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I. PROGRAM RESOURCES
1. Addressing Early Marriage in Areas of High HIV Prevalence: A Program to Delay Marriage and Support Married Girls in Rural Nyanza, Kenya
2. Because I am a Girl: The State of the World's Girls
3. Enhanced Protection for Children Affected by AIDS
4. Mainstreaming and Scaling Up the Kenya Adolescent Reproductive Health Project
5. Mainstreaming Adolescent Reproductive Health in Senegal: Enhancing Utilization of the Findings from the Youth Reproductive Health Project
6. Our Future: Sexuality and Life Skills Education for Young People
7. Overlooked and Uninformed: Young Adolescents' Sexual and Reproductive Health and Rights
8. Providing New Opportunities to Adolescent Girls in Socially Conservative Settings: The Ishraq Program in Rural Upper Egypt
9. Scouting for Solutions: Research on Adolescent Health in Kenya and Uganda
10. Street Children and HIV& AIDS: Methodological Guide for Facilitators
11. Young South Africans, Broadcast Media, and HIV/AIDS Awareness: Results of a National Survey
12. Youth Research Working Papers
13. Youth in the Middle East and North Africa: Demographic Opportunity or Challenge?
II. RESEARCH SUMMARIES
1. Associations between sexual behaviour change among young people and decline in HIV prevalence in Zambia
2. Culture-specific factors contributing to HIV risk among Jamaican adolescents
3. Enrolling adolescents in HIV vaccine trials: Reflections on legal complexities from South Africa
4. Escaping the triple trap: coping strategies of pregnant adolescent survivors of domestic violence in Mulago hospital, Uganda
5. Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential
6. Highly efficient HIV transmission to young women in South Africa
7. Innovative approaches to cohort retention in a community-based HIV/STI prevention trial for socially marginalized Peruvian young adults
8. Knowledge about safe motherhood and HIV/AIDS among school pupils in a rural area in Tanzania
9. Knowledge of HIV/AIDS and sexual practices among adolescents in Benin City, Nigeria
10. Long-term follow-up of 414 HIV-infected Romanian children and adolescents receiving lopinavir/ritonavir-containing highly active antiretroviral therapy
11. Practice brief: adolescents and HIV clinical trials: ethics, culture, and context
12. Predictors of dual method use for pregnancy and HIV prevention among adolescent South African women
13. Sexual stigma, sexual behaviors, and abstinence among Vietnamese adolescents: implications for risk and protective behaviors for HIV, sexually transmitted infections, and unwanted pregnancy
14. Study of peer-led intervention on reproductive health education and AIDS prevention in joint venture factories in Kunshan county
15. Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa
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I. PROGRAM RESOURCES
1. Addressing Early Marriage in Areas of High HIV Prevalence: A Program to Delay Marriage and Support Married Girls in Rural Nyanza, Kenya (2007, PDF, 1.06 MB)
This brief describes a program addressing the problem of early marriage, the reproductive risks associated with early marriage, and the risk of HIV infection transmission within marriage. The program was based on the Population Council's analysis of the 2003 Kenya Demographic and Health Survey (KDHS) as well as on formative research within the rural Nyanza community in Kenya.
Organization: Population Council
Contact: publications@popcouncil.org
2. Because I am a Girl: The State of the World's Girls 2007 (PDF, 4.08 MB)
This 98-page publication summarizes issues of inequality and poverty faced by many girls and includes relevant tables and statistics. This is the first of several reports on the topic to come from this group, and it offers an eight-point action plan listing steps through which individuals, organizations, and governments can contribute to improve girls' lives.
Organization: Plan International
Contact: http://www.plan-beapartofit.org/international/about/contact/contactus/
3. Enhanced Protection for Children Affected by AIDS (2007, PDF, 1.58 MB)
A companion paper to The Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS
This publication discusses the protection issues facing children affected by AIDS, outlining the actions needed to reduce their vulnerability. It calls for enhanced social protection, legal protection and justice, and alternative care, underpinned by efforts to address the silence and stigma that allow discrimination, abuse and exploitation of children to continue.
