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I. PROGRAM RESOURCES

1. "As if They Were Watching My Body": Pornography and the Development of Attitudes Towards Sex and Sexual Behaviour among Cambodian Youth
2. Education Sector Responses to HIV and AIDS: Learning from Good Practices in Africa
3. Engaging Boys and Men to Empower Girls: Reflections from Practice and Evidence of Impact
4. From the Ground Up: Education and Livelihoods in Southern Sudan
5. Creating Participatory Radio with Children: A Facilitator's Guide
6. IPPF Framework for Comprehensive Sexuality Education
7. Marriage and Childbirth as Factors in School Exit: An Analysis of DHS Data from Sub-Saharan Africa
8. The Role of Open, Distance and Flexible Learning (ODFL) in HIV/AIDS Prevention and Mitigation for Affected Youth in South Africa and Mozambique
9. Sexual and Reproductive Health of Adolescents and Youths in the Republic of Korea: A Review of Literature & Projects 1990-2003
10. The Shame of War: Sexual Violence against Women and Girls in Conflict
11. Improving the Reproductive Health of Married and Unmarried Youth in India: Evidence of Effectiveness and Costs from Community-based Interventions
12. Women and Girls Living with HIV/AIDS: Overview and Annotated Bibliography
13. Working Together: A Guidebook for Training of Trainers on Mainstreaming Children's Participation

II. RESEARCH SUMMARIES

1. Age at first sex and HIV infection in rural Zimbabwe
2. Autonomy and susceptibility to HIV/AIDS among young women living in a slum in Belo Horizonte, Brazil
3. A comparative analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: Evidence from Demographic and Health Surveys (DHS)
4. Effectiveness of small scale income generating activities in reducing risk of HIV in youth in the Republic of Congo
5. Factors associated with HIV sero-positivity in young, rural South African men
6. Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV
7. Health risk behaviors among HIV-infected youth in Bangkok, Thailand
8. HIV prevalence and predictors among rescued sex-trafficked women and girls in Mumbai, India
9. How can a child be a mother? Discourse on teenage pregnancy in a Brazilian favela
10. Knowledge and attitudes of young people in Guyana to HIV/AIDS
11. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial
12. Prevalence of bacterial vaginosis among young women in low-income populations of coastal Peru
13. Reaching youth through franchise clinics: assessment of Kenyan private sector involvement in youth services

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I. PROGRAM RESOURCES

1. "As if They Were Watching My Body": Pornography and the Development of Attitudes Towards Sex and Sexual Behaviour among Cambodian Youth (2006, PDF, 736 KB)

Pornography can influence gender-based violence, the use of commercial sex workers, the spread of HIV/AIDS, and the rape of children. This report explores how representation of sexual practices in pornographic media affects Cambodian children and their gender identities.
Organization: World Vision Cambodia
Contact: laurence_gray@wvi.org

2. Education Sector Responses to HIV and AIDS: Learning from Good Practices in Africa (2006, PDF, 3.4 MB)

This 98-page report is based on a 2006 regional workshop in South Africa and a background paper prepared for the meeting. It provides a useful overview of issues related to education and HIV/AIDS, including a review of published literature and the experiences shared at the workshop. The London-based Commonwealth Secretariat and the Association for the Development of Education in Africa (ADEA) coordinated the project.
Organization: Commonwealth Secretariat
Contact: j.jha@commonwealth.int

3. Engaging Boys and Men to Empower Girls: Reflections from Practice and Evidence of Impact (2006, PDF, 154 KB)

This 10-page report summarizes lessons learned from emerging experiences in engaging boys and men to address changes in gender norms, so as to empower girls and women in diverse settings. The paper was prepared as part of an expert meeting on eliminating discrimination and violence against girls. Additional expert papers from this meeting are also available.
Organization: United Nations Division for Advancement of Women
Contact: daw@un.org

4. From the Ground Up: Education and Livelihoods in Southern Sudan (2007, PDF, on crin.org – 826 KB or womenscommission.org – 871 KB)
See also: Untapped Potential: Displaced Youth (PDF, 688 KB).

