[Street children and AIDS in Haiti]. / Enfants de la rue et SIDA en Haïti.

This study is a qualitative inquiry KAP about sexuality, and adoption and preservation of safe sexual behaviors, among the children of the street in Port-au-Prince, Haiti. Three groups of participating children of the street were observed in Port-au-Prince for three months, during June through August 1991. The information was collected with the use of pre-tested charts for each theme chosen. Then, individual interviews were conducted with leaders identified among the educators and children of the street. One of the main goals of Aids educational programs of street children should be to make them believe in the existence of the disease, and the real risk it poses for death. The strategies that we will use to convince them should deal with the different social, psychological, economical, and environmental factors that characterized the children as follows: 1) their adherence to a peer group and the relationship of power between the older and younger children; 2) the fundamental importance of money in their life, and that all relationships that they have are based on the capacity of people to give them something, such as money; 3) the role of their social appearance and their need to behave like other children for even one day; 4) their low self-esteem; 5) their feeling of powerlessness and resignation related to their living conditions; 6) the influence of the street culture; and 7) their understanding of sexuality as an immediate pleasure.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: In Haiti, observations of 70 boys, 6-17 years old, living in the streets of Port-au-Prince and interviews with 10 key informants were conducted so researchers could learn the knowledge, attitude, and practices of the boys concerning sexuality and sex behaviors. The street children were observed at the airport parking lot, the Madankolo bus station, and the market in the rich quarter of Port-au-Prince. They did not use condoms. They did not feel that they would develop AIDS or any illness. They perceived AIDS as only a long-term fatal disease less dangerous than other daily events. Sexually transmitted diseases (STDs) indicated sex with prostitutes, which elevated their social stature among street children. They had insufficient knowledge of the cause, transmission modes, and prevention of HIV infection. They had poor self-esteem. They did not value or protect their bodies. They perceived the condom as being imposed by the outside. The group was unstable, transient, and without a charismatic leader. It had an authoritarian leader who was not well respected. A boy with whom another boy feels comfortable may be a vehicle for HIV prevention messages. The link unifying two friends is greater than the link to the group. Sex with men was a quick way for the boys to earn money. The boys preferred heterosexual relationships. The boys have adopted a street mentality to survive in the street where life is always dangerous, violent, and geared towards acquisition of goods or money. When designing an AIDS/STD education program, one must address the following: the importance of money as a tool for social validation, the emotional forces of the street child which made him grow up quickly, his very developed survival instinct, and violence of which he is a victim and which he practices.

Psychosexual characteristics of male university students in Brazil.

Male freshmen (N = 268) at the State University of Campinas (UNICAMP) in the state of Sao Paulo in Brazil responded to a questionnaire concerning aspects of their sexuality from the onset of adolescence. Topics such as physical changes, first ejaculation, masturbation, homosexual manifestations, and sexual practices were investigated, as well as present attitudes toward virginity, intercourse, birth control, abortion, and prevention of AIDS. The quality of the relationship established with parents and the possibilities for dialogue about sex in the family circle were also surveyed. The majority of the subjects revealed satisfactory development in most areas of their sexuality, as well as a good relationship with their parents. Nevertheless, great difficulty was found in dialogue about sex within the family circle. Of these young men, 32% were still virgins at the end of their freshman year, but a considerable number of those already sexually active reported behavior which was inappropriate for the prevention of pregnancy and AIDS. The results are analyzed using psychoanalytic theories of psychosexual development.

PIP: A random sample of 268 male freshmen of mean age 19.6 years at the State University of Campinas in the state of Sao Paulo, Brazil, responded to a questionnaire in 1990 on aspects of their sexuality from the beginning of their adolescence. Topics such as physical changes, first ejaculation, masturbation, homosexual manifestations, and sexual practices were investigated, as well as present attitudes toward virginity, intercourse, birth control, abortion, and AIDS prevention. The quality of their relationships with parents was also surveyed. The sample comprised 31% of the entering students for that year. 32% were living with their parents. Most respondents reported satisfactory development in most areas of their sexuality, as well as a good relationship with their parents. However, they found it very difficult to discuss sex within their family circles. 32% were still virgins at the end of their freshman year. 28% and 20% had homosexual manifestations during childhood/early adolescence and currently, respectively, including fantasies, attraction to men/boys, physical contact with men/boys, and sexual intercourse with men/boys. 38% of the sexually active men reported taking no measures to prevent pregnancy and HIV transmission.

[Relations of the adolescent]. / Las relaciones del adolescente.

