Combating HIV/AIDS in children and youth: obstacles to behaviour change and the role of theory

Abstract

Objectives To study the impact of education on HIV/AIDS in sub-Sahara Africa and to assess the implementation of HIV education policies in Rwanda. Methods - A literature review on the relation between HIV/AIDS and education in sub-Sahara Africa; - A field study in Rwanda to assess the implementation of HIV/AIDS education policies in this country: o 28 in-depth interviews with stakeholders in policy development and implementation; o in-depth interviews with the school authorities and 8 teachers of 5 secondary schools; o focus group discussions with 84 students of the same schools. Results The literature review shows that despite two decades of experience the impact of HIV/AIDS education on sexual behaviour of children and youth is small. Programmes that are successful usually share several characteristics: they embed HIV/AIDS in broader SRH education, teach specific skills, focus on a specific behaviour, are long and intense and use trained facilitators. On the other hand, social norms, lack of materials and insufficient teacher training hinder the good implementation of HIV/AIDS education. The literature review also shows a lack of qualitative evaluations of HIV/AIDS education due to the methodological difficulty of measuring sexual behaviour and the lack of good universal indicators. Behavioural theories can fill this gap, and provide a good basis for development, implementation, monitoring and evaluation of HIV/AIDS education interventions. However, the literature review revealed difficulties in correctly using behavioural theories and showed that several aspects of these theories have not yet been tested. Theory and practice are still very distant. The interviews held as part of the field study revealed that the number of partners involved in the development and implementation of HIV/AIDS education policies has recently exploded, putting a great burden upon government structures to harmonize programmes and coordinate activities. On the field this results in duplication, contradictory messages and lack of quality control of HIV/AIDS education. Students, even in schools with anti-AIDS clubs, HIV/AIDS curriculum and peer educators, unanimously express a need for more HIV/AIDS and sexuality education, educational material and access to services. Conclusions HIV/AIDS education should be comprehensive in order to have effect. Researchers should be supported in developing implementation methods for behavioural theories and indicators that can be used universally, and coordination efforts should be strengthened.