This issue departs from Youth InfoNet's regular format to provide summaries of 23 presentations on youth reproductive health and HIV made at the annual meeting of the Global Health Council, "Youth & Health: Generation on the Edge," held June 1-4, 2004 in Washington, DC. YouthNet's interns contributed by covering the presentations at the meeting. The next issue of Youth InfoNet will also focus on summaries from this conference, covering other topic areas.
Click on each presentation's title to read further information available from the Global Health Council.
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I. Youth-Friendly Services – 10 summaries of projects designed to improve services for youth in countries in every region of the world.
II. Private Sector – 4 summaries of projects on livelihoods, private clinics, and workplace interventions.
III. Gender – 4 summaries of studies about gender and interventions on gender.
IV. Media – 5 summaries of local and international media projects.
1. Bridging the Gap Between Health Providers and Youth. Cheetham N, Quintana A, Hidalgo C.
As part of its objective to aid health professionals in the Andean region with developing more youth-friendly services, the YouthAccess project conducted workshops with 120 health professionals in Peru, Bolivia, and Ecuador. As a result, 28 action plans were developed in 54 health centers focusing on training health center personnel, involving youth, promoting services to youth, and improving referral systems. All but one of the health centers advanced one to three levels in terms of youth participation, 439 additional adults from the centers were trained, and various mechanisms of referral improvement were implemented. Some challenges to reform included overcoming internal resistance to increased attention for adolescent health and overcoming the traditional emphasis on treatment versus prevention.
2. Enhancing Pharmacist Practitioner Contribution to Reproductive Health Access. King R, Loghin F, Bojita M.
In Romania, many adults and youth obtain contraceptive products from community pharmacies. The Train Pharm Project trained more than 1,000 pharmacists in 54 skills-certification workshops through 20 master trainers. The skill certification workshops included an overview of reproductive health and family planning, contraceptives, sexually transmitted diseases, menopause, and communication. As a result, between 1999 and 2002 nearly one-third of Romania's pharmacists were trained to provide frontline health care to youth and women.
3. Making Health Services More Attractive to Young Men. Nascimento M, Barker G.
Young men are less likely than young women to seek health services when they need them. They also are less likely to be attuned to their own health needs. In this context, Promundo has developed a project to improve access to and quality of health services for young men in Rio de Janeiro, Brazil. The project has taken a two-pronged approach: improving the health centers and increasing demand for their services with young men. Initial project results confirm that changing staff attitudes to welcome and accept young men is a major challenge. Parents are gatekeepers and must be engaged.
4. Making Public Sector Facilities Youth-Friendly: Tanzania's Case Study. Achimpota N, Keyonzo N, Chalimilla G, et al.
The majority of young people in Tanzania access their health services from the public sector. The Infectious Disease Center (IDC) has been in existence for more than a decade, with adolescents composing thirty percent of its client load. Despite IDC's efforts to provide treatment for sexually transmitted infections to youth, the need for youth-friendly services was essential. In collaboration with Pathfinder International/ African Youth Alliance (AYA), IDC developed and implemented YFS in four of its Dar es Salaam facilities. Baseline studies were conducted to assess key areas and quality improvements were made. Youth-friendly service areas included training of IDC staff in adolescent sexual reproductive health, sensitization of managers and the community, and strengthening of the existing referral system. After initial program implementation, visits increased from a total of 5,681 youth clients served in 2002 to 17,606 in 2003. Success of the program was largely due to participatory involvement and leadership of management to identify and address feasible activities to promote youth-friendly services.
5. Reaching Vulnerable Youth with Sexual and Reproductive Health Services in Uganda. Ssempebwa R, Tumwebaze L, Colton T.
In an effort to increase access to youth-friendly health services for street children and commercial sex workers in Kampala, the Uganda Youth Development Link (UYDEL) developed and implemented programmatic responses including establishing and upgrading drop-in centers to offer youth-friendly services, establishing "barefoot mobile services" at places where young sex workers and street children congregate, providing the same services as the drop-in centers, strengthening referral networks, and providing livelihood skills training to youth. As a result, visits to drop-in centers and outreach providers rose in 2003, 60 young people have discontinued sex work, and 37 youth have been trained in other means of income generation.
6. RxGen: Reaching Youth Through Pharmacies. Beitz J.
Pharmacies are uniquely positioned to offer reproductive health information and services to adolescents. However, they often lack client-centered approaches targeted at youth. PATH's RxGen project sought to increase adolescent access to reproductive health services through pharmacies in Cambodia, Kenya, and Nicaragua. Additionally, RxGen sought to increase awareness of pharmacy services and establish reproductive health services within pharmacy training programs. Pharmacists and pharmacy staff were trained in emergency contraception (EC), adolescent health, and customer service. Youth-oriented materials were developed and distributed to adolescent clients and job aid materials for pharmacy staff. Evaluation results showed effective implementation of youth-friendly services, an increase in EC knowledge, and appropriate counseling by pharmacy counter staff.
7. Striking Alliances with Faith-Based Organizations to Improve Adolescent Sexual and Reproductive Health. Acquah C, Essandoh E.
