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1. Exclusion, Gender and Education: Case Studies from the Developing World
2. Framework for Action on Adolescents and Youth. Opening Doors with Young People: 4 Keys
3. Girls' Adolescence in Burkina Faso: A Pivot Point for Social Change
4. Giving Girls Today and Tomorrow: Breaking the Cycle of Adolescent Pregnancy
5. Helping Parents in Developing Countries Improve Adolescents' Health
6. International Classification of Functioning, Disability and Health – Children and Youth Version (ICF-CY)
7. Learning from Adolescents to Prevent HIV and Unintended Pregnancy
8. Listening to Youth: The Experiences of Young People in Northern Uganda
9. A Measure of Success: Building Monitoring and Evaluation Capacity in Small, Community-based Programs. Lessons Learned from Three Youth Reproductive Health Programs in India
10. Program Scan Matrix on Child Marriage: A Web-based Search of Interventions Addressing Child Marriage
11. Summaries of Projects in Developing Countries Assisting the Parents of Adolescents
12. Women's Empowerment in Ethiopia: New Solutions to Ancient Problems
1. Accessing married adolescent women: the realities of ethnographic research in an urban slum environment in Dhaka, Bangladesh
2. Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial
3. Challenge of evaluating a national HIV prevention programme: the case of loveLife, South Africa
4. The impact of maternal experience of violence and common mental disorders on neonatal outcomes: a survey of adolescent mothers in Sao Paulo, Brazil
5. HIV risk perception and constraints to protective behaviour among young slum dwellers in Ibadan, Nigeria
6. Knowledge of HIV/AIDS, sexual behaviour and prevalence of sexually transmitted infections among female students of the University of Buea, Cameroon
7. Long-term protection against HBV chronic carriage of Gambian adolescents vaccinated in infancy and immune response in HBV booster trial in adolescence
8. A nested case-control study of sexual practices and risk factors for prevalent HIV-1 infection among young men in Kisumu, Kenya
9. Perceptions and practice with regard to reproductive health among out-of-school adolescents
10. Reaching disenfranchised youth and mobile populations in Ghana through voluntary counselling and testing services for HIV
11. Sex, condoms, gender roles, and HIV transmission knowledge among adolescents in Leon, Nicaragua: Implications for HIV prevention
12. Sexual practices of church youths in the era of HIV/AIDS: Playing the ostrich
13. Sexual risk-taking behaviors among boys aged 15-18 years in Tehran
14. Skinning the goat and pulling the load: transactional sex among youth in Dar es Salaam, Tanzania
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1. Exclusion, Gender and Education: Case Studies from the Developing World (2007; 230 pages; separate PDFs for the preface and eight chapters, each about 1 MB)
This book, a companion volume to a prior work (Inexcusable Absence), analyzes school enrollment, completion, and learning with case studies in seven countries. Case studies cover heterogeneous countries — Laos (Hmong Hill Tribes), China (ethnic minorities), Pakistan (Balouchi and other isolated tribes in outlying provinces), India (scheduled castes and scheduled tribes), and Guatemala (indigenous groups) — where girls from minority groups are especially disadvantaged and homogenous countries — Bangladesh and Tunisia — where girls are on a par with boys.
Organization: Center for Global Development
Contact: cgd@cgdev.org
2. Framework for Action on Adolescents and Youth. Opening Doors with Young People: 4 Keys (2007, PDF, 46 pages, 2.94 MB)
This document articulates UNFPA's strategy for working with governments and partners in promoting the development of young people worldwide. The "Four Keys" guiding UNFPA's efforts are creating a supportive policy environment; facilitating gender-sensitive, life-skills-based sexual and reproductive health (SRH) education; promoting a core package of SRH services; and fostering young people's leadership and participation.
Organization: UNFPA
Contact: youth@unfpa.org
3. Girls' Adolescence in Burkina Faso: A Pivot Point for Social Change (2007, PDF, 38 pages, 1.52 MB)
Adolescent girls in sub-Saharan Africa are clearly disadvantaged compared with their male counterparts. Burkinabé girls are frequently married at a young age, and more than one-third of married girls find themselves in polygamous unions as second or third wives, married to much older men. This report aims to fill gaps in our knowledge about adolescent Burkinabé girls so that we can better serve their needs.
