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I. PROGRAM RESOURCES
1. Conducting a Participatory Situation Analysis of Orphans and Vulnerable Children Affected by HIV/AIDS
2. Early Marriage: A Harmful Traditional Practice
3. Entre Nous: Youth Friendly Health Services in Europe
4. Girls, HIV/AIDS, and Education
5. The Impact of Conflict on Women and Girls in West and Central Africa and the UNICEF Response
6. JAWS: HIV/AIDS Teacher's Guide and HIV/AIDS Series
7. Making Services Youth-Friendly with Limited Resources
8. More Than Words? Action for Orphans and Vulnerable Children in Africa
9. Network: Non-consensual Sex
10. Our Voice, Our Future: Young People Report on Progress Made on the UNGASS Declaration
11. Reaching Vulnerable Youth: Providing SRH Services to Street Kids in Guatemala and Bolivia
12. Transatlantic Dialogue: U.S. – E.U. Knowledge is Power. Youth Advocacy Conference Summary
II. RESEARCH SUMMARIES
1. Coercive sexual experiences during adolescence and young adulthood: a public health problem
2. Confronting the sugar daddy stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya
3. Evaluating the sexual behaviour, barriers to condom use and actual use by university students in Nigeria
4. For young Mexican men, having a confidant raises the odds of condom use
5. For young South Africans, community opportunities may have unexpected links to sexual behavior
6. Heroin and HIV risk in Dar es Salaam, Tanzania: youth hangouts, mageto and injecting practices
7. The impact on condom use of the "100% Jeune" social marketing program in Cameroon
8. Knowledge and attitudes towards HIV/STD among Indian adolescents
9. Psychological distress among AIDS orphans in rural Uganda
10. Quality of parent-child relationship and adolescent HIV risk behaviour in St. Maarten
11. Sexual risks and concerns about AIDS among adolescents in Anguilla
12. What do we know about the perceptions educators have of HIV/AIDS and its impact on the holistic development of adolescent learners?
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I. PROGRAM RESOURCES
1. Conducting a Participatory Situation Analysis of Orphans and Vulnerable Children Affected by HIV/AIDS: Guidelines and Tools (2005)
English (PDF, 1.9MB)
French (PDF, 977K)
This comprehensive manual provides detailed information about conducting a situation analysis of orphans and vulnerable children with emphasis on ethical concerns and special needs of children. Topics covered include management, data collection and analysis, documentation and dissemination of results, and translating data into action. A matrix describes steps, time needed, and who should be involved. Appendices include resources, criteria for selecting psychosocial support persons, and examples of forms, interview guides, and baseline surveys.
Contact: aidspubs@fhi.org
2. Early Marriage: A Harmful Traditional Practice (2005, PDF, 1.2MB)
This 40-page report examines early marriage from a statistical perspective, presenting data on women aged 20-24 who were married by age 18 and girls aged 15-19 who are currently married. Findings are presented on the relationship between early marriage and socio-economic and demographic variables, characteristics of marriages, and sexual and reproductive health. Also included are discussions of polygamous unions, domestic violence, decision-making abilities of girls and women, and a multivariate analysis for 50 countries to assess statistical significance.
Contact: pubdoc@unicef.org
3. Entre Nous: Youth Friendly Health Services in Europe (2004, PDF, 1.3MB)
This issue of the European magazine for sexual and reproductive health focuses on youth-friendly services across Europe. Articles included cover a variety of perspectives on youth-friendly services from across Europe including Estonia, Russia, the Netherlands, and southeastern Europe.
Contact: entrenous@who.dk
4. Girls, HIV/AIDS, and Education (2004)
This 25-page UNICEF report discusses the relationship between girls, HIV, and education, including demographic data illustrating the powerful role of education in preventing HIV, as well as the risks that girls face when attending school. Three strategic priorities are outlined: getting and keeping girls in school, providing life skills-based education, and protecting girls from gender-based school violence.
Contact: pubdoc@unicef.org
5. The Impact of Conflict on Women and Girls in West and Central Africa and the UNICEF Response (2005, PDF, 306K)
This report examines how conflicts in West and Central Africa (Sierra Leone, Liberia, Cote d'Ivoire, and the Democratic Republic of Congo) have affected women and girls, including vulnerability to physical abuse and sexually transmitted infections, particularly HIV/AIDS, and the use of sexual violence as a strategic and tactical weapon of war. Examples of several UNICEF projects in health and education across the region are included.
