Methodology and Baseline Results From the Evaluation of a Sexuality Education Activity in Mpumalanga and KwaZulu-Natal, South Africa

Teaching comprehensive sexuality education using a praxis co-created with adolescents

BACKGROUND

 Despite its reported positive deliverables, comprehensive sexuality education (CSE) in South African schools is unable to document an influence in reducing alarming statistics regarding adolescent sexual health. Prior research points to a gap that exists between what studies suggest and what is implemented in practice.

AIM

 Drawing on Freire's theory of praxis, the aim of this study was to involve the voice of adolescents in reforming CSE - specifically, how the programme could be developed with the objective to co-construct a praxis in order to support sexuality educators in a delivery of CSE that is more responsive to the needs of adolescents.

SETTING

 Ten participants were purposively selected from all five school quintiles in the Western Cape province of South Africa to take part in this study.

METHODS

 A qualitative descriptive design with aspects of a phenomenological approach was utilised. Rich data were collected by means of semistructured interviews and were analysed thematically with ATLAS.ti.

RESULTS

 The results illustrate the suggestions made by the participants towards the improvement of the CSE programme. They reported on approaches and strategies used to teach CSE that imply that it is often not delivered comprehensively - confirming the disjuncture between what the curriculum envisages and what is executed in practice.

CONCLUSION

 The contribution might lead to change in disconcerting statistics and consequently an improvement in the sexual and reproductive health of adolescents.Contribution: The participants from this study assisted in co-constructing a praxis for CSE teachers to inform their practice.

Impact evaluation of scripted lesson plans for HIV-related content in a life orientation curriculum: results from two provinces in South Africa

BACKGROUND

Young people under age 25 years are a key population at risk of unintended pregnancies, HIV and other sexually transmitted infections. School-based programming, focusing on youth under 17 years is strategic given that many in this age group are in school or are required to be in school and spend a considerable amount of their time at school. Prior evaluations of school-based HIV prevention programs for young people often employed weak study designs or lacked biomarkers (e.g., HIV or STI testing) to inform outcomes.

METHODS

This study used longitudinal data collected in 2016 from a cohort of grade-8 girls from Mpumalanga and KwaZulu-Natal Provinces in South Africa. We followed them for 2 years to examine the impact of the South African Department of Basic Education's revised scripted lesson plans for the HIV and sexual content of a "life orientation" curriculum on knowledge, attitudes, condom use behaviors, pregnancy incidence, and genital herpes incidence. Schools were randomized to intervention and control arms. Multivariable analyses were undertaken using hazard modeling for incidence-based outcomes (genital herpes and pregnancy) and generalized linear latent and mixed modeling for outcomes measured at each time period (knowledge, attitudes, and condom use).

RESULTS

At end line, 105 schools were included from the two provinces (44 from Mpumalanga and 61 from KwaZulu-Natal). Fifty-five were intervention and fifty were control schools. A total of 2802 girls were surveyed at both time periods (1477 intervention and 1325 control). At baseline, participating girls were about 13.6 years; by end line, they were about 2 years older. Longitudinal data demonstrated few differences between intervention and control groups on knowledge, attitudes, condom use, genital herpes, and pregnancy experience. Monitoring data demonstrated that the program was not implemented as intended. Our results demonstrated 7% incidence of genital herpes in the two-year follow-up period indicating sexual risk-taking among our cohort.

CONCLUSIONS

We did not find significant effects of the revised life orientation curriculum on key outcomes; however, this may reflect poor implementation. Future HIV prevention programs for young people need to be implemented with fidelity to ensure they meet the crucial needs of the next generation.

TRIAL REGISTRATION

This study has been registered at ClinicalTrials.gov . The trial registration number is: NCT04205721 . The trial was retrospectively registered on December 18, 2019.

HIV-Related Knowledge, Attitudes, and Behaviors among Grade 10 Girls and Boys in Mpumalanga and KwaZulu-Natal: Cross-Sectional Results

BACKGROUND

Young people in KwaZulu-Natal and Mpumalanga South Africa are at high risk of HIV and other sexually transmitted infections. Programs are needed to reach these young people and change their knowledge, attitudes, and behaviors.

OBJECTIVE

The objective of this study is to use cross-sectional data from grade 10 female and male learners in randomly assigned intervention and control schools to examine knowledge, attitudes, and sexual behaviors.

METHODS

Participants were in grade 10 in the 2018 school year and were attending schools randomly assigned to the intervention and control arms for implementation of the Department of Basic Education's adapted life orientation curriculum that included scripted lesson plans. The study took place in two high HIV prevalence provinces in South Africa. Participants completed self-administered tablet-based surveys and female participants provided a dried blood spot for HIV testing.

RESULTS

Results demonstrate that two-fifths to one-half of male learners reported being sexually experienced and a quarter (KwaZulu-Natal) to a third (Mpumalanga) of the female learners reported the same. A greater percentage of learners in Mpumalanga reported consistent condom use than learners in KwaZulu-Natal. HIV prevalence among female grade 10 learners in both provinces was about 6-7%. No notable differences are observed between intervention and control school learners on the knowledge, attitudes, and behavior outcomes.

CONCLUSION

The findings demonstrate the importance of developing HIV prevention programs for young people in high HIV prevalence provinces since these young people remain at high risk for HIV and other negative outcomes.

TRIAL REGISTRATION

This study has been registered at ClinicalTrials.gov. The trial registration number is: NCT04205721. The trial was retrospectively registered on December 18, 2019.