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I. PROGRAM RESOURCES

1. Addressing Cross-Generational Sex: A Desk Review of Research and Programs
2. Another Way to Learn...Case Studies
3. Choices: A Guide for Young People
4. Evaluation of the African Youth Alliance Program in Ghana, Tanzania, and Uganda
5. Girls Count: A Global Investment and Action Agenda
6. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
7. Included, Involved, Inspired: A Framework for Youth Peer Education Programmes
8. "Saathiya" Country Research Brief: Evaluating Demand-side Impacts of a Youth-Friendly Initiative (YFI) in India: Baseline Findings
9. The Straight Talk Campaign in Uganda: Impact of Mass Media Initiatives Summary Report
10. Walking the Talk: Putting Women's Rights at the Heart of the HIV and AIDS Response
11. What Works in Unlocking Local Resources: A Case Study in National and Community-based Alliances
12. World Youth Report 2007
13. Young Voices in Research for Health 2007: Winners of the 2007 Essay Competition for the Under-30s
14. YOUth Magazine

II. RESEARCH SUMMARIES

1. Adolescent's views of and preferences for sexual and reproductive health services in Burkina Faso, Ghana, Malawi, and Uganda
2. Adverse perinatal outcomes of adolescent pregnancies in Cameroon
3. Coerced first sex among adolescent girls in sub-Saharan Africa: prevalence and context
4. Demographic correlates of constant condom use among sex workers in Tangail, Dhaka, Bangladesh
5. Effectiveness of a school-based AIDS education program among rural students in HIV high-epidemic area of China
6. Elevated risk for HIV-1 infection in adolescents and young adults in Sao Paulo, Brazil
7. Evaluation of a school-based reproductive health education program in rural southwestern Nigeria
8. Factors associated with sexual abstinence among adolescents in four sub-Saharan African countries
9. Family structure and adolescent sexual behavior in a poor area of Sao Paulo, Brazil
10. Herpes simplex virus type 2 infection among young uncircumcised men in Kisumu, Kenya
11. Hidden Love: Sexual ideologies and relationship ideals among rural South African adolescents in the context of HIV/AIDS
12. HIV/AIDS and sexual-risk behaviors among adolescents: Factors influencing the use of condoms in Burkina Faso
13. Improving health, improving lives: Impact of the African Youth Alliance and new opportunities for programmes
14. Influence of social connectedness, communication, and monitoring on adolescent sexual activity in Ghana
15. Is poverty a driver for risky sexual behaviour? Evidence from national surveys of adolescents in four African countries
16. Knowledge of correct condom use and consistency of use among adolescents in four countries in sub-Saharan Africa
17. Metaphors we love by: Conceptualizations of sex among young people in Malawi
18. Perceptions of risk to HIV infection among adolescents in Uganda: Are they related to sexual behaviour?
19. Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa
20. Preventing mother-to-child HIV transmission among South African adolescents
21. Sexual behavior, knowledge and information sources of very young adolescents in four Sub-Saharan African countries
22. The social context of induced abortions among young couples in Cote d'Ivoire
23. Stigmatization of AIDS patients: Disentangling Thai nursing students' attitudes towards HIV/AIDS, drug use, and commercial sex
24. The timing and role of initiation rites in preparing young people for adolescence and responsible sexual and reproductive behaviour in Malawi
25. Use of contraceptive methods by sexually active teenagers in Pelotas, Rio Grande do Sul State, Brazil

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I. PROGRAM RESOURCES

1. Addressing Cross-Generational Sex: A Desk Review of Research and Programs (2007, PDF, 92 pages, 615 KB)

This publication presents definitions for and prevalence of cross-generational sex, explores interventions and promising practices aimed at reducing risks associated with cross-generational sex outside of marriage, and makes recommendations for next steps.
Organization: Population Reference Bureau
Contact: prborders@prb.org

2. Another Way to Learn...Case Studies (2007)
English (PDF, 83 pages, 3.12 MB)
Spanish (PDF, 91 pages, 3.18 MB)

The "Another Way to Learn" initiative supports non-formal education in Africa, South Asia, the Caribbean, and Latin America. Its long-term goal is to develop sustainable livelihoods for low-income, low-literate populations by addressing vulnerability to HIV and AIDS and drug use, lack of education, and social exclusion. Central to these projects are innovative methods used to communicate in a meaningful way, engage people, and encourage their participation. This publication shares UNESCO's experiences with and rationale for reaching a vulnerable population affected by drug use.
Organization: UNESCO
Contact: m.dada@unesco.org

