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I. PROGRAM RESOURCES
1. Abuse Among Child Domestic Workers: A Research Study in West Bengal
2. Antiretroviral Therapy for HIV Infection in Adults and Adolescents in Resource-Limited Settings: Towards Universal Access. Recommendations for a Public Health Approach
3. Circle of Hope: Children's Rights in a World with AIDS
4. Empowering Young Women to Lead Change: A Training Manual
5. Girl Power: The Impact of Girls' Education on HIV and Sexual Behaviour
6. Moving Young: State of World Population 2006 – Youth Supplement
7. Preventing HIV/AIDS in Young People: Evidence from Developing Countries on What Works
8. Participatory Action Research: Local Causation of Primary School Drop-Outs and Exclusions in Kilimanjaro Region
9. Protecting the Next Generation – Resources from the Guttmacher Institute
10. Raising the Age of Marriage for Young Girls in Bangladesh
11. Review of the Evidence: Girls' Education and HIV Prevention
12. The Secretary General's Report on Violence against Children
13. Sexual and Reproductive Health of HIV Positive Women and Adolescent Girls: A Dialogue on Rights, Policies and Services: Global Economic Forum Report on Results
14. Sexual and Reproductive Health Needs of Women and Adolescent Girls Living with HIV: Research Report on Qualitative Findings from Brazil, Ethiopia and the Ukraine
15. Working with the Community for Improved Health: A New PRB Health Bulletin
16. Youth and Conflict: A Brief Review of Available Literature
17. Youth in a Global World
18. Youth Reproductive Health – eLearning Course
II. RESEARCH SUMMARIES
1. Achieving the global goals on HIV among young people most at risk in developing countries: young sex workers, injecting drug users and men who have sex with men
2. An adolescent-targeted HIV prevention project using African professional soccer players as role models and educators in Bulawayo, Zimbabwe
3. Before first sex: gender differences in emotional relationships and physical behaviors among adolescents in the Philippines
4. Changes in high-risk behaviors over time among young drug users in South Vietnam: a three-province study
5. Child sexual abuse and its outcomes among high school students in southwest Ethiopia
6. Conclusions and recommendations
7. Condom use among South African adolescents: developing and testing theoretical models of intentions and behavior
8. Do perceptions of friends' behaviors affect age at first sex? Evidence from Cebu, Philippines
9. The effectiveness of community interventions targeting HIV and AIDS prevention at young people in developing countries
10. The effectiveness of mass media in changing HIV/AIDS-related behaviour among young people in developing countries
11. The effectiveness of sex education and HIV education interventions in schools in developing countries
12. Efficacy of an American alcohol and HIV prevention curriculum adapted for use in South Africa: results of a pilot study in five township schools
13. The Impact of an HIV and AIDS Life Skills Program on Secondary School Students in KwaZulu-Natal, South Africa
14. Inclusion of AIDS educational messages in rites of passage ceremonies: reaching young people in tribal communities
15. Migration and vulnerability among adolescents in slum areas of Addis Ababa, Ethiopia
16. Overview of effective and promising interventions to prevent HIV infection
17. Review of the evidence for interventions to increase young people's use of health services in developing countries
18. Sexual and drug use risk behaviors among children and youth in street circumstances in Porto Alegre, Brazil
19. Sexual behaviour, contraception and fertility among in-school adolescents in Ikenne Local Government, south-western Nigeria
20. Sexual initiation, substance use, and sexual behavior and knowledge among vocational students in northern Thailand
21. 'Telling the truth is the best thing': teenage orphans' experiences of parental AIDS-related illness and bereavement in Zimbabwe
22. The transition of young people in a transitional society: the case of Serbia
23. Vulnerability and risk factors for sexually transmitted infections and HIV among adolescents in Kampala, Uganda
24. The weight of evidence: a method for assessing the strength of evidence on the effectiveness of HIV prevention interventions among young people
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I. PROGRAM RESOURCES
1. Abuse Among Child Domestic Workers: A Research Study in West Bengal (2006, PDF, 2.56 MB)
This four-year study of domestic workers in West Bengal, India, documents high levels of emotional, physical, and sexual abuse among children working as domestic helpers in Calcutta. The study also describes children's support systems and makes recommendations. Annexes profile four child domestic workers and discuss personal safety and local laws addressing abuse of children.
Organization: Save the Children
Contact: m.ray@scfukindia.org
2. Antiretroviral Therapy for HIV Infection in Adults and Adolescents in Resource-Limited Settings: Towards Universal Access. Recommendations for a Public Health Approach (2006, PDF, 1.39 MB)
This publication is a reference tool for countries as they develop or revise national guidelines for the use of antiretroviral therapy (ART) in adults and post-pubertal adolescents. It includes updated evidence, including new ART treatment options, and draws on the experience of established ART scale-up programs. Guidelines are useful for national and regional HIV program managers, managers of NGOs delivering HIV care services, and other policy-makers. Technical and clinical information are useful for clinicians in resource-limited settings.
Organization: WHO
Contact: hiv-aids@who.int
3. Circle of Hope: Children's Rights in a World with AIDS (2006, PDF, 4.34 MB)
This document describes a programmatic framework for responding to children affected by HIV/AIDS. This framework places children in the center, surrounded by families, communities, and institutions. Program examples and child profiles are provided.
Organization: Plan International
Contact: info@plan-international.org
4. Empowering Young Women to Lead Change: A Training Manual (2006)
Developed by the World YWCA and UNFPA, this training manual is designed to be used by young women to facilitate training on HIV/AIDS, leadership, economic justice, sexual and reproductive health, self esteem, and other issues. Also available in Spanish and French.
