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Rethinking HIV-prevention for school-going young people based on current behaviour patterns

Identifieur interne : 002C49 ( Pmc/Corpus ); précédent : 002C48; suivant : 002C50

Rethinking HIV-prevention for school-going young people based on current behaviour patterns

Auteurs : Maretha Visser

Source :

RBID : PMC:5639610

Abstract

Abstract

The aim of the research was to gain increased knowledge regarding the sexual risk behaviour of school-going young people in South Africa after two decades of HIV-education in schools, to contribute to the development of improved HIV prevention strategies. In collaboration with the Department of Education, a sample of 5305 learners (between 10 and 18 years in Grades 5–12) from high-risk communities were identified. They completed a survey that assessed self-reported sexual risk behaviour and variables that potentially underlie sexual risk, such as attitudes towards preventive behaviour, perceived social norms and self-efficacy (based on the theory of planned behaviour [TPB]) and social factors like caregiver relationships and gender norms (based on the social ecological theory). Lifetime sex was reported by 49.4% of boys and 30.5% of girls in Grades 8–12, while 56% of the sexually active young people reported consistent condom use. Accurate knowledge about HIV transmission was low (37.8%). Regression analysis showed that risk behaviour was more prominent among older male youths, who perceived social norms as encouraging sexual activity, who use alcohol excessively, and who have negative attitudes towards abstinence. Perceived traditional community gender norms and negative relationships with caregivers were also associated with sexual risk behaviour. This research showed that the TPB can be used in planning HIV prevention interventions for young people. It also revealed that HIV-prevention strategies should focus beyond educating the individual, to address community factors such as improving caregiver relationships, the culture of substance abuse, peer group norms and inequality in community gender norms. These community processes influence young people's behaviour and need to be addressed to allow the youth to make healthy behavioural choices.


Url:
DOI: 10.1080/17290376.2017.1376704
PubMed: 28934898
PubMed Central: 5639610

Links to Exploration step

PMC:5639610

Le document en format XML

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<p>The aim of the research was to gain increased knowledge regarding the sexual risk behaviour of school-going young people in South Africa after two decades of HIV-education in schools, to contribute to the development of improved HIV prevention strategies. In collaboration with the Department of Education, a sample of 5305 learners (between 10 and 18 years in Grades 5–12) from high-risk communities were identified. They completed a survey that assessed self-reported sexual risk behaviour and variables that potentially underlie sexual risk, such as attitudes towards preventive behaviour, perceived social norms and self-efficacy (based on the theory of planned behaviour [TPB]) and social factors like caregiver relationships and gender norms (based on the social ecological theory). Lifetime sex was reported by 49.4% of boys and 30.5% of girls in Grades 8–12, while 56% of the sexually active young people reported consistent condom use. Accurate knowledge about HIV transmission was low (37.8%). Regression analysis showed that risk behaviour was more prominent among older male youths, who perceived social norms as encouraging sexual activity, who use alcohol excessively, and who have negative attitudes towards abstinence. Perceived traditional community gender norms and negative relationships with caregivers were also associated with sexual risk behaviour. This research showed that the TPB can be used in planning HIV prevention interventions for young people. It also revealed that HIV-prevention strategies should focus beyond educating the individual, to address community factors such as improving caregiver relationships, the culture of substance abuse, peer group norms and inequality in community gender norms. These community processes influence young people's behaviour and need to be addressed to allow the youth to make healthy behavioural choices.</p>
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<div1 type="bibliography">
<listBibl>
<biblStruct>
<analytic>
<author>
<name sortKey="Aggleton, P" uniqKey="Aggleton P">P. Aggleton</name>
</author>
<author>
<name sortKey="Yankah, E" uniqKey="Yankah E">E. Yankah</name>
</author>
<author>
<name sortKey="Crewe, M" uniqKey="Crewe M">M. Crewe</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Ajzen, I" uniqKey="Ajzen I">I. Ajzen</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Akers, A Y" uniqKey="Akers A">A. Y. Akers</name>
</author>
<author>
<name sortKey="Holland, C L" uniqKey="Holland C">C. L. Holland</name>
</author>
<author>
<name sortKey="Bost, J" uniqKey="Bost J">J. Bost</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Albarracin, D" uniqKey="Albarracin D">D. Albarracín</name>
</author>
<author>
<name sortKey="Johnson, B T" uniqKey="Johnson B">B. T. Johnson</name>
</author>
<author>
<name sortKey="Fishbein, M" uniqKey="Fishbein M">M. Fishbein</name>
</author>
<author>
<name sortKey="Muellerleile, P A" uniqKey="Muellerleile P">P. A. Muellerleile</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Anderson, R" uniqKey="Anderson R">R. Anderson</name>
</author>
<author>
<name sortKey="Panchaud, C" uniqKey="Panchaud C">C. Panchaud</name>
</author>
<author>
<name sortKey="Singh, S" uniqKey="Singh S">S. Singh</name>
</author>
<author>
<name sortKey="Watson, K" uniqKey="Watson K">K. Watson</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Armitage, C J" uniqKey="Armitage C">C. J. Armitage</name>
</author>
<author>
<name sortKey="Conner, M" uniqKey="Conner M">M. Conner</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Bastien, S" uniqKey="Bastien S">S. Bastien</name>
</author>
<author>
<name sortKey="Kajula, L J" uniqKey="Kajula L">L. J. Kajula</name>
</author>
<author>
<name sortKey="Muhwezi, W W" uniqKey="Muhwezi W">W. W. Muhwezi</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Bekker, L G" uniqKey="Bekker L">L.-G. Bekker</name>
</author>
<author>
<name sortKey="Johnson, L" uniqKey="Johnson L">L. Johnson</name>
</author>
<author>
<name sortKey="Wallance, M" uniqKey="Wallance M">M. Wallance</name>
</author>
<author>
<name sortKey="Hosek, S" uniqKey="Hosek S">S. Hosek</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Biddlecom, A E" uniqKey="Biddlecom A">A. E. Biddlecom</name>
</author>
<author>
<name sortKey="Hessburg, L" uniqKey="Hessburg L">L. Hessburg</name>
</author>
<author>
<name sortKey="Singh, S" uniqKey="Singh S">S. Singh</name>
</author>
<author>
<name sortKey="Bankole, A" uniqKey="Bankole A">A. Bankole</name>
</author>
<author>
<name sortKey="Darabi, L" uniqKey="Darabi L">L. Darabi</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Bronfenbrenner, U" uniqKey="Bronfenbrenner U">U. Bronfenbrenner</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Catania, J A" uniqKey="Catania J">J. A. Catania</name>
</author>
<author>
<name sortKey="Gibson, D R" uniqKey="Gibson D">D. R. Gibson</name>
</author>
<author>
<name sortKey="Chitwood, D D" uniqKey="Chitwood D">D. D. Chitwood</name>
</author>
<author>
<name sortKey="Coates, T J" uniqKey="Coates T">T. J. Coates</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Cluver, L" uniqKey="Cluver L">L. Cluver</name>
</author>
<author>
<name sortKey="Boyes, M" uniqKey="Boyes M">M. Boyes</name>
</author>
<author>
<name sortKey="Orkin, M" uniqKey="Orkin M">M. Orkin</name>
</author>
<author>
<name sortKey="Pantelic, M" uniqKey="Pantelic M">M. Pantelic</name>
</author>
<author>
<name sortKey="Molwena, T" uniqKey="Molwena T">T. Molwena</name>
</author>
<author>
<name sortKey="Sherr, L" uniqKey="Sherr L">L. Sherr</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Cluver, L" uniqKey="Cluver L">L. Cluver</name>
</author>
<author>
<name sortKey="Boyes, M" uniqKey="Boyes M">M. Boyes</name>
</author>
<author>
<name sortKey="Orkin, M" uniqKey="Orkin M">M. Orkin</name>
</author>
<author>
<name sortKey="Sherr, L" uniqKey="Sherr L">L. Sherr</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Cluver, L" uniqKey="Cluver L">L. Cluver</name>
</author>
<author>
<name sortKey="Orkin, M" uniqKey="Orkin M">M. Orkin</name>
</author>
<author>
<name sortKey="Boyes, M E" uniqKey="Boyes M">M. E. Boyes</name>
</author>
<author>
<name sortKey="Sherr, L" uniqKey="Sherr L">L. Sherr</name>
</author>
<author>
<name sortKey="Makasi, D" uniqKey="Makasi D">D. Makasi</name>
</author>
<author>
<name sortKey="Nikelo, J" uniqKey="Nikelo J">J. Nikelo</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Coetzee, J" uniqKey="Coetzee J">J. Coetzee</name>
</author>
<author>
<name sortKey="Dietrich, J" uniqKey="Dietrich J">J. Dietrich</name>
</author>
<author>
<name sortKey="Otwombe, K" uniqKey="Otwombe K">K. Otwombe</name>
</author>
<author>
<name sortKey="Nkala, B" uniqKey="Nkala B">B. Nkala</name>
</author>
<author>
<name sortKey="Khunwane, M" uniqKey="Khunwane M">M. Khunwane</name>
</author>
<author>
<name sortKey="Van Der Watt, M" uniqKey="Van Der Watt M">M. van der Watt</name>
</author>
<author>
<name sortKey="Gray, G E" uniqKey="Gray G">G. E. Gray</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="De Palma, R" uniqKey="De Palma R">R. De Palma</name>
</author>
<author>
<name sortKey="Francis, D" uniqKey="Francis D">D. Francis</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Diener, E" uniqKey="Diener E">E. Diener</name>
</author>
<author>
<name sortKey="Emmons, R A" uniqKey="Emmons R">R. A. Emmons</name>
</author>
<author>
<name sortKey="Larsen, R J" uniqKey="Larsen R">R. J. Larsen</name>
</author>
<author>
<name sortKey="Griffin, S" uniqKey="Griffin S">S. Griffin</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Dinkelman, T" uniqKey="Dinkelman T">T. Dinkelman</name>
</author>
<author>
<name sortKey="Lam, D" uniqKey="Lam D">D. Lam</name>
</author>
<author>
<name sortKey="Leibbrandt, M" uniqKey="Leibbrandt M">M. Leibbrandt</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Dworkin, S L" uniqKey="Dworkin S">S. L. Dworkin</name>
</author>
<author>
<name sortKey="Hatcher, A M" uniqKey="Hatcher A">A. M. Hatcher</name>
</author>
<author>
<name sortKey="Colvin, C" uniqKey="Colvin C">C. Colvin</name>
</author>
<author>
<name sortKey="Peacock, D" uniqKey="Peacock D">D. Peacock</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Eaton, L" uniqKey="Eaton L">L. Eaton</name>
</author>
<author>
<name sortKey="Flisher, A J" uniqKey="Flisher A">A. J. Flisher</name>
</author>
<author>
<name sortKey="Aaro, L E" uniqKey="Aaro L">L. E. Aaro</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Freire, P" uniqKey="Freire P">P. Freire</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Frempong, G" uniqKey="Frempong G">G. Frempong</name>
</author>
<author>
<name sortKey="Reddy, V" uniqKey="Reddy V">V. Reddy</name>
</author>
<author>
<name sortKey="Kanjee, A" uniqKey="Kanjee A">A. Kanjee</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Gausset, Q" uniqKey="Gausset Q">Q. Gausset</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Gebreeyesus, H H" uniqKey="Gebreeyesus H">H. H. Gebreeyesus</name>
</author>
<author>
<name sortKey="Boer, H" uniqKey="Boer H">H. Boer</name>
</author>
<author>
<name sortKey="Kuiper, W A" uniqKey="Kuiper W">W. A. Kuiper</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Goodnight, B" uniqKey="Goodnight B">B. Goodnight</name>
</author>
<author>
<name sortKey="Salama, C" uniqKey="Salama C">C. Salama</name>
</author>
<author>
<name sortKey="Grim, E C" uniqKey="Grim E">E. C. Grim</name>
</author>
<author>
<name sortKey="Anthony, E R" uniqKey="Anthony E">E. R. Anthony</name>
</author>
<author>
<name sortKey="Armistead, L" uniqKey="Armistead L">L. Armistead</name>
</author>
<author>
<name sortKey="Cook, S L" uniqKey="Cook S">S. L. Cook</name>
</author>
<author>
<name sortKey="Toefy, Y" uniqKey="Toefy Y">Y. Toefy</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Gupta, G R" uniqKey="Gupta G">G. R. Gupta</name>
</author>
<author>
<name sortKey="Parkhurst, J O" uniqKey="Parkhurst J">J. O. Parkhurst</name>
</author>
<author>
<name sortKey="Ogden, J A" uniqKey="Ogden J">J. A. Ogden</name>
</author>
<author>
<name sortKey="Aggleton, P" uniqKey="Aggleton P">P. Aggleton</name>
</author>
<author>
<name sortKey="Mahal, A" uniqKey="Mahal A">A. Mahal</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Harrison, A" uniqKey="Harrison A">A. Harrison</name>
</author>
<author>
<name sortKey="Cleland, J" uniqKey="Cleland J">J. Cleland</name>
</author>
<author>
<name sortKey="Gouws, E" uniqKey="Gouws E">E. Gouws</name>
</author>
<author>
<name sortKey="Frohlich, J" uniqKey="Frohlich J">J. Frohlich</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Harrison, A" uniqKey="Harrison A">A. Harrison</name>
</author>
<author>
<name sortKey="Newell, M L" uniqKey="Newell M">M.-L. Newell</name>
</author>
<author>
<name sortKey="Imrie, J" uniqKey="Imrie J">J. Imrie</name>
</author>
<author>
<name sortKey="Hoddinott, G" uniqKey="Hoddinott G">G. Hoddinott</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Hendriksen, E S" uniqKey="Hendriksen E">E. S. Hendriksen</name>
</author>
<author>
<name sortKey="Pettifor, A" uniqKey="Pettifor A">A. Pettifor</name>
</author>
<author>
<name sortKey="Lee, S J" uniqKey="Lee S">S.-J. Lee</name>
</author>
<author>
<name sortKey="Coates, T J" uniqKey="Coates T">T. J. Coates</name>
</author>
<author>
<name sortKey="Rees, H V" uniqKey="Rees H">H. V. Rees</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="James, S" uniqKey="James S">S. James</name>
</author>
<author>
<name sortKey="Reddy, S P" uniqKey="Reddy S">S. P. Reddy</name>
</author>
<author>
<name sortKey="Taylor, M" uniqKey="Taylor M">M. Taylor</name>
</author>
<author>
<name sortKey="Jinabhai, C C" uniqKey="Jinabhai C">C. C. Jinabhai</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Jemmott, J B" uniqKey="Jemmott J">J. B. Jemmott</name>
</author>
<author>
<name sortKey="Heeren, G A" uniqKey="Heeren G">G. A. Heeren</name>
</author>
<author>
<name sortKey="Ngwane, Z" uniqKey="Ngwane Z">Z. Ngwane</name>
</author>
<author>
<name sortKey="Hewitt, N" uniqKey="Hewitt N">N. Hewitt</name>
</author>
<author>
<name sortKey="Jemmott, L S" uniqKey="Jemmott L">L. S. Jemmott</name>
</author>
<author>
<name sortKey="Shell, R" uniqKey="Shell R">R. Shell</name>
</author>
<author>
<name sortKey="O Leary, A" uniqKey="O Leary A">A. O'leary</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Jewkes, R" uniqKey="Jewkes R">R. Jewkes</name>
</author>
<author>
<name sortKey="Levin, J" uniqKey="Levin J">J. Levin</name>
</author>
<author>
<name sortKey="Penn Kekana, L" uniqKey="Penn Kekana L">L. Penn-Kekana</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Jewkes, R K" uniqKey="Jewkes R">R. K. Jewkes</name>
</author>
<author>
<name sortKey="Dunkle, K" uniqKey="Dunkle K">K. Dunkle</name>
</author>
<author>
<name sortKey="Nduna, M" uniqKey="Nduna M">M. Nduna</name>
</author>
<author>
<name sortKey="Shai, N" uniqKey="Shai N">N. Shai</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Kakoko, D C" uniqKey="Kakoko D">D. C. Kakoko</name>
</author>
<author>
<name sortKey="Astrom, A N" uniqKey="Astrom A">A. N. Astrom</name>
</author>
<author>
<name sortKey="Lugoe, W L" uniqKey="Lugoe W">W. L. Lugoe</name>
</author>
<author>
<name sortKey="Lie, G T" uniqKey="Lie G">G. T. Lie</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Kandel, D B" uniqKey="Kandel D">D. B. Kandel</name>
</author>
<author>
<name sortKey="Davies, M" uniqKey="Davies M">M. Davies</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Klepp, K I" uniqKey="Klepp K">K-I. Klepp</name>
</author>
<author>
<name sortKey="Flisher, A J" uniqKey="Flisher A">A. J. Flisher</name>