This report is based on findings from a November 2006 assessment in Southern Sudan where the Women's Commission for Refugee Women and Children looked at formal and non-formal education and livelihood projects and opportunities for Southern Sudanese, particularly youth, who are returning after decades of displacement.
Organization: Women's Commission for Refugee Women and Children
Contact: wcrwc@womenscomission.org

5. Creating Participatory Radio with Children: A Facilitator's Guide (2006, PDF, 2 MB)

Designed for young facilitators and producers, the guide encourages active participation of children in creating radio about children's issues. It provides information on how to write radio dramas as well as record and create sound effects. Tips and technical information for producing high quality dramas in various resource settings are included.
Organization: Community Media for Development
Contact: info@cmfd.org

6. IPPF Framework for Comprehensive Sexuality Education (2006, PDF, 741 KB)

This document was developed to support IPPF's strategic objective to increase access to comprehensive, youth-friendly, gender-sensitive sexuality education, and to build upon the recommendations of an extensive international consultation (involving IPPF staff, young people, and external organizations). It provides an in-depth overview of Comprehensive Sexuality Education (CSE), with a planning framework, resources, and sample curricula.
Organization: IPPF
Contact: info@ippf.org

7. Marriage and Childbirth as Factors in School Exit: An Analysis of DHS Data from Sub-Saharan Africa (2006, PDF, 408 KB)

This paper explores the potential importance of marriage and childbirth as determinants of school-leaving in sub-Saharan Africa and identifies some of the common underlying factors that contribute to premature school-leaving and early marriage and childbearing.
Organization: Population Council
Contact: pubinfo@popcouncil.org

8. The Role of Open, Distance and Flexible Learning (ODFL) in HIV/AIDS Prevention and Mitigation for Affected Youth in South Africa and Mozambique (2006, PDF, 685 KB)

This study asserts that governments must radically rethink education delivery to out-of-school youth. A traditional approach to education will not meet the educational challenges of the HIV epidemic in Mozambique and South Africa. The research looks at how open, distance, and flexible learning (ODFL) can reduce the effects of HIV on young people.
Organization: DFID
Contact: enquiry@dfid.gov.uk

9. Sexual and Reproductive Health of Adolescents and Youths in the Republic of Korea: A Review of Literature & Projects 1990-2003 (2007)

This book, available for purchase, is one of eight reviews of sexual and reproductive health of adolescents and youths in Asia. This volume addresses adolescent reproductive health in the Republic of Korea. This report encompasses materials, literature, policies, and other information from government, nongovernmental organizations, and academic researchers. Also recently published are reviews of sexual and reproductive health of youth in Malaysia and Mongolia.
Organization: WHO Western Pacific Region
Contact: bookorders@who.int

10. The Shame of War: Sexual Violence against Women and Girls in Conflict (2007, PDF, 4.51 MB)

This reference book and photo essay of portraits and testimonies documents the sexual violence women and girls suffer when men go to war. It examines the scope and nature of this violence and responses from the international community.
Organization: IRIN News
Contact: shameofwar@irinnews.org

11. 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 85-page report of a 10-year project in India describes six intervention projects with local partner organizations, all focusing in some way on community involvement. The project found that one of the best – and fastest – ways to improve adolescents' health is to involve parents, in-laws and the communities where adolescents live.
A companion briefing kit (PDF, 3.13 MB) of the project includes 17 two-page reports that present findings on various aspects of the separate projects.
Organization: ICRW
Contact: info@icrw.org

12. Women and Girls Living with HIV/AIDS: Overview and Annotated Bibliography (2007, PDF, 173 KB)

This report, with annotated bibliography, provides an overview of the added challenges faced by women and girls who are living with HIV and AIDS.
Organization: Bridge/IDS and International Community of Women Living with HIV/AIDS
Contact: bridge@ids.ac.uk

13. Working Together: A Guidebook for Training of Trainers on Mainstreaming Children's Participation (2006, PDF, 1.77 MB)

This manual is designed as a tool to train those involved with youth/children's projects to be more sensitive to involving children in activities that affect the children's lives. The guidebook contains 15 modules that cover pre-training knowledge assessment, training methods, and evaluation. The modules can be used in whole for a complete training, or separately to complement other materials and methods.
Organization: Child Workers in Asia Foundation
Contact: cwanet@csloxinfo.com

II. RESEARCH SUMMARIES

1. Age at first sex and HIV infection in rural Zimbabwe. Hallett TB, Lewis JJ, Lopman BA, et al. Stud Fam Plann 2007;38(1).
To investigate the distribution and consequences of early first sex, the study analyzed cross-sectional behavioral data linked to HIV status from 4,138 men and 4,948 women interviewed in rural Zimbabwe. We find that age at first sex (at a median age of 19 years for males and 18 years for females) has declined among males over the past 30 years but increased recently among females. Those in unskilled employment, those not associated with a church, and women without a primary education begin to have sex earlier than others. Early sexual debut before marriage precedes a lifetime of greater sexual activity but with more consistent condom use. Women who begin to have sex earlier than others of their age are more likely to be infected with HIV. This finding can be explained by their having a greater lifetime number of sexual partners than those whose first sexual experience occurs later.