3. Choices: A Guide for Young People (revised second edition, 2007)

Choices is a well-known guide, available for purchase, written for young people growing up in Africa. It provides them with accurate information about themselves and their bodies so that they can make informed decisions about their future. This new edition is the result of reviews and suggestions by school children, young people, NGO staff, teachers and health workers. Major changes include a new sequence and division of the content into more detailed and focused chapters. "Friendship and Love" now focuses on delaying sexual debut and "Making a Good Marriage" covers mutual monogamy and having good sexual relationships. There is a new chapter on HIV and AIDS that covers prevention and treatment in more detail as well as the impact of stigma and discrimination and how to reduce it.
Organizations: International HIV/AIDS Alliance and TALC UK
Contact: info@talcuk.org

4. Evaluation of the African Youth Alliance Program in Ghana, Tanzania, and Uganda (2007)
Summary (PDF, 56 pages, 537 KB)
Ghana (PDF, 94 pages, 1.24 MB)
Tanzania (PDF, 102 pages, 1.28 MB)
Uganda (PDF, 102 pages, 831 KB)

This evaluation was designed to determine whether exposure to the African Youth Alliance's (AYA) comprehensive, integrated program resulted in improved adolescent sexual and reproductive health knowledge, attitudes, and sexual behaviors among youth ages 17-22 in areas where AYA worked in Ghana, Tanzania, and Uganda. Overall findings are presented in a summary report and individual country reports.
Organization: JSI
Contact: jsiinfo@jsi.com

5. Girls Count: A Global Investment and Action Agenda (2008, PDF, 1.7 MB)

This 89-page report describes why and how to initiate effective investments that will give adolescent girls in developing countries a full and equal chance for rewarding lives and livelihoods. It discusses how the health of economies and families depends on protecting the rights of and fostering opportunities for girls. The report provides specific recommendations for civil society, governments, private-sector leaders, and donor agencies.
Organization: Center for Global Development
Contact: cgd@cgdev.org

6. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (2008, PDF, 134 pages, 1.73 MB)

These guidelines outline our current understanding of how clinicians should use antiretroviral agents to treat adults and adolescents infected with HIV-1. Recommendations are based upon expert opinion and scientific evidence. However, as the science rapidly evolves, the availability of new agents and new clinical data may rapidly change therapeutic options and preferences.
Organization: US Department of Health and Human Services, Panel on Antiretroviral Guidelines for Adults and Adolescents
Contact: ContactUs@aidsinfo.nih.gov

7. Included, Involved, Inspired: A Framework for Youth Peer Education Programmes (2008)

This publication, which outlines good practices in peer education, was developed by the International Planned Parenthood Federation to guide its member associations globally on developing and overseeing large or small youth peer education programs. Supervisors, trainers, and other young people can also use this framework in their work, and as a basic reference tool. The framework is useful in initiating a new peer education project or to rethink and improve existing activities.
Organization: International Planned Parenthood Federation
Contact: info@ippf.org

8. "Saathiya" Country Research Brief: Evaluating Demand-side Impacts of a Youth-Friendly Initiative (YFI) in India: Baseline Findings (2008, PDF, 177 KB)

The Saathiya (or "trusted partner") campaign aims to motivate young, married couples to seek family planning information and products. A baseline survey on couples' family planning knowledge, attitudes, and practices to inform program development was recently conducted. This report presents a preliminary analysis of the baseline data collected in the summer of 2007.
Organization: Private Sector Partnerships One
Contact: info@psp-one.com

9. The Straight Talk Campaign in Uganda: Impact of Mass Media Initiatives Summary Report (2007, PDF, 52 pages, 708 KB)

This report presents the findings of an evaluation of the Straight Talk mass media communication programs, which have been implemented in Uganda since 1993. The evaluation described here employed several strategies, including a household survey of adolescents, the main subject of this report. Other components included a household survey of parents, an assessment of the school environment, and a cost study. The adolescent household survey was conducted with approximately 2,000 males and females between the ages of 10 and 19 years. It was conducted in six districts in Uganda.
Organization: Population Council/Horizons
Contacts: horizons@pcdc.org, strtalk@straight-talk.or.ug

10. Walking the Talk: Putting Women's Rights at the Heart of the HIV and AIDS Response (2007, PDF, 60 pages, 2.61 MB)

This report shows how gender inequalities and the persistent and systematic violation of women's rights are leaving women and girls disproportionately vulnerable to HIV and AIDS. The authors argue that the goal of achieving universal access to HIV and AIDS services by 2010 will fail if women and girls remain invisible in our response to HIV and AIDS. They recommend that governments, donors, and civil society promote and put into practice a women's-rights-based and gender-sensitive approach to HIV and AIDS.
Organizations: ActionAid International and VSO
Contact: infoservices@vso.org.uk

