Promotion of the low risk "ABC" behaviors-Abstinence, Being
faithful, and Condom use-has had only limited success in Africa.
This book draws on a large qualitative study affiliated with an
adolescent intervention trial to examine how ABC promotion can be
improved. It evaluates the MEMA kwa Vijana sexual health program,
which was implemented in 62 primary schools and 18 health
facilities in rural Tanzania, scrutinizing its teacher-led
curriculum, peer education, youth-friendly health services, youth
condom distribution, and community mobilization components. The
book examines how implementing such a low-cost, large-scale program
involved many compromises, including those between national
policies and international "best practice" recommendations, between
the most desirable intervention design and one that was affordable
and sustainable at a large scale, between optimal teaching methods
and real-world teaching capacity, between ideal curriculum content
and what was acceptable to the local community, and between adults'
values and youths' realities. The program's impact is evaluated by
triangulating findings from three person-years of participant
observation, in-depth interviews, survey interviews, and biomedical
tests. The book also provides in-depth case studies to examine the
motivations and strategies of extraordinary young people who
practiced ABC behaviors. It outlines broad principles for ABC
promotion, including: acknowledging existing youth sexual
relationships; promoting each low risk behavior in complexity and
depth; working with preexisting, culturally compelling motivations;
and intervening at individual, interpersonal, community, and
structural levels. Many recommendations for the promotion of
specific ABC behaviors are discussed, such as reducing pressures
and incentives for girls to have sex; targeting male
risk-perception and self-preservation; promoting alternative forms
of masculinity than sexual conquest; strengthening premarital and
marital relationships; tailoring fidelity programs for hidden
couples, couples planning to marry, and monogamous and polygynous
married partners; and addressing pleasure, trust, pregnancy
prevention, and fertility protection in condom promotion. The book
concludes with additional recommendations specific to school
programs, and a review of promising complementary interventions for
out-of-school youth, women, men, couples, and parents.
General
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