</author>
<author>
<name sortKey="Kaaya, S F" uniqKey="Kaaya S">S. F. Kaaya</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Knerr, W" uniqKey="Knerr W">W. Knerr</name>
</author>
<author>
<name sortKey="Gardner, F" uniqKey="Gardner F">F. Gardner</name>
</author>
<author>
<name sortKey="Cluver, L" uniqKey="Cluver L">L. Cluver</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Leclerc Madlala, S" uniqKey="Leclerc Madlala S">S. Leclerc-Madlala</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Lynch, I" uniqKey="Lynch I">I. Lynch</name>
</author>
<author>
<name sortKey="Brouard, P" uniqKey="Brouard P">P. Brouard</name>
</author>
<author>
<name sortKey="Visser, M" uniqKey="Visser M">M. Visser</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Manosch, R" uniqKey="Manosch R">R. Manosch</name>
</author>
<author>
<name sortKey="Mahy, M" uniqKey="Mahy M">M. Mahy</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Mantell, J" uniqKey="Mantell J">J. Mantell</name>
</author>
<author>
<name sortKey="Harrison, A" uniqKey="Harrison A">A. Harrison</name>
</author>
<author>
<name sortKey="Hoffman, S" uniqKey="Hoffman S">S. Hoffman</name>
</author>
<author>
<name sortKey="Smit, J A" uniqKey="Smit J">J. A. Smit</name>
</author>
<author>
<name sortKey="Stein, Z A" uniqKey="Stein Z">Z. A. Stein</name>
</author>
<author>
<name sortKey="Exner, T M" uniqKey="Exner T">T. M. Exner</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Mfecane, S" uniqKey="Mfecane S">S. Mfecane</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Moletsane, R" uniqKey="Moletsane R">R. Moletsane</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Morojele, N" uniqKey="Morojele N">N. Morojele</name>
</author>
<author>
<name sortKey="Myers, B" uniqKey="Myers B">B. Myers</name>
</author>
<author>
<name sortKey="Townsend, L" uniqKey="Townsend L">L. Townsend</name>
</author>
<author>
<name sortKey="Lombard, C" uniqKey="Lombard C">C. Lombard</name>
</author>
<author>
<name sortKey="Pluddemann, A" uniqKey="Pluddemann A">A. Plüddemann</name>
</author>
<author>
<name sortKey="Carney, T" uniqKey="Carney T">T. Carney</name>
</author>
<author>
<name sortKey="Nkosi, S" uniqKey="Nkosi S">S. Nkosi</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Ofosu Amaah, A W" uniqKey="Ofosu Amaah A">A. W. Ofosu-Amaah</name>
</author>
<author>
<name sortKey="Egamberdi, N" uniqKey="Egamberdi N">N. Egamberdi</name>
</author>
<author>
<name sortKey="Dhar, A" uniqKey="Dhar A">A. Dhar</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Pallant, J" uniqKey="Pallant J">J. Pallant</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Pavot, W" uniqKey="Pavot W">W. Pavot</name>
</author>
<author>
<name sortKey="Diener, E" uniqKey="Diener E">E. Diener</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Pettifor, A" uniqKey="Pettifor A">A. Pettifor</name>
</author>
<author>
<name sortKey="O Rien, K" uniqKey="O Rien K">K. O’Brien</name>
</author>
<author>
<name sortKey="Macphail, C" uniqKey="Macphail C">C. MacPhail</name>
</author>
<author>
<name sortKey="Miller, W C" uniqKey="Miller W">W. C. Miller</name>
</author>
<author>
<name sortKey="Rees, H" uniqKey="Rees H">H. Rees</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Phetla, G" uniqKey="Phetla G">G. Phetla</name>
</author>
<author>
<name sortKey="Busza, J" uniqKey="Busza J">J. Busza</name>
</author>
<author>
<name sortKey="Hargreaves, J" uniqKey="Hargreaves J">J. Hargreaves</name>
</author>
<author>
<name sortKey="Pronyk, P" uniqKey="Pronyk P">P. Pronyk</name>
</author>
<author>
<name sortKey="Kim, J" uniqKey="Kim J">J. Kim</name>
</author>
<author>
<name sortKey="Morison, L" uniqKey="Morison L">L. Morison</name>
</author>
<author>
<name sortKey="Porter, J" uniqKey="Porter J">J. Porter</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Reddy, S P" uniqKey="Reddy S">S. P. Reddy</name>
</author>
<author>
<name sortKey="James, S" uniqKey="James S">S. James</name>
</author>
<author>
<name sortKey="Sewpaul, R" uniqKey="Sewpaul R">R. Sewpaul</name>
</author>
<author>
<name sortKey="Koopman, F" uniqKey="Koopman F">F. Koopman</name>
</author>
<author>
<name sortKey="Funani, N I" uniqKey="Funani N">N. I. Funani</name>
</author>
<author>
<name sortKey="Sifunda, S" uniqKey="Sifunda S">S. Sifunda</name>
</author>
<author>
<name sortKey="Omardien, R G" uniqKey="Omardien R">R. G. Omardien</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Reddy, S P" uniqKey="Reddy S">S. P. Reddy</name>
</author>
<author>
<name sortKey="James, S" uniqKey="James S">S. James</name>
</author>
<author>
<name sortKey="Sewpaul, R" uniqKey="Sewpaul R">R. Sewpaul</name>
</author>
<author>
<name sortKey="Sifunda, S" uniqKey="Sifunda S">S. Sifunda</name>
</author>
<author>
<name sortKey="Ellahebokus, A" uniqKey="Ellahebokus A">A. Ellahebokus</name>
</author>
<author>
<name sortKey="Kambaran, N S" uniqKey="Kambaran N">N. S. Kambaran</name>
</author>
<author>
<name sortKey="Omardien, R G" uniqKey="Omardien R">R. G. Omardien</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Ross, D A" uniqKey="Ross D">D. A. Ross</name>
</author>
<author>
<name sortKey="Dick, B" uniqKey="Dick B">B. Dick</name>
</author>
<author>
<name sortKey="Ferguson, J" uniqKey="Ferguson J">J. Ferguson</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Rotheram Borus, M" uniqKey="Rotheram Borus M">M. Rotheram-Borus</name>
</author>
<author>
<name sortKey="Flannery, D" uniqKey="Flannery D">D. Flannery</name>
</author>
<author>
<name sortKey="Rice, E" uniqKey="Rice E">E. Rice</name>
</author>
<author>
<name sortKey="Lester, P" uniqKey="Lester P">P. Lester</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Rotheram Borus, M J" uniqKey="Rotheram Borus M">M. J. Rotheram-Borus</name>
</author>
<author>
<name sortKey="Swendeman, D" uniqKey="Swendeman D">D. Swendeman</name>
</author>
<author>
<name sortKey="Chovnick, G" uniqKey="Chovnick G">G. Chovnick</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Rotheram Borus, M J" uniqKey="Rotheram Borus M">M. J. Rotheram-Borus</name>
</author>
<author>
<name sortKey="Swendeman, D" uniqKey="Swendeman D">D. Swendeman</name>
</author>
<author>
<name sortKey="Flannery, D" uniqKey="Flannery D">D. Flannery</name>
</author>
<author>
<name sortKey="Rice, E" uniqKey="Rice E">E. Rice</name>
</author>
<author>
<name sortKey="Adamson, D" uniqKey="Adamson D">D. Adamson</name>
</author>
<author>
<name sortKey="Ingram, B" uniqKey="Ingram B">B. Ingram</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Schaalma, H" uniqKey="Schaalma H">H. Schaalma</name>
</author>
<author>
<name sortKey="Aaro, L E" uniqKey="Aaro L">L. E. Aaro</name>
</author>
<author>
<name sortKey="Flisher, A J" uniqKey="Flisher A">A. J. Flisher</name>
</author>
<author>
<name sortKey="Mathews, C" uniqKey="Mathews C">C. Mathews</name>
</author>
<author>
<name sortKey="Kaaya, S" uniqKey="Kaaya S">S. Kaaya</name>
</author>
<author>
<name sortKey="Onya, H" uniqKey="Onya H">H. Onya</name>
</author>
<author>
<name sortKey="Klepp, K I" uniqKey="Klepp K">K.-I. Klepp</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Selikow, T A" uniqKey="Selikow T">T. A. Selikow</name>
</author>
<author>
<name sortKey="Ahmed, N" uniqKey="Ahmed N">N. Ahmed</name>
</author>
<author>
<name sortKey="Flisher, A J" uniqKey="Flisher A">A. J. Flisher</name>
</author>
<author>
<name sortKey="Mathews, C" uniqKey="Mathews C">C. Mathews</name>
</author>
<author>
<name sortKey="Mukoma, W" uniqKey="Mukoma W">W. Mukoma</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Senderowitz, J" uniqKey="Senderowitz J">J. Senderowitz</name>
</author>
<author>
<name sortKey="Kirby, D" uniqKey="Kirby D">D. Kirby</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Shefer, T" uniqKey="Shefer T">T. Shefer</name>
</author>
<author>
<name sortKey="Macleod, C" uniqKey="Macleod C">C. MacLeod</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Shisana, O" uniqKey="Shisana O">O. Shisana</name>
</author>
<author>
<name sortKey="Rehle, T" uniqKey="Rehle T">T. Rehle</name>
</author>
<author>
<name sortKey="Simbayi, L C" uniqKey="Simbayi L">L. C. Simbayi</name>
</author>
<author>
<name sortKey="Zuma, K" uniqKey="Zuma K">K. Zuma</name>
</author>
<author>
<name sortKey="Jooste, S" uniqKey="Jooste S">S. Jooste</name>
</author>
<author>
<name sortKey="Pillay Van Wyk, V" uniqKey="Pillay Van Wyk V">V. Pillay-van-Wyk</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Shisana, O" uniqKey="Shisana O">O. Shisana</name>
</author>
<author>
<name sortKey="Rehle, T" uniqKey="Rehle T">T. Rehle</name>
</author>
<author>
<name sortKey="Simbayi, L C" uniqKey="Simbayi L">L. C. Simbayi</name>
</author>
<author>
<name sortKey="Zuma, K" uniqKey="Zuma K">K. Zuma</name>
</author>
<author>
<name sortKey="Jooste, S" uniqKey="Jooste S">S. Jooste</name>
</author>
<author>
<name sortKey="Zungu, N" uniqKey="Zungu N">N. Zungu</name>
</author>
<author>
<name sortKey="Onoya, D" uniqKey="Onoya D">D. Onoya</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Stirling, M" uniqKey="Stirling M">M. Stirling</name>
</author>
<author>
<name sortKey="Rees, H" uniqKey="Rees H">H. Rees</name>
</author>
<author>
<name sortKey="Kasedde, S" uniqKey="Kasedde S">S. Kasedde</name>
</author>
<author>
<name sortKey="Hankins, C" uniqKey="Hankins C">C. Hankins</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Strebel, A" uniqKey="Strebel A">A. Strebel</name>
</author>
<author>
<name sortKey="Crawford, M" uniqKey="Crawford M">M. Crawford</name>
</author>
<author>
<name sortKey="Shefer, T" uniqKey="Shefer T">T. Shefer</name>
</author>
<author>
<name sortKey="Cloete, A" uniqKey="Cloete A">A. Cloete</name>
</author>
<author>
<name sortKey="Henda, N" uniqKey="Henda N">N. Henda</name>
</author>
<author>
<name sortKey="Kaufman, M" uniqKey="Kaufman M">M. Kaufman</name>
</author>
<author>
<name sortKey="Kalichman, S" uniqKey="Kalichman S">S. Kalichman</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Taylor, M" uniqKey="Taylor M">M. Taylor</name>
</author>
<author>
<name sortKey="Dlamini, S B" uniqKey="Dlamini S">S. B. Dlamini</name>
</author>
<author>
<name sortKey="Kagoro, H" uniqKey="Kagoro H">H. Kagoro</name>
</author>
<author>
<name sortKey="Jinabhai, C C" uniqKey="Jinabhai C">C. C. Jinabhai</name>
</author>
<author>
<name sortKey="De Vries, H" uniqKey="De Vries H">H. De Vries</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Taylor, T N" uniqKey="Taylor T">T. N. Taylor</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Visser, M J" uniqKey="Visser M">M. J. Visser</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Webb, T L" uniqKey="Webb T">T. L. Webb</name>
</author>
<author>
<name sortKey="Joseph, J" uniqKey="Joseph J">J. Joseph</name>
</author>
<author>
<name sortKey="Yardley, L" uniqKey="Yardley L">L. Yardley</name>
</author>
<author>
<name sortKey="Michie, S" uniqKey="Michie S">S. Michie</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Webb, T L" uniqKey="Webb T">T. L. Webb</name>
</author>
<author>
<name sortKey="Sheeran, P" uniqKey="Sheeran P">P. Sheeran</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Wight, D" uniqKey="Wight D">D. Wight</name>
</author>
<author>
<name sortKey="Plummer, M L" uniqKey="Plummer M">M. L. Plummer</name>
</author>
<author>
<name sortKey="Mshana, G" uniqKey="Mshana G">G. Mshana</name>
</author>
<author>
<name sortKey="Wamoyi, J" uniqKey="Wamoyi J">J. Wamoyi</name>
</author>
<author>
<name sortKey="Shigongo, Z S" uniqKey="Shigongo Z">Z. S. Shigongo</name>
</author>
<author>
<name sortKey="Ross, D A" uniqKey="Ross D">D. A. Ross</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Wislar, J S" uniqKey="Wislar J">J. S. Wislar</name>
</author>
<author>
<name sortKey="Fendrich, M" uniqKey="Fendrich M">M. Fendrich</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Woolf King, S E" uniqKey="Woolf King S">S. E. Woolf-King</name>
</author>
<author>
<name sortKey="Maisto, S A" uniqKey="Maisto S">S. A. Maisto</name>
</author>
</analytic>
</biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">SAHARA J</journal-id>
<journal-id journal-id-type="iso-abbrev">SAHARA J</journal-id>
<journal-id journal-id-type="archive">RSAH</journal-id>
<journal-id journal-id-type="publisher-id">rsah20</journal-id>
<journal-title-group>
<journal-title>SAHARA J : Journal of Social Aspects of HIV/AIDS Research Alliance</journal-title>
</journal-title-group>
<issn pub-type="ppub">1729-0376</issn>
<issn pub-type="epub">1813-4424</issn>
<publisher>
<publisher-name>Taylor & Francis</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">28934898</article-id>
<article-id pub-id-type="pmc">5639610</article-id>
<article-id pub-id-type="publisher-id">1376704</article-id>
<article-id pub-id-type="doi">10.1080/17290376.2017.1376704</article-id>
<article-categories>
<subj-group subj-group-type="article-type">
<subject>Article</subject>
</subj-group>
<subj-group subj-group-type="heading">
<subject>Original Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Rethinking HIV-prevention for school-going young people based on current behaviour patterns</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Visser</surname>
<given-names>Maretha</given-names>
</name>
<xref ref-type="aff" rid="AF1"></xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<aff id="AF1">
<label>
<sup>a</sup>
</label>
<institution>
<named-content content-type="department">PhD, is a professor in Psychology at the Department of Psychology</named-content>
,
<named-content content-type="institution-name">University of Pretoria</named-content>
</institution>
,
<named-content content-type="city">Pretoria</named-content>
,
<country>South Africa</country>
</aff>
</contrib-group>
<author-notes>
<corresp id="cor1">
<label>*</label>
Email:
<email xlink:href="maretha.visser@up.ac.za">maretha.visser@up.ac.za</email>
</corresp>
</author-notes>
<pub-date pub-type="collection">
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>21</day>
<month>9</month>
<year>2017</year>
</pub-date>
<volume>14</volume>
<issue>1</issue>
<fpage seq="8">64</fpage>
<lpage>76</lpage>
<permissions>
<copyright-statement>© 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group</copyright-statement>
<copyright-year>2017</copyright-year>
<copyright-holder>The Author(s)</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
<license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:type="simple" xlink:href="RSAH_A_1376704_O.pdf"></self-uri>
<abstract>
<title>Abstract</title>
<p>The aim of the research was to gain increased knowledge regarding the sexual risk behaviour of school-going young people in South Africa after two decades of HIV-education in schools, to contribute to the development of improved HIV prevention strategies. In collaboration with the Department of Education, a sample of 5305 learners (between 10 and 18 years in Grades 5–12) from high-risk communities were identified. They completed a survey that assessed self-reported sexual risk behaviour and variables that potentially underlie sexual risk, such as attitudes towards preventive behaviour, perceived social norms and self-efficacy (based on the theory of planned behaviour [TPB]) and social factors like caregiver relationships and gender norms (based on the social ecological theory). Lifetime sex was reported by 49.4% of boys and 30.5% of girls in Grades 8–12, while 56% of the sexually active young people reported consistent condom use. Accurate knowledge about HIV transmission was low (37.8%). Regression analysis showed that risk behaviour was more prominent among older male youths, who perceived social norms as encouraging sexual activity, who use alcohol excessively, and who have negative attitudes towards abstinence. Perceived traditional community gender norms and negative relationships with caregivers were also associated with sexual risk behaviour. This research showed that the TPB can be used in planning HIV prevention interventions for young people. It also revealed that HIV-prevention strategies should focus beyond educating the individual, to address community factors such as improving caregiver relationships, the culture of substance abuse, peer group norms and inequality in community gender norms. These community processes influence young people's behaviour and need to be addressed to allow the youth to make healthy behavioural choices.</p>
