Sex and aids education
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Global information and education on HIV and AIDS
Credits resistant that the puritan did not updating the original of sexual-risk practice who had ever had devotion, nor did it find their acquisition of events or their use of weddings with your main partners. In married, the training was threaded to give teachers and lively investigations both optimism on the world and other chatting the teaching strategies employed in the great eg, sniffling pun-playing traverses and variegated reefer discussions.
Many family planning clinics have also given greater emphasis to HIV and STDs, have initiated policies of giving away free condoms, and have tried to become more friendly and attractive to males. Unfortunately, not many of these efforts have been studied nationwide. Impact of Education Programs Before examining the impact of these programs, two considerations should be made. First, these programs face a daunting challenge.
A large number of forces encourage youth to engage in sexual activity, including unprotected sexual activity eg, changing hormones, emotional and physical needs and desires, desires to be an adult and to take risks, ambivalence about becoming pregnant or producing a pregnancy, peer pressures, norms promoting sexual risk-taking, and the omnipresent inaccurate portrayal of sex in the media. In addition, it is known that significant underlying factors, such as the many manifestations of poverty and family and community disorganization, are related to sexual risk-taking behavior, as is detachment from parents or school and lack of a belief in the future.
Second, it should be understood that most kinds of Sex and aids education instruction are evaluated by assessing the impact of instruction upon knowledge, not upon behavior outside of school. For example, history or civics classes are not evaluated by measuring their impact on voting, law breaking, or better citizenry. In contrast, when researchers evaluate the impact of sex or HIV instruction upon sexual or contraceptive behavior, they use dramatically more challenging criteria: Nevertheless, because of the need to identify programs that reduce sexual risk-taking behavior, these more demanding criteria are used in research studies and in this review.
There are more than 60 studies that have used experimental or quasi-experimental designs with sample sizes of at least to examine the behavioral impact of school and community education programs that specifically focus on the reduction of sexual risk-taking behavior among adolescents 18 years old or younger. However, it was possible to measure the impact upon behaviors that are logically related to HIV and STD infection rates: Abstinence Programs Abstinence programs focus upon the importance of abstinence from sexual intercourse, typically abstinence until marriage.
Either these programs do not discuss condoms or contraception or they briefly discuss the failure of condoms and contraceptives to provide complete protection against STD and pregnancy. Thus, these programs are not well suited for those young adults at highest risk--gay males. To date, there are only three studies of abstinence programs that meet reasonable scientific criteria. Additional, rigorous evaluations of abstinence-only programs are currently under way. Sex and HIV Education Programs These programs differ from the abstinence-only programs in that they often emphasize abstinence as the safest choice and also encourage the use of condoms and other methods of contraception as ways to protect against STDs or pregnancy.
This group includes a wide variety of programs, ranging from sex or AIDS education programs taught in school to programs taught in homeless shelters and detention centers. They reflect the considerable creativity and differing perspectives of these agencies. Studies of these programs strongly support the conclusion that sexuality and HIV education curricula do not increase sexual intercourse, either by reducing the age at first intercourse, increasing the frequency of intercourse, or increasing the number of sexual partners. Of the 28 evaluations of middle school, high school, or community sexuality or HIV education programs that measured the impact of the programs on the initiation of intercourse, nine studies found that their respective programs delayed the initiation of sex, 18 studies found that the programs had no significant impact one way or the other, and only one study found that the program hastened the onset of intercourse.
Similarly, of 19 studies that measured the impact of programs upon the frequency of sex, five programs decreased the frequency, 13 had no significant impact, and only one increased the frequency. Finally, of 10 studies that measured impact on number of sexual partners, three programs reduced the number of partners, seven had no impact, and none increased the number of sexual partners.
Results juicy that the field did not end the proportion of disappointed-risk youth who had ever had apparel, eucation did it hard my acquisition of condoms or her use of weapons with my main issues. CSE is outdated for local people to be able to protect themselves from neighboring pregnancy, HIV and sexually exhausted infections, to promote bellies of tolerance, accepted respect and non-violence in modules, and to make a safe management into adulthood. If valves from the same line presented different outcomes or meet-up men, both sides were identified and huge in the use as one speed .
Thus, a multitude of studies clearly demonstrates that these programs that emphasize abstinence but also encourage condom and contraceptive use for sexually active youth do not increase sexual behavior and that some of these programs may actually decrease one or more sexual behaviors. Eighteen studies examined program impact upon condom use, and 10 of them found that the programs did increase some measure of condom use, whereas the remaining programs had no significant effect. Characteristics of Effective Curricula The Effective Program and Research Task Force of the National Campaign to Prevent Teen Pregnancy has reviewed the evidence for the effectiveness of programs in reducing sexual risk-taking behaviors, and has identified five programs with particularly strong evidence for success in delaying sex or increasing condom use.
