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I. PROGRAM RESOURCES
1. Children on the Brink 2004: A Joint Report of New Orphan Estimates and a Framework for Action
2. Conducting a Situation Analysis of Orphans and Vulnerable Children Affected by HIV/AIDS
3. At The Crossroads: Accelerating Youth Access to HIV/AIDS Interventions
4. Facing the Future Together: Report of the Secretary General's Task Force on Women, Girls and HIV/AIDS in Southern Africa
5. Nonconsensual Sex among Young People: Four Briefs
6. What Religious Leaders Can Do About HIV/AIDS: Action for Children and Young People
7. The Global Impact of HIV/AIDS on Youth
8. Risk and Protection: Youth and HIV/AIDS in Sub-Saharan Africa
9. Trafficking in Human Beings, Especially Women and Children, in Africa
10. No Status: Migration, Trafficking and Exploitation of Women in Thailand
11. Growing Up in Pakistan: The Separate Experiences of Males and Females
12. Reaching Out to Bring Young Haitians In: FHI Helps Two Organizations Work with Youth in High-Risk Settings
13. Socioeconomic Disadvantage and Unsafe Sexual Behaviors among Young Women and Men in South Africa
14. Culturally Appropriate Information, Education and Communication Strategies for Improving Adolescent Reproductive Health in Cusco, Peru
15. Making Commitments Matter: A Toolkit for Young People to Evaluate National Policy (French)
II. RESEARCH ARTICLES
1. Asian/Pacific islander adolescent sexual orientation and suicide risk in Guam
2. Asking semi-literate adolescents in rural Tanzania about sexual behaviour
3. Behavior change evaluation of a culturally consistent RH program for young Kenyans
4. Breastfeeding among teenage and adult mothers in Brazil
5. Compensated sex: a practice at the heart of young Mexican women's vulnerabilities
6. Early age of first sex: a risk factor for HIV infection among women in Zimbabwe
7. Emergency contraception: knowledge and practices of students in Durban, South Africa
8. Gender and class differences in young people's sexuality and HIV/AIDS risk-taking behaviors in Thailand
9. Gender differences in condom-related behaviors and attitudes among Mexican adolescents
10. Knowledge, attitudes, and experiences of sex trafficking by young women in Benin City, Nigeria
11. Meeting the contraceptive needs of unmarried young people: attitudes of formal and informal sector providers in Vientiane Municipality, Lao PDR
12. Patterns of sexual behavior among secondary school students in Swaziland
13. "Peer" educator initiatives for adolescent reproductive health projects in Indonesia
14. Perceptions and attitudes regarding sex and condom use among Chinese college students
15. Psychosexual development among HIV-positive adolescents in Abidjan, Cote d'Ivoire
16. Relationships between older men and younger women: implications for STIs/HIV in Kenya
17. Sexual behavior more risky in rural than urban areas among young women in Nyanza Province, Kenya
18. Some factors in condom use amongst first-year Nigerian University students and black and white South Africans
19. Youth, sexuality, and sex education messages in Indonesia
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I. PROGRAM RESOURCES
1. Children on the Brink 2004: A Joint Report of New Orphan Estimates and a Framework for Action (2004)
This biennial report produced jointly by UNAIDS, UNICEF, and USAID provides statistics on orphans under the age of 18 and an overview of the developmental needs of orphans as they progress through childhood. The report provides an overview of a framework for protection, care, and support of orphans including strategies for strengthening the capacity of families, developing community-based responses, ensuring access to essential services, improving policy and legislation, and creating a supportive environment for orphans.
- Organizations: UNAIDS, UNICEF, USAID
- Languages: English, French, Spanish
- Contact: pubdoc@unicef.org
2. Conducting a Situation Analysis of Orphans and Vulnerable Children Affected by HIV/AIDS (2004) (PDF, 824K)
This report describes the rationale and uses of a situation analysis of orphans and vulnerable children, with steps for conducting a situational analysis — planning, gathering and analyzing information, reporting and communicating findings, and other details. It includes a useful list of references and resources.
3. At The Crossroads: Accelerating Youth Access to HIV/AIDS Interventions (2004) (PDF, 297K)
This publication highlights the ways in which young people remain at the center of the HIV/AIDS epidemic. Utilizing a bulleted format and graphics, the pamphlet provides information and statistics about the demographics of youth and HIV, their access to services, prevention programs, and the need to scale-up efforts.