Organization: World YWCA and UNFPA
Contact: martinez@unfpa.org
5. Girl Power: The Impact of Girls' Education on HIV and Sexual Behaviour (2006, PDF, 692 KB)
This review of evidence on the impact of schooling on sexual behavior and on HIV rates (1990-2006) found that the relationship between education and HIV has evolved with the epidemic and that, currently, there is strong evidence to suggest that education has a protective effect on girls. The report includes recommendations.
Organization: Action Aid
Contact: mail.jhb@actionaid.org
6. Moving Young: State of World Population 2006 – Youth Supplement (2006, PDF, 2.32 MB)
This supplement to the State of the World's Population annual report provides a youth perspective about this year's theme, migration. Profiles of 10 young people are included that provide examples of different kinds of migration and their impact on global themes and on individual lives. Also available in French and Spanish.
Organization: UNFPA
Contact: martinez@unfpa.org
7. Preventing HIV/AIDS in Young People: Evidence from Developing Countries on What Works (2006)
Summary
Full report
This report provides evidence-based recommendations for policy-makers, program managers, and researchers to guide efforts towards meeting the UN goals on HIV/AIDS and young people. The recommendations are based on a systematic review of the effectiveness of interventions provided through schools, health services, mass media, communities, and to young people who are most vulnerable to HIV infection. The report classifies these interventions into three categories:
• Steady (don't implement yet; needs more work and evaluation)
• Ready (implement widely, but evaluate carefully)
• Go (implement on a large scale while monitoring coverage and quality)
Organization: WHO/RHR
Contact: cah@who.int
8. Participatory Action Research: Local Causation of Primary School Drop-Outs and Exclusions in Kilimanjaro Region (2006, PDF, 6.66 MB)
This research report describes the reasons why children leave school in Kilimanjaro, Tanzania, with the goal of enabling the school system to identify and assist children at risk. The study uses participatory action research with schools, teachers, government officials, and community members as a tool for social transformation, by informing and guiding recommendations to schools and communities. It also includes a profile of a vulnerable child and identifies factors that place him or her at risk.
Organization: Mkombozi Centre for Street Children
Contact: info@mkombozi.org
9. Protecting the Next Generation – Resources from the Guttmacher Institute (2006)
These resources were prepared as part of the "Protecting the Next Generation" project that is studying adolescents in Burkina Faso, Ghana, Malawi and Uganda.
Fact Sheets – These fact sheets briefly summarize findings on young people and sexual and reproductive health.
• Les adolescents au Burkina Faso (PDF, 198 KB)
• Adolescents in Ghana (PDF, 175 KB)
• Adolescents in Malawi (PDF, 175 KB)
• Adolescents in Uganda (PDF, 175 KB)
Comprehensive and Qualitative Reports – These summarize the findings from nationally representative surveys of adolescents who answered questions about relationships and sources of information and knowledge about sexual and reproductive health. Qualitative reports analyze puberty, initiation rites, knowledge of HIV and pregnancy, relationships, health problems and attitudes about HIV/AIDS, among other topics.
Comprehensive Reports
• Santé sexuelle et reproductive des adolescents au Burkina Faso: Résultats d'une enquête nationale en 2004 (PDF, 1.25 MB)
• Adolescent Sexual and Reproductive Health in Ghana: Results from the 2004 National Survey of Adolescents (PDF, 744 KB)
• Adolescent Sexual and Reproductive Health in Malawi: Results from the 2004 National Survey of Adolescents (PDF, 909 KB)
• Adolescent Sexual and Reproductive Health in Uganda: Results from the 2004 National Survey of Adolescents (PDF, 862 KB)
Qualitative Reports
• Expériences d'adolescents en santé sexuelle et reproductive au Burkina Faso (PDF, 709 KB)
• Qualitative Evidence of Adolescents' Sexual and Reproductive Health Experiences in Selected Districts of Malawi (PDF, 1.19 MB)
Organization: Guttmacher Institute
Contact: buyit@guttmacher.org
10. Raising the Age of Marriage for Young Girls in Bangladesh (2006, PDF, 772 KB)
This report describes a three-year program implemented by Pathfinder International that worked to delay early marriage via three means: primary and secondary school support, advocacy, and vocational training. Over the course of the program, primary and secondary school enrolment increased significantly, while the incidence of early marriage decreased.
Organization: Pathfinder International
Contact: information@pathfind.org
11. Review of the Evidence: Girls' Education and HIV Prevention (2006)
This CD ROM from the UNAIDS Inter-Agency Task Team (IATT) on Education contains more than 100 documents, case studies, reports, tools, curricula, and other materials from a range of settings and in several languages. Resources demonstrate the importance of girls' education as a strategy for reducing the vulnerability of girls to HIV infection; provide examples of progress to date and suggestions for how the education sector can better meet the needs of girls; and advocate for intensified action around girls' education as part of national responses to HIV and AIDS.
Organization: UNAIDS, UNESCO
Contact: info-iatt@unesco.org
12. The Secretary General's Report on Violence against Children (2006, PDF, 168 KB)
This policy report is based on a joint study produced by the Office of the High Commissioner on Refugees, UNICEF, and WHO. The report describes the global situation and different types of violence, and provides recommendations to prevent and address them. The report is also available in Arabic, Chinese, French, Russian, and Spanish.
