EDITORIAL: Assessing the Impact of Sexuality and HIV/AIDS Education in Africa

Friday Okonofua

Abstract

Since the dawn of the HIV/AIDS epidemic, the centrality of sexuality education and HIV/AIDS education as critical in efforts to curtail the disease has come to the fore. Before HIV/AIDS, sexuality education was a difficult paradigm to propose in Africa, with many stakeholders believing that sexuality education would promote sexuality and increase promiscuity among youth. With a continent rankled by religious and cultural fundamentalism, this belief rapidly gained support, and till date has not completely gone away. With the onset of HIV/AIDS and its predilection to affect un-educated and ignorant African population, policymakers have begun to accept the concept of sexuality education as key to eradicating the disease1. Educating young people and other vulnerable persons reduces the risk of HIV infection by encouraging them to assert their sexual and reproductive health and rights in a responsible manner. Education also enables all sexually active youth and adults to undergo HIV testing, and empowers them to respond to testing results in the most appropriate and sensible manner. In particular, for the large number of HIV positive persons in the continent, sexuality education enables them to seek appropriate medications, to respond to disease or treatment complications in an evidence-based manner, and to comply with prevention and treatment methods in ways to reduce the chances that they would transmit the disease to others. In many parts of Africa, HIV/AIDS prevalence and mortality burden appear to be falling or are stabilizing. Much of this fall or curtailment can be attributed to sexuality education, which has been the main focus of the HIV/AIDS control measures in the continent. HIV/AIDS education remains the number one intervention that has been implemented by many African countries for the control of HIV/AIDS,
and remains part of all HIV/AIDS interventions in the continent. However, despite the key role of sexuality and HIV/AIDS education, there has been limited research that evaluates the impact of sexuality education, or even the practice of sexuality education in the continent. Measuring its impact would be important to challenge some continuing opposition to its practice and to determine how best to implement its tenets to achieve higher level of effectiveness and impact for HIV/AIDS prevention. It is within this context that the editorial board of the African Journal of Reproductive Health is pleased to publish two articles in this edition2,3 that report the results of a national assessment of the implementation of sexuality and HIV/AIDS education in Nigeria. Nigeria has the second highest burden of HIV/AIDS (in terms of absolute numbers) in the continent, with sexuality education being the main intervention being applied by governments and non-governmental organizations at national and sub-national levels for the curtailment of the disease. Right from the early 1990s till date, sexuality and HIV/AIDS education focusing on youth has been implemented throughout the country. The two papers published in this edition3, 4 report the results of a national research and evaluation survey conducted by the University of Ibadan multidisciplinary research and evaluation group (INSERT) in 2014. To our knowledge, this is the first effort to document an assessment of the extent and depth of implementation of the nationally approved sexuality and HIV/AIDS education curriculum in Nigeria. The report shows several gaps in implementation, including poor quality teaching methods and the exclusion of adolescents who are not in school. However, the nature of these gaps needs to be further understood in order to strengthen and improve current strategies for constraining the disease.
Okonofua Impact of Sexuality Education
African Journal of Reproductive Health June 2015; 19 (2) : 10
The editorial board of the journal strongly believes that there is a need to go beyond assessment of the implementation to research that evaluates the impact of sexuality and HIV education on various sexual and reproductive health indicators in the continent. Nigeria recently witnessed a decline in the prevalence of HIV/AIDS from over 5% in the 1990s to 3.4% in 20135, although marked differences still exist between different States and geo-political zones in the country. The extent to which sexuality and HIV/AIDS education has contributed to this decline is not known. Also, not known is the extent to which sexuality education ameliorates other sexual and reproductive health indicators for sexually active persons, which serve as the precursors and risk factors for acquiring and spreading the virus. A review of 80 studies that measure the impact of sexuality and HIV/AIDS education for young people throughout the world5 showed the programs to be effective in reducing sexual risk behaviours, and increasing the use of condoms during unsafe sexual encounters. However, in low income countries characterized by poor access to sexual and reproductive health information and services, HIV discrimination and stigma, cultural and religious dogmas and low status of women, the magnitude of the benefits of sexuality education may not be as profound as those witnessed in high income countries. Also, socio-economic disadvantages - high rates of poverty and unemployment – which prevail in Africa, may place youth and other vulnerable persons in positions where they may not be able to act appropriately on the tenet of sexuality and reproductive health education. Clearly, there is a critical unmet need for intervention and evaluatory research that tests the effectiveness and relative effectiveness of
sexuality and HIV/AIDS education curricular or training programs in the African continent. Such research would identify what works or do not work in implementing sexuality and HIV/AIDS education, and would help to develop strategies for scaling the sustained prevention of HIV/AIDS throughout the continent. Also within the context of the present “fence-seating” by policymakers on issues relating to sexuality education, the provision of accurate and compelling data that proves its effectiveness will be crucial for attaining the much needed political will for implementing sexuality education and addressing HIV/AIDS and other sexual and reproductive health challenges in the continent.

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References

Okonofua FE, Hammed A, Nzeribe E, Saidu BB, Abass T, Adeboye A, Adegun T, Okorocha C. Perceptions of policymakers towards maternal mortality and unsafe abortion in Nigeria. International Perspectives of sexual and Reproductive Health 2009, 35(4): 194-202. 2. Ezebunwa Nwokocha, Ifeoma Isiugo-Abanihe, Femi Omololu, Uche Isiugo-Abanihe and Bola Udegbe. Implementation of Family Life and HIV/AIDS Education in Nigerian Schools: A Qualitative Study on Scope, Delivery and Challenges 3. Bola I. Udegbe, Funke Fayehun, Uche C. Isiugo- Abanihe, Williams Nwagwu, Ifeoma IsiugoAbanihe and Ezebunwa Nwokocha. Evaluation of the Implementation of Family Life and HIV Education Programme in Nigeria 4. Federal Republic of Nigeria. Global AIDS Response, Country Report, Nigeria 2013. 5. Kirby D et al. Sex and HIV education programs: Their impact on sexual behaviours throughout the world. Journal of Adolescent Health 2007; 40, 206-217.

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