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I. PROGRAM RESOURCES
1. Advice Columns in South African Print Publications
2. Effects of Programs Supporting Orphans and Vulnerable Children
3. Faces of Positive Change: Highlighting Positive Changes in the Lives of Orphans and Vulnerable Children in Ethiopia
4. Formative Assessment of Youth Reproductive Health Needs in Menofia and Ismailia Governorates
5. Girls' Success: Mentoring Guide for Life Skills
6. Increasing HIV/AIDS Therapy Adherence among Youth in Mozambique: the TAP/Pathfinder International Experience
7. It Works! Communication for HIV Prevention and Social Change in Adolescents: A Mid-Term Review
8. Learn without Fear -- Youth in Action against Violence in Schools
9. SAWAKA Jali Watoto Program Supporting Most-Vulnerable Children, Tanzania: A Case Study
10. A Study on Violence against Girls: Report on the International Girl Child Conference
11. Training Guide for HIV Counseling and Testing for Youth: A Manual for Providers
12. TV Soap Operas in HIV Education: Reaching out with Popular Entertainment
13. Why Women and Girls Need an AIDS Vaccine
II. RESEARCH SUMMARIES
1. Association of age at first sex with HIV-1, HSV-2, and other sexual transmitted infections among women in northern Tanzania
2. Contraceptive practices and sexual initiation among young people in three Brazilian state capitals
3. Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia
4. Empowering teenagers to prevent pregnancy: lessons from South Africa
5. Family Life and HIV/AIDS Education (FLHE) in schools in Enugu State: baseline study of reproductive health issues among in-school adolescents in Enugu State
6. HIV/AIDS education effects on behaviour among senior high school students in a medium-sized city in China
7. HIV/AIDS-related knowledge, sources and perceived need among senior high school students: a cross-sectional study in China
8. HIV prevalence and associated risk factors among individuals aged 13-34 years in rural Western Kenya
9. HIV testing among adolescents in Ndola, Zambia: how individual, relational, and environmental factors relate to demand
10. Multiple sex partner behavior in female undergraduate students in China: A multi-campus survey
11. Perception and practice of emergency contraception among female undergraduates of the University of Ibadan, Nigeria
12. Risk-taking behaviors among vertically HIV-infected adolescents in northern Thailand
13. Strategies and ethical considerations for the recruitment of young men who have sex with men: challenges of a vaccination trial in Mexico
14. Trends in primary and secondary abstinence among Kenyan youth
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I. PROGRAM RESOURCES
1. Advice Columns in South African Print Publications (2009, 17 pages, Microsoft Word, 1.44 MB)
This paper reports on a study about letters to and responses from advice columnists in 13 South African publications over a three-month period. Approximately 40 percent of letters to the columnists asked for advice about multiple concurrent partnerships, but less than half of the answers included information related to HIV and the increased risk of infection that accompanies such relationships. Instead, the columnists chose to focus on emotional or moral issues of concurrent partnerships. The paper highlights this missed opportunity to address HIV-prevention issues.
Organization: Soul City Institute for Health and Development Communication
Contact: admin@onelovesouthernafrica.org
2. Effects of Programs Supporting Orphans and Vulnerable Children (2009, 50 pages, 492 KB)
This report summarizes findings from evaluations of four programs, two in Kenya and two in Tanzania, that support orphans and other vulnerable children (OVC). The report focuses on the outcomes, emerging issues, and lessons learned. Implications of the findings are offered to provide guidance to OVC service providers, donors, and policy-makers.
Organization: MEASURE Evaluation, Futures Group International
Contact: measure@unc.edu
3. Faces of Positive Change: Highlighting Positive Changes in the Lives of Orphans and Vulnerable Children in Ethiopia (2009, 52 pages, 2.4 MB)
This book provides stories about the children, families, and communities who have participated in and benefited from the PC3 Program (Positive Change: Children, Communities, and Care). The program is a five-year (2004-2009) effort designed to provide care and support to half a million orphans and vulnerable children and their families in Ethiopia.
