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I. PROGRAM RESOURCES
1. Evaluation of Stepping Stones: A Gender Transformative HIV Prevention Intervention
2. Field Assessment of Emergency Plan Centrally-Funded HIV Prevention Programs for Youth
3. Guidelines for Integrating Sexual and Reproductive Health into the HIV/AIDS Component of Country Coordinated Proposals to be Submitted to the Global Fund to Fight AIDS, Tuberculosis and Malaria Round 7 and Beyond
4. Investing in our Future
5. Keep the Promise: A Teaching Resource on Advocacy and HIV and AIDS
6. Keeping the Promise: Five Benefits of Girls' Secondary Education
7. Quantitative Research Instrument to Measure School-Related Gender-Based Violence
8. Teaching Adults to Communicate with Youth from a Muslim Perspective
9. Teacher Identities and Empowerment of Girls against Sexual Violence
10. Women, Girls, Boys and Men: Different Needs – Equal Opportunities
11. Young People's Sexual and Reproductive Health in the Middle East and North Africa
12. Young Single Motherhood: Contested Notions of Motherhood and Sexuality in Policy Discourses/Program Interventions
13. Youth in Crisis - Coming of Age in the 21st Century
14. Youth Issues Paper No. 7: Youth Peer Education in Reproductive Health and HIV/AIDS: Progress, Process, and Programming for the Future
15. YouthLens Briefs Nos. 19-21
16. YouthNet End of Program Report – Taking Action: Recommendations and Resources
II. RESEARCH SUMMARIES
1. Attitudes towards HIV/AIDS and other sexually transmitted diseases in secondary school students in Izmir, Turkey: changes in time
2. Coerced first sexual intercourse and selected reproductive health outcomes among young women in KwaZulu-Natal, South Africa
3. Evaluation of the reach and impact of the 100% Jeune youth social marketing program in Cameroon: findings from three cross-sectional surveys
4. Exposure to MTV's global HIV prevention campaign in Kathmandu, Nepal; Sao Paulo, Brazil; and Dakar, Senegal
5. Factors associated with safe sex among public school students in Minas Gerais, Brazil
6. Fighting AIDS among adolescent women: effects of a public communication campaign in Brazil
7. MTV's "Staying Alive" global campaign promoted interpersonal communication about HIV and positive beliefs about HIV prevention
8. Pubertal transitions in health
9. Quasi-experimental evaluation of a national primary school HIV intervention in Kenya
10. Severe complications of circumcision: an analysis of 48 cases
11. Sexual behaviours and contraception among university students in Turkey
12. Theory-based predictors of condom use among university students in the United States and South Africa
13. Trends in HIV Infection: Prevention-Related Attitudes and Behaviors Among Secondary School Students in Western Uganda
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I. PROGRAM RESOURCES
1. Evaluation of Stepping Stones: A Gender Transformative HIV Prevention Intervention (2007, PDF, 3.55 MB)
This research brief summarizes an evaluation of Stepping Stones, an HIV prevention program that aims to improve sexual health through building stronger, more gender-equitable relationships with better communication between partners. The qualitative study found fewer new infections among those participating in the program, compared to a control arm.
Organization: South Africa Medical Research Council
Contact: rjewkes@mrc.ac.za
2. Field Assessment of Emergency Plan Centrally-Funded HIV Prevention Programs for Youth (2007, PDF, 375 KB)
This report includes a description of the strengths and weaknesses of the 14 funded programs and recommendations for strengthening them. An appendix includes a summary of a meeting discussing the evaluation process and the assessment tool used. The tool can be used more broadly to evaluate programs at the design, implementation, or evaluation phases.
Organization: MEASURE Evaluation
Contact: measure@unc.edu
3. Guidelines for Integrating Sexual and Reproductive Health into the HIV/AIDS Component of Country Coordinated Proposals to be Submitted to the Global Fund to Fight AIDS, Tuberculosis and Malaria Round 7 and Beyond (2007, PDF, 271 KB)
These guidelines are designed to help agencies better utilize the resources of the Global Fund for sexual and reproductive health (SRH). Youth SRH guidelines are included in sections on voluntary counseling and testing, gender-based violence, and scaling up STI and HIV prevention.
