International Public Health Commons^™

Addressing Sexual Violence And Hiv Risk Among Married Adolescent Girls In Rural Nyanza, Kenya, Chi-Chi Undie

Poverty, Gender, and Youth

Married adolescent girls form a large segment of Kenyan youth, yet they are largely overlooked by researchers and program managers concerned with the lives of adolescents. In settings such as Nyanza Province, Kenya, rates of HIV infection are extremely high, and evidence is increasing in some settings that girls who are married are much more likely to be infected, compared with their unmarried sexually active counterparts. Research indicates that the risk of HIV infection following forced sex is likely higher than following consensual sex. Finding ways to tackle sexual violence and HIV infection simultaneously has therefore become a major public …

Biruh Tesfa Provides Domestic Workers, Orphans, And Migrants In Urban Ethiopia With Social Support, Hiv Education, And Skills, Annabel Erulkar, Belaynesh Semunegus, Gebeyehu Mekonnen

Poverty, Gender, and Youth

In Ethiopia, the HIV epidemic is increasingly urban and female. An estimated 7.7 percent of the urban population in Ethiopia is HIV-positive, compared with less than 1 percent of the rural population. Nationally, the female-to-male ratio of HIV infection is 3 to 2. Girls who migrate from rural to urban areas may be less protected, more vulnerable to violence and sexual abuse, and less equipped to avoid abusive situations—all of which may increase HIV risk. The Biruh Tesfa (“Bright Future”) program addresses the social isolation of out-of-school adolescent girls aged 10–19, including rural-to-urban migrants, domestic workers, and orphans. Using a …

Biruh Tesfa ('Bright Future') Program Provides Domestic Workers, Orphans And Migrants In Urban Ethiopia With Social Support, Hiv Education And Skills, Annabel Erulkar, Herma Gebru, Gebeyehu Mekonnen

Poverty, Gender, and Youth

This brief provides details about the Biruh Tesfa (“Bright Future”) program in Ethiopia established by the former Ethiopia Ministry of Youth and Sports (currently Ministry of Women, Children and Youth) with technical assistance from the Population Council. Biruh Tesfa aims to address the social isolation of adolescent girls by building their social capital and participation and giving them access to basic literacy, life skills, and HIV and reproductive health information. This evaluation of Biruh Tesfa shows early success and the program, which was initially pilot-tested in the low-income area of Mercato in Addis Ababa, was ultimately expanded to four urban …

First Generation Of Gender And Hiv Programs: Seeking Clarity And Synergy, Judith Bruce, Nicole Haberland, Amy Joyce, Eva Roca, Tobey Nelson Sapiano

Poverty, Gender, and Youth

In the past decade, there have been expanding resources to address the underlying gender dimensions of HIV. This has been particularly urgent in sub-Saharan Africa as the female-to-male infection ratios in young populations has reached 3 to 1 and sometimes above. The phrase “gender and HIV” has become commonplace yet does not provide any specific guidance as to target audiences, content, or measurable results. It can include everything from microcredit programs for HIV-positive women, to workplace programs seeking to change negative male norms, to efforts to increase respect for diverse sexual and gender identities. This review, conducted by the Population …

Biruh Tesfa Procure Aux Employées Domestiques, Aux Orphelines Et Aux Immigrantes Des Zones Urbaines Éthiopiennes Une Assistance Sociale, Une Formation Sur Le Vih Ainsi Qu'un Programme De Développement Des Compétences, Annabel Erulkar, Belaynesh Semunegus, Gebeyehu Mekonnen

Poverty, Gender, and Youth

En Éthiopie, l'épidémie de VIH se révèle de plus importante en milieu urbaine et chez la population féminine. On estime que 7,7% de la population urbaine d'Éthiopie est séropositive, par rapport à moins de 1% de la population rurale. À l'échelle nationale, le rapport femme/homme en termes d'infection par le VIH est de 3 à 2. Il est possible que les filles qui migrent depuis les zones rurales vers les milieux urbains soient moins protégées, plus vulnérables à la violence et aux agressions sexuelles, et également moins bien équipées pour se prémunir contre ces situations d’abus (toutes susceptibles d’accroître le …

