Reproductive Health

of Young Adults:
Contraception,
Pregnancy and
Sexually Transmitted
Infections/HIV
Reproductive Health Series
Reproductive Health Issues
of Young Adults

Topics to be covered
 Why focus on young adults
 Defining young adults
 Characteristics of young adults
 Reproductive health risks and consequences
 STI/HIV risks and consequences
Why Focus on the Reproductive
Health of Young Adults?
More than 1 of every 4 persons
worldwide is between ages
10 and 24 years
Youth Are Assets

Youth are a great potential resource

Reproductive Health Risks and
Consequences for Young Adults
Risks:
 Unintended and too-early pregnancy

 STIs, including HIV/AIDS

 Unsafe abortion

 Sexual violence
Consequences:
 Medical
and unwanted
 Psychological
sexual activity
 Social

 Economic
HIV/AIDS Risk for Youth
About half of all new HIV infections are among youth
 HIV/AIDS epidemic among youth remains largely
invisible to adults
 Stopping HIV/AIDS requires working with youth in a
comprehensive way
 Young women are several times more likely to get
infected than young men
Today’s young people are the AIDS generation
Transition from Childhood to Adulthood

Adulthood

Involves
Childhood physiological,
psychological,
cognitive, social
and economic
changes

Universal process that varies by individual and culture

Defining Young Adults
Adulthood
Childhood

Terms used: adolescents, young people,

young adults, teenagers, youth

Age Range: 10-24 years

Factors Affecting the Reproductive
Health Needs of Young Adults
 Age
 Marital status  Sexual activity
 Gender norms  School status
 Childbearing status
 Economic/social status
 Rural/urban
 Peer pressure
 Political/cultural
Married and Unmarried Youth
Common Characteristics:

Biological

Need for accurate
information

Differences:

Access to services

Contraceptive needs
Gender Affects the Reproductive
Health of Youth

Gender involves roles and relationships that are

determined by society and culture. Gender affects:

 Expectations of sexual activity of boys and girls

 Views regarding responsibility for contraception
 Social consequences of pregnancy
 Degree of risk for HIV/AIDS infection
 Cultural acceptance of harmful behaviors and practices
 Client-provider interactions
Gender Affects HIV/AIDS, Other Risks
 Males have more ability to use a condom than
females, for cultural reasons
 Culture accepts harmful behaviors and practices
against females
Fertile Years Prior to Marriage Increasing

1890
Menarche Marriage

7.2 years
10 14.8
14.8 22.0
22.0 30
Age

1988
Menarche Marriage

11.8 years
10 12.5 24.3 30
Age
Source: U.S. data: adapted from Alan Guttmacher Institute, 1995.
Average Age at First Intercourse for
Unmarried, Sexually Active Youth
Average age
25

20

15

10
Latin America Asia North America
Age at first Age at first Age at
intercourse, intercourse, marriage
males females females

Source: CDC Surveys; WHO, 1997; AGI, 1995.

Young Adults and Contraceptive Use


Few married youth use contraceptives before first
birth

After becoming sexually active, unmarried youth delay
use of contraceptives about a year

Common reasons for non-use of contraceptives
among unmarried youth:
 did not expect to have sex
 lacked information about contraception
 lacked access to contraceptives
Limited Contraceptive Use:
Characteristics of Youth
 Tend not to plan ahead or anticipate
consequences
 Think they are not at risk
 Feel invulnerable
 Lack confidence or motivation to use
 Embarrassed or not assertive
 Lack power and skill to negotiate use
 Social or cultural expectations or beliefs
Limited Contraceptive Use:
Barriers to Access
Lack of access to services or methods:
 Clinics not designed to be inviting to youth