Organization: United Nations
Contact: http://www.violencestudy.org/r25
13. Sexual and Reproductive Health of HIV Positive Women and Adolescent Girls: A Dialogue on Rights, Policies and Services: Global Economic Forum Report on Results (2006, PDF, 111 KB)
This report summarizes discussions from two electronic forums on human rights dimensions of services and policies related to the sexual and reproductive health of HIV positive women. One forum was open to health professionals and HIV-positive women, while the other was limited to HIV-positive women only. The paper discusses rights, policies, and services separately; includes conclusions about improving services and changing policies; and provides suggestions for going forward.
Organization: EngenderHealth, Harvard University, ICW, Ipas, and UNFPA
Contact: martinez@unfpa.org
14. Sexual and Reproductive Health Needs of Women and Adolescent Girls Living with HIV: Research Report on Qualitative Findings from Brazil, Ethiopia and the Ukraine (2006, PDF, 196 KB)
This research report explores the sexual and reproductive health intentions and needs of HIV-positive women and adolescent girls in Brazil, Ethiopia, and the Ukraine and probes issues relating to family planning, sexually transmitted infections, breast and cervical cancer, maternity care services, and the prevention of mother-to-child transmission, as well as issues of access and quality of care. It includes recommendations for further research.
Organization: EngenderHealth and UNFPA
Contact: info@engenderhealth.org
15. Working with the Community for Improved Health: A New PRB Health Bulletin (2006, PDF, 302 KB)
Does community participation help or hurt health programs in developing countries? This Health Bulletin explores community participation in health, using five case studies of participatory processes and their role in instigating important health and well-being benefits. Case studies examine community involvement in neonatal health, water and sanitation, adolescent reproductive health, "family surveillance," and female genital cutting.
Organization: Population Reference Bureau
Contact: popref@prb.org
16. Youth and Conflict: A Brief Review of Available Literature (2006, PDF, 667 KB)
This literature review highlights key themes, trends, and promising prospects for conflict-affected youth, as well as programs that aim to assist them. Five programmatic themes are discussed: class and gender, advocacy, participation, work, and holism. Program areas discussed include vocational training, reproductive health, basic skills training, peace education, empowerment, and psychosocial programming. The review includes recommendations and resources.
Organization: EQUIP3
Contact: http://www.equip123.net/webarticles/anmviewer.asp?a=16&z=47
17. Youth in a Global World (2006, PDF, 116 KB)
This eight-page brief describes what it's like to grow up in today's world, with a special focus on four major experiences in people's lives: schooling, health, marriage, and childbearing. It highlights changes, cites trends, and suggests ways policies and programs could further improve the lives of youth.
Organization: Population Reference Bureau
Contact: popref@prb.org
18. Youth Reproductive Health – eLearning Course
This new web-based course developed by YouthNet is part of the USAID Global Health eLearning Center. The course is divided into seven modules that provide state-of-the-art information on key issues affecting young people's reproductive health, including how to avoid unwanted pregnancy, HIV/AIDS, and sexually transmitted infections (STIs). It is especially geared towards those working with, or on behalf of, young people in developing countries.
Organization: USAID Global Health eLearning Center
Contact: GHLearningAdministrator@usaid.gov
II. RESEARCH SUMMARIES
1. Achieving the global goals on HIV among young people most at risk in developing countries: young sex workers, injecting drug users and men who have sex with men. Hoffmann O, Boler T, Dick B. World Health Organ Tech Rep Ser 2006;938.
A systematic literature review identified programs in developing countries targeting young people in the three selected groups most at risk from HIV — young sex workers, injecting drug users, and men who have sex with men. Well documented evaluations of interventions that target youth these groups are scarce. However, there is evidence of effectiveness for programs that are facility-based and use outreach to provide information and services to at-risk young people. There is growing evidence from developing countries of successful interventions that target groups most at risk from HIV, and these programs should be widely implemented provided that they are carefully planned and monitored and have a strong evaluation component. However, there is an urgent need to disaggregate data by age in order to determine how effective these programs are in reaching young people and to better understand the specific needs of at-risk young people as opposed to older age groups.
2. An adolescent-targeted HIV prevention project using African professional soccer players as role models and educators in Bulawayo, Zimbabwe. Clark TS, Friedrich GK, Ndlovu M, Neilands TB, McFarland W. AIDS Behav 2006 Jul;10(4 Suppl).
Given their high social status, professional soccer players may be effective in HIV education as role models and educators. In our study, professional soccer players provided HIV education in an interactive curriculum for 7th grade boys and girls in Bulawayo, Zimbabwe. Students in intervention classrooms demonstrated significant increases in knowledge and attitudes using pre-, immediately post- and five-month post-intervention surveys. There was a delayed increase in these factors among control students, suggesting a possible diffusion of information from their peers who received the intervention curriculum. Given these results and the magnitude of the HIV epidemic, this pilot program should be replicated in other communities in sub-Saharan Africa. Continual efforts should be made to rigorously evaluate the approach and improve its effectiveness.
3. Before first sex: gender differences in emotional relationships and physical behaviors among adolescents in the Philippines. Upadhyay UD, Hindin MJ. Int Fam Plan Perspect 2006 Sep;32(3).