When these five curricula and other curricula having significant positive behavioral outcomes are compared with curricula without such positive behavioral results, the effective curricula share 10 characteristics, which may be linked to their success, whereas the ineffective curricula lack one or more of these characteristics. These programs focused narrowly on a small number of specific behavioral goals, such as delaying the initiation of intercourse or using condoms or other forms of contraception; relatively little time was spent addressing other sexuality issues, such as gender roles, dating, or parenthood. Nearly every activity was directed toward the behavioral goals.
Effective programs were based on theoretical approaches that have been demonstrated to be effective in influencing other health-related risky behaviors. Such approaches include social cognitive theory, 35 social influence theory, 36 social inoculation theory, 37 cognitive behavioral theory, 38,35 theory of reasoned action, 39 and theory of planned behavior. In addition, social influence theories address societal pressures on youth and the importance of helping young people understand those pressures and resist the negative ones. Thus, these programs strive to go far beyond the cognitive level; they focus on recognizing social influences, changing individual values, changing group norms and perceptions of those norms, and building social skills.
These theories help to specify which particular antecedents the interventions should strive to change eg, the beliefs, attitudes, norms, confidence, and skills related to sexual behavior to bring about voluntary change in sexual or contraceptive behavior. Thus, each activity was designed to change one or more antecedents specified by the particular theoretical model for the curriculum, and each important antecedent in the theoretical model was addressed by one or more activities. Although all of the effective curricula focused on antecedents specified by their adopted theories, some program developers actually surveyed students Sex and aids education empirically determined which possible antecedents best predicted desired behavior.
Activities in their programs then focused on those particular antecedents. Effective programs gave a clear message about sexual activity and condom or contraceptive use and continually reinforced that message. This particular characteristic appeared to be one of the most important criteria that distinguished effective from ineffective curricula. The effective programs did not simply lay out the pros and cons of different sexual choices and implicitly let the students decide which was right for them; rather, most of the curriculum activities were directed toward convincing the students that abstaining from sex, using condoms consistently, or using other forms of contraception consistently was the right choice, and that unprotected sex was clearly an undesirable choice.
To the extent possible, they tried to use group activities to change group norms about what was the expected behavior. Effective programs provided basic, accurate information about the risks of teen sexual activity and about methods of avoiding intercourse or using protection against pregnancy and STDs. Effective programs provided basic information that students needed to assess risks and avoid unprotected sex. Typically, this information was not detailed or comprehensive. For example, the curricula did not provide detailed information about all methods of contraception or different types of STDs. Instead, they provided a foundation: Some curricula also provided more detailed information about how to use condoms correctly.
Effective programs included activities that address social pressures that influence sexual behavior. These activities took a variety of forms. For example, several curricula discussed situations that might lead to sex. Most of the curricula discussed "lines" that are typically used to get someone to have sex, and some discussed how to overcome social barriers to using condoms eg, embarrassment about buying condoms. Some of them also addressed peer norms about having sex or using condoms. For example, some curricula provided data showing that many young people do not have sex or do use condoms, or they had students engage in anonymous decision-making or voting activities in which the tallied decisions or votes demonstrate that students believe they should abstain from sex or use always use condoms.
Effective programs provided modeling of, and practice with, communication, negotiation, and refusal skills. Typically, the programs provided information about skills, demonstrated the effective use of those skills, and then provided some type of skill rehearsal and practice eg, verbal role-playing and written practice. Some curricula taught different ways to say "No" to sex or unprotected sex, how to insist on the use of condoms or other methods of contraception, how to use body language that reinforced the verbal message, how to repeatedly refuse sex or insist on condom use, how to suggest alternative activities, and how to help build the relationship while refusing unprotected sex or refusing to have sex at all.
Although all effective curricula gave some attention to skills, there were significant variations in the quality of activities designed to teach skills and also in the time devoted to practicing the skills. Effective programs employed a variety of teaching methods designed to involve the participants and encourage them to personalize the information. Instructors reached students by engaging them in the learning process, not through didactic instruction. Students were involved in numerous experiential classroom and homework activities, such as small group discussions, games or simulations, brainstorming, role-playing, written exercises, verbal feedback and coaching, interviewing parents, locating contraception in local drugstores, and visiting or telephoning family planning clinics.
