South Africa HealthWise Program

Category 3

Data have shown that substance use may be a precursor to involvement in sexual behavior, suggesting that substance use prevention could serve to lower sexual risk. HealthWise South Africa is a school-based program designed to reduce sexual and substance use risk behavior and to promote positive use of leisure time among high-school learners. HealthWise adapted TimeWise, a curriculum that was used successfully in the US, to the South African context and integrated it with the Life Skills curriculum already used in South African schools. Teachers were trained to use the curriculum’s series of lessons to help students identify their interests, find local resources to allow them to pursue their interests, and anticipate ways to overcome obstacles.

Goal of the Practice
  • Testing the effectiveness of a comprehensive universal prevention program to reduce the risk of HIV/AIDS and STDs, as well as substance use, among adolescents in South Africa
  • Reducing the transmission of HIV/AIDS and other STIs
  • Reducing drug and alcohol abuse
  • Increasing positive uses and experiences of free and leisure time
Core Components
  • Piloting and adapting a curriculum to the South African context and integrating it into an existing life skills curriculum
  • Training teachers to facilitate HealthWise lessons
  • The curriculum consists of twelve lessons in grade eight and six booster lessons in grade nine. It emphasizes group discussions, small group work, and self reflection
Noteworthy Results
  • First school-based experimental study conducted in South Africa to report any positive findings
  • Moderate positive effect on the substance use of high school adolescents in this study, particularly among girls
  • Positive effect on condom use skills, including perceived condom self-efficacy and proper condom use
  • Results at the end of the first phase showed a program effect that reduced sexual onset among boys but increased onset among girls
  • Youth in HealthWise reported many fewer incidents of heavy alcohol use in the past month than their counterparts in the control group
  • HealthWise girls were significantly less likely to have initiated smoking and to have smoked in the past month as compared to the control group girls
Lessons Learned
  • Despite a clear and sound hypothesis and evidence, curriculum testing and adaptation was critical. HealthWise had to consider a more collectivist culture than the individualist culture of the U.S. It also needed to reflect on context, norms, and language. Curriculum was adjusted to literacy, comfort level in expressing oneself in writing or in groups, and speed of learning.
  • Fidelity to HealthWise methodology/curriculum impacted effectiveness and outcomes, demonstrating the importance of teachers’ abilities to follow the sequencing and speed of lessons. Based on teacher feedback, HealthWise modified its original structure and curriculum to better respond to local needs, but findings show that allowing ‘flexibility’ in presentation didn’t positively impact outcomes.
  • The type and frequency of leisure activities had little bearing on sexual risk. Rather, students’ level of interest (or lack of interest) and motivation had a greater influence on their risk behaviors for substance use and sexual activity.
  • Given the significant barriers to accessing healthy activities, the project employed youth development specialists to link students to community resources.
Focus Areas
Implemented By
Pennsylvania State University
Participating Organization
  • University of Western Cape
  • University of Cape Town
South Africa
Target Population
Adolescents (ages 13-17)
1000 - 5000
Implementation Years
03/2004 - 11/2008