HIV Interventions with Youth

Approximately 50 percent of HIV infections worldwide are in young people between the ages of 10 and 24. During these years, youth learn, explore, and make decisions that will affect the rest of their lives. If they do not receive the information and services they need to make informed choices, they are more likely to engage in risk behaviors that can have such adverse consequences as high rates of early pregnancy and sexually transmitted infections (STIs), including HIV.

Interventions for youth should be guided by the following principles:

• Youth are not one single audience. Rather, youth are a complex group of people requiring appropriate segmenting based on such factors as age, geographic setting, family, school and civil status, and special needs. It is important to remember that not all youth are equally at risk for HIV/AIDS.

• Start young. Youth programs often start too late, after many young people have become sexually active and sexual attitudes and behaviors are already well formed. By reaching preteens and older children, programs can affect the emerging norms of young people. For example, the very young (six- to ten-year-olds) can be exposed to messages about healthy body image, body sovereignty (good touches versus bad touches), and support of people living with HIV/AIDS (PLHA).

• Examine the context of young people's lives. Interventions must look at the contextual factors in young people's lives, such as their economic status, ability to pay for school, family situation and civil status. Successful interventions will conduct formative research that examines the context of health decision-making behaviors and seeks ways to address them.

• Reach people who influence and control your access to youth. Prepare the environment. Youth are strongly influenced by the many people and institutions that surround them. It is important to reach the gatekeepers who control access to youth and are key to implementing HIV/AIDS prevention and care programs. Take into account young people's immediate and extended families, teachers, community leaders, religious leaders and media icons. Since youth interventions are often controversial, it is essential to advocate with community and political leaders.

• Link HIV programs to non-health sectors. Young people are not particularly interested in health issues like HIV/AIDS. Young people invest their time and interest in such areas as religion, schools, job training, agriculture, sports and the media. Interventions must take advantage of these sectors and seek to integrate HIV messages into their activities.

• Do not separate HIV from other reproductive health and life issues. Young people do not compartmentalize their lives. They are often more worried about an unwanted pregnancy than about HIV. A life skills/healthy lifestyle approach will build problem-solving and decision-making skills and help young people assess their risk for STI/HIV and take protective actions.

• Remember the health services and condoms. Young people need access to user-friendly STI services, voluntary counseling and testing (VCT), and other resources for reproductive health. They also need access to condoms and the skills to correctly use them. The best STI/HIV prevention programs for youth have direct linkages to trained, adolescent-friendly health care providers, pharmacists and community-based distribution (CBD) workers. Outreach, peer education, media, hotlines, and information, education, and communication (IEC) materials can provide referrals to these services.

• Youth are assets. When programming for youth, approach them as assets to society, not as problems to be overcome. Youth are resilient in the face of great societal challenges. Look for and seek to expand the reach of the networks and activities that support positive behaviors for youth.

• Involve youth in meaningful ways. Young people must be involved in every aspect of an intervention program, including its research, design, and implementation. This means that program designers must move beyond consultation to meaningful participation with youth. Doing this requires planners to make changes in their approach–by, for example, using simple concepts, flexible hours and specialized training. It is also important for program planners to seek participation and cultivate the voices of youth who are not usually heard–the youngest, the marginalized, and those directly affected by HIV/AIDS.

• The most effective programs offer healthy choices. There is no one right approach to HIV prevention with youth. Young people must be able to choose the healthy behaviors that best fit with their lifestyles–whether abstinence (delay of sexual initiation or "reclaiming their virginity"), condoms, or monogamy for older young people in stable, faithful relationships.

Youth want information from diverse sources. For example:

• Peer education is an effective strategy. Young people respond best to other young people–where they work, study, and play. This is why peer education/promotion/motivation is a crucial outreach strategy. But because young people move quickly through different phases of life, youth peer education/promotion/motivation programs should expect a high rate of turnover and a constant need for training and re-training.

• Anonymous sources increase access to information. In addition to peer education, youth are interested in seeking information from anonymous sources such as hotlines and the Internet.

• Make it fun! Young people enjoy the media, theater, lively arts and technology. The more fun the means for delivering information, the more likely young people will listen and retain what is being taught.

Resources

1. Family Health International. Meeting the needs of young clients: a guide to providing reproductive health services to adolescents. Arlington, VA: FHI, 2000.
2. Family Health International. Network: Adolescent Reproductive Health 2000;20(3). Arlington, VA: FHI, 2000.
3. Family Health International. How to create an effective peer education project. Arlington, VA: FHI, 1997.
4. National Pediatric and Family HIV Resource Center. Guidelines for children's participation in HIV/AIDS programs. NPHRC, 1999. http://www.pedhivaids.org.
5. Pathfinder International. Getting to scale in young adults reproductive health programs. Focus on young adults. Watertown, MA: Pathfinder International 2000. http://www.pathfind.org.
6. Pathfinder International. Listening to young voices: facilitating participatory appraisals on reproductive health with adolescents. Focus on young adults. Watertown, MA: Pathfinder International, 1999. http://www.pathfind.org/focus.
7. Pathfinder International. Promoting reproductive health for young adults through social marketing and mass media: A review of trends and practices. Focus on young adults. Watertown, MA: Pathfinder International, 1997. http://www.pathfind.org/focus.
8. UNAIDS. Adolescent sexuality. UNAIDS Best Practices Digest. Geneva: UNAIDS, 2000. http://www.unaids.org.
9. UNAIDS. Impact of HIV and sexual health education on the sexual behavior of young people. Geneva: UNAIDS, 1997. http://www.unaids.org.
10. UNESCO. School health education to prevent AIDS and STDs: a resource package for curriculum planners. Geneva: UNESCO, 1994. http://www.unesco.org.
11. http://www.advocatesforyouth.org
12. http://www.siecus.org
13. http://www.paho.org
14. http://www.cdc.gov
15. http://www.path.org