</abstract>
<trans-abstract xml:lang="fr">
<title>Résumé</title>
<p>L'objectif de la recherche est d'acquérir une connaissance accrue des comportements sexuels à risque des jeunes scolarisés en Afrique du Sud après deux décennies d'éducation sur le VIH offerte à l’école, afin de contribuer au développement de stratégies visant à améliorer la prévention du VIH. En collaboration avec le ministère de l'Éducation, un échantillon de 5305 apprenants (entre 10 et 18 ans et qui étaient entre la 5e et la 12e année de leur cursus scolaire) provenant de communautés à haut risque ont été identifiés. Ils ont complété un questionnaire qui a évalué les comportements sexuels à risque auto-déclarés ainsi que les facteurs qui sont en rapport avec les risques sexuels, tels que les attitudes à l'égard des comportements préventifs, la perception des normes sociales et l'auto-efficacité (selon la théorie du comportement planifié) ainsi que des facteurs sociaux comme les relations avec les travailleurs sociaux et les normes liées au genre (basées sur la théorie de l'écologie sociale). Le sexe à vie a été signalé par 49,4% des garçons et 30,5% des filles de la 8e à la 12e année, tandis que 56% des jeunes sexuellement actifs ont déclaré qu’ils utilisaient de manière constante le préservatif. Une connaissance précise de la transmission du VIH était faible (37,8%). L'analyse de régression a montré que les comportements à risque étaient plus importants parmi les jeunes hommes âgés, qui sont d’avis que les normes sociales encouragent une activité sexuelle ; par ailleurs, ils consomment l'alcool de manière excessive et ont des attitudes négatives à l'égard de l'abstinence. La perception des normes traditionnelles de la communauté à l’égard du genre et les relations négatives avec les travailleurs sociaux étaient également associées à un comportement sexuel à risque. Cette recherche a montré que la théorie du comportement planifié peut être utilisée dans la planification des interventions de prévention du VIH pour les jeunes. Il a également révélé que les stratégies de prévention du VIH devraient aller au-delà de l'éducation de l'individu, pour aborder les facteurs communautaires tels que l'amélioration des relations avec les travailleurs sociaux, la culture de la toxicomanie, les normes du groupe de pairs et l'inégalité dans les normes communautaires à l’égard du genre. Ces processus communautaires influent sur le comportement des jeunes et doivent être pris en compte pour permettre aux jeunes de faire des choix de comportement sains.</p>
</trans-abstract>
<kwd-group kwd-group-type="author">
<title>Keywords</title>
<kwd>HIV-prevention</kwd>
<kwd>sexual risk behaviour</kwd>
<kwd>school going youth</kwd>
<kwd>perceived social norms</kwd>
<kwd>community gender norms</kwd>
<kwd>South Africa</kwd>
</kwd-group>
<kwd-group kwd-group-type="author" xml:lang="fr">
<title>Mots clés</title>
<kwd>Prévention du VIH</kwd>
<kwd>comportement sexuel à risque</kwd>
<kwd>jeunesse scolaire; perception des normes sociales</kwd>
<kwd>normes communautaires à l’égard des genres</kwd>
<kwd>Afrique du Sud</kwd>
</kwd-group>
<funding-group>
<award-group>
<funding-source>
<named-content content-type="funder-name">United States Agency for International Development</named-content>
<named-content content-type="funder-identifier">10.13039/100000200</named-content>
</funding-source>
</award-group>
<funding-statement>This work was supported by the United States Agency for International Development.</funding-statement>
</funding-group>
<counts>
<fig-count count="0"></fig-count>
<table-count count="6"></table-count>
<equation-count count="0"></equation-count>
<ref-count count="81"></ref-count>
<page-count count="13"></page-count>
</counts>
</article-meta>
</front>
<body>
<sec id="S001">
<label>1.</label>
<title>Introduction</title>
<p>South Africa has one of the highest HIV prevalence rates in the world. It is estimated that about 6.8 million people in South Africa (18.9% of the population between 15 and 49 years) are infected (UNAIDS,
<xref rid="CIT0072" ref-type="bibr">2014a</xref>
). The most recent national household survey (Shisana et al.,
<xref rid="CIT0067" ref-type="bibr">2014</xref>
) estimated that 7.1% of young people from 15 to 24 years are infected. Although the disease has stabilised over the past five years, 1.7% of the population gets newly infected each year (Shisana et al.,
<xref rid="CIT0067" ref-type="bibr">2014</xref>
). A large proportion of new infections is among young people (15–24 years) (United Nations Children’s Fund,
<xref rid="CIT0074" ref-type="bibr">2013</xref>
), especially young women (24.1%) (Shisana et al.,
<xref rid="CIT0067" ref-type="bibr">2014</xref>
; UNAIDS,
<xref rid="CIT0073" ref-type="bibr">2014b</xref>
). AIDS is currently the leading cause of death among adolescents in Africa (Bekker, Johnson, Wallance, & Hosek,
<xref rid="CIT0008" ref-type="bibr">2015</xref>
). Young people are at the centre of the global HIV and AIDS epidemic, especially regarding opportunities for HIV prevention (Bekker et al.,
<xref rid="CIT0008" ref-type="bibr">2015</xref>
; Manosch & Mahy,
<xref rid="CIT0046" ref-type="bibr">2006</xref>
).</p>
<p>HIV education has been formally implemented in schools in the past two decades (Department of Basic Education,
<xref rid="CIT0017" ref-type="bibr">1998</xref>
,
<xref rid="CIT0018" ref-type="bibr">2003</xref>
,
<xref rid="CIT0020" ref-type="bibr">2011</xref>
). The interventions varied from short-term awareness and information campaigns to large-scale implementation of life skills and peer education programmes and the institutionalisation of the subject Life Orientation as part of the school curriculum. The persistently high levels of new infections among young people show that these interventions are not effective in addressing HIV risk. They are not addressing the underlying reasons for new infections successfully (Stirling, Rees, Kasedde, & Hankins,
<xref rid="CIT0068" ref-type="bibr">2008</xref>
). For school-based HIV-prevention strategies to be effective among young people, it should be based on an understanding of young people's sexual risk behaviour and the underlying drivers for these behaviours. This research, done in collaboration with the Department of Basic Education, aims to understand young people's sexual risk behaviour and the underlying factors influencing their actions.</p>
<p>Several South African studies highlighted the discrepancy between HIV awareness and reported sexual risk behaviour of young people (James, Reddy, Taylor, & Jinabhai,
<xref rid="CIT0036" ref-type="bibr">2004</xref>
). The Youth Risk Behaviour Survey (YRBS) (Reddy et al.,
<xref rid="CIT0056" ref-type="bibr">2013</xref>
) reported that 36% of learners in Grades 8–11 reported being sexually active and only 33% of them reported consistent condom use. High levels of early sexual debut (before 15 years of age) was consistently reported over the past decade (Pettifor, O’Brien, MacPhail, Miller, & Rees,
<xref rid="CIT0053" ref-type="bibr">2009</xref>
; Reddy et al.,
<xref rid="CIT0056" ref-type="bibr">2013</xref>
; Shisana et al.,
<xref rid="CIT0067" ref-type="bibr">2014</xref>
). Twelve per cent learners reported early sexual debut (Reddy et al.,
<xref rid="CIT0056" ref-type="bibr">2013</xref>
). Shisana et al. (
<xref rid="CIT0067" ref-type="bibr">2014</xref>
) highlighted intergenerational sex (partner five years older) reported by 33.7% of young females (15–19 years) and multiple sexual partners reported by 37.5% of young men (15–24 years) as contributing to young people's HIV risk. Increasing condom use at last sexual encounter was regarded as a success story in HIV prevention among young people (Shisana et al.,
<xref rid="CIT0066" ref-type="bibr">2009</xref>
), but condom use was found to decline again during the past five years to 67.5% of males and 49.8% of females (15–24 years) reporting condom use at last sex (Shisana et al.,
<xref rid="CIT0067" ref-type="bibr">2014</xref>
).</p>
<p>Numerous studies have been conducted to understand young people's sexual risk behaviour. Many interacting individual, relational, and environmental factors were identified that influence high-risk sexual behaviour (Eaton, Flisher, & Aaro,
<xref rid="CIT0025" ref-type="bibr">2003</xref>
; Harrison, Cleland, Gouws, & Frohlich,
<xref rid="CIT0033" ref-type="bibr">2005</xref>
; Selikow, Ahmed, Flisher, Mathews, & Mukoma,
<xref rid="CIT0062" ref-type="bibr">2009</xref>
):
<list list-type="order">
<list-item>
<p>Factors within the person (psychological factors such as cognitions, self-efficacy, self-esteem, low-risk perception).</p>
</list-item>
<list-item>
<p>Relational factors (such as interpersonal environment, peer pressure, lack of role models).</p>
</list-item>
<list-item>
<p>Social and structural factors (gender norms, shared beliefs and values, legal, political, economic, and organisational elements of society).</p>
</list-item>
</list>
</p>
<p>Peer pressure among young people unmistakably undermines healthy social norms and HIV prevention messages (Selikow et al.,
<xref rid="CIT0062" ref-type="bibr">2009</xref>
). Gender inequalities and social norms about sexuality (Jewkes, Dunkle, Nduna, & Shai,
<xref rid="CIT0039" ref-type="bibr">2010</xref>
; Mantell et al.,
<xref rid="CIT0047" ref-type="bibr">2006</xref>
; Strebel et al.,
<xref rid="CIT0069" ref-type="bibr">2006</xref>
), sexual coercion, alcohol use (Harrison, Newell, Imrie, & Hoddinott,
<xref rid="CIT0034" ref-type="bibr">2010</xref>
), and economic conditions (Dinkelman, Lam, & Leibbrandt,
<xref rid="CIT0023" ref-type="bibr">2008</xref>
; Ofosu-Amaah, Egamberdi, & Dhar,
<xref rid="CIT0050a" ref-type="bibr">2009</xref>
) were prominent factors underlying HIV risk behaviour.</p>
<p>Despite large volumes of research on HIV among young people in Southern Africa, there is no evidence-based best practice model for HIV-prevention among the school-going population yet (Harrison et al.,
<xref rid="CIT0034" ref-type="bibr">2010</xref>
). One indisputable guideline for HIV-prevention is that programmes should be grounded in the understanding of adolescent sexual behaviour and empirical data that may explain adolescent risk-taking behaviour. Prevention strategies should be targeted at specific risk factors underlying behaviour in the context (Gupta, Parkhurst, Ogden, Aggleton, & Mahal,
<xref rid="CIT0032" ref-type="bibr">2008</xref>
; Rotheram-Borus, Swendeman, & Chovnick,
<xref rid="CIT0059" ref-type="bibr">2009</xref>
; Taylor,
<xref rid="CIT0071" ref-type="bibr">2004</xref>
). Gupta et al. (
<xref rid="CIT0032" ref-type="bibr">2008</xref>
, p. 773) stressed that ‘context really does matter and that a combination of successful approaches in one place might not be transferable to another’. This research was conducted to investigate the underlying reasons for school-going young people's sexual risk behaviour to inform a new generation of HIV-prevention strategies.</p>
<p>The social-cognitive theory of planned behaviour (TPB) (Ajzen,
<xref rid="CIT0001" ref-type="bibr">1991</xref>
) and social ecological theory (SET) (Bronfenbrenner,
<xref rid="CIT0010" ref-type="bibr">1995</xref>
) was used to understand the various factors underlying sexual risk behaviour of young people. According to the TPB, behaviour is influenced by an individual's behavioural intentions, which is in turn influenced by: (a) the individual's attitudes and beliefs towards that behaviour; (b) subjective perception of social norms; and (c) a sense of perceived control (self-efficacy) to perform the behaviour.</p>
<p>Several studies showed that the TPB is a promising theoretical framework to predict sexual risk behaviour in both international (Albarracín, Johnson, Fishbein, & Muellerleile,
<xref rid="CIT0004" ref-type="bibr">2001</xref>
; Armitage & Conner,
<xref rid="CIT0006" ref-type="bibr">2001</xref>
; Webb, Joseph, Yardley, & Michie,
<xref rid="CIT0078" ref-type="bibr">2010</xref>
) and African contexts (Gebreeyesus, Boer, & Kuiper,
<xref rid="CIT0030" ref-type="bibr">2007</xref>
; Jemmott et al.,
<xref rid="CIT0037" ref-type="bibr">2007</xref>
; Kakoko, Astrom, Lugoe, & Lie,
<xref rid="CIT0040" ref-type="bibr">2006</xref>
; Schaalma et al.,
<xref rid="CIT0061" ref-type="bibr">2009</xref>
). However, behavioural intentions were found not to be directly related to actual behaviour (Albarracín et al.,
<xref rid="CIT0004" ref-type="bibr">2001</xref>
; Schaalma et al.,
<xref rid="CIT0061" ref-type="bibr">2009</xref>
). Other social and environmental factors were found to moderate the relationship between behavioural intention and actual behaviour (Eaton et al.,
<xref rid="CIT0025" ref-type="bibr">2003</xref>
; Rotheram-Borus, Swendeman, Flannery, et al.,
<xref rid="CIT0060" ref-type="bibr">2009</xref>
; Webb & Sheeran,
<xref rid="CIT0079" ref-type="bibr">2006</xref>
). To capture the influence of various contextual factors on sexual risk behaviour of young people, the SET (Bronfenbrenner,
<xref rid="CIT0010" ref-type="bibr">1995</xref>
) is used in this research. According to Bronfenbrenner (
<xref rid="CIT0010" ref-type="bibr">1995</xref>
), behaviour takes place in a dynamic social context where the individual and social context are in constant interaction. Individual behaviour is thus shaped by the social and environmental milieu. The influence of contextual factors such as socioeconomic status, relationship with parents/caregivers, perceived gender norms, and community resources were investigated in this research, based on the research findings of Eaton et al. (
<xref rid="CIT0025" ref-type="bibr">2003</xref>
) and Harrison et al. (
<xref rid="CIT0033" ref-type="bibr">2005</xref>
).</p>
<p>The goal of the research was to investigate current risk behaviour of school-going young people and to explore the underlying reasons for sexual risk behaviour using variables related to the TPB and SET. Another goal was to assess the value of these theories in understanding sexual risk behaviour.</p>
</sec>
<sec id="S002">
<label>2.</label>
<title>Methods</title>
<p>A cross-sectional behavioural survey was used. This was part of a baseline study to inform the development of school interventions to reduce sexual risk behaviour of learners.</p>
<sec id="S002-S2001">
<label>2.1.</label>
<title>Sample</title>
<p>A three-stage sampling approach was used. The Department of Basic Education selected 142 schools in specific (mostly rural) districts in four provinces (KwaZulu-Natal, Free State, North West, and Mpumalanga), to participate in the research. These districts were regarded as most adversely affected by the HIV and AIDS epidemic (Shisana et al.,
<xref rid="CIT0066" ref-type="bibr">2009</xref>
) and in need of prevention interventions. The study population thus included learners in the age category 10–18 years who were enrolled in these specific schools. In each school, one class per grade group was selected randomly, by drawing a number from a box. Thirty learners from each selected class were systematically selected from the class list by choosing every second learner on the list, until there were 30 learners from the class. This was done to avoid selection bias. The behavioural survey was completed by 5305 learners. Of these, 1523 were junior learners (Grades 5–9 in primary and middle schools) and 3782 were senior learners (Grade 8–12 in secondary schools).</p>
</sec>
<sec id="S002-S2002">
<label>2.2.</label>
<title>Survey</title>
<p>A self-report survey assessed sexual risk behaviour of young people and factors identified as potentially underlying risk behaviour (see
<xref rid="T0001" ref-type="table">Table 1</xref>
). The following questions and scales were included in the survey.
