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1. Addressing the Vulnerability of Young Women and Girls to Stop the HIV Epidemic in Southern Africa
2. Assessment of Youth-Friendly Postabortion Care Services: A Global Tool for Assessing and Improving Postabortion Care for Youth
3. Break the Silence — Prevent Sexual Exploitation and Abuse in and around Schools in Africa
4. Children and AIDS: Third Stocktaking Report
5. Generation of Change: Young People and Culture
6. Marriage Considerations in Sending Girls to School in Bangladesh: Some Qualitative Evidence
7. Painful Lessons: The Politics of Preventing Sexual Violence and Bullying at School
8. Pathfindings: Youth-Friendly Postabortion Care Services in Africa
9. Peer Education in Sexual and Reproductive Health for HIV-positive Youth in Romania: Pilot Project – Final Report
10. Promoting Adolescent Sexual and Reproductive Health in East and Southern Africa
11. Recovery and Reintegration of Children from the Effects of Sexual Exploitation and Related Trafficking
12. Rethinking how to Prevent HIV in Young People
13. Saving Young Lives: Pathfinder International's Youth-Friendly Postabortion Care Project
14. Trends and Determinants of Adolescent Childbearing in Bangladesh
15. What's in the Gap?: Factors Associated with the Interval between Age at First Sex and Age at First Marriage in Cameroon and their Implications for Reproductive Health and Women's Empowerment
16. You, Your Life, Your Dreams — A Book for Caribbean Adolescents
17. Youth Reproductive and Sexual Health
1. Age differences at sexual debut and subsequent reproductive health: Is there a link?
2. Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability
3. Condom use at last sex as a proxy for other measures of condom use: is it good enough?
4. Education and vulnerability: the role of schools in protecting young women and girls from HIV in southern Africa
5. Effectiveness of peer education in HIV/STD prevention at different types of senior high schools in Shanghai, People's Republic of China
6. Effects and effectiveness of life skills education for HIV prevention in young people
7. The epidemiology of HIV infection among young people aged 15-24 years in southern Africa
8. Factors associated with lack of antiretroviral adherence among adolescents in a reference centre in Rio de Janeiro, Brazil
9. Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched nonpledgers
10. Risky sexual practices among youth attending a sexually transmitted infection clinic in Dar es Salaam, Tanzania
11. Sexual behaviour of rural college youth in Maharashtra, India: an intervention study
12. “They have opened our mouths”: increasing women's skills and motivation for sexual communication with young people in rural South Africa
13. The unintended consequences of intended pregnancies: youth, condom use, and HIV transmission in Mozambique
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1. Addressing the Vulnerability of Young Women and Girls to Stop the HIV Epidemic in Southern Africa (2008, 26 pages, 11.3 MB)
This document provides a summary of the evidence, the research gaps, and the actions required to turn the AIDS epidemic around for girls and young women in southern Africa. It addresses the current status of the epidemic in the region, including the impact of age disparate and intergenerational sex, biological vulnerability, economic empowerment, education, and gender-based violence.
Organization: UNAIDS Regional Support Team for Eastern and Southern Africa
Contact: http://www.unaidsrstesa.org/contact_us
2. Assessment of Youth-Friendly Postabortion Care Services: A Global Tool for Assessing and Improving Postabortion Care for Youth (2008, 34 pages, 4.7 MB)
This tool is designed to help assessment teams, project managers, supervisors, and providers collect detailed information on the quality of postabortion care (PAC) services provided to adolescents at specific facilities in order to make those services more youth friendly.
Organization: Pathfinder International
Contact: tech-comm@pathfind.org
3. Break the Silence — Prevent Sexual Exploitation and Abuse in and around Schools in Africa (2008, 16 pages, 979 KB)
This publication presents a brief overview of the sexual exploitation and abuse that occur in and around schools in Africa. This abuse impedes children's rights to protection, education, and non-discrimination as set out in the Convention on the Rights of the Child. The authors recommend priority actions for children, families, aid agencies, and governments to take in response to this problem.
