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S exual health education. David Ross London School of Hygiene & Tropical Medicine Bergen, 7 th May 2014. What is the primary objective? . Education (improving knowledge and skills) or Behaviour Change. Education and Behaviour Change. Example

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S exual health education

Sexual health education

David Ross

London School of Hygiene & Tropical Medicine

Bergen, 7th May 2014


What is the primary objective
What is the primary objective?

Education (improving knowledge and skills)

or

Behaviour Change


Education and behaviour change
Education and Behaviour Change

Example

  • In his briefing before travelling to Africa, a British businessman is told that >80% of female sex workers in the city he will be visiting are HIV-infected, but still has unprotected sex with them

    conversely

  • The man joins a new peer group (eg. a religious group) where having sex with a female sex worker is socially unacceptable, and changes his behaviour


Objective
Objective

Comprehensive sexual health education

  • Should aim for behaviour change to reduce sexual risk and encourage positive development of the individual’s sexuality and relationships

  • Should, at a minimum, achieve education (ie. improved knowledge and skills)

  • Foundation for future sexual life and for additional interventions


Objective1
Objective

Other school subjects

  • Religious knowledge


Sexual health education objectives
Sexual Health Education Objectives

  • Improve knowledge

  • Provide skills & hence self-efficacy

  • Change attitudes & encourage action plans

    in order to give the person the option to ….

  • Change behaviour

    • Delay onset of sexual activity

    • Decrease number of sexual partners

    • Select low-risk partners

    • Use protection from STIs, HIV, and unwanted pregnancy (contraception & condoms)

    • Early recognition and treatment of sexually transmitted infections

      in order to…..


Objectives cont d
Objectives (cont…d)

  •  satisfying & healthy relationships

  • unintended pregnancies

  • HIV

  •  other STIs


Comprehensive sexual health education
Comprehensive Sexual Health Education

Provides scientifically-accurate information about all aspects of sexuality and sexual health, including:

  • Abstinence as the safest way of avoiding pregnancy and STIs

  • Risk reduction through reduction of partners, contraception and condom use, male circumcision, avoiding injected drugs

  • Sexual anatomy and physiology

  • Interpersonal communication skills

  • Responsible sexual decision making

  • Sexual orientation

  • Menstrual hygiene

  • Sex and relationships, bonding, etc

  • Myths & misconceptions

  • Legal issues (eg. rape, homosexuality)


Comprehensive sexual health education1
Comprehensive Sexual Health Education

More controversial issues:

  • Social norms

  • Acceptable behaviour


S ummaries of evidence
Summaries of evidence

Kirby et al. 2006 in “Preventing HIV/AIDS…” WHO Techn Rep Ser 938 (www.who.int)

Kirby et al. 2006 “The impact of sex and HIV…” for FHI

NapieralaMavedzenge et al 2013. “Effectiveness of HIV…” UNICEF Tech Brief


The 17 kirby characteristics
The 17 Kirby Characteristics

Domain 1: Process of developing the curriculum

  • Multidisciplinary team

  • Assessed needs & assets of target group

  • Used logic model that specified health goals etc

  • Activities consistent with community values & resources

  • Pilot-tested

Kirby D et al 2006. The Impact of Sex and HIV Education Programs in Schools and Communities on Sexual Behaviors among Young Adults. FHI.


The 17 kirby characteristics cont d
The 17 Kirby Characteristics (cont…d)

Domain 2: Content

  • Focused on clear health goals

  • Focused on specific behaviours

  • Addressed multiple risk and protective factors

  • Created a safe social environment

  • Multiple activities for each targeted risk/protective factor

  • Teaching methods that involved participants

  • Appropriate to culture, age, and sexual experience

  • Logical sequence

Kirby D et al 2006. The Impact of Sex and HIV Education Programs in Schools and Communities on Sexual Behaviors among Young Adults. FHI.


The 17 kirby characteristics cont d1
The 17 Kirby Characteristics (cont…d)

Domain 3: Implementation

  • Support from authorities

  • Careful selection, training, monitoring, supervision & support

  • If needed, activities to recruit and retain participants

  • Implemented all activities with fidelity

Kirby D et al 2006. The Impact of Sex and HIV Education Programs in Schools and Communities on Sexual Behaviors among Young Adults. FHI.


Must follow best practice
Must follow best practice

  • Content

  • Process


Impact of comprehensive sexual health education
Impact of comprehensive sexual health education

  • Strong, high quality evidence of consistent impact on knowledge and reported attitudes

  • Mixed results for changes in reported sexual risk behaviours

  • Mixed, but mainly null, results for biological outcomes

    Based on review of “high quality” studies

NapieralaMavedzenge et al 2013. “Effectiveness of HIV…” UNICEF Tech Brief


Limitations of research
Limitations of Research

1. Limitations of theory

  • Know too little about the relationships between:

    • Knowledge

    • Intentions

    • Self-efficacy

    • Planned action

    • Social and peer pressures

    • Risk vs reward perceptions


Limitations of research1
Limitations of Research

2. Limitations of measurement

  • Sexual behaviour


Limitations of our research
Limitations of Our Research

3. May be overpowered by social norms

  • Require many cohorts?

  • Multiple interventions?


Limitations of our research1
Limitations of Our Research

4. Relationship between intervention and outcome unlikely to be linear

  • Tipping point

  • Multiple cohorts (eg. risk of transmission by age of partner)

  • Potential lag



Future
Future

  • Many encouraging results

  • Lots of potential for further intervention development & testing


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