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Intervention program reduced HIV-associated risk factors in Kenyan schools
Cho H. J Adolesc Health. 2011;doi:10.1016/j.jadohealth.2010.08.007.
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In the Nyanza province of Kenya, a comprehensive community-based school support intervention prevented school dropout, delayed sexual debut and reduced HIV-associated risk factors.
“Several recent experimental studies have demonstrated reductions in HIV risk by improving enrollment and attendance at school,” according to the report published in the Journal of Adolescent Health.
For this reason, Hyunsan Cho, PhD, and Denise Hallfors, PhD, both with Pacific Institute for Research and Evaluation, and colleagues said, “Intervention students would show greater attachment to school and prosocial adults and have higher educational aspirations, more positive future expectations, more protective attitudes about early sex, and less sexual activity.”
The intervention was implemented in the community with the highest HIV prevalence (15%) in Kenya and consisted of support for school fees, uniforms, and a “community visitor” to monitor school attendance and help resolve problems leading to absence or dropout. The researchers set out to determine whether this intervention would keep adolescent orphans in school and reduce HIV-related risk factors.
In the randomized controlled trial,105 orphans aged 12 to 14 years were randomly assigned by household, gender and baseline survey report of sexual behavior. Data were analyzed using generalized estimating equations during two time points, controlling for gender and age.
Results revealed, after 1 year, students in the intervention group were less likely than those in the control group to drop out of school (4% vs. 12%; P=.05), begin sexual intercourse (19% vs. 33%; P=.07), or report attitudes supporting early sex (P<.001), thereby reducing risk factors associated with HIV infection. In addition, the researchers reported that school support also increased prosocial bonding and gender equity attitudes.
Regarding the next course of action, Cho and Hallfors said: “Most orphans are not able to pay for secondary school education and need support. We advocate for policies that would universally provide this support. But in the meantime, we are raising money for scholarships for these children.”
The researchers told Infectious Disease News: “Physicians should consider supporting policies that help orphans to stay in school. Nurses from Moi University participated as research assistants in our study; they helped identify a number of common health problems (malaria, parasites, monthly menses for girls) that kept orphan children from coming to school. We also recommend access to primary health care as part of comprehensive school support.”
Further research is needed to better understand factors that mediate the association between educational support and delayed sexual debut, and how gender may moderate these relationships, the researchers said. – by Ashley DeNyse
Disclosure: Drs. Cho and Hallfors report no relevant financial disclosures.
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