Comprehensive Sexuality Education Linked to Lower Rates of HIV, Pregnancy Among Adolescent Girls

Comprehensive sexuality education (CSE) and school attendance were associated with a reduction in “risky” sexual behaviors among girls aged 12 to 18 years, according to a study published in Journal of Acquired Immune Deficiency Syndromes: JAIDS.

According to the study, exposure to CSE was also associated with increased access to HIV testing among adolescent girls, regardless of whether they were actively in school.

To understand the relationship between CSE and risky behavior that may result in unintended pregnancy or HIV among school-aged adolescent girls, researchers collected data from 9673 girls aged 12 to 18 years in South Africa. The median (IQR) age was 15 years (13-17).

The household-based representative sample showed that most respondents were enrolled in school (89.4%) and (59.9%) received CSE within the past 12 months (59.9%).

The authors also found that 27.9% of respondents had 1 parent who was no longer alive, 5.1% of adolescents had HIV, and 8% of caregivers had HIV.

For adolescents who were sexually active, 30.8% had previously been pregnant, 25.8% had at least 1 sexual partner who was 5 or more years older, 39.8% had at least 2 sexual partners in their lifetime, and 6.8% had engaged in transactional sex.

Overall, the adolescent girls who were enrolled in school and had attended CSE within 12 months of taking the survey had reduced odds of acquiring HIV. When stratified by the full sample and girls who were sexually active, both adjusted odds ratios (AORs) were still reduced (full sample: AOR: 0.76; 95% CI, 0.61-0.95; P < .05; sexually active sample: AOR: 0.62; 95% CI, 0.40-0.96; P < .05).

Although school attendance alone was not significantly associated with HIV status for either sample, it was associated with reduced odds of the following:

• Engaging in sexual activity
• Early sexual debut
• Engaging in transactional sex
• Engaging in age disparate sex
• Using condoms inconsistently in the previous 12 months
• Having 2 or more sexual partners in the previous 12 months
• Having ever been pregnant

Further, regardless of school enrollment, adolescent girls who attended CSE in the previous 12 months were more likely to get tested for HIV and were more confident in obtaining condoms compared with those who had not attended CSE.

The study authors added that although the results demonstrated self-efficacy among the participants regarding HIV testing and condom access, condom access does not necessarily correlate to condom use.

“CSE within the schooling system should work in tandem with adolescent access to sexual and reproductive health services,” the authors said. “Access to contraception and HIV and sexually transmitted infection testing remains critical.”

They also noted limitations of their study, most notably not including other factors that could play a role in adolescents’ sexual behaviors. Additionally, pregnancy or HIV contraction could have happened before CSE attendance.

“Future studies would benefit from using longitudinal data to assess the impact of prolonged exposure to CSE on risky sexual behaviour,” the authors said.

Reference

George G, Beckett S, Reddy T, et al. The role of schooling and comprehensive sexuality education in reducing HIV and pregnancy among adolescents in South Africa J Acquir Immune Defic Syndr. Published online March 18, 2022. doi:10.1097/QAI.0000000000002951