2. Autonomy and susceptibility to HIV/AIDS among young women living in a slum in Belo Horizonte, Brazil. Chacham AS, Maia MB, Greco M, et al. AIDS Care 2007;19(Suppl 1).
This study explored the link between autonomy, or control over major domains of economic, social, and sexual life, and susceptibility to HIV infection among poor young women living in an urban slum area of Brazil. A cross-sectional survey was carried out on a random sample of 356 young women between 15 and 24 years old. Indicators of autonomy that relate to sexuality, mobility, and freedom from threat by partners were significantly correlated with practices linked to HIV prevention, and with access to health services promoting prevention, especially among adolescents. Young women who talked to their partner about condom use before first intercourse, and co-decided with them on condom use were more likely to use condoms. In contrast, those who had ever been victim of physical violence by a partner, or whose partners restricted their mobility were less likely to use condoms. Young women were more likely to have accessed health services for gynecological examinations, family planning services and HIV testing if they had ever been pregnant. The findings indicate that structural gender inequalities translate into unequal relationships and reduced autonomy, increasing young women's susceptibility to HIV. A bias in HIV testing and reproductive health services towards pregnant women leaves many susceptible youth without early access. The study suggests the development of a reproductive health policy that ensures that young women access services before they get pregnant, and that also reaches young males.

3. A comparative analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: Evidence from Demographic and Health Surveys (DHS). Magadi MA , Agwanda AO, Obare FO. Soc Sci Med 2007;64(6).
This paper uses Demographic and Health Surveys data from 21 countries in sub-Saharan Africa to examine the use of maternal health services by teenagers. A comparison of maternal health care between teenagers and older women, based on bivariate analysis shows little variation in maternal health care by age. However, after controlling for the effect of background factors such as parity, premarital births, educational attainment, and urban/rural residence in a multivariate analysis, there is evidence that teenagers have poorer maternal health care than older women with similar background characteristics. The results from multilevel logistic models applied to pooled data across countries show that teenagers are generally more likely to receive inadequate antenatal care and have non-professional deliveries. An examination of country-level variations shows significant differences in the levels of maternal health care across countries. However, there is no evidence of significant variations across countries in the observed patterns of maternal health care by maternal age. This suggests that the observed patterns by maternal age are generalizable across the sub-Saharan Africa region.

4. Effectiveness of small scale income generating activities in reducing risk of HIV in youth in the Republic of Congo. Bazika JC. AIDS Care 2007;19(Suppl 1).
This report examines the outcomes from income-generating HIV prevention activities initiated in 2002 for youth in Ewo, Republic of Congo. Four years later, a follow-up inquiry found that the organized schemes had collapsed, and only 24.2% of the youth were involved in income-generating activities. The follow-up visit explored practices associated with risk of HIV in young people. The findings suggest that for the youth in Ewo, income-generating activities bring revenue, autonomy, and new skills that contribute to reduced susceptibility to HIV.

5. Factors associated with HIV sero-positivity in young, rural South African men. Jewkes R, Dunkle K, Nduna M, et al. Int J Epidemiol 2006;35(6).
The study sought to describe factors associated with HIV infection in men aged 15-26 years, in rural Eastern Cape Province, South Africa. It included a sample of 1,277 sexually experienced Xhosa male volunteers, from 70 villages, who participated in a cluster randomized controlled trial of an HIV behavioral intervention. Xhosas circumcise during manhood initiation rituals. The study had a cross-sectional design, with analysis of the study's baseline interviews. The main measure was HIV serostatus and sexual practices measured with an interviewer-administered questionnaire. About 2% of the men were HIV positive. A logistic regression model showed HIV positivity to be associated with age (OR 1.55; 95%CI 1.22-1.95), having made a woman pregnant (OR 2.93; 95% CI 1.28-6.68), having been circumcised (OR 0.40; 95% CI 0.16-0.98), and having had sex with a man (OR 3.61; 95% CI 1.0-13.0). The findings provide further evidence to suggest that circumcision is protective. There was much heterosexual risk taking among men but only pregnancy (with its association with sexual frequency) predicted HIV seropositivity. Although relatively rare, same-sex sexual experiences were a risk factor. Male-male sexual contact is rarely assessed in HIV research in Africa and almost never addressed in general HIV prevention programming. These findings suggest that it should be given more attention.

6. Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV. Jewkes R, Dunkle K, Nduna M, et al. Int J Epidemiol 2006;35(6).
This paper aims to describe factors associated with HIV serostatus in young, rural South African women and the relationship between intimate partner violence (IPV) and HIV. A total of 1,295 sexually active female volunteers, aged 15-26, from 70 villages were recruited to participate in a cluster randomized controlled trial of an HIV behavioral intervention. The main measures were HIV serostatus, and IPV and sexual practices measured using a questionnaire administered during baseline interviews. About 12.4% of women had HIV and 26.6% had experienced more than one episode of physical or sexual IPV. After adjusting for age, HIV infection was associated with having three or more past year partners [odds ratio (OR) 2.39; 95% confidence interval (95% CI) 1.48-3.85], sex in past 3 months (OR 3.33; 95% CI 1.87-5.94), a partner three or more years older (OR 1.69; 95% CI 1.16-2.48), and a more educated partner (OR 1.91; 95% CI 1.30-2.78). IPV was associated with HIV in two-way analyses (OR 1.56; 95% CI 1.08-2.23), but the effect was non-significant after adjusting for HIV risk behaviors. The experience of IPV was strongly associated with past year partner numbers, time of last sex, and partner's education; it was also marginally associated with partner age difference. Adverse experiences in childhood, including sexual abuse, increased the likelihood of having more past year partners (OR 1.43; 95% CI 1.21-1.69). IPV was strongly associated with most of the identified HIV risk factors. Our findings provide further evidence of links between IPV and HIV among women, and of the importance of joint prevention.

7. Health risk behaviors among HIV-infected youth in Bangkok, Thailand. Rongkavilit C, Naar-King S, Chuenyam T,et al. J Adolesc Health 2007;40(4).
The study sought to describe health risk behaviors, including sexual risk, alcohol/substance use, and medication adherence in HIV-infected youth in Bangkok. HIV-infected Thai youth 16-25 years of age were enrolled (29 men and 41 women). Interviews were completed with participants at a baseline visit and a 3-month visit to assess health risk behaviors. Twenty-eight (40%) were on antiretroviral therapy at baseline visit. Mean adherence was 94.3-98.2% over the past month and 90.9-96.3% over the past 3 months, though up to one-third reported less than 95% adherence. The proportion of youth with consistent condom use in the previous 30 days at baseline (55.6%) was comparable to the proportion at the 3-month visit (58.3%) (p = 1.0). Men were more likely to have a partner with unknown HIV status and were less likely to disclose HIV status to their partners. Forty-nine youth (70%) had used alcohol in the past 12 months; nine (12.9%) had used more than 20 times. Approximately 1/4 had used alcohol in the previous 30 days at baseline and at 3-month visit. Substance use besides cigarettes was uncommon. Levels of treatment adherence were high among Thai youth receiving antiretroviral therapy. Alcohol use was prevalent, though other drug use was not. Sexual acts without a condom in both genders and nondisclosure among males were concerning. Interventions focusing on sexual risk reduction for HIV-infected youth are needed and must be scaled up in Thailand.

8. HIV prevalence and predictors among rescued sex-trafficked women and girls in Mumbai, India. Silverman JG, Decker MR, Gupta J, Maheshwari A, et al. J Acquir Immune Defic Syndr 2006;43(5).
Despite the rapid spread of India's HIV epidemic through commercial sex and the large numbers of minor girls trafficked to India for sex work each year, little HIV research has been conducted among victims of sex trafficking. This study examines the prevalence and predictors of HIV infection among sex-trafficked women and girls rescued from brothels in Mumbai, India. Case records and HIV testing results of sex-trafficked women and girls (N = 175) were reviewed. HIV prevalence and HIV risk were assessed based on demographics and exposure to sex work. Approximately one quarter (22.9%) of trafficked individuals tested positive for HIV. The mean age at trafficking was marginally younger for women and girls infected with HIV (15.9 years) as compared to those not infected (17.2 years; P = 0.06). Girls trafficked as minors reported longer periods of brothel confinement as compared to those trafficked at older ages (18.5 vs. 9.6 months; P = 0.007). Among Indian victims, those trafficked from the states of Karnataka or Maharashtra were more likely than those trafficked from West Bengal to be HIV-positive (odds ratio [OR] = 7.35, 95% confidence interval [CI]: 2.23 to 24.21). Longer duration in brothels was associated with greater likelihood of HIV infection; a 3% to 4% increased risk for HIV was observed for each additional month of brothel captivity. Findings demonstrate the need for increased attention to HIV among young victims of sex trafficking in research and practice, and to the rescue of sex trafficking victims as a form of HIV prevention.

