For the purposes of this review, schools are defined as any formal educational establishment providing training or education to youths who are younger than 25 years of age. As the field of HIV prevention evolves, schools are increasingly being included as part of multicomponent HIV interventions. This review evaluates such interventions only if the specific impact of the school intervention has been separately evaluated or if the school component represents the major part of the overall intervention and a substantial part of the overall impact of the intervention could be attributed to the school intervention.
A large number of sex education and HIV education interventions are being implemented in schools worldwide. They vary widely in terms of objectives, structure, length, content, implementation strategy and other characteristics (4, 12, 13). In practice, however, the choice and implementation of interventions in schools in developing countries is constrained by the availability of teachers and curricular materials as well as teacher training; access to other financial, material and technical resources; and the culture and norms of both the local communities and the schools themselves (9, 15). Inadequate levels of training and the prevalence of didactic teaching methods may mean that teachers are sometimes unable to use the participatory, student-centred techniques that are often necessary for effective skill building (6, 9). Furthermore, in many societies, resistance among teachers to discussing sexual behaviour with adolescents or issues such as age, sex and status differentials may mean that pupils or teachers, or both, feel uncomfortable discussing sexual matters in the classroom (8, 16). Resistance to discussing the use of condoms is particularly widespread in schools (2, 9); authors have reported that sometimes, where discussions of condoms are included in an intervention, the information communicated to pupils about condoms has been mostly negative in order to discourage condom use and encourage abstinence (17).
In order to overcome some of these obstacles to school-based interventions, programme developers and staff have provided structured curricula to guide activities, have trained teachers, and have involved trained individuals other than teachers in delivering the interventions. Curriculum is defined here as an organized set of activities or exercises designed to convey specific knowledge, skills or experiences in an ordered or incremental fashion. Such activities may be implemented either in the classroom during the school day or after school.
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