Organization: Global AIDS Alliance (GAA) and partners
Contact: lschechtman@globalaidsalliance.org
4. Investing in our Future (2006, PDF, 3.04 MB)
This framework, focusing on youth in East Asia and the Pacific, identifies the practical components of comprehensive sexual and reproductive health programs to target 10- to 24-year-olds, as well as strategies for program success. It provides guidance to policy-makers and program managers.
Organization: WHO, UNFPA, UNICEF
Contact: bookorders@who.int
5. Keep the Promise: A Teaching Resource on Advocacy and HIV and AIDS (2006, PDF, 2.10 MB)
This faith-based resource, written for teachers and group leaders of 11- to 16-year-olds, provides classroom materials on HIV and AIDS designed to motivate students to take action in the fight against the pandemic. Its objective is to build awareness, educate, and inspire young people to express their views by way of a letter-writing campaign.
Organization: The Ecumenical Advocacy Alliance
Contact: info@e-alliance.ch
6. Keeping the Promise: Five Benefits of Girls' Secondary Education (2006, PDF, 2.18 MB)
This paper analyzes the gender gaps in secondary participation across sub-Saharan Africa, discusses the multiple barriers to girls' education, and finds that secondary education for girls improves primary school attendance, social benefits, health benefits, HIV/AIDS mitigation, and poverty alleviation. Strategies for promoting and improving girls' secondary education are included, with case studies, analysis, and reporting.
Organization: Center for Gender Equity, AED
Contact: communicationsmail@aed.org
7. Quantitative Research Instrument to Measure School-Related Gender-Based Violence (2006, PDF, 957 KB)
This paper presents quantitative research instruments developed for a study examining gender-based violence in schools in Malawi. It summarizes a sampling methodology, interview guidelines, and analysis approaches to assess knowledge, attitudes, practices, and experiences of youth and teachers regarding all types of gender-based violence in their schools. USAID funded the study through Safe Schools Program.
Organization: DevTech Systems, CERT
Contact: rcolumbia@devtechsys.com
8. Teaching Adults to Communicate with Youth from a Muslim Perspective (2007, PDF, 3.45 MB) and Participant Handbook (PDF, 2.28 MB)
The manual and handbook encourage open discussion about sexuality, reproductive health, and HIV in the context of the Muslim faith. Participants practice communication skills and learn factual information as linked to religious teachings and appropriate Quran verses. It is not designed to promote religion.
Organization: Family Health International/YouthNet
Contact: youthnetpubs@fhi.org
9. Teacher Identities and Empowerment of Girls against Sexual Violence (2006, PDF, 450 KB)
This report describes the way that teachers' behavior toward students influences negative gender relationships. In particular, male teachers are found to behave violently toward boys, creating negative role models, and to sexualize and sexually harass girls, disempowering them. Some recommendations, including reflective practices for teachers and trainees, are included.
Organization: United Nations
Contact: daw@un.org
10. Women, Girls, Boys and Men: Different Needs – Equal Opportunities (2006, PDF, 3.33 MB)
This handbook sets forth standards for the integration of gender issues from the outset of a new complex emergency or disaster, so that humanitarian services reach their target audience and neither exacerbate the problem nor inadvertently put people at risk.
Organization: Inter-agency Standing Committee (IASC)
Contact: www.humanitarianinfo.org/iasc/content/contact/default.asp
11. Young People's Sexual and Reproductive Health in the Middle East and North Africa (2007, PDF, 123 KB)
This eight-page brief summarizes the changes among youth's sexual and reproductive health in the Middle East and North Africa. It provides useful data and points out the lack of access to information and services related to sexual and reproductive health.
Organization: Population Reference Bureau
Contact: popref@prb.org
12. Young Single Motherhood: Contested Notions of Motherhood and Sexuality in Policy Discourses/Program Interventions (2006, PDF, 450 KB)
This working paper examines issues related to young single motherhood, and questions current policies and approaches, even by those attempting to help these mothers. This provocative paper, based on an analysis of specific projects and the literature, addresses ways to help young single mothers form alliances to seek redress to injustices they face.
