This issue departs from Youth InfoNet's regular format to provide summaries of 30 presentations on youth reproductive health and HIV made at the annual meeting of the American Public Health Association, held November 15-19, 2003 in San Francisco, California. YouthNet covered the presentations at APHA and offer this report as a guide through the wealth of information made available at the conference.
Click on each presentation's title to read further information available on the APHA Web site.
To subscribe to Youth InfoNet (and other electronic notices of YouthNet publications and information), or to propose submissions to this newsletter, please send an email to youthnetpubs@fhi.org.
I. Knowledge, Attitudes, and Behavior Change – fifteen summaries of research from Bangladesh, India, Jamaica, Kenya, Romania, and other countries.
II. Parents, Providers, and Community – five summaries from Bangladesh, Burkina Faso, El Salvador, and Mexico.
III. Gender and Social Norms – three summaries from the Philippines and African countries.
IV. Orphans and Vulnerable Children – four summaries focusing on Kenya and Zambia.
V. Media and Youth Involvement – three summaries on global efforts and an African project.
1. A novel approach to adolescent HIV prevention education. Combining emergency contraception and condom education and promotion in Morelos, Mexico: what happens to condom use and attitudes? Walker D, Torres P, Gutierrez JP, et al.
This study combined HIV education and condom promotion with emergency contraception education to examine the impact of the combined program on HIV/AIDS knowledge and risk behavior/attitudes. Forty public high schools participated in the teacher training in HIV/AIDS and a condom promotion curriculum, while some also received an emergency contraception curriculum. The data show that the combined curriculum may increase condom use and the intention to use EC, if it is necessary.
2. Abstinence: a review of efforts to promote abstinence and delayed first sex among adolescents in the United States and the developing world. Wertheimer ER.
A review of available research shows that school and community-based programs in the United States that deliver abstinence-only messages until marriage do not affect sexual behavior for youth. Comparable data for the developing world is not available. However, results from the United States suggest that comprehensive messages are the best approach for adolescents – teaching abstinence as the safest method but in the context of other life decisions, including contraceptive choices. More data is needed to assess antecedents of adolescent's high-risk sex behaviors.
3. Addressing adolescent dual protection (HIV/STI and unplanned pregnancy prevention) through a peer education model: results of a regional project in Honduras and Nicaragua. Sanghvi R, Kohn D.
Using peer education, condom distribution, and linkages to local health services, IPPF/WHR implemented a community-based dual protection project for youth. The primary objective was to increase knowledge, attitudes, and practices around condom use (both male and female) to promote dual protection. Preliminary results from surveys and focus group discussions show that there is a great unmet need for adolescent education about sexual and reproductive health, specifically dual protection. Findings also revealed that the peer education model is both effective and potentially cost-effective.
4. Adolescent abortion decision-making narratives: a Web-based inquiry into social and health risk assessment among urban Kenyan secondary students. Mitchell E, Halpern CT, Muthuuri ES, et al.
A two-year longitudinal internet survey, TeenWeb, examined pregnancy and abortion issues surrounding knowledge, experience, and decision-making processes of 679 Nairobi secondary school students. Nearly half of the respondents were not aware that abortion is legal when it can save a mother's life. Low knowledge on a variety of measures carries implications for abortion law reform and family life education in Kenyan schools.
5. AIDS action clubs: improving adolescent reproductive health in Zimbabwe. Nairne DE, Malunga G, Hall C, Fleming W.
AIDS action clubs have been established in 24 rural primary and secondary schools. They are voluntary clubs aimed to improve reproduce health and prevent HIV through IEC efforts, life skills development, and teaching income generating skills. Some 1,200 club members have been trained, benefiting approximately 10,000 youth indirectly. Trainings have shown that meaningful youth participation has been a key factor in prompting youth to address their health.
6. An assessment of HIV/AIDS knowledge and prevalence of risk behaviors among Romanian youth. Freier MC, Babikian T, Lang D, et al.
A survey of 1,502 secondary students in Romania (13-25 years old) examined high-risk HIV/AIDS behaviors, information and myths, and the need for school-based HIV/AIDS prevention programs. Students demonstrated correct knowledge regarding transmission through unprotected sex (95%) and injecting drug use (92%), but myths still existed, namely that HIV could be transmitted through sterile instruments during blood tests, insect bites, and public toilets. Very few students (13%) recognized the higher transmission risk for females. Nearly half of the sexually active students reported infrequent condom use. Binge drinking was associated with decreased condom use and increased number of sexual partners. Results suggest that Romanian youth are engaging in HIV/AIDS risk behaviors. Although adequate knowledge regarding HIV risk was displayed, student's information did not translate into protective behaviors.
