M ARCH 1 997 COMMUNICATING with ADOLESCENTS about AIDS EXPERIENCE from EASTERN and SO UTHERN AFRICA R UTH NOU ATI AND WAMBUI K IAI ' IONAL DEVELOPM ENT RESEAR CH CENTRE COMMUNICATING with ADOLESCENTS about AIDS EXPERIENCE from EASTERN and SOUTHERN AFRlCA RUTH NOUATI AND WAMBUI KIAI INTERNATIONAL DEVELOPMENT RESEARCH CENTRE Ottawa • Cairo • Dakar •Johannesburg • Montevideo Nairobi • New Delhi • Singapore Published by the International Development Research Centre PO Box 8500, Ottawa, ON, Canada KIG 3H9 March 1997 Legal deposit: 1st quarter 1997 National Library of Canada ISBN 0-88936-832-5 The views expressed are those of the author(s) and do not necessarily represent those of the International Development Research Centre. Unless otherwise stated, copyright for material in this report is held by the authors. Mention of a proprietary name does not constitute endorsement of the prod­ uct and is given only for information. A microfiche edition is available. The catalogue of IDRC Books may be consulted online. Gopher: gopher.idrc.ca Web: http://www.idrc.ca This book may be consulted online at http://www.idrc.ca/books/focus.html TABLE OF CONTENTS Page Chapter 1 INTRODUCTION Chapter 2 STUDY OBJECTIVES AND RESEARCH METHODOLOGY 33 2.1 Study Objectives 33 2.2 Study Methodology 33 Chapter 3 RESULTS OF THE RAPID ASSESSMENT OF THE PROGRAMS TARGETING ADOLESCENTS AND YOUTHS. 43 3.1 Types of HIV/AIDS communication programs targeted at adolescents. 43 3.2 Summary of a rapid process evaluation of the programs that were visited. 44 3.3 Cultural considerations in HIV/AIDS prevention programs 50 3.4 Overview of HIV/AIDS behavioral programs targeted at adolescents. 65 3.5 Overview of media efforts in HIV/AIDS communication to adolescents. 78 3.6 Government efforts to prevent HIV/AIDS among adolescents 92 3.7 Donor assistance to programs on HIV/AIDS communication to adolescents. 99 Table of Contents Page Chapter 4 DESCRIPTION OF SPECIFIC PROGRAMS THAT WERE ASSESSED FOR THEIR HIV/AIDS COMMUNICATION TO ADOLESCENTS 107 4.1 Formai school based programs 107 4.2 Informai school based programs 120 4.3 Religious based community programs 130 4.4 Secular based community programs 149 4.5 Mass media initiatives targeted at adolescents for HIV/AIDS prevention 165 4.6 Donor agency programs in HIV/AIDS prevention 186 Chapter 5 METHODS FOR EVALUATING PROGRAMS AIMED AT PREVENTING HIV/AIDS/STDS AMONG ADOLESCENTS 203 Chapter 6 CONCLUSION 219 Chapter 7 APPENDIX 227 LIST OF ABBREVIATIONS 233 FOREWORD The 20th century has made dramatic advances in the contrai of infectious diseases. Public water treatment, and sewage disposai systems have dra­ matically reduced water borne diseases that ravaged the world for many cen­ turies. The success of these public health interventions is not dependent on human behaviour. For example, if the only source of water is clean treated water, then individuals will drink clean water without making any extra ef­ fort to clean the water. There have also been very major advances in the field of bio-medicine and many new therapies have evolved. Immunizations services have significantly reduced morbidity and mortality from illnesses such as measles, diphtheria, tetanus, poliomyelitis, and disease like smallpox has been eradicated. Today, the world is faced with the global pandemic of HIV/AIDS that has evolved rapidly in the past 15 years since it was first described. The disease is now described as endemic in sub Saharan Africa and the ~idemic is rap­ idly evolving in the Asian continent. The HIV/AIDS epidemic has had a significantly negative impact on individual families through loss of loved ones, communities by increasing the burden of caring for the ill, and coun­ tries through reduced productivity. The HIV/AIDS epidemic presents special challenges and new frontiers for public health interventions and research. AIDS is a sexually transmitted disease that has clearly demonstrated how the interaction of human behavi­ our with a micro-organism can result in an epidemic of untold proportions. The ugly diseases of yore centuries such as tuberculosis, typhoid and dysen­ tery are once again rearing the heads in the wake of the AIDS epidemic. The adverse effects of this epidemic are most pronounced in underdeveloped countries, and within poor communities in developed countries. As we look forward to the 21st century, the human population is reminded that even in an age where drugs to treat most ailments are available, human behaviour and individuals aspirations are critical in the contrai of disease. Factors that affect human and social behaviour, such as poverty, discrimina- Foreword tian, and disenfranchisement have ta be addressed on a global basis if HIV/AIDS epidemic is ta be controlled. HIV/AIDS has revealed the gaps in the understanding of haw human behaviour is motivated and how it can be changed. Research in this field will be one of the most important frontiers of scientific development as we go into the next century. In this publication we present a review of