School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents
Amanda J Mason-Jones1,2,3, David Sinclair4, Catherine Mathews5,6, Ashraf Kagee7, Alex Hillman1, Carl Lombard8
1. University of York, Department of Health Sciences, York, UK
2. University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa
3. University of Stellenbosch, Interdisciplinary Health Sciences, Cape Town, South Africa
4. Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
5. South African Medical Research Council, Health Systems Research Unit, Tygerberg, Cape Town, South Africa
6. University of Cape Town, School of Public Health and Family Medicine, Cape Town, South Africa
7. Stellenbosch University, Department of Psychology, Matieland, Western Cape, South Africa
8. South African Medical Research Council, Biostatistics Unit, Cape Town, South Africa
Mason-Jones AJ, Sinclair D, Mathews C, Kagee A, Hillman A, Lombard C. School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD006417. DOI: 10.1002/14651858.CD006417.pub3.
Access the full-text article here: DOI: 10.1002/14651858.CD006417.pub3
Cochrane researchers conducted a review of the effects of school-based interventions for reducing HIV, sexually transmitted infections (STIs), and pregnancy in adolescents. After searching for relevant trials up to 7 April 2016, they included eight trials that had enrolled 55,157 adolescents.
Why is this important and how might school-based programmes work?
Sexually active adolescents, particularly young women, are at high risk in many countries of contracting HIV and other STIs. Early unintended pregnancy can also have a detrimental impact on young people's lives.
The school environment plays an important role in the development of children and young people, and curriculum-based sexuality education programmes have become popular in many regions of the world. While there is some evidence that these programmes improve knowledge and reduce self-reported risk taking, this review evaluated whether they have any impact on the number of young people that contracted STIs or on the number of adolescent pregnancies.
What the research says
Sexual and reproductive health education programmes
As they are currently configured, educational programmes alone probably have no effect on the number of young people infected with HIV during adolescence (low certainty evidence). They also probably have no effect on the number of young people infected with other STIs (herpes simplex virus: moderate certainty evidence; syphilis: low certainty evidence), or the number of adolescent pregnancies (moderate certainty evidence).
Material or monetary incentive-based programmes to promote school attendance
Giving monthly cash, or free school uniforms, to encourage students to stay in school may have no effect on the number of young people infected with HIV during adolescence (low certainty evidence). We do not currently know whether monthly cash or free school uniforms will reduce the number of young people infected with other STIs (very low certainty evidence). However, incentives to promote school attendance may reduce the number of adolescent pregnancies (low certainty evidence).
Combined educational and incentive-based programmes
Based on a single included trial, giving an incentive such as a free school uniform combined with a programme of sexual and reproductive health education may reduce STIs (herpes simplex virus; low certainty evidence) in young women, but no effect was detected for HIV or pregnancy (low certainty evidence).
There is currently little evidence that educational programmes alone are effective at reducing STIs or adolescent pregnancy. Incentive-based interventions that focus on keeping young people, especially girls, in secondary school may reduce adolescent pregnancy but further high quality trials are needed to confirm this.