Table 1 Descriptions for iterventions for young people

Economic empowerment of women

1) Shaping the Health of Adolescents in Zimbabwe (SHAZ!) Program[20]

Increased knowledge, Increased economic empowerment, Reduced inter-generational TS

Pilot study

- 50 poor orphaned, out-of-school, girls aged 16-19 years

- Increase in HIV-related knowledge and relationship

- Uncontrolled study for 6 months

- Power, no significant change in current sexual activity or condom use at last sex

- Microcredit loans

- Living on the

- Increased relationship power[21]

- Business skills training

outskirts of Harare, Zimbabwe

- Increased HIV risk through new mobility and economic strategies

- Mentorship

- 315 aadolescent girls, orphans, average age 18

- Increase in HIV-related knowledge and relationship power, no significant change in current sexual activity or condom use at last sex

Phase II study:

Randomized clinical trial (RCT)

Study

- Decrease in food insecurity

Duration 24 months, Adaptation of Stepping Stones, including expanded training including negotiation skills, Integrated social support

- Increase in equitable gender norms

- Physical and sexual violence reduce by 58% over a 2-year period

Access to HIV and reproductive health services

2) Intervention with Microfinance for AIDS & Gender Equity (IMAGE)[22, 23], South Africa

Reduced HIV risk behaviour

Cluster randomised trial, duration of 3 year

- A sample of 430 poor women aged 14-35 years identified through participatory wealth ranking

- 55% increase in experience of IPV after 1 year

- Increase in HIV knowledge, communication, testing & risk reduction

- 32% reduction in communication with household members to young people in households

- Greater involvement in collective action and social groups

- No impact on HIV incidence in wider community

- No difference in unprotected sex at last occurrence with non-spousal partner in past 12 months

- 11% increase in condom use

At last sex

- Microfinance (individual borrowing and repayment of loans over 10 or 20 week cycles)

- Participatory learning and action curriculum integrated into loan meetings (10 training sessions done within centre meetings every 2 weeks (approx. 6 months)) Community mobilization for 6 to 9 months following initial training

- HIV prevention education

3) The Tap & Reposition Youth (TRY)[24, 25], Kenya

Increased reproductive health & HIV knowledge Increased sexual negotiation skills Increased Income & savings

Pre-test, post-test design, with matched comparison (222 pairs), length of participation ranged from <1 year (n = 71), 1 to 2 years (n = 81) and 2 to 3 years (n = 70)

- A total of Out-of-school females aged 16-22 years

- Increase Savings

- Group-based microfinance loans, Livelihoods skills training

- RH & HIV prevention training

- Increase in liberal attitudes towards gender roles

- Living in low income & slum areas of Nairobi

- 1.7 times more likely to refuse sex than girls in control group

- 3 times more likely to insist on condom use than girls in control group

4) Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania[26]

To evaluate the use of conditional cash transfers as a HIV and sexually transmitted infection prevention strategy to incentivise safe sex

An unblended, individually randomised controlled trial

- A sample of 2399 persons aged 18-30 years

- High value CCT arm v.s. controls: adjusted RR = 0.073 (95% CI 0.47-0.99)

- Intervention arms: low value conditional cash transfer v.s., high value conditional cash transfer

- High value CCT arm v.s., low value CCT arm: RR = 0.76 (95% CI0.49 -0.92)

- Significant reduction in the combined point prevalence of four curable STIs among high value CCT arm

- Tested participants every 4 months over a 12 months period for the presence of common STIs

5) Survival skills training for orphans (SSTOP)[27], Mozambique

To reduce transactional sex

Intervention:

- Females aged 14-19 years

Qualitative & anecdotal evidence found:

- Responsible for

- Increased financial organization

Income generating skills

caring for younger siblings, & other disadvantaged girls

- Increase vocational skills

- Reduction in early marriage

- Increased economic empowerment

- Girls aged 9-13 learned to make soap, candles, sewing, or knitting

- Reduction in early sexual activity without protection

- Girls aged 14-19 attended sewing classes; HIV prevention education; & gender training including legal protection for women

6) Creating futures[28] (Durban, South Africa)

Objective 1:

Pilot intervention combining Stepping Stones and Creating Futures

- Piloted in urban informal settlements in with 232 young people (110 men, 122 women)

Objective 1:

To strengthen young people’s livelihoods and economic power through reflection and action

- Livelihoods improved for women and men after the intervention

- The study design was an interrupted time-series design, with baseline measures at zero and two weeks and follow-ups at six and 12 months post-baseline.

- Average age of 21.7 years

- Mean earnings in the past month increased over the 12 months. For women this increased from US$14 at baseline to US$49 (a 345% increase (p < 0.0001)) at 12 months and for men from US$36 at baseline to US$104 (a 283% increase (p < 0.0001)) at 12 months

Objective 2: Aimed to reduce women’s experience and men’s perpetration of physical or sexual IPV

- Consisted of livelihoods and economic power intervention involving 21 sessions of three hours, delivered by trained peer facilitators

For objective 2:

Women reported a statistically significant reduction in their experience of sexual or physical IPV in the past three months from 29.9% at baseline to 18.9% at 12 months (a 37% reduction (p < 0.046)

- Women’s experience of sexual IPV also declined significantly from 11.1% at baseline to 3.6% at 12 months (p < 0.018)

- Men’s perpetration of physical or sexual IPV in the past 3 months, while declining from 25% to 21.9% (a 23% reduction) was not statistically

Significant

Economic empowerment plus school attendance

7) Zomba cash transfer[29], Malawi

Increased income Increased EducationReduce HIV risk

Randomised control trial, 2 years Cash transfers (CTs) conditional and on regular school attendance v.s. unconditional CTs (average amount US $10)