Organization: Save the Children
Contact: ussave@savechildren.org.et
4. Formative Assessment of Youth Reproductive Health Needs in Menofia and Ismailia Governorates (2009, 74 pages, 486 KB)
This document provides results of a formative assessment of youth reproductive health needs in two governorates of Egypt. Based on data collected, the authors recommend interventions that should be included in a strategic behavioral communication (SBC) plan designed to encourage young people to use youth-friendly services. Among the recommendations are engaging peer educators, using web-based media and mobile phone technology to reach youth, engaging parents, and mobilizing communities.
Organization: Family Health International/Egypt
Contact: publications@fhi.org
5. Girls' Success: Mentoring Guide for Life Skills (2009, 118 pages, 8.9 MB)
This guide discusses mentoring girls to help them develop important life skills. Some of the topics covered include healthy living, inner strength, making good choices, reproductive health, and sexuality. The guide provides discussion questions about each topic, and learning activities that can be conducted in mentoring sessions or when girls are in school or with their families.
Organization: Academy for Educational Development (AED) Center for Gender Equity
Contact: http://cge.aed.org/Contact.cfm
6. Increasing HIV/AIDS Therapy Adherence among Youth in Mozambique: the TAP/Pathfinder International Experience (2009, 8 pages, 455 KB)
This document provides an overview of the World Bank-funded Treatment Acceleration Project (TAP) in Mozambique. It outlines Pathfinder's comprehensive program for youth that integrates counseling, treatment, and care to promote HIV testing and antiretroviral therapy adherence for HIV-positive youth. The program demonstrates the effective role to be played by well-trained peer advocates and their collaboration with quality youth-friendly clinical services.
Organization: Pathfinder International
Contact: tech-comm@pathfind.org
7. It Works! Communication for HIV Prevention and Social Change in Adolescents: A Mid-Term Review (2009, 80 pages)
This report is a mid-term review of the Straight Talk Foundation's work on improving the sexual and reproductive health of adolescents in Uganda. It is primarily a qualitative assessment of progress made toward meeting the program's objectives and is informative for colleagues implementing similar programs in other contexts.
Organization: Straight Talk Foundation and CRC
Contact: pwalugembe@straighttalkuganda.org
8. Learn without Fear -- Youth in Action against Violence in Schools (2009, 33 pages, 2.3 MB)
Plan Germany brought together children from Colombia, Germany, Ecuador, India, the Philippines, Tanzania, and Uganda to create a manual with exercises and activities to address school violence. Activities include identifying areas in school grounds which are less safe, understanding stereotypes, and helping someone who has been hurt or bullied.
Organization: Plan International Deutschland
Contact: campaigns@plan-international.org
9. SAWAKA Jali Watoto Program Supporting Most-Vulnerable Children, Tanzania: A Case Study (2009, 26 pages, 647 KB)
In 2007-2008, the MEASURE Evaluation project evaluated the Jali Watoto (Care for Children) project in Tanzania. Jali Watoto is a child- and community-centered program that provides support to most-vulnerable children and their caregivers. The evaluation assessed the effectiveness of the program model in improving the well-being of most-vulnerable children and their caregivers in communities affected by HIV/AIDS. In addition, the paper outlines the programmatic implications of the findings for service providers and other stakeholders and makes recommendations regarding effective, replicable interventions.
Organization: MEASURE Evaluation
Contact: measure@unc.edu
10. A Study on Violence against Girls: Report on the International Girl Child Conference (2009, 100 pages, 5.8 MB)
This publication summarizes the discussions and outcomes of the International Conference on Violence against the Girl Child. The conference addressed gaps in knowledge, research, and responses to violence against girls in the home, and was a follow-up to the United Nations Secretary-General's Study on Violence against Children.
