Encouraging Behavior Change
Gaps in Research
- 1.
- Effective programs (as described in this compendium) must be expanded to reach many more young people, especially young people who are most neglected such as very young adolescents, out-of-school youth, young people living with HIV, homeless and rural youth.
- 2.
- Greater efforts are needed to help young people personalize HIV risks.
- 3.
- Sex education and condom promotion programs need to take into account the different motivations among young men and women for engaging in unsafe sex.
- 4.
- Clear policies supporting access to information and sexuality education are needed to reduce the risk of HIV transmission among young people.
- 5.
- Interventions are needed to counter gender norms, such as those that value girls’ sexual ignorance and virginity, which place girls at risk for HIV transmission.
- 6.
- Interventions are needed to reduce cross-generational sex.
- 7.
- Intensified efforts are needed to increase condom use and reduce multiple partnerships by people who know their HIV-positive status or who are on ARV treatment, including young people.
1. Effective programs (as described in this compendium) must be expanded to reach many more young people, especially young people who are most neglected such as very young adolescents, out-of-school youth, young people living with HIV, homeless and rural youth. Studies found adolescent girls did not know that anal sex increased the risk of HIV acquisition, did not use condoms, and did not know that oral sex carries a low risk of HIV acquisition. Out-of school-youth were at high risk of early sexual debut.
Gap noted globally for girls 15 to 19, as the proportion of these girls in school is quite low (Haberland and Rogow, 2007). Gap also noted, for example, in Nigeria (Fajola et al., 2008; Anyanti et al., 2008a); Egypt (Soliman et al., 2008); Nicaragua (Manji et al., 2007); Ethiopia (Alemu et al., 2007; Erulkar et al., 2006); over 30 countries in Africa and four countries in Asia (Dixon-Mueller, 2009); and Côte d’Ivoire, Senegal, Kenya, Tanzania, Uganda, Ethiopia, Sudan, Zambia and South Africa (Thomsen, 2007).
Haberland, N. and D. Rogow. 2007. “Sexuality and HIV Education: Time for a Paradigm Shift.” NY: Population Council.
2. Greater efforts are needed to help young people personalize HIV risks. Studies found that knowledge about HIV prevention was superficial and that young people believed that they were not personally at risk of HIV acquisition despite risky behaviors.
Gap noted, for example, in South Africa (Anderson et al., 2007, Stadler et al., 2007); Laos (Toole et al., 2008); and Burkina Faso, Ghana, Malawi and Uganda (Biddlecom et al., 2007).
Anderson, K., A. Beutel and B. Maughan-Brown. 2007. “HIV Risk Perceptions and First Sexual Intercourse among Youth in Cape Town, South Africa.” International Family Planning Perspectives33 (3): 98-105.
3. Sex education and condom promotion programs need to take into account the different motivations among young men and women for engaging in unsafe sex. Studies found that boys complained about reduced sensation with condoms to cover their fear of losing their erection when putting on a condom; girls believed that unsafe sex proved their love and trust in their partner.
Gap noted, for example, in Thailand (Vuttanont et al., 2006); Brazil (Mane et al., 2001, Juarez and Martin, 2006); South Africa (Moyo et al., 2008); Mozambique (Machel, 2001).
Vuttanont, U., T. Greenhalgh, M. Griffin and P. Boynton. 2006. "Smart Boys" and "Sweet Girls" -- Sex Education Needs in Thai Teenagers: A Mixed-Method Study.” The Lancet 368 (9552): 2068-2080.
4. Clear policies supporting access to information and services are needed to reduce the risk of HIV transmission among young people. Studies found that sex education was lacking.
Gap noted, for example, in India.
McManus, A. and L. Dhar. 2008. “Study of Knowledge, Perception and Attitude of Adolescent Girls Towards STIs/HIV, Safer Sex and Sex-Education: A Cross Sectional Survey of Urban Adolescent School Girls in South Delhi, India.” BMC Women’s Health 8:12.
5. Interventions are needed to counter gender norms, such as those that value girls’ sexual ignorance and virginity, which place girls at risk for HIV transmission. Studies found that gender norms valued sexual ignorance of girls and therefore girls were at risk of HIV acquisition. Some studies found that women did not know anything about HIV until they became HIV-positive.
Gap noted, for example, in 29 countries in Africa and Latin America (Clark et al., 2006); a review of more than 150 studies (Collins and Rau, 2000; Gupta et al., 2003 cited in Gillespie and Kadiyala, 2005); Zimbabwe (Feldman and Masophere, 2003); Ethiopia, Malawi, and Haiti (Mathur et al., 2003); and Tanzania (Silberschmidt and Rasch, 2001).
Clark, S., J. Bruce, A. Dude. 2006. “Protecting Young Women from HIV/AIDS: The Case against Child and Adolescent Marriage.” International Family Planning Perspectives 32 (2): 79-88.
6. Interventions are needed to reduce cross-generational sex. Studies found that young women relied on older men to pay their school fees in exchange for sex. Numerous studies found significant numbers of young girls having sexual relationships with older men, who are more likely to be HIV-positive and seek sexual partnerships with younger women.
Gap noted, for example, in a review of 45 quantitative and qualitative studies in Sub-Saharan Africa (Hope, 2007). Cameroon (Hattori and DeRose, 2008); South Africa (Reddy et al., 2008a, Jewkes et al., 2002 cited in Jejeebhoy and Bott, 2003); South Africa and Uganda (Geary et al., 2008; Katz and Low-Beer, 2008); Democratic Republic of Congo (Akilu, 2008a); Tanzania (Komrower et al., 2008, Silberschmidt and Rasch, 2001); Burkina Faso, Ghana, Malawi and Uganda (Bankole et al., 2007); Botswana (PHR, 2007a); Kenya (Longfield et al., 2004); Ghana (Goparaju et al., 2003); Zimbabwe (Gregson et al., 2002).
Hope, R. 2007. Addressing Cross-Generational Sex: A Desk Review of Research and Programs. Washington, DC: Population Reference Bureau.