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I. PROGRAM RESOURCES

1. Act, Learn and Teach: Theatre, HIV and AIDS Toolkit for Youth in Africa
2. Building Resilience: A Rights-based Approach to Children and HIV/AIDS in Africa
3. Bangladesh ARH Focused Community Assessment Final Report
4. Causes and Consequences of Early Marriage in the Amhara Region of Ethiopia
5. Change, Choice and Power: Young Women, Livelihoods and HIV Prevention
6. Monitoring and Evaluation of Projects to Combat Commercial Sexual Exploitation of Children (CSEC)
7. HIV/AIDS and Work: Global Estimates, Impact on Children and Youth, and Response
8. HIV Prevention in Basic Education: The Heart of a Community-based AIDS Response in Francophone Africa
9. Looking for More: A Review of Social and Contextual Factors Affecting Young People's Sexual Health
10. Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations: A Distance Learning Module
11. State of the World's Children 2007: Women and Children—The Double Dividend of Gender Equality
12. Young Children, HIV/AIDS and Gender: A Summary Review

II. RESEARCH SUMMARIES

1. Adolescents' sexual self-disclosure on the internet: deindividuation and impression management
2. Challenging and changing gender attitudes among young men in Mumbai, India
3. Condoms become the norm in the sexual culture of college students in Durban, South Africa
4. Effectiveness of an HIV prevention program for secondary school students in Mongolia
5. Environmental influences on risk taking among Hong Kong young dance partygoers
6. Evaluation of a school-based HIV/AIDS educational intervention in Ukraine
7. Factors related to induced abortion among young women in Edo State, Nigeria
8. Fruity, fun and safe: creating a youth condom brand in Indonesia
9. Girls' schooling in Tanzania: the key to HIV/AIDS prevention?
10. Knowledge, attitudes and sources of information regarding HIV/AIDS in Iranian adolescents
11. The Mpondombili Project: preventing HIV/AIDS and unintended pregnancy among rural South African school-going adolescents
12. Preventing HIV with young people: a case study from Zambia
13. Promoting sexual and reproductive health in early adolescence in South Africa and Tanzania: development of a theory—an evidence-based intervention programme
14. Psychosocial support and marginalization of youth-headed households in Rwanda
15. Romance and sex: pre-marital partnership formation among young women and men, Pune district, India
16. School-based sex education in Western Nepal: uncomfortable for both teachers and students
17. Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data
18. "Smart boys" and "sweet girls"—sex education needs in Thai teenagers: a mixed-method study
19. The success of Taiwanese fathers in guiding adolescents
20. Trends in protective behaviour among single vs. married young women in sub-Saharan Africa: the big picture
21. Uncovering and responding to needs for sexual and reproductive health care among poor urban female adolescents in Nicaragua
22. 'We are no longer called club members but caregivers': Involving youth in HIV and AIDS caregiving in rural Zambia
23. Where have all the condoms gone in adolescent programmes in the Democratic Republic of Congo

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I. PROGRAM RESOURCES

1. Act, Learn and Teach: Theatre, HIV and AIDS Toolkit for Youth in Africa (2006, PDF, 5.52 MB)
This new toolkit provides guidance to youth in Africa on how to use interactive theatre in HIV and AIDS education. The manual provides historical and theoretical background along with key points and tips to design and present an interactive play. A CD-ROM and posters are available. Similar toolkits have been developed for other regions in Arabic, French and Spanish.
Organization: UNESCO, Coordinating Committee for International Voluntary Service
Contact: h.drobna@unesco.org

2. Building Resilience: A Rights-based Approach to Children and HIV/AIDS in Africa (2006)
This report emphasizes how principles of universality, indivisibility, responsibility, and participation can provide a firm foundation for framing priorities and responses to children and families affected by HIV and AIDS.
Organization: Save the Children Sweden
Contact: info@rb.se

3. Bangladesh ARH Focused Community Assessment Final Report (2006, PDF, 656 KB)
This report summarizes an evaluation of an educational intervention among youth and parents, using booklets on puberty, relationships, risky behavior, and marriage and family planning and multiple media approaches such as videos, comic books, and others. The evaluation included two surveys with intervention and comparison sites. Mixed findings emerged in terms of impact on some types of knowledge and behaviors.
Organization: Bangladesh Center for Communication Programs, Health Communication Partnership
Contact: mboulay@jhuccp.org