7. Behavior risk assessment using focus groups in a high-risk night school student population, Mumbai, India. Bhardwaj S, Sequeira TIE, Gurnani PM, et al.
Ten focus groups were conducted with 150 students (majority boys, average age 16) to examine issues affecting teenage students who attend night school. Discussions focused on six themes: career choice and decision-making, parents' role in decision making, youth problems, role models, friends/peer group, and the role of night schools. Results found that night school students do take part in high-risk behaviors and are influenced both positively and negatively by their peer groups. Their role models include parents, friends, and media personalities, and many students know people living with HIV/AIDS.
8. Does knowledge of risk of contracting AIDS change sexual behavior? The case of Mozambican youth. Prata N, Morris L.
Analysis of the 2001 Adolescent and Young Adult Reproductive Health and Behavior Risk Survey sought to find out if knowledge of risk associated with contracting HIV/AIDS was linked to changing sexual behaviors. Findings showed that individuals who reported moderate to high risk to HIV/AIDS also reported a variety of behavioral changes in response to this knowledge. However, about half of both males and females who perceived themselves to be at no or low risk practiced the same risky behaviors as moderate to high-risk individuals.
9. Effectiveness of linking schools with sexual and reproductive health services: experiences from a pilot project in Bangladesh. Bhuiya I, Khan ME, Rob U, et al.
This Population Council study assessed the effectiveness of school-linked sexual and reproductive health programs using two intervention sites: one with school and community education linked to health services and the second with only community education linked to health services. Population based surveys were conducted both pre- and post-intervention in both sites. Findings reveal that knowledge on a number of knowledge indicators, including fertile period and modes of HIV transmission, were higher in the school-linked intervention site.
10. Evaluation of HIV/AIDS secondary education programs in Uganda. Jacob WJ, Morisky D, Nsubuga YK, et al.
The Ministry of Sports, Youth, and Culture in Uganda has commissioned a comprehensive evaluation of the national secondary school curriculum to prevent and control HIV/AIDS. Methods such as key informant interviews, focus group discussions, and individual assessments will be used. Results were not presented.
11. Moving beyond condoms: should social marketing programs do more to promote abstinence and partner reduction in sub-Saharan Africa? Armand F.
According to a 2002 household survey conducted in Uganda by Commercial Marketing Strategies, a majority of youth aged 14 to19 abstain from sex, often to avoid HIV/AIDS. These findings and others that suggest partner reduction played a large role in reducing HIV prevalence in Uganda, suggest that social marketing programs that are based around condom sales should diversify to include comprehensive messages.
12. Sexual health education in schools: what do pupils in Sri Lanka think? Perera B, Torabi MR.
Health and education authorities in Sri Lanka commissioned a cross-sectional survey of 3,134 students using a self-administered questionnaire to assess opinions on sex education in schools, and sexual behaviors. Most respondents were aged 18 to 20. More than 90% of boys and almost 80% of girls said they knew at least one friend with some sexual experience. Females (82%) and males (85%) supported comprehensive sex education in schools. These findings will be used to develop future policies surrounding sex education.
13. Strategies to improve reproductive health of adolescent girls in Bangladesh: experiences from a pilot project. Bhuiya I, Rob U, and Rahman L.
Targeting married and unmarried females, aged 15 to 19, who are at risk for pregnancy (wanted and unwanted), teachers and peer youth educators conducted reproductive health sessions in schools and within the community to educate girls about physical development, the fertile period, condoms, and mother-to-child-transmission of HIV. Knowledge increased as did antenatal care services including tetanus toxoid injections, postnatal care, RTI/STI check-ups, and contraceptive use.
14. USAID's "ABC" study of behavioral determinants of HIV prevalence decline in six developing countries. Halperin DT, Bessinger R, Fuchs N, et al.
USAID commissioned a study to analyze how ABC behaviors – abstinence or delay of sexual debut, fidelity or partner reduction, and condom use – have affected HIV prevalence in countries where HIV prevalence has declined (Uganda, Thailand, and Zambia) versus countries where HIV prevalence has not decreased (Cameroon, Kenya, and Zimbabwe). A comparative analysis of sexual behaviors from DHS and other quantitative and qualitative resources was conducted. Preliminary findings show A and B messages were especially important determinants of prevalence decline in Uganda.
15. What protects teenagers from risky behaviors? Taking an assets-based approach to adolescent reproductive health in Jamaica. Rosenbaum J, Fisher KS, and Burrell U.
A survey of 1,004 adolescents aged 12 to 16 examined 19 different assets (external and internal) to understand what protects youth from risky sexual behavior. The relationships that adolescents have with parents and within the community emerged as important assets that led to a decreased likelihood of early sexual initiation. Caring relationships, opportunities for participation, and high expectations emerged as overall protective factors in sexual initiation.
