HIV prevention in Mexican schools: prospective randomised evaluation of intervention
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.38796.457407.80 (Published 18 May 2006) Cite this as: BMJ 2006;332:1189All rapid responses
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Editor – Walker et al’s study of HIV prevention in Mexican schools
involved a very time-consuming and labour-intensive programme of education
followed by extensive evaluation, yet there was some basic yet vital
information which appeared to be missing. They report having evaluated
‘attitudes towards condom use’ but there was no clear assessment of what
motivated the teenagers’ decisions regarding condoms – did they find them
too expensive, were they difficult or embarrassing to obtain, did they
risk being ‘found out’ by buying them from local shops in small
communities? Furthermore, the possible influence of religion on their
attitudes was not discussed.
One must also wonder how the teenagers and their teachers felt about
the course itself, and what their own suggestions would have been to
improve it. 30 hours discussing sex and related issues is quite a demand
to place upon a teacher who had had only slightly more training than this
themselves on their 40-hour course. We do not know whether these teachers
were willing and enthusiastic volunteers, whether they had a scientific
background, and how well they actually understood the subject themselves.
Condom promotion by health professionals or young people may have been far
more acceptable and effective - if the authors’ comments that ‘teachers
rarely change their preconceptions about adolescent sexuality’ are to be
believed, then teachers were a strange choice to deliver this programme.
In Albania, where there are also economic difficulties and relatively
traditional attitudes to pre-marital sex, a programme has been started
whereby young doctors visit schools on World AIDS Day to speak to
teenagers. One of us (MM) gave such lectures recently and they were very
positively received by staff and students, who requested that further
classes be given.
Unfortunately this study seems to have missed these opportunities to gain
insight into why the programme was unsuccessful and thus to seek positive
directions for new research.
Competing interests:
None declared
Competing interests: No competing interests
Risky sexual behaviour
It is untenable to claim that condom and contraception education do
not increase risky sexual behaviour from the evidence presented in the
paper.85% of the males in the condom arm of the study had sex with
sexworkers or a casual partner compared to 71% of males in the other arm.
Also the females in the condom arm were more likely to have much older
partners which may suggest exploitation- a question not directly looked at
in this study.The increased in sex with casual partners and sexworkers and
coupled with acknowledged high incidence of condom slippage and breakage
found in the study is clearly evidence of risky sexual behaviour
facilitated by this intervention which was promoting condom use.
Competing interests:
None declared
Competing interests: No competing interests