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I. PROGRAM RESOURCES
1. Adolescence in Pakistan: Sex, Marriage and Reproductive Health
2. Child Pornography: Model Legislation & Global Review
3. Costing Adolescent Reproductive Health Intervention Studies: Preliminary Results from a Study in Tamil Nadu, India
4. Education Sector Global HIV & AIDS Readiness Survey 2004
5. Family Planning for Married Adolescent Girls
6. ICT for Development Success Stories: Youth, Gender, and Poverty
7. Reproductive Tract Infections among Married Adolescents in Rural Tamil Nadu
8. Spending Requirement Presents Challenges for Allocating Prevention Funding under the President's Emergency Plan for AIDS Relief
9. Suffering to Succeed? Violence and Abuse in Schools in Togo
10. What Future? Street Children in the Democratic Republic of Congo
II. RESEARCH SUMMARIES
1. "At the bottom of the social heap": a youth underclass in inner-city Harare?
2. Adolescents' use of maternal and child health services in developing countries
3. Decrease of human immunodeficiency virus prevalence in antenatal clinics in Abidjan, Cote d'Ivoire, 1995-2002
4. A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador
5. Disclosure of HIV infection from the perspective of adolescents living with HIV/AIDS and their parents and caregivers
6. Factors associated with condom use and knowledge about STD/AIDS among teenagers in public and private schools in Sao Paulo, Brazil
7. Factors associated with the reproductive health risk behavior of high school students in the Republic of the Marshall Islands
8. Gender role beliefs at sexual debut: qualitative evidence from two Brazilian cities
9. Reasons for condom use among young people in KwaZulu-Natal: prevention of HIV, pregnancy or both?
10. Reproductive knowledge, attitudes and behavior among adolescent males in Tehran, Iran
11. Trends in HIV-1 in young adults in south India from 2000 to 2004: a prevalence study
12. What is youth-friendly? Adolescents' preferences for reproductive health services in Kenya and Zimbabwe
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I. PROGRAM RESOURCES
1. Adolescence in Pakistan: Sex, Marriage and Reproductive Health (PDF, 323 KB, 2006)
This report presents research indicating Pakistani youth have little knowledge of reproductive health information. The authors conclude that interventions should be targeted at both young people and the people who serve as sources of information in the community.
Contact: research@mariestopes.org.uk
2. Child Pornography: Model Legislation & Global Review (PDF, 445 KB, 2006)
This report presents the findings from a global evaluation of current policies relating to the exploitation of children on the Internet. Based on lack of comprehensive international protection laws, recommendations for model legislation include clearly defining child pornography, ensuring criminal penalties, and establishing mandatory reporting requirements.
Contact: jderder@ncmec.org
3. Costing Adolescent Reproductive Health Intervention Studies: Preliminary Results from a Study in Tamil Nadu, India (PDF, 60 KB, 2006)
This research brief presents results from a cost analysis of an adolescent reproductive health intervention that found that using community health workers was less expensive than using doctors for provision of reproductive health services to young women.
Contact: rpande@icrw.org
4. Education Sector Global HIV & AIDS Readiness Survey 2004 (PDF, 2.14 MB, 2006)
This report presents the results of the first international survey of the education sector's capacity to manage the impact of HIV/AIDS. The surveys were designed to help nations understand the impact of HIV/AIDS, identify key problems in their response to the epidemic, and guide future programming and policies.
Contact: info-iatt@unesco.org
5. Family Planning for Married Adolescent Girls (PDF, 153 KB, 2006)
This two-page technical brief emphasizes that young married women are the most vulnerable sub-group of the sexually active population because health care providers ignore their needs, despite their need for adequate contraceptive options.
Contact: tnorton@jhuccp.org
6. ICT for Development Success Stories: Youth, Gender, and Poverty (2006)
This publication highlights global youth, gender, and poverty programs that use information and communication technologies in the following categories: health, education, use of mass media, and environment.
