are virtually nonexistent. Instead, single-dimensional approaches have been advocated to address multidimensional problems (e.g., the disproportionate reliance on the "peer educator" approach for all adolescent HIV-prevention needs). In addition, little formative research has been done to tailor messages to specific youth subgroups. Moreover, inappropriate selection criteria have been used to qualify youth as peers, and peer programs have typically been neither well supervised nor well evaluated. Finally, youth have not been regular participants in the planning, design, and evaluation of programs.
The following case study highlights some of the issues and limitations discussed above and is representative of typical interventions targeted to African youth to date.
In 1989, results from serosurveys in Addis Ababa, Ethiopia showed that 24 percent of female commercial sex workers between the ages of 12 and 16 were HIV-seropositive (Gebru et al., 1990). These results, while known to the Ministries of Health and Education, were not widely available to the public; a school-based HIV/AIDS education and prevention program was proposed. Before a new program of this type can begin, parents and other community members need to be educated about HIV prevention and the need for HIV education in junior and senior secondary schools. Focus group discussions with students and school teachers also help sensitize adolescents to the risk of HIV and build support and acceptance for the initiation of a strong school-based HIV/STD-prevention effort (Gebru et al., 1990).
A pilot HIV intervention project was implemented during 1990 and 1991, sponsored jointly by the Ministries of Health and Education. WHO/GPA assisted in the development and evaluation of educational materials and teaching methods that were incorporated into the curricular and extracurricular activities of Ethiopia's secondary schools.
The project had four specific objectives: (1) to teach students how to prevent HIV/STD transmission and enhance risk-reduction attitudes; (2) to reduce discriminatory attitudes toward HIV-positive fellow classmates and other community members; (3) to teach skills that would allow the students to disseminate HIV/STD-prevention messages to their families and the wider community; and (4) to train teachers to provide effective AIDS education and to stimulate student interest in becoming community health educators.
The project had multiple components. Innovative classroom curricula and teaching methods were developed that relied on role play, rehearsal of risk-avoidance skills, group discussions, drama, and peer educators. Sessions were held to train teachers and students to use these materials in class and in after-school clubs (such as drama, music, health education, and Red Cross clubs).