November 1996

School Health Education is a sexuality education programme based on social learning theory. The programme intends to change basic attitudes about sexual intercourse and to encourage safer sexual behaviours, delays in the initiation of sexual intercourse and, among sexually experienced youth, reductions in the number of their sex partners. The programme relies on existing structures, including a full-time health educator and health professionals. A local steering committee oversees the involvement and training of local leaders and heads of schools as well as of parents, teachers, and senior tutors.

The African Medical and Research Foundation, in conjunction with the Soroti School District Administration, implemented this intensified school health education programme in primary schools in a rural county (Kalaki) and the municipality of Soroti in northeastern Uganda between 1994 and 1996. Kaberamaido country was the comparison area, where students were exposed to the standard school health and HIV/AIDS education programme of Uganda. A survey of youth regarding their sexual health knowledge, attitudes, and behaviours informed the design of the programme, provided baseline data for evaluation, and offered a means of informing local leaders and students about the magnitude of risk for HIV faced by students in this area of Uganda.

Researchers collected baseline data during February and March 1994 from 38 primary schools randomly selected from all the primary schools in Kabermaido sub-district, which includes Kalaki and Kaberamaido counties and the municipality of Soroti. Ten students (5 boys and 5 girls) were selected randomly from the P7 class, using a serial counting method, in each of 12 schools in Kaberamaido county, 15 schools in Kalaki county, and 11 schools in Soroti. In two of Soroti’s largest schools, 20 students (10 male and 10 female) were randomly selected to participate in the baseline survey (total n=400; n=287 youth from intervention schools; n=113 youth from comparison schools). Students answered the self-administered, anonymous questionnaire in circumstances designed to ensure confidentiality. The same procedure was used in November 1996 to collect post-intervention data from students in the 1996 P-7 class. Questionnaires were in English, the language of instruction in upper primary schools in Uganda.

Between 1994 and 1996, the proportion of students at intervention schools who reported having ever had sex fell significantly from 43% to 11%. At the same time, the proportion of youth from comparison schools who reported ever having had sex remained virtually unchanged (26% in 1994 versus 27% in 1996).

Among sexually experienced youth in 1994, youth at intervention schools reported an average of 2.2 sex partners; by 1996, this number had fallen to an average of 1.4 sex partners. By contrast, reported numbers of sex partners among sexually experienced youth in comparison schools were 2.1 in 1994 and 2.0 in 1996. The difference was statistically significant.

The proportion of youth from intervention schools who discussed sexual health with teachers, as opposed to listening to lectures, increased significantly from 9% to 44%, while among youth at comparison schools, the proportion rose from 12% to 21%. In the intervention schools, the proportion of students who discussed sexual health matters with schoolmates increased from 30% at baseline to 50% at follow-up, while the change among youth at comparison schools was much smaller (29% at pretest; 36% at follow-up).

The proportion of youth from intervention schools who discussed sexual health with teachers, as opposed to listening to lectures, increased significantly from 9% to 44%, while among youth at comparison schools, the proportion rose from 12% to 21%. In the intervention schools, the proportion of students who discussed sexual health matters with schoolmates increased from 30% at baseline to 50% at follow-up, while the change among youth at comparison schools was much smaller (29% at pretest; 36% at follow-up).

Between 1994 and 1996, the proportion of students at intervention schools who reported having ever had sex fell significantly from 43% to 11%. At the same time, the proportion of youth from comparison schools who reported ever having had sex remained virtually unchanged (26% in 1994 versus 27% in 1996).

Among sexually experienced youth in 1994, youth at intervention schools reported an average of 2.2 sex partners; by 1996, this number had fallen to an average of 1.4 sex partners. By contrast, reported numbers of sex partners among sexually experienced youth in comparison schools were 2.1 in 1994 and 2.0 in 1996. The difference was statistically significant. (Note: At baseline, the youth from intervention schools were 3.7 times more likely to be sexually active than those from comparison schools (43% versus 26%, respectively). The youth from rural intervention schools were also 3.7 times more likely to have had sex than youth from comparison schools.)