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Indian Journal of Community Medicine

Evaluation of Sex Education and AIDS Prevention in Secondary Schools of Pune

Author(s): A.K. Pratinidhi, R.M. Gokhale, S.R. Karad

Vol. 26, No. 3 (2001-07 - 2001-09)

Abstract:

Research questions: 1. What is the change in the knowledge, attitude and decision making skills of the students after training in relation to sex and AIDS? 2. What is the perception of Nodal Teachers, Headmasters and Peer Educators about sex and AIDS education programme?

Objectives: To determine the change after training in relation to (i) Sex knowledge, (ii) AIDS knowledge, (iii) Attitude towards HIV infected person, (iv) decision making skills promoting healthy sexual behaviour.

Study design: Evaluation of 'sex and AIDS education project' both quantitatively and qualitatively.

Respondents: Secondary school children (IX and XI students), Nodal teachers and other teachers, Peer educators, Headmasters.

Study variables: Standard of the students, medium of instructions, sex of the student. Outcome: Change in knowledge, attitude and decision making skills in relation to above stated variables by scoring systems.

Statistical analysis: 'Z' test for mean and 't' test. Results: Significant improvement was seen in the areas of sex knowledge and AIDS knowledge during post training phase. Change in the scores in the areas of attitude and decision making skills were marginal.

Conclusion: Educational intervention strategy is useful for improving the knowledge of the students in relation to sex and AIDS.

Keywords : Sex education, AIDS prevention, Secondary school children

Introduction:

AIDS is a dreaded disease. At present, there is neither drug treatment for cure of the disease nor any effective vaccine to prevent the disease by medical intervention. Hence, Health Education i.e. IEC (Information, Education and Communication) activities bringing about behavioural changes in the community, promoting healthy sexual behaviour and preventing the risky ones is the best possible solution to the problem of AIDS.

Majority of the victims of HIV/AIDS are very young, under the age of 30 years, in the sexually active phase of life. It is, therefore, essential to 'catch them young'. Impart them knowledge on Sexology and STDs including AIDS before they indulge in high risk behaviour. Adolescent children are vulnerable to practice unsafe sex. Hence, this group is the most suitable target group for imparting IEC activities related to STDs including AIDS1-3.

Promotion of safe sex practices and prevention of high risk behaviour by sex and AIDS education to secondary school children can be considered as the most cost-effective way of combating AIDS, as school children are easily accessible1,4. Sevadham trust, an NGO from Pune undertook the project of education of school children about AIDS and sex to IX and XI standard students in Pune city. Sevadham trust conducted four days workshops for nodal teachers and peer educators. The teachers were given orientation of the programme and were also told about the expected contents (i.e. knowledge about sex, AIDS, healthy sexual behaviour etc.) of the training activities to be carried out in their respective schools. The peer educators were told about anatomy and physiology of reproductive system and were given AIDS knowledge (causation, modes of transmission and prevention). Importance of healthy sexual behaviour was emphasized. The nodal teachers or peer educators in presence of nodal teachers were expected to conduct training of general students in their respective schools.

The evaluation of the above said project was undertaken by Deptt. of Preventive and Social Medicine, B.J. Medical College, Pune.

Material and Methods:

For selection of sample, stratified random cluster sampling method was adopted. Stratification was done.

  1. According to the medium of instruction - English, Marathi, Urdu.
  2. The type of education i.e. co-education, schools only for boys and schools only for girls.
  3. The level of education facility upto SSC or SSC + Jr. College.

From each stratum, schools were randomly selected in such a way that representation from all types of schools was ensured. A cluster of 20 students was then identified from each selected school. The Headmaster/Principal, two nodal teachers and two peer educators from each school were interviewed. Thus it included 600 students, 60 peer educators, 60 nodal teachers and 30 headmasters.

Study period: July 1995 to March 1996.

In addition to pre and post training self filling of close ended questionnaire, observations were made on AIDS related activities in the school like essay competition, drama, street march etc. Anonymity and confidentiality were maintained throughout the study:

Methods used: Following were the techniques for collection of information from each category in the school.

