What Works for Women and Girls

negotiation skills and other critical elements were included. The evidence on sex educationseems to suggest, however, that such education, given to young people before they initiate sex,and that focuses on a number of key elements, can have positive outcomes.A recent review from UNESCO of studies of sex education in 29 developing countriesfound a number of positive outcomes: delayed initiation of sexual intercourse, decreasednumber of sexual partners, increased use of condoms and decreased sexual risk taking. Notevery intervention resulted in a decreased risk of HIV acquisition. However, no studies showedhastened initiation of sex, no studies showed an increased number of sexual partners, andno studies showed decreased use of condoms. Only one study of the 29 showed increasedsexual risk taking, with the remainder of studies showing no harmful effects of sex education(UNESCO, 2009). However, one community randomized trial in rural Tanzania found asignificant impact on knowledge and reported attitudes and behavioral outcomes but had noconsistent biological outcome as measured by seroconversion to HIV-positive over the threeyear period (Ross et al., 2007) and again for a longer period of time between 1999 and 2008(MEMA Kwa Vijana, 2008a and b). A review of studies that included comprehensive sex andHIV education programs in developing and developed countries found that two-thirds of thestudies reported that adolescents who received sex education were significantly more likelythan those who did not receive the intervention to have better knowledge and to engage inprotective behaviors (Kirby et al., 2007).Views on appropriate programs for adolescents vary. However, strong evidence supportscomprehensive sex education that includes promotion of delayed sexual initiation, and also informationon contraception including condoms so that when they do start having sex, young peoplewill be protected from unwanted outcomes. Yet according to the 2007 UNGASS reports, only40% of young men and 35% of young women had accurate knowledge of HIV/AIDS; less than70% of countries with generalized epidemics have implemented school-based HIV/AIDS educationand 61% have put in place HIV prevention for out of school youth (Bertozzi et al., 2008).Until recently, “programs promoting abstinence were found to be ineffective at increasingabstinent behavior and were possibly harmful,” according to the Cochrane Collaborative ReviewGroup on HIV Infection and AIDS (2004: 4). These conclusions were based on systematicreviews and a meta-analysis of high methodological quality, which met pre-determined criteriaof methodological rigor. Sixty reviews met the criteria (Cochrane Collaborative Review Groupon HIV Infection and AIDS, 2004) (Gray I). Cochrane reviews are the “gold standard” of studysyntheses. Further, a review of 86 sexuality education programs found no strong evidence thatabstinence-only programs delay sexual initiation, hasten a return to abstinence, or reduce thenumber of sexual partners among adolescents (Kirby, 2007). However, a study conducted from2001 to 2004 in the U.S. found that an abstinence-only curriculum (as opposed to an abstinence-onlyuntil marriage curriculum) which did not portray sex in a negative light, did notuse a moralistic tone and did not disparage the efficacy of condoms did result in a significantdelay of sexual debut among adolescents between the ages 12 and 14. Among the group thatreceived abstinence-only education, 20.6% of the participants reported coitus in the previousthree months, compared to 29% in the control group. The abstinence-only intervention didnot affect condom use (Jemmott III et al., 2010).116 CHAPTER 5 PREVENTION FOR YOUNG PEOPLE