Youth InfoNet is the monthly electronic newsletter produced by Family Health International (FHI) focusing on youth reproductive health and HIV prevention.

I. Program Resources

1. Analysing the Response of a Teacher Training Institution to HIV and AIDS: A Case Study from Zambia
2. ‘Aunties’ for Sexual and Reproductive Health: How Unwed Young Mothers Become Advocates, Teachers and Counsellors in Cameroon
3. Development Outreach: Youth & Development – Investing in the Next Generation
4. Education and HIV/AIDS Prevention: Evidence from a Randomized Evaluation in Western Kenya. Background Paper to the 2007 World Development Report
5. Education in Emergencies: The Gender Implications – Advocacy Brief
6. Educational Responses to HIV and AIDS for Refugees and Internally Displaced Persons: Discussion Paper for Decision-Makers
7. Evaluations of Five Programs for Orphans and Vulnerable Children in Kenya and Tanzania
8. Girls Left Behind: Redirecting HIV Interventions toward the Most Vulnerable
9. Jamaican Youth Risk and Resiliency Behaviour Survey 2005: School-based Survey on Risk and Resiliency Behaviours of 10-15 year olds
10. A Question of Security: Violence against Palestinian Women and Girls
11. Risk-Taking Behaviors among Youth Socializing in Target Venues of Carrefour, Haiti
12. Sexuality and HIV Education: Time for a Paradigm Shift

 II. Research Summaries

1. Behaviour change in generalised HIV epidemics: impact of reducing cross-generational sex and delaying age at sexual debut
2. College students in Nigeria underestimate their risk of contracting HIV/AIDS infection
3. Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial
4. HIV prevalence and predictors of infection in sex-trafficked Nepalese girls and women
5. Individual responsibility and social constraint: the construction of adolescent motherhood in social scientific research
6. Parent-adolescent sex communication in China
7. Sexual attitudes, pattern of communication, and sexual behavior among unmarried out-of-school youth in China
8. Teenage pregnancy and moral panic in Brazil
9. Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: prevalence, predictors, and associations with gender-based violence
10. Women's attitudes on human papillomavirus vaccination to their daughters

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I. Program Resources
1. Analysing the Response of a Teacher Training Institution to HIV and AIDS: A Case Study from Zambia (2007)
This 81-page report documents a study that examined the extent to which a teacher training institution in Zambia was able to address HIV and AIDS. It identifies the impact of HIV and AIDS on staff and students in the college and the existence of institutional policies, structures, teaching programs, and strategies. The authors conclude that the teacher training college is being only partially responsive to the future needs of teachers and needs much more support from the Ministry of Education and other partners.
Organization: UNESCO BREDA
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=site.breda@unesco.org

2. ‘Aunties’ for Sexual and Reproductive Health: How Unwed Young Mothers Become Advocates, Teachers and Counsellors in Cameroon (2007, PDF, 679 KB)
The “Aunties Programme” empowers young mothers to provide adolescents in their villages or urban neighborhoods counseling on sexual and reproductive health. This 36-page publication describes the program and its achievements and concludes that the approach is transferable to other countries with similar traditions and situations.
Organization: GTZ, InWEnt
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=srh@gtz.de 

3. Development Outreach: Youth & Development - Investing in the Next Generation (2007)
Nearly half the world’s population is under 25 years of age, and nine out of ten of these young people live in poor countries. The June 2007 issue of Development Outreach explores the implications of this trend, with articles on economics, AIDS, gender, and other related issues.
Organization: World Bank
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=devoutreach@worldbank.org 

4. Education and HIV/AIDS Prevention: Evidence from a Randomized Evaluation in Western Kenya. Background Paper to the 2007 World Development Report (2006, PDF, 742 KB)
This 33-page paper reports on results from a randomized evaluation comparing three school-based HIV/AIDS interventions in Kenya : 1) training teachers in the Kenyan government’s HIV/AIDS-education curriculum; 2) encouraging students to debate the role of condoms and to write essays on how to protect themselves against HIV/AIDS; and 3) reducing the cost of education.
Organization: World Bank
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=books@worldbank.org 

