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I. PROGRAM RESOURCES
1. Peer Education Trainer of Trainers Manual
2. Y-PEER Icebreakers Index Cards
3. Peer Approach in Adolescent Reproductive Health Education: Some Lessons Learned
4. Games for HIV/AIDS Training – India and Nepal
5. Young People We Care! A Book of Ideas to Help Young People Supporting Each Other In Their Communities
6. What Works in Youth Media: Case Studies from Around the World
7. Community Media for Development: Radio Programs for Youth in Mozambique
8. Primary Schooling in Sub-Saharan Africa: Recent Trends and Current Challenges
9. The Children of Africa Confront AIDS
10. Adolescence Education Newsletter
11. Progress in Reproductive Health Research
12. Youth Reproductive Health in Nepal: Is Participation the Answer?
13. Re-appraising Youth Prevention in South Africa: The Case of LoveLife
II. RESEARCH ARTICLES
1. Adolescent Reproductive Health and Awareness of HIV among Rural High School Students, North Western Ethiopia
2. Community Sex Education among Adolescents in Rural Uganda: Utilizing Indigenous Institutions
3. Intentions to Use Condoms in Rwandan Secondary School Students
4. Knowledge and Attitudes of High School Students Regarding HIV/AIDS in Tunisia: Does More Knowledge Lead to More Positive Attitudes?
5. School-based HIV Prevention Programmes for African Youth
6. Research Summaries from Developed Countries
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I. PROGRAM RESOURCES
1. Peer Education Trainer of Trainers Manual (2003, English, Russian, Bulgarian, Armenian, and Serbo-Croatian).
Youth Peer Education Electronic Resource (Y-PEER), which works in Eastern Europe, the Baltics, and Central Asia, has developed a 188-page manual to train trainers, focusing on peer education. It addresses sexual and reproductive health, HIV/AIDS, gender, and cultural sensitivity. The manual has three major sections: theory to practice, guidelines for training of trainers, and a sample peer education session.
2. Y-PEER Icebreakers Index Cards (2004, English, Russian).
These pocket-size, full color "icebreaker" cards for peer education training were developed by UNFPA within the framework of Y-PEER programs. The cards are intended for trainers and peer educators to use during peer education training sessions to promote a fun, open, and learning environment through principles of trust, education, and health.
3. Peer Approach in Adolescent Reproductive Health Education: Some Lessons Learned (2003).
This 69-page guide to peer education focuses on reproductive health and STIs/HIV/AIDS and is structured in these chapters: what is peer education; why use peer education; what research says, lessons learned, and guidelines.
4. Games for HIV/AIDS Training – India and Nepal (2003).
The International Services Association (INSA) India has developed games for HIV/AIDS training in school and community-based settings. The training emphasizes positive behavior and personal responsibility, dispels misconceptions and stigma, and instills confidence in youth. The project works in 14 states and targets adolescents in both formal and non-formal schools.
5. Young People We Care! A Book of Ideas to Help Young People Supporting Each Other In Their Communities (2003).
This guide can help youth to increase their involvement in, and support of, family and community members who are infected with HIV/AIDS. Intended for young people ages 15 to 20, the book provides facts on HIV and AIDS, offers information about peer education, teaches life skills, and demonstrates ways to perform community outreach. It includes a training guide and community activities.
6. What Works in Youth Media: Case Studies from Around the World (2003).
In this 80-page book, the International Youth Federation shows through seven case studies how youth can use media to spread their message, whether it be human rights issues, HIV/AIDS awareness, or developing employment skills. The case studies are from Albania, China, Mexico, United Kingdom, the United States, Vietnam, and Zambia.
7. Community Media for Development: Radio Programs for Youth in Mozambique (2004, English and Portuguese).
Working with street youth in Mozambique, GOAL Mozambique and the Community Media for Development project developed radio spots that address HIV/AIDS, children's rights, sexual abuse, and other issues. The youth use songs and skits in the radio broadcasts.