Organization: Institute of Social Studies
Contact: workingpapers@iss.nl
13. Youth in Crisis – Coming of Age in the 21st Century (2007, PDF, 4.81 MB)
This 80-page report describes the impact of the events shaping the lives of youth bearing the tragic consequences of their nations' worst problems – from the illegal forced marriage of teenage girls in Afghanistan and Ethiopia, to the tripling of school fees and the deteriorating education system in Zimbabwe. Case studies are compelling.
Organization: IRIN News
Contact: feedback@irinnews.org
14. Youth Issues Paper No. 7: Youth Peer Education in Reproductive Health and HIV/AIDS: Progress, Process, and Programming for the Future (2006, PDF, KB)
This 28-page report summarizes the latest thinking on youth peer education, based on a technical consultation held in 2006, with evidence of the degree of impact, examples of programs that are scaling up activities, and suggestions for the future.
Organization: Family Health International/YouthNet
Contact: youthnetpubs@fhi.org
15. YouthLens Briefs Nos. 19-21 (2007)
These four-page briefs synthesize recent research and program experiences in key areas for youth programming.
Organization: Family Health International for Interagency Youth Working Group
Contact: youthwg@fhi.org
16. YouthNet End of Program Report – Taking Action: Recommendations and Resources (2006, PDF, 588 KB)
The final report of the YouthNet Program (2001-2006) synthesizes its work into ten results, incorporating findings from research, technical assistance, country activities, global leadership, publications, and more. YouthNet Publications, 2002-2006, a separate CD-ROM that accompanies the report, includes all YouthNet publications produced during the life of the program.
Organization: Family Health International/YouthNet
Contact: youthnetpubs@fhi.org
II. RESEARCH SUMMARIES
1. Attitudes towards HIV/AIDS and other sexually transmitted diseases in secondary school students in Izmir, Turkey: changes in time. Yamazhan T, Gokengin D, Ertem E, et al. Trop Doct 2007;37(1).
The aim of this study was to evaluate the changes in the sexual attitudes of young people over a period of 7 years (1997-2004). The participants in the first and the second surveys were 633 and 654 grade 10 students from six high schools located in the central district of Izmir, Turkey, chosen randomly according to the stratified sampling method. The rate of having had a sexual experience was 11.3% and 22.8% in the first and second surveys, respectively (chi(2) P < 0.001).
2. Coerced first sexual intercourse and selected reproductive health outcomes among young women in KwaZulu-Natal, South Africa. Maharaj P, Munthree C. J Biosoc Sci 2007;39(2).
This paper uses data collected in 2001 from the second round of a longitudinal study of 1,130 sexually experienced young women in KwaZulu-Natal to investigate the relationship between coerced first intercourse and selected reproductive health outcomes and behaviors. Nearly 46% of all sexually experienced young women had reported that their first sexual encounter had been coerced. Young women who reported being coerced at first sex were significantly more likely to be black and living in an urban area. Those who had been coerced at first sex were also more likely to report having had an STI and having experienced unintended pregnancy, than those who had not been coerced at first sex. Coercion at first sex is an important social and public health problem that has a serious impact on the reproductive health and behaviors of young women. Interventions should directly address the issue of sexual coercion by ensuring that young women are aware of their reproductive rights.
3. Evaluation of the reach and impact of the 100% Jeune youth social marketing program in Cameroon: findings from three cross-sectional surveys (PDF, 307 KB). Plautz A, Meekers D. Reprod Health 2007;4(Article No.1).