11. What Works in Unlocking Local Resources: A Case Study in National and Community-based Alliances (2007, PDF, 35 pages, 2.13 MB)

This latest addition to the International Youth Foundation's What Works series offers an in-depth look at a multi-sector partnership that has affected the lives of over 125,000 young people in the war-torn region of Mindanao, Philippines. The publication draws on interviews with more than 50 corporate, NGO, and community leaders to detail the achievements of the Education & Livelihood Skills Alliance (ELSA) initiative over the past three years.
Organization: International Youth Foundation
Contact: youth@iyfnet.org

12. World Youth Report 2007 (2008, available as PDFs of separate chapters [approx. 1 MB each] or as a PDF of the entire report [7.45 MB])

The World Youth Report 2007 examines the challenges and opportunities existing for the world's roughly 1.2 billion young people between the ages of 15 and 24. Distinct from the 2003 and 2005 editions, it provides a regional overview summarizing the major youth development trends in the fifteen priority areas of the World Programme of Action for Youth. The report explores major issues of concern to youth development, including employment, education, health, poverty, and violence. It also highlights youth as a positive force for development and provides recommendations for supporting their essential contributions.
Organization: Youth at the United Nations
Contact: youth@un.org

13. Young Voices in Research for Health 2007: Winners of the 2007 Essay Competition for the Under-30s (2007, PDF, 146 pages, 2.46 MB)

Young professionals working on or interested in the broad spectrum of research for health were invited to enter this competition. The theme was "Equitable access: research challenges for health in developing countries."
Organizations: Global Forum for Health Research and The Lancet
Contact: info@globalforumhealth.org

14. YOUth Magazine (2007, PDF, 40 pages, 3.17 MB)

YOUth, the International Youth Foundation's new flagship magazine, offers interviews, personal stories, and essays focused on youth development around the world. Published twice a year, the magazine celebrates the power and promise of young people to change the world, while incorporating the varied voices and perspectives from those in the public, private, and nonprofit sectors. The stories and reports address HIV/AIDS, social apathy, and lack of educational opportunities.
Organization: International Youth Foundation
Contact: youth@iyfnet.org

II. RESEARCH SUMMARIES

1. Adolescent's views of and preferences for sexual and reproductive health services in Burkina Faso, Ghana, Malawi, and Uganda. Biddlecom AE, Munthali A, Singh S, et al. Afr J Reprod Health 2007;11(3).
Results from nationally-representative surveys of 12- to 19-year-olds in Burkina Faso, Ghana, Malawi, and Uganda in 2004 show that contraceptive and STI services and HIV testing are still under-utilized. A substantial proportion of sexually active adolescents do not know of any source to obtain contraception or get STI treatment, and socio-psychological reasons (e.g., embarrassment or fear) and financial cost remain common barriers to getting services. Adolescents' preferences are overwhelmingly for public clinics, with strongly positive perceptions of confidentiality, accessibility, and cost. Some gender and country differences exist, yet overall, female and male views are similar. Results highlight the need to inform youth about sources, increase availability of government health facilities, and improve youth's access to them, especially by reducing social barriers.

2. Adverse perinatal outcomes of adolescent pregnancies in Cameroon. Kongnyuy EJ, Nana PN, Fomulu N, et al. Matern Child Health J 2008;12(2).
The authors conducted a cross-sectional study to compare the outcomes of 268 adolescent pregnancies with 832 controls, delivered in four referral hospitals in Yaounde (Cameroon), between November 2004 and April 2005. The adverse fetal outcomes related to adolescent pregnancies were low birth weight (< 2,500 g) (odds ratios [OR], 1.71; confidence interval [CI], 1.15-2.50), premature babies (< 37 weeks) (OR, 1.77; CI, 1.24-2.52), and early neonatal death (OR, 2.18; CI, 1.04-4.48). The rates of stillbirth and intrauterine growth retardation were not significantly higher among adolescents. Adverse maternal outcomes associated with adolescent pregnancies were eclampsia (OR, 3.18; CI, 1.21-8.32), preeclampsia (OR, 1.99; CI, 1.24-3.15), perineal tear (OR, 1.45; CI, 1.06-1.99), and episiotomy (OR, 1.82; CI, 1.20-2.73). Caesarean delivery, instrumental delivery, and premature rupture of membranes were not significantly associated with adolescent pregnancy. Maternal factors associated with adverse fetal outcomes in adolescents were maternal age, number of prenatal visits less than four, and the state of being unemployed. Improving compliance with prenatal care could significantly reduce the frequency of adverse fetal outcomes in adolescent populations in Cameroon.