9. How can a child be a mother? Discourse on teenage pregnancy in a Brazilian favela. de Carvalho JE. Cult Health Sex 2007;9(2).
Contemporary research reveals the body as a privileged place for social memory and resistance, especially among those people who are politically and economically marginalized. But what might the body signify within the context of teenage pregnancy in conditions of chronic poverty? To explore these issues, semi-structured interviews were conducted with 21 boys and 17 girls living in a favela in Sao Paulo, Brazil. In their responses, young people drew a clear distinction between sex and parenthood. If sex sometimes holds negative connotations, maternity and the physical appearance of pregnancy increase social status. Young people's representations of teenage pregnancy do not portray it as a social or health problem. Instead, they understand it as a consequence of the desire to be visible and active in social life. Findings highlight the importance of investigating the relationship between young people's sexuality and the social imaginary, particularly in conditions of social inequality and suffering.

10. Knowledge and attitudes of young people in Guyana to HIV/AIDS. O'toole BJ, McConkey R, Casson K, et al. Int J STD AIDS 2007;18(3).
HIV prevalence in Guyana is the third highest in the Caribbean which, in turn, is the second most affected region in the world. Over 2,000 young people aged 12-20 years completed self-report questionnaires that examined their knowledge of HIV/AIDS, their attitudes to sexual behaviors, and their intentions with regard to virginity and use of condoms. Nearly one-quarter of young people aged 12-14 were sexually active and this rose to over one-third for youths aged 15 years and over, but condoms were only used consistently by two in five of these persons. Attitudes and intentions towards sexual behavior were significantly influenced by religious teaching as well as by gender and age. Hence, prevention strategies for the spread of HIV/AIDS should harness religious belief and practice, especially in societies such as Guyana where religious affiliation remains strong.

11. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Bailey RC, Moses S, Parker CB, et al. Lancet 2007;369(9562).
Our aim was to determine whether male circumcision had a protective effect against HIV infection and to assess safety and changes in sexual behavior related to this intervention. We did a randomized controlled trial of 2,784 men aged 18-24 years in Kisumu, Kenya. Men were randomly assigned to an intervention group (circumcision; n=1391) or a control group (delayed circumcision, n=1393), and assessed by HIV testing, medical examinations, and behavioral interviews during follow-ups at 1, 3, 6, 12, 18, and 24 months. HIV seroincidence was estimated in an intention-to-treat analysis. The trial was stopped early on December 12, 2006, after a third interim analysis reviewed by the data and safety monitoring board. The median length of follow-up was 24 months. Follow-up for HIV status was incomplete for 240 (8.6%) participants. 22 men in the intervention group and 47 in the control group had tested positive for HIV when the study was stopped. The 2-year HIV incidence was 2.1% (95% CI 1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p=0.0065); the relative risk of HIV infection in circumcised men was 0.47 (0.28-0.78), which corresponds to a reduction in the risk of acquiring an HIV infection of 53% (22-72). Adjusting for non-adherence to treatment and excluding four men found to be seropositive at enrollment, the protective effect of circumcision was 60% (32-77). Adverse events related to the intervention (21 events in 1.5% of those circumcised) resolved quickly. No behavioral risk compensation after circumcision was observed. Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa. Where appropriate, voluntary, safe, and affordable, circumcision services should be integrated with other HIV preventive interventions and provided as expeditiously as possible.

12. Prevalence of bacterial vaginosis among young women in low-income populations of coastal Peru. Jones FR, Miller G, Gadea N, et al. Int J STD AIDS 2007;18(3).
The goal of this study was to determine the prevalence of bacterial vaginosis (BV) in Peruvian women from socioeconomically deprived populations, and to determine the association between BV and risk factors for sexually transmitted diseases (STDs). Women were administered an epidemiologic survey to determine sexual risk behavior, and they provided biological samples to test for BV and STDs. The prevalence of BV was high (27%) and was significantly associated with having a bacterial STD or trichomoniasis. Age, marital status, a history of sex work (but not of sexual experience), frequency of intercourse, and unprotected intercourse were associated with BV. As BV may be a marker for STDs, screening for STDs should be performed in individuals with BV to promote early detection and treatment of co-infecting sexually transmitted pathogens.

13. Reaching youth through franchise clinics: assessment of Kenyan private sector involvement in youth services. Decker M, Montagu D. J Adolesc Health 2007;40(3).
This paper evaluates the ability of social franchise programs, which use private providers to offer reproductive health services, to provide services to youth in western Kenya. Although franchise clinics have rarely targeted youth, they appear to offer a viable alternative for providing reproductive health services to this age group.