HIV education in South African schools: the dilemma and conflicts of educators.

AIMS: Educators within the school system are well placed to facilitate the dissemination of knowledge and skills in order for adolescents to be equipped for appropriate sexual decision-making. The aim of this research was to provide an understanding of educators' beliefs, attitudes and behaviours with regard to sexual and reproductive health promotion. METHODS: Individual interviews were conducted with 15 educators from demographically diverse high schools in the Western Cape. One-off interviews were conducted with Grade 8 Life Orientation educators and principals. The interviews were audio-recorded, with one exception. The resulting data were analysed using the qualitative computer package NVivo, as well as the grounded theory method. RESULTS: The findings indicate that many educators are conflicted about HIV and sex education, as they perceive it as contradicting their values and beliefs. The overwhelming majority was in support of the promotion of abstinence, but felt personally challenged in teaching safe sex practices. CONCLUSIONS: The impact of broader socioeconomic factors on education was noted, such as the dysfunctional homes of learners, poor role models, inadequate life-skills, violence, and crime. The findings highlight the need for a comprehensive approach towards sexual health intervention programmes that is sensitive to the cultural and social context in which it is developed and implemented.

Process evaluation of a school-based HIV/AIDS intervention in South Africa.

AIMS: This paper presents a process evaluation that assessed the fidelity and quality of implementation, as well as the acceptability and subjective evaluations of a HIV/AIDS intervention among students and teachers. METHODS: The process evaluation was conducted as part of a cluster randomized controlled trial of a theory- and evidence-based school HIV/AIDS intervention in Cape Town. The intervention was designed for grade 8 high school students and delivered by teachers over a six-month period. Twenty-six schools participated in the trial, 13 in the intervention group and 13 in the control group. RESULTS: The success of implementation was varied within and across the schools, with some teachers implementing the intervention with more fidelity than others. This was influenced by a combination of individual characteristics and institutional factors. The factors that aided implementation included compliance with the current outcomes-based education approach; provision of teacher training; provision of teacher manuals with detailed information and instructions about the lessons and activities; continued monitoring and support for teachers; and student enthusiasm for the lessons. Proper implementation was hindered by large class sizes; too many activities in the intervention; teacher resistance to and inexperience in using participatory methods; teacher turnover; the low status of life orientation compared to other subjects; and a general disregard for life orientation among students. CONCLUSIONS: These findings are important for improving the intervention and contextualizing the results of the outcome evaluation; and to better plan for further large scale dissemination of school-based HIV/AIDS intervention programmes.

I am not "umqwayito'': a qualitative study of peer pressure and sexual risk behaviour among young adolescents in Cape Town, South Africa.

BACKGROUND: Young people in South Africa are susceptible to HIV infection. They are vulnerable to peer pressure to have sex, but little is known about how peer pressure operates. AIM: The aim of the study was to understand how negative peer pressure increases high risk sexual behaviour among young adolescents in Cape Town, South Africa. METHODS: Qualitative research methods were used. Eight focus groups were conducted with young people between the ages of 13 and 14 years. RESULTS: Peer pressure among both boys and girls undermines healthy social norms and HIV prevention messages to abstain, be faithful, use a condom and delay sexual debut. CONCLUSIONS: HIV prevention projects need to engage with peer pressure with the aim of changing harmful social norms into healthy norms. Increased communication with adults about sex is one way to decrease the impact of negative peer pressure. Peer education is a further mechanism by which trained peers can role model healthy social norms and challenge a peer culture that promotes high risk sexual behaviour. Successful HIV prevention interventions need to engage with the disconnect between educational messages and social messages and to exploit the gaps between awareness, decision making, norms, intentions and actions as spaces for positive interventions.

Process evaluation of the teacher training for an AIDS prevention programme.

This paper provides a process evaluation of a 6-day teacher training programme which forms part of a sexuality education project. The training aimed at providing teachers with the necessary knowledge and skills to effectively teach a 16-lesson Grade 8 (14 year olds) life skills curriculum consisting of participatory exercises on sexual reproductive health, human immunodeficiency virus (HIV), sexual decision-making, abstinence, consequences of sexual activity, safe sex practices, substance abuse and sexual violence. Questionnaires administered prior to the training, on completion of the training and at two follow-up time periods were analysed as well as participant observation notes. Findings indicate that teachers reported increased confidence and comfort in teaching the sexuality curriculum. However, many struggled with the transfer of sexual reproductive knowledge and facilitative teaching methods into the classroom context. This highlights the need for HIV education to form part of teacher trainee programmes. Ongoing support and engagement with teachers is needed to encourage alternative teaching practices.