HIV Prevention Knowledge Base
Behavioral Interventions: Comprehensive Sexuality Education
Opportunity in Crisis: Preventing HIV from Early Adolescence to Young Adulthood
This overview of the HIV epidemic among young people is one of the most up-to-date reports on HIV among this age group. It describes the epidemiology of the HIV epidemic among young people at a global and regional level, followed by detailed chapters focusing on very young adolescents, older adolescents and young adults, as well as adolescents and young people living with HIV, with case studies, maps, and easy-to-use data. There are statistics on demographic, epidemiological, and education level indicators among this population; a chapter on their knowledge, sexual behavior, access, and testing patterns; and HIV indicators for young people at higher risk. It advocates a continuum of prevention to protect young people from HIV and details other opportunities for action that arise from this public health crisis.
Sex Education: Access and Impact on Sexual Behaviour of Young People
This systematic review of 63 studies on the impact of sex and sexually transmitted infection education on young people’s sexual behavior found that most of the interventions increase young people’s knowledge. Approximately a third delayed sexual debut, frequency of sexual intercourse, and number of partners, while approximately 40 percent of the interventions increased the use of condoms and other contraceptives. The reduction in risky sexual practices was not dramatic, but was sufficient to reduce rates of pregnancy and sexually transmitted infections, the author notes. Although the studies covered a wide geographical area, their findings may not have worldwide applicability, and none of the studies looked at same-sex sexual behavior or population-level changes due to large-scale roll-out.
Effectiveness of an HIV/STD Risk-Reduction Intervention for Adolescents When Implemented by Community-Based Organizations: A Cluster-Randomized Controlled Trial
In this cluster randomized controlled trial of 86 community-based organizations serving African American adolescents, 1,700 adolescents either received a health promotion education intervention from an organization assigned to this group or from an organization assigned to deliver an intervention targeting HIV and sexually transmitted infections (STIs) risk reduction. The participants were followed up at three intervals for 12 months. Those in the HIV/STI intervention group were more likely to report consistently using condoms than their counterparts who did not receive the intervention. The study was the first of its kind to prove that community-based organizations are an efficient channel through which to implement HIV/STI risk reduction interventions. The study also found that training costs for facilitators were not prohibitively high.
Risk and Protective Factors that Affect Adolescent Reproductive Health in Developing Countries: A Structured Literature Review
This review examines which factors have the greatest bearing on adolescent health in a developing country setting, both in terms of risk and protection. Sixty-one papers were analyzed, and the review looked at factors associated with premarital sex, condom use, and pregnancy. It revealed that factors outside the individual, such as peer, partner, family, and school level, had little impact on sexual risk behaviors, while the strongest associations were related to adolescents themselves, such as gender, education, and non-sexual risk behaviors. The authors note the lack of rigorous research in this area and call for a broader research base. However, the review already identifies several important factors, for example, communication with partners, concurrently targeting different risk factors such as substance abuse and sexual behavior, and harnessing the powerful role of parents in influencing their adolescent children.
HIV Prevention in Young People in Sub-Saharan Africa: A Systematic Review
This is a systematic review of 23 studies of HIV education programs for young people in sub-Saharan Africa conducted from 2005 to 2008. The review constitutes an update of the first Steady, Ready, Go! review and uses its framework of evaluation of school-based interventions, health services, and geographically defined communities, with an additional section on interventions with biological outcomes. The authors describe school-based interventions as largely successful in terms of educating young people about sexual risk behaviors, but not enough to effect actual risk reduction. Interventions aimed at HIV prevention via improved access to health services can only be successful if they are acceptable to and used by young people. Interventions in geographically defined communities are particularly problematic to evaluate, the authors found. They conclude that a range of tools is needed and that a one-size-fits-all approach to young people and HIV prevention will not be effective.
Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases
This review summarizes research into sexual risk behavior and its consequences among young people in the United States. It is the largest, most in-depth systematic review of multiple kinds of programs. There is information about the prevalence of risky sexual behavior, and the resultant rates of teen pregnancy and sexually transmitted infections (STIs). There are detailed chapters on the case for prevention; factors affecting teenagers’ sexual behavior; a description of the review methodology; and the findings, divided into curriculum-based sex and HIV/STI prevention interventions and other types of programs. The report concludes with a chapter on application of research to communities, highlighting those that have strong evidence of efficacy in reducing teen pregnancy and rates of STIs.
Systematic Review of Abstinence-Plus HIV Prevention Programs in High-Income Countries]
This review focuses on evidence from high-income countries measuring biological, behavioral, cognitive, attitudinal, or other outcomes related to HIV risk reduction. The 39 studies included are only from North America due to a lack of available literature from other countries. Interventions promoted sexual abstinence, condom use, and partner reduction for HIV prevention, with abstinence the most effective choice. Most studies measured behavioral rather than biological outcomes. Twenty-three studies found a significant protective effect on sexual risk behavior, including incidence and frequency of unprotected sex, number of partners, condom use, and sexual initiation. No adverse effects on behavioral outcomes were found. Because of differences between studies, the authors could not aggregate most data. They recommend the HIV research community define consistent outcome measures that reflect HIV risk. This would enable biological data to be more easily pooled and overcome the statistical limitations that come with low incidence rates and small sample sizes.
