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1. Africa's Youthful Population: Risk or Opportunity?
2. Child Participation in Education Initiatives
3. Evaluation of Exposure and Retention of Youth Power Mass Media Campaign among At-Risk Youth Age 15-25 in Nine Cities in Uzbekistan
4. Improving Health, Improving Lives: The End of Programme Report of the African Youth Alliance
5. Madagascar (2006): HIV/AIDS TRaC Study Evaluating Abstinence among Youth
6. Report of the High-level Consultation on Improvement of Sexual and Reproductive Health and Rights of Young People in Europe
7. SHS Views
1. Are schools a good setting for adolescent sexual health promotion in rural Africa? A qualitative assessment from Tanzania
2. At greatest risk: pre- and early adolescent Bahamian youth experiencing anal intercourse
3. Attitudes toward condom use among high school and university students in Zimbabwe
4. A bird's eye view on the vulnerability of the young girl to HIV infection — a synergy of research
5. Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial
6. HIV/AIDS-related knowledge, attitudes and sexual behaviors as predictors of condom use among young adults in Croatia
7. How effective are street youth peer educators? Lessons learned from an HIV/AIDS prevention programme in urban Uganda
8. Impact of education in promoting the knowledge of and attitude to HIV/AIDS prevention: a trial on 17,000 Iranian students
9. Increased risk of chlamydial and gonococcal infection in adolescent sex workers in Madagascar
10. The natural history of human papillomavirus infection and cervical intraepithelial neoplasia among young women in the Guanacaste cohort shortly after initiation of sexual life
11. Predictors of condom use among young adults in South Africa: the Reproductive Health and HIV Research Unit National Youth Survey
12. A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme
13. Response rates for providing a blood specimen for HIV testing in a population-based survey of young adults in Zimbabwe
1. Africa's Youthful Population: Risk or Opportunity? (2007, PDF, 122 KB)
This four-page policy brief outlines the opportunities and risks that can result from the large numbers of youth growing up in sub-Saharan Africa today. The authors recommend key policy actions needed throughout the region to expand youth opportunities, give them the skills to participate fully in the economy and public life, and promote healthy behaviors.
Organization: Population Reference Bureau
Contact: popref@prb.org
2. Child Participation in Education Initiatives (2007, PDF, 1.05 MB)
This how-to-guide, produced from the experiences of the Catholic Relief Services with local partners in Zimbabwe, addresses child participation in many aspects of education programming. It focuses on orphans and other vulnerable children affected by HIV/AIDS, many of whom have not had easy access to education.
Organization: Catholic Relief Services
Contact: eeversmann@crs.org
3. Evaluation of Exposure and Retention of Youth Power Mass Media Campaign among At-Risk Youth Age 15-25 in Nine Cities in Uzbekistan (2006, PDF, 882 KB)
For three months in 2006, Population Services International (PSI) conducted a media campaign targeting youth at risk of injecting drug use. The campaign objectives were to raise awareness about the risk of injecting drug use and HIV and to encourage youth to obtain additional information. This 18-page report presents the results of a rapid analysis to measure the campaign's impact.
Organization: PSI
Contact: adairov.psi@buzton.com
4. Improving Health, Improving Lives: The End of Programme Report of the African Youth Alliance (2007, PDF, 693 KB)
The African Youth Alliance (AYA) sought to improve adolescent sexual and reproductive health, including the prevention of HIV/AIDS, among young people ages 10-24. The AYA program was implemented in Botswana, Ghana, Tanzania, and Uganda, in partnership with their governments, nongovernmental organizations, community-based organizations, youth, parents, religious leaders, the media, and policy-makers. This 36-page report summarizes the findings of the project by country and by theme.