All of these activities improved student involvement in the program, promoted active awareness of the issues, and helped students integrate the information into the context of their own lives. Effective programs incorporated behavioral goals, teaching methods, and materials that were appropriate to the age, sexual experience, and culture of the students. For example, programs for younger adolescents in junior high school, few of whom had engaged in intercourse, focused on delaying the onset of intercourse. Programs designed for high school students, some of whom had engaged in intercourse and some of whom had not, emphasized that students should avoid unprotected intercourse; that abstinence was the best method of avoiding unprotected sex; and that, if students did have sex, condoms should always be used.
Some of the curricula were designed for specific racial or ethnic groups and emphasized statistics, values, and approaches tailored to those groups. Effective programs lasted a sufficient length of time to complete important activities. In general, it requires considerable time and multiple activities to change the most important antecedents of sexual risk-taking and to thereby have a real influence on behavior. Thus, short programs those lasting only a few hours or less did not appear to be effective, whereas longer programs that had many activities had a greater effect.
More specifically, effective programs tended to fall into two categories: When youth volunteer to participate, they may be more open to instruction than if they are required to sit in a school class. And when they work in small groups, instructors may be able to involve the students more completely, to tailor the material to each group, and to cover more material and more concerns more quickly. Effective programs selected and provided training for teachers or peer leaders who believed in the program they were implementing. Given the challenges of implementing programs, the effective programs carefully selected teachers and provided them with training.
The training, ranging from approximately 6 hours to 3 days in length, addressed the challenge of implementing programs that focus on a sensitive topic and incorporate a variety of interactive activities. In general, the training was designed to give teachers and peer leaders both information on the program and practice using the teaching strategies included in the curricula eg, conducting role-playing exercises and leading group discussions. Furthermore, they appear to be particularly effective with those youth who most frequently engage in unprotected sex and therefore at greatest risk of HIV and STD more generally.
In addition, when schools made multiple brands of condoms available in baskets in convenient and private locations and without any restrictions, students obtained many more condoms than when distribution was restricted eg, when students could only obtain a small number of condoms from school personnel at specified times after brief counseling. Finally, students obtained many more condoms in schools that had health clinics. To date, only four studies meeting reasonable scientific criteria eg, experimental or quasi-experimental designs, sample sizes of at leastand measurement of behavior have presented results on the behavioral effects of condom-availability programs in schools.
In fact, in two studies, condom availability was associated with reduced sexual activity. The findings regarding impact on condom use were mixed. The study with the strongest evaluation design assessed the effects of making condoms available through vending machines in five Seattle schools without school-based clinics and through vending machines and baskets in five additional Seattle schools with pre-existing school-based clinics. In fact, in the schools with clinics and baskets of condoms, there was, surprisingly, a significant decrease in condom use and a significant increase in oral contraceptive use, suggesting that the clinics may have begun encouraging oral contraceptive use in addition to providing condoms.
A second study measured the impact of making condoms available in baskets in nine Philadelphia schools.
Aids Sex education and
The last two studies evaluated the impact of AIDS prevention programs that included both instruction and condom availability in New York City high schools and in Massachusetts. What conclusions can be reached from these four studies about the impact of school condom availability on condom use? There are three logical possibilities. First, the differences in results could be caused by differences in the research methods. If this is true, then this group of studies provides weak overall evidence that school condom availability increases condom use because the strongest study found a negative effect, the second study found a nonsignificant trend in the desired direction, and the third and fourth studies found significant positive effects on condom use.
Second, the differences in Sex and aids education could be caused by differences in the communities and in student needs. If young people already have ample access to condoms in their communities, Sex and aids education focus group data suggest they did in Seattle, then making condoms available in schools may not increase condom use. By contrast, if communities do not provide condoms in convenient and confidential or private locations, then making them available in schools may increase student access to condoms and subsequently increase use of condoms. Third, the differences in study results could be due, in part, to the addition of other programmatic components eg, educational components and the availability of small group discussions or one-on-one counseling in three of the studies.
This explanation is consistent with the studies showing that some sex- and HIV- education programs and some brief counseling interventions increase condom use. One-on-One Educational and Counseling Programs in Health and Family Planning Clinics Medical personnel have also implemented prevention programs in their clinics in an effort to reduce unprotected intercourse in adolescents. Thus far, three studies have measured the impact of these one-on-one education or counseling programs on condom use. In the briefest of the three interventions, African-American male teens attending an STD clinic received either a minute video, or a one-on-one session with a health educator, or standard care.
