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Strengthening the Evidence Base on Youth Sexual and Reproductive Strengthening the Evidence Base on Youth Sexual and Reproductive Health and Rights in the Eastern Caribbean CAROLINE ALLEN AND KAMILAH B. THOMAS-PURCELL for the United Nations Population Fund (UNFPA) ------------- 1 1 4 0.s 5670 0.s List of tables 7 List of figures 11 STRENGTHENING THE EVIDENCE BASE ON YOUTH List of abbreviations 13 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS IN Executive Summary 14 THE EASTERN CARIBBEAN Introduction 32 24 CAROLINE ALLEN AND KAMILAH B. THOMAS-PURCELL for UNFPA, the United Nations Population Fund The study ‘Strengthening the Evidence Base on Youth Sexual and 4 Reproductive Health and Rights in the Eastern Caribbean’ was 567 CONTENTS. written by Consultants Caroline Allen and Kamilah B. Thomas-Purcell with technical and financial support from UNFPA, the United Nations Population Fund Sub-Regional Office for the Caribbean. Unless -0 12 3 4 5 6789-567 89 234 otherwise attributed, the findings, interpretations and conclusions 1 expressed here-in are solely those of the consultant who prepared the work and do not necessarily reflect the views of UNFPA. References included in this document to other publications, reports, studies, websites should not be interpreted as an endorsement of the content by UNFPA. © 2012 0 UNFPA Sub-Regional Office for0 the Caribbean/Barbados UN House Marine Gardens 1. Methods 33 Hastings 1.1 Desk review 33 Christ Church 1.2 Stakeholder interviews 34 Tel: 246 467 6000 / 6137 1.3 Focus group discussions with young people 35 Fax: 246 435 3243 FGD research questions 36 Web site: http://caribbean.unfpa.org/public/ Sample selection 36 Research ethics 37 Data collection instruments 39 12 3Creative 4 Direction: 5 solo+studio (Barbados) Data management 39 6 5 0.s 0.s Selection and training of FGD facilitators 40 2.6 Biological risk factors 92 Data analysis 40 2.7 Social, economic and cultural factors 94 Limitations 40 influencing sexual behaviour 2.7.1 Gender-related norms and transactional sex 95 2. Desk review: Youth sexual and reproductive health 42 2.7.2 “Clustering” of risk factors among a minority of youth 97 in the Eastern Caribbean 2.7.3 Gender-based violence and child sexual abuse 98 2.1 HIV 43 2.7.4 Drug and alcohol use 105 2.1.1 Dominica 44 2.7.5 Stigma and discrimination 109 2.1.2 Grenada 47 2.7.6 Vulnerable populations and discrimination 112 2.1.3 St. Lucia 48 2.7.7 HIV knowledge among youth 114 2.1.4 St. Vincent and the Grenadines 50 2.8 Major findings from the desk review 115 2.2 Sexually transmitted infections 51 2.2.1 Gonorrhoea 51 3. Stakeholder interviews: Responses to youth 118 2.2.2 Syphilis 52 sexual and reproductive health in the Eastern Caribbean 2.2.3 STI surveillance in the Caribbean 53 3.1 Teenage pregnancy 119 2.2.4 Self-reported STI symptoms 57 3.2 Peer education and youth friendly health services 119 2.3 Pregnancy and maternal health in women and girls 59 3.3 Vocational education and the needs of 121 under 25 out-of-school youth 2.3.1 Dominica 60 3.4 Health and Family Life Education 122 2.3.2 Grenada 62 3.5 Gender-based violence 123 2.3.3 St. Lucia 62 3.6 Vulnerable populations 123 2.3.4 St. Vincent and the Grenadines 65 3.8 Government responses to HIV 125 2.4 Social and economic status of youth 66 12 3 4 - 2.4.1 Dominica 66 4. Focus group discussions with young people 128 2.4.2 Grenada 69 4.1 Characteristics of participants in the FGDs 129 2.4.3 St. Lucia 71 4.2 What are the factors that drive youth vulnerability, 131 2.4.4 St. Vincent and the Grenadines 73 or protect youth from HIV/STI/ teen pregnancy? 2.4.5 General findings on the social and economic status 76 4.2.1 Adolescence as a time of freedom and opportunity 131 of youth in project countries 4.2.2 Island life 134 0 2.5 Risk and protective factors for sexual and 77 4.2.3 Economic constraints 135 reproductive health among young people 4.2.4 Rules and restrictions 135 2.5.1 Behavioural factors 77 4.2.5 Safety and violence 136 2.5.2 Age at sexual debut and early sexual experiences 78 4.2.6 Perceptions of youth power and self-determination 139 2.5.3 Number of partners 87 4.2.6.1 Government 139 2.5.4 Condom use 90 4.2.6.2 Parents 140 4 5 0.snjrahkl 0.s 0.s 0.s 4.2.6.3 School 142 5.1.3 Improve access to biological prevention methods 198 4.2.6.4 Relationships 142 5.1.4 Improve support for teenage mothers 198 4.2.6.5 Religious leaders 144 5.1.5 Prioritize employment of youth 199 4.2.7 Who has more power, youth in-school or 144 5.1.6 Violence against women and children 199 out-of-school? 