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Last week, young people, people living with HIV, policy-makers, donors, researchers, program developers and many others working in the field of HIV gathered for the International AIDS Conference in Washington DC.  Youth was a major theme at this year’s conference, which emphasizes the importance of young people’s role in reversing the HIV epidemic.  We have put together the following recap of select FHI 360 youth-related presentations, conference declarations, links to blogs that provided live coverage, and daily bulletins to highlight some of the exciting events and outcomes from this landmark conference.

Selected FHI 360 Youth Poster Presentations:

Following are links to select poster presentations from the International AIDS Conference that highlight FHI 360’s innovative work with young people in the field of HIV.

“Positive Connections: Leading Information and Support Groups for Adolescents Living with HIV”

“Feasibility of Recruiting Adolescent Women into a Mock HIV Prevention Trial”

“Do Adolescents Under 18 Years Old Warrant Inclusion in HIV Prevention Clinical Research?”

“Domestic Violence Among Young Women in Tanzania: Participant Experiences and Measurement Issues”

Youth Declaration for Change:

As part of the youth pre-conference events the Washington DC YouthForce and CrowdOutAIDS/UNAIDS invited young people to develop a list of priority HIV responses. These responses were compiled to create The Declaration for Change, a document intended to advance the vision for an AIDS-free generation. Visit the Declaration for Change website to learn more about this initiative.

Washington D.C. Declaration:

The Washington D.C. Declaration, initiated in partnership with the International AIDS Society; the International AIDS Conference; and the University of California, San Francisco; is a commitment to work toward ending the AIDS epidemic. Learn more about the Washington D.C. Declaration here.

Live Blog Coverage:

FHI 360’s Degrees blog and the Washington Post both provided daily live coverage of the conference events.  Check out the archives to see the highlights.  

AIDS 2012 Daily Bulletins:

International AIDS Conference organizers released six daily bulletins proving an overview of conference events. You can access all six bulletins here.

This is the fourth post in our series, Adolescent Girls, Microbicides, and HIV Prevention Trials.

Photo by Anna Kaale (Study Coordinator) of a 17 year old study participant

A primary objective of the study titled “Adolescents Women and Microbicide Trials: Assessing the Opportunities and Challenges of Participation” is to determine how well-suited adolescents ages 15-17 are for participating in future HIV prevention trials. Usually HIV prevention trials, including microbicide studies, enroll participants ages 18 and older.  As part of our mock clinical trial (MCT), we asked the young women who completed the study about their experiences as study participants during their last visit.

Thus far, 135 adolescents and young women (ages 15-21) have enrolled in the MCT, and 23 participants have completed 6 months of participation.  Among participants who completed the mock trial, the vast majority felt very positive about their study experience, none felt stigmatized because of their participation, and two-thirds had told someone else that they were part of this study.

We asked the participants what they liked about participating in the study.  Responses included, “I learned a lot of things, especially about how to protect myself from HIV and pregnancy,” “They educate, they counsel and they do not favor or discriminate against anyone,” and “I was very happy because I got a chance to know my health status.”  A number of participants felt that regular HIV, STI, and pregnancy testing was a benefit, although a couple said they did not like the pelvic exams which were required for STI testing.

However, among the 135 enrolled participants, about 68% experienced challenges to their continued participation.  Twenty participants (15%) attended the baseline visit but no other visits, and another 72 (53%) missed at least one visit.  Our research team followed up with participants who had either purposefully dropped out of the study or who had not returned for their follow-up study visits. We wanted to learn why they dropped out and to understand any difficulties they experienced remaining in the study. 

With community-based follow-up, our team discovered that a number of participants had either moved away or they were in school or working during the week, which made it difficult for them to come to the clinic for their study visits.  Others were afraid to continue participating because of misconceptions about the research study.  For example, one participant acknowledged that she understood follow-up visits were important for the study goals but she stated, “for me it is not important because I thought you wanted to remove my uterus.”  The experience of a first-time pelvic exam was scary for some girls and it highlights that adolescents need counseling both before and after the exam to ensure they understand how STI testing works.  Other girls were reluctant to continue with the study because, for example, they did not like answering so many personal questions, but were afraid to tell the study team that they wanted to drop out. Interviewer: “If you were to tell us that you did not want to come to another clinic visit, what did you think would happen?”  Participant: “I didn’t think anything would happen but I was scared and I decided to keep quiet—I thought you would look down on me.”  This quote illustrates that girls are keenly aware of the potential of disappointing a researcher or of being judged. Therefore, careful attention should be paid to reassuring adolescents that their participation is voluntary and all information that they share with researchers, including reasons for dropping out of a study, makes a valuable contribution to the study. 