Organization: UNICEF Innocenti Research Center
Contact: florence@unicef.org
11. Training Guide for HIV Counseling and Testing for Youth: A Manual for Providers
Training guide (2008, 140 pages, 919 KB)
Manual for providers (2007, 88 pages, 496 KB)
This guide was developed to train providers to use HIV Counseling and Testing for Youth: A Manual for Providers. The training guide emphasizes an integrated approach to counseling youth during HIV testing. It features interactive exercises, participant practice sessions, PowerPoint slides, and other training tools. Among topics covered are an introduction to integrated counseling and testing services, clinical and nonclinical models of counseling and testing, major steps in providing integrated counseling and testing, an overview of sexually transmitted infections and pregnancy prevention methods, social marketing, and community support for integrated youth services.
Organization: Family Health International/Interagency Youth Working Group
Contact: youthwg@fhi.org
12. TV Soap Operas in HIV Education: Reaching out with Popular Entertainment (2009, 40 pages, 664 KB)
This document provides an overview of why and how the German Development Cooperation supports soap operas as an integral component of national and regional HIV programs. It also describes three soap operas designed to reflect and respond to three very different epidemics in Kyrgyzstan, Dominican Republic, and Côte d'Ivoire. Characters and target audiences include young people.
Organization: German HIV Peer Review Group
Contact: aidsprg@gtz.de
13. Why Women and Girls Need an AIDS Vaccine (2009, 4 pages, 813 KB)
Women's and girls' increased biological vulnerability to HIV infection, coupled with social and economic inequities, fuel the pandemic in resource-limited nations. This information sheet addresses some of the gender norms and inequalities that impede women's ability to prevent HIV infection and makes the case for development of an AIDS vaccine as a powerful equity tool.
Organization: IAVI
Contact: info@iavi.org
II. RESEARCH SUMMARIES
1. Association of age at first sex with HIV-1, HSV-2, and other sexual transmitted infections among women in northern Tanzania. Ghebremichael M, Larsen U, Paintsil E. Sex Transm Dis 2009;36(9):570-6.
The authors examined the association between age at first sex and the prevalence of sexually transmitted infections (STIs), including HIV-1 and HSV-2, in women in Moshi urban district, northern Tanzania. A total of 2,019 women aged 20 to 44 were randomly selected in a two-stage sampling, and they provided information on demographics and sexual behaviors. Blood and urine samples were drawn for STI testing. Women who had their first sexual intercourse between ages 18 and 19 (OR = 0.66; 95% CI = 0.50-0.86) or 20+ (OR = 0.46; 95% CI = 0.36-0.60) were less likely to have STIs, including HIV-1 and HSV-2, than were women who had their first intercourse before their 18th birthday. Early age at first sex was associated with having a regular noncohabitating partner, female circumcision, and coercion at first intercourse.
2. Contraceptive practices and sexual initiation among young people in three Brazilian state capitals. Marinho LF, Aquino EM, de Almeida Maria da C. Cad Saude Publica 2009;25(Suppl 2):S227-39.
This study investigated contraceptive use during first sexual intercourse among 2,790 young men and women. Researchers used the GRAVAD household survey to interview a probabilistic sample in three Brazilian capital cities. A hierarchical logistic regression analysis was used. The prevalence of contraceptive use was 68.3% for women and 65.3% for men. Among women, contraception use was associated with per capita monthly family income, color/race, and the use of women's magazines as a source of information on pregnancy and contraception. For both genders, use was more frequent when partners discussed pregnancy prevention before intercourse, when sexual initiation was delayed and in a motel, and when the partner was patient. The interval between the start of the relationship and sexual initiation appeared to be associated with use during first sex for men.
The full text (in Portuguese, 13 pages, 168 KB) is available online.
3. Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia. Kayeyi N, Sandoy IF, Fylkesnes K. BMC Public Health 2009;9(Article No.310).