8. Primary Schooling in Sub-Saharan Africa: Recent Trends and Current Challenges (2003).
This report estimates that more than 37 million children in sub-Saharan Africa ages 10 to 14 will not complete primary school. While there has been a steady increase of girl attendance at school over the past 20 years, a large gap remains between poor and rich children. Lack of education can lead to far-reaching consequences, including destabilized social, economic, and health structures, the report concludes.
9. The Children of Africa Confront AIDS (2003).
This collection of 15 essays by primarily developing country writers groups stories of children, youth, and AIDS into sections on vulnerability, coping, courage, and possibility. An excerpt and table of contents are available online, with ordering information.
10. Adolescence Education Newsletter (2003).
The December 2003 edition of the Adolescence Education Newsletter from UNESCO Asia and Pacific region includes articles on adolescent reproductive health programs, best practices in Bangladesh and Thailand, electronic resources, and the launch of the Reproductive Health Initiative for Youth in Asia (RHIYA).
11. Progress in Reproductive Health Research (2003).
This issue of the newsletter of the World Health Organization's Department of Reproductive Health and Research synthesizes information from a recent book of papers presented at a regional conference on adolescents (see Youth InfoNet No. 4, "Towards Adulthood, Exploring the Sexual and Reproductive Health of Adolescents in South Asia").
12. Youth Reproductive Health in Nepal: Is Participation the Answer? (2004).
This report summarizes findings from a five-year study in Nepal on the impact of participatory approaches in working with adolescents to understand and address their reproductive health needs. The project was implemented in one rural and two urban sites and provided different levels of education and adolescent-friendly services to the study and control sites. While results are mixed, the intervention site showed a general increase in use of reproductive health services, such as family planning methods and prenatal care, and increased knowledge of STD/HIV/AIDS.
13. Re-appraising Youth Prevention in South Africa: The Case of LoveLife (2003).
This essay critically examines assumptions and assertions by the South Africa LoveLife campaign, which is addressing the HIV/AIDS epidemic through broad advertising and service projects. The paper, presented at the South African AIDS conference in 2003, summarizes what the author sees as shortfalls of the project's conceptual framework.
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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. Adolescent reproductive health and awareness of HIV among rural high school students, North Western Ethiopia. Alene GD, Wheeler JG, Grosskurth H. AIDS Care 2004;16(1):57-68.
A cross-sectional study among 260 students from two rural high schools in North Western Ethiopia found that although the general awareness of HIV was high, only 44% of adolescent boys and 41% of adolescent girls showed correct knowledge of the virus and its modes of transmission. Knowledge of HIV and condoms was lower among students whose parents were farmers, significant so among girls (p=0.02). About half of sexually active single male students (49%) used condoms; 82% of adolescent males and 37% of adolescent females had some awareness of STDs. Almost 20% of sexually active males had previously experienced an STD, almost all of whom had visited a commercial sex worker. Targeted interventions are warranted among adolescents and sex workers in Ethiopia complemented by STD treatment services.
2. Community sex education among adolescents in rural Uganda: utilizing indigenous institutions. Muyinda H, Nakuya J, Whitworth JA, Pool R. AIDS Care 2004;16(1):69-79.
Although adolescent girls in Uganda are particularly vulnerable to HIV infection, providing relevant sexual health education to them is problematic. The senga (father's sister) is the traditional channel for socializing adolescent girls into sex and marriage among many ethnic groups in Uganda. This paper discusses the implementation and community acceptability of "modern" sengas, who were trained to provide HIV-related counseling to adolescent girls. Fourteen sengas were trained in two villages and, in the course of the one-year study, 247 individuals made a total of 403 visits to them. By including both traditional services (such as advice on and assistance with labial elongation) and modern health and sex education, the sengas provided a "middle road" between tradition and modernity. As a result, despite initial suspicion, the community generally supported this type of health education.
