This 44-page evaluation/advocacy document is one outcome of a global consultation on the health services response to the prevention and care of HIV among young people. In March 2003, researchers and practitioners from across the world met in Montreux, Switzerland with representatives of UN agencies to review the evidence for priority health service interventions to help countries better protect young people against HIV and AIDS. Based on the premise that "All countries have a network of health workers who could intervene more effectively with young people if they knew what to do and how to do it," participants in the consultation reviewed innovative experiences from countries in Africa, Asia, Latin America and Europe; a number of approaches emerged that are explored in this report. Designed for a wide range of policy makers and programmers, the document highlights specific country examples in text boxes and sidebars, with key strategic lessons articulated in narrative form.

A key finding to emerge from the evaluation is a communication-centric one: the health system is pivotal to the process of collecting and analysing information, shaping evidence-based policies, and mobilising other sectors to provide services that reach youth who are most in need. In short, the health system acts as "an intelligence centre to inform policy makers, the mass media, and others about risk-taking behaviour of young people and the importance of protective measures." The health sector cannot accomplish such a task alone, as reflected in the consensus that governmental and civil society organisations must participate fully to help meet what is described as "an urgent need to define at country level an essential package of interventions that can be delivered through health services to meet the needs of young people." Such interventions include: information and counselling to reduce risky behaviour; interventions to reduce the harmful effects of risky behaviour; and testing, treatment and care of adolescents with sexually transmitted infections (STIs), HIV or AIDS.

Based on a review of specific programmes, participants determined that adolescents need interventions that go beyond demonstration projects to reach broad populations, and which:

• Emphasise knowledge by developing young people's understanding of the transmission of HIV, and their personal skills in daily life to avoid the risks of infection. There was a consensus that the health system has a vital role to provide a range of effective, evidence-based interventions for young people, in large part because the health sector is responsible for disseminating clear and accurate epidemiological information about the spread of HIV, and for identifying the underlying factors that make young people vulnerable. For instance, "Clinics can become the hub for a local information group that involves young people, community based workers and volunteers. Giving a young person a leaflet can be the entry point for a broader discussion about risk activities, and a chance to listen to the young person and to provide guidance. The role of health workers is to oversee this process, validate the information and ensure that counselling is available." Furthermore, the school system was found to have an important role, in that the primary and secondary school curriculum should provide appropriate sexual and reproductive health education, fostered in part through the work of school nurses (e.g., in training teachers) and health workers (who could have a key role in shaping the information provided through sports, drama or dance groups, for instance). Health workers, in particular, can be instrumental in helping in-school (as well as out-of-school) youth develop life skills to stand up to peer pressure, to delay having sex, to negotiate the use of condoms, or to seek help if they have a problem.
• Increase access on the part of youth to services and supplies to avoid or treat infections. Here again, the health sector has a key role in developing policies to combat HIV and AIDS and in delivering health services; the idea is that, though provision of information and counselling are vital, they are not enough on their own. Sexually active youth need to be provided with condoms, and young injecting drug users (IDUs) need measures to reduce the risks of sharing needles. The health sector has a role in communication that directs youth specifically to such services: "Young people need to know where to get condoms at a price they can afford. They need to talk to a partner about using them before sex takes place, and be able to use them correctly. Life skills programmes need to practice negotiation skills and teach skills in condom use, especially as adolescents may be reluctant to confess to inexperience."
• Are youth-friendly in that they create a safe and supportive social environment that, for example, diminishes fear of stigma. For instance, at the Juventa reproductive health service for adolescents in St. Petersburg, Russia, "Young people are welcomed by staff who are trained to understand their fears and to provide effective, sensitive services including information, health education, psychological and social support, and medical care." In short, "Young people must have confidence in health-care providers to be able to access services and obtain the supplies that they need." To build that confidence among youth, clinics might keep in mind the following:
  
  • Staff must be well-trained with a reliable supply of effective STI medicines, while also being welcoming and guaranteeing privacy and confidentiality.
  • Referral between health services needs to be strengthened so that adolescents receive relevant services at whatever point they enter the system.
  • Information should be available in community settings, such as youth clubs and sports venues, to communicate details about cites for testing and treatment.
  • Staff at clinics should be trained to talk to young people about adopting safer sexual behaviour.
  • Service providers should be more proactive in providing information about STIs and the availability of treatment. Providers also need to reach out to adolescents in vulnerable groups, such as sex workers and pregnant girls.

  Outreach work, social marketing, and voucher schemes are other approaches described here as promising in terms of increasing service use among youth.

• Foster youth participation and community mobilisation. Examples are offered from programmes such as Zambia's HEART campaign, the content and design of the media for which is drawn up by a group of 35 young people aged 15-22. HEART also uses mass media to train health workers and neighbourhood health committees about malaria, tuberculosis (TB) and eye health. Holo Muchangwe Hachonda IV, Youth Communications Coordinator for HEART, says: "You have to form partnerships with young people to identify points for information giving and for behaviour change. You have to work with them on risk perception because they do not think that they are at risk of AIDS."

In conclusion, the authors urge that a national strategy group be formed to integrate the work of the health
sector with other agencies and government departments. In addition, advocacy carried out at national and local level is crucial; youth have a focal role to play here by helping win support from political leaders, legislators, religious leaders, youth icons and the mass media. In short, "Linkages with other sectors, the engagement of young people in quality improvement programmes, and a focus on training health workers to deliver sensitive, competent and adequately resourced interventions will result in benefits for all services for young people."