What Works for Women and Girls

to be reached with sex and HIV education in a variety of venues—in school, out of school, atwork—in both rural and urban areas. Continued efforts are needed to improve quality of thecontent, teaching and facilitation methods of sex and HIV/AIDS education and information,along with policies that support access to effective sex and HIV/AIDS education programsfor young people. Cell phone text messaging, computer programs, and the internet may be auseful way to provide sexuality education and HIV/AIDS information to young people (Kasi,2008). In addition, programs are needed which address the structural factors that affect youngpeople’s vulnerability and risks, such as gender norms and violence against women. [See alsoChapter 11. Strengthening the Enabling Environment]Peer education by youth living with HIV can reinforce messages about protective behaviorand can be part of a larger intervention. There are no studies, however, demonstrating thatpresentations by HIV-positive speakers alone can change sexual risk behavior (Paxton, 2002).Programs also need to help parents talk to children about sex. There is some evidence thatgood communication with parents is associated with delayed sexual debut. Studies in Mexico,South Africa, and Uganda found that parents can be an important source of information aboutsex (Givudian et al., 1996 cited in Weiss et al., 1996; Abdool Karim et al., 1991 cited in Wojcickiand Malala, 2001; Damalie, 2001).Traditional Gender Norms, Early Marriage Put Young Women at RiskA recent review of the global literature on adolescents found that “there is a significant unmetneed for information, education, and services for sexual and reproductive health for marriedand unmarried young people” (Shaw, 2009: 135). “Even if sexuality education programmesimprove knowledge, skills and intentions to avoid sexual risk or to use clinical services, reducingtheir risk may be challenging to young people if social norms do not support risk reductionand/or clinical services are not available” (UNESCO, 2009: 10). Programs are needed to challengegender norms as well as harmful practices, sexual relationships including early andforced marriage between young girls and older men, and sexual coercion, which increase HIVrisk for adolescent girls and women. [See Chapter 11A. Strengthening the Enabling Environment:Transforming Gender Norms]Early marriage is still common and each year 82 million girls marry before the age of 18(WHO, 2002a, cited in UNAIDS et al., 2004b). Research in 16 countries in sub-Saharan Africa(year(s) not specified) showed that on average, husbands of young girls ages 15 to 19 were, at aminimum, 10 years older than their young wives (UNICEF, 2001 cited in Mathur et al., 2003).Girls in child marriages are financially dependant on their husbands and cannot leave becausethey cannot repay their dowry, thus they have extremely limited power to refuse sex, negotiatecondom use or access HIV testing and services (Nour, 2006). Increased sexual experience isoften associated with increased age and therefore young girls married to older men are at anincreased risk of HIV transmission. Data collected in Zambia and Kenya (year(s) not specified)showed that “young married girls are more likely to be HIV-positive than their unmarriedpeers because they have sex more often, use condoms less often, are unable to refuse sex,and have partners who are more likely to be HIV-positive” (Clark, 2003; Luke and Kurz, 2002118 CHAPTER 5 PREVENTION FOR YOUNG PEOPLE