The Prevention And Management Of Hiv And Sexual And Gender-Based Violence: Responding To The Needs Of Survivors And Those-At-Risk, Sarah Raifman, Ian Askew, Sajeda Amin, Jill Keesbury, Saiqa Mullick, Judith A. Diers, Meiwita P. Budiharsana, Chi-Chi Undie, Mary Zama, Mantshi Menziwa, Sherry Hutchinson, Naomi Rutenberg

Reproductive Health

The Population Council seeks to understand the social, economic, political, and physical context of risks for sexual and gender-based violence and HIV. Among the top priorities of Council research are supporting and evaluating efforts to prevent violence and HIV, including creating safe spaces for adolescent girls, and working with men and boys to change gender norms within the community; and comprehensively responding to the needs of survivors (including those who are HIV-infected) by strengthening health systems and integrating services. The purpose of this guide is to provide practical guidance on the steps necessary to establish and strengthen sexual violence (SV) …

Focus On Male Youths In Addressing Alcohol And Drug Abuse Risk In The Context Of Hiv Prevention Among Young People, Population Council

Reproductive Health

Research evidence shows that people who abuse alcohol are more likely to engage in behavior that puts them at risk of HIV infection, including having unprotected sex. In 2010, the Population Council’s APHIA II Operations Research Project collaborated with the Support for Addictions Prevention and Treatment in Africa Centre in Kenya on research to identify factors associated with alcohol and drug use among out-of-school youth in Kibera, to identify specific factors contributing to HIV risk, and to assess the impact of an intervention to link youths with an alcohol and drug abuse problem to counseling and rehabilitation services. A key …

Integrating Alcohol Risk Reduction Into Htc Services, Population Council

Reproductive Health

This brief describes how screening for alcohol abuse and hosting long-term support groups through HIV testing and counseling centers (HTC) is one way to decrease high-risk sexual and alcohol behaviors among people who have tested for HIV. Findings from program activities funded by Population Council, Liverpool VCT and Support for Addiction Prevention and Treatment in Africa Center (SAPTA) found that screening HTC clients for alcohol abuse and referral to active support and counseling services is feasible. Follow up using SMS is also recommended. However, the lack of a control group in this study may hinder drawing direct causality between the …

Using Youth-Friendly Communication Approaches To Communicate Hiv/Aids With Young People Is Feasible And Acceptable, Population Council

Reproductive Health

HIV remains a major concern in Kenya among all segments of the population, including adolescents. New ways of delivering HIV information and services are therefore needed, especially to reach young people and encourage them to take up counselling and testing to know their sero-status. The APHIA II Operations Research Project collaborated with the Ministry of Education, Well Told Story, and the National AIDS and STD Control Programme to implement a project to enhance communication in schools about HIV and create demand for early counseling and testing. The project also sought to create a supportive environment in schools for young people …

Prevention With Positives: How Do We Reach Them In The Community?, Avina Sarna, Jerry Okal, Stanley Luchters, Nzioki King'ola, Scott Geibel

HIV and AIDS

In the past, HIV prevention efforts have focused primarily on developing risk-reduction interventions for those presumed to be HIV-negative and therefore at risk of becoming infected with HIV. In recognition of the need for prevention among people living with HIV (PLHIV), programs have been initiated in Africa, but primarily in clinical settings for those who are on antiretroviral therapy (ART). There is little knowledge about how to reach those PLHIV not on ART, and therefore not in regular contact with the health system or with effective prevention messages. This diagnostic study aimed to address the gap in information on how …

Monitoring And Evaluation Of The Emergency Plan Progress (Meepp): End-Of-Project Evaluation, Sam Kalibala

HIV and AIDS

This report evaluates the scope of the Monitoring and Evaluation of the Emergency Plan Progress (MEEPP) and the lessons learned from the project in Uganda, which aims to improve availability and quality of PEPFAR data.