PIP: Adolescents often feel like sexual beings because of the physical and psychological changes produced by their hormones. Adolescents are sometimes disturbed by their newly occurring sexual fantasies and by lack of understanding from their parents of the changes they are experiencing. These factors together with social pressures of various kinds occasionally make the adolescent forget that decisions about how to behave sexually should be made by the individual, not by others. Adolescents should be able to evaluate personal relationships for their positive or destructive qualities. Decisions by adolescents about their sexual behavior and about when a personal relationship should become a sexual relationship are made more difficult by the conflicting social, group, and interpersonal pressures they face. In a good sexual relationship as in a good friendship, the 2 persons feel confident and behave honestly with each other. Neither dominates the other, and the relationship is pleasurable rather than negative for both. According to research, the 1st sexual relations of an adolescent often occur with an adult. Sex is usually unpremeditated and unplanned. Many adolescents are disappointed in their 1st sexual experiences, which may have occurred in unfavorable circumstances. The combination of inadequate sex education and knowledge of what to expect and unrealistically high expectations from movies or stories probably are principal causes of disappointment. Adolescents in the process of maturing from childhood into adulthood are not completely prepared psychologically or socioculturally for parenthood. In Mexico, 75% of 1st unions are believed to begin before the woman is 20 years old. Most adolescents who become pregnant do not use contraception. In 1976, only 16% of new family planning acceptors were believed to be 15-19 years old. The proportion of births to mothers under 18 was estimated to have increased from 3.1% in 1968-70 to 10% in 1976. Adolescent pregnancies, especially those in very young mothers, are at high risk of complications. Adolescent parents may suffer psychological complications and may face problems of incomplete education, restricted employment opportunities, and marital instability.^ieng

[Preoccupation of young people with their sexuality].

PIP: Each adolescent in the transition from childhood to adulthood experiences crises, turning points which may be more or less profound and which may affect different individuals in different ways, until the corporal and psychic transition in complete. During the crises there may be modifications in mood, activity, and behavior. The crises are moments for changing direction or viewpoint, reviewing values, and making decisions. For most adolescents it is more helpful to provide company, guidance, and understanding while the crisis is in progress than it is to try to resolve the crisis directly. If the adolescent is not allowed to change, progress, and mature, be will remain fixated as a child in the body of an adult. Adolescents of both sexes are preoccupied by growth and physical changes in their bodies and by comparisons with others. Adolescent males are often concerned about the size of their genitalia and by the appearance of nocturnal emissions and erections, topics on which their fathers can provide reassurance. Adolescent females may be worried about menstruation and tend to be more interested than males in topics such as contraception, pregnancy, and delivery. Females worry more about their physical appearance and less about the development of their sex organs than males. Sexual development of females may be complicated by double standards of sexual behavior. Young females engaging in sexual activity are permanently worried about pregnancy and rejection, which may create insecurity and difficulty in intimate relationships. Adolescent females are concerned about their ability to establish and maintain satisfying marital relationships in the future.^ieng

Peru: reaching boys who sell sex.

PIP: Sex educational programs should employ trained workers to reach the male adolescent population in Peru. Sexual activity for boys begins between 13-15 years which often involves a prostitute; hence, accurate sex information is needed for these adolescents. Magazines and other media forms are utilized by males to obtain sex information. These young boys are often misinformed about healthy sexual practices and contraception. Sexually transmitted diseases (STD) are a problem for male adolescents; of the 92% of high school males who were sexually active, 23% had a STD infection. Poor economic conditions have contributed to young boys' engaging in sex for money such as prostitution and "fleteo". Private institutions have improved sex education by training educators to provide information on adolescent sexuality and by working directly with street children who sell sex. These outreach programs are concerned with emotional, economic, and sexual issues. Information about AIDS and sexually transmitted diseases are also provided by these organizations.^ieng

[Adolescent sexual and reproductive behavior in Latin America]. / Conducta sexual y reproductiva de los adolescentes en America Latina

PIP: The Latin American literature on adolescent sexual and reproductive behavior is reviewed to provide professionals in the area with more relevant findings. The data demonstrates that sexually active adolescents of both gender are increasing and starting sexual activity at an earlier age. For example in Panama one out of every 5 births is from an adolescent 15-19 with 25% of these out of wedlock; in Chile, 44% of live births are illegitimate. Factors that are affecting these changes are the media, peer groups and other sources of information competing with parental discipline (TV, movies, music). In spite of the high incidence of out-of-wedlock pregnancies, the majority of pregnancies among adolescents in Latin America and the Caribbean take place in marriage with the average age of marriage at 20, with variation between the rural and urban areas. In 1978 the total fertility rate of El Salvador's urban areas was 3.3 as against 8.4 in the rural. Young girls in developing countries have few options for education, retaining their virginity and marriage, so when presented with the change early on, they marry and get pregnant. Cuba remains the only Latin American Country where abortion is offered (up to 10 weeks) within the context of health services; while illegal abortion in the majority of Latin American countries continues to increase. The proportion of complications due to abortion for those under 20 ranges from 11-20% in the region. Illegal abortions has become a major cause of maternal mortality constituting from 12-53% of deaths among the majority of women 15-24. Significant data is given for pregnancy, factors that influence knowledge and use of contraception, and available sex education programs, an extensive bibliography in these areas is included.^ieng

Sex education and family planning services for young adults: alternative urban strategies in Mexico.

