Protecting the Next Generation: From Research to Action

1. Protecting the Next Generation: From Research to Action Melanie Croce-Galis Guttmacher Institute EuroNGOs Annual Meeting, June 2006

2. Most adolescents: Know about HIV Know how to prevent infection Approve of family planning But they experience: Disproportionate infection rates Early childbearing And don’t believe they are at risk Why young people?

3. Learning from young people • More than 20,000 young people consulted • Ages from 12-19 • New evidence includes survey data, focus group reports and in-depth interviews • Not just sexual behavior: How does sex fit into the context of people’s lives?

4. Cross-national evidence Burkina Faso Uganda Ghana Malawi

5. African Population and Health Research Center, Kenya • Centre for Social Research, Malawi • Initiative Privée et Communautaire de Lutte Contre le VIH/SIDA, Burkina Faso • Institut Supérieur des Sciences de la Population, Burkina Faso • Makerere Institute of Social Research, Uganda • Panos Eastern Africa, Uganda • Planned Parenthood Association of Ghana • University of Cape Coast, Ghana • Youth Net and Counseling, Malawi

6. What did we find?

7. We’re on the right track with Prevention

8. Who is an “adolescent”? • Where do they live? • Most live in rural areas (4 in 5; exception is Ghana) • Where can you find them? • Majority of 12-14-year-olds are in school (9 in 10; exception is Burkina Faso) • Who might they depend on? • 1 in 5 are orphans (1 or both parents have died) • 7-24% of females are already married

9. There is hope

10. Aspirations • “I would like to be a teacher or a health care worker or a financial technician. I want a job that will help me to provide for my needs.” (Burkina Faso) • “I would like to be a nurse…so that I may be able to assist my relatives instead of spending a lot of money in hospitals.” (Malawi)

11. Adults can help breakdown barriers

12. Social reasons most common barriers to getting contraceptive methods or STI treatment • Feeling afraid, embarrassed or shy to seek such services is a barrier to getting methods • 42-64% of sexually-active females • 38-59% of males • Cost of services and not knowing where to go also important barriers • Similar pattern for barriers to STI diagnosis & treatment (lack of awareness an exception)

13. Embarrassment at the clinic P1: They [adolescents] even go to private clinics because at hospital they just shout “Those having STIs should go there” so the person feels embarrassed. [laughs] P2: When you stay for a while like this, [the] consult medical officer saying “Eh! Those having gonorrhea whatever, there!” The way you know, so you stand amongst many people, so you feel embarrassed. —Malawi, FGD7, females, urban, out of school

14. Shyness/fear with parents I think some people ask their peers because when they ask their parents, they might think they want to indulge in such things. They will think they are naughty, so they turn to their peers… —Ghana, FGD3, males, urban, in school

15. Education is the best protection

16. Sex education • Sex education classes or talks in school still not widespread, but a lot of country variation • Lower end: Burkina Faso (14% of 12-19-year-olds received sex ed) & Malawi (20%) • Higher end: Uganda (38%) & Ghana (44%) • Challenges • 28% - 64% say sex education not offered in their schools • Burkina Faso 63% of girls and 51% of boys have never attended school

17. Multiple sources used for information on contraception, STIs or HIV 12-19 year old females

18. Awareness of HIV & contraceptive methods is high, but less so for STIs 12-19 year old females and males

19. While awareness is high, practical knowledge is low & misperceptions abound At least 1 in 4 adolescents think you cannot get pregnant the first time you have sex • Condoms widely heard of (70% or more of females & males), but less than 50% have actually seen a condom demonstration • Even in Uganda: 1 in 10 adolescents believe that AIDS can be cured through sex with a virgin

20. Very young adolescents need our help now

21. Younger adolescents know of sex, but aren’t yet experienced Sexual activity among 12-14 year old males *Limited to those who have heard of sexual intercourse

22. The health care system is the backbone

23. Public clinics/hospitals are the most known & preferred sources for FP, STIs & HIV testing • Most preferred source among sexually-active adolescents is public clinics or hospitals • 30%-60% for contraceptive methods • 25%-57% for STI treatment • Most known source for HIV test is public clinic/hospitals (43%-83%) • Yet many do not know of any source

24. HIV testing low; most went to hospital/clinic for test Sexually-active, 12-19 year old females

25. Gaps in contraceptive services & STI treatment • Ever use of contraceptive methods (among sexually-active adolescents) • 43-65% of females • 50-66% of males • Mainly male condom • No consistent pattern in seeking STI treatment • Roughly half did not seek care • Clinics, hospitals or doctors more common source last contacted

26. Summing Up • Prevention is key, but must continue to take into account the vast diversity of adolescents • Adolescents are hopeful for their future and want to protect their health • Adults can help break down barriers of stigma, shame • Education is the best protection • Very young adolescents need our help now • The health care system is the backbone

27. What does a survey not tell you? • Why the numbers are the way they are… • Whether preferences turn into behaviors • Whether political commitment or resources will improve given the evidence

28. To meet young people’s needs, adults need to listen to young people’s voices.

29. Surprises? Questions?

30. Protecting the Next Generation, including this presentation, is supported by the Bill & Melinda Gates Foundation, The Rockefeller Foundation and NICHD (R24 HD 43610). To learn more, visit www.guttmacher.org