Contact: gkps@gkpsecretariat.org.my
7. Reproductive Tract Infections among Married Adolescents in Rural Tamil Nadu (PDF, 38 KB, 2006)
This brief presents the results from a baseline study on two different approaches to increase correct diagnosis and treatment of reproductive tract infections among young women. The study found that low levels of treatment-seeking may indicate barriers to service or may result because women are reluctant to seek care until symptoms persist over time.
Contact: rpande@icrw.org
8. Spending Requirement Presents Challenges for Allocating Prevention Funding under the President's Emergency Plan for AIDS Relief (PDF, 1.5 MB, 2006)
This report from the U.S. government found that because of the restrictions placed on the President's Emergency Plan for AIDS Relief funding, implementation teams on the ground face specific challenges related to HIV prevention programs. Spending requirements mandate that 33 percent of prevention programs focus on the abstinence/faithfulness model. However, because some small country teams are exempt, other countries must spend more than 33 percent of their budget on these programs, challenging their ability to respond to local prevention needs.
Contact: gootnickd@gao.gov
9. Suffering to Succeed? Violence and Abuse in Schools in Togo (PDF, 3 MB, 2006)
This booklet presents the results of five programs on violence and abuse in schools in Togo. The main forms of violence against children in schools are: corporal punishment, forced labor, sexual harassment, and sexual violence.
Contact: Stefanie.conrad@plan-international.org
10. What Future? Street Children in the Democratic Republic of Congo (PDF, 1.52 MB, 2006)
This report profiles the dangers in the lives of street children in the urban areas of the Republic of Congo. The report alleges that sexual, physical, and emotional abuse of street children is common from civilians, police, and older street children. This report also reviews the major issues that push children into the streets including HIV/AIDS, lack of education, and violence in the home.
Contact: hrwnyc@hrw.org
II. RESEARCH SUMMARIES
1. "At the bottom of the social heap": a youth underclass in inner-city Harare? Kamete AY. J Youth Stud 2006;9(1).
This article explores the possibilities of the formation of an underclass among the inner-city youth of Harare. Using indicators developed by Roberts and other scholars, the paper suggests something different is happening among the inner-city youth. While not proclaiming the existence of an underclass, the paper traces the emergence of a distinct inner-city social group to both structural and cultural factors.
2. Adolescents' use of maternal and child health services in developing countries. Reynolds HW, Wong EL, Tucker H. Int Fam Plann Perspect 2006;32(1).
This logistic regression analysis of Demographic and Health Survey data for 15 developing countries examined adolescents' use of antenatal care, delivery care, and infant immunization services compared with use by older women. In general, the use of maternal and child health care did not vary by mother's age. In five of the 15 countries, women aged 18 or younger were less likely than women aged 19–23 to use either antenatal care or delivery care, or both (odds ratios, 0.5–0.9). Younger mothers in six countries were less likely than older mothers to have their infants immunized, particularly for diphtheria, pertussis, and tetanus (DPT) and for measles (0.5–0.8). The association of age and health care use was largely limited to Bangladesh, India, Indonesia, Nicaragua, Peru, and Uganda. In Latin America, controlling for parity allowed differences between adolescents and older women to emerge. Except in Uganda, there were no differences in health care use by mother's age in the African countries. Country-specific investigations are needed in Asia to better understand the reasons for differences in service use by age. In general, further systematic evidence would help identify long-term interventions that will be most effective in increasing adolescents' use of maternal and child health services.
3. Decrease of human immunodeficiency virus prevalence in antenatal clinics in Abidjan, Cote d'Ivoire, 1995-2002. Msellati P, Sakarovitch C, Bequet L, Atta H, Alioum A, Viho I et al. Int J STD AIDS 2006;17(1).