This study evaluates the 100% Jeune program, analyzing its reach and impact on condom use, level of sexual activity, and predictors of condom use. This analysis uses data from three waves of the Cameroon Adolescent Reproductive Health Survey, implemented at 18-month intervals between 2000 and 2003. The sample is restricted to unmarried youth aged 15-24; sample sizes are 1,956 youth in 2000, 3,237 in 2002, and 3,370 in 2003. Logistic regression analyses determine trends in reproductive health behavior and their predictors, as well as estimate the effect of program exposure on these variables. All regression analyses control for differences in sample characteristics. A comparison of trends over the 36-month study period shows that substantial positive changes occurred among youth. Results of dose response analyses indicate that some of these positive changes in condom use and predictors of use can be attributed to the 100% Jeune youth social marketing program. The program contributed to substantial increases in condom use, including consistent use with regular partners among youth of both sexes. Among males, it also contributed to consistent use with casual partners. Observed secular trends indicate that factors besides the 100% Jeune program also contributed to the observed improvements. Despite efforts to promote abstinence, the 100% Jeune program had no effect on levels of sexual activity or number of sexual partners. Likewise, there is no evidence that reproductive health programs for youth lead to increased sexual activity. Results show that 100% Jeune successfully used a variety of mass media and interpersonal communication channels to reach a high proportion of youth throughout the intervention period. Resources should be allocated to identify and understand predictors of abstinence and partner reduction to inform future programming decisions.
4. Exposure to MTV's global HIV prevention campaign in Kathmandu, Nepal; Sao Paulo, Brazil; and Dakar, Senegal. Geary CW, Burke HM, Castelnau L, et al. AIDS Educ Prev 2007;19(1).
In 2002, MTV aired a global media campaign, "Staying Alive," to promote HIV prevention among 16- to 25-year-olds. Skeptics believed that a global MTV campaign would reach only a small group of elite young people. MTV increased access to its campaign, however, by making all materials "rights free" to third-party (non-MTV) broadcasters. Over 789 million households in over 166 countries had access to some or all of the campaign. To understand the level of actual exposure and the types of young people exposed, data were analyzed from population-based household surveys in three diverse urban areas where a campaign evaluation was conducted: Kathmandu, Nepal; Sao Paulo, Brazil; and Dakar, Senegal. Exposure rates ranged from 12% in Kathmandu to 23% in Sao Paulo, and 82% in Dakar, reaching an estimated 32,000, 400,000, and 220,000 16- to 25-year-olds in each city, respectively. A number of personal, social and economic characteristics found to predict campaign exposure were identified in each site; in general, these were related to economic status and use of "new" media technologies. Though this skew toward more exposure by those with greater resources existed, we found that the campaign audience was in no way composed only of "elite" young people. The possibility of reaching millions of young people through global networks with minimal marginal costs after production creates a new paradigm for reaching an important segment of young people.
5. Factors associated with safe sex among public school students in Minas Gerais, Brazil. Viana FJ, Faundes A, de Mello MB, et al. Cad Saude Publica 2007;23(1).
A cross-sectional study was conducted to evaluate factors associated with safe sex among sexually active public school students in Minas Gerais State, Brazil. The study focused on correlations between multiple variables, including gender, age, schooling, current grade, ethnicity, religion, importance attributed to religion, mother's education, prior exposure to any sex education, promotion of juvenile protagonism, participation by health professionals in school activities, consistent condom use with casual or stable partners, and use of other modern contraceptive methods. Bivariate and multivariate logistic regression analyses were used. Male gender and participation by health professionals in school activities were positively associated with all indicators of safe sex, and maternal schooling of more than eight years was positively associated with consistent condom use with casual and stable partners. Secondary (versus elementary) schooling and age (older) were inversely associated with consistent condom use with casual and stable partners, respectively. Ascribing greater importance to religion and Evangelical religion were negatively associated with use of modern contraceptives at last sexual intercourse.
6. Fighting AIDS among adolescent women: effects of a public communication campaign in Brazil. Porto MP. J Health Commun 2007;12(2).
In 2003, Brazil's Ministry of Health launched a national Carnival Campaign aimed at promoting the use of condoms by adolescent women. It was broadcast on television and radio between February 16 and March 3, and it targeted young women between 13 and 19 years of age, a social group that had previously registered an increase in the number of AIDS cases and other sexually transmitted infections (STIs). The Ministry hired Kelly Key, a Brazilian pop singer, to deliver the campaign messages. One of the objectives was to empower the girls and encourage them not to be ashamed to buy condoms and to demand that their partners use them. The article presents the results of a national survey conducted with 1,006 adolescent women, which was sponsored by the Ministry of Health. The results show that campaign materials reached the main target audience and that they were very positively received. The campaign generated discussions in the adolescents' social environments and reinforced a social norm that favors the participation of women in the purchase and use of condoms.