4. Causes and Consequences of Early Marriage in the Amhara Region of Ethiopia (2006)
This document reports on a study that gathered quantitative and qualitative information on the practice of early marriage in Ethiopia and related issues such as socio-economic characteristics and marriage patterns. The report can guide the design, implementation, and monitoring of programs aimed at reducing the incidence of early marriage in Amhara, all of Ethiopia, and perhaps in other countries.
Organization: Pathfinder
Contact: tech-comm@pathfind.org

5. Change, Choice and Power: Young Women, Livelihoods and HIV Prevention (2007, PDF, 402 KB)
This paper explores the relationship between economic independence, empowerment, and reproductive health for girls and young women. With a focus on East and Southern Africa, it uses examples of promising programs to highlight potential responses and lessons learned.
Organization: IPPF, UNFPA, Young Positives
Contact: martinez@unfpa.org

6. Monitoring and Evaluation of Projects to Combat Commercial Sexual Exploitation of Children (CSEC) (2007, PDF, 705 KB)
This brief manual provides an introduction to monitoring and evaluation of child protection projects. The easy-to-read format provides theoretical information and practical advice to programmers who are new to monitoring and evaluation.
Organization: GTZ
Contact: nochildabuse@gtz.de

7. HIV/AIDS and Work: Global Estimates, Impact on Children and Youth, and Response (2006, PDF, 7.27 MB)
This report presents estimates of the global impact of HIV/AIDS on workers and work-age populations, including employment growth, child labor, sexual exploitation of children and youth, and youth needs for decent work. It emphasizes the need for legal and policy instruments to combat child labor and exposure to HIV.
Organization: International Labor Organization
Contact: pubvente@ilo.org

8. HIV Prevention in Basic Education: The Heart of a Community-based AIDS Response in Francophone Africa (2006, PDF, 1 MB)
French version (PDF, 1 MB)
This document profiles three projects in West Africa that utilized a multisectoral approach, linking the education, health, and national AIDS policy sectors to address the needs of youth, particularly girls. It highlights promising practices and instruments that can be used through education adapted to other contexts.
Organization: GTZ
Contact: aidsprg@gtz.de

9. Looking for More: A Review of Social and Contextual Factors Affecting Young People's Sexual Health (2006)
This report examines how policy, institutional, cultural and other factors influence sexual health of youth. It also reviews programs that address these factors and their impact. The report includes fifteen recommendations for the World Health Organization, which commissioned the report.
Organization: Australian Research Centre in Sex, Health and Society
Contact: arcshs@latrobe.edu.au

10. Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations: A Distance Learning Module (2006)
This module serves as an introduction to basic reproductive health services of women and girls in emergency settings. It includes chapter quizzes and a post-test, which can be completed online. A passing score results in certification and qualifies for continuing education credits for U.S. nurses. The module is also available in French.
Organization: The Women's Commission for Refugee Women and Children
Contact: info@womenscommission.org

11. State of the World's Children 2007: Women and Children—The Double Dividend of Gender Equality (2006, PDF, 1.82 MB)
This annual report from UNICEF examines the discrimination and disempowerment women face and outlines what can be done to address these issues. It looks at gender equality in the context of the Millennium Development Goals and shows how investment in women's rights will help children. Also available in Spanish and French.
Organization: UNICEF
Contact: pubdoc@unicef.org

12. Young Children, HIV/AIDS and Gender: A Summary Review (2006, PDF, 1.21 MB)
Attitudes towards gender that are formed in early childhood can play a significant role in creating adult behaviors that lead to the spread of HIV/AIDS. This working paper explores how to use the early years to lay the foundations for HIV/AIDS prevention.
Organization: Bernard Van Leer Foundation
Contact: http://www.bernardvanleer.org/contact

II. RESEARCH SUMMARIES

1. Adolescents' sexual self-disclosure on the internet: deindividuation and impression management. Chiou W-B. Adolescence 2006;41(163).
This study examined the effect of anonymity on adolescents' sexual self-disclosure on the Internet and the impact of topic intimacy on their reply intent for sexual disclosure. Using a survey with 1,347 adolescents, it found that male participants were more likely than females to engage in sexual self-disclosure and to respond to cyber partners' sexual disclosure. Results showed that the greater the anonymity, the greater the intent for sexual self-disclosure. Participants exhibited greater reply intent when cyber partners self-disclosed sexual topics with greater intimacy, and the effect of topic intimacy was more pronounced in male participants. The findings suggest that male adolescents tend to adopt a reciprocal strategy in responding to partners' sexual disclosure on the Internet, whereas females tend to employ a conservative strategy. It was concluded that male and female adolescents revealed differential self-presentation and impression management for their sexual self-disclosing and responding on the Internet.

