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close this bookInnovative Approaches to HIV Prevention (UNAIDS, 2000, 55 p.)
View the document(introduction...)
View the documentACKNOWLEDGEMENTS
View the documentINTRODUCTION
View the documentMETHODOLOGY
View the documentWHAT WORKS IN HIV PREVENTION?
View the documentWHAT WORKS WITH YOUNG PEOPLE?
View the documentWHAT WORKS WITH WOMEN AND MEN?
View the documentWHAT WORKS WITH PEOPLE WHO INJECT DRUGS?
View the documentWHAT WORKS WITH MEN WHO HAVE SEX WITH MEN?
View the documentWHAT WORKS WITH SEX WORKERS AND THEIR CLIENTS?
View the documentANNEX. SUMMARY OF CASE STUDY RESULTS
View the documentREFERENCES
View the documentBACK COVER

WHAT WORKS WITH YOUNG PEOPLE?

Approximately half of all people who acquire HIV become infected before they turn 25. Thus, it is crucial that work be undertaken to help young people protect their sexual health. However, there has been a great deal of uncertainty about how to approach HIV and AIDS prevention with young people. For example, there continues to be widespread concern that ‘too much’ sex education will encourage young people to become prematurely sexually active. Consequently, many sex education programmes have focused solely upon abstinence. Several studies have shown, however, that well-designed programmes of sex education, combining messages about safer sex as well as abstinence, may delay sexual debut, as well as increase preventive behaviours among those young people who are already sexually active (Grunseit, 1997). Where they have been able to access appropriate knowledge, skills and means, young people have shown a remarkable propensity to adopt safer behaviour.

The experiences of young people vary according to social and cultural context, gender, socioeconomic status and sexuality. In order to be successful, HIV prevention programmes need to abandon stereotyped images of young people and take full account of their diversity while recognizing that all young people need accurate information. However, it is important to be aware that young people, especially girls in developing countries, do not always have the freedom to make their own choices about sexual behaviour. They may, for example, be vulnerable to forced or coercive sex, and may sell or exchange sex to ensure their economic survival, or to gain the protection of adults. Young people in developing countries often have immediate needs for shelter, food and clothes which take priority over the threat of a disease which may or may not kill them in years to come (Swart-Kruger & Richter, 1997).

It is important that programmes take into account these structural constraints, barriers and challenges for daily survival which young people face. In addition, it is critical that a dialogue begin with policy-makers to make certain that the rights of young people are ensured, and that governments and international agencies work to address the specific needs of young people in especially vulnerable circumstances. It is also important to remember that, while young people may be at special risk of HIV infection, they also present an opportunity for halting the epidemic, since their sexual and other habits may not yet be firmly established.

YOUTH CASE STUDY 1

Setting:

University

Country:

Kenya

Intervention:

Peer-led education

Sponsoring institution/organization:

Family Planning Private Sector (an NGO)

The Kenyan NGO, Family Planning Private Sector (FPPS) initiated a peer education project for sexual and reproductive health in collaboration with staff and students in nine institutions of higher education. Students’ representatives and Deans from all the institutions were brought together in order to develop an outline curriculum. As a result, student leaders established ‘AIDS Awareness Clubs’ which became the main coordinating bodies for activities. Peer educators organized a variety of activities, including condom distribution and the publication of newsletters. Qualitative evaluation carried out in five of the institutions by FPPS and Family Health International along with an external consultant during March-April 1997, revealed that approximately 19 000 students were reached through the programme, and the project substantially increased students’ access to services as well as information. Among the most innovative aspects of the work was the way in which the project team secured the support of the colleges’ administration. Additionally, the initiative’s success stemmed largely from the fact that young people themselves were involved in all aspects of project design and implementation.

YOUTH CASE STUDY 2

Setting:

Community: out-of-school youth

Country:

Peru

Intervention:

Advocacy, information dissemination, and youth empowerment

Sponsoring institution/organization:

Institute of Population Studies at Cayetano Heredia University

During 1995-1997, the Institute of Population Studies at Cayetano Heredia University in Peru designed, implemented and evaluated a community-based programme in youth and sexual and reproductive health in two neighbourhoods in Peru. Programme staff aimed first to mobilize community resources in order to improve the quality and dissemination of information on related issues. Second, they aimed to promote more democratic models for sexual health promotion which respect the rights of young people. Third, they aimed to empower young people in identifying and seeking solutions to their own sexual and reproductive health (SRH) problems. In addition, the project sought to motivate local municipalities, education and health sectors, youth groups and community-based organizations to direct more resources towards youth SRH services.