This study reanalyzed data from a cross-sectional population survey conducted in Zambia in 2003. The analyses were restricted to women ages 15-24 years (n=1,295). Stratified random cluster sampling was used to select 10 urban and 10 rural clusters. A measure for neighborhood-level educational attainment was constructed by aggregating individual-level years-in-school. Multi-level mixed effects regression models were run to examine the neighborhood-level educational effect on HIV prevalence after adjusting for individual-level underlying variables (education, currently a student, marital status) and selected proximate determinants (ever given birth, sexual activity, lifetime sexual partners). HIV prevalence among young women ages 15-24 years was 12.5% in the urban and 6.8% in the rural clusters. Neighborhood educational attainment was found to be a strong determinant of HIV infection in both urban and rural populations. HIV prevalence decreased substantially by increasing level of neighborhood education. The likelihood of infection in low educational attainment areas was 3.4 times higher among rural women and 1.8 times higher among the urban women after adjusting for age and other individual-level underlying variables, including education. However, the association was not significant for urban young women after this adjustment. After adjusting for level of education in the neighborhood, the effect of the individual-level education differed by residence: there was a strong protective effect among urban women whereas it tended to be a risk factor among rural women.
The full text (11 pages, 282 KB) is available online.
4. Empowering teenagers to prevent pregnancy: lessons from South Africa. Jewkes R, Morrell R, Christofides N. Cult Health Sex 2009;11(7):675-88.
In South Africa, the rate of teenage pregnancy is high but has declined substantially over the last 20 years. In this paper, the authors argue that the key to the country's success has been an empowering social policy agenda that has sought to make young people aware of their rights and the risks of sexual intercourse. Furthermore, family responses and education policy have greatly reduced the potential negative impact of teenage pregnancy on the lives of teenage girls. However, more attention should be paid to issues of gender and sexuality, including the terms and conditions under which teenagers have sex. There needs to be critical reflection and engagement with men and boys on issues of masculinity, including their role in child rearing, as well as examination within families of their support for pregnancy prevention and their responses to pregnancies.
5. Family Life and HIV/AIDS Education (FLHE) in schools in Enugu State: baseline study of reproductive health issues among in-school adolescents in Enugu State. Nwaorgu OC, Onyeneho NG, Onyegegbu N, et al. Afr J Reprod Health 2009;13(2):17-32.
The authors studied the sexual and reproductive health (SRH) knowledge and practices among students in junior secondary school grades 1 and 3 in Enugu State, Nigeria. Results show that over 90% of the respondents were regularly involved in sexual activities. More than 17% indicated that they would definitely have sex in the next two years, while 19.2% said they might have sex in the next two years. The students lacked proper knowledge of protection, and knowledge scores on SRH issues were low, especially among the urban dwellers. Approximately 64% of respondents did not know if condoms prevent pregnancy. Some indicated that charms and herbs are effective ways of preventing pregnancy.
The full text (16 pages, 157 KB) is available online.
6. HIV/AIDS education effects on behaviour among senior high school students in a medium-sized city in China. Ye XX, Huang H, Li SH, et al. Int J STD AIDS 2009;20(8):549-52.
Few studies have examined the long-term effects of peer-led HIV prevention in Chinese adolescents. A two-year follow-up study was conducted among senior high school students in a medium-sized city of Fujian Province, from 1 March 2006 to 30 April 2008. In all, 3,068 students from 14 schools participated in an intervention in March 2006, and 893 students in five schools were followed up. Data were collected by a self-administered questionnaire at baseline, right after the intervention (one month later), and two years later. In the intervention group, the average knowledge score on information about reproductive health and HIV/AIDS and other sexually transmitted infections rose from 4.30 to 7.06 one month later (P < 0.01) and to 7.08 two years later (P < 0.01). Sustained increases were found in the attitude scores toward people living with HIV/AIDS and intention of condom use after the intervention. Future research should focus on strategies to sustain long-term behavior change.
7. HIV/AIDS-related knowledge, sources and perceived need among senior high school students: a cross-sectional study in China. Li S, Huang H, Xu G, et al. Int J STD AIDS 2009;20(8):561-5.