This study sought to describe HIV prevalence trends from 1995-2002 in pregnant women consulting antenatal clinics in Abidjan, Cote d'Ivoire. The study proposed HIV tests to pregnant women consulting antenatal clinics in Abidjan from 1995-2002 in a programme of prevention of mother-to-child transmission of HIV. Yearly prevalence was estimated. Overall, 36,442 women were tested. Prevalence decreased from 14-15% in 1995-96 to 11% in 2002. The prevalence among 18- to 22-year-old women dropped from 15% in 1995 to 8% in 2002, while for older women it increased slightly, or remained stable from 1995-1999 and decreased thereafter. HIV prevalence among women consulting antenatal clinics has been decreasing overall. This is the first such report among pregnant women in Abidjan, probably the result of different phenomena: aging of the epidemic and behavior changes (disease awareness and prevention campaigns).
4. A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador. Springer AE, Selwyn BJ, Kelder SH. BMC Int Health Hum Rights 2006;6(1).
This study examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains — aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors — among public secondary school students in central El Salvador. It employed a multi-stage sampling design in which school districts, schools, and classrooms were randomly selected. Data were collected using a self-administered questionnaire based on the United States Center for Disease Control and Prevention's Youth Risk Behavior Survey. Sixteen schools and 982 students aged 12-20 years participated in the study. Health risk behaviors with highest prevalence rates included: engagement in physical fight (32.1%); threatened/injured with a weapon (19.9%); feelings of sadness/hopelessness (32.2%); current cigarette use (13.6%); and no condom use at last sexual intercourse (69.1%). Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%). A high percentage of Salvadoran adolescents in this sample engaged in health risk behaviors, warranting enhanced adolescent health promotion strategies. Future health promotion efforts should target: the young age of sexual intercourse as well as low condom use among students, the higher prevalence of risk behaviors among urban students, and the important gender differences in risk behaviors, including the higher prevalence of reported feelings of sadness, suicidal ideation, and forced sexual intercourse among females, and higher sexual intercourse and substance use among males. Relevance of findings within the Salvadoran and the cross-national context and implications for health promotion efforts are discussed.
5. Disclosure of HIV infection from the perspective of adolescents living with HIV/AIDS and their parents and caregivers. Marques HH, Silva NG, Gutierrez PL, Lacerda R, Ayres JR, Dellanegra M et al. Cad Saude Publica 2006;22(3).
The study sought to identify relevant issues in the disclosure of HIV-positive status in children and adolescents, aiming to improve the quality of their healthcare. A qualitative study included adolescents living with HIV/AIDS and their parents and caregivers at AIDS reference services in Sao Paulo and Santos, Brazil. In-depth interviews and focus group were used. The main reasons for disclosure were: poor treatment adherence, sexual maturity, adolescent's request, and inadequate procedures by medical staff. Disclosure was a critical moment for adolescents, with a strong impact on their life plans and horizons. Adolescents infected through sexual transmission and drug use reported the most problematic scenes involved in disclosure. Despite its initial negative impact, disclosure resulted in improved healthcare and better dialogue among the adolescents, caregivers, and healthcare providers. The adolescents also requested clear, no-nonsense, honest information. The authors conclude that health services need to actively provide an adequate approach to facilitate disclosure of HIV-positive status to children and adolescents, realizing that it is a long-term process supported by the family and a multidisciplinary team.
6. Factors associated with condom use and knowledge about STD/AIDS among teenagers in public and private schools in Sao Paulo, Brazil. Martins LB, da Costa-Paiva LH, Osis MJ, de Sousa MH, Pinto-Neto AM, Tadini V. Cad Saude Publica 2006;22(2).
