1. Penelope Campbell August 2006
‘Baseline Assessment Informs Establishment of a Mobile Unit providing HIV/AIDS/STI information, skills-based counseling & services to vulnerable adolescents in Jamaica
Penelope Campbell August 2006

2. The “Bashy” Bus

3. Delivering Adolescent SRH Services

4. In a non-threatening environment

5. Overview
Jamaica's 2.6 m population experiencing a generalized epidemic
Est. prevalence of 1.5%
Est. 22,000 persons living with HIV
9,682 reported AIDS Cases (June 2005)
58% male, 42% female
Average rate of 372 per 100,000
Over 800 per 100,000 in some parishes (urban and tourist)
Predominantly heterosexual transmission (71%)

6. The Bashy Bus Route S u m m a r y o f A I D S C a s e s b y P a r i sn J a m a i c a 1 9 8 2 - 2 4 (R a t e p e r 1 , P o p . )
The Bashy Bus Route N W E S H a n o v e r T r e l a w n y S t . A n n S t . M a r y W e s t m o r e l a n d P o r t l a n d S t . E l i z a b e t h S t . C a t h e r i n e M a n c h e s t e r C l a r e n d o n S t . T h o m a s
AIDS/100,000 Pop.
100 . -
150
150 -
200 .
200 - .
300
300 . -
400

7. The Challenge Children and adolescents 40% of population
Early sex initiation (boys 13 yrs.; girls 15 yrs.)
High rate of forced sex (20%)
High rate of transactional sex (20%)
High rates of multiple sex partners (48% men, 16% women)
Adolescent girls 3 times more likely than boys to become HIV infected
50% report sex partner to be 5-10 years older
“Sex on the Bus”: risky sex practices between young people and transport operators widespread

8. “Turning a Negative into a Positive”
An alternative “bus service” (along major transport & high prevalence routes) delivering the following services for vulnerable adolescents :
SRH education: avoiding STIs, unwanted pregnancies
Life skills counselling: relationships, drug abuse
Getting help to restart school after pregnancy
Access to condoms & other contraceptives
VCT (rapid testing ) for HIV

9. “Bashy Bus Kru” – SRH education

10. Interactive Skits & Cultural Presentations

11. VCT (rapid) & Clinical Services HIV/STIs

12. Skills-based Counseling, Condom Access

13. Programme Objectives
By December 2009, 20,000 vulnerable adolescents will have:
Increased knowledge about HIV/AIDS and SRH issues
Improved risk assessment & sexual decision making skills
Increased access to HIV/AIDS/STI services
Improved sexual health behaviours & practices
Penelope Campbell

14. Research Objectives
Determine adolescents’ interest and preferences in the services and design of the Bus.
Build a baseline profile of the targeted adolescents re. their SRH knowledge, attitudes and behaviours
Prepare a performance framework for monitoring & evaluation (process & impact)

15. 96 adolescents participated in FGDs
Research Design
451 adolescents surveyed (structured interviews)
211 boys (47%) and 240 girls (53%)
96 adolescents participated in FGDs
4 intervention & 3 control communities
Findings disaggregated by age, gender & location

16. Research Findings 74% live with mother; only 33% with father
77% enrolled in school
74% live with mother; only 33% with father
1 in 5 live with neither parent (visiting relationship)
20% rely on neither parent for financial support
78% know where nearest health centre located
BUT 59% did not have positive impression
Girls & younger adolescents were especially reluctant
Boys felt proud accessing services (machismo)

17. Perceived vs. Real Needs
High interest in range of services proposed (70%) – especially 15+ age group
… but few (19%) actually sought any of services proposed in past 12 months
‘Real’ needs however were high:
1 in 2 reported having sex: boys (62%) girls (38%)
Early sex initiation common: 14.9 yrs for girls & 11.8 yrs for boys
84% “ready for sex”(47% never had sex before)
Only 27% had comp. HIV/AIDS knowledge
Early interventions with in-school sexually inactive adolescents that fosters age and positive attitudes and behaviours, including to delay sex, should help prevent some of the problems associated with early sexual activity including early pregnancies and disrupted schooling.

