Transitions to Adulthood in the Context of AIDS in South Africa

Executive Summary

“This study measures the effects of exposure to topics within the life skills curriculum on sexual and reproductive health knowledge and behaviors among youth in KwaZulu Natal, during the 1999-2001 periods.

The study is a prospective study of adolescents in KwaZulu Natal province that gathered data on sexual and reproductive health behaviors, education and employment experiences, family and environmental conditions, and other factors in their lives that may influence their sexual behavior and choices. One objective of the study was to contribute to the understanding of the effectiveness of life skills education in changing behavior.

Two administrative areas in KwaZulu Natal, Durban Metro and Mtunzini Magisterial Districts, were purposively selected. Within each area, all youth 14-22 years of age residing in a segmented, probability sample of Census Enumeration Areas (CEAs) were interviewed in the Wave 1 survey
(1999). In Wave 2 (2001), all youth 14-24 years of age residing in the same CEAs were included in the survey, including 2,222 of the 3,052 youth also interviewed in Wave 1.

Because the South Africa life skills initiative aimed to be a full coverage programme, it was not possible to use a randomized control design to measure programme impact. This is because schools initiated or developed life skills education at different speeds and intensities. The study therefore measured young people's recall of 11 topics from their school training, and assessed the differences in sexual and reproductive health knowledge and behaviors, given that these young people were differentially exposed to the topics. This is called measuring the dose-response relationship between indicators of exposure to education and sexual and reproductive health knowledge and behaviors.

All the multivariate models control for unmeasured factors using a variable for survey year. A significant effect for this survey year variable was found for many of the models and may be interpreted as reflecting the combined effects of maturation of youth, exposure to other sources of information other than life skills education, and general secular trends. Exposure to life skills education was measured by changes in recall of 11 key sexual-reproductive health topics based upon student report.

Outcomes included:

• sexual abstinence to either postpone first sex (delay initiation), or for those already initiated to reduce risk through secondary abstinence;
• reduced number of sex partners in the past 12 months;
• changes in condom use (i.e. condom use at first sex; condom use at last sex and consistency of condom use with all partners). Separate analyses were conducted by sex, race, and age.