Background: In South Africa, adolescents and young adults are at high risk of HIV, sexually transmitted infections, and unintended pregnancies. Recently, the Department of Basic Education (DBE) revised its sexuality and HIV prevention content and teaching strategies (using scripted lessons plans) to strengthen the overall sexuality education content of the life orientation curriculum delivered in schools. This paper presents impact evaluation results of the novel sexuality education program implemented since 2016 by Educational Development Center with support from the United States Agency for International Development.
Methods: A cluster randomized longitudinal evaluation was implemented in two districts in Mpumalanga and three districts in KwaZulu-Natal. The primary outcome of the evaluation was incidence of HSV-2 or pregnancy; and secondary outcomes included HIV prevalence, HIV testing, sexual experience, and knowledge and attitudes around HIV. One-hundred six schools were randomly assigned to either the intervention group, where scripted lesson plans of the revised sexuality lessons were taught to learners; or the control group, where previously developed life orientation materials were taught in schools. In total 3,145 grade-8 female learners were interviewed and had dried blood spots taken at baseline. Two-years later, 2,802 of the baseline sample of girls were found and interviewed again (78% response rate).
Results: Overall incidence of HSV-2 in the two-year follow-up was 7% while HIV prevalence in grade 10 was 6.5%; this demonstrates important HIV prevention needs in this population. Multivariate results demonstrated that incidence of HSV-2 was not statistically different between the intervention and control groups. However, compared to girls in the control group, those in the intervention group were significantly more likely to report being pregnant at endline (p< 0.05); and were more likely to have had an HIV test in the past 12 months (p< 0.10).
Conclusions: While the sexuality education program did not impact the incidence of HSV-2 among female learners, the curriculum holds promise given that it positively affected learners'' recent HIV testing behaviors. The lack of impact on biomarkers may be a result of weak implementation of the revised curriculum in the intervention group.