Organization: UNICEF
Contact: pubdoc@unicef.org
4. Mainstreaming and Scaling Up the Kenya Adolescent Reproductive Health Project (2007, PDF, 229 KB)
This 10-page paper describes how the Kenya Adolescent Reproductive Health project supported a public sector, multi-sectoral intervention to enhance young people's knowledge and behavior regarding reproductive health and HIV prevention. Based on the feasibility, acceptability, effectiveness, and cost of the youth reproductive health activities, and due to the interest of government and communities, including peer educators, religious and civic leaders, and parents, the activities have been mainstreamed and scaled up in other districts and provinces in Kenya.
Related article: Multisectoral Engagement Increases Support for Youth RH
Organization: Population Council
Contact: frontiers@pcdc.org
5. Mainstreaming Adolescent Reproductive Health in Senegal: Enhancing Utilization of the Findings from the Youth Reproductive Health Project (2007, PDF, 239 KB)
This paper outlines the process through which FRONTIERS, the Ministry of Health, the Ministry of Youth, and the Ministry of Education introduced and are expanding youth reproductive health activities in Senegal. The activities are also being replicated by other organizations in Francophone West Africa, including local government and nongovernmental agencies, donors, service delivery organizations, and international agencies.
Related article: Mainstreaming Adolescent Health: Building on Local Support Systems
Organization: Population Council
Contact: frontiers@pcdc.org
6. Our Future: Sexuality and Life Skills Education for Young People (2006-2007)
These three books, intended for children, provide information about puberty, friendship, gender, sexuality, pregnancy, sexually transmitted infections, HIV and AIDS, and drug use. All the books contain learning activities and illustrations. The topics and activities were designed for the Zambian national curriculum or to be used in extracurricular activities in or out of school. The books are accompanied by a Teachers' Guide.
Organization: International HIV/AIDS Alliance
Contact: mail@aidsalliance.org
7. Overlooked and Uninformed: Young Adolescents' Sexual and Reproductive Health and Rights (2007, PDF, 265 KB)
This is the first in a series of briefs on very young adolescents (10-14 years old). This briefhighlights the challenges faced by policy-makers, health professionals, and other adults, as well as young people themselves, in protecting their health and rights.
Organization: IWHC
Contact: communications@iwhc.org
8. Providing New Opportunities to Adolescent Girls in Socially Conservative Settings: The Ishraq Program in Rural Upper Egypt (2007)
The Ishraq program was designed as a holistic intervention to address the unmet needs of out-of-school adolescent girls. These new publications document the creation, implementation, and evaluation of the Ishraq pilot project. The short report highlights the challenges and successes of the pilot phase. The full-length research report also provides data from the baseline and endline surveys conducted during the pilot.
Organization: Population Council, Caritas, CEDPA, Save the Children
Contact: publications@popcouncil.org
9. Scouting for Solutions: Research on Adolescent Health in Kenya and Uganda (2006, PDF, 753 KB)
This report summarizes the results of a formative assessment conducted with Kenyan and Ugandan youth 12 to 15 years of age on their behavior, knowledge, opinions, social experiences, and information sources regarding sexuality and HIV. The report also offers recommendations for refining program activities and developing appropriate messages and educational materials.
Organization: PATH
Contact: kenyainfo@path.org
10. Street Children and HIV & AIDS: Methodological Guide for Facilitators (2006, PDF, 2.12 MB)
This training guide focuses on street children, their risk of contracting HIV/AIDS, and prevention of risk behaviors. Written by field practitioners and experts on guidance and counseling of youth in West Africa, it is structured to be a training tool for facilitators in the field. Its format and organization emphasize portability and functionality and include tools to measure the effectiveness of the facilitators' interventions.
Organization: P.A.U. Education/UNESCO
Contact: Tatiana.mora@paueducation.com or f.migeon@unesco.org
11. Young South Africans, Broadcast Media, and HIV/AIDS Awareness: Results of a National Survey (2007)
To better understand the attitudes of young South Africans toward the media's role in HIV prevention and education, the Kaiser Family Foundation and the South Africa Broadcasting Corporation conducted a survey of nearly 4,000 South Africans ages 15-24. The report examines media access, use, and exposure; the role of media in HIV prevention; and adolescent attitudes, concerns, and behaviors.