2. Challenging and changing gender attitudes among young men in Mumbai, India. Verma RK, Pulerwitz J, Mahendra V, et al. Reprod Health Matters 2006;14(28).
This article presents findings from a pilot intervention in 2005-6 to promote gender equity among young men from low-income communities in Mumbai, India. The project involved formative work on gender, sexuality and masculinity, and educational activities with 126 young men, aged 18-29, over a six-month period. The programme of activities was called Yari-dosti, which is Hindi for friendship or bonding among men, and was adapted from a Brazilian intervention. Pre- and post-intervention surveys, including measures of attitudes towards gender norms using the Gender Equitable Men (GEM) Scale and other key outcomes, qualitative interviews with 31 participants, monitoring and observations were used as evaluation tools. Almost all the young men actively participated in the activities and appreciated the intervention. It was often the first time they had had the opportunity to discuss and reflect on these issues. The interviews showed that attitudes towards gender and sexuality, as reported behavior in relationships, had often changed. A survey two months later also showed a significant decrease in support for inequitable gender norms and sexual harassment of girls and women. The results suggest that the pilot was successful in reaching and engaging young men to critically discuss gender dynamics and health risk, and in shifting key gender-related attitudes.

3. Condoms become the norm in the sexual culture of college students in Durban, South Africa. Maharaj P, Cleland J. Reprod Health Matters 2006;14(28).
This study sought to examine factors contributing to the increase in condom use among college students in Durban, KwaZulu-Natal, South Africa, and some of the barriers to consistent condom use. The study included six focus group discussions with male and female students aged 18-24 in three public tertiary education institutions, supplemented by a survey of 3,000 students aged 17-24. Condoms had become "part of sex" and highly acceptable to the great majority, and were easily accessible. They were primarily being used for preventing pregnancy; many students liked not having to go to a health facility for supplies. Less than half of male and only a third of female students thought male partners had greater influence over the decision of whether a condom was used. If a woman requested condoms, men and women agreed the man must comply. Some men were suspicious of women who agreed to have unprotected sex. Almost 75% of sexually active students surveyed reported condom use at last sexual intercourse, but consistent condom use, reported by only a quarter, remains the main challenge. It may be more effective to promote condoms for contraception among sexually active young people than for HIV prevention. Condoms have become the most commonly used contraceptive method among students, and this trend should be reinforced.

4. Effectiveness of an HIV prevention program for secondary school students in Mongolia. Cartagena RG, Veugelers PJ, Kipp W, et al. J Adolesc Health 2006;39(6).
In order to evaluate the effectiveness of a 3-year HIV prevention program for adolescents attending secondary school in Mongolia, comparisons were made of knowledge, attitudes, self-efficacy, and safe sex practices of grade 10 students from schools with a peer education prevention program to grade 10 students from schools without the intervention. The peer education programs started in the year 2000; in 2004, survey data were collected among 720 randomly selected students from eight schools with the peer education prevention program and 647 students from eight schools without this intervention. Students of schools with the program were statistically significantly more knowledgeable, had less traditional attitudes, and had greater awareness of their self-efficacy in regards to HIV and sexual health. These students were also more likely to practice safe sex, though the difference was not statistically significant. However, safe sex practice was found to be statistically significantly higher in a subset of schools that had small teams of peer educators. Adolescents in Mongolia are sexually active and at risk for infection with HIV and other STIs. Peer education programs, particularly those that are managed by small teams, appear effective and should be implemented more broadly.

5. Environmental influences on risk taking among Hong Kong young dance partygoers. Ngai SS-Y, Ngai N, Cheung C. Adolescence 2006;41(164).
This study investigates risk-taking behavior and its associated factors among young Hong Kong partygoers at rave parties or discos. Based on a survey of 300, 14- to 28-year-old dance partygoers recruited by outreaching social workers, the study provides data on risks in terms of the likelihood of drug abuse, coitus, unprotected coitus, fighting, and high-speed driving among the young people. Furthermore, it examines factors related to the dance party, together with a set of background factors on the partygoer's report of the chance of engaging in risky behavior as expected in the coming six months. Factors related to the dance party include the location (Hong Kong and Mainland China), fees, number of partners, dancers, police inspection, drug supply, drug sales, injuries, coitus, fighting, drug abuse, and environmental factors including light and audio effects, ventilation, drug circulation, underage admission, sex partners, fighting, and low-price beer. Implications of present findings for social policy and future research are discussed.