Contact: pubdoc@unicef.org
6. JAWS: HIV/AIDS Teacher's Guide and HIV/AIDS Series (2003-2005)
For detailed information, click here.
The HIV/AIDS Teacher's Guide is a companion document to the Junior African Writers HIV/AIDS Series (JAWS), a series of 24 story and information books (available for purchase) geared for children ages 5 to 18, covering basic HIV/AIDS information as well as life skills, gender and human rights, stigma and discrimination, normalization and disclosure, care and support, orphans and vulnerable children, death, loss, and grief. The teacher's guide assists in selecting age-appropriate stories, discussing each theme, choosing activities, and emphasizing key messages for each theme.
Contact: international@harcourteducation.co.uk
7. Making Services Youth-Friendly with Limited Resources (2005)
English (PDF, 134K)
Spanish (PDF, 145K)
This two-page brief focuses on affordable strategies for making sexual and reproductive health services more youth-friendly. The brief describes how associations used US$3,000 in seed grants to target small, creative activities with significant youth participation, and had an impact on the quality of youth services. Activities centered on youth-friendly spaces and education materials, sensitizing and training staff, and making services more affordable.
Contact: info@ippfwhr.org
8. More Than Words? Action for Orphans and Vulnerable Children in Africa. Monitoring Progress towards the UN Declaration of Commitment on HIV/AIDS (2005, PDF, 2.6MB)
The United Nations General Assembly Special Services on HIV/AIDS (UNGASS) adopted a Declaration of Commitment on HIV/AIDS in 2001 which included specific commitments related to orphans and vulnerable children. This report examines the progress of these indicators in Ethiopia, Mozambique, Uganda, and Zambia and includes recommendations. Findings focus on policies and strategies, education, health, nutrition, psychosocial support, family capacity, community capacity, and protection issues.
Contact: info@worldvision.org.uk
9. Network: Nonconsensual Sex (2005, PDF, 2.3MB)
This issue of Family Health International's quarterly magazine discusses aspects of nonconsensual sexual, which disproportionately affects youth, including potential health impacts, assistance to victims of sexual abuse, and prevention. Internet resources and references are included.
Contact: network@fhi.org
10. Our Voice, Our Future: Young People Report on Progress Made on the UNGASS Declaration of Commitment on HIV/AIDS (2005, PDF, 598K)
This report prepared by young people from 12 countries details the progress of the 2001 UNGASS Declaration of Commitment on HIV/AIDS. Youth collected and analyzed data on political and financial commitment, access to information services, and youth participation. A discussion includes 18 findings and recommendations related to each of the indicators.
Contact: martinez@unfpa.org
11. Reaching Vulnerable Youth: Providing SRH Services to Street Kids in Guatemala and Bolivia (2005)
English (PDF, 47K)
Spanish (PDF, 58K)
This two-page brief discusses IPPF/WHR's work with providing sexual and reproductive health (SRH) services to street children in Guatemala and Bolivia — a population that is extremely vulnerable and for which there are limited programs, resources, or data. The brief describes project activities and common strategies, key results, and lessons learned.
Contact: info@ippfwhr.org
12. Transatlantic Dialogue: U.S. – E.U. Knowledge is Power. Youth Advocacy Conference, 15 - 16 February 2005, Brussels. Program of Action (2005, PDF, 598K)
In early 2005, 50 youth ages 17 to 25 from the United States and European Union met in Brussels, Belgium, to discuss sexual and reproductive health. This 11-page document outlines the "Program of Action" from the conference, emphasizing barriers and recommendations regarding comprehensive sexuality education, access to services and supplies, and attention to HIV/AIDS.
Contact: info@mariestopes.org.uk
II. RESEARCH SUMMARIES
1. Coercive sexual experiences during adolescence and young adulthood: A public health problem. Irwin CE Jr, Rickert VI. J Adolesc Health 2005;36(5).
