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I. PROGRAM RESOURCES
1. Programme Planning Materials and Training Resources: A Compendium
2. Young Men and HIV Prevention. Horizons Report: HIV/AIDS Operation Research
3. The Men in Young Women's Lives: Findings from Adolescent Reproductive Health Intervention Studies in India
4. The Factors Influencing Transactional Sex among Young Men and Women in 12-Sub-Saharan African Countries
5. Qualitative Evidence on Adolescents' Views of Sexual and Reproductive Health in Sub-Saharan Africa
6. Adolescent Sexual and Reproductive Health: A Synthesis of Research Evidence
7. Science and Success in Developing Countries: Holistic Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections
8. Advocating for Adolescent Reproductive Health in Eastern Europe and Central Asia
9.
Going to Scale in Ethiopia: Mobilizing Youth Participation in a National HIV/AIDS Program
10. Improving the Reproductive Health of Youth in Mexico
11. Position Statement on Condoms and HIV Prevention
12. Issue Brief: The Effectiveness of Condoms in Preventing HIV Transmission
13. Adolescent Forum 42: Providing Comprehensive Sexuality Education
14. Youth: Choices and Change
15. The Main Thread
II. RESEARCH ARTICLES
1. Adolescent pregnancy prevention: an abstinence-centered randomized controlled intervention in a Chilean public high school
2. After the promise: the STD consequences of adolescent virginity pledges
3. Exploring the social and cultural context of sexual health for young people in Mongolia: implications for health promotion
4. The impact of life skills education on adolescent sexual risk behaviors in KwaZulu-Natal, South Africa
5. Perceptions of sex education for young people in Lesotho
6. Sexual and reproductive behaviour among single women aged 15-24 in eight Latin American countries: a comparative analysis
7. The sexual scripts of Kenyan young people and HIV prevention
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I. PROGRAM RESOURCES
1. Programme Planning Materials and Training Resources: A Compendium (2005, PDF, 836K)
This 300-page guide, produced by UNFPA and Margaret Sanger Center International, shares program planning materials, training resources, tools, and documented intervention experiences from throughout the world. Each resource contains contact information and a listing of elements addressed, including promotion of protective behaviors, community mobilization, and health education. The materials, most published since 2000, address cultural appropriateness, gender equity, healthy sexuality, and youth rights.
Contact: martinez@unfpa.org
2. Young Men and HIV Prevention. Horizons Report: HIV/AIDS Operation Research (2004, PDF, 189K)
This report from Horizons/Population Council focuses on programs in Brazil, Tanzania, and India involving young men, HIV prevention, and gender norms. The projects in Brazil and India focus on perceived male gender roles as they play a role in HIV transmission in early relationships. The Tanzania report summarizes the evaluation of a peer education and drama program aimed at changing attitudes and behaviors related to partner violence and the transmission of HIV.
Contact: Communications Unit, horizons@pcdc.org
3. The Men in Young Women's Lives: Findings from Adolescent Reproductive Health Intervention Studies in India (2005, PDF, 147K)
This brief from the International Center for Research on Women contains updates from five on-going intervention studies across India that examine how men's involvement can affect young women's reproductive health. The findings showed fathers as strong supporters of programs to increase their daughters' skills and well being, including sexual health. An education program for adolescent boys increased their participation by the inclusion of a popular local figure. Husbands were interested in maternal care but rarely participate. Community health educators were more successful in engaging men when using innovative techniques such as employing married community health educators. Finally, shame prevents men from seeking treatment for reproductive tract infections.
Contact: rpande@icrw.org
4. The Factors Influencing Transactional Sex among Young Men and Women in 12-Sub-Saharan African Countries (2004, PDF, 155K)
This study by the POLICY Project analyzes the risk of young men and women engaging in transactional sex using Demographic and Health Survey data from 12 sub-Saharan African countries. Results indicated that both young women and men are at higher risk of engaging in sex for money or gifts than older women and men. Also, enrollment in school, place of residence, and economic status did not decrease the probability of engaging in transactional sex for young women or men. Based on the data, prevention programs need to target and tailor messages to young unmarried women and men across economic, educational, and geographical groups.
Contact: http://www.policyproject.com/contact.cfm
5. Qualitative Evidence on Adolescents' Views of Sexual and Reproductive Health in Sub-Saharan Africa (2005, PDF, 405K)
This qualitative study from the Alan Guttmacher Institute presents the results of 55 focus group discussions conducted in 2003 on how youth from Burkina Faso, Ghana, Malawi, and Uganda view sexual and reproductive health issues. Topics include transactional sex, premarital pregnancy, HIV and STIs, condom use, and reproductive health services. The report concludes with policy and program implication of the findings on preventing the spread of HIV and STIs and reducing unwanted teenage pregnancies.
