Please note: This archive was last updated in 2005.

RHO archives : Topics : Adolescent Reproductive Health

Program Examples

The programs described below illustrate some of the strategies that have been developed to improve the reproductive health and well-being of adolescents.

Submit your own program example.

Also see the Sexwise program example in RHO's Gender and Sexual Health section. Sexwise is a BBC/IPPF collaboration to broadcast accurate information about sexual health to radio audiences worldwide, especially young people.

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Belize

In early 1995, with financial support from the European Union, the Belize Family Life Association (BFLA) moved its headquarters to the Mesopotamia Division, an economically disadvantaged area in Belize City, to reach the population that it would be serving. Soon after, BFLA, an affiliate of the International Planned Parenthood Federation/Western Hemisphere Region, started a youth-friendly clinic and educational/recreational center called Planet Youth.

Planet Youth works to promote young people's awareness of safer sexual behaviors, to educate them about sexual and reproductive health issues, and to provide a place where they can receive information about and access to contraceptives and related services. Planet Youth also operates as an educational/recreational center that offers young people a safe and comfortable environment where they can collectively share and exchange thoughts, ideas, and perspectives on the problems and challenges that they may face.

Planet Youth primarily serves as a drop-in center, but it also is the permanent home of the Youth Advocacy Movement (YAM) and a meeting place for its members to plan activities to raise awareness about adolescent reproductive and sexual health. The YAM has conducted several successful outreach activities, including Youth Awareness Workshops, Rap Sessions, Relationship Booster Sessions, Home Sessions (Yard Talk), and Youth to Parent Educational Sessions. The activities provide youth with the opportunity to take an active role in improving their own sexual and reproductive health and educating other youth about the issues. Ms. Deidra Lopez, a 17-year-old YAM first vice president, said, "The best thing about conducting these activities is that our youth leaders assign us responsibilities and guide us in a way that allows us to feel very confident about ourselves."

BFLA reaches out both to students and to young adults who no longer are in school. The association believes that establishing the youth center within the neighborhood where its primary population is located has greatly contributed to its success in reaching and affecting youth. In the words of 20-year-old Phillip Cadle, a veteran youth affiliate and spokesman-advisor, "What we do differently from many, if not all other youth clubs, is go where the young people are. We don't take them out of their natural environment, and bring them to an unfamiliar environment."

Planet Youth attempts to keep its message simple, informal, and current in order to engage its youth audience. For example, Planet Youth uses music and theater to provide pertinent sexual and reproductive health information in the form of positive entertainment. Lloyd Robinson, an 18-year-old drama impresario and program organizer for YAM, explains, "At BFLA, . . . we know what our peers like and what gets their attention. So, if it's music, we give it to them. If it's drama, we give it to them."

There are many factors that have contributed to the success of Planet Youth. Certainly, its committed staff is one of the most important. In addition, BFLA's donors continue to oversee the development of innovative and dynamic programs for young people, thus increasing the success that Planet Youth enjoys. The parents of the young people have pledged their support for BFLA's program and have increased their involvement in Planet Youth. Finally, there are the 25 YAM members who have shown their commitment and determination to reach out to peers and impact their lives in a positive and meaningful manner.

Lessons Learned

  • Reproductive and sexual health programs designed for young people, particularly for those who are not in school, benefit from meeting youth in their own environment.
  • Young people can leverage their knowledge and understanding of youth culture to develop successful strategies for reaching out to their peers to help them protect their sexual health.
  • Commitment from staff, donors, parents, and the young people themselves has been key to program success.

For more information about Planet Youth, please contact:
Jewwel Quallo Rosberg, Executive Director, Rafael Sosa, Youth Program Contact, 127 Barracks Road, P.O. Box 529, Belize City, Belize
Telephone 501-2-31-018; Fax 501-2-32-667; Email: [email protected]

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Canada

Since 1988, Street Kids International (SKI) has worked with local agencies in Asia, Africa, and Latin America to encourage, support, and educate exploited and marginalized youth throughout the world. A small but ambitious organization, SKI began by creating animated videos about and for street kids. These videos have been brought to the street by local workers who have been trained at SKI workshops and equipped with their materials. The Karate Kids (1990) adventure video and book explore sexuality and sexually transmitted diseases (AIDS in particular), and are available in 25 languages. Available in 16 languages, the Goldtooth video(1994) focuses on youth substance abuse, including glue and gasoline sniffing, a common health problem among street youth worldwide. Because they depict characters and situations that street youth can relate to, the videos have been extremely well-received. The in-depth discussions and information sharing that follow the videos help youth better understand sexual health issues and substance abuse, and offer opportunities to make healthy life choices.

Another important component of SKI is their business training and micro-enterprise credit programs. Working with numerous partner organizations, SKI has developed youth-specific business programs that range from apprenticeships and collectives to the promotion of individual businesses. The SKI Bicycle Courier Service, for example, enabled youth in Sudan to gradually pay for their bicycles from the wages they earned as bicycle couriers. The Shoe Shine Collective in the Dominican Republic provided youths with loans to purchase shoe-shine equipment, a safe place to store their equipment, and assistance with bulk purchases and individual savings plans. More recently, SKI has systematized its business development work with the Youth Skills Enterprise Initiative in Lusaka, Zambia. This program is implemented by the Zambian Red Cross and the YWCA of Zambia. Over its first three years of operation the program worked with 200 disadvantaged urban youth, seeing 72 percent of youth launch small businesses, and a 58 percent rate of loan repaymentquite high given the life circumstances of the beneficiaries. Similar programs are being piloted in Ecuador with the Program for Working Children. These "Street Business Partnerships" aim to respect the choices of street youth, respond to their economic needs, help them to reject exploitation and abuse, provide appropriate opportunities for learning, and help youth workers recognize their economic lives. SKI also is developing "The Street Business Toolkit" that will help youth workers bring business training to street youth. Training delivery will begin in the year 2000.

