This issue provides summaries of 24 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. This is the second (and last) installment of these summaries. YouthNet's interns contributed to these InfoNet issues by covering the presentations at the meeting.
Click on each presentation's title to read further information available from the Global Health Council.
For more information on YouthNet, go to the end of the text.
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I. Behavior Change Communication – 6 summaries of projects seeking to understand and improve youth reproductive health or HIV prevention behaviors.
II. Community Involvement – 4 summaries of projects on working with parents, intergenerational groups, and other community supports.
III. Voluntary Counseling and Testing – 3 summaries of studies on increasing youth access, volunteer counselors training, and social supports used.
IV. Peer Education – 3 summaries of peer educators at university, migrant, and school settings.
V. Orphans and Vulnerable Children – 3 summaries of projects working with street children, adolescent sex workers, and those who have survived a civil war.
VI. Youth Involvement and Policy – summaries of 4 projects promoting youth involvement and one project on policy implementation.
1. A Volunteer-Based Campaign Promoting Healthier Sexual Behaviors among Rural Youth. Tarba N, Koo B, Aghirus M, et al.
In the summer of 2003, the Society for Education on Contraception and Sexuality (SECS)
in Romania initiated a youth-led, volunteer-based campaign to promote healthier sexual behaviors among rural youth. Youth aged 14 to 25 in six districts of Romania served as the target population. Behavior change communication (BCC) information campaigns sought to increase youth awareness of risky sexual behavior and access to, and use of, family planning services. The BCC campaign slogan, "Everything You Do Is All Right, If I Am Always with You," aimed to promote preventive sexual behaviors. Health providers were trained to develop a client-centered approach. Adolescent volunteers distributed posters, diaries, leaflets, T-shirts, and other materials. The volunteers also encouraged youth to use reproductive health (RH) services within their primary health care settings. The campaign highlighted the importance of including young people in the design and implementation of projects affecting their sexual and reproductive health.
2. Listening to Girls to Respond to Cross-Generational Sex. Weissman A, Bunde E, Kumwenda M, et al.
Save the Children conducted focus groups with young women, young men, and older men in Malawi and Ethiopia to assess how and why girls and men engage in cross-generational relationships and to identify programmatic methods of response. Concentrating their efforts on young women and using suggestions from the focus groups, Save the Children tested three methods of intervention: a self-congratulatory worksheet for girls, partnering girls with a community "auntie," and training in business skills as an alternative means of income generation. Of the three, the worksheet and the business skills training appeared to be the best received by the young women.
3. Pilot Intervention to Address Cross-Generational Sex in Kenya. Berman J.
Focus groups were conducted with both young women and older men to examine the motivations behind cross-generational sex. These focus groups found that young women generally engage in such relationships because of a desire for material goods, while the older men are pursuing sexual gratification and social recognition. Focus groups also found that cross-generational relationships are an accepted social practice. Based on this research, a mass media campaign was organized to help reverse norms supporting such practices. Funding constraints limited evaluation efforts.
4. Selling Sex for Three Sweet Potatoes: Using Rights-Based Approaches and Participation for Youth Reproductive Health Action. Kamowa V, Shah M, Mololgo A, et al.
As a part of the Hope for African Children Initiative (HACI), participatory learning and action (PLA) exercises were conducted by CARE with youth and adults in rural Malawi focusing on issues related to high rates of HIV/AIDS in their communities. These exercises identified possible interventions, including increased access to information, a more welcoming health services delivery system, and more supportive cultural and religious beliefs and practices. To address these issues, HACI began efforts in two communities where 5,000 adolescents reside. Their activities included the establishment of community youth clubs; the engagement of youth, teachers, and parents in dialogue; and the training of health providers to offer youth-friendly services.
5. Social Constructs of Premarital Sex Behavior Among Adolescent Girls in India. Goyal R, Khanna A, Chakraborty S.
Qualitative and quantitative data were collected from 614 unmarried girls in eight urban localities and an equal number of villages in Rajasthan, India. Girls' prior knowledge of menstruation was poor, and misconceptions regarding virginity and conception were common. Girls who did not attend school were more likely to have had sex than school-going girls. Pre-marital sex was as prevalent in the villages as in the urban areas. Girls who were having pre-marital sex were found to have a better knowledge of reproductive health, although this did not lead to safe sexual behaviors.
