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I. PROGRAM RESOURCES
1. Africa's Orphaned Generations
2. Partnering with Local Organizations to Support the Reproductive Health of Adolescent Refugees
3. Adolescent and Reproductive Health: A Training Manual for Program Managers
4. Annotated Bibliography On HIV and Youth in sub-Saharan Africa
5. Non-consensual Sexual Experiences of Young People: A Review of the Evidence from Developing Countries
6. Towards Adulthood: Exploring the Sexual and Reproductive Health of Adolescents in South Asia
7. Actions that Protect: Promoting Sexual and Reproductive Health and Choice Among Young People in India
8. The ABCs and Beyond: Developing an Operations Research Agenda on Comprehensive Behavior Change Approaches for HIV Prevention
9. The Role of the Health Sector in Supporting Adolescent Health and Development
10. Consistency in the Reporting of Sexual Behavior among Adolescent Girls in Kenya: A Comparison of Interviewing Methods
11. "I Know My Goal" Campaign
II. RESEARCH ARTICLES
1. Adolescents in Vietnam: Looking Beyond Reproductive Health
2. Rural Children's Attitudes to People with HIV/AIDS in Mali: The Causes of Stigma
3. Unwanted Pregnancy and Sexually Transmitted Infection among Young Women in Rural Kenya
4. Research Summaries from Developed Countries
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I. PROGRAM RESOURCES
1. Africa's Orphaned Generations (2003)
This 56-page document presents statistics, projections, and strategies to address the growing HIV/AIDS orphan crisis in sub-Saharan Africa, including: strengthen the ability of families to care for orphans, improve community-based responses, create a supportive environment for children orphaned by AIDS, ensure that orphans have access to essential services (such as education), and ensure that the government protects the rights of orphans.
2. Partnering with Local Organizations to Support the Reproductive Health of Adolescent Refugees (2003)
This report summarizes three years of work on a project of the Women's Commission for Refugee Women and Children focusing on the reproductive health needs of adolescents in conflict settings. It provides project status, accomplishments, lessons learned, and plans for the future.
3. Adolescent Sexual and Reproductive Health: A Training Manual for Program Managers (2003, English/Spanish)
Designed to educate program managers to better respond to the sexual and reproductive health needs of adolescents, the manual includes four cross cutting themes: gender, human rights, youth-adult partnerships, and sustainability.
4. Annotated Bibliography on HIV and Youth in sub-Saharan Africa (2003)
This annotated bibliography provides a listing of HIV/AIDS documents focused on youth in sub-Saharan Africa since 1995. The bibliography includes substantive behavioral research studies, excluding summaries of program interventions and policy papers. The bibliography serves as background material for a project of the Alan Guttmacher Institute, "Protecting the Next Generation: Understanding HIV Risk Among Youth."
5. Non-consensual Sexual Experiences of Young People: A Review of the Evidence from Developing Countries (2003).
This report synthesizes the available information on non-consensual sex of youth in developing countries, covering males as well as females. The report reviews the research on the nature and extent of coercion, adverse consequences, underlying risk factors, and related issues. It concludes with programmatic and research recommendations.
6. Towards Adulthood: Exploring the Sexual and Reproductive Health of Adolescents in South Asia (2003).
This 244-page book contains 42 short papers based largely on presentations and sessions from an international conference on adolescent reproductive health in South Asia held in 2000, coordinated by several Indian institutions and the World Health Organization. It has an encyclopedic scope on issues with case studies, research results, and a broad topic scope (contraceptives, STIs, sex education, quality of services, etc.)
7. Actions that Protect: Promoting Sexual and Reproductive Health and Choice Among Young People in India (2003).
This paper synthesizes the current information on sexual and reproductive health behaviors of young people in India, focusing on factors that put adolescents at risk for unsafe sexual behaviors. These factors include poverty, gender inequity, and lack of access to education. Policy recommendations are included.
8. The ABCs and Beyond: Developing an Operations Research Agenda on Comprehensive Behavior Change Approaches for HIV Prevention (2003).