5. Education in Emergencies: The Gender Implications - Advocacy Brief (2006, PDF, 621 KB)
This 20-page advocacy brief provides an overview of education in a variety of emergency settings, including both natural and man-made disasters, and how emergencies are experienced differently by boys and girls. It discusses issues such as sexual violence, how protecting children can limit their educational opportunities, policy and program guidelines, and possible strategies and approaches for programs.
Organization: UNESCO
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=bangkok@unescobkk.org 

6. Educational Responses to HIV and AIDS for Refugees and Internally Displaced Persons: Discussion Paper for Decision-Makers (2007)
This 33-page paper focuses on the education sector’s responses to HIV/AIDS regarding prevention, treatment, care, and support needs of refugees and internally displaced persons, many of whom are young people. It is intended for policy-makers and implementers in ministries of education, civil society organizations, and donor and development agencies involved in emergency, reconstruction, and development responses.
Organization: UNESCO, UNHCR
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=aids@unesco.org 

7. Evaluations of Five Programs for Orphans and Vulnerable Children in Kenya and Tanzania (2007, PDF, 844 KB)
This two-page brief provides an overview of ongoing evaluations that are examining the effectiveness of programs for orphans and vulnerable children. The research includes evaluations of four projects in Kenya and Tanzania as well as a costing component. Also available are four case studies on individual programs, each about 35 pages.
Organization: MEASURE Evaluation
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=measure@unc.edu

8. Girls Left Behind: Redirecting HIV Interventions toward the Most Vulnerable (2007, PDF, 52 KB)
This four-page brief discusses the major factors that place girls at risk of HIV infection: social isolation, absence from school, child marriage, unsafe sex, and pressure to provide productive labor. The document offers suggestions on better reaching girls, including targeting areas with high concentrations of girls, increasing adolescent girls’ attendance in school, delaying marriage, supporting girls-only spaces, mentoring, and livelihoods initiatives.
Organization: Population Council
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=publications@popcouncil.org 

9. Jamaican Youth Risk and Resiliency Behaviour Survey 2005: School-based Survey on Risk and Resiliency Behaviours of 10-15 year olds (2007, PDF, 1.47 MB)
This 135-page document from the Jamaica survey is based on a nationally representative sample of 3,003 in-school youth aged 10-15. The survey included questions on risk and resiliency to determine factors that provide protection from teen pregnancy, HIV/AIDS, violence and obesity, in order to inform programs targeted at the early adolescent period.
Organization: MEASURE Evaluation
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=measure@unc.edu 

10. A Question of Security: Violence against Palestinian Women and Girls (2006, PDF, 855 KB)
This 135-page document reports on record high levels of violence perpetrated by family members and intimate partners in the occupied Palestinian Territories . Based on interviews and the other research, the authors found that two primary obstacles stand in the way of enhanced protection against domestic violence for Palestinian women and girls: discriminatory laws that condone and perpetuate such violence and the virtual absence of institutionalized policies to prevent violence, assist victims, and hold perpetrators accountable.
Organization: Human Rights Watch
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=hrwdc@hrw.org 

11. Risk-Taking Behaviors among Youth Socializing in Target Venues of Carrefour, Haiti (2007, PDF, 683 KB)
The Priorities for Local AIDS Control Efforts (PLACE) method identifies areas likely to have a higher incidence of HIV infection, and within these areas specific venues where AIDS prevention programs should be focused. This 67-page report discusses a modified PLACE approach used to better understand HIV prevention programming needs of young people in Carrefour , Haiti .
Organization: MEASURE Evaluation
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=measure@unc.edu 

12. Sexuality and HIV Education: Time for a Paradigm Shift (2007, PDF, 257 KB)
This four-page brief discusses the need to examine several issues in the context of curriculum-based sex education: gender attitudes and behaviors, reaching younger youth, teacher training, evaluating program effectiveness for boys and girls separately, and ways to better reach girls in school.
Organization: Population Council
Contact: http://us.f530.mail.yahoo.com/ym/Compose?To=publications@popcouncil.org

II. Research Summaries 

1. Behaviour change in generalised HIV epidemics: impact of reducing cross-generational sex and delaying age at sexual debut. Hallett TB, Gregson S, Lewis JJ, et al. Sex Transm Infect 2007;83(Suppl 1).

