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I. PROGRAM RESOURCES
1. The State of the World's Children 2004
2. Education and HIV/AIDS: A Sourcebook of HIV/AIDS Prevention Programmes
3. Youth-Strategic Directions for the World Bank
4. Clinic Assessment of Youth Friendly Services: A Tool for Improving Reproductive Health Services for Youth; A Rapid Assessment of Youth Friendly Reproductive Health Services
5. A Rapid Assessment of Youth Friendly Reproductive Health Services
6. Adolescent Cue Cards
7. Changing Youth Behavior Through Social Marketing: Program Experiences and Research Findings from Cameroon, Madagascar, and Rwanda
8. Too Young to Wed: The Lives, Rights and Health of Young Married Girls
9. HIV/AIDS and Child Labour: A State of the Art Review with Recommendations for Action
10. Policies for Orphans and Vulnerable Children: A Framework for Moving Ahead
11. Forgotten Families: Older People Caring for Orphans and Vulnerable Children Affected by HIV/AIDS
12. FRONTIERS Operations Research Summaries, Global Agenda Youth Studies
13. Cameroon: Peer Education and Youth-Friendly Media Reduce Risky Sexual Behavior
14. Misconceptions, Folk Belief, Denial Hinder Risk Perception among Young Zambian Men
II. RESEARCH ARTICLES
1. Assessing the Net Effect of Young Maternal Age on Birthweight
2. Disease and Health Seeking Patterns among Adolescents in Uganda
3. Orphans' Household Circumstances and Access to Education in a Maturing HIV Epidemic in Eastern Zimbabwe
4. Parents' Attitudes to Adolescent Sexual Behaviour in Lesotho
5. Pregnant or Positive: Adolescent Childbearing and HIV Risk in KwaZulu Natal, South Africa
6. Preventing Sexually Transmitted Infections and Unintended Pregnancy, and Safeguarding Fertility: Triple Protection Needs of Young Women
7. Reproductive Health Knowledge, Attitude and Practice among High School Students in Bahir Dar, Ethiopia
8. Research Summaries from Developed Countries: 12 new abstracts on screening for STIs among adolescents, bone density and injectable contraceptives, cervical cytology screening in teens, reproductive education model for young men, and more.
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I. PROGRAM RESOURCES
1. The State of the World's Children 2004 (2003, English/French/Spanish)
UNICEF reports that 121 million children worldwide are out of school, 9 million more girls than boys, and that educating girls is essential to reduce child mortality, HIV/AIDS, and other diseases. Educated women are more likely to have healthy children who will complete school. In sub-Saharan Africa, 24 million girls did not go to school in 2002, an increase of 4 million since 1990, reflecting in part a sharp drop in foreign aid.
- Organization: UNICEF
- Contact: pubdoc@unicef.org
2. Education and HIV/AIDS: A Sourcebook of HIV/AIDS Prevention Programmes (2003, English/French)
The book compiles experiences in designing and implementing programs targeted at school-age children, highlighting main program elements and comparing them to criteria that the UNAIDS Inter-Agency Task Team for Education considers to be sound programming practice.
- Organization: The World Bank and Partnership for Child Development
- Contact: eservice@worldbank.org
3. Youth-Strategic Directions for the World Bank DRAFT (2003)
This draft document presents the youth component of the World Bank's Children and Youth Strategy. It is designed to guide the World Bank's work with youth development through an integrated approach and "to provide a roadmap for youth empowerment and participation."
- Organization: World Bank
- Contact: socialprotection@worldbank.org
4. Clinic Assessment of Youth Friendly Services: A Tool for Improving Reproductive Health Services for Youth (2003)
This tool helps program managers and clinicians determine the extent to which current reproductive health services are youth-friendly. It can also help in developing a plan to tailor services to better meet the needs and preferences of young people.
5. A Rapid Assessment of Youth Friendly Reproductive Health Services (2003)
A report of assessments using the clinic assessment tool in Botswana, Ghana, Tanzania, and Uganda.