This report of a technical meeting organized by the Horizons Program focuses on operations research and future programming related to the "ABC" strategy (abstinence or delayed sexual initiation, be faithful/reducing number of partners, and condoms). Key points include ensuring that there is a clear distinction between ABC behaviors and other programs meant to influence these behaviors, creating a clear message, and developing new partnerships with faith-based organizations.
9. The Role of the Health Sector in Supporting Adolescent Health and Development (2003).
This report of a meeting of the World Health Assembly includes statements about adolescent health policy from officials from Bangladesh, Mexico, and Tanzania, as well as statements from UNICEF and others. It includes information on the status of adolescent reproductive health, ways to collect and synthesize information, policy development, and ways to support other sectors.
10. Consistency in the Reporting of Sexual Behavior among Adolescent Girls in Kenya: A Comparison of Interviewing Methods (2003).
In this report, the Population Council looks at three different types of reporting methods and compares the responses of adolescent girls in regards to their sexual behavior. The three methods used are face-to-face interviews, self-administered interviews with pencil and paper, and audio computer-assisted self-interviewing. While the face-to-face method was more consistent in the reporting of sexual behavior, the computer-assisted method had higher reporting of coerced sex and of sex with relatives, older men, and strangers.
11. "I Know My Goal" Campaign Ghana (2003)
This campaign targets girls ages 11 to 15 to protect themselves from HIV/AIDS. Sponsored by the Ghana Education Service's Girl Education Unit and part of the Stop AIDS Love Life national HIV/AIDS campaign, it works to improve self-esteem and decision-making skills about education, sex, and relationships.
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II. RESEARCH ARTICLES
Most of these articles are not available on-line without a subscription to the journal. To obtain the full article, you will need to contact the journal directly or through your organization's library.
1. Adolescents in Vietnam: looking beyond reproductive health. Mensch BS, Clark WH, Anh DN. Stud Fam Plann 2003;34(4):249-62.
This study includes a review of the literature in Vietnam on adolescent behavior and an analysis of data from a 1999 survey conducted in six provinces among nearly 1,500 males and females ages 15 to 22. The researchers concluded that the sexual behavior of unmarried adolescents in Vietnam is part of a broader context; researchers might broaden their focus beyond unprotected and unsanctioned sexual activity and its health consequences, specifically abortion and sexually transmitted diseases, especially HIV, to include data and research on schooling, work, and other aspects of young peoples' lives.
2. Rural children's attitudes to people with HIV/AIDS in Mali: the causes of stigma. Castle S. Culture, Health and Sexuality 2004;6(1):1-18.
Qualitative research among young people and other community members in rural Mali found significant misinformation about modes of HIV transmission, and that such misinformation contributes to stigmatization of those infected by HIV. The most frequently stated mode of transmission involved urinating in a place where someone with AIDS had already urinated. Shared clothes, food, and water were seen as sources of infection. Both children and teachers recommended that people with AIDS be isolated. Some thought even talking to them would lead to a risk of infection. Discriminatory views were likely to have been reinforced by parents and community elders who possessed the same misinformation. The rumor that AIDS results from sexual encounters between young women and dogs belonging to white people in Cote d'Ivoire was also widespread. The article proposed a holistic educational program to address HIV/AIDS and the social context in which infection occurs, with view to combating stigma and discrimination associated with HIV.
3. Unwanted pregnancy and sexually transmitted infection among young women in rural Kenya. Nzioka C. Culture, Health and Sexuality 2004;6(1):31-44.
This paper examines the strategies used by young women to deal with risks of unwanted pregnancy and infection by sexually transmitted infections, including HIV, given the increasingly common feature of early sexual debut and premarital sex among female Kenyan adolescents. Levels of knowledge concerning the protective value of condoms and other contraceptives are high, but unprotected sex is still common. Eight focus group discussions conducted with school-attending girls ages 15 to 19 in eastern Kenya suggest that, despite knowledge of the protective value of condoms and other contraceptives, the use of these methods by girls is hampered by inability to access them, the fear of the side effects of contraceptives, and the desire by girls to remain faithful to their religious calling. Most girls use traditional methods whose potency and efficacy is unproven. These findings suggest the need to make condoms more easily accessible to girls in rural areas, to train young women in being more assertive in sexual negotiations, and to provide education about the role of traditional methods.
