Abstract
Young people in KwaZulu-Natal and Mpumalanga South Africa are at high risk of HIV and other sexually transmitted infections. Programs are needed to reach these young people and change their knowledge, attitudes, and behaviors. The objective of this study is to use cross-sectional data from grade 10 female and male learners in randomly assigned intervention and control schools to examine knowledge, attitudes, and sexual behaviors. Participants were in grade 10 in the 2018 school year and were attending schools randomly assigned to the intervention and control arms for implementation of the Department of Basic Education's adapted life orientation curriculum that included scripted lesson plans. The study took place in two high HIV prevalence provinces in South Africa. Participants completed self-administered tablet-based surveys and female participants provided a dried blood spot for HIV testing. Results demonstrate that two-fifths to one-half of male learners reported being sexually experienced and a quarter (KwaZulu-Natal) to a third (Mpumalanga) of the female learners reported the same. A greater percentage of learners in Mpumalanga reported consistent condom use than learners in KwaZulu-Natal. HIV prevalence among female grade 10 learners in both provinces was about 6-7%. No notable differences are observed between intervention and control school learners on the knowledge, attitudes, and behavior outcomes. The findings demonstrate the importance of developing HIV prevention programs for young people in high HIV prevalence provinces since these young people remain at high risk for HIV and other negative outcomes. This study has been registered at ClinicalTrials.gov. The trial registration number is: NCT04205721. The trial was retrospectively registered on December 18, 2019.
Highlights
In 2017, adolescents and young people accounted for about one-third of new Human Immunodeficiency Virus (HIV) infec-Comprehensive HIV prevention includes behavioral, structural, and biomedical interventions [7, 8]
The findings demonstrate the importance of developing HIV prevention programs for young people in high HIV prevalence provinces since these young people remain at high risk for HIV and other negative outcomes
Our results demonstrate that young people in grade 10 in Mpumalanga and KwaZulu-Natal are sexually active and at risk of pregnancy and sexually transmitted infections
Summary
In 2017, adolescents and young people accounted for about one-third of new Human Immunodeficiency Virus (HIV) infec-Comprehensive HIV prevention includes behavioral, structural, and biomedical interventions [7, 8]. Comprehensive sex education programs often fail to meet the needs of the target population. This may be a consequence of a weak curriculum due to conservative attitudes of parents, community members, and school officials and lack of engagement of these key stakeholders to strengthen the program [10]. Even when a curriculum is strong with appropriate content for the target population, there is a risk of weak implementation due to attitudes of educators, poor training of implementers, and a lack of support from the community [9 - 11]. Awareness programs are needed to reach these young people and change their knowledge, attitudes, and behaviors
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