HIV Prevention Knowledge Base
Behavioral Interventions: Comprehensive Sexuality Education
Impact of Stepping Stones on Incidence of HIV and HSV-2 and Sexual Behaviour in Rural South Africa: Cluster Randomized Controlled Trial
This cluster randomized controlled trial of 2,700 men and women in 70 villages in the Eastern Cape province of South Africa tested the Stepping Stones program. It comprised 50 hours of participatory learning aimed at improving sexual health. Villages in the control group received a three-hour intervention of HIV and safer sex education instead. The primary outcome was incidence of HIV at 12 and 24 months, with secondary outcomes of herpes simplex type 2 (HSV-2) infection, unwanted pregnancy, depression, substance misuse, and sexual habits such as the number of partners and history of transactional sex. The intervention lowered rates of HSV-2 infection, but it did not have an impact on incidence of HIV. It did not have an effect on female behavior but reduced incidence of intimate partner violence perpetrated by male participants. Although the intervention failed to directly reduce HIV rates, it did have an impact on two risk factors for HIV, namely HSV-2 infection and intimate partner violence.
Standards for Curriculum-Based Reproductive Health and HIV Education Programs
A group of international youth HIV and reproductive health researchers, program implementers, curriculum development experts, educators, and others met to discuss the Kirby 2005 review of characteristics of effective curricula. This expert consultation provided the crucial perspective of those implementing curriculum-based health education programs in developing countries. Based on their program implementation experiences, each of the characteristics Kirby identified as a hallmark of successful programs was carefully reviewed and discussed. This resulted in the group developing 24 standards of high-quality health program features that can assess the quality of a curriculum—existing or proposed—and its implementation. The standards are divided into three sections: (1) curriculum development and adaptation, (2) curriculum content and approach, and (3) curriculum implementation. The implementation section has multiple examples and lessons learned from implementation experiences worldwide.
Risk and Protective Factors Affecting Adolescent Reproductive Health in Developing Countries
This report is a systematic review of 158 studies on adolescent sexual behavior risk and protective factors in developing country settings. The findings are presented as individual and also as cross-cutting risk factors. Important themes emerged; for example, only 1 percent of the more than 11,000 papers published on this topic met the review’s inclusion criteria, few studies consider contextual factors, and factors specific to non-westernized regions have been under-researched. There is also little evidence on the impact of coercive sexual practices despite the fact that adolescents are primary targets. Moreover, the most commonly analyzed factors were sociodemographic, but these are the least amenable to interventions. The review is subject to a number of limitations, such as clustering of research in a few countries and a paucity of data from North Africa, Eastern Europe, Central Asia, and the Caribbean. Because most of the studies reviewed are cross-sectional, causality cannot be determined.
Impact of Sex and HIV Education Programs on Sexual Behaviors of Youth in Developing and Developed Countries
This systematic review of 83 program evaluations had two main aims: to ascertain the effects of curriculum-based sex and HIV education on sexual risk behaviors, and to discover the shared characteristics of those programs that were effective. The studies covered composite risk-taking measures as well as individual risk factors such as timing of sexual debut, frequency of sex, number of sexual partners, and use of condoms and other contraceptives. The programs had an overall positive impact on one or more sexual risk behaviors, and outcomes were similar in developed and developing country settings. Factors that successful interventions had in common include curricula developed by diverse teams working toward clearly defined goals, a safe environment for young people that gave them ownership of the information, and implementation by trained educators with minimal support from authorities. The report offers recommendations, both for program designers and for further research.
Science & Success in Developing Countries: Holistic Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections
This report brings together 10 interventions in seven countries that had demonstrable success in reducing sexual risk factors such as initiation of sex, number of sexual partners, and contraceptive use. There are tables comparing the design and impact of the 10 interventions, and a chapter for each describing them in detail from program components and evaluation methodology to outcomes. What the programs have in common is that they treat young people in a holistic manner, consider sexual development to be a normal part of adolescence, and involve key stakeholders. They are described by the authors as culturally appropriate, thoughtful, and realistic. They provide comprehensive information covering both contraception and abstinence, and many of them incorporate youth health or health care referral services.
Primary School Action for Better Health: 12-18 Month Evaluation
This detailed report presents an evaluation of the Primary School Action for Better Health project, implemented in Nyanza and Rift Valley in Kenya. The project had numerous positive outcomes. First, it shifted pupils’ primary reported source of information about HIV away from the mass media and toward teachers and school texts, although this did not undermine female relatives as the preferred source of information for both sexes. Second, the project corrected misinformation among pupils and improved their critical thinking about HIV. Abstinence was presented as the only fully effective means of HIV prevention, and the project incorporated strategies to encourage it. However, information about condom use was often negative and at times even factually incorrect, reflecting teachers’ ambivalence about discussing condoms with pupils. Overall though, teachers responded well to the project, and HIV education is more prominent on the school curriculum as a result of the project, the study found.
Safer Choices: Reducing Teen Pregnancy, HIV and STDs
This randomized controlled trial of 20 high schools in California and Texas comprising a cohort of over 3,800 students tracked their sexual risk and protective behaviors after the implementation of Safer Choices, an educational program aimed at behavior change to prevent HIV, other sexually transmitted infections, and teen pregnancy. The most noticeable outcome was that condom use improved after the intervention. It also improved some psychosocial variables predominantly related to condom use. The effects were sustained over 31 months of follow-up. However, age at sexual debut remained the same, as did frequency of intercourse and number of sexual partners. The study supports further implementation of theory-driven, school-based, multicomponent programs to reduce HIV-related sexual risk behaviors, the authors found. Safer Choices was well received by both students and staff, and even after the study ended, most of the schools continued to use the curriculum.