3. Intentions to use condoms in Rwandan secondary school students. Rahlenbeck S, Uhagaze B. AIDS Care 2004;16(1):117-21.
A survey was conducted among 474 (213 female and 261 male) students (mean age 21 years) in three secondary schools in rural Rwanda in order to evaluate their attitudes towards condoms. Male students and those with sexual experience had more favorable attitudes towards condom utilization than female students and those without prior sexual contacts. Of the 44% with reported sexual experience, reported age at first encounter was lower in boys (16.8 years) than in girls (18.3 years; p=0.03); 73 students (36%) reported regular use of condoms. Forty-two claimed having more than one sexual partner (9%), of whom 20 (48%) claimed regularly using a condom. Intention to use condoms was reported by 77% of the male and 53% of the female students (p=0.001). In addition, those with prior use of condoms and those having multiple partners were more likely to report future use intentions than others. Future campaigns in Rwanda should therefore focus on sensitizing adolescents to a more positive attitude towards condoms and include modules to reduce condom misconceptions and stigma.
4. Knowledge and attitudes of high school students regarding HIV/AIDS in Tunisia: does more knowledge lead to more positive attitudes? Tebourski F, Ben Alaya D. J Adolesc Health 2004;34(3):161-2.
This survey in the capital city of Tunisia among 598 students ages 16 to 19, all Muslim, found high knowledge about HIV infection but some misconceptions about the role of condoms and HIV transmission mode. The study found that more knowledge did not necessarily result in more positive attitudes towards people living with AIDS (PWA). The authors deduced that knowledge was not sufficient to lead to more positive attitudes toward PWA and that the religious factor is likely to be the most important influence shaping these attitudes.
5. School-based HIV prevention programmes for African youth. Gallant M, Maticka-Tyndale E. Soc Sci Med 2004;58(7):1337-51.
This paper reviews 11 published and evaluated school-based HIV/AIDS risk reduction programs for youth in Africa. Most evaluations were quasi-experimental designs with pre-post test assessments. The program objectives varied, with some targeting only knowledge, others attitudes, and others behavior change. Ten of the 11 studies that assessed knowledge reported significant improvements. All seven that assessed attitudes reported some degree of change toward an increase in attitudes favorable to risk reduction. In one of the three studies that targeted sexual behaviors, sexual debut was delayed, and the number of sexual partners decreased. In one of the two that targeted condom use, condom use behaviors improved. The results of this review suggest that knowledge and attitudes are easiest to change, but behaviors are much more challenging. The article provides details about programs and identifies characteristics of the most successful programs. Clearly, however, more research is needed to identify, with certainty, the factors that drive successful school-based HIV/AIDS risk reduction programmes in Africa.
6. Research Summaries from Developed Countries:
Adolescent clinic visits for contraception: support from mothers, male partners and friends. Harper C, Callegari L, Raine T, Blum M, et al. Perspect Sex Reprod Health 2004;36(1):20-6.
To show differences in social support for adolescents' clinic visits, data from a prospective cohort study of 399 teenage clinic attendees using the pill, the implant, or condoms were collected through a questionnaire at baseline and at a one-year follow-up interview. Data were analyzed using multivariate regression analysis. Almost all teenagers (96%) reported that their mother, a male partner, or a friend was aware of their clinic visit for contraception; of these, 92-96% also said that their mother or a male partner was supportive. Teenagers who chose the pill or implant were more likely than condom users to report that their mother and male partner were aware and that their mother was supportive of their contraceptive clinic visit. Implant users were significantly more likely than those who chose the pill or condom to continue using their chosen method for one year. Teenagers who took part in high-risk behaviors were more likely than others to involve a friend but not their mother or a male partner in their contraceptive decision-making. Pregnancy prevention programs and counseling protocols that integrate supportive networks for teenagers into contraceptive services may help adolescents to use effective methods.
Body piercing and high-risk behavior in adolescents. Roberts TA, Auinger P, Ryan SA. J Adolesc Health 2004;34(3):224-9.