Meserete Hiwot ("Base Of Life"): Supporting Married Adolescents With Hiv Prevention And Reproductive Health In Rural Ethiopia, Annabel Erulkar, Aragaw Lamesgin, Eunice N. Muthengi

Poverty, Gender, and Youth

To better understand the lives of adolescents in rural Ethiopia, researchers conducted a survey of adolescents in Amhara Region. The study found that many girls experienced early, unwanted arranged marriages, resulting in early unwanted sexual initiation and pregnancy, as well as social isolation in new marital homes. Based on the findings of this study, the Population Council and the Ethiopian Ministry of Youth and Sports created a program to support girls who are married early, with a view to increasing their social networks, improving their ability to protect themselves from HIV/AIDS, and supporting their reproductive health. This program brief reports …

Understanding Adolescent Girls' Protection Strategies Against Hiv: An Exploratory Study In Urban Lusaka, Joseph Simbaya, Martha Brady, Allison Stone, Maya Vaughan-Smith

Poverty, Gender, and Youth

This report provides a descriptive analysis of how adolescent girls and young women in Lusaka, Zambia construct notions of risk and safety, perceive reproductive health and HIV risks, and identify behaviors and actions they can take to protect themselves. Findings suggests stronger social support networks, improved access to the range of reproductive health services and products, and safe and supportive spaces for girls would be beneficial. The report points to several areas for potential program attention, including more focused attention on the structural and environmental drivers of girls’ vulnerability.

Commercial Sex Workers In Five Ethiopian Cities: A Baseline Survey For Usaid Targeted Hiv Prevention Program For Most-At-Risk Populations, Woldemariam Girma, Annabel Erulkar

HIV and AIDS

This report presents findings from a baseline survey of commercial sex workers (CSWs) that was undertaken in five Ethiopian cities. 2,050 CSWs were interviewed for the survey. CSW were disproportionally young and came from extremely disadvantaged backgrounds. Most respondents also cited negative working standards from another profession, or family responsibilities as reasons leading to sex work. Condom use was very high but use may be inconsistent or over-reported and should be studied further. Findings also propose additional advocacy for positive peer support groups, more HIV testing for at-risk populations, and addressing violence among CSWs and other Ethiopian women.

The Overlooked Epidemic: Addressing Hiv Prevention And Treatment Among Men Who Have Sex With Men In Sub-Saharan Africa, National Aids Control Council Of Kenya, Population Council

HIV and AIDS

Globally, less than 1 out of 20 men who have sex with men (MSM) has access to HIV prevention and care. UNAIDS has estimated that at least 5 to 10 percent of all HIV infections globally occur through male-to-male sexual activity. In spite of the high risk of HIV infection and evidence of extensive sexual networks, national HIV programs in Africa have been slow to address MSM in prevention and treatment efforts. To address these issues, the Population Council and the National AIDS Control Council of Kenya convened a meeting on May 14–15, 2008. The goals of the meeting were …

Adolescent Girls In Urban Ethiopia: Vulnerability And Opportunity, Abebaw Ferede, Annabel Erulkar

Poverty, Gender, and Youth

In 2008, the Population Council undertook a survey of out-of-school, adolescent girls (aged 10 to 19) in slum areas of urban Ethiopia—a population that is highly vulnerable to HIV infection. The survey serves as a baseline for HIV prevention programs designed and implemented jointly by the Ministry of Youth and Sports, Regional Bureaus of Youth and Sports, and the Population Council. This study provided valuable direction for programmers interested in supporting adolescent girls, particularly early adolescent (10 to 14 years old) and out-of-school girls who are highly vulnerable and in need of dedicated attention. Special efforts are needed to support …

