Prevention Programs for Youth (Updated February 2008)

President George W. Bush's Emergency Plan for AIDS Relief is the largest commitment ever by any nation for an international health initiative dedicated to a single disease-- a five-year, $15 billion, comprehensive approach to combating the disease around the world. U.S. Department of State U.S. Agency for International Development U.S. Department of Defense U.S. Department of Commerce U.S. Department of Labor U.S. Department of Health and Human Services Peace Corps Mailing address: SA-29, 2nd Floor 2201 C Street, NW Washington, DC 20522-2920 www.PEPFAR.gov

Prevention Programs for Youth  Preventing new HIV infections among young people is a high priority for the U.S. President’s Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR). In some generalized epidemics in Africa, one of every three to four new infections occurs among young people under age 25, primarily young women. Youth are critical to the socio-economic fabric of communities and nations, and protecting them from HIV is essential. In countries that have had success in reducing HIV infection rates through the adoption of “ABC” prevention behaviors, young people have significantly changed their behaviors. PEPFAR, in partnership with host countries, seeks to build on these successes by establishing local programs and partnerships that support the uptake of these key prevention behaviors. The “ABC” approach tailors behavioral messages to the local epidemic context: “A” behaviors include abstinence, or delay of sexual debut for young people; “B” includes faithfulness to one partner or reducing the number of sexual partners; “C” emphasizes correct and consistent condom use, where appropriate. The Power of Partnerships In fiscal year 2007, the Emergency Plan allocated $601.3 million to support prevention in the 15 focus countries. As of September 30, 2007 in the 15 focus countries, nearly 197.8 million people were reached by community outreach programs promoting ABC and other related prevention strategies with PEPFAR support since the inception of the Emergency Plan. Among the greatest challenges to mounting effective prevention programs is the diversity of epidemics and prevention needs across countries. In low prevalence HIV epidemics, youth often represent a substantial proportion of most-at-risk populations, such as people in prostitution and injecting drug users, when HIV is concentrated. In generalized epidemics, youth at high risk include young women who are orphaned or otherwise lacking family protection, experience early sexual initiation or forced first sex, exchange sex for money or gifts, or have older partners. Young people are also vulnerable because they are often disadvantaged in access to information, perceive their risk as low, and experiment with risky behaviors. Reaching young people early, before they initiate sexual activity, can help them avoid risk-taking and maintain healthy behaviors. PEPFAR programs in countries with generalized epidemics work through schools, churches, and other community structures to support comprehensive, skills-based HIV education for youth. These programs provide young people with a basic understanding of HIV, help them personalize risk, and support them in developing the self-esteem, communication and decision-making skills they need to make healthy life choices.

PEPFAR takes an age- and culturally-appropriate approach to HIV prevention in young people: Emergency Plan funds may be used in schools to support programs that deliver age-appropriate “AB” information to young people age 10-14; Emergency Plan funds may be used in schools to support programs that deliver age-appropriate “ABC” information for young people above age 14; Emergency Plan funds may be used to support integrated ABC programs that include condom provision in out-of-school programs for youth identified as engaging in or at high risk for engaging in risky sexual behaviors; Emergency Plan funds may not be used to physically distribute or provide condoms in school settings; Emergency Plan funds may not be used in schools for marketing efforts to promote condoms to youth; and Emergency Plan funds may not be used in any setting for marketing campaigns that target youth and encourage condom use as the primary intervention for HIV prevention. In addition, PEPFAR recognizes the importance of creating supportive environments for young people, and works with adult “gatekeepers” such as parents, teachers and faith leaders who can support youth in making healthy choices. Recognizing the influence of mass media on young people, PEPFAR also supports strategic educational-entertainment programs that can reinforce positive norms and behaviors among youth. Particularly in sub-Saharan Africa, where young women are disproportionately vulnerable to HIV, PEPFAR places special emphasis on reaching girls with the skills, information and support they need to protect themselves. PEPFAR programs also address sexual and gender-based violence, cross-generational and transactional sex, economic vulnerability, and stigma and discrimination, which increase girls’ risk of HIV. The Emergency Plan at Work The following examples illustrate how the Emergency Plan is working under national strategies and in partnership with host nations to support prevention programs for young people: In Botswana, in partnership with the Ministry of Education, PEPFAR supports the development of Skills for Life: Botswana’s Window of Hope, an innovative HIV/AIDS life-skills curriculum for Botswana’s schools. The curriculum focuses on life-skills for primary and secondary students. The model is interactive, with age-appropriate components for every level of schooling, and messages and skills that are reinforced each year. The program is national in scope, with the potential to reach nearly all young Batswana.   In Uganda, the Young, Empowered and Healthy (YEAH) initiative focuses on cross-generational sex. The program highlights the risks of “Something for Something Love,” where sex is given in exchange for favors, money, or gifts. A radio serial drama, comic strips, youth discussion clubs, outreach activities, and write-in contests engage youth and adults in discussing the consequences of cross-generational sex, including HIV and unintended pregnancy.   In Mozambique, the JOMA Project aims to reduce the spread of HIV/AIDS by teaching young men to think critically about gender roles and healthy behavior. This project trains young men and teachers to communicate HIV prevention messages to their peers in schools and communities. With PEPFAR support, groups carry out micro-projects in schools to help overhaul male stereotypes steeped in history and social norms. Students produced “wall newspapers” containing articles exploring the social impact of HIV/ AIDS and murals that raise awareness of gender inequalities.   In Guyana, Haiti, and Tanzania, the American Red Cross Together We Can program reaches in-and out-of-school youth with a 12- module curriculum that uses dynamic, participatory techniques to reach youth in an intensive and high-quality manner. The program also seeks the participation of parents, teachers, religious leaders, government officials, and community leaders in order to create an enabling environment for youth behavior change. The curriculum emphasizes abstinence, being faithful, and other healthy behaviors including condom use for out-of-school, at-risk youth.