What Works for Women and Girls

44% and 100% of participants (Kirby et al, 2007a; Kirby et al., 2007b; Kirby et al.,2006; Kirby, 2009). (Gray I) (sex education, sexual partners, condom use, contraception,sex behavior)A community-randomized trial with a cohort of 9,645 adolescents in 20 communitiesin Mwanza Region, Tanzania that included multiple components to improve the sexualhealth of adolescents, resulted in statistically significant improvements in knowledge,reported attitudes, reported STI symptoms, and some behavior change but no changein HIV seroconversion rates. The intervention included comprehensive sex education,youth-friendly services, community-based condom promotion and distribution byyouth, and a range of community-wide, youth-focused activities. All students age 14 orolder in grades 4–6 in 1998 were eligible for enrollment and the final follow-up tookplace three years after recruitment, in 2001–2002. There were statistically significantdifferences among young men—but not young women—in the intervention groupcompared to the control group in sexual debut and having more than one sex partner inthe past year. Initiation of condom use was higher for both young men and women inthe intervention groups although condom use at last sex remained low, at below 30%.“Reported behavioral effects were stronger in male than female participants, possiblybecause young women were exposed to older male participants who had not benefitedfrom the programme” (Ross et al., 207: 1951). Furthermore, “the interventions thatwere tested within the trial were all directly targeted to adolescents themselves. Culturalnorms, however, such as gendered and age-related power relationships and marriageand fertility norms within marriage and fertility norms within the wider community,compromise the ability of adolescents to change their sexual behavior. Communitywideinterventions aimed at changing societal norms may be particularly important”(Ross et al., 2007: 1952) (Gray II) (sex education, behavior change, HIV seroconversion,Tanzania)A quasi-experimental study using 4,795 questionnaires from adolescents who participatedin a school-based sex education program in public schools in four municipalitiesin the state of Minas Gerais, Brazil found that the program succeeded in more thandoubling consistent condom use with casual partners from 58.3% prior to the programto more than 71% following the program, with no effect on age at first intercourse oron adolescents engagement in sexual activities (Andrade et al., 2009). (Gray III) (sexeducation, condom use, Brazil)A quasi-experimental research study in South Africa in 2001 found that of the 646students included, exposure to HIV/AIDS curriculum increased levels of knowledgerelated to HIV transmission, knowledge of risky behaviors, levels of approval of abstinence,intention to abstain or use a condom, and reported partner reduction amongmales. The intervention did not increase rates of sexual activity. Of the 22 schoolsincluded in the study, Life Orientation HIV/AIDS curriculum was taught in 11 schools,while the remaining 11 did not receive the class and served as controls. Two classroomsfrom each of the 11 intervention schools were selected to receive Life Orientation122 CHAPTER 5 PREVENTION FOR YOUNG PEOPLE