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I. PROGRAM RESOURCES
1. Adolescence Education Newsletter
2. Adolescence in Pakistan: Sex, Marriage and Reproductive Health
3. Africa's Orphaned and Vulnerable Generations: Children Affected by AIDS
4. Asylums of Exploitation: Internally Displaced Children in the Worst Forms of Child Labor Due to the Armed Conflict in Nepal
5. Early Childbearing in Honduras: a Continuing Challenge
6. Focus on...Integrating Family Planning and HIV Services
7. HIV Prevention for Girls and Young Women: Report Cards
8. Improving the Reproductive Health of Married and Unmarried Youth in India: Evidence of Effectiveness and Costs from Community-based Interventions
9. Innovative Practices of Youth Participation in Media
10. New Evidence on Young People from the Population Council, India
11. Orphans and Vulnerable Children Due to AIDS in Africa
12. Orphans and Vulnerable Children Toolkit: Version II
13. Pregnant AdolescentsDelivering on Global Promises of Hope
14. Youth Development Notes
15. Reproductive Health of Young Adults in India: The Road to Public Health
16. Sexuality and Social Change: Making the Connection
17. Ungefanyaje: What Would You Do?
18. What Future? Street Children in the Democratic Republic of Congo
19. World Development Report 2007Development and the Next Generation
20. YouthActionNet
II. RESEARCH SUMMARIES
1. Adolescent HIV prevalence, sexual risk, and willingness to participate in HIV vaccine trials
2. Assessing knowledge, exploring needs: a reproductive health survey of adolescents and young adults in Pakistan
3. Can the Internet be used effectively to provide sex education to young people in China?
4. Factors associated with self-efficacy for condom use and sexual negotiation among South African youth
5. Factors that shape young people's sexual behaviour: a systematic review
6. From the girl child to girls' rights
7. From trial intervention to scale-up: costs of an adolescent sexual health program in Mwanza, Tanzania
8. HIV incidence among women of reproductive age in Malawi and Zimbabwe
9. Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa
10. Reproductive health of Arab young people
11. Sexual risk behavior among South African adolescents: is orphan status a factor?
12. Social scripts and stark realities: Kenyan adolescents' abortion discourse
13. Substance use and sexual risk behavior among South African eighth grade students
14. Towards a definition of orphaned and vulnerable children
15. Young age is a risk factor for HIV among female sex workersan experience from India
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I. PROGRAM RESOURCES
1. Adolescence Education Newsletter (2006, PDF, 1.34 MB)
This biannual publication features articles describing the linkages between culture, religion, and youth sexual and reproductive health for countries in the Asia and Pacific region. It also includes research briefs and online resources.
Organization: UNESCO
Contact: arsh@unescobkk.org
2. Adolescence in Pakistan: Sex, Marriage and Reproductive Health (2006, PDF, 323 KB)
Marie Stopes conducted a quantitative and qualitative baseline study of knowledge, attitudes, and practices regarding sexuality and reproductive health in four districts. Topics discussed include puberty, sources and type of information, social norms, age of marriage, and community sensitization.
Organization: Marie Stopes International
Contact: research@mariestopes.org.uk
3. Africa's Orphaned and Vulnerable Generations: Children Affected by AIDS (2006)
This report shows how the AIDS epidemic continues to affect children disproportionately and in many harmful ways, leaving many of them orphaned and threatening their survival. The report contains new research and recommendations on orphans and vulnerable children.
Organization: UNICEF, UNAIDS, PEPFAR
Contact: pubdoc@unicef.org
4. Asylums of Exploitation: Internally Displaced Children in the Worst Forms of Child Labour Due to the Armed Conflict in Nepal (2006, PDF, 461 KB)
This comprehensive report based on a study of the impact of conflict on internally displaced children examines the children's histories and risk and protective factors, assesses the state of internally displaced children, and provides recommendations.