4. Research Summaries from Developed Countries:
Changes in female student sexual behaviour during the transition to university. Farrow R, Arnold P. J Youth Stud 2003;6(4):339-55.
This study examines how female university students' sexual behavior changes in the transitional stage of leaving home for university. A survey (n=273) asked how much change they had experienced in their sexual behavior since arriving on campus and to describe this change. A Likert scale was used to measure change. The most prevalent response (41 percent) experienced no change. Of the 56 percent reporting some change, 19 percent had a decrease in sexual activity, while 37 percent had an increase. The use of alcohol to reduce inhibitions was common and often associated with risk-taking. Many changes were due to the absence of parental guidance, newly found freedom, and greater choice of potential partners. Implications for a university's role in sex education and support services are discussed.
Changes in the transmission dynamics of the HIV epidemic after the wide-scale use of antiretroviral therapy could explain increases in sexually transmitted infections: results from mathematical models. Boily M-C, Bastos FI, Desai K, et al. Sex Transm Dis 2004;31(2):100-13.
Recent increases in bacterial sexually transmitted infections (STIs) and risky sexual behavior have coincided with the introduction of antiretroviral therapy (ART) in homosexual communities of industrialized countries. This study sought to understand the various effects of ART on risk behaviors and STIs by developing a mathematical model of bacterial STIs and treated/untreated HIV/AIDS infection for an open homosexual population. The impact of wide-scale use of ART on risky behavior, STIs, and HIV/AIDS was evaluated over a wide range of assumptions on treatment use, ART efficacy, and population characteristics. Over 10 years, up to 55% of new bacterial STIs could be attributed to the wide-scale use of ART in conjunction with modest increases (0-25%) in risky sex occurring at the population level rather than at the individual level. These increases have a negative impact on HIV if ART coverage is too low. Increasing treatment coverage helps to prevent more HIV infections despite larger increases in risky sex and STI that is predicted to ensue. Taking the differential impact of wide-scale use of ART into account helps to interpret recent behavioral and STI trends but a better understanding of the differential impact of ART on sexual network over time is required.
Cost-effectiveness analysis of screening adolescent males for chlamydia on admission to detention. Blake DR, Gaydos CA, Quinn TC. Sex Transm Dis 2004;31(2):85-95.
Chlamydia trachomatis infections can lead to serious and costly sequelae but it is usually asymptomatic, so many infected youth do not seek testing. Entry to a detention system provides an opportunity to screen and treat many at-risk youth. This study examined the cost-effectiveness of screening male youth for chlamydia on entry to detention, comparing three screening strategies with a hypothetical cohort of 4,000 male youth per year: universal screening using a sophisticated urine-based NAAT test, selective use of the sophisticated test on leukocyte esterase (LE)-positive urines, and no screening. The model incorporated costs of screening and treatment and medical cost savings from sequelae prevented in infected males and female partners. Universal NAAT screening was the most cost-effective strategy, preventing 37 more cases of pelvic inflammatory disease (PID) and 3 more cases of epididymitis than selective screening and saving an additional $24,000. The analysis was sensitive to NAAT cost, LE sensitivity, rate of PID development, PID sequelae cost, and number of female partners. Universal screening remained the most cost saving for prevalence as low as 2.8% or higher. Savings are primarily the result of the prevention of PID in recent and future partners of index males. Screening detained male youth using a urine-based NAAT provides a public health opportunity to significantly reduce chlamydia infections in youth at risk for sexually transmitted diseases.
Counterfactual models of neighborhood effects: the effect of neighborhood poverty on dropping out and teenage pregnancy. Harding DJ. AJS 2003;109(3):676-719.
This article found a causal effect of poverty and neighborhood on high school dropping out and teenage pregnancy. It shows that when two groups of children, identical at age 10 on observed factors, experience different neighborhoods during adolescence, those in high-poverty neighborhoods are more likely to drop out of high school and have teenage pregnancy than those in low-poverty neighborhoods. Causal inferences from such associations have been plagued by the possibility of selection bias. Using a new method for sensitivity analysis, these effects are shown to be robust to selection bias. Unobserved factors would have to be unreasonably strong to account for the associations between neighborhood and the outcomes.
