1. PERCEPTIONS ABOUT SEXUALITY AND RH AMONG POOR ADOLESCENTS IN PERU November 2002 Dorina Vereau

2. INTRODUCTION  13% of adolescents under 19 are mothers or are pregnant.  Peru has the highest HIV infection rate among the andean countries.

3.  Obtain information on knowledge, attitudes and sexual behavior of adolescents living in rural and peri-urban areas.  Know the frequency of sexual activity and the contraceptive prevalence rate.  Identify factors associated with adolescents’ sexual behavior.  Design intervention strategies based on the information collected. OBJECTIVES

4. METHODOLOGY  Quantitative and qualitative survey with random sample.  Analysis method: bivariate associations using Chi Square. EXPLICATIVE VARIABLES  Knowledge  Attitudes toward sex  Self-esteem  Family communication  Peer influence  Work for a salary EXPLICATIVE VARIABLES  Knowledge  Attitudes toward sex  Self-esteem  Family communication  Peer influence  Work for a salary OUTCOME VARIABLES  Ever had sex  Currently sexually active  Use a contraceptive method OUTCOME VARIABLES  Ever had sex  Currently sexually active  Use a contraceptive method

5. BASE LINE STUDY RESULTS

6. PREVALENCE OF SEXUAL ACTIVITY N = 2542 Yes 23.7% No 76.3% Ever had Sex Yes 11.4% No 88.6% Currently sexually active 14.3 years15 years 35.8%11% 18.6%3.9%

7. CONTRACEPTIVE PREVALENCE RATE Did you use contraception at your last sexual intercourse? Yes 84.6% No 15.4% Used a contraceptive method Boys Girls

8. CONTRACEPTIVE USE Boys Girls

9. % KNOWLEDGE ABOUT REPRODUCTIVE HEALTH ; WAYS TO PREVENT HIV/AIDS

10. GENDER STEREOTYPES  Adolescents boys and girls have a positive attitude towards premarital sex. Women could be raped and cheated, men hardly suffer, they can defend themselves...women have children, join men and suffer, men can have children elsewhere and they can live alone if they want, women can't …" (Boy, Huayllahuara, Huancavelica).

11. PERCEPTIONS ABOUT HEALTH SERVICES  Fear of being mistreated by doctors and nurses, shame of being seen by a stranger and lack of money, are the most common reasons why girls do not seek health services. Nurses yell "Why are you crying? if you didn't want to have a child, why did you sleep with a man?". Some are mean. Girls are afraid to be called "filthy" by the nurses. This is why I'm afraid to go to the hospital. (Girl, Tunsulla, Ayacucho) I don't like the clinic, they ask you to pay for everything: tests, bed, food...and I feel embarrassed because they look at us. (Girl, Acomarca, Huancavelica).

12. What kind of services do you want?  Services for adolescents should offer recreative and cultural activities (sports, dancing, music, occupational workshops).  Young health providers that are understanding and supportive.  Health facilities that are organized, clean and decorated for adolescents. PERCEPTIONS ABOUT HEALTH SERVICES

16.  Adolescents' knowledge of contraceptive methods and HIV/AIDS is incomplete.  Prevalence of sexual activity among males is higher than among females, and the average age at first intercourse for males is younger.  Little variety in the contraceptive methods used other than condoms, suggests that adolescents lack adequate access to methods requiring clinical intervention. CONCLUSIONS

17.  More variables were significantly associated with ever had sex and currently sexually active than with used a contraceptive.  Factors associated with adolescents’ sexual behavior are: –Peer influence –Communication with parents –Attitud toward sex –Payed labor CONCLUSIONS

18. MOBILE SERVICE Counseling on contraception Recreational Activities Psychological Counseling INTERVENTION STRATEGIES

19. Communication Strategies Peer Educators Teachers training in sex education Parents’ School

20. PERUVIAN MODEL “COMPREHENSIVE MOBILE SERVICE FOR ADOLESCENTS”  Goes where adolescents are.  Provides personal attention and youth friendly services.  Offers holistic health care.  Offers recreational activities.  Provides accurate and complete information that responds to adolescents’ needs.  Assures confidentiality.  Works in association with parents, teachers, and a leaders’ network.