 

Globally 5 million young people are living with HIV and this number is rising as children who are prenatallyinfected gain access to life-prolonging ARV treatment and new infections among youth continue.  In 2009, 370,000 babies were born HIV-positive; approximately 2,500 young people are newly infected with HIV daily. For many, HIV has become a chronic disease that necessitates lifelong treatment, care, and support. FHI 360 on behalf of USAID’s Interagency Youth Working Group will deliver two presentations at the 2012 International AIDS Conference focusing on the unique needs of young people living with HIV, and on the provision of ongoing, supportive counseling and sexual and reproductive health information.

On Sunday July 22, 2012 from 9:00 to 11:00am in Mini Room 2, FHI 360 will participate in a USAID-sponsored satellite session titled, “Journey of Life for Children Living with HIV: From Diagnosis to Adulthood.” This session will introduce several new tools and resources to address critical issues that youth living with HIV face along their continuum of care, including disclosure, adherence, retention, relationships, and sexuality. The goal of this session is to present the current evidence, best practices, and tools, and provide a forum for discussion and youth voices. (For more information about the satellite session, click on the image of the flyer.) Then on the 26th, from 12:30 to 2:30, FHI 360 will give a poster presentation on an innovative new tool, titled “Positive Connections: Leading Information and Support Groups for Adolescents Living with HIV,” designed to assist adult facilitators in starting and leading information and support groups for young people living with HIV.  Positive Connections will be available in the fall of 2012.

If you are attending the International AIDS Conference, please join us at these two exciting events!

Victoria Pascoe is a project associate at JSI where she works on issues relating to family planning and reproductive health. She is interested in sexual health and education and teaches a school-based health curriculum on puberty and adolescent development to 6th graders in Massachusetts.

The somewhat wary yet energetically charged group of 12-year-olds responds with a resounding “pituitary gland!”  The chorus dies down a bit and predictably becomes interspersed with giggles as we progress to body parts and reproductive anatomy in this “parroting” game we use to break the ice. When I ask if they know what the pituitary gland does I’m met by blank stares.  I explain that it is a small gland at the base of the brain; it releases hormones that trigger changes that occur during adolescence. For this brief overview of puberty, that’s as far as we delve into the role of the brain in the complex reaction of physical, cognitive and social changes that adolescents experience.

However, advances in neuroimaging technology over the past decade have shown that hormone production is just the tip of the iceberg in what is the complex and dynamic adolescent brain. Research* suggests that the prefrontal cortex — which is responsible for functions like impulse control, planning and decision-making, and risk assessment — continues to develop and mature throughout adolescence. These insights into the neurobiology of the adolescent brain are improving our understanding, shifting our conversations and informing how we relate to adolescents. This new knowledge is important for us to have about a stage of life that can be confusing for teens, who are weathering these changes, and also for their parents, who often struggle to understand and relate to them during this time.

Many resources have been produced to help parents and educators understand the implications of the new findings. Less has been said, however, about how this information translates in the health care setting. How can this information better inform the work of health care providers working with teens?  To address this need, JSI Research & Training Institute, Inc. (JSI) developed “Inside the Adolescent Brain: New Perspectives for Family Planning Providers,” an online course on the neurobiology of adolescent brain development to improve reproductive health care for adolescent patients.

Family planning providers sometimes feel mystified, discouraged, or frustrated in their work with young clients, and communication barriers threaten the open and honest dialogue that is essential to minimizing risky behaviors. This course guides providers though the interplay between sexual and neurological development, adolescent risk-taking behaviors and decision-making, and effective approaches for counseling and educating adolescent clients. For providers to successfully interact with teen clients, it is crucial that they reorient their expectations of adolescents, create a safe environment for care, and use adolescent-specific counseling and communication techniques.

