1. “I will be able to make a Difference”:
A formative Evaluation of Comprehensive Sexuality Education Innovation for Learners with Disabilities
Dr. Jill Hanass-Hancock, Siphumelele Nene

2. “It doesn’t matter whether they are in special schools or mainstream school but children have a right to be aware about their rights in terms of sex and sexuality.”
Teacher at a special school 2012

3. Literature on Sexuality, HIV and Disability in Africa Indicated that:
People with Disabilities
Lack HIV knowledge and are exposed to all HIV risk factors (Groce 2004)
Are at increased risk of abuse and exploitation (Kvam 2004, Hughes, K , Johnes 2012)
Have similar or higher HIV prevalence than the general population (Shisana 2009/12, Taegmayer 2008, Touko 2009, Beaudrap de, P ),
Lack sexuality education (Rohleder, 2009, Collin 2001, Groce &Traci 2004, Kelly 2002, Hanass-Hancock 2008)
Youth with disability use a “secret language of sex” (Chapel 2013/15)
Teacher
Have negative attitudes and lack of confidence, skills and classroom material for accessible sexuality education (Rohleder et al 2009, 2010, 2011, Phillander & Swartz 2006, Hanass-Hancock 2009, Chirawu & Hanass-Hancock 2014)
In addition, there were no evidence based interventions addressing disability and sexuality education in Africa (Hanass-Hancock 2009)

4. The Breaking the Silence Project
This is a three year pilot project that aims to develop an evidence based curriculum innovation to improve sexual and HIV education including prevention of sexual violence for the South African Life Orientation subject, targeting teachers in order to reach learners with disabilities
Pre-phase (2010/11):
Comprehensive literature reviews and stakeholder engagement
Phase 1 (2012):
Needs assessment with survey and FGD (including validation of research tools)
Phase 2 (2013):
Intervention development
Phase 3 (2014):
Pilot and formative evaluation (survey, FGD, in-depth interviews, observations)

5. Adapted Theory of Planned Behaviour

6. Pilot Intervention March 2014
100 participants were trained in 3 workshops across KwaZulu-Natal, South Africa

7. The Breaking the Silence Intervention (Phase 3)
It’s a curriculum innovation including a manual and 3 day training that considers:
Concepts and intersection of disability and sexuality
Beliefs, values and challenges
Policy and legal obligations
Child and adolescent sexual development
Teaching and presentation skills
Activities for the classroom in 6 modules with alternatives for 5 different disability types
Toolkit with worksheets, pictures and policy examples etc.

8. Study Design for Formative Evaluation
Framework: Adapted Theory of Planned Behaviour (TPB)
Formative Evaluation:
Pre- and post evaluation before workshops and at 12 months
Tools:
Cross-sectional survey-scales
IDI with teachers & FGD with students
Sampling:
100 teachers and support staff of special schools in KZN (Covering disability spectrum and urban-rural divide)
Analysis: Descriptive, bivariate, regression and conventional content analysis

9. Preliminary Results: In-depth Interviews Post Intervention (Phase 3)
Teachers Reported on four major themes
Perceptions of learners sexuality and sexual activities
Perceptions of learners knowledge, attitudes and beliefs
Perceptions of implementing the Breaking the Silence approaches
Contextual factors providing facilitators or barriers to sexuality education
Personal factors as enablers or barriers

10. Perceptions of Learners Sexuality and Sexual Activities
Sexual behaviour
One child got off from the bus with a girl and he pulled her into the bush and hoped his friends went with. They were laughing and giggling. What they did to her really I don’t want to know …
We have to keep reminding them, preparing them because some of them respond to their bodies very .. What do you call it basic instinct ….
Abuse and sexual violence
I said to her (mother). “your daughter will be turning twenty one next year, but we get a terrible smell coming out from her. She said, … that her brother is supporting the family … to keep that money in her home, she allowed the daughter to sleep with that”.
Preventative methods
No babies will be born because those children are on injections.

11. Perceptions of Learners Knowledge, Attitudes and Beliefs
Learners Sexual Knowledge
Children know about these things (masturbation and sex) …..generally the children are interested because it’s a big thing in their lives.
The cooking class … they are very innocent ….they giggle and laugh – a typical teenage reaction, there is nothing wrong about it, but they need to know when to stop.
Last year (after the adjustment of the act) one of the boys came to me … and said can I have sex with a girl now?
Perceived learners attitudes and believes
They believe that in a relationship if they want something they must get it from a woman, to change that mind set that if a woman fights with your you cannot retaliate and hit back

12. Perceptions of Implementing the Breaking the Silence Approaches
Importance of Sexuality Education
Because of the high numbers of children that are born that are unwanted, and there is a lot of promiscuity …. It is important because you need to catch them
Impact of Sexuality Education
They are becoming more aware and vigilant …. They are concerned about babies being born and nobody loves them … they choose to be more responsible
Initially, it was a problem; the words, the terminology like vagina, or penis or testicles, because of my sincere way of presenting, they began to open up
Adapting Methods and Approaches
You never have one class with the same level, cognitive level with the same age group with the same level of functioning, emotional development and maturity … we have to take all those factors into account

13. Contextual Factors Providing Facilitators or Barriers to Sexuality Education
Structural support
The fact that our principal has gone for the course and is driving this … that helped a lot
Training and education
Look, it (the manual) gives you a focus point .. To know where to start … starts breaking it down … its been a great help in getting people to say now I can do this.
Engaging parents
We need to carry on talking to them (parents) …. I showed them pictures everything. Its something the parents need to know about. The group that we brought here was so happy.

14. Cultural and Personal Factors
Cultural norms and beliefs
There is that religious factor because religion tells what is right but the modern approach contradicts what religion teaches about things like masturbation
Some peoples cultural beliefs come into play because within a culture it’s wrong to talk about these things openly with the children
Personal Factors
… to put this into practise is hard for them (older teachers). I am young, younger teachers are more open to talk about these things
And in fact what is easy is that the kids trust the teachers in school …. It is a huge help in being able to teach these children about this because they trust

15. First Impressions
Teachers continue to have a health-related approach to sexuality education
Sexual expression (e.g. masturbation, debut, abuse) are a major issue
The teachers who implemented perceive the intervention as helping them to break the silence
Ongoing support and engagement of a whole school are important
Addressing personal and contextual factors are central to the success of implementation
The presence and support from the Department of Education is the basis for change
Teachers who did not implement often didn’t have the buy in from the school leadership
The assumption of the DOE that teachers can train their peers is problematic
For more info visit the HEARD disability project at:

16. Thank you Project Publications from needs assessment:
Chirawu, P., Hanass-Hancock, J., Aderemi, T., de Reus, L., & Henken, A. (2014). "Protect or enable? Teacher’s beliefs and practices regarding provision of sexuality education to learners with disability in KwaZulu-Natal, South Africa.". Sexuality and disability, (32), 1,
Hanass-Hancock, J., Henken, S., Pretorius, L., de Reus, L., & van Brakel, W. (2014). The Cross-cultural Validation to measure the needs and practices of educators who teach sexuality education to learners with a disability in South Africa. Sexuality and disability, (32) 279–298
De Reuters, L., Hanass-Hancock J, Henken, S, Barkel, W (2014/15) The Voice of Educators: Challenges in Providing HIV and Sexuality Education to Learners with Disabilities in South Africa. Sex Education, in press
Chirawu, P., Hanass-Hancock, J., Aderemi, T., de Reus, L., & Henken, A. (2014). "Protect or enable? Teacher’s beliefs and practices regarding provision of sexuality education to learners with disability in KwaZulu-Natal, South Africa.". Sexuality and disability, (32), 1.