Contact: buyit@guttmacher.org
6. Adolescent Sexual and Reproductive Health: A Synthesis of Research Evidence (2004)
These three reports from the Alan Guttmacher Institute are part of a five-year study of youth reproductive health issues called Protecting the Next Generation: Understanding HIV Risk Among Youth. They provide an overview of youth reproductive health/HIV prevention, summarize key research results, identify information gaps, and prioritize areas for programs and policies.
Contact: buyit@guttmacher.org
7. Science and Success in Developing Countries: Holistic Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections (2005, PDF, 257K)
This paper from Advocates for Youth provides a description of 10 programs shown to be effective in preventing HIV, STIs, and teen pregnancy in developing countries. The highlighted programs were carefully evaluated on several criteria including publication in a peer-reviewed journal, experimental design, large sample size, and demonstration of effectiveness. Outcomes shown by the 10 programs included delay in sexual debut, reduction in risk for sexually active youth, reduction in incidence of STIs, and reduction in incidence of pregnancy. While a variety of strategies were applied including referral to sexual health services and mass media campaigns, all programs included comprehensive sex education.
Contact: questions@advocatesforyouth.org
8. Advocating for Adolescent Reproductive Health in Eastern Europe and Central Asia (2004, PDF, 404K)
This manual by Advocates for Youth is designed to develop adolescents' skills to advocate for reproductive health services and education. It illustrates steps to create campaigns and develop a feasible advocacy strategy with youth. Topics include conducting a needs assessment, building youth/adult partnerships, and mobilizing the community. Case studies of successful activities and strategies within Eastern Europe and Central Asia are included.
Contact: questions@advocatesforyouth.org
9. Going to Scale in Ethiopia: Mobilizing Youth Participation in a National HIV/AIDS Program (2004, PDF, 371K)
The Synergy Project, with FHI assistance, describes in this case study how a participatory learning and action (PLA) process assisted youth in communicating with other young people and adults about sexual and reproductive health needs. The project facilitated a national youth evaluation and needs assessment to affect national policy and services. The study includes lessons learned to show how building youth capacity with PLA is applicable in other settings.
Contact: youthnetpubs@fhi.org
10. Improving the Reproductive Health of Youth in Mexico (2004, PDF, 3.83MB)
This report summarizes the results of MEXFAM's Young People's Program (YPP), which conducted hundreds of presentations, activities, and educational courses over a 21-month period. After the intervention, sexual health knowledge and attitudes increased among youth but behaviors, like choice of contraceptive method during first intercourse, changed very little. Attitudes of community leaders also improved in regards to provision of information and health services to adolescents.
Contact: mdura@mexfam.org.mx
11. Position Statement on Condoms and HIV Prevention (2004, PDF, 273K)
This two-page position statement from UNFPA, WHO, and UNAIDS focuses on condoms as the most efficient and widely available form of protection against HIV and other sexually transmitted diseases. Because youth are a highly exposed group, it is especially important for young men and women to have information, skills, and access to high-quality affordable condoms.
Contact: martinez@unfpa.org
12. Issue Brief: The Effectiveness of Condoms in Preventing HIV Transmission (2005, PDF, 62K)
In response to U.S. debate on the effectiveness of condoms for preventing transmission of HIV, this two-page issue brief from the American Foundation for AIDS Research reviews key research about the effectiveness of the male and female condoms. It summarizes how condoms are highly effective in preventing transmission especially in conjunction with comprehensive prevention programs.
Contact: barbara.battle@amfar.org
13. Adolescent Forum 42: Providing Comprehensive Sexuality Education (2005)
This electronic publication from IPPF/Western Hemisphere Region provides links to resources on sexuality education, including Web sites, curricula, and publications in both English and Spanish. Materials are from many organizations, including PROFAMILIA, Planned Parenthood Federation of America, MEXFAM, Sexuality Information and Education Council of the United States (SIECUS), and FHI/YouthNet.
Contact: info@ippfwhr.org
14. Youth: Choices and Change (2005)
This book from PAHO, available for purchase, presents a variety of behavior change theories and their application to adolescent health. Section one addresses issues related to theoretical frameworks for youth. Section two analyzes behavior change and health promotion theories. Section three examines how models need to reflect the changing wants and needs of adolescents in a developmental process. Section four includes a series of recommendations for improving health and development of youth over the next decade.
