Youth InfoNet 38 – September 2007
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I. Program Resources
II. Research Summaries
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I. Program Resources
This literature review identifies the major factors affecting pregnancy among adolescents, as well as socioeconomic and political barriers that influence their access to healthcare services and information. It presents programmatic evidence of measures that can be taken at the household, community, and national levels to improve pregnancy outcomes among adolescents.
Organization: WHO
This 68-page guide from Catholic Relief Services/Zimbabwe highlights some of the possibilities for involving children in education initiatives, including leading the effort to educate their peers about HIV/AIDS and having the skills to counsel their classmates and refer them to trusted sources.
Organization: CRS
International Planned Parenthood/Western Hemisphere Region, along with eight other organizations, evaluated their youth programs to identify best practices for working with youth. This document synthesizes the strategies that proved to be effective. Each organization's project and evaluation results are discussed, along with key lessons and questions that emerged during the process of implementing, documenting, and evaluating these programs. The document offers strategic recommendations for organizations that work with youth.
Organization: IPPF/WHR
The research documented in this report examined knowledge about sexuality and sexuality-related rights among university students at the University of Nairobi, School of Law. The authors studied attitudes about and practices surrounding sexuality and sexual rights, gender differentials, and the ability of young men and women to negotiate healthy sexual relationships.
Organization: Centre for Rights Education and Awareness (CREAW) and School of Law, University of Nairobi, Kenya
The HIV/AIDS Impact on Education Clearinghouse newsletter highlights recent additions to the clearinghouse’s collection of documents. This issue links to related case studies, reports, and information about upcoming events worldwide.
Organization: UNESCO
This policy brief describes adolescent girls' reproductive health risks and how increasing their educational attainment reduces those risks, including early and unwanted fertility, and benefits their future families and society.
Organization: PRB, BRIDGE
Over five weeks during June-July 2007, the authors of this report used the PEER (Participatory Ethnographic Evaluation and Research) method to examine issues about sexual relationships, condom use, and HIV risk among young women from inner-city Kingston, Jamaica. Fourteen 15- to 24-year-old women were trained as peer researchers, and they interviewed their friends about social life, relationships, HIV and AIDS, and condom use. Results have been used to develop communications materials for an upcoming generic condom promotion campaign.
Organization: Options, Hope Enterprises, Ltd.
This report of a study provides fact-based information on the range of negative health consequences of trafficking and how these adolescents can improve after released from such situations with professional care. Understanding these consequences can help policy-makers and providers develop more holistic care for women who have been trafficked.
Organization: London School of Hygiene and Tropical Medicine
No. 22. Scaling Up Youth Reproductive Health and HIV Prevention Programs (2007, PDF, 4 pages 185 KB)
This brief summarizes the latest conceptual thinking and the successful scaling up approaches of large youth projects. It identifies challenging pragmatic issues as well as key actions needed for effective scale-up of youth projects.
No. 23. New Web Sites Make Information about Youth More Accessible (2007, PDF, 4 pages, 179 KB)
To address the growing volumes of information on youth, the new Interagency Youth Working Group site and expanded youth sections on the DHS and policy.com sites provide guidance to program planners and others.
No. 24. Youth Peer Education (2007, PDF, 4 pages, 184 KB)
A recent meeting and new research compile scientific evidence and program experiences to show that youth peer education projects can be effective. But the available information leaves questions about delivery strategies, the degree of rigor used in curriculum and planning, and other issues.
Organization: Family Health International
II. Research Summaries
Adolescents in the Niger Delta region engage in unhealthy sexual behavior, characterized by early age at sexual initiation, unsafe sex, and multiple sexual partners. The local socioeconomic conditions exert extra pressure on adolescents, with negative reproductive health consequences. There is an urgent need for stakeholders to develop a time-bound strategic framework and plan to redress this situation.
This article investigates the differentials and determinants of female age at first marriage in rural Nepal. The life table technique was employed to calculate median age at marriage. The proportional hazard model was used to study the effect of various socioeconomic variables and to identify the magnitude and significance of their effects on the timing of first marriage. The data were taken from a sample survey of Palpa and Rupandehi districts in rural Nepal. Both married and unmarried females of marriageable age were included in the survey. Median age at marriage was about 17 years for married females, whereas it was about 18 years according to combined data from married as well as unmarried females of marriageable age. Median age at marriage was about 16 years for uneducated females and 19 years for females educated up to intermediate level or higher. The analysis underestimates the median age at marriage for married females, probably due to right censoring. The risk of getting married early decreased gradually with increasing year-of-birth cohort. The risk of early marriage was higher among females of high socioeconomic status compared with those of low socioeconomic status. Females engaged in service married earlier than those engaged in household work. Families of high socioeconomic status are motivated, for religious and prestige reasons, to get their daughters married at an early age, preferably before menarche. Thus, education, occupation, and age at menarche are the most powerful factors in deciding the timing of first marriage in Nepal.
