{"id":1234,"date":"2016-12-07T15:52:18","date_gmt":"2016-12-07T15:52:18","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1234"},"modified":"2016-12-08T11:40:45","modified_gmt":"2016-12-08T11:40:45","slug":"school-based-sexuality-programmes-fail-to-demonstrate-an-influence-on-sti-and-pregnancy-outcomes","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2016\/12\/07\/school-based-sexuality-programmes-fail-to-demonstrate-an-influence-on-sti-and-pregnancy-outcomes\/","title":{"rendered":"School-based sexuality programmes fail to demonstrate an influence on STI and pregnancy outcomes"},"content":{"rendered":"<p>The 2016 UNAIDS Report \u2013 <a href=\"https:\/\/blogs.bmj.com\/sti\/2016\/12\/07\/unaids-2016-report-how-a-life-cycle-approach-can-help-the-world-get-on-the-fast-track-to-hiv-prevention\/\"><span style=\"color: #0563c1;font-family: Calibri\">Get on the Fast Track: a Life-Cycle Approach to STI Prevention\/STI\/blogs<\/span><\/a>\u00a0\u2013 underlines the particular vulnerability to infection of women at a relatively early phase of the life-cycle, especially in limited resource settings such as sub-Saharan Africa as a result of structural factors .\u00a0 These can seem intractable, but the authors of the report propose a number of practical measures for this group that include sexuality education in schools, social transfers and PrEP.\u00a0 So the recent publication of a <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD006417.pub3\/epdf\">Cochrane Review<\/a> of studies assessing the effectiveness of two of these interventions \u2013 sexuality education in schools and social transfers in the form of material incentives for girls to remain in school \u2013 is very timely \u2013 especially as five of the eight studies included in the analysis are based in the limited resource settings of sub-Saharan Africa that are the focus of the UNAIDS report.<\/p>\n<p>A number of both European and non-European countries have incorporated some form of sexuality education into their school syllabuses, and there have been attempts to investigate their effectiveness in a number of places, including the UK (<a href=\"http:\/\/sti.bmj.com\/content\/74\/6\/405.abstract\">Stephenson &amp; Johnson\/STIs<\/a>; <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2586352\/\">Stephenson &amp; Oakley<\/a>; <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1779834\/\">Henderson &amp; Hart<\/a>).\u00a0 Unfortunately many of these trials rely on self-reported data, a tendency that has been shown to be problematic in this area (<a href=\"http:\/\/sti.bmj.com\/content\/87\/2\/165.abstract?sid=7922d91b-9d4a-488b-9512-c2a59a286b64\">Langhaug &amp; Cowan\/STIs<\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/80\/suppl_2\/ii49.abstract?sid=3508c723-9f07-4eac-88c4-d52eec2c4786\">Plummer &amp; Hayes\/STIs<\/a>). The importance of the recent <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD006417.pub3\/epdf\">Cochrane Review<\/a> is that it focuses largely on biological outcomes: namely, rates of STIs and pregnancy at follow-up.\u00a0 The studies of sexuality education that are based on these outcomes have been undertaken in sub-Saharan Africa: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17721102\">Ross &amp; Hayes<\/a> (R&amp;H,Tanzania); <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20881473\">Cowan &amp; Pascoe<\/a> (C&amp;P, Zimbabwe); <a href=\"https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=2554412\">Duflo &amp; Kremer<\/a> (D&amp;K, Kenya). The same applies to studies of social transfers based on biological outcomes (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22341825\">Baird &amp; Oezler<\/a> (B&amp;O) and <a href=\"https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=2554412\">Duflo &amp; Kremer<\/a> (D&amp;K)).\u00a0 (The non-African studies in the analysis use pregnancy prevalence as their preferred outcome (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15661598\">Cabezon &amp; Garcia<\/a> (C&amp;G, Chile); <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2586352\/\">Stephenson &amp; Oakley<\/a> (S&amp;O, England); <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1779834\/\">Henderson &amp; Hart<\/a>) (H&amp;H, Scotland)).)<\/p>\n<p>So what biological evidence do we find of the effectiveness of <em>school-based education interventions<\/em>? Practically none, say the reviewers. \u00a0No difference was reported between intervention and control groups for HIV or for other STIs \u2013 except in the case of R&amp;H for syphilis prevalence at the end of follow up (RR 0.81: CI 0.47-1.39). \u00a0Even the statistically significant aggregate outcome for long-term pregnancy prevalence (0.55: CI 0.34-0.91) (C&amp;G, S&amp;O, H&amp;H, D&amp;K) seems largely accounted for by the results of C&amp;G, which were at particularly high risk of bias.\u00a0 When the latter were excluded, differences in pregnancy prevalence dropped to 0.93.<\/p>\n<p>When it came to the other element of this survey, <em>social transfers<\/em> (B&amp;O and K&amp;K), only B&amp;O reported a significant effect for HIV prevalence and HSV-2 prevalence.\u00a0 This evidence was considered weak because, in the former case, it concerned data for school \u2018drop-outs\u2019 which, say the reviewers, the B&amp;O study was not powered to detect, and, in the latter, because there was no measurement of prevalence at baseline.\u00a0 As for pregnancy outcomes, both studies reported a reduction in short-term prevalence (0.76).<\/p>\n<p>The trials of educational interventions may simply have been underpowered to detect small, but clinically important effects (especially with HIV).\u00a0 On the other hand, the authors of the review also point to a growing consensus among experts that the determinants of sexual health outcomes and sexual risk-taking are wider structural factors such as poverty and cultural gender norms that lie beyond the capacity of school-based education programmes to influence.\u00a0 The evidence for the effectiveness of incentives to stay at school, though as yet very inadequate, seems more encouraging.\u00a0 This is evidently a field that requires further research.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The 2016 UNAIDS Report \u2013 Get on the Fast Track: a Life-Cycle Approach to STI Prevention\/STI\/blogs\u00a0\u2013 underlines the particular vulnerability to infection of women at a relatively early phase of the life-cycle, especially in limited resource settings such as sub-Saharan Africa as a result of structural factors .\u00a0 These can seem intractable, but the authors [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2016\/12\/07\/school-based-sexuality-programmes-fail-to-demonstrate-an-influence-on-sti-and-pregnancy-outcomes\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4364,16494],"tags":[],"class_list":["post-1234","post","type-post","status-publish","format-standard","hentry","category-conditional-cash-transfers","category-sex-education-in-schools"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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