- Organization: Pathfinder
- Contact: information@pathfind.org
6. Adolescent Cue Cards (2003) (scroll to Adolescent Cue Cards)
These colorful and user-friendly job aids for providers offer helpful information and tips specific to the reproductive health needs of youth. Each of the eight two-sided cards covers a contraceptive method.
- Organization: Pathfinder
- Contact: information@pathfind.org
7. Changing Youth Behavior Through Social Marketing: Program Experiences and Research Findings from Cameroon, Madagascar, and Rwanda (2003, English/French)
This summarizes the implementation, evaluation, impact, and lessons learned from three PSI youth-oriented programs (100% Jeune, Top Réseau, and Centre Dushishoze). The programs focus on youth-friendly reproductive health services and mass media campaigns.
- Organizations: PSI and PRB
- Contact: info@psi.org
8. Too Young to Wed: The Lives, Rights and Health of Young Married Girls (2003)
This report examines issues related to early marriage and offers policy and programmatic recommendations to end the practice, which is widespread despite laws and agreements forbidding it. Child marriage deprives girls of basic rights, subjects them to discrimination and serious health risks, and contributes to deepening poverty, since young married girls lacking a formal education and jobs skills are less likely to participate in the workforce.
- Organization: International Center for Research on Women (ICRW)
- Contact: info@icrw.org
9. HIV/AIDS and Child Labour: A State of the Art Review with Recommendations for Action (2003)
This 75-page report synthesizes rapid assessments of child labor and HIV in South Africa, Tanzania, Zambia, and Zimbabwe, incorporating other data and highlighting the impact on young girls. It makes policy and programmatic recommendations and identifies research gaps and areas of collaboration by international organizations. Separate papers on each country are also available for downloading.
- Organization: International Labor Organization
- Contact: ipec@ilo.org
10. Policies for Orphans and Vulnerable Children: A Framework for Moving Ahead (2003)
This paper prepared by the POLICY project presents a summary of the global orphan and vulnerable children (OVC) situation and current policy responses; outlines existing policy frameworks for responding to OVC; identifies policy-level gaps in national responses to the growing OVC crisis; and proposes a country-level OVC policy package and recommendations for future policy dialogue and action.
- Organization: The Futures Group
- Contact: http://www.policyproject.com/contact.cfm
11. Forgotten Families: Older People Caring for Orphans and Vulnerable Children Affected by HIV/AIDS (2003)
This report includes case studies providing examples of positive change, describes collaborative efforts for all stakeholders, and makes policy recommendations. While focusing on older adults caring for orphans, it reports on programs for youth who are orphans, including flexible education programs.
- Organization: Help Age International and International HIV/AIDS Alliance
- Contact: publications@aidsalliance.org
12. FRONTIERS Operations Research Summaries, Global Agenda Youth Studies (2003)
These four summaries report on the Population Council's FRONTIERS three-year operations research study in Bangladesh, Kenya, Mexico, and Senegal. The studies tested the feasibility, cost, and effectiveness of community, health services, and education interventions. Compared with control sites, the interventions were effective, although the impact of the different types of interventions varied among countries. The project found, for example, reduced sexual activity among males, although the change did not reach statistical significance in all countries. The studies demonstrated that the interventions could be undertaken in conservative communities, with more than 80 percent of parents approving of giving reproductive health information to adolescents.
- Organization: Population Council, FRONTIERS Program
- Contact: frontiers@pcdc.org
13. Cameroon: Peer Education and Youth-Friendly Media Reduce Risky Sexual Behavior (2003)
Urban youth in Cameroon are knowledgeable about HIV/AIDS and the risks of early pregnancy, but their behavior often fails to reflect their knowledge. Peer education programs targeting youth through one-on-one counseling, theatrical performances, youth magazines, and sporting events increased abstinence and fidelity and improved consistent and correct condom use. Educators and service providers should actively involve youth in program development, empowering them to be advocates for safe sexual behavior.