The emotional relationships and physical behaviors that precede first intercourse, and how they differ by sex, may provide important cues about how to prevent sexual risk behavior. The study analyzed pre-coital activities of 2,051 adolescents aged 17-19 in Cebu, Philippines, using 1998-2000 and 2002 data from the Cebu Longitudinal Health and Nutrition Survey. The timing and tempo of emotional relationships and physical behaviors for males and females are described. Cox proportional hazards models are used to identify the characteristics associated with age at first sex. Males engage in pre-coital physical behaviors and first sex at younger ages than females. Although the standard order in which the two sexes engage in emotional relationships for the first time is the same, males progress through the sequence more quickly than females. After adolescents have progressed through the sequence of emotional relationships, there is a gap of a least a year before they begin to have sex. In the multivariate analysis, rapid progression through the sequence of emotional relationships was associated with initiating sex at a younger age for females (hazard ratio, 1.5), but not for males. The period between first date and first sex experienced by both males and females provides an opportunity to ensure that adolescents have access to the information and services that will allow them to make informed choices about sexual behavior.
4. Changes in high-risk behaviors over time among young drug users in South Vietnam: a three-province study. Thao le TL, Lindan CP, Brickley DB, Giang le T. AIDS Behav 2006 Jul;10(4 Suppl).
Vietnam is in the midst of an expanding HIV epidemic, primarily driven by an increase in injection drug use in young people. This study was conducted to understand the patterns and initiation of drug use, and the sexual risk behavior among youth in three provinces in southern Vietnam. A cross-sectional survey was conducted among male and female drug users under age 25 recruited from drug treatment centers (N = 560) and the community (N = 240) in Ho Chi Minh City, Dong Nai and Ba Ria-Vung Tau. The majority of those surveyed (82%) began by smoking heroin; after a year, 57% were injecting heroin and/or opium. Initiation of drug use frequently occurred in entertainment venues. Among injectors, 23% shared needles; 71% of all users were sexually active of whom 77% had unprotected sex. More than half of those recruited from treatment centers had previously been in drug treatment. Public health programs to prevent and treat the dual epidemics of HIV and drug abuse must be able to access and respond to the needs of youth, many of whom are unemployed and exposed to drug traffic.
5. Child sexual abuse and its outcomes among high school students in southwest Ethiopia. Worku D, Gebremariam A, Jayalakshmi S. Trop Doct 2006 Jul;36(3).
Child sexual abuse (CSA) is a major contributing factor to the burden of disease among children and adolescents. The aim of this study is to determine the prevalence of CSA and its outcomes among female high school students in Ethiopia. A cross-sectional study was conducted among Jirren high school female students in April 2005. A total of 323 female students from grade 9 were selected by systematic random sampling and they completed a self-administered questionnaire on experiences of sexual abuse. Data were cleaned and analyzed by SPSS/PC statistical package. The results revealed that the prevalence of CSA was 68.7%. Among the different forms of sexual abuses, verbal harassment was the most common (51.4%) followed by sexual intercourse, 18.0% and unwelcome kissing, 17.1%. The commonly indicated abusers in this study were unknown persons (36%) followed by school-mates (31.5%). Among victims of sexual abuse, 7.2% had an unwanted pregnancy and 5.9% had sexually transmitted diseases. The rate of other psychological effects of CSA, such as suicide ideation, suicide attempt, and sexual dysfunction, was high. The overwhelming majority (86.4%) considered sexual abuse to be a major social problem. The study revealed that the prevalence of CSA is high. Reproductive health education should be provided to students. Parents, police, and the public in general should be made aware of the problem before it endangers the lives of children and adolescents.
6. Conclusions and recommendations. Ferguson J, Dick B, Ross DA. World Health Organ Tech Rep Ser 2006;938.
An estimated 40 million people were living with HIV at the end of 2005. More than one quarter of this total are young people aged 15-24 years, and about 2 million young people are newly infected each year. Almost 25 years after the first cases of AIDS were recognized, the HIV pandemic continues to pose unprecedented challenges to individuals, families, communities and governments around the world, especially in developing countries, which bear the greatest burden. Young people are particularly affected in terms of transmission, vulnerability and impact.
7. Condom use among South African adolescents: developing and testing theoretical models of intentions and behavior. Bryan A, Kagee A, Broaddus MR. AIDS Behav 2006 Jul;10(4).
Models of intentions and behavior were developed and tested among adolescents from Cape Town, South Africa. Data from 261 participants who completed an initial measure of attitudes, beliefs, and prior behavior were used to develop a model of intentions to use condoms based on the Theory of Planned Behavior (TPB) and additional constructs found to be important in previous research with adolescents. Of the initial sample, 227 (87%) completed a behavioral follow-up 4 months later, and approximately one-third of those (n=72; 44 boys and 30 girls) reported having had sex in the prior 4 months. Data from this smaller sample were used to develop a model of condom use behavior based on intentions (as per the TPB) and the additional sub-population relevant constructs. Analyses generally supported the validity of the TPB in this context for predicting intentions and behavior. HIV knowledge and positive outlook (self-esteem and future optimism) were significantly related to TPB predictors of intentions. Intentions, acceptance of sexuality, and gender were significant predictors of behavior. Implications for the status of the TPB and the design of interventions for South African adolescents are discussed.
8. Do perceptions of friends' behaviors affect age at first sex? Evidence from Cebu, Philippines. Upadhyay UD, Hindin MJ. J Adolesc Health 2006 Oct;39(4).
