Addressing Cross-Generational Sex: A Desk Review of Research and Programs

The purpose of this 80-page review of cross-generational sex outside marriage, published by the Population Reference Bureau (PRB) and commissioned by the United States Agency for International Development (USAID) Bureau for Global Health, is to inform USAID staff on the range of programmatic approaches available to prevent or reduce cross-generational sex. The report states that there is need for further investment in large-scale programmes that address cross-generational sex, including related transactional sex, in the countries most affected. Effective programmes are likely to garner changes in social norms as well as address the determinants of individuals’ behaviour. To generate further knowledge on what works in what situations and best practice guidance, programmes need to be well designed and rigorously monitored and evaluated.

According to the report, authors writing about cross-generational sex describe a continuum of volition and behaviours - from coercion using violence and threats to situations in which the younger partner voluntarily participates. However, even with apparent agency in their actions, young women and girls may be vulnerable to exploitation in cross-generational relationships given the socioeconomic asymmetries in the relationship with an older man, and given the lack of choices facing those living in poverty. The author proposes that this "continuum of volition" and its related programmatic responses need to be better evaluated and understood. The report adds that while there is increasing understanding of why some girls seek out cross-generational relationships, there is too little information about how and why girls end these relationships.

The report describes how a number of broad programmatic approaches have been tried including 1) creating youth livelihood opportunities; 2) mobilising and empowering youth to adopt healthy lifestyles and avoid what is known in Uganda as "Something for Something Love"; 3) advocacy and what Population Services International has termed "social advocacy" - general awareness raising and mobilising public opinion to change a situation or societal norm; 4) social marketing and edutainment; 5) health education and youth rights; 6) addressing power asymmetries, inequity, and poverty; and, most promisingly, 7) addressing social and gender norms.

According to the report, many authors argue that rather than focusing only on sexual risk taking by young women and older men, programmes should concentrate on changing the social acceptability of such relationships. One potential approach to garnering wide changes in social norms and relationships might be through use of Stepping Stones or an adaptation of the Stepping Stones process for use in schools, such as the International AIDS Alliance programme in Zambia. This is because Stepping Stones provides a safe space for girls, boys, women, and men to identify and discuss their common concerns.

The author says that there is some evidence that use of mass media campaigns coordinated with interpersonal behaviour change communication can influence young people’s reproductive health behaviours, as well as men’s attitudes to gender equality and men’s sexual and reproductive health behaviours. However, a systematic review of the effectiveness of mass communication programmes in changing HIV and AIDS-related behaviours yielded mixed results. Of those interventions that achieved statistically significant results, the significance was only low to moderate. The report proposes that to generate further knowledge on what works in what situations and best practice guidance, programmes need to be well designed and rigorously monitored and evaluated.

The report makes a number of recommendations, including the following:

• When designing messages to reduce sexual risk taking by young people, it is important to recognise that youth easily discount risk of HIV infection with its consequences far in the future. Messages that focus on preventing events closer in time, such as preventing unintended pregnancy and the dangers of abortion and sexually transmitted infections, are more likely to influence behaviour in cross-generational sex.
• Evaluation studies are needed to confirm the impact on cross-generational sex of legal, policy, and programmatic measures that (1) keep girls in school and (2) make schools safer by reducing school-related gender-based violence.
• To change both societal norms and individual behaviours, programmes need to draw on theories for social as well as individual behaviour change, and develop approaches that (1) facilitate wide-ranging community discussions on issues such as human rights and what that means in terms of access to resources, control over one’s own body, and behaviours (agency), and economic productivity; and (2) advocate for change with local decision-makers and other influential leaders that stimulate the formation of social movements for change.
• There is a need for further evaluation of the effectiveness of comprehensive behaviour change approaches (whether through the use of mass media to create an enabling environment for individual behaviour change, through one-on-one or small group interpersonal behaviour change communication, or through social change methodologies) to gauge their impact in reducing cross-generational sex, as well as increasing condom use.
• Interpersonal interventions to address youth behaviour should specifically include information and skills building to counter prevailing inequitable constructs of femininity and masculinity, as such measures have been proven to be effective in improving sexual and reproductive health behaviours in unmarried as well as married youth.
• Participation of young people, girls and boys, in designing and in monitoring and evaluating interventions to reduce cross-generational and transactional sex is important.