[procaare] Cheap Solutions Cut AIDS Toll for Poor Kenyan Youths

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Cheap Solutions Cut AIDS Toll for Poor Kenyan Youths
--New York Times, August 6, 2006
*********** 

Cross-posted from AHILA-NET

Cheap Solutions Cut AIDS Toll for Poor Kenyan Youths
By CELIA W. DUGGER
Published: August 6, 2006
New York Times

At a time when millions of people each year are still being
infected with the virus that causes AIDS, particularly in Africa,
a rigorous new study has identified several simple, inexpensive
methods that helped reduce the spread of the disease among Kenyan
teenagers, especially girls.

In Kenya, where poverty drives some girls to sleep with older men
for money or gifts, teenage girls are seven times more likely to
be H.I.V. positive than boys the same age.

The new study found that when informed that older men are much
likelier to be infected, teenage girls were far less likely to
become pregnant by so-called sugar daddies.

The $1 million study, financed by the Partnership for Child
Development, a London-based nonprofit group, did not seek blood
tests for H.I.V., since its subjects were minors. Instead, it
relied on pregnancy as evidence of unprotected sex.

The study found that when girls in impoverished rural areas were
given free school uniforms instead of having to pay $6 for them 
the principal remaining economic barrier to education in Kenya 
they were significantly less likely to drop out and become
pregnant.

Researchers also found that classroom debates and essay-writing
contests on whether students should be taught about condoms to
prevent the spread of H.I.V. increased the use of condoms without
increasing sexual activity.

The methods, identified by economists affiliated with the Poverty
Action Lab at the Massachusetts Institute of Technology, offer a
splash of good news in an often bleak landscape. "I was very
reluctant to get involved in this, because I thought nothing would
work", said Michael Kremer, a Harvard economics professor who was
on the lab's team. "I'm very happy to see some things are
working."

The study was conducted over three years among 70,000 students in
the sixth to eighth grades in 328 schools in Kenya. Several
AIDS-prevention methods were tested in randomly selected schools,
and the results were compared with those from schools that did not
get the help.

The study also surveyed the students about condom use.

The researchers tested the results of training teachers in Kenya's
AIDS curriculum, which provides general information about how the
disease spreads and emphasizes the importance of abstinence until
marriage. The study found that approach had little or no impact on
students? practical knowledge about condoms or on rates of teenage
pregnancy.

In a recent telephone interview, Isaac Thuita, who leads the AIDS
control unit in Kenya?s Education Ministry, called the research
"very relevant, very important."

Such stringent studies of AIDS-prevention programs are rare and
important, given the life-and-death stakes and the growing amounts
donors are devoting to AIDS prevention. The United States
government, through President Bush?s global AIDS plan, spent $141
million worldwide last year to prevent the sexual transmission of
H.I.V.

When told about the findings in a recent telephone interview,
Warren W. Buckingham, the Kenya coordinator for the Bush AIDS
plan, singled out the researchers? approach to reducing the lure
of sex with older men as ?new and very intriguing.?

He said some American-financed programs including the Girl
Guides, Kenya's version of the Girl Scouts warned of the dangers
of cross-generational sex, but generally did not provide
statistics on sharply rising male infection rates with age.

"That's an important finding, and we can absolutely take it on to
refine our programs for girls," he said.

In Kenya, large-scale surveys based on H.I.V. blood tests have
found that infection rates, at less than one-half of 1 percent
among teenage boys, rise to 7 percent among men 25 to 29, and peak
at 9 percent among those 40 to 44.

Mr. Buckingham said the United States had also supported programs
to train teachers in Kenya's AIDS curriculum and to give free
school uniforms to AIDS orphans, though not more broadly to poor
children who could not afford them.

The researchers in Kenya found that most of the girls in the study
had no idea that adult men were much more likely than boys their
own age to infect them with H.I.V.

To test what would happen if the girls knew, the researchers
devised a 40-minute class for eighth graders.

The students were shown a 10-minute animated video about the risks
of relying on sugar daddies, made for the United Nations
Children's Fund. In schools lacking electricity, the research
project brought in a generator, television and VCR.

The movie itself did not address the risk of H.I.V., but it did
get the students' attention. "This was a very exciting day, to
have a television in their school," said Pascaline Dupas, a
Dartmouth College economist who oversaw that part of the study.

A representative from a nonprofit group working with the
researchers wrote the infection rates for males and females by age
on the blackboard. The class then discussed the implications.

A year after the researchers intervened, girls who had been given
information about the greater risk of sex with older men were 65
percent less likely to have gotten pregnant by an adult partner.

"That intervention is very, very cheap and could be scaled up
easily," said Esther Duflo, an economics professor at M.I.T. and a
member of the research team.