Organization: Population Council
Contact: dwarn@popcouncil.org
4. Giving Girls Today and Tomorrow: Breaking the Cycle of Adolescent Pregnancy (2007, PDF, 24 pages, 3.08 MB)
This report highlights the issue of adolescent pregnancy among married and unmarried adolescent girls, especially those living in poverty. It draws attention to current trends, and the social, economic, and health consequences of adolescent pregnancy for the girls themselves and for their families and countries.
Organization: UNFPA
Contact: martinez@unfpa.org
5. Helping Parents in Developing Countries Improve Adolescents' Health (2007, PDF, 44 pages, 1.1 MB)
The WHO convened a meeting of researchers engaged in projects involving parenting of adolescents in developing countries. This document provides a summary of the discussions in the meeting, which highlight the importance of parents in preventing adolescent health risk behaviors, the ways in which parents influence these behaviors, and the implications for programs aiming to improve adolescent health.
Organization: WHO
Contact: cah@who.int
6. International Classification of Functioning, Disability and Health – Children and Youth Version (ICF-CY) (2007, 359 pages, available for purchase)
This publication is designed to help all those concerned with the health, education, and well being of children and youth record characteristics of the developing child and the influence of environments surrounding the child. It provides a common and universal language for clinical, public health, and research applications to facilitate the documentation and measurement of health and disability in child and youth populations.
Organization: WHO
Contact: bookorders@who.int
7. Learning from Adolescents to Prevent HIV and Unintended Pregnancy (2007, PDF, 6 pages, 417 KB)
This publication summarizes key findings of a multi-year, multi-country study on the scope of young people's sexual and reproductive health needs in Sub-Saharan Africa. According to the author, one major challenge developing countries face is that the United States undermines efforts to provide better sex education and other needed services by restricting how its foreign aid can be used.
Organization: Guttmacher Institute
Contact: info@guttmacher.org
8. Listening to Youth: The Experiences of Young People in Northern Uganda (2007, PDF, 16 pages, 1 MB)
This summary report is based on findings from a May 2007 assessment in northern Uganda in which the Women's Commission for Refugee Women and Children interviewed young people about the impact of war on their lives and prospects for the future, and their recommendations to local, national, and international actors.
Organization: Women's Commission for Refugee Women and Children
Contact: info@womenscommission.org
9. A Measure of Success: Building Monitoring and Evaluation Capacity in Small, Community-based Programs. Lessons Learned from Three Youth Reproductive Health Programs in India (2007, PDF, 20 pages, 2.22 MB)
Although numerous nongovernmental organizations are working to address youth's health needs, few have the data they need to show whether these programs are making a difference. Their limited financial and human capacity hinders systematic monitoring and evaluation of their programs.
Organization: International Center for Research on Women
Contact: info@icrw.org
10. Program Scan Matrix on Child Marriage: A Web-based Search of Interventions Addressing Child Marriage (2007, PDF, 25 pages, 185 KB)
This document is a companion to a 60-page report examining factors associated with risk of or protection against child marriage, as well as strategies and the effectiveness of current approaches in preventing child marriage in developing countries.
Organization: International Center for Research on Women
Contact: info@icrw.org
11. Summaries of Projects in Developing Countries Assisting the Parents of Adolescents (2007, PDF, 248 pages, 1.94 MB)
This document identifies and summarizes 34 projects around the world that aimed to help parents of adolescents in developing countries improve their children's health and development. Each summary includes the project objectives, donor, implementing partner, implementation and approach, interventions, resources used, evaluation, outcomes, lessons learned, and future plans.
