Mixed methods study of SKILLZ for HIV prevention among adolescents in Ukraine

DETAILED SUMMARY

Importance

• The expansion and improvement of HIV education is critical to preventing the spread of HIV. The majority of HIV efforts in Ukraine are focused on secondary prevention and not on HIV-prevention. Due to the high number of people living with HIV in Ukraine, the purpose of the evaluation was to assess the effectiveness of the programme and develop strategies to improve its efficiency and effectiveness.

Objective

• To evaluate whether Free Kick improves HIV-related knowledge, attitudes, communication, and uptake of HIV testing services among youth aged 14–18 years, compared with no intervention or standard community activities in community-based camp settings across Ukraine.

Study details

• Study design: Mixed methods study with control group
• Data collection tools: In-person interviews; attendance registers, pre/post questionnaires, tracking short-term changes, and number of graduates
• Participants: Adolescents aged 14-18 years, Master Coaches, youth leaders, trainers and experts; community members who observed football tournaments or took part in HIV testing
• Implementation setting: Secondary schools, vocational schools, and communities in Ukraine (peri-urban and urban)
• Study period: 2013-2014

Intervention

• Other (Free Kick Program): i) a 7-session curriculum delivered during a 2- or 3-day camp; ii) soccer tournament; and iii) an opportunity to undergo HIV counselling and testing for participants and community members.

Results

• Communication about HIV improved. The share who had discussed HIV with an adult in the past two months rose from 37% to 71% (+33%), and discussion with a friend rose from 24% to 62% (+38%). For juvenile detainees, gains were approximately half as large (+15% and +22%, respectively),
• Readiness to take an HIV test increased slightly among all participants (89% to 92%), and remained high but marginally declined among juvenile detainees (94% to 93%)
• The share of all participants who said they would avoid a classmate with HIV dropped from 63% to 84%.
• Among all participants, confidence in HIV avoidance skills rose from 78% to 93% and the ability to refuse sex even when peers were having it rose from 74% to 87%.
• Quotes: 
  • “A friend of mine told me that he was not scared; it was just that the life was not the same without his beloved person. Now I can only dream about it. I want to find a person I will love, a person with HIV.” (Participant)
  • “A person can be a good person, a good family man/woman, but that’s just the way the circumstances have developed and he/she got infected with HIV… I have changed my attitude towards them.”

Conclusions and implications

• The Free Kick program produced meaningful improvements in HIV-related communication, stigma reduction, testing uptake, and behavioral self-efficacy among Ukrainian youth, with the education components (particularly case studies and role-plays) identified as the primary drivers of attitude change.