In a preparatory phase, information on the perceptions and needs of local young people was obtained. A survey of a representative sample of 800 young people was undertaken, along with focus group discussions, interviews with key members of the community and a rapid assessment of health services within the area. An advisory committee comprising representatives from governmental, nongovernmental, community and youth organizations was established. Subsequently, training programmes were designed and implemented with health workers, teachers and youth and school peer promoters. Additionally, a directory of reference services in youth health was compiled. The major output of the programme was the design and implementation of a campaign for improved sexual health among young people.

Qualitative and quantitative evaluation activities included the collection of data through activity records, individual and group interviews with key members of the community, post-workshop surveys and observations to assess the educational impact of SRH workshops. In addition, data were collected on the functioning of the health service network and the referral system. Young people assessed the educational workshops positively since they were participatory, entertaining and centred on their own problems and perspectives. The young people were genuinely committed to the programme strategy, as shown by their level of voluntary involvement as peer promoters. The level of involvement and support to the project from key people in the diverse working networks increased significantly. The evaluation concluded that the project strategy has high potential to impact on the SRH of young people, and to become established within the community.

YOUTH CASE STUDY 3

Setting:

Mass media

Country:

Dominican Republic

Intervention:

Communications campaign using radio, print and television

Sponsoring institution/organization:

Dominican Republic National HIV/AIDS Prevention Programme in collaboration with 20 government organizations and NGOs

During 1994-1997, a media prevention campaign aimed at young people was developed via collaboration between the Dominican Republic’s National HIV/STD Prevention Programme and twenty governmental and nongovernmental organizations. Before the media campaign, extensive research, including a KABP survey, was carried out in order to establish a profile of the young people at whom the intervention was aimed. Appropriate messages about HIV/AIDS were then developed and disseminated through radio, television and print media in three phases. The first phase was designed to increase awareness. The second phase attempted to ensure consistency in messages from different sources, and included the production of a manual for teachers and youth workers. The third phase concentrated on making young people aware of how to protect themselves from HIV infection and providing information about where they could access services and support.

An evaluation conducted in 1996, which involved focus group discussions with young people, revealed that the messages were perceived as well targeted, creative and imaginative. Young people reported that the messages had promoted discussion and helped them reflect on their behaviour. However, young people also reported that more work was needed in order to encourage better communication between parents and children. The overall approach has now been replicated in Guatemala, and other countries in the region are also looking at how the method can be adapted for their own use.

YOUTH CASE STUDY 4

Setting:

Community: sexually exploited youth

Country:

Nepal

Intervention:

‘Camps’ or shelters

Sponsoring institution/organization:

Maiti Project

In Nepal, the Maiti Project has targeted young people subjected to sexual exploitation and abuse, including young women who are at risk of being sold into prostitution in India. The project has undertaken a diverse range of activities, the focus of which is the establishment of camps in high-risk areas. Each of the camps functions as a shelter for approximately thirty girls who have been rescued from traffickers or who are in danger of being sold. The camps provide education and vocational training, as well as support and counselling. The project has worked closely with colleges, local pressure groups, village leaders, medical officers, lawyers and police. Evaluation suggests that the Maiti Project has prevented approximately 180 girls from being sold into brothels in India each year. In addition, 105 people have been imprisoned as a result of the project’s efforts to expose child traffickers. In 1997 alone, 60 girls were repatriated from India and 75% of these were subsequently reunited with their families. The project is most remarkable in its integrated approach to meeting the needs of young people, and the ways in which it takes account of the complex social and economic circumstances of vulnerable young people.

YOUTH CASE STUDY 5

Setting:

Community

Country:

Haiti

Intervention:

Health services and training for young people, families and teachers

Sponsoring institution/organization:

Fondation pour la Santeproductive et l’Education Familiale (FOSREF)

In Haiti, the Fondation pour la Santeproductive et l’Education Familiale (FOSREF) has attempted to ensure the provision of reproductive health services directly designed for young people. Two large medical centres designed specifically for young people have been established. The project has also provided technical support to staff working in other clinical settings to enable them to cater more effectively to the needs of young people. Other related project work has included the training of teachers and parents in order to expand the support network available to young people. Project staff have also played a central role in lobbying for national support for the creation of reproductive health services which adequately respond to the needs of young people. The participation of young people has been encouraged at every stage of development, management and implementation. In addition, an extensive peer education programme with young people adopting the roles of trainers and health promoters was established.

FOSREF staff carried out an evaluation in 1997 assisted by an external consultant. By that time, more than 125 000 young people had been reached through the project. More than 4 000 had received training in family life and reproductive health, including 300 specializing in STD/HIV prevention. Two hundred schools, within the geographical area of the project, were regularly visited by the peer educators. The training of peer educators was carried out by 18 youth specialist facilitators and assistant facilitators. More than 15 000 young people regularly attended the youth medical centres where they received a range of services including contraceptive counselling, prevention of STD/HIV, specialized HIV/AIDS counselling, antenatal care and support services. In addition to this formal evaluation, two studies were carried by young people themselves to assess the appropriateness and acceptability of the services from the point of view of the target group.