To date, SKI has offered more than 150 "Risk and Decision-Making Workshops," trained more than 4,000 youth workers, and reached an estimated 100,000 street youth. The Karate Kids and Goldtooth videos have been distributed in over 100 countries. SKI's videos and programs have been widely recognized as powerful and unique contributions to youth health. In 1997, the Goldtooth video won the UNICEF Meena Prize at the Ottawa International Film Festival, which recognizes outstanding animated films dealing with children's issues and rights.

Lessons Learned

  • Programs that serve adolescents should acknowledge their life realities rather than ignoring or negating them. They also should respect youth as individuals with specific problems, needs, and responses rather than as bad people invited or required to become good people.
  • The audience for adolescent programs includes the youth workers themselves as well as the hard-to-serve youth that they reach.
  • For programs to have a sustained impact, they must empower street youth to see their world differently. Programs also must empower youth workers to see themselves and street youth in a more positive and productive way.
  • Programs cannot claim to really understand street kids without in-depth contact with them.
  • Appropriate training materials must be developed and delivered in order for tools to be used appropriately in the field. Workers must be motivated and prepared to use the tools in effective and interactive ways.
  • Programs must build a capacity to evaluate their work.

For more information, please contact:
Street Kids International, 398 Adelaide St. W., Suite 1000, 10th Floor, Toronto, Canada M5V 1S7
Telephone: 800-387-5326 or 416-504-8994; Fax: 416-504-8977; Email: [email protected]; Website: www.streetkids.org

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El Salvador

Homies Unidos was created in 1996 in El Salvador by rival gang members who came together to find a better and safer life without violence. The organization is dedicated to providing educational and employment opportunities for young men and women (ages 8 to 35, although the majority are under the age of 24), so that they can find ways out of their violent lifestyles.

The twelve-year war in El Salvador caused millions of people to flee to the United States. Salvadoran parents worked two or more jobs, and their children were left to fend for themselves. In order to survive racism and alienation, children as young as eight or nine often turned to the streets, where they were recruited, sometimes forcibly, into gangs, which became their instant friends and family. With the end of the war, many young Salvadorans were deported to their home country, and returned with the language, hairstyles, clothes, signs, and discipline of the U.S. gangs. This expulsion added more violent gang members into a less-organized and violent local gang culture already in existence in El Salvador.

Gang members live an accelerated life style; many do not reach their 25th birthday. They readily experiment with intravenous drugs, tattoos, unprotected sex, and violence, and seek to have a family and children before they are killed. They do not fear death; in fact, they accept it as an early interruption to their lives. STIs, including HIV/AIDS, are not considered major factors in an already shortened life expectancy. Not only are gang members at risk of HIV due to their drug use, tattoos, and unprotected sex, but they often lack access to health services and education. Many injured gang members are turned away from hospitals and clinics whose staff fear them because of their association with HIV/AIDS and violence.

The founders of Homies Unidos knew that they had to address both the physical violence and the violence that comes with infections and illness. Thus they began the difficult task of convincing gang members of the need for protection during sex via an educational program to teach about sexually transmitted diseases. Homies' director, Jorge Rosales, developed workshops to reach out to the adolescent population, the first of which was held during a weekend retreat with 25 gang members. The gang members made jokes and asked outrageous questions, but at least Jorge had their attention. Jorge found that he needed to be able to connect with the gang members and translate medical terminology into street language. The program decided to use gang members familiar with the lifestyle, language, and codes of conduct of gangs to reach their own peers.

Claudia Reyes, a gang member now in her second year of medical school, has taken over all of the organization's health-related programs. She has instituted an inoculation and blood-typing program for members and beneficiaries; most youth have not had basic inoculations, and blood typing is crucial so that if they are injured in an accident or through gang or police violence, they will be able to get a blood transfusion immediately. Claudia has recruited other medical volunteers from her school and clinics, as well as obtained free vaccines and informational materials for the program.

Many gang members also seek information on health issues related to their sexual activity. They are most concerned about STIs, and may ask for condoms. This new openness about STIs has given rise to more educational efforts, namely a peer-education program on STIs. Claudia also leads this program, training new peer counselors and working to develop a core group of youth trainers and educators.

The obstacles to peer education are numerous. Gang members and youth at high risk are reluctant to sit in workshops; Homies often coaxes them into participating by relating it to their self-interest and to specific cases that all know of in the community. There also is reluctance to talk about personal things, yet at the same time conversations about sex are not taboo. The program has had to find a space in the life of gang members where they feel comfortable and are willing to hear new information. Since most do not plan to live long, Homies Unidos works to provide a vision of a better and longer life so that youth have a reason to care about their health.