To explore the effect of perceptions of friends' romantic and physical behaviors on adolescent sexual behavior and the relative influence of friends' sexual behaviors and maternal attitudes on age at first sex, the study used longitudinal data collected from 1943 adolescents who have never had sex at baseline in Cebu, Philippines. Logistic regression assessed whether adolescents' perceptions of friends' sexual behaviors, measured at ages 14 to 16 years, were associated with age at first intercourse. Survival analysis assessed the hazard of having first intercourse by ages 17 to 19 years. Final models adjusted for sociodemographics, mothers'/caretakers' disapproval of premarital sex, living with a caretaker, and the adolescents' own behaviors at baseline. Boys and girls, who at ages 14 to 16 years, perceived that their friends had ever had boyfriends/girlfriends, dated, held hands, kissed, petted or had sex were significantly more likely to have experienced that behavior by ages 17 to 19 years. For each additional behavior an adolescent perceived his or her friends to have experienced, the hazard of having sex at a younger age increased by 1.15 (p = .02) among boys and 1.19 (p < .002) among girls, after adjusting for mothers'/caretakers' disapproval of premarital sex and other factors. These results demonstrate the important role of peers in light of competing influences in adolescents' lives. They provide support for asking at early ages what romantic and physical behaviors adolescents think their friends have experienced. Interventions can use such information to better prepare adolescents to make responsible and informed decisions about sexuality.
9. The effectiveness of community interventions targeting HIV and AIDS prevention at young people in developing countries. Maticka-Tyndale E, Brouillard-Coylea C. World Health Organ Tech Rep Ser 2006;938.
To identify successful HIV/AIDS prevention interventions targeting youths and delivered in geographically bounded communities (for example, rural villages, urban settlements or neighborhoods) in developing countries, the authors did a systematic review and synthesis of studies evaluating interventions that were published between January 1990 and December 2004. Using predetermined criteria, all interventions were summarized into multiple tables to facilitate comparison. Results of the evaluations of each of four types of intervention were reviewed using predetermined thresholds of evidence. Type 1 interventions were those targeting youths and delivered through existing organizations or centers that served youths. Type 2 were those targeting youths but not affiliated with existing organizations or centers. Type 3 were those targeting all community members and delivered through traditional kinship networks. Type 4 were those targeting communities as a whole and delivered through community-wide events. Evaluations of 22 interventions were reviewed. Type 1 interventions produced primarily positive results at the required threshold of evidence. They are recommended for use in scaling-up projects but should be subject to continued rigorous evaluations. Studies of all other intervention types produced primarily positive results, but the evaluations were less rigorous so clear conclusions could not be drawn about their effectiveness. It is recommended that these interventions be continued and that priority should be given to implementing rigorous evaluations of these interventions. Considerable creativity, ingenuity and commitment is demonstrated in designing and delivering HIV interventions but there is a paucity of adequate evidence of their effectiveness. This precludes identification of the types of interventions that actually produce the targeted changes. It is essential that governments and donor agencies invest in high quality process and outcome evaluations and cost-benefit analyses so that effective interventions can be identified and promoted.
10. The effectiveness of mass media in changing HIV/AIDS-related behaviour among young people in developing countries. Bertrand JT, Anhang R. World Health Organ Tech Rep Ser 2006;938.
To review the strength of the evidence for the effects of three types of mass media interventions (radio only, radio with supporting media, or radio and television with supporting media) on HIV/AIDS-related behavior among young people in developing countries and to assess whether these interventions reach the threshold of evidence needed to recommend widespread implementation, the authors conducted a systematic review of studies that evaluated mass media interventions and were published or released between 1990 and 2004. Studies were included if they evaluated a mass media campaign that had the main objective of providing information about HIV/AIDS or sexual health. To be eligible for inclusion studies had to use a pre-intervention versus post-intervention design or an intervention versus control design or analyze cross-sectional data comparing those who had been exposed to the campaign with those who had not been exposed. Studies also had to comprehensively report quantitative data for most outcomes. Most of the 15 programs identified were from Africa (11). One programme used radio only, six used radio with supporting media, and eight others used television and radio with supporting media. The data support the effectiveness of mass media interventions to increase the knowledge of HIV transmission, to improve self-efficacy in condom use, to influence some social norms, to increase the amount of interpersonal communication, to increase condom use and to boost awareness of health providers. Fewer significant effects were found for improving self-efficacy in terms of abstinence, delaying the age of first sexual experience or decreasing the number of sexual partners. We found that mass media programs can influence HIV-related outcomes among young people, although not on every variable or in every campaign. Campaigns that include television require the highest threshold of evidence, yet they also yield the strongest evidence of effects. This suggests that comprehensive mass media programs are valuable.
11. The effectiveness of sex education and HIV education interventions in schools in developing countries. Kirby D, Obasi A, Laris BA. World Health Organ Tech Rep Ser 2006;938.
To review the impact of sex education and HIV education interventions in schools in developing countries on both risk behaviors for HIV and the psychosocial factors that affect them, the authors conducted a systematic review. Searches identified studies in developing countries that evaluated interventions using either experimental or strong quasi-experimental designs and measured the impact of the intervention on sexual risk behaviors. Twenty-two intervention evaluations met the inclusion criteria: 17 were based on a curriculum and 5 were not, and 19 were implemented primarily by adults and 3 by peers. These 22 interventions significantly improved 21 out of 55 sexual behaviors measured. Sixteen of the 22 interventions significantly delayed sex, reduced the frequency of sex, decreased the number of sexual partners, increased the use of condoms or contraceptives, or reduced the incidence of unprotected sex. Only one of the interventions (a non-curriculum-based peer-led intervention) increased any measure of reported sexual intercourse; 7 interventions delayed the reported onset of sex; 3 reduced the reported number of sexual partners; and 1 reduced the reported frequency of sexual activity. Of the 17 curriculum-based interventions, 13 had most of the characteristics believed to be important according to research in developed and developing countries and were taught by adults. Of these 13 studies, 11 significantly improved one or more reported sexual behaviors, and the remaining 2 showed non-significant improvements in reported sexual behavior. Among these 13 studies, interventions led by both teachers and other adults had strong evidence of positive impact on reported behavior. Of the 5 non-curriculum-based interventions, 2 of 4 adult-led and the 1 peer-led intervention improved one or more sexual behaviors. A large majority of school-based sex education and HIV education interventions reduced reported risky sexual behaviors in developing countries. The curriculum-based interventions having the characteristics of effective interventions in the developed and developing world should be implemented more widely. All types of school-based interventions need additional rigorous evaluation, and more rigorous evaluations of peer-led and non-curriculum-based interventions are necessary before they can be widely recommended.
