Adolescent Reproductive Health by wuyunyi

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									                   Adolescent Reproductive Health: 2005 -2008


An outcome assessment of an ABC-based HIV peer education
intervention among Kenyan university students.
Author:     Miller AN; Mutungi M; Facchini E; Barasa B; Ondieki W

Source:     Journal of Health Communication. 2008 Jun;13(4):345-356.

Abstract:   This study reports an outcome assessment on an HIV peer education
            intervention at the main campus of Kenyatta University in Nairobi,
            Kenya. A quasi-experimental separate sample pretest-posttest design was
            used. Campus-wide baseline and end line surveys were conducted with
            632 and 746 students, respectively, soliciting information on HIV-related
            knowledge, attitudes, and behavior. After 2 years of on-campus
            intervention, no changes in behavior were evident with respect to either
            abstinence or number of sexual partners. Small but statistically significant
            changes were found in condom attitudes and behavior, and a large
            increase in HIV testing was evident. It is recommended that future
            research more specifically compare abstinence versus multiple option
            peer education programs, giving special attention to the role of peer
            educators as models. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | PRE-POST TESTS | STUDENTS |
            HIV PREVENTION | PEER EDUCATORS | INTERVENTIONS |
            PROGRAM EVALUATION | PROGRAM EFFECTIVENESS | HIV
            TESTING | CONDOM USE | BEHAVIOR CHANGE | ABSTINENCE
            | MULTIPLE PARTNERS | DEVELOPING COUNTRIES | AFRICA,
            EASTERN | AFRICA, SUB SAHARAN | AFRICA | PROGRAMS |
            ORGANIZATION AND ADMINISTRATION | EDUCATION | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | LABORATORY
            EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND
            DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH | RISK
            REDUCTION BEHAVIOR | BEHAVIOR | FAMILY PLANNING,
            BEHAVIORAL METHODS | FAMILY PLANNING | SEXUAL
            PARTNERS | SEX BEHAVIOR


Document Number: 327076




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                   Adolescent Reproductive Health: 2005 -2008


Effectiveness of web-based education on Kenyan and Brazilian
adolescents’ knowledge about HIV/AIDS, abortion law, and
emergency contraception: Findings from Teen Web.
Author:     Halpern CT; Mitchell EM; Farhat T; Bardsley P

Source:     Social Science and Medicine. 2008 Aug;67(4):628-637.

Abstract:   Little evidence is available about the utility of web-based health
            education for students in low resource settings. This paper reports results
            from an evaluation of the Teen Web project, a multi-year, web-based
            health education intervention implemented in two urban settings:
            Nairobi, Kenya (N = 1178 school students) and Rio de Janeiro, Brazil (N=
            714 school students). A quasi-experimental, school-based pre-test/post-
            test design was implemented at each study site to determine if easy access
            to web-based reproductive health information, combined with
            intellectual "priming" about reproductive health topics, would result in
            improved knowledge and attitudes about topics such as condom use,
            access to HIV testing, emergency contraception and abortion laws.
            Students in web-access schools completed one web-based module
            approximately every 6-8 weeks, and in return, had access to the Internet
            for at least 30 min after completing each module. Although students were
            encouraged to access project-supplied web-based health information,
            freedom of web navigation was an incentive, so they could choose to
            access other Internet content instead. Most measures showed statistically
            significant differences between students in "web" and "comparison"
            conditions at post-test, but only about half of the differences were in the
            hypothesized direction. Results of an embedded experiment employing
            more directed feedback tripled the likelihood of correctly reporting the
            duration of emergency contraception effectiveness. Review of URL logs
            suggests that the modest results were due to inadequate exposure to
            educational materials. Future intervention should focus on teen's
            purposeful searching for health information when they are in personal
            circumstances of unmet health needs. (author's)

Language:   English

Keywords:   KENYA | BRAZIL | RESEARCH REPORT | PROGRAM
            EVALUATION | PRE-POST TESTS | ADOLESCENTS | STUDENTS
            | INTERVENTIONS | SCHOOL-BASED SERVICES | HEALTH
            EDUCATION | SEX EDUCATION | REPRODUCTIVE HEALTH |
            CONDOM USE | EMERGENCY CONTRACEPTION | COMPUTERS
            | TECHNOLOGY | INTERNET | PROGRAM EFFECTIVENESS |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | SOUTH AMERICA, EASTERN | SOUTH
            AMERICA | LATIN AMERICA | AMERICAS | PROGRAMS |



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                   Adolescent Reproductive Health: 2005 -2008

            ORGANIZATION AND ADMINISTRATION | YOUTH | AGE
            FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | EDUCATION | HEALTH | RISK
            REDUCTION BEHAVIOR | BEHAVIOR | CONTRACEPTION |
            FAMILY PLANNING | INFORMATION PROCESSING |
            INFORMATION | ECONOMIC FACTORS | INFORMATION
            NETWORKS | COMMUNICATION


Document Number: 327535



Factors associated with risky sexual behaviour among out-of-school
youth in Kenya.
Author:     Khasakhala AA; Mturi AJ

Source:     Journal of Biosocial Science. 2008 Sep;50(5):641-653.

Abstract:   This paper examines factors that may predispose unmarried and
            unemployed out-of-school youth to risky sexual behaviour. Data for
            analysis were derived from the Behaviour Surveillance Survey carried out
            in Kenya in late 2002. A total of 6129 male and female unmarried and
            unemployed out-of-school youth in the age range 15-24 years were
            successfully interviewed. However, for this paper only a sample of 3961
            comprising sexually experienced youth in the 12 months preceding the
            survey was used. Methods of analysis included descriptive statistics and
            multinomial logistic regression. Results for males indicate that factors
            associated with low and high risk were whether they had fathered a
            child, district of residence and frequency of alcohol use, while current age
            and age at first sexual debut stood out for those with low risk alone. For
            females the district of residence and age of partner at sexual debut were
            the factors that predisposed them to low-risk sexual behaviour, while for
            high risk the district of residence, current age and ever being pregnant
            were significant. The results indicate that for these youth, contextual and
            probably social factors appear to be the main determinants of risky sexual
            behaviour for both males and females. The findings also support those of
            other studies that link risky sexual behaviour among youth, especially
            males, to alcohol consumption. Programmes for intervention therefore
            need to focus on these aspects. There is also a need for studies that can
            look at district-specific factors for more focused interventions. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | DATA ANALYSIS | OUT-OF-
            SCHOOL YOUTHS | UNMARRIED | SEX BEHAVIOR | ALCOHOL
            USE AND ABUSE | INTERVENTIONS | AGE FACTORS |


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                   Adolescent Reproductive Health: 2005 -2008

            SOCIOECONOMIC FACTORS | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            RESEARCH METHODOLOGY | EDUCATIONAL STATUS |
            SOCIOECONOMIC STATUS | ECONOMIC FACTORS | MARITAL
            STATUS | NUPTIALITY | DEMOGRAPHIC FACTORS |
            POPULATION | BEHAVIOR | PROGRAMS | ORGANIZATION
            AND ADMINISTRATION | POPULATION CHARACTERISTICS


Document Number: 324183


Youth in Kenya: health and HIV. 2003 Kenya Demographic and
Health Survey (2003 KDHS).
Author:     Kenya. Central Bureau of Statistics; Kenya. Ministry of Health; Kenya
            Medical Research Institute; ORC Macro. MEASURE DHS

Source:     [Nairobi], Kenya, Central Bureau of Statistics, [2005]. 16 p.

Abstract:   Young people today face many health-related challenges. This report is
            designed to help program managers, parents, church groups and other
            people and organizations working with youth to understand some of
            these challenges. Drawing from the most recent Kenya Demographic and
            Health Survey, this report outlines the latest information about Kenya's
            young people, age 15 to 24. The Demographic and Health Survey
            collected data from more than 11,500 women and men nationwide
            including more than 4,000 young women and men age 15-24. (excerpt)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH
            SURVEYS | YOUTH | PERSONS LIVING WITH HIV/AIDS |
            ADOLESCENT HEALTH | EDUCATION | EMPLOYMENT |
            REPRODUCTIVE BEHAVIOR | DOMESTIC VIOLENCE | RISK
            BEHAVIOR | CONTRACEPTIVE USAGE | AFRICA, EASTERN |
            AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | DEMOGRAPHIC SURVEYS | POPULATION
            DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | AGE
            FACTORS | POPULATION CHARACTERISTICS | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | HEALTH |
            MACROECONOMIC FACTORS | ECONOMIC FACTORS |
            FERTILITY | CRIME | SOCIAL PROBLEMS | SOCIOCULTURAL
            FACTORS | BEHAVIOR | CONTRACEPTION | FAMILY
            PLANNING




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                   Adolescent Reproductive Health: 2005 -2008

Document Number: 308353


Evaluating the Kenya Girl Guides Association's HIV / AIDS peer
education program for younger youth: baseline results.
Author:     Juma M; Mwaniki M; Muturi C

Source:     Nairobi, Kenya, Population Council, Horizons, 2005 Nov. [10] p.
            (Horizons Research Update USAID Cooperative Agreement No. HRN-A-
            00-97-00012-00)

Abstract:   In Kenya, like in many other African countries, it is estimated that half of
            all new HIV infections occur among youth between the ages of 15 and 24
            (CBS, MOH, and ORC Macro 2004; NASCOP 2003). However, many of
            these individuals are much younger when they initiate sexual activity.
            Survey data show that 13 percent of girls and 31 percent of boys have had
            sex by age 15 (CBS, MOH, and ORC Macro 2004). Unfortunately, few
            prevention programs exist to help younger youth, specifically those
            between the ages of 10 and 14 years, to delay their sexual debut and
            develop communication and relationship skills that will keep them
            uninfected. In response to this need, the Kenya Girl Guide Association
            (KGGA) and Family Health International (FHI)/Impact began a program,
            which was developed by PATH, in 1999 to train young Girl Guides as
            HIV peer educators in their schools. The project aims to improve
            knowledge and skills related to HIV prevention and care among Girl
            Guides and their peers. In collaboration with KGGA and FHI/Impact, the
            Horizons Program is currently conducting a study to evaluate the
            effectiveness of this intervention model in achieving the objectives of the
            peer education program. This research update presents baseline findings
            from the intervention study. (excerpt)

Language:   English

Keywords:   KENYA | EVALUATION REPORT | YOUTH | PEER EDUCATORS |
            PERSONS LIVING WITH HIV/AIDS | ORGANIZATIONS | HIV
            PREVENTION | HEALTH EDUCATION | SEXUALLY
            TRANSMITTED DISEASE PREVENTION | BELIEFS |
            KNOWLEDGE | SEX BEHAVIOR | AFRICA, EASTERN | AFRICA
            SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES
            | EVALUATION | AGE FACTORS | POPULATION
            CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION
            | EDUCATION | HIV INFECTIONS | VIRAL DISEASES |
            DISEASES | POLITICAL FACTORS | SOCIOCULTURAL FACTORS
            | SEXUALLY TRANSMITTED DISEASES | REPRODUCTIVE TRACT
            INFECTIONS | INFECTIONS | CULTURE | BEHAVIOR




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                   Adolescent Reproductive Health: 2005 -2008



Document Number: 307107




Fact sheet: Sobering facts on alcohol and teen pregnancy.

Author:     National Campaign to Prevent Teen Pregnancy

Source:     Washington, D.C., National Campaign to Prevent Teen Pregnancy, 2005
            Oct. [1] p.

Abstract:   Teen sex combined with drug and/or alcohol use is increasing. Fully one-
            quarter of sexually experienced high school aged teens say they used
            alcohol and/or drugs the last time they had sex. The proportion of high
            school aged teens who used drugs and/or alcohol the last time they had
            sex has increased 18 percent----from 22% in 1991 to 25% in 2003. Lots of
            teens drink. Many start drinking in junior high and get drunk often. More
            than half of 8th graders and eight out of ten 12th graders have tried
            alcohol. Nearly 1/3 of all high school seniors say that most or all of their
            friends get drunk at least once a week. (excerpt)

Language:   English

Keywords:   UNITED STATES | PROGRESS REPORT | EPIDEMIOLOGIC
            METHODS | ADOLESCENTS, FEMALE | ADOLESCENT
            PREGNANCY | PREVENTION AND CONTROL | SEX BEHAVIOR |
            RISK BEHAVIOR | CAMPAIGNS | ALCOHOL USE AND ABUSE |
            DRUG USE AND ABUSE | NORTH AMERICA | AMERICAS |
            DEVELOPED COUNTRIES | RESEARCH METHODOLOGY |
            ADOLESCENTS | YOUTH | AGE FACTORS | POPULATION
            CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION
            | REPRODUCTIVE BEHAVIOR | FERTILITY | POPULATION
            DYNAMICS | DISEASES | BEHAVIOR | COMMUNICATION
            PROGRAMS | COMMUNICATION


Document Number: 306838




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                   Adolescent Reproductive Health: 2005 -2008


Models of Care Project. Linking HIV/AIDS treatment, care and
support in sexual and reproductive health care settings: examples
in action.
Author:     International Planned Parenthood Federation [IPPF]; Deutsche
            Gesellschaft fur Technische Zusammenarbeit [GTZ]

Source:     London, England, IPPF, 2005 Dec. 29 p.

Abstract:   IPPF wishes to showcase different models using a variety of entry points
            to bring SRH closer to HIV/AIDS. The three types of examples in action
            covered in this booklet use these entry points: Better linking of prevention
            and care through providing ARVs and opportunistic infection (OI)
            services (our case studies on the Dominican Republic, Kenya and
            Rwanda); Working with and developing programmes to reach specific
            populations (our case study on Colombia); Strengthening programming
            to address HIV/AIDS vulnerability and young people (our youth course).
            (excerpt)

Language:   English

Keywords:   DOMINICAN REPUBLIC | KENYA | RWANDA | COLOMBIA |
            PROGRESS REPORT | PILOT PROJECTS | HIV PREVENTION |
            AIDS PREVENTION | TREATMENT | CARE AND SUPPORT |
            INTEGRATED PROGRAMS | REPRODUCTIVE HEALTH |
            PROGRAM DEVELOPMENT | CARIBBEAN | AMERICAS |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA
            SOUTH OF THE SAHARA | AFRICA | AFRICA, CENTRAL |
            SOUTH AMERICA, NORTHERN | SOUTH AMERICA | LATIN
            AMERICA | STUDIES | RESEARCH METHODOLOGY | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | AIDS | MEDICAL
            PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
            HEALTH CARE | HEALTH | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION


Document Number: 315097


Social scripts and stark realities: Kenyan adolescents' abortion
discourse.

Author:     Mitchell EM; Halpern CT; Kamathi EM; Owino S

Source:     Culture, Health and Sexuality. 2006 Nov-Dec;8(6):515-528.




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                   Adolescent Reproductive Health: 2005 -2008

Abstract:   This study explores students' narratives and discourses about adolescent
            pregnancy and abortion elicited via internet-based open-ended questions
            posed in response to a cartoon vignette. We report on content analysis of
            recommendations and strategies for how to manage the unplanned
            pregnancy of a fictional young couple and in their own personal lives.
            The responses of 614 young people were analysed. Strategies vary
            widely. They include giving birth, adoption, running away, abortion,
            denial, and postponement until discovery. Young people were also
            queried about unplanned pregnancy resolution among their peers.
            Discourse analysis reveals competing social scripts on abortion. Florid
            condemnation of abortion acts in the hypothetical cases contrasts with
            more frank and sober description of peers' real life abortion behaviour.
            Students' language is compared with that found in official curricula. The
            rhetorical devices, moralizing social scripts and dubious health claims
            about abortion in students' online narratives mirror the tenor and content
            of their academic curricula as well as Kenyan media presentation of the
            issue. The need for factual information, dispassionate dialogue and
            improved contraceptive access is considerable. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | KAP SURVEYS | ADOLESCENTS
            | STUDENTS | PEER GROUPS | ABORTION | INTERNET |
            AUDIOVISUAL AIDS | PREGNANCY, UNPLANNED |
            PERCEPTION | ATTITUDE | PEER PRESSURE | LANGUAGE |
            MASS MEDIA | AFRICA, EASTERN | AFRICA, SUB SAHARAN |
            AFRICA | DEVELOPING COUNTRIES | SURVEYS | SAMPLING
            STUDIES | STUDIES | RESEARCH METHODOLOGY | YOUTH |
            AGE FACTORS | POPULATION CHARACTERISTICS |
            DEMOGRAPHIC FACTORS | POPULATION | EDUCATION |
            KNOWLEDGE SOURCES | COMMUNICATION | FERTILITY
            CONTROL, POSTCONCEPTION | FAMILY PLANNING |
            INFORMATION NETWORKS | EDUCATIONAL TECHNICS |
            EDUCATIONAL ACTIVITIES | REPRODUCTIVE BEHAVIOR |
            FERTILITY | POPULATION DYNAMICS | PSYCHOLOGICAL
            FACTORS | BEHAVIOR | PSYCHOSOCIAL FACTORS


Document Number: 310602


Condom use among sexually active Kenyan female adolescents at
risk for HIV-1 infection.
Author:     Cherutich P; Brentlinger P; Nduati R; Kiarie JN; Farquhar C

Source:     AIDS and Behavior. 2008


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                   Adolescent Reproductive Health: 2005 -2008



Abstract:   High rates of unintended pregnancy and HIV infection occur in sub-
            Saharan Africa yet few Kenyan studies have defined correlates of condom
            use in sexually active female adolescents. Female adolescents receiving
            reproductive health care and aged 15-19 were interviewed. The
            prevalence of ever-use of condom was 21.4% and 52 (7.3%) subjects were
            infected with HIV-1. Older age, higher levels of education, ever-use of
            hormonal contraceptives and higher numbers of sexual partners, non-
            consensual sex and exchange of sex for favours, were independent
            correlates of condom use. Condom use should be promoted in this
            population. Further exploration is needed on the developmental and
            contextual factors predisposing female adolescents to increased risk of
            HIV.

Language:   English

Keywords:   KENYA | RESEARCH REPORT | SURVEYS | CROSS SECTIONAL
            ANALYSIS | ADOLESCENTS, FEMALE | URBAN POPULATION |
            SEX BEHAVIOR | CONDOM USE | PREVALENCE |
            CORRELATION OF DATA | HIV INFECTIONS | RISK FACTORS |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            DEVELOPING COUNTRIES | SAMPLING STUDIES | STUDIES |
            RESEARCH METHODOLOGY | ADOLESCENTS | YOUTH | AGE
            FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | BEHAVIOR | RISK REDUCTION
            BEHAVIOR | MEASUREMENT | CORRELATION STUDIES |
            STATISTICAL STUDIES | VIRAL DISEASES | DISEASES |
            BIOLOGY


Document Number: 328121


Personal involvement of young people in HIV prevention
campaign messages: the role of message format, culture, and
gender.
Author:     Geary CW; Burke HM; Johnson L; Liku J; Castelnau L

Source:     Health Education and Behavior. 2008 April

Abstract:   To examine young people's reactions to and understanding of HIV
            prevention messages developed for MTV's global HIV prevention
            campaign Staying Alive, videotaped campaign materials were shown to
            focus group discussion (FGD) participants living in urban areas of Brazil,
            Kenya, Nepal, and Senegal. Responses related to "personal involvement"
            with the message were identified in the data from these FGDs and were


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                   Adolescent Reproductive Health: 2005 -2008

            examined in relationship to the emerging message themes, the message
            format (public service announcements [PSAs] vs. documentary), cultural
            context (site), and participant gender. Across groups, greater personal
            involvement (measured by personal connections, emotional reactions,
            and lessons learned) was found in responses about the documentary
            format compared to the PSA format. Exceptions were found for specific
            PSAs that were considered more relevant within specific gender or
            cultural contexts. Implications of findings for global campaigns were
            considered.

Language:   English

Keywords:   BRAZIL | KENYA | NEPAL | SENEGAL | RESEARCH REPORT |
            FOCUS GROUPS | PROGRAM EVALUATION | YOUTH | HIV
            PREVENTION | AIDS | CONDOM USE | STIGMA | CAMPAIGNS
            | TELEVISION SPOT | FILM AND VIDEO | ATTITUDE |
            BEHAVIOR CHANGE COMMUNICATION | SOUTH AMERICA,
            EASTERN | SOUTH AMERICA | LATIN AMERICA | AMERICAS |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | ASIA, SOUTHERN | ASIA | AFRICA,
            WESTERN | DATA COLLECTION | RESEARCH METHODOLOGY |
            PROGRAMS | ORGANIZATION AND ADMINISTRATION | AGE
            FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | HIV INFECTIONS | VIRAL DISEASES
            | DISEASES | RISK REDUCTION BEHAVIOR | BEHAVIOR |
            SOCIAL PROBLEMS | SOCIO-CULTURAL FACTORS |
            COMMUNICATION PROGRAMS | COMMUNICATION |
            TELEVISION | BROADCAST MEDIA | MASS MEDIA |
            PSYCHOLOGICAL FACTORS | BEHAVIOR CHANGE


Document Number: 325779


Multisectoral engagement increases support for youth RH.
Source:     Population Council. Frontiers in Reproductive Health
            Washington, D.C., Population Council, Frontiers in Reproductive Health,
            2007 May.

Abstract:   Collaboration among three key government ministries, communities, and
            local institutions helped to mainstream adolescent reproductive health
            activities in Kenya. Procedures and tools from the pilot project have been
            expanded throughout the pilot province, into two further provinces, and
            plans are in place to expand to an additional two provinces.

Language:   English



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                   Adolescent Reproductive Health: 2005 -2008



Keywords:   KENYA | SUMMARY REPORT | PILOT PROJECTS |
            ADOLESCENTS | STUDENTS | SECONDARY SCHOOLS |
            SCHOOL-BASED SERVICES | AIDS PREVENTION |
            REPRODUCTIVE HEALTH | SOCIAL MOBILIZATION | AFRICA,
            EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA |
            DEVELOPING COUNTRIES | STUDIES | RESEARCH
            METHODOLOGY | YOUTH | AGE FACTORS | POPULATION
            CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION
            | EDUCATION | SCHOOLS | PROGRAMS | ORGANIZATION
            AND ADMINISTRATION | AIDS | HIV INFECTIONS | VIRAL
            DISEASES | DISEASES | HEALTH | SOCIAL CHANGE | SOCIO-
            CULTURAL FACTORS


Document Number: 327076


Regarding "male and female circumcision associated with
prevalent HIV infection in virgins and adolescents in Kenya,
Lesotho, and Tanzania" [letter]
Author:     Adams J; Trinitapoli J; Poulin M

Source:     Annals of Epidemiology 2007 Nov

Abstract:   Brewer, Potterat, Roberts, and Brody (BPRB) provide the latest in a series
            of papers encouraging researchers to explore nonsexual routes of human
            immunodeficiency virus (HIV) transmission in sub-Saharan Africa (SSA).
            Whereas recent findings demonstrate that circumcision provides a
            substantial protective effect against contracting HIV, BPRB suggest
            tempering the enthusiasm for any interventions based on these findings
            until hygienic means to obtaining circumcisions can be guaranteed. They
            highlight levels of HIV prevalence among self-reported virgins in several
            SSA countries and assess variation in these countries in light of male and
            female circumcision practices - which they suggest add to the mounting
            evidence supporting iatrogenic transmission routes. We agree that
            medical practitioners should take care in implementing any new
            strategies (i.e., hygienic circumcision should be the goal, not just
            circumcision). Furthermore, we recognize that identifying routes of HIV
            transmission in SSA is an empiric question demanding rigorous
            exploration - that transmission routes should not be a foregone
            conclusion. But in light of our experience collecting data in this context
            and assessing data quality, we contend that the evidence in BPRB calls for
            an alternate interpretation. (excerpt)

Language:   English


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                   Adolescent Reproductive Health: 2005 -2008



Keywords:   KENYA | LESOTHO | TANZANIA | RESEARCH REPORT |
            CRITIQUE | METHODOLOGICAL STUDIES | DATA ANALYSIS |
            ADOLESCENTS | HIV TRANSMISSION | HIV PREVENTION |
            MALE CIRCUMCISION | FEMALE GENITAL CUTTING | HYGIENE
            | VIRGINITY | DATA QUALITY | SEX BEHAVIOR | DEVELOPING
            COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN |
            AFRICA | AFRICA, SOUTHERN | RESEARCH METHODOLOGY |
            YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS |
            DEMOGRAPHIC FACTORS | POPULATION | HIV INFECTIONS |
            VIRAL DISEASES | DISEASES | MEDICAL PROCEDURES |
            MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH | HARMFUL TRADITIONAL PRACTICES |
            TRADITIONAL HEALTH PRACTICES | CULTURE | SOCIO-
            CULTURAL FACTORS | PUBLIC HEALTH | BEHAVIOR


Document Number: 322604


Mainstreaming and scaling up the Kenya Adolescent Reproductive
Health Project.
Author:     Askew I; Evelia H

Source:     [Washington, D.C.], Population Council, Frontiers in Reproductive
            Health, 2007 March.