Researchers interviewed 575 sexually active 15 to 19 year-old women in 2001-2002 as part of the ongoing Rakai surveillance project in rural Uganda. Chi-square tests and logistic regressions were used to investigate associations between coerced first intercourse and selected reproductive health behaviors and outcomes. Fourteen percent of young women reported that their first sexual intercourse had been coerced. After the effects of respondents' demographic characteristics were accounted for, young women who reported coerced first intercourse were significantly less likely than those who did not to be currently using modern contraceptives, to have used condoms at last intercourse, and to have used them consistently during the preceding six months; they were also more likely to report their current or most recent pregnancy as unintended (among ever-pregnant women) and to report one or more genital tract symptoms.
2. Confronting the sugar daddy stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya. Luke N. Int Fam Plan Perspect 2005;31(1).
"Sugar daddy" relationships, which are characterized by large age and economic asymmetries between partners, are believed to be a major factor in the spread of HIV in sub-Saharan Africa. In order to determine how common they are, and whether they are related to unsafe sexual behavior, researchers surveyed 1,052 men ages 21-45 in Kisumu, Kenya, in 2001. These researchers analyzed data on these men and their 1,614 recent nonmarital partnerships to understand the prevalence of sugar daddies and sugar daddy relationships, as well as a range of age and economic disparities within nonmarital partnerships. Logistic regression models were constructed to assess relationships between condom use at last sexual intercourse and various measures of age and economic asymmetry. The results indicated the mean age difference between unmarried sexual partners was 5.5 years, and 47 percent of men's female partners were adolescents. Fourteen percent of partnerships involved an age difference of at least 10 years, and 23 percent involved more than the mean amount of male-to-female material assistance. Men who reported at least one partnership with both of these characteristics were defined as sugar daddies and made up five percent of the sample; sugar daddy relationships accounted for four percent of partnerships. Condom use decreased in sugar daddy partnerships and with the largest age and economic differences between partners.
3. Evaluating the sexual behaviour, barriers to condom use and actual use by university students in Nigeria. Sunmola AM. AIDS Care 2005;17(4).
What kinds of barriers prevent university students in Nigeria from using condoms? Researchers analyzed the association between condom use at last intercourse and the barriers to use, in addition to risky sexual practices. A total of 96 women and 128 men were randomly surveyed. Results indicated both men and women felt that condoms hindered their sexual satisfaction, caused health problems for them, and reduced their sexual interest. However, the findings also showed that obtaining condoms from clinics, and the perception that condoms do not cause health problems, predicted the likelihood of condom use for both sexes. Researchers recommended that intervention efforts make condoms freely available in tertiary institutions, and that such interventions be tailored to overcome the relevant barriers that interfere with condom use for both women and men.
4. For young Mexican men, having a confidant raises the odds of condom use. MacLean R. Int Fam Plann Perspect 2005;31(1), summary of research by Marston et al. in Culture Health and Society 2004;6(5). In Mexico City, unmarried young men who discuss their personal problems with one, two, or three or more confidants are significantly more likely to have used contraceptives for sexually transmitted infection (STI) prevention at last intercourse than are men without a confidant. Researchers questioned 8,086 men aged 15-60 in 1992-1993 about their demographic characteristics and sexual history, contraceptive use at last intercourse, attitudes toward condoms, knowledge and perceived risk of HIV/AIDS, and people with whom they discussed their personal problems. The sample for analysis comprised all unmarried respondents who were younger than 25 and had had sex in the past 12 months. The researchers conducted univariate and multivariate regression analyses to evaluate relationships between social and individual-level variables and contraceptive use at last sex for pregnancy prevention, for STI prevention, and for either purpose. Analysis revealed a number of significant predictors of contraceptive use for pregnancy or STI prevention: secondary or higher education, top-level job or student status, positive attitude toward condoms, perceived lack of risk for HIV infection, high level of knowledge about HIV/AIDS, two cumulative female partners, and frequency of sex of at least once per month during past year.
. For young South Africans, community opportunities may have unexpected links to sexual behavior. London S. Int Fam Plann Perspect 2005;31(1).