3. Coerced first sex among adolescent girls in sub-Saharan Africa: prevalence and context. Moore AM, Awusabo-Asare K, Madise N, et al. Afr J Reprod Health 2007;11(3).
Using nationally representative surveys from 12- to 19-year-old girls in Burkina Faso, Ghana, Malawi, and Uganda collected in 2004, the authors examine the prevalence of sexual coercion at sexual debut among unmarried girls and its correlates. In Malawi, 38 percent of girls said that they were "not willing at all" at their first sexual experience followed by Ghana at 30 percent, Uganda at 23 percent, and Burkina Faso at 15 percent. In-depth interviews collected in 2003 with the same demographic shows that there are four primary types of sexual coercion: forced sex; pressure through money or gifts; flattery, pestering, and threatening to have sex with other girls; and passive acceptance. The article concludes with the research and policy implications of these findings.

4. Demographic correlates of constant condom use among sex workers in Tangail, Dhaka, Bangladesh. Eva NA, Munakata T, Onuoha FN. Adolescence 2007;42(168).
This study examines some demographic factors that may affect such condom use among Bangladeshi female commercial sex workers at a brothel in Tangail (n = 196; mean age = 23.44 years), and the streets of Dhaka (n = 112; mean age = 25.92 years). The chi2 results indicated that sex workers over 19 years of age were 2.52 times more likely than adolescents under 19 to work on the street rather than at a brothel (chi2 = 8.73, p < .0.01, OR = 2.52, 95% CI = 1.35-4.72). Brothel sex workers aged over 19 years were 3.26 times more likely to use condoms regularly with clients compared to adolescents aged below 19 years (chi2 = 6.23, p < 0.01, OR = 3.26, 95% CI = 1.25-8.53).

5. Effectiveness of a school-based AIDS education program among rural students in HIV high-epidemic area of China. Cheng Y, Lou C-H, Mueller LM, et al. J Adolesc Health 2008;42(2).
This study evaluated the feasibility and effectiveness of a life-planning skills training program using participatory methods among rural, senior-high-school students in Shangcai County, Henan Province, China. The study was a quasi-experimental study conducted in three Shangcai County senior high schools with comparable sociocultural, economic, and demographic characteristics (two interventions and one control). The intervention, a life-planning skills program that uses participatory training methods, combining information education with effective skills building, was provided to all first-grade students (14-18 years old; 87% of them between 15 and 17 years old) in the intervention group from October 2003 to December 2003. In total, 717 students from the intervention group, and 457 from the control group enrolled at baseline, and over 91% of these were followed up at posttest. Results suggest that the intervention increased subjects' knowledge significantly, changed their attitudes positively, and improved their protection self-efficacy. The intervention also significantly improved subjects' communication with teachers and peers on HIV/AIDS issues (p < .0001). However, no significant change was observed on respondents' attitudes toward premarital sex or their communication with parents between the two surveys (p > .05).

6. Elevated risk for HIV-1 infection in adolescents and young adults in Sao Paulo, Brazil. Bassichetto KC, Bergamaschi DP, Oliveira SM, et al. PLoS ONE 2008;3(1).
Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study, the authors compare people recently infected (RI) with HIV-1, as defined by the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection. Subjects were identified from 2002 to 2004 at four testing sites in Sao Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p < 0.001) among the individuals without recent infection (n = 158, 95.8%) compared to seven individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in < 25 and > 59 years-old age strata (p < 0.001). The majority of study participants were male (78.4%), 25 to 45 years old (65.8%), white (63.2%), and single (61.7%); those with family incomes of four or more times the minimum wage constituted the largest group (41.0%), but with an equally distributed educational level among all income levels. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both heterosexual (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% having 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use; and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable, according to the multivariate analysis. The authors conclude that HIV-1 has been spreading among younger individuals in Sao Paulo, and preventive approaches should, therefore, target this age stratum. The full text of the article is available online (PDF, 104 KB).