A mathematical model of heterosexual spread of HIV was developed to predict the population-level impact of reducing cross-generational sex and delaying sexual debut. The impact of behavior change on the spread of HIV is sensitive to the structure and reaction of the sexual network. Reducing cross-generational sex could have little impact on the risk of infection unless it is accompanied by a reduction in the number of risky sexual contacts. Even peer-to-peer sexual mixing can support high endemic levels of HIV. The benefit of delaying sexual debut is comparatively small and is reduced if males continue to prefer young partners or if young women spend more time unmarried. In Manicaland , Zimbabwe , if older men were to use condoms as frequently as young men, the reduction in risk of infection could exceed that generated by a two-year delay in first sex. The authors conclude that, at the individual-level, avoiding sex with older partners and delaying sexual debut can decrease the risk of infection, but at the population-level, these interventions may do little to limit the spread of HIV without wider-ranging behavioral changes throughout the sexual network. 

2. College students in Nigeria underestimate their risk of contracting HIV/AIDS infection. Ijadunola KT, Abiona TC, Odu OO, et al. Eur J Contracept Reprod Health Care 2007;12(2).

This article assesses the perceptions of personal risk of acquiring HIV/AIDS infection among students of selected tertiary institutions in Osun State , Nigeria , and determines the correlates of perceptions of personal risk of infection. The study employed a cross-sectional descriptive design. An interviewer-administered questionnaire was applied to the 405 study participants, and correlates of perceptions of personal risk of HIV infection were evaluated using multiple logistic regression analysis, confidence intervals, and odd ratios. Only 15% of the students perceived themselves to be at moderate-to-high risk of acquiring HIV infection compared with 85% who perceived themselves to be at little or no risk. Investigators' assessment of risk status of the participants revealed that 77% of the participants were actually at high risk of infection and only 23% at low risk. The sensitivity, specificity, and negative predictive value of the students' self-perception of personal risk compared with their assessed risk were 7, 58 and 16%, respectively, with a Kappa statistic of 0.178. The only significant correlate of self-perception of personal risk was a recent symptom of sexually transmitted infections. The authors conclude that college students exhibited an “optimism bias” associating high rates of HIV risk indicators with low levels of perceived personal risk of infection, which has implications for HIV/AIDS control in Nigeria . 

3. Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial. Hildesheim A, Herrero R, Wacholder S, et al. JAMA 2007;298(7).

The objective of the study described in this article was to determine whether vaccination against HPV types 16 and 18 increases the rate of viral clearance in women already infected with HPV. The trial was a Phase 3, masked, community-based randomized trial conducted in two provinces of Costa Rica . Trial participants were 2,189 women aged 18 to 25 years who were recruited between June 2004 and December 2005. Participants were positive for HPV DNA at enrollment, had at least 6 months of follow-up, and had follow-up HPV DNA results. Participants were randomly assigned to receive three doses of a bivalent HPV-16/18 L1 protein viruslike particle AS04 candidate vaccine (n=1,088) or a control hepatitis A vaccine (n=1,101) over 6 months. Presence of HPV DNA was determined in cervical specimens by a molecular hybridization assay using chemiluminescence with HPV RNA probes and by polymerase chain reaction using SPF10 primers and a line probe assay detection system before vaccination, and by polymerase chain reaction after vaccination. The authors compared rates of type-specific viral clearance using generalized estimating equations methods at the 6-month visit (after 2 doses) and 12-month visit (after 3 doses) in the 2 study groups. There was no evidence of increased viral clearance at 6 or 12 months in the group who received HPV vaccine compared with the control group. Clearance rates for HPV-16/18 infections at 6 months were 33.4% (82/248) in the HPV vaccine group and 31.6% (95/298) in the control group (vaccine efficacy for viral clearance, 2.5%; 95% confidence interval, -9.8% to 13.5%). Human papillomavirus 16/18 clearance rates at 12 months were 48.8% (86/177) in the HPV vaccine group and 49.8% (110/220) in the control group (vaccine efficacy for viral clearance, -2.0%; 95% confidence interval, -24.3% to 16.3%). There was no evidence of a therapeutic effect for other oncogenic or nononcogenic HPV categories among women receiving all vaccine doses, among women with single infections, or among women stratified by the following entry variables: HPV-16/18 serology, cytologic results, HPV DNA viral load, time since sexual debut, Chlamydia trachomatis, or Neisseria gonorrhoeae infection, hormonal contraceptive use, or smoking. The authors conclude that in women positive for HPV DNA, HPV-16/18 vaccination does not accelerate clearance of the virus and should not be used to treat prevalent infections. 

