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PROGRAMMING FOR YOUTH IN HIV & REPRODUCTIVE HEALTH. Shanti Conly USAID/GH ANE/EE PHN SOTA October 2002. SESSION OVERVIEW. Transition to Adulthood: RH/HIV Issues “State of the Science” re: Contextual factors influencing youth behaviors Effective interventions—”What Works”

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Programming for youth in hiv reproductive health

PROGRAMMING FOR YOUTHIN HIV & REPRODUCTIVE HEALTH

Shanti Conly

USAID/GH

ANE/EE PHN SOTA

October 2002


Session overview
SESSION OVERVIEW

  • Transition to Adulthood: RH/HIV Issues

  • “State of the Science” re:

    • Contextual factors influencing youth behaviors

    • Effective interventions—”What Works”

    • A Framework for Youth Programming

  • USAID/W Support for Youth Programs/YouthNet

  • Approaches adopted by ANE & EE Missions


I the transition to adulthood rh hiv issues
I. THE TRANSITION TO ADULTHOOD: RH/HIV ISSUES

Age Range: 10-24 years

Pre-Teens thru Young Adults

Preferred Terms: Youth, Young People


KEY MARKER EVENTS VARY IN TIMING AND SEQUENCE

24

23

22

21

20

  • First Pregnancy

  • and Childbirth

  • Leaving Home

  • Marriage

  • Starting Work

  • Sexual Initiation

  • Alcohol/Drug Use

  • Leaving School

  • Puberty

19

Age

18

17

16

15

14

13

12

11

10


YOUTH IN GLOBAL PERSPECTIVE

  • 1.7 billion youth aged 10-24 globally

  • 30 percent of total population in developing regions


Youth are diverse
YOUTH ARE DIVERSE

  • Younger/Older

  • Boys/Girls

  • Married/Unmarried

  • Sexually Active/Not

  • In/Out of School

  • Parents/Not

  • Rural/urban

  • Economic status

  • At-risk/Vulnerable

    Programs Need to “Segment for Success”


The social context
THE SOCIAL CONTEXT

  • Gap between puberty and marriage growing with rising education and age at marriage

  • Premarital sexual activity increasing; double-standard in social norms for boys vs. girls

  • Lack of empowerment of young women; coercive and unwanted sex common

  • Political sensitivity around teen sexual activity

  • Openness/flexibility: a formative period, potential to influence life-long behaviors


Key youth rh hiv issues
KEY YOUTH RH/HIV ISSUES

  • Poor knowledge of RH and HIV

  • Low use of contraception/condoms

  • Unintended pregnancy, unsafe abortion

  • HIV and STIs

  • Early childbearing and maternal deaths

  • Poor nutrition, anemia

  • Injecting drug use/other substance abuse



Ee sexual activity contraceptive use young women
EE: SEXUAL ACTIVITY &CONTRACEPTIVE USE, YOUNG WOMEN

Age 15-19

Age 20-24

74%

73%

70%

66%

85%

73%

63%

54%

87%

72%

79%

80%

Moldova

Romania

Ukraine

Moldova

Romania

Ukraine

Source: CDC.


Ee contraceptive method choice among young women
EE: CONTRACEPTIVE METHOD CHOICEAMONG YOUNG WOMEN

Age 15-19

Age 20-24

Moldova

Romania

Ukraine

Moldova

Romania

Ukraine

Source: CDC


Ee high rates of induced abortion
EE: HIGH RATES OF INDUCED ABORTION

Age 15-19

Age 20-24

Source: CDC


Ane differences in marriage rates
ANE: DIFFERENCES IN MARRIAGE RATES

Age 15-19 Taiwan

Philippines

Thailand

Indonesia

Nepal

Age 20-24 Taiwan

Philippines

Thailand

Indonesia

Nepal

Percent Ever Married

Source: EWC


Ane contraceptive use among young married women
ANE: CONTRACEPTIVE USE AMONG YOUNG MARRIED WOMEN

Values less than 5% not shown

Age 15-19

Age 20-24

Source: DHS Surveys.


Ane premarital sexual activity
ANE: PREMARITAL SEXUAL ACTIVITY

Premarital Sex Among Youth Sexually Active Before Age 20

Source: EWC

Note: For Nepal, among age 20-22


Ane knowledge and attitudes about condoms
ANE: KNOWLEDGE AND ATTITUDES ABOUT CONDOMS

Single, sexually active male Filipinos 15-24 (1994):

  • 30% used contraception at last sex—but only 9% used condoms

  • Over 95% know about condoms, but only 58% knew condoms can prevent HIV/AIDS

  • Negative attitudes to condoms widespread:

    • Reduces pleasure (58%)

    • Too expensive (34%)

    • Too embarrassing to buy (47%)

    • Against religion (32%)


YOUTH AND HIV/AIDS

Half of all new infections in young people age 15–24; over 2 million new infections every year


YOUNG WOMEN ARE EPICENTER OF GENERALIZED EPIDEMICS

HIV PREVALENCE BY AGE & SEX, KISUMU, KENYA, 1998


Youth also important in concentrated epidemics
YOUTH ALSO IMPORTANT IN CONCENTRATED EPIDEMICS

High-risk populations include many youth:

  • Young sex workers and trafficked girls

  • Young injecting drug users

  • Young men who have sex with men

  • Young men who visit sex workers

  • Street children/orphans

  • Refugee youth


Young sex workers and hiv myanmar
YOUNG SEX WORKERS AND HIV, MYANMAR

35

28

22

14

Source: Sentinel surveillance data for March-April 2000, AIDS Prevention and Control Project, Department of Health, Myanmar.