JSI’s online course prepares family planning practitioners to support adolescents and effectively provide them with the health information they need to navigate this often tumultuous period. Facilitating improved communication and strengthening relationships in this way will not only result in improved health outcomes but also will foster positive experiences in the health care setting, for both practitioners and teens alike.

* For more information on this research, refer to The National Campaign to Prevent Teen and Unplanned Pregnancy’s Report – The Adolescent Brain: A Work In Progress

This course was funded by Office of Population Affairs/Office of Family Planning, U.S. Department of Health and Human Services and Centers for Disease Control and Prevention.)

The course is available for FREE on JSI’s eLearning Management Platform here

At yesterday’s landmark Family Planning Summit, hosted by the UK Government and the Bill & Melinda Gates Foundation and UNFPA, global leaders from national governments, donor organizations, civil society, the private sector, and the research and development community committed to increasing contraceptive access for 120 million women and girls by 2020.  The commitments made at this unprecedented event also included sustaining access for the approximately 260 million women who currently use contraceptives and aim to deliver contraceptives, information, and services to a total of 380 million women and girls by 2020. The government of Malawi committed to increasing the rate of contraceptive use by 60% by 2020, with specific focus on young women ages 15-24. Malawi also committed to raising the legal age of marriage to 18 and improving youth sexual reproductive health programs.

These global commitments are crucial to addressing the critical need for contraception among adolescents globally. In developing countries, approximately one-third of adolescent girls give birth before they turn 20. It is estimated that as many as 50 percent of pregnancies worldwide are unintended and a disproportionate amount of unintended pregnancies occur among young, unmarried girls who often lack access to contraception. Approximately 85 to 95 percent of sexually active young women who do not use contraceptives become pregnant within one year of initiating intercourse.  The unmet need for contraception among adolescents is as high as 68% in some regions, such as sub-Saharan Africa, South-central Asia, and Southeast Asia. 

Fulfilling the unmet need for family planning among adolescents could prevent an estimated 7.4 million unintended pregnancies.  Preventing unintended pregnancies among adolescents would reduce the number of maternal deaths as well as improve educational and employment opportunities for young women.  Thus, the commitments made yesterday have the promise to vastly improve the health and lives of millions of young people globally.

To learn more about the family planning commitments made at yesterday’s summit, read the DFID and Bill & Melinda Gates Foundation press release

 

 

I was very shocked when I visited one of the communities in the outskirts of town… to find a 9-year-old boy and his 11-year-old sister drunk.”Amplify Your Voice

This alarming statement, written by a young woman in Tanzania, portrays the sad reality of adolescent alcohol use. Globally, more young people are drinking at a younger age, and the consequences are dire.  Adolescent alcohol use is associated with alcohol-fueled homicide and suicide, alcohol dependence, and alcohol poisoning. Alcohol also contributes to an increased risk of mental health problems and alcohol-related injuries from motor vehicle accidents, falls, burns, and drowning. Approximately 10–20% of the violent deaths among young people are alcohol related.  Vulnerable young people, such as street youth and young people who sell sex, are at far greater risk of early initiation of alcohol use and frequent consumption of alcohol than the general youth population.

Alcohol lowers inhibitions and contributes to higher rates of risky sexual behaviors, such as early initiation of sexual activity, multiple sexual partners, inconsistent condom use and transactional sex.  For example, adolescents who use alcohol are approximately three times less likely to use condoms. These factors all place young people who use alcohol at a greater risk of unplanned pregnancy and of contracting HIV and other STIs.

People who begin drinking at an early age, who drink frequently, or who drink large amounts are at high risk for developing alcohol dependence and are at greater risk of being perpetrators and victims of violence than their non- or less-drinking counterparts. Hazardous and harmful levels of alcohol use, as well as alcohol dependence, are risk factors for intimate partner violence. Alcohol-fueled violence contributes to young people’s vulnerability to physical injury, psychological trauma, HIV infection and unintended pregnancy.