Lessons Learned

  • Programs that want to reach an at-risk youth audience must look to youth leadership from the target population and train them to become the experts. Youth look to their peers and identify with them more readily than they do others. At Homies, youth serve as peer educators, as well as board members, fundraisers, and program staff.
  • Programs must provide information appropriate to the level of knowledge and skills of the community, as well as use the language of youth. Written information should be handed out to reinforce the messages of the training.
  • Programs must make condoms available to youth, so that availability is not an excuse for lack of use.
  • Programs should target young women. Sessions should emphasize negotiating skills so they can say no to unprotected sex, reinforce their self-esteem, and show them how to use condoms.
  • Programs like this need to reach out to and raise awareness in the larger community, because youth pass on the education to family and friends.

STIs are a form of violence that can be diminished through education and practice. Homies Unidos is changingand savingyoung people's lives.

For more information, please contact:
Sigfredo Rivera, Director, Colonia Lomas de San Francisco 3, Avenida #2, San Francisco 2, Apartamento 3, San Salvador, El Salvador
International mail: Vip# 2285, P.O. Box #025364, Miami, FL 33102-5364 USA
Telephone: 503-273-6180; Email: [email protected] or [email protected]

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Indonesia

Around midnight, Dede pulls his motorcycle up beside the large, dark field at the end of the main street through town. Before he gets his helmet off, two young men holding hands approach him and ask for condoms. Dede is a street outreach worker working in the gay community on behalf of Lentera, a program of the Indonesia Planned Parenthood Association. Lentera was founded in 1993 by a group of young people concerned about the sexual health of their peers. The program for gay youth was one of its first initiatives, as the gay community at that time was becoming increasingly concerned about what they heard about AIDS from other countries.

Lentera's strategy with gay youth is to provide them the information, support, and services so that they choose to lead healthy lives. The program first reaches gay youth in the cruising areas where they hang out and meet sexual partners at night. Street outreach workers are available several nights a week to talk, provide condoms, and refer them for services. The program has developed a pamphlet series that uses gay slang while discussing issues such as correct condom use, relationships, and STIs. Outreach workers also help organize events in the community, such as monthly support-group meetings and weekend retreats that provide a supportive environment for young gay men. Finally, Planned Parenthood's clinic provides STI services one evening a week to gay youth if needed.

Lessons Learned

  • Involving gay youth in the overall program built trust between Lentera and the gay community. The program has had at least one gay staff member since it was founded, and encourages gay youth to get involved as volunteers both for the gay community and for the other programs Lentera provides. Support-group meetings and weekend retreats are fully planned and organized by gay youth.
  • Selection, training, and supervision of outreach workers is key to the program's success. Outreach workers receive a three-day training, and then must accompany a senior outreach worker for a month before being assigned to their own field location. They must commit to doing outreach at least two nights a week for at least six months, and they are required to write short reports each time they go into the field. A strong code of ethics, developed and reviewed periodically by the street outreach team, guides their work in the field. A part-time staff supervises outreach workers and goes to the field monthly to get feedback from the gay community about the team's performance.
  • Evaluation research has helped focus the program to target specific risk behaviors. After the first year of outreach, Lentera had built enough trust with the gay community to conduct almost 200 interviews with gay men about their relationships and sexual behavior. The program was then able to identify key risks and target them more effectively. For instance, research found that youth often used condoms with partners the first few times they had sex, but abandoned them once the couple felt like they were in a more stable relationship. Information, Education, and Communication (IEC) messages were adjusted accordingly. Lentera also found that the most common reason for not using a condom was not having a condom, prompting the program to develop a more innovative condom distribution scheme through the small food stands gay youth frequent at night.
  • While supporting safe sexual behavior, the program also must pay attention to a broader spectrum of gay youth's needs. Issues around sexual identity, how to tell friends and family one is gay, depression, concern about the religious implications of being homosexual, problems with relationships, drinking and drug use as well as coping with life after marriage are dealt with in various ways through the program.
  • Reaching gay youth through a program that works broadly with young people has several benefits. First, many gay youth who are not open about their sexual orientation feel more comfortable working for an organization that is not solely gay-identified. Second, work with gay youth has built broader understanding and acceptance for the gay community among the wide range of young people the program works with.

For more information, please contact:
Ika Harmawaty, Project Manager, Lentera, Jl. Tentara Rakyat Mataram, Gg. Kapas JTI/705, Badran, Yogyakarta 55231 Indonesia;
Telephone: 62-274-513595; Fax: 62-274-586767; Email: [email protected]

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Jamaica

"For me, the Women's Center really changed my life The Women's Center taught us to think, 'You are a woman, you have a child, you have a goal.' This has stayed with me."
Former Program Participant

Jamaica's adolescent pregnancy rates are among the highest in the Caribbean, with the birth rate for women age 15 to 19 at 108 births per 1,000 women. Forty-five percent of all Jamaican women aged 15 to 24 years have been pregnant by age 19, and 41 percent have given birth. To help address the socioeconomic and health consequences of adolescent pregnancy, the Women's Center of Jamaica Foundation (WCJF) has supported adolescents in (1) returning to school and completing their education, and (2) preventing a second pregnancy during their adolescent years.

Since its inception in 1977, WCJF has developed a strategy to accomplish these goals that addresses young mothers' immediate and long-term needs. The program offers academic instruction for girls aged 12 to 16 who are pregnant; personal and group counseling about the challenges of teen pregnancy and motherhood; and referrals to local hospitals and clinics for health services, including family planning. The program also offers practical services to support young mothers during and after their pregnancies, such as day care for infants, classes in parenting and child nutrition, information about women's and children's legal rights, job skills training, and vocational training placement for women aged 18 to 24.