The educational, employment, and recreational opportunities available locally to South African adolescents are associated with their sexual behavior, although not always in expected directions or in the same way for males and females, according to a population-based survey in one province. Researchers surveyed 2,992 participants ages 14 to 22 about their sexual behavior, their education and work experiences, their participation in extracurricular activities (classified as youth programs, sports, or religious clubs) and their households. Among adolescent women, when only individual and household factors were included in the analysis, the likelihood of condom use was reduced for respondents living in a house made of traditional materials and was elevated for women whose household included an adult with 12 or more years of schooling. After addition of community factors, only household education remained significantly associated with condom use at last sex. In addition, the higher the community's average wage, the greater the likelihood of condom use. Among adolescent men, when only individual and household factors were considered, the likelihood of condom use at last sex was positively associated with working and with household education. When community factors were added to the analysis, these associations persisted.
6. Heroin and HIV risk in Dar es Salaam, Tanzania: youth hangouts, mageto, and injecting practices. McCurdy SA, Williams ML, Kilonzo GP, et al. AIDS Care 2005;17 (Suppl 1).
HIV risk through needle sharing is an emerging phenomenon in Africa. This article details the ways that young people become initiated into heroin use, how they progress to injecting, and the important role of local neighborhood hangouts in facilitating this process. Their practices, interactions, and narratives also provide insights into what may be the most appropriate HIV-prevention interventions. Researchers conducted semi-structured interviews with 51 male and female injectors residing in eight neighborhoods in Dar es Salaam, Tanzania. These interviews revealed that injectors begin smoking heroin in hangout areas with their friends, either because of peer pressure, desire, or trickery. As users build a tolerance for the drug, they move along a continuum of practices until they begin to inject. Injecting heroin, a comparatively recent practice in Africa, coincides with: (1) Tanzania transitioning to becoming a heroin consuming community; (2) the growing importance of youth culture; (3) the technical innovation of injecting practices and the introduction and ease of use of white heroin; and (4) heroin smokers', sniffers', and inhalers' perceived need to escalate their use through a more effective and satisfying form of heroin ingestion.
7. The impact on condom use of the "100% Jeune" social marketing program in Cameroon. Meekers D, Agha S, Klein M. J Adolesc Health 2005;36(6).
In order to measure the reach of the "100% Jeune" social marketing campaign and to assess its impact on condom use and on the predictors of condom use, researchers analyzed data from the 2000 and 2002 waves of a reproductive health survey of youth aged 15-24 years, with sample sizes of 2,097 and 3,536, respectively. Results indicated a high exposure to campaign activities. During the course of the intervention, there were significant changes in perceived condom attributes and access, self-efficacy, and perceived social support. Consistent with these changes, the percentage of youth who used a condom in last sex with their regular partner increased from 32 percent to 45 percent for females (p < .05) and from 44 percent to 61 percent for males (p < .01). This indicates a need for more and possibly different campaign activities to focus specifically on risk perception and self-efficacy among females. The results also show that repeated program exposure is needed to achieve behavior change. Hence, future programs can enhance their effectiveness by using a mix of mass media and interpersonal communications to repeatedly expose youth to key campaign messages.
8. Knowledge and attitudes towards HIV/STD among Indian adolescents. Khalil SN, Ross MW, Rabia M, Hira S. Int J Adolesc Youth 2005;12(1/2).
This study examined the relationship of knowledge, health beliefs, attitudes, and risk behaviors to HIV/STD risk intentions among 1,230 Indian adolescents and also examined predictive utility of the Health Belief Model (HBM). The HBM is partially, but significantly, related to the likelihood of "preventive intention" changes in young people. This study revealed that how adolescents perceive a disease depends upon the language spoken at home; Indian adolescents may assimilate health messages more completely when those messages are conveyed in the local language. Parent education levels do not influence "preventive intention" changes. However, it was observed that a low level of maternal education encouraged children's "preventive intentions." Girls especially have shown a higher intention to practice safer sex behaviors. Knowledge about HIV/STD appears to influence preventive intention to practice safer sex behaviors. Indian male adolescents are more likely to report that they engage in risky behavior than female adolescents, but all Indian adolescents need greater access to relevant health education.
9. Psychological distress among AIDS orphans in rural Uganda. Atwine B, Cantor-Graae E, Bajunirwe F. Soc Sci Med 2005;61(3).