Organization: WHO
Contact: cah@who.int
12. Women's Empowerment in Ethiopia: New Solutions to Ancient Problems (2007, PDF, 20 pages, 1.33 MB)
This paper documents the challenges and successes of two programs that combine increased access to reproductive health care and family planning with comprehensive social change. In collaboration with partners, community and religious leaders, and medical providers, these programs have advanced changes in law enforcement and community values to overcome harmful traditional practices.
Organization: Pathfinder International
Contact: tech-comm@pathfind.org
1. Accessing married adolescent women: the realities of ethnographic research in an urban slum environment in Dhaka, Bangladesh. Rashid SF. Field Methods 2007;19(4).
This article reports on the difficulties of obtaining reproductivehistories from women in the slums of Dhaka, the capital of Bangladesh.Access to women in these slums is controlled by several gatekeepers.The gatekeeper obstacle is common in all field research, butis particularly problematic when the research involvesinterviewing young Muslim women on the sensitive issue of reproductivehealth and family planning.
2. Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial. Ross DA, Changalucha J, Obasi AI, et al. AIDS 2007;21(14).
Twenty communities in rural Tanzania were randomly allocated to receive either a specially designed program of interventions (intervention group) or standard activities (comparison group). The intervention had four components: community activities; teacher-led, peer-assisted sexual health education in years 5-7 of primary school; training and supervision of health workers to provide 'youth-friendly' sexual health services; and peer condom social marketing. Impacts on HIV incidence, herpes simplex virus 2 (HSV2) and other sexual health outcomes were evaluated over approximately three years in 9,645 adolescents recruited in late 1998 before entering years 5, 6, or 7 of primary school. The intervention had a significant impact on knowledge and reported attitudes, reported symptoms of sexually transmitted infection, and several behavioral outcomes. Only five HIV seroconversions occurred in boys, whereas in girls the adjusted rate ratio (intervention versus comparison) was 0.75 [95% confidence interval (CI) 0.34, 1.66]. Overall HSV2 prevalences at follow-up were 11.9% in male and 21.1% in female participants, with adjusted prevalence ratios of 0.92 (CI 0.69, 1.22) and 1.05 (CI 0.83, 1.32), respectively. There was no consistent beneficial or adverse impact on other biological outcomes. The beneficial impact on knowledge and reported attitudes was confirmed by results of a school examination in a separate group of students in mid-2002. The intervention substantially improved knowledge, reported attitudes, and some reported sexual behaviors, especially in boys, but had no consistent impact on biological outcomes within the three-year trial period.
3. Challenge of evaluating a national HIV prevention programme: The case of loveLife, South Africa. Pettifor AE, MacPhail C, Bertozzi S, et al. Sex Transm Infect 2007;83(Suppl 1).
In 1999, a national HIV prevention program for youth, called loveLife, was launched in South Africa. This paper describes the challenges faced in trying to evaluate such a program and the types of evidence that could be used to better understand the effect of programs of national scale. A range of methods were planned to evaluate the program, including national household surveys and program monitoring data. Given the urgent need to scale-up programs in an effort to reduce new HIV infections, a range of evidence should be assessed to measure the effect of large-scale, complex behavioral interventions as an alternative to randomized controlled trials.
4. The impact of maternal experience of violence and common mental disorders on neonatal outcomes: a survey of adolescent mothers in Sao Paulo, Brazil. Ferri CP, Mitsuhiro SS, Barros MC, et al. BMC Public Health 2007 Aug 16;7(Article No.209).
The aim of this study was to investigate the independent and interactive effects of maternal exposure to violence and depression upon neonatal outcomes among pregnant adolescents in a disadvantaged population from Sao Paulo, Brazil. The authors recruited 930 consecutive pregnant teenagers admitted for delivery. Violence was assessed using the Californian Perinatal Assessment. Mental illness was measured using the Composite International Diagnostic Interview (CIDI). Apgar scores of newborns were estimated and their weight measured. About 22% of mothers reported lifetime violence (2% during pregnancy), and 24.3% had a common mental disorder in the past 12 months. The exposures were correlated and each was associated with low education. Lifetime violence was strongly associated with Common Mental Disorders. Violence during pregnancy (PR = 2.59(1.05-6.40) and threat of physical violence (PR = 1.86(1.03-3.35) and any common mental disorders (PR = 2.09 (1.21-3.63) (as well as depression, anxiety and PTSD separately) were independently associated with low birth weight. Efforts to improve neonatal outcomes in low-income countries may be neglecting two important independent but correlated risk factors: maternal experience of violence and common mental disorder.