7. MTV's "Staying Alive" global campaign promoted interpersonal communication about HIV and positive beliefs about HIV prevention. Geary CW, Burke HM, Castelnau L, et al. AIDS Educ Prev 2007;19(1).
In 2002, MTV launched a global multicomponent HIV prevention campaign, "Staying Alive," reaching over 166 countries worldwide. An evaluation of this campaign focused on three diverse sites: Kathmandu, Nepal; Sao Paulo, Brazil; and Dakar, Senegal. Data were collected before and after campaign implementation through population-based household surveys. Using linear regression techniques, the evaluation examined the effects of campaign exposure on interpersonal communication about HIV, and the effects of campaign exposure and interpersonal communication on beliefs about HIV prevention. What emerged was a consistent positive effect of exposure on interpersonal communication across all sites, although there were differences among sites with regard to whom the respondent talked to about HIV. The evaluation also revealed a consistent positive effect of exposure on HIV prevention beliefs across sites when interpersonal communication was simultaneously entered into the model. Finally, in two sites, a relationship was found between interpersonal communication and HIV prevention beliefs, controlling for exposure; although, once again, the effects differed based on the type of person with which the communication took place. These similar findings in three diverse sites provide ecological validity of the findings that "Staying Alive" promoted interpersonal communication and influenced young people's beliefs about HIV prevention in a positive way, which is evidence for the potential of a global media campaign to have an impact on social norms.
8. Pubertal transitions in health. Patton GC, Viner R. Lancet 2007;369(9567).
Puberty is accompanied by physical, psychological, and emotional changes that help ensure reproductive and parenting success. Human puberty stands out in the animal world for its association with brain maturation and physical growth. Its effects on health and wellbeing are profound and paradoxical. On the one hand, physical maturation propels an individual into adolescence with peaks in strength, speed, and fitness. Clinicians have viewed puberty as a point of maturing out of childhood. However, puberty's relevance for health has shifted with a modern rise in psychosocial disorders of young people. It marks a transition in risks for depression and other mental disorders, psychosomatic syndromes, substance misuse, and antisocial behaviors. Recent secular trends in these psychosocial disorders coincide with a growing mismatch between biological and social maturation, and the emergence of more dominant youth cultures.
9. Quasi-experimental evaluation of a national primary school HIV intervention in Kenya. Maticka-Tyndale E, Wildish J, Gichuru M. Eval Program Plann 2007;30(2).
This study examined the impact of a primary-school HIV education initiative on the knowledge, self-efficacy, and sexual and condom use activities of upper primary-school pupils in Kenya. A quasi-experimental mixed qualitative-quantitative pre- and 18-month post-design using 40 intervention and 40 matched control schools demonstrated significant program impact on targeted objectives of (1) adequate program delivery and, for standard 6 and 7 pupils (ages 11–16 years), (2) increased HIV-related knowledge; (3) increased communication with parents and teachers about HIV and sexuality; (4) increased assistance to fellow pupils to avoid sexual activity; (5) increased self-efficacy related to abstinence and condom use; (6) decreased exposure to HIV through delayed first intercourse, decreased sexual activity, and increased condom use. Results support the conclusions that the existing infrastructure is adequate for national roll-out of the program; that the program has its most beneficial effect on sexually inexperienced youth and should therefore be implemented with the youngest age groups possible; and that gains are gender specific, with boys reporting increased condom use while girls are more likely to decrease or delay sexual activity. Based on these results, the program began national roll-out to all primary schools in 2005. By June 2006, the program was operating in 11,000 of the country's nearly 19,000 schools.
10. Severe complications of circumcision: an analysis of 48 cases. Ceylan K, Burhan K, Yilmaz Y, et al. J Pediatr Urol 2007;3(1).