Is It Feasible To Integrate Alcohol-Related Risk Reduction Counseling Into Vct Services? Findings From Kenya, Caroline Mackenzie, Karusa Kiragu, George Odingo, Rukia Yassin, Peter Shikuku, Patrick Angala, Nduku Kilonzo, William Sinkele, Melania Akinyi

HIV and AIDS

In Kenya, an estimated 30 percent of men report to be alcohol users which may be fueling the HIV pandemic, due to its association with high-risk sexual behavior and reduced inhibitions. The Population Council’s Horizons program collaborated on a study to improve screening of clients for alcohol use, provision of feedback of screening results, and referrals to care and support during voluntary testing and counseling (VCT) for HIV. Overall, the results indicate that it is feasible to integrate alcohol risk reduction counseling into VCT, and that it is generally accepted by providers and clients alike. This study therefore supports the …

Promoting Gender Equity As A Strategy To Reduce Hiv Risk And Gender-Based Violence Among Young Men In India, Ravi K. Verma, Julie Pulerwitz, Vaishali Sharma Mahendra, Sujata Khandekar, A.K. Singh, S.S. Das, Sunil Mehra, Anita Nura, Gary Barker

HIV and AIDS

The Horizons Program, CORO for Literacy, MAMTA, and Instituto Promundo developed, piloted, and scaled-up a behavior-change intervention in India to examine the effectiveness of interventions to improve young men’s attitudes toward gender roles and sexual relationships, and to reduce HIV risk behaviors and partner violence. The results of this study suggest that young men became less supportive of inequitable gender norms after participating in the interventions. Similarly, there were significant improvements among intervention participants in key outcome indicators, including condom use, partner communication, partner violence, and attitudes toward PLHIV. To maximize the chances of long-term sustainability of these positive changes, …

Catalyzing Personal And Social Change Around Gender, Sexuality, And Hiv: Impact Evaluation Of Puntos De Encuentro´S Communication Strategy In Nicaragua, Irela Solorzano, Amy Bank, Rodolfo Pena, Henry Espinoza, Mary Ellsberg, Julie Pulerwitz

HIV and AIDS

Somos Diferentes, Somos Iguales (SDSI) is a communication for social change strategy whose objective is to prevent future HIV infections in Nicaragua, through mass communication actions that include educational entertainment programs, strengthening of local capacity, and the development of alliances within the communities. This report presents the results of an interinstitutional evaluation to explore the impact of SDSI on gender equity, stigma reduction, personalization of risk perception, knowledge and use of services, interpersonal communication, HIV prevention practices, and individual and collective effectiveness for HIV prevention. The impact evaluation showed that the SDSI strategy made a great contribution in key aspects …

Propiciando Cambio Personal Y Social Alrededor Del Género, Sexualidad Y Vih: Evaluación De Impacto De La Estrategia De Comunicación De Puntos De Encuentro En Nicaragua, Irela Solorzano, Amy Bank, Rodolfo Pena, Henry Espinoza, Mary Ellsberg, Julie Pulerwitz

HIV and AIDS

Somos Diferentes, Somos Iguales (SDSI) is a communication for social change strategy whose objective is to prevent future HIV infections in Nicaragua, through mass communication actions that include educational entertainment programs, strengthening of local capacity, and the development of alliances within the communities. This report presents the results of an interinstitutional evaluation to explore the impact of SDSI on gender equity, stigma reduction, personalization of risk perception, knowledge and use of services, interpersonal communication, HIV prevention practices, and individual and collective effectiveness for HIV prevention. The impact evaluation showed that the SDSI strategy made a great contribution in key aspects …

Assessment Of Risk Factors For Hiv Infection In Female Sex Workers And Men Who Have Sex With Men In Ciudad Del Este, Paraguay, Magda Chinaglia, Waimar Tun, Maeve Mello, Magdalena Insfran, Juan Diaz

HIV and AIDS

Research conducted by the Population Council/Brazil, supported by the USAID-funded Horizons Project, documents findings from a study in Paraguay among men who have sex with men and female sex workers to estimate HIV and syphilis prevalence; examine knowledge, attitudes, and risk behaviors related to HIV and STIs; and describe the contextual and behavioral factors influencing HIV and STI transmission. Findings provide guidance to the development of HIV and STI prevention and care interventions and further operations research to test strategies and interventions to reduce the spread of HIV and STIs in these groups.

