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PROGRAMMING FOR YOUTH IN HIV & REPRODUCTIVE HEALTH

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

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  1. PROGRAMMING FOR YOUTHIN HIV & REPRODUCTIVE HEALTH Shanti Conly USAID/GH ANE/EE PHN SOTA October 2002

  2. 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

  3. I. THE TRANSITION TO ADULTHOOD: RH/HIV ISSUES Age Range: 10-24 years Pre-Teens thru Young Adults Preferred Terms: Youth, Young People

  4. 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

  5. YOUTH IN GLOBAL PERSPECTIVE • 1.7 billion youth aged 10-24 globally • 30 percent of total population in developing regions

  6. 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”

  7. 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

  8. 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

  9. EE: HIV AMONG YOUTH INJECTING DRUG USERS RUSSIA

  10. 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.

  11. EE: CONTRACEPTIVE METHOD CHOICEAMONG YOUNG WOMEN Age 15-19 Age 20-24 Moldova Romania Ukraine Moldova Romania Ukraine Source: CDC

  12. EE: HIGH RATES OF INDUCED ABORTION Age 15-19 Age 20-24 Source: CDC

  13. 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

  14. ANE: CONTRACEPTIVE USE AMONG YOUNG MARRIED WOMEN Values less than 5% not shown Age 15-19 Age 20-24 Source: DHS Surveys.

  15. ANE: PREMARITAL SEXUAL ACTIVITY Premarital Sex Among Youth Sexually Active Before Age 20 Source: EWC Note: For Nepal, among age 20-22

  16. 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%)

  17. YOUTH AND HIV/AIDS Half of all new infections in young people age 15–24; over 2 million new infections every year

  18. YOUNG WOMEN ARE EPICENTER OF GENERALIZED EPIDEMICS HIV PREVALENCE BY AGE & SEX, KISUMU, KENYA, 1998

  19. 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

  20. 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.

  21. THAILAND: THE IMPORTANCE OF CHANGING SOCIAL NORMS Thai Males 15-24 Ever Having Had Sex with A Sex Worker

  22. II. THE STATE OF THE SCIENCE: “WHAT WORKS”

  23. 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”

  24. 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

  25. 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

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. PROMOTING HEALTHY BEHAVIORS:THE THREE-LEGGED STOOL Healthy Youth Behaviors Supportive Policies and Community Norms Expanded Access to Quality Services Improved Knowledge, Attitudes, Skills

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

  36. 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

  37. 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)

  38. YOUTHNET…VALUE ADDED? YOUTHLENS

  39. 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

  40. NEED FOR STRATEGIC PARTNERSHIPS

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