<table-wrap id="T0001" orientation="portrait" position="float">
<label>Table 1.</label>
<caption>
<title>Assessment scales used.</title>
</caption>
<pmc-comment>OASIS TABLE HERE</pmc-comment>
<table frame="hsides" rules="groups">
<colgroup>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left">Scale</th>
<th align="center">Examples of items</th>
<th align="center">Number of items</th>
<th align="center">Response scale</th>
<th align="center">Reliability in this research</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left">Sexual risk scale</td>
<td align="left">I have had sex the past three months
<break></break>
I used a condom the last time I had sex</td>
<td align="char" char=".">7</td>
<td align="left">Yes/no</td>
<td align="char" char="(">0.74 (
<italic>n</italic>
 = 4067)</td>
</tr>
<tr>
<td align="left">HIV knowledge</td>
<td align="left">A person can get HIV from having unprotected sex</td>
<td align="char" char=".">9</td>
<td align="left">Yes/no</td>
<td align="char" char="(">0.59 (
<italic>n</italic>
 = 3763)</td>
</tr>
<tr>
<td align="left">Life satisfaction</td>
<td align="left">I have the important things I want in life</td>
<td align="char" char=".">5</td>
<td align="left">5-point scale</td>
<td align="char" char="(">0.55 (
<italic>n</italic>
 = 3676)</td>
</tr>
<tr>
<td align="left">Depression</td>
<td align="left">I feel unhappy, sad or depressed</td>
<td align="char" char=".">7</td>
<td align="left">5-point scale</td>
<td align="char" char="(">0.68 (
<italic>n</italic>
 = 3737)</td>
</tr>
<tr>
<td align="left">Relationship with caregiver</td>
<td align="left">My caregiver supports and encourages me.
<break></break>
My caregiver is a role model of how I want to be.</td>
<td align="char" char=".">11</td>
<td align="left">5-point scale</td>
<td align="char" char="(">0.74 (
<italic>n</italic>
 = 3582)</td>
</tr>
<tr>
<td align="left">Personal perception of gender norms</td>
<td align="left">I think a woman should obey her partner</td>
<td align="char" char=".">11</td>
<td align="left">5-point scale</td>
<td align="char" char="(">0.80 (
<italic>n</italic>
 = 3561)</td>
</tr>
<tr>
<td align="left">Perception of community gender norms</td>
<td align="left">People in my community think a woman should obey her partner</td>
<td align="char" char=".">9</td>
<td align="left">5-point scale</td>
<td align="char" char="(">0.72 (
<italic>n</italic>
 = 3592)</td>
</tr>
<tr>
<td align="left">Attitude towards abstinence</td>
<td align="left">Having sex at my age is responsible/
<break></break>
irresponsible</td>
<td align="char" char=".">7</td>
<td align="left">Positive/ negative</td>
<td align="char" char="(">0.60 (
<italic>n</italic>
 = 2832)</td>
</tr>
<tr>
<td align="left">Perceived social norms on abstinence</td>
<td align="left">Most people I respect expect me not to have sex</td>
<td align="char" char=".">7</td>
<td align="left">5-point scale</td>
<td align="char" char="(">0.70 (
<italic>n</italic>
 = 4067)</td>
</tr>
<tr>
<td align="left">Perceived control to abstain</td>
<td align="left">Whether I have sex or not is my own decision</td>
<td align="char" char=".">5</td>
<td align="left">5-point scale</td>
<td align="char" char="(">0.80 (
<italic>n</italic>
 = 3865)</td>
</tr>
<tr>
<td align="left">Attitude towards condom use</td>
<td align="left">Using a condom every time I have sex is acceptable/unacceptable</td>
<td align="char" char=".">8</td>
<td align="left">Positive/ negative</td>
<td align="char" char="(">0.66 (
<italic>n</italic>
 = 2903)</td>
</tr>
<tr>
<td align="left">Perceived social norms on condom use</td>
<td align="left">Most of my friends who are sexually active use condoms</td>
<td align="char" char=".">6</td>
<td align="left">5-point scale</td>
<td align="char" char="(">0.71 (
<italic>n</italic>
 = 3810)</td>
</tr>
<tr>
<td align="left">Perceived control to use condoms</td>
<td align="left">I will be able to use a condom when my friends expect me not to use one</td>
<td align="char" char=".">5</td>
<td align="left">5-point scale</td>
<td align="char" char="(">0.71 (
<italic>n</italic>
 = 3810)</td>
</tr>
</tbody>
</table>
</table-wrap>
</p>
<sec id="S002-S2002-S3001">
<label>2.2.1.</label>
<title>Demographic information</title>
<p>Questions were asked about gender, age, grade, household composition, and socio-economic status. A socioeconomic status scale was developed where the learners’ perception of their socio-economic status (score 0, 1 or 2) was combined with a figure coupled with the construction of their houses (0 for an informal house (shack) and 1 for a formal house). The socioeconomic status score was expressed on a scale from 0 to 10.</p>
</sec>
<sec id="S002-S2002-S3002">
<label>2.2.2.</label>
<title>Sexual risk behaviour</title>
<p>Self-reported sexual risk behaviour was assessed using indicators of the United Nations General Assembly Special Session (United Nations General Assembly Special Session on HIV/AIDS [UNGASS],
<xref rid="CIT0075" ref-type="bibr">2009</xref>
), also used in the Youth Risk Survey (Reddy et al.,
<xref rid="CIT0055" ref-type="bibr">2010</xref>
,
<xref rid="CIT0056" ref-type="bibr">2013</xref>
) and the household survey (Shisana et al.,
<xref rid="CIT0067" ref-type="bibr">2014</xref>
). The following indicators were used: (a) lifetime sex; (b) current sex (the past three months); (c) forced to have sex; (d) current multiple partners; (e) sex for money/gifts; (f) sex with a person five years and older; (g) sex under the influence of alcohol; (h) having been pregnant or fathered a child; (i) consistent condom use, and (j) condom use at last sex.</p>
<p>For the purpose of analysis, a sexual risk scale was calculated for each senior learner to determine a level of sexual risk. For ethical reasons, junior learners did not complete all sexual risk items. The sexual risk scale consisted of different types of behaviour that could increase a person's risk for HIV. The assumption was that the more types of risk behaviour an individual engaged in, the higher his/her risk exposure. A positive answer to each of the following indicators was given a score of one:
<list list-type="bullet">
<list-item>
<p>Lifetime sexual activity.</p>
</list-item>
<list-item>
<p>Current sexual activity (past three months).</p>
</list-item>
<list-item>
<p>Current sex with more than one partner (multiple partners).</p>
</list-item>
<list-item>
<p>Current sex with a partner five years and older (intergenerational sex).</p>
</list-item>
<list-item>
<p>Currently receiving money or gifts for sex (transactional sex).</p>
</list-item>
<list-item>
<p>Non-consistent condom use.</p>
</list-item>
<list-item>
<p>Non-condom use at last sex.</p>
</list-item>
</list>
</p>
<p>For example, if a learner reported three types of risk behaviour, a score of three was given on a scale of zero to seven. The internal consistency of this scale was 0.74 (
<italic>n</italic>
 = 4067).</p>
</sec>
<sec id="S002-S2002-S3003">
<label>2.2.3.</label>
<title>HIV-related knowledge</title>
<p>Nine knowledge indicators developed by UNGASS (
<xref rid="CIT0075" ref-type="bibr">2009</xref>
) were used to assess the percentage of learners who could correctly identify ways of HIV transmission and could reject major misconceptions. This scale was a criterion-based measurement to differentiate between learners with high and low knowledge levels; it therefore had a lower alpha coefficient of 0.588 in this research (
<italic>n</italic>
 = 3763).</p>
</sec>
<sec id="S002-S2002-S3004">
<label>2.2.4.</label>
<title>Psychological well-being</title>
<p>Two existing scales were used to assess psychological well-being. The life satisfaction scale (Diener, Emmons, Larsen, & Griffin,
<xref rid="CIT0022" ref-type="bibr">1985</xref>
; Pavot & Diener,
<xref rid="CIT0052" ref-type="bibr">2008</xref>
) was used to evaluate individuals’ subjective satisfaction with their lives. The scale consists of five items rated on a five-point scale. In international research, Diener et al. (
<xref rid="CIT0022" ref-type="bibr">1985</xref>
) obtained high reliability of the scale (test-retest 0.82; alpha coefficient of 0.87). In this research, the reliability was lower (0.55,
<italic>n</italic>
 = 3737).</p>
<p>Depressive mood was assessed through the seven items of the depression scale of Kandel and Davies (
<xref rid="CIT0041" ref-type="bibr">1982</xref>
). Responses were recorded on a five-point scale. Kandel and Davies (
<xref rid="CIT0041" ref-type="bibr">1982</xref>
) reported an alpha coefficient of 0.82, while the reliability in this research was somewhat lower (0.68).</p>
</sec>
<sec id="S002-S2002-S3005">
<label>2.2.5.</label>
<title>Relationship with parent/caregiver</title>
<p>The learners’ subjective assessment of the quality of their relationship with their caregivers was assessed using 11 items developed for this research from the Safe, Caring, and Child-friendly Schools Framework (Department of Basic Education,
<xref rid="CIT0019" ref-type="bibr">2008</xref>
). Responses were recorded on a five-point scale. The reliability of the scale was 0.74 for this research.</p>
</sec>
<sec id="S002-S2002-S3006">
<label>2.2.6.</label>
<title>Perception of gender norms</title>
<p>The learners’ acceptance of traditional gender roles vs. equality in gender roles was assessed using items from the gender relationships scale of Jewkes, Levin, and Penn-Kekana (
<xref rid="CIT0038" ref-type="bibr">2002</xref>
). Learners had to rate the extent to which they agree with statements such as ‘I think a woman should obey her partner’ on a five-point scale. The responses were accumulated into a personal gender norm perception scale with a reliability of 0.80 for this research.</p>
<p>The same questions were reformulated and used to assess individuals’ perceptions of community gender norms. An example of an item from the scale was phrased: ‘People in my community think a woman should obey her partner’. The reliability of the perception of community gender norms scale was 0.72.</p>
</sec>
<sec id="S002-S2002-S3007">
<label>2.2.7.</label>
<title>Substance abuse</title>
<p>Self-reported use of alcohol, excessive alcohol consumption (more than five drinks per occasion), cigarette smoking, excessive cigarette smoking, and use of illegal drugs the past month were recorded, using yes/no answers. Questions developed for the research of Morojele et al. (
<xref rid="CIT0050" ref-type="bibr">2013</xref>
) were adapted for this research.</p>
</sec>
<sec id="S002-S2002-S3008">
<label>2.2.8.</label>
<title>Attitudes, social norms, and personal control</title>
<p>Personal attitudes, perceived social norms and personal control related to sexual abstinence and condom use based on the TPB (Ajzen,
<xref rid="CIT0001" ref-type="bibr">1991</xref>
) were assessed using questions developed for this research.
<list list-type="bullet">
<list-item>
<p>
<italic>Attitudes</italic>
: Descriptive words indicating a positive or negative attitude were provided to learners, requiring them to indicate the statement they agreed with most. For example, ‘Having sex at my age is responsible/irresponsible’. Eight statements were given to assess attitude towards sexual abstinence and condom use. The reliability of the scales was 0.60 and 0.66, respectively.</p>
</list-item>
<list-item>
<p>
<italic>Perceptions of social norms</italic>
: Learners’ perceptions of important role players’ (parents, teachers, friends, boy/girlfriend) approval or disapproval of risk behaviour was assessed. This represents the perceived expectations of their behaviour. Seven items were answered on a five-point scale for sexual abstinence and condom use.</p>
</list-item>
<list-item>
<p>
<italic>Personal control (self-efficacy)</italic>
: The learners’ confidence to perform protective behaviour in difficult scenarios containing peer group pressure was assessed. Five questions were used in each scale, producing adequate reliability scores.</p>
</list-item>
</list>
</p>
<p>Two versions of the survey were used. The senior learners (Grades 8–12) completed the whole survey, while specific questions on sexual risk behaviour and condom use were omitted from the survey completed by junior learners (Grades 5–9). This was done because of a request by the provincial Education Departments for ethical reasons.</p>
<p>The questionnaire was piloted in two schools per province that resembled the sample schools to assess learners’ level of understanding and the language used. Adjustments were made accordingly.</p>
</sec>
</sec>
<sec id="S002-S2003">
<label>2.3.</label>
<title>Data collection procedures</title>
<p>Officials of the four participating provincial education departments were trained during a two-day training session to conduct the assessment in the selected schools. Training focused on the goal of the assessment, the meaning of each item, how to create a comfortable and confidential situation and how to assure privacy and respect for human rights of each learner. They practised in role play situations.</p>
<p>Data gathering was done using paper and pencil questionnaires in a classroom setting where a Life Orientation educator and the educational official were present. The questionnaire was presented in English. The completion of the questionnaire was mediated question by question. The official translated each question into the vernacular of the learners as they proceeded through the questionnaire to enhance comprehension. To ensure privacy in answers, the questionnaires were completed anonymously. Completed questionnaires were placed in a sealed box to be opened at another venue by the researchers.</p>
</sec>
<sec id="S002-S2004">
<label>2.4.</label>
<title>Ethical considerations</title>
<p>Ethical clearance was obtained from the Ethics Committee of Humanities at the University of Pretoria, South Africa. The provincial departments of Education and school management teams approved the research. Parents were informed through communiqués from the district offices. Parents of the learners in the sample completed consent forms before data collection took place. Only learners whose parents consented could be included in the sample. Learners included in the sample were informed about the aims of the study and signed assent forms before completing the questionnaires. They were alerted to the fact that participating was completely voluntary. They could decide not to complete the survey and that they need not answer any questions with which they felt uncomfortable. To enhance confidentiality and privacy, no identifying information was asked in the questionnaire. The educational officials were trained to show respect to learners to protect them from harm. The learners did not receive benefits from participation, except some refreshments after completing the survey.</p>
</sec>
<sec id="S002-S2005">
<label>2.5.</label>
<title>Data analysis</title>
<p>Data was analysed using SPSS version 22. In addition to descriptive data, scale scores were calculated for variables by adding responses to specific items and transposing the result into continuous scales from 0 to 10 (low to high score). Data for senior and junior learners were calculated separately because junior learners did not complete all the questions. Independent t-tests were used to compare condom users and non-condom users to determine variables that influence condom use. To identify variables related to sexual risk of senior learners, biographical data and scale scores were correlated with the sexual risk scale. Variables with significant correlations higher than 0.1 were entered into a stepwise linear regression analysis (Pallant,
<xref rid="CIT0051" ref-type="bibr">2010</xref>
) to identify the most prominent predictors of sexual risk behaviour.</p>
<p>The sensitive nature of questions related to sexual risk behaviour, resulted in high levels of missing data. To account for missing data and give an accurate presentation of data, percentages are given in terms of the number of respondents who answered each question and not for the sample as a whole. Missing values in sexually related questions hampered the regression analysis. There were 670 learners who left some of the items blank. Based on the nature of the questions, we decided to use the positive answers in the analysis. This implies that we made the assumption that if a learner did not answer a question, this indicated non-agreement with the statement. This allowed for a larger sample size in the regression analysis (
<italic>n</italic>
 = 3637 instead of 2967). To investigate the implications of this decision, a regression analysis with missing values and when missing values were re-coded, were done and resulted in similar findings.</p>
</sec>
</sec>
<sec id="S003">
<label>3.</label>
<title>Results</title>
<sec id="S003-S2001">
<label>3.1.</label>
<title>Demographic description of the learners</title>
<p>Participants were 55.8% female and 44.2% male between 10 and 18 years. The largest group was 16 years and older (48%) and 29% were 13 years and younger. The division of junior and senior learners was made based on the type of school they attended. Junior learners were in primary and middle schools (Grade 5–9), and senior learners were in secondary schools (Grade 8–12). There was thus some overlap regarding grades between the two groups of learners (
<xref rid="T0002" ref-type="table">Table 2</xref>
). Learners came from North West Province (30.4%), KwaZulu-Natal (25.4%), Mpumalanga (23.7%) and the Free State Province (20.5%).
