Catalyzing Gender Norm Change for Adolescent Sexual and Reproductive Health: Investing in Interventions for Structural Change

Why Gendered Power Structures Are Central to ASRH Social Norms Programming?

To translate the concepts of gender and power structures into better funding, research, interventions, and measurement, it is important that these concepts and language become routine in ASRH-related social norms work. For example, based on abstracts alone, we note that although at least six of the eight articles in this volume are addressing gender norms, only one explicitly refers to them as such. Since social norms on ASRH are almost
always gender norms, it is better to use that term in referring to them. It is, in fact, impossible to think of ASRH-related social norms that are not fundamentally about gender and power, given that control of women’s and girls’ bodies, sexuality and reproduction is at the heart of gender inequality , and ASRH is by definition about sexuality and reproduction at the critical stage of physical maturation and life transitions where their significance
becomes paramount.

This underlying motivation for defining sexual and reproductive control during adolescence is one reason why ASRHrelated norms are often pervasive as gendered “meta norms,” such as child marriage, early pregnancy, violence against women, and more restricted mobility, schooling, economic opportunity, and decision-making for girls than boys .

This is also why such norms are not just perpetuated through shared social expectations but actively enforced through social sanctions that very clearly emphasize the underlying gendered power dynamics: there are real and sometimes brutal costs for girls and/or their families for violating norms that relate to sexuality and reproduction dranging from mistreatment,violence, abandonment, social or economic exclusion disfigurement,rape, or even death .

Therefore, it is critical to keep a focus on gender and power in ASRH social norm programming,
recognize and address the unique complexity of these norms, and challenge the underlying structures that perpetuate them.

Catalyzing Gender Norm Change for Adolescent Sexual and Reproductive Health

Highly prevalent at-risk sexual behaviours among out-of-school youths in urban Cameroon

Introduction:

Cameroon has a high prevalence of out-of-school youths. Therefore, research relating to out-of-school youths and HIV/AIDS is
imperative, since they might engage in high risk sexual behaviours. The current study investigated the highly prevalent at-risk sexual behaviours among out-of-school youths in urban Cameroon. Methods: A cross-sectional design was adopted using a self-administered questionnaire to collect data from a cluster sample of 405 out-of-school youths, aged 15-24 years. Statistics was calculated using SPSS version 20 at the level 0.05.

Results:

By age less than 16 years, more females, 90.2% than males, 71.8% had experienced sex (p < 0.001); more females, 40.4% than males, 23.2% used condoms during first sex (p < 0.01); more males, 70.8% than females, 46.0% had multiple sequential sexual partners during the last one year prior to this study (p < 0.001); more males, 42.6% than females, 18.0% had multiple concurrent sexual partners during the study period (p < 0.01); more youths who did not belong to a well-defined social network, 80.8% had experienced sex than those who belonged, 55.8% (p < 0.001); more youths who did not belong to a well-defined social network had multiple sequential sexual partners, 46.7% than those who belonged, 32.3% (p < 0.01); more youths who belonged to a well-defined social network, 24.3% used condoms consistently than those who did not belong, 15.4% (p < 0.01). Conclusion: Sexual risk behaviours exist among out-of-school youths in urban Cameroon. There is need for campaigns and interventions to bring about sexual behaviour change especially among those with low socioeconomic status. Youths should be encouraged to join well-defined social networks. sexual behaviours among out-of-school youths in urban Cameroon

Responses to HIV in sexually exploited children or adolescents who sell sex

One of the crucial gaps in the current HIV response is that we are not reaching children and adolescents aged 10–17 years who sell sex, with life-saving prevention, treatment, protection, care, or support;by protection we refer to all child and social protection interventions that aim to protect rights and provide social and economic support. Under the Convention on the Rights of the Child (CRC)—the most widely ratified human rights treaty—and its Optional Protocol on the sale of children, child prostitution, and child pornography, adolescents younger than 18 years are
protected from all forms of sexual exploitation and entitled to the right to health. Children are defi ned by the CRC as all persons aged younger than 18 years.

Adolescents are defined by the UN as all persons aged 10–19 years. This Comment focuses on the HIV concerns of children and adolescents aged 10–17 years who are exploited in the sex industry through selling sex, and does not consider other forms of sexual exploitation. The term “sexually exploited children and adolescents aged 10–17 years who sell sex” describes the behaviour that renders this group at-risk of HIV and does not describe identity. Children younger than 18 years who sell sex, irrespective of the reason, are considered under international law to be sexually
exploited children.

There are no accurate global estimates of the number of sexually exploited children and adolescents aged 10–17 years, nor of the subset of those who sell sex.However, many studies show that substantial percentages of sex workers in many countries began selling sex aged younger than 18 years.

For example,in Ukraine, adolescent girls aged 10–19 years who sell sex comprise an estimated 20% of the female sex-worker population. Evidence also shows that this group is more vulnerable than older cohorts to health
harms—including sexually transmitted infections, HIV,and violence. For example, in Ukraine in2006,HIV prevalence among females aged 15–19 years selling sex exceeded 19%, compared to 1·4% in the general adult population. Also, in eight countries in eastern and southern Africa, median HIV prevalence g sex workers younger than 25 years is 11%.

Many factors specifi c to children and adolescents aged 10–17 years contribute to this vulnerability, including severe circumstances of initiation and involvement, such as physical force and lack of control over their situation and finances and an inability to negotiate condom use. Some studies show increased biological vulnerability to HIV in adolescent girls, which  is linked to weaker mucosal immunity of the adolescent female genital tract. Other reasons are systemic—these include legal and policy barriers to access to sexual and reproductive health and rights (SRHR) and other services; frequent contact with uniformed services such as police; and lack of confidential and adolescent-friendly HIV services.

Health interventions that target sex workers aged 18 years and older generally do not address the specific needs of this group because of law and policy barriers.The interventions that do target the group often focus exclusively on the immediate removal of the child from the sex trade, rather than the provision of necessary SRHR and HIV treatment, prevention, and care.
Responses to HIV in sexually exploited children or adolescents who sell sex

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