When Youth Leave School, Influences Don’t Stop: Examining Community and Longer Term Influences

1. Social Justice Sexual Health When Youth Leave School, Influences Don’t Stop: Examining Community and Longer Term Influences Eleanor Maticka-Tyndale, PhD Canada Research Chair in Social Justice and Sexual Health Associate Dean, Research and Graduate Studies University of Windsor

2. The Challenge: Interventions to Change Behaviours • Can produce modest changes • Rely on self report • Usually measured in the short-term BUT • Widespread epidemic with serious individual and societal consequences • Need sustained, widespread change

3. Complexities of Behaviour Change • Multiple influences and fields • School – Family – Community– Friends -- Media …. • Habits – Traditions – Culture – New/Modern • Time • Youth mature

4. Focus of Work in Kenya & Nigeria • Goal: widespread, sustained changes that reduce spread of HIV among youth • Use existing infrastructures • Schools: curriculum, teachers, trainers, inspectors, TTCs, Ministry staff • Communities: religious & traditional leaders, parents, women’s groups, … • Any and all existing resources (e.g., NYSC in Nigeria)

5. Strategies/Interventions Kenya Nigeria • Focus: school programme -- reached out to parents & community members • Agents of change: teachers, parents, community leaders, students • Scale: start in 1 province – spread to country • Training: in- & pre-service teachers, Head Teachers, TTC instructor, MoE trainers, inspectors, faith leaders, health workers, peer leaders • Focus: School & community programming • Agents of change: teachers, NYSC, youth • Scale: 1 state • Training: in-service teachers, peer leaders, NYSC members

6. Research Design Kenya Nigeria • Sample: 40 control, 40 intervention sites; CRCT • Location: Upper primary (STD 6-7; N~7,400) • Data Collection: surveys, focus groups, interviews , observations (students, teachers, communities); pre, 9 mos, 18 mos, 30 mos; repeated cross-sections • Sample: 20 control, 20 school only, 20 school+community; CRCT • Location: Junior Secondary (7-9) (N~14,800) • Data Collection: surveys, focus groups, interviews, observations (students, teachers, communities); pre, 9 mos, 18 mos; repeated cross-sections + longitudinal

7. Schools and Communities

8. Kenya: School Programme Effects Statistically significant effects: programme compared to control • Results Replicated: • Over 3 succeeding cohorts of students • In schools in 6 additional provinces

9. Statistically significant effects controlling for intervention Kenya: Community Effects

10. Nigeria: NYSC Community Programming Worked with youth and community leaders to set priorities and activities Examples of activities: • Youth groups for in- and out-of- school youth • Social spaces for youth (elders donated space/land) • House to house visits • Youth write & present dramas, songs, poems • Meetings, debates, public rallies, public presentations, seminars & talks to faith-based organizations, bike riders, hair salons, barber shops etc. • Assist PHAs • Train Community Youth (condom use; income generating skills for girls and women)

11. Nigeria: Summary Results

12. Nigeria: Programme Effects Statistically significant effects compared to controls

13. Additional Observations • School vs School+Community – knowledge, attitudes and beliefs • For boys: Larger number of desirable gains for school+community(7/11) than school only (1/11) • For girls: Equally desirable gains for school + community (4/11) as for school onkly (4/11) • More desirable results for males (8/11 – mostly in school+C) than females (4/11)

14. As Youth Mature Do changes weaken?

15. Kenyan youth who went on to secondary school • Secondary School students from schools with compared to schools without programme • Less likely to report: • sexual debut (even though they are older) • Sex with a non-agemate • More likely to report: • Condom use • VCT use (not directly addressed in PSABH)

16. Take-home messages

17. Schools, Communities, Time and Youth Maturation • Schools don’t operate in isolation: What’s going on in the community makes a difference. Increasing number of researchers paying attention. • Assumed Wisdom – effects weaken over time. This may not be the case.

18. Social Justice Sexual Health

19. E. Maticka-Tyndale, J. Wildish, & M. Gichuru (2007). Testing a National Primary School HIV Intervention in Kenya. Evaluation and Program Planning, 30: 172-186. • I. Luginaah, E. Maticka-Tyndale, W. Kairi, J. Wildish, C. Brouillard-Coyle (2007) Extending HIV/AIDS Prevention Efforts in Kenya: Primary Schools as Community-Based Organizations. Environment and Planning C: Government and Policy. 25. p. 439-450. • E. Maticka-Tyndale, J. Wildish, & M. Gichuru (2010) 30-Month Quasi-Experimental Evaluation Follow-up of a National Primary School HIV Intervention in Kenya. Sex Education. 10 (2):113-130. • E. Maticka-Tyndale & E. Tenkorang (2010) A Multi-level Model of Condom Use among Upper Primary School Students in Nyanza, Kenya. Social Science and Medicine. 71: 616-625 • E. Tenkorang & E. Maticka-Tyndale.(2013) HIV testing among youth attending secondary school in Kenya: A multi-level analysis. Studies in Family Planning. 44 (2): 169-187 • E. Maticka-Tyndale, R. Mungwete. & W. Jayeoba (2013) Replicating Impact of a Primary School HIV Prevention Programme: Primary School Action for Better Health, Kenya. Health Education Research.doi: 10.1093/her/cyt088 • E. Tenkorang & E. Maticka-Tyndale (in press) Individual and School-Level Influences on the Timing of Sexual Debut among Youth In Kenya. International Perspectives on Sexual and Reproductive health. • R. Arnold, E. Maticka-Tyndale, E. Tenkorang, D. Holland, A. Gaspard, & I. Luginaah. (2012) Two year evaluation results of school- and community-based HIV prevention programmes in Nigeria. African Journal of Reproductive Health. 16(2): 103-125.