Contact: sales@paho.org
15. The Main Thread (2005)
This handbook on sexuality and personal relationships among youth, available for purchase, is designed for teachers, educators, and health staff who work with young people between the ages of 13 and 19. The content facilitates sex education through models and methods to impart knowledge and skill, and also includes discussion of values and attitudes. More than 30 practical models have been included along with value clarification exercises and topics for in-depth study. Topics include self-esteem, sexuality and contraceptives, and relationships.
Contact: themainthread@lafa.nu
II. RESEARCH ARTICLES
1. Adolescent pregnancy prevention: an abstinence-centered randomized controlled intervention in a Chilean public high school. Cabezon C, Vigil P, Rojas I, et al. J Adolesc Health 2005;36(1):64-9.
This prospective, randomized study evaluated the efficacy of an abstinence-centered sex education program in adolescent pregnancy prevention, called the TeenSTAR Program, as applied to the first year of high school in Santiago, Chile. A total of 1,259 girls were divided into three cohorts depending on the year they started high school: the 1996 cohort of 425 students, which received no intervention; the 1997 cohort, in which 210 students received an intervention and 213 (control group) did not; and the 1998 cohort, in which 328 students received an intervention and 83 (control group) did not. Students were randomly assigned to control and intervention groups in these cohorts, before starting with the program. All cohorts were followed up for 4 years; pregnancy rates were recorded and subsequently contrasted in the intervention and control groups. Pregnancy rates were measured with risk ratio with 95% confidence interval calculated for intervention and control groups in each cohort. Pregnancy rates for the intervention and control groups in the 1997 cohort were 3.3% and 18.9%, respectively (RR: 0.176, CI: 0.076-0.408). Pregnancy rates for the intervention and control groups in the 1998 cohort were 4.4% and 22.6%, respectively (RR 0.195, CI: 0.099-0.384). The abstinence-centered TeenSTAR sex education intervention was effective in the prevention of unintended adolescent pregnancy.
2. After the promise: the STD consequences of adolescent virginity pledges. Bruckner H, Bearman P. J Adolesc Health 2005;36(4):271-8.
The study examined the effectiveness of virginity pledges in reducing sexually transmitted disease (STD) infection rates among young adults in the US (ages 18-24). Data are drawn from the National Longitudinal Study of Adolescent Health, a nationally representative study of US students enrolled in grades 7-12 in 1995. During a follow-up survey in 2001-2002, respondents provided urine samples, which were tested for human papilloma virus, chlamydia, gonorrhea, and trichomoniasis. The study reports descriptive results for the relationship of pledge status and STD rates as well as health behaviors commonly associated with STD infection. Pledgers are consistently less likely to be exposed to risk factors across a wide range of indicators, but their STD infection rate does not differ from non-pledgers. Possible explanations are that pledgers are less likely than others to use condoms at sexual debut and to be tested and diagnosed with STDs. Adopting virginity pledges as an intervention may not be the optimal approach to preventing STD acquisition among young adults.
3. Exploring the social and cultural context of sexual health for young people in Mongolia: implications for health promotion. Roberts AB, Oyun C, Batnasan E, et al. Soc Sci Med 2005;60(7):1487-98.
Little is known about the social and cultural context in which the sexual knowledge, attitudes, and behavior of Mongolian young people are created and negotiated. This study employed qualitative research methods to explore and describe the social and cultural context in which sexual behavior is negotiated among secondary school students in Ulaanbaatar, Mongolia. Students and teachers from two schools in Ulaanbaatar and health professionals were selected by purposeful sampling to participate in six semi-structured focus group interviews in 2000. Thematic content analysis was conducted on the focus group transcripts. Seven themes were extracted including embarrassment, lack of knowledge, concepts of sex, perceptions of condoms, gender roles, peer norms, and the influence of drinking on sexual activity. Results presented are the first description of the social and cultural context of sexual health and highlight the combined impact of these themes on safer sex practices in Mongolia. These findings are not generalizable, but their agreement with the Mongolian and the international literature indicates that they may be transferable. Implications for STI and HIV/AIDS prevention efforts and further research in Mongolia are discussed.
4. The impact of life skills education on adolescent sexual risk behaviors in KwaZulu-Natal, South Africa. Magnani R, Macintyre K, Karim AM, et al. J Adolesc Health 2005;36(4):289-304.
