
Summary (12 pages, 453 KB)
Full report (60 pages, 2 MB)
This report provides a global overview of the trafficking of children and young people for sexual purposes, the range of interventions needed to combat trafficking, the need for a holistic and integrated approach, and nations' goals and targets for reducing trafficking.
Organization: ECPAT International and The Body Shop
Contact: info@ecpat.net
II. RESEARCH SUMMARIES
1. Access to sexual and reproductive health for young people: bridging the disconnect between rights and reality. Shaw D. Int J Gynaecol Obstet 2009;106(2):132-6.
Of the 1.5 billion young people globally, 78% live in Asia and Africa, the poorest regions of the world. The majority of young people infected with HIV are female, and adolescent girls have a significant increased risk for maternal mortality and morbidity, such as fistula. Denial of young people's sexuality and rights by conservative and traditional forces has lethal consequences, especially for women and girls. Countries have committed to these rights through numerous international instruments and many are making progress, but challenges at the community level are significant.
2. Adolescent childbearing in Nicaragua: a quantitative assessment of associated factors. Lion KC, Prata N, Stewart C. Int Perspect Sex Reprod Health 2009;35(2):91-6.
Data from the 2001 Nicaragua Demographic and Health Survey were used to examine the sexual and reproductive behavior of 3,142 females ages 15-19. Age at sexual debut and age at first birth were assessed using life table analysis, and the impacts of various factors on these measures were then examined in Cox proportional hazard models. Among sexually active females, current use of modern contraceptives was examined using logistic regression analysis. Rural residence, rising levels of education, and greater wealth were associated with older age at sexual debut. Having had first sex before age 15 was associated with an increased risk of having an earlier first birth, whereas having first had sex at age 16 or later was associated with a decreased risk. Among sexually active females, current use of a modern method was positively associated with being married or in a stable union and with having given birth, and negatively associated with lacking health care autonomy and wanting a baby within two years.
3. Adolescent sexual and reproductive health in developing countries: an overview of trends and interventions. Hindin MJ, Fatusi AO. Int Perspect Sex Reprod Health 2009;35(2):58-62.
Today there are more than one billion 10-19 year olds, 70% of whom live in developing nations. They are growing up with greater access to formal education, an increasing need for computer skills and Internet literacy, different job opportunities, and more exposure to new ideas through media, telecommunications, and other avenues. The environment in which young people are making decisions related to sexual and reproductive health is also rapidly evolving. Rates of sexual initiation during young adulthood are rising or remaining unchanged in many developing countries; childbearing and marriage are increasingly unlinked; and in many countries, high HIV prevalence adds to the risks associated with early sexual activity.
4. Condom use amongst out of school youths in a local government area in Nigeria. Adebiyi AO, Asuzu MC. Afr Health Sci 2009;9(2):92-7.
A cross-section of 350 out-of-school youth ages 15-24 years in a local government area of Nigeria was enrolled using cluster sampling. About 75% had ever had sexual intercourse. Of these, 56.5% used no protection and 29.0% used condoms. Up to 78.6% had had sex within the preceding 12 months, with 38.9% condom use. The most common reason for not using a condom was that it reduces sexual enjoyment. Those who believed a single unprotected sexual exposure may result in HIV infection reported more condom use than those who believed otherwise. Those who had prior discussion with their partners on HIV/AIDS reported more condom use compared to those who had not. Also, those who had sexual intercourse spontaneously reported less condom use than those who had previously discussed with their partner the possibility of having sex.
5. Correlates of misperceptions in HIV knowledge and attitude towards people living with HIV/AIDS (PLWHAs) among in-school and out-of-school adolescents in Ghana. Sallar AM. Afr Health Sci 2009;9(2):82-91.
A cross-sectional quantitative and qualitative study was conducted among adolescents ages 10-19 (n = 483; mean age, 16.6) in the Ashanti region of Ghana. When asked how to prevent acquiring AIDS, participants mentioned sexual abstinence (78.1%), condom use (72.7%), fidelity to partner (72.5%), not sharing needles (76.4%), and reducing sexual partners (56.7%). Statistically significant associations were found in high misperception scores and having negative attitudes toward PLWHAs (0.001 < p < 0.009). Out-of-school adolescents were less likely to be willing to take care of relatives with HIV/AIDS, allow PLWHAs to conceal their status, or allow PLWHAs to work with others. Out-of-school students were also more likely to provide PLWHAs with less healthcare, and they indicated that PLWHAs should be isolated. The author concludes that out-of-school adolescents constitute a hard-to-reach population, and mechanisms should be developed to help reduce their misperceptions that fuel stigma and discrimination.
The full text (PDF, 173 KB) is available online.
6. Early coital debut and associated HIV risk factors among young women and men in South Africa. Pettifor A, O'Brien K, Macphail C, et al. Int Perspect Sex Reprod Health 2009;35(2):82-90.
