The review “School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents,” conducted by a group of researchers in 2016, aims to evaluate the results of school programs for prevention of sexually transmitted diseases (STDs), HIV, and unwanted pregnancy in school-aged young adults. The review analyzes eight different studies, performed in various areas, including African countries (Malawi, Zimbabwe, South Africa, Tanzania, and Kenya), Latin America (Chile), as well as England and Scotland. The primary data method used is literature analysis, as the review summarizes the methods, results, and conclusions of the eight studies in question; the review is clearly structured and provides a coherent overview of the results and conclusions, as well as an evaluation of the evidence and findings.
Relevance
The unprotected sex in adolescents is an issue present not only in developing countries but all over the world, although it is considered to be more prevalent in poorer areas due to the failures of health and education systems. It is a persistent problem that affects the well-being of teenagers in the long term: “Sexually active adolescents, particularly young women, are at high risk in many countries of contracting HIV and other STIs. Early unintended pregnancy can also have a detrimental impact on young people’s lives” (Mason-Jones et al., 2016, p. 2). The study reports that over half of the new HIV cases occur in individuals aged 15 to 24 (Mason-Jones et al., 2016, p. 6), while a great percentage of pregnancies in young women under the age of 18 are unwanted and frequently terminated (Mason-Jones et al., 2016, p. 6).
These issues are mostly caused by the fact that school-aged young adults do not have immediate access to contraceptives and condoms (Mason-Jones et al., 2016, p. 6), particularly because of their desire to keep their sexual activity secret from parents. Thus, school environment plays an important role in the sexual education of adolescents, especially when the parents are unaware of their sexual activity and are not devoted to educating them on this sensitive matter. Moreover, school is also the primary place for adolescents to find their sexual partners: “As many young people spend a substantial amount of time in school, it is also an arena for peer connections and the development of relationships” (Mason-Jones et al., 2016, p. 6). Therefore, the introduction of effective sexual and reproductive health programs into schools has a potential to solve the issues related to teenagers’ sexual and reproductive health (Mason-Jones et al., 2016, p. 6).
Evidence
To gather sources of information, the researchers conducted a search of various databases, including MEDLINE, CENTRAL, UNAIDS, WHO, CDC, NHS, AEGIS, and so on for journal articles, reviews, conference presentations, and other relevant papers and resources. Out of the total 2166 records found, 983 were removed as duplicates, 1112 excluded after screening, and 63 full-text articles rejected as ineligible, leaving eight studies for meta-analysis (Mason-Jones et al., 2016, p. 9). These 8 cluster-RCT studies enrolled a total of 55157 participants (Mason-Jones et al., 2016, p. 2), and were based on evaluating biological evidence of the effects of school-based interventions.
The authors themselves criticize some of the studies used: for instance, none of the studied interventions included providing condoms and contraception, which are considered the most efficient methods of school-based interventions (Mason-Jones et al., 2016, p. 24). In addition, the majority of the studies also report either moderate or low certainty of results (Mason-Jones et al., 2016, p. 4) and few studies examined the effects of the interventions on all three aspects discussed (HIV, STDs, and pregnancy). Besides, the fact that the studies are scattered across various countries also contributes to the low level of reliability of their conclusions, as some of the effects or lack thereof could be influenced by cultural or religious factors (for instance, some religions prohibit the use of condoms). Overall, the evidence presented in the study is not conclusive, and more tests will be required to evaluate the effectiveness of school-based interventions.
Clarity
The review is clear and coherent. The data and findings are presented both in text and in tables, and each result is explained in detail. The language and presentation are easily accessible for a general reader, partly because the authors do not use overcomplicated terminology. Each claim made by the researchers is supported by factual evidence either from the studies discussed or from credible sources, such as WHO or the UN. Overall, the review is direct and comprehensible, although it might seem repetitive at times, as most findings are repeated at least twice throughout the text.
Findings
The review discusses the results of the studies used in great detail, providing a coherent summary of findings both in the abstract and in the results section. Generally, the effect of the interventions was either low of absent. The prevalence of new HIV cases was small with “no statistically significant differences between intervention and control groups in young women […] or young men” (Mason-Jones et al., 2016, p. 15). There was also no demonstrable effect on the incidence of HSV; however, the prevalence of syphilis, only measured by one of the studies, was lower in the intervention group (Mason-Jones et al., 2016, p. 16). The interventions also had no apparent effect on underage pregnancy in the short term, although some have shown a reduction in the long-term pregnancy prevalence (Mason-Jones et al., 2016, p. 16). Nevertheless, only one of the trials “reported an effect that reached standard levels of statistical significance” (Mason-Jones et al., 2016, p. 16), and the risk of bias for this trial was considered to be at a high level. In general, the review presents a detailed summary of the results and shows how most of the studies have shown either a low effect of the interventions or a complete lack thereof.
Conclusion
According to the conclusion of the authors, the lack of statistically significant results demonstrated by the studies is mainly caused by the wrong method of interventions. The programs proposed by the studies were educational, incentive-based, or both. None of the programs included contraception or condom provision, which, according to the researchers, is one of the decisive factors for the effective decrease in HIV, STDs, and unwanted pregnancy among adolescents: “there is little evidence that curriculum-based educational programmes alone, as they are currently configured and without the provision of contraception and condoms, are effective in reducing risk behaviours for adolescents and improving their health outcomes” (Mason-Jones et al., 2016, p. 24). The authors agree that changing the structure of the interventions would potentially promote their effectiveness, although more tests are required to prove this hypothesis (Mason-Jones et al., 2016, p. 24). Overall, the present review is coherently structured and provides a useful summary of the less effective interventions. Most importantly, it explains the importance of addressing the design of school-based interventions to develop efficient alternatives that would have an impact on adolescents’ sexual health on a global level.
References
Mason-Jones, A. J., Sinclair, D., Mathews, C., Kagee, A., Hillman, A., & Lombard, C. (2016). School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents (Review). Cochrane Database of Systematic Reviews, (11), 1-90. Web.