Promoting Healthier Behavior
Information and education on sexual and reproductive health is critical to adolescents’ development and well-being. Promoting behaviour change is essential to reducing adolescent pregnancy and stemming the HIV/AIDS pandemic.
At the ICPD, countries agreed that “… information and services should be made available to adolescents to help them understand their sexuality and protect them from unwanted pregnancies, sexually transmitted diseases and subsequent risk of infertility. This should be combined with the education of young men to respect women’s self-determination and to share responsibility with women in matters of sexuality and reproduction”.(1)
Programmes to provide information on sexuality also increasingly focus on giving adolescents the skills they need to make the transition to adulthood—and tend to their health needs as adults. Improving young people’s knowledge is easier than helping them develop new skills. Programming is also more time consuming and expensive, as teachers and youth leaders themselves must first learn the skills—and learn how to teach them effectively. But if young people are to be expected to communicate their needs, seek out needed care and make good choices, this investment is critical.
While all young people require information and skills to abstain or stay free of the consequences of unprotected sexual relations and enjoy healthy and positive lifestyles, programmes need to target those who are most vulnerable and at risk.
BEHAVIOUR CHANGE COMMUNICATION The various approaches intended to improve knowledge, skills and attitudes are now often referred to as “behaviour change communication” (BCC). BCC topics for young people include reproductive biology, human development, relationships and feelings, sexuality, communication and negotiation, gender issues, safer sex practices (including abstinence, delay of first sexual encounter and limitation of partners), and methods of protection against pregnancy and STIs including HIV.
Methods of delivering the information can include formal and informal education, drama and folk communications, mass media (including television, radio, newspapers and other print media, and increasingly electronic media), telephone hotlines and interpersonal communications and counselling. Using several of these formats, a single programme can reach different segments of the youth population and reinforce the messages.
BCC activities can generate demand for reproductive health services, ensure that communities accept these services, support young people in using them, publicize their locations and offerings, and reassure young people that they are welcome. Such activities must be sensitive to the different needs of diverse youth populations, particularly to differences between young men and women in knowledge, skills, power and access.
In Zambia, HIV prevalence among adolescents aged 15-19 declined from 28 per cent in 1993 to 15 per cent in 1998. This change is attributed to young people having fewer partners and using condoms more, in response to various behaviour change activities. Supporting young people to abstain and ensuring that those who choose to have sex have access to condoms are both critical to success.
In Brazil, the percentage of adolescents reporting using condoms has grown. In 1994, only 4 per cent said they used a condom in their first sexual encounter. In 1999, nearly half (48 per cent) said they used condoms regularly. The increase has been attributed to greater awareness of STIs and HIV/AIDS, as well as of the hardships related to unwanted pregnancies.(2)
BEHAVIOUR CHANGE AND HIV
REDUCTION IN UGANDA
people have played a significant role in the
reduction of HIV prevalence in Uganda from its peak at around 15 per cent of
adults in 1991 to 5 per cent by 2001. An increase in the age when young people
become sexually active, reductions in casual and commercial sex partners, and
increased condom use all played a part in the decline.
The centrepiece of Uganda’s response,
starting in 1986, was strong political support from President Museveni, and a
multisectoral response that has involved more than 700 government agencies and
NGOs in the fight against HIV/AIDS. Community actions promoted behaviour
change and the empowerment of women and girls, educated in- and out-of-school
youth, and countered discrimination against people living with HIV.
Community-based and face-to-face
communication was key to spreading behaviour change messages. Uganda’s
first voluntary counselling and testing centre was opened in 1990, with follow-up
support provided through post-test clubs open to all who had been tested, regardless
Ugandan youth have significantly
changed their sexual behaviour. In one school district in 1994, more than 60 per
cent of students 13 to 16 years old reported that they were already sexually active. In
2001, the figure was fewer than 5 per cent.
Uganda, which has considerable experience
with education programmes on sexual and reproductive health, hopes to
reach 10 million students with a new curriculum on HIV/AIDS.See Sources
Adolescents report a variety of sources for what they know, or think they know, about sexuality and reproductive health. In many settings, a large proportion of young people seem to rely most on the least reliable sources—other young people or the entertainment media. Young people go to different sources for different kinds of information—the news media can be important sources for information about HIV/AIDS, for example.
In most cases parents are not the primary source of information, although young women may rely on their mothers for information about menstruation and pregnancy risks.(3) Young men rely more on teachers, health care professionals or their friends.
Misperceptions abound, and can result in risky behaviour. For example: “A girl cannot get pregnant the first time she has sex;” “HIV virus is very small and go through the pores in a condom;” “You can tell by looking when someone has HIV/AIDS.”(4)
Studies of young people’s knowledge, attitudes and practice find a mixture of anxiety and ignorance; over-confidence, on the one hand, that they know all about it and regret, on the other hand, that they knew too little. As they emerge from puberty into awareness of the wider world, young people are often very concerned about accidental pregnancy, HIV/AIDS and other threats to their health, but they find it very hard to raise such delicate topics.
Young women may fear that asking questions will label them as promiscuous. Young men may feel that pregnancy is a woman’s concern. Young people of both sexes tend to discount the risks of sexually transmitted infections and HIV/AIDS to themselves and their partners.(5) Young people are concerned not to appear more interested in sex than they really are.
Adults are often reluctant to discuss sexual and reproductive health with adolescents, sometimes from embarrassment at raising “private matters”, sometimes because they think it will encourage promiscuity or at least experimentation with sex. Parents, educators and health care professionals may lack accurate information or training in imparting it to young people. Relatively little of young people’s information about sexual and reproductive health comes from these sources,(6) although a study in Germany found that 69 per cent of girls said that their information came from their mothers. Parents are a more important source for younger teens.(7)
Today’s young people tend to absorb their knowledge haphazardly from family, friends and other peers, school, television, movies and the Internet. The result is widespread ignorance, partial information, mistaken beliefs and myths. The best solution, especially for older adolescents, is formal sex education. Programmes vary widely in quality, but studies have repeatedly shown that accurate information at the right time and at the appropriate age encourages responsible behaviour and tends to delay the onset of sexual activity.(8) The important features are that information is available, accurate and appropriate for the adolescent’s age and stage of development. Young people want, appreciate and will act on such information.(9)