The program has developed cooperative relationships with schools, courts, churches, and health centers. It also has increased the involvement of girls' parents and led to the development of an extensive referral network. Staff work with local schools to ensure that each adolescent is placed in a school when it is time for her to leave a WCJF center. The program provides follow-up counseling and monitors student's progress for two years after they return to the regular school system. By providing a supportive, nonjudgmental environment where girls continue their education, the program helps these adolescents prepare for motherhood, build self-esteem, and gain skills to move forward with their lives.

Program successes have led to broad community support, expansion of services, and, in 1985, change of national policy to specifically allow young mothers to return to school. To date, the program has helped more than 22,000 teenage mothers return to the school system, and now serves as a model for other efforts. In 1997 alone, the program reached 3,016 girls, representing about 51 percent of births to girls under age 16 in Jamaica. In any one year, only 1.4 percent of girls reached by the program had a second pregnancy before graduation or starting work. The program now operates from seven primary centers and 13 outreach stations that help serve young mothers who cannot travel from remote or rural areas. It also offers three terms of classes per year, and can enroll as many as 120 students at each center.

Lessons Learned

  • Providing a supportive environment where pregnant girls can continue their education can make a significant difference in their futures. Young mothers leave the program with the skills and confidence that enable them to move forward in their lives.
  • Societal attitudes and opposition to young, unwed mothers are difficult to overcome. Change and acceptance come very slowly. A systematic public relations program using other interested groups can help increase awareness and support.
  • Stable program funding is difficult to secure. Success comes from developing relationships with agencies performing related work, using all avenues to promote elements, and sharing recognition among agencies to minimize competition.
  • Finding dependable and committed staff can be difficult. Individuals' attitudes are as important as educational qualifications.
  • Combining education, information, and services are key to pregnancy prevention.

For more information, please contact:
Mrs. Pamela McNeil, National Director, Jamaica Women's Center Foundation, Program for Adolescent Mothers, 42 Trafalgar Road, Kingston 10, Jamaica
Telephone/Fax: 876-926-5768.

This program example was adapted from material presented in the Case Study of the Women's Center of Jamaica Foundation, Program for Adolescent Mothers, which is available online at http://www.fhi.org/en/wsp/wspubs/jamaica.html.

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Kenya (Kenya Scouts Association)

In Kenya, about half of school-age youth are out of school and difficult to reach. In addition, the government does not allow open discussion of human sexuality, reproductive health, or sexually transmitted infections (STIs) and HIV/AIDS prevention on the radio or television. As a result, most out-of-school youth do not have access to information or discussion about these topics.

Since 1995, PATH's Kenya office has worked with the Kenya Scouts Association (KSA) to provide reproductive health information to youth through scout clubs. The Kenya Scouts Association has 12,000 adult volunteers and over 175,000 scouts. Due to the program's success, the Ministry of Education asked the KSA to develop programs to reach out-of-school youth as well as provide a Family Life Education course in their programming.

With funding from the Rockefeller Foundation, KSA developed a two-year pilot project in 1995 to determine whether scouts could effectively reach out-of-school youth with a Family Life Skills curriculum that would improve their sexual and reproductive health decision-making. Project activities sought to address: (1) high rates of unplanned teenage pregnancies; (2) the high prevalence of STIs, including HIV; and (3) the poor dialogue between parents and children about reproductive health issues.

The program was implemented at two sites. One site recruited about 30 youth (aged 11 to 16 years) and involved both in-school and out-of-school youth in the hope that they would learn from each other. The second program site, a training and rehabilitation center for street children, recruited 24 youths and 16 of their parents, who agreed to participate in the project's educational activities.

Scout leaders at both sites received training to help them present the Family Life Skills curriculum. Using weekly lesson plans, leaders covered topics such as sexuality and gender roles, the life cycle, male and female anatomy, rites of sexual passage, health and personal hygiene, self-esteem, decision making, population dynamics, drug and substance abuse, pregnancy prevention, STIs and HIV/AIDS, sexuality and feelings, relationships, and sexual abuse and violence in the family. The 18 lesson plans amounted to over 72 hours of classroom time. Group games, exercises, and teamwork exercises were used to reinforce key messages and create an enjoyable atmosphere. At the second site, scout leaders also worked with parents and interested adults to strengthen their communication skills and help them talk with youth about sexuality. Following their training, the parents participated in inter-generational discussions with the youth.

PATH and KSA staff members monitored the progress of the project, and project staff visited the two sites weekly to observe how sessions were handled. Exit interviews with scouts were conducted to get feedback on the curriculum. Parent-child discussions also were monitored to evaluate the quality of their interactions and whether new skills learned through the program were being used.

Data analysis showed that the project was a tremendous success. The project demonstrated that it is possible to reach out-of-school youth with Family Life Skills through scouting programs, and that scouting has the potential to reach large audiences because it works through existing infrastructures. Machakos, the site with a homogeneous group of out-of-school youth, recorded the greatest enthusiasm among youth.