 Providers reluctant to serve unmarried youth

 Laws/policy may prohibit provision to unmarried youth

Youth may:
 Lack transportation to clinic or money for

contraceptives or services
 Fear judgment or discovery

 Be concerned about having pelvic exam

High Proportion of Births are Unintended

Sub-Saharan Africa Latin America

3 out of 6 2 out of 6

Percent of last births that were unintended

to all women under age 20, average for regions
Source: Adapted from Population Reports, 1995.
Psychological and Social Consequences
of Pregnancy for Unmarried Youth
 Social stigmas for unmarried mothers and children
 Limited education
 Fewer career or job opportunities
 Heavy economic burden
 Depression, loss of self-confidence and lack of hope
 Consequences more severe for young women than men
 Children of young parents may face psychological,
social and economic obstacles
Maternal Mortality Higher for Young Women
Maternal mortality rate per 1000 live births
28

24

20

16

12

0
Nigeria Bangladesh Ethiopia

 15 years 20-24 years 30-34 years

Source: Studies in Family Planning, 1986; British Journal of Ob/Gyn, 1985.

Medical Risks of Pregnancy in Young Women

Under
Under age
age 16:
16: May
May result
result in:
in:
Small
Small pelvis
pelvis Obstructed
Obstructed or
or
prolonged
prolonged labor
labor
First
First births:
births:
Hypertensive
Hypertensive
disorders
disorders of
of Hemorrhage,
Hemorrhage, eclampsia
eclampsia
pregnancy
pregnancy

Can be fatal for both mother and child

Maternity Care
Prenatal Care:
 To educate young women on

proper pregnancy care and assess

risk for complications
Delivery:
 To monitor for possible

complications
Prenatal and postpartum:
 To provide information on

contraception, breastfeeding, child-

care skills and child health
Risk of Unsafe Abortion
Each year at least 2 million young women
worldwide have unsafe abortions mainly due to:
 Inaccessibility or costs of safe services

 Self-induced methods

 Unskilled or non-medical providers

 Delay in seeking procedure past first 3 months of

pregnancy
Family planning can reduce unsafe abortion
Consequences of Unsafe Abortion
3 out of 5 women seeking hospital care for unsafe abortion
complications in Africa, Asia and Latin America are under age 20

Complications:
Complications:
•• Infection
Infection
•• Hemorrhage
Hemorrhage Can
•• Injury
Injuryto
toreproductive
reproductiveorgans
organs Canresult
resultin:in:
•• Intestinal •• Infertility
Infertility
Intestinalperforations
perforations •• Death
•• Toxic Death
reactions to
Toxicreactions todrugs
drugs •• Psychological
Psychologicaltrauma
trauma
•• Negative
Negativesocial
socialreactions
reactions
Youth at High Risk for STIs/HIV
Primary
Primary factors
factors are
are behavioral:
behavioral:

Non-use
Non-use or or incorrect
incorrect
use
use ofof condoms
condoms

Little
Little knowledge
knowledge
of
of STIs
STIs
 Failure to seek treatment
Failure to seek treatment
 Multiple partners or partners with
Multiple partners or partners with
High
High
multiple
multiple partners
partners STI
STI
risk
risk
 Consequences of STIs, Including HIV

Curable
Curable STIs:
STIs:
Mostly bacterial
Mostly bacterial
Can lead to PID and infertility
Can lead to PID and infertility
Harmful
Harmful medical,
medical,
psychological,
psychological,
Incurable
Incurable STIs:
STIs: and
and social
social

Viral
Viral consequences
consequences

Can
Can lead
lead to
to chronic
chronic disease
disease or
or
death
death (HIV/AIDS)
(HIV/AIDS)
Risks and Consequences of
Sexual Abuse

Rape, sexual assault, involuntary prostitution

can result in:

Physical injury

Unintended pregnancy

STIs

Psychological trauma

Increased likelihood of high-risk sexual behavior
Summary and Next Steps
Young adults face high risks of pregnancy and STIs

To
To address
address this:
this:
Young
Young adults
adults need
need information,
information, skills,
skills,
and
and access
access toto services
services