5. HIV risk perception and constraints to protective behaviour among young slum dwellers in Ibadan, Nigeria. Adedimeji AA, Omololu FO, Odutolu O. J Health Popul Nutr 2007;25(2).
Multistage sampling techniques were used to select 1,600 urban slum dwellers, aged 15-24 years, in Ibadan. Of these, 1,042 (65%) respondents who reported unprotected sex in the last three months were selected for analysis. Although the sexually active respondents demonstrated basic knowledge of HIV/AIDS and high risk perception, risky behavior was common and protective behavior was poor. About 48% of 505 males and 12% of 537 females had multiple partners. Similarly, 29% of males and 38% of females were engaged in transactional sex. Only 14% of males and 5% of females used any form of protection, resulting in the high rates of sexually transmitted infections reported by 27% of males and 10% of females. Structural and environmental constraints were identified as barriers to adopting protective behavior. Therefore, program and policy interventions should be designed to address the peculiar circumstances of young urban slum dwellers to curtail the HIV epidemic.
6. Knowledge of HIV/AIDS, sexual behaviour and prevalence of sexually transmitted infections among female students of the University of Buea, Cameroon. Nkuo-Akenji T, Nkwesheu A, Nyasa R, et al. Afr J AIDS Res 2007;6(2).
The authors conducted a cross-sectional study involving the analysis of a questionnaire completed by 522 female students and the voluntary testing of 108 sexually active females for HIV, syphilis, chlamydia, and gonorrhea. Knowledge of the protective effects of abstinence, condom use, and fidelity were independent of sexual practices (OR = 0.86, p = 0.611, f = 0.22; OR = 1.26, p = 0.213, f = 0.05; and OR = 1.18, p = 0.344, f = 0.029, respectively). The prevalence of HIV, syphilis, chlamydia, and gonorrhea among the participants tested was 3.9%, 6.1%, 24.1% and 30.1%, respectively. The authors conclude that the relatively high prevalence of STIs among female students of the University of Buea stems from inadequate knowledge of the major modes of STI/HIV transmission and inadequate use of preventive methods.
7. Long-term protection against HBV chronic carriage of Gambian adolescents vaccinated in infancy and immune response in HBV booster trial in adolescence. van der Sande MA, Waight PA, Mendy M, et al. PLoS ONE 2007;2(8).
Chronic infection with hepatitis B virus (HBV) arising in childhood is associated with hepatocellular carcinoma in adult life. Between 1986 and 1990, approximately 120,000 Gambian newborns were enrolled in a randomized controlled trial to assess the effectiveness of infant HBV vaccination on the prevention of hepatocellular carcinoma in adulthood. These children are now in adolescence and approaching adulthood, when the onset of sexual activity may challenge their hepatitis B immunity. Thus a booster dose in adolescence could be important to maintain long-term protection. Fifteen years after the start of the HBV infant vaccination study, 492 vaccinated and 424 unvaccinated children were identified to determine vaccine efficacy against infection and carriage in adolescence. At the same time, 297 of the 492 infant-vaccinated subjects were randomly offered a booster dose of HBV vaccine. Anti-HBs was measured before the booster, and two weeks and 1 year after. Vaccine efficacy 15 years after vaccination was 67.0% against infection as manifest by anti-HBc positivity (95% CI 58.2-74.6%), and 96.6% against HBsAg carriage (95% CI 91.5-100%). About 31% of participants had detectable anti-HBs with a GMC of 32 IU/l. For 168 boosted participants, GMC anti-HBs responses were 38 IU/l prior to vaccination, 524 IU/l two weeks after boosting, and 101 IU/l after 1 year. The authors conclude that HBV vaccination in infants confers very good protection against carriage up to 15 years of age, although a large proportion of vaccinated subjects did not have detectable anti-HBs at this age. The response to boosting persisted for at least a year.