<table-wrap id="T0002" orientation="portrait" position="float">
<label>Table 2.</label>
<caption>
<title>Grade groups of junior and senior groups.</title>
</caption>
<pmc-comment>OASIS TABLE HERE</pmc-comment>
<table frame="hsides" rules="groups">
<colgroup>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left"> </th>
<th align="center">Senior boys
<break></break>
(
<italic>n</italic>
 = 1702)</th>
<th align="center">Senior girls
<break></break>
(
<italic>n</italic>
 = 2080)</th>
<th align="center">Junior boys
<break></break>
(
<italic>n</italic>
 = 624)</th>
<th align="center">Junior girls
<break></break>
(
<italic>n</italic>
 = 899)</th>
<th align="center">Total
<break></break>
(
<italic>n</italic>
 = 5305)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left">Grade 5</td>
<td align="char" char="."> </td>
<td align="char" char="."> </td>
<td align="char" char=".">14.2</td>
<td align="char" char=".">12.4</td>
<td align="char" char=".">3.7</td>
</tr>
<tr>
<td align="left">Grade 6</td>
<td align="char" char="."> </td>
<td align="char" char="."> </td>
<td align="char" char=".">16.3</td>
<td align="char" char=".">13.8</td>
<td align="char" char=".">4.2</td>
</tr>
<tr>
<td align="left">Grade 7</td>
<td align="char" char="."> </td>
<td align="char" char="."> </td>
<td align="char" char=".">34.4</td>
<td align="char" char=".">32.4</td>
<td align="char" char=".">9.3</td>
</tr>
<tr>
<td align="left">Grade 8</td>
<td align="char" char=".">21.0</td>
<td align="char" char=".">18.3</td>
<td align="char" char=".">33.5</td>
<td align="char" char=".">39.8</td>
<td align="char" char=".">24.5</td>
</tr>
<tr>
<td align="left">Grade 9</td>
<td align="char" char=".">18.7</td>
<td align="char" char=".">21.2</td>
<td align="char" char=".">1.6</td>
<td align="char" char=".">1.6</td>
<td align="char" char=".">15.0</td>
</tr>
<tr>
<td align="left">Grade 10</td>
<td align="char" char=".">33.0</td>
<td align="char" char=".">33.8</td>
<td align="char" char="."> </td>
<td align="char" char="."> </td>
<td align="char" char=".">24.0</td>
</tr>
<tr>
<td align="left">Grade11</td>
<td align="char" char=".">19.7</td>
<td align="char" char=".">17.7</td>
<td align="char" char="."> </td>
<td align="char" char="."> </td>
<td align="char" char=".">13.3</td>
</tr>
<tr>
<td align="left">Grade 12</td>
<td align="char" char=".">7.7</td>
<td align="char" char=".">8.9</td>
<td align="char" char="."> </td>
<td align="char" char="."> </td>
<td align="char" char=".">6.1</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p>Note: Values are in percentage.</p>
</table-wrap-foot>
</table-wrap>
</p>
<p>The majority of learners (64.1%) reported that their families were coping financially with enough money in their households for basic needs (food and clothes). About 10% of the learners indicated that they did not have enough money to meet their basic needs.</p>
<p>Learners were mostly cared for either by both parents (29.6%) or by their mothers as single parents (36.7%). A large group of learners (29.5%) was in the care of grandparents or other family members. About a third of the learners (34.8%) reported that one or both of their parents had died.</p>
</sec>
<sec id="S003-S2002">
<label>3.2.</label>
<title>Sexual risk behaviour</title>
<p>Lifetime sex was reported by 49.4% of senior boys and 30.5% of senior girls, compared to 16.3% and 5.5% of the junior boys and girls (
<xref rid="T0003" ref-type="table">Table 3</xref>
). Current sexual activity (during the past three months) was reported by 27.9% of senior boys and 19.4% of senior girls, with fewer juniors currently involved in sexual activities (5.5% boys and 3.6% girls). The average age of sexual debut for sexually active learners (juniors and seniors) was between 15 and 16 years. A third of the learners who reported being sexually active, reported sexual debut before they were 15 years old (43.4% of the sexually active boys, 19.3% of the sexually active girls).
<table-wrap id="T0003" orientation="landscape" position="float">
<label>Table 3.</label>
<caption>
<title>Reported sexual behaviour.</title>
</caption>
<pmc-comment>OASIS TABLE HERE</pmc-comment>
<table frame="hsides" rules="groups">
<colgroup>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left"> </th>
<th colspan="2" align="center">Seniors</th>
<th colspan="2" align="center">Juniors</th>
<th align="center">Total (
<italic>n</italic>
 = 5305)</th>
</tr>
<tr>
<th align="center"> </th>
<th align="center">Boys (
<italic>n</italic>
 = 1702)</th>
<th align="center">Girls (
<italic>n</italic>
 = 2080)</th>
<th align="center">Boys (
<italic>n</italic>
 = 624)</th>
<th align="center">Girls (
<italic>n</italic>
 = 899)</th>
<th align="center"> </th>
</tr>
</thead>
<tbody>
<tr>
<td align="left">Had sex in their lifetime</td>
<td align="char" char="(">831 (49.4%) (
<italic>n</italic>
 = 1682)</td>
<td align="char" char="(">623 (30.5%) (
<italic>n</italic>
 = 2042)</td>
<td align="char" char="(">102 (16.3%) (
<italic>n</italic>
 = 624)</td>
<td align="char" char="(">48 (5.5%) (
<italic>n</italic>
 = 872)</td>
<td align="char" char="(">1623 (30.6%) (
<italic>n</italic>
 = 5304)</td>
</tr>
<tr>
<td align="left">Current sex (last 3 months)</td>
<td align="char" char="(">408 (27.9%) (
<italic>n</italic>
 = 1462)</td>
<td align="char" char="(">299 (19.4%) (
<italic>n</italic>
 = 1541)</td>
<td align="char" char="(">29 (5.5%) (
<italic>n</italic>
 = 527)</td>
<td align="char" char="(">27 (3.6%) (
<italic>n</italic>
 = 750)</td>
<td align="char" char="(">772 (17.8%) (
<italic>n</italic>
 = 4337)</td>
</tr>
<tr>
<td align="left">Was forced to have sex</td>
<td align="char" char="(">157 (10.6%) (
<italic>n</italic>
 = 1481)</td>
<td align="char" char="(">166 (10.0%) (
<italic>n</italic>
 = 1660)</td>
<td align="char" char="(">39 (7.1%) (
<italic>n</italic>
 = 549)</td>
<td align="char" char="(">36 (4.7%) (
<italic>n</italic>
 = 766)</td>
<td align="char" char="(">407 (9.0%) (
<italic>n</italic>
 = 4522)</td>
</tr>
<tr>
<td align="left">Had multiple partners past 3 months</td>
<td align="char" char="(">271 (31.3%) (
<italic>n</italic>
 = 866)</td>
<td align="char" char="(">82 (13.1%) (
<italic>n</italic>
 = 626)</td>
<td align="char" char="("> </td>
<td align="char" char="("> </td>
<td align="char" char="(">354 (23.4%) (
<italic>n</italic>
 = 1513)</td>
</tr>
<tr>
<td align="left">Sex under influence of alcohol</td>
<td align="char" char="(">135 (15.7%) (
<italic>n</italic>
 = 860)</td>
<td align="char" char="(">58 (9.2%) (
<italic>n</italic>
 = 630)</td>
<td align="char" char="("> </td>
<td align="char" char="("> </td>
<td align="char" char="(">197 (13.0%) (
<italic>n</italic>
 = 1515)</td>
</tr>
<tr>
<td align="left">Sex for money or gifts past 3 months (transactioinal sex)</td>
<td align="char" char="(">84 (9.8%) (
<italic>n</italic>
 = 857)</td>
<td align="char" char="(">41 (6.5%) (
<italic>n</italic>
 = 631)</td>
<td align="char" char="("> </td>
<td align="char" char="("> </td>
<td align="char" char="(">127 (8.4%) (
<italic>n</italic>
 = 1512)</td>
</tr>
<tr>
<td align="left">Sex with person more than 5 years older (intergenerational sex)</td>
<td align="char" char="(">171 (20.0%) (
<italic>n</italic>
 = 855)</td>
<td align="char" char="(">142 (22.8%) (
<italic>n</italic>
 = 623)</td>
<td align="char" char="("> </td>
<td align="char" char="("> </td>
<td align="char" char="(">319 (21.3%) (
<italic>n</italic>
 = 1498)</td>
</tr>
<tr>
<td align="left">Have been pregnant or fathered a child</td>
<td align="char" char="(">94 (10.9%) (
<italic>n</italic>
 = 862)</td>
<td align="char" char="(">132 (20.9%) (
<italic>n</italic>
 = 632)</td>
<td align="char" char="("> </td>
<td align="char" char="("> </td>
<td align="char" char="(">230 (15.2%) (
<italic>n</italic>
 = 1513)</td>
</tr>
<tr>
<td align="left">Condom use every time past 3 months</td>
<td align="char" char="(">484 (57.1%) (
<italic>n</italic>
 = 848)</td>
<td align="char" char="(">337 (55.3%) (
<italic>n</italic>
 = 609)</td>
<td align="char" char="("> </td>
<td align="char" char="("> </td>
<td align="char" char="(">831 (56.2%) (
<italic>n</italic>
 = 1479)</td>
</tr>
<tr>
<td align="left">Condom used at last sex</td>
<td align="char" char="(">590 (70.2%) (
<italic>n</italic>
 = 840)</td>
<td align="char" char="(">446 (71.6%) (
<italic>n</italic>
 = 623)</td>
<td align="char" char="("> </td>
<td align="char" char="("> </td>
<td align="char" char="(">1049 (71.0%) (
<italic>n</italic>
 = 1477)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p>Notes: Because of missing values, percentages are given in terms of the number of responses to each question. Number of responses are given per question. For ethical reasons, questions about sexual behaviour and condom use were posed only to the senior learners and are reported for senior learners who reported that they have been sexually active.</p>
</table-wrap-foot>
</table-wrap>
</p>
<p>In this sample, 9% of learners (junior and senior) reported having been forced to have sex, almost equal numbers of boys and girls. More than half of them (55%) told no one about the abuse.</p>
<p>Of the sexually active senior boys, 31.3% reported having multiple sexual partners, 20% intergenerational sex and 15.7% having sex while under the influence of alcohol. Alcohol consumption was more prominent among senior boys than girls: 29% of senior boys in the sample reported current (past 30 days) alcohol use, compared to 16.7% of senior girls. Heavy or binge drinking was reported by 17% of the senior boys and 7.4% of the senior girls.</p>
<p>Of the sexually active senior girls, 20.9% reported having been pregnant, and 22.8% reported intergenerational sex. More than half of the sexually active senior learners (56.2%) reported consistent condom use and more than two-thirds (71%) reported condom use at last sexual encounter.</p>
<p>The sexual risk scale (
<xref rid="T0004" ref-type="table">Table 4</xref>
) revealed that the majority of senior learners (59.4%) did not report sexual risk behaviours. Among the 40.6% who reported some sexual risk behaviour, 9.2% learners reported engagement in more than three sexually risky behaviours. These learners can be regarded as at extreme risk for HIV. In the sexually active group, 28.5% regarded themselves as at risk for HIV, while 80.5% reported that they know how to protect themselves against HIV.
<table-wrap id="T0004" orientation="portrait" position="float">
<label>Table 4.</label>
<caption>
<title>Distribution of senior learners on the sexual risk scale.</title>
</caption>
<pmc-comment>OASIS TABLE HERE</pmc-comment>
<table frame="hsides" rules="groups">
<colgroup>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left"> </th>
<th align="center">Risk score</th>
<th align="center">
<italic>N</italic>
 = 3782</th>
<th align="center">%</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left">No risk</td>
<td align="char" char=".">0</td>
<td align="char" char=".">2245</td>
<td align="char" char=".">59.4</td>
</tr>
<tr>
<td rowspan="3" align="left">High risk</td>
<td align="char" char=".">1</td>
<td align="char" char=".">208</td>
<td align="char" char=".">5.5</td>
</tr>
<tr>
<td align="char" char=".">2</td>
<td align="char" char=".">544</td>
<td align="char" char=".">14.4</td>
</tr>
<tr>
<td align="char" char=".">3</td>
<td align="char" char=".">436</td>
<td align="char" char=".">11.5</td>
</tr>
<tr>
<td rowspan="4" align="left">Extreme risk</td>
<td align="char" char=".">4</td>
<td align="char" char=".">239</td>
<td align="char" char=".">6.3</td>
</tr>
<tr>
<td align="char" char=".">5</td>
<td align="char" char=".">92</td>
<td align="char" char=".">2.4</td>
</tr>
<tr>
<td align="char" char=".">6</td>
<td align="char" char=".">16</td>
<td align="char" char=".">0.4</td>
</tr>
<tr>
<td align="char" char=".">7</td>
<td align="char" char=".">2</td>
<td align="char" char=".">0.1</td>
</tr>
</tbody>
</table>
</table-wrap>
</p>
<p>The knowledge indicator showed that learners’ knowledge of HIV was low – 37.8% of all learners in the sample group had accurate HIV knowledge. In an analysis of variance it was found that girls had significantly higher levels of knowledge than boys (
<italic>F</italic>
 = 46.94;
<italic>p</italic>
 < .001). Senior learners also had higher levels of knowledge than junior learners (
<italic>F</italic>
 = 47.11;
<italic>p</italic>
 < .001). Knowledge levels increased with age, ranging from 5.7% of 10-year-olds to 46.1% of 17-year-olds. Further analysis showed that learners had 80% of the answers correct. There were specific areas where respondents lacked knowledge about the transmission of HIV: 37% of the learners indicated that insects could transmit HIV; 31% thought having sex with a healthy-looking person would be safe, while 35% thought birth control pills would protect them from HIV. About 10% of learners believed that HIV could be transmitted through various forms of casual contact.</p>
</sec>
<sec id="S003-S2003">
<label>3.3.</label>
<title>Factors influencing condom use of senior learners</title>
<p>Senior learners that reported consistent condom use were compared to those that did not report condom use, through independent t-tests (
<xref rid="T0005" ref-type="table">Table 5</xref>
). Condom users had significantly more knowledge about HIV, they perceived others to support condom use, they had a more positive attitude towards condom use, they reported more perceived self-control with regard to risk behaviour, and they had more positive relationships with their caregivers.
<table-wrap id="T0005" orientation="portrait" position="float">
<label>Table 5.</label>
<caption>
<title>Variables related to condom use of senior sexually active learners.</title>
</caption>
<pmc-comment>OASIS TABLE HERE</pmc-comment>
<table frame="hsides" rules="groups">
<colgroup>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left">Scales</th>
<th align="center">Condom users
<break></break>
(
<italic>n</italic>
 = 575)</th>
<th align="center">Non-condom users
<break></break>
(
<italic>n</italic>
 = 1039)</th>
<th align="center">
<italic>T</italic>
</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left">Perceived social norm supporting condom use</td>
<td align="char" char=".">6.82</td>
<td align="char" char=".">6.27</td>
<td align="char" char=".">5.74***</td>
</tr>
<tr>
<td align="left">Attitude towards condom use</td>
<td align="char" char=".">8.10</td>
<td align="char" char=".">7.68</td>
<td align="char" char=".">4.14***</td>
</tr>
<tr>
<td align="left">HIV knowledge</td>
<td align="char" char=".">8.34</td>
<td align="char" char=".">8.07</td>
<td align="char" char=".">3.61***</td>
</tr>
<tr>
<td align="left">Self-control to abstain</td>
<td align="char" char=".">6.23</td>
<td align="char" char=".">5.78</td>
<td align="char" char=".">3.58***</td>
</tr>
<tr>
<td align="left">Self-control to use condoms</td>
<td align="char" char=".">5.98</td>
<td align="char" char=".">5.6</td>
<td align="char" char=".">3.35**</td>
</tr>
<tr>
<td align="left">Relationship with caregivers</td>
<td align="char" char=".">7.39</td>
<td align="char" char=".">7.13</td>
<td align="char" char=".">3.34**</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p>**
<italic>p</italic>
 < .01.</p>
<p>***
<italic>p</italic>
 < .001.</p>
</table-wrap-foot>
</table-wrap>
</p>
</sec>
<sec id="S003-S2004">
<label>3.4.</label>
<title>Factors underlying sexual risk behaviour of senior learners</title>
<p>Various factors potentially underlying sexual risk behaviour of young people were assessed in the questionnaire. Variables that correlated significantly and higher than 0.1 with the sexual risk score were entered into a stepwise linear regression analysis with sexual risk as the independent variable. A model was identified that explained 27.4% of the variance of sexual risk (
<italic>F</italic>
(3368) = 126.658;
<italic>p</italic>
 < .001) (
<xref rid="T0006" ref-type="table">Table 6</xref>
). The variables related to sexual risk behaviour were the following. Learners’ perceptions of social norms related to abstinence, attitude, and intention to abstain from sex are the variables that affect sexual risk behaviour the most. Furthermore, excessive alcohol consumption and current smoking are related to risk behaviour. Similarly, personal and perceived community gender norms and the quality of the parent-child relationships are social processes that have an important effect on young people's sexual risk behaviour. Age and gender were also prominent factors influencing sexual risk behaviour.
