Lessons learned: an update on the published literature concerning the impact of HIV and sexuality education for young people

Questions have been raised about the ability of HIV/AIDS and sexuality education for young people to modify behaviour, its potential for producing undesirable effects, and dubious rigour in evaluating it. A review of the literature conducted for the World Health Organisation’s former Global Programme on AIDS in 1993, and a more recent update commissioned by the United Nations Joint Programme on HIV/AIDS (UNAIDS) in 1997 examined these issues. The latter review of 68 articles found good support for the efficacy of HIV/AIDS and sex education in reducing unwanted outcomes of young people’s sexual behaviour. Of 53 articles describing specific interventions, 22 reported significant decreases in coital activity or its markers (e.g. pregnancy) in those who received the intervention(s) compared with controls, and 27 studies reported no effect. Although three studies found a positive relationship between receiving sex education and increased sexual activity, they should be viewed in the context of overwhelming evidence in the opposite direction, and methodological limitations to the extent to which they can be generalised. Lack of rigour and an adequate description of interventions is, however, a feature of many of the studies evaluating the effects of HIV/AIDS and sex education. Although the reviews demonstrate the value of appropriately conducted and targeted interventions, formal sex/HIV education is only one source of information about sexual issues for young people. Further, timing education prior to the onset of sexual intercourse may increase the chance that young people will adopt measures aimed at protecting their health.