- Organization: Population Council, FRONTIERS Program
- Contact: frontiers@pcdc.org
14. Misconceptions, Folk Belief, Denial Hinder Risk Perception among Young Zambian Men (2003)
This two-page research brief summarizes a longer report available from PSI, including survey results and programmatic suggestions. Survey results show that misinformation is spread through gossip and hearsay, and that young men fear retribution or are too shy to ask for clarification from friends or family. Many young Zambian men attribute HIV infection to sorcery or the strength of a person's blood and cite promiscuous-looking females as the most frequent transmitter of STIs/HIV.
- Organization: Population Services International (PSI)
- Contact: rcramer@psi.org
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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. Assessing the net effect of young maternal age on birthweight. Borja JB , Adair LS. Am J Human Biol 2003;15(6):733-40.
This study examined the direct biological effect of age on birthweight and the indirect effect that associated socioeconomic factors have through more proximate determinants including prenatal care, maternal diet, and nutritional status during pregnancy. It used data from 214 adolescent and 415 adults and their infants from the Cebu, Philippines longitudinal study. When controlling for socioeconomic, biological, and behavioral risk factors, young maternal age remained a significant predictor of low birthweight, but not of birthweight itself. Compared to adults, adolescents tend to be shorter and weigh less than the standard weight-for-height at a given month of gestation, factors that are significant predictors of low birthweight. However, socioeconomic, biological, and behavioral risk factors affect the birthweight in grams.
2. Disease and health seeking patterns among adolescents in Uganda. Mbonye AK. Int J Adolesc Med Health 2003;15(2):105-12.
The study evaluated the impact of adolescent-friendly health services piloted in the Jinja district of Uganda by assessing adolescents' knowledge, attitudes, and practices related to access and utilization of services; by assessing the perceptions and skills of health workers; and by identifying options for scaling up services and sustainability of such services. Using structured questionnaires and in-depth interviews with 128 adolescents and 42 health workers, it compared four health units that had implemented a package of adolescent-friendly services with four control health units of comparable levels of service. The units that implemented adolescent-friendly services had improved access and use of services among adolescents, which led to reduced morbidity from STIs, HIV, and unwanted pregnancies. In order to reach more adolescents, services have to be made more widely available. Training of health workers, a constant supply of contraceptives and STI drugs, and offering voluntary HIV testing and counseling services are key program issues to consider.
3. Orphans' household circumstances and access to education in a maturing HIV epidemic in eastern Zimbabwe. Nyamukapa CA, Foster G, Gregson S. J Soc Dev Afr 2003;18(2):7-32.
As the cumulative impact of high morbidity and mortality from HIV takes its toll on the adult population, levels and patterns of orphanhood will change, along with the impact on child development. In the area of Zimbabwe examined, orphans are found disproportionately in rural, female-, elderly- and adolescent-headed household, each a risk factor for extreme poverty. The over-representation in rural areas could reflect urban-rural migration around the time of death of the parent due to loss of income and the high cost of living in towns. Over-representation in female-, elderly- and adolescent-headed households could reflect the predisposition of men to seek employment in towns, estates, and mines; the reluctance of second wives to take responsibility for their predecessors' children; and stress in the extended family system. The death of the mother was found to have a strong detrimental effect on a child's chances of completing primary school education, the strength of effect increasing with time since maternal death. The death of the father had no detrimental effect, despite the fact that paternal orphans were typically found in the poorest households.