Policy-makers
Policy-makers and
and providers
providers need
need to
to
know
know how
how and
and where
where to
to reach
reach youth,
youth,
and
and what
what contraceptive
contraceptive and
and STI/HIV
STI/HIV
services
services are
are needed
needed
How to Reach Young Adults

Topics to be covered
 Who provides information and
 Who provides information and services to young
services
adults
to young adults
 What reproductive health information
 What reproductive health information is needed
by is needed
young adultsby young adults
  Where
Where services
services for adults
for young young areadults
best are
provided
best provided
Youth Involvement Is Critical
 Involve perspective of target audience
 Work with youth, rather than for youth
 Draw on youth’s energy, hope, eagerness to learn and
resilience

Youth “should be involved from

the start as full partners….”
 World Health Organization, 2001
Who Provides Information and
Services to Youth?
Teachers
To offer a range of
services, various providers
need to be involved

Doctors

Peer Educators

Nurses Community Workers

Provider Attitudes Often Negative
Toward Young Adults
I wouldn't I don't want Anyone that
want my child to talk about age who is
to get sexuality; it sexually active
contraception. may must be a bad
encourage person.
them...
Sexuality: Open Discussions
Are Important
 Difficult topic to discuss openly for both youth and
adults
 Includes a wide range of issues, such as peer
pressure, sexual identity, sexual orientation, sexual
capability, sexual coercion

Helps youth understand and express their feelings
 Promotes responsible sexual behavior, helps prevent
unintended pregnancy and STIs
Communication Skills Needed
by Providers
 Reflective listening
 Open-ended questions
 Positive body language
 Characteristics that
help communication:
 sincerity, honesty,

non-judgment, respect, sense of humor

Confidentiality is critical in serving youth

Provider Training Needed
 Technical knowledge
 Knowledge of issues
facing young adults
 Gender awareness
 Counseling skills
 For some: how to train
young people in
communication skills
What Reproductive Health Information
and Education Do Youth Need?

Young adults need information and skills to be

able to take responsibility for their sexuality.
 Risks and consequences of sexual activity

 Contraceptives and STIs

 Sex education

 Fertility issues for men and women

 Gender issues

Information and education should be age-specific

Research Shows Sex Education Helps

Sex education:
 Does not lead to earlier or

increased sexual activity

 Can give young people skills to

delay sexual activity

 Can increase contraceptive use

It is important to begin sex education early

Source: WHO, 1993.

 Elements of Effective
Sex Education Programs
Content:
Content: Teaching
Teachingmethods/
methods/program
program
design:
design:
 Provides
Providesbasic,
basic,accurate
accurate
information
information
 Provides
Providesmodeling
modelingandand
 Focuses on practice
Focuses on practiceof
ofcommunication
communication
reducing
reducingsexual
sexual Effective
Effective and
andnegotiation
negotiationskills
skills
risk-taking
risk-taking Programs
Programs
 Trains instructors
Trains instructors
 Addresses peer  Involves students in
Addresses peer Involves students in
pressures
pressures teaching
teachingmethods
methods
 Strengthens individual  Lasts at least 14 hours or
Strengthens individual Lasts at least 14 hours or
and
andgroup
groupvalues
valuesagainst
against has
hasintensive
intensivesmall-group
small-group
unprotected
unprotectedintercourse
intercourse work
work

Source: U.S. National Technical Information Services, 1995.

Sexuality: What Youth Need to Know
Includes issues of identity, societal roles, human
relationships, biological development

Youth need to learn:

 How their bodies, minds and feelings are changing

 How to communicate about sexuality

 How to handle societal and peer pressures

 How to make responsible decisions about sexual activity,

including abstinence
Ways of Expressing Sexuality
Young people need to know
alternatives to risky sexual behavior
 Holding hands

