A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa

Background The HIV/AIDS epidemic remains of global significance and there is a need to target (a) the adolescent age-groups in which most new infections occur; and (b) sub-Saharan Africa where the greatest burden of the epidemic lies. A focused systematic review of school-based sexual health interventions in sub-Saharan Africa to prevent HIV/AIDS and Sexually Transmitted Infections (STI) in this age group was therefore conducted. Methods Searches were conducted in Medline, Embase, Cinahl and PsychINFO according to agreed a priori criteria for studies published between 1986 and 2006. Further searches were conducted in UNAIDS and WHO (World Health Organization) websites, and 'Google'. Relevant journals were hand-searched and references cited in identified articles were followed up. Data extraction and quality assessment was carried out on studies selected for full text appraisal, and results were analysed and presented in narrative format. Results Some 1,020 possible titles and abstracts were found, 23 full text articles were critically appraised, and 12 articles (10 studies) reviewed, reflecting the paucity of published studies conducted relative to the magnitude of the HIV epidemic in sub-Saharan Africa. Knowledge and attitude-related outcomes were the most associated with statistically significant change. Behavioural intentions were more difficult to change and actual behaviour change was least likely to occur. Behaviour change in favour of abstinence and condom use appeared to be greatly influenced by pre-intervention sexual history. Conclusion There is a great need in sub-Saharan Africa for well-evaluated and effective school-based sexual health interventions

Perceptions of the HIV counselling and testing programme by patients in a rural regional hospital in South Africa

Background: Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) have become a major public health challenge worldwide in the past few decades. The impact is felt in all sectors in South Africa, as in other parts of sub-Saharan Africa. Several health-related approaches have been adopted to facilitate an understanding of and reduction in the risk factors associated with HIV and AIDS. Following the demonstration of underperformance by the new voluntary counselling and testing (VCT) guidelines in South Africa, otherwise referred to as HIV counselling and testing (HCT), in providing practical suggestions on ways to optimally engage clients to ensure that testing for HIV is being performed, an evaluation to ascertain other patient-influencing factors on healthcare worker-initiated HCT was needed. Thus, the aim of this study was to describe patients’ perceptions of the benefits of and barriers to HCT, and their willingness to test.Method: One hundred and seventy-two patients referred for HCT were randomly selected over a three-month period. Data were collected by a research assistant using the modified standardised World Health Organization/ Health Global Access Project (HGAP) questionnaire.Results: The majority of the participants demonstrated a good perception of the benefits of and barriers to HCT, and most reported good self-efficacy with regard to protecting themselves against HIV infection and preventing the acquisition thereof. However, only 74% were confident enough to test for HIV, while 28% reported being reluctant to notify their partners of their status if they tested positive, and 38% reported fear of healthcare workers showing discrimination as a barrier to HCT.Conclusion: Despite excellent perceptions of the HCT programme, a significant association between participants’ perceptions of HCT and their willingness to test for HIV was not reported (p 0.05)