Transcript AIDS Action Clubs: Improving Adolescent Reproductive

AIDS Action Clubs: Improving Adolescent Reproductive
Health in Zimbabwe
By
Clarence S. Hall, DrPH, Dorothy E. Nairne, PhD, Gift Malunga, MS, and
William O. Fleming, MSPH
A Presentation
at the
131st Annual Meeting of the American Public Health Association
San Francisco, California
November 18, 2003
Africare
Africare House
440 R Street, NW
Washington, DC 20001
202-462-3614, [email protected]
The Context

Population:
11,900,000
44% under 15 years of age
36% between the ages of 10 and 24 years
68% live in rural areas
 Economy:
Per Capita GNP: $520 (Malawi--$190; South Africa--$1360;
Zambia $320
Inflation: Over 100%
Increasing Poverty
Poor Micro-economic Performance
 Food shortages, malnutrition and hunger
 Teens:
Very High Unemployment
Lack of Recreational Outlets
Vulnerable to Risky Behavior and Crime
The Problem

HIV/AIDS Prevalence: 33%

Deaths Per Week: Nearly 2000

PLWAs: 2 million
Women: 1.2 million
Children: 240,000

Surge in STD & TB Infections

Life expectancy decrease from 60 to 40 years—35 years by
2020 if trend continues
 Adolescents:
35% of youth will be orphans by 2010
Higher Infection rate among females than males
Increasing number of youth “heads of households”
High rate of teenage pregnancies
Government’s Response

5-Year HIV/AIDS Strategy targeting adolescents

Multisectoral approach including civil society

Life skills and HIV/AIDS Action Program (1992)

In-school AIDS Action Clubs
Baseline Survey


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Target Area: Mashonaland Central Province
Two of Seven Districts (Bindura & Mt. Darwin)
Total Population: 856,736
47% under 15
35.5% between 10-24 years
Methodology:
KAPC
Individual Interviews and Focus Groups
In and out-of-school youth
Teachers
Parents
Sampling and Size:
Multi-stage cluster sampling procedure
used to select wards, enumerating areas
and individuals
209/230 adolescents and young adults
Selected Findings

First sexual encounter occurred between 9 and 15 years.

Sexual experience most common among men (82%) than women (18%).

Young adults aged 20-24 were more likely than younger ones aged 15-19
to have had sexual experience (89 percent vs. 11 percent respectively).

Primary school adolescents who had friends with boy/girl friends as well
as friends who have had sexual intercourse were 26% and 37%
respectively.

Seventy percent of secondary students who had sex stated that
experimentation was the main reason.

Parents were very suspicious of HIV/AIDS school programs. Most
believed their children were being taught how to have sex and the syllabus
encourages children to experiment.
Adolescent Reproductive
Health Initiative (ARHI)

Purpose: To effectively reach adolescents (10-24 years) with
reproductive health
information and promote positive attitudes and behaviour.

Objectives:
1.
Provide relevant adolescent reproductive health information and/or
technical assistance to all participating community-based initiatives
(CBIs);
Provide reproductive health messages to 100,000 adolescents and
young people;
Disseminate CBI best practices to at least 30 community groups and
indigenous non-governmental organizations (NGOs);
Increase planning and management skills of 25 CBIs; and
Prepare a minimum of 10 participating CBIs to be self-sustaining
through income generating and other fundraising activities.
2.
3.
4.
5.

Countries: Malawi, South Africa, Zambia & Zimbabwe

Sponsors: Bill & Melinda Gates Foundation
AIDS Action Clubs

Goal: To effectively reach adolescents (10 – 25 years) and teachers
with reproductive health information and promote positive attitudes and
behavior change through the establishment of AIDS Action Clubs.

Objectives:
1.
Instill in-depth knowledge, promote effective communication, positive
attitudes and behaviors related to HIV/AIDS and STD;
Equip adolescents with life skills to enable them to make informed
choices;
Facilitate accessibility to reproductive health services;
Empower adolescents with self-reliant skills through income generating
activities (IGAs); and
Establish and strengthen links with relevant organizations, ministries
and other stakeholders.
2.
3.
4.
5.
Major Components

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Formation of AIDS Action Clubs led by teacher (30-80 students)
Training of adolescents, CBI leaders, school administrators,
teachers, parents and health providers.
Production of IEC materials (pamphlets, songs, drama, t-shirts,
and caps).
Introduction and Support for IGAs (15% invested in club and
HIV/AIDS activities).
Youth Friendly Corners.
National Media Events.
National Competitions (theater groups, music groups, and essays)
Volunteer activities in the community to support orphans and
people living with AIDS.
Establish linkages to networks and social services that support
AIDS Action Clubs activities.
ARHI Evaluation

Independent Consultant

Objectives:
1.
Determine whether or not Africare met program objectives;
Measure the impact of key outcomes; and
Document improvements in health outcomes.
2.
3.

Review of periodic reports, project documents, health facilities
records.

Individual interviews (Action Club members, staff, school
administrators, stakeholders and implementing partners).

Focus group discussions (teachers, community leaders,
parents, health providers, in-and out-of-school youth).
AIDS Action Clubs Results

Behavior and Health Impact
1.
Increasing openness to talking about HIV/AIDS.
2.
Increasing numbers of youth accessing services through the youthfriendly services.
3.
Reduction in sexual partners among both male and females.
4.
Self-reported abstinence and delay of onset of sexual activity.
5.
More compassionate treatment of PLWAs.
6.
Increased support of clubs and HIV/AIDS programs by school
administrators.
7.
Increasing parental involvement in AIDS Action Clubs.
8.
Less students hanging around rural shopping centers.
AIDS Action Clubs Results
Con’t

Other Effects of ARHI
1.
Over 2 million youth reached in the four participating countries.
2.
One hundred forty-four (144) CBIs participated.
3.
Youth involved in ARHI more confident and assertive as their
knowledge of reproductive health and interaction with
communities increased.
4.
Increased retention of girls after the first 2 years of secondary
school.
5.
Youth friendly training of health providers instituted through
ARHI.
6.
Communities that have participated in the training are more
engaged and taking more interest in HIV/AIDS awareness.
Lessons Learned

Successful AIDS Action Clubs must have the full support and
encouragement of the school administration.

The viability of income generating activities questionable due to
the very poor state of the economy---frequent price changes and
short supply of inputs.

Out-of-school youth are very much in need of sources of income.
Most are unemployed and engage in deviant behavior.

Out-of-school youth should be given the option of remaining as
members of the AIDS Action Clubs after leaving secondary
school. They are a great source of leadership and a resource for
training activities.
Conclusions/Recommendations

AIDS Action Clubs and their combination of strategies are effective
approaches to reaching adolescents and youth at risk for HIV and other
sexually transmitted diseases.

Scaling up of this best practice should be considered by other countries in
the region with similar challenges and issues among adolescents.

Theatre groups are highly effective HIV/AIDS outreach activities in rural
and peri-urban areas where radio, print or television coverage is limited.

More attention should be given to making condoms accessible to sexually
active adolescents.

Indicators for adolescents in the Demographic Health Surveys (DHS)
should be revised to include age at first intercourse, number of sexual
partners, increased condom use, rate of unwanted pregnancies, HIV and
STD infection rates.