12. Efficacy of an American alcohol and HIV prevention curriculum adapted for use in South Africa: results of a pilot study in five township schools. Karnell AP, Cupp PK, Zimmerman RS, Feist-Price S, Bennie T. AIDS Educ Prev 2006 Aug;18(4).
Adapting school-based prevention programs developed in the United States for use in African schools may present an alternative to the time-consuming process of developing home-grown programs. The researchers report the results of a pretest-posttest field trial of an alcohol/HIV prevention curriculum adapted from an American model and delivered to ninth-grade students in five South African township schools. The revised intervention was based primarily on the Project Northland alcohol prevention and Reducing the Risk safer sex programs. The researchers found significant differences in change from baseline to follow-up between students in intervention and comparison groups on intentions to use a condom; drinking before or during sex; and, among females, sex refusal self-efficacy. The results of the field trial suggest that behavioral interventions developed in Western countries may be rapidly adapted to work in other cultural contexts.
13. The Impact of an HIV and AIDS Life Skills Program on Secondary School Students in KwaZulu-Natal, South Africa. James S, Reddy P, Ruiter RA, McCauley A, van den Borne B. AIDS Educ Prev 2006 Aug;18(4).
The evaluation of the Department of Educations' life skills program on HIV and AIDS prevention among Grade 9 students in 22 randomly allocated schools in KwaZulu-Natal, South Africa, showed only a significant increase in student knowledge about HIV/AIDS in the intervention group compared with the control group. No effects were found on safe sex practices (condom use, sexual intercourse) or on measures of psychosocial determinants of these practices (attitude and self-efficacy). A process evaluation among the teachers showed that some implemented the program fully (seven schools) and some partially (four schools). An exploratory analysis showed that students who received the full intervention were more positive in their perceptions about sexual behavior and social connectedness (at 10-month follow-up) and reported less sex and more condom use (at 6-month follow-up) than students in the partial and control groups. These limited effects therefore call for further analysis of the content and implementation strategies used in the classroom.
14. Inclusion of AIDS educational messages in rites of passage ceremonies: reaching young people in tribal communities. Groce N, Mawar N, Macnamara M. Cult Health Sex 2006 Jul-2006 Aug 31;8(4).
The impact of HIV on tribal populations has received little attention. Often living in remote areas, further isolated by language, tradition and endogamous marriage patters, members of such communities have been assumed to be at lower risk for HIV. However, there is growing awareness that tribal peoples are sometimes at considerable risk for HIV, as well as other sexually transmitted infections. Young people in such communities may be particularly vulnerable. Traditional practices may forbid discussion of sex at the same time as increasing exposure to outside influences bring new attitudes and expectations about sex and sexuality. Concerned about the implications of the HIV epidemic on tribal populations, a review was conducted of available data on the HIV epidemic within tribal groups. Based on findings from this review, we propose a largely unexplored avenue for reaching tribal populations: namely, the incorporation of the HIV and AIDS related messages into traditional coming of age ceremonies. Such an intervention however can be one component of a comprehensive approach to reaching these often hard-to-reach populations but it may be an especially effective way to reach young people within these communities.
15. Migration and vulnerability among adolescents in slum areas of Addis Ababa, Ethiopia. Erulkar AS, Mekbib T-A, Simie N, Gulema, T. J Youth Stud 2006 Jul;9(3).
Studies of urban rural migration often find the most likely migrants are adolescents and young people. Yet few studies have explored patterns of adolescent migration and the role of migration in transitions to adulthood. This study uses data from a population-based survey of over 1000 adolescents aged 10–19 in slum areas of Addis Ababa. Twenty-three per cent of boys and 45 per cent of girls have migrated into the city, mostly from rural areas, mainly for educational or work opportunities. Nearly one quarter of female migrants moved to escape early marriage in their rural homes. Migrants in this study were more vulnerable than natives in terms of lacking of parental presence, schooling, and social connectedness. Such young people, most of whom are girls, are 'falling through the cracks' of policy and programs and in need of increased program attention.
16. Overview of effective and promising interventions to prevent HIV infection. Auerbach JD, Hayes RJ, Kandathil SM. World Health Organ Tech Rep Ser 2006;938.
The authors reviewed what is known about the efficacy and effectiveness of a range of prevention approaches that are at various stages of research. These interventions attempt to induce behavioral change, apply technologies or modify social environments. Our intention was not to provide an exhaustive review of all types of HIV prevention strategies but rather to illustrate the landscape of interventions that have been developed and evaluated in different settings and that have the potential for widespread application among both adults and young people. There is a large quantity of evidence from experimental and observational research as well as from practical real-world experience in both developed and developing countries. This evidence supports the implementation and scale-up of a number of interventions and strategies. At the same time, there is a need to continue to develop new and more effective interventions while attending to a number of behavioral and social issues that cut across virtually all interventions designed to prevent the spread of HIV. We caution against confusing lack of implementation with lack of effectiveness and call for continual improvement in the quality and quantity of evidence. We have also identified a number of important directions for future HIV prevention research.
