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

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

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

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

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 Schools n = 11 T2 Schools n = 11 Learners n = 397 6 months after T1 Learners n = 447 Intervention Implemented Schools n = 11 T3 Schools n = 11 Learners n = 415 4 months after T2 Learners n = 353

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

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

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

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

12. Results Demographic Characteristics: 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

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

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

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

16. Intervention Development Modified Precede Risk Model 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 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 HIV I N T E R V E N T I O N HIV T R A N S M I S I O N

17. Logic Model

18. Recommendations Enactive Learning for Skill Development and Practice Enactive Learning for Skill Development and Practice Development of teacher skills that enable learner skills Enable Implementation 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 Emphasis on Social Environment School, Parents and Community Programme Evaluation Programme Evaluation

19. Thank You