7. Evaluation of a school-based reproductive health education program in rural southwestern Nigeria. Ajuwon AJ, Brieger WR. Afr J Reprod Health 2007;11(2).
This quasi-experimental study compared the relative efficacy of teacher instruction alone, peer education alone, and a combination of these two on reproductive health knowledge, attitude, perceived self-efficacy, and sexual practices among secondary school students in the Ibarapa district of southwestern Nigeria. A baseline questionnaire was administered to a systematic sample of students in four schools that were randomized into four treatment arms: teacher instruction alone (E1), peer education alone (E2), combination of teacher instruction and peer education (E3), and control (C). The results were used to design the contents of the interventions, which were implemented for one academic session. A follow-up survey using the same sampling procedures as baseline was conducted to measure the outcome of the intervention. The control group had superior reproductive health knowledge at baseline. By the follow-up survey, however, all three intervention schools showed significant knowledge gains, while the control school students' mean score increased slightly. Increase in knowledge was greatest among E3 (+5.0 points), followed by E2 (+3.4), E1 (+1.4), and C (0.3). Students at the intervention schools showed a significant positive shift in attitude toward use of contraceptives, with mean increase of 0.6, 0.5, and 0.9 points in E1, E2, and E3, respectively. Scores that measured the students' perceived self-efficacy for safe sex increased significantly among E1 (from 10.8 to 11.8) and E3 (from 10.4 to 12.6). Reported condom use was significantly higher among E2 (from 16.7% to 62.8%) (p < 0.05) and E3 (from 22.8% to 53%) (p < 0.05) compared to E1 (28.6% to 47.4%) (p > 0.05) and control (from 25% to 45.8%) (p > 0.05). Overall, the students from E3 showed more improvement in knowledge, attitude, and self-efficacy than their counterparts from E1, E2, and control.

8. Factors associated with sexual abstinence among adolescents in four sub-Saharan African countries. Kabiru CW, Ezeh A. Afr J Reprod Health 2007;11(3).
Drawing on nationally representative data collected from Burkinabe, Ghanaian, Malawian, and Ugandan adolescents, this study examines differences among four groups of never married, 15- to 19-year-olds: primary abstainers (sexually inexperienced), secondary abstainers (last sex more than 12 months prior to the survey), recent abstainers (sexually active in last year but not in the last 3 months), and sexually active (had sexual intercourse in the last 3 months). The percentage of primary abstinent adolescents ranged from 42% (Malawian males) to 85% (Ghanaian males). In general, a greater proportion of females than males were primary abstainers. Primary abstainers were younger than sexually experienced adolescents. Current involvement in a romantic relationship was a significant predictor of sexual status with primary abstainers being the least likely to be romantically involved. Overall, findings suggest that adolescents' gender, prior sexual experiences, and contextual circumstances, such as romantic partnerships, should be considered when designing abstinence promotion programs.

9. Family structure and adolescent sexual behavior in a poor area of Sao Paulo, Brazil. Peres CA, Rutherford G, Borges G, et al. J Adolesc Health 2008;42(2).
This cross-sectional study included 296 young people who were recruited through a vocational school and completed an anonymous, self-administered questionnaire. The authors examined associations between family structure and various risk behaviors. Ages ranged from 13-24 years (82%, 15-18); 67% were of Afro-Brazilian ancestry; and 56% were female. Median family monthly income was about US$200. Less than half lived with both parents, and 14% lived with neither parent. Rates of many risk behaviors, including involvement in crime and violence, drug and alcohol use, and sexual risk, were lowest among those living with both parents, higher among those living with one parent, and highest among those living with neither parent. For example, 26% of females living with both parents, 37% with one parent, and 71% with neither parent were sexually active (p = .003). Family structure and a personal or parental history of drug or alcohol problems were significant independent predictors of sexual activity. The authors conclude that prevention programs should explore ways to support parents to be present and involved in the lives of their adolescent children.

10. Herpes simplex virus type 2 infection among young uncircumcised men in Kisumu, Kenya. Mehta SD, Moses S, Agot K, et al. Sex Transm Infect 2008;84(1).
This paper identifies factors associated with herpes simplex virus type 2 (HSV-2) infection among men aged 18-24 in Kisumu, Kenya. To do so, the authors analyzed baseline data from a randomized trial of male circumcision. Participants were interviewed for sociodemographic and behavioral risks. The outcome was HSV-2 by antibody status. Risk factors were considered singly and in combination through logistic regression models. Among 2,771 uncircumcised men, 766 (27.6%; 95% confidence interval (CI) 26.0% to 29.3%) tested antibody positive for HSV-2. The median age at first sex was 16 years, and the median number of lifetime sexual partners was four. HSV-2 seroprevalence increased from 19% among 18-year-olds to 43% among 24-year-olds (p < 0.001). In multivariable analysis, statistically significant risks for infection were increasing age (adjusted odds ratio (AOR) = 1.22-2.58), being married or having a live-in female partner (AOR = 1.80; 95% CI 1.28 to 2.53), preferring "dry" sex (AOR = 1.39; 95% CI 1.14 to 1.69), reported penile cuts or abrasions during sex (AOR = 1.58; 95% CI 1.32 to 1.91), increasing lifetime sex partners (multiple response categories; AORs ranging from 1.65 to 1.97), and non-student occupation (multiple response categories; AORs ranging from 1.44 to 1.93). Risk decreased with reported condom used at last sex (AOR = 0.82; 95% CI 0.68 to 0.99). The authors conclude that primary prevention efforts should be initiated at an early age. The same behavioral interventions used currently for HIV prevention — abstinence, reducing the number of sex partners and increasing condom use — should be effective for HSV-2 prevention.