Lessons Learned

Key findings from this project included:

  • Working with homogeneous groupseither in-school or out-of-schoolworks best. Interactions between in- and out-of-school youth were minimal in the mixed group.
  • Despite low levels of participation at the beginning, scouts participated more willingly as their comfort level with the material increased.
  • It is important to spend sufficient time training scout leaders to use the lesson plans because they have not previously taught reproductive health issues in depth. It also is necessary to ensure that the content is not diluted as the lesson plans are adapted to the scouting program.
  • Sessions on self-esteem helped parents gain self-confidence and participate effectively.
  • Involving all stakeholders (parents, teachers, scout leaders, management board of scouting movement) in planning and implementing the project helped address potential concerns and build support for the project.

In October 1998, KSA received funding from UNFPA to expand this project to all its scout units over a four-year period. PATH continues to provide technical assistance to KSA in revising and strengthening the training materials for both scouts and parents, and to train more scout leaders and volunteers.

For more information, please contact:
George Kahuthia, Senior Program Officer, or Samson Radeny, Program Officer, PATH (Program for Appropriate Technology in Health) Kenya, P.O. Box 76634, Nairobi, Kenya
Telephone: 254-2-577-177; Fax: 254-2-577-172; Email: [email protected] or [email protected]

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Kenya (Mathare Youth Sports Association)

Mathare—a ghetto of villages outside Nairobi—is one of the largest and poorest slums in Africa. Many of the several hundred thousand people who live in Mathare are adolescents with little opportunity for social activity or recreation. Many Mathare youth are neither in school nor employed. Adolescent pregnancy, sexually transmitted infections, and sexual abuse are common.

Since 1987, the Mathare Youth Sports Association (MYSA) has pioneered innovative programs to promote sports, environmental improvement, community development, and reproductive health information. MYSA is an organization run by and for youth. Youth developed the founding principles for the organization and members carry out the management duties and make the operating decisions. MYSA has a strict code of ethics and accountability that applies to all of its activities. MYSA builds self-esteem and directs the skills of young people into their community and their own self-improvement.

MYSA has changed the lives of thousands of young people in Kenya. Youth who have been involved in MYSA have become youth leaders and role models for others. Some have gone on to professional sports, graduated from universities, and become local leaders. Twenty-five leaders have taken special training and lead HIV/AIDS awareness and counseling program in the slums.

MYSA programs include the following:

  • Community service. MYSA bases its work on the belief that sports is related to health and the environment. Instead of paying a fee to play on the football teams, members participate in regular environment clean-up projects. Each week, between 25 and 30 teams clear garbage and ditches in their neighborhood. Teams earn points in the league standings for every completed clean-up project. This helps develop a sense of pride among the youth, and builds the community's trust and appreciation of MYSA.
  • Sports program for girls. MYSA began a program for girls in 1992. By 1994, the girls' league included 25 teams, with over 2,000 girls between the ages of 12 and 15 playing for MYSA. The girls' program helps promote positive interactions between boys and girls. Challenges for this program have included changing traditional attitudes toward women's place in sports and in the home. For the program to become successful, female leaders had to be identified and trained as coaches, referees, and organizers so girls could organize their own program.
  • HIV/AIDS education. In 1994, MYSA began a peer education program about HIV/AIDS. To create awareness about AIDS, risky sexual behaviors, unwanted pregnancy, and other reproductive health issues, talks are given to both players and supporters before each game. Players are encouraged to ask questions about condoms and other reproductive health services. Each unit has trained leaders who can help youth obtain more information about reproductive health services, and MYSA has established links with other reproductive health services also located in Mathare. Condoms are supplied by the Family Planning Association of Kenya and are distributed for free at the MYSA office. Over 75 MYSA youth have received special training and lead HIV/AIDS awareness, prevention, and counseling programs.
  • Shootback. In August 1997, the Shootback photography program was developed to strengthen relationships in the community and to offer a vocational outlet for creative boys and girls aged 8 to 18. The project allows kids to express their voice and share the story of their lives from their perspective. Children have been taught the art of photography and editing images as they depict life in the Mathare slum.

Although MYSA has not undergone a formal evaluation, one sign of its impact is the sheer number of youth who have participated in its programs—over 10,000 since 1987. In 1995, over 4,500 boys and girls and 300 teams from 50 villages and estates participated in the football league and environmental cleanup. Many MYSA members are in school now because they feel motivated by their peers and can afford school fees through program scholarships.

 Lessons Learned

  • Youth involvement is key to the success of a program for adolescents. MYSA views the skills and ideas of youth as its strongest resource. It also has defined their responsibilities and codes of behavior, with a system of fair but strict disciplinary action. To keep members motivated, MYSA recognizes the contributions of its members.
  • Responsive and effective management is essential to a program's sustainability. Because MYSA's early program was not tied to a specific project document, it was adaptable and responsive to the needs of its members. As it has grown, MYSA has established management principles that ensure good governance and accountability.
  • Role models are important. Many MYSA members come from single-parent households and lack positive male role models. As a result, many older players serve as role models for the younger members. MYSA also has given girls opportunities to become leaders and gain respect from their male peers. Younger players are more likely to stay in school and adopt healthy behavior because they model the behavior of older MYSA leaders.

For additional information, please contact:
Mathare Youth Sports Association, P.O. Box 69038, Nairobi, Kenya
Telephone: 2542-76-36-14; Tel/fax: 2542-583-055; Email: [email protected]

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Nicaragua

Puntos de Encuentro is a feminist, nonprofit organization specializing in the use of mass media to connect and inform youth about controversial topics from HIV/AIDS and sexuality to domestic violence. Associate Director Amy Banks said at the Eighth International Communication for Development Roundtable, we have to talk frankly about sex and sexuality, gender relations, power relations violence, subordination, and the like. . . . The challenge obviously is to figure out the right mix of confrontation and accommodation—meaning: not shy away from taking taboo or controversial subjects even when your position is likely to be totally unpopular . . . but to know how to do it with tact so that rather than getting the door shut in your face, you actually get invited in. The best way I know how to do that is to humanize the issues, turn them into human dramas that people can relate to.

