Over the past 20 years, public health officials and social workers have reached consensus on the magnitude, complex determination and health and social consequences of adolescent problems. The emerging HIV/AIDS pandemic and the recently reconsidered role of classic sexually transmitted diseases have reinforced the need to promote changes that reduce risks related to adolescent behaviour. Traditional intervention strategies to prevent sexual health problems among young people are currently being re-evaluated. The effectiveness of any programme attempting to modify sexual risks among the young can be improved to the extent that action occurs at various levels. Community intervention is an alternative that combines actions at many levels. The Cayetano Heredia University in Lima, Peru, recently developed a community-based intervention programme on the sexual and reproductive health of young people. Called "Sexual Health in a Young City", the programme targeted young people between 15 and 24 years of age in two neighbourhoods in Lima, Breña and Pueblo Libre. The preparatory phase began in November 1995, and the campaign took place between July 1996 and February 1997.

Sexual Health in a Young City sought to mobilize community resources to:

• Improve young people's skills to prevent unplanned pregnancies and sexually transmitted diseases, including HIV/AIDS;
• Promote models of social and sexual relations among young people from the perspective of mutual respect and full, voluntary and safe exercise of their sexuality;
• Promote youth organization by empowering them to identify and address their own sexual and reproductive health problems;
• Motivate other social actors to mobilize resources to reduce sexual and reproductive health risks;
• Facilitate the collaboration among institutions offering social and sexual and reproductive health services to young people, in order to promote better use of such services.

In the implementation phase the team monitored and evaluated processes through activity records; it used qualitative individual and group interviews to learn opinions and expectations of community actors and networks involved; it held post-workshop surveys to evaluate the educational impact of the sexual and reproductive health workshops with young people; and it evaluated the health service network and the referral system.

The municipalities and local health and education authorities responded positively. However, no community actor took the lead to continue the programme. Nevertheless, the participants felt motivated and better equipped to implement similar activities in their own institutions and to collaborate with other social actors.

The young people were enthusiastic about the educational workshops, the core educational activity. Most of the youth said they initially had poor expectations, but they had found the sessions entertaining, participatory and relevant to their own problems and perspectives. Some, mostly girls, insisted on attending again.

Among the programme limitations were: the implementation period was too short due to budget restrictions; lack of attention for the perceptions and expectations of the major institutional decision makers involved and lack of advocacy work; various programme actors were not encouraged enough to take on some of the work assigned to the technical staff; lack of promotion of youth involvement and more opportunities for interaction among the diverse networks.

Despite these flaws, the programme showed that the more important social actors in a community can be involved in co-ordinating efforts to improve youth sexual health. Some of the corporate social actors showed interest in this work and they participated enthusiastically in task-specific working networks.

Youth were receptive to the participatory workshops led by trained peer educators which promoted autonomy. Large groups of young people who are genuinely committed to the strategy can become peer promoters in this sort of programme. With the attention of a dedicated supervisor, expenses can be limited to transportation.

Youth health services were particularly willing to participate in innovative experiences that bring them closer to young people. Bridging the gaps that separate them from their potential clients may, however, require profound structural changes. A committed and legitimate community actor, such as the municipality, may play a key role in co-ordinating and continuing an integrated programme. Interventions of this sort must seek commitments in one or more privileged social actors.

A programme of this type could make a difference and raise expectations and interest among the young and other social actors. Its successful entrenchment in the community and impact on the young depend on committed leadership, clarity in the political strategy, and adequate access to resources and the ability to generate them.

This programme offers new approaches to working with youth sexual and reproductive health. These approaches should transcend the traditional models of compartmentalized and isolated school sex education by integrating gender and sexual and reproductive rights perspectives, youth involvement and committed community participation.

Carlos F. Cáceres, Carlos Cabezudo, Oscar Jiménez, Rocío Valverde, Griselda Pérez-Luna; Institute of Population Studies/Universidad Cayetano Heredia and REDESS Jóvenes, Simón Salguero 233, Surco, Lima, Peru. Tel: +51-1-242-8925; Fax: +51-1-445-8909; e-mail: ccaceres@upch.edu.pe

Making a start: community members are asked to share ideas for improving their community. They are encouraged to examine their hopes and fears, personal relationships and daily life problems.

• What is love?  The groups discuss different types of loving relationships.
• The condom: older and younger persons both learn about condom use.
• Hopes and fears: participants are asked to imagine possible different futures for themselves: a best and a worst future and the steps needed to embark on the path to the best future.
• Sexual encounters: attention is given to situations that lead to sexual encounters and the influences on sexual behaviour such as alcohol use, traditions, money and communication (saying yes and saying no)
• Taking responsibility: the groups look at who is responsible and who takes control in sexual situations; issues of assertiveness and trust are also addressed.
• Coping with AIDS: the groups examine how they can help one another cope with AIDS and death in the community.
• Community challenge: the groups can present the issues they dealt with to one another and agree on changes they would like to see in six months' time.