6. Evaluation of a school-based HIV/AIDS educational intervention in Ukraine. Kyrychenko P, Kohler C, Sathiakumar N. J Adolesc Health 2006;39(6).
The study sought to assess changes observed in knowledge, attitudes toward people living with HIV, and self-efficacy and behavioral intentions of senior secondary school students after an HIV/AIDS educational intervention in Vinnitsa, Ukraine. A quasi-experimental, nonequivalent control group design with pretest-posttest components was employed. Two secondary schools (intervention and control) were randomly assigned to the study. A random sample of the 15- to 16-year-old students (100 participants in each school) completed anonymous self-reported pre- and post-intervention questionnaires. In addition, a three-month follow-up questionnaire was administered in both schools to assess the longevity of the intervention outcomes. Outcome scale scores were compared between the two groups on baseline, first, and second posttests separately. After intervention, significantly higher knowledge, attitudes, and self-efficacy scores were observed among students in the intervention school than in the control school (96.2 +/- 6.2 [SD] vs. 82.6 +/- 8.3, respectively, p < .01; 24.4 +/- 4.4 vs. 21.7 +/- 4.8, respectively, p < .01; 21.9 +/- 2.6 vs. 20 +/- 3.8, respectively, p < .01). As a result of the intervention, significantly higher proportions of students in the intervention school than in the control school reported that they do not intend to use alcohol and narcotics and do intend to use condoms (p < .01). This AIDS education program was able to considerably improve students' knowledge, attitudes and self-efficacy, and promoted positive changes in participants' behavior intentions; it should therefore be extended to more schools to multiply its effects. Studies with actual HIV-risk behavior outcomes are urgent for Ukraine.

7. Factors related to induced abortion among young women in Edo State, Nigeria. Murray N, Winfrey W, Chatterji M, et al. Stud Fam Plann 2006;37(4).
Sub-Saharan Africa has the highest death rate from induced abortion in the world, and young women in southern Nigeria are particularly likely to terminate their pregnancies. This study assesses the prevalence of and factors associated with induced abortion among 601 young women aged 15-24 who were surveyed in Edo State, Nigeria, in 2002. It found that 41 percent of all pregnancies reported by the young women surveyed were terminated, and the age-specific abortion rate for 15-19-year-olds in Edo State was estimated at 49 abortions per 1,000 women, which is slightly higher than previous local estimates and nearly double the countrywide estimate for women aged 15-49. Explanatory multivariate models were constructed to predict the likelihood that a young woman has experienced sexual intercourse, has become pregnant, and has undergone an induced abortion, controlling for important demographic and risk-behavior factors. Young women unmarried at the time of the interview were found to be significantly more likely than married women to have had an abortion. Young women who have experienced transactional or forced sex are also significantly more likely to report ever having had an abortion, as are young women who have experienced more than one pregnancy. Suggestions are offered for modifying the content and target populations of behavioral change messages and programs in the area.

8. Fruity, fun and safe: creating a youth condom brand in Indonesia. Purdy CH. Reprod Health Matters 2006;14(28).
DKT Indonesia, a social marketing enterprise, undertook research among young people in Indonesia to develop a strategy to heighten understanding of safer sex and increase the availability and use of condoms among sexually active youth. The centerpiece of this campaign was the launch in 2003 of Fiesta condoms, with a range of flavors, colors, shapes and pricing aimed to appeal to young people. Working with key commercial and NGO partners, distribution has focused on places where young people often congregate and shop. The campaign relies heavily on the media, including TV commercials, radio talk shows, print media and mobile text messaging. DKT has also partnered with MTV, the Staying Alive campaign and other NGO and private sector partners to educate young people on a range of reproductive and sexual health issues. Based on retail audits and focus group discussions, the Fiesta brand has been a success. In three years, it has gained a 10% share of the condom market and helped to increase overall condom sales by 22%. Young people identify Fiesta as "their" brand and have started to use Fiesta condoms in significant numbers.

