You are currently browsing the monthly archive for January 2011.

Amy Weissman, Regional Adolescent and HIV/AIDS Specialist, The Americas and Caribbean Office, UNICEF

Given recent successes with male circumcision, microbicides, and PrEP, we are turning attention to biomedical interventions for HIV prevention.  As we learn how to implement these important interventions, it is critical that we not abandon other known effective prevention strategies.  Because helping to establish healthy behaviors is easier than changing set patterns, pre-risk interventions—those that reach adolescents before they initiate sex or other risk-related practices—are key to reducing HIV among young people.  One effective pre-risk intervention is to involve parents (or other primary caregivers).

According to UNAIDS’s 2010 report on the global AIDS epidemic, there has been a 50% reduction in infections among young people in South Africa.  Michel Sidibe, executive director of UNAIDS attributes this reduction in part to changes in parent-child communication regarding sexuality.  He says: “Now, more people are willing to talk to their children.” (free New York Times account required)

Does talking to one’s children really make a difference?  According to research, there is a strong link between parent-child sexual communication and decreased adolescent sexual risk behavior—studies have found that adolescents who talked with their parents about sexual issues were more likely to use condoms or have fewer sex partners compared to those who had not.  These conversations are most effective in reducing sexual risk behavior when they take place before the young person initiates sex.

Parents can help their children navigate through sexual, drug-use, and other risk-related decision-making because they can reach their children before risk behaviors start. Parents can also engage their children in continuous and sequential discussions that build upon one another as the child matures, and they can be supportive and involved in their children’s lives more generally. 

Through monitoring and effective communication, caregivers can help adolescents establish healthy sexual behaviors, such as avoiding pregnancy and preventing HIV infection.  Monitoring of children’s social activities (knowing where they are, who they’re with, and ensuring they return home) is associated with less frequent sexual behavior, fewer sexual partners, more consistent contraceptive use, and less drug abuse.

Effective communication by caregivers who are knowledgeable, skilled, comfortable, and confident in communicating with their children about sex-related matters is linked to decreased sexual risk-taking by adolescents, increased condom use, and increased communication between the adolescent and his or her partner.

Although most kids want their parents to talk with them about sex, and although many parents would like to do so, it doesn’t happen as often as it should.  Sexuality tends to be a difficult topic for parents to discuss.  According to parents in Botswana, talking about sexuality with their children “brings shame into the home.” So, what to do?  We should provide opportunities for parents to acquire the necessary comfort and skills to talk with their children.  Doing so ensures that caregivers can play their important role in reaching young people early with HIV prevention messages, helping to shape and form healthy behaviors that will protect their children throughout their lives.

While we should be excited about the advent of pills and microbicides to help prevent HIV transmission—after all, these are critical approaches to achieving a reduction in HIV incidence—they are only part of our toolkit of “combination prevention.”  According to a study published in The Lancet, “new technologies provide substantial opportunities to re-invigorate behavioral approaches to HIV prevention.”  So we should take this opportunity to do so.  And in particular, let us focus on behavioral interventions that not only reduce risk, but also encourage more open, informed communication between parents and children, create a healthier environment, and promote positive outcomes that extend beyond physical health.  Take a moment and imagine a world where parents and children communicate better—how bad could that be?

We recently heard about malaria-inspired clothing designs that were exhibited at Swahili Fashion Week, an annual gathering of designers from Swahili-speaking countries. This year, three designers were chosen to develop a collection inspired by malaria and show their creations on the runway. The malaria fashion project resulted from a collaboration among John Hopkins University’s Center for Communication Programs; VOICES for a Malaria-Free Future project; Malaria Haikubaliki (“Malaria Is not Acceptable”), Tanzania’s national malaria communication campaign; and Swahili Fashion Week.

View more photos of the malaria-inspired clothing collection at Swahili Fashion Week.