Data from a nationally representative survey that included 7,692 sexually active South African youth ages 15-24 were used to assess characteristics related to sexual debut and to respondents' first sexual partner. Poisson regression analyses were conducted to identify relationships among these characteristics and partner age differences, early coital debut (i.e., before age 15), forced sex with one's first partner, and nonuse of condoms at first sex. Eighteen percent of young men and 8% of young women reported early coital debut. The likelihood of early debut was elevated among females and males who had had an older first partner and among females who had had forced sex. Lack of condom use at first sex was associated with early coital debut and forced sex for males. Among females, the likelihood of nonuse was elevated for respondents who had had an early debut but had not had forced sex, and among those who had had both a later debut and forced sex. Intervention efforts should encourage youth to delay coital debut and promote strategies to make young people's first sexual experience safer.
7. Exposure to information and communication about HIV/AIDS and perceived credibility of information sources among young people in northern Tanzania. Bastien S, Leshabari M, Klepp K-I. Afr J AIDS Res 2009;8(2):213-22.
A structured face-to-face interview was completed by 993 young people out of school, between the ages of 13 and 18, in Kilimanjaro, Tanzania; additionally, the questionnaire was self-administered by 1,007 students attending either their last year of primary or first year of secondary school. Significant factors associated with the frequency of exposure to HIV/AIDS information and frequency of communication about HIV/AIDS included urban/rural location, sex, socio-economic status, and educational attainment. Both groups ranked the radio as the most frequent source of HIV/AIDS information. The in-school group reported significantly more frequent exposure to all sources of HIV/AIDS information, and they communicated more frequently about the topic than did the out-of-school group. The in-school group gave high credibility ratings to medical doctors, the radio, and parents as sources of information, whereas the out-of-school group attributed the most credibility to the mass media. Irrespective of school attendance, the young people ranked friends, parents, and doctors as preferred communicators of sexual and reproductive health information.
8. Gender differences in intention to remain a virgin until marriage among school pupils in rural northern Tanzania. Njau B, Mtweve S, Manongi R, et al. Afr J AIDS Res 2009;8(2):157-66.
This study was conducted in 10 districts in northern Tanzania in July 2005. Out of 65 villages, four were randomly selected. In total, 953 primary school pupils, ages 10 to 14 years, participated in an interview and questionnaire. About 54% were girls and 41% were ages 12 to 13. Thirty-four percent of boys and 28.5% of girls said they had the intention to remain a virgin until marriage. Among the male respondents, having the intention to remain a virgin until marriage was associated with sharing a bedroom with a brother under age 18 years and with saying that girls have the right to say no to sex. Among the female respondents, having the intention to remain a virgin until marriage was associated with living with both parents and saying that they had the confidence to refuse sex with someone who has authority or power.
9. Health discourse, sexual slang and ideological contradictions among Mozambican youth: implications for method. Groes-Green C. Cult Health Sex 2009;11(6):655-68.
Findings from fieldwork on condom use among young people in Mozambique confirm the need to remain alert to the ideological and linguistic bias of applied research methods. Using conventional health discourse to interview young people about their sexuality resulted in incorrect or socially acceptable answers rather than accurate information about their sexual behavior. In order to gain a deeper understanding of sexual cultures and to make HIV prevention efforts relevant to young people, the author suggests that researchers and policy-makers approach respondents with a language that is sensitive to the local ideological and linguistic context.
10. Patterns and trends in adolescents' contraceptive use and discontinuation in developing countries and comparisons with adult women. Blanc AK, Tsui AO, Croft TN, et al. Int Perspect Sex Reprod Health 2009;35(2):63-71.
Demographic and Health Survey data from more than 40 countries were used to examine the proportions of 15- to 19-year-old women who are currently married or are unmarried but sexually active; their rates of contraceptive adoption, current use, discontinuation, method switching and contraceptive failure; trends in these indicators; and comparisons with older women. In many countries, the proportion of adolescent women using contraceptives increased substantially over the last two decades. Prevalence among adolescents increased faster than among older women. Greater proportions of adolescents than of older women discontinued using a contraceptive method within a year or experienced contraceptive failure. The authors conclude that expanded demand for contraceptive supplies, services, and information can be expected to challenge the preparedness, capacity, and resources of existing family planning programs and providers.
11. Premarital romantic partnerships: attitudes and sexual experiences of youth in Delhi, India. Jaya J, Hindin MJ. Int Perspect Sex Reprod Health 2009;35(2):97-104.
Attitudes toward and behavior within romantic partnerships were examined using data collected in 2004 from unmarried youth (583 males and 475 females, ages 15-19) living in economically disadvantaged neighborhoods in Delhi, India. Associations between specific attitudes or behaviors and age, gender, and sexual experience were determined using Fisher's exact tests. Sixty-two percent of males and 53% of females reported that someone of the opposite sex had expressed an interest in them; 86% of males and 63% of females reported feeling good about it. In addition, 67% of males and 47% of females reported that they liked someone of the opposite sex. Compared with females, males were more likely to seek information about the person they were interested in (76% vs. 61%), and to engage in heterosexual premarital sex (32% vs. 6%). Females were less likely than males to report that it is okay to engage in premarital sex if the male and female love one another (14% vs. 33%). For both males and females, television and films were the most popular source of information on issues related to sexual health. Gender disparities in the formation of premarital romantic partnerships and in the experience of sexual relations make a strong case for sexuality education programs tailored differently for young men and for young women.