This research evaluated risk behaviors in HIV-positive adolescents (n=153) receiving routine HIV medical care from their providers at a large medical center in Bucharest, Romania. Although the participants were of an appropriate age (m=15.94 years) to have acquired HIV (there were large numbers of pediatric AIDS cases during Ceausescu's Communist regime), many (20%) reported acquiring HIV sexually relatively recently. As a whole, this group of youth exhibited significant deficits in HIV knowledge, attitude, subjective norm, perceived control, and intention. Significant risk behavior also appeared in terms of reports of unprotected intercourse with both HIV-positive and -negative partners. These results imply a change in the epidemiological model for HIV transmission in Romania, with increased sexual transmission of HIV. Discussion centers on interpretations of these patterns and drawing implications for HIV risk reduction for young people in Romania.
The aim of this study was to determine seroprevalence and correlates of exposure to HPV 16, 18, and 53 among 15- to 30-year-old drug users in Baltimore, Maryland, United States. Young, newly initiated injection and noninjection drug users underwent a behavioral risk assessment and HPV serology testing. Sex-specific analyses were performed comparing seropositive and seronegative participants using chi2, Mann-Whitney tests, and logistic regression. Participants (n=553) were 43.0% female, 40.2% African American, and median age was 24 years. HPV seroprevalence among females and males, respectively, was HPV-16, 38.2% and 7.0%; HPV-18, 42.4% and 7.3%; and HPV-53, 27.7% and 5.1%. Correlates of HPV seropositivity among females included being African American and anal sex, and among males, having had sex with another male. HPV seroprevalence was high among young drug users and significantly higher among females than males, supporting previous findings. Further research is required to fully understand HPV risk factors among men and the contribution of anal transmission in women.
Matched longitudinal data for 1,661 mothers and their children were analyzed in this study. The mothers were interviewed in 1994, when their children were aged 9 to 11, about socio-demographic characteristics, their marital relationships, and women's status. Cox proportional hazards models are used to assess unmarried children's age at first sex as reported by the children in 2005 at ages 20 to 22. After multivariate adjustment, the analysis indicates that when parents make household decisions jointly, sons report delaying first sex. In households in which mothers have higher status, daughters report delayed first sex. The results demonstrate that long-term positive effects on children, particularly delaying first sex, occur in families in which parental decision-making is cooperative and in which women have high status.
A survey was conducted among 392 tertiary level students in the University of Dhaka, Bangladesh. Students demonstrated a high knowledge of transmission and prevention of HIV and AIDS yet held considerable misconceptions. All students said that unprotected sex with an HIV-positive man or woman can transmit the HIV virus to a negative man or woman. However, 43.6% believed that there is a preventive vaccine for HIV, and 39.8% believed that HIV can be cured if it is diagnosed early. Multivariate regression analysis indicated that the students who had more knowledge on HIV and AIDS were older boys, had fathers with more income, had fathers who worked in business or service, had more mass media exposure, were senior students, were living in a university dormitory, and were students of the faculty of arts, social sciences, or science. The findings of this study suggest that a special course on health education, including risk perception of HIV and AIDS and issues related to sexual and other high-risk behavior should be included in the course curriculum irrespective of disciplines at tertiary levels.
This paper examines the sexual and social practices of young people in contemporary Iran. Young people in urban areas live under the rubric of a fundamentalist, Islamist regime that restricts social freedoms such as premarital heterosexual contact, homosexual encounters, dancing, alcohol consumption, and large group gatherings. Drawing on close focus research and individual and group interviews, the authors analyze young people's responses to these constraints. Findings suggest that many young adults use their “rebellious” social behavior to make political statements against a regime that dissatisfies them. In their own words, they say that they are enacting and bringing about a “sexual revolution.”
The goal of this study was to define the performance characteristics of the Focus ELISA HSV-1 and HSV-2 assay among 100 university students. HSV-1 and HSV-2 Focus ELISA and Western Blot assays were performed on sera from university students who reported no history of genital herpes. HSV-2 and HSV-1 seroprevalence by Western Blot were 3.4% and 48%, respectively. In this population, the positive predictive value of the Focus HSV-2 ELISA was 37.5%, the sensitivity was 100%, and specificity was 94.1%. The PPV of the Focus HSV-1 ELISA was 96.7%, the sensitivity was 69.0%, and the specificity was 97.8%. In this low-prevalence population, the positive predictive value of the Focus HSV-2 ELISA test was low. This finding, together with those reported elsewhere, indicates that caution is warranted when recommending HSV screening in low-prevalence or heterogeneous populations. Consideration should be given to raising the cutoff index value for defining a positive test result.
In this study, stigma was measured at two levels: individual and community (social norm). There were commonalities and differences in the correlates of readiness among men and women. For men and women, knowledge about HIV prevention, knowledge about a source for VCT, discussion about condom use for HIV prevention, and perceived risk were strong predictors of readiness for HIV testing. Knowledge that an apparently healthy person can be HIV-infected is only significant for women. Perceived stigma is a significant predictor for both men and women, although the specific dimension of note differs between the sexes. Social norm is strongly and directly associated with readiness among men but has no apparent influence among women. For both sexes, social norm appears to have strong mediating influence on the relationship between personal perceived stigma and readiness. The results strongly suggest that to eliminate HIV-related stigma, it is not enough to target individual cognitive processes; strategic efforts should target social structures in order to change negative social norms.