This study aimed to compare knowledge about STI/AIDS and identify the factors associated with adequate knowledge and consistent use of male condoms in teenagers from public and private schools in the city of Sao Paulo, Brazil. The study selected 1,594 adolescents ranging from 12 to 19 years of age in 13 public schools and 5 private schools to complete a questionnaire on knowledge of STI/AIDS and use of male condoms. Prevalence ratios were computed with a 95% confidence interval. The score on STI knowledge used a cutoff point corresponding to 50% of correct answers. Consistent use of male condoms was 60% in private and 57.1% in public schools (p > 0.05) and was associated with male gender and lower socioeconomic status. Female gender, higher schooling, enrollment in private school, Caucasian race, and being single were associated with higher knowledge of STIs. Teenagers from public and private schools have adequate knowledge of STI prevention, however this does not include the adoption of effective prevention. Educational programs and STI/AIDS awareness-raising should be expanded in order to minimize vulnerability.
7. Factors associated with the reproductive health risk behavior of high school students in the Republic of the Marshall Islands. Suzuki K, Motohashi Y, Kaneko Y. J Sch Health 2006;76(4).
This study used data from a survey conducted among high school students from grades 9 through 12 at 2 schools in Majuro, the capital of the Marshall Islands. The questions inquired about knowledge, attitude, and behavior related to reproductive health, experience of sexual acts, and pregnancy. Multiple logistic regression analysis was performed to assess the association between risk behavior and knowledge, attitude, and other factors. Data obtained from 433 students were used in the analysis. Factors significantly associated with reproductive health risk behavior among both the boys and the girls were a negative attitude toward condom use (odds ratio of the risk group to the low-risk group: boys, 19.54; girls, 4.10), not considering receiving public health information and services as a human right (8.10, 3.96), and not knowing where to go for consultation about questions and concerns related to sex (3.32, 4.73). A factor associated with risk behavior in boys alone was acceptance of sexual acts without love (8.46), and factors in girls alone were insufficient knowledge concerning routes of infection by sexually transmitted diseases (6.75) and lack of future life plans (5.00). Neither age nor sex education was a significant predictor. In conclusion, considering reproductive health not to be a personal right was associated with the risk behavior of high school students in the Marshall Islands in regard to reproductive health.
8. Gender role beliefs at sexual debut: qualitative evidence from two Brazilian cities. Moore AM. Int Fam Plann Perspect 2006;32(1).
Twenty-four focus groups on women's beliefs about gender roles at sexual debut were conducted in 2002 with low- and middle-income women aged 18–21 and 30–39 who were recruited from public and private venues in Recife, capital of Pernambuco, and Belo Horizonte, capital of Minas Gerais, Brazil. The data were analyzed for common themes, and quotations were chosen to illustrate those themes. Focus group participants perceived that men have an urgent need for sex. This perception caused women to fear abandonment, anger or violence if they refused to have sex with their partner. The participants believed that women had to be passive the first time they had sex because taking the initiative (for example, by asking their partner to practice contraception) would lead him to accuse them of having previous sexual experience. Also, they believed they had to say no to sex under all circumstances to protect their reputation. To decrease the occurrence of unwanted intercourse, interventions must address the social expectations that influence men's and women's sexual behavior.
9. Reasons for condom use among young people in KwaZulu-Natal: prevention of HIV, pregnancy or both? Maharaj P. Int Fam Plann Perspect 2006;32(1).
Data collected in 2001 from 2,067 sexually active men and women aged 15–24 in KwaZulu-Natal were examined in bivariate and multivariate analyses to assess reasons for condom use, and levels and determinants of use. Overall, 59% of respondents said that they used condoms at last sexual intercourse, including 6% who used them with another method. The main reason for use (cited by 64% of users) was protection against both pregnancy and HIV infection. Two-thirds of respondents thought that becoming or making someone pregnant in the next few weeks would be a big problem; fewer than one in five viewed their risk of HIV infection as medium or high. Among both sexes, young people who would consider a pregnancy highly problematic were more likely to use condoms than their counterparts who would view a pregnancy as no problem (odds ratios, 1.4–2.3). In sharp contrast, young men and women who perceived themselves as having a medium to high risk of HIV infection were less likely to use condoms than their counterparts who perceived themselves as being at no risk (0.2–0.3). Prevention programs could increase condom use in this population by increasing awareness of the twin risks of pregnancy and HIV infection, and by promoting condoms for protection against these dual risks.