4. Parents' attitudes to adolescent sexual behaviour in Lesotho. Mturi AJ. Afr J Reprod Health 2003;7(2):25-33.
This study investigated the knowledge, attitudes, and opinions of parents on various aspects of adolescents' sexual and reproductive health in Lesotho, using a qualitative methodology. Findings reveal that parents are aware that male and female adolescents engage in sexual relationships. Some parents believe that adolescents are too young to initiate sexual activities while others said they don't mind older unmarried adolescents having sex. In addition, parents felt that adolescents do not face discrimination in obtaining family planning services. In relation to passing sexual and reproductive health knowledge to adolescents, there seems to be a dilemma on who should take the responsibility. A number of policy implications have emerged from this study. There should be awareness campaign for parents who are not aware that adolescents engage in sexual relationships. Parents should be encouraged to communicate with their adolescent children on sex-related matters. Governments should carry on with the dialogue on introducing sex education in schools curriculum.
5. Pregnant or positive: adolescent childbearing and HIV risk in KwaZulu Natal, South Africa. Rutenberg N, Kaufman CE, Macintyre K, et al. Reprod Health Matters 2003;11(22):122-33.
In communities where early age of childbearing is common and HIV prevalence is high, adolescents may place themselves at risk of HIV because positive or ambivalent attitudes towards pregnancy reduce their motivation to abstain from sex, have sex less often, or use condoms. This study analyzed cross-sectional survey data from KwaZulu Natal, South Africa, to explore whether an association exists between the desire for pregnancy and perceptions of HIV risk among 1,426 adolescents in 110 local communities. Findings suggest that some adolescents, girls more than boys, were more concerned about a pregnancy if they lived in environments where youth were perceived to be at high risk of HIV infection. The probability that pregnancy was considered a problem by boys was positively correlated with the proportion of adult community members who thought youth were at risk of acquiring HIV, and for girls by the proportion of peers in the community who thought youth were at risk of HIV. Youth also felt that becoming pregnant would be a bigger problem for the African girls than for white and Indian girls. The analysis suggests that for some adolescents, in addition to effects on educational and employment opportunities, the danger of HIV infection is becoming part of the calculus of the desirability of a pregnancy.
6. Preventing sexually transmitted infections and unintended pregnancy, and safeguarding fertility: triple protection needs of young women. Brady M Reprod Health Matters 2003;11 (22):134-41.
While dual protection means concurrent protection against unintended pregnancy and STI/HIV, a more comprehensive notion of "triple protection" would include the safeguarding of fertility. This paper argues for this explicit connection, to draw out the connection between infertility and STIs, using the "visibility" of fertility and infertility and people's immediate connection with them. This in turn could bolster STI prevention and control efforts, while also highlighting the connections between infertility and unsafe abortion and delivery practices. Building on efforts to promote dual protection, a strategic opportunity exists to include prevention of infertility into safer sex messages and to address the fragmentation of reproductive health and HIV/AIDS programs.
7. Reproductive health knowledge, attitude and practice among high school students in Bahir Dar, Ethiopia. Kibret M. Afr J Reprod Health 2003;7(2):39-45.
This study investigated the reproductive health knowledge, attitude, and practice of high school students using self-administered questionnaires and focus group discussions. The students had high knowledge of contraceptives and where to obtain contraceptive services, but use was low due to lack of access to services, carelessness, unplanned sexual intercourse, and pressure from sexual partners. The study indicates that young people engage in sexual relationships at an early age without protection or with unsafe non-conventional methods. There was no significant difference between the demographic variables and contraceptive use at first intercourse. Educational level of the respondents was the only demographic variable that had significant association with sexual experience. We recommend improved access to family planning information and services and family life education programs based on the needs and experience of these young people as a potential solution to alleviate their reproductive health problems.
8. Research summaries from developed countries:
Acceptability of urine screening for Neisseria gonorrheae and Chlamydia trachomatis in adolescents at an urban emergency department. Monroe KW, Weiss HL, Jones M, Hook EW 3rd. Sex Transm Dis 2003;30(11):850-3.