 Hugging

 Dry kissing

 Body rubbing

 Masturbation

 Mutual masturbation

 Sexual intercourse with a condom

Fertility Awareness
Involves education about:
 The reproductive system

 Fertility

 The menstrual cycle

 How pregnancy occurs

 Attitudes and cultural norms
about fertility, the use of
contraception and childbearing
Important for both males and females
 Fertility of Men and Women
 Males are fertile all the time after
beginning sperm production
 Females are fertile for a period of
time during each cycle
 Menstrual cycle:
 begins with menstrual bleeding
 ovulation occurs
 if egg is not fertilized, cycle
begins again in about 2 weeks
 Fertile time can begin about 6 days
before ovulation
Gender Awareness for Youth

Important to emphasize communication and shared

responsibility between boys and girls
Where Can Information and Services
for Youth Be Provided?

 Home
 Health clinics
 School-based
programs
 Community-based
youth organizations
 Mass media
 Effective Programs for Young Adults

Identify target group, Involve youth

analyze assets and
needs

Work with community,

Incorporate including family
evaluation members

Make services Use materials

accessible, as designed by and
identified by youth for youth
Youth-Adult Partnerships
Elements of good partnerships:
 Organizational commitment

and capacity
 Attitude shifts among adults

and youth
 Selection, recruitment and

retention of youth
 Substantive levels of youth

participation
Family Involvement
 Many youth want to talk to family members about sexuality
 Crucial elements:
 availability of family members
 attitudes and knowledge
 communications skills
 Programs needed to help parents
learn necessary skills and information
 Family members can support youth
in seeking services and information
Health Clinics Designed for Youth

 Separate units for youth

 Outreach clinics with specially trained staff
 Mobile clinics
 Special hours
 Convenient and safe locations
 Youth-to-youth promotion
 Low or no-cost services
Traditional Health Clinics:
An Opportunity to Reach Youth
 Providers can take advantage of existing opportunities for
providing information to young adults

 With every client, the provider should ask:

““IfIf you
you are
are sexually
sexually active,
active, what
what are
are you
you doing
doing to
to
prevent
prevent pregnancy
pregnancy and
and STIs?”
STIs?”
 Referrals to other services and providers
Elements of School-Based Programs
Large numbers of youth can be reached
efficiently at schools
 Family life education curricula

 School-based or linked clinical services

 Training of instructors

and administrators
 Involvement of families

and community
Community-Based Youth Organizations

 Multi-service organizations: recreation,

sports teams, vocational training, tutoring
 Workplace and religious groups:
information and services
 Peer promoters or educators: information,
counseling and condoms
 Youth centers for pregnant and parenting
teens: continuing education and skills
training
Mass Media and Other Creative Outreach

Mass media: radio, television,
film, comic books

Telephone hotlines

Entertainment: drama groups,
puppet shows, concerts

Computer technology: Web sites,
CD ROMS, distance learning

Social marketing
Summary

Lessons learned:
 Sex education is valuable for young adults

 Education needs to focus on skills and

attitudes as well as information

 Programs need to involve youth in the

design
 Forming effective youth-adult partnerships

influences attitude changes

Contraceptive Options for Young Adults

Topics to be covered
 Contraceptive methods
 Emergency contraception
 Dual method use
 Postpartum and postabortion
contraception
Contraceptive Issues for Young Adults

Non-medical issues:
 High-risk behavior

 Lack of accurate information

 May not use methods consistently and correctly

 Have unplanned and sporadic sexual activity

 Lack of knowledge or access to emergency

contraception
Complete Abstinence
 Most effective way to prevent
pregnancy and STIs
 No sexual intercourse
 May include other forms of sexual
expression
 Option for all youth, including those
who have begun sexual activity
 Requires high motivation, self-control,
communication and social support
Barrier Methods
Includes male and female condoms, spermicides,
diaphragms and cervical caps
 Are most effective when used consistently and

correctly
 Pregnancy rates in typical use

range from 12 percent for condoms

to 21 percent for spermicides
 Safe, with no systemic effects
Barrier Methods: Advantages
 Male condom is the most effective method for STI/HIV
prevention
 Female condom is an alternative to male condom
 Most methods are accessible and available
 Good for infrequent sexual activity
 User-controlled
 Easily initiated and discontinued
Barrier Methods: Counseling
Successful use requires:
 Partner participation and negotiation skills