Researchers in this study investigated the psychosocial consequences of AIDS orphanhood in a rural district in Uganda and identified potential areas for future interventions. The study population consisted of 123 children ages 11 - 15 years whose parents (one or both) were reported to have died from AIDS and 110 children of similar age and gender living in intact households in the same neighborhood. Symptoms of psychological distress were assessed using the Beck Youth Inventories of Emotional and Social Impairment (BYI). The standardized interview also included questions concerning current and past living conditions. A multivariate analysis of factors with possible relevance for BYI outcome showed that orphan status was the only significant outcome predictor. Orphans had greater risk (vs. non-orphans) for higher levels of anxiety, depression, and anger. Furthermore, orphans had significantly higher scores than non-orphans on individual items in the Beck Youth Depression Inventory that are regarded as particularly "sensitive" to the possible presence of a depressive disorder (i.e., vegetative symptoms, feelings of hopelessness, and suicidal ideation). High levels of psychological distress found in AIDS orphans suggest that material support alone is not sufficient for these children.
10. Quality of parent-child relationship and adolescent HIV risk behaviour in St. Maarten. McBride DC, Freier MC, Hopkins GL, et al. AIDS Care 2005;17(Suppl 1).
The objective of this analysis was to describe the extent of youth risk behavior in St. Maarten and explore the relationship between quality of parental-child relationship and adolescent HIV risk behaviors. The sample consisted of 1,078 students (age range 14 – 18 years). The data was collected by self-report survey in 2001 in the classrooms of all seven secondary schools in St. Maarten. The survey instrument included demographic information, and used questions derived from the Center for Disease Control's (CDC) Youth Risk Behavior Survey (YRBS) to assess health risk behavior prevalence, including tobacco, alcohol, and drug use, and sexual activity. The survey also asked youth to rate their relationship with their parents. Analysis showed a relatively high rate of risk behavior in this school population. Multivariate analysis showed that a "great" relationship with both parents, as perceived by the student, was significantly associated with lower rates of tobacco and alcohol use as well as lower rates of sexual activity.
11. Sexual risks and concerns about AIDS among adolescents in Anguilla. Kurtz SP, Douglas KG, Lugo Y. AIDS Care 2005;17(Suppl 1).
Concerns regarding HIV/AIDS infection and the health risk behaviors among youth in the Caribbean are growing. Considering that approximately 30 percent of the Caribbean's population falls between the ages of 10 and 24, there is considerable need for research on youth in this region. This paper reports findings regarding the sexual risks and concerns about AIDS among 1,225 enrolled school students in Anguilla, drawn from self-administered health surveys conducted in 2002. Although more than 40 percent of youth reported lifetime alcohol use, experience with other drugs was moderate. Males initiated sexual activity at a much younger median age than females (11 years for males vs. 14 years for females), and were twice as likely to have had sexual intercourse. In a multivariate logistic regression model, being sexually active was predicted by male gender, recent substance use, recent depression, and a history of physical and sexual abuse. Only 22 percent of sexually active youth under 12 years of age reported using condoms at last intercourse, compared to 71 percent of those 13 and over. Older sexually active youth were also much more likely than younger ones to express ongoing concern about becoming infected with HIV.
12. What do we know about the perceptions educators have of HIV/AIDS and its impact on the holistic development of adolescent learners? de Lange N, Greyling L, Leslie GB. Int J Adolesc Youth 2005;12(1/2).
This research attempted to determine what perceptions educators have regarding HIV/AIDS and its impact on the holistic development of adolescent learner. To achieve these aims, researchers chose a qualitative, descriptive, and contextual research design. The first theme regarding the educators' perceptions of HIV/AIDS revealed various influences: an awareness of the prevalence of HIV/AIDS, medical knowledge of HIV/AIDS, causes of HIV/AIDS, and feelings about it, as well as views on what is needed for stopping the spread. The second theme regarding the impact of HIV/AIDS on the holistic development of the learners showed the following influences on educators' perceptions: understanding of the impact of HIV/AIDS on the holistic development of the adolescent (physically, cognitively, emotionally, socially and morally), on the family, on the peer group, on the school, and on the community.
