1. Kelly Hallman, Kasthuri Govender, Eva Roca, Emmanuel Mbatha,
Mike Rogan, and Hannah Taboada.
Population Council, Isihlangu, University of KwaZulu-Natal
Global Youth Enterprise & Livelihoods Development Conference
Washington, DC
September 14-16, 2010
Building economic, health
and social capabilities
among adolescents
threatened by HIV and AIDS
The Siyakha Nentsha
(“Building with Young People”)
program in KwaZulu-Natal

2. Strategic Planning:
Used Research to Learn
 Which adolescents to invest in
- Identify highest concentrations of poor & vulnerable by gender, age,
geography
 When vulnerabilities—that must be addressed by
programs—begin
 Whether poor adolescents are already being reached by
“youth” initiatives
 What was missing from existing programs

3. Formative research:
Structural factors associated with
adolescent HIV risk behaviors
• Residing in relative poverty
• Fewer social connections
• Non-cohesive community
• Orphanhood
Source: Hallman 2004, 2005, 2007, 2008, 2010; Hallman & Roca 2007

4. Durban Program Scan
• Few adolescent SRH or HIV programs
address social, economic, and cultural
underpinnings of risk behaviors
• Few livelihood programs make conceptual
link to health risk behaviors
– Not context-, age-, culture- or gender-specific
– Design not evidenced based
– Delivery weak
– Little monitoring or evaluation

5. Setting
• Semi-rural KwaZulu Natal
– Poverty and income inequality
– Unemployment
– Early pregnancy
– Early school leaving
– HIV

6. Intervention purpose
Improve functional capabilities and well-being of
adolescents at high risk for:
HIV and STIs teenage pregnancy parenthood
school dropout loss of one or both parents
lack of knowledge of further employment and training opportunities

7. Intervention rationale
•Secondary schools
•Least selective sample in this context
•Scalable – DOE is base
•Bundled accredited package
•Females and males
•Resounding community feedback
•Male attitudes, behaviors and future prospects
•Work both sides of gender equation

8. Intervention content
• Knowledge and skills for pregnancy and HIV prevention
and AIDS mitigation; accessing preventive, treatment and
care services
• Skills for:
– managing personal and familial resources
– Accessing social benefits, education and training opportunities
– planning and aspiring for the future
– building savings/assets over time
• Building and strengthening social networks and support

9. Intervention theory of change
• Participation builds skills
• Visible local role models enhance aspirations
• Leadership on HIV and standing in community
• Respect from community increases agency
• Skills and self-identity as capable economic/
health/ social decision maker raises agency
• Agency increases sexual decision making power

10. Credibility –
Sound programming principles
• Maximum use of existing infrastructure
– Tapping & building local human capacity
• Make consistent with local reality
– Facilitator pay rate same as gov. auxiliary social
worker
– Local residence: no absences; know local realities
– National accreditation of program
→ cache and door opener for grads
– Curriculum geared to local opportunity structures
• Designed with an eye toward scale-up
– DOE decision-making from Day 1

11. Credibility - Project team
Learners
Facilitators
Educators
Tribal Authority
KZN DOE
kdkd
Isihlangu Health
& Development
Agency
Population
Council
HEARD
UKZN
AccuData

12. Credibility – Project design
• Incorporated into school day
• Least selective sample in this context
• Reaching maximum number in vulnerable community
• Females and males
• Responding to community needs
• Male attitudes, behaviors and future prospects
• National accreditation of
– Curriculum
– Implementing organization as training providers

13. Credibility -
Randomized
program design
HIV education,
social support
+ financial
literacy
HIV
education
and social
support Delayed
intervention

14. Credibility – M& E Indicators
• Relevant
• Objective
• Transparent
• Systematic and continuous
• Participatory
• Usable

15. Credibility - Research Methods
• Longitudinal survey w
grade 10 & 11 students
• FGs & IDIs w
students (F, M),
guardians, teachers,
school principals and program facilitators
to assess experience with intervention

16. Males Females
Have you discussed... No Program Program No Program Program
Self-esteem, attitudes, values 85 98* 83 94*
Gender relations 58 91* 62 84*
Sexuality 88 100* 91 95
Violence and sexual abuse 85 99* 91 97
Financial decisionmaking 73 89* 64 86*
Interpreting data 61 83* 53 77*
Looking for work 70 89* 70 85*
Career guidance 73 92* 77 89*
Saving 40 89* 66 83*
How to start a business 62 88* 64 81*
Social grants 45 89* 45 86*
Results

17. Results
0
10
20
30
40
50
60
Boys* Girls
Whostarted having sex?
Learnerswho did not participate were less likely to
remain abstinent than learners in Siyakha Nentsha
No Programme
Siyakha Nentsha

18. Results
0
20
40
60
80
100
Round 1 Round 2
Confidence inabilitytouse condoms correctly increased
significantlyamongprogramme participants compared
tothose withno programme
Siyakha Nentsha females* No prog females
Siyakha Nentsha males No prog males

19. Results
0
5
10
15
20
Round 1 Round 2
SiyakhaNentshagirls significantlyincreased
theirconsistentcondomuse compared to
girls who didn'thave the programme
Siyakha Nentsha females No prog females

20. Results
0
20
40
60
80
Round1 Round2
SiyakhaNentshaparticipants were moreable
to successfullyopenabank account
Siyakha Nentsha males* No prog males

21. Way forward
•In dialog with DOE about
possible scale up
•Follow-up participants to
assess longer-term impact of
intervention

22. Selected resources
• Hallman, K. 2010, in press. “Social exclusion: The gendering of adolescent HIV
risks in KwaZulu-Natal, South Africa,” in J. Klot and V. Nguyen eds., The Fourth
Wave: An Assault on Women - Gender, Culture and HIV in the 21st Century.
Social Science Research Council and UNESCO.
• Hallman, K. 2008.“Researching the determinants of vulnerability to HIV amongst
adolescents,” IDS Bulletin, 39(5), November 2008.
• Bruce, J. and Hallman, K. 2008. “Reaching the girls left behind,” Gender &
Development, 16(2): 227-245.
• Hallman, K and Roca, E. 2007. “Reducing the social exclusion of girls,”
www.popcouncil.org/pdfs/TABriefs/PGY_Brief27_SocialExclusion.pdf
• Hallman, K. 2007. “Nonconsensual sex, school enrollment and educational
outcomes in South Africa,” Africa Insight (special issue on Youth in Africa), 37(3):
454-472.
• Hallman, K. 2005. “Gendered socioeconomic conditions and HIV risk behaviours
among young people in South Africa,” African Journal of AIDS Research 4(1):
37–50. Abstract: http://www.popcouncil.org/projects/abstracts/AJAR_4_1.html

23. Thank you!
Our funders: ESRC/Hewlett Joint Scheme
& DFID via the ABBA RPC