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.

"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." - Sexually Transmitted Infections

"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." - Global Public Health

"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." - Studies in Family Planning