Abstract:   From 1999-2003, FRONTIERS implemented a Global Agenda program of
            operations research (OR) projects to address the reproductive health (RH)
            needs of adolescents in four countries - Bangladesh, Kenya, Mexico, and
            Senegal. The project was implemented in two districts of Western
            Province in Kenya, and was known as the Kenya Adolescent
            Reproductive Health Project (KARHP). The project supported a public
            sector, multisectoral intervention to enhance young people's knowledge
            and behaviour regarding reproductive health and HIV prevention, and
            systematically tested its feasibility, acceptability, effectiveness and cost.
            This OR project, implemented jointly with PATH, demonstrated that such
            a multisectoral intervention could be implemented by the public sector,
            was acceptable to communities, its effect in influencing reproductive
            health and HIV/AIDS knowledge, attitudes and behaviour was
            understood, and the type and amount of financial and other resources
            needed to implement each of the component activities was calculated.
            The pilot project showed that it was possible to reach 50% of the adult
            population (over 7,200) and over two-thirds of all 10-19 year olds, in and
            out of school (over 30,000) living in the project area, through supporting
            three Government of Kenya ministries: Ministry of Education, Science


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                   Adolescent Reproductive Health: 2005 -2008

            and Technology (MOEST); Ministry of Gender, Sports, Culture and Social
            Services (MGSCSS); and Ministry of Health (MOH). FRONTIERS and
            PATH subsequently undertook a broad and systematic dissemination of
            the findings and their programmatic, financial and policy implications.
            Dissemination included the communities where the study was
            implemented, district level ministry staff, and national-level stakeholders
            in the three ministries and other interested organizations. These activities
            were completed by April 2003. (excerpt)

Language:   English

Keywords:   KENYA | BANGLADESH | MEXICO | SENEGAL | SUMMARY
            REPORT | OPERATIONS RESEARCH | YOUTH | REPRODUCTIVE
            HEALTH | KNOWLEDGE | SEX BEHAVIOR | ATTITUDE | HIV
            PREVENTION | INTERVENTIONS | AFRICA, EASTERN | AFRICA,
            SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | ASIA,
            SOUTHERN | ASIA | NORTH AMERICA | AMERICAS | AFRICA,
            WESTERN | RESEARCH METHODOLOGY | PROGRAM
            EVALUATION | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION | AGE FACTORS | POPULATION
            CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION
            | HEALTH | SOCIOCULTURAL FACTORS | BEHAVIOR |
            PSYCHOLOGICAL FACTORS | HIV INFECTIONS | VIRAL
            DISEASES | DISEASES


Document Number: 315805


Expanding safe spaces and developing skills for adolescent girls.
Author:     Austrian K

Source:     New York, New York, Population Council, 2007 Oct.
            Promoting Healthy, Safe, and Productive Transitions to Adulthood Br
            No. 29

Abstract:   Almost 1 billion people around the globe live in urban informal
            settlements, or "slums," and the number of such residents is increasing. In
            Kenya, 60 percent of Nairobi's nearly 3 million inhabitants live in slum
            areas characterized by high levels of poverty and HIV. Kibera, the largest
            of these slums, is about 2.5 square kilometers and home to almost 800,000
            people, commonly migrants from rural areas. The term "informal
            settlements" underscores their non-permanence and implicitly justifies
            the lack of infrastructure and services provided by the government,
            including water, electricity, health services, sanitation, and public schools.
            Most residents rely on an informal system of services provided by NGOs,



                                         13
                   Adolescent Reproductive Health: 2005 -2008

            faith-based groups, and local entrepreneurs, and live in one-room houses
            made of semi-permanent materials such as mud, wooden planks, or metal
            sheets. The majority of slum residents live in extreme poverty, with
            residents sustaining themselves in whatever manner they can, often
            through informal-sector activities such as petty trade or casual labor.
            (excerpt)

Language:   English

Keywords:   KENYA | PROGRESS REPORT | BASELINE SURVEYS |
            ADOLESCENTS, FEMALE | SLUMS | ETHNIC GROUPS |
            MICROECONOMIC FACTORS | HUMAN GEOGRAPHY |
            CURRICULUM | LEADERSHIP | PROGRAM EVALUATION |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | SURVEYS | SAMPLING STUDIES |
            STUDIES | RESEARCH METHODOLOGY | ADOLESCENTS |
            YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS |
            DEMOGRAPHIC FACTORS | POPULATION | URBANIZATION |
            URBAN POPULATION DISTRIBUTION | POPULATION
            DISTRIBUTION | GEOGRAPHIC FACTORS | CULTURAL
            BACKGROUND | ECONOMIC FACTORS | GEOGRAPHY |
            SOCIAL SCIENCES | SCIENCE | SOCIOCULTURAL FACTORS |
            EDUCATION | ORGANIZATION AND ADMINISTRATION |
            PROGRAMS


Document Number: 326786


Adolescent Reproductive Health and Development Policy plan of
action, 2005—2015.
Author:     Kenya. Ministry of Planning and National Development. National
            Coordinating Agency for Population and Development; Kenya. Ministry
            of Health. Division of Reproductive Health

Source:     Nairobi, Kenya, Ministry of Planning and National Development,
            National Coordinating Agency for Population and Development, 2005
            Aug.

Abstract:   Estimates indicate that more than half the world's population is below the
            age of 25 -- the largest youth generation in history -- and nearly one-third
            is between the ages of 10 and 24. Their numbers are still growing,
            particularly in sub-Saharan Africa. About 83 per cent of all adolescents
            currently live in developing countries with Africa holding the largest
            proportion. In Kenya specifically, the high fertility and declining
            mortality that are typical of the region have yielded a youthful



                                         14
                   Adolescent Reproductive Health: 2005 -2008

            population. Over 40 per cent of Kenyans are younger than 15 years and
            only about 4 per cent are aged 65 years and above according to the 1999
            census data. This means that over half of Kenya's population of about 31
            million is aged below 24 years, with the larger proportion being
            adolescents. Indeed, more than one-quarter of the country's population
            consists of young people aged 10 to 24 years. Unfortunately, pervasive
            social, economic and health problems mean that circumstances for
            Africa's and Kenya's adolescents are often especially difficult even though
            these young people comprise form a formidable force that can no longer
            be ignored. Thus, Africa -- Kenya included -- must rise to the massive
            challenge of providing its adolescents with opportunities for a safe,
            healthy and economically productive future. (excerpt)

Language:   English

Keywords:   KENYA | SUMMARY REPORT | PLANNING | GOALS |
            ADOLESCENTS | REPRODUCTIVE HEALTH | POLICY |
            BEHAVIOR CHANGE COMMUNICATION | IMPLEMENTATION |
            MONITORING | PROGRAM DEVELOPMENT | AFRICA, EASTERN
            | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | ORGANIZATION AND ADMINISTRATION |
            YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS |
            DEMOGRAPHIC FACTORS | POPULATION | HEALTH |
            POLITICAL FACTORS | SOCIOCULTURAL FACTORS |
            COMMUNICATION PROGRAMS | COMMUNICATION |
            BEHAVIOR CHANGE | BEHAVIOR | PROGRAMS | EVALUATION


Document Number: 304869


Research on Adolescent health in Kenya and Uganda.
Author:     Winkler J; Wood S

Source:     Nairobi, Kenya, Program for Appropriate Technology in Health [PATH],
            Scouting for Solutions, 2006 Oct.
            USAID Cooperative Agreement No. GPO-A-00-05-00009-00

Abstract:   Scouting for Solutions is a five-year project that aims to prevent the
            spread of HIV and AIDS by promoting health sexual behavior amongst
            Scouts in Kenya and Uganda, including the promotion of abstinence until
            marriage, fidelity in marriage, and monogamous relationships. The
            project, funded by the US Agency for International Development, is being
            implemented by the US-based nongovernmental organization PATH, in
            conjunction with national Scouts associations in Kenya and Uganda. By
            2009, the project will reach an estimated 325,000 girls and boys aged 12-15



                                        15
                   Adolescent Reproductive Health: 2005 -2008

            years with intensive and repeated HIV prevention strategies and health
            promotion activities. (excerpt)

Language:   English

Keywords:   KENYA | UGANDA | SUMMARY REPORT | LITERATURE REVIEW
            |ADOLESCENTS, FEMALE | SEX EDUCATION | ABSTINENCE |
            FIDELITY | PROMOTION | HIV PREVENTION | KNOWLEDGE |
            PUBLIC OPINION | AFRICA, EASTERN | AFRICA SOUTH OF THE
            SAHARA | AFRICA | DEVELOPING COUNTRIES |
            ADOLESCENTS | YOUTH | AGE FACTORS | POPULATION
            CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION
            | EDUCATION | FAMILY PLANNING, BEHAVIORAL METHODS |
            FAMILY PLANNING | SEX BEHAVIOR | BEHAVIOR |
            MARKETING | ECONOMIC FACTORS | HIV INFECTIONS |
            VIRAL DISEASES | DISEASES | SOCIOCULTURAL FACTORS |
            ATTITUDE | PSYCHOLOGICAL FACTORS


Document Number: 317992


Nurse-Midwives' attitudes towards adolescent sexual and
reproductive health needs in Kenya and Zambia.
Author:     Warenius LU; Faxelid EA; Chishimba PN; Musandu JO; Ong'any AA

Source:     Reproductive Health Matters. 2006 May

Abstract:   Adolescent sexuality is a highly charged moral issue in Kenya and
            Zambia. Nurse-midwives are the core health care providers of adolescent
            sexual and reproductive health services but public health facilities are
            under-utilized by adolescents. The aim of this study was to investigate
            attitudes among Kenyan and Zambian nurse-midwives (n = 820) toward
            adolescent sexual and reproductive health problems, in order to improve
            services for adolescents. Data were collected through a questionnaire.
            Findings revealed that nurse-midwives disapproved of adolescent sexual
            activity, including masturbation, contraceptive use and abortion, but also
            had a pragmatic attitude to handling these issues. Those with more
            education and those who had received continuing education on
            adolescent sexuality and reproduction showed a tendency towards more
            youth-friendly attitudes. We suggest that critical thinking around the
            cultural and moral dimensions of adolescent sexuality should be
            emphasized in undergraduate training and continuing education, to help
            nurse-midwives to deal more empathetically with the reality of
            adolescent sexuality. Those in nursing and other leadership positions
            could also play an important role in encouraging wider social discussion


                                        16
                   Adolescent Reproductive Health: 2005 -2008

            of these matters. This would create an environment that is more tolerant
            of adolescent sexuality and that recognizes the beneficial public health
            effect for adolescents of greater access to youth-friendly sexual and
            reproductive health services. (author's)

Language:   English

Keywords:   KENYA | ZAMBIA | RESEARCH REPORT | KAP SURVEYS | ,
            FEMALE | NURSE-MIDWIVES | WOMEN IN DEVELOPMENT |
            ATTITUDE | ADOLESCENT HEALTH SERVICES | SEXUALLY
            TRANSMITTED DISEASE PREVENTION | REPRODUCTIVE
            HEALTH | SEX BEHAVIOR | ABORTION | SCHOOLS, NURSING |
            PSYCHOSOCIAL FACTORS | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | DEVELOPING COUNTRIES | AFRICA,
            SOUTHERN | SURVEYS | SAMPLING STUDIES | STUDIES |
            RESEARCH METHODOLOGY | ADOLESCENTS | YOUTH | AGE
            FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | HEALTH PERSONNEL | DELIVERY
            OF HEALTH CARE | HEALTH | ECONOMIC DEVELOPMENT |
            ECONOMIC FACTORS | PSYCHOLOGICAL FACTORS |
            BEHAVIOR | HEALTH SERVICES | SEXUALLY TRANSMITTED
            DISEASES | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS
            | DISEASES | FERTILITY CONTROL, POSTCONCEPTION |
            FAMILY PLANNING | SCHOOLS | EDUCATION


Document Number: 304722


Services for prevention of mother-to-child transmission (PMTCT).
Integrating Contraceptive information into PMTCT services is
challenging, particularly for youth.
Author:     Reynolds HW; Kimani J Arlington, Virginia, Family Health International
            [FHI], YouthNet, 2006 May.

Source:     YouthNet Briefs on Reproductive Health and HIV / AIDS No. 12.
            Research Results;USAID Development Experience Clearinghouse DocID
            / Order No.

Abstract:   Programs designed to prevent mother-to-child transmission (PMTCT) of
            HIV are usually part of antenatal care programs. These services typically
            include HIV counseling and testing for pregnant women and, if they test
            HIV-positive, provision of antiretroviral drugs to prevent transmission of
            HIV to the baby (called vertical transmission). Another critically
            important service that could be offered through PMTCT activities -- but
            rarely is -- is the provision of contraceptive information and methods.


                                        17
                   Adolescent Reproductive Health: 2005 -2008

            Contraception could help prevent future unintended births to HIV-
            infected women. Services for the prevention of mother-to-child
            transmission are relatively new additions to antenatal programs, and
            little information exists about young women's access to, and use of, these
            services. Moreover, because adolescents and young women are early in
            their reproductive years, they are likely to want children in the future.
            How family planning services and messages are integrated into PMTCT
            services for these younger women requires particular attention. To better
            understand these issues, Family Health International/YouthNet
            conducted a study at four diverse antenatal care clinics with PMTCT
            programs in several regions of Kenya. Antenatal programs are relatively
            widespread in Kenya, and PMTCT services are growing rapidly in the
            country. (excerpt)

Language:   English

Keywords:   KENYA | SUMMARY REPORT | YOUTH | PREVENTION OF
            MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION |
            COMMUNICATION STRATEGY | ADOLESCENT PREGNANCY |
            CONTRACEPTIVE METHODS | KNOWLEDGE | AFRICA,
            EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA |
            DEVELOPING COUNTRIES | AGE FACTORS | POPULATION
            CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION
            | DISEASE TRANSMISSION CONTROL | PREVENTION AND
            CONTROL | DISEASES | HIV INFECTIONS | VIRAL DISEASES |
            COMMUNICATION | REPRODUCTIVE BEHAVIOR | FERTILITY |
            POPULATION DYNAMICS | CONTRACEPTION | FAMILY
            PLANNING | SOCIOCULTURAL FACTORS


Document Number: 303800


Sexual behavior and STI / HIV status among adolescents in rural
Malawi: an evaluation of the effect of interview mode on reporting.
Author:     Mensch BS; Hewett PC

Source:     [Unpublished] 2006. Presented at the 2006 Annual Meeting of the
            Population Association of America, Los Angeles, California, March 30 -
            April 1, 2006.

Abstract:   Our understanding of the dynamics of HIV transmission in developing
            countries is seriously compromised by unreliable data on sexual
            behavior. Epidemiological studies in Africa have observed little
            association between self-reported risky sexual behavior and HIV status. A
            large multi-site study of factors determining HIV prevalence in four


                                        18
                   Adolescent Reproductive Health: 2005 -2008

            African cities revealed considerable numbers of women who were HIV
            positive yet reported themselves to be virgins or reported having only
            one sexual partner and few episodes of sexual intercourse. The
            inconsistency between reported sexual behavior and HIV incidence has
            prompted some epidemiologists to question the conventional explanation
            for the African AIDS epidemic. Arguing that pre-conceived notions of
            African sexuality have unduly influenced researchers, several
            epidemiologists suggest that it is not risky sexual behavior but rather
            parenteral transmission resulting from medical injections with
            contaminated needles that has played a substantial role in the spread of
            HIV. While these scientists have closely examined the data on
            heterosexual transmission, they are less thorough in their assessment of
            survey data on sexual behavior data. Gisselquist and Potterat assert:
            "[The care with which these [surveys] ... have been performed, the
            familiarity of investigators with local conditions, their experience in the
            conduct of such studies, and the consistency of response makes summary
            dismissal of such results untenable." The willingness of these and other
            researchers to accept survey data of questionable validity has serious
            implications for interpretations of the etiology of HIV transmission.
            (excerpt)

Language:   English

Keywords:   MALAWI | KENYA | RESEARCH PROPOSAL |
            METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS |
            INTERVIEWS | SURVEY METHODOLOGY | HIV TRANSMISSION
            | PREVALENCE | SEX BEHAVIOR | RISK BEHAVIOR | DATA
            QUALITY | DATA REPORTING | COMPUTER PROGRAMS AND
            PROGRAMMING | EVALUATION | DEVELOPING COUNTRIES |
            AFRICA, SOUTHERN | AFRICA, SUB SAHARAN | AFRICA |
            AFRICA, EASTERN | RESEARCH METHODOLOGY | DATA
            COLLECTION | SURVEYS | SAMPLING STUDIES | STUDIES |
            HIV INFECTIONS | VIRAL DISEASES | DISEASES |
            MEASUREMENT | BEHAVIOR | DATA ANALYSIS |
            INFORMATION PROCESSING | INFORMATION


Document Number: 318890


Tuko Pamoja: adolescent reproductive health and life skills
curriculum.
Author:     Behague S; Christenson K; Martin S; Wysong M; Kibusu K

Source:     Nairobi, Kenya, Program for Appropriate Technology in Health [PATH],
            2006 Mar.


                                        19
                   Adolescent Reproductive Health: 2005 -2008



Abstract:   Adolescence is a time of dynamic change, filled with new feelings,
            physical and emotional changes, excitement, questions, and difficult
            decisions. During this time, young people need information about their
            own sexuality and skills to help them plan for a happy future. As they
            move through adolescence, young people begin to have different kinds of
            relationships with their peers, family members, and adults; good
            communication and other relationship skills can help ensure that these
            relationships are satisfying and mutually respectful. Young people need
            to learn how to manage new feelings about sexuality in order to make
            responsible decisions about their health, reproduction, and parenthood.
            This curriculum, entitled Tuko Pamoja (We Are Together), can help
            facilitate dialogue between adults and young people on issues related to
            adolescent reproductive health. It’s for teachers; community, religious,
            and youth group leaders; health care professionals; and anyone working
            with young people. The curriculum is designed to delay sexual debut and
            promote sexual and reproductive health by addressing gender,
            reproductive health, preventive behaviours, sexually transmitted
            infections, HIV and AIDS, abstinence, gender violence, and decision-
            making, communication, and other important life skills. (excerpt)

Language:   English

Keywords:   KENYA | MANUAL | CHILD | YOUTH | ADOLESCENTS |
            CURRICULUM | ABSTINENCE | DRUG USE AND ABUSE |
            ABORTION | SAFETY | GENDER ISSUES | SEX BEHAVIOR | RISK
            BEHAVIOR | PUBERTY | INTERPERSONAL RELATIONS | SELF
            ESTEEM | DECISION MAKING | SEXUAL EXPLOITATION |
            VOLUNTARY COUNSELING AND TESTING | SEXUALLY
            TRANSMITTED DISEASE PREVENTION | HIV PREVENTION |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            DEVELOPING COUNTRIES | AGE FACTORS | POPULATION
            CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION
            | EDUCATION | FAMILY PLANNING, BEHAVIORAL METHODS |
            FAMILY PLANNING | BEHAVIOR | FERTILITY CONTROL,
            POSTCONCEPTION | PUBLIC HEALTH | HEALTH |
            SOCIOCULTURAL FACTORS | REPRODUCTION |
            PSYCHOLOGICAL FACTORS | HIV TESTING | LABORATORY
            EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND
            DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | SEXUALLY
            TRANSMITTED DISEASES | REPRODUCTIVE TRACT
            INFECTIONS | INFECTIONS | DISEASES | HIV INFECTIONS |
            VIRAL DISEASES


Document Number: 315809



                                       20
                   Adolescent Reproductive Health: 2005 -2008



RxGen pharmacy project: reaching youth through pharmacies.
PATH develops a model for increasing youth's access to
reproductive health services.
Source:     Program for Appropriate Technology in Health [PATH]
            [Seattle, Washington], PATH, 2006.

Abstract:   During adolescence, people are more likely to take risks and less capable
            of predicting and dealing with the consequences than at any other time of
            life. Reproductive health is especially threatened; rates of sexually
            transmitted infections (STIs) are highest among young people aged 15 to
            24 years. For young women, in particular, adolescence is a time of
            vulnerability--a time when their ability to negotiate safe sexual
            interactions is often slight. Complications from pregnancy, childbirth,
            and unsafe abortions have become the major causes of death for girls
            aged 15 to 19. PATH is working to reduce adolescents' risk of unintended
            pregnancy and sexually transmitted infections by making it easier for
            them to get the health information and products they need. Our point of
            contact is the pharmacy, an anonymous setting that is less threatening
            and more accessible than a health care clinic. (excerpt)

Language:   English

Keywords:   CAMBODIA | KENYA | NICARAGUA | VIETNAM | PROGRESS
            REPORT | PHARMACISTS | REPRODUCTIVE HEALTH |
            PHARMACIES | YOUTH PROGRAMS | PROGRAM
            ACCESSIBILITY | TRAINING ACTIVITIES | CURRICULUM |
            REFERRAL AND CONSULTATION | CONTRACEPTION | LOGOS
            | DEVELOPING COUNTRIES | ASIA, SOUTHEASTERN | ASIA |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            CENTRAL AMERICA | LATIN AMERICA | AMERICAS | HEALTH
            PERSONNEL | DELIVERY OF HEALTH CARE | HEALTH |
            HEALTH FACILITIES | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION | PROGRAM EVALUATION | TRAINING
            PROGRAMS | EDUCATION | PROGRAM ACTIVITIES | FAMILY
            PLANNING | MARKETING | ECONOMIC FACTORS


Document Number: 308256


Choosing life in a world with HIV/AIDS.
Source:     Ray of Hope: A Newsletter of the Hope for African Children Initiative
            2006 Mar.



                                        21
                   Adolescent Reproductive Health: 2005 -2008

Abstract:   "The impact of HIV/AIDS is so big that communities can no longer cope.
            Children are being orphaned at an alarming rate and poverty fuelled by
            the epidemic is quickly engulfing our communities,'' says Osunga Kuyoh,
            the Coordinator of Sirembe Child Development Program, a community-
            based organization assisting children and families impacted by
            HIV/AIDS in North West Gem Location of Siaya District in western
            Kenya. Recent statistics from Sirembe Mobile VCT, supported by Centres
            for Disease Control (CDC), indicated the HIV prevalence rate in North
            West Gem was 23%, compared to the national rate of 6.7%. "This figure is
            pretty high and signals worse things to come. It means many more
            children are on their way to orphan-hood as infected adults die from the
            disease,'' he says. But beyond the grim statistics is a resolute community
            initiative towards off the negative impact of the disease. Through the
            Sirembe Child Development Program, residents of North West Gem have
            come together to support children made vulnerable by the disease and
            carry out HIV prevention campaigns. The organization, supported by
            HACI through Save the Children Canada, has also set up HIV/AIDS
            clubs in 12 schools. "School children provide a window of opportunity in
            the war against HIV/AIDS because if they are educated about the
            epidemic at an early age, they will grow up armed with all the
            information required to prevent it and will be able to make the right
            choices,'' says Osunga. (excerpt)

Language:   English

Keywords:   KENYA | CRITIQUE | PERSONS LIVING WITH HIV/AIDS |
            ORPHANS AND VULNERABLE CHILDREN | CHILDREN |
            ADOLESCENTS | NONGOVERNMENTAL ORGANIZATIONS |
            CARE AND SUPPORT | HIV PREVENTION | CAMPAIGNS |
            SCHOOL-BASED SERVICES | STIGMA | AFRICA, EASTERN |
            AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | HIV INFECTIONS | VIRAL DISEASES | DISEASES |
            YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS |
            DEMOGRAPHIC FACTORS | POPULATION | ORGANIZATIONS |
            POLITICAL FACTORS | SOCIOCULTURAL FACTORS | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH |
            COMMUNICATION PROGRAMS | COMMUNICATION |
            PROGRAMS | ORGANIZATION AND ADMINISTRATION |
            SOCIAL PROBLEMS | FAMILY AND HOUSEHOLD


Document Number: 303639




                                        22
                   Adolescent Reproductive Health: 2005 -2008


Baseline survey results for the "Young Men as Equal Partners"
Project. 10-24 year-olds from Nyando, Bondo and Homa Bay
districts in Nyanza Province, Kenya.
Author:     Thomsen S; Katz K; Janowitz B

Source:     [Nairobi], Kenya, Family Health International [FHI], 2007 Feb.