4. HIV prevalence and predictors of infection in sex-trafficked Nepalese girls and women. Silverman JG, Decker MR, Gupta J, et al. JAMA 2007;298(5).

This study determined the prevalence of HIV infection among repatriated sex-trafficked Nepalese girls and women and identified trafficking-related predictors of such infection. Medical and case records of 287 repatriated girls and women reporting being trafficked from Nepal for sexual exploitation, and receiving rehabilitative services between January 1997 and December 2005, were systematically reviewed in January 2006. Among 287 girls and women, 109 (38.0%) tested positive for HIV. Compared with those trafficked at 18 years or older, girls trafficked prior to age 15 years were at increased risk for HIV (adjusted odds ratio [AOR], 3.70; 95% confidence interval [CI], 1.32-10.34), with 20 of 33 (60.6%) infected among this youngest age group. Additional factors associated with HIV positivity included being trafficked to Mumbai (AOR, 4.85; 95% CI, 2.16-10.89) and longer duration of forced prostitution (AOR, 1.02; 95% CI, 1.01-1.03; indicating increased risk per additional month of brothel servitude). In post hoc analyses, girls trafficked prior to age 15 years had increased odds of having been detained in multiple brothels (odds ratio [OR], 5.03; 95% CI, 1.96-12.93) and in brothels for a duration of 1 year or more (OR, 2.67; 95% CI, 1.12-6.33) vs. those trafficked at 18 years or older. These findings demonstrate the need for greater attention to reducing and intervening in sex trafficking in South Asia , particularly among the very young. 

5. Individual responsibility and social constraint: the construction of adolescent motherhood in social scientific research. Breheny M, Stephens C. Cult Health Sex 2007;9(4).

This literature review addresses research on the dominant social attitudes toward adolescent motherhood. Although adolescent motherhood has been framed as a social problem in social scientific research, recent researchers have attempted to go beyond the focus on disadvantage to suggest that outcomes for adolescent mothers depend upon individual differences and contextual factors related to successful mothering. Social structures have also been considered, and adolescent motherhood has been investigated from the perspective of the mothers themselves. Each of these approaches to researching adolescent motherhood provides a subject position for adolescent mothers, with associated potential for both positive and negative impact on their social lives. These implications and the alternatives to individualizing success and discounting social constraint require consideration. Useful strategies could include valuing motherhood regardless of the social and economic position of the mother, and addressing structures which contribute to the exclusion of adolescent mothers from education and economic participation. 

6. Parent-adolescent sex communication in China. Zhang L, Li X, Shah IH, et al. Eur J Contracept Reprod Health Care 2007;12(2).

This study explores the patterns and related factors of parent-adolescent sex communication and its relationship with adolescent sexual behavior. Community-based data were collected in 2001 in Changchun , China . Unmarried adolescents 15-19 years of age (322 young men and 360 young women) were included in a survey using self-administered questionnaires. Overall, sex communication with parents was relatively infrequent. There was a significant gender difference in the pattern of sex communication, with male adolescents being more likely to talk with fathers and female adolescents with mothers. Logistic regression analysis revealed that gender of adolescents, quality of communication with mothers on general topics, and adolescent's perception of mother being the main source of sex knowledge were predictive of the level of sex communication between mother and her adolescent children. This study reveals that the quality of communication on general topics between parents and their adolescent children is one of the important factors related to sex communication between them. It is essential that Chinese parents are better informed and skilled to be involved, in addition to school and community, in the sex education of their adolescent children. They should be able to communicate appropriately on sex-related issues with them. 

7. Sexual attitudes, pattern of communication, and sexual behavior among unmarried out-of-school youth in China. Wang B, Li X, Stanton B, Kamali V, et al. BMC Public Health 2007;7(Article No.189).

