Arusha, Tanzania: New programs and policies aimed at preventing HIV in Africa should focus on providing earlier and more comprehensive sex education and reinforcing national health care systems to better serve youth, according to important new research released today. Published by the Guttmacher Institute and institutional partners in Burkina Faso, Ghana, Kenya, Malawi and Uganda, “Protecting the Next Generation: Learning from Adolescents to Prevent HIV and Unintended Pregnancy,” compiles policy and program recommendations based on findings from national surveys of about 20,000 African adolescents, as well as focus group discussions and in-depth interviews with hundreds of young people, parents, teachers and health care providers. Guttmacher and partners released the report at the Fifth African Population Conference in Arusha, Tanzania, December 10-14, Africa’s premier gathering of academics and health experts.
The study found that at least half of 15–19-year-olds in Burkina Faso, Ghana, Malawi and Uganda did not receive any sex education because it is not offered at their school, they drop out of school before reaching the grade in which sex education is offered, or they have never attended school.
Though nine in 10 young Africans in the four countries have heard of HIV, fewer than 40% of 15–19-year-olds can both correctly identify ways of preventing the virus and reject common myths about HIV, for instance, that the virus can be spread via mosquito bites. The researchers found that the proportion of adolescents with low knowledge about pregnancy prevention is even greater. This lack of knowledge can lead to risky behavior.
“Adolescents’ knowledge of HIV prevention remains dangerously superficial,” said Dr. Akinrinola Bankole, coauthor of the report and director of international research at the Guttmacher Institute. “What is urgently needed is comprehensive school-based sex education, which is proven to be effective in helping adolescents avoid HIV infection and unwanted pregnancy.”
The report makes the following four recommendations for improving school-based sex education in Africa:
- Adopt comprehensive curricula that provide accurate sexual health information
- Target very young adolescents with information before they have sex for the first time
- Support teacher training to expand coverage of sex education
- Help adolescents stay in school
Only one-third to one-half of young women and about one-half of young men who had sex in the past year report using any form of contraception; most often they used the male condom. The study also found that, across the four countries, 32–65% of sexually active adolescents prefer to receive contraceptive care and sexually transmitted infection (STI) testing and treatment at health facilities, but fear and embarrassment were among the main reasons preventing them from seeking such services. Some 24–44% of these at-risk adolescents did not know of a source for contraceptive services; and 31–67% either had never heard of STIs or did not know of a source for STI care.
“The young people we surveyed cited doctors and nurses as trusted sources of information, yet even some of those who had experienced sexually transmitted infections had not gone to the clinic. Fear, shame and embarrassment were the main reasons cited for not seeking services,” added Bankole.
The report recommends that program designers and policymakers take the following actions to improve adolescents’ access to the formal health sector:
- Ensure the widespread availability of contraceptive methods, especially the male condom
- Conduct outreach to inform young people about the services available and where to get them
- Train mid-level providers, such as midwives and nurses, to augment the delivery of health services
“The evidence suggests that these targeted investments in the formal health and education sectors could have real impact on young people’s health and lives,” Bankole concluded. “Investing in the health and education of adolescents is an investment that ultimately benefits the greater society.”
Further in-depth research findings are available in the December 11(3) issue of the African Journal of Reproductive Health.
Click here for the full report