A sample of 1289 never married girls aged 13-22 years in 176 enumeration areas in Zomba

One-year follow-up:

- Reduced onset of sexual activity by 31.1%

At 18 months follow-up:

- Intervention group had 64% reduction in HIV prevalence and 76% reduction in HSV-2 prevalence

- Reduced age of partners in those in intervention

- No significant differences between conditional and unconditional intervention group, although the study was not powered to show this

8) Western Kenya schooling intervention[30]

To reduce HIV incidence in schools

Randomised control trial, 4 years, Comparing 4 school-based HIV/AIDS interventions:

A sample of 70,000 school boys and girls in school

Teacher training:

- No impact childbearing

- Increase in HIV knowledge If pregnant, more likely to be married

- Training teachers in HIV/AIDS curriculum

Critical thinking:

- Increase knowledge & condom use

- Critical thinking on role of condoms

- No impact on sexual activitySchool uniforms:

- Reduction in dropout rates 17% in boys, 14% in girls

- Reducing the cost of education by providing school uniforms

- Reduction in teen marriage 9% in girls

- Reduced childbearing 12%Relative risks:

- Relative risk campaign

- Reduction in childbearing 28%

- Increased sexual activity in boys

- No impact on pregnant teen couples

- Reduction in cross-generational pregnancies 61%

Gender empowerment and safe spaces for young people

9) Binti Pamoja Centre (Daughters United centre)[31, 32], Kenya

Create safe spaces for girls to reduce: violence, Female genital mutilation, Sexual abuse, Rape, Prostitution Poverty and Increase: Reproductive health knowledge, Financial education, Leadership & personal skills

Community intervention:

Girls aged 11-18 living in the Kibera slum

2002 to present

- Sampled adolescents from 4 ethically distinct villages in Kibera

- Baseline data highlights social isolation for many girls & 55% of girls live with neither or only one parent

- Mapped all safe spaces in the community

- >30 safe spaces established reaching >1000 girls

- Used photography, drama, writing & group discussion

- Positive changes in social networks, mobility & gender norms

- Increased financial literacy, banking services usage, savings, & communication with parents/guardian on financial issues

- Peer education & empowerment workshops

- Developing skills in budgeting, savings, setting financial goals

- Increased confidence & positive self-esteem

- Provided educational scholarships

10) Siyakha Nentsha[33], South Africa

A life-orientation program to improve lifelong skills & well being of young people

Quasi-experimental, control arm, 18 month follow-up, 4 years Three study arms:

Boys & girls aged 14-16 in schools

- Increased autonomy for girls in how they spend their money & control their lives

- Increased HIV related knowledge

- Young men had reduced onset of sexual activity and fewer partners

- SRH/HIV, social support, financial education

- SRH/HIV & social support

- Delayed Intervention (i.e. control group)

11) ICRW Vitu Newala[34], Tanzania

Understand specific vulnerabilities of adolescent girls and empower them, increase girls positive attitudes and beliefs on girls’ social protection

Pilot project Qualitative assessments throughout:

Adolescent girls

- Video parlours, discos & traditional initiation ceremonies identified as places where girls felt unsafe

- Repeating the same participatory learning activities,

- Community put in place laws & changed practices to provide social protection

- Series of IDIs with young people,

- An evaluation workshop

Comprehensive sexuality and behaviour change communication

12) Soul City Institute for health & development[35], South Africa

Increase: social change, Social mobilization, Advocacy and reduce HIV incidence

Promoting health & social change via TV, radio, & print Soul Buddyz:

Soul buddyz:

Soul City & Soul Buddys exposure

- Spin off of Soul City TV series using edutainment

- Children aged 8-14 years, their teachers & their caregivers

- Increased: Self-perceptions on risk, Resistance to peer pressure

One love:

- One love: Adults

- Statically significant shifts in social norms, especially sexual norms

- Reduced Perception of

- Challenged social norms on multiple & concurrent partnership

women’s dependence on men (68% vs. 61%, p < 0.05)

13) Stepping Stones[36, 37], South Africa

Increase: Sexual health knowledge, Communication skills, Ccritical reflection and reduce Sexual health risk

Cluster randomised controlled trial, 2 years

A sample of 1077 HIV negative Persons aged 15-26 years, mostly attending school

- HIV IRR = 0.85 (95%CI: 0.60, 1.20; p = 0.35)

- HSV2 IRR = 0.69 (95%CI: 0.47, 1.03; p = 0.07)

- 70 villages randomized to either 13 3-hour sessions and 3 peer group meetings, or a 3-hour session on safer sex and HIV.

- Men’s disclosure of perpetrating severe Intimate partner violence reduced at 12 & 24 months (p = 0.11 & p = 0.05)

- Reduced Problem drinking among men

Parenting and socialisation

14) Families Matter! (FMP),[38, 39], Kenya

Reduce age at first sex and increase ppositive parenting practices

Community-based intervention using parent-child dyads, 2 years (2004-2006)

375 Parents/carers of 10-12 year-olds

- Increased Parenting skills & communication about sexuality & risk reduction

Five consecutive 3-hour sessions on sexual risks and effective parent-child communication

- Parents’ attitudes regarding sexuality education changed positively.

Five of the six composite parenting scores reported by parents, and six of six reported by children, increased significantly at 1 year post-intervention.

15) Mema kwa Jamii (Good Things for Communities, MkJ),[40, 41], Tanzania

Reduce SRH risks in youth through improved parenting

Community-based pilot parenting intervention, 2007-2010

Approximately 1355 parents of young people aged 10-18 years

Qualitative indications of impact on:

- Parents socialised their male children differently from female

Opinion leaders in four communities trained to training peer parents on parenting following diffusion of innovation theory over a period of 1 year

- Improved parent-child relationships and collective efficacy