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I. PROGRAM RESOURCES
1. Boosting Prevention: The Join In-Circuit on AIDS, Love, and Sexuality
2. Dare to be Different: Enhancing Life Skills Education for HIV Prevention in South African Schools
3. Ensuring a Healthier Tomorrow in Central America: Protecting the Sexual and Reproductive Health of Today's Youth
4. Growing Together: Youth and the Work of the United Nations
5. HIV and AIDS Training Toolkit
6. Learn Without Fear: The Global Campaign to End Violence in Schools
7. Orphans and Vulnerable Children in High HIV-Prevalence Countries in Sub-Saharan Africa: DHS Analytical Studies 15
8. Talking About Sex: Using Youth Language in Sexuality Education
9. Youth Country Teams Assess their Governments' Progress on Youth and HIV
II. RESEARCH SUMMARIES
1. Adolescent boys: who cares?
2. Association between knowing someone who died of AIDS and behavior change among South African youth
3. Changing prevalence of hepatitis C virus infection among teenagers in an endemic area in Taiwan
4. Condom use among sexually active Kenyan female adolescents at risk for HIV-1 infection
5. Declining HIV prevalence among young pregnant women in Lusaka, Zambia
6. Does community clustering mitigate the negative effect of poverty on adolescent condom use in South Africa?
7. Exploring opportunities to project a "responsible man" image: Gatekeepers' views of young men's sexual and reproductive health needs in Uttaranchal, India
8. Increase in sexual risk behavior and prevalence of chlamydia trachomatis among adolescents in Northern Thailand
9. The influence of Islam on AIDS prevention among Senegalese university students
10. Intrauterine devices and adolescents
11. Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya
12. Marriage and childbirth as factors in dropping out from school: an analysis of DHS data from sub-Saharan Africa
13. One foot wet and one foot dry: transition into motherhood among married adolescent women in rural Vietnam
14. A parentadolescent intervention to increase sexual risk communication: results of a randomized controlled trial
15. Predicting hypothetical willingness to participate (WTP) in a future phase III HIV vaccine trial among high-risk adolescents
16. Reproductive health awareness among adolescent girls in rural Bangladesh
17. Strategies for developing gender-specific HIV prevention for adolescents in Vietnam
18. Why has HIV stabilized in South Africa, yet not declined further? Age and sexual behavior patterns among youth
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I. PROGRAM RESOURCES
1. Boosting Prevention: The Join In-Circuit on AIDS, Love, and Sexuality (2008, 36 pages, 1.5 MB)
This publication describes an adaptable HIV prevention tool and the results of its use to date in more than 18 countries. Initially developed by the German Federal Centre for Health Education, the "Join-in Circuit" is a workshop with a circuit of five or more stations, at which facilitators help participants learn about HIV through interactive problem-solving, games, and conversation. The flexibility of the circuit allows it to address prevention among many different groups, such as young people aged 12-14 and up and young adults, including soldiers, prisoners, factory workers, and sex workers.
Organization: Deutsche Gesellschaft fr Technische Zusammenarbeit (GTZ)
Contact: aidsprg@gtz.de
2. Dare to be Different: Enhancing Life Skills Education for HIV Prevention in South African Schools (2008, 8 pages, 634 KB)
The Horizons project worked with local stakeholders to develop and pretest the Dare to Be Different (D2BD) curriculum targeting 10- to 14-year-old youth. Pilot results from three primary schools indicated that this curriculum filled a gap in South Africa's Life Skills and HIV and AIDS Education Program and that the D2BD curriculum was accepted by learners, teachers, and parents.
Organization: Horizons/Population Council
Contact: horizons@popcouncil.org
3. Ensuring a Healthier Tomorrow in Central America: Protecting the Sexual and Reproductive Health of Today's Youth (2008, 71 pages, 1 MB)
El Salvador, Guatemala, Honduras, and Nicaragua have the highest rates of adolescent childbearing in Latin America. Moreover, current HIV prevalence has surpassed the 1 percent threshold in Honduras and is nearing that magnitude in El Salvador and Guatemala. This report, based on recent national surveys, presents key patterns and trends in the sexual and reproductive behavior of 15- to 24-year-olds in these four countries and identifies important gaps and needs.