School As A Workplace In Kenya: Evaluation Of The Teachers Matter Hiv/Aids Project, Karusa Kiragu, Caroline Mackenzie, Jennifer Weiss, Murungaru Kimani, Debbie Gachuhi

HIV and AIDS

The Horizons program of the Population Council embarked on an operations research initiative in Kenya to test the feasibility of implementing a teacher-centered workplace program based in schools. The study was conducted in partnership with the Ministry of Education, the Kenya Institute of Education, the Teachers Service Commission, and UNICEF. Called Teachers Matter, the project’s main audience was primary and secondary school teachers. The purpose of the research was to assess whether such a program would improve teachers’ HIV-related knowledge, attitudes, and behaviors; increase the proportion of teachers seeking voluntary testing and counseling; and enhance their ability to cope with …

Migration/Mobility And Vulnerability To Hiv Among Male Migrant Workers: Andhra Pradesh 2007-08, Niranjan Saggurti, Anrudh K. Jain, Saumya Ramarao, Hanimi Reddy Modugu, Ajay Kumar Singh, Suvakanta N. Swain, Ravi K. Verma

HIV and AIDS

The Population Council, in collaboration with TNS India Pvt. Ltd., undertook a study in Andhra Pradesh, India, to examine the patterns of male migration and its links with HIV risk. The goal was to provide evidence to inform the design and implementation of HIV interventions for male migrant workers. The study documented the volume and patterns of mobility, including the social dynamics within the contract system that employs these men as laborers, and the sexual risk behaviors and addictive behaviors of male migrants. The results suggest a predominance of interdistrict movements of men within Andhra Pradesh with a strong positive …

Migration/Mobility And Vulnerability To Hiv Among Male Migrant Workers: Karnataka 2007-08, Shiva S. Halli, Raluca Buzdugan, Niranjan Saggurti, Ravi K. Verma, Stephen Moses, James Blanchard, Anrudh K. Jain, Saumya Ramarao, Ajay Kumar Singh, Suvakanta N. Swain

HIV and AIDS

The present study was undertaken by the Population Council and the Karnataka Health Promotion Trust to study the patterns and factors driving migration among men and the extent to which they engage in high-risk activities associated with HIV. The specific objectives of the study were: to understand the patterns and factors driving the migration of men seeking work in the state of Karnataka; to describe the characteristics of vulnerable subpopulations among migrant men; and to examine the determinants of high-risk sexual behavior among the subpopulations of migrant men, with an emphasis on their mobility as one possible factor. Results suggest …

Migration/Mobility And Vulnerability To Hiv Among Male Migrant Workers: Maharashtra 2007-08, K. Anil Kumar, Shalini Bharat, Niranjan Saggurti, Ravi K. Verma, Anrudh K. Jain, Saumya Ramarao, Kanchan Mukherjee, Ajay Kumar Singh, Suvakanta N. Swain

HIV and AIDS

HIV prevalence in Maharashtra is one of the highest among Indian states. The specific objectives of this study were: to understand the patterns and drivers of migration/mobility of men who migrate for the purpose of work in the state of Maharashtra; to describe the characteristics of vulnerable subpopulations among migrant men; and to examine the determinants of high-risk sexual behavior among the subpopulations of migrant men with particular emphasis on the role of mobility in determining the sexual risk behavior. The present study clearly demonstrates that these male migrants, married or otherwise, retain strong connectivity to their native villages, but …

