Publication Date
December 1, 2003

Horizons/Population Council and Partners

"As national education programs incorporate HIV prevention into school curricula, policymakers and educators need to know what they can expect from these initiatives. Can such courses influence the behavior of students as well as their knowledge and attitudes? If not, what can these courses reasonably be expected to accomplish, and what part can they play in overall HIV programming for youth?"

It is in this context that the United States-based Horizons Program, which conducts global operations research with partners around the world, studied several school-based life skills curriculum programmes developed to prevent HIV/AIDS. Four summaries based on this research examine the effects of these HIV/AIDS-prevention programmes in Mexico, Thailand, and South Africa. Highlights include:

  • Programming for HIV Prevention in Mexican Schools - The Mexican Institute of Family and Population Research (IMIFAP) developed a 30-session student curriculum called "A Team Against AIDS (Un Equipo Contra el SIDA)" and a 36-hour teacher-training programme in the city of Toluca, where there was local interest in implementing a standardised curriculum. Students must pass this class just as they would other courses in the curriculum.

    IMIFAP, the Mexican Ministry of Public Education (SEP), and Horizons then examined the effects of this programme, focusing on 4 of the 8 high schools in Toluca (2 schools had received the intervention and 2 schools were serving as controls). Key findings indicate that the programme:

    1. did not increase sexual activity
    2. improved students' knowledge, including knowing that abstinence prevents HIV, and this improvement was maintained one year after the intervention
    3. increased students' confidence in their ability to obtain and use condoms
    4. helped improve students' attitudes about people living with HIV/AIDS (PLHA)
    5. did not have an effect on condom use among sexually experienced students.

    Evaluators also found that uncertainty about the study and cultural values about sexual activity made some students hesitant to answer researchers' questions during focus group discussions. Another finding was that teacher training was essential to the teachers' ability to teach the course. Finally, intervention design needs to take into account differences between males and females.

    Click here to access the research summary in PDF format; see contact details below for information about obtaining the full evaluation.

  • Programming for HIV Prevention Among College Students in Thailand - The Thai Ministry of Education and the Program for Appropriate Technology in Health (PATH) developed the "Teens on Smart Sex" Program for Thai college students. The curriculum, which consists of 8 two-hour sessions conducted once a week, is based on the Theory of Reasoned Action behaviour change model (young people must first learn and practice behaviours in order to successfully use them at the appropriate time). Six rajabhat (teacher training) colleges located within 90 km of Bangkok were selected for the study. All second-year students from 3 of the colleges received the intervention, while second-year students at the other 3 colleges served as the control group.

    As in the Mexico study, this programme did not increase initiation of sexual activity. Students already had high levels of knowledge, and the programme improved these levels. It also improved students' attitudes about condom use, particularly among females, and caused a jump in actual condom use among participating women. Males feel more pressure from friends to engage in sexual activity than female students; the programme did not affect these perceptions. The programme fostered increased communication about HIV/AIDS among specific intervention subgroups (e.g., sexually inexperienced females who talked with a boyfriend), but gaps remain (e.g., participation had no effect on the proportion of students talking about HIV/AIDS with family members or health professionals). Also as in the Mexico study, the programme improved students' acceptance of PLHA. After the 3-day teacher training course, teachers' mean scores on HIV knowledge, attitudes about sexuality and gender, and attitudes toward PLHA each increased significantly; however, some felt uncomfortable teaching sensitive aspects of the course (e.g., demonstrating condom use).

    Click here to access the research summary in PDF format; see contact details below for information about obtaining the full evaluation.

  • The Impact of Life Skills Education on Adolescent Sexual Risk Behaviors - In 1998 the South African Ministry of Education mandated implementation of a comprehensive life skills education programme in all secondary schools by 2005. Developed by the national and provincial South African departments of education, health, and social welfare, the Life Skills Programme aims to increase knowledge and develop skills to help youth protect themselves from HIV infection and to safeguard their reproductive health. The 16-hour curriculum is taught at least once a week over 2 school terms.

    To assess the effects of exposure to the life skills programme, the University of Natal-Durban School of Development Studies, Horizons, The Population Council's Policy Research Division, and Tulane University undertook a prospective study of a population-based sample of youth in two districts of KwaZulu Natal Province, South Africa, from 1999 to 2001. To summarise the findings in brief, knowledge about HIV prevention topics increased, particularly among Africans, males, and younger youth, while gains in sexual and reproductive health-related knowledge were in general modest and uneven. Youth exposed to life skills are more likely to use condoms, but there was no effect on other key behaviours. Based on these and other findings, evaluators conclude that:

    1. Life skills education should equally emphasise all methods of preventing pregnancy and transmission of sexually transmitted infections (STIs) and HIV
    2. Youth appear to be practicing secondary abstinence in response to messages or changes in society (not those associated with life skills education); the programme should help reinforce those changes
    3. Life skills education for black populations needs to be strengthened
    4. Life skills education should be tailored to the needs of different groups.

    Click here to access the research summary in PDF format; see contact details below for information about obtaining the full evaluation.

  • Programming for HIV Prevention in South African Schools - the Medical Research Council of South Africa and the Horizons Program studied the 16-hour Life Skills Grade 9 Curriculum described above as it was introduced in the Pietermaritzburg region of KwaZulu Natal Province in 2001. Twenty-two schools participated, 11 as intervention schools and 11 as control schools.

    As in the Mexico and Thailand studies, the programme did not increase sexual activity but did help raise already-high levels of knowledge about HIV transmission and prevention. Among participants, especially males, approval of teenage abstinence increased. Most students intended to either abstain or use a condom, but the programme did not result in increased condom use. More males in the intervention group than in the control group reduced their number of sexual partners (few females had multiple partners). After the course, nearly half of both male and female students expressed some level of doubt in their ability to resist peer pressure from friends to engage in sexual activity; students would like the course to better address peer pressure and practical communication skills. Teachers found teaching the course to be rewarding, but reported focusing on factual aspects of the curriculum rather than on the life skills aspects (e.g., communication and decision-making).

    Click here to access the full research summary in PDF format; see contact details below for information about obtaining the full evaluation.


March 2004 USAID HIV/AIDS E-Newsletter (click here for the archives).