Organization: Plan International
Contact: http://www.plan-international.org/about/contact
4. Children and AIDS: Third Stocktaking Report (2008, 48 pages, 1.9 MB)
This report examines progress, emerging evidence, and current knowledge and practice of preventing mother-to-child transmission of HIV, providing pediatric HIV care and treatment, preventing infection among adolescents and young people, and protecting and supporting children affected by HIV and AIDS. The document also provides the latest child-specific statistics and analysis and calls for several focused, achievable actions that can significantly improve prospects for children and women.
Organization: UNICEF, UNAIDS, WHO, UNFPA
Contact: aidscampaign@unicef.org
5. Generation of Change: Young People and Culture (2008, 56 pages, 3 MB)
The youth supplement to the State of the World's Population report addresses how culture shapes and nurtures the lives of young people. It describes how young people develop their own subcultures, which are often different from and may conflict with the dominant culture. The supplement includes stories of youth facing child marriage, challenging gender norms, and working to improve their lives and the world.
Organization: UNFPA
Contact: martinez@unfpa.org
6. Marriage Considerations in Sending Girls to School in Bangladesh: Some Qualitative Evidence (2008, 21 pages, 490 KB)
This paper analyzes how parents' decisions about their daughters' schooling were affected by the rise in dowry demands in two villages in Northern Bangladesh. The influence of programs such as secondary school scholarships for girls is best viewed in the context of familial concerns about marriage and dowry.
Organization: Population Council
Contact: pubinfo@popcouncil.org
7. Painful Lessons: The Politics of Preventing Sexual Violence and Bullying at School (2008, 92 pages, 728 KB)
This paper identifies policies, programs, and legal instruments that address school violence in the developing world. It also draws implications for related policy, practice, and research.
Organization: Overseas Development Institute, Plan International
Contact: publications@odi.org.uk
8. Pathfindings: Youth-Friendly Postabortion Care Services in Africa (2008, 6 pages, 111 KB)
This brief provides a short summary of findings from Pathfinder's Youth-Friendly Postabortion Care Project, which was implemented in eight African countries.
Organization: Pathfinder International
Contact: tech-comm@pathfind.org
9. Peer Education in Sexual and Reproductive Health for HIV-positive Youth in Romania: Pilot Project – Final Report (2007, 14 pages, 133 KB)
This report describes the results of a pilot intervention aimed at building the institutional capacity of organizations that provide peer education about sexual and reproductive health to HIV-positive youth in Romania.
Organization: JSI Research and Training Institute, UNOPA
Contact: http://www.unopa.ro/index.php?c=contact
10. Promoting Adolescent Sexual and Reproductive Health in East and Southern Africa (2008, 344 pages, each chapter can be downloaded individually)
The authors of this volume comprise a network of researchers working in east and southern Africa. They discuss perspectives on adolescent sexual and reproductive health from both the social and biomedical sciences and provide concrete empirical evidence from existing programs. With its careful analysis of what does and does not work at the local level, this book can be a useful tool for academics, practitioners, policy-makers, and program managers.
Organization: Nordiska Afrikainstitutet, Sweden and HSRC Press
Contact: http://www.hsrcpress.ac.za/help.php?section=contactus&mode=update
11. Recovery and Reintegration of Children from the Effects of Sexual Exploitation and Related Trafficking (2008, 55 pages, 256 KB)
Many experts believe that the international community is failing overall to meet the recovery and reintegration needs of children who have been sexually exploited or trafficked. This report discusses strategies for improving the world's response to exploited children and challenges and barriers that must be addressed.
Organization: Oak Foundation
Contact: cap@oakfnd.ch
12. Rethinking how to Prevent HIV in Young People (2008, 6 pages, 124 KB)
This brief examines the results and policy implications of two major randomized controlled intervention trials on adolescent sexual and reproductive health. These trials found that the interventions successfully increased young people's knowledge about how to prevent HIV. However, increased knowledge did not lead to a decrease in HIV prevalence. The authors conclude that other interventions in addition to education, such as changing social norms, are needed to reduce HIV in young people.
