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Changing Youth Behaviors: Findings from U.S. and Developing Country Research and Their Implications for A, B and C

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Changing Youth Behaviors: Findings from U.S. and Developing Country Research and Their Implications for A, B and C

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    1. Changing Youth Behaviors: Findings from U.S. and Developing Country Research and Their Implications for A, B and C Douglas Kirby, Ph.D., ETR Associates July 24, 2003

    2. We should be dedicated to the lives of young people, not to our own ideologies.

    3. Question #1: Can individual programs have a significant impact on: A (abstain from sex)? B (be faithful) (number of partners)? C (condom use)?

    4. Sex and HIV/AIDS Education Programs for Adolescents

    5. The Number of Programs with Different Effects on Sexual and Contraceptive Behaviors

    6. The Number of Programs with Different Effects on Sexual and Contraceptive Behaviors (Continued)

    7. Conclusions about the Impact of Sex/HIV Education Programs Some, but not all, programs had positive effects on A, B or C. Thus, different programs can achieve these outcomes. Some programs had positive effects on A and B and C. That is, the same programs can achieve all these outcomes. About 1/3 of the programs significantly delayed sex, reduced the frequency, reduced the number of partners and increased contraceptive use; about increased condom use. These programs did not have negative effects Did not increase sexual behavior Did not decrease condom or contraceptive use Emphases on abstinence and condom use were compatible, not conflicting.

    8. Other Diverse Types of Programs Also Affected A, B or C: Health clinics (with revised clinician/patient protocols) Service learning programs Comprehensive youth development programs with sex/HIV education components Mass media programs focusing on abstinence or condom use

    9. In different countries, different approaches were needed and were effective Uganda in the mid to late 1980s U.S. in the late 1990s

    10. Proximal Individual-Level Risk and Protective Factors for Sexual and Condom-Use Behaviors Basic knowledge about HIV transmission Motivation to avoid contracting HIV (fear) Perceived susceptibility to contracting HIV Perceived severity of contracting HIV Positive perceived norms about sex, # partners, and condom use Self-efficacy to refrain from sex or use condoms

    11. The Single Most Important Characteristic of Effective Programs in the U.S. and Uganda A clear message about behavior (A, B and/or C) Uganda: Initial primary focus on B; later added A and C U.S.: Primary focus on A and C; need to add B

    12. Question #2: Is it possible to have a country-wide impact on A, B and C?

    13. U.S.: Percentage of 9th-12th Graders Who Had Ever Had Sexual Intercourse, by Gender

    14. U.S.: Percentage of 9th-12th Graders Who Had Four or More Sexual Partners During Lifetime

    15. U.S.: Percentage of 9th-12th Graders Who Used a Condom the Last Time They Had Sex

    16. Uganda: Percent of Men and Women 15-19 in Urban Areas Who Have Had Sex

    17. Uganda: Median Age of First Sex among Youth 15-24 Years Old in Urban Areas

    18. Uganda: Percent of Never-Married 15-24 Year-Old Women in Urban Areas Who Had Sex in the Past 12 Months

    19. Uganda: Percent of Single 15-24 Year Old Men and Women Who Had Sex in the Past 6 or 12 Months with Two or More Partners

    20. Uganda: Percent of Single 15-24 Year Old Men Had Sex in the Past 6 or 12 Months with Three or More Partners

    21. Uganda: Percent of Single 15-24 Year Old Men and Women Who Had Sex in the Past Year with a Non-Marital/Non-Cohabitating Partner Who Used a Condom at Last Sex

    22. Conclusion: It is possible to have country-wide effects on A, B, and C.

    23. Question #3: Did These Changes in A, B and C Significantly Affect Important Reproductive Health Outcomes?

    24. U.S.: Pregnancy Rate Among 15-19 Year Old Females

    25. Uganda: HIV Seroprevalence among 20- to 24- Year-Old Antenatal Women in Kampala

    26. Conclusion: The country-wide changes in behavior can significantly improve important reproductive health outcomes country-wide.

    27. Disinhibition

    28. Broad Definition: The process in which one protective behavior reduces perceived risk and inhibition and thereby increases a different risk behavior.

    29. Partner Disinhibition: Does reducing the number of sexual partners and increasing the length of each relationship reduce the use of condoms?

    30. Of course: In both the U.S. and Uganda, young adults are less likely to use condoms after they have sex multiple times with the same partner. In both the U.S. and Uganda, young adults are more likely to use condoms with casual sexual partners.

    31. Condom/Contraceptive Disinhibition: Does increasing the use of condoms or contraception increase sexual activity and number of sexual partners?

    32. U.S.: Results of studies of school-based clinics prescribing or providing contraception: Initiation of sex 3 delayed sex 1 had no significant impact 0 hastened sex Frequency of sex 0 increased frequency 2 had no significant effect 0 reduced frequency

    33. In the U.S., studies of school condom-availability programs: Initiation of sex 1 delayed sex 3 had no significant impact 0 hastened sex Frequency of sex 0 increased frequency 1 had no significant effect 2 reduced frequency

    34. In the U.S., studies of school condom-availability programs (continued): Number of partners 0 increased number 1 had no significant impact 1 decreased number

    35. Initial Conclusion: Making condoms and contraception more available does not increase sexual behavior in the U.S. (no disinhibition)

    36. But Wait: All of these programs emphasized that abstinence was the best approach. All were very modest programs (that sometimes had no impact on condom or contraceptive use either).

    37. Consider a Huge U.S. Intervention: The Increased Availability of Contraception in U.S. in Late 1960s: Among sexually active teens, contraceptive use increased substantially over time Percent of teens sexually active increased also (disinhibition)

    38. Uganda: Percent of Never-Married 15-24 Year Old Women in Urban Areas Who Had Sex in the Past 12 Months

    39. Uganda: Responses to the Question: Does the Availability of Condoms Increase Sexual Behavior among Young People? No Thats a no brainer. Of course it does.

    40. Uganda: Percent of Single 15-24 Year Old Men and Women Who Had Sex in the Past 6 or 12 Months with Two or More Partners

    41. Final Conclusion about Disinhibition When condoms or contraception suddenly become much more available and thereby reduce the risks associated with HIV or pregnancy, more young people will have sex (disinhibition). We need to address this, not deny it or ignore it, and not overstate it. We need to measure it more accurately.

    42. Overall Conclusions: We can have a positive impact on A and B and C, and can improve important reproductive health outcomes (e.g. HIV prevalence and pregnancy). We should simultaneously encourage A and B and C. We should give young adults a balanced, accurate message, emphasizing that abstinence is the safest approach; that if young adults are going to have sex, they should have sex with an uninfected partner in a mutually monogamous relationship; and that if they have sex with other partners, they should always use condoms. We should try to prevent our promotion of one behavior (A or B or C) from undercuting our promotion of other behaviors.

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