In 1991, Puntos de Encuentro released La Boletina, a magazine that took a progressive look at women, sexuality, and domestic violence. Accessible to low-literate populations and popular in young adult circles, it now has a distribution of 150,000. The radio show, Joven sin Nombre, was later aired and has approximately 75,000 listeners every night. In this teen show that combines talk with pop music, teens anonymously call in and talk openly about topics of importance to their lives, especially taboo topics such as sexuality. In 1996, Puntos expanded their outreach and aired the television drama, El Sexto Sentido, which sends a strong message to youth: Take control of your life. The drama portrays youth dealing with complex issues such as HIV/AIDs, abortion, sexual orientation, and domestic violence. These media outlets have received and sustained popularity among youth and have opened a safe space for dialogues about controversial issues.

Lessons Learned

  • It is not enough to have short-lived media campaigns a couple of times a year. The effort needs to be continuous, sustained, and omnipresent.
  • No single issue should be viewed in isolation, but instead should be treated within the entire complexity of peoples daily lives and realities. Single-message campaigns have limited effect, whereas campaigns that link issues together have lasting resonance and stronger possibilities for creating change.
  • Programs must be willing to address and create a safe space for teens to talk about controversial issues.

For more information, please email [email protected] or visit www.puntos.org.ni.

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The Pacific Islands

The Pacific Adolescent Reproductive Health (ARH) Project is a regional initiative of the United Nations Population Fund (UNFPA) with funding assistance from the United Nations Foundation for International Partnerships (UNFIP). This three-year project started in 2001 and is executed and implemented by the Secretariat of the Pacific Community (SPC) in collaboration with nine Pacific Island countries: Fiji Islands, Solomon Islands, Vanuatu, Samoa, Tonga, Tuvalu, Federated States of Micronesia, Kiribati, and the Marshall Islands. The goal of the project is to provide adolescents with information and services geared to meet their reproductive health needs. At the end of the project, it is envisioned that the government and NGOs will integrate a reproductive health and HIV/AIDS information and services package into existing programs.

One third of the population of the Pacific Islands is between 10 and 24 years old, with current statistics indicating an increase in STIs and HIV/AIDS and teen pregnancies. Social problems contributing to reproductive health risks include substance abuse, sexual assault, casual and commercial sex, and the increase in the number of street children.

The ARH Project works to support in-school and out-of-school youth, providing sex education and counseling in the schools and multipurpose youth centers. Particularly for girls, the project also introduces livelihood and life-skills initiatives. The project involves parents and religious and community leaders in the education so that youth can have a safe environment in which to discuss their reproductive and sexual health. Awareness-raising activities include drama, song, dance, and mass media tailored to age groups and sectors of society.

Lessons Learned

  • Involve youth in the design, planning, development, implementation, and evaluation of the program.
  • Train and empower parents, guardians, and community leaders to talk about sexuality.
  • Work with existing health care services to integrate adolescent reproductive health services.

For more information about the ARH Project, please contact:
Dr. Jimmie Rodger, ARH Director
Telephone: 679-338-2180 or 679-337-0733; Fax: 679-337-0584; Email: [email protected]

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South Africa

Extensive research has indicated that South African public health facilities are failing to provide adolescent-friendly health services. The National Adolescent Friendly Clinic Initiative (NAFCI) is an accreditation program designed to improve the quality of adolescent health services at the primary-care level and strengthen the public sectors ability to respond to adolescent health needs. NAFCI is implementing an innovative approach to improving adolescent health services by making health services more accessible and acceptable to young people, establishing national standards and criteria for adolescent health care in clinics throughout the country, and building the capacity of health care workers to provide quality services. NAFCI is an integral component of the largest, most innovative public health program ever launched in South Africa, loveLife (www.lovelife.org.za/kids/index.html). LoveLife is a multidimensional initiative focused on improving the sexual and reproductive health of South African adolescents. Its main goal is to bring about positive behavior change to reduce pregnancy, STIs, and HIV/AIDS.

NAFCI has identified several principles to guide the development of all adolescent programs:

  • Adolescents are entitled to a full range of reproductive health services.
  • Each adolescent must be seen as an individual with particular needs for information and services, determined by factors such as age, sex, culture, life experiences, and social circumstances.
  • Gender inequities and differences characterize the social, cultural, and economic lives of adolescents and influence their development.

NAFCI is currently being piloted in ten government clinics in South Africa and is being implemented in four phases.

The concept phase included identifying problems and needs, developing program guidelines, and promoting the initiative. The planning phase established program targets, activities, and timelines; identified pilot sites; and developed and tested assessment tools. The accreditation phase includes clinic self-appraisals and improvement, to be followed by external assessments, which will be done when the clinics are ready for external scrutiny, and award of achievement stars. In the final phase, NAFCI will monitor standards in accredited clinics, evaluate the program, and feed the lessons learned into planning for national roll-out.

