• 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.

HIV prevention efforts have started addressing young men and the social pressures that often lead to risky sexual behavior, especially peer pressure (85, 160, 187). Men often play dominant sexual roles within and outside marriage. Men face greater exposure than women to the risks of unsafe sex because, on average, they begin sex earlier and have more partners but marry later 103, 160). In addition, many men would consider their masculinity compromised by having fewer sex partners and always using condoms—behavior that could limit the spread of HIV (68, 299, 322).

For young men, being able to talk about problems, including concerns about sexuality, and to obtain support are important steps to avoiding risk. Yet many boys grow up without the opportunity to communicate (103). In Kenya, for example, less than half of fathers reported in a nationwide survey having discussed sex, HIV/AIDS, or male-female relationships with their teenage sons in the preceding year (177).

Health care facilities designed for adult women and children can have the effect of discouraging young men and adult men from seeking help there (237, 322). To motivate men to take better care of their health, UNAIDS launched a two-year worldwide campaign in 2000 entitled "Men Make A Difference." The campaign encourages AIDS-prevention programs to establish male-friendly health services with convenient service hours. It encourages training health care providers to offer males confidential care and support (160).

JHU/PCS and NCPD

This Kenyan booklet urges leaders to support reproductive health care for youth.

Presenting adult role models of responsible male behavior and mutually supportive and respectful relationships also can help young men (103, 249). Many young men grow up witnessing irresponsible or abusive behavior towards women in their communities or their own families (232). As adults, they tend to adopt such behavior themselves (119).

A seminar on male involvement programs in the US developed several principles to guide the structure, design, and overall messages of reproductive health programs for boys and young men (249):

• Make male focus mainstream. Efforts to focus on boys and men should be an integral part of program service delivery, not just an occasional add-on.
• Look for men where they are. Programs should reach males where they congregate, including schools, workplace, sports events, and military barracks. Programs should use language and media that appeal to men.
• Men need a safe place. Male-only activities help create an atmosphere in which men can reveal their concerns, hopes, and fears.
• Use adults as mentors and role models for young men. Successful male-involvement programs for young men involve adult men. Experience suggests that slightly older peers—men five to seven years older—are able to communicate most effectively with adolescents.
• Build on the culture. Programs are more successful when they understand and respect cultural and religious values.
• Locate the program in the community. Successful programs consult with the community to plan activities and to allay concerns. Community involvement also helps keep programs going.

David Awasum for JHU/CCP

In Kigali, Rwanda, a group of street youth form a football club, which also serves to provide AIDS education. In some places a growing number of street children are living with HIV/AIDS. Outreach programs can find young men where they spend most of their time and approach them on their own terms.