18. Sexually active adolescents:
20% females & 66% males did not use condom at first sex
37% females & 30% males did not use condom at last sex with their main sex partner
1 in 10 reported forced sex (93% did not feel need to ‘get help’ afterwards)
1 in 4 reported multiple sex partners
1 in 5 had sex partner - 5 years or older
Ave. age sex partners of girls was 21 yrs compared to 16 yrs for boys
1 in 10 girls are teen mothers (94% unintended; 18% under 16)

19. Taking services to adolescents
Over 80% interested in mobility of service:
Bus will allow them to express themselves freely and in privacy
‘Bus workers not from area’, do not know parents
However, 30% did not want Bus to visit ‘their corner’ because:
Don’t want it to look like ‘dem have AIDS’
People/peers will know ‘their business’
The Bus may be better deployed in central, more ‘neutral’ locations

20. Adolescents’ expectations of service
Top 3 priorities:
Building healthy relationships (including with their parents)
Condoms & contraceptives
HIV testing
Most important youth-friendly qualities:
RESPECT (90%)
Clarity of information (90%)
Confidentiality (80%)
Participation (80%)

21. Preferences and Interests
Music & Entertainment (skits)
Simple IEC materials visual that ‘do not look too educational’ or ‘boring’
Condoms (‘good’, brand) & contraceptives
Personal testimonials and…
Sanitary pads (girls)
Timing:
Sundays - because ‘boring’
Weekends - evenings
Weekdays - afternoons

22. Deterring Factors Too many “old, grumpy, grumpy people”
Judgmental people; staff with ‘attitude’
Magazines showing ‘nastiness’ like oral sex
Any association with homosexuals
Should not look overtly educational
Negative promotion of safer sex
No explicit references to ill health, HIV or AIDS
Sex is not bad; it is the negative consequences of unsafe sex which they wish to avoid

23. Recommendations Establish regular schedule
Tailor services to adolescents (gender, age, location)
Ensure RESPECT
Provide ENTERTAINMENT
Visit “neutral” locations rather than corners that young people own
Work with non-adolescents (e.g. parents, older men, ‘influentials’)
Build capacity of local SRH services to better serve adolescents (as referral sources)

24. Performance Framework
Process:
# of visitors per Bus Stop (1st time & repeat)
Approval rating (exit interviews)
% of follow up visits & referrals fulfilled
Outcome (2 years):
% with comprehensive HIV knowledge
% that knows nearest health centre; % with favourable impression; % uses family planning services there
Impact (4 years):
Condom use at last sex (regular & non-regular)
Age of sexual debut; % insist ‘no condom, no sex’; % with multiple sex partners; % unplanned pregnancy
Disaggregated by age, sex & location

25. Expected Impact (4 yrs.)
Increase mean age of sexually debut from 11.8 and years for boys and girls respectively to 14 years for boys and 16 years for girls
Increase condom use at last sex with a regular partner from 70% to 75% and from 63% to 68% respectively
Increase condom use at last sex with non regular partner from 69% to 79% and 50% to 60% respectively

26. Expected Impact (4 yrs.)
Decrease proportion with multiple sex partners in the last 12 months from 82% to 62% for boys and 65% to 45% for girls
Increase from 63% to 73% the girls with older sex partners (5+ yrs older) that insist on ‘no condom no sex’
Decrease proportion of girls that became pregnant while in school from 53% to 43%

27. Acknowledgements
Rohan Bell & Angela Stultz, Research Analysis & Associates, Jamaica
Claudette Richardson-Pious, staff & young people, Children First, Jamaica
Global Fund HIV/AIDS Project, National HIV/AIDS Programme, Ministry of Health, Jamaica

28. THANK YOU