HIV prevention in Mexican schools: Prospective randomised evaluation of intervention

Division of Reproductive Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
BMJ (online) (Impact Factor: 17.45). 06/2006; 332(7551):1189-94. DOI: 10.1136/bmj.38796.457407.80
Source: PubMed


To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception.
Cluster randomised controlled trial.
40 public high schools in the state of Morelos, Mexico.
10 954 first year high school students.
Schools were randomised to one of three arms: an HIV prevention course that promoted condom use, the same course with emergency contraception as back-up, or the existing sex education course. Self administered anonymous questionnaires were completed at baseline, four months, and 16 months. Students at intervention schools received a 30 hour course (over 15 weeks) on HIV prevention and life skills, designed in accordance with guidelines of the joint United Nations programme on HIV/AIDS. Two extra hours of education on emergency contraception were given to students in the condom promotion with contraception arm.
Primary outcome measure was reported condom use. Other outcomes were reported sexual activity; knowledge and attitudes about HIV and emergency contraception; and attitudes and confidence about condom use.
Intervention did not affect reported condom use. Knowledge of HIV improved in both intervention arms and knowledge of emergency contraception improved in the condom promotion with contraception arm. Reported sexual behaviour was similar in the intervention arms and the control group.
A rigorously designed, implemented, and evaluated HIV education course based in public high schools did not reduce risk behaviour, so such courses need to be redesigned and evaluated. Addition of emergency contraception did not decrease reported condom use or increase risky sexual behaviour but did increase reported use of emergency contraception.

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    • "When designing school-based programs, regional differences need to be taken into account as some schools might be more comfortable with a single sex delivery for HIV prevention interventions [25]. Furthermore, despite the intensive training, teachers rarely change their preconceptions about adolescent sexuality [37]. Compounding these problems is the issue that many adolescents lack strong role models and mentors to guide them through the exploration that naturally occurs as a part of adolescent self-identity development, thus potentially leading to unhealthy and risky sexual practices [26]. "
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    ABSTRACT: In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported. Community-based interventions (CBIs) for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk, or already infected with, HIV. This paper evaluates the impact of CBIs on HIV knowledge, attitudes, and transmission. We included 39 studies on educational activities, counseling sessions, home visits, mentoring, women's groups, peer leadership, and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence. Our review findings suggest that CBIs to increase HIV awareness and risk reduction are effective in improving knowledge, attitudes, and practice outcomes as evidenced by the increased knowledge scores for HIV/AIDS (SMD: 0.66, 95% CI: 0.25, 1.07), protected sexual encounters (RR: 1.19, 95% CI: 1.13, 1.25), condom use (SMD: 0.96, 95% CI: 0.03, 1.58), and decreased frequency of sexual intercourse (RR: 0.76, 95% CI: 0.61, 0.96). Analysis shows that CBIs did not have any significant impact on scores for self-efficacy and communication. We found very limited evidence on community-based management for HIV infected population and prevention of mother- to-child transmission (MTCT) for HIV-infected pregnant women. Qualitative synthesis suggests that establishment of community support at the onset of HIV prevention programs leads to community acceptance and engagement. School-based delivery of HIV prevention education and contraceptive distribution have also been advocated as potential strategies to target high-risk youth group. Future studies should focus on evaluating the effectiveness of community delivery platforms for prevention of MTCT, and various emerging models of care to improve morbidity and mortality outcomes.
    Full-text · Article · Aug 2014 · Infectious Diseases of Poverty
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    • "Most theories of healthy behavior regard cognitive determinants of the HIV risk such as knowledge, attitude, and behavioral intention to address preventive strategies.[13] Previous studies revealed that educational interventions could improve knowledge, self-efficacy, attitude, behavioral intention, and also behavior of condom using.[14151617] However, Walker's study showed education could not improve condom using behavior.[18] "
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    ABSTRACT: The effectiveness of a theory-based educational intervention on intension for sexual abstinence among female university students was evaluated. Female students were recruited from humanity sciences department through cluster sampling. Educational intervention was applied for four 90-min sessions and by application of cognitive theories during 4 weeks. One hundred and nine female students with mean age of 20.74 ± 1.57 years took part in the study. Despite the similarity of two groups of intervention (n = 53) and control (n = 59) at baseline, there were significant differences between the two groups in mean scores of the variables, knowledge (4.62 ± 1.38 vs. 3.53 ± 1.61), perceived susceptibility (14.05 ± 1.51 vs. 12.37 ± 2.11), and perceived benefits (28.41 ± 2.14 vs. 27.51 ± 3.05), at follow-up time after 3 months (P < 0.05). Additionally, these variables were observed with improvement over 3 months in the intervention group (P < 0.05). However, this study showed no significant effect on the behavior intention and self-efficacy. This study showed that educational intervention could improve knowledge, perceived benefits, and self-efficacy of the female students regarding HIV/AIDS.
    Full-text · Article · Jan 2013 · Journal of research in medical sciences
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    • "It can be argued that the absence of significant effects on behavioral change is a result of limited behavioral-gap due to the shortness of follow-up assessments that are normally allowed by school-based evaluation. However, results from Walker et al (2006) defeat this argument, since even the increase in condom use reported immediately after the intervention could not be maintained one year after the intervention. In addition, in a long follow-up, Wight et al (2002) report no statistically significant difference on students' rate of contraception uptake. "
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    ABSTRACT: Unlike traditional approaches to sexuality and HIV education which can be constrained by the sensitive nature of the subject, Information Technology (IT) can be an innovative teaching tool that can be used to educate people about HIV. This is especially relevant to interventions targeting young people; the population group fond of using IT, and the same group that is more vulnerable to HIV/AIDS. Yet, there are significantly few empirical studies that rigorously evaluated computer-assisted school-based HIV/AIDS interventions in developing countries. The modest studies conducted in this area have largely been conducted in developed countries, leaving little known about the effectiveness of such interventions in low resource settings, which moreover host the majority of HIV/AIDS infections. This research addresses this gap by conducting a controlled pre-post intervention evaluation of the impacts of the World Starts With Me (WSWM), a computer-assisted HIV/AIDS intervention implemented in schools in Uganda. The research question was: did the WSWM intervention significantly influence students’ sexual behaviors, HIV/AIDS knowledge, attitudes and self-efficacy? To address this question, questionnaires were simultaneously administering to 146 students in an intervention group (the group receiving the WSWM intervention) and 146 students in a comparison group (the group who did not receive the WSWM intervention), before (February 2009) and after the intervention (December 2009). Findings indicate that the intervention significantly improved students’ HIV/AIDS knowledge, attitudes self-efficacy, sex abstinence and fidelity, but had no significant impact on condom use. The major reason for non-use of condoms was lack of knowledge about condom use which can be attributed to teachers’ failure and inabilities to demonstrate condom use in class. To address this challenge, intervention teachers should be continuously trained in skills-based and interactive sexuality education. This training will equip them with self-confidence and interactive teaching skills, including tactics for emphasizing building students’ skills through role plays and interactive assignments. In addition, the HIV interventions themselves should include interactive virtual condom use demonstrations that can be accessed by students themselves.
    Full-text · Article · May 2012
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