4. Facing the Future Together: Report of the Secretary General's Task Force on Women, Girls and HIV/AIDS in Southern Africa (2004)
This 26-page report produced by United Nations agencies describes the impact of HIV/AIDS on women and girls in nine countries in Southern Africa. It addresses the vulnerability of girls and women to HIV and the burden the pandemic places on them. This report emphasizes that gender inequality and its manifestations (e.g., gender-based violence, lack of education, and the need for economic independence) have fueled the epidemic and must be addressed explicitly. It covers six topical areas with suggestions for action in each: prevention, education, violence, property and inheritance, care-giving, and access to treatment.
5. Nonconsensual Sex Among Young People: Four Briefs (2004)
Forced sexual relations among married young women in developing countries (PDF, 157K)
Sexual coercion: young men's experiences as victims and perpetrators (PDF, 163K)
The adverse health and social outcomes of sexual coercion: experiences of young women in developing countries (PDF, 160K)
Nonconsensual sex among youth: youth reproductive health/HIV programs need to consider patterns of coerced sex (PDF, 156K)
These four four-page research briefs summarize the main themes of a global meeting on youth nonconsensual sex held in New Delhi in September 2003. The meeting was organized by the Population Council in collaboration with the World Health Organization and Family Health International/ YouthNet. Participants included researchers, legal analysts, representatives from community-based NGOs, policymakers, and youth.
6. What Religious Leaders Can Do About HIV/AIDS: Action for Children and Young People (2003)
This workbook is a cooperative effort between UNICEF, the World Conference of Religions for Peace, and UNAIDS. Intended for use by religious leaders from a variety of faiths who work with children and youth, it provides them with information about the HIV epidemic and how they can work to address it.
7. The Global Impact of HIV/AIDS on Youth (2004)
This two-page fact sheet provides a summary of the most recent data about the current status of HIV/AIDS on young people, including the impact by region, effect on young women and girls, factors that make adolescents particularly vulnerable, and key components of prevention, care, and treatment interventions.
8. Risk and Protection: Youth and HIV/AIDS in Sub-Saharan Africa (2004) (PDF, 504K)
This 40-page report provides an overview of adolescent HIV knowledge and behaviors from 24 countries in Sub-Saharan Africa. It examines economic, cultural and social conditions that influence youth's vulnerability to HIV/AIDS; knowledge and beliefs of youth; patterns of sexual behavior (within and outside marriage); protective behaviors and implications of the findings for policymakers, program planners, and health professionals.
9. Trafficking in Human Beings, Especially Women and Children, in Africa (2003)
This 80-page research report, conducted by UNICEF's Innocenti Research Centre, examines issues involving the trafficking of women and children, including mapping patterns, a normative framework, policy issues, and emerging better practices for 53 countries in Africa, based on a desk review, field visits, and an expert workshop. Organization: UNICEF
10. No Status: Migration, Trafficking and Exploitation of Women in Thailand. Health and HIV/AIDS Risks for Burmese and Hill Tribe Women and Girls (2004) (PDF, 853K)
This 60-page report from Physicians for Human Rights describes why Burmese and hill tribe women and girls in Thailand are at increased vulnerability to HIV/AIDS. Based on qualitative data from individuals and key informants, it addresses how policies affect human rights issues and includes recommendations for action.
11. Growing Up in Pakistan: The Separate Experiences of Males and Females (2004) (PDF, 480K)
This working paper examines gender differences of adolescents in Pakistan using data from a nationally representative survey of young people. It found that education plays a key role in the transition to adulthood and examined the distinction between the transition to adult work roles and adult family roles.
12. Reaching Out to Bring Young Haitians In: FHI Helps Two Organizations Work with Youth in High-Risk Settings (2004) (PDF, 1.46MB)
This "snapshot from the field" describes how two youth organizations in Haiti, FOSREF and VDH, are incorporating HIV prevention with other activities.
13. Socioeconomic Disadvantage and Unsafe Sexual Behaviors among Young Women and Men in South Africa (2004) (PDF, 1.1MB)
In South Africa as in many countries, the majority of new HIV infections are among youth. Using data from household surveys, this study found that relative economic disadvantage significantly increases the likelihood of risky sexual behaviors, particularly among young women and orphans. Economic status also affects access to prevention messages in the media.