Abstract:   Two cross-sectional, population-based household surveys among young
            men in the targeted districts were designed to conduct this evaluation.
            The baseline survey was planned to take place prior to the
            implementation of the YMEP program and a follow-up survey would be
            conducted one year after program implementation. From January to
            February 2006, FHI, in conjunction with Impact Research and
            Development Organization (IRDO), carried out the baseline survey in
            Nyando, Homa Bay and Bondo districts in Nyanza. A total of 1,058 boys
            and young men between the ages of 10 and 24 were interviewed. All
            survey participants were asked about their knowledge of HIV/AIDS and
            sources of reproductive health information, including exposure to sex
            education in schools and peer education. Questions about knowledge of
            reproductive health, family planning and STIs were asked only to 13-24
            year olds. Only 15-24 year olds were asked about their sexual behaviours
            and experiences, HIV risk perceptions and attitudes toward gender
            equity. (excerpt

Language:   English

Keywords:   KENYA | RESEARCH REPORT | KAP SURVEYS | ADOLESCENTS,
            MALE | YOUTH | PERSONS LIVING WITH HIV/AIDS | MEN'S
            INVOLVEMENT | SEX BEHAVIOR | GENDER ISSUES |
            INEQUALITIES | CONDOM USE | UTILIZATION OF HEALTH
            CARE | DEVELOPING COUNTRIES | AFRICA, EASTERN |
            AFRICA, SUB SAHARAN | AFRICA | SURVEYS | SAMPLING
            STUDIES | STUDIES | RESEARCH METHODOLOGY |
            ADOLESCENTS | AGE FACTORS | POPULATION
            CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION
            | HIV INFECTIONS | VIRAL DISEASES | DISEASES | PROGRAMS
            | ORGANIZATION AND ADMINISTRATION | BEHAVIOR |
            SOCIOCULTURAL FACTORS | SOCIOECONOMIC FACTORS |
            ECONOMIC FACTORS | RISK REDUCTION BEHAVIOR | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH


Document Number: 323689




                                        23
                   Adolescent Reproductive Health: 2005 -2008


Vulnerability to HIV infection among Luo female adolescent
orphans in western Kenya.
Author:     Nyambedha EO

Source:     African Journal of AIDS Research. 2007 Nov

Abstract:   Large-scale surveys have reported that about 55% of orphans worldwide
            are adolescents. In Kenya, the majority of HIV-infected adolescents are
            females. The current study used the anthropological methods of in-depth
            case studies to analyse how migratory life situations of individual female
            adolescent orphans in the Luo community of Western Kenya may
            increase their exposure to HIV. The study shows that the ability of the
            female adolescent orphans to adopt risk-preventive behaviour in relation
            to HIV is determined by a range of factors beyond their control of
            individual sexual behaviour. Although analysis of a single case study
            limits generalization of the findings, the results provide insights into the
            reason for sex differentials in HIV infection rates among adolescents as
            reported in some large-scale surveys. The paper recommends that HIV
            prevention strategies for adolescents should examine the specific life
            situations of female orphans by focusing on the impacts of HIV and AIDS
            and poverty on the protective role of the family. It also recommends that
            keeping female adolescent orphans in school or in vocational training can
            be an effective HIV prevention strategy for them. (author's

Language:   English

Keywords:   KENYA | RESEARCH REPORT | QUALITATIVE RESEARCH |
            ORPHANS AND VULNERABLE CHILDREN | ADOLESCENTS |
            HIV PREVENTION | FOSTERING | SEX BEHAVIOR | SEX
            FACTORS | MIGRATION | DEVELOPING COUNTRIES | AFRICA,
            EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH
            METHODOLOGY | FAMILY AND HOUSEHOLD |
            SOCIOCULTURAL FACTORS | YOUTH | AGE FACTORS |
            POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
            POPULATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES
            | CHILD REARING | BEHAVIOR | POPULATION DYNAMICS


Document Number: 314047




                                         24
                   Adolescent Reproductive Health: 2005 -2008


Sexual initiation and contraceptive use among female adolescents
in Kenya.
Author:     Ikamari LD; Towett R

Source:     African Journal of Health Sciences. 2007

Abstract:   This paper examines the timing of sexual initiation and contraceptive use
            among female adolescents in Kenya. Data are drawn from the 2003 Kenya
            Demographic and Health Survey. The main analytical tools are regression
            models. A Cox regression model is used to consider the probability of a
            young woman having first sex during adolescence and linear regression
            model to quantify the effects of a set of factors on female adolescent's age
            at first sexual debut. Finally, logistic regression model is used to model
            the probability of a sexually experienced adolescent woman using a
            contraceptive method. The results obtained indicate the onset of sexual
            activity is early and contraceptive use is fairly low and both the timing of
            first sex and contraceptive use are affected by a variety of factors. Despite
            engaging in unsafe sex practices, the majority of the adolescents do not
            view themselves as being at the risk of contracting HIV/AIDS. A number
            of recommendations are proposed. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | RECOMMENDATIONS |
            DEMOGRAPHIC AND HEALTH SURVEYS | STATISTICAL
            REGRESSION | KAP SURVEYS | ADOLESCENTS, FEMALE |
            WOMEN IN DEVELOPMENT | FIRST INTERCOURSE |
            CONTRACEPTIVE USAGE | PROBABILITY | AGE FACTORS |
            RISK BEHAVIOR | PERCEPTION | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            DEMOGRAPHIC SURVEYS | POPULATION DYNAMICS |
            DEMOGRAPHIC FACTORS | POPULATION | DATA ANALYSIS |
            RESEARCH METHODOLOGY | SURVEYS | SAMPLING STUDIES |
            STUDIES | ADOLESCENTS | YOUTH | POPULATION
            CHARACTERISTICS | ECONOMIC DEVELOPMENT | ECONOMIC
            FACTORS | SEX BEHAVIOR | BEHAVIOR | CONTRACEPTION |
            FAMILY PLANNING | STATISTICAL STUDIES |
            PSYCHOLOGICAL FACTORS


Document Number: 324425




                                         25
                   Adolescent Reproductive Health: 2005 -2008


Addressing early marriage in areas of high HIV prevalence: a
program to delay marriage and support married girls in rural
Nyanza, Kenya.
Author:     Erulkar A; Ayuka F

Source:     New York, New York, Population Council, Frontiers in Reproductive
            Health, 2007 Mar. Promoting Healthy, Safe, and Productive Transitions to
            Adulthood Brief No. 19

Abstract:   Married adolescent girls form a large segment of Kenyan youth, yet they
            are largely overlooked by researchers and programmers concerned with
            the lives of adolescents. As evidence demonstrates, this neglected
            population of married girls is likely to be vulnerable and in need of
            support. HIV infection is much higher among adolescent girls in sub-
            Saharan Africa than among boys. In settings such as Nyanza Province,
            Kenya, rates of HIV infection are extremely high, and evidence is
            increasing in some settings that girls who are married are much more
            likely to be infected with HIV, compared with their unmarried
            counterparts who are sexually active. This brief describes a program
            addressing the problem of early marriage, the reproductive risks
            associated with early marriage, and the risk of HIV infection transmission
            within marriage. The program was based on the Population Council's
            analysis of the 2003 Kenya Demographic and Health Survey (KDHS) as
            well as on formative research within the rural Nyanza community.
            (excerpt)

Language:   English

Keywords:   KENYA | SUMMARY REPORT | PREVALENCE | RURAL AREAS |
            CHILD MARRIAGE | ADOLESCENTS, FEMALE | PREVENTION
            AND CONTROL | HIV PREVENTION | MARRIAGE
            POSTPONEMENT | AFRICA, EASTERN | AFRICA, SUB SAHARAN
            | AFRICA | DEVELOPING COUNTRIES | MEASUREMENT |
            RESEARCH METHODOLOGY | GEOGRAPHIC FACTORS |
            POPULATION | MARRIAGE PATTERNS | MARRIAGE |
            NUPTIALITY | DEMOGRAPHIC FACTORS | ADOLESCENTS |
            YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS |
            DISEASES | HIV INFECTIONS | VIRAL DISEASES


Document Number: 315800




                                        26
                   Adolescent Reproductive Health: 2005 -2008


Trends in primary and secondary abstinence among Kenyan youth.
Author:     Chiao C; Mishra V

Source:     Calverton, Maryland, Macro International, Demographic and Health
            Research Division, MEASURE DHS, 2007 Nov. DHS Working Papers No.
            36;USAID Contract No. GPO-C-00-03-00002-00

Abstract:   Promoting sexual abstinence among never-married youth is an important
            component of HIV/AIDS prevention campaigns for youth in countries
            with generalized epidemics. The objective was to examine trends in
            primary and secondary abstinence among never-married youth age 15-24
            in Kenya over a ten-year period and to explore the role of HIV prevention
            knowledge, schooling, and contextual factors in affecting abstinence
            behavior. Data were from Kenya Demographic and Health Surveys
            conducted in 1993, 1998, and 2003. Primary abstinence was defined as
            never-married youth who never had sex. Secondary abstinence was
            defined as never-married youth who ever had sex but not in the past
            year. Logistic regression models were used to estimate the effects of
            prevention knowledge, schooling, and contextual factors in affecting
            abstinence behavior, after accounting for sampling weights and clustering
            in the survey design. Both primary and secondary abstinence levels have
            risen in the past 10 years in Kenya. The abstinence levels were higher
            among female youth than among male youth. Multivariate analyses show
            that knowledge that abstinence can prevent HIV infection was positively
            associated with the likelihood of practicing abstinence (both primary and
            secondary). However, knowledge that condom use can prevent HIV
            infection was associated with lower abstinence practice. In-school youth
            were 4-5 times more likely to abstain from sex than those working
            (aOR=4.12; p=0.000 for female youth and aOR=4.83; p=0.000 for male
            youth). Not-in-school female youth were about as likely to abstain as
            working female youth, but not-in-school male youth were about 2 times
            more likely to abstain than working male youth. Muslim youth were
            much more likely to abstain than other youth. Female youth with weekly
            exposure to television and those with a secondary or higher education
            were significantly more likely to have abstained, whereas male youth
            were significantly less likely. Effects of these factors on secondary
            abstinence practice were generally weaker, but sexually experienced in-
            school male youth were significantly more likely to have abstained in th
            Effects of the contextual variables on the likelihood of abstinence were
            generally small and insignificant, except for primary abstinence among
            female youth. Increasing knowledge that abstinence can prevent HIV
            infection and keeping youth in schools can help promote abstinence
            behavior. Abstinence programs need to be gender sensitive and culturally
            appropriate. (author's)

Language:   English


                                        27
                   Adolescent Reproductive Health: 2005 -2008



Keywords:   KENYA | TECHNICAL REPORT | DEMOGRAPHIC AND HEALTH
            SURVEYS | DATA ANALYSIS | YOUTH | ADOLESCENTS |
            STUDENTS | PRIMARY SCHOOLS | SECONDARY SCHOOLS |
            ABSTINENCE | HIV INFECTIONS | TRANSMISSION | HIV
            PREVENTION | KNOWLEDGE | CONDOM USE | BEHAVIOR |
            SEX EDUCATION | PROGRAM EFFECTIVENESS | DEVELOPING
            COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN |
            AFRICA | DEMOGRAPHIC SURVEYS | POPULATION DYNAMICS
            | DEMOGRAPHIC FACTORS | POPULATION | RESEARCH
            METHODOLOGY | AGE FACTORS | POPULATION
            CHARACTERISTICS | EDUCATION | SCHOOLS | FAMILY
            PLANNING, BEHAVIORAL METHODS | FAMILY PLANNING |
            VIRAL DISEASES | DISEASES | INFECTIONS | SOCIOCULTURAL
            FACTORS | RISK REDUCTION BEHAVIOR | PROGRAM
            EVALUATION | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION


Document Number: 322987


Converging evidence suggests nonsexual HIV transmission among
adolescents in sub-Saharan Africa [letter]
Author:     Brewer DD; Potterat JJ; Muth SQ; Brody S

Source:     Journal of Adolescent Health. 2007

Abstract:   In their article on human immunodeficiency virus (HIV) infection in
            Zimbabwean adolescents, Gavin and colleagues do not specifically
            consider blood exposures to explain HIV infection in virgins. They
            recruited a nationally representative sample of girls aged 15-19 years;
            90% agreed to be tested. Strikingly, 41% of 192 HIV-positive girls
            reported no sexual exposure. The authors suspect the infected virgins
            lied. This suspicion is not based on empiric evidence such as physical or
            laboratory examination, nor psychometric measures of response validity.
            We are not aware of evidence that underreporting of sexual experience in
            Africa is positively related to HIV infection, and false positive tests likely
            predominated in previous studies comparing self-reports and markers of
            sexually transmitted disease and pregnancy in African youth. The
            authors venture that HIV might have been vertically transmitted, though
            they undermine their speculation, observing that "it is unlikely that many
            perinatally infected infants in Zimbabwe would survive for 15-19 years".
            (excerpt

Language:   English



                                          28
                   Adolescent Reproductive Health: 2005 -2008



Keywords:   AFRICA, SUB SAHARAN | ZIMBABWE | KENYA | LESOTHO |
            TANZANIA | CRITIQUE | ADOLESCENTS, FEMALE | PERSONS
            LIVING WITH HIV/AIDS | HIV TRANSMISSION | VIRGINITY |
            NEEDLE PIERCING | FEMALE GENITAL CUTTING |
            DEVELOPING COUNTRIES | AFRICA | AFRICA, SOUTHERN |
            AFRICA, EASTERN | ADOLESCENTS | YOUTH | AGE FACTORS |
            POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
            POPULATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES
            | SEX BEHAVIOR | BEHAVIOR | RISK BEHAVIOR | HARMFUL
            TRADITIONAL PRACTICES | TRADITIONAL HEALTH
            PRACTICES | CULTURE | SOCIOCULTURAL FACTORS


Document Number: 312685


Male and female circumcision associated with prevalent HIV
infection virgins and adolescents in Kenya, Lesotho, and Tanzania.
Author:     Brewer DD; Potterat JJ; Roberts JM Jr; Brody S

Source:     Annals of Epidemiology 2007 Mar

Abstract:   Remarkable proportions of self-reported virgins and adolescents in
            eastern and southern Africa are infected with HIV, yet non-sexual routes
            of transmission have not been systematically investigated in such
            persons. Many observers in this region have recognized the potential for
            HIV transmission through unhygienic circumcision procedures. We
            assessed the relation between male and female circumcision (genital
            cutting) and prevalent HIV infection in Kenyan, Lesothoan, and
            Tanzanian virgins and adolescents. We analyzed data from recent cross-
            sectional national probability sample surveys of adolescents and adults in
            households, focusing on populations in which circumcision was common
            and usually occurred in puberty or later. Circumcised male and female
            virgins were substantially more likely to be HIV infected than
            uncircumcised virgins (Kenyan females: 3.2% vs. 1.4%, odds ratio [OR] =
            2.38; Kenyan males: 1.8% vs. 0%, OR undefined; Lesothoan males: 6.1%
            vs. 1.9%, OR 3.36; Tanzanian males: 2.9% vs. 1.0%,OR 2.99; weighted
            mean phi correlation = 0.07, 95% confidence interval, 0.03 to 0.11). Among
            adolescents, regardless of sexual experience, circumcision was just as
            strongly associated with prevalent HIV infection. However,
            uncircumcised adults were more likely to be HIV positive than
            circumcised adults. Self-reported sexual experience was independently
            related to HIV infection in adolescent Kenyan females, but was unrelated
            to HIV infection in adolescent Kenyan, Lesothoan, and Tanzanian males.
            HIV transmission may occur through circumcision


                                        29
                   Adolescent Reproductive Health: 2005 -2008



Language:   English

Keywords:   KENYA | LESOTHO | TANZANIA | RESEARCH REPORT |
            DEMOGRAPHIC AND HEALTH SURVEYS | DATA ANALYSIS |
            MALE CIRCUMCISION | FEMALE GENITAL CUTTING | HIV
            INFECTIONS | PREVALENCE | VIRGINITY | HYGIENE |
            HEPATITIS | AFRICA, EASTERN | AFRICA SOUTH OF THE
            SAHARA | AFRICA | DEVELOPING COUNTRIES | AFRICA,
            SOUTHERN | DEMOGRAPHIC SURVEYS | POPULATION
            DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION |
            RESEARCH METHODOLOGY | MEDICAL PROCEDURES |
            MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH | HARMFUL TRADITIONAL PRACTICES |
            TRADITIONAL HEALTH PRACTICES | CULTURE |
            SOCIOCULTURAL FACTORS | VIRAL DISEASES | DISEASES |
            MEASUREMENT | SEX BEHAVIOR | BEHAVIOR | PUBLIC
            HEALTH


Acknowledging young people's sexuality and rights.
Author:     Reinders J; Darwisyah W; Okwaput A; Wongwareethip; Obbuyi A

Source:     Exchange on HIV / AIDS, Sexuality and Gender. 2007 Winter

Abstract:   Today, over 50% of young people worldwide are sexually active by the
            time they are Liberal attitudes of a new global youth culture, combined
            with not acknowledging young people's sexuality and rights and not
            providing them with information, lead to unprepared experimenting
            with sexuality. Young people in many countries are therefore
            increasingly affected with sexual health problems. Examples of these are
            teenage pregnancy, early motherhood, unsafe abortions, STIs including
            HIV, sexual harassment and abuse. In addition, young people's lower
            sexual health status is fuelled by gender inequality, exclusion for being
            HIV positive and discrimination based on sexual orientation. Sexuality
            education is needed to prevent these problems, but also to guide young
            people in a healthy sexual development and should therefore start at an
            early age, at least before the age of 15. To be effective, a comprehensive
            and rights-based approach supports young people best in making their
            own decisions about their sexual life, whenever this will start. (excerpt)

Language:   English

Keywords:   UGANDA | KENYA | INDONESIA | THAILAND | SUMMARY
            REPORT | TEACHERS | YOUTH PROGRAMS | SEXUALITY |
            HUMAN RIGHTS | SEX EDUCATION | CURRICULUM |



                                        30
                   Adolescent Reproductive Health: 2005 -2008

            COMPUTERS | TRAINING PROGRAMS | DEVELOPING
            COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN |
            AFRICA | ASIA, SOUTHEASTERN | ASIA | EDUCATION |
            PROGRAMS | ORGANIZATION AND ADMINISTRATION |
            PERSONALITY | PSYCHOLOGICAL FACTORS | BEHAVIOR |
            POLITICAL FACTORS | SOCIOCULTURAL FACTORS |
            INFORMATION PROCESSING | INFORMATION


Document Number: 314267


Integrating reproductive health and HIV services for youth.
Author:     Scholl E; Finger W

Source:     YouthLens on Reproductive Health and HIV / AIDS No. 21
            YR: 2007 Research Triangle Park, North Carolina, Family Health
            International [FHI], Interagency Youth Working Group, 2007 Mar.

Abstract:   Young people, especially those who are sexually active, need access to a
            variety of reproductive health (RH) and HIV services, including
            contraception, HIV counseling and testing, testing and treatment for
            other sexually transmitted infections (STIs), pre- and postnatal care, and
            postabortion care. Frequently youth seek services only when there is an
            acute illness or problem - such as a symptomatic STI or pregnancy - and
            do not typically seek preventive services, such as contraception to avoid
            pregnancy. Also, health facilities serving youth sometimes offer one
            primary service or have separate units providing different types of
            services. In either situation, to provide comprehensive care, a provider
            may need to refer clients between contraceptive and HIV/STI services. As
            a result, although many young people are at risk of both pregnancy and
            HIV/STIs, they may receive only one service while related sexual health
            needs are not addressed. An integrated approach can make a variety of
            services available during the same hours, at the same facility, or from the
            same provider. While such integration seems appealing, more analysis
            was needed to address whether this was feasible, what needs were
            unmet, and what kinds of models might work best. (excerpt)

Language:   English

Keywords:   TANZANIA | HAITI | KENYA | SUMMARY REPORT | YOUTH |
            CONTRACEPTION | ADOLESCENT HEALTH SERVICES | UNFPA
            | MOTHER-TO-CHILD TRANSMISSION | TREATMENT |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | CARIBBEAN | AMERICAS | AGE
            FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC



                                        31
                   Adolescent Reproductive Health: 2005 -2008

            FACTORS | POPULATION | FAMILY PLANNING | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH | UN |
            INTERNATIONAL AGENCIES | ORGANIZATIONS | POLITICAL
            FACTORS | SOCIOCULTURAL FACTORS | TRANSMISSION |
            INFECTIONS | DISEASES | MEDICAL PROCEDURES | MEDICINE
            | SCHOOLS | EDUCATION


Document Number: 315529


National Youth Shadow Report: Progress Made on the UNGASS
Declaration of Commitment on HIV / AIDS. Kenya.
Author:     Omondi RO; Arege DM; Ndegwa JN

Source:     New York, New York, Global Youth Action Network, Global Youth
            Coalition on HIV / AIDS, [2006].

Abstract:   Over half of all new infections worldwide each year are among young
            people between the ages of 15 and 24. Every day, more than 6,000 young
            people become infected with HIV - almost five every minute. Yet the
            needs of the world's over one billion young people are often ignored
            when strategies on HIV/AIDS are drafted, policies developed, and
            budgets allocated. This is especially tragic as young people are more
            likely than adults to adopt and maintain safe behaviors. Young people are
            vulnerable to HIV infection because they lack the crucial information,
            education, and services to protect themselves. The 2001 United Nations
            General Assembly Special Session on HIV/AIDS noted, "Poverty, under-
            development and illiteracy are among the principal contributing factors
            to the spread of HIV/AIDS". These factors are particularly poignant for
            young people who are so often voiceless and powerless in society. Young
            people are in a transitional phase between childhood and adulthood, and
            are rarely taken into account in official statistics, policies, and programs.
            This year, 2006, marks five years since the DOC was put into effect. The
            author and 60 young leaders in HIV/AIDS will participate in the Five
            Year AIDS 2006 Review at the United Nations Secretariat to advocate to
            decision-makers to scale-up comprehensive, evidence-based
            interventions on HIV/AIDS for and with young people. (excerpt)

Language:   English

Keywords:   KENYA | SUMMARY REPORT | RESEARCH METHODOLOGY |
            PREVALENCE | YOUTH | HIV INFECTIONS | AIDS | SEX
            EDUCATION | CONDOM USE | COMMUNITY PARTICIPATION |
            INFORMATION SOURCES | RECOMMENDATIONS | AFRICA,
            EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA |


                                         32
                   Adolescent Reproductive Health: 2005 -2008

            DEVELOPING COUNTRIES | MEASUREMENT | AGE FACTORS |
            POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
            POPULATION | VIRAL DISEASES | DISEASES | EDUCATION |
            RISK REDUCTION BEHAVIOR | BEHAVIOR | ORGANIZATION
            AND ADMINISTRATION | INFORMATION


HIV counseling and testing for youth: a manual for providers.
Author:     Fischer S; Reynolds H; Yacobson I; Barnett B; Schueller J

Source:     Arlington, Virginia, Family Health International [FHI], YouthNet
            Program, 2005.

Abstract:   At 1.7 billion strong, today’s generation of youth is the largest in history.
            Among the many challenges young people face is the risk of HIV/AIDS.
            Youth account for an estimated half of the five million new HIV
            infections each year — approximately 6,000 young people become
            infected every day. Although these statistics are sobering, with early
            detection of HIV through counseling and testing, more people can receive
            care and support and adopt healthy behaviors to improve their quality of
            life and avoid infecting others. In addition, HIV counseling and testing
            offers youth who test negative with an opportunity to change behaviors
            that may put them at risk of infection in the future. HIV counseling and
            testing provides an important opportunity for young people to think
            about issues related to sexual behaviors, including the prevention of other
            sexually transmitted infections (STIs) and unintended pregnancy. The
            counseling and testing process can be a powerful tool for helping young
            people deal with peer pressure and begin to adopt and sustain healthy
            behaviors that will benefit them the rest of their lives. (excerpt)

Language:   English

Keywords:   KENYA | MANUAL | EVALUATION | YOUTH | COUNSELORS |
            COUNSELING | HIV TESTING | CONTRACEPTIVE METHODS |
            REFERRAL AND CONSULTATION | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA
            | AGE FACTORS | POPULATION CHARACTERISTICS |
            DEMOGRAPHIC FACTORS | POPULATION | CLINIC ACTIVITIES
            | PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION | LABORATORY EXAMINATIONS AND
            DIAGNOSES | EXAMINATIONS AND DIAGNOSES |
            CONTRACEPTION | FAMILY PLANNING


Document Number: 291242




                                         33
                   Adolescent Reproductive Health: 2005 -2008



Tuko Pamoja. A guide for talking with young people about their
reproductive health.
Author:     Martin S; Madiang’ O; Muthuuri E; Trangsrud R; Kaplan J

Source:     Nairobi, Kenya, Program for Appropriate Technology in Health [PATH],
            2005 Nov.