Sexual Risk and Protective Factors: Factors Affecting Teen Sexual Behavior, Pregnancy, Childbearing and Sexually Transmitted Disease: Which Are Important? Which Can You Change?
This review presents in a table format more than 500 risk and protective factors that can affect the rate of teen pregnancy and sexually transmitted infections (STIs), and assesses the extent to which interventions aimed at reducing teen pregnancy and STI rates can change them. The findings are based on over 400 studies. The review gives each intervention a star rating (one star denoting a factor that is the most difficult to change directly by pregnancy and STI programs, up to three stars denoting those factors most amenable to change by pregnancy and STI programs). The factors fall into four broad categories: individual biological factors; disadvantage and dysfunction in the teenager’s lives and environments; the sexual values and modeled behavior of teenagers as well as their parents, peers, and partners; and connections that discourage early sexual activity and teen pregnancy, such as attachment to influential adults in schools and via religious organizations.
The Effectiveness of Sex Education and HIV Interventions in Schools in Developing Countries
This systematic review of 22 studies from developing countries worldwide assessed the efficacy of interventions to reduce a total of 55 sexual risk behaviors, such as sexual debut, frequency of sexual intercourse, condom use, and sexually transmitted infections. The studies included those that used both curriculum- and non-curriculum–based interventions; incorporated characteristics that were known to be effective HIV prevention interventions or did not, and were led by teachers, other adults or peers. The review found that reported risky sexual practices were lower after most school-based sex and HIV education interventions. The authors recommend wider implementation of curriculum-based programs incorporating interventions that are already known to be effective, and caution that more research is needed to evaluate peer-led and non-curriculum–based interventions.
A Randomized Controlled Trial Testing an HIV Prevention Intervention for Latino Youth
This randomized controlled trial tested the effectiveness of a HIV prevention intervention in a cohort of 550 Latino adolescents. The participants underwent six 50-minute modules delivered in English or Spanish by adult facilitators either on HIV or health promotion. They were then followed up for a year and self-reported their sexual behavior. Sexual intercourse, multiple partners, and unprotected sex were reported less by the adolescents in the HIV group. At follow-up, adolescents in the HIV group who were sexually inexperienced at baseline reported less incidences of unprotected sex in the previous three months compared to the adolescents in the health promotion group. The study was the first to demonstrate that such an intervention can be effective among Spanish-speaking young people, and the activities may have applicability in Latin American and other Spanish-speaking countries, although more research is needed to test the generalizability of the findings, the authors note.
Education and HIV/AIDS Prevention: Evidence from a Randomized Evaluation in Western Kenya
This randomized controlled trial compared three different school-based HIV interventions. They were teacher training in the government’s HIV education curriculum, encouraging debate and essay writing among students in condom use for HIV prevention, and making education less expensive. Teenage childbearing, associated with unprotected sex, was the primary outcome of the study, while the secondary outcome was HIV knowledge, attitudes, and behavior. Teacher education did not reduce teen pregnancies, but it increased the number of teen pregnancies within marriage. The student essay writing and debates intervention was associated with higher self-reported condom use at the same level of sexual activity. Lower education costs were associated with lower dropout rates as well as fewer teen pregnancies. However, to determine whether self-reported condom use after the school-based intervention is associated with lower incidence of HIV, biomarker tests would need to be used, the authors note.
Relative Risks and the Market for Sex: Teenagers, Sugar Daddies and HIV in Kenya
This randomized control trial tested the Relative Risks Information Campaign, which was implemented among 2,500 Grade 8 students in 71 schools in Kenya, comparing them with the cohort a year ahead or below as the control group. The information campaign informed the teenagers of the higher prevalence of HIV among adult men and their partners relative to teenage boys. The intervention led to a 65 percent reduction in teenage pregnancies to adult male partners, suggestive of a significant reduction in cross-generational unprotected sex. It also led to an increase in self-reported condom use among teenage couples. This suggests a substitution effect, but it did not lead to an increase in pregnancies where both partners were teenagers. The author argues that educating teens about HIV risks without specifying the risk distribution may be missing out on an important opportunity for risk reduction.
School & Community Course A & B Training Notes
This training manual is one of only four rigorously evaluated curricula in Africa that demonstrated impact on sexual behavior. Program A is for trainers, teachers, and parents involved in the implementation of the AIDS Education Syllabus. It provides a plethora of learning resources, including detailed trainers’ notes, timed session outlines, and many handouts. Course B uses the core courses from course A. In addition, it enables participants to evaluate their action plans for implementation of the syllabus and ascertain any weaknesses and gaps. The course equips participants to provide factual information to young people to promote safe sexual behavior. The training should also enable participants to strengthen their inter-sectoral networking and set up support activities.