A total of 2,668 senior high school students, ages approximately 15-24 years, participated in a self-administered questionnaire. Information was collected on their knowledge about HIV and other sexually transmitted infections as well as their sources of information and perceived information need. Approximately 6.8% had a low level of knowledge about HIV/AIDS, 29.6% had a moderate level, and 63.7% had a high level. The most important information sources were, in rank order, TV/video (72.1%), school heath education curriculum (51.8%), and reading materials (45.7%). About half of the students confirmed a need for more information.
8. HIV prevalence and associated risk factors among individuals aged 13-34 years in rural Western Kenya. Amornkul PN, Vandenhoudt H, Nasokho P, et al. PLoS One 2009;4(7):e6470.
From a demographic surveillance system, the authors selected a random sample of Asembo, Kenya residents ages 13-34 years, who were contacted at home and invited to a nearby mobile study site. From October 2003 to April 2004, consenting participants were interviewed on risk behavior and tested for HIV and HSV-2. HIV voluntary counseling and testing was offered. Of 2,606 eligible residents, 1,822 (70%) enrolled. Primary reasons for refusal included not wanting blood taken, not wanting to learn HIV status, and partner or parental objection. Females comprised 53% of 1,762 participants providing blood. Adjusted HIV prevalence was 15.4% overall: 20.5% among females and 10.2% among males. HIV prevalence was highest in women ages 25-29 years (36.5%) and men ages 30-34 years (41.1%). HSV-2 prevalence was 40.0% overall: 53% among females, 25.8% among males. In multivariate models stratified by gender and marital status, HIV infection was strongly associated with age, higher number of sex partners, widowhood, and HSV-2 seropositivity.
The full text (11 pages, 200 KB) is available online.
9. HIV testing among adolescents in Ndola, Zambia: how individual, relational, and environmental factors relate to demand. Denison JA, McCauley AP, Dunnett-Dagg WA, et al. AIDS Educ Prev 2009;21(4):314-24.
A cross-sectional survey among randomly selected 16- to 19-year-olds in Ndola, Zambia, covered individual (e.g., HIV knowledge), environmental (e.g., distance), and relational factors (e.g., discussed voluntary counseling and testing [VCT] with family) that relate to demand for HIV testing. Multivariate regression analysis compared 98 respondents who planned to test for HIV within the year with 341 respondents who did not. Discussing HIV testing with family members was strongly associated with planning to test. Discussions with sex partners and friends about VCT were also associated with HIV testing plans. Significant individual factors were having ever had sex and HIV risk perception. Relational and individual factors strongly correlated with VCT demand, supporting the need to examine these factors when implementing and evaluating adolescent VCT strategies.
10. Multiple sex partner behavior in female undergraduate students in China: A multi-campus survey. Yan H, Chen W, Wu H, et al. BMC Public Health 2009;9(Article No.305).
A total of 4,769 unmarried female undergraduates completed anonymous questionnaires. These students were recruited using randomized cluster sampling by type of university and students' major and grade. Data gathered included information about how demographics, families, peers, work, and other factors (major, academic performance, and sex-related knowledge and attitudes) influence risk behavior. Approximately 18% (n=863) of the students reported ever having sexual intercourse, and 5.3% reported having multiple sex partners (29.3% of all women having sexual intercourse). Several demographic, family, peer and work influences, and student factors were risk factors for ever having sex. However, risk factors for multiple sex partners only included working in a place of entertainment, having current close friends that were living with boyfriends, poor academic performance, and positive attitudes toward multiple partners. These women also were more likely to practice masturbation, start having sex at a younger age, have sex with married men or men not their "boyfriends" at first coitus, and not use condoms consistently.
The full text (11 pages, 238 KB) is available online.
11. Perception and practice of emergency contraception among female undergraduates of the University of Ibadan, Nigeria. Bello FA, Olayemi O, Fawole AO, et al. J Reprod Contracept 2009;20(2):113-21.