Abstract:   Adolescence is the time of transition between childhood and adulthood.
            During this time, young people experience many physical, emotional and
            social changes. Physical changes, such as menstruation in girls or
            development of facial hair in boys, can be confusing and worrisome for
            adolescent. During adolescence, young people develop new interests and
            attempt to establish their independence from adults. Peer pressure
            increases and can become particularly difficult for young people to resist.
            Providing young people with support by talking with and listening to
            them as well as ensuring they have access to accurate information can
            help them understand the wide range of changes they are experiencing,
            and make this transition period easier. Unfortunately, many adolescents
            do not have access to the reproductive health information they need to
            make informed choices about their health and their futures. They may be
            embarrassed asking parents or other adults questions about sexual and
            reproductive health. Although parents, teachers, religious and
            community leaders, and health care providers are expected to educate
            adolescents about personal and physical development, relationships and
            their roles in society, it may be difficult for them to do so in a comfortable
            and unbiased way. For this reason, it is important to meet adolescents’
            needs for information and services. This ca help them resist peer
            pressure to become sexually active and protect themselves against
            unintended pregnancies and sexually transmitted infections, including
            HIV, if they decide to have sex. Young people have both the need and
            the right to access this type of information and services. Adolescent
            reproductive health education provides adolescents with information
            about reproductive physiology and puberty; protective behavior,
            including abstinence and contraceptives; and the responsibilities and
            consequences that come with sexual activity. (escerpt)

Language:   English

Keywords:   KENYA|MANUAL|YOUTH
            |ADOLESCENTS|CURRICULUM|GROUP
            PROCESSES|ABSTINENCE|DRUG USE AND
            ABUSE|ABORTION|SAFETY|GENDER ISSUES|SEX
            BEHAVIOR|RISK BEHAVIOR|PUBERTY|INTERPERSONAL
            RELATIONS|SELF ESTEEM|DECISION MAKING|SEXUAL
            EXPLOITATION\VOLUNTARY COUNSELING AND


                                         34
                   Adolescent Reproductive Health: 2005 -2008

            TESTING|SEXUALLY TRANSMITTED DISEASE
            PREVENTION|HIVE PREVENTION |AFRICA, EASTERN | AFRICA,
            SUB SAHARAN |AFRICA |DEVELOPING COUNTRIES |AGE
            FACTORS| POPULATION | EDUCATION | SOCIAL BEHAVIOR|
            BEHAVIOR| FAMILY PLANNING, BEHAVIORAL METHODS|
            FAMILY PLANNING| FERTILITY CONTROL, POST CONCEPTION|
            PUBLIC HEALTH | HEALTH | SOCIAL CULTURAL FACTORS|
            REPRODUCTION| PSYCHOLOGICAL FACTORS| HIV TESTING|
            LABORATORY EXAMINATIONS AND DIAGNOSES|
            EXAMINATIONS AND DIAGNOSES| MEDICAL PROCEDURES|
            MEDICINE |HEALTH SERVICES| DELIVERY INFECTIONS|
            DISEASES| HIV INFECTIONS| VIRAL DISEASES


Document Number: 315810


Reaching Kenyan youth with HIV messages in school.
Author:     Taravella S

Source:     Arlington, Virginia, Family Health International [FHI], Institute for HIV /
            AIDS, 2005.

Abstract:   Nuru is an upbeat 17-year-old Kenyan who is well-liked and has many
            friends. The daughter of a trucker, she lives in a boarding-school, where
            she has come to know other young people from different parts of the
            country, different classes and different tribes. Known for her good
            judgment, Nuru has abstained from sexual activity and is something of a
            role model for her younger friend, Janet. But Nuru's boyfriend Leon, a
            soccer player at the school, recently left Nuru for the more free spirited
            Angel. Angel, who once had sex with a teacher to improve her grades, is
            kept by a sugar-daddy--who happens to be Janet's father. In a recent six-
            month period, Leon had sex with six different people and has since
            become HIV positive. In the teenagers' skittish community, this prompted
            some to question aloud whether Leon should continue playing team
            sports or whether another player could even safely wear Leon's jersey.
            Meanwhile, Nuru's friend Oscar is facing his own HIV dilemma as he
            adjusts to living with his HIV-positive uncle. In many ways, Nuru and
            her circle of friends define the challenges of adolescence for young
            Kenyans. The challenges are very real, but Nuru and her friends are not:
            Nuru (meaning light in Swahili), Janet, Leon, Oscar and Angel are all
            characters in a popular comic book series. The Nuru comic books have
            proven remarkably effective at reaching young people with health
            messages they may not hear in other ways. (excerpt)

Language:   English



                                        35
                   Adolescent Reproductive Health: 2005 -2008



Keywords:   KENYA | PROGRESS REPORT | EVALUATION | PERSONS
            LIVING WITH HIV/AIDS | SCHOOL AGE POPULATION | HIV
            INFECTIONS | SCHOOL-BASED SERVICES | HIV PREVENTION |
            NEWSPAPERS | SEX FACTORS | UNICEF | DEVELOPING
            COUNTRIES | AFRICA, EASTERN | AFRICA SOUTH OF THE
            SAHARA | AFRICA | VIRAL DISEASES | DISEASES |
            POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
            POPULATION | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION | PRINTED MEDIA | MASS MEDIA |
            COMMUNICATION | UN | INTERNATIONAL AGENCIES |
            ORGANIZATIONS


Document Number: 295757


The sexual scripts of Kenyan young people and HIV prevention.
Author:     Maticka-Tyndale E; Gallant M; Brouillard-Coyle C; Holland D; Metcalfe K

Source:     Culture, Health and Sexuality. 2005 Jan

Abstract:   The scripting of sexual encounters among young people in Kenyan is
            described using results of 28 focus group discussions conducted with
            young people attending primary school standard 7, from four different
            ethnic groups and living in 22 different communities. Sexual encounters
            were described as both mundane and inevitable and followed a
            predetermined scripted sequence of events and interactions in which girls
            and boys played complementary roles. These scripts were set within
            discourses of force and the exchange of gifts for sex. The gendered nature
            of the script and its social and cultural foundations are discussed.
            Potential strategies for developing HIV prevention programming are
            discussed from the perspective of existing sexual scripts. (author's

Language:   English

Keywords:   KENYA | RESEARCH REPORT | FOCUS GROUPS | YOUTH |
            PERSONS LIVING WITH HIV/AIDS | HIV PREVENTION | SEX
            BEHAVIOR | FEMALE ROLE | MALE ROLE | GENDER ISSUES |
            CULTURE | AFRICA, EASTERN | AFRICA SOUTH OF THE
            SAHARA | AFRICA | DEVELOPING COUNTRIES | DATA
            COLLECTION | RESEARCH METHODOLOGY | AGE FACTORS |
            POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
            POPULATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES
            | BEHAVIOR | SOCIAL BEHAVIOR | SOCIOCULTURAL FACTORS




                                        36
                   Adolescent Reproductive Health: 2005 -2008

Document Number: 303930


Factors associated with sexual activity among high-school students
in Nairobi Kenya.
Author:     Kabiru CW, Oripnas P

Source:     Department of Health Promotion and Behavior, College of Public Health,
            308 Ramsey Center, University of Georgia, Athens, GA 30602-6522, USA.

Abstract:   The high level of HIV infection in sub-Saharan Africa has led to an
            increased interest in understanding the determinants of sexual activity
            among young people, who are at high risk of sexually transmitted
            infections. The present study examined socio-demographic, behavioral,
            and psychosocial factors associated with heterosexual activity among a
            sample of 3556 male and female high-school students in Nairobi, Kenya.
            Approximately 50% of the males and 11% of females reported having had
            sexual intercourse at least once in their lifetime with a significant
            proportion reporting multiple sexual partnerships. Sexual activity was
            associated with various factors including religiosity, perceived parental
            attitudes towards sex, living arrangements, and school characteristics.
            However, the pattern of association differed for males and females.
            Results suggest that adolescents may benefit from sex education
            programs addressing multiple factors that may predispose adolescents to
            sexual activity, and that take into account gender differences.

Language:   English

Document Number: 20081007


Condom use among sexually active Kenyan female adolescents at
risk for HIV-1 infection.
Author:     Cherutich P, Brentlinger P, Nduati R, Kiare JN, Farquhar C

Source:     National AIDS/STD Control Programme, Ministry of Health-Kenya, P.O.
            Box 19361-00202, Nairobi, Kenya. pcheru@aidskenya.org

Abstract:   High rates of unintended pregnancy and HIV infection occur in sub-
            Saharan Africa yet few Kenyan studies have defined correlates of
            condom use in sexually active female adolescents. Female adolescents
            receiving reproductive health care and aged 15-19 were interviewed. The
            prevalence of ever-use of condom was 21.4% and 52 (7.3%) subjects were
            infected with HIV-1. Older age, higher levels of education, ever-use of



                                        37
                   Adolescent Reproductive Health: 2005 -2008

            hormonal contraceptives and higher numbers of sexual partners, non-
            consensual sex and exchange of sex for favours, were independent
            correlates of condom use. Condom use should be promoted in this
            population. Further exploration is needed on the developmental and
            contextual factors predisposing female adolescents to increased risk of
            HIV.

Language:   English


Quasi-experimental evaluation of a national primary school HIV
intervention in Kenya.
Author:     Maticka-Tyndale E, Wildish J, Gichuru M

Source:     Department of Sociology and Anthropology, University of Windsor, 401
            Sunset Avenue, Windsor, Ont., Canada N9B 3P4. maticka@uwindsor.ca

Abstract:   This study examined the impact of a primary-school HIV education
            initiative on the knowledge, self-efficacy and sexual and condom use
            activities of upper primary-school pupils in Kenya. A quasi-experimental
            mixed qualitative-quantitative pre- and 18-month post-design using 40
            intervention and 40 matched control schools demonstrated significant
            program impact on targeted objectives of (1) adequate program delivery
            and, for standard 6 and 7 pupils (ages 11-16 years), (2) increased HIV-
            related knowledge; (3) increased communication with parents and
            teachers about HIV and sexuality; (4) increased assistance to fellow pupils
            to avoid sexual activity; (5) increased self-efficacy related to abstinence
            and condom use; (6) decreased exposure to HIV through delayed first
            intercourse, decreased sexual activity and increased condom. Results
            support the conclusions that the existing infrastructure is adequate for
            national roll-out of the program; that the program has its most beneficial
            effect on sexually inexperienced youth and should therefore be
            implemented with the youngest age groups possible; and that gains are
            gender specific, with boys reporting increased condom use while girls
            are more likely to decrease or delay sexual activity. Based on these
            results, the program began national roll-out to all primary schools in
            2005. By June 2006, the program was operating in 11,000 of the country's
            nearly 19,000 schools. Avenue, Windsor, Ont., Canada N9B 3P4.
            maticka@uwindsor.ca

Language:   English

Keywords:   ADOLESCENT| AGE FACTORS |CHILD| COMMUNICATION
            |CONDOMS/UTILIZATION |FEMALE |FOCUS GROUPS |HIV
            INFECTIONS/EPIDEMIOLOGY/PREVENTION & CONTROL
            |HEALTH KNOWLEDGE, ATTITUDES, PRACTICE |HUMANS


                                        38
                   Adolescent Reproductive Health: 2005 -2008

            |KENYA/EPIDEMIOLOGY |MALE |MODELS, EDUCATIONAL
            |PROGRAM EVALUATION/METHODS |QUESTIONNAIRES
            SCHOOL HEALTH SERVICES/ORGANIZATION &
            ADMINISTRATION |SELF EFFICACY
            SEX EDUCATION/METHODS |SEX FACTORS |SEXUAL
            BEHAVIOR/PSYCHOLOGY


Identification of novel risks for non-ulcerative sexually transmitted
infections among young men in Kisumu, Kenya.
Author:     Mehta SD, Moses S, Ndinya-Achola JO, Agot K, Maclean I, - Bailey RC

Source:     Department of Epidemiology and Biostatistics, University of Illinois,
            Chicago School of Public Health, IL 60622, USA. supriyad@uic.edu. 2007
            Oct

Abstract:   Objectives:
            STI prevention interventions often aim to reduce HIV
            incidence. Understanding STI risks may lead to more effective HIV
            prevention.

            Goal:
            To identify STI risks among men aged 18-24 in Kisumu, Kenya.

            Study design:
            We analyzed baseline data from a randomized trial of male circumcision.
            Participants were interviewed for sociodemographic and behavioral risks.
            Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were
            diagnosed by polymerase chain reaction assay and Trichomonas vaginalis
            (TV) by culture. The outcome for logistic regression analysis was infection
            with NG, CT, or TV.

            Results:
            Among 2743 men, 214 (7.8%; 95% CI: 6.8%-8.8%) were infected with any
            STI. In multivariable analysis, statistically significant risks for infection
            were: living one's whole life in Kisumu (OR = 1.50; 95% CI: 1.12-2.01),
            preferring "dry" sex (OR = 1.47; 95% CI: 1.05-2.07), HSV-2 seropositivity
            (OR = 1.37; 95% CI: 1.01-1.86), and inability to ejaculate during sex (OR =
            2.04; 95% CI: 1.15-3.62). Risk decreased with increasing age and
            education, and cleaning one's penis less than 1 hour after sex (OR = 0.51;
            95% CI: 0.33-0.80).

            Conclusion:
            Understanding how postcoital cleaning, "dry" sex, and sexual dysfunction
            relate to STI acquisition may improve STI and HIV prevention.




                                          39
                   Adolescent Reproductive Health: 2005 -2008

Language:   English

Keywords:   ADOLESCENT |ADULT |COHORT STUDIES |CROSS-SECTIONAL
            STUDIES |HUMANS |KENYA/EPIDEMIOLOGY |MALE |MALE
            UROGENITAL |DISEASES |EPIDEMIOLOGY |ETIOLOGY
            |PREVENTION & CONTROL |URINE |RANDOMIZED
            CONTROLLED TRIALS AS TOPIC |RISK FACTORS |SEXUAL
            BEHAVIOR |SEXUALLY TRANSMITTED DISEASES|
            EPIDEMIOLOGY |ETIOLOGY |PREVENTION & CONTROL/URINE


Document Number: 20080117


Determinants of teenage pregnancies: the case of Busia District in
Kenya.
Author:     Were M,

Source:     Kenya Institute for Public Policy Research and Analysis, P.O. Box 56445,
            00200 Nairobi, Kenya. mwere@kippra.or.ke 2007 May

Abstract:   Sub-Saharan Africa has one of the highest levels of teenage pregnancies in
            the world. In spite of that, there is paucity of empirical research on causes
            of teenage pregnancies in African countries. This paper investigates the
            determinants of teenage pregnancies based on a case study of Busia
            District in Kenya. The data are from a household survey conducted in
            1998/1999. Empirical results indicate that girls' education level has
            significant influence on the probability of teenage birth, with non-
            schooling adolescents and those with primary school level education
            being more vulnerable. Among the variables used as proxies for access to
            sex education, availability of church forums that educate adolescents
            about sex and family life issues reduce probability of teenage pregnancy.
            Age is positively related to teenage pregnancies, with older adolescents
            being more predisposed to pregnancies. Though use of contraceptives is
            found to have a positive effect, only a small proportion of adolescents
            were using modern contraceptives and, supply side factors such as
            quality and availability were not accounted for. Other key factors as
            outlined by the adolescents themselves include peer pressure and social
            environment-related factors like inappropriate forms of recreation, which
            act as rendezvous for pre-marital sex, as well as lack of parental guidance
            and counselling. Overall, lack of access to education opportunities, sex
            education and information regarding contraceptives, as well the
            widespread poverty predispose girls to teenage pregnancies. The
            problem of teenage pregnancies should be viewed within the broader
            socio-economic and socio-cultural environment in which the adolescents
            operate. For instance, lack of parental guidance on issues of sexuality and


                                         40
                  Adolescent Reproductive Health: 2005 -2008

            sex education was reinforced by cultural taboos that inhibit such
            discussions. Adolescents should be equipped with the relevant
            knowledge to enable them make informed choices regarding sexual
            relationships. This should be complemented with broader programmes
            aimed at promoting girl education and poverty alleviation.

Language:   English

Keywords:   ADOLESCENT|ADOLESCENT BEHAVIOR|
            PSYCHOLOGY|ADOLESCENT DEVELOPMENT/PHYSIOLOGY|
            ADULT| AGE FACTORS| CONTRACEPTION
            BEHAVIOR/*STATISTICS & NUMERICAL DATA |EDUCATIONAL
            STATUS |FEMALE |HEALTH KNOWLEDGE, ATTITUDES,
            PRACTICE |HUMANS |INTERVIEWS AS TOPIC |KENYA
            |MARITAL STATUS/STATISTICS & NUMERICAL DATA |PEER
            GROUP |PREGNANCY |PREGNANCY IN
            ADOLESCENCE/PSYCHOLOGY/*STATISTICS & NUMERICAL
            DATA |PROBABILITY |QUESTIONNAIRES |RISK FACTORS |SEX
            EDUCATION |SEXUAL BEHAVIOR/PSYCHOLOGY/STATISTICS &
            NUMERICAL DATA |SOCIAL ENVIRONMENT
            |SOCIOECONOMIC FACTORS


Document Number: 20070604


Adult male circumcision outcomes: experience in a developing
country setting.
Author:     Krieger JN, Bailey RC, - Opeya JC, Ayieko BO, Opiyo FA, Opiyo FA, Agot
            K, Parker C, Ndinya-Achola JO, Moses S

Source:     Department of Urology, University of Washington, Seattle, WA 98195,
            USA. jkrieger@u.washington.edu 2007 Aug

Abstract:   Introduction:
            We examined male circumcision outcomes among young adults in and
            African setting.

            Materials and methods:
            Participants were healthy, sexually active, uncircumcised, HIV-
            seronegative males aged 18-24 years. The main outcomes measured
            included complications, healing, satisfaction and resumption of
            activities.

            Results:




                                       41
                   Adolescent Reproductive Health: 2005 -2008

            Of 1,475 procedures, 26 (1.8%) were associated with 27 adverse events,
            most commonly wound disruption/delayed healing (0.6%), wound
            infection (0.4%), and bleeding (0.3%). Adverse events per clinician
            averaged 3.8 and 2.1% for procedures 1-100 and 101-200, respectively,
            and <1% for procedures 201-300, 301-400 and >400, respectively (p <
            0.001). Participants resumed normal general activities after a median of 1
            postoperative day and 93% with regular employment resumed working
            within 1 week. After 30 days, 99% of participants reported being very
            satisfied. After 90 days, 65% reported having had sex, 45% reported that
            their partners had expressed an opinion, 92% of whom were very
            satisfied with the outcome.

            Conclusions: Safe and acceptable adult male circumcision services can be
            delivered in developing country settings.

Language:   English

Keywords:   ADOLESCENT| ADULT |AGE FACTORS | CIRCUMCISION,
            MALE|ADVERSE EFFECTS| DEVELOPING COUNTRIES |HIV
            INFECTIONS|PREVENTION & CONTROL |HUMANS |KENYA
            |MALE


Document Number: 20071004


Reaching youth through franchise clinics: assessment of Kenyan
private sector involvement in youth services.
Author:     Decker M, Montagu D,

Source:     Harder & Company Community Research, San Francisco, California,
            USA. 2007 Feb 24

Abstract:   This paper evaluates the ability of social franchise programs, which use
            private providers to offer reproductive health services, to provide
            services to youth in western Kenya. Although franchise clinics have
            rarely targeted youth, they appear to offer a viable alternative for
            providing reproductive health services to this age group.

Language:   English

Keywords:   ADOLESCENT |ADOLESCENT BEHAVIOR |ADOLESCENT
            HEALTH SERVICES |ORGANIZATION & ADMINISTRATION
            |UTILIZATION |ADULT |CONTRACEPTION
            BEHAVIOR/STATISTICS & NUMERICAL DATA |FEMALE
            |HEALTH KNOWLEDGE, ATTITUDES, PRACTICE| HUMANS|


                                        42
                   Adolescent Reproductive Health: 2005 -2008

            KENYA |NEEDS ASSESSMENT |PRIVATE SECTOR |PROGRAM
            EVALUATION |REPRODUCTIVE HEALTH SERVICES
            |ORGANIZATION & ADMINISTRATION |UTILIZATION


Document Number: 20070301


Poor pregnancy outcomes among adolescents in South Nyanza
region of Kenya.
Author:     Magadi M

Source:     Centre for Research in Social Policy, Department of Social Sciences,
            Loughborough University, Leicestershire, UK. m.a.magadi@lboro.ac.uk
            2007 July

Abstract:   In this paper, we examine factors associated with poor pregnancy
            outcomes among teenagers in South Nyanza region of Kenya. The
            analysis is based on a recent WHO funded study on Adolescent safe
            motherhood in the region, which involved a survey of 1247 adolescents
            aged 12-19 and in-depth interviews with 39 of the adolescents who had
            experienced very early pregnancies or a pregnancy wastage. The
            indicators of poor pregnancy outcomes analysed include pregnancy
            wastage and pre-term delivery. A striking finding is the unusually high
            rate of pre-term deliveries, especially in cases of unintended pregnancies.
            Analysis of the qualitative data based on in-depth interviews sheds
            some light on possible explanations for the poor pregnancy outcomes
            observed among these adolescents. In particular, unsafe abortion
            attempts and poor maternal health-care emerge as important issues of
            concern.

Language:   English

Keywords:   |ABORTION, INDUCED |ABORTION,
            SPONTANEOUS/EPIDEMIOLOGY |ADOLESCENT |ADULT |AGE
            FACTORS |CHILD |FEMALE |HUMANS
            |KENYA/EPIDEMIOLOGY |PREGNANCY|PREGNANCY
            OUTCOME |EPIDEMIOLOGY |PREGNANCY IN ADOLESCENCE
            |STATISTICS & NUMERICAL DATA |PREGNANCY, UNPLANNED
            |PREMATURE BIRTH/EPIDEMIOLOGY/ETIOLOGY |PRENATAL
            CARE/UTILIZATION |SOCIOECONOMIC FACTORS


Document Number: 20071012




                                         43
                   Adolescent Reproductive Health: 2005 -2008


What is youth-friendly? Adolescents' preferences for reproductive
health services in Kenya and Zimbabwe.
Author:     Erulkar AS, Onoka CJ, Phiri A

Source:     African Journal of Reproductive Health. 2005 Dec

Abstract:   While there has been increased attention to youth-friendly reproductive
            health services, little research has been conducted among adolescents in
            developing countries to assess what characteristics of reproductive health
            services are most important to them. Large scale population-based
            surveys were carried out among youth in Kenya and Zimbabwe. A list of
            characteristics that programmers often think of as youth-friendly was
            read to respondents, after which they were asked to assess the
            importance of those characteristics in choosing their reproductive health
            services. Adolescents rated confidentiality, short waiting time, low cost
            and friendly staff as the most important characteristics. The least
            important characteristics included youth-only service, youth involvement
            and young staff, suggesting that adolescents do not prioritize stand-alone
            youth services such as youth centres, or necessarily need arrangements
            particular to youth such as youth involvement. The findings imply that
            most existing clinical services, even in the most resource-poor settings,
            are in a position to improve their level of youth friendliness.

Language:   English

Keywords:   ADOLESCENT| ADOLESCENT BEHAVIOR| ADULT| CHILD|
            FEMALE KENYA| MALE| REPRODUCTIVE HEALTH SERVICES
            |ORGANIZATION & ADMINISTRATION| ZIMBABWE


Document Number: 20060522


Adult Male Circumcision: Effects on Sexual Function and Sexual
Satisfaction in Kisumu, Kenya.
Author:     Krieger, J. N.; Mehta, S. D.; Bailey, R. C.; Agot, K.; Ndinya-Achola, J. O.;
            Parker, C., and Moses

Source:     J Sex Med. 2008 Aug 28

Abstract:   Introduction:
             Male circumcision is being promoted for HIV prevention in high-risk
            heterosexual populations. However, there is a concern that circumcision
            may impair sexual function.



                                          44
                  Adolescent Reproductive Health: 2005 -2008



           Aim:
           To assess adult male circumcision's effect on men's sexual function and
           pleasure.

           Methods:
           Participants in a controlled trial of circumcision to reduce HIV incidence
           in Kisumu, Kenya were uncircumcised, HIV negative, sexually active
           men, aged 18-24 years, with a hemoglobin >/=9.0 mmol/L. Exclusion
           criteria included foreskin covering less than half the glans, a condition
           that might unduly increase surgical risks, or a medical indication for
           circumcision. Participants were randomized 1:1 to either immediate
           circumcision or delayed circumcision after 2 years (control group).
           Detailed evaluations occurred at 1, 3, 6, 12, 18, and 24 months. Main
           Outcome Measures. (i) Sexual function between circumcised and
           uncircumcised men; and (ii) sexual satisfaction and pleasure over time
           following circumcision.

           Results:
           Between February 2002 and September 2005, 2,784 participants were
           randomized; including the 100 excluded from this analysis because they
           crossed over, were not circumcised within 30 days of randomization, did
           not complete baseline interviews, or were outside the age range. For the
           circumcision and control groups, respectively, rates of any reported
           sexual dysfunction decreased from 23.6% and 25.9% at baseline to 6.2%
           and 5.8% at month 24. Changes over time were not associated with
           circumcision status. Compared to before they were circumcised, 64.0% of
           circumcised men reported their penis was "much more sensitive," and
           54.5% rated their ease of reaching orgasm as "much more" at month 24.

           Conclusions:
           Adult male circumcision was not associated with sexual dysfunction.
           Circumcised men reported increased penile sensitivity and enhanced ease
           of reaching orgasm. These data indicate that integration of male
           circumcision into programs to reduce HIV risk is unlikely to adversely
           effect male sexual function.


