Science and Success in Developing Countries: Holistic Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections

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Executive Summary [HTML] [PDF]

Program Components

• Comprehensive sexual health program to encourage 1) delayed initiation of sex and 2) reductions in sexual risk-taking behaviors among sexually experienced youth
• Community-designed, culturally consistent program
• Traditional reliance on young parents in the community to guide youth on sexuality-related issues
• Training of young parents to be "Friends of Youth" (FOYs) regarding adolescent sexual health issues and advocacy
• FOYs providing outreach to youth groups
• FOYs providing outreach and advocacy to adults to promote a positive environment for sexual health information and services for youth
• Sex education curriculum entitled Life Planning Skills for Young People in Kenya
• Training of teachers to improve communication with youth
• Training of local doctors, clinicians, and chemists in making sexual health services youth-friendly
• Referral of youth for youth-friendly sexual health services

For Use With

• Urban and rural youth, ages 10 to 24
• In- and out-of-school youth

Evaluation Methodology

• Quasi-experimental evaluation with four intervention locations in the municipality of Nyeri, Kenya, and a comparison municipality, Nyahururu
• Interviewer-administered and self-administered questionnaires at baseline in 1997 and at follow-up in 2001
• Baseline survey of 1,544 randomly selected youth in the intervention and comparison sites; follow-up survey of 1,865 randomly selected youth in intervention and comparison sites

Evaluation Findings

• Increased communication with parents and other adults about sexual health—females
• Delayed initiation of sexual intercourse—males
• Increased abstinence among sexually experienced youth—females
• Reduced number of sex partners—females
• Increased use of condoms—males

Program Description

The Nyeri Youth Health Project is a locally designed reproductive and sexual health program for young people, implemented with the assistance and guidance of the Family Planning Association of Kenya (FPAK) and the Population Council. The objectives of the Project are to delay the onset of sexual intercourse among youth who are not yet sexually active; to prevent sexually experienced youth from suffering negative consequences of sexual activity; and to create a reproductive health information and service environment responsive to the needs of youth.[12,13]

In consonance with Kikuyu traditions, the program relies on young parents, atiri. Specifically, the program trains the atiri to be "friends of youth" (FOYs) and to provide young people with guidance on sexuality-related issues. The community's members select respected and well-known young parents, who are then trained by FPAK. Trainers use Life Planning Skills for Young People in Kenya to improve FOYs' knowledge and skills related to values, community, adolescent development, sexuality, gender roles, relationships, pregnancy, STIs, HIV and AIDS, harmful traditional practices, substance use, children's rights, and advocacy.[12,13]

Trained FOYs conduct activities with existing youth groups and/or form new youth groups; they also work with young people individually. FOYs encourage youth to delay the initiation of sex and encourage sexually experienced youth to reduce sexual risk-taking behaviors. In addition, FOYs work with community adults to encourage positive attitudes and a positive climate within which to address adolescent sexual health issues. Finally, FOYs also work with schools, assisting teachers to better communicate with youth about sexual health. Each FOY is assigned a specific geographic area where about 300 adolescents live. While they are responsible for activities in their own area, they also work cooperatively in pairs or small groups to complement and promote each other's skills. In addition, local doctors, clinicians, and chemists (mostly from the private sector) receive training in providing youth-friendly sexual and reproductive health services. FOYs refer youth in need of sexual health services to these providers.[12,13]

Evaluation Methodology

The Nyeri Youth Health Project comprised activities carried out between 1998 and 2000 in four areas of Nyeri (in which lived approximately 14,000 youth, ages 10 to 24). The quasi-experimental evaluation compared youth living in the project sites with youth in a comparison municipality, Nyahururu. The populations in the intervention and comparison municipalities were similar in terms of ethnic and religious composition, socioeconomic status, and health and education infrastructure. Moreover, Nyahururu is over 100 kilometers from Nyeri, making it unlikely that the Nyeri Youth Health Project affected youth in Nyahururu. Baseline and end-line surveys among youth in intervention and comparison sites permitted an assessment of the Project.[12,13]