14. Culturally Appropriate Information, Education and Communication Strategies for Improving Adolescent Reproductive Health in Cusco, Peru (2004) (PDF, 721K)
This paper reports on an operations research study conducted in the Andean highlands of Peru focusing on IEC materials designed specifically for indigenous youth. The interventions included a weekly radio program and school based peer promoters. Approximately 235 adolescents were surveyed in pre- and post-tests using self-administered questionnaires. Results suggest that knowledge of reproductive health, anatomy, pregnancy and contraception, and HIV/STI transmission all increased and that both parents and youth enjoyed and were supportive of the programs.
15. Making Commitments Matter: A Toolkit for Young People to Evaluate National Policy (French) (2004)
This manual — now available in French — is designed for youth organizations to assess progress in reaching the goals of the World Programme of Action for Youth, prioritize activities, and initiate action at the national level. Topics covered include health, HIV, education, employment, drug abuse, youth participation, and more.
II. RESEARCH ARTICLES
Most of these articles are not available on-line without a subscription to the journal. To obtain the full article, you will need to contact the journal directly or through your organization's library.
1. Asian/Pacific islander adolescent sexual orientation and suicide risk in Guam. Pinhey TK, Millman SR. Am J Public Health 2004;94(7):1204-6.
The study examined the effects of same-sex orientation on suicide risks for Guam's Asian/Pacific Islander adolescents, using a probability sample and logistic regression analysis to identify suicide risk factors. Same-sex orientation was associated with a greater risk of suicide attempt, especially for boys. Adolescents who reported suffering physical abuse in the context of a romantic relationship, engaging in binge drinking, and experiencing feelings of hopelessness were at greater risk for suicidal ideation and attempts. Race/ethnicity was associated with suicide risk for both boys and girls, and patterns suggest that membership in the same racial/ethnic group decreased suicide risk for girls and increased risk of suicide for boys. Gay, lesbian, and bisexual Asian/Pacific Islander adolescents in Guam deserve intervention and counseling programs to reduce suicide risk.
2. Asking semi-literate adolescents about sexual behaviour: the validity of assisted self-completion questionnaire (ASCQ) data in rural Tanzania. Plummer ML, Wight D, Ross DA, et al. Trop Med Int Health 2004;9(6):737-54.
To develop and test a sexual behavior survey method for semi-literate populations, combining the privacy of a self-completion questionnaire (SCQ) with the clarity of a face-to-face questionnaire (FFQ), the study administered an assisted self-completion questionnaire (ASCQ) in 1998 and in 2000 to some 6,000 Tanzanian primary school students (mean age 15.1 years), using a research assistant reading questions to groups of 20. By comparing the types of answers, the study concluded that higher proportions of respondents reported sensitive information in the ASCQ than the FFQ, although in some cases this may have related to answer order bias. The results suggest that an ASCQ may be useful in assessing sexual behavior in African adolescents, particularly for older, male and/or educated respondents. However, triangulation with data from other surveys raises questions about the validity of self-reported sexual behavior in general.
3. Behavior change evaluation of a culturally consistent reproductive health program for young Kenyans. Erulkar AS, Ettyang LI, Onoka C, et al. Int Fam Plan Perspect. 2004;30(2):58-67.
Few rigorous evaluations have been conducted of locally designed, culturally consistent adolescent reproductive health programs. A quasi-experimental research design was used to measure behavioral changes associated with a culturally consistent reproductive health program for young people in Kenya. Baseline and endline surveys were conducted in 1997 and 2001, respectively, in the project and control areas. Multivariate analysis was used to assess whether the project was associated with changes in young people's sexual initiation, safer-sex behavior, and discussion of reproductive health issues with adults. Among the many changes in the 36-month project, females in the project site were significantly more likely than those in the control site to adopt secondary abstinence and less likely to have had three or more sex partners. Males in the project site were more likely to use condoms than those in the control site. Both males and females in the project site were more likely to discuss sexual and reproductive health issues with a nonparent adult than were young people in the control site. Interventions that adapt to indigenous traditions can be both acceptable to communities and associated with significant changes in young people's behavior.