6. Social Isolation, Economic Vulnerability, Gender: HIV Risk Factors. Hallman K, Diers J.
Interviews were conducted in 1999 with 3,052 young people ages 14-22 residing in KwaZulu-Natal, South Africa to assess HIV and pregnancy risk behaviors; these individuals were followed up in 2001. Social isolation and relative poverty were associated with higher levels of risk behaviors for both boys and girls, including early sexual debut. For girls, social isolation is correlated with a greater risk of coercive or economically motivated sexual encounters.
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7. Assessment of Parents' Knowledge and Skills Training. Hui W, Yuemin Z, Jikuan Z, et al.
In China parents are traditionally not involved in sexual and reproductive health education of adolescents. This study examined the impact on parents and youth of training parents in a school sexual education program. Qualitative and quantitative methods were used and pre- and post-surveys were conducted among students (n=500) and parents (n=500) in intervention and control schools. The study found that training parents resulted in a highly significant effect on the knowledge, attitudes, and skills of both students and parents. The investigators concluded that it is feasible to train parents in reproductive health and that short-term participation training can improve parent's knowledge and attitudes, and communication between parents and children.
8. Intergenerational Communication: Key to Young Women's Reproductive Health. Barua A, Agrawal V, Walia S, et al.
This intervention research focused on young married women in India who frequently have little access to reproductive health information or services. The project worked with community based organizations to bring together younger and older women and provide them with RH information. The inclusion of older women from the community along with the use of a culturally appropriate venue (community groups) was found to be an important method of improving the RH knowledge and access to services for an underserved population. Results have found that more groups and young women are participating. Older women are increasingly supportive of the young girls and their needs.
9. Qualitative and Quantitative Data for Redesigning Community-Based Interventions in Pre-Adolescent Programs. Pena R, Martinez J, Navarro K, et al.
In August 2002, PATH launched the Entre Amigas project in Managua, Nicaragua. The data collected using both qualitative and quantitative approaches helped establish the baseline and validate the intervention strategies. The research included interviews with girls, parents, teachers, health personnel, and other key informants as well as a community-based survey of 612 girls ages 10-14. The results showed that girls are responsible for the most of the house work; lack confidence in their relationships; are exposed to violence and afraid of physical and sexual abuse; and do not discuss sexual and reproductive health, HIV/AIDS, or pregnancy-related issues. Television is their main communication media.
10. Using "Appreciative Community Mobilization" to Engage Communities Around Adolescent Sexual and Reproductive Health Issues. Macabangun-Fajardo C.
Save the Children's adolescent sexual and reproductive health program in the Philippines aims to improve the largely unmet reproductive health needs of youth aged 13-18. The program uses "appreciative community mobilization" - a process that focuses on communities' strengths, assets, and resources through group sessions with parents, adolescents, and other community members. The 4-D cycle (discover, deliver, design, and dream) served as a good strategy to reach the community. Subsequently, local governments allocated funding for adolescent reproductive health, requested technical assistance, and worked to create youth-friendly services at health centers.
11. Challenges in Voluntary Counseling and Testing for Youth: The Case of Karago Refugee Camp, Kibondo, Tanzania. Likwelile O.
In the refugee camps in Kibondo, Tanzania, most adolescents were afraid to go for VCT at hospitals and clinics because of communal stigma to HIV/AIDS. The International Rescue Committee designed a program to increase youth access to VCT through cultural activities, peer educators, improved linkages, and involvement of youth and the larger community. Since the program began, adolescents accessing VCT services have increased. It was determined that a deliberate effort to involve girls, parents, and religious leaders in the process can ensure community participation and project sustainability.