Organization: Terre des homes, CREPHA, Save the Children, Nepal
Contact: delegate@wlink.com.np
5. Early Childbearing in Honduras: a Continuing Challenge (2006, PDF, 1.63 MB)
This paper reviews issues regarding early childbearing in Honduras, one of Central America's poorest countries, focusing on reducing high levels of adolescent childbearing as a critical way to improve the lives of women and their families.
Organization: Guttmacher Institute
Contact: info@guttmacher.org
6. Focus on...Integrating Family planning and HIV/AIDS Services (2006, PDF, 350 KB)
This digest includes a section on integrated services for youth, summarizing four key publications that provide useful resources and guidance for programs.
Organization: INFO Project
Contact: inforeports@infoforhealth.org
7. HIV Prevention for Girls and Young Women: Report Cards (2006)
These summaries of HIV prevention activities in Jamaica, Malawi, Mozambique, and Philippines focus on strategies and services for females 15-24 years old, with recommendations for key stakeholders. The reports seek to increase and improve programmatic, policy, and funding actions for HIV prevention for girls and young women.
Organization: IPPF, UNFPA, Global Coalition on Women and AIDS, Young Positives
Contact: martinez@unfpa.org
8. Improving the Reproductive Health of Married and Unmarried Youth in India: Evidence of Effectiveness and Costs from Community-based Interventions (2006, PDF, 772 KB)
This report on a 10-year program describes six intervention studies that tested a variety of models for improving the reproductive health of youth. It focuses on gender-based constraints, involving men and boys, community mobilization, and cost-effective strategies.
Organization: ICRW and local partner organizations
Contact: pande@icrw.org
9. Innovative Practices of Youth Participation in Media (2006, PDF, 3.35 MB)
This report looks at 12 youth initiatives using radio, television, print, and/or computer technologies to address issues including reproductive health, democracy and civic engagement. Profiles are from Ghana, Haiti, India, Kyrgyzstan, Mexico, Mozambique, Nigeria, Somalia, South Africa, Vietnam, and Zambia.
Organization: UNESCO
Contact: h.padhy@unesco.org
10. New Evidence on Young People from the Population Council, India (2006)
Seven new research briefs from the Population Council/India describe various projects with youth, including livelihoods, married girls, income use, and partnerships between young men and women.
Organization: Population Council
Contact: info-india@popcouncil.org
11. Orphans and Vulnerable Children Due to AIDS in Africa (2006)
This online searchable database of 400 resources, available in English and French, discusses orphans and vulnerable children in Africa. Topics include a discussion of the definition of AIDS orphans, the international response, support mechanisms, and vulnerabilities faced by orphan children.
Organization: CEPED
Contact: ceped@ceped.cirad.fr
12. Orphans and Other Vulnerable Children Support Toolkit CD-ROM: Version II (2006)
The International HIV/AIDS Alliance and Family Health International have published an updated version of the CD-ROM on supporting orphans and other vulnerable children. It contains over 650 documents sharing learning and resources from a wide range of organizations. Copies of the CD-ROM can be ordered free of charge.
Organization: International HIV/AIDS Alliance and FHI
Contact: http://www.aidsalliance.org/sw35388.asp
13. Pregnant AdolescentsDelivering on Global Promises of Hope (2006, PDF, 464 KB)
This paper discusses the situation of pregnant adolescents: who they are, health concerns, social and economic influences, health services, and the way forward.
Organization: WHO
Contact: bookorders@who.int
14. Youth Development Notes (2006)
These research briefs cover a variety of topics on youth.
Organization: World Bank
Contact: childrenandyouth@worldbank.org
15. Reproductive Health of Young Adults in India: The Road to Public Health (2006, PDF, 500 KB)
This report describes the activities and successes of a community-based pilot project in four Indian states that addressed youth attitudes and behavior about reproductive health.
