Youth In sub-Saharan Africa Research Articles

Effectiveness of HIV prevention for youth in sub-Saharan Africa: systematic review and meta-analysis of randomized and nonrandomized trials

Systematically assess the effectiveness of HIV-prevention interventions in changing sexual behaviour of young people (10-25 years) in sub-Saharan Africa. Three online databases were searched using prespecified terms. Additional articles were identified on websites of international organizations and by searching bibliographies. Randomized and nonrandomized trials of interventions aiming to reduce risk behaviour were included as well as single-arm studies reporting effects of differential exposure to an intervention. Data were extracted independently in duplicate using predefined data fields. Thirty-one studies on 28 interventions met the inclusion criteria, including 11 randomized trials. Difficulties with implementing planned activities were reportedly common and differential exposure to intervention was high. Two hundred and seventeen outcome measures were extracted: 88 early (within 1 year of intervention) and 129 late outcomes (more than 1 year after the end of the intervention). Sex education and condom promotion among youth did not increase sexual behaviour as well as risky sexual behaviour. No positive effects on sexual behaviour were detected either and condom use at last sex only increased among males [relative risk = 1.46; 95% confidence interval = 1.31-1.64]. One study reported a reduction of herpes simplex virus-2, but not HIV incidence. There remains a stark mismatch between the HIV burden in youth and the number of attempts to design and test prevention interventions - only two trials report biological outcomes. More effective interventions targeting youth are needed. Attention should go to studying implementation difficulties, sex differences in responses to interventions, determinants of exposure to interventions and perhaps inclusion of other factors apart from HIV/AIDS which influence sexual behaviour.

Sexuality, HIV risk and potential acceptability of involving adolescent girls in microbicide research in Kisumu, Kenya

Current microbicide clinical trials primarily enroll adult participants; however, females under the age of 18, because of their high rates of HIV acquisition, represent an important population for future microbicide clinical research. We sought to understand the individual, family and community-level factors that may influence the acceptability of microbicide use and research involving adolescent girls. We conducted 30 interviews with adolescent girls aged 14-17 and nine focus group discussions with adolescent girls, parents and community leaders in Kisumu, Kenya. Participants discussed adolescent sexuality, HIV prevention methods, perceptions about microbicide use and views about microbicide research involving adolescent girls. Adolescent sexual activity is stigmatised yet acknowledged to be a natural part of the 'adolescent stage.' Desperation to stop the spread of HIV among youth and support for female-initiated HIV prevention methods led to enthusiasm about microbicides and future microbicide research. Yet concerns about microbicides were numerous and included: difficulty using it in a timely manner due to the rushed, unplanned nature of adolescent sex; a fear of trying experimental products; concerns about microbicide efficacy; and parental worry that supporting microbicide use in youth would defy societal pressures that denounce adolescent sexual activity. Microbicide acceptability for youth in sub-Saharan Africa may be bolstered by desperation for new methods to stop the spread of HIV, yet hindered by misgivings about experimental HIV prevention methods for youth. Understanding and addressing the microbicide's perceived benefits and shortcomings, as well as the broader context of adolescent sexuality and HIV prevention, may facilitate future research and promotion of microbicides in this high-risk group.

The Reliability and Validity of Self–Report Measures Used to Evaluate Adolescent HIV/AIDS Prevention Programs in Sub–Saharan Africa

The use of reliable and valid tools to evaluate theory-based health interventions is widely accepted as critical to the behavioral sciences. However, quite often the psychometric properties of survey instruments used to evaluate behavioral interventions are not published, limiting our understanding of how the theory works. The purpose of this study was to present the results of psychometric analyses on measures used to evaluate an HIV/AIDS prevention program for youth in Tanzania. We first began by pilot-testing a self-administered questionnaire with sixth and seventh-grade students in nine schools in 11 villages throughout the Kahe ward of Tanzania (n = 524). Theory-based scales tapped into intrapersonal, social and attitudinal factors. Reliability was evaluated by examining internal consistency, while validity was determined by examining content, construct and discriminant validities. The results indicate that the scales constructed are reasonably reliable and valid measures. Use of these measures should be considered when designing, implementing, and analyzing interventions targeting youth in sub-Saharan Africa.