<table-wrap id="T0006" orientation="portrait" position="float">
<label>Table 6.</label>
<caption>
<title>Regression analysis of variables related to sexual risk.</title>
</caption>
<pmc-comment>OASIS TABLE HERE</pmc-comment>
<table frame="hsides" rules="groups">
<colgroup>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
<col width="1*"></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left"> </th>
<th align="center">Beta</th>
<th align="center">
<italic>t</italic>
(3631)</th>
<th align="center">
<italic>p</italic>
-Level</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left">Perceived social norms supporting abstinence</td>
<td align="char" char=".">−0.138</td>
<td align="char" char=".">−11.067</td>
<td align="char" char="."><.000</td>
</tr>
<tr>
<td align="left">Current excessive alcohol use</td>
<td align="char" char=".">0.779</td>
<td align="char" char=".">10.676</td>
<td align="char" char="."><.000</td>
</tr>
<tr>
<td align="left">Intention to abstain</td>
<td align="char" char=".">−0.153</td>
<td align="char" char=".">−8.882</td>
<td align="char" char="."><.000</td>
</tr>
<tr>
<td align="left">Age</td>
<td align="char" char=".">0.161</td>
<td align="char" char=".">9.393</td>
<td align="char" char="."><.000</td>
</tr>
<tr>
<td align="left">Positive attitude towards abstinence</td>
<td align="char" char=".">−0.047</td>
<td align="char" char=".">−4.680</td>
<td align="char" char="."><.000</td>
</tr>
<tr>
<td align="left">Current cigarette smoking</td>
<td align="char" char=".">0.389</td>
<td align="char" char=".">4.415</td>
<td align="char" char="."><.000</td>
</tr>
<tr>
<td align="left">Personal gender norms</td>
<td align="char" char=".">0.034</td>
<td align="char" char=".">1.975</td>
<td align="char" char="."><.05</td>
</tr>
<tr>
<td align="left">Caregiver relationship</td>
<td align="char" char=".">−0.067</td>
<td align="char" char=".">−4.379</td>
<td align="char" char="."><.001</td>
</tr>
<tr>
<td align="left">Gender</td>
<td align="char" char=".">−0.149</td>
<td align="char" char=".">−3.120</td>
<td align="char" char="."><.01</td>
</tr>
<tr>
<td align="left">Perceived community gender norms</td>
<td align="char" char=".">0.046</td>
<td align="char" char=".">2.778</td>
<td align="char" char="."><.01</td>
</tr>
</tbody>
</table>
</table-wrap>
</p>
<p>The analysis indicates that variables such as life satisfaction, depression, HIV knowledge, and self-control to abstain in the face of peer pressure were, in relation to the other variables, not as prominent predictors of sexual risk behaviour.</p>
<p>The group of learners as a whole (seniors and juniors) experienced an average level of support from significant others to abstain from sex (6.3 on a scale of 0–10). Girls received more support (7.03 on a scale 0–10) than boys (5.5 on a scale 0–10). Of the girls, 71% experienced that their parents/caregivers disapproved of young people becoming sexually active, while 60.3% of their friends also disapproved of being sexually active at a young age. Similarly, boys experienced that 62% of their parents/caregivers disapproved of young people being sexually active. In contrast, boys experience that 71% of their friends encourage them to have sex. Half of the boys (52.6%) in this study (10–18 years old), perceived their friends to be sexually active. Boys thus experience strong peer pressure to be sexually active. Boys also experience less control and self-efficacy related to their sexual decisions (5.0 on a scale of 0–10) than girls (6.04 on a scale of 0–10).</p>
</sec>
</sec>
<sec id="S004">
<label>4.</label>
<title>Discussion</title>
<p>The sexual risk patterns identified in this research compared well with those of recent similar studies among young people in South Africa. The data can, therefore, be seen as an accurate reflection of the risk reported among young people; despite the younger age group included (10–18 years) and that learners came from areas identified as at high risk. In the sample of 5305 learners, 49.4% of the boys and 30.5% of the girls 14 years and older reported having had sex. This compares with the 36% of learners reported being sexually active in the YRBS (Reddy et al.,
<xref rid="CIT0056" ref-type="bibr">2013</xref>
). The rate of early sexual debut remains high when compared to previous research (Pettifor et al.,
<xref rid="CIT0053" ref-type="bibr">2009</xref>
; Shisana et al.,
<xref rid="CIT0067" ref-type="bibr">2014</xref>
). In this study, 33% of sexually active junior and senior learners reported having sex before the age of 15 years – 6.7% of the sample as a whole.</p>
<p>Almost a third of the sexually active senior boys (31.3%) reported having had multiple sexual partners during the past three months. This figure was slightly lower than the 47% reported by Reddy et al. (
<xref rid="CIT0056" ref-type="bibr">2013</xref>
) and slightly higher than the 20.1% reported by Shisana et al. (
<xref rid="CIT0067" ref-type="bibr">2014</xref>
). Even so, it causes concern. Intergenerational sex was prevalent among senior boys as well as girls (20% and 22.8%, respectively), in contrast with Shisana et al. (
<xref rid="CIT0067" ref-type="bibr">2014</xref>
) who found that intergenerational sex is far more prevalent among girls than boys (33.6% vs. 4.1%). Intergenerational sex of boys may be the result of a measurement issue, but needs to be further investigated as it does not receive much attention in the literature. Transactional sex was likely underreported in this study, as 9.8% of boys and 6.5% of girls reported receiving money or goods for sex. It is possible that they associated the question with sex work or were not open about their activities or transactional sex is not as high as anticipated. A high percentage of sexually active girls (20.9%) reported having been pregnant, while 10.9% boys acknowledged that they fathered a child. These results are similar to the findings of the YRBS (Reddy et al.,
<xref rid="CIT0056" ref-type="bibr">2013</xref>
). Consistent condom use among senior sexually active learners (56.2%), and condom use at last sexual encounter (71%) was higher than previously reported (Reddy et al.,
<xref rid="CIT0056" ref-type="bibr">2013</xref>
; Shisana et al.,
<xref rid="CIT0067" ref-type="bibr">2014</xref>
), but still cause for concern. Learners’ perceptions of their own risk of exposure to HIV was low. In the sexually active group, 28.5% regarded themselves as at risk of HIV. The low perception of personal risk is echoed in the UNAIDS (
<xref rid="CIT0072" ref-type="bibr">2014a</xref>
) report where 82% of South African young people are of the opinion that they are not at risk of HIV infection.</p>
<p>Although 87.5% of learners reported that they had learned about HIV in their schools, there seems to be a lack of HIV knowledge. Only 37.8% of the sample as a whole had accurate knowledge about HIV. It was found that knowledge levels increased with age. While only 5.7% of 10-year-olds had accurate knowledge, 46.1% of the 17-year-olds answered all questions correctly. Shisana et al. (
<xref rid="CIT0067" ref-type="bibr">2014</xref>
) found even lower levels of HIV knowledge among young people aged 15–24 years (28.6%). Prevention interventions, therefore, have to focus on increasing HIV knowledge, specifically the areas identified as problem areas, as the core of school interventions.</p>
<p>Inconsistencies in data from various studies highlighted the sensitivity of the topic and the influence of the choice of respondents and the data collection process on the research findings. Self-report of sensitive behaviour may not always be accurate and can be influenced by many internal and external factors. There is not a way to accurately verify the data (Catania, Gibson, Chitwood, & Coates,
<xref rid="CIT0011" ref-type="bibr">1990</xref>
). From the findings of various studies, it is possible to identify common behavioural trends of young people that can be used in planning prevention efforts.</p>
<p>This research shows that despite two decades of HIV education in schools (Department of Education,
<xref rid="CIT0017" ref-type="bibr">1998</xref>
,
<xref rid="CIT0018" ref-type="bibr">2003</xref>
,
<xref rid="CIT0020" ref-type="bibr">2011</xref>
), the consistently high sexual risk behaviour of learners and the lack of HIV knowledge emphasise the lack of effective interventions and the importance of relooking HIV prevention in schools. There is no shortage of research, programmes, and guidelines for HIV prevention in schools (Anderson, Panchaud, Singh, & Watson,
<xref rid="CIT0005" ref-type="bibr">2013</xref>
; Biddlecom, Hessburg, Singh, Bankole, & Darabi,
<xref rid="CIT0009" ref-type="bibr">2007</xref>
; Department of Basic Education,
<xref rid="CIT0018" ref-type="bibr">2003</xref>
,
<xref rid="CIT0020" ref-type="bibr">2011</xref>
; Department of Health,
<xref rid="CIT0021" ref-type="bibr">2003</xref>
; Family Health International,
<xref rid="CIT0026" ref-type="bibr">2009</xref>
; Klepp, Flisher, & Kaaya,
<xref rid="CIT0042" ref-type="bibr">2006</xref>
; Ross, Dick, & Ferguson,
<xref rid="CIT0057" ref-type="bibr">2006</xref>
; Senderowitz & Kirby,
<xref rid="CIT0063" ref-type="bibr">2006</xref>
). This research demonstrates that a gap still exists between existing knowledge about HIV prevention and interventions implemented in South African schools. HIV interventions are often short-term and knowledge-driven, and many challenges exist in the implementation of HIV prevention in schools (Aggleton, Yankah, & Crewe,
<xref rid="CIT0002" ref-type="bibr">2011</xref>
; Frempong, Reddy, & Kanjee,
<xref rid="CIT0028" ref-type="bibr">2011</xref>
; Shefer & MacLeod,
<xref rid="CIT0065" ref-type="bibr">2015</xref>
; Visser,
<xref rid="CIT0076" ref-type="bibr">2005</xref>
).</p>
<sec id="S004-S2001">
<label>4.1.</label>
<title>Factors predicting sexual risk behaviour</title>
<p>This research identified several variables underlying sexual risk behaviour that should be targeted for prevention interventions to be effective. Perceived social norms played the most important role in encouraging sexual risk behaviour. Perceived social norms refer to the behaviour young people observe amongst their peers; what they perceive others approve of and expect of them (Ajzen,
<xref rid="CIT0001" ref-type="bibr">1991</xref>
). Peer group pressure is thus the strongest predictor of risk behaviour, particularly for males. Sexual risk behaviour was also prominent among learners that do not intend to abstain from sex or have negative attitudes towards abstinence. These results show that variables from the TPB (intentions, attitude, and perceived social norms) were strong predictors of sexual risk behaviour. Unlike previous research that highlighted perceived behavioural control as the most prominent explanation of intention to implement protective behaviour (Albarracín et al.,
<xref rid="CIT0004" ref-type="bibr">2001</xref>
; Armitage & Conner,
<xref rid="CIT0006" ref-type="bibr">2001</xref>
; Jemmott et al.,
<xref rid="CIT0037" ref-type="bibr">2007</xref>
; Kakoko et al.,
<xref rid="CIT0040" ref-type="bibr">2006</xref>
; Schaalma et al.,
<xref rid="CIT0061" ref-type="bibr">2009</xref>
), perceived social norms were the strongest predictor of risk behaviour in the present study. Learners’ perceived behavioural control or self-efficacy was fairly low in this study. Boys, in particular, did not experience having enough control to make decisions about their behaviour in the face of difficult situations involving peer group pressure.</p>
<p>Similarly, this research confirms the value of the TPB in predicting condom use. The learners that reported consistent condom use differed from non-condom users in their attitude towards condom use, perceived social norms, and feeling in control of sexual decisions and condom use. This confirms the results of previous research (Hendriksen, Pettifor, Lee, Coates, & Rees,
<xref rid="CIT0035" ref-type="bibr">2007</xref>
; Schaalma et al.,
<xref rid="CIT0061" ref-type="bibr">2009</xref>
) that the TPB is of value in predicting condom use. The TPB thus has potential as a framework to explain sexual risk behaviour and to plan preventive interventions.</p>
<p>HIV risk behaviour was prominent for older learners and males. More males than females reported being sexually active, having multiple partners, and having sex under the influence of alcohol. Males also reported experiencing high levels of peer pressure to engage in sexual risk behaviour. In contrast to the current prevention strategies that focus largely on young females (Shisana et al.,
<xref rid="CIT0067" ref-type="bibr">2014</xref>
; UNAIDS,
<xref rid="CIT0073" ref-type="bibr">2014b</xref>
), this research demonstrated the importance of prevention interventions amongst young males. It is during the adolescent years that young men develop their behavioural patterns and beliefs about gender norms. If interventions can address the peer group and gender norms young men are exposed to, a difference can be made in their current and future high-risk behaviour and can furthermore impact risk situations for young females.</p>
<p>In addition to individual variables, social and cultural factors such as peer group and community gender norms and a culture that promotes substance abuse, influenced learners’ sexual risk behaviour. These are social processes not under the control of the individual, as explained by the SET (Bronfenbrenner,
<xref rid="CIT0010" ref-type="bibr">1995</xref>
). Risk is embedded in broader social structures (Rotheram-Borus, Swendeman, Flannery, et al.,
<xref rid="CIT0060" ref-type="bibr">2009</xref>
) that need to be changed to shape healthier behaviour.</p>
<p>Learners that ascribed to traditional gender norms or perceived such norms in their community, engaged in more sexual risk behaviours. These young people attach more status to males than females, believe that males can have more than one girlfriend, and that a woman does not have the right to refuse sex with her partner (Jewkes et al.,
<xref rid="CIT0038" ref-type="bibr">2002</xref>
,
<xref rid="CIT0039" ref-type="bibr">2010</xref>
). These beliefs encourage risk behaviour amongst males, such as having multiple partners, and disempower women to protect themselves from HIV and take control of their sexual health. The development and reaction towards gender norms should, therefore, form part of HIV prevention strategies for young people.</p>
<p>Excessive alcohol consumption and cigarette smoking predicted sexual risk behaviour. This confirms previous research (Taylor, Dlamini, Kagoro, Jinabhai, & De Vries,
<xref rid="CIT0070" ref-type="bibr">2003</xref>
; Woolf-King & Maisto,
<xref rid="CIT0082" ref-type="bibr">2011</xref>
). The relationship between substance use and sexual risk was explained by Reddy et al. (
<xref rid="CIT0055" ref-type="bibr">2010</xref>
), who found that different risk behaviours cluster together, especially for male respondents. They found that some individuals who have risk-prone profiles, engage in more than one type of risky behaviour. If one wishes to address HIV risk, various forms of substance abuse therefore also need to be addressed.</p>
<p>A positive caregiver relationship was identified as a protective factor against sexual risk behaviour. The quality of the relationship with a parent or caregiver has been consistently identified as an important factor in the mental health and healthy behaviour choices of HIV-affected adolescents in South Africa (Cluver, Boyes, Orkin, & Sherr,
<xref rid="CIT0013" ref-type="bibr">2013</xref>
; Cluver, Orkin, Boyes, Sherr, Makasi, et al.,
<xref rid="CIT0014" ref-type="bibr">2013</xref>
; Knerr, Gardner, & Cluver,
<xref rid="CIT0043" ref-type="bibr">2013</xref>
). Despite these findings, parents or caregivers have not been involved in HIV prevention efforts in schools.</p>
</sec>
<sec id="S004-S2002">
<label>4.2.</label>
<title>Factors not predicting sexual risk behaviour</title>
<p>Four factors that were expected to underlie sexual risk behaviour, but were not prominent in the regression analysis, need to be highlighted.