Organization: Pathfinder
Contact: information@pathfind.org
16. Sexuality and Social Change: Making the Connection (2006, PDF, 505 KB)
This report calls for more emphasis on gender and sexuality and on the interactions among sexuality, health, religion and issues of social justice. It includes a discussion on sexuality education and youth.
Organization: Ford Foundation
Contact: office-of-communications@fordfound.org
17. Ungefanyaje: What Would You Do? (2006)
UNICEF created an online game in Swahili and English that empowers young people to make good life choices and prevent HIV. The game takes the player through a series of relationship-based scenarios that emphasize the importance of HIV prevention and testing.
Organization: UNICEF
Contact: http://www.unicef.org/voy/about/about_428.html
18. What Future? Street Children in the Democratic Republic of Congo (2006, PDF, 1.79 MB)
In French: Quel avenir? Les enfants de la rue en Rpublique dmocratique du Congo
This report describes the types of abuse faced by children in the Democratic Republic of Congo and factors that cause children to leave their homes. It provides a discussion of international treaties designed to protect children and includes recommendations.
Organization: Human Rights Watch
Contact: hrwdc@hrw.org
19. World Development Report 2007Development and the Next Generation (2006)
This report discusses the importance of youth in shaping the future, focusing on youth and education, health care, employment, families, and citizenship. The report identifies policy directions for youth development.
Organization: World Bank
Contact: feedback@worldbank.org
20. YouthActionNet (2006)
This initiative of the International Youth Federation works to connect youth worldwide to create change. Utilizing an interactive website, created by and for young people, it includes searchable youth project pages, youth-created web pages, discussion forums, links to opportunities, and resources.
Organization: YouthActionNet
Contact: info@youthactionnet.org
II. RESEARCH SUMMARIES
1. Adolescent HIV prevalence, sexual risk, and willingness to participate in HIV vaccine trials. Jaspan HB, Berwick JR, Myer L, Mathews C, Flisher AJ, Wood R et al. J Adolesc Health 2006;39(5).
To determine human immunodeficiency virus (HIV) prevalence, sexual risk behaviors, and attitudes toward HIV vaccine trials among 11-19 year-olds in a periurban community near Cape Town, South Africa, the study performed HIV antibody testing on oral transudate and assessed sexual risk behaviors and willingness to participate in HIV vaccine trials using self-administered questionnaires. Of the 510 adolescents selected, 356 (73%) participated. The HIV prevalence of the group was 10.6% (95% confidence interval [CI] 7.5-14.4). One-third of adolescents had experienced sexual debut, with a mean age of 14.6 years. Number of lifetime sexual partners was independently associated with HIV infection (odds ratio [OR] = 1.62; 95% CI 1.1-2.3). In a multivariate analysis, increasing age, female gender, and attending school were independently associated with having had sex. The majority of adolescents (79%) were willing to participate in an HIV vaccine trial. Increasing age and length of residence in the community were significantly associated with willingness to participate. The prevalence of HIV and risk behavior among adolescents in this community is high. HIV vaccine trials in adolescents in this setting will be facilitated by their willingness to participate.
2. Assessing knowledge, exploring needs: a reproductive health survey of adolescents and young adults in Pakistan. Shaikh BT, Rahim ST. Eur J Contracept Reprod Health Care 2006;11(2).
The sexual and reproductive health (SRH) needs of adolescents have increased over the last few years, but are largely unmet. Lack of involvement of youth in the programs and limitations of the mass media in a conservative milieu are some of the issues. Our objectives were to assess the baseline SRH knowledge and to suggest interventions based on needs with regard to SRH promotion, so that the level of existing services could be upgraded. A cross-sectional survey was conducted in 20 villages of Lahore, in which 400 adolescents and young adults were interviewed using a semi-structured questionnaire. Respondents were equally divided in gender in all villages, using stratified random sampling. Males are relatively more knowledgeable than females about puberty (M = 68%; F = 58%), pregnancy (M = 55%; F = 43%), family planning (M = 62%; F = 50%) and sexually transmitted infections (M = 56%; F = 44%). Yet, a large majority needs clarification on concepts and perceptions. Peers, media and a family doctor could be the acceptable source of information on SRH. Life skills programs to increase unmarried girls' cognitive skills and young men's involvement in such programs are a must. Involving families and communities will enhance the effectiveness of youth programs.
