Youth.now - Jamaica

Programme actions include establishing service sites and systems; launching a mass media campaign; designing interventions for specific groups (preteens, boys); awarding small grants for NGOs; offering multidisciplinary training of trainers; conducting community education, outreach, and advocacy; and drafting policies and guidelines. Youth.now features different strategies for different ages and sexes. However, common strategic themes include affirming adolescents as full of potential and value; giving adolescents opportunities for autonomy; equipping adolescents with life skills; ensuring supportive, caring, nurturing environments; and increasing access to quality services (for older age groups).

Specifically, Youth.now is testing and evaluating 5 approaches to delivering youth-friendly RH services through NGOs or public-sector facilities. Organisers are drafting service delivery guidelines based on this process. To date, 9 service sites have been set up in 6 parishes; 2 are planned. These facilities include:

• a wellness centre that offers fitness facilities to attract young men as well as family planning services
• a stand-alone public health centre that does regular outreach in nearby schools and communities
• a joint venture with an NGO to provide RH services to youth along with skills training, community advocacy, and tutoring
• a programme with the YMCA in Kingston to provide 100 street boys with reproductive counseling, education, and condoms
• programmes linking schools and health centres at 2 locations in St. Elizabeth and another in Kingston. The guidance counselor, the school nurse, or the peer educator discusses services available at the health centres as well as RH issues broadly.

Messages in the mass media campaign are tailored to specific age groups. Radio, TV, and print ads for Jamaicans ages 10-12, for example, focus on abstinence. One poster reads "go real slow...take the time to know!". Self-knowledge and abstinence are implied in the messages geared toward the 13- to 15-year olds, who are told to "know yourself before you give yourself" and "since love so nice, wait 'til it's right!". Messages for the older group focus on responsible behaviour and protection against STIs and HIVAIDS, with slogans like "my programme is virus protected". In addition, a 24-hour electronic factline - "Friend's Hotline" - has been set up. Ten episodes of "YOW", a half-hour television magazine programme featuring teen moderators and popular music, have been produced. Condom use, emergency contraception, and sexual behaviour are among the topics explored on the programme. Finally, a series of fact sheets is being developed.

Seven groups of 20 adults including clinical providers, pastors, peers, and men have undergone training that is designed to help them come to terms with their own sexuality. Once trained, adults are encouraged to reach out to their own constituencies; many have been listed in a locally available directory of trainers and facilitators. A subset of 25 persons has received additional training to become master trainers. Health centre staff are also being trained to create a youth-friendly environment. In an effort to further protect adolescents' privacy, dental nurses, who see schoolchildren routinely and who are sometimes trusted with confidences, are also being trained in sexual and reproductive health counseling.

Youth, Children, Reproductive Health, HIV/AIDS, Abstinence, Gender.

This programme seeks to address issues highlighted by some of the following statistics related to Jamaican youth:

• The mean age of initiating sexual activity is 13 years for boys and 15 years for girls.
• 74% of youths ages 15 to 19 and close to 10% of those ages 10 to 14 reported being sexually active.
• 40% of Jamaican women have been pregnant at least once before age 20, and more than 80% of adolescent pregnancies are unplanned.
• Close to one out of 60 AIDS cases between 1982 and the end of 2001 were ages 10 to 19. During 2001, there were 69 new cases for the 15 to 24 age group. Adolescent females ages 10 to 14 and 15 to 19 had two and three times the risk of HIV infection, respectively, than boys of the same age group.
• While 86% of adolescents know about HIV/AIDS, only 11% of young men ages 15 to 19 perceived themselves to be at personal risk.
• 31% of boys and 59% of girls ages 15 to 19 used contraception at the first sexual encounter. 41% of sexually active boys ages 15 to 19 had more than one partner in the previous year and did not consistently use condoms.
• 88% of teens ages 15 to 19 cited condoms as a way to prevent infection, compared with 57% of those 10 to 14.

In a study of adolescents' impression of clinics prior to Youth.now, on a scale of 1 to 10 the centres received the lowest rating of 1. Adolescents referred to dirty clinics; a lack of privacy; and unfriendly attitudes toward youth, especially sexually active youth. One organiser comments that many adults don't acknowledge that few young people will simply approach a provider with a reproductive health problem. "They will come with a question about a skin problem or some other issue. But a skilled provider can, in fact, in the conversation - it's not a counseling session yet - discover issues related to reproductive health." Preliminary results of a 2003 client survey indicate that centres where staff have been trained are getting better ratings.

A 2002 evaluation of the impact of the mass media campaign found that 82% of adolescents and 90% of adults recalled programme messages, with 49% of the former saying that the messages would affect their thoughts and behaviours. The message of abstinence resonated strongest with young women and with youth ages 10 to 12. The message of safe sex with the use of a condom was best received among young men, especially in the oldest group.