The effect of weekly iron and vitamin A supplementation on
hemoglobin levels and iron status in adolescent schoolgirls in
western Kenya
Author:    Leenstra, T.; Kariuki, S. K.; Kurtis, J. D.; Oloo, A. J.; Kager, P. A., and Ter
           Kuile, F. O.

Source:    Eur J Clin Nutr. 2007 Oct 10.



                                           45
                   Adolescent Reproductive Health: 2005 -2008



Abstract:   Background/Objectives:
            Iron deficiency anemia is a major public health problem in developing
            countries and may affect school performance and physical work capacity
            in nonpregnant adolescents, and may increase the risk of anemia during
            subsequent teenage pregnancies. We assessed the effect of weekly iron
            (120 mg elemental iron) and vitamin A (25 000 IU) supplementation on
            hemoglobin, iron status and malaria and nonmalaria morbidity in
            adolescent schoolgirls.

            Subjects/Methods:
            A total of 279 schoolgirls aged 12-18 years from public primary schools in
            Kisumu, western Kenya. Double-blind randomized placebo-controlled
            trial using a factorial design.

            Results:
            Five months of iron supplementation was associated with a 0.52 g dl(-1)
            (0.21, 0.82) greater increase in hemoglobin relative to iron placebo. The
            effect was only observed in girls with iron deficiency on enrollment (1.34
            g dl(-1) (0.79, 1.88)), but not in iron-replete girls (-0.20 g dl(-1) (-0.59,
            0.18)). Similar differences in treatment effect were seen between
            menstruating and non-menstruating girls. The effect of iron was
            independent of vitamin A. The baseline prevalence of vitamin A
            deficiency was low (6.7%) and no sustained increase in hemoglobin was
            seen with weekly vitamin A (-0.07 g dl(-1) (-0.38, 0.25)). Incidence of
            malaria parasitemia was higher in the iron than iron-placebo groups
            (Rate ratio 1.33 (0.94, 1.88)).

            Conclusions:
            Weekly iron supplementation results in substantial increases in
            hemoglobin concentration in adolescent schoolgirls in western Kenya,
            which may outweigh possible risks caused by malaria, but only in iron-
            deficient or menstruating girls and not in iron-replete and non-
            menstruating girls.


The sexual scripts of Kenyan young people and HIV prevention.
Author:     Maticka-Tyndale, E.; Gallant, M.; Brouillard-Coyle, C.; Holland, D.;
            Metcalfe, K.; Wildish, J., and Gichuru, M
Source:     Cult Health Sex. 2005 Jan; 7(1):27-41.

Abstract:   The scripting of sexual encounters among young people in Kenyan is
            described using results of 28 focus group discussions conducted with
            young people attending primary school standard 7, from four different
            ethnic groups and living in 22 different communities. Sexual encounters
            were described as both mundane and inevitable and followed a


                                          46
                   Adolescent Reproductive Health: 2005 -2008

            predetermined scripted sequence of events and interactions in which girls
            and boys played complementary roles. These scripts were set within
            discourses of force and the exchange of gifts for sex. The gendered nature
            of the script and its social and cultural foundations are discussed.
            Potential strategies for developing HIV prevention programming are
            discussed from the perspective of existing sexual scripts.


A nested case-control study of sexual practices and risk factors for
prevalent HIV-1 infection among young men in Kisumu, Kenya.
Author:     Mattson, C. L.; Bailey, R. C.; Agot, K.; Ndinya-Achola, J. O., and Moses

Source:     Sex Transm Dis. 2007 Oct; 34(10):731-6.

Abstract:   Objectives:
            To investigate sexual practices and risk factors for prevalent HIV
            infection among young men in Kisumu, Kenya.

            Goal:
            The goal of this study was to identify behaviors associated with HIV in
            Kisumu to maximize the effectiveness of future prevention programs.

            Study design:
            Lifetime sexual histories were collected from a nested sample of 1337
            uncircof male circumcision to reduce HIV incidence.

            Results:
            Sixty-five mumcised participants within the context of a randomized
            controlled trial en (5%) tested positive for HIV. Multiple logistic
            regression revealed the following independent predictors of HIV: older
            age, less education, being married, being Catholic, >4 lifetime sex
            partners, prior treatment for an STI, sex during partner's menstruation,
            ever practicing bloodletting, and receipt of a medical injection in the last 6
            months. Prior HIV testing and postcoital cleansing were protective.

            Conclusions:
            This analysis confirms the importance of established risk factors for HIV
            and identifies practices that warrant further investigation.




                                         47
                   Adolescent Reproductive Health: 2005 -2008


Exploring sexuality: a journey towards embracing sexual rights.
Source:     Center for Rights Education and Awareness (CREAW) and the School of
            Law, University of Nairobi

Abstract:   This study was carried out between March and May 2006 as a joint
            project of the Center for Rights Education and Awareness (CREAW) and
            the School of Law, University of Nairobi and sought to address the
            following questions: What are the levels and sources of awareness on
            sexuality and sexuality-related rights among students at the School of
            Law in particular and the University of Nairobi in general? What is the
            nature and extent of sexuality-related rights' violations among students
            and staff at the School of Law? To what extent do both the law curricula
            and the university's administrative policies and practices address
            sexuality issues and sexuality-related rights? What are the prevailing
            perceptions, attitudes and practices among both students and staff at the
            School of Law in regard to sexuality and sexuality-related rights? What
            ought to be done to empower students at the School of Law in particular
            and University of Nairobi in general, to claim and protect their sexuality-
            related rights? (excerpt)


HIV / AIDS TRaC study evaluating abstinence among urban youth
(10-14 years). Second round.
Source:     Kenya (2005)

Abstract:   Nimechill (meaning "I have chilled" or "I am abstaining") is an abstinence
            promotion mass media campaign. This study identifies perceptions that
            influence abstinence in urban 10-14 year olds, evaluates Nimechill's
            effectiveness in changing those perceptions and abstinence levels over a
            seven month period (September 2004 to April 2005), and provides
            guidance for future abstinence promotion campaigns. Nimechill's aim
            was to change three perceptions correlated with abstinence: social norms,
            self-efficacy and behavioral intentions to remain abstinent. Nimechill's
            persuasion strategy was based on positive affect (messages were
            optimistic and encouraging, rather than risk based) and positive deviance
            (messages featured older youth, aged 14-16, defying early teenage sex
            norms). The USD $550,000 campaign (Kshs 41.5 million) was delivered
            through television, radio, print, billboards, poster, T-shirts, and event
            sponsorships. (excerpt)




                                         48
                   Adolescent Reproductive Health: 2005 -2008


Youth in Kenya: health and HIV.
Source:     2003 Kenya Demographic and Health Survey (2003 KDHS).

Abstract:   Young people today face many health-related challenges. This report is
            designed to help program managers, parents, church groups and other
            people and organizations working with youth to understand some of
            these challenges. Drawing from the most recent Kenya Demographic and
            Health Survey, this report outlines the latest information about Kenya's
            young people, age 15 to 24. The Demographic and Health Survey
            collected data from more than 11,500 women and men nationwide
            including more than 4,000 young women and men age 15-24. (excerpt)


Expanding safe spaces and developing skills for adolescent girls.
Author:     Austrian, K.

Abstract:   Almost 1 billion people around the globe live in urban informal
            settlements, or "slums," and the number of such residents is increasing. In
            Kenya, 60 percent of Nairobi's nearly 3 million inhabitants live in slum
            areas characterized by high levels of poverty and HIV. Kibera, the largest
            of these slums, is about 2.5 square kilometers and home to almost 800,000
            people, commonly migrants from rural areas. The term "informal
            settlements" underscores their non-permanence and implicitly justifies
            the lack of infrastructure and services provided by the government,
            including water, electricity, health services, sanitation, and public schools.
            Most residents rely on an informal system of services provided by NGOs,
            faith-based groups, and local entrepreneurs, and live in one-room houses
            made of semi-permanent materials such as mud, wooden planks, or metal
            sheets. The majority of slum residents live in extreme poverty, with
            residents sustaining themselves in whatever manner they can, often
            through informal-sector activities such as petty trade or casual labor.
            (excerpt)

            Dialogue between adults and young people on issues related to
            adolescent reproductive health. It for teachers; community, religious, and
            youth group leaders; health care professionals; and anyone working with
            young people. The curriculum is designed to delay sexual debut and
            promote sexual and reproductive health by addressing gender,
            reproductive health, preventive behaviours, sexually transmitted
            infections, HIV and AIDS, abstinence, gender violence, and decision-
            making, communication, and other important life skills. (excerpt)




                                         49
                   Adolescent Reproductive Health: 2005 -2008


Trends in primary and secondary abstinence among Kenyan youth.
Author:     Chiao C and Mishra, V.

Abstract:   Promoting sexual abstinence among never-married youth is an important
            component of HIV/AIDS prevention campaigns for youth in countries
            with generalized epidemics. The objective was to examine trends in
            primary and secondary abstinence among never-married youth age 15-24
            in Kenya over a ten-year period and to explore the role of HIV prevention
            knowledge, schooling, and contextual factors in affecting abstinence
            behavior. Data were from Kenya Demographic and Health Surveys
            conducted in 1993, 1998, and 2003. Primary abstinence was defined as
            never-married youth who never had sex. Secondary abstinence was
            defined as never-married youth who ever had sex but not in the past
            year. Logistic regression models were used to estimate the effects of
            prevention knowledge, schooling, and contextual factors in affecting
            abstinence behavior, after accounting for sampling weights and clustering
            in the survey design. Both primary and secondary abstinence levels have
            risen in the past 10 years in Kenya. The abstinence levels were higher
            among female youth than among male youth. Multivariate analyses show
            that knowledge that abstinence can prevent HIV infection was positively
            associated with the likelihood of practicing abstinence (both primary and
            secondary). However, knowledge that condom use can prevent HIV
            infection was associated with lower abstinence practice. In-school youth
            were 4-5 times more likely to abstain from sex than those working
            (aOR=4.12; p=0.000 for female youth and aOR=4.83; p=0.000 for male
            youth). Not-in-school female youth were about as likely to abstain as
            working female youth, but not-in-school male youth were about 2 times
            more likely to abstain than working male youth. Muslim youth were
            much more likely to abstain than other youth. Female youth with weekly
            exposure to television and those with a secondary or higher education
            were significantly more likely to have abstained, whereas male youth
            were significantly less likely. Effects of these factors on secondary
            abstinence practice were generally weaker, but sexually experienced in-
            school male youth were significantly more likely to have abstained in the
            past year than sexually experienced working male youth. Effects of the
            contextual variables on the likelihood of abstinence were generally small
            and insignificant, except for primary abstinence among female youth.
            Increasing knowledge that abstinence can prevent HIV infection and
            keeping youth in schools can help promote abstinence behavior.
            Abstinence programs need to be gender sensitive and culturally
            appropriate. (author's)




                                        50
                   Adolescent Reproductive Health: 2005 -2008


Relative risks and the market for sex: teenagers, sugar daddies and
HIV in Kenya.
Author:     Dupas, P.

Abstract:   An information campaign that provided Kenyan teenagers in randomly
            selected schools with the information that HIV prevalence was much
            higher among adult men and their partners than among teenage boys led
            to a 65% decrease in the incidence of pregnancies by adult partners
            among teenage girls in the treatment group relative to the comparison.
            This suggests a large reduction in the incidence of unprotected cross-
            generational sex. The information campaign did not increase pregnancies
            among teenage couples. These results suggest that the behavioral choices
            of teenagers are responsive to information on the relative risks of
            different varieties of a risky activity. Policies that focus only on the
            elimination of a risky activity and do not address risk reduction strategies
            may be ignoring a margin on which they can have substantial impact.
            (author's)


Football teams offer competition and education on HIV / AIDS.
Struggling youth find new beginning.
Author:     Finger, W..

Abstract:   Neema Sanga, 19, grabs her baby, a two-month old boy named Rahel, as
            her football teammates from the Upendo Vocational Educational School
            take a break at halftime. Neema holds the little boy as she discusses her
            transformation, a result of joining the football team. (Some countries refer
            to football as "soccer.") "Before joining the team, I was having lots of
            sexual partners and spent my time having sex and using bhangi
            (marijuana)," she says. "Now, I like playing football more than my
            previous life." Across town, two primary school boys' teams are also
            playing a game. At their halftime, a 15-year-old named Tony echoes the
            story of Neema. "I am trying to separate myself from the bad groups,
            where I was using a lot of bhangi and alcohol," he says. "The training
            with the team is helping a lot, as well as the gathering with the other
            boys, which gives me support. It is helping me free myself from the bad
            guys." (excerpt)




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                   Adolescent Reproductive Health: 2005 -2008


Sexual initiation and contraceptive use among female adolescents
in Kenya.
Author:     Ikamari, L. D. and . Towett R

Source:     African Journal of Health Sciences. 2007; 14(1-2):1-13.

Abstract:   This paper examines the timing of sexual initiation and contraceptive use
            among female adolescents in Kenya. Data are drawn from the 2003 Kenya
            Demographic and Health Survey. The main analytical tools are regression
            models. A Cox regression model is used to consider the probability of a
            young woman having first sex during adolescence and linear regression
            model to quantify the effects of a set of factors on female adolescent's age
            at first sexual debut. Finally, logistic regression model is used to model
            the probability of a sexually experienced adolescent woman using a
            contraceptive method. The results obtained indicate the onset of sexual
            activity is early and contraceptive use is fairly low and both the timing of
            first sex and contraceptive use are affected by a variety of factors. Despite
            engaging in unsafe sex practices, the majority of the adolescents do not
            view themselves as being at the risk of contracting HIV/AIDS. A number
            of recommendations are proposed. (author's)


Factors inhibiting educated mothers in Kenya from giving
meaningful sex-education to their daughters.
Author:     Mbugua, N.

Source:     Soc Sci Med. 2007 Mar; 64(5):1079-89.

Abstract:   Public health studies advocate the education of women, especially
            mothers, stating that educated mothers are highly likely to pass on their
            education to their children, as well as enforce in their homes healthy
            practices thereby protecting entire families from disease. Whereas this is
            usually true in regard to most infectious diseases such as influenza, it is
            not usually the case when it comes to sexually transmitted infections
            (STIs) such as HIV/AIDS. The research is based on a survey focus group
            discussion with high-school students (aged 17-19) and interviews with 10
            high-school teachers in 1996. In 2003, data were collected from a focus
            group with fourth-form students and interviews with 4 teachers and 15
            mothers whose daughters were in high school. The findings indicate that
            most educated mothers in urban Kenya experience socio-cultural and
            religious inhibitions which hinder them from providing meaningful sex-
            education to their pre-adolescent and adolescent daughters. This paper
            discusses these inhibitions and the steps educated mothers take to ensure
            that their daughters receive some form of sex-education.



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                   Adolescent Reproductive Health: 2005 -2008


Gender-role Attitudes and Reproductive health communication
among female Adolescents in South Nyanza, Kenya.
Author:     Obare F; Agwanda A, and Magadi, M.

Source:     African Population Studies/Etude De La Population Africaine. 2006;
            21(1):37-54.
Abstract:   In this paper, we use data from three districts of Nyanza Province in
            Kenya to examine gender-role attitudes and reproductive health
            communication among adolescent females aged 12-19 years. We test for
            differences in gender-role attitudes between younger (12-15) and older
            (16-19) adolescents. We explore the possible association between
            educational attainment and gender-role attitudes by estimating a
            random-effects model. We also examine the association between gender-
            role attitudes and reproductive health communication via an unordered
            multinomial logit model. The results show that adolescent females in this
            setting hold conservative views on decision making within the home and
            at the same time portray less conservative views concerning marriage and
            reproductive behaviour. We also find some differences by age regarding
            gender-role attitudes and reproductive health communication. Our
            findings further indicate that educational attainment is significantly
            associated with gender-role attitudes, which in turn are significantly
            associated with reproductive health communication. (author's)


Reaching Kenyan youth with HIV messages in school.
Abstract:   Nuru is an upbeat 17-year-old Kenyan who is well-liked and has many
            friends. The daughter of a trucker, she lives in a boarding-school, where
            she has come to know other young people from different parts of the
            country, different classes and different tribes. Known for her good
            judgment, Nuru has abstained from sexual activity and is something of a
            role model for her younger friend, Janet. But Nuru's boyfriend Leon, a
            soccer player at the school, recently left Nuru for the more free spirited
            Angel. Angel, who once had sex with a teacher to improve her grades, is
            kept by a sugar-daddy--who happens to be Janet's father. In a recent six-
            month period, Leon had sex with six different people and has since
            become HIV positive. In the teenagers' skittish community, this prompted
            some to question aloud whether Leon should continue playing team
            sports or whether another player could even safely wear Leon's jersey.
            Meanwhile, Nuru's friend Oscar is facing his own HIV dilemma as he
            adjusts to living with his HIV-positive uncle. In many ways, Nuru and
            her circle of friends define the challenges of adolescence for young
            Kenyans. The challenges are very real, but Nuru and her friends are not:
            Nuru (meaning light in Swahili), Janet, Leon, Oscar and Angel are all
            characters in a popular comic book series. The Nuru comic books have



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                   Adolescent Reproductive Health: 2005 -2008

            proven remarkably effective at reaching young people with health
            messages they may not hear in other ways. (excerpt)


Determinants of Consistent Condom Use Vary by Partner Type
among Young Men in Kisumu, Kenya:
Author:     Westercamp, N.; Mattson, C. L.; Madonia, M.; Moses, S.; Agot, K.;
            Ndinya-Achola, J. O.; Otieno, E.; Ouma, N., and Bailey, R. C.

Source:     A Multi-level Data Analysis. AIDS Behav. 2008 Sep 13.

Abstract:   To evaluate whether determinants of consistent condom use vary by
            partner type among young sexually active Kenyan men, we conducted a
            cross-sectional assessment of lifetime sexual histories from a sub-sample
            of men enrolled in a clinical trial of male circumcision. 7913 partnerships
            of 1370 men were analyzed. 262 men (19%) reported never, 1018 (74%)
            sometimes and 92 (7%) always using a condom with their partners.
            Condoms were always used in 2672 (34%) of the total relationships-212
            (70%) of the relationships with sex workers, 1643 (40%) of the casual and
            817 (23%) of the regular/marital relationships. Factors influencing
            condom use varied significantly by partner type, suggesting that HIV
            prevention messages promoting condom use with higher-risk partners
            have achieved a moderate level of acceptance. However, in populations
            of young, single men in generalized epidemic settings, interventions
            should promote consistent condom use in all sexual encounters,
            independently of partner type and characteristics.


Youth, Church and Sexuality in Kenya.
Author:     Kangara L.,

Source:     Egerton University Kenya & Institute of Tropical Medicine and Infectious
            Diseases, Jomo Kenyatta University of Science and Technology, Kenya

Abstract:   The church holds an important place in the socioeconomic and political
            life of Kenya. Out of a total population of 30 million, over 50% are
            Christians and despite the social changes that have occurred in the lives
            of Kenyans, religious institutions continue to celebrate an era of chastity
            and sexual conservatism. In an era of sexual freedom, religious
            institutions still hamper dispensation of sex education that can guide and
            assist its members towards surviving in the global sex culture. In a world
            that is characterized by technological advanced and increased
            connectivity, people are confronted with sexuality issues on a daily basis -
            through television, radio, music, newspapers, magazines, adverts,
            dressing, etc, making it impossible to escape the invasion. Without


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                   Adolescent Reproductive Health: 2005 -2008

            adequate information about sex, people face a risk of being swallowed up
            by a culture that does not rhyme with the doctrine they receive in
            religious institutions. While churches need to preserve the sanctity of
            marriage (as seen in their discouragement of condoms and insistence of
            abstinence), such an objective can only be attained if people possess
            adequate knowledge of their sexuality and how to express it in a
            changing society. Hence the purpose of this study was to examine what
            Christian churches are doing to create a conducive environment for
            young people to discuss sexuality issues openly without fear or guilt.
            Kenya is a country where 80 percent of the population is Christian and
            sexuality issues have not been given spaces for discussion within
            churches on "moral" ground. Religious leaders have a role to play in
            addressing social and development issues within communities. All over
            Africa churches through their church leaders have the capacity to
            influence a community's response on various issues

            This study aims to qualitatively seek young Christian's views and how
            their different churches are dealing with sexuality issues. The Method
            used was in-depth literature review on various Kenyan newspapers on
            sections that have reported on issues of sexuality, then focus group
            discussion that involved young people, church leaders/ elders. The
            discussion was recorded and thereafter transcribed and analyzed. The
            Findings indicated that the churches have made progress on certain areas
            especially in urban areas but a lot still needs to be done in rural areas.
            Churches in rural areas still do not openly discuss or debate sexuality
            issues.


Partnering with Religious Leaders to Advance ASRH1 Rights:
Lessons Learnt from the Network of Adolescents and Youth of
Africa.

Author:     Ravon L.,

Source:     PPFA-International, Africa Regional Office, Kenya

Abstract:   Background and objectives:
            The Network of Adolescents and Youth of Africa (NAY A) was launched
            in 2002 to contribute towards the creation of an enabling policy
            environment that fosters ASRH and rights in selected African countries.
            The network has chapters in Benin, Cameroon, Kenya, Nigeria, Sudan and
            Uganda, and is composed of approximately 100 member organizations.
            One of the key strategies of the program has been to enlist the support of
            religious leaders in advocating for the enactment and implementation of
            national policies to improve ASRH rights.



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       Adolescent Reproductive Health: 2005 -2008


A study of the NAYA program was carried out in 2005 to evaluate the
initial program design and to determine whether partnerships with
religious leaders had proven to be a strategic means of advocating fm
ASRH rights. The purpose of this presentation is to highlight both the pros
and cons of working with religious leaders as a means of improving
ASRH rights.

Findings and lessons learnt:
With regard to the program's work with religious leaders, the study found
that NAYA chapters generally focused on a very limited scope of ASRH
topics, shied away from controversial issues relating to youth sexuality,
and failed to clearly convey NAYA's commitment to the sexual rights of
youth and adolescents. It has been a challenge for NAYA members to be
assertive about their commitment to ASRH rights when working with
religious leaders. As a result, many of the religious leaders that have
partnered with NAYA appear to be unaware of the program's key vision
and mission, and few share its commitment to advancing ASRH rights.
Although NAYA has partnered with close to 150 religious leaders, very
few have actively participated in advocacy activities aimed at advancing
ASRH rights. This is due to the failure of NAYA chapters to clearly
articulate the type of support they require from religious leaders, and
because the program's work with religious leaders has been insufficiently
geared towards well-defined ASRH advocacy objectives.

Conclusions and recommendations:
In order for partnerships with religious leaders to be an effective ASRH
advocacy strategy:
     ASRH advocates must be assertive about their commitment to
       ASRH rights, and must clearly spell out their ASRH policy
       objectives to the religious leaders with whom they partner.
     ASRH advocacy program must clearly articulate the type of
       support they are requesting of religious leaders.
     Program activities with religious leaders should be geared towards
       very tangible ASRH advocacy outputs, not merely awareness-
       raising.
     Programs should encourage religious leaders to advocate for
       ASRH and rights in a wide range of social and political forums,
       rather than merely encourage them to discuss ASRH topics during
       their weekly sermons.
     Programs should make a concerted effort to work with religious
       leaders that represent all the major religious denominations in the
       regions in which these programs are implemented.




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                   Adolescent Reproductive Health: 2005 -2008


Male Circumcision Adds No Value to One's Life, Just Scars.
Author:     University Students Speak

Source :    Moi University, Eldoret, Kenya

Abstract:   Background and Objective:
            Human beings socialize the young in various ways. Every preceding
            generation sets the values for the incoming group. Every stage of life
            marks a socialization process with different dimensions. In African
            communities, initiation into adulthood rites defines a community's
            understanding of sexuality (Khamasi et al, 2005). Male circumcision is a
            rite that certain communities enact to symbolize transition from
            childhood to adulthood. It is also a socialization process into cultural
            practices, norms, and values that make one community distinct from their
            neighbors. For males it reflects what constitutes ones masculinity.

            This paper is a product of a research survey that was designed to
            investigate the value of male circumcision as perceived by students in a
            public university campus in Kenya. A sample of 65 males from selected
            ethnic groups that practice male circumcision as a rite of passage and of
            65 females was selected (n= 130). Questionnaires were used to generate
            data from both groups whereas face to-face interviews were used to
            solicit information from 25 females. The 25 females were known to the
            second "Author as sexually active and therefore their knowledge and
            experience with circumcised and uncircumcised men was important.

            Findings and lessons learnt:
            The findings show that male circumcision is perceived to be valuable to
            the respondent's lives for both social and medical reasons. Among the
            reasons given as to how the rite adds value are: hygiene (45%); cultural
            and religious beliefs (29%); enhances pleasure during intercourse (10%)
            and builds one's self esteem (16%). The decision to be circumcised
            depended on the parents who are largely informed by their own cultural
            and/or religious beliefs. Though majority of the male respondents were
            circumcised between age 10 and 15, none was consulted for consent
            before surgery was performed. However, majority of the respondents
            expressed that "male circumcision adds value to one's life and not just
            scars".