Thailand the importance of changing social norms
THAILAND: THE IMPORTANCE OF CHANGING SOCIAL NORMS

Thai Males 15-24 Ever Having Had Sex with A Sex Worker



Contextual influences on youth behaviors
CONTEXTUAL INFLUENCES ON YOUTH BEHAVIORS

  • Multiple, contextual “risk” and “protective” factors influence youth behaviors

  • These influences operate at the individual, family, school, peer and community levels

  • Contextual factors not easily amenable to programmatic intervention?

  • Thai program to protect girls from sex work: girls identified by family “risk factors”


FINDINGS FROM PROGRAM EVALUATIONS: WHAT WORKS?

  • Caveats regarding evidence base

  • No evidence that education or services for youth increase sexual activity

  • Programs more effective in influencing knowledge and attitudes than behaviors


School based programs
SCHOOL-BASED PROGRAMS

  • Most interventions  knowledge & attitudes

  • ~50% had impact on behaviors in short-term; long-term impact less certain

  • Programs have broad reach; despite challenges in implementation, acceptable in many contexts

  • Need more info on key elements of effective school programs in developing countries


Key elements of effective sex education u s research
KEY ELEMENTS OF EFFECTIVE SEX EDUCATION(U.S. Research)

  • Clear focus on specific behavioral goals

  • Accurate info about risks/ways to avoid risk

  • Teaching methods reflect behavior change theory, help youth personalize information

  • Goals, materials, appropriate to age, culture and sexual experience

  • Attention to social and peer pressures

  • Opportunities to practice communication, negotiation and refusal skills

  • Adequate duration/Minimum # of hours


Mass media programs
MASS MEDIA PROGRAMS

  • Mass media has broad reach, influential with youth

  • Consistently affects knowledge, attitudes, norms

  • Less evidence of direct influence on sexual and contraceptive behaviors

  • Links to more personalized activities needed for behavior change?

  • Links to social marketing promising for increasing access to, use of, condoms


Peer education programs
PEER EDUCATION PROGRAMS

  • Peer education approach appears promising

  • Key questions require further investigation

    • Magnitude of effects on peer contacts vs. peer promoters

    • Reach—selection of peer promoters key

    • Level of training and supervision required

    • Turnover/Sustainability


Workplace programs
WORKPLACE PROGRAMS

  • Wide variability in program types–target specific groups of out-of-school youth, for example:

    • Young army recruits in Thailand

    • Garment workers in Cambodia

    • Young sex workers in India

  • Impacts on knowledge, attitudes, skills

  • Evidence is thin on behavioral effects, but has potential where many youth employed


Other community based programs
OTHER COMMUNITY-BASED PROGRAMS

  • Wide variety of educational programs for out of school youth, especially for girls, married youth

    • India Better Life Options Program:

      Non-formal ed, vocational and life skills training, FLE

  • May have potential for improving health practices and increasing use of health services

  • Need better outcome information


Health facility programs
HEALTH-FACILITY PROGRAMS

  • “Youth friendly” Clinical Services”— Trained staff, convenient hours, location, etc.

  • On their own do not appear to attract youth for preventive services

  • Need outreach and community mobilization to obtain support for providing youth RH services

  • Not a promising strategy for primary prevention


Youth centers
YOUTH CENTERS

  • Do not increase the use of RH services by adolescents

  • Most use is for recreational rather than counseling/clinical purposes

  • Much use by males out of target ages

  • Does not appear promising/cost-effective


Summary a framework for youth programming
SUMMARY: A FRAMEWORK FOR YOUTH PROGRAMMING

Multi-component programs are needed to address multiple contextual influences & varying needs:

  • Improve policies, change social norms and build community support

  • Reach youth early with clear, consistent messages, accurate info & life skills

  • Improve access to condoms and other services, especially thru non-clinical channels


PROMOTING HEALTHY BEHAVIORS:THE THREE-LEGGED STOOL

Healthy Youth

Behaviors

Supportive Policies and Community Norms

Expanded Access to Quality Services

Improved Knowledge, Attitudes, Skills


Iii usaid w support for youth rh hiv programs

III. USAID/W SUPPORT FOR YOUTH RH/HIV PROGRAMS


Youth a priority for global health bureau
YOUTH A PRIORITY FOR GLOBAL HEALTH BUREAU

  • Youth are central to USAID HIV/AIDS Goals

    • High prevalence countries: Reduce HIV by 50% in 15-24 year olds

    • Low prevalence countries: Keep HIV below 1%

  • Youth important in Population & Reproductive Health

    • High unmet need– both unmarried & married youth

    • Early Childbearing: Health, social, demographic impacts


Multiple gh mechanisms support youth rh programs
MULTIPLE GH MECHANISMS SUPPORT YOUTH RH PROGRAMS

  • Dedicated GH Activity provides technical leadership on youth RH/HIV (YOUTHNET)

  • Mainstreaming through other Agreements (POLICY, PCS, IMPACT, AIDSMARK)


YOUTHNET…VALUE ADDED?

YOUTHLENS


Key y outh n et roles
KEY YOUTHNETROLES

  • Global Technical Leadership

    Advance evidence base, develop tools, build capacity

  • Short-term Technical Assistance

    Provide specialized youth expertise to Missions

  • Focus Countries?

    Help scale up youth programs for national impact



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