School-Based Sexual Health Education Interventions to Prevent STI/HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

December 2016 - Structural Prevention

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Sani, A.S., Abraham, C., Denford, S., and Ball, S. BMC Public Health (2016) 16: 1069, doi: 10.1186/s12889-016-3715-4.

This review examined the impact of school-based sexual health programs on sexually transmitted infections (STIs), including HIV, and condom use. Results showed that all 31 programs examined provided education on STI transmission and prevention, safe sex, and pregnancy prevention. Programs were delivered via multiple media, including lectures, discussions, role-plays, movies, songs, counseling, and quizzes administered by a range of figures including teachers, peer educators, and health educators and providers. Condom distribution occurred in three programs. Two studies examined program exposure and HIV outcomes, and found no impact. Studies similarly found no impact on incidence of herpes simplex virus 2 infections; for other STIs, studies showed mixed results. One study found no impact; another found reduced gonorrhea, chlamydia, and trichomonas at 42 months post-intervention, but not at 54 months. Fifteen programs reported significant increases in condom use, but sixteen did not. Meta-analysis found participants were more likely to use condoms following both randomized controlled trials (RCTs) and non-RCTs at 6 months post-intervention, but this effect was sustained only for RCTs at 6–10 months and >10 months follow-up periods. The authors concluded that program planners should base programs in theory; adapt programs based upon pre-existing models; and link programs to health services. Future programs should also report on the processes of the intervention to clarify the mechanisms behind effective and ineffective program elements.

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