The authors performed a cross-sectional questionnaire study with 383 female undergraduates in Nigeria, in June 2006, to assess their perceptions about and proper use of emergency contraception (EC). One hundred and five (48.2%) of the students had been sexually exposed. Only 32 (30.5%) used regular contraception. Seventy-three (24.3%) female undergraduates were aware of EC. Only 29 (7.6%) had used EC before. Most would not use EC drugs in the future due to lack of awareness (64.8%), fear for future fertility, and fear that EC was injurious to health. Use of EC was associated with awareness of correct interval for use. The authors concluded that there was poor knowledge about EC and poor use. Most knowledge was acquired from peers and was inaccurate.
12. Risk-taking behaviors among vertically HIV-infected adolescents in northern Thailand. Lee B, Oberdorfer P. J Int Assoc Physicians AIDS Care (Chic Ill) 2009;8(4):221-8.
This study reports on a quantitative survey conducted from 2007 to 2008 at two pediatric HIV clinics in northern Thailand among vertically HIV-infected adolescents aged > 13 years, with disclosed HIV status. The survey assessed sociodemographics, substance use, sexual behavior, peer behaviors, knowledge, and attitudes regarding HIV disclosure. Fifty-four adolescents (median age 14.6 years) participated; 18.5% reported previous alcohol use but none reported drug use; 35.2% reported presexual activity, and 3.7% reported sexual activity. Nearly all (96.3%) knew that HIV could be transmitted sexually, but knowledge regarding other sexually transmitted infections was poor. Nearly half (48.1%) had never disclosed their status to anyone.
13. Strategies and ethical considerations for the recruitment of young men who have sex with men: challenges of a vaccination trial in Mexico. Gutierrez-Luna A, Angeles-Llerenas A, Wirtz VJ, et al. Clin Trials 2009;6(4):365-72.
The aim of this study was to describe and analyze recruitment strategies, ethical considerations, and recruitment outcomes from a study to evaluate the efficacy of the human papilloma virus vaccine in young men who have sex with men (MSM). The recruitment settings were university and community sites in the state of Morelos, Mexico. To be eligible, participants had to be men between 18 and 23 years old who were free of anal-genital lesions as confirmed by clinical exploration, HIV negative, with no history of sexual relations with female partners, and with fewer than five male lifetime sexual partners. Recruitment goals were 25 study participants in a four and a half month period. In addition to traditional recruitment strategies (flyers and media advertising, specific training of the recruitment team, and adequate choice of recruitment sites), local leaders in the MSM community were engaged in the process. In total, 723 MSM were initially contacted, and 243 filled out the recruitment questionnaire, of which 151 met the criteria to be invited to the clinical examination. After clinical examination and interviews with the recruitment team, 131 fulfilled the inclusion criteria, of whom 73 were enrolled in the study. Attending meetings with MSM activist organizations was the most successful recruitment strategy (326), followed by recruitment at bars and dance clubs (107).
14. Trends in primary and secondary abstinence among Kenyan youth. Chiao C, Mishra V. AIDS Care 2009;21(7):881-92.
The authors used data from Kenya Demographic and Health Surveys in 1993, 1998, and 2003 to examine 10-year trends in primary and secondary abstinence among never-married youth ages 15-24 and to explore the role of HIV prevention knowledge, schooling, and contextual factors in affecting their abstinence behaviors. Their analysis shows that both primary and secondary abstinence levels have risen in the past 10 years, with the abstinence levels higher among females than among males. Logistic regression models indicate that knowledge that abstinence can prevent HIV infection was positively associated with the likelihood of practicing abstinence. However, knowledge that condom use can prevent HIV infection was associated with lower abstinence practice. In-school youth were more likely to abstain from sex than those working. Effects of the contextual variables were only significant on the likelihood of primary abstinence among female youth.
The full text (20 pages, 165 KB) is available online.
