• Editors' Summary
• Credits

1. The Invisible Epidemic
2. How Young People Become Infected
3. Why So Vulnerable?
4. Addressing the Epidemic
5. Reaching Out
• Involving Parents and Families
• Involving Men
• Reaching Youth at Special Risk
• Building Partnerships with Youth
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

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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.

Reaching Out

Addressing the HIV/AIDS epidemic among young people requires reaching not only youth themselves but also others who influence their lives. Parents and other family members can help prevent HIV/AIDS among young people. Similarly, AIDS-prevention programs can do more to address men, both adolescents and adults, who often play dominant roles in sexual relationships with young women.

Meeting the challenges of HIV/AIDS also requires reaching out to the millions of vulnerable youth on the margins of economies and societies. Engaging young people themselves to plan and carry out AIDS-prevention programs can help assure that programs meet their needs.

Parents, of course, greatly influence their children's health behavior. In a US study that asked students who most influenced their decisions about sex, 37% cited their parents, while 30% cited their friends (261). In addition to parents, other adult family members and others in the community influence adolescent health behavior.

Studies show that young people with a stable, positive, and supportive family environment that includes parental monitoring engage in less risk-taking (29, 191, 200, 304). Parental affection helps deter such adolescent behavior problems as violence and delinquency (318). In a US school sixth and seventh graders with supportive parents were less likely to use drugs or to get into fights and were more likely to delay sex than classmates who were emotionally detached (355). A variety of other studies report similar findings (19, 36, 209, 242, 396, 426).

Parents often say that young people should be taught about HIV/AIDS. In Brazil, for example, the vast majority of women interviewed in a low-income area said that they did not want their daughters to grow up as uninformed about sex as they themselves were (393). In a study in Kenya over three-quarters of parents of children ages 10 to 14 said that adolescents should be taught in school about HIV/AIDS and other STIs, as well as about family planning and other reproductive health subjects (177).

Some youth programs have sought to involve parents in reproductive health education, training parents in workshops and discussion groups, providing print materials, hotlines, and other information sources, and depicting parental roles in mass media presentations (103, 276). The best programs are often those that bring parents and young people together and stimulate an exchange of views (192).

Consejo Nacional de Prevención y Control del SIDA (CONASIDA)

"The good thing about a family: No secrets. Everything is shared," says this Mexican poster. The words "Time for Action" appear below. The poster depicts an older brother showing condoms to his younger brother. Studies show that young people with a stable, supportive family and parental monitoring take fewer risks.

Parent-child communication. Communication between parents and their children about sex is often difficult. Parents and children alike often are embarrassed to talk about sex and avoid the topic (36, 393). In South Africa adolescent women said they were afraid to talk to their parents about sex (217). In Zimbabwe young people said that communication with parents about sex was often one-sided, with the parents mainly warning about the dangers of sex (402). In Mexico young people also cited such communication barriers as lack of time, not getting along with their parents, and lack of trust in their parents' advice (393).

In many cultures parents traditionally did not discuss sex with their children. Instead, grandparents, aunts, and uncles played this role. Now the breakdown of traditional cultures has left many parents with the challenge of talking to their children about HIV/AIDS as well as sex, and many are ill-prepared (186, 402).

HIV/AIDS is a particularly sensitive topic that many parents avoid. In Kenya less than half of the parents of teenage children had discussed HIV/AIDS with them in the preceding year (177). Many parents know little about HIV/AIDS and worry that they do not have the information to give their children (36, 120, 133). In the US parents said one reason for poor communication was that their teenage children might ask questions the parents could not answer (142). In developing countries, especially in rural areas, parents often are less educated than their children and worry that they lack the knowledge to talk with them about sex (402). China trains youth peers to educate young people about HIV and sex, in part because many parents are unsure what to say (54).

Kenya Ministry of Health, Jisimamie, BADC, NASCOP

This poster from Kenya advocates communication between parents and their children about HIV/AIDS. Even though talking about sex can be difficult for adults and youth alike, most experts agree that communication about sex should begin early and occur frequently.

When parents do talk to their children about sex, they often fail to do so effectively. In Zimbabwe, although many parents said that they had discussed AIDS, none of the adolescents interviewed cited parents as an important source of AIDS information (402). In a US study 90% of mothers said they had spoken to their children about sex, but only two-thirds of the children agreed (142).

Most researchers agree that parent-child communication about HIV/AIDS and sexuality should begin early so that it can evolve comfortably as the child matures. A single serious talk about sex as a child enters puberty is likely to be strained and awkward. Similar discussions before, however, provide the groundwork for a successful discussion (37). Parent-child communication is most likely to be successful, of course, in a close, loving relationship.

In the US the National Campaign to Prevent Teen Pregnancy has developed 10 tips to help parents communicate with their adolescent children about sex (260). These tips are:

• Be clear about your own sexual values before you talk to your children about sex.
• Talk to your children early and often about sex.
• Be sure to have a two-way discussion and not a lecture.
• Supervise and monitor your children.
• Know your children's friends and their families.
• Discourage early, frequent, and steady dating in favor of group activities.
• Discourage dating where the age difference is large, especially for young girls.
• Know what programs your children are watching on TV, listening to on the radio, and what they are reading.
• Let your children know that you value education.
• Let your children know that you value them.