The challenge is not to forget about the tiny African country once the media’s attention turns elsewhere.

Like Madonna, I was in Malawi last week. On Saturday, I listened to the evening news on Blantyre's Joy FM radio while riding with 18 other adults in a battered public minibus.

All the other women were holding babies on their laps. At every stop, children crowded the windows — some selling bags of water or ears of grilled corn, others simply begging for small bills.

Similar headlines

And on the radio? The news was about Madonna, of course. Not just within Malawi, but around the world, just about everyone — from development economists and adoption law experts to celebrity gossip columnists and talk show hosts — seems to want to weigh in on roughly the same set of questions.

They ask: Does Madonna really want to raise this child or is she just seeking attention? How does her husband feel about it all? Did the baby's father understand what he was agreeing to? And is the adoption even legal?

The real issue

At the same time, a new UNICEF estimate shows that more than 18 million African children will be orphaned this decade unless we do more to fight HIV/AIDS. Sadly, that report attracted much less attention than the Madonna-related news.

Many Malawian adults — much like their American counterparts — may be hindering, rather than helping, protect adolescents’ health.

I cannot help but wonder whether the media is missing the real question about David Banda — the baby boy at the center of all the attention. What we should ask ourselves is this: Is enough being done right now so that the next generation of children in Malawi and elsewhere will have healthy parents to care for them?

In other words, does the next generation of Malawian parents — those who are adolescents today — have the knowledge, skills and resources to have healthy relationships and protect themselves against diseases such as HIV/AIDS?

Need for strategy

Research conducted by the Guttmacher Institute and colleagues in Malawi and three other African countries (Burkina Faso, Uganda and Ghana) offers important clues to these questions. We asked more than 20,000 young people in Sub-Saharan Africa to tell us what they know about HIV and AIDS — and how to protect themselves.

What would they like to know more about and how would they like to get the information? How do they actually behave — and what do their hopes for the future look like?

Bleak statistics

The picture that emerges from these surveys points the way toward better strategies for protecting the next

Nearly all teenagers belong to a church or mosque and attend services at least once a week — while more than seven in 10 adolescents are in school.

generation — and ensuring that tomorrow's children grow up at home with healthy parents.

Today, an estimated 12% of Malawians are living with HIV/AIDS. And more than one-quarter of adolescents have lost one or both parents, often to the AIDS epidemic. That is a shockingly high number.

But there is also plenty of hope, starting with the fact that Malawian youth are becoming better educated about the disease — and about how to protect themselves.

HIV awareness

Almost every Malawian adolescent has heard something about HIV/AIDS, and most can accurately name at least one way to avoid transmission of the virus (such as using a condom, not having sex at all or not sharing needles).

Perhaps surprisingly, orphans often know more about HIV — and how to protect themselves than do their peers living with both parents. Maybe that is because they tend to rely on well-informed "official" sources such as teachers and health care providers — rather than on family members.

High contraction rates

About a third of young Malawian men and a quarter of young women start having sex before turning 19. When they do, they probably will not use a condom.

About a third of young Malawian men and a quarter of young women start having sex before turning 19. When they do, they probably will not use a condom.

Fewer than three in 10 teens use any kind of contraception the first time they have sex. Malawian adolescents say they do not use condoms because they "feel safe," or because they simply do not have one.

They may also not know quite enough about how to use one: Only about a quarter of young men and just 14% of young women have attended sex education classes.

Social fabric

Much more remains to be done to improve basic sex education and to make condoms and other birth control methods more easily available to sexually active youth.

One of Malawi's greatest assets is the country's strong social fabric. Young Malawians are not bereft of community, ambition or hope for the future.

Good intentions

Indeed, nearly all teenagers belong to a church or mosque and attend services at least once a week. Eight in 10 adolescent boys and more than seven in 10 girls are currently in school, and most expect to graduate from high school.

Perhaps surprisingly, orphans often know more about HIV — and how to protect themselves than do their peers living with both parents.

And, even when not living with both parents, many young people, especially young women, have a responsible adult keeping an eye on them. More than half of teen girls report that their guardians always know where they go at night, what they do with their free time, and who their friends are.

It is, of course, wonderful that young people can rely on these social supports. But when it comes to dealing with teens and sex, many Malawian adults — much like their American counterparts — may be hindering, rather than helping, protect adolescents' health.

Lack of candor

Young people say that the biggest barrier to getting help protecting themselves from sexual risks (by obtaining birth control or getting advice about or treatment for sexually transmitted infections) is that they are shy or embarrassed about seeking care.

As adults, we need to provide youth with support and respect, not pass judgment. The stakes are simply too high. At one meeting I attended in Lilongwe, Malawi’s capital, speaker after speaker explained that parents and other adults could not talk with young people about sex because of the country’s social conservatism.

The government's role

Finally, one woman stood up and said, “If the culture is preventing us from talking about these things with our children, then we must change the culture. Otherwise, our children will continue to die.”

At one meeting I attended in Lilongwe, speaker after speaker explained that parents and other adults could not talk with young people about sex because of the country’s social conservatism.

So, can Madonna's visit really make a difference in the lives of Malawians? Despite many encouraging efforts underway in the country, clearly the situation could be better.

The challenge for both the Malawian government and the international community is to focus on rapid and sustained improvements in Malawians' — and especially adolescents' — sexual and reproductive health.

The stakes

And for the public in the developed world, whose imagination was captured by a little Malawian boy, the challenge is not to forget about the tiny African country once the media's attention turns elsewhere.