 High level of motivation, self-confidence, self-control

Key messages:
 Always carry with you, so barrier methods are

available when needed

 Communication and shared responsibility are vital

 Consistent and correct use are key to effectiveness

Male Condom

 Use for pregnancy protection and if at risk for STIs

 Use with other methods for STI protection
 Incorporate into sexual activities
 Use can result in delayed ejaculation
Male Condom: Use
When using:
 Open package carefully

 Do not unroll before putting it on

 Hold rim of condom during withdrawal

 Use only water-based lubricants

Oral Contraceptives
 Very safe and effective when used
consistently and correctly
 Many non-contraceptive health benefits
 Rapid return to fertility
 Use independent of sexual intercourse
 Can be used without partner’s knowledge
 Usually requires visit to clinic or other trained
provider
 No STI protection
Oral Contraceptives: Counseling
 Contraceptive benefit wears off quickly
 Pills must be taken daily
 Possible side effects include nausea or breakthrough
bleeding
 Link pill-taking to a daily routine
 Encourage use of condoms for backup if pills not
taken correctly or if at risk for STIs
Injectables and Implants
 Very effective against pregnancy
 Non-contraceptive health benefits

No daily action required or supplies
needed at home

Use independent of sexual intercourse and
can be used without partner knowledge
 Require clinic visit
 No STI protection
Injectables and Implants: Counseling
Progestin-only injectables and implants:
 Bleeding irregularities likely
 Return to fertility

 delayed with injectables

 immediate upon removal of implants

 Use condoms if at risk for STIs

Implants:
 Appropriate for those wanting long-term method
Intrauterine Devices (IUDs)

 Very effective at pregnancy prevention

 Use independent of intercourse
 Quick return to fertility
 Requires clinic visit for insertion and removal
 No STI protection
Intrauterine Devices (IUDs): Counseling

Eligibility:
 Not usually recommended for young women at increased risk

for STIs
 Not recommended for those with recent or current STIs

 Under age 20 and nulliparous women may have increase risk

of expulsion
Counseling messages:
 IUDs are not appropriate for those with high-risk behavior

 Important to check for signs of expulsion

Lactational Amenorrhea Method (LAM)

Temporary and effective method for

breastfeeding women

For LAM to be effective the woman must be:

 Fully or nearly fully breastfeeding

 Amenorrheic

 Within the first six months postpartum

LAM provides no protection against STIs

Traditional Methods
Periodic abstinence and withdrawal:
 Always available

 Can promote reproductive health awareness

 High pregnancy rates in typical use

 No STI protection

 Require considerable motivation

 Periodic abstinence is difficult for young women

with irregular menstrual cycles

 Training about fertility awareness essential
Sterilization

Generally not an appropriate method for young adults

Emergency Contraception
 Prevents pregnancy after unprotected intercourse
 Not meant to be a regular method
 After use, a regular method should be initiated or resumed
 Can be used at any time during cycle
 Does not protect against STIs
 Most effective when used early after unprotected
intercourse
 Method options:
 combined oral contraceptive pills
 progestin-only contraceptive pills
Emergency Contraception:
Combined Oral Contraceptives
Pill
Pill Regimens
Regimens
 Prevents 75% of expected
within
within 72
72 hours
hours after
after
pregnancies unprotected
unprotected intercourse
intercourse
 Requires 2 doses,
low-dose
low-dose high-dose
high-dose
12 hours apart pills
pills pills
pills
 Each dose contains at least
100 mcg of ethinyl estradiol
and 500 mcg of levonorgestrel 12 hours 12 hours
 May cause nausea and
vomiting repeat
repeat dose
dose repeat
repeat dose
dose
Emergency Contraception:
Progestin-Only Oral Contraceptives
 More effective than combined Pill
Pill Regimen
Regimen
pills for emergency within
within 72
72 hours
hours
after
after unprotected
unprotected
contraception intercourse
intercourse
 Requires 2 doses, 12 hours first
first dose
dose
apart
 Each dose contains 750 mcg 750
750 mcg
mcg levonorgestrel
levonorgestrel

