Mixed Methods Study of Two HIV Prevention Programs for Youth in Ethiopia

DETAILED SUMMARY

Importance

• Adolescents and young adults in Ethiopia face elevated risk of HIV infection but have limited access to youth-friendly prevention programs. This evaluation examined Youth Action Kit (YAK) and Sports for Life (SFL).

Objective

• To evaluate whether YAK and SFL improve HIV knowledge, communication, and protective behaviors among mixed-gender adolescents and young adults over 12–15 months in Ethiopian schools and youth clubs.

Study details

• Study design: Pre/post intervention study (mixed methods); no control group
• Data collection tools: Pre- and post-surveys; knowledge tests; attitudinal scales; behavior questions; qualitative interviews
• Participants: Mixed-gender adolescents and young adults aged 13–24 years (≈50% female); mean age at baseline 17.8 years (males) and 16.9 years (females), rising to 18.7 and 17.6 years respectively at endline
• Implementation setting: Schools and youth clubs in Ethiopia (13-20% rural; 75–81% urban)
• Study period: December 2005–April 2007

Intervention

• Youth Action Kit (YAK): A peer-led HIV/AIDS communication and life skills package promoting knowledge, communication, and safe behaviors.
• Sports for Life (SFL): A sport-based program using football games and discussions to promote abstinence condom awareness, gender-equitable norms, and HIV knowledge.

Results

• Sample: 1,099 youth at baseline; 1,025 at endline; 40% of males and 42% of females completed both rounds.
• Significant improvements (ranging from p < 0.05 to p < 0.001, depending on the specific measure) in HIV-related knowledge, attitudes toward abstinence and gender equity, reduced HIV-related stigma, self-efficacy to resist unwanted sex and peer pressure, and communication about HIV and condoms with partners, peers, and family members; not every individual indicator within these domains reached statistical significance.
• Mean age at first sex increased significantly among males (16 to 18, p < 0.01) but did not change significantly among females (16 to 16); age of first sexual partner decreased significantly for both males (16 to 17, p < 0.05) and females (23 to 20, p < 0.05).
• Transactional sex declined significantly among males (26% to 11%, p < 0.01); declines in female-reported sexual coercion (22% to 12%) and receiving something for sex (29% to 27%) were not statistically significant in the source data.
• HIV testing increased significantly among both males and females.

Conclusions and Implications

• Results demonstrate that YAK and SFL effectively improve HIV knowledge, gender-equitable norms, communication skills, and self-efficacy, and support protective sexual behaviors.
• Findings support the value of sport-based and peer-led models in improving HIV prevention outcomes among youth.