17. Review of the evidence for interventions to increase young people's use of health services in developing countries. Dick B, Ferguson J, Chandra-Mouli V, Brabin L, Chatterjee S, Ross DA. World Health Organ Tech Rep Ser 2006;938.
This chapter of the longer WHO report reviews the evidence base for interventions that aim to increase young people's use of health services in developing countries. We identified published and unpublished studies and reports from developing countries that provided information about interventions designed to increase young people's use of health services. The studies were classified into six different types based on whether they included some or all of the following characteristics: training for service providers and clinic staff; making efforts to improve the quality of the facilities; implementing community activities to generate demand and support for the services; and involving other sectors, notably schools and the media. The levels of evidence required to make decisions about policies and programs were defined for each of these types. Despite the lack of detailed descriptions of interventions in the studies and difficulties interpreting the data reported in the evaluations, the studies provided evidence of increased use of health services by young people for those types of interventions that included training for service providers, making improvements to clinic facilities and implementing activities in the community, with or without the involvement of other sectors. The evidence for the effectiveness of interventions to increase young people's use of health services was sufficient to recommend that interventions that include training for service providers, making improvements to clinics and using activities in the community should be widely implemented with careful monitoring of quality and coverage and that those that additionally involve other sectors should also be widely but cautiously implemented, provided they include a strong evaluation component. Operations research is also required to better understand the content of the interventions and their mechanisms of action.
18. Sexual and drug use risk behaviors among children and youth in street circumstances in Porto Alegre, Brazil. de Carvalho FT, Neiva-Silva L, Ramos MC, Evans J, Koller SH, Piccinini CA, Page-Shafer K. AIDS Behav 2006 Jul;10(4 Suppl).
A cross-sectional study was conducted to assess sexual and drug use risk in 161 children and youth in street circumstances in Porto Alegre, Brazil. Median age was 14 and 79% were male. Overall, 59% reported ever having had sex; a significantly higher proportion of males (66%) compared to females (30%). Overall, 39% reported illicit drug use in the last year, and only 1.2% reported injection drug use. In multivariate analyses, correlates of unsafe sex included younger age of sexual debut, and having a steady sex partner. Independent correlates of illicit drug use included lack of family contact, increased hours in the street daily, having had an HIV test, and older age. A high proportion of children and youth in street circumstances reported high risk sex and drug exposures, confirming their vulnerability to HIV/STD. Services Centers, such as where this research was carried out, offer an opportunity for interventions.
19. Sexual behaviour, contraception and fertility among in-school adolescents in Ikenne Local Government, south-western Nigeria. Salako AA, Iyaniwura CA, Jeminusi OA, Sofowora R. Niger J Clin Pract 2006 Jun;9(1).
A cross-sectional study was conducted among in-school adolescents in six secondary schools in the health districts of Ikenne Local Government to assess the sexual behavior, contraception and fertility experiences of the adolescents between the months of May and November 2002. Relevant information was collected from 1140 in-school adolescents with the aid of pre-tested, structured, self-administered questionnaires, selected by using multistage and stratified random sampling techniques During the same period, twelve (12) Focus Group Discussions (FGDs) sessions were conducted using an FGD Guide in the selected schools to highlight differences in opinions of students and also to highlight identification of the group consensus. The mean ages at first intercourse were 13.9 +/- 2.8 years and 14.8 +/- 2.4years for males and females respectively. Boys initiated sex earlier than girls (statistically significant at p<0.05). Sexual intercourse had been experienced by 28.5% of the adolescent students, significantly more (37.6%) males than females (20.4%) The school adolescents who responded as being married were.4.5% (26 males, 23 females) of the respondents. Knowledge on contraception was 36.9% and 22.1% for male and female students respectively, more males than females had knowledge of contraception in a significant proportion, apparently due to increase awareness of the male condom among males. Current use of contraception was equally low, and was found to be 10.9% and 6.0% for males and females respectively. The reasons for non-use were mainly that of non-availability (22.3%), cost (11.8%) negative attitude towards contraception due to societal disapproval (33.2%) and lack of knowledge of how to use them (21.3%). The proportion of adolescents that had ever experienced symptoms associated with Sexually Transmitted Infections (STIs) was 26.8%. Multiple factors were found to be responsible for the deplorable reproductive health situation of the adolescents in this community. The need for provision of sexuality and life planning education in schools including the provision of youth friendly health services in the community were highlighted.
20. Sexual initiation, substance use, and sexual behavior and knowledge among vocational students in northern Thailand. Liu A, Kilmarx P, Jenkins RA, Manopaiboon C, Mock PA, Jeeyapunt S, Uthaivoravit W, van Griensven F. Int Fam Plan Perspect 2006 Sep;32(3).