This study evaluated the association of body piercing with socio-demographic factors, peer substance use, and high-risk behaviors, a cross-sectional analysis using Wave II of the National Longitudinal Study of Adolescent Health (Add Health) Public Use Dataset – a nationally representative, school-based sample of 4,337 adolescents, aged 13-18 years, surveyed in 1996. The major predictor variable was body piercing at locations other than the ears. The outcome variables were selected from five areas of high-risk behaviors including sexual intercourse, substance use (problem drinking, smoking, and marijuana use), violent behavior (fighting and inflicting injuries), antisocial behavior (truancy, shoplifting, and running away), and mood problems (depression, suicidal ideation, and suicide attempts). In logistic regression analyses, controlling for socio-demographic factors, piercing was associated with sexual intercourse, smoking, marijuana use, truancy, running away from home, suicidal ideation, and suicide attempts. Body piercing may serve as a marker for higher levels of peer substance use and potential problem behavior.
Coital debut: the role of religiosity and sex attitudes in the Add Health Survey. Rostosky SS, Regnerus MD, Wright ML. J Sex Res 2003 ;40(4):358-67.
While recent reviews suggest that religiosity is associated with the delay of adolescent coital debut, few studies have examined this association using longitudinal data to test theoretically driven models. We analyzed data from 3,691 adolescents (ages 15-21), testing the hypothesis that adolescent religiosity and sex attitudes (at Wave 1) predict later coital debut (at Wave 2) and that these predictive relationships vary by gender. Findings indicated that beyond demographic factors and number of romantic partners, religiosity reduced the likelihood of coital debut for both males and females. After accounting for the effects of religiosity, anticipation of negative emotions after coital debut (sex attitude factor 1) further reduced its likelihood for females and males. Finally, adolescent girls, but not boys, who anticipated positive emotions following sexual intercourse (sex attitude factor 2) were more likely to debut. While virginity pledge status was associated with coital debut for boys and girls, more conservative beliefs about sex appeared to mediate its effect.
The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Chesson HW, Blandford JM, Gift TL,et.al. Perspect Sex Reprod Health 2004;36(1):11-9.
We synthesized the existing literature on STD costs to estimate the lifetime medical cost per case of eight major STDs-HIV, human papillomavirus (HPV), genital herpes simplex virus type 2, hepatitis B, chlamydia, gonorrhea, trichomoniasis, and syphilis. We then estimated the total burden of disease by multiplying these cost-per-case estimates by the approximate number of new cases of STDs acquired by youth aged 15-24. The total estimated burden of the nine million new cases of these STDs that occurred among 15 to 24-year-olds in 2000 was $6.5 billion (in year 2000 dollars). Viral STDs accounted for 94% of the total burden ($6.2 billion). HIV and HPV accounted for 90% of the total medical costs ($5.9 billion). The large number of infections acquired by persons aged 15-24 and the high cost per case of viral STDs, particularly HIV, results in a substantial economic burden.
Initiation of sexual intercourse among middle school adolescents: the influence of psychosocial factors. Santelli JS, Kaiser J, Hirsch L, et al. J Adolesc Health 2004;34(3):200-8.
Using longitudinal data from the Healthy and Alive! Project, researchers conducted hierarchical, logistic regression with adjustment for intraclass correlation over two sequential periods, including seventh and eighth grades (N = 3,163), to assess the independent influence of psychosocial and demographic factors. Internally reliable scales to assess psychosocial influences were created, based on major theories of behavior. The sample was 52% female, 51% black, 30% Hispanic, 9% white, and 3% Asian. At baseline, 13% of girls and 39% of boys reported already having initiated sexual intercourse. Personal and perceived peer norms about refraining from sex were a strong and consistent protective factor. Alcohol and other drug use, poor academic performance, male gender, and black race were consistent risk factors. Self-efficacy showed a mixed effect: protective in the seventh grade but increasing risk in the eighth grade. Speaking a language other than English was a protective factor in seventh grade. Both psychosocial and demographic factors provided independent explanatory power. Psychosocial factors, particularly norms about having sex, influence initiation of sexual intercourse. These data suggest that programs to delay initiation of sexual intercourse should reinforce norms about refraining from sex.
