Condoms In Schools Research Articles

Giving condoms to school children: educators’ views on making condoms available in South African schools

One of the policy goals of the South African Department of Basic Education’s National Policy on HIV, STIs and TB of 2017 is to reduce the incidence of HIV and pregnancy among learners. This is expected to be achieved by improving access to prevention services, including the provision of condoms in schools. This study uses street- level bureaucracy theory to explain how educators can play a more productive role in ensuring that policy goals are achieved. Educators provide their views on their role as condom promotion agents, their perception of demand and utilisation among learners, as well as their insights on suitable distribution mechanisms in the school setting. Trepidation exists among educators about their roles in the promotion and education of condoms. Educator statements suggest that they see the value in their policy-ascribed role to deliver sexual health messages and are also open to performing a role in the distribution of condoms at schools. However, our findings reveal that their role as policy communicators or “street-level bureaucrats” is complicated by inadequate policy guidance. We therefore conclude that to achieve optimal outcomes in terms of safer sexual practices among learners, condom messaging and distribution mechanisms in school settings require evidence-informed implementation strategies.

Enablers and deterrents on the school-based condom availability and distribution: a scoping review

Background In an effort to decrease teenage pregnancies and sexually transmitted diseases, there are discussions on the implementation of a school-based condom availability and distribution policy. However, there is a dearth of information on the extent and range of the empirical evidence supporting this policy initiative. Hence, this study aimed to identify enablers and deterrents of the program to serve as groundwork for health professionals and policy makers toward a more comprehensive adolescent program in the country. Methods A scoping review of literature based on the five-stage framework by Arskley and O’Malley was utilized in the study. Two researchers performed a comprehensive search of peer-reviewed literature through PubMed, ScienceDirect, EBSCOhost and ProQUEST published from 1985 to 2016. Inclusion criteria for records were: i) Original research published in a peer-reviewed journal; ii) Focused on school-based condom availability and distribution; iii) Study participants were students in a secondary public or private schools; iv) Published in English language. Two researchers independently appraised each record against the set inclusion criteria. Likewise, independent abstraction of data from selected studies were performed. Disagreements in screening, selection, and abstraction were settled through consensus. Results A total of 2,114 records were initially screened for eligibility, of which eight met the inclusion and exclusion criteria. Seven of the studies were conducted in the USA and one study was carried-out in Mexico. Notably, none of the published papers originated in Asia. Four essential themes emerged that reinforces the program: i) establishment of state-level policy; ii) engagement of stakeholders and parents on public dialogue: iii) empowering activities in schools; and iv) increasing condom reach and coverage. On the other hand, four significant barriers were recognized; i) assumption that condom availability and distribution to adolescents promote sexual promiscuity; ii) lack of parental support due to religious and moral concerns and the acceptance of the students to certain programs; iii) discomfort and embarrassment felt in general by the students towards acquiring condoms in schools; and iv) structural barriers such as poor coverage and gender differences among male and female students. Conclusions These findings suggest that there have been limited studies conducted on the success and challenges of school-based condom availability program. Although study results have shown substantial benefits of the program, emergence of thematic insights relating to parental support, sexual attitude and behavior, program coverage and structural implications acted as major enablers and deterrents on condom availability and distribution program. It is crucial to recognize these existing issues to generate strategic recommendation and action for improvements of the program.

Acceptability and stakeholders perspectives on feasibility of using trained psychologists and health workers to deliver school-based sexual and reproductive health services to adolescents in urban Accra, Ghana

BackgroundAdolescent sexual and reproductive health is recognized as a key developmental issue of international concern. However, adolescents’ access to sexual and reproductive health (SRH) information and services is largely inadequate in sub-Saharan Africa. With increasing enrollment in schools, this could be an avenue to reach adolescents with SRH information and services. This study was therefore conducted to assess the acceptability and stakeholders’ perspectives on the feasibility of using health workers and trained psychologists to provide school-based SRH services in Ghana.MethodsFourteen (14) focus group discussions (N = 136) were conducted; 8 among adolescents aged 12–17 years (4 boys, 4 girls groups), 4 among parents (2 males, 2 females groups) and two among mixed teacher groups. We also conducted 18 in-depth interviews with teachers, managers of schools, health workers, clinical psychologists, as well as adolescent SRH program managers in the Ghana Health Service, Ghana Education Service, UNICEF, UNESCO and National Population Council, Ghana. We audio-recorded all interviews and took field notes. Interviews were transcribed and transcripts imported into NVivo 11 for analysis using grounded theory approach to qualitative data analysis.ResultsMany respondents reported that it was challenging for parents and/or teachers to provide adolescents with SRH information. For this reason, they agreed that it was a good idea to have health workers and psychologists provide SRH information and services to adolescents in school. Although, there was general agreement about providing SRH services in school, many of the respondents disagreed with distribution of condoms in schools as they believed that availing condoms would encourage adolescents to experiment with sex. While majority of respondents thought it was acceptable to use psychologists and health workers to provide school-based sexual and reproductive health to adolescents, some teachers and education managers thought the implementation of such a program would oppose practical challenges. Key among the challenges were how to pay for the services that health workers and trained psychologists will render, and the availability of psychologists to cater for all schools.ConclusionStakeholders believe it is feasible and acceptable to use trained psychologists and health workers to deliver school-based SRH information and services in the Ghanaian school context. However, provisions must be made to cater for financial and other logistical considerations in the implementation of school-based SRH programs.

