Effects of PREPARE, a Multi-component, School-Based HIV and Intimate Partner Violence (IPV) Prevention Programme on Adolescent Sexual Risk Behaviour and IPV: Cluster Randomised Controlled Trial
Outcomes: Gender‑Based Violence, Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways This study measured social norms explicitly, focusing on perceived expectations from peers, family, and partners around condom use and delaying sex. The intervention addressed both descriptive and injunctive norms by attempting to shift young people’s perceptions of what behaviors are typical and appropriate in their communities. While the intervention improved knowledge and some attitudes related to HIV prevention, it did not significantly alter social norms or risk behaviors. However, the program’s success in reducing intimate partner violence suggests that interventions targeting gender norms and relationship expectations may have stronger effects than those aiming to influence sexual risk behavior through norm change alone. This highlights the complexity of changing sexual behavior and the importance of addressing a broader set of structural and relational norms.
Objectives To assess whether a multi-component school-based intervention could delay sexual debut, increase condom use, reduce number of sexual partners, and decrease intimate partner violence among South African adolescents.
Methods A cluster-randomized controlled trial was conducted in 42 public high schools in Western Cape province, enrolling 3,451 Grade 8 students. Surveys at baseline, 6 months, and 12 months measured behaviors and motivational factors, including social norms related to condom use and delaying sex.
Intervention Details The intervention combined: (1) 21 weekly after-school educational sessions on HIV, relationships, and gender using interactive, skills-based methods; (2) school-based sexual and reproductive health education and referrals; and (3) a school safety initiative including staff training and a Photovoice project. Facilitators emphasized communication, decision-making, values, and gender norms.
Results No significant differences were found between intervention and control groups in sexual debut, condom use, or number of partners at 12 months. However, participants in the intervention group had higher HIV and condom knowledge and were significantly less likely to report experiencing intimate partner violence (35.1% vs. 40.9%). Social norms measures showed little change. Participants who attended more sessions reported improved attitudes and reduced IPV, but not significant behavior changes.
Conclusions While the intervention did not change sexual behaviors, it reduced intimate partner violence and improved knowledge. This suggests that targeting gender norms and relationship dynamics may be more effective than solely addressing sexual risk behavior. Shifting entrenched social norms likely requires more intensive, sustained efforts integrated with broader structural support.
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