8. A nested case-control study of sexual practices and risk factors for prevalent HIV-1 infection among young men in
This study investigated the sexual practices and risk factors for prevalent HIV infection among young men in Kisumu, Kenya with the goal of identifying behaviors associated with HIV. Lifetime sexual histories were collected from a nested sample of 1,337 uncircumcised participants within the context of a randomized controlled trial of male circumcision to reduce HIV incidence. Sixty-five men (5%) tested positive for HIV. Multiple logistic regression revealed the following independent predictors of HIV: older age, less education, being married, being Catholic, >4 lifetime sex partners, prior treatment for an STI, sex during partner's menstruation, ever practicing bloodletting, and receipt of a medical injection in the last six months. Prior HIV testing and postcoital cleansing were protective.
9. Perceptions and practice with regard to reproductive health among out-of-school adolescents. Kushwah SS, Mittal A. Indian J Community Med 2007;32(2).
The Ministry of Health and Family Welfare in Madhya Pradesh, India recently implemented a reproductive health program for out-of-school adolescents. This study assessed the knowledge gained by adolescents who participated in the program, the attitude of adolescents toward reproductive and sexual health, and resulting behavior of the adolescents who participated.
10. Reaching disenfranchised youth and mobile populations in Ghana through voluntary counselling and testing services for HIV. Wyss S, Ablordeppey J, Okrah J, et al. Afr J AIDS Res 2007;6(2).
This paper documents the evaluation of a 20-month project to provide voluntary counseling and testing (VCT) to a mobile population of youth surrounding the Agbogbloshie market in Accra, Ghana. The specific objectives of the evaluation were to determine: 1) to what extent targets for providing VCT services to the specified population were reached; 2) how HIV prevalence among clients compared to that of the general population; 3) to what extent former clients self-reported behavior change; and 4) whether useful lessons could be drawn regarding fees, hours, and location of services, as well as use of peer educators to increase use of VCT services among the target population. Various methodologies, including questionnaires, focus group discussions, a review of the service statistics, and an exit poll of clients were used to evaluate the project. The service statistics demonstrated that the project exceeded the life-of-project target for number of clients by nearly 40%. Prevalence for the VCT client population (aged 15–25) was higher than for the general population (aged 15–24), although the gender differentials were similar. Focus group data suggested that clients may have adopted behavior changes as a result of VCT. Finally, focus group discussions and VCT service trends showed that the high number of clients was largely influenced by three factors: services being free, location and hours of services being convenient to the target population, and use of peer educators to promote the services. In addition, the evaluation highlighted the importance of the counseling component of VCT, even as counseling can get short-changed at the expense of HIV testing when large numbers of clients are involved. The evaluation stressed the need to appropriately remunerate peer educators for their work whenever possible. Finally, VCT programs continue to face challenges such as HIV stigma as a barrier to people coming to be counseled and tested; insufficient availability of medication, support, and services for HIV-positive clients; and difficulty of ensuring the sustainability of VCT programs.
11. Sex, condoms, gender roles, and HIV transmission knowledge among adolescents in Leon, Nicaragua: Implications for HIV prevention. Manji A, Pena R, Dubrow R. AIDS Care 2007;19(8).
A population-based cross-sectional survey was conducted among 246 adolescents in Leon, Nicaragua. In many respects, Leon adolescents were typical of those in other Latin American countries, with a mixture of correct and incorrect knowledge about transmission of HIV and sexually transmitted infections, a higher proportion of males than females reporting having had sex or using condoms, and inconsistent condom use. While some sexual attitudes conformed to the ideology of machismo, others did not, providing an opening for prevention interventions. Some dimensions of HIV/AIDS stigma were high, and most adolescents disapproved of same-sex sexual behavior. Intervention against homosexuality-related stigma is particularly urgent because a concentrated HIV epidemic may be emerging in Nicaragua among men who have sex with men. Personal religious beliefs did not appear to pose a barrier to condom use. In a multivariate model, being out of school was a significant correlate of having had sex and of insufficient HIV/AIDS-related knowledge. Accordingly, HIV prevention interventions must reach adolescents both in and out of school. A multi-component approach to prevention is needed, including programs based in schools, communities, the mass media, and health facilities.
