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Preventing Hiv/Aids in Young People: A 92-4-120938-0_FM_a The World Health Organization was established in 1948 as a specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health, a respon- sibility that it fulfils in part through its extensive programme of publications. The Organization seeks through its publications to support national health strategies and address the most pressing public health concerns of populations around the world. To respond to the needs of Member States at all levels of development, WHO pub- lishes practical manuals, handbooks and training material for specific categories of health workers; internationally applicable guidelines and standards; reviews and anal- yses of health policies, programmes and research; and state-of-the-art consensus reports that offer technical advice and recommendations for decision-makers. These books are closely tied to the Organization’s priority activities, encompassing disease prevention and control, the development of equitable health systems based on pri- mary health care, and health promotion for individuals and communities. Progress towards better health for all also demands the global dissemination and exchange of information that draws on the knowledge and experience of all WHO’s Member coun- tries and the collaboration of world leaders in public health and the biomedical sciences. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures the broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease throughout the world, WHO’s books contribute to achieving the Organization’s principal objective — the attainment by all people of the highest possible level of health. The WHO Technical Report Series makes available the findings of various interna- tional groups of experts that provide WHO with the latest scientific and technical advice on a broad range of medical and public health subjects. Members of such expert groups serve without remuneration in their personal capacities rather than as representatives of governments or other bodies; their views do not necessarily reflect the decisions or the stated policy of WHO. An annual subscription to this series, comprising about six such reports, costs CHF 168.00/US$ 106.00 (CHF 128.40/ US$ 115.00 in developing countries). For further information, please contact: WHO Press, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland (tel. +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]; order on line: http://www.who.int/bookorders). 92-4-120938-0_FM_b 92-4-120938-0_FM_i WHO Technical Report Series 938 PREVENTING HIV/AIDS IN YOUNG PEOPLE A SYSTEMATIC REVIEW OF THE EVIDENCE FROM DEVELOPING COUNTRIES UNAIDS Inter-agency Task Team on Young People Edited by David A. Ross, Bruce Dick & Jane Ferguson 92-4-120938-0_FM_ii WHO Library Cataloguing-in-Publication Data Preventing HIV/AIDS in young people : a systematic review of the evidence from developing countries : UNAIDS interagency task team on HIV and young people / editors: David Ross, Bruce Dick, Jane Ferguson. (WHO technical report series ; no. 938) 1.HIV infections - prevention and control. 2.Acquired immunodeficiency syndrome - prevention and control. 3.Adolescent. 4.Sex education. 5.Program evaluation. 6.Developing countries. I.Ross, David A. II.Dick, Bruce. III.Ferguson, Jane. IV.World Health Organization. V.Series. ISBN 92 4 120938 0 (NLM classification: WC 503.6) ISBN 978 92 4 120938 0 ISSN 0512-3054 ©World Health Organization2006 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication. Typeset in India Printed in Geneva 92-4-120938-0_FM_iii Table of contents 1. Introduction and rationale Bruce Dick, Jane Ferguson, & David A. Ross 1 1.1 Background 1 1.2 Young people, HIV/AIDS and the global goals 2 1.3 Priorities for action 4 1.4 Objectives and limitations 5 1.5 Process and methodology 7 1.6 Scope and limitations of the data 9 1.7 Challenges in interpreting the findings and follow up 10 2. Young people: the centre of the HIV epidemic Roeland Monasch & Mary Mahy 15 2.1 Introduction 16 2.2 Data and methods 17 2.3 Types of epidemics 17 2.4 Progress towards UNGASS commitments 24 2.5 Limitations of the data 34 2.6 Conclusions 35 3. Overview of effective and promising interventions to prevent HIV infection Judith D. Auerbach, Richard J. Hayes, & Sonia M. Kandathil 43 3.1 Introduction 43 3.2 Interventions to change behaviour 44 3.3 Biomedical interventions: evaluating technologies 51 3.4 Social interventions 58 3.5 Behavioural and social issues in developing and implementing interventions 61 3.6 Conclusion 63 4. The weight of evidence: a method for assessing the strength of evidence on the effectiveness of HIV prevention interventions among young people David A. Ross, Danny Wight, Gary Dowsett, Anne Buvé, & Angela I.N. Obasi 79 4.1 Introduction 80 4.2 Types of interventions and evidence on effectiveness 81 4.3 Thresholds for strength of evidence needed for widespread implementation 84 4.4 What information do policy-makers need? 88 4.5 Assessing the quality of an intervention 91 4.6 Types of evidence and their relative weight 92 4.7 Conclusion 98 iii 92-4-120938-0_FM_iv 5.The effectiveness of sex education and HIV education interventions in schools in developing countries Douglas Kirby,Angela Obasi,&B.A. Laris 103 5.1Introduction and background 104 5.2Methods 111 5.3Findings 117 5.4Discussion and recommendations 142 6.Review of the evidence for interventions to increase young people’s use of health services in developing countries Bruce Dick,Jane Ferguson,Venkatraman Chandra-Mouli, Loretta Brabin,Subidita Chatterjee,&David A. Ross 151 6.1Introduction 152 6.2Methods 153 6.3Findings 158 6.4Discussion 191 6.5Conclusions 199 7.The effectiveness of mass media in changing HIV/AIDS- related behaviour among young people in developing countries Jane T. Bertrand&Rebecca Anhang 205 7.1Introduction 206 7.2Methods 207 7.3Findings 226 7.4Discussion 236 8.The effectiveness of community interventions targeting HIV and AIDS prevention at young people in developing countries Eleanor Maticka-Tyndale&Chris Brouillard-Coyle 243 8.1Introduction 244 8.2Methods 244 8.3Findings 247 8.4Go, ready, steady, do not go 276 8.5Conclusions 281 9.Achieving the global goals on HIV among young people most at risk in developing countries: young sex workers, injecting drug users and menwho have sex with men Oliver Hoffmann,Tania Boler,&Bruce Dick 287 9.1Introduction 288 9.2Methods 289 9.3Findings 293 9.4Discussion 306 iv 92-4-120938-0_FM_v 10. Conclusions and recommendations Jane Ferguson, Bruce Dick, & David A. Ross 317 10.1 Introduction 317 10.2 The road to “Steady, Ready, Go” 319 10.3 Results 322 10.4 Discussion 328 10.5 Recommendations 335 Glossary 343 Acknowledgements 347 v 92-4-120938-0_FM_vi 92-4-120938-0_CH01_1 1. Introduction and rationale Bruce Dick,a Jane Ferguson,a & David A. Rossb 1.1 Background In 1995, WHO in collaboration with UNFPA and UNICEF convened a study group on programming for adolescent health and development. One of the products of this group was a joint technical report publication on Program- ming for adolescent health and development (1). The report synthesized the evidence for the effectiveness of interventions for adolescent health and de- velopment, and it set the direction and provided the conceptual framework for much of the programming for young people’s health and development that has taken place since its publication (2–6). The challenges posed by HIV have progressed inexorably during the past decade, especially for young people in developing countries. (Young people are defined in this report as those aged 10–24 years; this group combines adolescents – aged 10–19 years – and youth – aged 15–24 years). At the same time, many lessons have been learnt about developing and implementing programmes for young people’s health and development, including pro- grammes to prevent the spread of HIV.
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