3. Can the Internet be used effectively to provide sex education to young people in China? Lou C, Zhao Q, Gao E-S, Shah IH. J Adolesc Health 2006;39(5).
To assess the feasibility and effectiveness of sex education conducted through the Internet, two high schools and four colleges of a university in Shanghai were selected as research sites. Half of these were assigned to the intervention group and the other half to the control group. The interventions consisted of offering sexual and reproductive health knowledge, service information, counseling and discussion to all grade one students in the intervention group. The intervention phase lasted for 10 months and was implemented through a special web site, with web pages, online videos, Bulletin Board System (BBS) and expert mailbox. In total, 624 students from the intervention and 713 from the control schools/colleges participated in the baseline survey, and about 97% of them were followed up in a post-intervention survey to assess changes that can be attributed to the sex education interventions provided through the Internet. The median scores of overall knowledge and knowledge of specific aspects of reproductive health such as reproduction, contraception, condoms, sexually transmitted infections (STIs) and HIV/AIDS were significantly higher in the intervention group as compared with those in the control group at post-intervention (p < .0001), although no significant differences were found between these two groups in the baseline survey (p > .05). Group by time interaction effects in ordinal logistic regression analysis were found on knowledge score (p < .0001) and in attitude of high school students toward sex-related issues (p < .05), suggesting that interventions increased subjects' knowledge significantly and changed high school students' attitudes to being less liberal toward sex. The intervention also had a positive influence on students' attitudes toward providing contraceptive services for unmarried people. Providing sex education to students in Shanghai through the Internet was found feasible and effective. The Internet-based sex education program increased students' reproductive health knowledge effectively and changed their attitudes toward sex-related issues in terms of being less liberal toward sex and more favorable to providing services to unmarried young people. The Internet thus offers an important and hitherto untapped potential for providing sex education to students and young people in China.
4. Factors associated with self-efficacy for condom use and sexual negotiation among South African youth. Sayles JN, Pettifor A, Wong MD, MacPhail C, Lee S-J , Hendriksen E et al. J Acquir Immune Defic Syndr 2006;43(2).
To identify factors associated with high self-efficacy for sexual negotiation and condom use, the Reproductive Health and HIV Research Unit (RHRU) examined a nationally representative sample of 7,409 sexually active South African youth aged 15 to 24 years. Using logistic regression modeling, the study found among female respondents (n = 3,890) factors associated with high self-efficacy were: knowing how to avoid HIV (odds ratio [OR] = 2.30, 95% confidence interval [CI]: 1.05 to 5.00), having spoken with someone other than a parent or guardian about HIV/AIDS (OR = 1.46, 95% CI: 1.01 to 2.10), and having life goals (OR = 1.28, 95% CI: 1.10 to 1.48). Not using condoms during their first sexual encounter (OR = 0.61, 95% CI: 0.50 to 0.76), a history of unwanted sex (OR = 0.66, 95% CI: 0.51 to 0.86), and believing that condom use implies distrust in one's partner (OR = 0.57, 95% CI: 0.51 to 0.86) were factors associated with low self-efficacy among female respondents. Male respondents (n = 3,519) with high self-efficacy were more likely to take HIV seriously (OR = 4.03, 95% CI: 1.55 to 10.52), to believe they are not at risk for HIV (OR = 1.38, 95% CI: 1.12 to 1.70), to report that getting condoms is easy (OR = 1.85, 95% CI: 1.23 to 2.77), and to have life goals (OR = 1.30, 95% CI: 1.10 to 1.54). Not using condoms during their first sexual experience (OR = 0.51, 95% CI: 0.39 to 0.67), a history of having unwanted sex (OR = 0.47, 95% CI: 0.34 to 0.64), believing condom use is a sign of not trusting one's partner (OR = 0.63, 95% CI: 0.46 to 0.87), and refusing to be friends with HIV-infected persons (OR = 0.52, 95% CI: 0.32 to 0.85) were factors associated with low self-efficacy among male respondents. The social cognitive model (SCM) was used to identify factors associated with self-efficacy for condom use and sexual negotiation. Many of these factors are modifiable and suggest potential ways to improve self-efficacy and reduce HIV sexual risk behavior in South African youth.