Organization: Kaiser Family Foundation
Contact: http://www.kff.org/about/contact.cfm
12. Youth Research Working Papers (2007)
These studies of research conducted by the YouthNet project both found a high level of unmet need for contraception among VCT clients. They both recommend that VCT services implement screening of youth VCT clients for risk of unintended pregnancy, include contraceptive counseling in the VCT sessions, and either provide contraceptives or refer clients to another provider for this service.
Organization: Family Health International
Contact: publications@fhi.org
13. Youth in the Middle East and North Africa: Demographic Opportunity or Challenge? (2007, PDF, 147 KB)
This policy brief gives an overview of demographic trends of youth and these trends' implications on human and economic development.
Organization: Population Reference Bureau
Contact: popref@prb.org
II. RESEARCH SUMMARIES
1. Associations between sexual behaviour change in young people and decline in HIV prevalence in Zambia (PDF, 377 KB). Sandoy IF, Michelo C, Siziya S, et al. BMC Public Health 2007;7(Article No.60).
Evidence suggests that HIV prevalence amongst young Zambians has declined recently, especially in higher-education groups. The authors of this article studied trends in key sexual behavior indicators among 15-24-year-olds from 1995 to 2003, including the associations between sexual-behavior change and education. They found that men and lower-education groups reported more than one sexual partner in the year immediately prior to the survey more frequently than did women and higher-education groups (p<0.01), but these proportions declined over time regardless of sex and residence. Substantial delays in child-bearing were observed, particularly among higher-education and urban respondents. Condom use at least for casual sexual intercourse increased from 1995 to 2003; the level was highest among urban and higher-education groups. The number of women reporting frequent dry sex using traditional agents fell during the period. Participants from the rural area and those with less education reported more sexual experience than urban and higher-education participants in 2003. The reported number of sexual partners during the year immediately prior to the survey was a factor that reduced the association between HIV and survey times among sexually active young urban men and women. The authors conclude that risk behaviors clearly decreased, especially in higher-educated and urban groups, and there is a probable association here with the decline in HIV prevalence in the study population. Fewer sexual partners and condom use were among the core factors involved for both sexes; and for women, a further factor was delayed child-bearing.
2. Culture-specific factors contributing to HIV risk among Jamaican adolescents. Hutchinson MK, Jemmott LS, Wood EB, et al. J Assoc Nurses AIDS Care 2007;18(2).
This article describes the results from an elicitation research study addressing the factors that contribute to HIV risk among Jamaican adolescents. Focus group and survey data were collected from parents, adolescents, and teachers in Kingston, Jamaica, from 2004 and 2005. Guided by an ecological extension of the Theory of Planned Behavior, focus groups and survey questionnaires identified cultural factors at the individual, family, and societal levels that significantly influence Jamaican adolescents' behavioral, normative, and control beliefs related to sexual behaviors that contribute to risk for HIV and other sexually transmitted infections. Although some factors were similar to those reported among adolescents living in the United States, others were culture-specific influences and beliefs that were unique to Jamaica. Results from this study could contribute to the development of theory-based, culture-specific HIV risk-reduction interventions for use with Jamaican adolescents.
3. Enrolling adolescents in HIV vaccine trials: Reflections on legal complexities from South Africa. Slack C, Strode A, Fleischer T, et al. BMC Med Ethics 2007;8(Article No.5).
South Africa is likely to be the first country in the world to host an adolescent HIV vaccine trial. Adolescents may be enrolled in late 2007. In the development and review of adolescent HIV vaccine trial protocols, there are many complexities to consider and much work to be done if these important trials are to become a reality. This article sets out essential requirements for the lawful conduct of adolescent research in South Africa, including compliance with consent requirements, child protection laws, and processes for the ethical and regulatory approval of research. The authors outline likely complexities for researchers and research ethics committees, including determining that trial interventions meet current risk standards for child research. Explicit recommendations are made for role-players in other jurisdictions who may also be planning such trials. The article concludes with concrete steps for implementing these important trials in South Africa and other jurisdictions, including planning for consent processes; delineating privacy rights; compiling information necessary for ethics committees to assess risks to child participants; training trial site staff to recognize when disclosures trigger a mandatory reporting response; networking among relevant ethics committees; and lobbying the National Regulatory Authority for guidance.