Participants in this study associated having multiple sexual partners with several harmful health- and non-health-related outcomes, including sexually transmitted infections, and frequently confirmed that the practice also bolsters their sense of maleness and boosts their acceptance and ranking among peers. Young males’ involvement in multiple sexual partnerships should not always be seen as a consequence of their ignorance of or indifference to the risks inherent in the behavior. Having multiple sexual partners could also result from the integrality of the behavior to the social processes through which male youths validate their masculinity, mark their transition from boyhood to manhood, and configure their identities to gain acceptance into a local male peer community. Sexuality education curricula that ignore adolescents' understandings of the benefits of their sexual practices may not deliver expected objectives.
This nationally representative study, encompassing all single youth (15-24 years) in a subpopulation of Ethiopia’s DHS 2000, aimed to determine the influences of socio-demographic characteristics on sexual behavior and assess the knowledge and awareness of HIV/AIDS and other STIs. Of the 890 male and 3,988 female youth included in the study, 25.5% of males and 16.1% of females ever had sexual intercourse. Among these, 65.8% of the males and 24.6% of the females had two or more sexual partners in the past 12 months. Condom use in the last sexual act was reported by 22.7% and 10% of male and female youth, respectively. About 19.4% of male and 22.2% of female youth who ever had sexual intercourse ever used a family planning method. Although the majority of youth is aware of HIV/AIDS, awareness about other STIs is low. On binary logistic regression analysis, the odds of ever having sexual intercourse were higher for the employed and older youth. Male urban youth were more likely to ever have sexual intercourse than male rural youth (adjusted OR 4.2; 95% CI 1.8-9.5). Male youth with some form of education were more likely to use condoms (adjusted OR 4.9; 95% CI 1.01-24.7). For female youth with some form of education, the risk of ever having sexual intercourse was reduced by 50%, but they were more likely to report having two or more sexual partners in the last 12 months (adjusted OR 2.1; 95% CI 1.1-4.1). Female youth who had media exposure also were more likely to report having two or more sexual partners in the last 12 months (adjusted OR 2.9; 95% CI 1.3-6.8) but were more likely to use a condom during last sexual intercourse (adjusted OR 15.7; 95% CI 2.2-117). Among single Ethiopian youth, the overall sexual activity is relatively lower than reported from other African countries, but high-risk sexual behavior is common.
The aim of this study was to determine what motivates youth to learn about HIV/AIDS prevention and to assess their curriculum design preferences. Students from a university in Tigray, Ethiopia filled out a structured questionnaire that assessed demographics and their preferences for independent, carrier, and integrated HIV/AIDS curriculum designs. On average, participants were highly motivated to learn about HIV/AIDS. Motivation to learn was primarily related to social norms and was not related to self-efficacy to discuss HIV/AIDS in class. The often-discussed reluctance to discuss sexuality and condom use in curricula in sub-Saharan Africa seems to be more related to existing negative social norms than to lack of self-efficacy. Participants revealed a high preference for the independent, carrier, and integrated curriculum design options. However, students with a higher motivation to learn about HIV/AIDS were more attracted to the independent course design.
The study involved data collection from 716 students aged 11-22 in four secondary schools in an urban area in Zambia. Students completed a questionnaire and were invited to write down any inquiries they had about sexuality and reproduction. Findings revealed that boys and girls lack adequate information about human reproduction and STIs, including HIV. To avoid misconceptions and myths, they also need clear information on contraceptives and masturbation. Responses indicate that young people would welcome guidance and support related to contraception, pregnancy, abortion, and STIs/HIV, but also on love and relationships. Culture, religion, and gender are important factors influencing sexuality and sexual abuse. These issues need to be taken into consideration when developing youth-friendly programs for young people.
This article summarizes key findings of a multiyear, multicountry study on the scope of young people’s sexual and reproductive health needs in sub-Saharan Africa. Evidence was gathered in Burkina Faso, Ghana, Malawi, and Uganda, where in-depth interviews with 12- to 19-year-olds and interviews with key adults in adolescents’ lives were conducted. The evidence shows that teens are concerned about and want to protect themselves from unplanned pregnancy and HIV, but that misinformation about sex and its consequences is common and many adolescents do not get the education and services they need.
This review explores trends and outcomes related to education, family formation, and sexual and reproductive health, and the interrelationships among these areas. It is based on published and unpublished reports. Over the past 20 years, school enrollment has increased for much of the subcontinent. However, although the gender gap has narrowed, females remain educationally disadvantaged. Likewise, marriage is occurring later today than a generation ago, posing new challenges of out-of-wedlock births, clandestine abortions, and an increased likelihood of engaging in premarital sex. Although population growth has slowed in much of the region, in many countries of sub-Saharan Africa, the population is doubling every 30 years. Although AIDS is the predominant cause of death among young people, maternal mortality remains a major risk of death for youth — in some countries, the risk of maternal mortality is 600 times greater than in the industrialized world.
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