5. Factors that shape young people's sexual behaviour: a systematic review. Marston C, King E. Lancet 2006;368(9547).
Qualitative research is starting to reveal how social and cultural forces shape young people's sexual behavior and can help explain why information campaigns and condom distribution programs alone are often not enough to change it. A systematic review was undertaken to identify key themes emerging from such research, to help inform policymakers developing sexual health programs, and guide future research. A review of 268 qualitative studies of young people's sexual behavior published between 1990 and 2004 was conducted and a comparative thematic analysis performed, coding each document according to themes it contained. Relations were then identified between codes, grouping them accordingly into broader overall themes. Documents were classified as either primary or secondary depending on their quality and whether they contained empirical data. From the 5452 reports identified, 246 journal articles and 22 books were selected for analysis. Seven key themes emerged: young people assess potential sexual partners as "clean" or "unclean"; sexual partners have an important influence on behavior in general; condoms are stigmatizing and associated with lack of trust; gender stereotypes are crucial in determining social expectations and, in turn, behavior; there are penalties and rewards for sex from society; reputations and social displays of sexual activity or inactivity are important; and social expectations hamper communication about sex. The themes do not seem to be exclusive to any particular country or cultural background, and all themes were present, in varying degrees, in all countries assessed. This study summarizes key qualitative findings that help in understanding young people's sexual behavior and why they might have unsafe sex; policymakers must take these into account when designing HIV programs. Considerable overlap exists between current studies, indicating the need to broaden the scope of future work.
6. From the girl child to girls' rights. Croll EJ. Third World Q 2006;27(7).
The term "the girl child" has become an increasingly common phrase on international and national development discussions. This paper, based largely on field and documentary research across East, South, and Southeast Asia, suggests that this term has not translated into effective, sustained, or transformative national programs or local projects in support of girls. It also argues that the cause of girls might be served better by an emphasis on girls' rights embedded in frameworks that include gender entitlements and expectations of children and take campaigns directly into the familial environment.
7. From trial intervention to scale-up: costs of an adolescent sexual health program in Mwanza, Tanzania. Terris-Prestholt F, Kumaranayake L, Obasi AI, Cleophas-Mazige B, Makokha M, Todd J et al. Sex Transm Dis 2006;33(10 Suppl).
This study sought to estimate annual costs of a multifaceted adolescent sexual health intervention in Mwanza, Tanzania, by input (capital and recurrent), component (in-school, community activities, youth-friendly health services, condom distribution), and phase (development, startup, trial implementation, scale-up). Financial and economic providers' costs and intervention outputs were collected to estimate annual total and unit costs (1999-2001). The incremental financial budget projects funding requirements for scale-up within an integrated model. The 3-year economic costs of trial implementation were US$ 879,032, of which approximately 70% were for the school-based component. Costs of initial development and startup were relatively substantial (approximately 21% of total costs); however, annual costs per school child dropped from US$ 16 in 1999 to US$ 10 in 2001. The incremental scale-up cost is approximately 1/5 of ward trial implementation running costs. Annual costs can reduce by almost 40% as project implementation matures. When scaled up, only an additional US$ 1.54 is needed per pupil per year to continue the intervention.
8. HIV incidence among women of reproductive age in Malawi and Zimbabwe. Kumwenda N, Hoffman I, Chirenje M, Kelly C , Coletti A, Ristow A et al. Sex Transm Dis 2006;33(11).
