Guttmacher Institute

This 86-page research report proposes that new programmes and policies designed to prevent HIV in Africa should focus on providing earlier and more comprehensive sexual health information and reinforcing national health care systems to better serve youth. Published by the Guttmacher Institute and institutional partners in Burkina Faso, Ghana, Kenya, Malawi, and Uganda, the report compiles policy and programme recommendations based on findings from national surveys of approximately 20,000 African adolescents, as well as focus group discussions, and in-depth interviews with hundreds of young people, parents, teachers, and health care providers.

The research found that many adolescents are sexually active and need help to prevent negative consequences stemming from this activity. Adolescent females in sub-Saharan Africa tend to have sex at an earlier age than their male counterparts, and, thus, are at particular risk for HIV, unwanted pregnancy, and other adverse outcomes. The research also suggests that many adolescents do not use contraceptives, have experienced unwanted sex, have multiple or much older partners, and lack adequate knowledge about avoiding sexually transmitted infections (STIs) and pregnancy.

The research points to mass media as a major source for sexual and reproductive health information. In focus group discussions in the four countries, adolescents cited numerous reasons why radio, in particular, is one of their preferred sources of information. For example, they noted that radio is a reliable source (Uganda), it reaches a wide audience (Ghana), it gets information to young people quickly (Malawi), listeners do not need to go somewhere for the information (Burkina Faso), and parents can listen and teach their children what they learn (Malawi). However, adolescents also noted the limitations of mass media, including both the fact that one can not easily ask questions and, in the four focus countries, as many as one in four adolescents have no access to the mass media. Similarly, the research suggests that new technologies are promising, but still reach relatively few adolescents.

The report identifies comprehensive school-based sex education as an effective and efficient way to educate adolescents, improving knowledge and reducing sexual risk behaviours, and proposes that, based on this research, school-based sex education does not increase sexual activity. The report makes the following four recommendations for improving school-based sex education in Africa:

• adopt comprehensive curricula that provide accurate sexual health information;
• design interventions for very young adolescents with information before they have sex for the first time;
• support teacher training to expand coverage of sex education; and
• help adolescents stay in school.

The report recommends that programme designers and policymakers take the following actions to improve adolescents' access to the formal health sector:

• ensure the widespread availability of contraceptive methods, especially the male condom;
• conduct outreach to inform young people about the services available and where to get them; and
• train mid-level providers, such as midwives and nurses, to augment the delivery of health services.

The report concludes that the strong desire of adolescents, including those who are already sexually active, to obtain information and services needed to protect their sexual and reproductive health is very encouraging. These facts suggest that increasing preventive behaviours among adolescents who are already sexually active is achievable. For young people in sub-Saharan Africa, providing sexual and reproductive health information and services that reflect the reality of their lives is not merely the best means of ensuring their successful transition to adulthood and lifelong health, it is also a sure step toward achieving social progress and economic development for their countries.