The study analyzed the acceptability of urine screening for Neisseria gonorrhoeae and Chlamydia trachomatis in adolescents in a pediatric emergency department. It used a prospective enrollment of adolescents aged 14-20 visiting an urban pediatric emergency department and measured acceptance of urine STD screening rates. Of 1,231 potential participants, 879 (71%) agreed to participate and 352 (29%) declined screening. Participants were similar to those refusing to participate in terms of gender. In multivariate analysis, age, race/ethnicity, and insurance status were associated with variation in STI test acceptance, whereas the presence of a parent was not. Despite similar training, 1 of 3 recruiters had significantly lower acceptance rates than her peers. Overall, 10% of patients enrolled were found to have one or both infections. Urine screening for STIs can be efficiently conducted in an emergency department setting. This screening appears to be acceptable to most patients.
Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. Brener ND, Billy JO, Grady WR. J Adolesc Health 2003;33(6):436-57. The study reviewed the existing empirical literature (peer-reviewed journals since 1980) to assess cognitive and situational factors that may affect the validity of adolescents' self-reports of alcohol and other drug use, tobacco use, behaviors related to unintentional injuries and violence, dietary behaviors, physical activity, and sexual behavior. Self-reports of each of six types of health-risk behaviors are affected by both cognitive and situational factors. These factors, however, do not threaten the validity of self-reports of each type of behavior equally. The importance of assessing health-risk behaviors as part of research activities involving adolescents necessitates the use of self-report measures. Researchers should familiarize themselves with the threats to validity inherent in this type of assessment and design research that minimizes these threats as much as possible.
Bone mineral density in adolescent and young adult women on injectable or oral contraception. Cromer BA.
Curr Opin Obstet Gynecol 2003;15(5):353-7.
This report critically reviews recent original research articles that pertain to bone mineral density in young adult women utilizing injectable depot medroxyprogesterone acetate or oral contraceptives. Some evidence indicates that depot medroxyprogesterone acetate and ultra-low dose oral contraceptives (containing 20 microg ethinyl estradiol) may interfere with the large increases normally observed in adolescence; however, the same degree of bone loss (or lack of bone gain) associated with these drugs is not so impressive in young adult women who would typically be experiencing small changes in bone mass. Data obtained from young adult women show that low dose (30-40 microg ethinyl estradiol) oral contraceptives seem to be more protective of bone than ultra-low dose oral contraceptives. The few extant data suggest that there may be substantial increases in bone mass after discontinuation of depot medroxyprogesterone acetate; no information is available regarding the response of bone after discontinuation of oral contraceptives. As the clinical risk for fracture is usually several decades later, several exogenous factors such as diet and exercise may exert overriding influences on later bone health. Moreover, without contraception, the clinical outcome may be unwanted pregnancy and its potential impact on bone health.: Recent findings suggest that depot medroxyprogesterone acetate and ultra-low dose oral contraceptives may interfere with achieving optimal peak bone mass in very young women; however, there may be substantial recovery after cessation of these methods and overriding long-term influences on bone health imposed by a myriad of lifestyle factors.
Cervical cytology screening in teens. Moscicki A-B. Curr Womens Health Rep 2003;3(6):433-7.
New guidelines for when to initiate cervical cancer screening have recently been revised. The American Cancer Society now recommends that screening be initiated within 3 years of the onset of vaginal intercourse but no later than 21 years of age. Natural history studies of human papillomavirus (HPV; the cause of abnormal cytology and cervical cancer) suggest that there is little risk of a significant precancerous lesion going undetected within the first 3 to 5 years after the onset of sexual activity. The new recommendations will assist in the over-referral and overtreatment of adolescents with HPV.
Core group evolution over time: high-risk sexual behavior in a birth cohort between sexual debut and age 26. Humblet O, Paul C, Dickson N. Sex Transm Dis 2003;30(11):818-24.