In Nyeri, researchers conducted an initial census of all households in the project site. Households were eligible for selection if they had at least one resident age 10 to 24. Following the listing, 100 eligible households were selected per FOY area of operation, using a random number generator. [In Nyahururu, the same practice was followed, except that there were no FOY areas of operation.] In both intervention and comparison sites, one adolescent was interviewed per household. Where there was more than one adolescent per household, the Kish grid was used to randomly select one adolescent for interviewing. For each selected adolescent, interviewers paid up to three visits to the household to locate and interview the youth. In addition, the parent of every fourth selected adolescent was interviewed separately. For adolescents, interviewers used two questionnaires. The longer, more structured, intervieweradministered questionnaire collected data on knowledge, attitudes, behaviors, experiences, and lifestyle. The second, self-administered questionnaire was anonymous and collected information on more sensitive topics, such as sexual experience, use of family planning, and STI history.[12,13]

During the baseline survey in 1997, 1,544 unmarried youth, ages 10 to 24, were interviewed in Nyeri and Nyahururu. At follow-up in 2001, 1,865 youth were interviewed in the two municipalities. At baseline, 87 percent of eligible youth were interviewed and, at follow-up, 90 percent were interviewed. The sample at baseline was slightly younger than at follow-up: at baseline, only 16 to 20 percent of the sample was over age 19; at follow-up, 24 to 30 percent of the sample was over age 19. At baseline, a greater proportion of youth were in school than were in school at follow-up. Comparing respondents, youth in the intervention site were significantly more likely to be Catholic than were youth from the comparison site. Also, at follow-up, male youth from the intervention site were significantly better educated than males from the comparison site. At both baseline and follow-up, school status was a significant predictor of whether youth had initiated sex in the three years prior to the survey: in-school youth were roughly half as likely to have initiated sex as were out-of-school youth. As a result, multivariate analysis controlled for age, socioeconomic status, school status, educational attainment, religion, and whether respondents lived with at least one parent.[12,13]

Outcomes

• Behaviors—
  • Increased communication with parents and other adults about sexual health—Between baseline and follow-up, the proportion of youth in the intervention site reporting conversations with a parent about sexual health topics rose significantly among females from 26 to 37 percent. At the same time, fewer female youth in the comparison site reported conversations with parents about sex (down from 39 to 19 percent). This comparative change in parent-child communication about sexual health issues was statistically significant for female youth. Youth's conversations with adults other than parents increased significantly among both male and female youth in the intervention community from 39 to 47 percent of male youth and from 49 to 57 of female youth while proportions dropped among youth in the comparison community (from 39 to 31 percent of males and from 54 to 26 percent of females).[12]
  • Delayed initiation of sexual intercourse—Between 1997 and 2001, the proportion of male youth in the intervention site who had initiated sex dropped from 34 to 24 percent while it rose from 30 to 33 percent among males in the comparison site. The difference in delay was statistically significant among male youth in the intervention site, versus male youth in the comparison site.[12,13]
  • Increased abstinence among sexually experienced youth—The proportion of sexually experienced youth in the intervention site who reported abstinence from sex in the previous six months rose from 40 to 53 percent while dropping from 39 to 26 percent among females in the comparison site. At follow-up, sexually experienced female youth from the intervention site were three times more likely to abstain from sex as females from the comparison site, a finding that was statistically significant.[12,13]
  • Reduced number of sex partners—The proportion of sexually experienced youth reporting three or more sexual partners in the last three years dropped among females in the intervention site from 14 to five percent while rising from 13 to 30 percent among females in the comparison site. By follow-up, female youth in the intervention site were 90 percent less likely than female youth from the comparison site to have had multiple sexual partners, a statistically significant outcome.[12,13]
  • Increased use of condoms—The proportion of sexually experienced youth from the intervention site reporting condom use at last sex rose among females from 22 to 32 percent and among males from 39 to 45 percent. At the same time, condom use at last sex dropped among youth at the comparison site: among females from 28 to 25 percent and among males from 41 to 16 percent. The difference in condom use was statistically significant for male youth.[12,13]

For More Information, Contact

• Population Council, P.O. Box 17643-00500, Enterprise Road, Nairobi, Kenya; (254-2) 2713480/1/2/3; fax (254-2) 2713479
  
  or
• Family Planning Association of Kenya, P. O. Box 30581, Nairobi, Kenya; 604296; e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it