Protecting the Next Generation Project - Global

A central component of the project is drawing on in-country partners for local knowledge, insights, and perspectives (for example, on the particular religious, cultural, and political sensitivities that attention to adolescent sexual health may ignite). In addition, programme activities will be designed around the perspectives of young people, with special focus on their sexual risk-taking behaviour. The responses of adolescents to questions - for instance, what motivates engagement in risky behaviours? What barriers to safer behaviour (such as gender roles, relationships between generations, cultural and religious values, or poverty) are rooted more broadly in young people's lives? - will inform project activities. These activities will include:

1. Establishing a knowledge base of policy-relevant evidence
• Obtaining new information to increase understanding of adolescents' risk for HIV/AIDS, STDs, and unintended pregnancy through in-depth interviews and a national survey of adolescent women and men in each focus country.
• Exploring the health service and information needs of adolescents, both through their own reports and through interviews with providers, teachers, and advocates.
• Comparing findings among the four focus countries with what is known about adolescents' HIV/STD risk throughout Sub-Saharan Africa, Asia, and Latin America.
2. Stimulating policy and programme reform
• Engaging stakeholders throughout the project by communicating findings to policymakers, health care providers, and the media within each country, regionally and internationally.
• Working collaboratively with local NGOs and advocates to design outreach activities and products, taking advantage of existing networks and communications opportunities wherever possible.
• Strengthening skills and knowledge exchange among in-country partners as well as between project partners from different countries.

In late 2002, The Guttmacher Institute and its partners participated in a planning workshop in Nairobi, where the project design and methodology were finalised. In January and February 2003, partners conducted a total of 53 focus group discussions with adolescents in the programme areas. In each focus group, 7-10 young people aged 14-19 shared their perspectives on topics like sexual activity, knowledge about and symptoms of HIV and sexually transmitted infections (STIs), sexual and reproductive health information and services, and perception and management of HIV, STIs, and pregnancy risk. Separate discussions were held with young women and young men, in-school and out-of-school youth, and those living in urban and rural areas (and, in some countries, young women who are married and unmarried).

As part of Phase 2, a four-day workshop was conducted in May 2003 in Cape Coast, Ghana, at which research partners from all four country partners, The Guttmacher Institute, and the African Population and Health Research Center (APHRC) developed the design and guidelines for individual in-depth interviews with adolescents in an effort to complement the issues being covered in the National Survey of Adolescents. To gain insight into the sexual and reproductive health of adolescents, interviewers strategised about how to create a comfortable environment in which they can candidly discuss participants' personal experiences and decisions regarding their sexual and reproductive health. Approximately 60-70 in-depth interviews will be conducted per country in the second half of 2003.

Analyses of the focus group discussion and in-depth interview transcripts will follow. A nationally representative survey will be conducted with approximately 5,000 adolescents in each of the four countries in late 2003 and early 2004. The questionnaire will focus on adolescents' views and use of differnt health services, knowledge and perception of sexual and reproductive health problems, risk perceptions and behaviours, and support/pressures from friends and family on sexual and reproductive issues.

As part of a strategy to build on existing communications and advocacy efforts in each country, The Guttmacher Institute met with NGOs, government officials, journalists, programme administrators, educators, health care providers, and marketing professionals in Uganda in 2002 and in Burkina Faso and Ghana in 2003. The Guttmacher Institute plans a similar visit to Malawi in June-July 2003, and seeks recommendations of individuals and organisations working there to improve young people's sexual and reproductive health. Please contact Leila Darabi at ldarabi@guttmacher.org with suggestions.

Youth, HIV/AIDS, Health, Family Planning.

Programme organisers note that HIV/AIDS has been particularly devastating in Sub-Saharan Africa, where it is now the leading cause of death. Adolescents, constrained by a variety of social, economic, and cultural factors, are particularly vulnerable to the infection. Some argue that their unique needs are largely unacknowledged and receive little policy and programme attention. Despite the urgency and scope of the problem, according to The Guttmacher Institute and its partners, significant gaps in knowledge persist.