            Conclusions and Recommendations
            This paper analyses the respondent's perceptions, ways in which the
            perceptions admiration and sometimes abuse. The paper calls the readers
            to investigate ways in which rites of passage as socialization processes
            could be used to educate the youth to understand human sexuality from
            a holistic perspective and promote safe sex and therefore move towards



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                   Adolescent Reproductive Health: 2005 -2008

            reducing risky behaviors that contribute to unplanned pregnancies, STls
            including HIV and AIDS and unsafe abortions.

Keywords:   Sexuality| male circumcision| safe sex| sexuality| socialization


The Youth for Youth (Y 4Y) program in Western Kenya: Improving
rural youths' knowledge, skills and access to reproductive health
services.
Author:     Albert Obbuyi

Source:     Youth for Youth, Bungoma, Ministry of Education, Kenya

Abstract:   Background objectives:
            Many youths in Kenya are at risk of HIV/STls and unwanted pregnancies
            due to limited access to information, low self-efficacy and unwelcoming
            health facilities. The Youth for Youth (Y4Y) program was designed to
            improve rural youth's reproductive health knowledge and life skills, to
            increase access to services, and to reduce risky sexual behaviours. It was
            launched in September 2003 in Bungoma district, Kenya, and is a joint
            effort of two local NGOs, an American university, and two government
            ministries

            Y 4Y has three main components: (1) Extra-curricular sexuality education
            and skills-building using peer educators in secondary schools and
            mentors in primary schools; (2) Peer service delivery where teen peer
            providers in participating health clinics provide information and
            condoms directly to youths; and (3) Quality monitoring through regular
            school meetings and youth satisfaction exit cards at health facilities.

            To assess impact, the program used anonymous self administered
            student questionnaires, pre- and post intervention, in both the
            intervention area (Webuye division) and a comparison area (Kimilili
            division). A 35-minute video was made in August 2004 for replication
            purposes.

            Main findings:
             Y4Y has reached over 4000 youths in two years.
             Y 4 Y seems to have significantly-raised AIDS knowledge and
              condom self-efficacy.
             Y4Y seems to have decreased forced sex among boys and girls in
              primary schools and among girls in secondary schools.
             Y4Y seems to have increased condom use in primary schools for both
              boys and girls, and for girls in secondary schools.




                                        58
                   Adolescent Reproductive Health: 2005 -2008


               In both comparison and intervention areas, a marked increase in
                sexual activity and pregnancies' occurred, possibly due to cultural
                encouragement of sexual activity -during the male circumcision
                period of July-August 2004.

            Conclusions:
             Y4Y was successful in raising knowledge and self efficacy, as well as
               reducing some risky behaviours. However, its impact on secondary
               school boys' behaviour was marginal.
             Y4Y faced numerous challenges mostly due to limited time available
               at schools, opposition of some teachers and church leaders, and lack
               of cooperation of some providers.
             Male circumcision ceremonies seem to contradict efforts in reducing
               unprotected sex. Linking Y4Y to
             male circumcision ceremonies could increase the programs efficacy
             It is difficult youth access to clinical services, partly because clinics are
               closed during times most convenient to youths(evenings and
               weekends).Training youths as peer providers is valuable, but
               mobilization of youths to use the services and overcoming provider
               antagonism are ongoing challenges.


Rights-Based Youth VCT services: What Works.
Author:     Omondi E,

Source:     Family Health Options Kenya

Abstract:   Background:
            Twenty Friends of the Youth (FOYs) and 40 Peer Youth Educators (PYEs)
            were trained in right-based approach and life planning skills. Their role is
            to refer youth for VCT services, conduct youth friendly days and parent
            youth discussion forums and to provide youth with IEC materials at
            youth friendly corners. The project's HIV prevention initiatives put most
            vulnerable youth at the centre of its outreach activities especially young
            girls in low income areas

            Eight VCT Counsellors were recruited and trained to provide youth
            friendly VCT services. They also conduct VCT outreach activities
            targeting the underserved youth in the slums. Monitoring and
            supervision is carried out by three Project Coordinators. Three Project
            Advisory Committees were formed to guide the implementation process.
            A baseline survey provided the benchmark data. All trainings and
            recruitment considered gender balance.




                                          59
                   Adolescent Reproductive Health: 2005 -2008

            Findings/lessons learned:
            "There is nothing for the youth without the youth." Active involvement of
            the youth in interventions that concern them enhance their ownership.
            More female youth tested HIV positive than their male counterparts.
            Strengthening referral networks with other partners providing ARVs
            helped in assisting young people testing HIV positive to access treatment
            and care. Availability of ART therefore compliments VCT services.
            Functional Post Test Clubs cushion the anxiety that comes with the
            knowledge of being HIV positive among the youth. Participation, rights
            and gender were the driving force behind services and information
            provision.

            Conclusion and recommendations:
            Addressing the fears and the needs of young people in a non-judgmental
            and non-moralizing manner when they go for VCT, not only makes them
            open up, but also enables them to confidently provide possible solutions
            when they test HIV positive. The youth need strong partnership with
            adults not tokenism and each young person especially the girl child, has
            specific concerns and needs that VCT Counsellors need to address. An
            integrated VCT model that addresses the sexual needs of HIV positive
            youth, their rights and welfare, gender disparity, lack of participation and
            inability to uphold the rights of young people is the best way forward for
            the future. A healthy youth is a healthy future able to conquer social
            economic challenges.



Non-consensual Sexual Experiences of Young People in Kenya:
Boys as Perpetrators and Victims.
Author:     Carolyne Njue-Ngari,

Source:     Consultant, formerly Population Council

Abstract:   Several studies have shown that non-consensual sex among young people
            in Kenya is relatively common, especially for girls but also for boys. In
            particular, first sexual experience is likely to be non-consensual, and so
            may influence the person's future perceptions of appropriate sexual
            behavior and expression of their sexuality. This paper draws on data
            collected during a baseline survey for an adolescent reproductive health
            intervention in Western Province of Kenya; over 3,500 adolescents aged
            10 - 19 years were individually interviewed, including 951 boys and 2,571
            girls, drawn randomly from all households with adolescents in this age
            range. The objectives of the study were to determine the type of sexual
            activities experienced the nature and consensuality of first and
            subsequent intercourse, experiences with forced sex, and the correlates of
            perpetrating or suffering non-consensual sex among boys.


                                         60
                   Adolescent Reproductive Health: 2005 -2008



            The study confirmed that for sexually experienced girls, almost 40% were
            coerced at first intercourse, including those in romantic relationships, and
            that 10% of boys reported being coerced; 45% of girls reported ever
            experiencing non-consensual sex. The study highlights the role played by
            'sweet talking' and persuasion through gifts or money, and explores the
            often ambiguous way in which these approaches to initiating romantic
            relationships and/or sexual experiences play out in this social context.
            Forced first time sex was reported by 16°/" of girl's and 4% of boys, and
            the implications of these findings are explored with reference to
            qualitative data collected simultaneously. The sexual experiences of boys
            were examined in more detail - 21% reported ever having persuaded or
            forced a girl to have sex and I 7% reported ever having themselves been
            persuaded or forced, with 1 0% reporting both experiences. Multiple
            logistic regression was used to identify the correlates of boys reporting
            perpetrating or suffering coerced sex. Boys who witnessed violence and
            discord among parents, who held traditional gender role attitudes and
            who were out of school were significantly more likely to coerce a girl to
            engage in sex than were other boys; moreover, those whose initiation was
            early and unwanted, or occurred with someone other than a girlfriend
            appeared to be significantly more likely to have ever persuaded or forced
            a girl to have sex than others. A significant finding was the link between
            the experience of coerced first sex and subsequent perpetration of forced
            sex.

            The paper will also discuss a number of methodological problems with
            undertaking research into adolescent sexual behavior, in particular the
            importance of the use of nuanced language when asking questions about
            sexual behaviors, understanding the role of gift giving and receiving in
            the context of initiating relationships, both consensual and non-
            consensual, and the difficulties in detecting and describing same-sex
            sexual experiences and in determining whether this was coerced or
            voluntary.


Adolescent Sexual and Reproductive Health and Rights: Mysteries
of Menstruation For School Going Girls.
Author:     Mercy Musomi M,

Source:     Girl Child Network, Nairobi, Kenya

Abstract:   Objectives
             Understanding menstruation as a reproductive health Right
             Demystification of menstruation among adolescent girls

            Background:


                                         61
       Adolescent Reproductive Health: 2005 -2008

Menstruation, the monthly shedding of the uterine lining, is a normal,
natural process that occurs in all healthy adult women who have not
reached menopause. Girls can begin to menstruate at any time between
eight and eighteen years. To deal with the management of the flow,
women over the ages have used unhygienic materials like grass, sponges,
cotton pads, mattresses, tissue paper and other absorbents to control the
blood. In addition, over decades, women have been taught that having
periods is shameful. The embarrassment surrounding menstruation is a
somewhat universal phenomenon, found in most cultures of the world
and with many associated code words, euphemisms and phrases used as
linguistic substitutes: examples of reference made to menstrual flow -
curse, womanly chromosomes, monsoon winds, red devil etc. Women
and girls have indirectly, if not directly, absorbed the message that
menstrual blood is dirty, smelly, unhygienic and unclean. With all these
negative messages it is natural for women to want to hide their
menstruation. But menstruation is a natural physical process - a harmless
by-product of a biological event.

Findings:
In the year 2004 Girl Child Network conducted a research on. Gender
Equity and Equality in primary Education. The researchers used
sampling methods among them materials facts sheet, interview guides,
questionnaire, and focus group discussions. One of the many factors that
hinder girls from attending schools through out the years was outlined as
lack of sanitary towels. The study targeted boys and girls, teachers, school
managers, school committees and Ministry of Education officials. During
the dissemination, the Ministry of Education officials singled out lack of
sanitary towels as one of the factors that leads to increase of drop out of
girls from school while "still in school". This is because on average a girl
will lose 3-5 days from school in a month hence missing approximately 1
0-15 days in a 3 month term!
After the Launch of Sanitary Towel Campaign by Girl Child Network
girls have been able to speak out openly on menstruation which has been
seen as a taboo in some communities. Girls have been using socks, leaves,
rags which they wash after use to reuse it again and other unhygienic
materials.

Lessons learnt:
 Lack of Sanitary towels has left many girls out of the school system as
   they are passive rather than active participants in the education
   system.
 Menstruation issues have been seen as a taboo in many communities.
 After sensitization people are ready to talk about Sanitary towels and
   other reproductive health issues which seemed to be very sensitive.




                             62
                   Adolescent Reproductive Health: 2005 -2008

            Conclusion:
            Menstruation being sexual reproductive health issue which sta/1s at
            adolescent is surrounded by so many myths that women have been
            forced to keep it a secret leading to a lot of, suffering, especially for the
            young adolescent girls that are confused with their body changes. It's
            upon the responsibility of development workers in collaboration with the
            government to break the silence and speak out about menstruation and
            its management. It's through this that our girls can enjoy the free primary
            education as we achieve the Millennium Development goal on education.


Addressing Adolescent Sexual and Reproductive Health (ASRH)
through a multi-sectoral public program.
Author:     Evelia H.,

Source:     Population Council, Nairobi, Kenya

Abstract:   Background:
            This paper outlines a public sector program highlighting the unique
            experiences and opportunities of a multi sectoral approach in fostering
            ASRH and rights. It draws on the experience of the Kenya Adolescent
            Reproductive Health and HIV/AIDS prevention Project (KARHP)
            implemented in Vihiga and Busia districts of Western Province since
            1999. Funded by USAID, the pilot project was implemented by
            Population Council and Program for Appropriate Technology in Health
            (PATH) in collaboration with three government Ministries of Education,
            Ministry of Health, and the Ministry of Gender, Sports, Culture and
            Social Services. The project developed and pilot tested innovative
            approaches for public sector authorities to work with adolescents, their
            parents, teachers and community leaders and health workers in
            providing sexual and reproductive health information and skills. It
            sought to establish the viability and effectiveness the approaches to
            increase ASRH knowledge, rights, and health service uptake among in
            and out of school adolescents aged 10-19 years. The successful
            implementation of the pilot project generated interest among partners
            and the beneficiaries leading to its expansion in the two original districts
            in 2003 and eventually it's scaling up into eight districts of Western
            Province in 2005.

            Findings:
            The pilot project showed that multi-sectoral approaches are feasible and
            effective in achieving positive sexual and reproductive health (SRH)
            behavior change among adolescents. SRH education provided through a
            life skill manual increased knowledge, consciousness, and
            communication of adolescent sexual and reproductive health rights. End-
            line survey findings showed increased levels of delayed onset of sexual


                                         63
                    Adolescent Reproductive Health: 2005 -2008

             activity, reduced number of sexual partners, reduced .incidences of
             sexual violence, reduced levels of unplanned pregnancies especially
             among in-school youth and the related drop out rates due to pregnancy,
             and reduced STI infection rates and safer sexual practices. Parent to-child
             discussion on SRH improved and communities became very receptive to
             information and dialogue about ASRH creating a large constituency for
             the program.

             Conclusion:
             Multi sectoral programs playa crucial role in providing appropriate SRH
             information and services for the majority of adolescents. They provide
             feasible opportunities for promoting sexual and reproductive health
             rights among the young people while creating a wider supportive
             environment. They also provide the best avenues for reaching the vast
             majority of young people with ASRH information and services for
             shaping positive sexual and reproductive health behavioral attributes.
             Providing leadership through partnerships encourages ownership and
             increases effective utilization of experiences and sustainability of ASRH
             and HIV/AIDS programs through the public sector.

Keywords:    ADOLESCENTS| SEXUAL AND REPRODUCTIVE HEALTH AND
             RIGHTS| MULTI SECTORAL AND PUBLIC SECTOR
             APPROACHES| HIV|AIDS| POSITIVE BEHAVIOR CHANGES



Sexual activities and implications for the reproductive health of adolescent
street girls in Nairobi.

Author:      Njiru R.,

Source:      University of Nairobi

Abstract:    Background and Objectives:
             In the last few years, there has been a continued increase in the number of
             street children in most urban areas in Kenya. This has occurred despite
             government, civil society and religious organizations' efforts to
             rehabilitate them. Several studies have been carried out on the street
             children mainly focusing on reasons for leaving home or rehabilitation
             centre’s to live in the streets. The few health related studies have focused
             on general health problems for both girls and boys together which
             presupposes that they face similar problems. There has been no specific
             study targeting street girls and more so their reproductive health. This
             study, therefore, examined the sexual behaviour or activities of adolescent
             street girls in Nairobi and how this behaviour impacts on their
             reproductive health. Specifically, the study sought to find out the age at
             which the girls start experiencing sex, reasons behind their sexual


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                   Adolescent Reproductive Health: 2005 -2008


            behaviour, sexual harassment or assault in the streets, whether or not they
            practice safe sex, and how these sexual activities impact on their
            reproductive health.

            Method:
            Qualitative data was collected through in depth interviews with a
            purposively selected sample of fifty adolescent street girls. Supplementary
            data included four FGDs, twelve key informant interviews, and
            observations. Data was analyzed qualitative Findings: Findings show that
            sexual debut for street girls begins as early as four years old. Reasons for
            in/voluntarily having sex include; money and gifts, protection, comfort.
            Initiation, punishment or fear of assault. There is very limit&4-
            contraceptive use linked to lack of power to negotiate for safe sex and
            unaffordability of contraception. This has serious reproductive health
            consequences such as STls and HIV/AIDS; unplanned pregnancies, early-
            age delivery; abortions and post-abortion complications.

            Conclusion/recommendations:
            In light of the findings of the study, the overall solution to the street
            children problem is socio-economic empowerment and strengthening
            family relationships. However, while girls are still on the streets, there is
            need for sexual and reproductive health education, life skills and
            empowerment of street girls to negotiate for safe sex. Family planning and
            counselling services should be made affordable, accessible and friendly to
            street girls. In addition, further research on street girls and reproductive
            health of boys would help shape reproductive health programmes for all
            street children.

Keywords:   ADOLESCENT STREET GIRLS| SEXUAL ACTIVITIES|
            BEHAVIOUR| REPRODUCTIVE HEALTH STIS AND HIV/ AIDS|
            UNPLANNED PREGNANCY| ABORTION.


Factors associated with risky sexual behaviour among the out of school
youth in Kenya.
Author:     Khasakhala A.,

Source:     Population Studies and Research Institute, University of Nairobi, Kenya

Abstract:   This paper examines factors that may predispose out of school youth to
            risky sexual behaviour. The data is from the Behaviour surveillance
            Survey carried out in Kenya in late 2002. The survey interviewed
            unmarried out of school youth aged 15-24 in eight districts representing
            the eight provinces of Kenya. The focus is on those who had sex in the last
            12 months of the survey. The factors that are examined in the paper are



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                   Adolescent Reproductive Health: 2005 -2008


            age at first sexual debut, use of condom at first sexual debut, median age
            at first sexual intercourse, number of sexual partners, sex with commercial
            sex workers without condom, frequency of condom use with non and
            commercial partners, level of education, district of residence, religion of
            respondent, current age (As at time of survey) among others.

            Methods of analysis include descriptive statistics and multivariate analysis
            in order to determine which variables if any are predictors of risky sexual
            behaviour. An index of risky sexual behaviour consisting of such variables
            as sex in past twelve months, sex with commercial sex partners without
            condom, number of commercial an~ non commercial sex partners,
            frequency of alcohol use, frequency of condom use with commercial and
            non commercial partners (all these relate to last twelve months).

            Preliminary analysis of data indicate that out of a sample of 6129 out of
            school youth, who were successfully interviewed, 64.6 percent reported
            ever having sex, only 13.8 percent used condom at first sexual debut.
            Median age at first sexual debut was 16 years for both males and females.
            52.5 percent of males had their first sexual debut between ages 15 and 17
            while 51.6 percent of the females had their first sexual debut between ages
            18 and above. More females reported having ever attended school than
            males (51.6 percent and 48.4 percent respectively). 50 percent of the
            respondents were Christians (protestant). 57.1 of males reported having
            had sex within 12 months of the survey as compared with 42.9 percent of
            the females. Whereas 8.1 % of the males reported having had sex with
            more than one commercial sexual partner, 43.5% reported that they had
            sex with more than one non-commercial partners (12 months prior to
            survey). The preliminary multivariate results for males indicate that age at
            sexual debut and circumcision status are high predictors of risky sexual.
            behaviour for males. The paper will offer some explanations for such
            findings once detailed analysis has been completed and policy
            implications thereof. Results for females are yet to be included.


Community Perceptions of Young Girls' Sexual Behavior and Health
Implications in Nairobi's Informal Settlements.
Author:     Elizabeth Kimani,

Source:     African Population and Health Research Center (APHRC), Nairobi, Kenya

Abstract:   Background and Objectives:
            The objective of this paper is to explore community perceptions of young girls'
            sexual behavior and the implications of such behavior on their health in two slum
            settings in Nairobi. Although much is known about the sexual behavior of young
            people in the context of urban poverty, far less attention has been given to the
            intricate, less obvious factors that shape such behavior. Results from other


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                    Adolescent Reproductive Health: 2005 -2008

            studies indicate early sexual debuts for female slum-dwellers in Nairobi. Money
            transfers for sex as a means of sheer survival in the slums are also well-
            documented. This paper however, goes beyond a mere description of sexual
            behavior to center on the highly nuanced drivers behind girls' sexual behavior in
            informal settlements and the health implications of the same.

            Data and methods:
            Data used are derived from a study carried out in 2004 by the African Population
            and Health Research Center which sought to clarify the linkages between food
            security, child health, and schooling. A total of thirty-two focus group
            discussions and sixty in-depth interviews were conducted with parents,
            community leaders, teachers, and young boys and girls. It was in the course of
            this study that issues to do with sexuality emerged as also being important among
            slum residents. The data was analyzed using the qualitative computer software
            QSR NUDIST.

            Results:
            Several factors shape girls' sexual behavior in informal settlements, including
            living arrangements and the construction of gender roles. These factors leave
            girls at seemingly greater risk for HIV transmission and unwanted pregnancies.
            Furthermore, vulnerability to HIV/AIDS in urban poor settings has greatly
            informed young girls' perceptions of sex and relationships with the opposite sex.
            For example, feelings of fear and negativity towards sex were expressed in many
            focus group discussions with girls. However, this perceived danger does not
            seem to playa part in influencing young girls' sexual behavior.


            Conclusions and recommendations:
            Finding ways to present healthy relationships (whether sexual or not) among
            young boys and girls in the slum areas as an option and a positive phenomenon is
            of critical necessity. In the fight against HIV and AIDS, the importance of
            information on risk and gender vulnerability for instance in developing context-
            specific interventions cannot be over-emphasized.



Like Chocolate: Adolescent Emergency Contraception use in
Nairobi.
Author:     Jill Keesbury.,

Source:     Population Council, Nairobi

Abstract:   Background and Objectives:
            In 2004, the Kenyan media featured a set of reports alleging that an
            epidemic of emergency contraception (EC) abuse had emerged among
            adolescents in Nairobi. Fueling an already heated debate on reproductive
            rights in Kenya, both a newspaper article and a television news story
            suggested that easy access to EC encouraged risky sexual behaviors



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       Adolescent Reproductive Health: 2005 -2008

among adolescents. The features implied that although educated youth
have adequate knowledge of the modes of HIV transmission, access to EC
has encouraged frequent and risky sexual encounters. According to the
newspaper, young women in Nairobi were so regularly and repeatedly
engaging in such risky behavior that they were "using (EC pills) like
chocolate."

Despite the compelling nature of these reports, little empirical evidence
exists--either in Kenya or abroad-linking EC access and risky sexual
behaviors among adolescents. To test popular assumptions, while at
the same time contributing to a growing understanding of adolescent
sexuality, the Population Council undertook a rapid diagnostic
assessment of EC use among adolescents in Nairobi.

Methodology:
This rapid assessment was conducted over a two-month period in 2005
using a quantitative survey instrument administered to 300 participants.
To ensure that findings are directly relevant to the current public debate
on EC, efforts were made to collect information from the same type of
respondents cited in the media reports: namely young women in Nairobi
between the ages of 14 and 25. The survey measured prior contraceptive
knowledge, use, and participation in risky sexual behaviors, such as
having sex for money and having sex without a condom. Repeat use of
EC was also assessed, and participants were asked to rank their own
susceptibility to both pregnancy and sexually transmitted infections,
including HIV.

Expected Findings and Conclusions:
Data analysis, currently underway, focuses on understanding the
characteristics of three types of adolescents: those who have knowledge
of EC, but have not used it; those who have used it once; and those who
have used it more than once. Within each of these categories, the
relationships between contraceptive knowledge of all types, knowledge
and access to EC, risk perception and risky behaviors are being explored.
Key findings on the sexual behaviors and prevalence of EC use in all
three populations will be presented.

This information will help assess the validity of media claims regarding
an epidemic of EC abuse in Nairobi and consequent risky sexual
behaviors. It will contribute to the emerging literature on the
relationships between easy access to EC, adolescent sexuality, and HIV
transmission. It is also intended to serve as formative research for a future
qualitative study that further investigates the linkages between access to
EC and risk perception.




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                   Adolescent Reproductive Health: 2005 -2008


The situation of SRHR in Kenyan secondary schools-the SBB
experience-Focus on Machakos District.
Author:     Gathumbi N.,

Source:     Sisters Beyond, Kenya

Abstract:   Background and objectives:
            Sisters Beyond Boundaries (SBB) is an organization of women whose
            mission is to build capacities of women and the youth to promote and
            protect Sexual reproductive Health and Rights. They do this through
            providing education, information on SRHR, networking, and advocacy
            for policies that are responsive
            to the SRHR needs of the target group.

            SBB has been implementing a program on Sexual and Reproductive
            Health in selected schools in Machakos district of Eastern province,
            Kenya since 2003. The objectives of the program are:
             To engage the students on SRHR issues in a bid to establish their
               needs and come up with ways of addressing those needs
             To transform the education system trough policy advocacy from its
               current status to one that is responsive to the SRHR needs of the
               youth

            This program has revealed a big gap that exists within our education
            system. It lacks adequate education on SRHR, correct/factual information
            and services required by the youth when they are in school. There is
            currently no clear policy on SRHR education in Kenyan schools. The only
            SRHR available is what is taught in Biology classes, which both the youth
            and the teachers admit is not adequate to appropriately empower them in
            matters relating to sexuality and reproductive health.

