Lessons Learned From a Review of Interventions for Adolescent and Young Key Populations in Asia Pacific and Opportunities for Programming

This review was initiated to identify interventions on HIV prevention in the Asia Pacific region with demonstrated or potential impact for adolescent and young key populations (YKP), "looking at the role of individual and structural factors in accessibility and delivery." From the United Nations Children’s Fund (UNICEF) East Asia and Pacific Regional Office, the review studied prevention interventions "that worked, didn't work, or implications from research interventions on what could work, looking at individual and structural factors and the interplay between them to identify opportunities to improve the accessibility and delivery of high-impact HIV prevention interventions for YKP in AP." [Footnotes have been removed by the editor throughout.]

Condom use among men who have sex with men (MSM), transgenders, sex workers (SW), and their clients was low or inconsistent and associated with younger ages and lower education - often due to subjective factors of perceived risk reduction (e.g., wealthier clients are less likely to be infected) - and to drug and alcohol use. "Structural factors associated with condom negotiation and use included economic hardship, knowledge of HIV (closely related to individual factors of risk perception and self-risk assessments), violence and trafficking, peer education and peer influence, availability of condoms and support of the brothel or entertainment venue managers, and cultural norms." It was found that sexual coercion, forced sex, and trafficking negatively influenced condom use, but venues with mandatory condom use rules had higher rates of use, and SWs had more ability to negotiate condom use with clients. Also, peer engagement in creating prevention campaigns increased the likelihood of involvement in prevention: "...the more FSW [female sex workers] were involved in the development of HIV prevention messages and method of delivery, the more likely they were to communicate it to their peers when they move establishments."

Testing for HIV was impeded by clients not knowing where to get tested and the perception of stigma, among other factors. From China, a study used "the Internet to facilitate VCT [voluntary counselling and testing] uptake in 2 cities using active recruitment through instant messaging (1 of 4 went for VCT), online gay chat rooms (1 of 6), mobile phones (1 of 10), e-mail (1 of 140), and passive recruitment through placement of banners on front pages of 3 major Chinese gay Web sites (42.9% of study participants were aged 18-24 years; total reported uptake 12.87%). Active recruitment was more successful with younger MSM. Factors that could impact future Internet prevention interventions included the desire for a peer professional to facilitate (38.6%) and for the intervention to take place in the evenings when youth had time and privacy. The potential to reach out to YFSW through the Internet was also found to be significant. Multivariate analyses showed that willingness to participate in online prevention programmes was significantly associated with higher Internet use and younger age (20-30 years)."

Sex education in secondary school was associated with less sexual intercourse and alcohol and drug use in 15-18 year olds in Hong Kong.

The study concludes with recognition of the need for more evaluative studies of programmes working with adolescent populations. It suggests that "[d]espite evidence that structural factors around service delivery and engagement of entertainment venue managers yielded higher impact results related to preventative behavior, it is impossible to generalize from these studies any specific conclusions regarding interventions that work for adolescent and YKP across Asia."