This study sought to determine the incidence of HIV-1 and to inform HIV prevention and vaccine trials by conducting a multisite study in Malawi and Zimbabwe. Women of reproductive age were enrolled in a prospective study. They received 5 intensive HIV counseling and condom promotion sessions over 2 months. Subsequently, HIV-negative women completed quarterly follow-up visits. HIV incidence rates and predictors of HIV acquisition were assessed. A total of 2,016 HIV-negative women were enrolled in the condom promotion and counseling phase of the study. Of these, 1,679 were tested for HIV during follow up and 113 women seroconverted, resulting in an overall HIV incidence rate of 4.7 per 100 women-years (95% confidence interval = 3.8-5.6). Incidence rates were similar across sites. The major predictors of HIV acquisition were young age, presence of sexually transmitted infections, being unmarried, and higher educational level. The incidence of HIV continues to be high among women in both Malawi and Zimbabwe despite counseling and condom promotion.
9. Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa. Dunkle KL, Jewkes RK, Nduna M, Levin J, Jama N, Khuzwayo N et al. AIDS 2006;20(16).
The study examined associations between perpetrating intimate partner violence and HIV risk behavior among young men in rural South Africa, analyzing baseline data from men enrolled in a randomized controlled trial of the behavioral intervention, Stepping Stones. Structured interviews were conducted with 1,275 sexually experienced men aged 15-26 years from 70 villages in the rural Eastern Cape. The interviews asked about the type, frequency, and timing of violence against female partners, as well as a range of questions about HIV risk behaviors. A total of 31.8% of men reported the perpetration of physical or sexual violence against female main partners. Perpetration was correlated with higher numbers of past year and lifetime sexual partners, more recent intercourse, and a greater likelihood of reporting casual sex partners, problematic substance use, sexual assault of non-partners, and transactional sex. Men who reported both physical and sexual violence against a partner, perpetration both before and within the past 12 months, or more than one episode of perpetration reported significantly higher levels of HIV risk behavior than men who reported less severe or less frequent perpetration of violence. Young men who perpetrate partner violence engage in significantly higher levels of HIV risk behavior than non-perpetrators, and more severe violence is associated with higher levels of risky behavior. HIV prevention interventions must explicitly address the links between the perpetration of intimate partner violence and HIV risk behavior among men, as well as the underlying gender and power dynamics that contribute to both.
10. Reproductive health of Arab young people. DeJong J, El-Khoury G. BMJ 2006;333(7573).
The Arab region, though diverse, is characterized by patriarchal social systems and family structures that give prominence to the role of men in both public and private spheres. Only recently has this situation been challenged by public policies and reforms in family laws. Since the international conference on population and development in Cairo in 1994, governments have pledged to improve the sexual and reproductive health of adolescents by providing integrated health services, including contraception for sexually active adolescents and health education. Most regions of the world still fall well short of these recommendations, especially for unmarried young people, but those in Arab countries are particularly underserved.
11. Sexual risk behavior among South African adolescents: is orphan status a factor? Thurman TR, Brown L, Richter L, Maharaj P, Magnani R. AIDS Behav 2006;10(6).
While some believe that orphans may be at particular risk of HIV infection due to earlier age of sexual onset and higher likelihood of sexual exploitation or abuse, limited empirical evidence has examined this phenomenon. Utilizing data from 1,694 South African youth aged 14-18, of whom 31% are classified as orphaned, the analysis found both male and female orphans significantly more likely to have engaged in sex as compared to non-orphans (49% vs. 39%). After adjusting for socio-demographic variables, orphans were nearly one and a half times more likely than non-orphans to have had sex. Among sexually active youth, orphans reported younger age of sexual intercourse, with 23% of orphans having had sex by age 13 or younger compared to 15% of non-orphans. Programmatic implications of these findings for the care and protection of orphans are discussed.
