Advocating for Effective Youth HIV Prevention Interventions
In May 2004, the World Health Organization (WHO), working with the London School of Hygiene and Tropical Medicine and the members of the Inter-agency Task Team on Young People, called a group of experts together, (people working in public health and HIV prevention, and people responsible for developing and implementing policies and programmes), to carry out a review of the available research relating to HIV prevention interventions designed for young people in developing countries, in order to be clear about which interventions are effective and which are not. They wanted policy makers and programmers to know what they could be confident about implementing widely in countries NOW!
They hoped this review would guide policy-makers and politicians to start investing more in HIV prevention programs for young people that could help them meet the Declaration of Commitment on HIV/AIDS and other global goals. To make it easy for non-technical people to understand the available research, they grouped all the HIV prevention interventions into four categories: GO, READY, STEADY, or DO-NOT-GO:
To come up with these recommendations, all the available evidence for programs focusing on HIV prevention among young people in developing countries was reviewed.
The team went through the following steps to come up with their recommendations:
Of course, ultimately we want to decrease HIV transmission among young people! But we know that to achieve this will require many different types of interventions, in schools, in the media, through health services etc. So for this study the researchers focused on interventions that would achieve the global goals that governments had committed themselves to achieving: increasing knowledge; increasing life skills and self-efficacy (having the skills to purchase and negotiate condom use for example); and increasing the use of health services.
If you want to reach young people, what channels are available for reaching them? The researchers decided the following 'settings' were important for reaching young people.
A range of interventions are provided through the settings that were the focus of the review, and it is important to be clear about what exactly is being done. For example in geographically defined communities, some interventions may be for the general population, and include young people without being specifically designed for them, while others are targeted explicitly for youth. Some may use youth-led organizations or peer education to reach young people; others may rely on professionals or trained adults. Policy makers need to know which types of prevention interventions work in these different settings.
Making recommendations about prevention interventions relies on good science - we need evidence to show that a specific intervention helps achieve a decrease in HIV incidence, or at least an increase in knowledge, increased life skills, and increased use of services. However, not all interventions need the same level of evidence.
The threshold of evidence is an indication of how strong the evidence would need to be in order to feel confident about recommending an intervention for widespread implementation. How strong the evidence needs to be (high, medium, or low) will depend on a variety of factors, such as how feasible and acceptable the intervention is, whether the intervention could possibly cause young people harm if not properly implemented, or if the intervention might have additional health and social benefits for young people. This is an important step, because in general, the stronger the evidence, the more difficult and expensive it is to obtain, and the less likely it is to be available.
How strong is the evidence out there to show that the intervention works? A little, a medium amount, or a lot? Or is there mixed evidence, meaning it's unclear whether or not the intervention works? The strength of the evidence depends on many things, such as how well the research study was designed and what type of research method was used.
It's pretty simple when you think about it: if the threshold of evidence required to feel confident about recommending an intervention for wide-scale implementation is medium, and the available research shows that intervention has strong evidence to show that it is effective, then we can safely say it should be implemented NOW. But if an intervention has weak evidence to show its effectiveness and it is felt that a high threshold of evidence is required, then we may not want to invest in it until there's more evidence to show whether or not it really works. After all, the last thing we need are BAD prevention programs that do not give us what we need and deserve.
If not, categorize it as STEADY (more research needed) or DO NOT GO (do not implement or fund this intervention!)