Sources Tools/techniques
Headmasters Interviews with semi open-ended questionnaire.
Nodal Teachers Interviews with semi open-ended questionnaire.
Peer Educators Close ended questionnaire (pretested) + interview + observation of training sessions.
Students Close ended questionnaire (pretested) + focus group discussions.
Parents Group discussion.
Trainers of Sevadham team Observation of training sessions.

Results and Discussion: The evaluation work of sex and AIDS education project was started in the month of July 1995. The Headmasters/Principals from all 30 schools were contacted personally and a schedule of visits to the schools was planned.

Pre-training questionnaire was filled in by the students and peer educators. Anonymity of the filled in questionnaire was maintained. Non-participant observation of workshops organised by Sevadham training team for nodal teachers and peer educators were made on six occasions during Aug/Sept. 1995. Observations were also made of actual conduction of sessions in the schools by the nodal teachers and the peer educators. Post-training questionnaire was filled in after minimum period of one month after training sessions were conducted by nodal teachers and peer educators. Interviews of Headmaster/Principals, focus group discussion with the students and group discussion with parents were undertaken during post training visits to the schools.

Table I: Distribution of schools under the IEC project and evaluation study.

Type of School No. of schools
covered by
Sevadham
trust (n=89)
No. of
schools for
study (n=30)
Medium of instructions in the school under study
Marathi 50 18(60.0)
English 37 11(36.6)
Urdu 2 1(3.33)
Standard-wise distribution of schools
IX standard only 61 25(83.33)
IX and XI standard 28 5(16.66)
Sex-wise distribution of the schools
Co-education 62 20(66.66)
Exclusively for girls 18 5(16.67)
Exclusively for boys 9 5(16.67)

Distribution of schools covered by Sevadham Trust, Pune under the project and schools randomly selected for evaluation is given in Table I.

All those who were envisaged to be included in the sample could be contacted and there were no dropouts from the study population.

Table II: Mean marks secured by students during the pre and post training phases of sex education and AIDS education programme.

Standard Area of assessment with weightage of marks Total
Sex knowledge 42 AIDS knowledge 28 Attitude 14 Decision making skills 16 mean marks
IX standard (n=500) Mean marks (S.D.) secured by the students
Pre training 21(4.28) 11(4.19) 10(1.63) 9(2.16) 51(11.92)
Post training 29(2.23) 18(3.16) 14(2.35) 10(2.50) 71(8.99)
Increase in marks 8 7 4 1 20
Increase in percentage 19.05 25.00 28.57 6.25 20.00
t value 37 29.8 31.82 6.7 30.1
p value <0.001 <0.001 <0.001 <0.001 <0.001
XI standard (n=100)
Pre training 22(3.3) 11(11.01) 11(4.75) 10(3.1) 54(8.54)
Post training 31(3.5) 17(6.9) 14(3.88) 11(4.2) 73(4.84)
Increase in marks 9 6 3 1 19
Increase in percentage 21.43 21.43 21.43 6.25 19.00
t value 18.6 4.62 9.71 1.91 19.4
p value <0.001 <0.001 <0.001 NS <0.001

Table II shows that XI standard students had significantly higher mean total score as compared to IX standard students in the pre-training evaluation (p<0.05).

The higher scores in areas of sex knowledge, attitude and decision making skills observed in XI standard students were also significant (p<0.05, <0.001, <0.001 respectively).

Students from IX and XI standards when independently tested in the areas of sex knowledge, AIDS knowledge, attitude and decision making skills, there was a significant improvement in all the four areas for both IX and XI standard students except in decision making skill for XI standard students. Improvement in the area of attitude was maximum for IX standard students followed by AIDS knowledge and sex knowledge. Whereas, for XI standard students same increase i.e. 21.43% was seen in all the three areas, improvement in decision making skills appeared to be the most difficult. Most of the situations in which the decision making skills were evaluated, students might not be familiar with them. It might have appeared abstract and ambiguous to them and hence they might not have responded correctly. When training is given in the form of anecdotes and case studies related to real life situations it may help them in improving the decision making skills.