4. Escaping the triple trap: coping strategies of pregnant adolescent survivors of domestic violence in Mulago hospital, Uganda. Kaye DK, Ekstrom AM, Johansson A, et al. Scand J Public Health 2007;35(2).
The objective of this study was to describe strategies that pregnant adolescents employ in coping with domestic violence. This qualitative study involved 16 in-depth interviews with adolescent domestic violence survivors who attended the antenatal clinic in Mulago hospital, Kampala, Uganda, from January to May 2004. Theoretical sampling, necessitated by the emergent theory from sequential data collection and analysis, further provided diversity of experiences from adolescents of different ages, parity, pregnancy duration, and socioeconomic status until saturation was reached. Data were analyzed using grounded theory. Survivors described varied experiences of physical, sexual, and psychological violence. Coping strategies employed were analyzed as: minimizing damage decreasing impact and severity of violence , physical or social withdrawal, seeking help, and retaliation (fighting back). The authors conclude that coping strategies adopted by pregnant adolescent survivors range from problem-focused approaches to emotion-focused approaches. Coping strategies are influenced markedly by adolescence and pregnancy.
5. Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential. Bearinger LH, Sieving RE, Ferguson J, et al. Lancet 2007;369(9568).
Country-level data show that continued investment in effective prevention and treatment strategies is essential to protect adolescents' sexual and reproductive health. Whereas strategies must be tailored to the developmental needs of this age group and their social contexts, effective approaches are multifaceted. All adolescents need access to quality youth-friendly services provided by clinicians trained to work with this population. Sex education programs should offer accurate, comprehensive information while building skills for negotiating sexual behaviors. Girls and boys also need equal access to youth development programs that connect them with supportive adults and with educational and economic opportunities. Although progress has been made since the 1994 International Conference on Population and Development, adolescents continue to be disproportionately burdened by threats to their sexual and reproductive health.
6. Highly efficient HIV transmission to young women in South Africa. Pettifor AE, Hudgens MG, Levandowski BA, et al. AIDS 2007;21(7).
Young women in sub-Saharan Africa are at very high risk of HIV acquisition, and high prevalence levels have been observed among women reporting one lifetime partner and few sexual contacts. Such findings have led to hypotheses that the probability of HIV transmission from men to women must be far higher than previously appreciated. To test this hypothesis, the authors used data from a cross-sectional national household survey of HIV among South African women aged 15-24 years to estimate the per-partnership transmission probability from men to women. Estimates were obtained using maximum likelihood methods and a transmission probability model allowing for random error in the self-reported number of lifetime partners. Sensitivity analyses were employed to assess the robustness of the per-partnership transmission probability estimates to the assumed HIV prevalence in male partners. Results indicated that HIV prevalence in women was 21.2. The mean reported number of lifetime partners was 2.3. A significant increase in prevalence was observed with increasing lifetime partner numbers. The authors conclude that the per-partnership probability of HIV transmission from men to women in this population is very high. Before this, the majority of studies examining per-partnership transmission probabilities estimated values below 50%. Identifying the factors that may drive the efficient spread of HIV in sub-Saharan Africa is essential for the development of effective prevention interventions.
7. Innovative approaches to cohort retention in a community-based HIV/STI prevention trial for socially marginalized Peruvian young adults. Villacorta V, Kegeles S, Galea J, et al. Clin Trials 2007;4(1).
In a large trial in Peru, the authors implemented various retention strategies to maintain high participation rates over time, which are important in ensuring validity, adequate statistical power, and generalizability of results. These novel participant retention strategies were used to follow highly marginalized populations for two years, because traditional locator information, such as telephone numbers and official identification (e.g. passport, driver's license, the local equivalent of a social security number) were often unreliable or unavailable. The strategies included detailed preliminary ethnographic research to identify the behaviors of key target groups, approaches to develop strong informal bonds between project staff and participants outside of study settings, and methods to enhance positive participant attitudes towards the study. The overall study retention rate after two years was 84%, even though only 26% of the study populations supplied complete locator information (telephone, address and the names of two friends). The authors conclude that the two-year retention rate in this study was sufficient to maintain required sample sizes. The methods used to maintain contact with the populations were labor intensive, low tech, and adequate for these populations, and could be used to retain study participants in other marginalized, urban, low-income areas.
