Karen Hardee
Jill Gay
Melanie Croce-Galis
Nana Ama Afari-Dwamena
Publication Date
July 1, 2014

Reproductive Health Program Population Council (Hardee), What Works Association (Gay, Croce-Galis), Center for Policy and Advocacy, Health Policy Project, Futures Group (Gay, Croce-Galis), and Consultant in Epidemiology and Occupational Health (CEOH) (Afari-Dwamena)

In this study, in order to evaluate the high rates of HIV infection among adolescent girls and to present evidence on what works globally to address the risk, researchers reviewed evidence on programming for adolescents from 150 studies and evaluations from 2001 to June 2013. [Footnotes are removed by the editor.]

"Given the multiple influences on the lives of adolescents, from family to community to society, it is important to look beyond the health sector for interventions to reach adolescent girls. The evidence for programming for adolescent girls falls under a range of interventions in 3 areas: (1) to address the enabling environment: increase educational attainment for girls, promote gender-equitable norms, include a focus on adolescents in programs to reduce gender-based violence, and strengthen legal norms to protect adolescent girls; (2) information and service needs of adolescent girls: provide age-appropriate comprehensive sex education, increase knowledge about and access to information and services including condoms and other contraceptives, and expand harm reduction programs to include adolescent girls who inject drugs; and (3) social support: promote caring relationships with adults and provide support for adolescent female orphans and vulnerable children (OVC)."

In the discussion of these areas, interventions are described that include:

  • Keeping girls in school - including abolishing fees and providing conditional cash transfers.
  • Promoting gender-equitable attitudes: "Training, peer and partner discussions, and community-based education that questions harmful gender norms can improve HIV prevention, testing, treatment, and care....Addressing gender norms requires working with boys and girls, both separately and together....The NGO [non-governmental organisation], Promundo, started with Program H to promote more gender-equitable attitudes among young men, resulting in significant increases in male condom use in Brazil and India, significant reduction in use of violence against female partners in India, and significant changes in gender attitudes among young men in Brazil. Improvements in gender norm scale scores were associated with changes in at least 1 key HIV/sexually transmitted infection risk outcome....Changing gender norms on a national scale would require augmenting these programs with structural interventions at the national level, engaging policymakers and community leaders, along with mass media, to promote equitable gender norms."
  • Breaking the cycle of gender-based violence: "[P]rograms that reduce gender-based violence starting at an early age will help break this multigenerational cycle." Education programmes can teach adolescence about the nature of sexual abuse. According to UNICEF, “'[a] major gap in sex education programs is the need for both girls and boys to understand what constitutes coercive sex.'...Public health campaigns can influence communities so that violence against women becomes unacceptable.  Learning approaches involving men and women can create more gender-equitable relationships, thereby decreasing violence. Training teachers about gender-based violence is a promising strategy to change norms about acceptance of gender-based violence...."
  • Advocating for changing legal norms and enforcement on such acts as child marriage and rape.
  • Providing comprehensive sex education: "[B]efore the onset of sexual activity [providing sex education] may be effective in preventing transmission of HIV by increasing age at first sex and for those who are sexually active, increasing condom use, testing, and reducing the number of sexual partners....The quality of sexuality education is as important as its provision; fidelity to successful components must be maintained. Training for teachers to conduct age-appropriate participatory sexuality education, which can improve students' knowledge and skills, is essential." The research recommends combining education with accessible and youth-friendly health services.
  • Providing youth-friendly health services: "Promoting condoms through mass media in individual or group sessions, along with skills training, provision of condoms, and motivational education can increase condom use." Services accessible to and settings inviting to youth can increase protective behaviours, including testing; and service in crises, including post-rape prophylaxis and emergency contraception, is in need of strengthening.
  • Providing harm reduction programmes for injecting drug users, tailored by gender and adapted for adolescents.
  • Improving communication between adolescent girls and supportive adults: "[S]eminars on communication skills to empower [mothers] to better communicate with their daughters on matters concerning HIV, AIDS, and sexuality" were requested, for example, by a group of mothers in a study in Uganda.
  • Working with OVC and their caregivers: "Successful interventions for OVC include psychological counseling and mentoring...."

(See the What Works for Women & Girls website for more information and resources.)


JAIDS website, (Journal of Acquired Immune Deficiency Syndromes, July 1 2014 - Volume 66 - Issue - pages S176–S185), June 20 2014, and emails from Jill Gay to The Communication Initiative on June 24 2014 and January 14 2016.