some of the programs that are spe­ cifically targeting youth with HIV/AIDS prevention activities in the coun­ tries of Malawi, Zambia, Uganda and Kenya. These countries are at the epicentre of the HIV/AIDS epidemic. They are also some of the poorest countries in the world and are grappling with major problems of poverty, internai human population displacement, and refugees. This publication presents the results of a rapid assessment of HIV/AIDS communications ta the youth. The first half of the publication reviews the current status of the HIV/AIDS epidemic in the region and its impact on the youth, and traces the main themes in HIV/AIDS prevention and com­ munication activities with the youth. The second half of the publication de­ scribes the specific programs that were visited in the region. The study documents the types of activities that are being carried out, the difficulties being experienced and some of the successes. There is a need for impact evaluation of all these programs in order ta determine which method really reduces the incidence of STDS/HIV/AIDS among the youth. We have in­ cluded a guide for evaluating HIV/AIDS prevention programs among the youth. This guide can be adapted for other types of programs. This publication records the staries of men and women in Eastern Africa, who have tremendous commitment ta the work they do even with minimal resources, because they have a vision for the youth of the African continent. It is a story of innovation, creativity, determination and partnership be­ tween adults and youth, communities and governments, countries, aid agencies and NGOs. We hope ta convey the excitement the we experienced, and tremendous hope that exists for the future of the youth in the continent. It is our hope that the readers will be motivated and recognize that there is a lot that can be achieved even with minimal resources. ACKNOWLEDGMENTS We acknowledge the encouragement and support of Sandra Baldwin, Regional Representative East and Southern Africa (JDRC) and Jacques Habib Sy, Program Officer for initiating this project and providing encouragement ta com­ plete it. Jane Thairu, Janet Musia, James Ochieng, Jacinta Achieng for faithfu.lly typing this docu­ ment. This work was made possible by IDRC (Interna­ tional Development Research Corporation, Ot­ tawa, Canada). Njeri Muhoro and Dr. Dorothy Mbori-Ngacha for carefu.lly editing this text. DEDICATION To the youth of East and Southern Africa who are our "Window of Hope". CHAPTER 1 r!Jl. INTRODUCTION The HIV/ AIDS epidemic has been termed as one of the greatest challenges facing humanity in the 20th century. In the current situation, where a cure continues to elude researchers, and where infection results in death, curbing the spread of HIV/ AIDS through prevention has been the focus of efforts all over the world. Epidemiology of HIV/AIDS Acquired immunodefficiency syndrome (AIDS) was first described among homo­ sexual men in the USA in 1981 ( WHO/GPA, 1994). The etiology of AIDS was identified to be the HIV virus in 1983. Since then the epidemic has spread all over the world and has become a major pandemic. lt is speculated that extensive spread of the HIV virus began in the late 70's in western Europe and sub Saharan Africa. Based on this assumption and epidemiological data, three epidemiologi­ cal patterns have been described (Chin). Pattern 1 disease found in the Americas, Australia, and Western Europe is characterized by homosexual and intravenous drug use (IVDU) transmission and a male:female ratio of 10:1. Pattern 2 countries which include sub-Saharan Africa and Caribbean are characterized by heterosex­ ual transmission with a male:female ratio of 1:1. Pattern 3 countries include countries in the Asian continent which became exposed to the HIV epidemic in the mid 80' s. Pattern 3 countries arre characterized by heterosexual transmissions and IVDU as the main modes of transmission (Chin, WHO/GPA 1994). By 1994 WHO estimated that over 17 million people had acquired HIV AIDS world wide. Table 1 (Page 2) illustrates the estimated distribution of HIV infections in the world. Methods of HIV/AIDS data collection In the mid 80's WHO/GPA program began National AIDS Control Programs in the member countries and provided funding and technical support services. Methods of documenting the unfolding AIDS epidemic were developed and in­ cluded a system of sentine! surveillance and case reports. To facilitate case reports, an AIDS case definition was developed to be used as an epidemiological tool in situations where HIV serological testing was not avail- 1 Introduction Table 1: Estimated global distribution of total HIV infections in adults from late 1970's /early SO's to mid 1994. Region Estimated Total HIV Infections Sub Saharan Africa 10,000,000 South & South -East Asia 2,500,000 Latin America 2,000,000 North America 1,000,000 North Africa and Middle East 100,000 Western Europe 50,000 Eastern Europe & Central Asia 50,000 East Asia and Pacifie 50,000 Australia 25,000 able.