16. Accidents happen, pregnancy doesn't have to: lessons learned from advocating for improved adolescent access to emergency contraception in California. Beleutz J, Brown A.
Population Services International's Emergency Contraception (EC) Advocacy Project works with health care providers to address some of the barriers that teens face when accessing EC. The project developed a toolkit and resource guide to help recruit "EC Advocates" to increase access to EC in communities. The program advocates for greater EC education for adolescents, increased provision and prescription of EC, greater health staff education of EC, and greater opportunity for adolescents to access EC in a timely manner.
17. Bangladesh parents' knowledge and attitude about adolescent reproductive health issues. Rob U, Bhuiya I, Rahman L.
A survey of 1,578 parents in urban areas of Bangladesh revealed low levels of communication with children on sexual and reproductive health, and low levels of knowledge surrounding numerous sexual and reproductive health issues. Parents were, however, supportive of condom use to prevent unwanted pregnancy and infections, delayed age at first marriage, and delayed child bearing. Almost all parents (90%) supported providing reproductive health to adolescents, citing schools as the most appropriate place to do it. Strategically including parents may build a supportive environment for youth.
18. Community based initiatives to improve youth sexual and reproductive health in rural Burkina Faso: findings from evaluation research. Mukenge M, Yaro Y.
Community mobilization interventions were used to educate and improve knowledge of youth sexual and reproductive health (YSRH) issues in three rural communities in Burkina Faso. After research in the communities, youth associations trained 47 peer educators in sexual and reproductive health, who then conducted group discussions and home visits about specific YSRH topics. Discussions utilized video, theater, music, and cultural events. Results showed an increase of knowledge of AIDS, condom use, and intent for adolescent's to use condoms in the future.
19. How prepared are providers in Mexico to provide reproductive health services to youth? Vernon R, Mejia R, Palma JL.
Data from a national sample of service providers from 56 public clinics, 180 private physicians, and 240 pharmacy workers revealed adolescents are not likely to receive quality youth-friendly services. The analysis measured services according to adjustments needed to meet youth needs and in provider attitudes towards the sexual behavior of young clients. MEXFAM's Gente Joven project is currently helping providers deliver more youth-friendly services.
20. Partnering with pharmacies to meet the reproductive health needs of adolescents. Wolfe K, Sulzbach SL.
This project developed "youth-friendly" pharmacies in El Salvador and Mexico to encourage adolescent use of pharmacies to obtain condoms and other contraceptives and to prevent the embarrassment and stigma that is sometimes associated with purchasing contraceptives. The project also trained pharmacists in reproductive health and contraceptives while using a "low-key" media campaign to spread information to youth. The youth-friendly pharmacies have been well received and may play an influential role in teen contraceptive use.
21. Gender, sexuality, and communication about sexual and reproductive health among Filipino youth. Erickson PI, Badiane L, Ramos-Jimenez P, et al.
The impact of gender roles on sexual behavior and reproductive health decision-making among Filipino youth was examined and a pilot intervention promoting positive male involvement in reproductive health decision-making was developed and evaluated. Methods used were in-depth interviews and focus group discussions, as well as a review of adolescent sexual reproductive health policy and service delivery. Focus groups were gender segregated, and age-grouped discussions created collages depicting themes including sexuality. Results found that traditional gender constrictions and social norms inhibit discussion of sexual and reproductive health with parents, teachers, and between sexes. However, youth in same sex groups discuss these issues freely. Same sex discussions are appropriate for sex education and peer education; however these forums need to consider the social and political climate in the Philippines.
22. Giving in to sexual demand: gender role expectations, coercion, aggression, and African youth's risk for HIV/AIDS. Longenfield K, Klein M.
Focus groups (n=33) were conducted with youth aged 15 to 24 in urban areas of Eritrea, Tanzania, Zambia, and Zimbabwe to examine gender expectations. Themes discussed included gendered expectations, relationship dynamics, risk for STI/HIV, and sexual coercion and aggression. Outcomes show that gendered expectations and distrust contribute to miscommunication and conflicts. When sex is coerced, little attention is given to the risk of unprotected sex; some male participants described such sex as "condom sabotage." The data suggest that it is important to work with youth before they become sexually active and increase knowledge among adults who work with youth about the issue of sexual coercion.
23. Partnership with male cultural leaders for adolescent sexual and reproductive health (ASRH) and prevention of HIV infection among young people. A case of Uganda. Dairo AE, Namanya B.