12. Social Support for HIV Testing among Zambian Youth. Denison J, McCauley A, Dunnett-Dagg W, et al.
Forty youth who had undergone voluntary counseling and testing (VCT) and nine family members participated in in-depth interviews to examine types of social support and their role in seeking VCT, disclosing their status, accessing care, and the impact of HIV disclosure on families. The research found that young people often involve family and peers in their testing experience and typically disclose test results to the same people they originally informed of their decision to get tested. Sexual partners were involved to a lesser degree. These findings suggest that future interventions for youth VCT should also involve family and friends of youth since they play a critical role in the decision making process. Programs should link care and support for HIV and incorporate enhanced methods of test result disclosure.
13. Volunteer Youth Counselors for HIV Voluntary Counseling and Testing. Ricca J Duron J, Vinelli E.
The Red Cross operates two VCT centers in Honduras; these centers receive young clients ages 15-24 who are at high risk for HIV infection. In an attempt to decrease cost and increase client satisfaction, volunteer youth counselors were employed to administer pre and post test counseling as well as a rapid HIV test. The youth counselors were local university students and were given an intensive seven-day training. The students provided youth VCT services for four hours per week for six months as a part of university required social service. It was found that volunteer youth VCT counselors are able to maintain a high level of service quality while also attaining high client satisfaction.
14. Male Adolescents as Partners in Peruvian Sexual and Reproductive Health Programs. Dinev M, Vereau D, Osorio A, et al.
A retrospective analysis of a peer educator program implemented by Pathfinder International and local NGOs in eight regions of Peru was conducted to examine separately male and female experiences as peer educators. Using indirect sources of data (reports, training modules and communication products developed), the analysis concluded that discussions held by the peer educators differed in content depending on the sex of the educator and that teachers preferred to select male peer educators.
15. Mayihlome Graduate Alive Programme: Mobilizing Student Leaders to Arm Themselves. Dhlamini B, Mntambo S, Kgowedi M, et al.
Access to quality reproductive health information and services in South Africa is limited and this, in combination with other factors, has led to a dramatic increase in HIV infection particularly among youth. In an attempt to address this issue, the Mayihlome Graduate Alive Programme was developed. The program offers university and technical school students the skills to be educators and advocates around the issue of HIV/AIDS and to develop campus programs that can educate, inform, and mobilize other students. Ten institutions and 100 youth leaders were trained in communication skills, strategic planning, and advocacy. The students involved in the initiative are empowered to transfer the leadership skills they have acquired through the program into other areas of their lives.
16. Realizing and Responding to the Situation of Burmese Migrant Youth in Thailand. Nopachai S, Tin E, Win N, et al.
Burmese migrants in Thailand, particularly youth, have difficulty accessing health services due to a variety of legal and socio-cultural factors. The Raks Thai Foundation implemented a reproductive health project for migrant workers in Samut Sakhorn. Youth peer educators are trained in community outreach and referrals and have developed and disseminated targeted information, education, and communication materials. The enthusiasm of the youth peer educators has contributed greatly to the success of the project.
17. From Survivors to Health Promoters: Lessons Learned. Tarani E.
Kosovar adolescents and young adults have directly experienced the brutality of civil strife and war. As a result, access to reproductive health services and information for adolescents is limited, particularly for minorities and those in rural areas. Research conducted by the Kosovar Youth Council found that youth were interested in learning more about sexual and reproductive health. Using peer educators, youth received education in reproductive health, prevention of HIV, and safer sexual behavior. The project also aimed to improve youth-friendly services and IEC materials.
18. Reaching Vulnerable Youth: A Regional Experience with Providing Sexual and Reproductive Health Services to Street Kids in Guatemala and Bolivia. Sanghvi R, Kohn D, Rogers D, et al.
This presentation described the experience of two projects addressing the reproductive health needs of young street kids in Guatemala and Bolivia. The projects sought to expand the capacity of member associations and increase access to sexual and reproductive health services for socially disadvantaged youth, particularly street children. Project activities include an information, education, and communication campaign and enhanced service delivery. Both projects provide services, either on-site or clinic-based. The Bolivian project also included advocacy and recommendations for government programs.
