Washington, DC — As part of the Global Health Council's Annual Conference, held June 1-4 in Washington, DC, public health experts and practitioners exchanged findings on youth perspectives on AIDS intervention programs in Nigeria and South Africa.
Speaking to the theme of the conference, "Youth & Health: Generation on the Edge," two presenters on the panel, "Taking Stock: Evaluating Youth Interventions in Africa," highlighted the importance of understanding young Africans' attitudes and behaviors towards AIDS intervention programs on June 3, 2004.
"The real important thing is to use this data to tailor programs and adopt programs to be more effective," Audrey Pettifor, deputy director of the Reproductive Health Research Unit of the University of the Witwatersand in Johannesburg, said,
Pettifor presented results from a national survey of 11,904 youths in South Africa that was completed in August 2003. Begun in 1999, this survey is one of the largest of its kind in the world, Pettifor said.
With the goal of determining the efficacy of loveLife, the largest youth-targeted HIV intervention program in South Africa, interviewers asked youths aged 15-24 years old about their sexual behavior, contraceptive use, attitudes concerning HIV, perceived risk of HIV, and awareness, participation and response to loveLife. The questionnaire was translated into nine South African languages. Anonymous HIV testing was administered using Orasure for every respondent, she said.
Researchers found that the HIV prevalence among 15-24 year old South Africans was 10 percent. The report also found that nearly 1 in 4 women aged 20-24 is HIV positive compared to 1 in 14 men of the same age.
"This confirms findings from other surveys concerning the huge gender disparity between young women and men," Pettifor said.
"One of the big challenges for us is that loveLife is a multifaceted program," Pettifor said. "How do you measure exposure, and at what point do you expect exposure to actually have an impact on behavior?"
She outlined several difficulties in determining whether there is a causal relationship between seeing a loveLife billboard to getting tested for HIV. It is difficult to measure "exposure" to loveLife, and how that might be related to youths taking action, she said.
"At the end of the day, any impact we are going to see will be those of the combined efforts of everyone," Pettifor said.
Pettifor said that she and her colleagues hope this survey will be the first of several to come. Ideally, she said, national surveys of youths in South Africa would occur every two years, but this is contingent on adequate financial support.
LoveLife receives major funding from the Kaiser Family Foundation and the Bill and Melinda Gates Foundation.
Joel Mayowa, senior program officer of Youth Action Rangers of Nigeria, a youth-led non-governmental organization based in Lagos, Nigeria, presented results from a questionnaire-survey of twelve Voluntary Counseling/Testing (VCT) and Referral services in Lagos. The objectives of the survey were to measure "youth friendliness" of VCT Centers and elicit reasons for youth reluctance to visit VCT Centers.
The Youth Action Rangers found that administrative procedures were not "friendly" for youth, Mayowa said.
"The location of the visitor centers, the lack of the skill of the service providers, and the cost - these seem to be the major factors in inhibiting the youth from attending these centers, not religious, traditional or moral background issues," Mayowa said.
Eighty percent of offered services charged youth and adults similar fees, he said. Only one of the twelve VCT Centers surveyed consulted young adults in the Center's decision-making process, 58 percent of the service providers reported that none of their staff have been specifically trained to serve youth, two-thirds of the centers did not have guidelines or techniques for staff to use with young clients, and none of the VCT Centers employed peer educators, he said.
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Overall, recurring themes regarding health service provision for youth concerned the lack of privacy, confidentiality, and training on how to communicate with youth at these clinics, he said. Mayowa's presentation concluded that supervision of and sensitization programs for VCT staff are necessary.
Both panel presenters agreed that young Africans' feelings and reactions are a mystery to policy leaders and decision-makers. As loveLife seeks to expand the number of its clinics from 16 to 200 by 2006, surveys such as these are costly and complicated, but feasible and necessary, Pettifor said.
"We found overwhelmingly that young people were actually happy to talk with somebody," she said. "This is the first opportunity that somebody is asking them about anal sex or condom use."