<italic>Socio-economic status</italic>
did not predict sexual risk behaviour, in contrast with previous research (Cluver, Boyes, Orkin, Pantelic, et al.,
<xref rid="CIT0012" ref-type="bibr">2013</xref>
; Cluver, Boyes, Orkin, & Sherr,
<xref rid="CIT0013" ref-type="bibr">2013</xref>
; Cluver, Orkin, Boyes, Sherr, Makasi, et al.,
<xref rid="CIT0014" ref-type="bibr">2013</xref>
; Leclerc-Madlala,
<xref rid="CIT0044" ref-type="bibr">2008</xref>
; Wight et al.,
<xref rid="CIT0080" ref-type="bibr">2006</xref>
). The current research included at-risk schools, mostly from low socio-economic communities. This limited the variance in the socio-economic variable. Additionally, a very crude measure of socio-economic status was used, depending on the learners’ subjective assessment of having enough or not enough money for basic needs. The finding in this research does
<italic>not</italic>
have implications for the value of poverty alleviation interventions as HIV prevention strategy.</p>
<p>
<italic>HIV knowledge</italic>
was the second factor that did not predict sexual risk behaviour. In this study, 37.8% of the learners had accurate HIV knowledge. A comparison of plots of the two variables (HIV knowledge and sexual risk) showed that the two variables had different structures that were unrelated. Unlike the results for sexual risk behaviour, HIV knowledge differentiated condom users from non-condom users. Learners thus need accurate knowledge in their decision to use condoms. This research consequently demonstrated that various other factors had a stronger influence on sexual risk behaviour than the level of HIV knowledge. Prevention packages should therefore not only focus on HIV knowledge, but should address the other variables underlying sexual risk behaviour.</p>
<p>
<italic>Perceived control</italic>
of sexual behaviour (self-efficacy) did not predict sexual risk behaviour as expected (Schaalma et al.,
<xref rid="CIT0061" ref-type="bibr">2009</xref>
). Perceived control focused on learners’ preparedness for own decision-making and their skills to resist peer pressure. The learners’ sense of control was rather low (5.7 on a scale of 0–10). Learners, especially boys, felt influenced by the social norms and peer pressure and did not perceive that they have enough control to make their own decisions. On the other hand, learners’ sense of personal control distinguished condom users from non-condom users.</p>
<p>
<italic>Mental health</italic>
, as assessed by life satisfaction and depression, also did not play a role in learners’ sexual risk behaviour as expected. It seems that the social processes influenced behaviour more than individual factors.</p>
<p>These results demonstrate that interventions have to focus on both individual and social levels to make a difference in young people's risk behaviour. The broader structural factors that shape and constrain individual behaviour (Gupta et al.,
<xref rid="CIT0032" ref-type="bibr">2008</xref>
) need to be addressed to enable individual change.</p>
</sec>
</sec>
<sec id="S005">
<label>5.</label>
<title>Recommendations</title>
<p>The results of the research revealed that 40.6% of the learners reported sexual risk behaviour on the sexual risk scale. Risk behaviour differs between age and gender groups. HIV prevention therefore has to be targeted at the needs of specific groups. Primary prevention and health promotion should be the focus for learners who are not likely at risk, so as to encourage delay of sexual debut and knowledge about condom use (mostly at primary school). Risk reduction programmes will focus on the learners who are at risk of HIV to promote condom use and decrease high-risk sexual behaviour. This research emphasised that HIV prevention should focus on individual and structural factors to change community gender norms and relationships between young people. Based on the results of this research, HIV prevention in schools should include the following:</p>
<p>
<italic>Accurate information</italic>
about HIV risk and protective behaviour should form part of training in sexual and reproductive health, which should be the core of a school intervention. Knowledge needs to be conveyed in a way that learners can make it part of their own lifestyle, such as using drama interventions (Gausset,
<xref rid="CIT0029" ref-type="bibr">2001</xref>
). Most current HIV prevention programmes in schools focus solely on HIV knowledge (Department of Education,
<xref rid="CIT0020" ref-type="bibr">2011</xref>
).</p>
<p>In addition to awareness and knowledge, HIV prevention should include a
<italic>behaviour change component</italic>
to assist young people in adopting a healthy lifestyle. The TPB showed promise as a theoretical framework to promote a healthy lifestyle which includes delayed sexual debut, reduced number of partners (especially intergenerational partners), protected sex and knowledge of HIV status. Positive attitudes towards abstinence and condom use as protection against HIV should be highlighted. Most of all, learners should be challenged to develop a critical awareness (Freire,
<xref rid="CIT0027" ref-type="bibr">1993</xref>
) of the influence that peer group and community gender norms have on their behaviour. This involves an intellectual understanding of how current ways of thinking about gender and sexuality negatively influence their decision making. It also involves dialogue and critical discussion between boys and girls to negotiate new ways of relating that is healthy for both parties and can lead to gender transformation and gender justice (Shefer & MacLeod,
<xref rid="CIT0065" ref-type="bibr">2015</xref>
). Especially boys need to challenge gender norms that expect of them to be sexually active, have many partners and use substances to prove their masculinity (Dworkin, Hatcher, Colvin, & Peacock,
<xref rid="CIT0024" ref-type="bibr">2013</xref>
; Lynch, Brouard, & Visser,
<xref rid="CIT0045" ref-type="bibr">2010</xref>
; Mfecane,
<xref rid="CIT0049" ref-type="bibr">2010</xref>
). Such honest conversations between young people, facilitated by a trained adult, have shown to make a difference in how young people make decisions and relate to each other.</p>
<p>Young people also need to develop confidence in their ability to take control of their own sexual decision making. They should have the skills to resist peer pressure and other contradicting influences. Positive peer group pressure can be strengthened through leadership development as an alternative means of influencing young people's behaviour.</p>
<p>These interpersonal negotiations should be duplicated on broader community levels, including parents and caregivers so that adults can discuss and model positive gender relationships for the youth. Social transformation is needed, focusing on economic and social empowerment of women to reduce intergenerational sexual relationships and gender-based violence (Hendriksen et al.,
<xref rid="CIT0035" ref-type="bibr">2007</xref>
; Stirling et al.,
<xref rid="CIT0068" ref-type="bibr">2008</xref>
). Large volumes of research and advocacy documents exist to promote equality in gender roles and empowerment of women to prevent HIV infection (e.g. Jewkes et al.,
<xref rid="CIT0039" ref-type="bibr">2010</xref>
; Mantell et al.,
<xref rid="CIT0047" ref-type="bibr">2006</xref>
; Stirling et al.,
<xref rid="CIT0068" ref-type="bibr">2008</xref>
; Strebel et al.,
<xref rid="CIT0069" ref-type="bibr">2006</xref>
). These principles need to be implemented as part of school interventions and on the community level to model positive gender relationships. Change in community norms and social structures is necessary to sustain behaviour change structures (Rotheram-Borus, Swendeman, Flannery, et al.,
<xref rid="CIT0060" ref-type="bibr">2009</xref>
).</p>
<p>This research provides evidence that the quality of young people's relationships with their parents or caregivers is a protective factor against sexual risk behaviour. Parents/caregivers should, therefore, be involved in school-based HIV prevention efforts, especially to learn parenting skills and how to communicate about sensitive topics. Training in parenting skills could improve caregivers’ understandings of child development and to improve the quality of parent-child relationships (Knerr et al.,
<xref rid="CIT0043" ref-type="bibr">2013</xref>
). Additionally, parents/caregivers are role models and the primary sources of information and guidance for young people related to sexual development (Akers, Holland, & Bost,
<xref rid="CIT0003" ref-type="bibr">2011</xref>
; Goodnight et al.,
<xref rid="CIT0031" ref-type="bibr">2014</xref>
). Previous research showed that young people exposed to communication about sex at home showed higher self-efficacy, positive attitudes and intentions, responsible decision making, limited risky sexual behaviour, and increased knowledge about sex (Bastien, Kajula, & Muhwezi,
<xref rid="CIT0007" ref-type="bibr">2011</xref>
; Coetzee et al.,
<xref rid="CIT0015" ref-type="bibr">2014</xref>
). Effective caregiver-youth communication about sex can, therefore, protect young people from a range of risk behaviours (Bastien et al.,
<xref rid="CIT0007" ref-type="bibr">2011</xref>
; Goodnight et al.,
<xref rid="CIT0031" ref-type="bibr">2014</xref>
; Rotheram-Borus, Flannery, Rice, & Lester,
<xref rid="CIT0058" ref-type="bibr">2005</xref>
). Parents/caregivers should thus be empowered to overcome the barriers (De Palma & Francis,
<xref rid="CIT0016" ref-type="bibr">2014</xref>
; Moletsane,
<xref rid="CIT0048" ref-type="bibr">2011</xref>
) and develop the skills (Bastien et al.,
<xref rid="CIT0007" ref-type="bibr">2011</xref>
; Goodnight et al.,
<xref rid="CIT0031" ref-type="bibr">2014</xref>
; Phetla et al.,
<xref rid="CIT0054" ref-type="bibr">2008</xref>
) to effectively talk to young people about sensitive issues like sex, pregnancy, contraceptives, and HIV prevention. There is evidence of effective interventions for caregivers to provide sexual education for young people (Akers et al.,
<xref rid="CIT0003" ref-type="bibr">2011</xref>
).</p>
</sec>
<sec id="S006">
<label>6.</label>
<title>Limitations</title>
<p>The sample of learners was not a random sample representative of the population of young people in the country. The study was conducted in four provinces in schools selected because of a potentially high risk for HIV and lack of interventions in the school. Bias can exist based on the location of the schools and the socioeconomic climate in the community, as well as the unique characteristics of the schools involved. Additionally, learners had various degrees of exposure to prevention programmes that may have influenced their knowledge, attitudes, and behaviour. Despite the fact that the results of this study cannot be generalised to the population as a whole, the large sample size allows for identification of general behaviour patterns.</p>
<p>Language used could have played a role in the accuracy of data. The questionnaire was presented in English and translated where necessary during completion. Some misunderstandings could have occurred. Questions were formulated based on the concepts of international HIV literature, which may not have been part of the conceptual framework of 10–15-year-olds in a rural area. This might have contributed to inconsistencies and missing responses.</p>
<p>Earlier research identified many constraints in the accuracy of self-reported sexual behaviour (Catania et al.,
<xref rid="CIT0011" ref-type="bibr">1990</xref>
). The social and personal desirability of responses can influence the data, especially since there are significant differences between genders in this regard. Several patterns of over- and underreporting were found to interact in collecting data on sexual behaviour. Girls were found to often under-report sexual activity (Wislar & Fendrich,
<xref rid="CIT0081" ref-type="bibr">2000</xref>
) while boys, in line with the peer norms they perceive, may conversely over-report (Catania et al.,
<xref rid="CIT0011" ref-type="bibr">1990</xref>
). Learners may have difficulty conveying sensitive information despite all assurances given by data collectors. The results on self-reported sexual behaviour patterns thus have to be interpreted against the complexities involved in gathering sensitive data, but the current research is not unique in this regard. It applies to all similar research.</p>
</sec>
<sec id="S007">
<label>7.</label>
<title>Conclusions</title>
<p>The research confirmed many previous research findings about sexual risk behaviour among young people that can contribute to identifying common patterns. The research also provided evidence of underlying factors of sexual risk that was often found in qualitative research. The research highlighted the importance of re-thinking school-based HIV prevention, because of the high levels of sexual risk behaviour that still exist after two decades of school-based interventions. The value of the TPB to understand and influence sexual risk behaviour was demonstrated. Of similar importance, the research identified peer group and community gender norms, a culture of substance abuse and quality of relationship with caregivers as underlying young people's sexual risk behaviour. HIV prevention should therefore not focus on young people's knowledge, skills, and behaviour alone. It is even more important to raise critical awareness of the influence of gender and peer group norms on sexual risk behaviour. These broader structural factors shape and constrain individual behaviour (Gupta et al.,
<xref rid="CIT0032" ref-type="bibr">2008</xref>
). Awareness of these factors can empower young people to re-negotiate and transform their own healthier social norms. The protective power of positive parent-child relationships should also be explored and enhanced. The research also focused on the importance of interventions for boys/men to renegotiate gender norms that will allow them to make healthy choices.</p>
<p>Sustainable change requires shifting community and peer group norms and the broader social structures that shape behaviour underlying HIV-epidemics and the social problems that accompany it. This research emphasised the statement of Stirling et al. (
<xref rid="CIT0068" ref-type="bibr">2008</xref>
): ‘Nothing less than social transformation is needed now to turn this epidemic around’ (p. S3).</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgements</title>
<p>I acknowledge the valuable contributions of Anita Govan (Link Community development) and Provincial departmental officials in the data collection and Dr Nicolaas Claassen and Wilhelm Haupt in data management and analysis. I thank Dr Saadhna Panday and Dr Faith Khumalo (Department of Basic Education) for their critical input in the report.</p>
</ack>
<ref-list>
<title>References</title>
<ref id="CIT0001">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Aggleton</surname>
<given-names>P.</given-names>
</name>
,
<name>
<surname>Yankah</surname>
<given-names>E.</given-names>
</name>
, &
<name>
<surname>Crewe</surname>
<given-names>M.</given-names>
</name>
</person-group>
(
<year>2011</year>
).
<article-title>Education and HIV/AIDS – 30 years on</article-title>
.
<source>
<italic>AIDS Education and Prevention</italic>
</source>
, (
<issue>6</issue>
),
<fpage>495</fpage>
<lpage>507</lpage>
. doi:
<pub-id pub-id-type="doi">10.1521/aeap.2011.23.6.495</pub-id>
<pub-id pub-id-type="pmid">22201234</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0002">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ajzen</surname>
<given-names>I.</given-names>
</name>
</person-group>
(
<year>1991</year>
).
<article-title>The theory of planned behaviour</article-title>
.
<source>
<italic>Organisational Behaviour and Human Decision Processes</italic>
</source>
, ,
<fpage>179</fpage>
<lpage>211</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/0749-5978(91)90020-T</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0003">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Akers</surname>
<given-names>A. Y.</given-names>
</name>
,
<name>
<surname>Holland</surname>
<given-names>C. L.</given-names>
</name>
, &
<name>
<surname>Bost</surname>
<given-names>J.</given-names>
</name>
</person-group>
(
<year>2011</year>
).
<article-title>Interventions to improve parental communication about sex: A systematic review</article-title>
.
<source>
<italic>Pediatrics</italic>
</source>
, ,
<fpage>494</fpage>
<lpage>510</lpage>
. doi:
<pub-id pub-id-type="doi">10.1542/peds.2010-2194</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0004">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Albarracín</surname>
<given-names>D.</given-names>
</name>
,
<name>
<surname>Johnson</surname>
<given-names>B. T.</given-names>
</name>
,
<name>
<surname>Fishbein</surname>
<given-names>M.</given-names>
</name>
, &
<name>
<surname>Muellerleile</surname>
<given-names>P. A.</given-names>
</name>
</person-group>
(
<year>2001</year>
).
<article-title>Theories of reasoned action and planned behavior as models of condom use: A meta-analysis</article-title>
.
<source>Psychological Bulletin</source>
, (
<issue>1</issue>
),
<fpage>142</fpage>
<lpage>161</lpage>
. doi:
<pub-id pub-id-type="doi">10.1037/0033-2909.127.1.142</pub-id>
<pub-id pub-id-type="pmid">11271752</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0005">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Anderson</surname>
<given-names>R.</given-names>
</name>
,
<name>
<surname>Panchaud</surname>
<given-names>C.</given-names>
</name>
,
<name>
<surname>Singh</surname>
<given-names>S.</given-names>
</name>
, &
<name>
<surname>Watson</surname>
<given-names>K.</given-names>
</name>
</person-group>
(
<year>2013</year>
).
<source>
<italic>Demystifying data: A guide to using evidence to improve young people’s sexual health and rights</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">New York</named-content>
,
<named-content content-type="state">NY</named-content>
</publisher-loc>
:
<publisher-name>Guttmacher Institute</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0006">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Armitage</surname>
<given-names>C. J.</given-names>
</name>
, &
<name>
<surname>Conner</surname>
<given-names>M.</given-names>
</name>
</person-group>
(
<year>2001</year>
).