9. Girls' schooling in Tanzania: the key to HIV/AIDS prevention? Vavrus F. AIDS Care 2006;18(8).
This article explores the relationship between schooling for girls and HIV/AIDS prevention in the United Republic of Tanzania. It is based on a survey administered to upper-level primary school students in rural Tanzania designed to ascertain their numeracy and literacy skills as well as their knowledge of HIV/AIDS. The findings show that female students generally have stronger literacy and numeracy skills but less knowledge about HIV/AIDS than their male counterparts. This suggests that general education may not be the best vaccine against HIV/AIDS for young women; rather, AIDS-specific education and skills training may be required to increase the likelihood of prevention because of gender differences in how young people utilize knowledge acquired in school.

10. Knowledge, attitudes and sources of information regarding HIV/AIDS in Iranian adolescents. Yazdi CA, Aschbacher K, Arvantaj A, et al. AIDS Care 2006;18(8).
The World Health Organization recently reported an alarming trend of increasing HIV infection in Iran, with adolescents being a particularly important target group for primary prevention. An anonymous questionnaire, derived from standard surveys such as the Safer Choices questionnaire and the 2001 Youth Risk Behavior Survey, was distributed to 1,227 Iranian students attending 19 randomly selected high schools in Hashtgerd in 2002. Students reported that television (84%) and school teachers (66%) were the best sources of HIV/AIDS information, while parents (27%) and school books (15%) were least informative. Most students knew that heterosexual intercourse (90%) and shared intravenous needles (94%) can cause HIV infection; however, salient misconceptions were revealed. Only 53% were aware that condoms protect against infection through sexual intercourse. More effective school-based HIV/AIDS education is needed in Iran.

11. The Mpondombili Project: preventing HIV/AIDS and unintended pregnancy among rural South African school-going adolescents. Mantell JE, Harrison A, Hoffman S, et al. Reprod Health Matters 2006;14(28).
The Mpondombili Project is a school-based intervention in rural KwaZulu-Natal that aims to promote delay in the onset of sexual activity and condom use as complementary strategies for both sexually experienced and inexperienced youth. Interactive training was carried out with peer educators, teachers and nurses over a 15-month period, and a manual developed. The intervention was implemented in late 2003 with 670 adolescents in two schools. Issues covered included HIV/STI transmission, risk behaviors, HIV testing, pregnancy and contraception, gender inequality, sexual communication and negotiation, managing abusive situations, fear of AIDS, stigma and discrimination and sexual rights. The diversity of young people's relationships and their vulnerability to sexual risk call for the promotion of both risk avoidance (delay in sexual initiation) and risk reduction (condom use) together, regardless of ideology, especially where HIV is well-established, to protect their health.

12. Preventing HIV with Young People: A Case Study from Zambia. Gordon G, Mwale V. Reprod Health Matters 2006;14(28).
The US President's Emergency Plan for AIDS Relief (PEPFAR) is funding thousands of community-based organizations, international NGOs and government services in high HIV prevalence countries to persuade young people to abstain from sex until marriage (Abstinence, Behavior Change, Youth – ABY). This paper describes how this strategy is being implemented in Zambia and community responses to it. It is derived from published information and observations and discussions in the Eastern Province in 2005-2006. A few NGOs have challenged the strategy, but many took the funds and are paying large numbers of peer educators to promote abstinence only. Messages are rife that condoms have holes or don't work sufficiently well to make them worth using. Condom promotion materials have been replaced. Service providers refuse to give condoms to young people. Young people who had attended sexuality and life skills programs that gave them accurate information are rejecting inaccurate messages and demanding condoms. Without this education, however, inaccurate messages will spread quickly. It is not possible to promote condoms only for high-risk people without stigmatizing both the people and condoms, and it also jeopardizes promoting condom use for contraception. Everything possible must be done to reduce negative messages about condoms. Everyone involved in HIV/AIDS needs to reflect on their own work in relation to this new climate and ensure that all prevention options are widely available, correct information is given, and condoms are available for everyone who needs them.