Organization: Guttmacher Institute
Contact: info@guttmacher.org
4. Growing Together: Youth and the Work of the United Nations (2008, 101 pages, 4.8 MB)
This publication shows how various parts of the United Nations system support youth development with a diverse range of programs covering all 15 priority areas of the World Programme of Action for Youth. Several of these priority areas relate to reproductive health and HIV, and numerous UN agencies include activities on these topics in their programming. This document includes illustrative activities for each agency, key publications, and contact information.
Organization: United Nations
Contact: youth@un.org
5. HIV and AIDS Training Toolkit (2008)
The World Association of Girl Guides and Girl Scouts (WAGGGS) created a toolkit that aims to educate young women worldwide about HIV and AIDS. Available for purchase (₤11.99) in English, French, and Spanish, the toolkit was produced by WAGGGS with support from UNAIDS and is designed for member organizations to provide training support for leaders and trainers.
Organization: World Association of Girl Guides and Girl Scouts
Contact: wagggs@wagggsworld.org
6. Learn Without Fear: The Global Campaign to End Violence in Schools (2008, 88 pages, 2.7 MB)
French (2.9 MB)
Spanish(1.9 MB)
Plan's new report, a comprehensive global examination of school violence, focuses on three major areas: sexual violence, corporal punishment, and bullying.
The report shows that:
Girls as young as age 10 are being forced to have sex by their
teachers to pass exams and are threatened with poor grades and
failure if they refuse.
Every year, more than 350,000,000 children suffer some type of
violence in school.
The document discusses local interventions and legal and social mechanisms for curbing in-school violence and outlines a call to action.
Organization: Plan International
Contact: info@plan-international.org
7. Orphans and Vulnerable Children in High HIV-Prevalence Countries in Sub-Saharan Africa: DHS Analytical Studies 15 (2008, 113 pages, 637 KB)
This study estimates the size and distribution of the population of orphans and vulnerable children (OVC) in eight sub-Saharan African countries with relatively high rates of HIV. It highlights the heavy burden and the multi-dimensional nature of caring for OVC, particularly with regard to schooling and health care.
Organization: Macro International and Universit de Montral
Contact: reports@macrointernational.com
8. Talking About Sex: Using Youth Language in Sexuality Education (2007, 3 pages, 93 KB)
This article explains that language shapes the way people think about life and, therefore, influences actions. It proposes that analyzing the metaphors young people use while talking about sex can provide valuable insights into the ways in which youth understand sex, sexual behavior, and sexual relationships. These insights may have potential for enhancing the effectiveness of sexuality education interventions.
Organization: African Population and Health Research Center (APHRC)
Contact: info@aphrc.org
9. Youth Country Teams Assess their Governments' Progress on Youth and HIV (2008; all reports are approximately 12-14 pages and about 350-750 KB)
With two years left for countries to achieve the goals and targets of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS), young people are actively participating in the tracking and reporting of UNGASS commitments. These young people have produced ten reports to present at the UNGASS seven-year review.
Egypt | India | Jamaica | Kenya | Nepal | Nigeria | Senegal | United States | Vietnam | Zimbabwe
Organization: Global Youth Coalition on HIV/AIDS
Contact: info@youthaidscoalition.org
II. RESEARCH SUMMARIES
1. Adolescent boys: who cares? Schmid GP, Dick B. Bull World Health Organ 2008;86(9):659.
This editorial comments on another article in this issue of the Bulletin about adverse events after traditional male circumcision. (See "Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya".) The editorial's authors find it surprising that despite significant morbidity among adolescents and young men, so little attention has been paid to the complications of traditional male circumcision by most organizations. They go on to say that in addition to improving adolescent boys' access to safe male circumcision services when these are provided within a traditional context, we must also carefully regulate the providers in the formal health-care system to ensure that they are adequately trained and have the equipment and supplies to perform male circumcision safely and effectively.