 “It was a …party, everyone was handing me alcohol, and I just wanted to fit in.  I downed one shot, then two shots, then a beer, then two beers, until I had consumed more alcohol than words… I don’t remember anything after that. He had sex with me…This doesn’t happen to me. This couldn’t have happened to me.”—youth author, Scarleteen

The potential negative sexual and reproductive health outcomes associated with young people’s alcohol use are alarming, and measures to reduce alcohol consumption and the potentially harmful, sometimes fatal, results of alcohol use among this age group are imperative.  We invite you to join us July 10-11 for an online discussion about alcohol and its effect on young people’s sexual and reproductive health.  Moderated by FHI 360 and USAID, this forum will give participants an opportunity to discuss alcohol use among young people, associated sexual and reproductive health consequences, programmatic responses to alcohol use among adolescents, and policies aimed at reducing alcohol use.  To learn more about this topic, read our recently released YouthLens publication, “Alcohol and Its Effect on Young People’s Reproductive and Sexual Health.”

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A young woman from Zimbabwe writes about adolescent pregnancy and the experiences of her peers as part of our Stories Behind the Statistic series, produced by the IYWG for the Gates Foundation blog, Impatient Optimists.

Working directly with young people in Zimbabwe, I have seen how adolescent pregnancy is a harsh reality that many young girls encounter. For these young girls, becoming pregnant is an ordeal that is hardly ever planned and is often the result of social, economic and financial circumstances that rob them of their autonomy.  

Because of very difficult economic conditions, many young women engage in intergenerational relationships.

For example,  one 14-year-old girl told me how being offered small gifts including sweets and chips resulted in her sexual relationships with older men, causing her to become pregnant, get married early, and endure an unsafe abortion. Other young girls hope to contribute to their family’s income by working on farms, and one girl told me how this has increased her risk of sexual violence. She has to travel long distances to fetch firewood and work in the fields. Being so far away from her home, without many people around, puts her at risk of sexual abuse. Sexual abuse or rape while working in the fields has left some young girls unwillingly pregnant and exposed to HIV and STI infection.

Sometimes young girls and women are overpowered by societal pressure exerted on them to get married early.

Society gives unmarried women nicknames such as “Chipo Chiroorwa,” which means “get married now or risk becoming ridiculed.” I have seen how, by succumbing to such pressure, these girls then have to deal with the overwhelming psychological trauma of becoming pregnant very young, giving up their dreams, and being forced into parenthood without necessarily being prepared for it. 

Natsai, aged 18, told me how becoming pregnant when she was 15 resulted in nothing but loss: loss of love, time, education and physical health. The first four months of the pregnancy were traumatic because she suffered quietly. She did not dare share her news with anyone because she feared rejection, stigma and discrimination from her family and community.

When her aunt discovered Natsai was pregnant, her aunt chased her from home, and she eloped with her boyfriend who was unemployed. She dropped out of school to look for a job on a nearby farm to fend for herself and her baby.  Natsai’s story typifies those of many girls and young women whom I have seen putting on brave smiles that hide sad stories about the detrimental effects that adolescent pregnancy has had on their lives.

Most young women I know who became pregnant were not ready to get married or drop out of school. Many were exposed to HIV infection, underwent unsafe abortions, and will deal with rejection all their lives. They have faced many adverse consequences as a result of getting pregnant before they are physically, emotionally, and socially mature enough to be mothers.

There is an African proverb that says, “It takes the whole village to raise a child.” Likewise, the issue of early and unintended pregnancy is not one individual’s responsibility; everyone has a role to play in preventing adolescent pregnancy. Young women need increased access to equal opportunities, education in sexual and reproductive health, youth-friendly services, social support, education, employment, and empowering life skills, so that unplanned childbearing does not hinder the achievement of their dreams at a young age.

To learn more about adolescent pregnancy visit the Interagency Youth Working Group’s “Adolescent Pregnancy” topic page.

Are you inspired to act on behalf of women and girls who deserve the opportunity to determine their own futures; who desperately need access to family planning education and contraceptives? Keep an eye out for ongoing information about, and ways to pledge support for, the upcoming Family Planning Summit on July 11, 2012. The Summit is being hosted by the Gates Foundation and the UK’s Department for International Development (DFID) with the aim of addressing the unmet need for contraceptives for the 120 million women in the poorest countries who, over the next eight years, will want and need but don’t have access to them. It’s about investing in women and girls and putting family planning front and center on the global agenda. Join the conversation with @gatesfoundation and check Impatient Optimists regularly for details.

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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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