HIV This Week

Kirby DB, Laris BA, Rolleri LA. Sex and HIV education programs: their impact on sexual behaviours of young people throughout the world. J Adolesc Health 2007;40:206-17.

This paper reviews 83 studies that measure the impact of curriculum-based sex and HIV education programmes on sexual behaviour and mediating factors among youth under 25 years anywhere in the world. Two thirds of the programmes significantly improved one or more sexual behaviours. The evidence is strong that programmes do not hasten or increase sexual behaviour but, instead, some programs delay or decrease sexual behaviours or increase condom or contraceptive use. Effective curricula commonly incorporated 17 characteristics that describe the curricula development; the goals, objectives, and teaching strategies of the curricula themselves; and their implementation. Programmes were effective across a wide variety of countries, cultures, and groups of youth. Replications of studies also indicate that programmes remain effective when implemented by others in different communities, provided all the activities are implemented as intended in similar settings.

Editors’ note : It is very encouraging to see that school-based sex and HIV education programmes that are replicated as intended (sometimes referred to as programme fidelity) achieve similar positive results in differing cultural contexts. Identifying the core components, as this review has done, is critical to understanding the building blocks that make such sex and HIV education programmes both effective and replicable.

Plautz A, Meekers D. Evaluation of the reach and impact of the 100% Jeune youth social marketing program in Cameroon: Findings from three cross-sectional surveys. Reprod Health 2007;4:1 [Epub ahead of print]

The 100% Jeune youth social marketing program in Cameroon aims to address the high STI/HIV prevalence rates and the high levels of unwanted pregnancy. This study evaluates the 100% Jeune program, analyzing its reach and impact on condom use, level of sexual activity, and predictors of condom use. This analysis uses data from three waves of the Cameroon Adolescent Reproductive Health Survey, implemented at 18-month intervals between 2000 and 2003. The sample is restricted to unmarried youth aged 15-24; sample sizes are 1,956 youth in 2000, 3,237 in 2002, and 3,370 in 2003. Logistic regression analyses determine trends in reproductive health behaviour and their predictors, as well as estimate the effect of program exposure on these variables. All regression analyses control for differences in sample characteristics. A comparison of trends over the 36-month study period shows that substantial positive changes occurred among youth. Results of dose response analyses indicate that some of these positive changes in condom use and predictors of use can be attributed to the 100% Jeune youth social marketing program. The program contributed to substantial increases in condom use, including consistent use with regular partners among youth of both sexes. Among males, it also contributed to consistent use with casual partners. The program did not decrease the level of sexual activity or reduce the number of sexual partners, despite efforts to promote abstinence. Observed secular trends indicate that factors besides the 100% Jeune program also contributed to the improvement observed in several areas. Results show that 100% Jeune successfully used a variety of mass media and interpersonal communication channels to reach a high proportion of youth throughout the intervention period. In a context in which a variety of governmental and non-governmental partners are increasing youth-focused reproductive health programming, the 100% Jeune program reached a higher proportion of youth than did other programs. Collective efforts of multiple organizations over time can lead to improvements in adolescent reproductive health. Resources should be allocated to identify and understand predictors of abstinence and partner reduction to inform future programming decisions.  

Editors’ note : Repeated measures using similar sampling frames can provide strong evidence of trends in reported sexual behaviour. Attributing positive changes to one programme component which is part of a broader comprehensive HIV prevention strategy may be difficult but this study did find a dose-response effect for exposure to the programme. Nevertheless, multiple approaches can be synergistic in creating the social norm change that is critical for sustained, effective HIV prevention in this critical age group where incidence often climbs abruptly with age.