Organization: African Youth Alliance
Contact: info@ayaonline.org
5. Madagascar (2006): HIV/AIDS TRaC Study Evaluating Abstinence among Youth (2007, PDF, 70 KB)
From late 2005 to early 2006, Population Services International (PSI) Madagascar conducted a household survey to investigate reproductive health of a representative sample of youth between the ages of 15 and 24 years. This 17-page report presents findings from the survey, which examined abstinence in youth and was designed to provide evidence for social marketing decision making.
Organization: PSI
Contact: andryr@psi.mg
6. Report of the High-level Consultation on Improvement of Sexual and Reproductive Health and Rights of Young People in Europe (2007, PDF, 367 KB)
Representatives from 23 member states of the WHO European Region, the European Commission, the International Planned Parenthood Federation European Network, and Lund University attended a two-day meeting to evaluate the midterm results of a youth sexual and reproductive health and rights project. This document reports trends in sexual and reproductive health of young people in the European Union countries and offers recommendations on developing national policies and programs for youth.
Organization: WHO Europe
Contact: postmaster@euro.who.int
7. SHS Views (2007, PDF, 3.45 MB)
This 32-page issue of UNESCO's Social and Human Sciences Sector magazine focuses on youth development. Articles discuss UNESCO's experiences in youth and HIV, poverty, violence, gender, and policy.
Organization: UNESCO
Contact: webmaster.shs@unesco.org
1. Are schools a good setting for adolescent sexual health promotion in rural Africa? A qualitative assessment from Tanzania. Plummer ML, Wight D, Wamoyi J, et al. Health Educ Res 2007;22(4).
This study examined the experiences of various stakeholders of rural Tanzanian primary schools, focusing on the implications for potential sexual health programs. From 1999 to 2002, participant observation was conducted in nine villages for 158 person-weeks. Participants included pupils, those who had recently left school, parents, and teachers. Half of Year 7 pupils were 15-17 years old, and few went on to secondary school, suggesting that primary schools may be a good venue for such programs. However, serious challenges include low enrollment and attendance rates; limited teacher training; little access to teaching resources; and official and unofficial practices that may alienate pupils and their parents, such as corporal punishment, pupils being made to do unpaid work, forced pregnancy examinations, and some teachers' alcohol or sexual abuse. At a national level, improved teacher training and supervision are critical, as well as policies that better prevent, identify, and correct undesired practices. At a program level, those developing interventions need to simplify the subject matter, introduce alternative teaching methods, help improve teacher-pupil and teacher-community relationships, and closely supervise and appropriately respond to undesired practices.
2. At greatest risk: pre- and early adolescent Bahamian youth experiencing anal intercourse. Yu S, Deveaux L, Lunn S, et al. Int J STD AIDS 2007;18(6).
This article describes the prevalence of anal and vaginal intercourse among Bahamian pre- and early adolescents and associations with other risk behaviors, family interactions, and intrapersonal correlates. Data were from 1,274 students aged 9-14 years who completed self-administered questionnaires at baseline of a larger school-based behavioral intervention study. Youth who reported having had anal intercourse engaged in significantly higher rates of several risk behaviors and were significantly more likely to engage in risk behaviors over the next six months, compared with youth with a history of vaginal intercourse only, who in turn were more likely than virgin adolescents to engage in risk behaviors. Youth indulging in anal intercourse also perceived significantly lower levels of parental monitoring. Multivariate analyses revealed that anal intercourse, vaginal intercourse, reduced parental monitoring, depression, and perceived high-risk involvement of friends were associated with both past involvement and future intention to engage in other risk behaviors. Anal intercourse poses a direct threat to the health of these children and is a flag for a constellation of other risks.
3. Attitudes toward condom use among high school and university students in Zimbabwe. Cort MA, Modeste NN. Int Q Community Health Educ 2007;26(1).
