UN Integrated Regional Information Network - December 9, 2008

These are the findings of a ground-breaking study released last week at the International Conference on AIDS and STIs in Africa (ICASA), the first in sub-Saharan Africa to measure biological markers like HIV infection and pregnancy, as well as knowledge, attitudes and reported practice.

"This trial shows that we can improve knowledge of young people through HIV education in primary schools, but also that this knowledge is clearly not enough to make an impact on actual behaviour," said David Ross, lead researcher of the study and public health specialist at the London School of Hygiene and Tropical Medicine, which conducted the study in cooperation with Tanzania's National Institute of Medical Research.

More than 13,000 young people participated in the rigorous long-term evaluation assessing the impact of Mema kwa Vijana (Good things for young people, in Swahili), an HIV prevention project in Mwanza, northwestern Tanzania, that aimed to reduce the rate of new infections among the youth through sexual health education at primary schools, clinics and communities.

UNAIDS estimates that 45 percent of HIV transmissions occur in the 15 to 24 age group, making prevention education targeted at them vital to stemming the epidemic.

The study confirmed that such education can increase knowledge over time, and those who participated retained more knowledge about the prevention of HIV and other sexually transmitted infections (STIs) five years after leaving primary school than those who did not.

Girls who received the education were around 25 percent more likely to correctly identify three modes of STI transmission; a statistically significant increase was also seen among boys.

However, the researchers found no significant difference in the rates of pregnancy, HIV and other STIs between the group of young people in the study and those in the control group.

Social norms

There is a difference between what young people say they do, and what they actually do, pointed out Ross. "Knowledge was not enough to affect true [sexual] behaviour, and that must be at least partly due to the vulnerability that people have because of surrounding social norms," he said.

"Young people may want to change their behaviour, but there are so many other pressures - social pressures, structural pressures, economic pressures - that dissuade them from reducing their risk."

Francis Ndowa, coordinator of the STIs team at the World Health Organisation, agreed that while correct information was critical, other factors were fundamental. "They need the facts instead of myths and misconceptions, but there are other factors in the community and in the upbringing that we need to look at, that force youngsters into certain behaviour."

Social norms can also affect policies on HIV and sexual education. "A lot of policy makers, who are also parents themselves, think that if you give information of a sexual nature to youngsters in school you turn them into being promiscuous," Ndowa told IRIN/PlusNews.

In fact, the opposite is true. "You give them information to protect them from the adverse affects of sexuality and they can be more prepared," she said.

Applying lessons

Ross cautioned against applying the results too widely. "One cannot say that this study applies everywhere; context is important. Every society is at a different stage in their understanding of the epidemic, their reaction to the epidemic as well as the epidemic itself."

Nevertheless, the study had policy implications for HIV prevention programming. "But the results are consistent - young people's knowledge is changing, so something has got across, but it's not enough."

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