Resumen
Between 2010-2014, Fundacion Huesped and the Youth for Health Network implemented a sexuality education program, dance4life, in public schools in Argentina. A process evaluation was conducted in 2014 to assess the implementation of the program between 2010 and 2013, and make preliminary assessments of the impact on youth sexual and reproductive health.
A mixed-methods approach (qualitative-quantitative), using validated tools and frameworks, was applied through self-reported surveys, semi-structured interviews, and focus groups with students, peer educators, teachers, and staff. This was complemented by a desk review of past reports and program-related documents.
According to UNAIDS, there are 36.7 million [34.0 million–39.8 million] people living with HIV globally (1). This number has been increasing since the early nineties, although the level at which it is increasing has declined since 2000; this is thought to be a product of a greater number of people on antiretroviral treatment (ART) who are now living longer. On the other hand, there has been a decrease in total new infections, from 3.2 million in 2000, to 2.1 million in 2015, as well as a decrease in new infections among children under 15: from 490,000 [430,000–560,000] in 2000 to 150,000 [110,000–190,000] in 2015 [1]. Of these new infections, 14% are among young men 15-24 years old, and 20% are among young women 15-24 years old. There has also been a decline in AIDS-related deaths, from 1.5 million (1.3-1.8) in 2000, to 1.1 million (940,000-1.3) in 2015 and a significant increase in people on ART: from 770,000 in 2000 to 17 million in 2015.
In Argentina, an estimated 120,000 people were living with HIV in 2015 (an HIV rate of 13.5/100,000), and as with many other middle-income countries, there are great geographical differences [2]. The HIV rate in the Autonomous City of Buenos Aires (CABA) is estimated at 26.6, whereas it is estimated at 4.8 in the province of Santiago del Estero and 7.2 in Formosa [2]. Young people 15-24 years of age represent 16.6% of the total national population (if including 25-29 year olds, it raises to 24.3%) [3]. Social determinants of health put young people at increased risk of infection, and poor outcomes [4,5].
The program successfully trained over 2,000 “agents4change” (youth facilitators) over the four year period. The experiences reported were generally positive, highlighting peer-education as the most novel and attractive component for all the stakeholders. Educators and young people reported that the fact that this was a global program with international involvement was one of the positive aspects. 93% of respondents correctly identified modes of HIV transmission. Correct knowledge on contraceptive use was also high: 68% for the injectable; 99% for the condom. Positive changes in attitude were reported: 72% of respondents indicated great change in their respect for people living with HIV, and 60% in their capacity to openly talk about sexuality (60%). 80% said they knew how to avoid unwanted sex.
Although the dance4life program had overall positive results, including increasing awareness of sexuality and confidence in decisions about sex, there are issues that would need to be addressed: e.g. project sustainability assuring lasting effects on school culture, and health system integration to improve health outcomes. Having baseline and monitoring data is critical to compare changes in young people’s knowledge, attitudes, and practices about sex and HIV.