The Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal in Durban undertook to “explore the impact of the iThemba Lethu programme on HIV risk-taking behaviour among youth living in Cato Manor”. The sample for the retrospective research was the first group of children who participated in the iThemba Lethu HIV Prevention Programme pilot (2002 – 2006). The research was conducted in 2008 and included a self-administered survey tool and focus groups in two schools in Cato Manor and two control schools. The final report was released by HEARD in 2010.
“the iThemba Lethu HIV prevention programme represents an innovative and far-reaching response to the HIV pandemic, spearheaded and executed by talented and committed personnel. The forward-thinking nature of the iThemba Lethu leadership is reflected in their willingness to invite an objective, external evaluation of their programme in order to inform future scale-up”.
From the outset, the report recognised that iThemba Lethu set out with a specific goal to:
· address issues that were visibly neglected in other HIV prevention programmes;
· recognised the need for a well-grounded programme empowering learners to take control of their lives through personal vision, valuing each other, making wise decisions and prioritising abstinence as the most reliable form of HIV prevention in the context in which the programme is implemented.
iThemba Lethu understood that a single programme could not tackle the broad range of interventions being covered by parallel programmes and therefore the iThemba Lethu programme developers made a conscious decision to focus on aspects that were patently not being covered by these agencies.
The report detailed the iThemba Lethu programme design and concept that centres on:
· initiating dialogue on specific issues with young children (starting with pre-adolescents in Grade 5) which is an age group that most programmes do not address;
· building resilience and a sense of self-worth in the children;
· giving them sound public health messages that will empower them to avoid risky behaviour.
Results of Qualitative analysis
· iThemba Lethu is a highly valued programme in the community;
· learners, teachers and parents all praised the programme for providing much needed material, social and spiritual support;
· the programme fostered dialogue on issues related to gender, religion, violence, self esteem, substance use, hope and HIV;
· the youth workers (mentors) were praised as the linchpins of the intervention;
· youth workers were commended for their ongoing commitment to the youth;
· learners recognised the importance of abstinence as an important HIV prevention tool and a means to prevent teenage pregnancy;
· learners were ambivalent about the 100% efficacy of condom use as an HIV prevention strategy. (This is not surprising given the age group (10-15 years) and the economically challenged context in which the children live).
Results of Quantitative analysis
· high scores on a number of resilience dimensions including hope, mastery and optimism;
· participation in iThemba Lethu showed a lower likelihood of children ‘ever having had sex’;
· this effect (lower likelihood of ‘ever having had sex’) was stronger in boys;
· particularly significant is the fact that only 20% of the iThemba Lethu boys reported having had sex in the past year (compared to 35% of boys not exposed to the iThemba Lethu programme);
· children who had previously engaged in sexual activity indicated being prepared to change behaviour (i.e this suggests evidence of ‘secondary abstinence‘);
· participation in iThemba Lethu was associated with an increased positive attitude to abstaining;
· increased perception of friend support for abstaining;
· increased perception in being able to control whether or not they abstained from sex;
· participants exposed to iThemba Lethu did not consider condoms to be the ‘most reliable’ form of HIV prevention.
In summary, the overall evaluation revealed:
· success achieved in building confidence and resilience;
· success in creating a safe place for children to explore issues around HIV and abstinence – particularly in the context of difficult socio-economic conditions in which they live;
· the programme is novel in the extent to which it embraces a wide-ranging approach involving learners, teachers and the family;
· a commitment to a child development approach;
· an explicit concern with the broader determinants of the children’s health;
· success in creating an environment for positive communication about life skills, HIV/AIDS and socio economic challenges;
· inclusive activities that constitute the programme and a holistic approach of engaging youth, teachers and caregivers/parents;
· the programme did not concentrate on encouraging the children to use condoms;
· that other harm reducing strategies were employed – such as encouraging school attendance, and working to create safe and supportive home and school environments.
Finally the evaluation states:
“that the iThemba Lethu HIV Prevention Programme has fulfilled its objective
of imbuing young people with hope and a sense of destiny.
It has helped young people understand the value of sound relationships
(not only sexual relationships)
and most importantly, it has led to a significant increase
in the number of young people who have chosen to delay sexual debut.
Of importance is the significant reduction in the number of male learners in the intervention group
who had sex in the last year compared to those in the control group.”