Prevention of STIs/HIV

1. Prevention of STIs/HIV Robert T. Brown, M.D. Professor, Clinical Pediatrics & OB/Gyn The Ohio State Univ. College of Medicine & Public Health Chief, Adolescent Medicine Children’s Hospital Columbus, OH, USA

2. Adolescent Population

3. AGE AT FIRST SEXUAL INTERCOURSE(USA)

4. Socioeconomic status Educational attainment of both teen and parent Mother who was a teen parent Religiosity Degree of goal orientation Substance abuse Peer pressure The media Parent connectedness Poor discipline FACTORS AFFECTING SEXUAL ACTIVITY

5. Sex, Age, and Education % of women 20-24 who had any sexual relationship before their 20th birthday % Years of Schooling

6. Volition of Early Intercourse Age at first intercourse

7. Latin American women who have married or started a sexual relationship (%)(sex in the context of marriage) Activity before age 20

8. SEXUAL PRACTICES OF VIRGINAL HIGH SCHOOL TEENS

9. Negative Consequences of Sexual Activity Among Adolescents • Pregnancy • Premature sexual activity • Sexually transmitted infections • Coerced sexual activity • (Gender identity issues)

10. STI RISK(by Gender) Estimated risk (%) in 1 act of unprotected intercourse, all ages

11. STIs • WHO estimate: at least 1/3 of >333 million cases of curable STIs in <25 y/o’s • Knowledge of STIs is poor • Use of alcohol/drugs puts young people at risk • Myth: symptoms AND the infection go away over time • Myth: Good personal hygiene will prevent STI/HIV acquisition

12. STIs: Prevalence of Symptoms by Country • S. Korea, Botswana, Nigeria, Philippines, Thailand, Argentina, Peru • Ages: vary betw 13-29 • Percent symptomatic: female – 1-14%; male – 2-10%

13. HIV Facts • 6000 youth per day acquire HIV - >1/2 are young women • End of 2001: 11.8 million 15-24 y/o pos. for HIV/AIDS – most not aware • >13 million children <15 y/o lost one or both parents to AIDS – majority in Africa – by 2010, est. # = 25 million • 2/3 newly infected with HIV in Sub-Saharan Africa are female

14. HIV Facts • Young people 15-24 y/o account for half of the ~5 million new AIDS cases/year • HIV/AIDS highly associated with poverty • Females more susceptible than males: • 7.3 million young women living with HIV vs. 4.5 million young men • 2/3 newly infected youth, 15-19 y/o, in sub-Saharan Africa are female

15. Young Women at Greater Risk • Biologically: immature vaginas at incr. risk of tears, ectropion, etc • Socially: at disadvantage with older partners who more likely already infected with HIV, other STIs • Younger girls with older men have little power to negotiate condom use – married or single

16. Young Women at Greater Risk • Common myth: sex with a virgin can cure AIDS or STIs • Young women married to husbands 10 yrs older much more at risk for HIV compared with married to similar age partners • Young women poorly educated about HIV/AIDS/STIs: • Due to taboos on discussing sex • Feeling of invincibility

17. Preventing STIs/HIV Among Adolescents: Programs that Work (USA) Characteristics: • Use of trained adult/peer facilitators • Content specific to skills for reducing sexual risk behaviors: • Refusal skills • Condom use skills • Use of interactive, participatory educational strategies • Duration & intensity of programs • Need to define what is a program as it blends in with community/other factors Robin, et al: J Adol Hlth, 2004, 34:3-26

18. Preventing STIs/HIV Among Adolescents: Programs that Work(Developing Countries) • Adolescent Reproductive Health Intervention Goals: • Creating supportive environment for youth • Improvement of reproductive health knowledge • Increasing utilization of health and related services

19. Preventing STIs/HIV Among Adolescents: Programs that Work(Developing Countries) • Settings: • School-based • Mass media based • Community based • Workplace based • Health facility based

20. Preventing STIs/HIV Among Adolescents: Programs that Work(Developing Countries) • Evaluation: • Creating supportive environment hard to evaluate • School based programs have strongest evaluations • Interventions best at improving RH knowledge and attitudes • Less consistently successful in changing behaviors

21. Preventing STIs/HIV Among Adolescents: Programs that Work(Developing Countries) • There is no evidence that any of the programs increased sexual risk-taking behaviors • Little evidence of any positive behavior change • Youth support centers & youth friendly services have little evidence of efficacy • Rigorous, long-term evaluations are sorely needed Speizer, et al: J Adol Hlth, 2003, 33:324-348

22. Key Point in Sexuality Education Students do not appear to change their sexual behavior or increase their use of contraceptives unless the program provides specific information on how to resist sexual pressures and how to prevent pregnancy and disease.

23. Abstinence Only Sex Education • An ideologically motivated approach to sexuality education • No clear cut evidence that it is effective • Study of Minnesota, USA, program showed no positive effect; possible negative effect (SIECUS Policy Update, December, 2003)

24. Preventing STIs/HIV Among Adolescents, Programs that Work:The Youth Development Approach • Interventions targeted at increasing youth resiliency & competencies • Seattle Social Development Project: • For primary school children (ages 6-12 yrs) • Focus on • School bonding (connectedness) • Academic success • Prevention of health risk behaviors • Training & support programs for parents & teachers