Using data from a baseline survey of a comprehensive sex education program that was conducted in a suburb of Shanghai in 2000-2002, this study describes sexual attitudes, patterns of communication on sexual matters, and premarital sexual behavior among 1,304 out-of-school Chinese youth. The majority (60%) of out-of-school youth held favorable attitudes toward premarital sex. Males were more likely to have favorable attitudes than females. Male youth generally did not communicate with either parent about sex, while one-third of female youth talked to their mothers about sexual matters. Both males and females chose their friends as the persons with whom they were most likely to talk about sexual matters. About 18% of the youth reported having engaged in sexual intercourse. One-fifth of sexually active youth had always used a contraceptive method, and one-quarter had been pregnant (or had impregnated a partner). There were no gender differences in rate of premarital sex or frequency of contraceptive use. Multivariate analysis revealed that age, education, family structure, parents' discipline, attitudes toward premarital sex, pattern of communication, and dating were significantly associated with youth premarital sex. The authors concluded that prevention programs that empower communication and sexual negotiation skills and that promote condom use should be implemented for this vulnerable group. 

8. Teenage pregnancy and moral panic in Brazil. Heilborn ML, Brandao ER, Da Silva Cabral C. Cult Health Sex 2007;9(4).

This paper examines teenage pregnancy as a sociohistorical construct of increasing concern in Brazil . It presents findings from more than five years of empirical research alongside an analysis of a sample of newspaper articles representative of the dominant positions in the Brazilian press concerning teenage pregnancy. In contrast to mainstream arguments and to broader moral panic surrounding teenage pregnancy, the authors argue that contemporary patterns of sexual behavior among young people in Brazil do not signal growing permissiveness and are not straightforwardly related to poverty, family dysfunction, or lack of life projects on the part of young people themselves. On the contrary, early pregnancy and parenthood retain strong continuities with core Brazilian values and norms of sexual culture. 

9. Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: prevalence, predictors, and associations with gender-based violence. Dunkle KL, Jewkes R, Nduna M, et al. Soc Sci Med 2007;65(6).

This article explores the prevalence and predictors of transactional sex with casual partners and main girlfriends among 1,288 men aged 15-26 from 70 villages in the rural Eastern Cape province of South Africa . Data were collected through face-to-face interviews with young men enrolling in the Stepping Stones HIV prevention trial. A total of 17.7% of participants reported giving material resources or money to casual sex partners and 6.6% received resources from a casual partner. Transactionally-motivated relationships with main girlfriends were more balanced between giving (14.9%) and getting (14.3%). The authors constructed multivariable models to identify the predictors for giving and for getting material resources in casual and in main relationships. Each model resulted in remarkably similar predictors. All four types of exchange were associated with higher socioeconomic status, more adverse childhood experiences, more lifetime sexual partners, and alcohol use. Men who were more resistant to peer pressure to have sex were less likely to report transactional sex with casual partners, and men who reported more equitable gender attitudes were less likely to report main partnerships underpinned by exchange. The most consistent predictors of all four types of transaction were perpetration of intimate partner violence and rape against women other than a main partner. The strong and consistent association between perpetration of gender-based violence and both giving and getting material goods from female partners suggests that transactional sex in both main and casual relationships should be viewed within a broader continuum of men's exercise of gendered power and control. HIV prevention interventions need to explicitly address transactional sex in the context of ideas about masculinity, which place a high emphasis on heterosexual success with, and control of, women. 

10. Women's attitudes on human papillomavirus vaccination to their daughters. Chan SS, Cheung TH, Lo WK, et al. J Adolesc Health 2007;41(2).

This study assesses the impact of an information pamphlet on Chinese women’s acceptance of human papillomavirus (HPV) vaccine. The pamphlet increased the study subject’s self-perceived knowledge on cervical cancer and HPV and had a positive influence on women accepting HPV vaccination for their daughters (p<.001).

 Youth InfoNet is distributed to about 6,000 individuals every month and to multiple listservs, which drive distribution up to 100,000. Recent issues of Youth InfoNet are available at http://www.fhi.org/en/Youth/YouthNet/Publications/YouthInfoNet/index.htm