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Scaling-up of HIV and Sexuality Education

Scaling-up of HIV and Sexuality Education. Kai Haldre MD PhD University of Tartu, Estonia West Tallinn Central Hospital Women’s Clinic Centre for Reproductive Medicine. Republic of Estonia 1.3 million inhabitants ( ~ 15 000 births per year) 69% Estonians

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Scaling-up of HIV and Sexuality Education

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  1. Scaling-up of HIV and Sexuality Education Kai Haldre MD PhD University of Tartu, Estonia West Tallinn Central Hospital Women’s Clinic Centre for Reproductive Medicine

  2. Republic of Estonia 1.3 million inhabitants (~15 000 births per year) 69% Estonians 31% (mainly) Russian-speaking minority Independent republic since 1918 Soviet occupation since the WW II – thereafter very closed society Regained independence in 1991 Parliamentary democracy European Union member since 2004 Sexuality can be openly discussed

  3. Background • In 1996 new school curriculum:mandatory sexuality education lessons integrated in a compulsory subject Human and Civil Studies • First youth counselling services addressing sexual health matters were set up in 1991–1992 and have resulted in 20 counselling centres by 2010

  4. HIV infection in Estonia, 1988–2009 Registered new cases (blue), all cases (red)

  5. Human Studies program:holistic approach to sexuality education Personal and social education Health education Sexuality education Drug education

  6. Objectives of the study • to determine whether changes occurred in young people’s sexuality-related knowledge and behaviour during 1992–2009 • to determine the cost-effectiveness of introducing and offering compulsory sexuality education at basic schools

  7. Materials and methods • costs of introducing school-based SE • based on 5-9 grades of basic schools • results of 12 population-based surveys • Sexuality related knowledge and behaviour • national databases of health indicators • Unwanted pregnancies • STI (gonorrhoea, syphilis) • HIV • Costs were compared to poor health outcomes averted

  8. Impact Measures Although group “at risk” (sexually active) increased by one third, trends 2001-2009: • Teenage birth rate decline: 13.3% • Teenage abortion rate decline: 30.1% • Among 15-24: • decline HIV incidence: 90% (but most are IDU related) • decline syphilis incidence: 95.6% • decline gonorrhoea incidence: 79.5% • Condom use at first intercourse increase: 27% in early 1990ies and 75% in 2007

  9. Cost-effectiveness - conclusion • School-based sexuality education can be considered cost saving if 4% of HIV reduction can be attributed to it (very conservative scenario) • Impact in Estonia interlinked with free youth-friendly SRH services

  10. Authors of the Estonian study • Radboud University Nijmegen Medical Center, The Netherlands • Rob Baltussen,Evert Ketting • University of Tartu, Estonia • Kai Part, Eva Palm, Prof Raul-Allan Kiivet • Qalys Health Economics, TheNetherlands • Jari Kivela

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