to adolescent girls. First, practical and culturally relevant information needs to be developed and disseminated through existing communication channels, including schools, radio, youth organizations, and traditional channels such as female initiators. Second, such communication should concurrently target adolescent boys and older men, a strategy that is seldom used. Finally, sustained efforts from multiple channels are critical to influencing social norms.
Adolescents, like other age groups, are a heterogeneous group for which numerous multifaceted intervention strategies are required to achieve behavior change. Youth intervention strategies can target by access point (e.g., schools, clinics, media, street corners); by age of target audience (with different methods and messages for those aged 10-15, 16-20, and 21 and over); by marital status; and, as discussed earlier, by gender. Adolescents living in urban centers should be targeted differently from their counterparts in rural villages. Youth living in sparsely populated rural areas, such as the eastern province in Cameroon or the desert in Botswana, respond to different intervention approaches than youth living on the streets in large urban centers such as Lagos, Nigeria, or Dar es Salaam, Tanzania. Youth living on the streets have different needs and respond to different messages than youth living in families.
Prevention interventions targeted to youth should include not only individual behavioral but also structural/environmental components (Table 5-4). Yet most interventions targeted to African youth to date have typically focused on behavior-change intervention and the promotion and provision of condoms (UNICEF, 1995; Grunseit and Kippax, 1993). Strategies used have included setting up drop-in centers in the community that encourage youth to stop in on an ad hoc basis; sending outreach workers into markets, bus terminals, and truck stops; organizing community sports activities and clubs; initiating anti-AIDS clubs; and training adults—such as traditional initiators for coming-of-age ceremonies—who have regular access to youth.
HIV intervention programs need to expand beyond health-related components by linking with organizations that have the resources and expertise to incorporate economic, educational, and policy-based components into HIV-prevention programs. Examples are organizations that could improve access to education by providing school fee waivers or stipends or offer income-generating possibilities. Although such linked programs are admittedly difficult to implement, the few that exist have shown exciting results, albeit on a limited scale (Delehanty, 1993; Leonard, 1994).
AIDS care and management, especially coping with death and dying, should