4. Breastfeeding among teenage and adult mothers in Brazil. Frota DA, Marcopito LF. Rev Saude Pública 2004;38(1):85-92 (Portuguese).
To estimate the prevalence of breastfeeding among teenage (younger than 20 years old) and adult mothers of six-month-old children and to identify factors associated with weaning, a cross-sectional study was done of a sample of 237 teenage mothers and 239 adult mothers living in the city of Montes Claros, Brazil, whose babies were six-months-old at the time the interview was carried out. Mothers answered a questionnaire at home. Breastfeeding prevalence in children aged 6 months was 71% among teenage mothers and 77% among adult mothers, but after adjusting for control variables the role of adolescence added considerable weight to weaning. Factors associated with weaning were: marital status, mother's occupation after delivery, difficulty to breastfeeding in the first days after delivery, and exclusive breastfeeding at the time of hospital discharge. The observed interactions with teenagers in regard to weaning suggest that motherhood in this age group has unique features that should be further investigated.
5. Compensated sex: a practice at the heart of young Mexican women's vulnerabilities (STI/HIV/AIDS). Theodore FL, Gutierrez JP, Torres P, et al. Salud Publica Mex 2004;46(2):104-12 (Spanish).
To discuss the risks for Mexican young women who engage in sexual relations in exchange for social or economic benefits, also known as compensated sex (CS), this qualitative study involved youths 15 to 25 years of age in Cuernavaca, Morelos, Mexico, between September 2001 and December 2002. The theoretical framework included sociology of knowledge, post-structuralism, and gender studies. Research methods consisted of six focal groups and eight interviews with young subjects identified or self-declared as having practiced CS. To conceal their CS practices as a way to obtain social or economic benefits, young girls disguise it as "courtship" and subject themselves to rules and behaviors that restrain them in terms of condom use and expose them to STI. Although CS itself may not necessarily constitute a risky practice, the courtship context in which young women tend to develop these practices exposes them to a greater risk of STIs.
6. Early age of first sex: a risk factor for HIV infection among women in Zimbabwe. Pettifor AE, van der Straten A, Dunbar MS, et al. AIDS 2004;18(10):1435-42.
To explore the relationship between early age of coital debut (15 years of age or younger) and risk for HIV infection among sexually active urbanized Zimbabwean women, a cross-sectional analysis was conducted of screening data from a cohort of 4,675 sexually active women aged 18-35 years, recruited from public sector family planning clinics in and around Harare, November 1999 and September 2002. They received a brief behavioral interview and HIV testing; 4,393 (94%) had complete data on sexual behaviors and HIV serostatus and were included in this analysis. HIV prevalence in this sample was 40%. While the median age of coital debut was 18 years, 12% of women reported coital debut at age 15 or younger. Women with early coital debut had a significantly higher risk profile, including multiple lifetime partners and not completing high school. HIV risk was increased for women reporting early age of coital debut, controlling for duration of sexual activity and current age; this effect was attenuated somewhat after controlling for other factors such as number of sexual partners. Results show that early coital debut is a significant predictor of prevalent HIV infection independent of other identified factors in this population. HIV prevention strategies should include delaying the age of first coitus and should address the barriers that may prevent young women from so doing.
7. Emergency contraception: knowledge and practices of tertiary students in Durban, South Africa. Roberts C, Moodley J, Esterhuizen T. J Obstet Gynaecol 2004 Jun;24(4):441-5.
This study assessed the knowledge, attitudes about, and use of emergency contraception among tertiary students in Durban, South Africa through the use of a self-administered confidential questionnaire. A total of 436 students (57% of study group) had heard of emergency contraception. Few knew the specific methods of emergency contraception and only 12% knew the correct time limit in which it must be used. Only 60 students (8%) knew how effective emergency contraception was in preventing pregnancy. Ninety-one students (12%) had used emergency contraception and 50% responded that if they had to, they would use it or recommend it to a friend. Predictors for a high knowledge score were: University of Natal students, having heard of emergency contraception, having used it before, and having received formal sex education. Overall, knowledge and use of emergency contraception by tertiary students is limited. The study reported a need for carefully designed education programs and promotion of emergency contraception on campuses.