levonorgestrel 12 hours

 Much less likely to cause

repeat
repeat dose
dose
nausea and vomiting than
combined pills 750
750 mcg
mcg levonorgestrel
levonorgestrel
Dual Protection: Pregnancy and STIs

Dual method use:

Primary
Primarymethod
methodfor
forpregnancy
pregnancy Condoms
Condomsadded
added
prevention
prevention for
forSTI
STI
prevention
prevention

Other option for dual protection:

Condom
Condomas asprimary
primary Emergency
Emergency
method
methodfor
for contraceptive
contraceptivepills
pills
pregnancy
pregnancyandand ififcondoms
condomsnot notused,
used,
STI
STIprevention
prevention ororififthey
theybreak
breakor
orslip
slip
Postpartum Contraceptive Options
Delivery 3 weeks 6 weeks 6 months onward
All women
Condoms/Spermicides
IUD
Diaphragm/cervical cap

Breastfeeding women
Lactational Amenorrhea Method
Progestin-only Methods/Natural Family Planning
Combined Estrogen-Progestin

Non-breastfeeding women
Progestin-only Methods
Combined Estrogen-Progestin Methods/Natural Family Planning
Postabortion Contraceptive Options

First trimester procedure 6 weeks

Any method

Second trimester procedure 6 weeks

Condoms/Spermicides/Combined Estrogen-Progestin/Natural Family
Planning/Progestin-only
IUD
Diaphragm/cervical cap
Summary of Contraceptive Options for Youth

Barrier Methods,
Progestin-only
Age and Parity OCs, Implants, IUDs
Injectables
Traditional, LAM

Nulliparous

Under 18 Can generally use

No restriction
18-19

20 and over

Source: WHO, 2004.

STI/HIV Prevention and Treatment:
Priority for Young Adults

Topics to be covered
 STI/HIV risks and consequences
 Most common STIs, including HIV
 STI/HIV prevention
 STI/HIV counseling
 Voluntary counseling and testing
 Risk assessment
 STI/HIV management and treatment
STI/HIV Risk Higher in Young Adults

Behavioral
Behavioral susceptibility:
susceptibility:
 Youth
Youth feel
feel invulnerable,
invulnerable, don’t
don’t believe
believe itit could
could happen
happen
to
to them
them
 Condoms not used consistently or correctly
Condoms not used consistently or correctly
 Have multiple partners, or partners with multiple
Have multiple partners, or partners with multiple
partners
partners
 Other factors such as drug and alcohol use
Other factors such as drug and alcohol use

Biological
Biological susceptibility
susceptibility in
in young
young women:
women:
 Cervical ectopy
Cervical ectopy
STI Consequences for Young Adults
 Symptoms: vaginal or penile discharge, painful
urination, abdominal pain or genital sores
 Can be transmitted from mother to infant during
pregnancy, delivery or breastfeeding
 Untreated, can lead to chronic disease, infertility or
death
 Psychological, social and economic impact
Most Common STIs
Providers need to know STI prevalence in their areas

Curable
Curable (mostly
(mostly bacterial)
bacterial)
Trichomoniasis,
Trichomoniasis, chlamydia,
chlamydia,
gonorrhea,
gonorrhea, syphilis
syphilis

Incurable
Incurable (viral)
(viral)
HIV/AIDS,
HIV/AIDS, human
human papilloma
papilloma virus
virus
(HPV),
(HPV), hepatitis
hepatitis B,
B, herpes
herpes
Curable STIs

