Siyabonga Dlamini

Reasons for inconsistent condom use by rural South African high school students.

Aim: To describe the condom use practices of high school students, compare the beliefs of students who used condoms with those who did not, investigate gender differences in condom use and identify factors that prevent condom use.

An epidemiological perspective of substance use among high school pupils in rural KwaZulu-Natal.

OBJECTIVES To investigate prevalence and the factors influencing substance use among rural high school pupils in KwaZulu-Natal in order to develop and implement intervention programmes. DESIGN Cross-sectional study. SETTING Twenty-eight high schools in southern KwaZulu-Natal. SUBJECTS One thousand three hundred and eighteen grade 10 pupils. OUTCOME MEASURES An anonymous self-reporting questionnaire was used to investigate the use of alcohol, tobacco (cigarettes), cannabis and solvents. RESULTS Of the male scholars, 52.9% (95% confidence interval (CI): 45.4-60.3) reported ever using alcohol, 16.9% (CI: 11.5-24.0) reported using cannabis, and 13.1% (CI: 7.2-22.5) had smoked more than one cigarette daily. Among male pupils 45.5% (CI: 38.6-52.6) had inhaled benzine and 34.6% (CI: 28.0-41.8), thinners; 7.4% (CI: 3.4-15.2) had used cocaine and 4.1% (CI: 1.0-10.6), crack. Female pupils reported significantly less use of alcohol (25.5%, CI: 17.6-35.3), cannabis (2.3%, CI: 1.3-4.1), cigarettes (more than one daily) (2.0%, CI: 1.0-4.1), and inhalation of benzine (18.8%, CI: 13.8-25.2) and thinners (10.8%, CI: 7.2-16). Logistical regression indicated that the odds of smoking cigarettes increased significantly (p < 0.0005) with use of the other substances. CONCLUSION The results of this study confirm the prevalence of multi-substance use among pupils at the majority of rural high schools in this district and the need for targeted interventions to reduce/prevent this.

Effects of a Teenage Pregnancy Prevention Program in KwaZulu-Natal, South Africa

Researchers aimed to determine the effects of a teenage pregnancy (TP) prevention program for 816 high school students attending 16 KwaZulu-Natal, South African schools through a randomized control trial. Data were collected at baseline and at the 8-month follow-up in 2009. Results were calculated using multivariate analyses of program effects employing Mplus 6, and indicated significantly healthier attitudes, including intentions to abstain from sex whilst at school, plans to communicate with partners about teenage pregnancy, and increased reports of condom use. Researchers thus provide some support for the effectiveness of a TP prevention program that should be further strengthened in a comprehensive approach that includes schools and families.

Changing sexual behaviour to reduce HIV transmission - a multi-faceted approach to HIV prevention and treatment in a rural South African setting.

Abstract This community household survey undertaken in Melmoth, a rural area in KwaZulu-Natal, South Africa, investigated the influence of cumulative exposure of complementary interventions by a non-governmental organisation, LoveLife which aimed to bring changes in beliefs about HIV and AIDS prevention and treatment, and to reduce sexual risk behaviour. Amongst the 1294 respondents (15–40 years of age) increasing the number of exposures to different LoveLife interventions included use of television and radio messages, billboards, a free monthly magazine for youth, special school sports and community events, involvement of youth peer educators, and support for schools through classroom programmes and by linking clinic staff and peer educators. Cumulative exposure to LoveLife interventions resulted in more respondents believing that HIV could be prevented (p<0.005) and treated (p=0.007) and that people should test for HIV (p=0.03). Half of the respondents reported using a condom at last sex and cumulative exposure to LoveLife was associated with increased condom use (p<0.005). However, despite exposure to LoveLife, only 41.9% respondents had ever tested for HIV and cumulative exposure to LoveLife did not significantly influence respondents going to hospital for anti-retroviral treatment. The dose-response effect of cumulative LoveLife exposure appeared to have a positive influence on some beliefs and practices, but did not discriminate the extent of LoveLife exposure nor exposure to other HIV/AIDS interventions.

The association between HIV testing and sexual behaviour amongst rural Zulu high school students in Kwazulu-Natal, South Africa

This cross-sectional study investigated the prevalence of HIV testing amongst South African high school students, their perceptions about HIV testing, and the influence of HIV testing on their sexual behaviour. Grade 10 students at 28 high schools completed a questionnaire based on the I-Change Model. Of 1,192 students, 57 (4.8%) had been tested for HIV. More tested students knew a person with HIV/AIDS (p<0.005), knew other people who had been tested (p<0.005), perceived support from family (p<0.005) and friends (p=0.003), and reported self-efficacy and further intentions to be tested (p<0.005). HIV counselling and testing can promote prevention messages to reduce the prevalence of HIV infection amongst HIVseronegative people, and decrease transmission amongst those HIV-seropositive. Early diagnosis and care can improve outcomes for HIV/AIDS. Encouraging HIV testing among school students may contribute to a reduction in HIV incidence and persuade students to reduce risky sexual behaviour.

P2-482 Evaluating a school based RCT to reduce gender-based violence among high school students in KwaZulu-Natal, South Africa (SA)

Gender-based violence is a public health problem in South Africa associated with increased risk of HIV infection. KwaZulu-Natal is the epicentre of the HIV epidemic in South Africa with youth of 15–24 years at high risk of infection. A school based RCT aimed to develop, implement and evaluate an intervention to reduce gender-based violence, defined as verbal (belittling), physical (hitting) and sexual (forced sex) abuse, among grade 9 students. Schools (16) were randomly selected in two Districts and trained facilitators implemented a 16 module classroom-based intervention based on prior elicitation research, in 8 experimental schools. Students completed a self-reporting questionnaire at T1 and 8 months later at T2. Of 764 students, 46.7% male, both sexes reported perpetrating violence and being abused verbally, physically and sexually. Although there was a reduction in verbal abuse (belittling boy/girlfriend) and physical abuse (hitting boy/girlfriend) after the intervention programme, a reduction in hitting was reported only by female students (β coefficient 0.16, p=0.025, 95% CI−0.047 to 0.688). The study found that students who had attended the school-based intervention programme were three times less likely than the control group to report being forced to have sex (p=0.046, OR 2.95, 95% CI 1.02 to 8.53). These findings of a reduction in gender-based violence among students exposed to the intervention indicates that such a programme is useful for universal prevention efforts, but also highlights the importance of more focused attention on male students. In addition to school-based programmes there is a need for support at community level to reinforce school-based initiatives.