The Window of Hope project implemented by the Christian Health Association of Ghana (CHAG) works to improve access to youth-friendly services in 10 rural and peri-urban health facilities. Project activities have included staff training and orientation, quality improvements in facilities, and the identification and training of alternative channels for reaching youth. The project also engaged in sensitization and negotiation with board members and church leaders. As a result of the interventions, youth patronage has increased at clinic and outreach sites, as has community awareness and acceptance.
8. Vietnam's Model for Scaling Up Youth-Friendly Services. Thuy H, Nhan V, Wedeen L, et al.
Vietnamese youth account for a small percentage of reproductive health (RH) clients in government clinics because the facilities are not perceived as youth-friendly. The Reproductive Health Projects (RHPs), a collaboration between the Ministry of Health, Pathfinder International, EngenderHealth and Ipas worked to enhance and increase the quality of RH services. In response to poor utilization of RH services by youth, the RHPs have worked to develop and implement pilot youth-friendly services (YFS) in three provinces. These services were integrated into existing systems in provincial hospitals, MCH/FP centers, and district health centers. A number of strategies were employed including establishing ties with local communities through secondary schools, universities, pharmacies, recreation centers, renovation of facilities to promote YFS, and improvements in social marketing to reflect adolescent RH. Preliminary results of pilot activities suggest progress in YFS implementation.
9. Youth and Providers Together Define Youth-Friendly Services. De Bruyn M, Nga D, Thuy P, et al.
In this pilot project, university students aged 18-26 in Nigeria and Vietnam were brought together with healthcare providers to engage each other in defining youth-friendly services. The students participated in educational sessions on sexual and reproductive health, following which they wrote plays on the subject of unwanted pregnancy and performed them for the providers and other community leaders. Afterwards, providers and students discussed how existing health services could be made friendlier for youth. While financial constraints hindered replication on a larger scale, videotapes of the plays were made for distribution.
10. Youth-Friendly Services and Sexual Education in Bosnia and Herzegovina. Blagojeviae Z, Avdiae A.
This project, implemented by the International Rescue Committee and the United Nations Population Fund, aims to introduce youth-friendly services into Bosnia and Herzegovina and to provide information regarding sexuality and medical services to adolescents. Activities include concerts, information stands, debates, workshops, presentations, the creation of health centers, and media appearances. The project has also worked to address sexual and reproductive health issues in the educational curriculum. Overall, it has been found that peer counseling is the most effective choice for educational products, while free products and services are important factors in attracting young people to medical centers.
11. The Effect of Integrating Livelihoods into Reproductive Health Programs in Urban Slums in India. Grant M, Sebastian M, Mensch B, et al.
This quasi-experimental, two-group study examined the impact of introducing livelihood training to existing reproductive health education for adolescent girls in India's urban slums. The intervention sites received vocational training (for example in handicrafts) and reproductive health education while the control sites only received reproductive health education. Baseline and end line studies were conducted with adolescents and their parents. Analyses of results indicate that the livelihoods intervention has resulted in increased reproductive health knowledge as well as increased friendships and mobility of girls. Lessons learned include the importance of marketing training, parental involvement, and the need for a longer intervention.
12. Patterns and Determinants of Commercial Sector Use among Adolescent Condom Users in Jamaica and Urban Cameroon. Zellner S, Berg R.
Survey data of 910 adolescents aged 15-19 in Jamaica and 3,536 young adults aged 15-24 in Cameroon were analyzed for factors that "attract youth to private sector reproductive health products and services" and to determine those factors that limit youth commercial sector participation. Results suggest that financial issues are significant factors in determining whether or not Cameroonian youth and Jamaican boys access condoms in the commercial sector. Other significant factors varied by gender and country.
13. "Sewing a Healthy Future": A Youth Sexual Reproductive Health Initiative in Garment Factories in Phnom Penh, Cambodia. Kenny D, Socheat C.
Migrant adolescent girls dominate the garment industry in Cambodia; research has indicated that this population is also more likely to engage in unsafe sexual activity. To address these issues, an intervention focused on 50,000 workers in twenty-five factories in and around Phnom Penh. The project, headed by CARE Cambodia and five local NGO partners, aims to improve reproductive health through behavior change communication (BCC)/peer networks, health service support and referral, and workplace advocacy. Evaluation results showed the peer referral concept was both popular (94% of workers supported the concept) and effective (59% of workers reported they knew referral peers). Increased management involvement, cultural sensitization, and development of industry networks were found to be keys to successful advocacy. Suggested improvements included clarifying definitions of the role of the referral peers and expansion of the network.
14. Young Clients' Willingness to Pay for Sexual and Reproductive Health Services. Koladycz R.
While many organizations offer discounted sexual and reproductive health services to youth, there are limited data about young people's willingness to pay. IPPF surveyed youth clients in Brazil, Chile, Colombia, and Peru to determine if they would be willing to pay more for services. The survey examined demographics, ability, and willingness to pay, as well as client satisfaction. Results indicate that most youth are willing to pay slightly more particularly if efforts are made to increase client satisfaction. The model created a profile of clients that would be lost if prices were raised so that strategies could be designed to mitigate this possibility.
