Population Council Research that makes a difference

With support from The Global Fund to Fight AIDS, Tuberculosis and Malaria, Population Council researchers designed an operations research project to determine the feasibility of expanding male youth's access to reproductive health information and condom services through their peers.

Researchers determined that youth clubs were an ideal place to reach male youths in an organized manner. Some 7,000 youth clubs operate in Bangladesh. Eleven youth clubs were selected from three upazillas (the subdistrict level) in Dhaka District. Each of the selected clubs had nearly 100 male youth members. A quasi-experimental design was used to assess the impact of interventions. One group (experimental group 1) received life skills and reproductive health education along with condom services. Another group (experimental group 2) received life skills and reproductive health education only. A control group received neither education or condom services. Focus group discussions were conducted among gatekeepers and youths before implementing the interventions. A total of 1,065 club members aged 15–24 years were identified, and baseline information was collected from 880 randomly selected youths.

Two project implementation committees were formed at two experimental upazillas for smooth implementation of interventions. Fourteen peer educators were identified and trained on the reproductive health module so that they could conduct four one-hour sessions among their peer club members. Behavior change communication materials such as a poster on the dual protection properties of condoms, pamphlets on condoms and ejaculation, a booklet on safe sex practices (e.g., ABC [abstinence, be faithful, and/or use condoms consistently and correctly]), and banners to publicize the course at youth clubs were developed and distributed. A flipchart was developed for the reproductive health module for peer educators to use during reproductive health sessions, and a model of a penis was used to demonstrate the correct use of condoms. Finally, several outdoor activities such as dramas, games, observance of World AIDS Day, and quiz competitions were organized in the experimental clubs.

The quality of reproductive health information delivery was monitored, and feedback was provided to peer educators to improve the way they delivered the information. Some 79 percent of targeted male youths attended at least one reproductive health educational session, and more than 73 percent of the targeted youths attended all four of the sessions. Nearly 250 condoms were sold to youths by each club per month. Condoms were supplied to the peer educators by the project at the government rate (12 condoms cost Tk1.20), and peer educators sold them to youths for the same price.

After conducting the interventions for seven months the endline survey was conducted in February 2006 among the same youth respondents surveyed at baseline. The project evaluation indicated that knowledge of STIs and HIV, contraception, the dual benefits of condom use, the importance of consistent use of condoms, and correct condom use increased significantly in the experimental groups compared to the control. Knowledge regarding the health risks of teen pregnancy also increased significantly over time in the experimental groups as compared to the control. The intervention resulted in significant positive attitudinal change in the experimental groups regarding use of condoms by unmarried sexually active youth for safer sex practices compared to the control. Increasing use of condoms over time was observed in experimental group 1, while condom use remained the same in group 2 and the control group.

Project experience indicates that the skills and efficiency of information providers are vital for the success of the program. Youth need to be trained effectively so that they can impart life skills and reproductive health information to their peers; and life skills and reproductive health education is not enough to effect positive behavioral changes if services are not available as needed.

In its second phase, the project is being scaled up in 100 youth clubs to address managerial and programmatic issues so that the activities can be replicated at the national level.

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Related project: Strengthening Safe Sex Decisionmaking: Creating Conditions for Scaling Up Access to Life Skill Sexual and Reproductive Health Education and Condom Services