Lessons Learned

  • Developing a system that is sustainable and can be maintained by the district and provincial health systems with minimum resources is challenging.
  • It can be difficult to keep health care providers motivated and interested in implementing NAFCI in light of the many other primary health care programs and initiatives that are being introduced.
  • Even though NAFCI focuses on adolescents, it will contribute to improved quality of care at all levels, thus supporting other initiatives.

For more information, please contact:
Dr. Kim Dickson-Tetteh, Reproductive Health Reseach Unit, Chris Hani Baragwanath Hospital, P.O. Bertsham 2013, Soweto, South Africa
Email: [email protected]

Information for this program example was obtained from Reproductive Health Matters 9(17) (May 2001).

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Thailand

The Urban Life Network, Lifenet, is an approach to meeting youth health needs, particularly reproductive health, by building skills and strengthening relationships. The network, based at the Chiang Mai University Faculty of Nursing, was established to respond to increased morbidity of Thai adolescentsmostly due to HIV/AIDS and motorcycle accidentslinked to the migration of young people seeking educational and work opportunities in urban areas like Chiang Mai. Several research studies have shown that as youth who come to the city are freed from traditional mechanisms of control over sexual behavior and have opportunities to expand friendships and relationships with other young people, exposure to HIV, unwanted pregnancies, and other reproductive health problems has increased.1 A study of these social networks found that (1) young people's risk behaviors occur in clusters of small groups of friends; (2) friendship groups significantly influence risk behaviors; and (3) "sexual bridging" occurs between categories of sexual identities, ethnic, occupational, and age groups.2 While there were clear links between young people's new-found freedom, entertainment, and alcohol and drug use with unsafe sex and accidents, Lifenet sought to understand what kind of a project intervention could affect the risks youth were taking. The resulting strategy has been implemented to mobilize local resourcesand youth themselvesto redefine cultural values within their peer groups, leading to more positive and protective behaviors.

Lifenet's strategy is threefold. First, the group aims to build networks of support among young people at risk so that peers can redefine their subcultures to promote healthy behaviors instead of risky behaviors. Second, they encourage linkages between youth programs and individuals with existing networks of organizations, based on the understanding that networks help young people feel connected in ways that encourage them to protect themselves. Finally, they strive to overcome negative attitudes about youth by engaging local leaders and decision makers, such as teachers from the Teachers' Training College and staff of the local health promotion and disease prevention offices, in the program. Mobilizing decision makers ensures that youth will be treated with respect, that they receive reinforcing messages in school, and that the program receives the support it needs to work in the community.

Lifenet reaches young people who frequent entertainment establishments and who work as migrant construction workers. Because of their understanding of how social networks impact risk-taking behavior, peer-based education has been used to target behaviors in the contexts in which they occur. In the beginning of the project, Lifenet members reached out to entertainment establishments where youth spend time, and learned of the intense need for reproductive health information, family and adolescent counseling, and a safe place to gather among youth who frequented these establishments. The outreach team encountered problems of family abuse, neglect, low self-esteem, gender role confusion, and emotional problems among the young people they were reaching.

After gaining a better understanding of the subcultures of the youth Lifenet planned to reach, outreach workers built relationships with the management of discos, bars, and other nightspots and started conducting entertainment and educational activities which included "disk jockeys" and key staff of these establishments. The outreach team also mapped youth networks and determined the relationships among youth in a given setting. This process allowed Lifenet to identify 30 "key leaders"—that is, youth who were at high-risk and who were influencing their friends to take risks. These youth leaders then were recruited and trained with life skills, such as problem solving, reasoning, and communication skills. They were also trained in network mobilization strategies so that they could effectively build support systems among their peers. The youth decided to name their group Cycle of Life, and they have developed a newsletter to address youth concerns such as relationship advice, health information, and future aspirations. Lifenet has since set up a drop-in center where Cycle of Life members have access to a computer and other supplies to support their activities. A mobile phone hotline carried by one of the outreach workers provides counseling, support, and assistance in emergencies.

By gathering to discuss their problems, Cycle of Life members and their peers have formed a support network within which they can discuss their problems, and they have come to realize that they are not "bad kids" for going to entertainment establishments. Now they are involved in social action to promote safe entertainment for young people. Cycle of Life is expanding its membership by recruiting friends from among other night-spot patrons. Within the first year of the project, the Cycle of Life network expanded to include 175 youth.

To complement the peer program, Lifenet also engaged Teachers' College teachers in a participatory learning process which introduced them to the perspectives and needs of young people and people with HIV/AIDS. The process resulted in a shared commitment by a small group of teachers to develop a sexuality education curriculum based on students' experiences and needs. The teachers then gained support from their network of teachers and from administrators. In its second year, the curriculum is being refined and expanded to two additional provinces.

Lessons Learned

  • Programs that serve youth should use life-skills training and network mobilization strategies that have been successful in their target population.
  • Links to health promotion centers, the department of social welfare, juvenile courts, secondary and tertiary educational institutions, and other governmental and nongovernmental organizations are important to program success.
  • Reproductive health education materials should be adapted into formats that are engaging and entertaining to youth, using language and terminology that youth understand.

For more information, please contact:
Dr. Warunee Fongkaew or Ms. Ratchanee Srionsri, Urban Life Network Project, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand 50200.
Telephone: 66-53-946073; Fax: 66-53-894174

Lifenet is supported by the Ford Foundation.