Organization: MEMA kwa Vijana
Contact: http://www.memakwavijana.org/contacts.html
13. Saving Young Lives: Pathfinder International's Youth-Friendly Postabortion Care Project (2008, 28 pages, 1.5 MB)
This report describes Pathfinder's recent experience implementing the Youth-Friendly Postabortion Care (YFPAC) Project in eight African countries. The document is a longer companion piece to Pathfindings: Youth-Friendly Postabortion Care Services in Africa. It contains program descriptions, an overview of the process of making PAC services youth friendly, key results, challenges, lessons learned, and recommendations.
Organization: Pathfinder International
Contact: tech-comm@pathfind.org
14. Trends and Determinants of Adolescent Childbearing in Bangladesh (2008, 32 pages, 180 KB)
Using four sets of Bangladesh Demographic and Health Survey data collected during 1993-1994, 1996-1997, 1999-2000, and 2004, the authors examine the trends and determinants of adolescent childbearing in Bangladesh.
Organization: Opinion Research Corp. Macro International Inc. (ORC Macro)
Contact: reports@macrointernational.com
15. What's in the Gap?: Factors Associated with the Interval between Age at First Sex and Age at First Marriage in Cameroon and their Implications for Reproductive Health and Women's Empowerment (2008, 30 pages, 98 KB)
Recent research on reproductive and sexual health has focused on age at marriage as a determinant of an array of population and health outcomes. The authors propose that for many reproductive health concerns, it is not age at marriage that should be the focus of analysis but rather the number of years that have elapsed between sexual debut and marriage. This paper explores the factors associated with the length of the interval between initiation of sex and formation of a union in order to gain insight into this aspect of women's reproductive lives.
Organization: Opinion Research Corp. Macro International Inc. (ORC Macro)
Contact: reports@macrointernational.com
16. You, Your Life, Your Dreams — A Book for Caribbean Adolescents (2008; document is divided into several PDFs, of which the smallest is 98 KB and the largest 1.3 MB)
This is an educational resource for young people and for staff in government ministries, youth clubs, family planning agencies, and other organizations that work with youth. Easy to read and visually attractive, the document provides accessible, objective information on a broad range of issues relating to adolescent sexual and reproductive health. Originally developed for use in English-speaking Africa and now available in four languages, it was extensively adapted to reflect both the unique challenges facing young people in Caribbean nations and the sub-region's multi-ethnic culture.
Organization: Family Care International
Contact: publications@familycareintl.org
17. Youth Reproductive and Sexual Health (2008, 107 pages, 596 KB)
This report exposes gaps in basic health knowledge among youth around the world. The study compares key reproductive and sexual health indicators for young women and men ages 15–24 in 38 developing countries throughout Africa, Asia, Latin America, and the Caribbean. The data come from Demographic and Health Surveys and AIDS Indicator Surveys conducted between 2001 and 2005.
Organization: Macro International
Contact: reports@macrointernational.com
1. Age differences at sexual debut and subsequent reproductive health: Is there a link? Gomez AM, Speizer IS, Reynolds H, et al. Reprod Health 2008;5(Article No. 8):8 p.
The authors studied whether sexual debut with an older partner had subsequent reproductive health outcomes among 599 sexually experienced women aged 15–24 in Port-au-Prince, Haiti. Logistic regression models, controlling for socioeconomic and demographic factors, were used to examine whether age differences at first sex were significantly associated with diagnosis of sexually transmitted infections (STI) in the previous 12 months and family planning method use at last intercourse. Sixty-five percent of women reported sexual initiation with a partner younger or less than five years older, 28% with a partner five to ten years older, and 7% with a partner ten or more years older. There was a trend toward decreased likelihood of recent use of family planning methods in women who had first sexual intercourse with a partner five to nine years older compared to women with partners who were younger or less than five years older. Age differences were not linked to recent STI diagnosis.
2. Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability. Leclerc-Madlala S. AIDS 2008;22(Suppl 4):S17-25.
This paper reviews the current state of knowledge on age-disparate sexual relationships in the context of the southern African HIV/AIDS epidemic. Studies reveal a complex interplay of meanings and motives that prompt both men and women across socioeconomic strata to engage in intergenerational sex. Age-disparate relationships are meaningful and perceived as beneficial at a number of levels, including social, physical, psychological, as well as economic and symbolic. Relationships with older men are a common and readily available way for young women to gain materially, affirm self-worth, achieve social goals, increase longer-term life chances, or otherwise add value and enjoyment to life. Awareness of HIV risks in these relationships remains low. HIV prevention policies and programs need to understand how those engaged in risky behavior perceive their sexual relationships and conceptualize the choices they make and the strategies they use.
3. Condom use at last sex as a proxy for other measures of condom use: is it good enough? Younge SN, Salazar LF, Crosby RF, et al. Adolescence 2008;43(172):927-31.
Condom use at last sex is a widely used indicator in sexual behavior research; however, there is little empirical research validating this indicator. This study examined whether a single-event recall period (the last time coitus occurred) was consistent with longer recall periods (14 days and 60 days) for a sample of 566 African American adolescent females. The findings from this study demonstrate that condom use at last coitus is a valid proxy for condom use behaviors spanning longer time periods.
4. Education and vulnerability: the role of schools in protecting young women and girls from HIV in southern Africa. Jukes M, Simmons S, Bundy D. AIDS 2008;22(Suppl 4):S41-56.
This analysis combines the results of previous literature reviews and updates them with the findings of recent randomized controlled trials about the effect of schooling on vulnerability to HIV infection. There is a growing body of evidence that keeping girls in school reduces their risk of contracting HIV. The relationship between educational attainment and HIV has changed over time, with educational attainment now more likely to be associated with a lower risk of HIV infection than it was earlier in the epidemic. Educational attainment cannot, however, be isolated from other socioeconomic factors as the cause of HIV risk reduction. The findings of this analysis suggest that the equitable expansion of primary and secondary schooling for girls in southern Africa will help reduce their vulnerability to HIV. Evidence of ineffective HIV prevention education in schools also underlines the need for careful evidence-based program design. Despite the challenges, recent evidence suggests that highly targeted programs promoting realistic options for young adults may lead to safer sexual behavior. Targeted education programs have also been successful in changing students' attitudes to people living with HIV and AIDS, which is associated with testing and treatment decisions.
5. Effectiveness of peer education in HIV/STD prevention at different types of senior high schools in Shanghai, People's Republic of China. Shen LX, Hong H, Cai Y, et al. Int J STD AIDS 2008;19(11):761-7.
A peer education intervention was conducted in several different types of senior high schools, including three key senior schools, four ordinary senior schools, and three vocational schools in Shanghai for three months. A cohort of 1,910 students was surveyed (n = 976 intervention group, n = 934 control group) through anonymous questionnaires, both pre- and post-intervention. There were significant differences in the results among students from these different types of schools. Peer education is an efficient method of increasing high school students' knowledge of AIDS and other sexually transmitted infections. However, the content and the schedule of educational programs should be modified according to the needs of students at different types of schools. Students in vocational schools require more health education.
6. Effects and effectiveness of life skills education for HIV prevention in young people. Yankah E, Aggleton P. AIDS Educ Prev 2008;20(6):465-85.
This review of the literature on the effects and effectiveness of life skills education for HIV prevention identified a surprising number of rigorously designed and evaluated interventions from Africa, Latin America, Asia, and the Pacific. Most interventions used life skills training as a component of an overall education strategy. Programs worked best to positively influence knowledge, attitudes, intentions, skills, and abilities. Programs rarely produced consistent effects on sexual behavior. Also, life skills training had little effect on biological outcomes. The narrow focus on achieving behavioral outcomes may cause a failure to document other positive impacts.