Emergency contraception: latest changes. Webb AMC. J Fam Plann Reprod Health Care 2004;30(1):7-8.
This editorial points out continued issues that require attention regarding easy access to emergency contraception for youth, including cost, availability from pharmacies or by prescription, and venues where it is available.
Epidemiology of human papilloma virus infection and abnormal cytologic test results in an urban adolescent population. Tarkowski TA, Koumans EH, Sawyer M, et al. J Infect Dis 2004;189(1):46-50.
The study determined the prevalence of and the risk factors for human papilloma virus (HPV) infection and abnormal cytologic test results in 312 adolescent girls (mean age, 16.1 years). Subjects had a median of two years of sexual activity and four lifetime sex partners. Independent risk factors for HPV were lifetime number of sex partners, age of partner, and douching. Cytologic abnormalities were common (20.9% of subjects had atypical squamous cells of uncertain significance, and 17% had high- or low-grade squamous intraepithelial lesions) and were significantly associated with detection of HPV; however, most (52%) subjects with HPV had normal cytologic test results.
Factors associated with the content of sex education in U.S. public secondary schools. Landry DJ, Darroch JE, Singh S, et al. Perspect Sex Reprod Health 2003;35(6):261-9.
While sex education is almost universal in U.S. schools, its content varies considerably, with abstinence and basic information on HIV more commonly taught than birth control and how to access STD and contraceptive services. This study analyzed data on 1,657 respondents to a 1999 national survey of teachers providing sex education in grades 7-12 and found that the content of sex education varied by region and by instructors' approach to teaching about abstinence and contraception. Instructors teaching that contraceptive methods are ineffective and presenting abstinence as teenagers' only option had significantly reduced odds of teaching various skills and topics. Instructors' approach to teaching about methods is a very powerful indicator of the content of sex education. Given the well-documented relationship between what teenagers learn about safer sexual behavior and their use of methods when they initiate sexual activity, sex education in all U.S. high schools should include accurate information about condoms and other contraceptives.
Homophobia and the production of shame: young people and same-sex attraction. Hillier L, Harrison L. Cult Health Sex 2004;6(1):79-94.
Research among same-sex attracted young people in Western cultures has described a minority group of adolescents whose sexuality is negated by the significant institutions and people in their lives. Very often, there is a silence in the family and at school about same-sex sexuality and when a young person's homosexuality is suspected or disclosed s/he suffers from denial, discrimination, and abuse. Living in hostile environments leaves such young people at high-risk of drug abuse, depression, and suicide. This paper describes some of the ways young people resist being positioned in these negative ways, based on autobiographical stories from 200 same-sex attracted young Australians.
The laboratory diagnosis of common genital viral infections. Chan EL, Kingston MA, Carlin EM. J Fam Plann Reprod Health Care 2004;30(1):24-5.
This overview of techniques used to diagnose genital human papilloma virus (HPV) and herpes simplex virus (HSV) points out that these viral genital infections have increased in prevalence in recent years, mostly among youth, and that they are frequently asymptomatic, with transmission often occurring during this time. This information is critical when counseling high-risk individuals because diagnosis of HPV and HSV infection is usually clinical.
Outcomes of teen parenting programs in New Mexico. Philliber S, Brooks L, Lehrer LP, et al. Adolescence 2003;38(151):535-53.
Although teen pregnancy rates in the U.S. have recently declined, the need for programs for pregnant and parenting teens remains. This report presents information from 53 programs that served pregnant and parenting teens in the state of New Mexico between 1997 and 2000. Data on 3,194 teens, including their characteristics, the services they received, and several key outcomes, are examined. The analysis found that the programs successfully promoted educational attainment as well as gains in employment. Prevalence of late prenatal care and low birth weight babies was lower than statewide averages, and the rate of repeat pregnancy was lower than that reported by many other programs.
Patterns of contraceptive use within teenagers' first sexual relationships. Manlove J, Ryan S, Franzetta K. Perspect Sex Reprod Health 2003;35(6):246-55.