With a sample of students (n=504) from Matabeleland, Zimbabwe, Africa, this study investigated the extent to which knowledge of AIDS and two components of the Health Belief Model are related to: 1) attitude toward condom use, and 2) intentions to use a condom in future sexual encounters. Results indicated that knowledge of AIDS is not significantly related to either of these two dependent variables. However, belief in the efficacy of condoms, and lack of barriers to the use of condoms were significantly related to both variables. Discussion focused on the role of religion and socioeconomic status in influencing attitudes and decisions about condom use.
4. A bird's eye view on the vulnerability of the young girl to HIV infection — a synergy of research. van den Berg D, van Rooyen L. Int J Adolesc Youth 2007;13(3).
This research focused on the vulnerability of young South African girls to HIV and the contextual factors that contribute to their vulnerability. Research on this topic has been done on an ad hoc basis and was not consolidated or linked to other research findings, which means that we lack a clear, holistic picture of the status and vulnerability of young girls to HIV infection. The authors reviewed other studies on this topic and analyzed, integrated, and synthesized the results.
5. Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Paavonen J, Jenkins D, Bosch FX , et al. Lancet 2007;369(9580).
This interim analysis of a large, international phase III study assessed the efficacy of an AS04 adjuvanted L1 virus-like-particle prophylactic candidate vaccine against infection with human papillomavirus (HPV) types 16 and 18 in young women. Women (n=18,644) aged 15-25 years were randomly assigned to receive either HPV16/18 vaccine (n=9,319) or hepatitis A vaccine (n=9,325) at 0, 1, and 6 months. Of these women, 88 were excluded because of high-grade cytology and 31 for missing cytology results. Thus, 9,258 women received the HPV16/18 vaccine and 9,267 received the control vaccine in the total vaccinated cohort for efficacy, which included women who had prevalent oncogenic HPV infections, often with several HPV types, as well as low-grade cytological abnormalities at study entry and who received at least one vaccine dose. We assessed cervical cytology and subsequent biopsy for 14 oncogenic HPV types by PCR. The primary endpoint — vaccine efficacy against cervical intraepithelial neoplasia (CIN) 2+ associated with HPV16 or HPV18 — was assessed in women who were seronegative and DNA negative for the corresponding vaccine type at baseline (month 0) and allowed inclusion of lesions with several oncogenic HPV types. This interim event-defined analysis was triggered when at least 23 cases of CIN2+ with HPV16 or HPV18 DNA in the lesion were detected in the total vaccinated cohort for efficacy. Analyses were done on a modified intention-to-treat basis. Mean length of follow-up for women in the primary analysis for efficacy at the time of the interim analysis was 14.8 (SD 4.9) months. Two cases of CIN2+ associated with HPV16 or HPV18 DNA were seen in the HPV16/18 vaccine group; 21 were recorded in the control group. Of the 23 cases, 14 (two in the HPV16/18 vaccine group, 12 in the control group) contained several oncogenic HPV types. Vaccine efficacy against CIN2+ containing HPV16/18 DNA was 90.4% (97.9% CI 53.4-99.3; p<0.0001). No clinically meaningful differences were noted in safety outcomes between the study groups. The adjuvanted HPV16/18 vaccine showed prophylactic efficacy against CIN2+ associated with HPV16 or HPV18 and thus could be used for cervical cancer prevention.
6. HIV/AIDS-related knowledge, attitudes and sexual behaviors as predictors of condom use among young adults in Croatia (PDF, 207 KB). Stulhofer A, Graham C, Bozicevic I, et al. Int Fam Plan Perspect 2007;33(2).
Data from a multistage probability sample of 1,093 Croatians aged 18-24 surveyed in 2005 were used in regression models that examined the associations between HIV-related knowledge, attitudes, and sexual behavior and predictors of condom use at first and last sexual intercourse and condom use consistency. For both men and women, condom use at first intercourse and positive attitudes toward condom use were the most robust predictors of condom use at last intercourse and consistent condom use. In addition, for women, having peers with less traditional attitudes regarding sexuality was associated with consistent condom use (odds ratio, 1.3). Risky sexual behaviors are common among young adults in Croatia. Pragmatic and comprehensive sex education programs should target young people before they become sexually active.