13. Promoting sexual and reproductive health in early adolescence in South Africa and Tanzania: development of a theory—an evidence-based intervention programme. Aaro LE, Flisher AJ, Kaaya S, et al. Scand J Public Health 2006;34(2).
This article describes the organization, theoretical basis, and methodological approach of a project that aims to develop and evaluate school-based interventions targeting adolescents aged 12-14 years. Researchers from European and African universities developed interventions that were conducted in Cape Town and Polokwane (South Africa) and Dar es Salaam (Tanzania). In each site, the interventions were evaluated through large-scale field experiments with intervention schools and delayed intervention schools, and with baseline and two follow-up data collections. Minimum sample sizes were estimated for each site based on local data and taking into account that the unit of allocation was schools and not individual students (the design effect). During the formative phase as well as within the field experiments, qualitative studies were also conducted. The interventions were consistent with the Intervention Mapping approach, and the theoretical framework was based on a modified version of the Theory of Planned Behavior. The limitations of Western social cognition models were recognized, and the theoretical framework has therefore been expanded in two directions: towards integrating cultural processes and towards taking societal factors and constraints into account. The project will throw light on the application of social cognition models as well as on the usefulness of the Intervention Mapping approach to intervention development in sub-Saharan Africa.

14. Psychosocial support and marginalization of youth-headed households in Rwanda. Thurman TR, Snider L, Boris N, et al. AIDS Care 2006;18(3).
This research aims to characterize the psychosocial aspects of well-being among youth-headed households (YHH) in Gikongoro, Rwanda, through examination of social support and marginalization. Data is presented on perceived availability of support from relatives, an unidentified adult, peers, and other community members and an index of social marginalization. A total of 692 interviews were completed with YHH aged 13-24 who are beneficiaries of a basic needs program. Sixteen percent of youth reported there was no one they felt they could go to with a problem. In times of need, only 24% felt relatives would help them, while 57% felt neighbors would offer assistance. Most youth reported significant caring relationships: 73% reported access to a trusted adult who offers them advice and guidance, and most indicated close peer relationships. However, many youth also perceived a lack of community support, with 86% feeling rejected by the community and 57% feeling the community would rather hurt them than help them. Social support is a low-cost critical resource for the care of vulnerable youth and an understanding of existing social support networks would enhance the design and implementation of psychosocial and community-based care initiatives.

15. Romance and Sex: Pre-Marital Partnership Formation among Young Women and Men, Pune District, India. Alexander M, Garda L, Kanade S, et al. Reprod Health Matters 2006;14(28).
Using qualitative and survey data in a rural and an urban slum setting in Pune district, India, this paper describes patterns of pre-marital romantic partnerships among young people aged 15-24, in spite of norms that discourage opposite-sex interaction before marriage. Twenty-five to forty percent of young men and 14-17% of young women reported opposite-sex friends. Most young people devised strategies to interact with others, largely from the same neighborhood. There were wide gender differences with regard to making or receiving romantic proposals, having a romantic partner and experiencing hand-holding, kissing and sexual relations. For those who engaged in sexual relations, the time from the onset of the partnership to having sexual relations was short. Sex most often took place without protection or communication, and for a disturbing minority of young women, only after persuasion or without consent. Among those who were unmarried, a large percentage had expected to marry their romantic partner, but for a third of young women and half of young men, the relationship had been discontinued. Partnership formation often leads to physical intimacy, but intimacy should be wanted, informed and safe. Findings call for programs that inform youth in non-threatening, non-judgmental and confidential ways, respect their sexual rights and equip them to make safe choices and negotiate wanted outcomes.

16. School-based sex education in Western Nepal: uncomfortable for both teachers and students. Pokharel S, Kulczycki A, Shakya S. Reprod Health Matters 2006;14(28).
The National Adolescent Health and Development Strategy (2000) of Nepal considers adolescents a key target group for information and services. The extent to which sex education is being provided in schools has received little attention, however. At higher secondary level, students are supposed to be taught basic sex education using a chapter in a textbook called Health, Population and Environment. Little is known about how or how well this material is covered. In a study in 2002 among adolescents in eight schools in the Nawalparasi district in the western region of Nepal, eight teachers responsible for teaching this subject were interviewed. Survey data was collected from 451 students and four focus group discussions were held with 26 of them. These indicated that adolescents in these schools were not getting the information they needed. Most of the teachers did not want to deal with sensitive topics and feared censure by their colleagues and society. Some lacked the skills to give such instruction. Many students also felt uncomfortable with the topics. The challenge is to strengthen sex education, make it more appropriate for the students and ensure that teachers are more comfortable and able to give instruction on the topic.

17. Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data. Cleland J, Ali MM. Lancet 2006;368(9549).
Focusing on young single African women, this study aimed to assess trends in a set of behaviors – sexual abstinence, contraceptive use, and condom use – that are known to affect the rates of HIV transmission. A secondary analysis of public-access data sets in 18 African countries (132,800 women) was performed and changes were calculated in a set of behavioral indicators over time. These trends were standardized from nationally representative surveys to adjust for within-country changes in age, education, and type of residential location. Between about 1993 and 2001, the percentage of women reporting no sexual experience changed little. During the same period, the percentage of sexually experienced women who reported no sexual intercourse in the previous 3 months (secondary abstinence) rose significantly in seven of 18 countries and the median for all 18 countries increased from 43.8% to 49.2%. Use of condoms for pregnancy prevention rose significantly in 13 of 18 countries and the median proportion increased from 5.3% to 18.8%. The median rate of annual increase of condom use was 1.41 percentage points (95% CI 1.12-2.25). In the 13 countries with available data, condom use at most recent coitus rose from a median of 19.3% to 28.4%. Over half (58.5%) of condom users were motivated, at least in part, by a wish to avoid pregnancy. Condom promotion campaigns in sub-Saharan Africa have affected the behavior of young single women; the pace of change has matched the rise in contraceptive use by married couples in developing countries over recent decades. Thus, continuing efforts to promote condom use with emphasis on pregnancy prevention are justified.

18. "Smart boys" and "sweet girls"—sex education needs in Thai teenagers: a mixed-method study. Vuttanont U, Greenhalgh T, Griffin M, et al. Lancet 2006;368(9552).
In Thailand, rapid increases in economic prosperity have been accompanied by erosion of traditional cultural and religious values and by negative effects on sexual health of young people. An investigation assessed knowledge, attitudes, norms, and values of teenagers, parents, teachers, and policymakers in relation to sex and sex education in Chiang Mai, Thailand, with a view to informing sex education policy. Six secondary schools were selected for maximum variation in socioeconomic background, religious background, and location. Methods were: narrative interviews with key stakeholders, and analysis of key policy documents; questionnaire survey of 2301 teenagers; 20 focus groups of teenagers; questionnaire survey of 351 parents; and two focus groups of parents. Qualitative and quantitative data were assessed separately with thematic and statistical analysis, respectively, then combined. Five important influences on Thai teenagers' sexual attitudes and behavior emerged: ambiguous social roles leading to confused identity; heightened sexual awareness and curiosity; key gaps in knowledge and life skills; limited parental input; and impulsivity and risk-taking. Male teenagers aspire to be "smart boys," whose status depends on stories of sexual performance and conquests. Female teenagers, traditionally constrained and protected as "sweet girls," are managing a new concept of dating without their parents' support, and with few life skills to enable them to manage their desires or negotiate in potentially coercive situations. School-based sex education is biologically focused and inconsistently delivered. Results of this large exploratory study suggest five approaches that could be developed to improve sex education: targeted training and support for teachers; peer-led sex education by teenagers; story-based scenarios to promote applied learning; local development of educational materials; and use of trained sexual health professionals to address learning needs of pupils, teachers, and parents.

19. The success of Taiwanese fathers in guiding adolescents. Beckert TE, Strom RD, Strom PS, et al. Adolescence 2006;41(163).
The purpose of this study was to examine similarities and differences in Taiwanese fathers' and adolescents' perceptions of paternal competencies. A multi-source – fathers (n = 176) and 10- to 14-year-old adolescent children (n = 176) – and single-method (both generations completed the Parent Success Indicator) investigation was employed. Generational assessments were compared, and effects of independent variables were examined. Impressions from both generations were significantly different by child school grades and the amount of time fathers spent talking to and doing things with their adolescents.

20. Trends in protective behaviour among single vs. married young women in sub-Saharan Africa: the big picture. Cleland J, Ali MM, Shah I. Reprod Health Matters 2006;14(28).
The trends in contraceptive uptake and condom use among single and married young women show distinct patterns in sub-Saharan Africa. A large median increase of 1.4 percentage points per year in condom use by single young women for pregnancy prevention was witnessed in 18 countries, based on Demographic and Health Survey data from 1993 to 2001. In contrast, a modest increase in condom use was noted for married or cohabiting young women. Condom promotion in Africa has been, therefore, a success for single women. Its promotion for pregnancy prevention offers even greater potential, as pregnancy prevention is the main or partial motive of most single women who use condoms. While a myriad of research studies on condom use among young single people have been conducted and published, the needs of the married and cohabiting population have been neglected by researchers and program staff alike, despite the fact that more than half of HIV infections in the severe epidemics of Southern and East Africa are occurring in this group. The barriers to condom adoption by married couples may not be as severe as is often assumed.