10. Reproductive knowledge, attitudes and behavior among adolescent males in Tehran, Iran. Mohammadi MR, Mohammad K, Farahani FK, Alikhani S, Zare M, Tehrani FR et al. Int Fam Plann Perspect 2006;32(1).
A population-based study of 1,385 males aged 15–18 in Tehran was conducted using a self-administered questionnaire. Participants were questioned about their beliefs and knowledge regarding reproductive health, and asked whether they had engaged in sexual activity. Bivariate and multivariate analyses were performed to identify factors associated with sexual knowledge, attitudes and behavior. Twenty-eight percent of the sample reported having engaged in sexual activity. Sexual experience was associated with older age, access to satellite television, alcohol consumption, and permissive attitudes toward sex. Substantial proportions of respondents held misconceptions regarding condoms, STIs, and reproductive physiology. Attitudes toward premarital sex were more permissive among respondents who were older, were not in school, had work experience, had access to the Internet or satellite television, lived separately from their parents, or reported having used alcohol, cigarettes, or drugs. The relatively high prevalence of sexual activity and the lack of knowledge regarding STIs and contraceptives pose a significant threat to the sexual and reproductive health of adolescent males in Iran. Programs are needed to provide adolescents with the information and skills to make safe sexual decisions.
11. Trends in HIV-1 in young adults in south India from 2000 to 2004: a prevalence study. Kumar R, Jha P, Arora P, Mony P, Bhatia P, Millson P et al. Lancet 2006;367(9517).
The study analysed unlinked, anonymous HIV-1 prevalence data from 294,050 women attending 216 antenatal clinics and 58,790 men attending 132 STI clinics in 2000-04. Southern and northern states were analysed separately. The age-standardised HIV-1 prevalence in women aged 15-24 years in southern states fell from 1.7% to 1.1% in 2000-04 (relative reduction 35%; p(trend) < 0.0001, yearly reduction 11%), but did not fall significantly in women aged 25-34 years. Reductions in women aged 15-24 years were seen in key demographic groups and were similar in sites tested continuously or in all sites. Prevalence in the north was about a fifth of that in the south, with no significant decreases (or increases) in 2000-04. Prevalence fell in men aged 20-29 years attending STI clinics in the south (p(trend) < 0.0001), including those with ulcerative STIs (p(trend) = 0.0008), but reductions were more modest in their northern counterparts. A reduction of more than a third in HIV-1 prevalence in 2000-04 in young women in south India seems realistic, and is not easily attributable to bias or to mortality. This fall is probably due to rising condom use by men and female sex workers in south India, and thus reduced transmission to wives. Expansion of peer-based condom and education programs for sex workers remains a top priority to control HIV-1 in India.
12. What is youth-friendly? Adolescents' preferences for reproductive health services in Kenya and Zimbabwe. Erulkar AS, Onoka CJ, Phiri A. Afr J Reprod Health 2005;9(3).
While there has been increased attention to youth-friendly reproductive health services, little research has been conducted among adolescents in developing countries to assess what characteristics of reproductive health services are most important to them. Large scale population-based surveys were carried out among youth in Kenya and Zimbabwe. A list of characteristics that programmers often think of as youth-friendly was read to respondents, after which they were asked to assess the importance of those characteristics in choosing their reproductive health services. Adolescents rated confidentiality, short waiting time, low cost and friendly staff as the most important characteristics. The least important characteristics included youth-only service, youth involvement and young staff, suggesting that adolescents do not prioritize stand-alone youth services such as youth centres, or necessarily need arrangements particular to youth such as youth involvement. The findings imply that most existing clinical services, even in the most resource-poor settings, are in a position to improve their level of youth friendliness.