11. Hidden Love: Sexual ideologies and relationship ideals among rural South African adolescents in the context of HIV/AIDS. Harrison A. Cult Health Sex 2008;10(2).
This multi-method qualitative study examined sexuality and relationship formation among sexually experienced young people aged 14-19 in KwaZulu/Natal, South Africa. In this setting, sexual activity is highly stigmatized, particularly for young teenage women. Dominant sexual ideologies center on "good behavior," the idea that "sex is wrong," and abstinence as a preferred prevention strategy. Young women's relationships are often hidden, but sexual relationships are also an important part of the transition to adulthood. These dichotomies of love and romance versus stigma and secrecy frame young people's discourse about sexuality. A discourse about healthy sexuality is largely absent, impeding the prevention of HIV in this setting.

12. HIV/AIDS and sexual-risk behaviors among adolescents: Factors influencing the use of condoms in Burkina Faso. Guiella G, Madise NJ. Afr J Reprod Health 2007;11(3).
Using a unique set of data collected in 2004 from a nationally representative survey of adolescents, this study examines adolescents' risky and protective sexual behavior in Burkina Faso. Findings show that 11% of adolescent males had sexual intercourse in the last twelve months with more than two partners but did not use condoms. Logistic regression analysis shows that the odds of using condoms increased with years of schooling and self-efficacy in use of condoms. Females who were very confident of getting a male partner to wear a condom were six times more likely to have used a condom at last sex than those who were not confident at all.

13. Improving health, improving lives: Impact of the African Youth Alliance and new opportunities for programmes. Daniels U. Afr J Reprod Health 2007;11(3).
The African Youth Alliance (AYA) was a partnership to improve adolescent sexual and reproductive health and prevent HIV/AIDS in Botswana, Ghana, Tanzania, and Uganda. The AYA model was a comprehensive range of integrated interventions, implemented concurrently and at scale using a multi-sectoral approach. AYA was funded for five years (2000-2005) with $56.7 million from the Bill and Melinda Gates Foundation. A post-test evaluation was conducted by John Snow Inc. (JSI) in 2006 and combined case-control and self-reported exposure design. Case-control design data were analyzed using Propensity Score Matching (PSM), and the Self-Reported Exposure design data were analyzed using PSM and instrumental variable (two-stage regression) (IV). The results show AYA's significant and positive treatment effects on sexual knowledge, attitudes, and behaviors. The research suggests a comprehensive, multi-component approach such as AYA's can be effective in improving some key ASRH variables.

14. Influence of social connectedness, communication, and monitoring on adolescent sexual activity in Ghana. Kumi-Kyereme A, Awusabo-Asare K, Biddlecom A, et al. Afr J Reprod Health 2007;11(3).
This paper examines connectedness to, communication with, and monitoring of unmarried adolescents in Ghana by parents, other adults, friends, and key social institutions and the roles these groups play with respect to adolescent sexual activity. The paper draws on nationally representative survey data from 2004, qualitative evidence from focus group discussions, and in-depth interviews with adolescents in 2003. Adolescents show high levels of connectedness to family, adults, friends, school, and religious groups. High levels of adult monitoring are also observed, but communication with family about sex-related matters was not as high as with non-family members. The qualitative data highlight gender differences in communication. Multivariate analysis of survey data shows a strong negative relationship between parental monitoring and recent sexual activity for males and females, and limited effects of communication. Creating a supportive environment and showing interest in the welfare of adolescents appear to promote positive sexual and reproductive health outcomes.

15. Is poverty a driver for risky sexual behaviour? Evidence from national surveys of adolescents in four African countries. Madise N, Zulu E, Ciera J. Afr J Reprod Health 2007;11(3).
This paper contributes to conflicting evidence on the link between poverty and risky sexual behavior by examining the effect of wealth status on age at first sex, condom use, and multiple partners using nationally representative adolescents' data from Burkina Faso, Ghana, Malawi, and Uganda. The results show that the wealthiest girls in Burkina Faso, Ghana, and Malawi had later sexual debut compared with their poorer counterparts but this association was not significant for Uganda. Wealth status was weaker among males and significant only in Malawi, where those in the middle quintile had earlier sexual debut. Wealthier adolescents were most likely to use condoms at the last sexual act, but wealth status was not associated with number of sexual partners. Although the link between wealth status and sexual behavior is not consistent, there is evidence that poor females are vulnerable to infection because of earlier sexual debut and non-use of condoms.