2. Association between knowing someone who died of AIDS and behavior change among South African youth. Palekar R, Pettifor A, Behets F, et al. AIDS Behav 2008;12(6):903-12.
The authors examined the association between knowing someone who died of AIDS and self-reported behavior change, condom use at last intercourse, number of partners in the prior 12 months, and attitudes toward HIV among South African youth aged 15-24. They found that more than 40% of youth reported knowing someone who died of AIDS, most commonly a neighbor. Using multivariable logistic regression, they found that high school-educated youth who knew someone who died of AIDS were significantly more likely to report having changed their behavior as a result of HIV. However, the authors found no association between knowing someone who died of AIDS and actual HI-prevention behavior. While youth tended to have increased odds of perceiving HIV to be serious, they did not consistently perceive their risk of contracting HIV to be higher when they knew someone who died of AIDS. The results suggest that part of the key to effecting behavior change in youth may lie in better understanding what factors increase youth's perceived risk of contracting HIV.
3. Changing prevalence of hepatitis C virus infection among teenagers in an endemic area in Taiwan. Huang C-F, Huang J-F, Dai C-Y, et al. Trans R Soc Trop Med Hyg 2008;102(9):929-34.
This study aimed to clarify the changing prevalence of hepatitis C virus (HCV) infection among teenagers in the endemic maritime area of Tzukuan Township, Taiwan after several public education strategies were put in place. In addition to viral hepatitis markers and biochemical profiles, the authors compared the epidemiological characteristics of 887 and 394 teenagers (aged 13-16 years) enrolled in 1995 and 2005, respectively. Compared with the results of surveillance in 1995, the prevalence of anti-HCV seropositivity and HCV RNA had decreased significantly by 2005. Transfusions and anti-HCV-positive families were the main risk factors among the 25 anti-HCV-positive teenagers in 1995 and became non-significant among the four anti-HCV-positive teenagers in 2005. In conclusion, the seroprevalence of HCV infection significantly decreased after one decade of intervention among the teenage population in this endemic area.
4. Condom use among sexually active Kenyan female adolescents at risk for HIV-1 infection. Cherutich P, Brentlinger P, Nduati R, et al. AIDS Behav 2008;12(6):923-9.
The authors interviewed female adolescents, aged 15-19, who were receiving reproductive health care. The prevalence of ever-use of condom was 21.4%, and 52 (7.3%) subjects were infected with HIV-1. Older age, higher levels of education, ever-use of hormonal contraceptives, higher numbers of sexual partners, nonconsensual sex, and exchange of sex for favors were independent correlates of condom use.
5. Declining HIV prevalence among young pregnant women in Lusaka, Zambia. Stringer EM, Chintu NT, Levy JW, et al. Bull World Health Organ 2008;86(9):697-702.
This study examined trends in HIV seroprevalence among pregnant and parturient women between 2002 and 2006 in Lusaka, Zambia. The authors analyzed HIV seroprevalence trends from two Lusaka sources: (1) antenatal data from a city-wide program to prevent mother-to-child HIV transmission and (2) delivery data from two anonymous unlinked cord-blood surveillances performed in 2003 and 2005-2006, where specimens from more than 97% of public-sector births in each period were obtained and analyzed. Between July 2002 and December 2006, the Lusaka district tested 243,302 antenatal women for HIV; 54,853 (22.5%) were HIV infected. Over this period, the HIV seroprevalence among antenatal attendees who were tested declined steadily from 24.5% in the third quarter of 2002 to 21.4% in the last quarter of 2006. The cord-blood surveillances were conducted between June and August 2003 and again between October 2005 and January 2006. Overall HIV seroprevalence declined from 25.7% in 2003 to 21.8% in 2005-2006. Among women ≤17 years of age, seroprevalence declined from 12.1% to 7.7%.
6. Does community clustering mitigate the negative effect of poverty on adolescent condom use in South Africa? Robinson AL, Seiber EE. Int Fam Plan Perspect 2008;34(3):121-6.