This innovative malaria awareness campaign led us to consider the implications of malaria for youth. Pregnant women and people living with HIV (PLWH) are at higher risk of contracting malaria and suffering from or dying of it than others. The negative impact of malaria on PLWH is of particular concern for youth, because nearly half of all new HIV infections occur among young people between the ages of 15 and 24. Furthermore, approximately 16 million adolescent girls ages 15-19 give birth each year, and adolescent pregnancies account for more than 10 percent of all births worldwide. Thus, the negative health outcomes associated with malaria in pregnancy have the potential to affect millions of adolescent girls. Malaria during pregnancy increases the risk of maternal anemia, stillbirth, spontaneous abortion, low birth weight, and neonatal death. Every year, up to 200,000 women and infants die as a result of malaria in pregnancy.

The topic of malaria is often ignored within the context of adolescent sexual and reproductive health. The importance of malaria awareness in the field of public health is well known, but have you ever considered that malaria awareness may be an important component of improving the reproductive health of adolescents? We want to hear your thoughts about malaria and youth reproductive health. Leave a comment and let us know what you think.

Kathy Lancaster, MPH, is a Global Health Research Fellow at FHI.

I was happy to begin my new year in Washington, DC attending the 1st International Workshop on HIV and Women from Adolescence through Menopause. The workshop covered a wide range of topics, including biology of risk, contraception, aging, toxicity, mucosal immunity, hormone interactions, social behavior aspects, and pregnancy. Nearly 30 countries were represented from Africa, South America, North America, and Asia. The two-day conference consisted of invited lectures, abstract-driven scientific presentations, and poster sessions to generate a strategic agenda for future management for women and HIV.

Although the workshop was not specific to youth, presenters frequently reminded participants that women and adolescents are disproportionally affected by HIV and that HIV prevention and treatment activities need to focus on adolescent girls. One study presented by Yanga Zembe from Medical Research Council in Cape Town, South Africa, highlighted that young women’s capacity to act independently in their sexual lives is often overpowered by male-biased social norms. These norms limit women’s ability to protect themselves from potential risky sexual encounters. Prevention messages and activities need to take young women’s social environment into consideration.

Another presenter pointed out that as the number of adolescents living with HIV grows, it is imperative to understand the myriad challenges to involving and keeping youth in HIV treatment. Of the adolescents who are engaged in HIV treatment, few have actually achieved suppressed viral loads. According to Dr. Glenda Gray, young people find it difficult to disclose their HIV status—including to the very people who might be in a position to help them. Adherence to HIV drug treatment is challenging for adolescents. Young people may not completely understand the importance of  strictly adhering to their HIV treatment or they may refuse to take the drugs altogether because of the negative side effects associated with treatment. Treatment facilities urgently need to create adolescent-specific care to address these concerns.

To learn more about the workshop or view presentations, click here.

Economic disparities fuel the HIV epidemic and contribute to other negative health outcomes among young people, especially adolescent girls. Sustainable livelihood programs aim to address these inequalities by providing young people with career training, skills development, and access to capital.  The following is the story of one young woman whose life was dramatically changed by a livelihood program.

In the city of Kisumu, Kenya, in the slum district of Nyllenda, there is a small, blue tin building located on a crowded dirt road. On most days, a woman named Mary sits in the back room of this building, quietly working at her sewing machine.

When Mary was 10, her life fell apart. First, she lost both of her parents in an automobile accident. After that, Mary and her six siblings moved in with her grandmother. The cost of feeding seven extra people was too much for the grandmother, and as the oldest sibling, Mary quickly became the primary caretaker. She was forced to leave school to sell small food items by the roadside. One day, Mary was raped by a group of men after stopping to ask for directions. Then, Mary met an older man whom she believed would support her financially, and she became romantically involved with him. At 18, however, she had a baby, and the man left her.

Her story is not uncommon; many adolescent girls in developing countries are faced with sexual violence, unintended pregnancy, lack of education, and pressure to contribute to a family income. However, Mary’s story took a turn for the better. One year ago, Mary enrolled in a sustainable livelihood program that she says has carried her from “nothing to something.” She learned many new skills and now earns enough wages to support herself and her family, and she is no longer dependent on men. She sells school uniforms and purses and hopes to one day own a tailoring business. Mary’s story demonstrates the tremendous effect economic opportunity can have on the life of adolescents.

