Promoting Abstinence, Being Faithful, and Condom Use with Young Africans

Promoting Abstinence, Being Faithful, and Condom Use with Young Africans : Qualitative Findings from an Intervention Trial in Rural Tanzania

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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.
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Product details

  • Hardback | 500 pages
  • 156 x 232 x 34mm | 798.32g
  • Lanham, MD, United States
  • English
  • 0739168444
  • 9780739168448

Table of contents

Part one: Introduction Chapter 1: Introduction Chapter 2: Research Methods Chapter 3: Typical Young People's Lives and Sexual Relationships Part two: Intervention Evaluation Chapter 4: MEMA kwa Vijana Intervention Overview and Community Mobilization Chapter 5: The MEMA kwa Vijana School Program Chapter 6: MEMA kwa Vijana Health Services and Condom Distribution Chapter 7. Impact of the MEMA kwa Vijana Intervention Part three: Young People Who Practiced Low Risk Sexual Behaviors Case Study Series 1: "So It Is Like This! Not For Me": Young People Who Abstained Chapter 8: Abstinence Case Study Series 2: "This One Is Enough": Young People Who Limited Their Partner Number and/or Were Monogamous Chapter 9: "Being Faithful": Limiting Partner Number and/or Practicing Fidelity Case Study Series 3: "The First Time He Didn't Have One, So I Refused": Young People Who Used Condoms Chapter 10: Condom Use Part four: Recommendations Chapter 11: Intervention Recommendations Appendix 1: Outline of the Teacher's Guide for Year 5 in the Final MEMA kwa Vijana School Curriculum Appendix 2: Outline of the Teacher's Guide for Year 6 in the Final MEMA kwa Vijana School Curriculum Appendix 3: Outline of the Teacher's Guide for Year 7 in the Final MEMA kwa Vijana School Curriculum Swahili and Sukuma Glossary
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Review quote

This book presents a comprehensive and analytical account of the qualitative component of a large intervention study of sexual behaviour change undertaken in rural north-western Tanzania... Relevant definitions and concepts are explained in full for readers... The particular strength of this book lies in the study findings, which contain rich cultural knowledge that will prove invaluable to other researchers, particularly non-Africans. Equally illuminating is the series of case studies that describe in depth the backgrounds, lives and sexual experiences of individual participants... This is a well-written book of great practical value to both the qualitative and quantitative researcher working in the context of sexual behaviour change in Africa and elsewhere. Sexually Transmitted Infections This book by Mary Louisa Plummer adeptly documents research and implementation experiences, as well as the opportunities and challenges involved in promoting the ABC approach, in rural Tanzania... Several features make this book remarkable. First, it draws on methodologically rigorous evaluation research and, second, it critically examines the effectiveness of the ABC approach, which hitherto has been taken for granted and has not merited close academic scrutiny... Third, this book provides a very comprehensive description of the triangulation approach for evaluating the efficacy of a sexual and reproductive health program by combining several quantitative and qualitative methods. Plummer's book is also unique in that it critically examines the experiences of young people (the target group) in addition to the challenges and opportunities faced by those implementing the MEMA kwa Vijana intervention, using in-depth case studies from the implementation sites... The case studies make the book particularly riveting, ... the description of young people's experiences in addressing risks and vulnerabilities associated with HIV prevention in Plummer's book is rich, radical and intellectually stimulating, yet easily and readily accessible to a variety of audiences, both academic and non-academic. Global Public Health Promoting Abstinence, Being Faithful, and Condom Use with Young Africans provides a comprehensive description and evaluation of the MEMA kwa Vijana intervention that was developed, implemented, and evaluated over 12 years in primary schools in rural Tanzania. Despite the overall lack of success of MEMA kwa Vijana in reducing HIV acquisition during this time period, Plummer's text is comprehensive and provides important reading for those interested in developing, evaluating, and understanding HIV prevention interventions and their complexities. This book remains one of the few that provides a detailed description of the factors shaping the intervention's lack of success and suggests pointers for alternative future approaches. Studies in Family Planning Plummer's Promoting Abstinence, Being Faithful and Condom Use draws on extensive and meticulously collected qualitative data to answer some of the most important questions about the lives of millions of young people in contemporary Africa. It is, in many respects, a substantial advance for our understanding of both the interventions we implement and the realities of the lives of their expected beneficiaries. This book compels us to look at ourselves and young people in new ways to further consider the meanings of our actions and inactions for young people in Africa in the context of poverty and HIV/AIDS. -- Chimaraoke Izugbara, African Population and Health Research Centre This thoughtful and detailed work provides an important analytical assessment of how and why behavioral HIV prevention interventions for adolescent populations in sub-Saharan Africa ultimately succeed or fail. Drawing on ten years of fieldwork and a rich qualitative dataset, the book explores the implementation of the Mema kwa Vijana intervention project in rural Tanzania. Using young people's own voices, Plummer clearly explains the difficult and complex personal and social choices that underlie consistent practice of the ABCs of 'abstain, be faithful and use condoms,' thus deconstructing many of the myths regarding the 'simplicity' of the ABC approach. The multidisciplinary social science/public health approach will make this an important text for a wide range of audiences, and a must-read for both scholars and practitioners embarking on HIV prevention research in this setting. -- Abigail Harrison, Population Studies and Training Center, Brown University This is a formidably comprehensive account of a major theory-based community-based sexual health intervention RCT in the Mwanza district of Tanzania. Mary Plummer describes many of the real everyday challenges to the implementation of this most carefully-designed intervention. A range of ideological, cultural, linguistic, attitudinal, material, gendered, methodological and other barriers - some anticipated but many not - had large impacts on inputs and outcomes. The development and progress of the complex intervention and evaluation are described in great detail, with immense thoughtfulness, insight and honesty, always showing respect for the very real people and the very real lives that were observed. The overwhelming take-home message from the book is that seemingly simple approaches - such as the ABC approach, and/or the use of social-cognitive approaches to behaviour change - are anything but simple. Each and every behaviour has a deeper meaning within communities and societies, and this absorbing volume makes a crucially important contribution in highlighting many of these meanings - as well as the importance of detailed and painstaking research in uncovering these complexities. This will be a most valuable addition to the reading lists of students and researchers who may be planning health-related intervention work in poorer (indeed, any) countries - as well as for those who want to look behind the headlines of the often overly-polished journal articles. -- Roger Ingham, Centre for Sexual Health Research, University of Southampton
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About Mary Louisa Plummer

Mary Louisa Plummer was the Social Science Coordinator for the MEMA kwa Vijana trial and currently is a consultant to the UK Medical Research Council's Social and Public Health Sciences Unit. She lives in Dar es Salaam, Tanzania.
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