Kelly Hallman, Kasthuri Govender, Eva Roca, Emmanuel Mbatha, Mike Rogan, and Hannah Taboada.

Population Council, Isihlangu, University of KwaZulu-Natal\

Global Youth Enterprise & Livelihoods Development ConferenceWashington, DC

September 14-16, 2010

Building economic, health and social capabilities among adolescents

threatened by HIV and AIDS

The Siyakha Nentsha (“Building with Young People”)

program in KwaZulu-Natal

Strategic Planning: Used Research to Learn

Which adolescents to invest in - Identify highest concentrations of poor & vulnerable by

gender, age, geography

When vulnerabilities—that must be addressed by programs—begin

Whether poor adolescents are already being reached by “youth” initiatives

What was missing from existing programs

Formative research:

Structural factors associated with adolescent HIV risk behaviors

• Residing in relative poverty• Fewer social connections• Non-cohesive community• Orphanhood

Source: Hallman 2004, 2005, 2007, 2008, 2010; Hallman & Roca 2007

Durban Program Scan• Few adolescent SRH or HIV programs

address social, economic, and cultural underpinnings of risk behaviors

• Few livelihood programs make conceptual link to health risk behaviors– Not context-, age-, culture- or gender-

specific– Design not evidenced based – Delivery weak– Little monitoring or evaluation

Setting

• Semi-rural KwaZulu Natal– Poverty and income inequality– Unemployment– Early pregnancy– Early school leaving– HIV

Intervention purposeImprove functional capabilities and well-being of

adolescents at high risk for:HIV and STIs teenage pregnancy parenthood

school dropout loss of one or both parentslack of knowledge of further employment and training opportunities

Intervention rationale • Secondary schools

• Least selective sample in this context• Scalable – DOE is base • Bundled accredited package

• Females and males• Resounding community feedback• Male attitudes, behaviors and future prospects

• Work both sides of gender equation

Intervention content • Knowledge and skills for pregnancy and HIV

prevention and AIDS mitigation; accessing preventive, treatment and care services

• Skills for: – managing personal and familial resources – Accessing social benefits, education and training opportunities– planning and aspiring for the future – building savings/assets over time

• Building and strengthening social networks and support

Intervention theory of change• Participation builds skills

• Visible local role models enhance aspirations• Leadership on HIV and standing in

community• Respect from community increases agency• Skills and self-identity as capable economic/

health/ social decision maker raises agency • Agency increases sexual decision making

power

Credibility – Sound programming principles

• Maximum use of existing infrastructure– Tapping & building local human capacity

• Make consistent with local reality – Facilitator pay rate same as gov. auxiliary social

worker– Local residence: no absences; know local

realities– National accreditation of program

→ cache and door opener for grads– Curriculum geared to local opportunity

structures• Designed with an eye toward scale-up

– DOE decision-making from Day 1

Credibility - Project team

LearnersFacilitatorsEducators

Tribal Authority

KZN DOE kdkd Isihlangu Health & Development

Agency

Population Council

HEARD

UKZNAccuData

Credibility – Project design• Incorporated into school day

• Least selective sample in this context• Reaching maximum number in vulnerable

community

• Females and males• Responding to community needs• Male attitudes, behaviors and future prospects

• National accreditation of– Curriculum– Implementing organization as training providers

Credibility -Randomized

program design

HIV education,

social support + financial literacy

HIV education and social support Delayed

intervention

Credibility – M& E Indicators

• Relevant• Objective• Transparent• Systematic and continuous• Participatory• Usable

Credibility - Research Methods

• Longitudinal survey w grade 10 & 11 students

• FGs & IDIs w students (F, M), guardians, teachers, school principals and program facilitators to assess experience with intervention

  Males Females

Have you discussed... No Program Program No Program

Program

Self-esteem, attitudes, values

85 98* 83 94*

Gender relations 58 91* 62 84*

Sexuality 88 100* 91 95

Violence and sexual abuse 85 99* 91 97

Financial decisionmaking 73 89* 64 86*

Interpreting data 61 83* 53 77*

Looking for work 70 89* 70 85*

Career guidance 73 92* 77 89*

Saving 40 89* 66 83*

How to start a business 62 88* 64 81*

Social grants 45 89* 45 86*

Results

Results

0

10

20

30

40

50

60

Boys* Girls

Who started having sex? Learners who did not participate were less likely toremain abstinent than learners in Siyakha Nentsha

No Programme

Siyakha Nentsha

Results

0

20

40

60

80

100

Round 1 Round 2

Confidence in ability to use condoms correctly increased significantly among programme participants compared

to those with no programme

Siyakha Nentsha females* No prog females

Siyakha Nentsha males No prog males

Results

0

5

10

15

20

Round 1 Round 2

Siyakha Nentsha girls significantly increasedtheir consistent condom use compared to

girls who didn't have the programme

Siyakha Nentsha females No prog females

Results

0

20

40

60

80

Round 1 Round 2

Siyakha Nentsha participants were more ableto successfully open a bank account

Siyakha Nentsha males* No prog males

Way forward

• In dialog with DOE about possible scale up

• Follow-up participants to assess longer-term impact of intervention

Selected resources• Hallman, K. 2010, in press. “Social exclusion: The gendering of

adolescent HIV risks in KwaZulu-Natal, South Africa,” in J. Klot and V. Nguyen eds., The Fourth Wave: An Assault on Women - Gender, Culture and HIV in the 21st Century. Social Science Research Council and UNESCO.

• Hallman, K. 2008.“Researching the determinants of vulnerability to HIV amongst adolescents,” IDS Bulletin, 39(5), November 2008.

• Bruce, J. and Hallman, K. 2008. “Reaching the girls left behind,” Gender & Development, 16(2): 227-245.

• Hallman, K and Roca, E. 2007. “Reducing the social exclusion of girls,” www.popcouncil.org/pdfs/TABriefs/PGY_Brief27_SocialExclusion.pdf

• Hallman, K. 2007. “Nonconsensual sex, school enrollment and educational outcomes in South Africa,” Africa Insight (special issue on Youth in Africa), 37(3): 454-472.

• Hallman, K. 2005. “Gendered socioeconomic conditions and HIV risk behaviours among young people in South Africa,” African Journal of AIDS Research 4(1): 37–50. Abstract: http://www.popcouncil.org/projects/abstracts/AJAR_4_1.html

Thank you!

Our funders: ESRC/Hewlett Joint Scheme& DFID via the ABBA RPC