WUNRN
What HIV Programs
Work for Adolescent Girls?
Direct Link to Full Study Text
JAIDS
Journal of Acquired Immune Deficiency Syndromes:
Author: Karen
Hardee - Jill Gay - Melanie Croce-Galis
- Nana Ama Afari-Dwamena
Affiliation: Reproductive
Health Program Population Council (Hardee), What Works Association (Gay,
Croce-Galis), Center for Policy and Advocacy, Health Policy Project, Futures
Group (Gay, Croce-Galis), and Consultant in Epidemiology and Occupational
Health (CEOH) (Afari-Dwamena)
July 1, 2014 - In this study, in order to evaluate the high
rates of HIV infection among adolescent girls and to present evidence on what
works globally to address the risk, researchers reviewed evidence on
programming for adolescents from 150 studies and evaluations from 2001 to June 2013.
[Footnotes are removed by the editor.]
"Given the multiple
influences on the lives of adolescents, from family to community to society, it
is important to look beyond the health sector for interventions to reach
adolescent girls. The evidence for programming for adolescent girls falls under
a range of interventions in 3 areas: (1) to address the enabling environment:
increase educational attainment for girls, promote gender-equitable norms,
include a focus on adolescents in programs to reduce gender-based violence, and
strengthen legal norms to protect adolescent girls; (2) information and service
needs of adolescent girls: provide age-appropriate comprehensive sex education,
increase knowledge about and access to information and services including condoms
and other contraceptives, and expand harm reduction programs to include
adolescent girls who inject drugs; and (3) social support: promote caring
relationships with adults and provide support for adolescent female orphans and
vulnerable children (OVC)."
In the discussion of these areas,
interventions are described that include:
- Keeping
girls in school - including abolishing fees and providing conditional cash
transfers.
- Promoting
gender-equitable attitudes: "Training, peer and partner discussions,
and community-based education that questions harmful gender norms can
improve HIV prevention, testing, treatment, and care....Addressing gender
norms requires working with boys and girls, both separately and
together....The NGO [non-governmental organisation], Promundo, started
with Program H to promote more gender-equitable attitudes among young men,
resulting in significant increases in male condom use in Brazil and India,
significant reduction in use of violence against female partners in India,
and significant changes in gender attitudes among young men in Brazil.
Improvements in gender norm scale scores were associated with changes in
at least 1 key HIV/sexually transmitted infection risk outcome....Changing
gender norms on a national scale would require augmenting these programs
with structural interventions at the national level, engaging policymakers
and community leaders, along with mass media, to promote equitable gender
norms."
- Breaking
the cycle of gender-based violence: "[P]rograms that reduce gender-based
violence starting at an early age will help break this multigenerational
cycle." Education programmes can teach adolescence about the nature
of sexual abuse. According to UNICEF, “'[a] major gap in sex education
programs is the need for both girls and boys to understand what
constitutes coercive sex.'...Public health campaigns can influence
communities so that violence against women becomes unacceptable.
Learning approaches involving men and women can create more
gender-equitable relationships, thereby decreasing violence. Training
teachers about gender-based violence is a promising strategy to change
norms about acceptance of gender-based violence...."
- Advocating
for changing legal norms and enforcement on such acts as child marriage
and rape.
- Providing
comprehensive sex education: "[B]efore the onset of sexual activity
[providing sex education] may be effective in preventing transmission of
HIV by increasing age at first sex and for those who are sexually active,
increasing condom use, testing, and reducing the number of sexual
partners....The quality of sexuality education is as important as its
provision; fidelity to successful components must be maintained. Training
for teachers to conduct age-appropriate participatory sexuality education,
which can improve students' knowledge and skills, is essential." The
research recommends combining education with accessible and youth-friendly
health services.
- Providing
youth-friendly health services: "Promoting condoms through mass media
in individual or group sessions, along with skills training, provision of
condoms, and motivational education can increase condom use."
Services accessible to and settings inviting to youth can increase
protective behaviours, including testing; and service in crises, including
post-rape prophylaxis and emergency contraception, is in need of
strengthening.
- Providing
harm reduction programmes for injecting drug users, tailored by gender and
adapted for adolescents.
- Improving
communication between adolescent girls and supportive adults:
"[S]eminars on communication skills to empower [mothers] to better
communicate with their daughters on matters concerning HIV, AIDS, and
sexuality" were requested, for example, by a group of mothers in a
study in
- Working
with OVC and their caregivers: "Successful interventions for OVC
include psychological counseling and mentoring...."