8. Gender and class differences in young people's sexuality and HIV/AIDS risk-taking behaviours in Thailand. Thianthai C. Culture, Health and Sexuality 2004;6(3):189-203.
This study examines gender and class differences in young people's beliefs about sexuality and HIV/AIDS risk-taking behaviors in Thailand. Sixty young people aged 15—19, divided equally by gender and socioeconomic background, participated in focus groups and in-depth interviews covering the differences between "good" and "bad" girls/boys, perceptions of sexuality, social class variations in young people's knowledge of HIV/AIDS, perceptions of risk, and the most influential institutions shaping young people's sexual attitudes. Results showed that young people screened potential sexual partners utilizing an image of "good girls/boys" as potential HIV/AIDS-free partners; young people defined sexuality in terms of love/sexual relationships, premarital sex, promiscuity, and virginity; and HIV/AIDS awareness varied according to class. Young people of all classes failed to demonstrate an in-depth understanding of how they can contract AIDS. They neither viewed themselves as being in an at-risk group, nor considered their sexual behaviors to be at-risk. Family, friends, and mass media were reported to be among the most influential institutions shaping young people's sexual attitudes. In the struggle against HIV/AIDS, these institutions together with health education not only protect but also can empower young people in Thailand.
9. Gender differences in condom-related behaviors and attitudes among Mexican adolescents living on the U.S.-Mexico border. Martinez-Donate AP, Hovell MF, Blumberg EJ, et al. AIDS Educ Prev 2004;16(2):172-86.
Research on gender differences in risk behaviors and determinants is needed to develop effective HIV prevention interventions targeting Mexican adolescents. This study examined gender differences in the likelihood of unprotected sex and theoretical correlates among 370 high school students in the border city of Tijuana who completed a face-to-face interview and a self-administered survey. Differences in sexual initiation, condom use, intentions to use condoms in the future, and attitudes towards condoms in this population were assessed. Although male students initiated sexual practices earlier than females, females were more likely to have unprotected sex. Females perceived themselves as more likely to avoid unprotected sex in the future and held more favorable attitudes about condoms. The results suggest that stereotypical gender roles and communication barriers place Tijuana female high school students at higher risk for HIV infection than their male peers.
10. Knowledge, attitudes and experiences of sex trafficking by young women in Benin City, South-South Nigeria. Okonofua FE, Ogbomwan SM, Alutu AN, et al. Soc Sci Med 2004;59(6):1315-27.
This study was designed to determine the knowledge, attitudes, and experiences of young women in Benin City towards international sex trafficking, which is high in this area. A random household sample of 1,456 women aged 15-25 years was interviewed with a structured questionnaire that elicited information on women's experiences of, and attitudes towards international sex trafficking. Virtually all women had heard of international sex trafficking; nearly a third had been approached by someone offering to assist them to travel abroad; and 44% knew of someone who was currently engaged in sex work abroad. Women of poorer socio-economic status (out-of-school, unemployed, parents uneducated and unemployed) were more likely to report having been offered assistance to travel abroad. About 80% supported the notion that sex trafficking should be stopped, while 19% felt it should be allowed to continue. The perception that sex trafficking leads to wealth creation and economic gains for women was the most common reason given by those wanting the practice to continue. By contrast, the fear of adverse health consequences and the need to maintain social and religious morals were the reasons given by those wanting the practice to discontinue. These results suggest that programs that promote the economic well being of women, and social advocacy focusing on harm reduction will be most helpful in reducing the rate of sex trafficking in Benin City.
11. Meeting the contraceptive needs of unmarried young people: attitudes of formal and informal sector providers in Vientiane Municipality, Lao PDR. Sychareun V. Reprod Health Matters 2004;12(23):155-65.
This study explored the attitudes of formal and informal sector providers in serving the contraceptive needs of unmarried youth in Vientiane Municipality. It examined provider perceptions of quality of care, approaches to confidentiality and privacy, level of comfort in discussing sexual matters, and differences between providers in the two sectors. In-depth interviews were carried out with 56 key informants, followed by a quantitative survey of 150 formal sector and 100 informal sector providers. The study found ambivalence and discomfort among providers in communicating with unmarried youth and providing contraceptives to them, with a low priority placed on youth's right to privacy and confidentiality. Providers tended to attribute difficulties almost entirely to young people's inhibitions and unwillingness to listen. Less than 60% of formal sector providers would supply contraceptives to unmarried youth, compared to 80% of informal providers, but the latter were more likely to charge a fee for supplies. Both formal and informal sector providers need training in communication and counseling skills for serving unmarried youth. Programs must ensure that unmarried youth have access to good quality contraceptive services and supplies.
