Abstract

Southern Africa remains the epicentre of the human immunodeficiency virus (HIV) epidemic with AIDS the leading cause of death amongst adolescents. Poor policy translation, inadequate programme implementation and fragmentation of services contribute to adolescents’ poor access to sexual and reproductive health and rights (SRHR) services. This study assessed an integrated, school-based SRHR and HIV programme, modelled on the South African Integrated School Health Policy in a rural, high HIV-prevalence district. A retrospective cohort study of 1260 high-school learners was undertaken to assess programme uptake, change in HIV knowledge and behaviour and the determinants of barrier-methods use at last sexual intercourse. Programme uptake increased (2%–89%; P < 0.001) over a 16-month period, teenage-pregnancy rates declined (14%–3%; P < 0.050) and accurate knowledge about HIV transmission through infected blood improved (78.3%–93.8%; P < 0.050), a year later. Post-intervention, attending a clinic perceived as adolescent-friendly increased the odds of barrier-methods use during the last sexual encounter (aOR=1.85; 95% CI: 1.31–2.60), whilst being female (aOR=0.69; 95% CI: 0.48–0.99), <15 years (aOR=0.44; 95% CI: 0.24–0.80), or having >5 sexual partners in the last year (aOR=0.59; 95% CI: 0.38–0.91) reduced the odds. This study shows that the unmet SRHR needs of under-served adolescents can be addressed through integrated, school-based SRHR programmes.

中文翻译：

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在资源有限的环境中向高中青少年提供综合的性生殖健康和权利以及艾滋病毒计划

摘要

南部非洲仍然是人类免疫缺陷病毒 (HIV) 流行病的中心，艾滋病是青少年死亡的主要原因。政策翻译不力、计划实施不力和服务分散导致青少年难以获得性和生殖健康及权利 (SRHR) 服务。本研究评估了一个综合的、以学校为基础的 SRHR 和 HIV 项目，该项目仿照南非一个 HIV 高流行地区的综合学校卫生政策。对 1260 名高中生进行了一项回顾性队列研究，以评估项目的接受情况、艾滋病毒知识和行为的变化以及最后一次性交时使用屏障方法的决定因素。计划采用率增加（2%–89%；P < 0.001）在 16 个月的时间里，少女怀孕率下降（14%–3%；P  < 0.050），并且对通过受感染血液传播 HIV 的准确知识有所提高（78.3%–93.8%；P  < 0.050），一年之后。干预后，参加被认为对青少年友好的诊所增加了在最后一次性接触期间使用屏障方法的几率（aOR=1.85；95% CI：1.31–2.60），而女性（aOR=0.69；95% CI） ：0.48–0.99）、<15 岁（aOR=0.44；95% CI：0.24–0.80）或去年有超过 5 个性伴侣（aOR=0.59；95% CI：0.38–0.91）降低了几率。这项研究表明，服务不足的青少年未满足的 SRHR 需求可以通过综合的、以学校为基础的 SRHR 计划来解决。