12. Social scripts and stark realities: Kenyan adolescents' abortion discourse. Mitchell EM, Halpern CT, Kamathi EM, Owino S. Cult Health Sex 2006;8(6).
This study explores students' narratives and discourses about adolescent pregnancy and abortion elicited via Internet-based, open-ended questions posed in response to a cartoon vignette. We report on content analysis of recommendations and strategies for how to manage the unplanned pregnancy of a fictional young couple and in their own personal lives. The responses of 614 young people were analyzed. Strategies vary widely. They include giving birth, adoption, running away, abortion, denial, and postponement until discovery. Young people were also queried about unplanned pregnancy resolution among their peers. Discourse analysis reveals competing social scripts on abortion. Florid condemnation of abortion acts in the hypothetical cases contrasts with more frank and sober description of peers' real life abortion behavior. Students' language is compared with that found in official curricula. The rhetorical devices, moralizing social scripts, and dubious health claims about abortion in students' online narratives mirror the tenor and content of their academic curricula as well as Kenyan media presentation of the issue. The need for factual information, dispassionate dialogue, and improved contraceptive access is considerable.
13. Substance use and sexual risk behavior among South African eighth grade students. Palen L-A, Smith EA, Flisher AJ, Caldwell LL, Mpofu E. J Adolesc Health 2006;39(5).
We examined the covariation of substance use and various sexual behaviors in 2,204 students from one area of South Africa. There was an association between lifetime substance use and both sexual activity and certain sexual risk behaviors. At the most recent sexual encounter, there was an association between substance use and being unfamiliar with one's sexual partner, but no association between substance use and condom use.
14. Towards a definition of orphaned and vulnerable children. Skinner D, Tsheko N, Mtero-Munyati S, Segwabe M, Chibatamoto P, Mfecane S et al. AIDS Behav 2006;10(6).
A focus on orphaned and vulnerable children (OVC) in terms of the HIV pandemic is important, but the terms need accurate definition. Twelve focus group interviews of service providers, community leaders, OVCs, and their caretakers were conducted at six project sites across Botswana, South Africa, and Zimbabwe. The loss of a parent through death or desertion is an important aspect of vulnerability. Additional factors leading to vulnerability included severe chronic illness of a parent or caregiver, poverty, hunger, lack of access to services, inadequate clothing or shelter, overcrowding, deficient caretakers, and factors specific to the child, including disability, direct experience of physical or sexual violence, or severe chronic illness. Important questions raised in this research include the long-term implications for the child and community, and the contribution of culture systems.
15. Young age is a risk factor for HIV among female sex workersan experience from India. Sarkar K, Bal B, Mukherjee R, Saha MK, Chakraborty S, Niyogi SK et al.
J Infect 2006;53(4).
A cross-sectional community-based study was conducted to study the prevalence of HIV and associated risk factors among brothel-based sex workers of West Bengal, in eastern India. Unlinked anonymous HIV testing was performed on 2,076 sex workers. Of these, 558 were interviewed using a pre-tested questionnaire to study their risk factors. Overall HIV seroprevalence was 5.9%. All infections were HIV-1, except for four HIV-2 infections in sex workers from Kolkata. Surprisingly, HIV infection was much higher (12.5%) in younger sex workers (age < or =20 years) compared with older age groups (5.4%) (P=0.002; odds ratio 2.40, 95% CI: 1.29-4.38). The higher rates of infection could be associated with larger areas of cervical ectopy for younger sex workers who are subjected to repeated trauma during sexual intercourse, facilitating higher HIV transmission. Behavioral factors may increase a young sex worker's risk of acquiring HIV infection, including professional immaturity with clients, which might lead to more unprotected sex. HIV status was associated with another sexually transmitted infection in the previous year but not with literacy status, daily income, duration of sex work, number of clients entertained per day, entertaining clients outside a brothel (in a hotel), and reported condom use.
