Impact

Impact
In recent years, a number of reviews have considered the impact and effectiveness of sex, relationships and HIV
education. In view of the effectiveness of different HIV prevention strategies in resource-poor settings, researchers
argue that, while sex and relationships education can affect sexual behaviour, nonetheless their effect on biological
outcomes (such as HIV and STIs) may be relatively insignifi cant.42
Authors of the most comprehensive review so far43 argue that the choice and implementation of school-based
programmes in poorer countries is constrained by the availability of teachers together with lack of access to necessary
fi nancial, material and technical resources. In addition, the culture and norms of local communities and schools
themselves may prohibit open discussion of sexual matters and actively discourage condom use in an attempt to
promote abstinence. A total of twenty-two intervention evaluations were included in the study.44 Results indicated
that sixteen out of twenty-two programmes signifi cantly delayed sex, reduced the frequency of sex, decreased the
number of sexual partners, increased the use of condoms or contraceptives, or reduced the incidence of unprotected
sex. Several studies also measured positive impacts on personal values, peer norms, communication about
sex and condoms and decreased use of alcohol. In terms of the duration of impact, the positive effects of some
programmes lasted from a few months to a few years. Mema Kwa Vijana was the only evaluated programme to
investigate the impact of the school-based education on STI and HIV prevalence. The authors found no signifi cant
impact on HIV, genital herpes, syphilis and chlamydia and no measurable impact on either pregnancy or childbearing.
Further long-term evaluations of Mema Kwa Vijana are currently underway.
Nonetheless, these studies strongly support the argument that sex and HIV education do not increase sexual
behaviour and a substantial number of programmes actually signifi cantly decrease one or more types of sexual
activity. The review determined that programmes led by both teachers and other adults had strong evidence of
positive impact on reported behaviour. Programmes were found to be effective irrespective of their implementation
in primary, secondary or night school settings. Similar proportions of the curriculum-based programmes were
effective regardless of whether they were taught by teachers or other adults and they were effective for both male
and female students. The reviewers argue that the similarity in terms of intervention impact in both developed and
developing country settings bodes well for effective implementation regardless of the degree of economic development
and HIV prevalence.
Reviews have also been produced that refer specifi cally to different types of programmes. These are discussed
below before considering the broader reviews.