8. Knowledge about safe motherhood and HIV/AIDS among school pupils in a rural area in Tanzania (PDF, 258 KB). Mushi DL, Mpembeni RM, Jahn A. BMC Pregnancy Childbirth 2007;7(Article No.5).
This study used qualitative and quantitative descriptive methods to assess school pupils knowledge of safe motherhood and HIV/AIDS in pregnancy. An anonymous questionnaire was used to assess the knowledge of 135 pupils ranging in age from 9 to 17 years. The pupils were randomly selected from 3 primary schools. Underlying beliefs and attitudes were assessed through focus group interviews with 35 school children. Key informant interviews were conducted with six schoolteachers, two community leaders, and two health staffs. Results indicated that knowledge about safe motherhood and other related aspects was generally low. While 67% of pupils could not mention the age at which a girl may be able to conceive, 80% reported it is safe for a girl to be married before she reaches 18 years. Many school pupils believed that complications during pregnancy and childbirth are due to non-observance of traditions and taboos during pregnancy. Birth preparedness, important risk factors, danger signs, postpartum care and vertical transmission of HIV/AIDS and its prevention measures were almost unknown to the pupils. For long-term and sustained impact, school children must be provided with appropriate safe motherhood information as early as possible, through innovative school-based interventions.
9. Knowledge of HIV/AIDS and sexual practices among adolescents in Benin City, Nigeria. Wagbatsoma VA, Okojie OH. Afr J Reprod Health 2006;10(3).
A cross sectional study to determine the knowledge of HIV/AIDS and sexual practices of adolescents was undertaken in Benin City, Nigeria. The sample size for the survey was 920, whereas the total population for selected schools was 1,692, giving a sampling ratio of 1:2. An overwhelming majority of the adolescents were aware of HIV/AIDS but only 16.2% knew the cause of the disease. The response that kissing, living with infected persons, and sharing their utensils could lead to infection was an indication of lack of knowledge. The authors conclude that the study populations knowledge is poor and correlates with its reckless sexual practices.
10. Long-term follow-up of 414 HIV-infected Romanian children and adolescents receiving lopinavir/ritonavir-containing highly active antiretroviral therapy. Kline MW, Rugina S, Ilie M, et al. Pediatrics 2007;119(5).
The purpose of this work was to evaluate the long-term outcomes of treatment of HIV-infected children and adolescents with lopinavir/ritonavir-containing highly active antiretroviral therapy in a resource-limited setting. The authors studied an inception cohort of 414 HIV-infected children receiving lopinavir/ritonavir-containing highly active antiretroviral therapy between November 2001 and August 2006 at the Romanian-American Children's Center in Constanta, Romania. They measured safety and effectiveness by the percentage of children remaining on treatment, rates of mortality, and changes in plasma HIV RNA concentrations and CD4+ lymphocyte counts. The results show that highly active antiretroviral therapy can be administered safely and effectively to children and adolescents in resource-limited settings. Lopinavir/ritonavir-containing highly active antiretroviral therapy is a safe, effective, and durable treatment option for antiretroviral drug-experienced older children and adolescents with advanced HIV infection.
11. Practice brief: adolescents and HIV clinical trials: ethics, culture, and context. MacQueen KM, Karim QA. J Assoc Nurses AIDS Care 2007;18(2).
One quarter of HIV infections globally occur among young people 15 to 24 years of age, and more than half of all new infections are in people younger than 25 years. Some of the most effective options for slowing the epidemic are biomedical, and several promising methods are in development, including microbicides, vaccines, and pre-exposure prophylaxis (PREP, or the daily use of antiretrovirals to prevent the acquisition of HIV). There is widespread reluctance to enroll minors in such biomedical prevention trials because of concerns about vulnerability related to physical maturity, experiential maturity, and diminished autonomy, as well as legal and social challenges that vary across and within nations. However, excluding minors from trials misses an important opportunity to evaluate the effectiveness, acceptability, and safety of innovative interventions under the best conditions for identifying and resolving potential problems. The challenges of including minors in HIV prevention trials are highlighted through the example of one rural South African community that has been particularly devastated by the HIV epidemic.
