Rethinking HIV-prevention for school-going young people based on current behaviour patterns.
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Perceived social norms—especially peer expectations around sexual activity—were the strongest predictors of risk behavior. Gender norms that promote male dominance and discourage condom use contribute to risky practices. The study underscores the need to reshape social norms through peer group interventions, gender-transformative education, and community-wide engagement, particularly involving caregivers. Sustainable change requires shifting both individual beliefs and the broader social structures that influence youth behavior.
Objectives The study aimed to understand current sexual risk behaviors among school-going youth in South Africa, assess factors underlying these behaviors, and evaluate how well the Theory of Planned Behavior (TPB) and Social Ecological Theory (SET) explain sexual decision-making. The goal was to inform more effective HIV prevention strategies for schools.
Methods A cross-sectional behavioral survey was conducted with 5,305 learners aged 10–18 from 142 schools in four high-risk provinces. The survey measured self-reported sexual risk behavior, HIV knowledge, attitudes, social norms, gender norms, and caregiver relationships. Statistical analyses included descriptive statistics, t-tests, and stepwise regression to identify predictors of risk behavior and condom use.
Results Nearly half of senior boys and nearly a third of senior girls reported lifetime sexual activity. Condom use was inconsistent, and HIV knowledge was low, with only 37.8% of learners answering knowledge questions accurately. Regression analysis showed that perceived peer norms, negative attitudes toward abstinence, substance use, and adherence to traditional gender norms were key predictors of risky sexual behavior. Positive relationships with caregivers and self-efficacy were protective factors.
Conclusions The findings highlight persistent sexual risk behaviors among youth despite decades of school-based HIV education. Effective HIV prevention must go beyond knowledge-sharing to address peer pressure, gender norms, and substance use, particularly among boys. The TPB proved useful in predicting behavior, but social and community-level influences, as emphasized by SET, were also critical.
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