Among the limitations of the concept of a sexually transmitted disease core is uncertainty about the stability of sexual behavior over time. The objective was to shed light on characteristics and stability of the core group by assessing sexual behavior longitudinally in a birth cohort. The goals were to describe group size and characteristics of people who report 5 or more heterosexual partners per year (a surrogate for the core group) at ages 18, 21, and 26 years. We used a prospective cohort study with a computer-presented questionnaire on sexual behavior. Of the original cohort members, 991 (97.3% of those believed to be alive) responded at at least one age. A total of 14.7% of women and 26.0% of men were in the core group at either age 18 or 21 or 26, but only 0.5% and 0.9% of women and men, respectively, were in the core group at all ages. Those in the core group were significantly more likely to report concurrent partnerships and higher sexually transmitted disease (STD) rates. Early age at first sex was consistently associated with being in the core group, whereas those with less education were more likely to be in the core group at age 18 but not at later ages. The high degree of variability in sexual behavior over time of individuals adds another degree of complexity to the identification of a core group for STD transmission.
HIV/STI associated risk behaviors among self-identified lesbian, gay, bisexual, and transgender college students in the United States. Lindley LL, Nicholson TJ, Kerby MB, Lu N. AIDS Educ Prev 2003;15(5):413-29.
An Internet survey was conducted during the 2001-2002 academic year to examine the health risk behaviors, including HIV/STI associated behaviors, of self-identified lesbian, gay, bisexual, and transgender (LGBT) college students in the United States. A total of 450 LGBT college students completed the entire online survey. Most respondents attended a 4-year (96.9%), coeducational (98.6%), non-religiously affiliated (87.5%), public (68.6%) institution. Eighty-nine percent reported having sex with someone of the same sex and 45% had multiple (6 or more) sex partners during their lifetime. Most reported using a condom consistently during penile-vaginal (61%) and anal sex (63%). However, only 4% used a condom or other barrier consistently during oral sex and 28% used a condom or other barrier during their last sexual encounter. Injection drug use and needle-sharing behavior was low (2.1% and 1.1%, respectively). Comparisons with heterosexual college students' HIV/STI associated risk behaviors are included. Results may be useful for HIV/STI prevention programs targeting LGBT college students.
Man2man: a promising approach to addressing the sexual and reproductive health needs of young men. Sherrow G, Ruby T, Braverman PK, Bartle N, Gibson S, Hock-Long L. Perspect Sex Reprod Health 2003;35(5):215-9.
This pilot approach to providing young men with sexual and reproductive health information was generally successful. Working through a collaborative partnership of a family planning council, university, hospital, and community treatment agency, the project involved trained facilitators and small group meeting at schools after school hours. It consisted of 15 weekly, two-hour sessions delivered to 10-12 adolescents, covering personal development, life skills, fatherhood, relationships, and health/sexuality. It has grown over four years from 44 participants to more than 200 a year. The project has found that young men, despite conventional wisdom, do express themselves emotionally when in a safe environment. The evaluation found that trained male mentors, the program format, and collaboration work well. To enrich the program, according to the desires of the participants, it is adding sexual health skill-based activities and female perspectives (through a panel of young women or an adult female guest facilitator).
New options in contraception for teenagers. Zite NB, Shulman LP. Curr Opin Obstet Gynecol 2003;15(5):385-9.
Unintended pregnancy continues to exact a considerable economic, social, and personal cost in industrialized nations despite the ready availability of safe, reliable, and highly effective methods of contraception. Adolescents still demonstrate some of the highest rates of unintended pregnancy and thus may benefit from considering new contraceptive options. The recent launch of several new combination oral contraceptive pills with novel side effect profiles has expanded the choices for teenagers who choose to use a daily oral contraceptive. Of potentially greater interest is the recent availability of several non-daily contraceptives, as compliance remains a critical issue with successful contraceptive use in adolescents. New contraceptive methods bring unique side effect profiles and delivery systems that may improve overall contraceptive compliance, especially among teenagers who are more prone to misuse from a wide array of side effect and compliance issues. Even the most accepted method, however, will not provide effective contraception if the process by which contraception is provided fails to address the unique concerns and lifestyle issues of each individual adolescent.
