Programming for HIV Prevention in South African Schools

Executive Summary

As national education programmes incorporate HIV prevention into school curricula, policymakers and educators need to know what they can expect from these initiatives. An evaluation study conducted in KwaZulu Natal, South Africa, provides important insights into whether learners that participated in a fact-based, interactive course had more knowledge about HIV risks, prevention, and care practices; more positive attitudes toward prevention practices and people living with HIV and AIDS; and a higher prevalence of reported safe behaviors than comparable learners who did not participate in the course.

The Medical Research Council of South Africa and the Horizons Programme studied the Life Skills
Grade 9 curriculum, a school-based HIV/AIDS program, as it was introduced in the Pietermaritzburg region of KwaZulu Natal Province in 2001. The 16-hour Grade 9 curriculum was taught at least once a week in the second and third quarters as part of the subject, “Life Orientation.”

The study used a quasi-experimental research design that included surveying teachers and students over time. Twenty-two schools participated: 11 of the schools in which the course was first introduced served as intervention schools, and 11 where the course had not been taught served as control schools. To measure the effectiveness of the programme among students, a pre-test, multiple post-test control group design was used. Students completed the surveys at baseline (T1), immediately after the course was finished (T2), and four months later (T3). Teachers’ impressions of the program were also determined from a questionnaire they answered at the completion of the program.

Key findings include

• Intention to have sex did not increase among learners.
  

  At baseline more than two-thirds of the students in both control and intervention groups did not
  intend to have sexual intercourse, and a similar proportion maintained this intention to remain
  abstinent after the course and four months later. Consequently, the proportion of those students
  who intended to have sex remained stable. However, after the course, a significantly greater
  proportion of learners in the intervention group intended to use a condom instead of having
  unprotected sex compared to those in the control group (33 percent vs. 23 percent;

• Approval of teenage abstinence increased within the intervention group, particularly
  among males.
  
  Students were asked if they believed that it is a good idea not to have sex while a teenager. Sixtyone
  percent of intervention males and more than seventy-five percent of intervention females
  supported abstinence among teenagers at baseline. For both groups there was a statistically
  significant increase in the proportion that agreed with the statement at T2 (males: p .001;
  females: p .05) and this was maintained for both groups at T3. In contrast, support for abstinence
  among the control group was less at T2 and T3 compared to T1.
• Young men reduced their number of sex partners slightly.
  
  Males in the intervention group reduced their number of sexual partners more than the control
  group, but this difference was not statistically significant.
• Students had high levels of knowledge, and the program improved these levels
  further.
  
  At baseline both control and intervention learners had a mean score of 13 correct answers out of 15
  on a questionnaire about HIV/AIDS. As a result of participating in the course, the mean number of
  correct answers increased for intervention learners while the mean remained largely unchanged for
  the control learners.
• Youth already had some positive attitudes and behaviors.
  
  This study revealed that at baseline, the vast majority of male and female learners did not support
  sexual coercion of girls by boys, and 85 percent of learners who had sex in the last six months
  reported using a condom. Life skills programs should reinforce already existing positive attitudes
  and behaviors.

Conclusions and Recommendations

The Life Skills Grade 9 Curriculum had a positive impact on students’ knowledge of HIV/AIDS, attitudes about abstinence, and intention to use condoms. These effects are important for laying the groundwork for behavior change that will protect young people from HIV/AIDS. There was, however, no evidence of increased adoption of such protective behaviours as abstinence and condom use.

This may be because the teachers did not focus as strongly on the life skills components as on the factual HIV/AIDS information. Moreover this was the first time that the teachers had taught this particular curriculum. Their skills, comfort level, and effectiveness are likely to improve with experience. The following recommendations emerged from the study and aim to improve teacher preparation and support, and the overall program:

• Choose and train teachers who are committed to the programme.
  
  As indicated by this study, being able to meet the learners’ needs enhances teachers’ feelings that they are “doing something” important and contributes to their sense of satisfaction. The choice of appropriate teachers therefore will always be crucial to the successful implementation of a life skills program focusing on HIV and AIDS.
• Provide teachers with moral, material, and technical support.
  
  Ongoing training, provision of updated materials and information, access to and liaisons with health professionals, and a forum to interact about the strengths and challenges of such a programme need to be in place to ensure support to teachers.
• Ensure dedicated time and teachers to implement the program.
  
  The findings reflect that time and adequately prepared teachers are both needed to foster positive programme results.
• Provide a programme that teaches skills as well as information, and addresses the
  different needs of learners.
  
  The findings indicate that most learners in this study context were adequately prepared with information about HIV and AIDS. However, such information needs to be reinforced and complemented by skills building to create changes on several variables, such as resisting peer pressure, talking to a partner about sex and taking steps to prevent HIV infection, including abstaining from sex, and negotiating and using condoms. Learner differences also need to be taken into account, since all learners are not the same sex and age, they are not all sexually active, nor do they have the same knowledge and perceptions about HIV and AIDS issues.