HIV/STI Risk-Reduction Intervention Efficacy with South African Adolescents Over 54 Months
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways This study provides compelling evidence that early, theory-based HIV/STI risk-reduction interventions can foster lasting shifts in sexual behaviors and the psychosocial drivers of behavior among South African adolescents. While not explicitly framed around social norms, the intervention indirectly influenced normative beliefs—particularly perceptions of parental approval and sexual negotiation self-efficacy—highlighting how targeting individual-level determinants rooted in social expectations can sustain protective behaviors over time.
Objectives The study aimed to test whether a culturally tailored, theory-driven HIV/STI risk-reduction intervention for early adolescents in South Africa could produce lasting reductions in unprotected intercourse and STI acquisition over a 54-month follow-up period.
Methods This cluster-randomized controlled trial involved grade 6 learners (mean age 12.4) in Eastern Cape Province, South Africa. Schools were randomly assigned to either the intervention or an attention-matched health-promotion control. Outcomes were measured at 3, 6, 12, 42, and 54 months post-intervention using self-reported sexual behavior, psychosocial scales based on social cognitive theory and the theory of planned behavior, and biologically confirmed STIs.
Intervention Details “Let Us Protect Our Future” was a 12-module HIV/STI risk-reduction intervention implemented over six sessions. Grounded in social cognitive theory and the theory of planned behavior, it used interactive methods (e.g., role-play, group discussions, comic book storylines) and was delivered in small, mixed-sex groups by trained facilitators. It aimed to increase knowledge, self-efficacy, outcome expectancies, and skills related to abstinence and condom use. Parental engagement was encouraged through take-home assignments.
Results The intervention significantly reduced reports of unprotected vaginal sex (OR = 0.42) and heterosexual anal sex, and increased communication with parents about abstaining from sex over the 54-month period. Effects on self-reported sexual activity and multiple partners were weaker or attenuated over time. Among sexually active adolescents, the intervention significantly reduced curable STIs at 42 months but not at 54 months. Across five post-intervention follow-ups, the intervention improved all targeted psychosocial constructs (e.g., self-efficacy, knowledge, perceived parental approval), though some effects diminished over time.
Conclusions This study demonstrates the long-term efficacy of early, culturally grounded HIV prevention interventions in sub-Saharan Africa. Even a brief, 12-hour program delivered in early adolescence can have enduring effects on risk behaviors and the psychosocial underpinnings of sexual decision-making. By enhancing perceived parental norms and communication, the intervention shows how social expectations, though not directly measured as community norms, can be shifted to support healthier adolescent behaviors.
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