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close this bookEffective Approaches for the Prevention of HIV/Aids in Woman (PAHO, WHO; 1995; 62 pages)
View the documentExecutive summary
View the document1. Introduction
View the document2. Opening of the meeting
Open this folder and view contents3. Women and HIV/AIDS
close this folder4. Effective approaches to prevention of HIV/AIDS in women
close this folder4.1 Promoting safer sexual behaviour
View the documentAIDS prevention for women: a community-based approach in Botswana
View the documentEducational interventions for AIDS prevention among single migratory female factory workers in Thailand
View the documentWomen Helping to Empower and Enhance Lives: a prevention programme for hard-to-reach women in the USA, Mexico and Puerto Rico
View the documentReproductive health education and services for adolescents in Mexico
View the documentEffective approaches to HIV/AIDS prevention in women through the promotion of safer sexual behaviour - Conclusions
Open this folder and view contents4.2 Prevention of HIV/AIDS/STD through STD care and condom promotion
Open this folder and view contents5. Experiences from other fields: implications for HIV/AIDS prevention
Open this folder and view contents6. Future directions: national policies and large-scale programmes
View the document7. Overall conclusions
View the documentAppendix 1 - Agenda
View the documentAppendix 2 - List of participants
View the documentAppendix 3 - List of background papers
View the documentAppendix 4 - Selected reading list
 

Reproductive health education and services for adolescents in Mexico

Presented by Dr. José A. Aguilar Cil, MEXFAM, Mexico City, Mexico.

Young people aged 10-19 account for 25% of Mexico’s population of 88 million, and as is the case throughout the world, many are sexually active at a young age. A survey conducted among middle-to-higher education students found that the average age at first intercourse was 15.7 years for boys and 17.0 years for girls, and that 60% of pregnancies among adolescents are unwanted. Yet, to varying degrees, societies tend to deny or not acknowledge that many young people are sexually active when they are, limiting access to reproductive health services, information about pregnancy and disease prevention, or even to an informed adult to talk about sex. Social norms that make it difficult to openly discuss sex and sexuality put young girls (and boys) at greater risk during this period which can be fraught with a whole array of reproductive health problems such as early pregnancy and premature parenthood, illegal abortion, sexual abuse, and STDs including HIV infection.

For these reasons, in addition to the fact that sex education was not being offered in schools, the Mexican Family Planning Foundation (MEXFAM) decided to put the results of a number of surveys to use and tackle some of the issues facing Mexican youth. In its first attempt, between 1986 and 1988, Gente Joven (the name given to this youth-centred initiative) established 13 adolescent centres that scheduled activities for young people. However, an evaluation revealed shortcomings including the fact that a limited number of already highly motivated young people were being reached at a high cost. This experience also gave a realistic profile of Mexican adolescents. For example, first intercourse often takes place in an unforeseen and unplanned fashion, with only one out of six young people using a contraceptive method at this time.

Using insights from these three years Gente Joven closed its centres and began reaching out to adolescents from all walks of life, and in different settings (e.g. schools, factories and on the street). Five themes were chosen for a basic package of materials that could be adapted to a variety of settings, sub-groups of adolescents, and types of media. The five themes were; family communication, puberty and the human life process, sexuality, STDs (including HIV), and early pregnancy and contraception.

In schools, five two-hour long educational sessions are held on five consecutive days in order to capitalize on the fact that one module leads into the next. The emphasis in factories and other work sites is given to discussions, debate, and analysis of issues and decision-making about family planning and sexual behaviour. Whenever the average age of workers is between 15 and 20, an adapted and sometimes condensed version of the school course is given. To reach street kids who are mostly unemployed school drop-outs, an alliance was formed between MEXFAM and the Popular Youth Council. This council has its origins in the 1980s, when members from 30 youth gangs came together to try to reduce conflicts with the police and carry out educational work that would benefit the community. This NGO’s approach is to disseminate information through music, theatre and discussions. Seventeen coordinators (MEXFAM staff) direct the street youth programme, assisted by over 1500 peer educators who provide information on reproductive and sexual health and refer youths to appropriate medical and counselling services. Peers also distribute condoms to adolescents over 16 and will provide them to adolescents under 16 if directly asked.

Because of its popularity, the Gente Joven programme began using radio as a vehicle for communicating information on sexuality, family planning and health, on ways of improving communication with others, and on the important role affection plays in human, including sexual relations. By 1993, one hundred, 25-minute programmes were produced (Table 2).

Table 2

Gente Joven programme on reproductive health for adolescents - a MEXFAM initiative

Number of adolescents (10-19) receiving sex educationin school in 1992 - full 10 hour course

22,864

Additional number of adolescents (10-19) given talks in response to requests from schools in 1992

82,548

Professionals (e.g. psychologists, social workers, educators) reached through talks and courses -1992

2,756

Parents reached through talks and courses - 1992

1,742

Number of cities where Gente Joven programme offered

52

Number of people reached through the Youth Gang programme in the first year

 

 

• Adolescents (received sex education)

2,500

 

• Parents (received training)

380

 

• Promoters (received training)

150

Number of participating MEXFAM community doctors

248

Number of 25” minute radio programmes produced (broadcast by 67 stations)

100

Number of workplace where programme has been developed

300

One of the key features of this programme, which is only partially and briefly described here, has been its “reach”. Since its inception, 600000 adolescents, 300000 parents and 16000 professionals in direct contact with adolescents have participated in training, courses, or other forms of communication about HIV/AIDS. Though not rigorously evaluated, anecdotal information points to a reduction in the number of unwanted pregnancies and number of children desired.

As Gente Joven has evolved, so has the realization that gender differences are a major factor contributing to the discrepancy between knowing about safe sex and practising safe sex, including abstinence. For example, in a study about AIDS prevention among adolescents, the difference between the social roles of girls and boys and ambivalence regarding condom use became quite clear. The programme has now introduced gender sensitivity into its training courses and has begun conducting courses in which boys and girls meet separately to discuss their particular concerns (which research showed were different), and are then brought together for further discussion.

Lessons learned

• Young people can be reached and influenced by sexuality-related information presented and discussed in a forthright manner that moves beyond mere facts, providing teenagers with the basis for making intelligent, informed decisions.

• This is best achieved by reaching out to young people on their own turf, in schools, community centres, work sites and on the street. The importance of reaching out-of-school youth, who are often the most elusive but also may have the greatest needs, should be underscored.

• Young people respond well to novel activities (e.g. street theatre) and to messages conveyed, for example, at sports events or by rock groups.

• A positive attitude towards the sexuality of young people can be developed in parents and other adults and improved communication then achieved.

• There are gender differences in young people in their views on sexuality (e.g. boys want to know more about fertility, while girls have other concerns such as ambivalent social/cultural messages) which have major implications for the use of condoms for HIV prevention and contraception. These issues should be addressed in programmes for young people.

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