12. Sexual practices of church youths in the era of HIV/AIDS: Playing the ostrich. Nweneka CV. AIDS Care 2007;19(8).
The church could be a powerful force for social and behavioral change, particularly in the current efforts to combat the HIV/AIDS pandemic. Anecdotal evidence suggests that church youths are sexually active but few studies have documented the sexual practices of these youths. This article looks at the sexual practices of 341 youths in two churches in southern Nigeria. Sixty-five percent were sexually experienced. Two males initiated sexual activity at the ages of seven and nine years, while three females initiated sexual activity at eight years and another one at nine years. In all, seven youths, or 3.2% of the sexually experienced respondents, initiated sexual activity before the age of ten years and approximately 12% before 15 years of age. By 19 years of age, 42% of the females and 44% of the males had become sexually active. In the 12 months preceding the study, 19% of the sexually experienced youths abstained from sex, 30% had one sexual partner, and 28% had more than one sexual partner. Sixty percent had used condoms, and 24% of these young people used them always. These results suggest that sexual practices of committed church youths might be similar to those of youths in the wider society. More might be achieved by a proactive engagement of the church in young people's sexual and reproductive health matters.
13. Sexual risk-taking behaviors among boys aged 15-18 years in Tehran. Mohammad K, Farahani FK, Mohammadi MR, et al. J Adolesc Health 2007;41(4).
Data were collected with a population-based, cross-sectional survey of adolescent males in Tehran, Iran. Of 1,385 subjects, 382 reported sexual experience (27.7%). Two factors were considered as sexual risk-taking behavior (not using condom or inconsistent condom use in sexual contacts and ever had multiple sexual partners in lifetime). Several other factors were considered as independent variables and their relations were assessed using t test, chi2 test, and logistic regression models. Predictors of condom non-use included having no access to the Internet, feeling regretful at sexual debut, having one sexual partner in lifetime, and lower knowledge of condoms. Predictors of multiple sexual partners among adolescent boys included older age, drinking alcohol, early sexual debut, and poor knowledge of reproductive physiology. The authors conclude that appropriate intervention programs should (1) encourage and enable Iranian boys to delay first sex and abstain from unwanted and unplanned penetrative sex, (2) stress the health risks of alcohol use in terms of sexual health, and (3) enhance their knowledge about different aspects of reproductive health, particularly STI/HIV prevention.
14. Skinning the goat and pulling the load: transactional sex among youth in Dar es Salaam, Tanzania. Maganja RK, Maman S, Groues A, et al. AIDS Care 2007;19(8).
This paper sheds light on the broader context of sexual relationships among youth at risk for HIV, how transactional sex plays out in these relationships, and how the transactional nature of relationships affects women's risk for HIV. The authors conducted 60 in-depth interviews and 14 focus group discussions with young men and women, 16-24 years old, in Dar es Salaam, Tanzania. These data guided the development of a community-based HIV and violence prevention intervention for young men. Youth described the exchange of sex for money or other material goods in all types of sexual relationships. While the exchange was explicit in casual relationships, young women voiced material and monetary expectations from their committed partners as well. Young men described their pursuit of multiple partners as sexually motivated, while women sought multiple partners for economic reasons. Young men were aware of the expectations of material support from partners, and acknowledged that their ability to provide for a partner affected both the longevity and exclusivity of their relationships. Youth described a deep mistrust of the motivations and commitment of their sexual partners. Furthermore, young women's financial dependence on men affected their ability to negotiate safe sexual behaviors in both casual and committed relationships. Programs designed to reduce HIV risk among Tanzanian youth need to take into account the transactional component of sexual relationships and how such exchanges differ according to partner type.
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