Shegs James PhD Health Promoting Schools National Conference 14-16 September 2006

1. Shegs James PhD Health Promoting Schools National Conference 14-16 September 2006 University of the Western Cape Cape Town The Evaluation of the South African HIV and AIDS Risk Reduction Programme for Secondary School Learners: Refocusing the effort

2. MRC / HORIZONS Evaluation Evaluation of DOE Lifeskills Programme focusing on HIV / AIDS in KwaZulu-Natal Background and Introduction

3. Test whether learners that participate in a fact – based interactive curriculum will have: More knowledge about HIV risks, prevention and care practices More positive attitudes towards safe practices and PLWA Higher prevalence of safe behaviours than comparable learners that did not participate in the programme AIM

4. DOE driven programme Guided by the School Act of 1996 and the Tirisano document Supported by Departments of Health and Social Development Co ordinated by the Psychological Guidance and Special Education Services (PGSES) section of DOE provincially KZN Lifeskills Programme

5. MRC Evaluation Multi – level evaluation aiming to determine the effects of the teacher training programme on learners Master Training Teacher Training Learner Implementation

6. Learner Programme • 16 hour programme • Implemented in the 2nd and 3rd quarters of 2001 • Life orientation lesson

7. Learner Allocation and Sampling Total Number of Schools 22 Random Sampling Allocation Control (No Teacher Implementation) Intervention (Teacher Implementation) Schools n = 11 T1 Schools n = 11 Learners n = 513 Baseline Learners n = 628 Intervention Implemented Schools n = 11 T2 Schools n = 11 Learners n = 397 6 months after T1 Learners n = 447 Schools n = 11 T3 Schools n = 11 Learners n = 415 4 months after T2 Learners n = 353

8. Questionnaires Semi-structured Demographic profile of learners Knowledge Attitude – condom use; PLWA Perceptions – sexual behaviour Communication- safer sex Social support Assertiveness Sexual Behaviour Intention about sexual behaviour Study Instrument

9. HIV / AIDS – Facts Modes of transmission, immune system, HIV / AIDS progression Understanding my body Keeping my body safe and healthy Learner Programme (Intervention)

10. Lifeskills Self-esteem & self-awareness Relationships – family, peer group, community, Attitudes & Values Sex and sexuality Rape and abuse Decision- making, Conflict Resolution, Assertiveness Basic counselling skills, Care and support Substance abuse Learner Programme (Cont.)

11. Didactic and interactive teaching, group work and role play Body wise edited by Harriet Perlman Sexuality Education and the World of the Teenager Life Skills and HIV / AIDS Education Talking About Life – HIV / AIDS and Life Skills Training Manual Soul City Package Methodology and Materials

12. Demographic Characteristics: Mean age of learners 15.8 years (range 12-21years) Almost equal numbers of male and female learners in the intervention and control groups Largely Zulu speaking learners Increase in knowledge about HIV and AIDS in the intervention group Results

13. Two categories of intervention implementation Full programme (Intervention 1) - programme implemented every week for many weeks worked on all 11 topics Partially implemented programme (Intervention 2) - programme implemented a few weeks, or often or occasionally worked on 7 of the 11 topics Data Analysis

14. Increase in knowledge about HIV More positive perceptions of sexual behavior Decrease in reported sexual activity Increase in condom use at last sex in the short term Increase in perceived social support four months after the intervention Full Implementation

15. Detail review of literature about the sexual behavior of young people A review of the evaluations carried out by Visser and colleagues and Magnani and colleagues about the lifeskills programme in KZN and other provinces Refocus of Programme

16. HIV I N T E R V E N T I O N HIV T R A N S M I S S I O N • Cognitive / Behavioural factors influencing risk behaviors • Attitude to condom use • Descriptive norms • Intentions to use condoms • Pregnancy prevention • Self-efficacy to obtain / use condoms • Knowledge about HIV / AIDS • Beliefs about transmission • Communication about condom use • Perception of risk – HIV • Denial about HIV /AIDS • Sexual risk behaviors • Early initiation of sex • Multiple sexual partners • Unprotected sexual intercourse • Social / Environmental factors influencing sexual risk behavior • Proof of virility • Sexual coercion / violence • Poverty • Gender inequities – men - proof of fertility; fatherhood; multiple partners; females - condemnation of premarital sex • Parent communication – disapproval of youth sex • Accessibility of condoms – non-availability; lack of user-friendly clinics • Peer influence Intervention DevelopmentModified Precede Risk Model

17. Logic Model

18. Enactive Learning for Skill Development and Practice Development of teacher skills that enable learner skills Enable Implementation Development of policy that places the programme on the timetable and allows for capacity development of fellow teachers Emphasis on Social Environment School, Parents and Community Programme Evaluation Recommendations

19. Thank You