Primary Investigator: Prof. P Reddy Project Director: Ms S James Health Promotion Research and Development Unit Presentation to the Portfolio Committee April 12, 2005 http://www.mrc.ac.za

The Evaluation of a Life Skills HIV / AIDS Prevention Programme

AIM 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

KZN Lifeskills Programme Training Master training Teacher training Implementation with learners Training of peer educators 

Lifeskills Programme (cont) Supportive Strategies Motivational workshops – Middle management, members of the school governing body, parents, traditional leaders and healers. On – going support and workshops with trained educators. On – going collaboration with other role players and partners in the integrated plan. On – going monitoring and evaluation of programme implementation.

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

Evaluation Learner Programme 16 hour programme HIV and AIDS facts Lifeskills Methodology and Materials Implemented over two school terms Life orientation lesson

Learner Evaluation Study Design: Randomised Control Trial Study Area : Midlands District, KwaZulu – Natal Study Sample : Grade 9 learners: 22 randomly allocated schools Study Time frame: Baseline (T1), T2 ( 6 months after baseline), T3 (4 months after T2 Study Instrument: Semi-structured questionnaire Data analysis: SPSS version 10 using ANOVA with repeated measures on the interval dependent measures Ethical Approval: Nelson R. Mandela School of Medicine

Results Sexual behaviour Overview of learner responses Attitudes towards HIV+ people Gender norms

Figure 1: Learners’ Reported Sexual Activity at T1 and T2

Figure 2a: Learners’ report of intended sexual activity in the next three months (Intervention)

Figure 2b: Learners’ report of intended sexual activity in the next three months (Control)

Data Analysis 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

Results Effectiveness of teacher training programme Knowledge of HIV and AIDS Social acceptability of condoms Social perceptions about sexual behaviour Perception of social support Sexual behaviour

Figure 3: Secondary school learners knowledge about transmission of HIV / AIDS

Figure 4: Secondary school learners’ perceived negative consequences of condom use

Figure 5: Secondary school learners’ perceptions of social support

Figure 6: Secondary school learners’ social perceptions of sexual behaviour

Sexual Behaviour Sex in the recalled period Group was a significant predictor of sex in the recalled period at T3 30% of control group responded yes to having had sex vs 21% in the intervention group at T3 (p = 0.01) Intention not to have sex amongst learners who received the full programme vs the control at T3 (p = 0.05) Learners that received the partial programme reported more intention to have sex with a condom in the next three months than those in the full programme or control groups (p < 0.01) The intervention did not impact on reported condom use at last sex at T2 or T3

Conclusions and Recommendations Quality and content of lessons effected learner outcomes Implementation takes place within the context of the present school environment, school culture, communication amongst stakeholders, teacher efficacy and teacher behaviour. Full implementation of the programme resulted in statistically significant changes in variables that impact on intention to safer sex practices and subsequent sexual behaviour

Conclusions and Recommendations Choose and train teachers who are committed to the programme Provide teachers with moral, material and technical support Ensure dedicated time and teachers to implement the programme Provide a programme that teaches skills as well as information Address the needs of learners

Utilization of the Results Dissemination to Policy Makers Launch of the data to the Departments of Health and Education (Nationally and Provincially) Dissemination to the scientific community Peer reviewed journal article – The impact of a HIV and AIDS lifeskills programme on secondary school students in KwaZulu-Natal, South Africa: The need for full implementation. James S, Reddy P, Ruiter R, van den Borne B Conferences Reproductive Health Priorities Conf (2002) International AIDS Conference (2003) Synthesis Workshop on Stigma (UK 2003) Dissemination to the stakeholder community Horizons international comparison report Horizons/MRC final report On-going education PhD Thesis