12. Premarital sexual behavior among male college students of Kathmandu, Nepal. Adhikari R, Tamang J. BMC Public Health 2009;9(Article No.241):9p.
A cross-sectional survey of male college students in Kathmandu was conducted between April and May 2006. A self-administered questionnaire was completed by 573 male students. Association between premarital sex and the explanatory variables was assessed. Despite the religious and cultural restrictions, about two-fifths of survey respondents (39%) reported that they had had premarital sex. The study also showed that substantial proportions of students indulge in sexual activities as well as risky sexual behavior. Sex with commercial sex workers and multiple sex partners, and inconsistent use of condoms with non-regular partners were common among the students. Less than two in five male students (57%) had used condoms at first sexual intercourse. Students aged 20 and above were more likely to have had premarital sex compared with younger students ages 15-19. Students who believe in Hindu religion were more than two times more likely to have premarital sex compared with those who follow other religions. Participants who had close unmarried friends who experienced premarital sexual intercourse were eight times more likely to be sexually active than those who did not have such sexually active friends. School- or college-based sexuality education could benefit out-of-school youths as well, because their partners often are students.
The full text is available online (PDF, 235 KB).
13. Readiness of youth in rural Ethiopia to seek health services for sexually transmitted infections. Molla M, Emmelin M, Berhane Y, et al. Afr J AIDS Res 2009;8(2):135-46.
The authors performed a cross-sectional survey among 3,743 randomly selected youths ages 15-24 years in 2004, and in-depth interviews with 10 health care providers in 2006. Less than 38% of the youths knew the common STIs. Among the sexually active youths (n = 802), 3.9% reported having at least one STI symptom in the past 12 months, and half of those who had had an STI symptom did not seek care from any source. The healthcare providers reported that the stigma associated with premarital sexual activity, the shamefulness of having an STI, and a perceived lack of confidentiality and uneasiness with the public health services were impediments to treatment-seeking in the study area. The youths in this study preferred to consult with health care providers of the same gender who were young, friendly, and had a reputation for being empathetic. Embarrassment about having an STI and fear of being noticed by a familiar individual were perceived barriers to seeking healthcare. The results suggest that young people are vulnerable to HIV exposure due to lack of knowledge about STIs and especially as a result of having an untreated STI.
14. Risk and protective factors that affect adolescent reproductive health in developing countries: a structured literature review. Mmari K, Blum RW. Glob Public Health 2009;4(4):350-66.
A comprehensive and systematic literature search was conducted on studies that examined factors that are most important to adolescent reproductive health relating to ever having had premarital sex, condom use, pregnancy, early childbearing, sexually transmitted infections, and HIV. While the search identified more than 11,000 publications, only 61 were retained for the final analysis. The results show that factors that were significantly associated to the outcomes were primarily related to the adolescents themselves. In fact, very few factors outside the individual were found to be related to sexual risk behaviors. This contrasts to similar research conducted among youth samples in the United States.
15. Role of parents in adolescent sexual activity and contraceptive use in four African countries. Biddlecom A, Awusabo-Asare K, Bankole A. Int Perspect Sex Reprod Health 2009;35(2):72-81.
Data were collected in 2004 in nationally representative surveys of 12- to 19-year-olds in Burkina Faso, Ghana, Malawi, and Uganda. Bivariate analysis was used to compare gender differences for two outcomes among unmarried 15- to 19-year-olds having had sexual intercourse in the last 12 months and, among those who had had sex in this period, having used contraception at last sex. Unmarried adolescents reported moderate to high levels of parental monitoring and low levels of parent-child communication about sexual matters. In all countries, adolescent males who reported low monitoring were at elevated risk of having had sex in the last year, as were their female counterparts in three of the countries. Communication with parents was positively associated with sexual activity among Malawian males and Ugandan females. Parental monitoring was not associated with contraceptive use at last sex, whereas parent-child communication was associated with such use among Ghanaian females and among Ugandan adolescents of both genders. The authors conclude that programs to improve adolescent sexual and reproductive health should include dimensions of parental involvement.
16. Youth as research fieldworkers in a context of HIV/AIDS. Francis D, Hemson C. Afr J AIDS Res 2009;8(2):223-30.
While youth-to-youth research approaches have increased in both popularity and practice, our understanding of the processes and mechanisms underlying the successes or failures of 'peer researchers' is still developing. This study addresses the question through qualitative research, drawing on observations of the process of training out-of-school youths as research fieldworkers, reflections on the interviews with respondents, and focus group discussions with the young fieldworkers. The authors found several advantages to using fieldworkers who are close in their characteristics to that of respondents. These benefits included ready access to respondents, the immediate use of language appropriate to the respondents, and an ability to swiftly establish rapport. The authors also observed several limitations: the peer researchers struggled with the wish of some respondents to establish supportive friendships with them, they lacked the authority of an academic researcher, and they sometimes resorted to false promises in attempts to get cooperation. The authors conclude that using youths as peer researchers is neither better nor worse than using professional researchers, but each approach can produce its own challenges and possibilities.
