What does Positive Youth Development (PYD) look like in HIV/AIDS and sexual and reproductive health (SRH) programming in low- and middle-income countries (LMICs)? What is evidence of the effectiveness of a PYD approach in improving HIV/AIDS and SRH outcomes? How does PYD impact cross-sectoral outcomes? This YouthPower Learning webinar, drew on the Systematic Review of Positive Youth Development in Low- and Middle-Income Countries (see Related Summaries, below) to explore those questions as it delved deeper into PYD, which a guiding principle of the United States Agency for International Development (USAID)'s Youth in Development Policy. Speakers included:
- Martie Skinner, Research Scientist, The Social Development Research Group, University of Washington, United States (US)
- Alice Welbourn, Founding Director, Salamander Trust, United Kingdom (UK)
- Andrew Gibbs, Senior Specialist Scientist at the Gender and Health Research Unit, South African Medical Research Council & Honorary Research Fellow, Health Economics and HIV/AIDS Research Division [HEARD], University of KwaZulu-Natal, South Africa
- Kate Plourde, Senior Technical Officer, Global Health Population and Nutrition Department, FHI 360
PYD is an approach that aims to build and support the competencies, skills and abilities of youth so that they are empowered to reach their full potential. PYD programmes have these features: build skills; engage youth in making a contribution; build healthy relationships, promote bonding; foster belonging and membership; provide clear and consistent positive norms; create safe spaces; and provide access to youth friendly services/service integration. To achieve the vision of healthy, productive, and engaged youth, PYD programmes, practices, and policies work with youth to improve their:
- Assets: Youth have the necessary resources, skills, and competencies to achieve desired outcomes.
- Agency: Youth perceive and can employ their assets and aspirations to make or influence their own decisions about their lives and set their own goals, as well as to act upon those decisions to achieve desired outcomes, without fear of violence or retribution.
- Contribution: Youth are engaged as a source of change fortheir own and for their communities' positive development.
- Enabling environment: Youth are surrounded by an environment that maximises their assets, agency, access to services, and opportunities, as well as their ability to avoid risks, stay safe and secure, and be protected.
Such programmes use a wide variety of PYD activities including adult-led education, peer education, media, and activities with parents or teachers. Characteristics of effective programmes:
- Based on theoretical approaches that have demonstrated to influence health-related behaviours
- Intervene at multiple levels (e.g., family, peer, community etc.)
- Deliver and reinforce a message about using condoms or other forms of contraception consistently
- Provide accurate information about sexually transmitted infections (STIs)/HIV and methods to prevent pregnancy and STIs
- Provide skill-building activities focused on communication, negotiation, and refusal skills
- Train teachers, community members, or peer leaders to implement the programme and use interactive modalities (e.g., video, role play etc.)
- Address gender-related issues
PYD programmes in SRH/HIV are prevalent in LMICs and work across sectors and domains; this is appropriate, considering that young people face complex issues. They tend to be focused more on HIV risk behaviours and less on SRH outcomes such as family planning and fertility reduction. Experimental studies show that PYD programmes on SRH and HIV/AIDS outcomes effectively increased boys and girls' self-efficacy to use condoms with their partners, contraceptive use, and utilisation of SRH services. Programmes reduced sexual risk behaviours such multiple partners and incidents of unprotected sex, and adolescent girls report fewer incidents of unwilling sex.
Some key takeaways from the webinar:
- Economic interventions have better intimate partner violence (IPV) and SRH outcomes when they integrate gender-transformative components.
- Change in social norms is possible, but it can take many years and demands considered investment in training, time, and funding.
- There are promising interventions, two of which were discussed during this webinar, that work with young people to prevent IPV and HIV-risk behaviour.
Among the recommendations offered:
- Programme implementers should leverage existing PYD resources to expand the scope of their programnes. Implementers working on SRH and HIV programs should look to PYD programmes for examples of holistic (cross-sectoral and multi-setting) youth development.
- Implementers and funders should target PYD approaches to SRH and HIV prevention more inclusively. PYD programmes on SRH and HIV/AIDS preventions should address gender attitudes toward boys, girls, youth with disabilities, and lesbian, gay, transgender, bisexual, and intersex (LGBTI) individuals.
- There is a need for more rigorous evidence about the effectiveness of PYD outcomes as they related to SRH and HIV. More evaluations of SRH outcomes such as family planning, fertility reduction, and access to SRH services are needed. Support for high-quality evaluations of promising models, including impact evaluations and cost-benefit analysis should be considered.
- Most evidence of SRH and HIV program effectiveness has been built upon programming in African countries. However. There is no evidence of the effectiveness of this type of programming in Latin America and the Caribbean (LAC) and Asia.
- Engage youth in program design, implementation and evaluation to improve programme effectiveness. Engaging youth should be included from program inception and throughout the program cycle.
YouthPower Learning website, October 13 2017; and email from Alice Welbourn to The Communication Initiative on October 15 2017. Image credit: Photo © 2011 Tanzeel Ur Rehman Cover Asia Press, Courtesy of Photoshare