Thailand has undergone dramatic social changes in the last two decades, yet little is known about factors related to sexual initiation among adolescents. A survey using the audio computer-assisted self-interviewing method was conducted to assess social and demographic characteristics, substance use, sexual behavior, and knowledge of HIV and STIs among 1,725 vocational school students aged 15-21 living in northern Thailand. Gender differences for these factors were evaluated using chi-square and Mann-Whitney U tests. Multivariate survival analysis using Cox proportional hazards models assessed associations between these variables and sexual initiation for each gender. Males initiated sexual intercourse at an earlier age than females (median ages of 17 and 18, respectively). At any given age, sexual initiation was associated with having a nonagricultural background and using alcohol or methamphetamine (adjusted rate ratios, 1.3-2.9). For males, initiation was also associated with having parents who did not live together, having a friend as a confidant, tobacco use, high perceived risk for HIV and high STI knowledge (1.3-1.7). For females, other factors associated with earlier initiation were younger age at interview, living away from family, lacking a family member as a confidant, high perceived risk for STIs and ever having smoked marijuana (1.3-2.4). Interventions to ameliorate the adverse consequences of early sexual initiation need to address social influences such as parents and peer groups. Programs should identify and target high-risk subgroups, such as those who are sexually experienced at an early age and those engaged in patterns of generalized risk-taking.
21. 'Telling the truth is the best thing': teenage orphans' experiences of parental AIDS-related illness and bereavement in Zimbabwe. Wood K, Chase E, Aggleton P. Soc Sci Med 2006 Oct;63(7).
Loss is highly complex and dependent on developmental stage, resilience, quality of care, and social support networks, and often includes a progression of experiences from the onset of a parent's or caregiver's illness, through to the aftermath of death. For several reasons, AIDS-related bereavement is likely to be especially complicated and difficult to accommodate. Understandings of bereavement and grief among African children, and adults' responses to orphans' psychological difficulties, remain under-developed. This paper focuses on the narratives of older children in their teens in six sites in Zimbabwe who have experienced parental AIDS-related illness and death. A key finding is that, while many orphaned teenagers desire direct communication with adults about parental illness and death, adults themselves — whether the sick parent, other relatives in the household or a caregiver following parental loss — are often ill-equipped to identify and manage children's distress positively. While most existing psychosocial interventions focus on bereaved children, this paper suggests that, in order to create an enabling environment for orphans, building the capacity of key adults in orphans' lives, particularly surviving relatives, caregivers, and teachers to address emotional issues relating to parental loss constructively is an essential, but neglected, area of programming.
22. The transition of young people in a transitional society: the case of Serbia. Tomanovic S, Ignjatovic S. J Youth Stud 2006 Jul;9(3).
The paper is based on a multidimensional comprehensive survey of 3180 young people aged 17–35 from Serbia in June 2003. It examines the process of becoming an adult in a transitional society undergoing profound social crisis. The paper focuses on different aspects of transition, notably on family transition. The 'structured individualization' hypothesis was tested in several dimensions: the pace at which independence is gained, the milestones of transition, resources available and norms related to the process. The findings show that the individualization process is hindered by a combination of structural and cultural factors. The structural constraints are related to the lack of resources stemming from unemployment and housing problem. The cultural constraints stem from paternalistic family relations related to infantilization and retraditionalization in the family domain. Young people use the only strategy available in the process of transition: they postpone the key life events that would normally bring them to adulthood. The basics of individualization — becoming independent from their families of origin — occurs approximately 10 years later among young people in Serbia than is the case among their peers in most Western European societies.
23. Vulnerability and risk factors for sexually transmitted infections and HIV among adolescents in Kampala, Uganda. Rassjo EB, Mirembe FM, Darj E. AIDS Care. 2006 Oct;18(7).
Three hundred and six sexually experienced adolescents participated in a study on sexually transmitted infection (STI) prevalence and associated risk factors. The prevalence of Neisseria gonorrhoea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and syphilis was 4.5%, 9%, 8% and 4% for females and 4.7%, 5.7%, 0% and 2.8% for males. HIV-seropositivity was found in 15.2% of females and 5.8% of males. Structured face-to-face interviews were used to obtain information about social background, sexual experience and genital symptoms. Four focus-group discussions were used in order to validate the interview data. Females were more likely to be infected by the four treatable STIs and HIV, despite risky behavior being more common among males. Unemployment, little formal education, the presence of bacterial STIs and post-coital bleeding or a bad smell from the vagina was highly associated with the risk for HIV in females. The higher prevalence of STIs, including HIV, among adolescent girls cannot be explained by sexual behavior only, as boys reported more risk behavior and were still less affected by STIs. Biological and social factors are definitely of importance.
24. The weight of evidence: a method for assessing the strength of evidence on the effectiveness of HIV prevention interventions among young people. Ross DA, Wight D, Dowsett G, Buve A, Obasi AI. World Health Organ Tech Rep Ser 2006;938.
To design a method for assessing the strength of evidence on the effectiveness of different interventions to prevent the spread of HIV that will be the basis for the reviews in this series. The literature on the evaluation of public health interventions was reviewed, and a method was developed in consultation with colleagues involved in this series of reviews and others. The method involves the following steps. First, define the key types of intervention that policy-makers need to choose between in the population setting under consideration. Second, define the strength of evidence that would be needed to justify widespread implementation of the intervention. Third, develop explicit inclusion and exclusion criteria for the studies under review. Fourth, critically review all eligible studies and their findings, by intervention type. Fifth, summarize the strength of the evidence on the effectiveness of each type of intervention. Sixth, compare the strength of the evidence provided by the studies against the threshold of evidence that would be needed to recommend widespread implementation. Seventh, from this comparison, derive evidence-based recommendations related to the implementation of each type of intervention in the setting or population group. The method proposed here provides a systematic, rigorous and transparent approach to reviewing evidence on the effectiveness of interventions of different types and in different population settings in order to generate recommendations for policy-makers.