The authors used baseline survey data from a study called "Transitions to Adulthood in the Context of AIDS in South Africa" to test whether youth from disadvantaged households are less likely than others to use a condom at first sex. Random effects logistic regression assessed the relationship between poverty and condom use among 14- to 22-year-olds at first sex, correcting for shared characteristics of adolescents within each community. Twenty-three percent of young people had used a condom at first sex. Poor and extremely poor females were about one-third as likely as non-poor females to use a condom at first sex. Among males, however, there was no association between poverty and condom use. The importance of community clustering of neighborhood-level characteristics differs by gender in South Africa. Poverty remains a central risk factor for HIV among young women, regardless of the surrounding context, but not among men.
7. Exploring opportunities to project a "responsible man" image: Gatekeepers' views of young men's sexual and reproductive health needs in Uttaranchal, India. Khan ME, Mishra A, Morankar S. Int Q Community Health Educ 2008;28(1):13-31.
The authors conducted 32 in-depth interviews and four focus group discussions with parents, formal and informal community leaders, teachers, and selected development officials. The findings indicate that these gatekeepers are worried about rapid changes in the aspirations, expectations, and behavior of young men. Most of them were very concerned about the rise in drinking, use of drugs, and changing values about sexuality among young men. They felt that many of these changes are consequences of wider societal changes; rising aspirations; tremendous increase in electronic media; and globalization of a new youth culture where extramarital sex, alcohol consumption, and violence are expressions of masculinity and symbols of the affluent class. Overall, gatekeepers felt that television, films, and peers now exert more influence on young people and that parents are losing their ability to guide and mentor their children.
8. Increase in sexual risk behavior and prevalence of chlamydia trachomatis among adolescents in Northern Thailand. Whitehead SJ, Leelawiwat W, Jeeyapant S, et al. Sex Transm Dis 2008;35(10):883-8.
In 1999 and 2002, 1,725 and 966 vocational students, respectively, were interviewed using computer-assisted self-interview methods. Urine samples were collected and tested for chlamydia trachomatis and neisseria gonorrhoeae by polymerase chain reaction. Chlamydia trachomatis prevalence increased from 3.2% to 7.5% in women and from 2.5% to 6.0% in men. There was an increase in the reported mean lifetime number of steady sexual partners among both men (3.4–4.7, P = 0.01) and women (2.5–3.3, P <0.001), and in the mean lifetime number of casual partners among men (1.1–2.1, P <0.001) and women (0.3–1.1, P = 0.04). Reported consistent condom use decreased significantly among women with casual partners (43%–19%, P = 0.03) but not among men (25%–31%, P = 0.31). The authors conclude that these findings are consistent with other studies suggesting profound social changes are changing norms of adolescent sexual behavior in Thailand and that they highlight the need for adolescent sexual health services and prevention programming.
9. The influence of Islam on AIDS prevention among Senegalese university students. Gilbert SS. AIDS Educ Prev 2008;20(5):399-407.
Senegal has involved Muslim leaders in its prevention campaign for more than a decade. Senegal also has the lowest HIV/AIDS prevalence rate in sub-Saharan Africa. This study examines how Islam influences AIDS prevention by testing whether Senegalese participants' religiosity scores explain their risky decisions associated with sex, condom use, and drug use. Participants with higher religiosity scores were more likely to abstain from sex. However, participants high in religiosity were not more likely to report that they did not use condoms when sexually active.
10. Intrauterine devices and adolescents. Gold MA, Johnson LM. Curr Opin Obstet Gynecol 2008;20(5):464-9.
This article reviews adolescents' knowledge of and attitudes toward IUDs; the mechanism of action of copper-releasing and levonorgestrel-releasing IUDs; the benefits of using IUDs with adolescents; and the IUD's safety, side effects, and noncontraceptive benefits such as management of menstrual disorders and endometriosis. The authors conclude that IUDs are a safe and effective long-term contraceptive method with no increase in risk of pelvic inflammatory disease, tubal infertility, or ectopic pregnancies. Because adolescents contribute disproportionately to the epidemic of unintended pregnancy, IUDs should be considered as a first-line contraceptive choice regardless of parity. The levonorgestrel-releasing intrauterine system is a particularly good choice for adolescents because of associated noncontraceptive benefits such as decreased menstrual bleeding, dysmenorrhea, and decreased pain associated with endometriosis. There is a clear need for more studies in the use of the IUD among adolescents.
11. Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya. Bailey RC, Egesah O, Rosenberg S. Bull World Health Organ 2008;86(9):657-736.
Young males intending to undergo traditional or clinical circumcision were identified by a two-stage cluster sampling method. During the July–August 2004 circumcision season, 1,007 males were interviewed 30–89 days post-circumcision. Twenty-four men were directly observed during and 3, 8, 30, and 90 days post-circumcision, and 298 men underwent clinical exams 45–89 days post-procedure. Twenty-one traditional and 20 clinical practitioners were interviewed to assess their experience and training. Inventories of health facilities were taken to assess the condition of instruments and supplies necessary for performing safe circumcisions. Of 443 males circumcised traditionally, 156 (35.2%) experienced an adverse event compared with 99 of 559 (17.7%) circumcised clinically. Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion, and erectile dysfunction also observed. Participants were aged 5 to 21 years, and half were sexually active before circumcision. Practitioners lacked knowledge and training. Proper instruments and supplies were lacking at most health facilities. The authors conclude that extensive training and resources will be necessary in sub-Saharan Africa before male circumcision can be aggressively promoted for HIV prevention. Two-thirds of African men are circumcised, most by traditional or unqualified practitioners in informal settings. Safety of circumcision in communities where it is already widely practiced must not be ignored.
12. Marriage and childbirth as factors in dropping out from school: an analysis of DHS data from sub-Saharan Africa. Lloyd CB, Mensch BS. Popul Stud (Camb) 2008;62(1):1-13.
Leaving school prematurely is often claimed to be among the most negative consequences of early marriage and pregnancy for girls in less-developed countries. However, an analysis of the relative frequency with which these events actually occur or are named as reasons for leaving school reveals that, at least in the case of francophone Africa, they explain no more than 20% of dropouts. To the extent that demographic events trump school or family factors as determinants of school-leaving, the authors' data indicate that it is union formation — defined by the Demographic Health Survey as first marriage or cohabitation — rather than childbirth that is more likely to have this effect. "Schoolgirl pregnancy" typically accounts for only between 5% and 10% of girls' departures from school. Furthermore, the risks of leaving school because of pregnancy or marriage have declined over time with the decline in rates of early marriage and childbearing.
13. One foot wet and one foot dry: transition into motherhood among married adolescent women in rural Vietnam. Klingberg-Allvin M, Binh N, Johansson A, et al. J Transcult Nurs 2008;19(4):338-46.
In-depth interviews were conducted with 22 women younger than 20 who were either pregnant or had newly delivered. Young women experienced ambivalence in the transition to motherhood in that they felt too young but also happy to be able to please their husband and the extended family. Participants felt they lacked power in making decisions about pregnancy, delivery, and contraceptive use. They also expressed feelings of being patronized and ignored in encounters with health care providers. Findings might be used for reproductive health care providers, social workers, and educators in their contact with young mothers to empower them to make their own decisions about marriage, childbearing, and contraception.
14. A parent–adolescent intervention to increase sexual risk communication: results of a randomized controlled trial. Villarruel AM, Cherry CL, Cabriales EG, et al. AIDS Educ Prev 2008;20(5):371-83.
This article reports results of a randomized controlled trial designed to test an intervention to increase parent–adolescent sexual risk communication among Mexican parents. Data were analyzed from parents (n = 791) randomly assigned to an HIV risk reduction or health promotion intervention. Measures were administered at pretest, posttest, and 6- and 12-month follow-ups. Generalized estimation equation analysis indicates parents in the HIV risk reduction intervention reported significantly more general communication, more sexual risk communication, and more comfort with communication than parents in the control intervention. Behavioral, normative, and control beliefs significantly mediated the effect of the intervention on all communication outcomes. This study demonstrates the efficacy of an intervention to increase the quality and quantity of parent–adolescent communication related to general and sex-specific communication.