Read more about livelihood programs.

In 2000, United Nations delegates and world leaders declared eight Millennium Development Goals to be met by 2015:

Goal 1: Eradicate extreme poverty and hunger.
Goal 2: Achieve universal primary education.
Goal 3: Promote gender equality and empower women.
Goal 4: Reduce child mortality.
Goal 5: Improve maternal health.
Goal 6: Combat HIV/AIDS, malaria, and other diseases.
Goal 7: Ensure environmental sustainability.
Goal 8:  Develop a Global Partnership for Development.

Improving the health and well-being of youth is paramount to achieving the Millennium Development Goals. Why? Read on:

Goal 1: Eradicate extreme poverty and hunger.
462 million young people live on less than $2.00 a day.

Goal 2: Achieve universal primary education.
Early marriage and unintended pregnancy are two of the most prominent reasons girls drop out of school.

Goal 3: Promote gender equality and empower women.
Gender discrimination often starts from the day a girl is born; in some countries infant girls are less likely to survive than infant boys due to gender preference and neglect. Greater equality for female children and adolescent girls is necessary to ensure that women have equal rights later in life.

Goal 4: Reduce child mortality.
Infant and child mortality is highest amongst children of adolescent mothers. Young mothers are also more likely to have low-birth-weight babies, increasing the risk of childhood malnourishment, poor development, or death.

Goal 5: Improve maternal health.
Unintended and early pregnancy among adolescents negatively effects adolescent maternal health.  Girls between the ages of 10 and 14 are five times more likely to die in pregnancy or childbirth, and girls ages 15 to 19 are two times more likely to die than women ages 20 to 24.

Goal 6: Combat HIV/AIDS, malaria, and other diseases.
Nearly half of all new HIV infections occur among young people between the ages of 15 and 24. Approximately 7,000 young people are infected with HIV daily.  Ninety-seven percent of these new infections occur in low- and middle-income countries with limited access to HIV-prevention information and care.

Goal 7: Ensure environmental sustainability.
1.7 billion people live in countries that are “water stressed.”   Deforestation and lack of water puts a great burden on adolescent girls living in rural areas. In some rural areas, women and girls spend approximately three hours a day fetching water.  Increasing amounts of deforestation means that girls must walk further to find wood for fuel. If girls are spending half the day looking for water and fuel, then they are not in school.

Goal 8:  Develop a Global Partnership for Development.
One of the targets of goal eight is to provide decent and productive work for youth.

“Addressing the needs of adolescents, especially those of girls, is critical to the achievement of every one of the Millennium Development Goals.” – UNFPA

Learn more about the Millennium Development Goals.

Recently, a compelling story about the perils of early marriage caught our attention. In a book called I Am Nujood, Age 10 and Divorced, Yemini Nujood Muhammed Nasser tells her own courageous story about her fight to end her forced marriage to a 30-year-old man.

Named 2008 woman of the year by Glamour magazine, Nujood recounts her family’s move from a rural village to a large metropolitan area, where her parents were unable to afford the high cost of living or care for her and her 16 siblings. Nujood and her siblings had begun begging in the streets when her father received a proposition: a man from his home village asked to marry one of his daughters. He accepted.  In February 2008, Nujood, the oldest single daughter, was married in exchange for the equivalent of US$750.

As is common for child brides, Nujood was immediately taken out of school, and she became isolated from friends and family when she moved to her husband’s village several hours away. Nujood was treated poorly by her new mother-in-law and was repeatedly raped by her husband. Unfortunately, most of Nujood’s family did not sympathize with her plight. They said it was her duty as a wife to obey her new husband and that divorce would dishonor her family. However, encouraged by her father’s second wife, Nujood decided she would go through the court system to demand a divorce. Alone and afraid, she made her way to the courthouse, approached the judge, and requested permission to divorce her husband. Over time, with help from a few sympathetic judges and a women’s rights activist lawyer, Nujood’s divorce was granted. Her story of bravery and determination has become an international sensation and serves as a symbol of hope for all victims of child marriage. 