7. How effective are street youth peer educators? Lessons learned from an HIV/AIDS prevention programme in urban Uganda. Mitchell K, Nyakake M, Oling J. Health Educ 2007;107(4).
This paper explores lessons learned resulting from a process evaluation of a peer-led HIV/AIDS prevention program targeting street children and youth in urban Uganda. The purpose was to investigate aspects of implementation that either enhanced or hindered the effectiveness of the peer educator (PE) role. The process data derive from three reviews conducted throughout the project's lifespan. The reviews used participatory evaluation methods such as focus groups (four) and workshops (three), and drew on monitoring data such as activity evaluations. The street youth in this project made effective peer educators. The authors suggest that letting the target group choose their peers and focusing on street youth undergoing rehabilitation engendered ownership of PEs by the target group and accountability among PEs themselves. The role was highly coveted, and the PEs became powerful role models. The most useful work of the PEs lay in helping their peers to leave the risky environment of the streets, hence reducing their vulnerability to HIV/AIDS.
8. Impact of education in promoting the knowledge of and attitude to HIV/AIDS prevention: a trial on 17,000 Iranian students. Jodati AR, Nourabadi GR, Hassanzadeh S, et al. Int J STD AIDS 2007;18(6).
This study assessed the impact of an educational course on knowledge and attitude of students regarding HIV/AIDS prevention in Tabriz, Iran. The study was conducted by self-assessment technique among university students before and after an educational training program. The knowledge of students increased significantly (P<0.05). The attitude toward the problem also improved positively in the subjects (P<0.05). The authors conclude that short-term training courses and continuous educational programs (i.e., peer education, and others) should be provided to young students through the course materials in the universities and schools.
9. Increased risk of chlamydial and gonococcal infection in adolescent sex workers in Madagascar. Pettifor AE, Turner AN, Van Damme K, Hatzell-Hoke T, et al. Sex Transm Dis 2007;34(7).
This study examined young sex workers' risk of acquisition of sexually transmitted infections (STIs) and compares this risk with that of their older counterparts. Its goal was to evaluate the effect of young age — 16-19 years vs. 20 years and older — on risk of incident infection with Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT). A randomized controlled trial of 1,000 sex workers in Madagascar was conducted. STI testing was conducted at baseline, 6, 12, and 18 months. About 13% of the cohort (n=134) was composed of young women aged 16-19 years. STI incidence rates in this group over the 18-month study period were high: 51.9/100 woman-years (WY) for GC and 47.4/100 WY for CT compared to 27.4/100 WY and 19.1/100 WY for sex workers over age 20, respectively. In multivariable models, young sex workers were at significantly higher STI risk compared with their older peers: The adjusted risk ratio (aRR) for GC comparing younger to older women was 1.50 (95% confidence interval (CI): 1.20, 1.88); for CT, the aRR was 1.72 (95% CI: 1.35, 2.19) and for GC or CT combined, the aRR was 1.42 (95% CI: 1.22, 1.66). This exploratory analysis suggests that additional research is warranted to identify effective and acceptable prevention strategies that benefit young women, and interventions already proven effective among adolescents should be given high priority for scale-up.
10. The natural history of human papillomavirus infection and cervical intraepithelial neoplasia among young women in the Guanacaste cohort shortly after initiation of sexual life. Rodriguez AC, Burk R, Herrero R, et al. Sex Transm Dis 2007;34(7).
