“Siyakha Nentsha”Enhancing the Economic,

Health, and Social Capabilities of Highly

Vulnerable Youth

by Kelly Hallman, Eva Roca, Kasthuri Govender, Emmanuel Mbatha and Mike Rogan

Population CouncilIsihlangu Health and Development Agency

University of KwaZulu-NatalKwaZulu-Natal, Department of Education

Thank youOur funders

The William and Flora Hewlett FoundationEconomic and Social Research Council

DFID via the ABBA RPC

KwaZulu-Natal Department of EducationMS. NOMALI MAGWAZA & STAFF (UMBUMBULU)

MR. N. CELE, DISTRICT MANAGER (UMBUMBULU)

Additional team membersNombango Anna Sibeko / Thabile Shozi / Mboneni Genesis Thwala / Nduduzo Blessing Msomi

Pretty Thandani Cele / Nontobeko Charlotte Cele / Sabelo Emmanuel MkhizeBanele Precious Ngcobo / Njabulo Freedom Ndlovu / Noxolo Peaceful MakhanyaNokulunga Dorah Shange / Suprise Patience Mseleku /Sithembile Pretty Gumede

Mbali Pretty Mseleku / Bongekile Carol Shozi / Ayanda Mthabela / Siphiwe Cyril Mbava

Purpose

Improve functional capabilities and well-being adolescents at high risk for

• HIV and STIs

• teenage pregnancy• school dropout• non-receipt of social benefits• actual or potential loss of one or both parents

Project team

LearnersParentsSchools

Tribal Authority

KZN DOE kdkd Isihlangu

Health & Development

Agency

Population Council HEARD AccuData Advisory Group

Formative research: Adolescent HIV risk behaviors

influenced by

• Relative wealth• Social capital• Being an orphan

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

Project content

• Longitudinal survey– In learners households– GPS coordinates

• Government-accredited multi-session intervention – 10th & 11th graders during school hours

• Participatory reflective learning– Role-plays/drama– Workbooks/portfolios and diaries– Community mapping

• Focus group with participants, parents, and mentors

CurriculumGovernment-accredited multi-session intervention

• Increase knowledge and skills for pregnancy and HIV prevention and AIDS mitigation; accessing preventive, treatment and care services

• Develop skills to manage personal and familial resources; access existing social benefits, education and training opportunities; plan and aspire for the future; build savings/assets over time

• Build and strengthen social networks and support

Participants

•Secondary learners•Least selective sample•Scalable •Bundled package

•Females and males•Resounding community feedback•Male knowledge and behaviors•Gender attitudes

Program implementation

• Recent matriculants in local community selected and receive training to serve as facilitators/mentors

• Classroom based intervention during school hours led by a pair young adult facilitator/mentors

• 2-3 hours per week of exposure for 2 academic years

Research design

• Randomized to secondary school classrooms (grades 10-11) in seven schools

• Three study arms1. SRH/HIV, Social Support, Financial Education

2. SRH/HIV, Social Support

3. Delayed Intervention

Outcomes• SRH and HIV/AIDS : knowledge, skills

and behaviors, including adoption of safer sexual behaviors and service use

• Economic skills: ability to plan and manage personal and familial finances; identify and access available social benefits; articulate a plan for pursuing future livelihood-enhancing opportunities

• Social networks and support: access to friends, adult role models and individuals/groups who can assist with crisis management and provide links to opportunities