15. Attitudes Toward Gender and Sexuality among Vietnamese Youth. Ha V, Minh T, Trang Q, et al.
The research study compared gender roles and sexuality attitudes between young married couples and unmarried youth. The study included interviews and focus group discussions and was conducted in 7 communes, with 465 married couples, in which wives were under 35, and 498 unmarried girls and 468 unmarried boys were from 13-26 years of age. Older men and women were found to have more traditional views about both gender roles and sexuality, although older women expressed more equitable attitudes about gender. Unmarried youth have more equitable gender attitudes than married people; adolescent attitudes regarding sexuality are more liberal but most (particularly girls) believe that premarital sex is unacceptable.
16. REDLAC: A Regional Youth Network Promotes Activism and Sexual Rights. Correa C.
The Latin American and Caribbean Youth Network for Sexual and Reproductive Rights (REDLAC), a network of 17 organizations and groups made up of youth working with youth in 15 countries in the region, was founded in 1999. All members are under 29 years old. The mission of REDLAC is to promote empowerment of youth to fully exercise their sexual and reproductive rights from an inclusive, gender sensitive, youth, and rights perspective. REDLAC's agenda is completely set by young people although they coordinate closely with feminist and other youth movement agendas. They actively participate in the local, regional, and international meetings of NGOs, the UN, and other organizations.
17. Sexual and Reproductive Health and Gender: Community-Based Approaches with Pre-Adolescent Girls. Quintanilla M, Navarro K, Weinberg C, et al.
Based on an assessment in early 2003, Centor de Estudios y Promocion Social (CEPS) designed multisectoral interventions in Managua, Nicaragua aimed at girls aged 10 to 14 years old and their support networks. Participatory community involvement was determined to be critical to redefining gender roles for girls.
18. Young Women at a Table: Strategies for Participation. Zumaeta R.
Young people in Peru continue to face gender-specific obstacles in negotiating sexual relationships and advocating for reproductive rights. One avenue for addressing these issues is through improved participation of youth in community activities. Through the work of the Institute of Education and Health, adolescents gain an understanding of the role that gender plays in their participation in community activities as well as skills and strategies to overcome gender-based constraints.
19. Creating a Mass Media Project with Community Involvement. Weinberg C, Pena R, Navarro K, et al.
To build on the information shared through peer and network activities, Puntos de Encuantro, a Nicaraguan NGO, has included a 13-year-old girl character in its widely viewed television soap opera, Sexto Sentido ("Sixth Sense"). The character's role was constructed using baseline findings from Entre Amigas project, and scripts are validated with the girls in the community. The show is used to raise awareness of development and reproductive issues among young girls. The series explores girls' self-efficacy and negotiation skills, beliefs about adolescent body changes and virginity, and relationships.
20. Is There a Global Media Culture? Geary C.
This literature review found that global media and advertising in particular have tended to create common interests in music, clothing styles, products, and in some cases values, especially in urban areas throughout the world. However, cultural differences remain, with more connection to parents, for example, in Asia. Some observers have assumed that this global youth culture will have negative assumptions, such as undermining local values and parental authority. Others have observed the power of global media to instill positive values and trends as well, such as more awareness of women's rights, democracy, and environmental issues.
21. Staying Alive: A Global Prevention Media Campaign. Franklin G, Mahler H.
MTV, with 42 channels worldwide and mostly based outside the US, reached more than 800 million households with its Staying Alive AIDS prevention campaign, the world's largest AIDS media campaign which is a partnership with FHI, USAID, UNAIDS, Kaiser Family Foundation, and others. The campaign sought to increase awareness and prevention, reduce stigma and discrimination, and empower youth to action. The campaign included short public service announcements, longer programming including a documentary and concert report, confidential Web site, research billboards, and marketing materials. MTV forms partnerships with audience, celebrities, and musicians. In 2002, the campaign was adopted in Kenya, where local TV stations could air the material rights free. One local station expanded the campaign through two locally designed forums.
22. Use of Drama/Music to Communicate Adolescent Sexual and Reproductive Health Messages. Kusaga C, Kajane G, Gaborone M, et al.
The African Youth Alliance (AYA) works with partners throughout Africa to improve adolescent reproductive health. TAYOA and Ghetto Artists are organizations in Tanzania and Botswana respectively that work with AYA through performing arts. Staff members from both organizations are trained by AYA in life planning skills (including pregnancy prevention, condom use, negotiation skills, gender equality, etc). These messages are integrated into TAYOA and Ghetto Artist's music and dramatic performances. The festivals are informative, entertaining, and draw large crowds. To date, TAYOA has reached more than 35,000 people and Ghetto Artists reaches an estimated 16,000 people annually.
23. Young People Address Sex and Sexuality: An Innovative Model. Rawat H, Dengele B, Singh U.
The Community Aid and Sponsorship Program (CASP) works in adolescent sex and sexuality in India, a country where such issues are generally still viewed as private. CASP works with youth to research and produce animation films on adolescent sexual and reproductive health. The films are presented in schools and on local TV stations; they have stimulated conversation between parents and children and have led to some schools teaching lessons in sexuality as a part of their curriculum.