Post-training mean total score was significantly higher for XI standard students as compared to IX standard students. The improvement was also significant in individual areas of sex knowledge, AIDS knowledge and decision making skills.

Table III: Mean marks secured by Peer Educators during pre and post training phases of sex education and AIDS education programme (n=60).

Standard Area of assessment with weightage of marks Total
Sex knowledge 42 AIDS knowledge 28 Attitude 14 Decision
making
skills 16
mean marks
IX standard (n=50) Mean marks (S.D.) secured by the peer educators
Pre training 23(5.01) 19(4.65) 10(2.27) 8(3.35) 60(6.96)
Post training 35(1.89) 24(2.06) 13(1.83) 13(2.08) 85(3.01)
Increase in marks 12 5 3 5 25
Increase in percentage 28.57 17.86 21.43 31.25 25.00
t value 15.8 6.9 7.2 8.9 23.4
p value <0.001 <0.001 <0.001 <0.001 <0.001
XI standard (n=100)
Pre training 24(2.65) 20(4.22) 13(3.95) 9(3.25) 66(26.45)
Post training 37(1.84) 27(2.12) 13(2.37) 12(2.14) 89(3.13)
Increase in marks 13 7 0 3 23
Increase in percentage 30.95 25.00 0 18.75 23.00
t value 12.7 4.7 0 2.4 2.7
p value <0.001 <0.001 NS <0.05 <0.05

Peer educators of IX and XI standards were tested in the areas of sex knowledge, AIDS knowledge, attitude and decision making skills. The mean total pre-training score of XI standard peer educators was found to be significantly higher than the peer educators from IX standard. Although marked improvement in post-training phase was seen in both IX and XI standard peer educators, it was significantly more in the XI standard peer educators. The scores for attitude were same for the students and peer educators of IX standard during pre-training phase, whereas, higher mean score was seen for attitude of the peer educators of XI standard as compared to the students of the same standards. Surprisingly, lower decision making skills were observed for peer educators of both IX and XI standards as compared to the students of corresponding standard (p<0.05) before training.

The total mean post training scores were significantly higher in the peer educators as compared to the students of the corresponding standards. Similar trend was seen in all the areas of assessment, except attitudinal change. It is not surprising to see higher scores for peer educators during post training phase, as they had received training in the specially conducted workshops for two days duration by Sevadham Trust. The post training score obtained by peer educators could be looked upon as an indication of the score attainable by the students with some additional efforts. The nodal teachers and peer educators had only one session with the students on AIDS and sex education. If these sessions are repeatedly conducted during the year at regular intervals, it is likely that the general students population may also attain a level which is comparable to that attained by the peer educators.

Table IV: Mean marks secured by the students having access to mass media during pre and post training phase (n=600).

Standard Area of assessment with weightage of marks Total
Sex knowledge 42 AIDS knowledge 28 Attitude 14 Decision
making
skills 16
mean marks
some media (n=539)
Pre training 22 12 10 9 53
Post training 29 18 14 12 73
Increase in marks 7 6 4 3 20
Increase in percentage 16.67 21.43 28.57 18.75 20.00
t value 19.07 34.09 16.12 14.15 20.8
p value <0.001 <0.001 <0.001 <0.001 <0.001
No Media (n=61)
Pre training 21 10 10 8 49
Post training 25 16 13 10 64
Increase in marks 4 6 3 2 15
Increase in percentage 9.52 21.43 21.43 12.50 15.00
t value 5.48 17.09 6.63 3.92 6.22
p value <0.001 <0.001 <0.001 <0.001 <0.001

It was observed that the students having access to mass media i.e. television, radio and newspaper had higher baseline scores of total mean marks as compared to those who did not have access to any mass medium and the difference was statistically significant. The significant difference in the total mean marks persisted even in the post training phase. Hence, it is recommended that the training package should take special efforts for the students who did not have access to any type of mass medium, so that they can attain the level of marks during post training phase as attained by the students having access to some mass media, specially television.

Further scrutiny of marks secured by the students in individual areas of assessment indicated that the students with access to some mass media scored significantly higher marks in the areas of AIDS knowledge and decision making skills as compared to students having no access to any mass medium. This difference persisted in the post training phase also. The training package, in fact is expected to abolish these differences so that all the students attain a certain level of marks irrespective of accessibility to any mass medium.