Condom Availability in Schools: A Practical Approach to the Prevention of Sexually Transmitted Infection/HIV and Unintended Pregnancy

Adolescents and young adults are highly impacted by sexually transmitted infections (STIs) and unplanned pregnancy in the United States and globally. Consistent and correct use of male latex condoms is associated with protection against both STIs and pregnancy. Providing adolescents and young adults with access to free condoms in schools may increase the use of condoms by improving condom availability, eliminating cost, and decreasing embarrassment associated with purchasing condoms. Studies demonstrate that condom availability in schools is associated with the increased use of condoms and improved overall sexual health. The Society for Adolescent Health and Medicine encourages schools to make condoms available to students as part of efforts to decrease rates of STIs and unplanned pregnancy in adolescents and young adults. The Society for Adolescent Health and Medicine also encourages health care providers to advocate for and support the availability of condoms in local schools.

Perceptions of Women Teachers on Condom Availability in Schools: South African perspective

The former Minister of Education in South Africa recently stated that education authorities will not be making condoms available to learners at school. In her opinion, …holding teachers responsible for distributing condoms would make teaching very, very difficult. On the contrary, despite acknowledging a dissident view which says that condom availability in schools may encourage sexual activity, one may argue that one way of increasing condom access for adolescents is to make condoms available in schools. Utilising a sample of 281 women teachers from primary and secondary schools in the eastern Free State region, South Africa, the study investigates perceptions of women teachers on condom availability in schools through a structured questionnaire. The majority of women teachers in the sample were aware that some schools in their area distribute condoms to learners and regard the distribution of condoms in schools not as a responsibility of teachers.

School Condom Program Reduced STIs in Males

School Condom Program Reduced STIs in Males

AMA criticized for calling for condoms in schools

The American Medical Association (AMA) has reported a policy advocating the distribution of condoms in school and downplaying the value of abstinence-only program. This has drawn criticism from political leaders and physicians. At issue is the long-running debate of what should be emphasized as part of sex education for teens the role of abstinence-only programs – especially for those who have not yet become sexually active and the role of programs promoting safer sex for those already having sex. The policy states that making condoms available in schools helps increase condom use without hastening the onset of sexual activity. Moreover it also states that abstinence-only programs are of limited value and require rigorous evaluation. However US Representative Tom Coburn M.D. one of the few practicing physicians in Congress and an AMA member criticized the policy as politically correct and medically irresponsible. He has accused AMA of breaking with common sense and sound medical principle. However AMA believes that the jury is still out on abstinence-only approaches. Amidst this criticism though other groups are beginning to step forward to defend AMAs statement.

Impact of a High School Condom Availability Program on Sexual Attitudes and Behaviors

While making condoms available in high schools has provoked much debate, evidence on the actual effects of such programs on students' attitudes and behavior is sparse. Prior to implementation of a condom availability program in a Los Angeles County high school, 1,945 students in grades 9-12 (98% of eligible students) completed a self-administered anonymous survey on their sexual behavior and on related knowledge and attitudes; one year later, 1,110 students (59% of eligible students) completed a follow-up survey. There was no significant change over time in the percentage of males or females who had ever had vaginal intercourse or who had had vaginal intercourse during the year prior to the survey. The percentage of males who reported using condoms every time they engaged in vaginal intercourse during the past year increased significantly, from 37% to 50%, and the percentage of males who reported condom use at recently initiated first vaginal intercourse increased from 65% to 80%. On the other hand, female respondents showed no significant change in their condom use. The self-reported likelihood of using a condom for vaginal intercourse during the following year did not change significantly for students who had had vaginal intercourse, but it increased dramatically for those who, had never had vaginal intercourse. The students' attitudes toward sex and condom use either remained the same between surveys or changed in a direction favoring less sexual behavior and greater risk prevention. The condom availability program appears not to have produced an increase in sexual activity among high school students, and it appears to have led to improved condom use among males. The apparent strong effect on students' intention to use condoms and on males' use at first vaginal intercourse suggests that such programs may have a particular impact on the least sexually experienced adolescents.

Students' acquisition and use of school condoms in a high school condom availability program.