15. Predicting hypothetical willingness to participate (WTP) in a future phase III HIV vaccine trial among high-risk adolescents. Giocos G, Kagee A, Swartz L. AIDS Behav 2008;12(6):842-51.
This study sought to determine whether the theory of planned behavior (TPB) predicted stated hypothetical willingness to participate (WTP) in future Phase III HIV vaccine trials among South African adolescents. Hierarchical logistic regression analyses showed that TPB significantly predicted WTP. Of all the predictors, subjective norms significantly predicted WTP (OR = 1.19, 95% C.I. = 1.06-1.34). A stepwise logistic regression analysis revealed that subjective norms (OR = 1.19, 95% C.I. = 1.07-1.34) and attitude toward participation in an HIV vaccine trial (OR = 1.32, 95% C.I. = 1.00-1.74) were significant predictors of WTP. The addition of knowledge of HIV vaccines and HIV vaccine trials, perceived self-risk of HIV infection, health-promoting behaviors, and attitudes toward HIV/AIDS yielded nonsignificant results. These findings provide support for the theory of reasoned action and suggest that psychosocial factors may play an important role in adolescents' WTP in Phase III HIV vaccine trials.
16. Reproductive health awareness among adolescent girls in rural Bangladesh. Uddin J, Choudhury AM. Asia-Pac J Public Health 2008;20(2):117-28.
Analysis of data revealed that a sizable proportion of adolescent girls had incorrect knowledge or misconceptions about the fertile period, reproduction, sexually transmitted infections, and HIV/AIDS. Age, education (either of adolescents or their mothers), residence, and exposure to mass media were the significant predictors of adolescent girls' knowledge about reproductive health. Strong efforts and improved access to mass media and education could improve rural Bangladeshi adolescent girls' awareness about reproductive health.
17. Strategies for developing gender-specific HIV prevention for adolescents in Vietnam. Lerdboon P, Pham V, Green M, et al. AIDS Educ Prev 2008;20(5):384-98.
The authors discuss the process of developing the "Exploring the World of Adolescents" gender-specific HIV prevention curricula for 15- to 21-year-old adolescents living in both rural and urban Vietnam. The curricula are modeled after an existing HIV prevention program previously adapted and evaluated in Vietnam ("Vietnamese Focus on Kids") and based in social learning theory (prevention motivation theory) contextualized within socioeconomic changes. The overall capacity-building and participatory strategies for program development included (a) review of the HIV/AIDS and socioeconomic conditions in Vietnam, (b) review of the Vietnamese Focus on Kids curriculum themes and the theoretical constructs from the protection motivation theory, (c) analysis of qualitative and quantitative needs assessment data to incorporate culturally significant issues of gender and sexuality, and (d) a review of themes and activities from existing evidence-based adolescent reproductive health curricula.
18. Why has HIV stabilized in South Africa, yet not declined further? Age and sexual behavior patterns among youth. Katz I, Low-Beer D. Sex Transm Dis 2008;35(10):837-42.
HIV prevalence and four HIV-related sexual behaviors in 15- to 24-year-old South Africans and Ugandans were compared before the stabilization of HIV prevalence and during its decrease. According to standard indicators, 15- to 24-year-old South Africans have shown behavior change and have moderate risk behaviors. Yet the HIV prevalence of South African youth is more than twice the prevalence among Ugandan youth, despite two times greater reported condom use and an increase in secondary abstinence among young females. The authors observed inconsistent use of condoms and an extended age distribution of risk together with age and partner mixing. These factors increase the cumulative risk beyond indicators that are based on sexual behavior in the last year and condom use at last sexual act. The authors conclude that comprehensive HIV prevention in South Africa needs to be intensified beyond individual age groups, should clearly promote consistent condom use and reduction in sexual partners, and should focus on the transmission dynamics including older age groups.
