Original articles
The impact of life skills education on adolescent sexual risk behaviors in KwaZulu-Natal, South Africa

https://doi.org/10.1016/j.jadohealth.2004.02.025Get rights and content

Abstract

Purpose

To assess the impact of exposure to life skills education by youth in KwaZulu-Natal Province (KZN, South Africa) on knowledge and behaviors associated with the spread of HIV/AIDS.

Methods

Data come from a panel study of 2222 youth from several population subgroups in KZN. The youth were aged 14–24 years when interviewed in 1999 and 2001. The intervention was a full coverage life skills education program for all students in middle and secondary schools. Impact was measured as net dose-response relationships between life skills exposure and outcomes. Econometric methods were used to control for nonrandom exposure to life skills education. Outcomes included sexual behavior and condom use indicators.

Results

Significant effects, albeit modest in magnitude, were observed on selected areas of sexual-reproductive health knowledge and perceived condom self-efficacy, along with larger effects on condom use at first and last sex. No consistent effects on age at sexual initiation, secondary abstinence, or partnering behaviors were observed among these youth.

Conclusions

School-based life skills education appears capable of communicating key information and helping youth develop skills relevant to reducing HIV risk. However, the South African national program has yet to be fully implemented, and whether this initiative will result in sustained behavior modification among youth on a sufficient scale to affect the HIV/AIDS epidemic is uncertain.

Section snippets

Study design

As virtually all secondary schools in KZN Province had implemented some form of life skills initiative by the end of 2001, life skills education was for all intents and purposes a “full coverage” program in the province during the period of study, and thus neither randomized nor matched control group designs could be used to isolate the impact of program exposure. Instead, we took advantage of the variability in program scope and intensity across schools in the province and measured impact by

Exposure to life skills education

Exposure to life skills education was ascertained from interviews with both principals and adolescents in school. The proportion of school principals reporting that their school had some form of life skills program increased from 60% in the Wave 1 survey to 93% in Wave 2, and the proportion reporting presence of trained teachers from 76% to 94% (data not shown). However only about 15% of schools had fully adopted the KZN Province’s life skills curriculum and trained teachers in its

Discussion

The data reviewed in this paper suggest that some progress has been made in students’ exposure to life skills education in KZN. By 2001, most secondary school students in Durban Metro and Mtunzini Districts were exposed to some information that can help them reduce their risk of exposure to HIV/STIs and pregnancy, or help them cope with a family member. This is a substantial increase since 1999. The most substantial expansion in exposure to life skills education was found among students from

Conclusions

Contrary to a number of prior studies in Africa [5], [8], [10], our study findings suggest that school-based life skills education can help youth not only acquire knowledge and develop relevant skills to enable them to reduce risk of HIV transmission, but also to change selected behaviors. Both fixed-effects and instrumental variable estimates indicate a positive impact of exposure to life skills topics related to sexual-reproductive health knowledge, skills and behaviors. That the two

Acknowledgements

This research was made possible through support provided by the U.S. Agency for International Development (USAID) through the HORIZONS Project (under the terms of Co-operative agreement No. HRN-A-00-97-00012-00), the FOCUS on Young Adults Program (Co-operative agreement No. CCP-3-73-A00-6002-00), the MEASURE-Evaluation Project (Co-operative agreement HRN-A-00-97-00018-00), and by a Rockefeller Foundation grant to the Population Council’s Policy Research Division. The opinions expressed herein

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