7. The epidemiology of HIV infection among young people aged 15-24 years in southern Africa. Gouws E, Stanecki KA, Lyerla R, et al. AIDS 2008;22(Suppl 4):S5-16.
Data on HIV prevalence among young people in the general population were obtained from national population-based surveys conducted between 2000 and 2007, and data on sexual behavior were obtained from repeat surveys between 1994 and 2007. The authors also used linear or exponential regression to analyze HIV prevalence trends among young women attending antenatal clinics in recent years. Patterns of HIV infection among young people are similar across the countries included in this analysis. The prevalence of HIV increased after the age of 15 years, more rapidly among women than among men, reaching a peak among women in their twenties and men in their thirties. Between 2000 and 2007 the prevalence of HIV among antenatal clinic attendees was constant in Mozambique and South Africa and declined in Lesotho, Namibia, Swaziland, Zambia, Botswana, Malawi, and Zimbabwe, but only reached statistical significance (P < 0.05) in the last three. Changes toward safer sexual behavior were observed over time among young men and women in the general population in this region.
8. Factors associated with lack of antiretroviral adherence among adolescents in a reference centre in Rio de Janeiro, Brazil. Filho LF, Nogueira SA, Machado ES, et al. Int J STD AIDS 2008;19(10):685-8.
This cross-sectional study included adolescents (101 people aged 10–19 years) followed at Instituto de Puericultura e Pediatria Martagao Gesteira and Hospital Universitario Clementino Fraga Filho. Adherence was determined by self-report (number of missed antiretroviral therapy [ART] doses in three days prior to the interview). Adherence was categorized as taking ≥ 95% of the ARTs (adherent), or < 95% (nonadherent). The mean time on ART was 91 months, and the mean adherence was 94% (21 were nonadherent, 80 were adherent). The risk factors associated with nonadherence were if the patient was not concerned about ART, odds ratio (OR) = 3.47 (95% confidence interval [CI] = 1.13-10.68); if they did not carry an extra dose of ART, OR = 6.63 (95% CI = 1.73-25.47); and if a health-care worker taught them how to take ART, OR = 0.27 (95% CI = 0.08-0.93). Adherence among adolescents was higher than expected. Factors associated with lack of adherence were interviewees being unaware of ART and lack of commitment to the treatment.
9. Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched nonpledgers. Rosenbaum JE. Pediatrics 2009;123(1):e110-20.
This study compares the sexual activity of adolescent virginity pledgers with matched nonpledgers. The subjects for this study were National [U.S.] Longitudinal Study of Adolescent Health respondents, a representative sample of middle and high school students who, when surveyed in 1995, had never had sex, had not taken a virginity pledge, and were >15 years of age (n = 3,440). Adolescents who reported taking a virginity pledge on the 1996 survey (n = 289) were matched with nonpledgers (n = 645) by factors including prepledge religiosity and attitudes toward sex and contraception. Five years after the pledge, they compared pledgers and matched nonpledgers on self-reported sexual behaviors and positive test results for chlamydia trachomatis, neisseria gonorrhoeae, and trichomonas vaginalis, and safer sex outside of marriage by use of contraception and condoms in the past year and at last sex. Five years after the pledge, 82% of pledgers denied having ever pledged. Pledgers and matched nonpledgers did not differ in premarital sex, sexually transmitted infections, and anal and oral sex variables. Pledgers had 0.1 fewer past-year partners but did not differ in lifetime sexual partners and age of first sex. Fewer pledgers than matched nonpledgers used contraception and condoms in the past year or contraception at last sex. The author concludes that the sexual behavior of virginity pledgers does not differ from that of closely matched nonpledgers, and pledgers are less likely to protect themselves from pregnancy and infection before marriage. Virginity pledges may not affect sexual behavior but may decrease the likelihood of taking precautions during sex.