YOUTH CASE STUDY 6

Setting:

Community households

Country:

Egypt

Intervention:

Telephone hotline

Sponsoring institution/organization:

Ministry of Health and private sponsors

An AIDS hotline and counselling service evolved out of a trial telephone counselling service established during the early 1990s in Egypt. It was an attempt to provide a channel for people to discuss issues surrounding sex and sexuality within a context where cultural taboos prohibit their open discussion in public. Even with limited advertising, people began to call, and an evident need for the service was identified. In September 1996, after securing personnel and office space from the Ministry of Health (MoH), and funding from the Ford Foundation, the hotline was opened. Counsellors were appointed by the MoH and underwent an intensive 4-week training. The objectives of the project are to provide accurate information about HIV/AIDS to the general public, including young people, and to provide confidential and anonymous HIV/AIDS counselling services.

A team of trained counsellors answer all calls, and callers can choose whether to speak to a woman or a man. The hotline is advertised on bulletin boards, trains, metros, buses, and in Arabic newspapers. Supervisory monitoring of the calls is conducted, to ensure the quality of the information and services provided. Evaluation has taken the form of monitoring the services and gathering basic demographic data on the callers using the service. Questions are asked to determine the level of education of each caller, how they learned about the hotline, whether or not they are married and from where they are calling. The volume of calls is monitored and daily statistics on the numbers of callers, their gender breakdown and the sorts of questions asked are recorded. Between September 1996 and May 1998, 18 628 calls were made, averaging around 1 000 per month. More than 50% of callers are between the ages of 13 and 25 years, and 70% are unmarried. Most callers have had a high school or university education, and less than 20% are women. Although the project originally focused on Greater Cairo, calls are also made from rural settings and from other countries where Arabic newspapers are read.

The number of calls made to the hotline has surpassed all expectations. The anonymity of the hotline appears to have provided a vital link to information and counselling services that would otherwise not be available. Through the hotline, people are able to discuss issues such as sexuality, condom use, pre-marital sex and homosexuality, which are rarely addressed in public forums. At the time of its operation, this was the only HIV/AIDS Hotline run by a government service in the Middle East.

YOUTH CASE STUDY 7

Setting:

Schools

Country:

Viet Nam

Intervention:

Skills-based HIV/AIDS and STD prevention

Sponsoring institution/organization:

UNICEF and the Vietnam Ministry of Education and Training (MOET)

In Vietnam, a skills-based HIV/AIDS/STD prevention project was begun as a UNICEF-assisted HIV/AIDS prevention project of the Vietnam Ministry of Education and Training (MOET) in 1997. The primary goal of the project was to work with schools to equip young people with information and skills required for promoting healthy behaviour, and avoiding risky situations, especially related to HIV/AIDS. The major focus was on student knowledge, attitudes and values and behaviours. An anticipated secondary outcome was a similar impact on teaching staff.

The project trained teachers in skills-based health education for HIV/AIDS and other STD prevention, and supported them in implementing the new approach in the classroom. Skills-based HIV/AIDS/STD-related lessons were developed for grades 1-12 and integrated into the existing curriculum. New teachers’ guidebooks and student worksheets were developed by those trained. In the initial implementation year, a total of 300 teachers implemented and 15000 students studied life skills and HIV/AIDS prevention. Another 5000 young people studied life skills and other topics with 140 Viet Nam Red Cross trainers supported by UNICEF.

YOUTH CASE STUDY 8

Setting:

Schools

Country:

Uganda

Intervention:

School health education

Sponsoring institution/organization:

Uganda AIDS Commission

A school health education programme in primary schools aimed at AIDS prevention in the Soroti district of Uganda emphasized improved access to information and other resources for healthy sexual behaviour decision-making; improved peer interaction regarding information and decision-making related to HIV/AIDS, sexuality and health; and improved quality of performance of the existing school health education system. A cross-sectional sample of students, average age 14 years, in their final year of primary school was surveyed before and after 2 years of interventions. The percentage of students who stated they had been sexually active fell from 42.9% (123 out of 287) to 11.1% (31 out of 280) in the intervention group, while no significant change was recorded in a control group. The changes remained significant when segregated by gender or rural and urban location. Students in the intervention group tended to speak to peers and teachers more often about sexual matters. Over the study period, these students became more likely to give as reasons for abstaining from sex those associated with a rational decision-making model rather than a punishment model. A primary school health education programme which emphasizes social interaction methods can be effective in increasing sexual abstinence among school-going adolescents in Uganda. The programme does not have to be expensive and can be implemented with staff present in most districts in the region.