Youth participation in the fight against AIDS in South Africa: from policy to practice

The high rate of HIV infection among youth in Africa has prompted both national and international attention. Education and prevention programmes are seen as the primary way of decreasing this rate. This paper reviews 11 published and evaluated school-based HIV/AIDS risk reduction programmes for youth in Africa. Most evaluations were quasi-experimental designs with pre-post test assessments. The programme objectives varied, with some targeting only knowledge, others attitudes, and others behaviour change. Ten of the 11 studies that assessed knowledge reported significant improvements. All seven that assessed attitudes reported some degree of change toward an increase in attitudes favourable to risk reduction. In one of the three studies that targeted sexual behaviours, sexual debut was delayed, and the number of sexual partners decreased. In one of the two that targeted condom use, condom use behaviours improved. The results of this review suggest that knowledge and attitudes are easiest to change, but behaviours are much more challenging. The article provides details about programmes and identifies characteristics of the most successful programmes. Clearly, however, more research is needed to identify, with certainty, the factors that drive successful school-based HIV/AIDS risk reduction programmes in Africa.