Positive Action for HIV in Schools in Kenya: A Guide for Program Designers and Implementers

This 32-page report shares findings from a study to test the feasibility of using comic books, role models, and edutainment to communicate HIV and AIDS messages to in-school young people with a view to improving their knowledge about the epidemic, enhancing communication about it, and promoting positive attitudes and behaviour among them. The study was conducted as a pilot and used a quasi-experimental pre- and post-intervention design without a comparison group. It was implemented between 2010 and 2011 in eight secondary schools in Nairobi, Kenya, by the APHIA II Operations Research (OR) Project in collaboration with the AIDS Control Unit in the Ministry of Education, Well Told Story, and the National AIDS/STI Control Programme (NASCOP).

Eight secondary schools in Nairobi, Kenya were selected to participate in the study. The interventions were implemented over a five-month period during the school year and involved the use of youth-friendly communication channels including: colourful comic books, guides and posters; use of role models; and educative performances (edutainment). The intervention activities were preceded by formative research involving group discussions and written essays with students, teachers, and parents/guardians from six of the eight schools to obtain information to guide the intervention design. According to the report, formative research showed that current approaches of conveying HIV and AIDS messages appear repetitive, boring, and lack in-depth information for many young people.

Most students preferred more relevant, interactive, appealing, and realistic approaches of conveying the messages, which could be accomplished through the use of role models, celebrities, guidance and counselling teachers, and school nurses. Feedback from students and teachers showed that the intervention activities were well received. The edutainment slogan of know your status, plan your future resonated well with students. This was evident when students responded positively to the presentations and the performances by joining in chanting the slogan and asking questions about HIV and AIDS. Some teachers also reported that they overheard students re-chanting the messages. Students and teachers further reported using the materials for various purposes. For example, some teachers reported using the materials to initiate discussions during student club meetings, peer education and counseling sessions, and to make the discussions lively. Some students used the interactive sections of the comic books to express their ideas about HIV and AIDS, draw posters based on these ideas, and pin the posters on the notice boards in their classrooms.

Key findings from the study include:

• Students need HIV and AIDS and other sexual and reproductive health information: Although there have been numerous behaviour change communications programmes, the study showed that many in-school young people still need accurate information not only on HIV-related topics but other sexual and reproductive health issues as well. This was evident from the formative research, the questions which were retrieved from the drop boxes, and from structured self-administered interviews. In addition, 82% and 79% of the students indicated at baseline and endline interviews respectively that they would like to receive information on HIV and AIDS at school.
• Using youth-friendly channels to communicate HIV and AIDS messages is feasible and acceptable to students: Nearly all students (97%) who obtained and read the communications materials liked them. Moreover, qualitative feedback from students and teachers showed that the interventions were relevant and realistic to in-school youth. The acceptability of the interventions to students and teachers could largely be attributed to the involvement of various levels of education stakeholders (education managers, school principals, teachers, parents/guardians, and students) in the conceptualisation and design of the activities.
• There was increased knowledge of modes of HIV transmission and where to get tested for HIV among students exposed to the interventions: At endline, the proportions of male and female students that mentioned specific modes of HIV transmission were significantly higher among those who read the communications materials than among those who did not obtain or read them. In addition, the proportions of male and female students that knew where to get tested for HIV were significantly higher among those who read the materials than among those who did not obtain or read them.
• There was increased communication about HIV and AIDS among students exposed to the interventions: Among male and female students who participated in the endline interviews, the proportions that had ever talked about HIV testing and counselling with anyone were significantly higher among those who read the communications materials than among those who did not obtain or read them. In addition, the proportion of students that had ever talked to classmates or friends about HIV testing and counselling was significantly higher among those who read the materials than among those who did not obtain or read them.
• There were positive changes in attitudes towards people living with HIV among students exposed to the interventions: At endline, the proportions of male and female students reporting that children living with HIV should be allowed in school were significantly higher among those who read the communications materials than among those who did not obtain or read them. In addition, among male students who knew of a fellow student who was living with HIV, the proportion reporting negative reactions towards them (for example, avoiding, teasing, ridiculing, or harassing them) was significantly lower among those who read the materials; 73% of female students who knew of a fellow student who was living with HIV reported positive reactions towards them (for example, showing compassion, assisting, counseling or praying for them) compared to 54% of those who did not obtain or read the materials.
• There was reduced fear of getting tested for HIV among students exposed to the interventions: Among male and female students who participated in the endline interviews, the proportions that indicated that they would accept HIV testing, counselling or test results were significantly higher among those who read the communications materials. Although the proportion of female students that was tested for HIV within five months preceding endline interviews was higher among those who read the materials than among those who did not (36% compared to 29%), the difference was not statistically significant. The corresponding figures for male students were 34% among those who read the materials and 33% among those who did not obtain or read them. This suggests interventions might have been more effective in reducing the fear of getting tested than in increasing the uptake of testing.
• There were positive changes in the sexual behaviour of students exposed to the interventions: At endline, the proportions of male or female students that had sex in the last one month (among those who had ever had sex) was significantly lower among those who read the communications materials than among those who did not obtain or read them. Moreover, although not statistically significant, the proportions of sexually active male or female students who used a method at last sex to prevent pregnancy or STIs including HIV and AIDS were higher among those who read the materials.

The report concludes that the study showed that:

• in-school youth need accurate information not only on HIV and AIDS but other SRH issues as well;
• using comic books, role models and edutainment to communicate HIV and AIDS messages to in-school youth is acceptable to members of the school community; and
• the use of such channels leads to improved knowledge of SRH issues, enhanced communication about SRH, and positive changes in attitudes and behaviour of students.

The major recommendations from the study are that:

• there is need to constantly provide HIV and AIDS and other SRH information to in-school youth using age-appropriate channels; and
• all education stakeholders (education managers, school principals, teachers, parents/guardians, and students) need to be involved in the conceptualisation and design of such channels to ensure that they are acceptable and feasible within the school setting.