December 2003

Programming for HIV Prevention in
Mexican Schools

Key Findings

The program did not increase sexual activity. The great majority of students were not sexually experienced and most continued to abstain from sex during and after the course. Although there was an increase in sexual activity among both male and female students, this increase was similar for both the intervention and control groups. At each measurement point, twice as many males as females reported being sexually experienced. For example, at baseline, 28 percent and 23 percent of males and 9 percent and 5 percent of females in the control and intervention groups, respectively, reported ever having had sexual relations. These proportions increased gradually and, at T4, 36 and 32 percent of male students and 18 and 12 percent of female students reported ever having had sex.

The program improved students’ knowledge, including knowing that abstinence prevents HIV, and this improvement was maintained one year after the intervention. Questions about HIV knowledge were grouped into three categories—transmission, potential consequences, and biomedical aspects—and knowledge scores were calculated for each. For all three categories the intervention and control groups scored similarly at baseline, but the intervention group demonstrated improved knowledge at T2, T3, and T4 compared to baseline figures, whereas there was little change in the control group. For example, at T1, mean knowledge scores on the biomedical aspects of HIV were 3.61 and 3.64 (out of a maximum of 5), respectively, for the control and intervention groups. At T2, the mean score for the intervention group increased to 4.38 (p < .05), while the control group remained stable (3.66). Again, these levels were maintained at T3. At T4, the intervention group’s mean score (4.27) remained higher than the control group’s (3.62) (p < .05).

When asked specifically about abstinence at baseline, about half of students in the control (47 percent) and intervention (53 percent) groups, respectively, knew that abstinence prevents HIV. During the second round of data collection, the proportion of students in the intervention group who understood that abstinence protects from HIV increased to 59 percent while the proportion in the control group actually decreased to 41 percent (p < .05). Similar figures were reported at T3 and T4.

Students in the intervention group gained confidence in their ability to obtain and use condoms. Based on the questions, “I am certain I can get a condom if I want to,” and “I am certain of how to use a condom effectively,” a variable was developed to measure confidence in obtaining and using condoms. At T1, 54 percent and 55 percent of male students and 20 percent and 17 percent of female students in the control and intervention groups, respectively, indicated that they felt confident in both obtaining and using condoms. At T2, within the intervention group, the proportion of students reporting confidence in obtaining and using condoms increased to 82 percent for intervention males, but only to 57 percent for control males (p < .001). For intervention females the increase was more striking com-pared to control females (67 vs. 32 percent; p < .001). The increase in confidence among the intervention group remained consistent through-out the other follow-up rounds of data collection (Figure 1).  

The program helped improve students’ attitudes about PLHA. Among the 946 students who participated in all rounds of data collection, at baseline, 69 percent of those in the control group and 73 percent in the intervention group agreed that an HIV-positive student should continue to go to school. After the intervention, 72 percent of students in the control group maintained this opinion, while the proportion in the intervention group increased to 89 percent (p < .001). A similar difference was also found at T4 (control: 77 percent; intervention: 87 percent; p < .001).

“A Team Against AIDS” did not have an effect on condom use among sexually experienced students. Questions about condom use, such as “Did you use a condom at last sex?” were grouped together, and a scale was created. Mean scores were elicited for all sexually experienced students to provide a measure of condom use behavior. No statistically significant differences occurred between the intervention and control schools at any point in the study. The few female students who were sexually experienced were as likely to use condoms as their sexually experienced male classmates.

Uncertainty about the study and cultural values about sexual activity made some students hesitant to answer. During FGDs, some students reported that a more careful explanation of study objectives would have been beneficial and would have positively influenced their attitudes about participation. Some also noted that the cultural values attached to virginity and sexuality made it difficult for them to respond to questions about sexual behavior. Also, some were concerned about whether the questionnaires were anonymous. Future studies must address these student concerns.

Teacher training was personally beneficial and essential to the teachers’ ability to teach the course. Teachers were extremely supportive of the curriculum and noted that the training gave them the confidence to talk about sexuality with adolescents and improved their HIV knowledge. For example, prior to training, teachers’ mean score on a scale measuring their knowledge about HIV/AIDS was 1.14 (out of 2). After the training, this score increased to 1.30 (p < .05). Similarly, the mean score on a scale that measured self-efficacy to teach the course changed from 1.07 (out of 3) to 2.29 (p < .05) post-training.

Intervention design needs to take into account differences between males and females. Although far fewer female students indicated ever having been sexually active compared to males, they were more likely to have sex consistently over the recall period of six months. Among the minority of Mexican students who reported having initiated sexual activity at baseline, 69 and 62 percent of males in the control and intervention groups, respectively, and 83 percent of females in both groups reported having had sex in the recall period. This finding suggests that females may have older, regular partners.

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This page updated
19 Oct 2007