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 ...
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.
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.
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.
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.
Sexually Transmitted Infections
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.
Global Public Health
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.
Studies in Family Planning
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.
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.
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