In Mexico, youth face difficulties in obtaining reliable information on sex education and family planning through existing community programs. Two alternative strategies to provide these services are being tested in poor urban areas of Monterrey. In one experimental area, Integrated Youth Centers were established, which provide sex education and family planning services as well as counseling, academic tutoring, and recreational activities. In another area, trained young adults and community counselors work through informal networks to provide sex education and family planning information. Both utilization and the cost of these services are examined in the context of plans for expanding coverage in Mexico-U.S. border areas.

PIP: In Mexico, youth face difficulties in obtaining reliable information on sex education and family planning through existing community programs. 2 alternative strategies to provide these services are being tested in poor urban areas of Monterrey. In 1 experimental area, Integrated Youth Centers (IYC) were established which provide sex education and family planning services as well as counseling, academic tutoring, and recreational activities. In another area, trained young adults and community counselors work through informal networks to privide sex education and family planning information. Both utilization and the cost of these services are examined in the context of plans for expanding coverage in Mexico-US border areas. This project has demonstrated that it is feasible to provide sex education and family planning services to young adults in a variety of formats. In terms of cost-effectiveness, these results suggest that the development of an IYC is neither the most effective nor least expensive alternative available for providing these services. The Community Youth Program has been much more effective in reaching young adults, particularly single males, at less than 1/3 of the cost of operating an IYC. Another important finding is that both youth programs seem to reach a youger, unmarried group not previously served by other programs.

[Sex education and the problem of early sexual relations among adolescents]. / La educacion sexual frente al problema de las relaciones sexuales precoces en los adolescentes.

PIP: Puberty today occurs about 2 years earlier than it did at the beginning of the century. The age of menarche is now usually between 11-13 years, while the establishment of spermatogenesis and appearance of the 1st ejaculation usually occurs between 13-15 years. The ages at which adolescents feel mature, want to behave like adults, and initiate sexual activity are now lower than in the past. Sexual relations may occur between adolescents before they are fully capable of recognizing their consequences as autonomous and responsible acts guided by a system of moral convictions. Both marriage and parenthood may have unfavorable consequences for future personality development, sexual adjustment, and the personal-social adaptation of the individual. In Cuba, the persistence of traces of bourgeois mentality can be seen in the tendency to teach young girls false concepts of female behavior. Traits such as submissiveness, passivity, and fragility are stressed, and girls are taught to inhibit their sexuality from a very young age. Adolescent boys are expected to display virility and machismo. Adolescent boys may be so interested in the physical aspects of sexual activity that they deprecate the aspects, considering them to be weak female traits. Boys are more likely to separate the sexual object and the love object, while such duality is unusual in girls. Among the most serious problems of adolescent sexual activity in Cuba is a high rate of abortions among young adolescents. Some adolescents are promiscuous and have frequent changes of partner. The age group 15-19 years has the 3rd highest rate of syphilis and the 2nd highest of gonorrhea. The proportion of births to minors has increased from 22% in 1973 to almost half in some provinces. Divorce rates have been in constant increase in Cuba, and psychosocial immaturity of very young spouses is a principal factor in divorce. The widening temporal gap between attainment of puberty and marriage, which is likely to be postponed until the completion of ever more time-consuming educations, is a factor in increased premarital sex although it is not a determinant of it. An adequate sex education program would help adolescents develop responsible attitudes and good foundations for their future sexual adjustments. It would also help prevent adolescent pregnancy, with its frequent negative consequences.^ieng

Third world programs confront adolescent fertility.

PIP: Recently, there have been efforts to identify workable youth programs and effective research projects that could deal with the problem of adolescent fertility. Typical objectives identified at various conferences concerned with this problem included the following: 1) focus attention on the adverse medical and socioeconomic efforts of early pregnancy; 2) draw attention to the current dimensions of adolescent fertility and its changing patterns; 3) encourage development of programs; and 4) impress decision makers with the importance of programs for adolescents. These conferences express a sense of urgency in developing programs before teen-age pregnancy reaches epidemic proportions. Most of the projects already underway are still pilot efforts and have an impact on a very small sector of the population. Yet, they are positive steps toward a solution of the rising problems of adolescent fertility and help to identify workable solutions. A few of these projects -- underway in Colombia, Argentina, Chile, Cost Rica, Guatemala and Mexico -- are reviewed. The consensus of all conferences held to date has been that cross-cultural interchanges is crucial to the spread of programs and ideas that can be adapted to local conditions. 2 key recommendations have emerged from a meeting of donor and support agencies held in Washington, D.C. in May: 1) a major conference should take place during the International Year of the Child (1979) that would focus on early sexual activity and fertility and 2) an Adolescent Fertility Council should be appointed. An Adolescent Fertility Council would provide a structure to correlate and stimulate interaction, while recognizing that country and culture specific programs are essential.^ieng