1. Investing when it counts:
Reviewing the Evidence and charting the course for very young adolescents
Martha Brady, Senior Associate, Population Council
Girls and HIV
AIDS2016 Satellite Session
Durban, South Africa
July 21, 2016

2. A research guide on the instinctive needs of very young adolescents (VYAs)
Illuminate health and social dimensions of lives of VYAs
Identify evidence
Recommendations for research and programming

3. Investing in VYAs: Why it matters
VYAs are generally overlooked, relatively low burden of disease
Critical life phase for shaping future health and development
Source: Sawyer et al., Lancet 2012

4. Stages of early adolescence

5. Diverging worlds of girls and boys
Percentage of adolescents ages and enrolled in school by gender, four selected countries
Gender differences in transitions from primary to secondary school
In LMICs, there is general pattern of VYA girls beginning to drop out of school at onset of puberty; diverge from path for boys
Issue is that VYAs who leave school may lack or have decreased access to educational and social resources (e.g., access to institutions and social networks, knowledge/skills/self-efficacy, self-esteem) afforded through schools
Data Sources: Demographic and Health Surveys, Ethiopia 2005; Zambia 2007; Kenya ; Malawi 2004.

6. Pivotal moment where lives can go off-track

7. Harmful gender attitudes are associated with:
Low rates of condom use (Impett et al 2006; Karim et al, 2003; Pleck, Sonenstein & Ku, 1993; Tang et al, 2001; Zambrana et al 2004)
Low rates of contraceptive use (Impett et al 2006; Kowaleski-Jones & Mott, 1998; Marsiglio, 1993; Pulerwitz and Barker, 2008; Stephenson et al, 2006)
Multiple sexual partners (Karim et al, 2003; Pleck et al 1993)
Some studies have looked at sequencing… they found its not just an association… e.g. Stephenson 2006 found that among couples in which the husband held more conservative gender role attitudes about women’s roles and behaviors were significantly less likely to subsequently adopt modern methods of contraception (hazards ratio 0.79, p<0.001)

8. is associated with: Less consistent condom use Unintended pregnancy
Unequal power in intimate sexual relationships
is associated with:
Less consistent condom use
(Greig and Koopman, 2003; Pulerwitz et al, 2002)
Unintended pregnancy
(Jewkes et al 2001; Miller et al 2010)
Sexually transmitted infections (STIs)
(Raiford et al 2013)
HIV infection
(Dunkle et al, 2004; Jewkes et al, 2010)
Longitudinal study in So Africa found that women with low relationship power equity at baseline were significantly more likely to acquire HIV than women with medium or high relationship power equity (IRR 1.51, p=0.027; Jewkes et al 2010, Lancet)

9. Recommendations for research
Validate methods of gathering information among VYAs
Disaggregate data:
2- and 3-year age intervals
Gender
Build program evidence base about what works, for which segments of VYAs
Embed research into program initiatives