Using the theory of planned behaviour to understand the motivation to learn about HIV/AIDS prevention among adolescents in Tigray, Ethiopia

Various studies indicate that school- or university-based HIV prevention curricula can reduce the prevalence of sexual risk behaviour among adolescent youth in Sub-Saharan Africa. However, effective HIV/AIDS prevention education may be problematic, if the needs of youth are not served adequately. To date, little attention has been given to the motivation of youth to learn about HIV/AIDS and about their preferences for HIV/AIDS curriculum design options. The aim of this study was to get insight into the determinants of the motivation of youth to learn about HIV/AIDS prevention and to assess their curriculum design preferences. Students from a university in Tigray, Ethiopia, filled out a structured questionnaire, which assessed demographics, variables that according to the Theory of Planned Behaviour are related to the motivation to learn, and their preferences for independent, carrier and integrated HIV/AIDS curriculum designs. On average, participants were highly motivated to learn about HIV/AIDS. Motivation to learn was primarily related to social norms and was not related to self-efficacy to discuss HIV/AIDS in class. The often discussed reluctance to discuss sexuality and condom use in curricula in Sub-Saharan Africa, seems to be more related to existing negative social norms, than to lack of self-efficacy. Participants revealed a high preference for the independent, carrier and integrated curriculum design options. However, students with a higher motivation to learn about HIV/AIDS were more attracted to the independent course design.

Youth's perceptions of HIV infection risk: a sex-specific test of two risk models

The study examines the associations between the cumulative and additive risk models and Nigerian youth's likelihood of perceiving vulnerability to HIV infection. Both models of risk seem to provide unique contributions to such understanding. The analysis is based on data from the 2003 Demographic and Health survey in Nigeria. For males, the model of cumulative risk revealed a consistent and positive association between the number of risk factors experienced and perceived vulnerability to HIV infection. For females, the same model revealed that those who had experienced two risk factors perceived more vulnerability to HIV infection than those who had experienced three risk factors. The model of additive risk revealed that having had a sexually transmitted disease was associated with males' perceptions of vulnerability to HIV infection, whereas past sexual activity and having had multiple sexual partners were linked to females' perceptions of vulnerability. These sex-specific findings are highly relevant for HIV prevention and intervention programmes for youth in sub-Saharan Africa as we strive to reverse current trends in the epidemic.