To determine what students know about a condom availability program in their high school, how they react to the program, whether they obtain condoms from it, and what they do with these condoms. Self-administered anonymous survey conducted 1 year after the program began. An urban California school district. A total of 1112 students, 9th through 12th grade, 59% of eligible students present on the survey day. History of obtaining condoms from the program, use of these condoms, knowledge about the program, and attitudes toward the program. Forty-eight percent of students had personally taken school condoms, and another 5% had gotten them from someone else, for a total of 53% who had obtained school condoms. Seventy percent of nonvirgins and 38% of virgins obtained condoms. Males were more likely than females to have obtained condoms (60% vs 45%). Fifty-four percent of students who had obtained school condoms had used them for sexual activity: 52% had used them for vaginal intercourse, 7% for anal intercourse, and 4% for fellatio. Students also explored school condoms without having sex, eg, removing them from the packet, putting them on fingers, or putting them on their penis or a partner's penis. Thirty-four percent of students who had used a condom for vaginal intercourse during the previous year had obtained the condom they last used from school, with more males than females reporting the school as their source (41% vs 26%). Eighty-eight percent of students knew that all students were allowed to obtain condoms, and 74% knew that parental permission was not required. Students generally supported the condom program: 88% thought the school should give out condoms, and 79% thought that if the school were to require parental permission for students to get condoms, students would get them less often than with the present system (which does not require permission). Thirteen percent agreed and 71% disagreed that "having condoms available at school makes it harder for someone who doesn't want to have sex to say no." Providing high school students with direct access to condoms leads to widespread use of school condoms, both for sexual activity and for exploratory activities that familiarize students with condoms. Condoms are of interest to both students who have and students who have not engaged in sexual activities for which condoms are recommended.

A process evaluation of condom availability in the Seattle, Washington public schools.

In 1993, Seattle began making condoms available in all of its 15 high schools. As part of an evaluation of this program, 16 focus groups with students from 13 high schools were conducted to explore students' perceptions of the school environment, program effectiveness, and suggestions for program improvement. The study also included data from a student survey conducted in 10 high schools. The focus group results revealed that students support school condom availability but have concerns about privacy when obtaining condoms. Students prefer obtaining condoms from baskets in private areas of school-based clinics to obtaining them from vending machines. Students do not believe that having condoms available has affected sexual activity or condom use among students. Recommendations for improving school condom availability include access to free condoms in private locations.

Condom Availability Programs in U.S. Schools

School condom availability programs have been promoted as a promising approach for increasing condom use among students, for reducing the risk of infections with the human immunodeficiency virus and with other sexually transmitted diseases and for preventing unintended pregnancy. Data from a telephone survey of key individuals at school condom programs across the United States suggest that as of January 1995, at least 431 public schools in 50 U.S. school district made condoms available-2.2% of all public high schools and 0.3% of high school districts. In about half of the schools that were surveyed, students obtained more than one condom per student per year, on average, and in 14% students obtained more than six. Students in alternative schools, in smaller schools, in schools that made condoms available in baskets and in schools with health clinics obtained more condoms per student per year than did students in other schools.

Student Opinions of Condom Distribution at a Denver, Colorado, High School

Over the past two decades, the reported number of women and men who have had intercourse by age 18 has increased by approximately 20%. Concomitant increases occurred in the incidence of teen-age pregnancies and sexually transmitted diseases (STDs), including HIV. Increasing condom availability within schools has been proposed as one means of preventing the serious potential consequences of unprotected sexual intercourse. Although published surveys report 68% to 75% of adults have supported distributing condoms in schools, little is known about what students think about making condoms available at school. In this survey, high school students in Denver initiated and helped conduct a school-wide survey to assess student opinions about condom distribution in their school. Of 931 high school students responding to the survey, 85% replied that condoms should be distributed in their school, and 76% believed making condoms more accessible would not change the frequency of sexual activity among teens.

Student Views of the School Nurse's Role in a Secondary School Condom Availability Program

In Massachusetts, the school committee of a Boston suburb's school board agreed to start a condom availability program at the community's 2 high schools. A nurse researcher conducted 11 focus groups with 112 students to determine students' attitudes and feelings, so they can be incorporated in designing the program. Most students were White, college-bound, and professional-class. The nurse grouped most students by age, gender, and academic tracking into homogeneous groups. A common thread throughout the discussions was a need for respect from adults. Every focus group talked a lot about the risk of humiliation and loss of respect of adults if they took condoms. Students suggested that they would not use the program if it required individual counseling. Overall, the students were concerned about the school nurse's role in safer sex counseling. Sexually active females conveyed a positive relationship with the school nurse, however. The lack of consistent nursing staff contributed to students' doubts about building a relationship with the nurse. Students clearly identified an adult with whom they could feel comfortable talking about sexual matters as someone who would be relaxed, nonjudgmental, knowledgeable, and available for discussion. Based on these findings, the nurse researcher recommended that school nurses have more time to enhance skills in effective and sensitive sexuality counseling and devote more time to counseling and HIV prevention education. She also suggested that schools include more parent and student sexuality education. Developmentally appropriate HIV prevention education should be provided to all students in both junior and senior high schools each year. Final recommendations were intensive inservice education for school nurses, anonymous condom availability, and identification of other school and community personnel to support school nurses.