Patterns Of Migration/Mobility And Hiv Risk Among Female Sex Workers: Andhra Pradesh 2007-08, Niranjan Saggurti, Ravi K. Verma, Hanimi Reddy Modugu, Saumya Ramarao, Ajay Kumar Singh, Vaishali Sharma Mahendra, Anrudh K. Jain

HIV and AIDS

This report presents the findings from the female sex workers study in Andhra Pradesh, India implemented by TNS India Private Limited and the Population Council in New Delhi. Specifically the study was undertaken to assess the volume and patterns of mobility of female sex workers; to describe the characteristics of mobile female sex workers; and too examine the determinants of HIV risk among female sex workers, with particular emphasis on mobility-related characteristics. The report concludes that targeting such highly mobile female sex workers in intervention programs requires a comprehensive understanding of their places of solicitation and sex. Female sex workers …

Patterns Of Migration/Mobility And Hiv Risk Among Female Sex Workers: Maharashtra 2007-08, Niranjan Saggurti, Vaishali Sharma Mahendra, Rajendra Singh, Saumya Ramarao, Suvakanta N. Swain, Ajay Kumar Singh, Anrudh K. Jain, Ravi K. Verma

HIV and AIDS

According to recent estimates, Maharashtra, India recorded high HIV prevalence among female sex workers, however there is a dearth of research documenting the migration patterns of sex workers and the linkages between their mobility and vulnerability to HIV. This Population Council study attempts to answer some of the questions on mobility and migration of female sex workers in Maharashtra as they relate to the HIV epidemic. Findings show an association between degree of mobility and the indicators of HIV risk such as consistent condom use with different types of partners, STI symptoms reported, sexual violence, and self-perception of risk for …

Informed Consent In Hiv Prevention Trials: Highlights From An International Workshop, Population Council

HIV and AIDS

Brief adapted from the report of a workshop co-hosted by the Population Council and Family Health International in May 2005. The brief focuses specifically on tools and strategies presented at the workshop that are being used in HIV-prevention trials to facilitate informed consent, explain difficult concepts, and assess comprehension among trial participants. Illustrative examples from completed and ongoing trials are highlighted. This brief will be useful for an audience of local researchers, advocates, and clinical trial staff.

Consentement Éclairé Dans Les Essais De Prévention Du Vih: Points Saillants D'Un Atelier International, Population Council

HIV and AIDS

Résumé adapté du rapport de l'atelier co-organisé par le Population Council et Family Health International en mai 2005. Le résumé se concentre spécifiquement sur les outils et stratégies présentés lors de l'atelier qui sont utilisés dans les essais de prévention du VIH pour faciliter le consentement éclairé, expliquer concepts difficiles et évaluer la compréhension parmi les participants à l'essai. Des exemples illustratifs d'essais achevés et en cours sont mis en évidence. Ce résumé sera utile à un public de chercheurs locaux, d'avocats et de membres du personnel des essais cliniques.

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Brief adapted from the report of a workshop co-hosted …

Engaging Communities In Supporting Hiv Prevention And Adherence To Antiretroviral Therapy In Zambia, Fiona Samuels, Joseph Simbaya, Avina Sarna, Scott Geibel, Phillimon Ndubani, Jolly Kamwanga

HIV and AIDS

In Zambia, the prevalence of HIV is estimated at 16 percent among 15–49-year-olds. This brief presents findings from an operations research study to access the outcomes of the Antiretroviral Community Education and Referral (ACER) project in two urban areas in Zambia—Lusaka and Ndola. The ACER project was implemented by the International HIV/AIDS Alliance, based in England, and the Alliance’s Zambia office, in conjunction with local Zambian partners. Launched in mid-2004, the two-year project built on previous formative research that examined knowledge and attitudes about prevention and treatment. The research was conducted by the Institute of Eco­nomic and Social Research in …