References

1. Celentano, DD et al. Risk factors for HIV-1 seroconversion among young men in northern Thailand. Journal of the American Medical Association 275:122-127 (1996).

2. "Sexual bridging" refers to sexual partnerships established across different categories of sexual identity, ethnicity, age, and occupational groups. From: Bond, Katherine C. Social and Sexual Networking in Urban Northern Thailand, doctoral dissertation, the Johns Hopkins University School of Hygiene and Public Health 1995.

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Uganda

Faced with the reality of alarmingly high HIV prevalence rates, the Government of Uganda began implementing HIV/AIDS education campaigns in 1986, about nine months after taking power. By the early 1990s, awareness of HIV/AIDS was very high, but there was concern that the high levels of knowledge were not associated with comparably high levels of behavior/sexual change. There also was a growing feeling in some quarters that perhaps the HIV/AIDS campaigns to date—progressive as they had been for their time—had not sufficiently addressed HIV/AIDS in the context of sexuality.

In 1993, UNICEF started facilitating the production of a monthly newspaper for adolescents, Straight Talk. This newspaper took a different approach to HIV education. It directly addressed sexuality, feelings, and values, and often only obliquely addressed HIV as many adolescents were suffering from "AIDS education fatigue."

Straight Talk, aimed at in-school adolescents ages 15 to 19 and in-school youths up to 24 years old, was produced out of the offices of Uganda's main English daily, The New Vision. In 1996, in response to requests from head teachers, the newspaper began to carry out a school-visits program.

By 1997, the paper had outgrown its home in the newspaper and became a nongovernmental organization (NGO), the Straight Talk Foundation. This enabled it to get direct donor funding, move to its own premises, recruit staff, and start new programs. The aim of the Straight Talk Foundation is to improve the mental, social, and physical status of Ugandan adolescents (ages 10 to 19) and young adults (ages 20 to 24). It has two mission statements: "keeping adolescents safe" and "communication for better health."

The Straight Talk newspaper has a mixed safer-sex message: delay for as long as possible; use condoms consistently and correctly if you are sexually active. More than 140,000 copies of the four-page newspaper are printed monthly and distributed to schools, community-based organizations, churches, and individuals; 40,000 copies also are inserted into The New Vision.

Straight Talk has a counseling page where adolescent-friendly counselors and doctors give advice to readers. It also encourages open dialogue between adults and youth on reproductive health topics. Straight Talk is produced in English, but the Straight Talk Foundation also produces occasional newspapers for out-of-school youth in three local languages.

One positive outcome of the Straight Talk newspaper has been the development of school-based Straight Talk clubs—organized for and by youth—where issues and information presented in the magazine can be discussed. The foundation also runs a school-visiting program where doctors and counselors visit approximately twelve secondary schools per term to discuss sexuality and reproductive health with students and teachers. These efforts have resulted in some improved attitudes toward women and greater acceptance of condoms.

In February 1998, Straight Talk Foundation started a new newspaper, Young Talk, for young adolescents in upper primary school. Young Talk's key topics include changes at puberty, child's rights and responsibilities, health, and hygiene. Young Talk advocates abstinence; however, information is given out about condoms when students request it. Primary school teachers are encouraged to use this magazine as a teaching tool in the classroom. Young Talk has a circulation of 270,000; more than half of these copies are distributed directly to 11,600 primary schools monthly.

To reach a wider audience, in April 1999 the Straight Talk Foundation launched a weekly English radio program that addresses adolescent reproductive health and gender issues. The English program is broadcast on five FM stations around the country. Plans are advanced to start a Luo radio show for out-of-school youth in Northern Uganda.

The Straight Talk Foundation's projects are funded by UNICEF, DFID, SIDA, DANIDA, Ford Foundation, DSW, UNAIDS, Save the Children Fund, EDF/EU, and Population Services International.

Lessons Learned

  • It is possible to openly address sexuality in the African context if the material is tasteful, well written, scientifically accurate, and based on adolescents' questions.
  • Adults are anxious for their children to have accurate information and generally are extremely supportive of Straight Talk Foundation's efforts.
  • It is important to develop strong mechanisms for distribution of information, education, and communication (IEC) materials, and to invest funds and resources into distribution.
  • It is important to have a mixed safer-sex message because adolescents are different ages and at different points in their sexual development. It is unfair to over-promote condoms to adolescents who want to abstain from sex and, conversely, to over-promote the value of abstinence to adolescents who already are sexually active. There must be a message for every adolescent, wherever they are on the safer-sex continuum.
  • The work of the Straight Talk Foundation has been possible because of the climate of press freedom in Uganda and because of the presence of a large cadre of workers in Uganda, such as HIV/AIDS counselors and doctors from STI clinics, who serve as writers and resource people. These people have greatly enriched the analysis of the Straight Talk Foundation.

For more information on the Straight Talk Foundation of Uganda, Straight Talk, and Young Talk magazines, please visit the Straight Talk website (www.straight-talk.or.ug) or contact:
Catherine Watson, Editorial Director, or Anne Akia Fiedler, Programme Director, Straight Talk Foundation, P.O. Box 9815, Kampala, Uganda
Telephone: 256-41-235209; Fax: 256-41-235843; Email: [email protected]

This program example was adapted from materials presented in Communicating with Adolescents about AIDS: Experience from Eastern and Southern Africa. Available at: www.idrc.ca/acb/showdetl.cfm?&DID=6&Product_ID=496&CATID=15.

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