12. Patterns of sexual behaviour among secondary school students in Swaziland, southern Africa. Buseh AG. Cult Health Sex. 2004;6(4):355-67.
To reach young people with HIV prevention messages, it is essential to understand young people's sexual risk behaviors. Students (n=941) from four coeducational secondary schools in Swaziland participated in a cross-sectional survey of sexual behaviors. Results indicate that considerable proportions of young people in this study were sexually experienced, irrespective of gender. Findings also suggest unacceptable high levels of sexual coercion, irrespective of age or gender. While boys may be less likely than girls to experience sexual coercion, being a male in this setting was not a protective factor. No significant differences were found on these variables in relation to location of the schools (rural vs. urban). The report suggests implications for developing and implementing HIV prevention programs.
13. "Peer" educator initiatives for adolescent reproductive health projects in Indonesia. Hull TH, Hasmi E, Widyantoro N. Reprod Health Matters. 2004;12(23):29-39.
A pilot project in Central and East Java, coordinated by the National Family Planning Coordinating Board (BKKBN), trained 80 peer educators (male/female teams) to carry out small-group information sessions in ten different districts, which reached 1,300 adolescents. In addition, 40 peer counselors in 20 teams carried out five outreach sessions each in their communities, attended by nearly 4,000 adults and adolescents. Educators chosen were older in age, knowledge level, authority, and communication skills than adolescents, but were well accepted as mentors. Adolescents wanted to know how to deal with sexual relationships and feelings, unwanted pregnancy, and STDs. With 42 million Indonesian adolescents needing information, the government cannot produce enough manuals to satisfy demand. New strategies are required to put information in the public domain, e.g. via the media. The approach described in this paper would probably be beyond the staffing and resource capacity of most districts in Indonesia. Nonetheless, it shows that there was great enthusiasm across a variety of communities for efforts to educate young people on protecting their reproductive health.
14. Perceptions and attitudes regarding sex and condom use among Chinese college students: a qualitative study. Zhang H, Stanton B, Li X, et al. AIDS Behav 2004;8(2):105-17.
Perceptions regarding sex and condom use among Chinese college students were examined within a framework provided by protection motivation theory. Data from semistructured individual interviews indicate that Chinese students generally perceive a low level of vulnerability to HIV/STIs and a minimum exposure from family to drugs and risky sexual behaviors. While only a small proportion of students reported being sexually experienced, the majority of them expressed tolerance toward premarital sex, and a high level perceived intrinsic rewards from sexual experience. Students view condoms to be efficacious in preventing pregnancy or HIV/STI, but they also perceive a high level of response cost for use of condoms. The findings suggest that efforts to adapt HIV/STI prevention programs targeting Chinese adolescents and young adults need to consider cultural aspects of perceptions regarding sex and condoms among Chinese students and to address the conflict between traditional Chinese cultural values and modern influences.
15. Psychosexual development among HIV-positive adolescents in Abidjan, Cote d'Ivoire. Dago-Akribi HA, Adjoua M-CC. Reprod Health Matters 2004;12(23):19-28.
Some 84,000 children with HIV/AIDS live in Cote d'Ivoire, where very little therapeutic or psychological help is available to them. The Yopougon Child Programme of the "Agence Nationale de Recherche sur le Sida," launched in Abidjan in October 2000, provides services for HIV-infected children and psychological consultations for children and their parents. This paper is about the psychosexual development of the HIV-positive adolescents in the Programme, 11 girls and 8 boys aged 13-17, their problems with HIV-related physiological and psychosexual changes, and relationships with their parents. The information was gathered in individual therapy sessions, group discussions, and family support sessions. Bodily development was of major importance to these adolescents, particularly among those who had not yet developed secondary sexual characteristics and were shorter and weighed less than their peers. Those who had not achieved puberty were unable to participate in traditional rituals and worried whether they could ever marry or have children. In most cases, adolescents with HIV have been infected by a sexually transmitted virus without having had sexual relations themselves. They need support dealing with their sexual development and sexual feelings, along with medical care, in a context in which HIV infection is a secret, impossible to talk about with their peers.