            Recommendations:
             Organizations working in the area of sexuality education should seek
               to come up with a curriculum that systematically tackles identified
               issues and needs in appropriate depth and share it out to enhance the
               efforts being made to address the issues.
             There is need to involve teachers so that they can inform the process
               of addressing the issues that they think are not being addressed
               within the education system with regard to SRH.
             Counseling services should be intensified to ensure that
               individualized cases that may not be handled in the open forums are
               attended.
             There's also need to assess and enhance the skills of SRHR education
               facilitators to ensure they meet the needs expressed by the youth




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                   Adolescent Reproductive Health: 2005 -2008

            Conclusion:
            The schools outreach program is one of the efforts being made to
            transform an education system that has been blind to the SRHR needs of
            the youth. The reception it has been accorded in all the schools visited is
            quite telling-that there is lot of work to be one if the youth and women in
            Kenya are to enjoy their SRHR fully. It is therefore important not to loose
            the goodwill that the teachers and the youth have shown and utilize the
            provided space to improve the SRHR situation in our schools.


Determining Knowledge and Attitudes of Peer Youth Educators
(PYEs) On Sexuality Education in Kenya (February 2006).
Author:     Koronya C.,

Source:     Planned Parenthood Federation of America - International, Africa
            Regional Office

Abstract:   Using primary and secondary data, this study sought to determine the
            knowledge and attitudes of Peer Youth Educators (PYEs) on sexuality
            education in Kenya. Further, it explored the nature of sexuality education
            provided by the PYEs to other youth and the challenges PYEs face in the
            course of providing sexuality education to other young people. Purposive
            sampling was used to select the respondents. Respondents were selected
            based on their availability, willingness to participate in the study, and on
            the number of years they have been involved in sexuality education. Only
            those PYEs with a minimum of two years experience in Peer Education
            participated in the study. The sample size was 131 respondents (n= 131).

            Data collected was both quantitative and qualitative. FGD guide and self
            administered questionnaire were developed, pre-tested and used in data
            collection. A structured self administered questionnaire was filled by 100
            PYEs while 4 FGDs were conducted .A literature review of relevant
            materials from the Internet, training manuals and curricula, books,
            journals, research reports and program reports was conducted. A total of
            131 young people from nongovernmental and community based
            organizations most of whom have been trained in peer education
            participated in this study conducted in Nairobi-Kenya.

            The study found that PYEs from different organizations were trained
            using different training curricula and that PYEs knowledge on sexuality
            education vary from one organization to another on certain areas
            depending on the emphasis of specific areas in the different curricula or
            their exclusion all together. Further, topics that are overlooked by the
            PYEs while disseminating sexuality information were either not covered
            or not well understood during the PYEs training. The PYEs attitudes
            towards sexuality education were positive as majority of the respondents


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                   Adolescent Reproductive Health: 2005 -2008

            considered all sexuality topics important for informing the young people.
            The greatest challenge facing PYEs in communicating sexuality
            information emanates from the fact that sexuality issues remain taboo
            and many religious groups consider sexuality information inappropriate
            for young people.

            In conclusion, sexuality education remains beyond reach of many young
            people and even PYEs shy off from discussing some of the vital topics on
            sexuality with their peers mostly because they feel incompetent to discuss
            them. Based on the findings, the study recommends the standardization
            of training curricula and manual to come up with a comprehensive
            sexuality education manual that will provide the much-needed relevant
            and accurate sexuality information to the young people. Further, there is
            need to step-up advocacy efforts for introduction of comprehensive
            school-based sexuality education that is appropriate to students' age,
            development level and cultural background and to clear these
            misconceptions within the communities on sexuality education.


Designing a Secondary School HIV Prevention Program: Kenya
Author:     Gichuru M.,

Source:     Cenlre for British Teacehrs, Kenya

Abstract:   Background:
            With a primary school HIV education programme being rolled- out
            across Kenya, attention is now turning to developing a program for
            secondary schools. This presentation reports results of formative research
            and how it was used to inform the content and design of a school-based
            HIV prevention programme for secondary school youth.

            Method:
            In September 2005, 21 focus groups were held with students from schools
            in 12 regions of Kenya. Interviews were held with 2 teachers in each
            participating school.

            Results:
            Youth had high levels of knowledge about HIV transmission and
            prevention and knew how to use and where to get condoms. They
            identified themselves as high risk for HIV because of their sexual activity
            and were concerned about their risk, but not enough to change behaviours.
            They claimed abstinence was what they should be doing, but they could
            not or did not want to abstain. Boys described this as a time when they
            should 'freely experiment' with many partners. Girls were split between
            those who shared this view and those who promoted abstinence to
            marriage. Enjoyment and need were the dominant reasons for sex with


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                   Adolescent Reproductive Health: 2005 -2008


            material gain also present for girls. With the exception of Muslim youth,
            boys claimed 5+ sexual partners and girls 2-3 in the past year. Muslim
            youth maintained that they were not sexually active. Youth were
            ambivalent about condom use. Youth and teachers alike identified local
            conditions and situations and school policies and procedures and that
            contributed to youth sexual activity.

            Conclusions:
            An HIV prevention program for secondary schools using a peer-leader
            model to capitalize on local age mate identification and role modeling was
            designed to address the situations, conditions, and personal experiences of
            secondary school youth. The program uses local narratives and interactive
            learning to shift norms and teach skills related to number of partners and
            condom use. Schools are being challenged to change policies and
            procedures to reduce their collusion in providing situations conducive to
            risky sexual practices.


Meeting the needs of youth with HIV prevention: Designing and
delivering school-based programmes to reach large populations.
Author:     Maticka-Tyndale E.,

Source:     Canada Research Chair in Social Justice & Sexual Helalh, Department of
            Sociology & Anthropology, University of Wine/sol; Canada

Abstract:   Background:
            If HIV is to be slowed in its progress, it is important to reach as many
            youth as possible with prevention programming before they become
            infected. Primary schools are one setting that has the capacity to reach
            large numbers of youth. Primary School Action for Better Health
            (PSABH) was designed to use the existing educational infrastructures to
            deliver an on-going HIV intervention in upper primary school grades
            across Kenya~ The intervention has demonstrated success in 6 different
            regions of Kenya and is currently being phased into all primary schools in
            the country using Ministry of Education infrastructure with support from
            OBT, the original implementing NGO.

            Method:
            This presentation uses results from a review of HIV prevention
            programmes delivered in diverse countries in sub Saharan Africa together
            with results from monitoriug the roll-out of PSABH to identify lessons
            that inform the development and delivery of large-scale school-based HIV
            prevention programming to reach youth in sub Saharan Africa.




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                   Adolescent Reproductive Health: 2005 -2008


            Results:
            Key characteristics of school-based prevention programmes that are
            sustainable, can be implemented on a large-scale and have a positive
            impact on the vulnerability of youth to HIV infection include designing
            programmes: with particular attention to sustainability and scale; that
            work within and build the capacity of the existing educational
            infrastructure; that address local situations and acknowledge and respect
            local concerns; that are responsive to the needs of teachers; that have a
            built-in monitoring and evaluation that feeds information back to schools
            on challenges, progress and emerging issues; that work within the
            capacities and limitations of local schools. Success also requires: local
            acknowledgement that HIV is a problem for youth and a desire to address
            the problem; national leadership supportive of HIV prevention
            programming in schools; schools that are functioning at least at a basic
            level.

            Conclusions:
            Most HIV prevention programmes are designed for testing on a small
            scale. These rarely go beyond delivery in a small number of schools -
            leaving the vast majority of youth without needed programming. It is
            possible, and preferable, to design programmes to scale, i.e. so that they
            can be delivered over wide geographical regions. It will take such wide-
            scale programmes to meet the HIV prevention needs of youth in sub
            Saharan Africa


Married adolescents and HIV in Nyanza.
Author:     Ayuka F.,

Source:     Population Council, Nairobi, Kenya

Abstract:   Background and objectives:
            Hitherto, most research on adolescents had focused on their reproductive
            health problems and HIV infection rates, which has been high amongst
            this group and has continued to grow. Currently, there has been a shift in
            focus to married adolescents because of emerging evidence that HIV
            infection rates may be higher in this group than in the unmarried
            adolescent. Married adolescents may also be more vulnerable because of
            the assumption that once married they enter the social category of adults.
            They are presumed to carry the same status and rights like any other
            married adult and have same service needs.
            The presentation will draw on formative research carried out by the
            Population Council in Rachuonyo district, Nyanza province to understand
            the process of marriage, perception of risk of HIV within and outside
            marriage, pre-marital and marital VCT among other issues. Eight Married


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                   Adolescent Reproductive Health: 2005 -2008


            adolescent girls were interviewed over three consecutive visits carried out
            over three successive days. Other respondents were, eight husbands of
            adolescents (not matched to interviewed adolescents so as to promote
            candid discussion of sensitive issues), four mothers, four fathers, four
            mothers-in laws and four fathers in-law, were interviewed once.

            Findings:
            While discussing the process of marriage, it was evident that the
            adolescents had known their spouses for a short time or not at all
            (marriage was arranged) the adolescents were getting married early
            because of death of their parents, most likely due to AIDS. The problems
            occasioned by such deaths, notably poverty, left the young girls with no
            alternative but to get married to any suitor, irrespective of time known or
            status. When asked about whether they ever declined sex from their
            husbands, most replied that it was up to the husband to decide whether or
            not to have sex. Declining sex from husband was met with violence and
            sometime forced sex, yet at times the reason for refusal was because the
            husband had brought another woman to the house and they were scared of
            being infected. The only place they could go without permission was the
            church. Any other place including the hospital was at the pleasure of the
            husband thus denying the girls access to reproductive health services.
            Distance and fear were reported as the biggest barriers to access VCT
            services. VCT being a recent phenomenon is located in established sites or
            clinics, which were considered too far by the respondents. For those who
            have not tested, the fear of receiving a positive result was expressed, while
            those who have tested voluntarily feared disclosing to their partners.

            Conclusions and recommendations:
            More research needs to be done to understand the relationship between
            HIV/ AIDS and adolescent marriage and ecological factors that encourage
            adolescent marriage. Programs need to explore the barriers to VCT, more
            specifically disclosure, distance and fear.


Expanding and integrating the Deaf HIV/ AI DS/STI Programme
towards efficiency.
Author:     Henderson K.,

Source:     Liverpool VCT & Care (LVCT) Kenya

Abstract:   Background:
            The Deaf community numbers approximately 650,000 out of about
            32,000,000 people in Kenya. It is most concentrated in the urbane regions
            and also spread out in the rural areas in lesser but significant numbers. In
            the Deaf community, access to education and services is more limited and


                                         74
       Adolescent Reproductive Health: 2005 -2008


employment either is lower or reaps less per capita income than the rest of
the population. With its own linguistic culture based in Kenyan Sign
Language, this community faces stigma and poverty at a more alarming
level than general.

As the mission of LVCT Kenya is to reduce the rate of HIV transmission
in Kenya, the organization aims to:
 Implement high quality voluntary counseling and testing (VCT) and
    care services throughout Kenya
 Provide technical assistance and support to GoK and partners
 Develop research- and evidence-based practice to inform policy

Since October 2003, LVCT has trained 12 Deaf counselours and
mobilizers and established three Deaf VCT stand-alone sites in Kisumu,
Mombasa, and Nairobi, reinforced by monthly mobile VCT clinics in
surrounding regions. After counlseling and testing, Deaf clients who test
positive for HIV are referred to local clinics that provide care and ART
therapy.

The objectives of the programme are two-fold:
 To increase provision and quality of VCT and care services for Deaf
   clientele
 To increase provision and quality of VCT services for the adjacent
   hearing population

In 2005, a coordinator position held by a Deaf professional was also
established to run the programme.

Findings/Lessons Learnt:
 Maintaining anonymity and confidentiality in Deaf community
 Mobilization of rural Deaf communities requires
 more support, consistency, time, and creativity
 Data on Deaf clientele is lacking
 Limited Deaf involvement in professional development
 Quality of care of Deaf PLWHA decreases after VCT service

Conclusions and Recommendations:
 Data collection of Deaf and physically challenged clientele needs to be
   incorporated in national data system
 VCT & Care scale-up then must begin to reflect above data e.g. access
   ramps & lifts, sign language fluency and sensitivity training among
   care providers
 Increase provision of Deaf counsellors at rural standalone sites near
   sizable Deaf communities and trim down over-reliance on costly
   mobile VCT activities



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                   Adolescent Reproductive Health: 2005 -2008


Keywords:   DEAF| CULTURE| BARRIERS TO ACCESS| HIV/AIDS| SEXUAL
            HEALTH


Left behind: Where are the youth living with disabilities in the war
against HIV/ AIDS?
Author:     Fredrick Ouko,

Source:     International Disabled Youth Initiative. (IDYl), Nairobi Kenya

Abstract:   Background and Objectives:
            Whereas youth account for the largest percentage of the world's
            population, less attention is being given towards addressing the myriad
            problems experienced by the world's vast majority.

            The situation is even more worse when a segment of this population are
            disabled youth, who have been excluded from the mainstream socio-
            economic and political life; forcing them into the dark alleys of the society
            resulting in object poverty and deprivation of their human rights.

            Every effort meant to fight the HIV/AIDS scourge is minus the focus on
            youth living with disabilities, yet they make the largest percentage of
            persons with disabilities and have varied needs that require specific
            attention. This abstract is therefore meant to bring to the fore:

                  The magnitude of the problem.
                  Why youth living with disabilities continue to remain the silent
                   statistics on HIV/AIDS.
                  What needs to be done and how.

            Findings:
            While there is no focus being accorded to disabled youth in terms of
            reducing the spread of HIV/ AIDS, the number of disabled youth being
            infected with the disease is on increase without any check. We know they
            are the poorest of the poor, yet the gnawing truth is that; HIV/AIDS is
            taking toll on them as it knows no disability.

            An attempt to create awareness on the disease amongst the youth has 'not
            made effort to target disabled youth specifically, yet they have differing
            needs. They continue to be left behind.

            Conclusion and Recommendation:
            It is high time sexuality issues among youth living with disability receive
            equal attention and efforts towards the fight against HIV/AIDS inculcate
            their active participation.


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                   Adolescent Reproductive Health: 2005 -2008



            Disabled youth are at the verge of extinction if urgent measures are not
            made to educate them on HIV/AIDS prevention. Young disabled women
            continue to be the most vulnerable due to their physical disability and lack
            of bargaining power; never than before, efforts to fight HIV/AIDS must
            reflect the diversity within the society for them to be successful in the end.

            HIV/AIDS knows no disability; we cannot win the fight against it without
            them.

            There is need for government intervention to augment the efforts that have
            been initiated by NGO's, CBOs, etc and use of more formalized victim
            empowerment programs should be designed for the disabled persons.


Teaching Human Sexuality to Freshers: An Educator's Reflection
on Students' Journals.
Author:     Khamasi W.,

Source:     Africa Population and Health Research Centre, Nairobi Kenya

Abstract:   Background Information and Objectives:
            After teaching family life education for almost 10 years and engaging in
            the study of sexuality (see Khamasi, 2002; Wambua & Khamasi, 2003;
            Khamasi & Maina-Chinkuyu, 2005) it became apparent that there was
            need to teach human sexuality as a course and not as a topic to university
            students. My department restructured the curricula and developed a
            course on human sexuality which is taught to first years (freshers) in the
            first semester. This was an intervention strategy to assist students
            understand their sexuality in a social environment where sexual activities
            are the norm. First year female students report to college and find senior
            male students waiting to grab the chance to befriend them for sex, a
            phenomena otherwise referred to as 'the gold rush'. Rush by senior male
            students for female freshers, 'the gold'.

            In teaching the course, various instructional skills were used. As a class
            we agreed to break the silence on issues of sexuality and call a 'spade a
            spade' in all discussions. There was no taboo word. Students were
            required to keep a journal and reflect on the topics discussed in class and
            with peers under whichever circumstances. The aim of offering the
            course is to promote sexual health through responsible, respective,
            pleasurable and safe sex or voluntary abstinence. This paper is our
            reflection on the students' reflections in their journals the first author.




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                   Adolescent Reproductive Health: 2005 -2008

            Findings and lessons learnt:
            Revelations through the journals point to the gains experienced in the
            process of learning about ones sexuality and how socialization processes
            inform/deform our understanding of our sexual bodies, sexual issues,
            peers in relation to sexuality and what we perceive the teaching of
            sexuality should entail. We agreed there was no taboo word in that class.
            The students therefore developed a non-judgmental attitude that
            accommodated each other's views.

            Conclusions and Recommendations:
            Offering the course in the first year first semester allowed freshers to
            understand human sexuality in a context that comprised of the newly
            found freedom on campus and the instantly acquired marketability as the
            'gold'/female fresher. This was in relation to one's body which on arrival
            on campus transforms to an object of desire by several senior male
            students, especially in the first two months of the semester. Most issues
            discussed in class were observable since they were enacted by majority of
            students when out of class and therefore relevant to the students' daily
            lives.

Keywords:   SEXUALITY| SEXUAL HEALTH| SAFE SEX| PLEASURABLE SEX


Translating Policies into Action for Improved Adolescent Health:
Advocacy for Policy Implementation.

Author:     Mutunga A.,

Source:     Family Care International, New York

Abstract:   Background:
            HIV/AIDS has reached epidemic proportions among young people in sub-
            Saharan Africa, with nearly 10 million currently infected. In response to
            this situation, Family Care International launched an l8-month regional
            advocacy project on HIV/AIDS aimed at strengthening the capacity of
            local organizations in Kenya, Mali, Niger, and Tanzania to advocate
            effectively for the implementation of existing policies aimed at reducing
            young people's risks for HIV/AIDS. Each country had a policy framework
            in place that addressed adolescent sexual and reproductive health (ASRH)
            and/or HIV/AIDS prevention. While the policies were generally
            supportive of young people's needs for sexual and reproductive health
            information and services, implementation of these government directives
            was lagging, particularly at the district level where responsibility for
            policy implementation is increasingly concentrated.
            In selected districts, FCI identified a range of local youth groups and
            community-based partners, trained them in advocacy strategies, and


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                   Adolescent Reproductive Health: 2005 -2008


            updated them on current ASRH and HIV/AIDS policies. Sub-grants and
            technical assistance were provided to enable local partners to launch a
            range of grassroots advocacy activities targeting district and local
            decision-makers. Activities included radio call-in programs; sports events;
            participatory community drama; music and dance performances; and
            information leaflets for religious leaders, teachers, parents, and health care
            providers.

            Objectives:
            Session participants will be able to:

            Results:
            Results of the initiative included successful grass roots advocacy
            campaigns, as well as the development of new networks of advocates and
            stronger youth organizations capable of advocating in support of HIV
            prevention and ASRH efforts.
            Conclusions and Recommendations:
            District-level officials often know little about the content of policies
            related to ASRH and have little guidance on their mandate for
            implementing these policies in their respective spheres. Grassroots Level
            activists, including youth advocates can play an important role in creating
            broad-based support or efforts to improve adolescent health and well-
            being, and encouraging key decision-makers at the district level to take
            action to implement policy directives.


Youth-Friendly services in an HIV/AIDS Comprehensive Care
Centre in Nairobi, Kenya: Preliminary results of Needs
Assessment.
Author:     Dr. Gathari Ndirangu

Source:     P.O. Box 17 KNH, Nairobi 00202, ggndirangu22@yahoo.com

Abstract:   Summary:
            Worldwide, 5 young people under the age of 24 are infected with HIV
            every minute, 7000 every day. In Kenya, like in many other countries in
            sub-Saharan Africa, half of all new HIV infections occur among
            adolescents and young adults aged 15-24 years. Girls are 2-3 times as
            likely to be infected as boys the same age.

            Despite this high rate of infection, many HIV positive youth have been
            observed not enter into HIV/AIDS care. Additionally, few of those who
            access care remain in it. In some parts of the country 9% of persons aged
            13-21 have tested HIV positive but the majority are not enrolled in care.




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       Adolescent Reproductive Health: 2005 -2008

In one region (Nyanza), only 5% of persons enrolled in HIV/AIDS care
are youth.

One of the major reasons for this low participation by young people
living with HIV/AIDS (YPLWHA) is lack of youth friendly services
(YFS). In Kenya, services at ARV clinics have not been youth friendly. A
survey in 2004 demonstrated that only 12% of health facilities were able
to provide YFS.

YFS should be accessible, acceptable, appropriate (in the right place at the
right time) and affordable. They should have convenient opening and
closing hours. Privacy and confidentiality should be guaranteed and
autonomy promoted. They should ensure short waiting times and
consultation with or without an appointment. It should be equitable,
inclusive, non-discriminatory and reach the vulnerable. Staff should be
competent and motivated, with ability to communicate in a non-
judgmental and considerate manner that also sets the right climate.

Since YPLWHA represent a very significant proportion of people living
with HIV/AIDS, every effort must be made to encourage them access and
remain in HIV/AIDS care and treatment.

Objectives:
To determine whether or not young people living with HIV/AIDS
consider it necessary to have a day and time set aside for them to attend
clinic at an HIV/AIDS comprehensive care centre (CCC) in a public
tertiary referral hospital in Nairobi, Kenya

Methods:
The study was carried out during school vacation in the month of August
2007. Consecutive HIV-positive adolescents and young adults attending
the CCC at Kenyatta National Hospital were interviewed by use of a
standard pre-designed questionnaire that was administered by clinicians
and counselors at the end of each consultation.

The month of August was chosen because it coincides with school
vacation when many school-going young people living with HIV/AIDS
attend the clinic.

Results:
A total of 27 consenting adolescents and young adults living with
HIV/AIDS were interviewed. The youngest was aged 14 and the oldest
26.




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         Adolescent Reproductive Health: 2005 -2008




 Age            Frequency            Percent
 <14            1                    3.7
 15-19          14                   51.9
 20-25          11                   40.7
 >25            1                    3.7




 Gender         Frequency            Percent
 Female         17                   63.0
 Male           6                    22.2
 Not Known      4                    14.8


Of the females, the mean age was 19.6 years while that of males was 16.8
years

The majority (25/27, 92.6%) felt there was need to have a clinic day
dedicated to the youth, while 2 (7.4%) felt there was no such need.

The most frequent expectation of a youth-friendly service was faster
service with a shorter waiting time, followed by health
education/counseling and recreation/socializing with peers.

Suggestions on improvement of care at the CCC, included change of
attitude by healthcare workers, and shorter waiting time. Other
expectations included, provision of free services, increase in supply of
drugs to last for a longer period to reduce on the number of days missed
from school, counseling by older PLWHA, and facilitation of income
generating activities.

Most (93%) were willing to participate in a youth support club. Males
were more likely to be willing to offer peer counseling than females,
83.3% and 64.7%, respectively

Conclusions:
Even though the number of YPLWHA interviewed was too small to make
any concrete conclusions, the findings indicate that the sex distribution of
YPLWHA in this group is consistent with the national HIV prevalence
rates where for every infected young man, 3 young women are infected.

As care for PLWA becomes more available in Kenya and possibly
elsewhere in low resource countries, there is need to reach a larger
proportion of adolescents and young adults. There is an overwhelming
expression by YPLWHA to obtain care in a friendlier atmosphere that


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                   Adolescent Reproductive Health: 2005 -2008

            addresses their needs that may not be possible in a general HIV/AIDS
            treatment and care setting.

            Recommendations:
            Just like other adolescents and young adults, YPLWHA require youth-
            friendly services and institutions should respond to meet that need.


Sexuality, HIV Risk and Potential acceptability of involving
Adolescent girls in Microbicide Research in Kisumu, Kenya.
Author:     Michele Montandon, Nuriye Nalan Sahin-Hodoglugil, Elizabeth Bukusi,
            Kawango Agot, Brigid Boland , Craig R Cohen

Source:     Center for Microbiology Research, KEMRI, Box 19464, Post Code 00202,
            Nairobi Honorary Lecturer, Department of Obstetrics and Gynecology,
            University of Nairobi, email: ebukusi@csrtkenya.org

Abstract:   Background:
            Microbicide clinical trials infrequently involve female participants under
            18, a population at high risk of HIV acquisition should you mention why
            this is so? Why it is difficult to involve those under the age of 18 despite
            the risks they face? . We sought to understand the individual, family and
            community-level factors that may influence the acceptability of
            microbicide research involving adolescent girls.

            Methods:
            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.

            Results:
            Adolescent sexual activity is stigmatized 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 and
            concerns about microbicide efficacy; and parental worry that supporting
            microbicide use in youth would defy societal pressures that denounce
            adolescent sexual activity.




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                   Adolescent Reproductive Health: 2005 -2008

            Conclusions and Recommendations:
            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.


Risk-Reducing Behaviors towards HIV infection among sexually
active female adolescents.
Author:     Professor Koigi Kamau, Dr. Ruth Jahonga, Dr. James Kiarie

Abstract:   Background:
            Sexually active adolescents constitute an HIV infection pandemic
            reservoir. Children continually replenish this reservoir as they evolve
            through adolescence to become adults. Knowledge on HIV transmission,
            level of risk perception for HIV infection and risk-reducing practices are
            prerequisites to the depletion of this HIV infection reservoir.