19. 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, Uganda, the African Youth Alliance worked with the Uganda Youth Development Link (UYDEL) to devise and implement a variety of programmatic responses. These included establishing and upgrading drop-in centers to offer youth-friendly services, establishing mobile services at places of congregation for young sex workers and street children, strengthening referral networks between UYDEL and other service delivery points, and providing livelihood skills training to youth. As a result, visits to drop-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.
20. Empowering Youth Through a Participatory Reproductive Health Program. Chen J, Zhang J, Geng Q.
The China Family Planning Association and the Program for Appropriate Technology in Health (PATH) have jointly implemented a large-scale youth reproductive health (RH) project that serves 12 major cities and two rural counties in China. Initiated in September 2000, the project seeks to improve the RH status of Chinese youth by creating a supportive environment and increasing their RH knowledge, awareness of positive gender and human rights values, safe sex practices, and access to and utilization of youth-friendly services. In order to hear youth voices and explore effective ways to work with youth, a participatory learning and action (PLA) approach was employed at the beginning of the project in all 14 project sites. This enabled project staff at the national and local levels to acquire more positive attitudes toward youth and to build their capacity to work more effectively with youth. Feedback from youth and adult stakeholders has demonstrated that participatory approaches have greatly contributed to the success of this large-scale youth RH project.
21. Health and Wealth in the Hands of Youth. Mukasa N, Kavuma J, Kizito R, et al.
Relationships between adolescents and adults in Uganda can often be strained, with adults having negative attitudes towards youth. The Health and Wealth project, initiated by Namirembe Diocese, recruited representatives from six youth community-based organizations (in- and out-of-school), seven school heads, and nine grassroots leaders in the community. These individuals led workshops on sensitizing youth and adults about one another's views, youth leadership in capacity-building, and health-seeking practices of young people. Within six months, the campaign had reached youth in 12 primary schools, seven secondary schools, and school clubs. Results show a total of 2,137 out-of-school youth trained in life-saving and livelihood skills. In addition, adults recognized positive changes in the youth.
22. Implementing Youth Reproductive Health Policies So They Matter. Greene M.
In 2003-2004, the United Nations Population Fund supported a nine-country study on identifying key actors and processes in policy development and implementation. Based on data from in-depth qualitative interviews, policy analysis, and literature reviews, the study found the key steps in developing policy that leads top implementation to be: multi-sector consultation, the establishment of a coordination mechanism, the existence of champions for advocacy, and regional cooperation. Obstacles included treatment of implementation as the end goal and a social reluctance that translates into political unwillingness.
23. Intergenerational Approaches: The Next Step to Youth-Adult Partnerships. Marphatia A.
The International Center for Research on Women conducted a review to assess if and how an intergenerational approach can enhance positive youth development, and to provide direction for incorporating this approach in programmatic efforts to prevent and mitigate HIV/AIDS, promote girls' education, and improve child protection. The study found the following key elements to successful intergenerational projects: 1) identify key adults who are important in providing support that adolescents seek; 2) include adolescents and adults in all phases of the project, from needs assessment to evaluation; 3) encourage both generations to serve in leadership, decision-making, and implementation roles; and 4) create a forum for open dialogue, communication, and mutual understanding through participatory approaches.
24. Youth Advocacy for Sexual and Reproductive Rights. Amatekpor Hodasi B, Kowalski-Morton S, Laure P, et al.
Youth Coalition (YC) is a group of young people, ages 15 to 29 years, working to promote sexual and reproductive health (RH) of adolescents throughout the world. The concept of the Youth Coalition was developed during the Youth Forum meeting at The Hague in 1999. Headquartered in Ottawa, Canada, its members are based in various countries and range from students to researchers to activists. The organization seeks to empower youth through their realization of their sexual and RH rights and ensure their participation in developing young people's capacity. Programming activities include awareness raising, training of YC members in the area of policy, and informing other youth and the general public of issues concerning sexual and RH rights. Members of Youth Coalition have actively participated in regional and international forums advocating for adolescent and youth sexual and reproductive rights.
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