The African Youth Alliance in Uganda sought to partner with male cultural leaders in five kingdoms to improve adolescent sexual and reproductive health. This process included a review of ASRH policies; review of cultural norms, values, and practices related to ASRH; examining DHS data by district; identification of a knowledgeable contact person who was able to reach cultural leaders; increasing cultural leaders' knowledge of ASRH and HIV/AIDS (including laws and policies) through seminars; prioritization of issues and development of interventions; and implementation of interventions by cultural institutions. Results include documentation of cultural norms, values, and practices; institutionalization and commitment of ASRH/HIV prevention initiatives within kingdoms; and open discussion of HIV/AIDS and harmful cultural practices. Lessons learned include the importance of a contact person for reaching cultural leaders, evidence-based data, and top-level commitment.
24. A community approach for sustainable development to support orphans from AIDS in Zambia. Kanter HL, Mataka EN.
The goal of this project was to provide sustainable development and support for children orphaned by AIDS in Zambia. The project had four main components: development of a community action plan to support and educate orphans; establishment of a partnership between NGOs and local leaders to provide sustainable development for orphans and the community; education of local leaders about social issues that are relevant to children; and development of a successful model by which the community can meet the needs of vulnerable children. As a result, the community has drilled a borehole, built a chicken coop, and planted a vegetable garden in order to provide sustenance for the children and generate income for the orphaned children. The classrooms were also up-graded because of the strong emphasis on child education in the project.
25. Community-based support for orphans and vulnerable children: the COPHIA model in Kenya. Mwaponda I, Colton TC.
The COPHIA model uses community mobilization interventions to identify and support orphans and vulnerable children (OVC) in Kenya. The project uses community implementation committees (CIC) to act as a link between local leaders and households that have OVC. Along with the CIC, local implementing partners provide educational, medical, and food support to the children. Finally, community health workers play an important role in the project as the people who identify and provide referrals to OVC households.
26. Orphans and vulnerable children: surveying the challenges and opportunities from a faith-based NGO perspective. Amayun MB, Casey K.
World Vision's Hope Initiative seeks to reduce the global impact of HIV/AIDS through the enhancement and partnerships focused on HIV/AIDS prevention, care, and advocacy. The initiative relies on identifying best practices, and then integrating these into existing World Vision programs. World Vision has begun to focus on orphans and vulnerable children with such activities as food supplementation, skills and vocational training, social and spiritual support, and youth focused prevention.
27. Tizenge youth orphan project: community led, multi-sectoral response to the orphan crisis. Fleming WO, Sakala F, Hall C.
The Tizenge Youth Orphan Project educates orphans and vulnerable children while also raising awareness about HIV/AIDS and STDs, along with information on care and support for those who are affected by these diseases. Operated by youth in Eastern Zambia, the community-based initiative works with children aged 5 to 24 and the communities they live in. Thus far, 13 villages have come together to build three schools while nine teachers and 30 caregivers have been trained in teaching literacy classes, reaching over 100 students. Other educational activities such as dramas and dances have reached over 3,000 people on the topics of HIV/AIDS and STDs.
28. At-risk adolescents seeking sexy media: a global investigation of the factors associated with adolescents' motivations for media use. Burke HM, Geary CW.
Theories suggest that young people's selection of media is motivated and purposive and that motivation for media selection is influenced by their lived experiences. Using baseline data from MTV's Staying Alive 2002 global AIDS campaign, for 4,000 youth aged 16 to 25 from urban areas of Brazil, Kenya, Nepal, and Senegal, YouthNet/FHI researchers sought to answer: "Are adolescents' sexual beliefs and behaviors associated with their interest in seeing and hearing about dating, sex, and relationships?" Analysis revealed that youth with more risky sexual behaviors often seek out more sexually explicit media, such as the material found in the MTV campaign.
29. Creating a worldwide movement against HIV/AIDS: a model for creating international youth activism. Elliot R, Taylor A, Tracy M, et al.
The Student Global AIDS Campaign presented a sustainable model of building an international network of student AIDS activists. Since 2001, more than 10,000 students from over 50 countries have been mobilized in political and educational activism. Their Global Youth Advocacy Network serves to share best practices and resources, as well as facilitate participation at advocacy events.
30. Scenarios from Africa: community mobilization and the production of high-quality short fiction films about HIV/AIDS. Winskel SK, Enger DD.
"Scenarios from Africa" is a community mobilization media project that works with young people to write and develop short fictitious films about HIV/AIDS. The films are directed by leading African directors. Contests were organized and held for youth under 25 to come up with ideas for short films on HIV/AIDS. These films help generate dialogue about HIV/AIDS, have high approval ratings, and encourage positive attitudes and responsible behavior. They are available in numerous languages and place an emphasis on hope, reflection, and dialogue.