Cross-sectional analyses of a 10,000-woman, population-based Guanacaste cohort suggest a lag of greater than or equal to 10 years between the peak of human papillomavirus (HPV) infection and the later peak of cervical intraepithelial neoplasia grade 3 (CIN 3). The authors explored early HPV natural history and CIN 3 prospectively. They followed 206 initially virginal women aged 18 to 26 semiannually for a median of 3.6 years after initiation of sexual life. A total of 53.4% of women tested positive during the study for one or more HPV type. Very few infections persisted for more than 1 to 2 years. Three women had histologically confirmed CIN 3, of which two showed persistent HPV 16. The other had serologic evidence of HPV 31. The authors conclude that HPV infection occurs frequently and clears rapidly in most young women initiating sexual intercourse. Persistent HPV 16 can cause early CIN 3. The peak age for CIN 3 will decline with the increased screening intensity and sensitivity typical of longitudinal studies.
11. Predictors of condom use among young adults in South Africa: the Reproductive Health and HIV Research Unit National Youth Survey. Hendriksen ES, Pettifor A, Lee S-J, et al. Am J Public Health 2007;97(7).
This study examined correlates of condom use among a national random probability sample of sexually experienced young adults aged 15 to 24 years (n=7,686) in South Africa. Using data from the Reproductive Health and HIV Research Unit National Youth Survey, the authors conducted gender-stratified bivariate and multivariate logistic regression analyses to determine predictors of whether respondents had used a condom during their most recent sexual intercourse. Condom use at sexual debut and talking with one's first sexual partner about condoms were the most significant predictors of condom use at most recent intercourse. Other significant predictors included high condom use self-efficacy, optimism about the future, and reported behavior change attributable to HIV/AIDS. Young adults who were married or had been involved in a relationship for 6 months or more were significantly less likely to have used a condom during their most recent sexual intercourse. Findings point to the importance of exposing youths to sexuality education before their sexual debut as well as voluntary counseling and testing and programming that supports young adults, particularly young women, in making informed decisions about sexual intercourse and condoms.
12. A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme. Plummer ML, Wight D, Obasi AI, et al. Health Educ Res 2007;22(4).
This study evaluated the school component of the adolescent sexual health program MEMA kwa Vijana (MkV), which was implemented in 62 primary schools in rural Mwanza, Tanzania from 1999 to 2001. The MkV curriculum was a teacher-led and peer-assisted program based on the Social Learning Theory. Process evaluation included observation of training sessions, monitoring and supervision, annual surveys of implementers, group discussions, and 158 person-weeks of participant observation. Most teachers taught curriculum content well, but sometimes had difficulty adopting new teaching styles. Peer educators performed scripted dramas well, but were limited as informal educators. The intervention appeared successful in addressing some cognitions, e.g., knowledge of risks and benefits of behaviors, but not others, e.g., perceived susceptibility to risk. MkV shared the characteristics of other African school-based programs found to be successful, and similarly found significant improvements in self-reported behavior in surveys. However, a substantial proportion of MkV survey self-reports were inconsistent, there was no consistent impact on biological markers, and extensive process evaluation found little impact on several key theoretical determinants of behavior. Improvements in self-reported survey data alone may provide only a very limited — and perhaps invalid — indication of adolescent sexual health program success.
13. Response rates for providing a blood specimen for HIV testing in a population-based survey of young adults in Zimbabwe. McNaghten AD, Herold JM, Dube HM, et al. BMC Public Health 2007;7(Article No.145).
This study used Chi-square analysis of weighted data to compare demographic and behavioral data of people who provided blood specimens for HIV testing versus those who did not when interviewed for the population-based Zimbabwe Young Adult Survey (YAS). Prevalence estimation determined the impact if people not providing specimens had higher prevalence rates than those who did. There was no significant difference by age, residence, education, marital status, perceived risk, sexual experience, or number of sex partners for women. A significant difference by sexual experience was found for men. Prevalence estimates did not change substantially when prevalence was assumed to be two times higher for persons not providing specimens. The authors conclude that when comparing people who provided specimens for HIV testing with those who did not, few significant differences were found. If those who did not provide specimens had prevalence rates twice that of those who did, overall prevalence would not be substantially affected. Refusal to provide blood specimens does not appear to have contributed to an underestimation of HIV prevalence.
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