The World's Youth: Adolescence in Eight Regions of the Globe

332 Children, Youth and Environments Vol. 17 No. 1 (2007) ISSN: 1546-2250 The World’s Youth: Adolescence in Eight Regions of the Globe Brown, Bradford B. and Larson, R.W. and Saraswathi, T.S. (2002). Cambridge, UK: Cambridge University Press; 369 pages. ISBN 0521006058. The World’s Youth is one of three volumes of edited papers published in 2002 that reflect on current conditions and future possibilities for adolescents in the world. The series of commissioned papers in The World’s Youth focuses on eight particular nations and regions. The other two volumes focus on external institutions and societal changes, respectively. It is often difficult to assess edited collections because the quality of contributions lacks consistency. To the editors’ credit, however, this is a tightly structured collection. The chapters are very cohesive in the themes they cover, each tackling issues that relate to family and peer relations, schooling, preparation for work, and physical and mental health, among others. To a large degree and as data allow, the authors provide empirically-based discussion in wellwritten and succinct chapters. The surprisingly large degree of consistency in the book is good for its overall comparative structure, but inevitably leads to a somewhat pedestrian rendering of a topic that is important as much for its critical and emotive nuances as for its solid empirical framing. Authors who deviate even a little from the book’s overall structure provide interesting and creative insights to an otherwise tightly circumscribed composition. For example, Bame Nsamenang questions the implications of Anglo-American paradigms for understanding youth in Sub-Saharan Africa and provides, in their place, a theoretically complex relational Afrocentric perspective. Similarly, Marilyn Booth argues for the primacy of family and Islam for Arab adolescents and lets the predominance of those two institutions guide her chapter. This is different from Verma and Saraswathi’s chapter on India that rigidly follows the prescribed 333 structure and for the most part eschews caste differences “… as a politically sensitive topic” (p. 106). Too bad! Contradictions between chapters are also illuminating. Stevenson and Zuma begin with the important point that in China and Japan, the terms “adolescent” and “teenager” are not as readily understood as they are in the Englishspeaking world. Alternatively, and somewhat surprisingly, Maria suggests that Southeast Asian countries for the most part accept the United Nations definition of “youth.” The book begins with a metaphor of diversity and ends with policy implications. Chapter 1 suggests that adolescence may be viewed through a metaphor of the kaleidoscope, as a “varied and colorful set of moving pictures” (p. 2). This metaphor accurately represents the structure of the book: the authors skillfully twist and turn the structures they present so that we see the complexity of the large, inter-related and convoluted contexts of young people the world over. To this end, the book is a huge success structurally. However, it fails to appreciate the fluid, mobile, transnational, experiential and relational aspects of living as a young person in the world today. Chapter 2 is a sensitive account of larger global demographic trends that highlights some gross inequalities perpetuated by the excesses of contemporary Western neo-liberal agendas. There follows accounts from eight regions and nations: Sub-Saharan Africa, India, China and Japan, Southeast Asia, Arab nations, Russia, Latin America and, lastly, Western countries. This kind of cross-regional and cross-cultural comparison is difficult to achieve, and alone makes this volume a tour de force. The book ends with a somewhat inevitable chapter on policy implications. Here, two of the editors reflect on larger institutional and global concerns. They then provide a framework for social policy in a series of bullet points that align with current concerns of the United Nations, the International Labor Organization (ILO), the World Health Organization and the World Bank, among others. The editors summarize the volume with the UN’s 1996 goals for youth policy and then add four bullets covering the need to reconsider family values, new media options, relevant school curricula and intervention programs. 334 Of course, the work reported in this volume is now seven years old (three years in the making and then published in 2002). Since then, there have been...

A systematic review of tobacco use among sub‐Saharan African youth

Aims (1) To provide a synthesis of prevalence data among young people in sub‐Saharan Africa (SSA); (2) to examine whether factors such as gender, age, socio‐economic status (SES), ethnicity, and urban versus rural location increase the risk for, or protect against tobacco use among SSA youth; and (3) to identify gaps in existing research, and offer suggestions for future research and prevention/intervention program development.Methods Using relevant databases, we identified articles reporting prevalence rates of current tobacco use among youth in SSA that were published in peer‐reviewed journals between 1990 and mid‐2004. Articles were included if they reported current tobacco use among SSA school‐aged populations. Articles pertaining to tobacco‐related medical conditions were excluded.Results Forty‐five articles (52 studies) from 15 of the 48 countries that comprise SSA were included. South Africa has the highest prevalence of current tobacco use of all the SSA countries. Across most countries, current tobacco use was higher among males than females. Higher SES appears to place youth at additional risk for tobacco use in specific country contexts. Rates of tobacco use among urban versus rural populations is country‐specific. The lower limit for tobacco use initiation in most countries is 12–14 years old.Conclusions Studies within countries should address the possible heterogeneity between regions, cities, or states, and prevention/interventions should be context‐specific within and between countries.

HIV Education for Young People: Intervention Effectiveness, Programme Development, and Future Research

Ph.D. Associate Professor in Health Education and Promotion at the Faculty of Health Sciences,Universiteit Maastricht. He is a social psychologist and was the principal researcher workingon the Long Live Love project, which involved a randomized control trial of a teacher-deliv-ered school-based sex education programme in the Netherlands. His current research includesHIV prevention among Dutch youth, migrant populations in the Netherlands, and youth insub-Saharan Africa.