New sex partner acquisition and sexually transmitted disease risk among adolescent females. Niccolai LM, Ethier KA, Kershaw TS, et al. J Adolesc Health 2004;34(3):216-23.
Interview data and biological specimens for STD testing were collected from a sample of 411 adolescent females (average age 17.3 years, 44% black and 42% Hispanic) enrolled in a longitudinal study. The relationship between having a new sex partner and incident STD infection was estimated with logistic regression. Acquisition of a new sex partner during the 12-month follow-up period was common (24%) and significantly associated with an incident STD infection (OR = 3.0, 95% CI = 1.6-5.7). Predictors of new partner acquisition were younger age, younger age at first intercourse, and alcohol or drug use before sex in past 30 days. Being in a new partnership was significantly associated with greater uncertainty about the partners' STD history and recent sex with others. Being in a new sex partnership is an important predictor of incident STD infection. Awareness of this risk can help clinicians identify individuals who are more likely to get STDs and therefore target STD testing and appropriate prevention messages.
Parental perspectives on vaccinating children against sexually transmitted infections. Mays RM, Sturm LA, Zimet GD. Soc Sci Med 2004;58(7):1405-13.
Young adolescents are presumed to be likely targets for potential new vaccines for STIs since adolescents' risk for STI increases as they age and become sexually active. Parents may not agree to have adolescents receive STI vaccines, however, even though such acceptance is the foundation for an effective immunization program. This qualitative study used in-depth interviews to elicit attitudes from 34 parents about accepting vaccines for genital herpes, human immunodeficiency virus, human papillomavirus, and gonorrhea for their children (aged 8-17). Data were collected from parents bringing their children for care at an urban clinic and a suburban private office. Content analysis of the responses revealed that most parents (>70%) approved the administration of all four of the STI vaccines proposed. Parents' wanted to protect their children, being concerned about disease characteristics and previous experience with the infections. Parents who declined the vaccines did so primarily because they perceived their children to be at low risk for the infections or they had low concern about features of the diseases. Most parents thought they should be the decision-maker regarding children receiving an STI vaccine.
Primary and secondary sexual abstinence in high school students. Loewenson PR, Ireland M, Resnick MD. J Adolesc Health 2004;34(3):209-15.
To assess reasons for choosing not to have sexual intercourse among two groups: virgins (primary abstainers) and already sexually experienced youth (secondary abstainers), the1998 Minnesota Student Survey was analyzed, which 73,464 Minnesota ninth- and twelfth-grade adolescents completed. Respondents identified reasons for abstinence from a checklist from which they could nominate all relevant items. Reasons for each group were analyzed using Chi-square with a conservative criterion value (p <.001) owing to large sample size. Logistic regression was used to examine the associations of gender, grade, and their interactions, with reasons for abstinence. Sixty-six percent reported never having had intercourse (primary abstainers). Among sexually experienced youth, 7.8% reported choosing not to have intercourse (secondary abstainers). Fear of pregnancy was the reason endorsed most often, more by girls than by boys (OR = 26 for primary abstainers, 6.9 for secondary abstainers). Fear of other adverse consequences, such as sexually transmitted infections, parental disapproval, or fear of getting caught, were generally selected by more girls than boys, and by more primary than secondary abstainers. Similarly, more girls and primary abstainers than boys or secondary abstainers generally selected statements reflecting normative beliefs on youth or their friends having intercourse. Fear of adverse consequences and normative beliefs about the appropriateness of having sexual intercourse were most frequently endorsed as important reasons by both groups of abstainers.
Relationship type, goals predict the consistency of teenagers' condom use. Rosenberg J. Perspect Sex Reprod Health 2004;36(1):37.
This survey among 701 vocational education students in Holland (average age 18) found that the type of relationships in which adolescents are involved and the motivations for having sex are associated with consistent condom use. Interventions that target subgroups, distinguishing between steady or casual partner, the meaning of the relationship, and the motivation for sex would be an effective way to increase consistent condom use, the study concluded.