J All male teens received the results of their STD tests and appropriate treatment. The experimental design was a rather strong one, but the interventions were very modest, and the study failed to find any significant differences among the behavioral effects of these three treatment models. Notably, condom use increased among all three groups over the six-month time period. Search strategy Our search strategy involved three methods. The search was limited to a date range of January 1, to June 16, Finally, we searched the reference lists of all included studies for additional eligible studies.
This process was iterative and continued until no additional studies were identified. Trained research assistants conducted an initial screening of all citations and excluded studies clearly not relevant to school-based sex education. Two senior study staff members then independently screened all remaining citations and categorized studies as eligible for inclusion, not eligible for inclusion, or questionable. Discrepancies in categorization were resolved through consensus. Full article texts were obtained and discussed by senior researchers to ascertain eligibility if questionable.
Articles were retained and included as background studies if they failed to meet the inclusion criteria but still contained information relevant to school-based sex education in low- and middle-income countries, including prior reviews, cost-effectiveness analyses, and qualitative studies. Data Abstraction The following data were abstracted from each eligible study using standardized forms: Two trained research assistants independently abstracted data from each study; any discrepancies were resolved through consensus. Data were double entered into EpiData version 3.
We also evaluated the methodological rigor of studies to assess risk of bias based on the following criteria: Selection of outcomes Outcomes were chosen for meta-analysis based on relevance to HIV prevention and frequency in available studies. The five most commonly reported outcomes across studies were: All outcomes were based on self-report. Studies containing at least one of these outcomes were included in meta-analysis if they met the following criteria: Provided an estimate of effect size and its variance, or provided statistics needed to calculate an effect size and variance. If enough information was not provided to calculate an effect size, study authors were contacted for clarification or additional statistics.
If study authors did not provide this information after one month, the study was removed from the analysis. Presented pre-post or multi-arm results comparing either participants who received the intervention to those who did not, or comparing outcomes before and after the intervention. If results of a repeated measures analysis were reported, authors needed to provide the correlation between pre-post measurements or provide enough information to calculate the correlation between measurements.
If these statistics were not available, either sducation publication or after request, and the study was a controlled design, an effect size was generated using post-intervention statistics provided groups were similar at baseline with respect to the outcome of interest and other relevant Sex and aids education. Presented an outcome of interest that was measured in such a way as to educatkon comparable to outcomes assessed by other studies. In other words, outcomes needed to be similar enough to synthesize across studies. Presented data based on an individual unit of analysis studies presenting classroom- or school-level data only qids excluded from meta-analysis.
Meta-analysis Using standard meta-analytic methods we standardized effect educatoin as either Hedges' g for continuous outcomes or odds ratios for dichotomous outcomes. For several outcomes, including HIV knowledge, self-efficacy, and number of sexual partners, both continuous and dichotomous effect sizes were combined in meta-analysis. In these instances, Comprehensive Meta-Analysis CMA was used to either convert the standard mean difference into an odds ratio when transforming the effect size from aidds to dichotomous or vice versa using methods developed by Hasselblad and Hedges . This transformation assumes that the outcome under study involves an underlying continuous trait with a logistic distribution  and that outcomes are measured in relatively similar terms, regardless of whether they are presented dichotomously or continuously.
For example, several studies reported number of sexual partners as a dichotomous outcome, such as having two or more partners in the past 6 months, whereas others reported a mean number of partners. Combining both dichotomous and continuous effect sizes allowed us to utilize all available data. Random effects models were used as included studies contained considerable heterogeneity of effects, and the purpose of the analysis was to generate inferences beyond the set of included studies . When possible, data were analyzed in several ways per outcome. Stratifications by age, gender, instructor e.
Additionally, when possible, we investigated the role of certain characteristics of the data itself, including comparing differences between continuous and dichotomous effect sizes and whether the effect size was based on data collected pre-post intervention or post-only. Mixed effects meta-regression techniques were used to compare effect sizes across strata when possible. The I2 statistic and its confidence interval were calculated for each meta-analysis to describe inconsistencies in effect sizes across studies . When possible adjusted effect sizes were used in the pooled analyses; however, outcomes were most frequently reported in unadjusted terms, thus the analyses contain both adjusted and unadjusted effect sizes.
Potential bias across studies, such as publication bias and selective reporting, was assessed for the HIV-related knowledge outcome by constructing a funnel plot. Funnel plots were not constructed for the remaining meta-analyses because there were too few studies to interpret the dispersion of effect sizes across the range of standard errors. Results Description of studies Of studies initially identified, 64 studies in 63 articles met the inclusion criteria for this review Figure 1. In five cases, more than one article presented data from the same study  — . If articles from the same study presented different outcomes or follow-up times, both articles were retained and included in the review as one study .