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UNICEF Jamaica ‘One Stop Shop’ Mobile Service for Vulnerable Adolescents A Children First (NGO) Initiative Jointly funded by UNICEF & Global Fund Penny Campbell January 2006. The “Bashy” Bus. Inside – the Clinic Area. A non-threatening environment. Child-friendly outreach.

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UNICEF Jamaica‘One Stop Shop’ Mobile Service for Vulnerable AdolescentsA Children First (NGO) Initiative Jointly funded by UNICEF & Global Fund Penny CampbellJanuary 2006

slide7

Overview

  • Jamaica's 2.6 m population experiencing a generalized epidemic
  • Estimated prevalence of 1.5 – 2 %
  • 22,000 persons living with HIV/AIDS
  • 9,209 reported AIDS Cases (Dec 2004)
  • Average rate of 354 per 100,000
  • Over 800 per 100,000 in some parishes (urban and tourist)
  • Predominantly heterosexual transmission (71%)
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slide9

The Challenge

  • Children and adolescents 40% of population
  • Early sex initiation (boys 13 yrs.; girls 15 yrs.)
  • High rate of forced sex (20%)
  • High rate of transactional sex (20%)
  • High rates of multiple sex partners (48% men, 16% women))
  • Adolescent girls 3 times more likely than boys to become HIV infected
  • Young girls having sex with HIV infected older men (50% report sex partner to be 5-10 years older)
  • “Sex on the Bus”: risky sex practices between young people and transport operators widespread (Youth.now, 2004)
slide10

“Turning a Negative into a Positive”

  • An alternative “bus service” for vulnerable adolescents (along major transport & high prevalence routes) delivering:
  • HIV/AIDS and sexual reproductive health information, STI clinical services
  • Counseling: relationships, sexual decision making, risk assessment skills; drug abuse; domestic violence and abuse; help restarting school after pregnancy
  • VCT – rapid testing
  • Referral and follow-up
slide11

Specific objectives

  • By December 2006, 5,000 vulnerable adolescents will have access to information, skills based counseling and services that serve to:
  • Increase access to information about HIV/AIDS and SRH issues
  • Improve sexual health behaviours & practices
  • Improve risk assessment & sexual decision making skills
  • Increase access to HIV/AIDS/STI services

Penelope Campbell

slide12

Expected outputs

  • Increased consistent, correct condom use
  • Increased contraceptive use (dual)
  • Reduction in multiple sex partners
  • Delayed first sex

Penelope Campbell

slide13

Baseline Study Commissioned to:

  • Determine adolescents’ interest and preferences in the services and design of the Bus.
  • Build a profile of the targeted adolescents to show their SRH knowledge, attitudes and behaviours
  • Prepare a performance framework for monitoring & evaluation (process & impact)

Research Design

  • Survey: 452 adolescents (structured interviews)
  • Focus group discussions (96 adolescents)
  • Disaggregated by age and gender
  • 212 (47% boys) and 240 (53% girls)
  • 4 targeted & 3 control communities
slide14

Criteria: Vulnerable Adolescents

  • High prevalence areas of HIV/AIDS/STIs
  • Communities where infrastructure limited (urban or rural) & adolescents have to travel far to access health or education services

Sampling Process

  • Key informants asked to list 3 communities that met criteria
  • Communities most frequently mentioned selected
  • Snowball sampling
slide15

Findings

  • Profile of Sample:
  • School enrolment high (89%)
  • 74% live with mother; only 32% with father
  • 1 in 5 live with neither parent (visiting relationship)
  • 1 in 4 rely on neither parent for financial support
  • 78% knew where nearest health centre located
  • But 59% did not have positive impression
  • Girls and younger adolescents were especially reluctant
  • Boys felt pride when accessing services (machismo reinforced)
slide16

Felt vs. Actual Needs

  • High interest in range of services proposed (70%)
  • … but few (19%) felt need in past 12 months
  • ‘Actual’ needs however were high:
  • 1 in 2 reported having sex: boys (62%) girls (38%)
  • Mean age sex initiation: girls (15 yrs), boys (12 yrs)
  • Only 33% correctly identified 3 safer sex practices
  • 69% held 2 or more sexual health myths
slide17

Among sexually active adolescents:

  • 20% females & 66% males did not use condom at first sex
  • 37% females and 30% males did not use condom at last sex
  • 1 in 10 girls are teen mothers
  • (94% unintended , 18% under 16)
  • 1 in 10 reported forced sex (93% did not feel need to ‘get help’ afterwards)
  • 1 in 4 reported multiple sex partners
  • 1 in 4 had sex partner - 5 years or older
slide18

Taking services to target group

  • Over 80% interested in mobility of service:
  • Bus will allow them to express themselves freely and in privacy
  • ‘Bus workers not from area’, do not know parents
  • However, avoid taking Bus to adolescent corners because:
  • Don’t want it to look like ‘dem have AIDS’
  • People/peers will know ‘their business”
  • Go to central, more ‘neutral’ locations
slide19

Adolescent Expectations of Service

  • Top 3 priorities:
  • Building healthy relationships
  • Family planning
  • HIV testing
  • Most important youth-friendly qualities:
  • RESPECT (90%)
  • Clarity of information (90%)
  • Confidentiality (80%)
  • Participation (80%)
slide20

Preferences and Interests

  • Entertainment (music, skits)
  • Simple IEC materials visual that ‘do not look too educational’
  • ‘Good’ condoms
  • Contraceptives
  • Live testimonials and…
  • Sanitary pads
  • Timing:
  • Sundays – because they are ‘boring’
  • Weekends – evenings
  • Mon to Fri - afternoons
deterring factors
Deterring Factors
  • Too many “old, grumpy, grumpy people”
  • Judgmental people; staff with ‘attitude’
  • Magazines showing ‘nastiness’ like oral sex
  • Any association with homosexuals
  • Should not look overtly educational
  • Negative slogans or messages (e.g. ill health)
  • Explicit references to HIV or AIDS
slide22

Performance Framework

  • Process:
  • # of visits (1st time & repeat)
  • Approval rating (exit interviews)
  • % of follow up visits fulfilled
  • % of referrals fulfilled
  • Output:
  • % correctly identifying 2 HIV/prevention methods
  • % correctly identifying 3 myths
  • Outcome:
  • Condom use at last sex (regular & non-regular)
  • Age of sexual debut
  • % with multiple sex partners
  • % unplanned pregnancy
slide23

Pilot Period (Aug – Nov 2005)

  • 2 major launches: Spanish Town, Montego Bay
  • 9,822 persons sensitized: 1,445 adults & 7,185 young people
  • 138 adolescents used services of doctor
  • 110 undertook HIV/STI testing (pre & post test counseling)
  • 217 counseled: relationships (especially with parents), education and skills access
slide24

The Way Forward

  • Full scale implementation
  • Establish regular schedule
  • Tailor services to specific needs of adolescents (gender, age, location)
  • Visit “neutral” locations rather than corners that young people own
  • Build capacity of non-adolescent groups (e.g. parents, older “friends”)
  • Build capacity of local SRH services to serve adolescents (as referral sources)
  • THANK YOU