Relationships of a brief measure of youth assets to health-promoting and risk behaviors. Murphey DA, Lamonda KH, Carney JK, et al. J Adolesc Health 2004;34(3):184-91.
To assess how assets affect behavior, six "assets" questions were added to an existing school-based survey of health-related behaviors. Asset questions dealt with students' grades in school, their communication with parents about school, students' perceptions of their role in school decision-making, students' participation in after-school activities and volunteering, and students' perceptions that they "matter" in their community. Participants were 30,916 Vermont students in grades 8-12, approximately equal numbers of girls and boys, 92% white. Fifty-nine percent of students' mothers had completed at least some postsecondary education (according to student report). Data were analyzed by Chi-square techniques and logistic regression. Number of assets (0-6) was negatively related to students' engagement in each of seven risk behaviors, and positively related to three health-promoting behaviors. The effects of number of assets were in most cases independent of demographic variables. Among the six assets, academic success (grades in school) contributed the greatest effect for most of the outcome measures; however, each of the assets contributed significant independent effects to multiple risk- and health-behaviors. Students' assets, even if relatively few, may make important contributions to wellness, independent of other well-established demographic factors.
Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Weinstock H, Berman S, Cates W Jr. Perspect Sex Reprod Health 2004;36(1):6-10.
Data from a variety of sources were used to estimate the incidence and prevalence of STDs among 15-24-year-olds in the United States in 2000. The quality and reliability of the estimates were categorized as good, fair or poor, depending on the quality of the data source. Approximately 18.9 million new cases of STD occurred in 2000, of which 9.1 million (48%) were among persons aged 15-24. Three STDs (human papillomavirus, trichomoniasis and chlamydia) accounted for 88% of all new cases of STD among 15-24-year-olds. These estimates emphasize the toll that STDs have on American youth. More representative data are needed to help monitor efforts at lowering the burden of these infections.
Some teenage mothers place high priority on avoiding repeat pregnancy in their early postpartum months. Coren C. Perspect Sex Reprod Health 2004;36(1):34-5.
Researchers interviewed 363 sexually active women at urban clinics serving relatively poor communities in Connecticut, ages 14 to 19, all nulliparous. Approximately half were pregnant, all in the third trimester at baseline. Structured interviews were held at baseline, at six and at 12 months later. Those who were pregnant were more likely than those who were not to report consistent use of hormonal contraception or dual methods six months and 12 months later, but the proportion using hormonal methods had reduced substantially by 12 months. While adolescent mothers appear to make a concerted effort to avoid a repeat pregnancy, they may have difficulty maintaining high levels of protection over time, the study concluded.
To screen or not to screen: prevalence of C. trachomatis among sexually active asymptomatic male adolescents attending health maintenance pediatric visits. Tebb KP, Shafer M-A, Wibbelsman CJ, et al. J Adolesc Health 2004;34(3):166-8.
This study estimated the prevalence of Chlamydia trachomatis (CT) among sexually active, asymptomatic, multiethnic adolescent males attending preventive health maintenance visits at pediatric clinics within a large health maintenance organization. First-void urines of sexually active 14 to 18-year-old males were screened for CT. The CT infection rate was 4% (27/711), 95% CI = 2.5%, 5.5%.
Wading through the stereotypes: positive and negative associations between media use and black adolescents' conceptions of self. Ward LM. Dev Psychol 2004;40(2):284-94.
Limited evidence exists to support the assumption that frequent media exposure may adversely affect the self-esteem and racial self-esteem of African American youths. To examine this issue, the author collected data among 156 African American high school students, testing connections among racial self-esteem, three dimensions of self-esteem, and multiple forms of media use. Whereas initial comparisons revealed media use to be a negative correlate of self-esteem, further analysis demonstrated that this association varied depending on the media genre and the domain of self in question, the content of students' media diets, and the individual characteristics of the viewer. In addition, both stronger identification with popular black characters and greater religiosity emerged as possible protective factors.