5.1.7 Support for key institutions: parents, 199 4.2.8 Sex and relationship education 148 schools and churches 4.2.8.1 School-based sex and relationship education 148 5.1.8 HIV knowledge, stigma and discrimination 199 4.2.8.2 Education from parents on sex and relationships 152 4.2.8.3 Finding out about sex and relationships from 156 Appendices 200 peers, the internet and reading Appendix 1: Research project information document 200 4.3 Why and how does youth vulnerability occur? 156 Appendix 2: Introductory verbal statement for 204 Why and how are some youth protected? stakeholder interviews 4.3.1 Influences on abstinence among young people 157 Appendix 3: Guide for stakeholder interviews 206 4.3.1.1 Types of young people who have not had sex 157 Appendix 4: Informed consent form for parents or 209 4.3.2 Do young people age 15-17 have choices about 163 guardians whether to have sex? Influences on sexual activity Appendix 5: Points to be covered in the introductory 210 4.3.2.1 Male control and the obligation to have sex 163 verbal statement for focus group discussions with 4.3.2.3 Peer pressure, materialism and transactional sex 169 young people 4.3.2.4 Popular culture and pornography 172 Appendix 6: Informed assent form for focus 212 4.3.3 Condom use 174 group discussion participants age 15 to 17 4.3.4 Drug and alcohol use 177 Appendix 7: Self-completion questionnaire for focus 213 4.3.5 Genital hygiene practices 179 group discussion participants 4.3.5.1 Vaginal practices 179 Appendix 8: Focus group discussion topic guide 214 4.3.5.2 Male circumcision 182 Appendix 9: Agencies represented in stakeholder 218 4.3.5.3 Genital hygiene as an STI prevention strategy 184 interviews 4.3.6 Teenage pregnancy 185 4.3.7 Health service responses 187 References 222 4.4 How would young people like things to change 191 to reduce their vulnerabilities? LIST OF TABLES Table 1: Dominica: Number of reported HIV cases 45 5. Discussion and recommendations 196 among 10-24-year olds, 2000 to 2010 5.1 Recommendations 197 5.1.1 Greater involvement and greater respect for 197 Table 2: Percentage of highly-at-risk populations 46 young people (MSM) who are HIV infected (percent positive based 5.1.2 Greater confidentiality 198 on two antibody-positive specimens), Dominica 2010 6 7 njrahkl 0.s 0.s 0.s Table 3: Grenada: Cumulative HIV and AIDS cases 47 Table 12: Dominica and Grenada: Percentage of young 84 and HIV Deaths from 1984 to 2008 women and men aged 15-24 who have had sexual intercourse before the age of 15, 2011 Table 4: Grenada: New HIV diagnoses by age group, 2009 48 Table 13: Dominica: Age difference with first sex 86 Table 5: Numbers of reported cases of sexually transmitted 55 partner, 2011 infection in Dominica, Grenada, St. Lucia and St. Vincent and the Grenadines, 2006 to 2009 Table 14: Number of non-commercial sex partners 87 in the past 12 months: OECS BSS with 15-24-year Table 6: Dominica: Number of reported cases 56 olds, Dominica, Grenada, St. Lucia and St. Vincent of sexually transmitted infection among 10 – 24-year and the Grenadines olds, 2000 to 2010 Table 15: Dominica, Grenada, St. Kitts and Nevis and 88 Table 7: Self reported Sexually Transmitted Infection 57 Antigua and Barbuda: Percentage of women and men Symptoms in the last 12 months, OECS BSS, Dominica, aged 15-49 who have had sexual intercourse with more Grenada, St. Lucia and St. Vincent and the Grenadines than one partner in the past 12 months, 2011 Table 8: Dominica and Grenada: self-reported 59 Table 16: Dominica, Grenada, St. Kitts and Nevis and 89 genital discharge and genital ulcer in the past Antigua and Barbuda: Average number of Sexual Partners 12 months, 2010 in the Last 12 Months, 2011 Table 9: Sexual Behaviours of students aged 13-15 80 Table 17: Condom use with commercial sex partners, 90 years, Global School-based Student Health Survey, OECS BSS, Dominica, Grenada, St. Lucia and St. Vincent Dominica, Grenada, St. Lucia and St. Vincent and and the Grenadines the Grenadines Table 18: Dominica and Grenada: Percentage of men 91 Table 10: Age at first sex, OECS BSS with 15-24-year 82 and women who had more than one partner in the past olds, Dominica, Grenada, St. Lucia and St. Vincent 12 months who used a condom at last sexual intercourse and the Grenadines Table 19: Commercial and transactional sex among 96 Table 11: Age mixing at first sex, OECS BSS with 84 those who had sex in the past 12 months, OECS BSS, 15-24-year olds, Dominica, Grenada, St.
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