10. Risky sexual practices among youth attending a sexually transmitted infection clinic in Dar es Salaam, Tanzania. Urassa W, Moshiro C, Chalamilla G, et al. BMC Infect Dis 2008;8(Article No.159):6 p.
The authors recruited 18- to 25-year-olds who were attending a sexually transmitted infection (STI) clinic. Social, sexual, and demographic characteristics were elicited using a structured standard questionnaire. Blood samples were tested for syphilis and HIV infections. Urethral, high vaginal, and cervical swabs were screened for common STI agents. A total of 304 youth were studied with mean age of 21.5 and 20.3 years for males and females, respectively. The mean age of first sex was 16.4 and 16.2 years for males and females, respectively. The first sexual partner was significantly older in females compared to male youth (23.0 vs. 16.8 years). About 93% of male youth reported more than one sexual lifetime partner compared to 63.0% of the females. Only 50% of males compared to 43% of females had ever used a condom and fewer than 8.3% of female youth used other contraceptive methods. Twenty-seven percent of pregnancies were unplanned and 60% of abortions were induced. Forty-two percent of female youth had received gifts or money for sexual favors. The HIV prevalence was 15.3% and 7.5% for females and males, respectively. The prevalence of other STIs was relatively low. Among male youth, use of alcohol or illicit drugs was associated with increased risk of HIV infection. However, the age of sexual initiation, number of sexual partners, or the age of the first sexual partner were not associated with increased risk of being HIV infected.
11. Sexual behaviour of rural college youth in Maharashtra, India: an intervention study. Ghule M, Donta B. J Reprod Contracept 2008;19(3):167-89.
The authors conducted an intervention study that consisted of a sample of 1,500 students (800 male and 700 female) at baseline and 1,953 (1,022 male and 931 female) students in post-intervention from eight colleges in Thane district of Maharashtra. The interventions included dissemination of information, education, and communication (IEC) materials; counseling in colleges; and provision of health care services at rural health centers in the experimental area. Male and female teachers and peer leaders were trained to provide IEC. Results showed that overall sexual experience (coital and non-coital) increased by 2.6% among male students in the control group and 1.0% among male students in the intervention group, and by 4.6% among female students in control group and 0.8% among female students in the intervention group. A significant improvement was noted in the use of condoms in the intervention group.
12. “They have opened our mouths”: increasing women's skills and motivation for sexual communication with young people in rural South Africa. Phetla G, Busza J, Hargreaves JR, et al. AIDS Educ Prev 2008;20(6):504-18.
This article presents findings from South Africa, where a social intervention to reduce levels of HIV and intimate partner violence actively promoted sexual communication between adults and young people. The authors assessed this component of the program using quantitative and qualitative methods, collecting data through surveys, direct observation, interviews, and focus group discussions. Women participating in intervention activities reported sexual communication with children significantly more often than matched women in the control group (80.3% vs. 49.4%). The content of communication with young people also appears to have shifted from vague admonitions about the dangers of sex to concrete messages about reducing risks. The congruence between these findings and existing literature on parent-child sexual communication suggests that conceptual frameworks and programs from developed settings can be adapted effectively for resource-poor contexts.
13. The unintended consequences of intended pregnancies: youth, condom use, and HIV transmission in Mozambique. Speizer IS, White JS. AIDS Educ Prev 2008;20(6):531-46.
Although unintended pregnancies can cause social and economic problems for sub-Saharan African youth, the consequences of intended adolescent pregnancies have gone unnoticed. This study uses data from the 2003 Mozambique Demographic and Health Survey to explore youth fertility desires and condom use. In multivariate analyses, controlling for other factors associated with condom use, female youth who want to get pregnant soon are significantly less likely to use condoms with nonmarital partners than youth who want to delay childbearing. Programs for sexually active youth should recognize the importance of fertility desires as a potential moderator of condom use, even if the woman is at risk of HIV or STI. Recommendations are provided for HIV prevention counseling for youth who want to get pregnant and youth who are ambivalent about a future pregnancy.
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