16. Knowledge of correct condom use and consistency of use among adolescents in four countries in sub-Saharan Africa. Bankole A, Ahmed FH, Neema S, et al. Afr J Reprod Health 2007;11(3).
Using data from the 2004 National Adolescent Surveys, the authors undertook a detailed analysis of knowledge of correct condom use and consistency of use, as well as their covariates, among adolescents in Burkina Faso, Ghana, Malawi, and Uganda. The strongest predictor of knowledge of correct condom use among both male and female adolescents is exposure to a condom use demonstration. In Burkina Faso, Ghana, and Uganda, adolescents who have seen a condom demonstration are two to five times as likely as those who have not to have good knowledge of correct condom use. Age, ever having received sex education in school, ever having attended school, and exposure to the radio are also significant predictors of knowledge of correct use, particularly among men. As indicated by behavior among young men, the extent to which adolescents use the condom consistently varies across countries. Yet, it is nowhere near the required 100% level. The proportion reporting consistent use of the method in the three months preceding the survey is 38% in Burkina Faso, 47% in Ghana, 20% in Malawi, and 36% in Uganda. Age difference between partners is a major determinant of consistent use of condoms: young men whose partner is 0-4 years younger are about two and a half times more likely to use condoms consistently than those whose partner is 5-9 years younger. Other important predictors of consistent condom use are residence, education, living arrangement, and exposure to mass media, specifically the radio and newspaper.

17. Metaphors we love by: Conceptualizations of sex among young people in Malawi. Undie C-C, Crichton J, Zulu E. Afr J Reprod Health 2007;11(3).
Eleven focus group discussions were conducted with 114 youth aged 14-19 years. Participants were asked to describe behaviors, attitudes, and motivations to reduce unplanned pregnancies and the spread of HIV/AIDS, with appropriate probes to illuminate their sexual worldviews. The various metaphors that emanated from the discussions suggest that young people in this study take a utilitarian approach to sex, and conceive it as a natural and routine activity of which pleasure and passion are essential components. Future research and prevention efforts (regarding sexuality education in particular) would do well to incorporate adolescents' language in programming as this can enhance understanding of the world of young people as well as the effectiveness of interventions addressing problems related to early sexual behavior.

18. Perceptions of risk to HIV infection among adolescents in Uganda: Are they related to sexual behaviour? Kibombo R, Neema S, Ahmed FH. Afr J Reprod Health 2007;11(3).
Using data from the 2004 National Survey of Adolescents, multivariate logistic regression models were fitted to examine the strength of the association between risky sexual behavior and perceived risk among 12- to 19-year-old adolescents in Uganda. After controlling for other correlates of sexual behavior such as age, education, residence, region, and marital status, the findings indicate highly significant positive association between perceived risk and risky sexual behavior among males but not females. The findings reveal that, regardless of their current sexual behavior, most female adolescents in Uganda feel at great risk of HIV infection. The findings also show that adolescents with broken marriages are much more vulnerable to high-risk sexual behaviors than other categories of adolescents. These results further emphasize the need for a holistic approach in addressing the social, economic, and contextual factors that continue to put many adolescents at risk of HIV infection.

19. Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa. Moore AM, Biddlecom AE, Zulu EM. Afr J Reprod Health 2007;11(3).
Using national survey data collected in 2004 in Burkina Faso, Ghana, Malawi, and Uganda, with 12- to 19-year-olds, the authors examine the prevalence of sex in exchange for money or gifts in the 12 months prior to the survey and its association with adolescents' social and economic vulnerability and condom use. Receiving something in exchange for sex is very common among sexually active, unmarried female adolescents, and there are no significant differences by household economic status, orphan status, level of schooling completed, or age difference between partners. Condom use at last sex in the 12 months prior to the survey is not associated with receiving gifts or money. Qualitative data based on focus group discussions and in-depth interviews collected in 2003 with adolescents suggest that receiving money or gifts for sex is not necessarily a coercive force, but rather can be a routine aspect of dating.

20. Preventing mother-to-child HIV transmission among South African adolescents. Varga C, Brookes H. J Adolesc Res 2008;23(2).
The authors used narrative methods (key informant workshops, questionnaires, focus groups, and case study analysis) to explore how sociocultural context shapes adolescent mothers' ability to adhere to programmatic recommendations regarding PMTCT in rural and urban South Africa. The study aims were to understand the extent to which mothers' decisions are borne out in PMTCT-related practices and to identify contextual elements that affect the link between individual resolutions and action. The results revealed rural adolescents as less likely than urbanites to successfully implement most PMTCT-related practices. HIV stigma, family decision-making and cultural norms surrounding infant feeding hampered mothers' efforts to implement practices that would decrease the risk for infant infection. Barriers to behavior change were analyzed along four domains: history, culture, gender, and power. Methodological aspects and programmatic implications are discussed.