Circumcision is still the most commonly performed surgery in Islamic and Jewish societies. This article reports findings from 48 cases with serious complications after circumcision that needed secondary surgical interventions. The aim of this study is to emphasize the important problem of circumcision complications. The 48 cases (mean age of 14 years, range of 5 months-24 years) were reviewed retrospectively. Circumcisions were performed at various medical centers or during religious ceremonies in environments other than health facilities. The most commonly observed complication was preputio-glandular fusion, seen in 25 cases (52%). The other complications were: meatal stenosis in 11 (23%), urethral fistula in five (10.4%), partial glandular amputation in four (8%), and opening distal urethra in three (6%). Adhesion freeing and revision were performed in all cases of preputio-glandular fusion; patients with meatal stenosis underwent meatotomy; urethral fistulae were repaired by simple closure; partial glans amputations were patched with buccal mucosa; and patients with complete open distal urethra were repaired by Mathieu (one patient) and tubularized incised plate urethroplasty techniques. There are many serious complications that can result from circumcision. To prevent these complications, the operation should be performed by educated and experienced personnel.
11. Sexual behaviours and contraception among university students in Turkey. Aras S, Orcin E, Ozan S, et al. J Biosoc Sci 2007;39(1).
An anonymous questionnaire was administered to 550 final-year university students aged 20-25 years in Izmir, Turkey. Male students opposed premarital sexual intercourse for both genders more often than female students did. The frequency of sexual intercourse among male students (61.2%) was higher than that among female students (18.3%). The mean age of first sexual intercourse was lower among male respondents than among female ones. The rate of condom use at first sexual intercourse was 47.4%. The frequency of having two or more past sexual partners and of practicing masturbation was higher among males than among females. It was found that there were culture-specific and gender-dependent differences in sexual attitudes and behaviors among the university students. These results may help in the planning of education and health policies in Turkey.
12. Theory-based predictors of condom use among university students in the United States and South Africa. Heeren GA, Jemmott JB 3rd, Mandeya A, et al. AIDS Educ Prev 2007;19(1).
This study compared the predictive value of the theory of planned behavior in university students in South Africa (N = 251) and the United States (N = 160) who completed an anonymous self-administered questionnaire. Multiple regression analyses revealed that condom use and intention were significantly predicted by positive condom attitude, subjective norm, self-efficacy, and attending university in South Africa. Significant interactions between country and predictors indicated that subjective norm predicted condom use and intention more strongly in the American sample than in the South African sample; attitude predicted intention more strongly in the American sample than in the South African one; but self-efficacy predicted intention more strongly in the South African sample than in the American one. The theory of planned behavior may provide a useful framework for interventions to reduce South African students' risk of HIV/AIDS and sexually transmitted infections. Such interventions should have a strong focus on building self-efficacy to use condoms.
13. Trends in HIV Infection: Prevention-Related Attitudes and Behaviors Among Secondary School Students in Western Uganda. Kilian AH, Kipp W, Jhangri GS, et al. J Acquir Immune Defic Syndr 2007;44(5).
The study used annual data collected in a group of sentinel secondary schools in 3 districts by means of a short, self-administered, and anonymous questionnaire. Fifteen secondary schools were randomly selected, and a cross-sectional survey of students was carried out each year between 1995 and 2001. All students from S (senior level) 2 to S4 were invited to complete the questionnaire. For data analysis, all completed questionnaires of students between the ages of 12 and 20 years were considered. In total, 6 surveys were carried out yielding 6,231 valid questionnaires. Ever use of condoms among sexually active youth increased significantly, from 48.8% in 1995 to 1996 to 72.8% in 2000 to 2001. Male students were more likely to report increased sexual abstinence during the time period than female students. Conversely, female students over the same time period reported having fewer sexual partners than male students. The number of sexually active students reporting sexual intercourse in the past 3 months remained the same. These data show significant positive changes in the sexual behavior of secondary school students in western Uganda. This could explain, in part, the decline of HIV prevalence rates among young people observed in this region.
