• Editors' Summary
• Credits

1. The Invisible Epidemic
2. How Young People Become Infected
3. Why So Vulnerable?
4. Addressing the Epidemic
• Towards an Enabling Environment
• AIDS Education
• Mass Media Communication
• Condom Use
• Voluntary Counseling, Testing, and Referral
• HIV Treatment and Care
• Youth Livelihood Approaches
5. Reaching Out
6. Consequences of Inaction
7. HIV/AIDS: What Young People Want to Know
8. Profiles
9. Youth at the Center

• Figures
• Tables
• Side-bars
• Bibliography

• Why young women face more risk
• Culture can hurt
• Profile: Going public
• Education should start early
• Condoms for dual protection
• Orphans: A new challenge
• What can parents do?
• Reaching street children
• Putting youth at the center

---

Use the world's largest
collection of HIV/AIDS
prevention materials...

www.jhuccp.org/mmc

Over 30,000 posters, pamphlets, videos,
audiotapes, photographs, training
materials, novelty items, and more on
HIV/AIDS prevention around the world.

Also...you can request What's New on
youth and AIDS, a newsletter issue high-
lighting new communication materials, from

JHU/PIP Media/Materials Clearinghouse
111 Market Place, Suite 310
Baltimore, MD 21202 USA
Email: mmc@jhuccp.org

---

• POPLINE
• Other reports
• To Order
• CCP Home Page

Published by the Population Information Program, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

In June 2001 member states at the United Nations General Assembly Special Session on AIDS agreed to "ensure that by 2005, at least 90% of young men and women aged 15 to 24 have access to the information and education necessary to develop the life skills required to reduce their vulnerability to HIV infection" (366). One way to achieve this goal, at least in theory, is through a country's education system—especially if programs reach students at an early age, before some begin to drop out of school (65). At the International AIDS Conference in Durban in 2000, the "Prevention Works" Symposium recommended that HIV/AIDS education begin early, focusing on children as young as five years old (180).

Nevertheless, there is considerable disagreement over HIV/AIDS education—including what to teach, at what age, in what setting, by whom, and to what end. Political pressures often keep sex education—and thus HIV/AIDS education—out of the classroom. Sensitivities about sexuality and young people's behavior often obstruct AIDS education even where there is a strong national commitment to address the AIDS crisis (329) (see Lack of Information). In spite of such obstacles, some school programs appear to have made gains, although evidence from program evaluation is sparse (327).

Comprehensive evaluations have examined the impact of HIV education programs worldwide. In Canada and the US researchers found that one-third of the 28 programs they reviewed delayed the age at sexual initiation among students participating (191). A more recent analysis that reviewed school-based education programs in Namibia, Nigeria, South Africa, and Zimbabwe found that some of the programs helped delay sexual initiation, decreased number of partners, and increased contraceptive use (430). For example, in Namibia a curriculum that emphasized abstinence and safer sex practices helped some female students delay the start of sexual activity but did not increase abstinence or condom use overall (437). In Brazil students participating in a school-based AIDS education program reported having fewer sex partners than students in schools without the AIDS program (58).

Important components of AIDS education programs for youth include addressing peer pressure and norms that encourage risky behavior (53, 190). Changing young people's risk-taking behavior requires going beyond providing information to helping young people acquire the ability to refuse sex and to negotiate with sex partners.

In Thailand a comprehensive education program for young people included problem-solving exercises, role playing, and analysis of "triggers" for unsafe sexual behavior (such as alcohol use). This program helped to achieve a 50% decline in new HIV cases, and the incidence of STIs among young men in the program was one-seventh of that among a control group without AIDS education (49).

Researchers have identified key elements of HIV/AIDS education programs, largely from US-based studies (190, 191). Programs are more likely to be successful by:

• Focusing on reducing specific risky, sexual behaviors;
• Using theoretical approaches to behavior change that have proved successful as a basis for program development;
• Having a clear message about sexual activity and condom use and continuously reinforcing this message;
• Providing accurate basic information about the risks of adolescent sexual activity and about methods of avoiding intercourse or using condoms against HIV infection;
• Dealing with peer pressure and other social pressures on young people to be sexually active;
• Providing modeling and practice of communication, negotiation, and refusal skills;
• Using a variety of teaching methods that involve the participants and help personalize information;
• Using teaching methods and materials appropriate to students' age, sexual experience, and culture;
• Selecting as teachers people who believe in the program and then training them to be effective.

More evaluation is needed of developing-country AIDS education for youth in school and out of school (436).

HIV/AIDS education programs should be age-appropriate—that is, programs for younger adolescents should focus on avoiding or delaying sex, while those for older adolescents should include discussion of condoms and other contraceptives in addition to urging abstinence (7, 53, 193). Of course, education cannot help young people who cannot avoid or delay sex, even if they want to—for example, young women trafficked into prostitution or raped in refugee camps.

DONNER L'EDUCATION SEXUELLE AUX ADOLESCENTS C'EST PREVENIR LES MATERNITES PRECOCES, LES GROSSESSES NON DESIREES, LES MST ET LE SIDA

Association for the Care of Children's Health (ACCH)

"To give sex education to adolescents is to prevent early births, unwanted pregnancies, STIs, and AIDS," says this poster from Cameroon. "If only I'd had good information!" this young woman reflects, while her classmates laugh at her on their way to school.

Peer education. Many strategies for youth now make peer education a key approach (80). Perhaps the most important goal of peer education is to establish standards for acceptable behavior. When youth play a role in developing social and group norms that protect against HIV infection, they serve as positive role models for behavior change (272).

Most young people find trained peer educators credible because they communicate well with other youth and set believable examples of behavior. Peers also can help other young people acquire such skills as sexual negotiation and assertiveness (65, 77, 80, 179).

For peer education programs to be effective, training of the peer educators is essential—including follow-up sessions that reinforce knowledge, beliefs, and skills (129, 194, 347).

Training not only should ensure that peer educators know how to teach about HIV/AIDS but also that they are able to see things from the perspective of the young people they are trying to reach (129).

A wide variety of peer AIDS-education programs in developing countries reach young people, including in Indonesia (139), Kenya (156), Peru (431), Thailand (49, 85), and Zambia (285, 331). While evidence from evaluation is slight, peer education programs have been found to reduce the incidence of STIs including HIV, change risky behavior, and improve health (129, 179), including among the peer educators themselves (269). In a US peer education program among youth, for example, condom use increased from 45% to 55% among participants surveyed (272). In Peru, in the absence of the Es Salud peer project, youth condom use in the project area would have been 39% less (431).

Peer education is sometimes assumed to be inexpensive, since it relies on volunteers. Costs can run high, however, to train, support, equip, and supervise peer educators (129). High turnover among peer educators requires continuous recruitment and training of replacements. Also, peer programs usually need professionals to provide guidance and support. While a growing consensus holds that peer educators should be compensated in some way, experience cautions against overcompensation to avoid distancing peer educators from their audience (82, 129, 347).