            Objective:
            To determine risk-reducing behaviors for HIV infection among sexually
            active adolescents

            Design:
            Cross-sectional descriptive study

            Setting:
            Maternity and emergency gynecological wards of Kenyatta National
            Hospital

            Subjects:
            Post abortion and postpartum single adolescents

            Results:
            Adolescents who knew of existence of HIV infection were 89.0%, but only
            63% knew of sexual route of transmission and 36.2% knew about mother
            to child transmission. On preventive behavior, use of condoms was the
            most commonly known (52.7%) while voluntary counseling and testing
            and antiretroviral treatment for PMTCT as HIV prevention strategies
            were known by 19.5% and 4.1% respectively. Ever use of condoms was
            37.0%. Only 57.5% perceived themselves as at risk of HIV infection and
            only 52.1% perceived their sex partners as being at risk of HIV infection.
            Age was not an important determinant of adoption of risk-reducing
            behavior. However, education at the level of high school and above was


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                   Adolescent Reproductive Health: 2005 -2008

            associated with higher frequency of knowledge of HIV status of partner
            (p<0.05), use of condoms (p<0.01), use of condoms at coitarche (p<0.05).
            Whereas perception of no risk for HIV infection was significantly
            associated with greater frequency of knowledge of self and sex partner’s
            HIV satus (<0.05 p<0.005 respectively), perception of being at risk of HIV
            infection was associated with significantly higher frequency of use of
            condoms at coitarche (58.4%, p<0.001) and ever rejection of coitus unless
            the partner’s HIV status is known(83.9%, p<0.001).

            Conclusion:
            Knowledge on transmission and on risk-reducing behavior is low, and so
            is the level of practice of risk-reducing behaviors and risk-perception for
            HIV infection. However, education and self-risk perception for HIV
            infection are associated with increased practice of risk-reducing behavior.
            It is therefore recommended that programs should be designed to
            address this need for pre-adolescence and adolescence active provision of
            factual information that would lead to enhanced knowledge, self-riks
            perception for HIV infection and risk-reducing practices for HIV infection


Youth Reproductive Health and HIV/AIDS Programs in Kenya.
Author:     Jennifer Liku1, Jane Schueller2, Garrett Hubbard2, John McWilliam1

Source:     Family Health International (FHI), Nairobi, Kenya; 2YouthNet, ARL
            Family Health International, P.O. Box 38835- 00623, Nairobi, Kenya
            E-mail: jliku@fhi.or.ke

Abstract:   Background:
            Young people in Kenya today face severe threats to their health and well-
            being. They also have an uphill struggle to stay in school, postpone
            marriage and childbearing, find gainful employment, and remain free of
            sexually transmitted infections (STIs), including HIV and other social
            vices such as substance abuse. Although most young people have heard
            about HIV/AIDS, many still do not know how to prevent it and do not
            believe they could be at risk. Those who possess information about
            reproductive health (RH) and HIV/AIDS often do not protect themselves,
            because they lack adequate decision-making skills, social support, or the
            ability to adopt safer sexual behaviors.

            In August/September 2005, FHI conducted an assessment of Youth
            Reproductive Health and HIV/AIDS Programs in Kenya in order to
            provide USAID/Kenya, the Government of Kenya, other stakeholders in
            Kenya, with a comprehensive list of Youth Serving Organizations (YSOs),
            identify youth reproductive health needs and gaps in programming, and
            make recommendations on what actions could be taken.



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                   Adolescent Reproductive Health: 2005 -2008

            Objectives:
            1) Determine how youth RH and HIV/AIDS programs address the needs
            of youth at different life stages and in varying settings; 2) Examine the
            social and cultural contexts in which youth programming takes place;
            and 3) Identify technical and program gaps and challenges.

            Methods:
            Background information on the youth program in Kenya was collected
            and a desk review conducted during the first phase. In phase two, key
            informant interviews (with youth, parents, government representatives
            and other stakeholders) and site visits were carried out to obtain more
            program-oriented information.

            Results:
            There is a wide range of youth serving organizations that offer both
            diverse and complementary services to young people. Disparities in
            geographic coverage, duplication of efforts and inadequate sharing of
            best practices were also noted. In addition, a number of needs/gaps were
            documented including limited adult-youth partnerships, inadequate
            awareness of relevant policies, and lack of social support systems for HIV
            positive youth among others.

            Conclusion:
            There is need for comprehensive youth programming in Kenya in order
            to respond to their RH and HIV/AIDS needs and address the gaps
            identified.


KAP among Nakuru Municipality Primary School pupils on
HIV/AIDS.
Author:     Dr. D.K Ngotho, Senior Lecturer,

Source:     Faculty of Health Sciences Egerton University, P.O Box, 536. Njoro.


Abstract:   Background:
            Despite the establishment of VCT centers for HIV/AIDS, the adolescents
            are a potentially risky group that is not catered for yet sexual practices are
            known to be even among those under the age of 15years.

            Objective:
            To determine knowledge, attitude and practice (KAP) among Nakuru
            Municipality Primary School pupils on HIV/AIDS.

            Design:
            Cross sectional study.


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                   Adolescent Reproductive Health: 2005 -2008



            Methodology:
            A structured and pre-tested questionnaire was administered to a sample
            of 1008 standard seven and eight children out of a population of 1982
            standard seven and eight children within the Nakuru Municipality on
            23rd September 2005.
            This comprised 547 boys and 461 girls.

            Results:
            The majority 892, (88.5%) felt youth should have no sex before marriage.
            Only 140 (13.9%) of the pupils were above the age of 14 years. Of all the
            girls 148, (32.1%) had not had menarche. Only 29 (2.9%) of the pupils had
            not heard of HIV/AIDS. The majority 884(87.7%) had seen people with
            AIDS and the majority of these people were known to them. The pupils
            empathized with them. No pupil had been tested for HIV/AIDS but
            majority 875, (86.8%) said they would disclose their HIV status and
            mainly to their family. About 19% (188 pupils) had had sex. Five girls had
            become pregnant. Of those who had had sex, about 60% had had the sex
            debut below the age of 15 years.
            The majority of the sexual partners were neighbours and the majority had
            had multiple sexual partners. Currently only about 53% had one partner.
            Despite this only 21 (11.2%) pupils were using condoms and irregularly
            at best.

            Recommendation/Conclusion:
            Sexual activity starts very early and the danger of HIV/AIDS among
            these children is real. It is evident that much more needs to be done than
            just passing on knowledge on sexuality in schools. There is an urgent
            need for establishing youth- friendly VCT clinics alongside the already
            existing clinics that are more or less adult oriented.


Determinants of Fertility among Adolescents and Youth 15-24 years
in Kenya.
Author:     Joyce W. Kinaro MA,

Source:     Population Studies (UoN), MPH (Boston, USA) Senior Program Officer,
            Planned Parenthood Federation of America International/Africa Region
            Office

Abstract:   Background:
            Teenage pregnancies are a major problem not only in Kenya but also in
            the whole world. Teenage pregnancies have demographic and health
            implications. Using data of 3506 of adolescents and youth 15-24 years
            from Kenya Demographic and Health Survey of 1998, this study explores
            factors that influence children ever born among this age group.


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                   Adolescent Reproductive Health: 2005 -2008



            Methodology:
            The study used cross tabulation and ordinary multiple regression
            analysis. The results from analysis suggest that the most significant
            influence of fertility among adolescents and youth is age at first birth and
            age itself. Religiosity is not a factor that influences children ever born
            among adolescents and youth 15-24 years.

            Result:
            The analysis among ethnic group indicated that Luo, Luhya and Kalenjin
            have the highest number of adolescents with 2 children and more.
            Education was found to be associated with children ever born. The study
            indicates that among women sampled in Kenya demographic and Health
            Survey of 1998, 52 % of children were born before their mothers were 25
            years. Mean age at first sex is found to be15.87, median at 16.00, mode at
            15 while minimum age at first sex is 8 years.

            Conclusion/Recommendation:
            Results of this study suggest that it is important to commence family life
            education before 8 years and intensify it before 15 years when majority of
            adolescents seem highly sexually active. Further studies are
            recommended to determine most appropriate messages and programs to
            sustain virginity.


Young Schooling Adolescents’ attitudes and Behavior towards
PLHA and Orphans.
Author:     Milka Juma, Margaret Mwaniki, Jane Mbugua, Charity Muturi

Source:     Horizons Program/Population Council, 2Kenya Girl Guides Association
            of Kenya, Family Health International

Abstract:   Background:
            In communities affected by HIV/AIDS young adolescents are
            increasingly providing care to as well as interacting with PLHA and
            orphans. However, little IS known about young adolescents’ attitudes
            and experiences with PLHA and orphans. Such knowledge would help
            programs to design interventions to enhance positive altitudes among
            young adolescents and motivate them to care and support PLHA and
            orphans in their communities.

            Methods:
            Data was collected from 1,348 Girl Guides and 1,384 male and female
            peers at 57 Primary, schools in Rift Valley and Coast provinces of Kenya,
            The survey was conducted using an interviewer assisted self
            administered questionnaire, This analysis focuses on 2148 young


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                   Adolescent Reproductive Health: 2005 -2008

            adolescents aged 10 -14 years, comprised of 1148 Girl Guides and 1040
            peers (548 boys and 492 peers) from 57 primary schools in Rift Valley and
            Coast provinces of Kenya.

            Results:
            No differences were observed by gender of between Girl Guides and their
            peers, Less than half the young adolescents are willing to buy food from a
            person with HIV or AIDS with 44% in Rift valley and 26% in Coast.
            Nearly half (46%) are afraid of people with AIDS with 22% feeling people
            with AIDS should be separated from others. Young people however had
            positive attitudes towards family members and children orphaned by
            AIDS, Eighty-eight percent and 75% are willing to care for a family
            member with AIDS and a child orphaned by AIDS respectively. Thirty-
            eight percent and 36% percent of respondents have played with or helped
            such a child respectively,

            Conclusions:
            Negative perceptions, fear and stigmatizing attitudes towards PLHA are
            prevalent among young people indicating that programs for young
            adolescents should include stigma reduction activities. On the positive
            side, the vast majority are willing to assist a child orphaned by AIDS, and
            many have already done so, Therefore, this type of assistance could easily
            be built into HIV/AIDS programs, for younger youth.


An Evaluation of an alternative Community Based Health
Programme for young people.
Author:     Annabel S. Erulkar, The Population Council Linus Ettyang, Family
            Planning Association of Kenya Charles Onoka, Family Planning
            Association of Kenya Alex Muyonga, Family Planning Association of
            Kenya Fredrick Nyagah, Family Planning Association of Kenya

Source:     The Population Council

Abstract:   Recently, there have been increasing investments in reproductive health
            (RH) programmes for young people in sub-Saharan Africa. Popular
            approaches in adolescent programming have included peer education
            programmes, youth centers, and youth-friendly health services. At the
            same time, there is little systematic evidence of the effectiveness of such
            programmes on young people, including impacts on their RH
            knowledge, sexual behaviour, and health seeking behaviour.

            In 1994, Family Planning Association of Kenya (FP AK) and Population
            Council (PC) initiated an innovative programme of research and
            intervention for young people in Kenya. Based on formative research
            conducted in Kenya, an intervention was designed to improve young


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                   Adolescent Reproductive Health: 2005 -2008

            people's access to both RH information and services. In the "Nyeri Youth
            Health Project", respected and well-known parents in the community are
            trained on adolescent reproductive health issues and advocacy. These
            parent motivators, referred to as "Friends of Youth" (FOYs), work in their
            own communities to educate both adolescents and other parents on
            reproductive health, and to encourage dialogue between them. In
            addition to the FOYs, FPAK trained a network of local doctors and
            medical officers from the private sector who provide youth-friendly
            reproductive health services to young people. Youth are referred to these
            providers by FOY s with a coupon, which entitles them to service at
            subsidized cost. This intervention was designed after an initial period of
            formative, qualitative research among adolescents and parents in Nyeri,
            and is consistent with Kikuyu traditions where parents assigned young
            parents - mutiri and atiri - to give guidance on sexually related issues.

            A quasi-experimental design was used to evaluate the impact of the
            three-year intervention. Baseline and end line surveys were conducted in
            both experimental and control sites. At end line, additional questions
            were added to measure exposure to the program. This paper describes
            experiences in implementing the "Nyeri Youth Health Project," and
            highlights the extent and nature of impact


The correlation between parents' and their adolescents' attitudes
toward the role of men and women in the society: The Case of
Central Kenya.
Author:     Linus Ettyang, Charles Onoka, Alex Muyonga, Fredrick Nyagah,
            Annabel S. Erulkar, (All of FPAK)

Source:     The Population Council

Abstract:   If parent's attitudes are predictors of adolescents attitudes towards the
            role of men and women in the society, what other factors helps to
            understand adolescents' attitudes toward the role of men and women in
            the society?
            This paper seeks to establish whether or not there is relationship between
            parents' and their adolescents' views on the gender roles in the society.
            The paper will explores other factors including adolescents' age, level of
            education, whether or not adolescents have had romantic relationships
            with persons of the opposite sex as well as living arrangements.

            The data used in the analysis is on 601 parents/guardians of l, 865
            adolescents interviewed in both Nyeri and Nyuhururu Municipalities.
            The sub-sample includes only those parents/guardians whose
            adolescents were between 10 and 14 years. Deliberate attempts were



                                        89
                   Adolescent Reproductive Health: 2005 -2008

            made to ask the parents/guardians similar questions as the adolescents in
            order to facilitate comparison.


Expanding Livelihood options among Adolescents through
Integrated Savings, Credit and Credit Programs: The experience of
K-REP Development Agency.
Authors:    Arimand Banu Khan, Annabel S. Erulkar, Ann Gathuku,

Source:     Population Council, K-Rep Development Agency


Abstract:   Currently, most interventions targeting adolescents in Kenya are limited
            to either the education or health sectors. Yet, unemployment and lack of
            livelihood opportunities and skills are often chief concerns among young
            people and their parents. To date, few programs exist that explore the
            expansion of young people’s livelihood options as a means to both
            alleviate poverty and as strategy to promote a healthy and safe transition
            to adulthood.

            In an effort to bridge this gap, in 1998, the Population Council, and K-Rep
            Development Agency (KDA), a micro-finance research and development
            organization in Kenya established a two-year pilot project entitled "Tap
            and Reposition Youth (TRY) Savings and Credit Scheme for Adolescent
            Girls". The objective was to improve the understanding of savings and
            credit programs in expanding livelihood opportunities for adolescent
            girls. TRY targeted out of ¬school adolescent girls and young women
            aged between 16-22, who were not employed in the formal sector, and
            who were residing in low income and slum areas of Nairobi. The project
            provided participants with access to credit, savings services and training
            in basic business and life skills including reproductive health. Over 200
            girls and young women participated in the project and received training,
            credit and savings services.

            In November 2000, Population Council conducted an endline survey
            among participants as well as dropouts from the program. In addition,
            qualitative data was collected through focus groups and longitudinal
            studies of a few selected participants. Findings revealed a significant
            demand for credit and savings among adolescents and that the group
            based lending methodology (with a few modifications) is, appropriate for
            bringing adolescent girls together and delivering credit and savings
            services. The experience of the pilot project demonstrated that such
            initiatives, if carefully designed and implemented, could be successful.




                                        90
                   Adolescent Reproductive Health: 2005 -2008

            Building on lessons from phase one, Population Council and KDA have
            entered into a second phase. This phase will scale up the intervention
            among adolescent girls in Nairobi, and pilot test savings and micro-credit
            schemes among boys in Nairobi as well as young people living in rural
            areas. The project also seeks to measure the impact of the project on
            adolescents' livelihoods, household and individual economics, sexual and
            reproductive health behavior, and social interactions and mobility. This
            paper will outline experiences and lessons learned in pilot testing a
            livelihoods initiative for adolescents in Kenya as well as describe some of
            the findings from qualitative studies associated with the project.


How Marriage changes Girls’ lives: Married Adolescents in Kenya.
Author:     Annabel S. Erulkar, Linus Ettyang, Charles Onoka, Alex Muyonga,
            Fredrick Nyagah,

Source:     The Population Council, Family Planning Association of Kenya

Abstract:   While there has been increased research and programmatic attention to
            adolescents, the attention has been focused largely on the unmarried,
            with little or no attention paid to young people who are married during
            their adolescent years. The lack of attention has resulted, in part, because
            once young people are married, they enter the social category of adult, no
            matter what their age. In marriage, they are presumed to carry the same
            status and rights as adults, an assumption that may be false. Girls in sub-
            Saharan Africa are most likely to marry at an early age, with median age
            at first marriage being 19 or below in 13 of 16 sub-Saharan African
            countries reviewed in a recent survey (Singh and Samara, 1996). Marriage
            has been described to have a significant impact on the quality of a girl's
            life, yet little research has focused on the way that early marriage changes
            young peoples' lives (Mensch, et aI, 1998).

            This paper draws on a representative, population-based study of over
            3000 adolescents in Central Province, Kenya. The paper describes the
            experience of marriage during adolescence for young women in Kenya
            and compares married girls in the sample with unmarried. First,
            descriptive analysis is presented on the nature and experience of
            adolescent marriages. Then, comparative analysis will explore differences
            between girls who have been married during their adolescent years -
            before age twenty - and girls who finished their adolescence without
            being married. Girls are compared on several levels, including
            educational attainment and reasons for leaving school, work and
            livelihoods, time use, mobility within the community, as well as sexual
            behaviour and family planning use. Finally, girls' own perceptions of the
            marriage experience will be examined. The findings have powerful



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                   Adolescent Reproductive Health: 2005 -2008

            programmatic and policy implications for this largely neglected group of
            young people.


Condoms: Attitudes, Use and Distribution among young people in
Western Kenya.
Author:     Maureen Kuyoh, Paul Feldblum, Julius Munyao, Michael Welsh, Lorie
            Broomhall

Source:     Family Health International. Nairobi, Kenya and North Carolina, USA

Abstract:   Introduction:
            Prior to implementing a controlled trial comparing different means of
            condom promotion, we conducted formative research among adolescents
            and young adults in western Kenya. We aimed to identify key
            determinants of and obstacles to condom use; uncover attitudes and
            beliefs that must be addressed in our intervention trial; gain an enhanced
            understanding of the operation of the Ministry of Health/German
            Technical Cooperation Reproductive Health community-based youth
            program; and Inform the development of a youth counselor training
            program, and o1her Information, education and communication
            materials.

            Methods:
            We used multiple data collection methods In 6 locations of Bondo,
            Kakamega and Vihiga districts; participant observations of the structure
            of the youth program, key informant and in-depth interviews with youth
            service providers and their clients; rapid street survey among, young
            people; focus group discussions (FGDs) with youth counselors and their
            clients; and direct observations of youth counselors during outreach
            activities. For this presentation, we focus on results from the rapid survey
            data (N=180), the FGDs (15 with youth counselors and 24 with clients),
            and in-depth interviews (34 with key informants and 36 with clients).

            Results:
            In the rapid survey, we enrolled young men and women age 15-24 years
            old. Educational level of the respondents W8r& equally divided between
            primary and secondary education; 23% were still in school. 82% were
            never married, and 81% were sexually experienced. FGDs with youth
            counselors and their clients revealed that poverty was a major
            contributing factor in early sexual debut and continued sexual activity
            especially among gifts. Knowledge of condom was high but use uneven,
            46% had ever used male condoms (more males than females) and ~"
            reported current condom use. We found that the GTZ youth counselor
            program is generally well received by the communities and the
            counselors achieve 8 certain prestige with their role. One third of


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                   Adolescent Reproductive Health: 2005 -2008

            respondents had received services from a youth counselor, mostly
            HIVJS11 counseling and information, and one in six sought STI services
            in the past year. YCS distribute large numbers of condoms, but myths
            about and negative perceptions of condoms persist, as does shame about
            STls and reluctance to seek treatment.

            Conclusions:
            The youth counselor program is a reliable and credible source of
            condoms and information on reproductive health for young people in
            parts of westem Kenya. The program Is viewed positively by most
            interviewees, and is being expanded into new districts. 'There are barriers
            to condom use related to rumors, myths1md the spontaneous nature of
            sex among young people.


Scaling up an Adolescent Reproductive Health and HIV Prevention
Project in Kenya.
Author:     Nzoya Munguti, Ian Askew, Rick Homan. Caroline Njue1, Eva Muthuri

Source:     FRONTIERS Population Council, Nairobi, Kenya, Family Health
            International, North Carolina, USA, Program for Appropriate Technology
            in Health (PATH), Nairobi Kenya

Abstract:   Introduction:
            The Kenya Adolescent Reproductive Health Program (ARHP) is based on
            a pilot project that was implemented between 1999 and 2003 by the
            FRONTIERS Program in collaboration with the Ministries of Education,
            Science and Technology (MOEST); Health (MOH) and; Gender, Sports,
            Culture and Social Services (MGSCSSS). The goal of the project was to
            address the concerns of the youth by making existing services more
            accessible and by providing young people with reproductive health
            information and skills. Following the successful implementation of the
            project, a cost analysis was conducted to estimate the additional financial
            resources required by the Ministries to expand the initiative from current
            levels of coverage. This presentation focuses on the costing elements and
            the additional resources required and challenges faced when taking the
            initiative to scale.

            Methods:
            Information on resource use was gathered from the two pilot districts of
            Western Kenya covering a period of 8 months. The assessment of costs
            was conducted from the perspective of the MOEST and MGSCSSS. Only
            direct costs such as materials/supplies, transport, accommodation and
            allowances were considered, Costs were assessed for expanding the
            package within the pilot districts and moving to new districts previously




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                       Adolescent Reproductive Health: 2005 -2008

                not covered. Annual costs were allocated per school and per location to
                inform the budget process within the target Ministries.

                Result:
                To introduce the initiative in districts previously not covered would
                require the MOEST to increase it's per school recurrent budget allocation
                (non-wage) by about 6% during the first year of expansion while the
                MGSCSSS would require to increase its budgetary allocations per location
                by about 569% (six times). However, to expand the initiative to cover
                more schools and locations within the pilot sites would exert less
                pressure on the Ministries budgets representing an increment of 2.4% and
                286% in per school and per location allocations during the first year of
                expansion. Efforts to rearrange the, existing resources to meet this
                requirement are constrained by a number of factors that include limited
                resources and weak linkage between planning and budgetary process.
                The latter limits the ability of districts to plan and execute new activities
                not covered in the budgets, a process which requires months of intense
                lobbying to meet budget timelines.


                Conclusions:
                The project has demonstrated that even when an initiative is financially
                affordable the process of re-organizing existing resources to meet this
                additional requirement is constrained; by. Poor linkage between the
                planning and budget process at both national and local
                levels, This could be improved by giving districts mandate to develop
                action plans and budgets that are flexible to accommodate emerging local
                needs.


Coercive First Sex among Adolescent Females in Sub-Saharan
Africa: Prevalence and Context.
Author:         Johannes John-Langba,

Source:         African Population and Health Research Center, Kenya

Abstract:       Background and Objectives:
                Sexual coercion that includes sexual intercourse has increasingly been
                drawing the attention of reproductive health researchers due to its
                connection to demographic and health outcomes of interest including
                STls and unintended pregnancy. Using a unique set of data collected in
                20032004 in Burkina Faso, Ghana, Malawi, and Uganda with young
                people, we comparatively examine:
               Coercive sex experiences
               The circumstances under which coercive sexual experiences take place;
                and


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           Adolescent Reproductive Health: 2005 -2008


   Social vulnerability to unwanted sexual intercourse.

    Methodology:
    Fifty-five FGDs; over 100 in-depth interviews and a nationally-
    representative household survey with approximately 5,000 respondents
    in each country on sexual and reproductive health were conducted with
    male and female adolescents.

    Findings:
    The most prevalent forms of coercion enunciated by the female
    respondents in all four countries were force, pressure from money or
    gifts, passive acceptance, being talked into having sex/pressure, and
    deception. While alcohol and drugs were named in the FGDs as ways that
    males coerce females into sex, this was not reported in the IDls.
    Data from the surveys show that among 12-19 year old females, the
    percent who said they were "not willing at all" to have sexual intercourse
    at sexual debut was15 percent in Burkina Faso, 24 percent in Uganda, 30
    percent in Ghana and 38 percent in Malawi. Surprisingly, age difference
    with the partner did not seem to be correlated with the probability of
    experiencing an unwanted sexual debut. Logistic regression was used to
    estimate the odds for being "not willing at all" at sexual debut among
    female adolescents aged 12-19 years in the four countries. Different
    patterns regarding when sex was unwilling emerged across the study
    sites with the most robust finding being that all females were significantly
    more likely to be coerced when their first sex partner was a casual
    acquaintance than when the partner was a boyfriend or husband.

    Conclusion:
    Sexual coercion is one of the many forms of violence against young
    people in number of African societies and reflects underlying structural
    factors that contribute to the oppression and exploitation of women in the
    region. By using a mixed methods approach, this study advances our
    understanding of the context of sexual coercion at sexual debut among
    young people in the countries where the study took place. Non-
    consensual sex needs to be put on the sexual and reproductive health and
    rights agenda as part of the process of protecting the next generation.




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