12. Predictors of dual method use for pregnancy and HIV prevention among adolescent South African women. MacPhail C, Pettifor A, Pascoe S, et al. Contraception 2007;75(5).
Dual contraceptive method use is advocated for adolescent women to prevent pregnancy, sexually transmitted diseases and HIV. In this study, the authors examined data from a nationally representative sample of South African women aged 15-24 years to establish factors associated with dual method use. Only 7% of current contraceptive users reported using dual methods, although this percentage increased to 28.1% when women reporting hormonal contraception and condom use at last sex were included. In multivariate analyses, having talked about condoms with a partner was most strongly associated with dual method use and suggests that communication skills might be the most effective way of increasing dual method use. Difficulty in accessing condoms was associated with lower odds of dual method use. The article concludes with recommendations to increase male involvement and encourage communication between partners for the integration of HIV prevention and other reproductive health care services.
13. Sexual stigma, sexual behaviors, and abstinence among Vietnamese adolescents: implications for risk and protective behaviors for HIV, sexually transmitted infections, and unwanted pregnancy. Kaljee LM, Green M, Riel R, et al. J Assoc Nurses AIDS Care 2007;18(2).
As rates of HIV increase in Vietnam, there is a need for data on social relations and sexual risk and protective behaviors among Vietnamese adolescents in a context of rapid social and economic changes. The authors report results from qualitative interviews with 159 Vietnamese adolescents living in Hanoi, Nha Trang City, and Ninh Hoa District and a survey of 886 adolescents in these same three sites. In the qualitative interviews, youths report a strong adherence to ideals and values regarding abstinence outside of marriage. Youth reported low rates of engagement in vaginal, anal, and/or oral sex with a significant difference in reported behaviors between males (29/469, 6.2%) and females (7/416, 1.7%; p = .000). A total of 15 of 32 sexually active youths reported rarely or never using condoms. Females had significantly higher scores for perceived sexual stigma than males, whereas males scored significantly lower than females on a scale of perceived self-efficacy for abstinence. The stigmatization of sexual relations outside of marriage particularly for young women reinforces abstinence; however, these same values decrease adolescents' ability to obtain accurate information about sexuality and HIV and sexually transmitted infections and engage in safer sex.
14. Study of peer-led intervention on reproductive health education and AIDS prevention in joint venture factories in Kunshan county. Sun X, Zhou J, Yan F, et al. J Reprod Contracept 2007;18(2).
A peer-led 8-month intervention on reproductive health promotion and STI/AIDS prevention was conducted in joint venture factories in Kunshan County through an existing family planning service network. Knowledge of contraception and STI/AIDS improved significantly, and the use of condoms also increased significantly in the experimental group after the intervention. No such changes occurred in the control group. This study demonstrates that peer-led education is an effective approach for expanding reproductive health and AIDS prevention services to unmarried young adults in the joint venture factories.
15. Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa. Jemmott JB 3rd, Heeren GA, Ngwane Z, et al. AIDS Care 2007;19(5).
HIV/AIDS is taking a heavy toll on South African youth. Reducing their risk for HIV requires an understanding of the determinants of their HIV risk behaviors that can be changed through intervention. This study draws upon the theory of planned behavior to identify the modifiable determinants of the intention to use condoms among Xhosa-speaking South African adolescents. The participants were 390 Xhosa-speaking 6th grade students in public schools in the township of Mdantsane, South Africa who completed an anonymous questionnaire. Multiple regression revealed that attitude and perceived behavioral control were significantly related to the intention to use condoms, whereas subjective norm was not, controlling for sexual experience, gender, and language preference. Consistent with this were additional analyses using beliefs as predictors: Hedonistic behavioral beliefs and control beliefs about condom-use negotiation and technical skills predicted intention, whereas normative beliefs did not. The theory of planned behavior may be a useful model of condom use among Xhosa-speaking South African adolescents. An emphasis on beliefs about the adverse effects of condom use on sexual enjoyment, the ability to negotiate condom use, and the ability to use condoms correctly might improve the efficacy of HIV/STI interventions for such adolescents.
