Population Council Research that makes a difference

Friends of Youth is a locally designed, culturally consistent adolescent reproductive health project taking place in Kenya. Originally called the Nyeri Youth Health Project (NYHP), Friends of Youth is a collaboration between the Population Council, the Family Planning Association of Kenya, and the Nyeri community in Central Province, Kenya.

Based on formative research among youth and adults in Nyeri, the NYHP employed respected parents nominated by the community to give young people (ages 10–24 years) sexual and reproductive health (SRH) information and to promote an improved environment responsive to their reproductive health information and service needs. The project was locally designed and consistent with Kikuyu culture where, traditionally, parents ask adults whom they trust to provide sexual and reproductive health information to their children as they undergo puberty rites.

In addition, formative research revealed that young people often visit private providers when they require reproductive health services. The NYHP trained a network of collaborating service providers, mostly from the private sector, on SRH and youth-friendly services. Young people in need of services were given coupons that entitled them to subsidized SRH services at participating service providers.

The intervention, which lasted from 1997 to 2001 was evaluated using a quasi-experimental research design in which baseline and endline surveys were conducted in both experimental and control sites. Overall, the project did not promote experimentation with sex or promiscuity, a fear that many policymakers have regarding family life education. The NYHP made significant impacts on a number of behavioral indicators, including condom use, secondary virginity, and reduction in the number of sex partners.

The extent to which the project had an impact on young people differed for girls compared to boys. The most ambitious objective of the project was to delay the age of sexual initiation among young people in the project area. The NYHP had a marginal impact on boys' initiation of sex, with the project site variable being predictive of delayed sexual initiation at the level of p<0.1. The NYHP made considerable impact in preventing young people from experiencing negative consequences of sexual activity.

Girls in the experimental site were significantly more likely to adopt secondary abstinence (odds ratio [OR] 3.3) and less likely to have had three or more sex partners (OR 0.1), compared to girls in the control site. Boys were significantly more likely than boys in the control site to have used a condom at last sex (OR 3.7). The fact that the NYHP did not impact upon girls' condom use is probably a reflection of the fact that they traditionally have little control over use of this method, and that the boys or men with whom they have sex are often older than the boys targeted in this intervention.

The project also improved the environment for young people in terms of communication on reproductive health issues. Both males and females in the project site were more likely to discuss SRH issues with a nonparent adult than were young people in the control site (OR 1.9 and 5.5, respectively).

The NYHP was unique in that it was designed and managed by the local community. The project demonstrated that a program that is well designed and well implemented can bring about behavior change among young people in sub-Saharan Africa.

Friends of Youth

With the support of the US Centers for Disease Control and Prevention (CDC) beginning in 2004, the NYHP has been scaled up to urban areas in Central Province (Nyahururu and Thika) and slums in Nairobi. Because it has expanded beyond Nyeri, the project is now more commonly referred to as Friends of Youth. Support from the CDC has allowed the project to add subsidized HIV voluntary counseling and testing services for young people in addition to the regular subsidized reproductive health services.