SampleFemales Males

Mean age ** 17.2 17.8

% describing household as poor or very poor 64.8 62.3

% having lost at least one parent 40.9 44.1

Maternal orphan 7.1 10.1

Paternal orphan 25.3 25.3

% having lost both parents 8.7 8.8

Has a South African ID card (of those 18+) (%) 50.7 51.5

Has a birth certificate (%) 66.5 64.8

Has a CV 5.3 7.7

Mean # close friends ** 2.6 3.2

Ever tried to start income generating activity 21.9 22.9

Ever actively looked for work** 7.2 15.4

Ever worked for pay ** 10.3 20.2

Is saving* 17.3 23.6

SampleFemales Males

Mean score on gender attitudes scale** 8.3 7.1

Belongs to at least one social organization 75.3 76.3

Has a role model* 86.3 81.7

Sometimes feels worthless* 23.7 18.2

Has no hope for the future 20.5 20.5

Heard of FP methods** 72.6 51.8

Know can get pregnant if have sex only once* 85.0 78.7

Know at least 2 ways HIV is transmitted 76.0 74.5

Know at least 2 ways to prevent HIV 71.2 67.2

Think close friends are at no risk for HIV 78.8 72.6

SampleFemales Males

Ever had sex ** 19.6 31.7

Mean age at first sex ** 16.9 15.0

First sex was tricked or forced ** 17.2 2.0

First sex partner - age difference from self ** +2.8 -.46

Mean number lifetime partners ** 1.3 4.2

Mean number partners in last year ** 1.0 2.0

Reported using a condom at last sex * 59.4 75.0

Ever talked to partner about avoiding/delaying sex* 64.7 48.3

Ever had an HIV test ** 17.3 7.4

Females, ever been pregnant % 14.5 ---

Males, ever made anyone pregnant % -- 7.6

Participant views of financial education

“We learnt about budgeting and saving and all those things, before we when we get money we spent it. This program was like an eye-opener to us, because, we know now when we get some money, we have to save something…”

- male participant

“It’s different, in school we learn mathematics and biology but here we learn things that we can use in the future.”

- female participant

Participant views of health education

“….. I didn’t understand about HIV and AIDS before but now I do. I didn’t learn that in school.”

–female participant

“It changed my attitude, because I know how to use a condom and I know how to trust my partner and I know how to advise my partner, when we are sitting together and talking about, how to have sexual intercourse and I know even to advise the community as a whole about HIV/AIDS…” –male participant

Baseline associations

• Factors associated with protective behaviors– Relative wealth– Social support (friends, role models)– Belonging to a community organization– Having tried to start an income-generating activity

• Factors associated with higher-risk behaviors – Having no hope for the future– Orphanhood– Personal luxury items

Communications

• Engage policymakers and programmers in dialogues to raise profile of issue

• Communicate the research process• Utilize products in addition to policy briefs, reports,

academic articles and website– Facebook, Brochures, Postcards, Multimedia, Video

• Non-traditional public events– Frontline Club, London

Multimedia

Lindiwe’s Story

(see pdf)

REFERENCES

1. Hallman, K. “Social exclusion: The gendering of adolescent HIV risks in KwaZulu-Natal, South Africa,” in J. Klot and V. Nguyen eds., (in press), The Fourth Wave: An Assault on Women - Gender, Culture and HIV in the 21st Century. 2009. Social Science Research Council and UNESCO.

2. Grant, M and Hallman, K. “Pregnancy-related School Dropout and Prior School Performance in South Africa,” Studies in Family Planning, 2008. 39(4): 369-382.

3. Hallman, K. “Researching the determinants of vulnerability to HIV amongst adolescents,” IDS Bulletin, 2008. 39(5): 36-44.

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

5. Hallman, K. “Nonconsensual sex, school enrollment and educational outcomes in South Africa,” Africa Insight (special issue on Youth in Africa), 2008. 37(3): 454-472.

6. Hallman, K. "Orphanhood Type and Sexual Debut: A panel study from KwaZulu-Natal, South Africa," (under review).

7. Kenworthy, N., Hallman, K. et al. “Geographies of Violence: Participatory Mapping with South African Adolescents to Understand Dimensions of Social Exclusion,” (under review).

POPULATION COUNCIL POLICY BRIEFS

1. “Identifying sources of adolescent exclusion due to violence: Participatory mapping in South Africa,” Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief no. 30. 2008. New York: Population Council. http://www.popcouncil.org/gfd/TA_Briefs_List.html

2. "Enhancing financial literacy, HIV/AIDS skills, and safe social spaces among vulnerable South African youth," Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief no. 4. 2007. New York: Population Council. http://www.popcouncil.org/gfd/TA_Briefs_List.html

3. "Reducing the social exclusion of girls," Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief no. 27. 2007. New York: Population Council. http://www.popcouncil.org/gfd/TA_Briefs_List.html

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