The other half of the equation: serving young men in a young women's reproductive health clinic. Raine T, Marcell AV, Rocca CH, Harper CC. Perspect Sex Reprod Health 2003;35(5):208-14.
Efforts to improve reproductive health typically target women. Family planning agencies serving high-risk young women may be particularly suited to integrating young men in their health promotion efforts. In 2001, a family planning clinic in San Francisco serving primarily young women opened a male clinic as part of a male involvement program that includes education and outreach components. Client volume was assessed by reviewing billing data. New male clients completed questionnaires on their demographic characteristics, sexual and health-seeking behavior, and reason for clinic visit. Before and after the male clinic opened, female clients completed questionnaires assessing their satisfaction with services and their attitudes on males' being served at the clinic. In the first year of the male clinic, the number of adolescent and adult male clients served at the facility increased by 192% and 119%, respectively, over the previous year. Among 110 males making first visits, 88% came for sexually transmitted disease testing or treatment. Three-quarters had learned of the clinic by word of mouth – from a sexual partner (37%), friend (29%) or sibling (6%) – rather than directly from outreach efforts. The proportion of female respondents very or mostly satisfied with their care was similarly high before (98%) and after (92%) the male clinic opened. Increasing capacity within the female reproductive health model to serve males is feasible. To reach at-risk males, "in-reach" efforts with female clients may be as important as targeted outreach efforts.
Promoting sexual health services to young men: findings from focus group discussions. Pearson S. J Fam Plann Reprod Health Care 2003;29(4):194-8.
Using data from nine focus group discussions with 75 men aged 13 to 21 in different locations in England, this study looked at whether young men need sexual health services, whether current services are appropriate and accessible, and what promotion strategies might increase service uptake. Young men's decision-making around sexual health may involve seeking advice from a close friend, but is less likely in some male social groups. Use of services by young men is most likely to obtain free condoms or to remedy a crisis situation. While a young man is becoming familiar with obtaining condoms from a service, the need for a quick, straightforward service seems important. The stereotypical view within the groups was that sexual health services are women-oriented. However, suggestions are given to make services more youth- and male-friendly. Promotion should aim to increase awareness and advance a positive image of a sexual health service. Effective promotion campaigns (designed with the input of local young men), combined with appropriate and accessible services, should help to increase service use among young men.
Topical microbicide use by adolescent girls: concerns about timing, efficacy, and safety. Short MB, Mills L, Majkowski JM, Stanberry LR, Rosenthal SL. Sex Transm Dis 2003;30(11):854-8.
Adolescent girls could benefit from topical microbicide use if the product is acceptable to them. Using focus groups, the study evaluated the views of girls, mothers, experienced healthcare providers, and medical students on timing of use, efficacy, and safety of topical microbicide use by adolescents. A delay between insertion and coitus presented a problem, and pre- and postcoital use had advantages depending on the group. Efficacy was evaluated by timing of use, smell, ability to feel the product, and confidence that it would spread sufficiently. There were concerns about physical side effects and the impact on normal vaginal flora. This study demonstrated the importance of understanding the unique needs and perspectives of adolescent girls and the adults who have an influence on their use.
The young men's clinic: addressing men's reproductive health and responsibilities. Armstrong B. Perspect Sex Reprod Health 2003;35(5):220-5.
This article summarizes the growth of a clinic in New York City serving predominantly Latino immigrants. Begun in 1987, it has grown recently, with clinic use almost tripling from 1998 to 2002, from 506 men to 1,452 men. The clinic, open twice a week, as part of a larger community health program, addresses predominantly sexual and reproductive health issues, as well as a limited package of other health services such as sports physicals and acne treatment. The clinic attempts to empower men to adapt and sustain behaviors to improve their health and the health of their partners, to use the clinic visit as a "teachable moment" where young men will ask questions, and to collaborate with governmental and community based organizations. Funding for men's services remains a problem, especially as interest and service needs expand.