21. Uncovering and responding to needs for sexual and reproductive health care among poor urban female adolescents in Nicaragua. Meuwissen LE, Gorter AC, Segura Z, et al. Trop Med Int Health 2006;11(12).
To meet the needs of female adolescents from low-income urban areas for sexual and reproductive health (SRH) care, vouchers providing free-of-charge access to SRH care at 19 primary care clinics were distributed in Managua, Nicaragua. These vouchers substantially increased the use of services, demonstrating that many adolescents are willing to use such services, if readily accessible. The voucher redemption made it possible to identify the nature of existing, but largely unmet, needs for SRH care. The medical files from 3,301 consultations with female adolescents were analyzed using descriptive statistical methods and multiple logistic regression. Female adolescents presented SRH problems that merited medical attention. The mean number of problems presented was 1.5 per consultation: 34% of the vouchers were used for contraceptives, 31% for complaints related to sexually transmitted infection (STI) or reproductive tract infection (RTI), 28% for advice/counseling, 28% for antenatal check-up and 18% for pregnancy testing. A new category of health care users emerged: sexually active girls who were neither pregnant nor mothers and who sought contraceptives or STI/RTI treatment. Contraceptive use doubled among the sexually active non-pregnant voucher redeemers. Consultation with a female doctor younger than 36 years was associated with a higher chance of having contraceptives prescribed. Accessible and appropriate SRH care has the potential to make an important contribution to the increased contraceptive use, decreased risk of unwanted teenage pregnancies and decreased prevalence of STIs/RTIs among underserved adolescents. Once adolescents access the services, providers have a crucial role in ensuring current and continuing needs are met.

22. 'We are no longer called club members but caregivers': Involving youth in HIV and AIDS caregiving in rural Zambia. Esu-Williams E, Schenk KD, Geibel S , et al. AIDS Care 2006;18(8).
This study assessed the strategy of building young people's capacity to provide care and support to people living with HIV and AIDS in rural Zambia. Members of youth anti-AIDS clubs in schools and communities were trained as adjunct caregivers, using a locally developed curriculum that allowed them to explore and challenge gendered notions of caregiving, and that emphasized networking with existing resources. Results show that caregiving increased among males (47% to 82%) and females (41% to 78%). Both sexes provided similar caregiving services, including help with household chores and personal care tasks. Youth also undertook activities with children to decrease their isolation, help them stay in school, and reach additional services. While clients and caregivers reported positive aspects of the programme, both reported frustration with the youths' inability to meet material needs. This study demonstrates that trained youth already involved in anti-AIDS efforts can meet a range of care needs and be valuable assets to their community. It also highlights the importance of communicating clearly what youth can and cannot do, ongoing monitoring and support of youth caregivers, and involving community leaders to give youth credibility and access to local resources.

23. Where have all the condoms gone in adolescent programmes in the Democratic Republic of Congo. Bosmans M, Cikuru MN, Claeys P, et al. Reprod Health Matters 2006;14(28).
Decades of mismanagement, combined with the withdrawal of international cooperation and a protracted war, have seriously affected the health system in the Democratic Republic of Congo (DRC) and the health status of the population. As part of a Belgian development cooperation program, a study was conducted in Kinshasa and Bukavu in April-May 2004 on how a rights-based approach could contribute to an effective and appropriate response to the sexual and reproductive health needs of Congolese adolescents. Access to condom information and supplies was studied in this context. A qualitative methodology was used, consisting of focus group discussions with adolescents and interviews with peer education program officers. These programs were supposed to be based on the recognition of adolescent sexual and reproductive health rights and the so-called ABC approach (abstinence, be faithful, condom use). We found, however, that sociocultural barriers and strict obedience to Vatican doctrine prevented adolescents from receiving accurate and comprehensive sexuality education, and that condom supplies were blocked by peer education program officers. The promotion of adolescent sexual and reproductive health rights is the responsibility of States, but the international community, non-governmental and faith-based organizations and donors play an essential role in assisting States in this respect, and they should never act in violation of adolescents' rights.