School-based program reduces risky sexual behaviors in South African teens

South Africa has an estimated 5.5 million individuals living with HIV or another sexually transmitted disease (STD), more than any other nation in the world, according to background information in the article. Almost 20 percent of South Africans age 15 to 49 have HIV, with new infections most common among those age 15 to 24. "It is estimated that more than one-half of all South African individuals aged 15 years in 2006 will not survive to 60 years of age," the authors write. "Young adolescents, before or just after the initiation of sexual activity, are singularly important to intervention efforts because they are highly vulnerable and have not established habitual patterns of sexual behavior."

To test the efficacy of a school-based prevention program in this environment, John B. Jemmott III, Ph.D., of the University of Pennsylvania, Philadelphia, and colleagues conducted a cluster-randomized, controlled study involving 18 primary schools in Eastern Cape Providence, South Africa and two six-session behavior-change interventions based on extensive research.

Nine schools were randomly assigned to participate in the HIV/STD intervention, which was designed to teach students how to avoid HIV and other STDs, enhance beliefs supporting abstinence and condom use, and increase the skills and self-confidence needed to choose less risky behaviors. The health-promotion intervention focused on behaviors linked to other diseases, such as heart disease, diabetes and cancer. The 1,057 participating children (average age 12.4) were asked about sexual behaviors before and three, six and 12 months after the intervention.

Averaged over the three follow-ups, a significantly smaller percentage of students in the HIV/STD risk reduction group than the health promotion group reported having unprotected vaginal intercourse (2.2 percent vs. 4.2 percent), having vaginal intercourse at all (4.8 percent vs. 7.2 percent) or having multiple sexual partners (1.8 percent vs. 3.2 percent).

"In conclusion, sexual transmission of HIV is a major risk faced by adolescents in sub-Saharan Africa, and interventions are needed urgently to reduce their risk," the authors write. "This study provides the first evidence that a theory-based, contextually appropriate intervention can reduce sexual risk behaviors, particularly unprotected vaginal intercourse, vaginal intercourse and multiple partners, among young South African adolescents in the earliest stages of their sexual lives."

"Future research with more sexually experienced adolescents will have to explore whether such interventions can have an effect on condom use and STDs, including HIV."

This study was funded by a research grant from the National Institute of Mental Health.