16. Relationships between older men and younger women: implications for STIs/HIV in Kenya. Longfield K, Glick A, Waithaka M, et al. Stud Fam Plann 2004;35(2):125-34.
The aim of this study is to contribute to the understanding of motivations for cross-generational relationships and how the perception of risk of acquiring STIs including HIV affects condom use in Kenya. Eight focus-group discussions were conducted with women and 28 interviews were held with men in four Kenyan towns. Women's primary incentive for engaging in such relationships is financial; men seek sexual gratification. Pressure from peers compels women to find older partners. Although some peers encourage such relationships, other groups, especially wives, same-aged boyfriends, and parents, disapprove of them. Couples are preoccupied by the threat of discovery. STI/HIV risk perception is low, and couples rarely use condoms. Material gain, sexual gratification, emotional factors, and recognition from peers override concern for STI/HIV risk. Women's ability to negotiate condom use is compromised by age and economic disparities. Programmatic strategies include communicating information about such relationships' STI/HIV risk, promoting consistent condom use, decreasing peer pressure to pursue such relationships, and improving women's access to alternative sources of income.
17. Sexual behavior is more risky in rural than in urban areas among young women in Nyanza Province, Kenya. Voeten HA, Egesah OB, Habbema JD. Sex Transm Dis 2004;31(8):481-7.
HIV/sexually transmitted disease interventions in sub-Saharan Africa have largely been focused on urban areas, where sexual behavior is supposed to be more risky than in rural areas. In a cross-sectional study, 584 household members aged 15 to 29 years in Kisumu town and the rural districts Siaya and Bondo were selected by multistage random sampling and were administered a face-to-face questionnaire to measure sexual risk behavior among young adults, comparing rural and urban areas. For women, sexual behavior was more risky in rural than in urban areas, also after adjusting for sociodemographic differences. Rural women reported less frequently being a virgin at marriage, a higher number of lifetime partners, and less consistent condom use with nonspousal partners. For men, sexual risk behavior was equally high in urban and rural areas. The potential for further HIV spread in the rural area of the study is large. HIV/STI interventions should be expanded from urban to rural areas.
18. Some factors in condom use amongst first-year Nigerian University students and black and white South Africans. Peltzer K, Oladimeji Y. Psychol Rep 2004;94(2):583-6.
A questionnaire was administered to 213 sexually active first-year Nigerian university students and 150 Black and 150 White South African adults. Nigerian students gave 90% correct answers on 6 of the 10 items of a measure of condom knowledge. The most common mistakes with respect to condom use were ignorance about putting a condom on just before ejaculation (37%), the use of an oil-based lubricant with a condom (29%), and when to take off a condom (28%). For the South African sample utility of the Health Belief Model and Theory of Reasoned Action for HIV prevention could be confirmed by intention to use condoms. Findings have relevant implications for developing culturally diverse HIV intervention programs if confirmed with larger diverse groups.
19. Youth, sexuality, and sex education messages in Indonesia: issues of desire and control. Holzner BM, Oetomo D. Reprod Health Matters. 2004;12(23):40-9.
Since the 1994 International Conference on Population and Development, the need for sexuality education for youth has been articulated, and numerous activities in Indonesia, especially Java, have been directed at young people. However, many parents, teachers, and religious leaders have considered it essential that such education should suppress youth sexuality. Using popular magazines, educational publications, and focus group discussions with young men and women in Surabaya, East Java, the authors argue that the dominant prohibitive discourse in Java denounces youth sexuality as unhealthy, reinforced through intimidation about the dangers of sex. In contrast, a discourse of competence and citizenship would more adequately reflect the actual sexual behavior of youth and raise new challenges for sexuality education. Information should be available to youth concerning different sexualities, respecting the spectrum of diversity. Popular youth media have an especially important role to play in this. The means to stay healthy and be responsible, contraceptives and condoms should be available at sites where youth feel comfortable about accessing them. Meanwhile, young Indonesians are engaging in different forms of sexual relationships and finding their own sources of information, independent of government, religious, and international organizations.
