South Africa - Transitions to Adulthood in the Context of AIDS 1999-2002

Prospective study of reproductive behavior and sexual health of adolescents in South Africa as well as their education and employment experiences, family and environmental conditions, and other factors in their lives that may influence their sexual behavior and choices. The study design includes 2 rounds of data collection from adolescents (ages 14-22), in KwaZulu-Natal (KZN), South Africa, during 1999 and 2001-2002. Additional data was collected at baseline and follow-up from all schools in the study area regarding the teaching of a Life Skills Programme in those schools. This programme, introduced initially in secondary schools, was a key strategy in the state's response to the HIV/AIDS epidemic in South Africa.  The survey data is complemented by data on communities (collected in May and June 2000) and an exploration of some of the principal results from the survey data based on focus groups and other qualitative approaches (carried out in August and September 2000).  The interviews covered the background characteristics of the respondents, education history, work experience, a diary of their activities in the previous 24 hours, exposure to the school-based Life Skills Programme, sexual relationships, contraceptive and condom knowledge, attitudes and use, connectedness to school, family and community, alcohol and drug use, and reproductive history. Because the South Africa life skills initiative aimed to be a full coverage program, it was not possible to use a randomized control design to measure program impact. This is because schools initiated or developed life skills education at different speeds and intensities. The study therefore measured young peoples 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: 1) sexual abstinence to either postpone first sex (delay initiation), or for those already initiated to reduce risk through secondary abstinence; 2) reduced number of sex partners in the past 12 months; and 3) 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.