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School Based Sex Education and HIV Prevention in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

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Listed:
  • Virginia A Fonner
  • Kevin S Armstrong
  • Caitlin E Kennedy
  • Kevin R O'Reilly
  • Michael D Sweat

Abstract

Objectives: School-based sex education is a cornerstone of HIV prevention for adolescents who continue to bear a disproportionally high HIV burden globally. We systematically reviewed and meta-analyzed the existing evidence for school-based sex education interventions in low- and middle-income countries to determine the efficacy of these interventions in changing HIV-related knowledge and risk behaviors. Methods: We searched five electronic databases, PubMed, Embase, PsycInfo, CINAHL, and Sociological Abstracts, for eligible articles. We also conducted hand-searching of key journals and secondary reference searching of included articles to identify potential studies. Intervention effects were synthesized through random effects meta-analysis for five outcomes: HIV knowledge, self-efficacy, sexual debut, condom use, and number of sexual partners. Results: Of 6191 unique citations initially identified, 64 studies in 63 articles were included in the review. Nine interventions either focused exclusively on abstinence (abstinence-only) or emphasized abstinence (abstinence-plus), whereas the remaining 55 interventions provided comprehensive sex education. Thirty-three studies were able to be meta-analyzed across five HIV-related outcomes. Results from meta-analysis demonstrate that school-based sex education is an effective strategy for reducing HIV-related risk. Students who received school-based sex education interventions had significantly greater HIV knowledge (Hedges g = 0.63, 95% Confidence Interval (CI): 0.49–0.78, p

Suggested Citation

  • Virginia A Fonner & Kevin S Armstrong & Caitlin E Kennedy & Kevin R O'Reilly & Michael D Sweat, 2014. "School Based Sex Education and HIV Prevention in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-18, March.
    • Handle: RePEc:plo:pone00:0089692
    DOI: 10.1371/journal.pone.0089692
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    References listed on IDEAS

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    3. Najafi, M. Kazem & Alizadeh, Zahra & Dehghani, Mahnaz & Herzog, Philipp & Azimisefat, Parisa, 2024. "Breaking taboos in sex education to promote self-protective knowledge and skills in children: A human-centered, stakeholder co-design approach for developing a cross-cultural sensitive board game," Children and Youth Services Review, Elsevier, vol. 162(C).
    4. Alberto Chong & Marco Gonzalez-Navarro & Dean Karlan & Martín Valdivia, 2020. "Do Information Technologies Improve Teenagers’ Sexual Education? Evidence from a Randomized Evaluation in Colombia," The World Bank Economic Review, World Bank, vol. 34(2), pages 371-392.
    5. Fatima Zahra & Nicole Haberland & Stephanie Psaki, 2022. "PROTOCOL: Causal mechanisms linking education with fertility, HIV, and child mortality: A systematic review," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(2), June.
    6. Victor Orozco-Olvera & Fuyuan Shen & Lucie Cluver, 2019. "The effectiveness of using entertainment education narratives to promote safer sexual behaviors of youth: A meta-analysis, 1985-2017," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-14, February.
    7. Morales, Alexandra & Garcia-Montaño, Eileen & Barrios-Ortega, Cristian & Niebles-Charris, Janivys & Garcia-Roncallo, Paola & Abello-Luque, Daniella & Gomez-Lugo, Mayra & Saavedra, Diego Alejandro & Va, 2019. "Adaptation of an effective school-based sexual health promotion program for youth in Colombia," Social Science & Medicine, Elsevier, vol. 222(C), pages 207-215.

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