Read the most recent YouthLens brief, Addressing Early Marriage of Young and Adolescent Girls, to learn about some successful approaches for delaying marriage.

In a well-off suburb of Johannesburg, South Africa, a bride-to-be listens to the radio as she happily dresses for her wedding, until an announcement stops her cold: a popular local DJ—whom she had dated five years earlier—is dying of an AIDS-related illness. Now she must decide whether to tell her groom of her previous relationship or keep her past, and her possible infection, to herself.

This scene opened the new South African television drama Intersexions, a series of 25 vignette-like episodes that tell independent but connected stories of people infected with and affected by HIV. The series offers a window into the characters’ relationships and the circumstances of their infections, following the spread of HIV within a sexual network across age, race, sexual orientation, and socioeconomic status. Each episode sheds more light on the interconnectedness of sexual networks and spurs viewers to reflect on the potential consequences of multiple and concurrent partnerships within their own networks.

Intersexions, sponsored by Johns Hopkins Health and Education in South Africa (JHHESA) has been wildly popular in South Africa. October’s opening episode was watched by more than half of all television viewers in South Africa, and by December, Intersexions had become South Africa’s most watched drama series and the second most watched television show overall on the South African Broadcasting Corporation (SABC). The show’s Web site includes a link to Ask the Dr., a space where anyone can submit a comment or question to Dr. Elna McIntosh, a licensed sexual health care practitioner. The site also contains a Radio Schedule, so audience members can tune into the weekly discussions on various radio stations around South Africa which support Intersexions episodes by focusing on themes raised in that week’s episode.

Have you seen Intersexions? Let us know what you think! Click here to learn about JHHESA’s other radio and television shows on love, sex, and health.

The IYWG is hosting an online forum to discuss youth peer education.  We’ll be focusing on the recently completed Evidence-Based Guidelines for Youth Peer Education.   Discussion topics include program planning, recruitment and retention of peer educators, training youth to be peer educators, leading peer education sessions, supervision and program management, monitoring and evaluation, and addressing gender in peer education.

The e-forum presents an opportunity for everyone – whether you’re a program manager, a supervisor, a peer educator, or just someone interested in improving youth peer education – to ask questions and share their experiences.

The forum will begin at 9 AM Eastern Standard Time (EST) on Monday, January 10th and end at 5 PM EST Thursday, January 13th.  Beginning on the 10th, you can submit questions to our experts and share your experiences with colleagues working in peer education.  Because our experts live in a variety of time zones, their responses will be posted beginning on the morning of January 11th.

Click here to learn more about our experts or register for the forum.

For many, the New Year marks a time for change, for new beginnings, and for renewed commitments. At the start of this new year, we would like to take a moment to remember that this is the United Nations International Year of Youth, which is being celebrated from August 2010 through August 2011.

In December 2009, the United Nations General Assembly adopted resolution 64/134 dedicating this year to youth. This resolution signifies the importance of youth-related issues. Currently, half of the world’s 7 billion people are younger than 25. More than one billion are between the ages of 12 and 24, and of these, nearly 85 percent live in low-resource countries.  Youth today face many challenges, including limited access to resources, healthcare, education, employment, and economic opportunities. Youth account for more than half of all new HIV infections, and have a high level of unmet family planning needs.

“Youth deserve our full commitment – full access to education, adequate healthcare, employment opportunities, financial services, and full participation in public life.” - United Nations Secretary-General Ban Ki-moon

Youth are our future. Young people in all countries can bring about positive social change; their ideas, energy, and vision are our greatest resources.

What are you doing to celebrate youth this year? Use the “leave a comment button” to join the conversation. If you want to participate in the UN Year of Youth, visit the links below:

The official Year of Youth Web site

Year of Youth Activities Calendar

IYWG logo

This blog is brought to you by the Interagency Youth Working Group (IYWG) with financial assistance from the U.S. Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief. The content is managed by FHI, which functions as the secretariat for the IYWG.
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