Preventing HIV/AIDS in Young People: A Systematic Review of the Evidence from Developing Countries

Published by the World Health Organization (WHO), this 342-page report evaluates various communication-centred approaches designed to prevent HIV/AIDS among young people around the world. In so doing, it provides evidence-based recommendations for policy-makers, programme managers, and researchers to guide efforts towards meeting the UN goals on HIV/AIDS and young people: achieving universal access to prevention, treatment and care, as well as attaining the Millennium Development Goal (MDG) on AIDS. The report was produced in conjunction with London School of Hygiene and Tropical Medicine, The Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Population Fund (UNFPA), and the United Nations Children's Fund (UNICEF).

These recommendations shared here are based on a systematic review of 80 studies in developing countries of the effectiveness of interventions provided through schools, health services, mass media, and communities, as well as those geared specifically to young people who are most vulnerable to HIV infection. The report classifies these interventions into 3 categories:

1. GO! (implement on a large scale while monitoring coverage and
   quality)
2. Ready (implement widely but evaluate carefully)
3. Steady (not ready yet for prime time; more research and development required)

Interventions graded as either "GO!" or "Ready" include:

• In schools: Sixteen of the 22 interventions significantly delayed sex, reduced the frequency of sex, decreased the number of sexual partners, increased the use of condoms or contraceptives, or reduced the incidence of unprotected sex. Curriculum-based interventions, led by adults, that are based on defined quality criteria, can have an impact on knowledge, skills and behaviours.
• In health services: Interventions can increase young people's use of services provided that they train service providers, make changes in the facilities to ensure that they are "adolescent-friendly", and create demand and community support through actions in the community.
• In the mass media: Interventions can have an impact on knowledge and behaviours if they involve a range of media, for example, television and radio supported by other media (e.g., print) and are explicit about sensitive issues but in line with cultural sensitivities. Campaigns that include TV require the highest threshold of evidence, yet they also yield the strongest evidence of effects.
• In communities: Increased knowledge and skills can be achieved through interventions that are explicitly directed to young people and work through existing organisations and structures.
• For young people most at-risk: Interventions that provide information and services through static and outreach facilities are most effective in reaching young sex workers, young injecting drug users, or young men who have sex with men.

The report makes additional specific recommendations for: policy-makers (for example, established community organisations serving young people can influence their knowledge,
attitudes and reported sexual behaviours to help prevent the spread of HIV), programme development and delivery staff (for instance, greater collaboration is needed between programme managers and researchers to facilitate effective monitoring and evaluation design) and for researchers (for example, evaluations of mass media programmes should focus on those that are comprehensive, have the potential for achieving population effects and use strong quasi-experimental designs to build a case for inferring causality).

"This report provides one perspective on defining priorities for action, and the authors hope that it will contribute to ongoing discussions and debates and will be enriched by other methods of assessing the evidence. If we are to engage the people responsible for policies, programmes, and resource allocation in order to give young people the attention that they warrant and to accelerate action for achieving the global goals, it will be necessary to make a compelling case for action, be clear about what needs to be done (based on the evidence) and demonstrate that what needs to be done is doable on a
reasonable scale in a reasonably sustainable way..."

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.

Click here to access the full report in PDF format, as well as other materials such as abstracts in Arabic, Chinese, French, Russian, and Spanish.