Curable with antibiotics

Access to treatment services important
opportunity

Often asymptomatic and
hard to diagnose

Can lead to PID and infertility
 Some can be transmitted
during childbirth or result in
adverse pregnancy outcomes
 Increases risk of HIV transmission
Most Common Curable STIs
Trichomoniasis:

Estimated to be most common STI globally

Associated with adverse pregnancy outcomes

Chlamydia and gonorrhea:


High rates in young adults

May lead to PID

Can infect newborn during childbirth

Syphilis:

High risk of congenital infection
HIV: High Risk for Young Adults
Half
Half of
of all
all infections
infections worldwide
worldwide are
are in
in people
people under
under
25
25 years
years of of age
age

 New infections concentrated in young women

 HIV can be transmitted through semen, vaginal
fluids, blood, breastmilk or in utero
 No vaccine exists

 Prevention strategies are essential

Other Viral STIs
Human papilloma virus (HPV):

Causes genital warts

Highly associated with
cervical cancer

Hepatitis B:

Causes liver damage

Vaccine available

Herpes:

Symptomatic or asymptomatic

Widespread among young adults
Addressing the HIV Epidemic:
Youth Central to Strategies
 Build support among leaders to speak out
 Use education and communication
 Address cultural, social and gender norms
 Promote condoms
 Make services youth-friendly
 Reach out to vulnerable youth
Orphans and Vulnerable Children (OVC)

By 2010, more than 25 million children will have lost
one or both parents to AIDS
 Needs to address:
 Whether orphans should know their serostatus
 Increased risk of sexual exploitation
 Stable family structure, educational opportunities
 Mental health supports, such as memory books
 Reproductive health and HIV prevention
STI Prevention
Should be part of all reproductive
health programs

 Provide information on STIs

 Counsel clients about safe
sexual behaviors
 Assess risk for STIs

Promote and distribute
condoms
STI Counseling
Messages for youth:
 All sexual activity puts them at risk for STIs/HIV

 Safest sexual behavior is abstinence

 For those sexually active, safe sexual behaviors include:

 Assessing if partner is infected

 Mutual monogamy
 Reducing number of
sexual partners
 Using condoms
Voluntary Counseling and Testing (VCT)
 Where HIV prevalence is high, young people want to know
their status
 VCT can help young adults use safer sexual practices and
reduce rates of STIs
 VCT presents challenges:
 Recruitment
 Preservation of
confidentiality
 Stigma
What is the VCT model?
Decision to seek testing

Pretest counseling
• The test process
• The implications of testing
• Risk assessments and risk prevention
• Coping strategies

Decision to test
Preventive
NO YES
Counseling
Posttest counseling
HIV-negative HIV-positive
• News given • News given
• Risk-reduction plan made • Risk-reduction plan made
• Discussion about disclosure of HIV status • Discussion about disclosure of HIV status

Follow-up counseling and support

• Medical care
• Emotional Support
• Social Support
Assessment of STI Risk
STI symptoms include:
 Vaginal or penile discharge, painful urination, abdominal

pain, or genital sores

Risk factors include:

 Number of sexual partners

 Client’s age

 Recent new partner

 Previous STI infection

 Partner has other partners or STI symptoms

STI Management:
Diagnosis and Treatment
Using laboratory tests:

Expensive and require client to return to clinic

Using syndromic approach:


Based on a person’s symptoms and signs
and the local epidemiology

Works well for ulcers and male urethral discharge;
does not work as well for vaginal discharge syndrome

During treatment, counseling should emphasize

partner notification
Summary
STI prevention and treatment –
a priority for those working with youth
 Young
Youngwomen
womenininparticular
particularneed
needattention
attentionsince
sinceHIV
HIV
rates
ratesare
areincreasing
increasingmost
most rapidly
rapidlyamong
amongthis
thisgroup
group
 Good
Goodcounseling
counselingcan
canhelp
helpall
allyouth
youthavoid
avoidSTI
STI
infection
infection
Youth Are Our Future