Teenagers have a high rate of unintended pregnancy, in part because of inconsistent use or nonuse of contraceptives. An analysis of data from 1,027 participants in the first two waves of the National Longitudinal Study of Adolescent Health examined the influence of relationship and partner characteristics on ever-use and consistent use of contraceptive methods during teenagers' first sexual relationships. Teenagers who had waited a longer time between the start of a relationship and first sex with that partner, discussed contraception before first having sex, or used dual contraceptive methods had significantly increased odds of ever or always using contraceptives. Adolescents who had taken a virginity pledge, had an older partner, had a greater number of close friends who knew their first partner, or reported having a relationship that was not romantic but that involved holding hands, kissing, and telling their partners they liked or loved them had decreased odds of contraceptive use or consistency. As relationship length increased, teenagers were more likely to ever have used a method, but less likely to always have used a method. Parents and programs should encourage teenagers to delay sexual intercourse, discuss contraception with partners before initiating sex, and be vigilant about contraceptive use, particularly in long-term sexual relationships and in relationships with older partners.
Psychosocial factors associated with adolescent boys' reports of dating violence. Howard DE, Wang MQ. Adolescence 2003;38(151):519-33.
This study found that nearly one of every 10 U.S. teenage boys reported physical dating violence, suggesting that it may be a more serious problem than has previously been recognized and that intervention programs should include a focus on boys as not only perpetrators but also recipients of dating violence. The study examined prevalence and its association with psychosocial factors among a nationally representative sample of 9th- through 12th-grade U.S. boys (N = 7,434) who completed the 1999 Youth Risk Behavior Survey. The dependent variable was physical dating violence; the independent variables were violence, suicide, substance use, and sexual risk behavior. Multivariate logistic regression was used to examine all significant independent variables. Nine percent of the boys reported physical dating violence; these boys were more likely to have reported sad or hopeless feelings, had attempted suicide, reported fighting, had multiple sex partners, and reported nonuse of condoms.
Qualitative assessment of venues for purposive sampling of hard-to-reach youth: an illustration in a Latino community. Auerswald CL, Greene K, Minnis A, et al. Sex Transm Dis 2004;31(2):133-8.
This qualitative study sought to understand venues for reaching Latino youth for research, outreach, testing, and interventions regarding risks of unintended pregnancy and STIs. The study conducted ethnographic interviews with 62 youth recruited primarily from street sites and mapped the venues, which demonstrated the dominance of venues by street gangs. Street sites are important venues for meeting sexual partners.
Towards consensus on good practice in the prescription of emergency contraception for young people. Baraitser P. J Fam Plann Reprod Health Care 2004;30(1):62-3.
This article solicited reactions from a 15-year-old girl, an "agony aunt" for young people's magazines, a general practitioner, a family planning doctor, a community pharmacist who prescribes emergency contraception, and a local genitourinary medicine consultant for reactions to two possible scenarios for how to respond to a 15-year-old seeking emergency contraception. The range of opinions raise questions about how much information should be given to a young person at the time of seeking EC.
Young people's leisure and risk-taking behaviours: changes in gender patterning in the West of Scotland during the 1990s. Sweeting H, West P. J Youth Stud 2003;6(4):391-412.
Over the course of the 1990s, evidence emerged of increasing public visibility, reduced restrictions on activities, and relatively greater increases in health-risk behaviors among females in developed countries, together with suggestions of a domestification of leisure among males. This paper uses data from two cohorts of 15-year-olds in the same geographical area (the West of Scotland), separated by 12 years (1987 and 1999) to examine changes in the gender patterning of young people's leisure, use of public space, and risk taking (as represented by substance use) over this time period. Gender differences in street-based (previously more males) and conventional/safe (previously more females) leisure disappeared over this period, while male excesses in watching sports and playing computer games increased. At the same time, female levels of drinking and experience of illicit drugs reached, and those of smoking overtook, their male counterparts. Changes in leisure activities over time accounted in part for the changing gender patterns in substance use. The paper discusses how greater public visibility and increased risk-taking behaviors among females have resulted from the lifting of constraints of respectability on young women's life-styles. These changes have been rapid and have significance in both social and health terms.