Qualitative observations:

Informal interviews were conducted with different categories of respondents like Headmasters, Nodal Teachers, Peer Educators and Parents.

The intention of these interviews was to know the perceptions of these categories of respondents about the programme, their opinions about the necessity of AIDS and Sex Education activities, the difficulties experienced by them and their suggestions to overcome these difficulties in order to strengthen the programme.

  1. Headmasters: Most of the Headmasters/Principals were convinced about the necessity of AIDS and Sex Education Programme but some of them lacked the desired motivation. The difficulties pointed out by them were inability to spare time and manpower for conducting the AIDS and sex education activities in the tight teaching schedule and limited number of teachers. The transfer of trained teachers was also an obstacle in the sustainability of the programme. In order to prevent collapsing of the programme for want of nodal teachers, some headmasters suggested training of more teachers who can act as nodal teachers.
  2. Nodal Teachers: almost all the nodal teachers felt that AIDS and sex education programme was the need of the hour.

The crucial problems identified by them were time adjustment for AIDS and sex education activities and transfer of trained teacher to other school. Some also expressed the need of lowering the burden on nodal teachers of other extra curricular school activities so that they could concentrate on AIDS related activities.

The suggestions given by them were:

  1. Training of more number of teachers from each school to act as nodal teachers.
  2. The nodal teachers from one school may train the students from some other school so that inhibition experienced by the students to discuss the delicate issues like sex and STDs with their own teachers could be minimised.
  3. There should be refresher training courses under the programme.
  4. There was a need of periodic meeting of nodal teachers with the trainers to discuss the problems in conducting the AIDS related activities and seek solutions to them.

The trainers' team should give backup support for solving problems in conducting training sessions for general student population by nodal teachers and peer educators. They should also reinforce the training of teachers by periodic meeting with the nodal teachers and peer educators during which difficult and off-beat questions asked by the students could be answered.

It should be ensured that the training material in the form of charts and posters should be provided to all the schools as it was found that some schools were not supplied with the training charts.

The sex and AIDS education should be included in the teaching curriculum so as to achieve the desired weightage.

Some nodal teachers felt and the DOs and DON'Ts for prevention of AIDS and STDs and promotion of healthy sexual behaviour should be stressed as per the need of the local situation.

  1. Peer Educators: Interviews with peer educators revealed that peer educators were satisfied with the programme conducted by Sevadham Training team. The peer educators conducted teaching sessions for other students on AIDS and sex education in presence of the nodal teachers.

The peer educators told that when AIDS and sex education was given by them to the general student population, some students asked questions and peer educators could not give satisfactory answers to all the questions. Hence, they demanded periodic visits by the training team to answer these queries.

  1. Students (Group discussion): The students were eager to know more and more about AIDS and many of them had some information about AIDS through mass media. They had many doubts, questions about sex and AIDS and felt embarrassed to ask such questions form their teachers and parents. The peer educators could not give satisfactory answers to all the questions. Hence they recommended that a 'Question Box' should be kept in all schools wherein the students can drop chits of questions. The training team should periodically visit the school to answer these questions.*

Recommendations:

Headmasters being the key persons in the success of the programme, efforts for motivation of Headmasters should be strengthened, so that selection of nodal teachers and peer educators, planning and implementation of programme will improve at the level of the schools.

Common problems of nodal teachers such as time constraint should be taken into account before planning the training sessions.

It should be ensured that all the students should acquire knowledge in key areas like mode of transmission of STDs and HIV and importance of healthy sexual behaviour.

References:

  1. AIDS Education in Schools. A Training Package; NCERT/NACO Publication, New Delhi. Oct. 1994.
  2. AIDS Prevention. Training for adolescent students. Module of Directorate of Health Services, Maharashtra State, Mumbai, 1993.
  3. World Health Organization, WHO 1994, AIDS Images of Epidemic, Geneva, 19-22.
  4. HIV and AIDS. Towards coherent approach for the schools. Micha Marland. 1990.
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