21. Sexual behavior, knowledge and information sources of very young adolescents in four Sub-Saharan African countries. Bankole A, Biddlecom A, Guiella G, et al. E. Afr J Reprod Health 2007;11(3).
New survey data from 12- to 14-year-olds in Burkina Faso, Ghana, Malawi, and Uganda are used to describe their sexual activity; knowledge about HIV, STIs, and pregnancy prevention; and sources of sexual and reproductive health information, including sex education in schools. Results show that very young adolescents are already beginning to be sexually active and many believe their close friends are sexually active. They have high levels of awareness but little in-depth knowledge about pregnancy and HIV prevention. Multiple information sources are used and preferred by very young adolescents. Given their needs for HIV, STI, and pregnancy prevention information that is specific and practical, and considering that the large majority are attending school in most countries in Sub-Saharan Africa, school-based sex education is a particularly promising avenue for reaching adolescents under age 15.

22. The social context of induced abortions among young couples in Cote d'Ivoire. Svanemyr J, Sundby J. Afr J Reprod Health 2007;11(2).
This paper draws on fieldwork conducted in 1998 and 1999 in the city of Bouake in Cote d'Ivoire and is based upon qualitative semi-structured interviews with men and women. The authors present some case stories based on interviews with young women having had an abortion, or with men having had a young partner who has had an abortion, both married and unmarried. It discusses how illegally induced abortion may be understood in relation to ongoing social processes characterized by economic hardship and tensions between the sexes and generations. One important finding is that the young often choose abortion because they cannot count on economic and practical assistance from parents in feeding and raising the child. Parents are also often pushing their children to have an abortion.

23. Stigmatization of AIDS patients: Disentangling Thai nursing students' attitudes towards HIV/AIDS, drug use, and commercial sex. Chan KY, Stoove MA, Sringernyuang L, et al. AIDS Behav 2008;12(1).
Students of a Bangkok nursing college (n = 144) were presented with vignettes describing a person varying in the disease diagnoses (AIDS, leukemia, no disease) and co-characteristics (injecting drug use [IDU], commercial sex [CS], blood transfusion, no co-characteristic). For each vignette, participants completed a social distance measure assessing their attitudes toward the hypothetical person portrayed. Multivariate analyses showed strong interactions between the stigmas of AIDS and IDU but not between AIDS and CS. Although AIDS was shown to be stigmatizing in and of itself, it was significantly less stigmatizing than IDU. The findings highlight the need to consider the non-disease-related stigmas associated with HIV as well as the actual stigma of HIV/AIDS in treatment and care settings. Methodological strengths and limitations were evaluated and implications for future research discussed.

24. The timing and role of initiation rites in preparing young people for adolescence and responsible sexual and reproductive behaviour in Malawi. Munthali AC, Zulu EM. Afr J Reprod Health 2007;11(3).
Data from a nationally representative survey of adolescents and in-depth interviews also conducted with adolescents were used in this study. SPSS was used to analyze survey data while N6 was used to analyze qualitative data. Results show that the onset of menarche in girls and various pubertal body changes in boys can be a cause of joy, excitement, or distress depending on how adolescents understand what this means to them at this critical stage when they start defining and comprehending their sexuality. Much more emphasis is put on educating girls about reproductive implications of menarche than on what is expected of boys as sexual beings, which may contribute to boys' greater indulgence in risky sexual behaviors than girls. The significance of initiation ceremonies in some communities provides an important platform through which programs can reach many adolescents and intervene, particularly in addressing the widely held notion among initiates that attending these ceremonies symbolizes that one is not a child anymore and can have sex.

25. Use of contraceptive methods by sexually active teenagers in Pelotas, Rio Grande do Sul State, Brazil. da Rocha CL, Horta BL, Pinheiro RT, et al. Cad Saude Publica 2007;23(12).
A cross-sectional study was performed from March to September 2002 in a representative sample of adolescents 15 to 18 years of age in the urban area of Pelotas, Rio Grande do Sul State, Brazil. Multiple-stage sampling was used, and in the 448 census tracts located in the urban area, 90 were sampled and households were visited in each tract. Information was collected on sexual initiation and use of contraceptive methods. Chi-square test was used to compare proportions. The sample included 960 adolescents. Eighty-eight percent of subjects reported the use of any contraceptive method. Condoms were the most commonly used method (63.2%). Low adolescent schooling was the only variable associated with increased risk of non-use of contraceptives. Condom use was higher among males, adolescents whose mothers had nine or more years of schooling, and those reporting several sexual partners in the previous year.