The study assessed the impact of exposure to life skills education by youth in KwaZulu-Natal Province (KZN, South Africa) on knowledge and behaviors associated with the spread of HIV/AIDS. Data come from a panel study of 2,222 youth from several population subgroups in KZN. The youth were aged 14-24 years when interviewed in 1999 and 2001. The intervention was a full coverage life skills education program for all students in middle and secondary schools. Impact was measured as net dose-response relationships between life skills exposure and outcomes. Econometric methods were used to control for nonrandom exposure to life skills education. Outcomes included sexual behavior and condom use indicators. Significant effects, albeit modest in magnitude, were observed on selected areas of sexual-reproductive health knowledge and perceived condom self-efficacy, along with larger effects on condom use at first and last sex. No consistent effects on age at sexual initiation, secondary abstinence, or partnering behaviors were observed among these youth. School-based life skills education appears capable of communicating key information and helping youth develop skills relevant to reducing HIV risk. However, the South African national program has yet to be fully implemented, and whether this initiative will result in sustained behavior modification among youth on a sufficient scale to affect the HIV/AIDS epidemic is uncertain.
5. Perceptions of sex education for young people in Lesotho. Mturi AJ, Hennink MM. Cult Health Sex 2005;7(2):129-43.
This study aimed to identify the views of young people, parents, and teachers concerning sex education in Lesotho. It was conducted at a time when the national government was considering the introduction of Population and Family Life Education, which includes sex education, into the national school curriculum. Forty-six focus group discussions were held with young people (10), parents (30) and teachers (6) to identify current sources of sex education and views of the proposed introduction of school-based sex education in Lesotho. Findings show the limited and problematic sources of sex education for adolescents in Lesotho. They also highlight broad support for the introduction of sex education in the national school curriculum among young people, parents, and teachers. Of key importance for the development of a sex education curriculum is the balance between providing young people with information and developing their skills in sexual empowerment and negotiating sexual pressure. The use of pupil-centered interactive pedagogies was seen as essential. Teachers, however, highlighted the need for training in the delivery of sex education, which includes instruction on course materials, teaching methodologies and developing sensitivity to teaching sexual issues to young people.
6. Sexual and reproductive behaviour among single women aged 15-24 in eight Latin American countries: a comparative analysis. Ali MM, Cleland J. Soc Sci Med 2005;60(6):1175-85.
A comparative analysis of exposure to sexual activity, contraceptive use, conceptions, and pregnancy resolutions among single women aged 15-24 in eight Latin American countries is presented. Using data from Demographic and Health Surveys, complete contraceptive and reproductive histories are constructed for single women aged 15 to 24 during the 5-year period preceding each survey. Pre-marital conception rates and overall and cause-specific life-table probabilities of contraceptive discontinuation are estimated. Pregnancy outcome and intention status of births are summarized. Trends in virginity, contraceptive protection, and conception rates for five sites are documented. In all eight countries, virginity accounts for over half of all single woman-years of exposure between age 15 and 24. The percentage of sexually active time protected by contraception is less than 20% in five countries, is about 30% in Peru, and 50% in Brazil and Colombia. The contribution of condoms to contraceptive protection ranges from one-tenth to one-fifth. Pre-marital conception rates among sexually active single women range from 14.1 per 100 woman-years in Nicaragua to 25.8 in Bolivia. Most pre-marital conceptions ended in live birth, and births that are legitimized by marriage or cohabitation are more likely to be wanted. In five settings, virginity has fallen over time, especially in Northeast Brazil and Colombia, and uptake of condoms has increased faster than use of other methods. Because of pervasive declines in the protective effect of virginity, conception rates among single women in Latin America are rising. Contraceptive uptake, particularly of condoms, is increasing but not sufficiently to offset the decline in virginity.
7. The sexual scripts of Kenyan young people and HIV prevention. Maticka-Tyndale E, Gallant M, Brouillard-Coyle C, et al. Cult Health Sex 2005;7(1):27-41.
The scripting of sexual encounters among young people in Kenya is described using results of 28 focus group discussions conducted with young people attending primary school standard 7, from four different ethnic groups and living in 22 different communities. Sexual encounters were described as both mundane and inevitable and followed a predetermined scripted sequence of events and interactions in which girls and boys played complementary roles. These scripts were set within discourses of force and the exchange of gifts for sex. The gendered nature of the script and its social and cultural foundations are discussed. Potential strategies for developing HIV prevention programming are discussed from the perspective of existing sexual scripts.