<article-title>Efficacy of the theory of planned behaviour: A meta-analytic review</article-title>
.
<source>
<italic>British Journal of Social Psychology</italic>
</source>
, ,
<fpage>471</fpage>
<lpage>499</lpage>
. doi:
<pub-id pub-id-type="doi">10.1348/014466601164939</pub-id>
<pub-id pub-id-type="pmid">11795063</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0007">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bastien</surname>
<given-names>S.</given-names>
</name>
,
<name>
<surname>Kajula</surname>
<given-names>L. J.</given-names>
</name>
, &
<name>
<surname>Muhwezi</surname>
<given-names>W. W.</given-names>
</name>
</person-group>
(
<year>2011</year>
).
<article-title>A review of studies of parent-child communication about sexuality and HIV/AIDS in Sub-Saharan Africa</article-title>
.
<source>
<italic>Reproductive Health</italic>
</source>
, ,
<fpage>103</fpage>
<comment>Retrieved from
<ext-link ext-link-type="uri" xlink:href="http://www.reproductive-health-journal.com/content/8/1/25">http://www.reproductive-health-journal.com/content/8/1/25</ext-link>
</comment>
doi:
<pub-id pub-id-type="doi">10.1186/1742-4755-8-25</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0008">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bekker</surname>
<given-names>L.-G.</given-names>
</name>
,
<name>
<surname>Johnson</surname>
<given-names>L.</given-names>
</name>
,
<name>
<surname>Wallance</surname>
<given-names>M.</given-names>
</name>
, &
<name>
<surname>Hosek</surname>
<given-names>S.</given-names>
</name>
</person-group>
(
<year>2015</year>
).
<article-title>Building our youth for the future</article-title>
.
<source>
<italic>Journal of the International AIDS Society</italic>
</source>
, (
<issue>2, Suppl. 1</issue>
),
<fpage>20027</fpage>
<comment>Retrieved from
<ext-link ext-link-type="uri" xlink:href="http://www.jiasociety.org/index.php/jias/article">http://www.jiasociety.org/index.php/jias/article</ext-link>
/view/20027</comment>
<pub-id pub-id-type="pmid">25724512</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0009">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Biddlecom</surname>
<given-names>A. E.</given-names>
</name>
,
<name>
<surname>Hessburg</surname>
<given-names>L.</given-names>
</name>
,
<name>
<surname>Singh</surname>
<given-names>S.</given-names>
</name>
,
<name>
<surname>Bankole</surname>
<given-names>A.</given-names>
</name>
, &
<name>
<surname>Darabi</surname>
<given-names>L.</given-names>
</name>
</person-group>
(
<year>2007</year>
).
<source>
<italic>Protecting the next generation in Sub-Saharan Africa: Learning from adolescents to prevent HIV and unintended pregnancy</italic>
</source>
.
<publisher-loc>New York</publisher-loc>
:
<publisher-name>Guttmacher Institute</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0010">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bronfenbrenner</surname>
<given-names>U.</given-names>
</name>
</person-group>
(
<year>1995</year>
).
<article-title>The developmental ecology through space and time, a future perspective: Examining lives in context</article-title>
.
<source>
<italic>Perspectives on the Ecology of Human Development</italic>
</source>
, ,
<fpage>619</fpage>
<lpage>647</lpage>
.</mixed-citation>
</ref>
<ref id="CIT0011">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Catania</surname>
<given-names>J. A.</given-names>
</name>
,
<name>
<surname>Gibson</surname>
<given-names>D. R.</given-names>
</name>
,
<name>
<surname>Chitwood</surname>
<given-names>D. D.</given-names>
</name>
, &
<name>
<surname>Coates</surname>
<given-names>T. J.</given-names>
</name>
</person-group>
(
<year>1990</year>
).
<article-title>Methodological problems in AIDS behavioural research: Influences on measurement error and participation bias in studies of sexual behaviour</article-title>
.
<source>
<italic>Psychological Bulletin</italic>
</source>
, (
<issue>3</issue>
),
<fpage>339</fpage>
<lpage>362</lpage>
. doi:
<pub-id pub-id-type="doi">10.1037/0033-2909.108.3.339</pub-id>
<pub-id pub-id-type="pmid">2270232</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0012">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cluver</surname>
<given-names>L.</given-names>
</name>
,
<name>
<surname>Boyes</surname>
<given-names>M.</given-names>
</name>
,
<name>
<surname>Orkin</surname>
<given-names>M.</given-names>
</name>
,
<name>
<surname>Pantelic</surname>
<given-names>M.</given-names>
</name>
,
<name>
<surname>Molwena</surname>
<given-names>T.</given-names>
</name>
, &
<name>
<surname>Sherr</surname>
<given-names>L.</given-names>
</name>
</person-group>
(
<year>2013</year>
).
<article-title>Child-focused state cash transfers and adolescent risk of HIV infection in South Africa: A propensity-score-matched case-control study</article-title>
.
<source>
<italic>Lancet Global Health</italic>
</source>
, ,
<fpage>e362</fpage>
<lpage>e370</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/S2214-109X(13)70115-3</pub-id>
<pub-id pub-id-type="pmid">25104601</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0013">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cluver</surname>
<given-names>L.</given-names>
</name>
,
<name>
<surname>Boyes</surname>
<given-names>M.</given-names>
</name>
,
<name>
<surname>Orkin</surname>
<given-names>M.</given-names>
</name>
, &
<name>
<surname>Sherr</surname>
<given-names>L.</given-names>
</name>
</person-group>
(
<year>2013</year>
).
<article-title>Poverty, AIDS and child health: Identifying highest-risk children in South Africa</article-title>
.
<source>
<italic>South African Medical Journal</italic>
</source>
, (
<issue>12</issue>
),
<fpage>910</fpage>
<lpage>915</lpage>
. doi:
<pub-id pub-id-type="doi">10.7196/SAMJ.7045</pub-id>
<pub-id pub-id-type="pmid">24300627</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0014">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cluver</surname>
<given-names>L.</given-names>
</name>
,
<name>
<surname>Orkin</surname>
<given-names>M.</given-names>
</name>
,
<name>
<surname>Boyes</surname>
<given-names>M. E.</given-names>
</name>
,
<name>
<surname>Sherr</surname>
<given-names>L.</given-names>
</name>
,
<name>
<surname>Makasi</surname>
<given-names>D.</given-names>
</name>
, &
<name>
<surname>Nikelo</surname>
<given-names>J.</given-names>
</name>
</person-group>
(
<year>2013</year>
).
<article-title>Pathways from parental AIDS to child psychological, educational and sexual risk: Developing an empirically-based interactive theoretical model</article-title>
.
<source>
<italic>Social Science and Medicine</italic>
</source>
, ,
<fpage>185</fpage>
<lpage>193</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/j.socscimed.2013.03.028</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0015">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Coetzee</surname>
<given-names>J.</given-names>
</name>
,
<name>
<surname>Dietrich</surname>
<given-names>J.</given-names>
</name>
,
<name>
<surname>Otwombe</surname>
<given-names>K.</given-names>
</name>
,
<name>
<surname>Nkala</surname>
<given-names>B.</given-names>
</name>
,
<name>
<surname>Khunwane</surname>
<given-names>M.</given-names>
</name>
,
<name>
<surname>van der Watt</surname>
<given-names>M.</given-names>
</name>
, … 
<name>
<surname>Gray</surname>
<given-names>G. E.</given-names>
</name>
</person-group>
(
<year>2014</year>
).
<article-title>Predictors of parent–adolescent communication in post-apartheid South Africa: A protective factor in adolescent sexual and reproductive health</article-title>
.
<source>
<italic>Journal of Adolescence</italic>
</source>
, (
<issue>3</issue>
),
<fpage>313</fpage>
<lpage>324</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/j.adolescence.2014.01.006</pub-id>
<pub-id pub-id-type="pmid">24636691</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0016">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>De Palma</surname>
<given-names>R.</given-names>
</name>
, &
<name>
<surname>Francis</surname>
<given-names>D.</given-names>
</name>
</person-group>
(
<year>2014</year>
).
<article-title>Silence, nostalgia, violence, poverty … : What does ‘culture’ mean for South African sexuality educators?</article-title>
<source>
<italic>Culture, Health & Sexuality</italic>
</source>
, (
<issue>5</issue>
),
<fpage>547</fpage>
<lpage>561</lpage>
.
<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1080/13691058.2014.891050">https://doi.org/10.1080/13691058.2014.891050</ext-link>
doi:
<pub-id pub-id-type="doi">10.1080/13691058.2014.891050</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0017">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<collab>Department of Basic Education, South Africa</collab>
</person-group>
(
<year>1998</year>
).
<source>
<italic>Notice of intention to determine national policy on HIV/AIDS for learners in public schools in terms of the National Education Policy Act, Notice of 1998</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">Pretoria</named-content>
</publisher-loc>
:
<publisher-name>Department of Education</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0018">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<collab>Department of Basic Education, South Africa</collab>
</person-group>
(
<year>2003</year>
).
<source>
<italic>Design an HIV/AIDS plan for your school</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">Pretoria</named-content>
</publisher-loc>
:
<publisher-name>Department of Education, Government Printer</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0019">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<collab>Department of Basic Education, South Africa</collab>
</person-group>
(
<year>2008</year>
).
<source>
<italic>Implementation guidelines for safe and caring child-friendly schools in South Africa</italic>
.</source>
<publisher-loc>
<named-content content-type="city">Pretoria</named-content>
</publisher-loc>
:
<publisher-name>Department of Basic Education</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0020">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<collab>Department of Basic Education, South Africa</collab>
</person-group>
(
<year>2011</year>
).
<source>
<italic>Guidelines for the implementation of peer education programmes for learners in South African schools</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">Pretoria</named-content>
</publisher-loc>
:
<publisher-name>Department of Basic Education</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0021">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<collab>Department of Health, South Africa</collab>
</person-group>
(
<year>2003</year>
).
<source>
<italic>School health policy and implementation guidelines</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">Pretoria</named-content>
</publisher-loc>
:
<publisher-name>Department of Health</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0022">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Diener</surname>
<given-names>E.</given-names>
</name>
,
<name>
<surname>Emmons</surname>
<given-names>R. A.</given-names>
</name>
,
<name>
<surname>Larsen</surname>
<given-names>R. J.</given-names>
</name>
, &
<name>
<surname>Griffin</surname>
<given-names>S.</given-names>
</name>
</person-group>
(
<year>1985</year>
).
<article-title>The satisfaction with life scale</article-title>
.
<source>
<italic>Journal of Personality Assessment</italic>
</source>
, ,
<fpage>71</fpage>
<lpage>75</lpage>
. doi:
<pub-id pub-id-type="doi">10.1207/s15327752jpa4901_13</pub-id>
<pub-id pub-id-type="pmid">16367493</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0023">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dinkelman</surname>
<given-names>T.</given-names>
</name>
,
<name>
<surname>Lam</surname>
<given-names>D.</given-names>
</name>
, &
<name>
<surname>Leibbrandt</surname>
<given-names>M.</given-names>
</name>
</person-group>
(
<year>2008</year>
).
<article-title>Linking poverty and income shocks to risky sexual behaviour: Evidence from a panel study of young adults in Cape Town</article-title>
.
<source>
<italic>South African Journal of Economics</italic>
</source>
, (
<issue>s1</issue>
),
<fpage>S52</fpage>
<lpage>S74</lpage>
. doi:
<pub-id pub-id-type="doi">10.1111/j.1813-6982.2008.00170.x</pub-id>
<pub-id pub-id-type="pmid">18815625</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0024">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dworkin</surname>
<given-names>S. L.</given-names>
</name>
,
<name>
<surname>Hatcher</surname>
<given-names>A. M.</given-names>
</name>
,
<name>
<surname>Colvin</surname>
<given-names>C.</given-names>
</name>
, &
<name>
<surname>Peacock</surname>
<given-names>D.</given-names>
</name>
</person-group>
(
<year>2013</year>
).
<article-title>The impact of a gender transformation HIV and anti-violence program on gender ideologies and masculinities in two rural South African communities</article-title>
.
<source>
<italic>Men and Masculinity</italic>
</source>
, (
<issue>2</issue>
),
<fpage>1</fpage>
<lpage>17</lpage>
.</mixed-citation>
</ref>
<ref id="CIT0025">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Eaton</surname>
<given-names>L.</given-names>
</name>
,
<name>
<surname>Flisher</surname>
<given-names>A. J.</given-names>
</name>
, &
<name>
<surname>Aaro</surname>
<given-names>L. E.</given-names>
</name>
</person-group>
(
<year>2003</year>
).
<article-title>Unsafe sexual behaviour in South African youth</article-title>
.
<source>
<italic>Social Science and Medicine</italic>
</source>
, ,
<fpage>149</fpage>
<lpage>165</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/S0277-9536(02)00017-5</pub-id>
<pub-id pub-id-type="pmid">12435558</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0026">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<collab>Family Health International</collab>
</person-group>
(
<year>2009</year>
).
<source>
<italic>Guidelines for youth peer education in HIV and reproductive health</italic>
.</source>
<publisher-loc>
<named-content content-type="city">Research Triangle Park</named-content>
</publisher-loc>
:
<publisher-name>Family Health International</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0027">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Freire</surname>
<given-names>P.</given-names>
</name>
</person-group>
(
<year>1993</year>
).
<source>
<italic>Education for critical consciousness</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">New York</named-content>
,
<named-content content-type="state">NY</named-content>
</publisher-loc>
:
<publisher-name>Continuum</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0028">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Frempong</surname>
<given-names>G.</given-names>
</name>
,
<name>
<surname>Reddy</surname>
<given-names>V.</given-names>
</name>
, &
<name>
<surname>Kanjee</surname>
<given-names>A.</given-names>
</name>
</person-group>
(
<year>2011</year>
).
<article-title>Exploring equity and quality education in South Africa using multilevel models</article-title>
.
<source>
<italic>Compare: A Journal of Comparative and International Education</italic>
</source>
, (
<issue>6</issue>
),
<fpage>819</fpage>
<lpage>835</lpage>
. doi:
<pub-id pub-id-type="doi">10.1080/03057925.2011.607488</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0029">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gausset</surname>
<given-names>Q.</given-names>
</name>
</person-group>
(
<year>2001</year>
).
<article-title>AIDS and cultural practices in Africa: The case of the Tonga (Zambia)</article-title>
.
<source>
<italic>Social Sciences and Medicine</italic>
</source>
, ,
<fpage>509</fpage>
<lpage>518</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/S0277-9536(00)00156-8</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0030">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gebreeyesus</surname>
<given-names>H. H.</given-names>
</name>
,
<name>
<surname>Boer</surname>
<given-names>H.</given-names>
</name>
, &
<name>
<surname>Kuiper</surname>
<given-names>W. A.</given-names>
</name>
</person-group>
(
<year>2007</year>
).
<article-title>Using the theory of planned behaviour to understand the motivation to learn about HIV/AIDS prevention among adolescents in Tigray, Ethiopia</article-title>
.
<source>
<italic>AIDS Care</italic>
</source>
, (
<issue>7</issue>
),
<fpage>895</fpage>
<lpage>900</lpage>
. doi:
<pub-id pub-id-type="doi">10.1080/09540120701203311</pub-id>
<pub-id pub-id-type="pmid">17712693</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0031">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Goodnight</surname>
<given-names>B.</given-names>
</name>
,
<name>
<surname>Salama</surname>
<given-names>C.</given-names>
</name>
,
<name>
<surname>Grim</surname>
<given-names>E. C.</given-names>
</name>
,
<name>
<surname>Anthony</surname>
<given-names>E. R.</given-names>
</name>
,
<name>
<surname>Armistead</surname>
<given-names>L.</given-names>
</name>
,
<name>
<surname>Cook</surname>
<given-names>S. L.</given-names>
</name>
, … 
<name>
<surname>Toefy</surname>
<given-names>Y.</given-names>
</name>
</person-group>
(
<year>2014</year>
).
<article-title>Perceived control and communication about sex: A study of South African families</article-title>
.
<source>
<italic>African Journal of AIDS Research</italic>
</source>
, (
<issue>1</issue>
),
<fpage>31</fpage>
<lpage>36</lpage>
. doi:
<pub-id pub-id-type="doi">10.2989/16085906.2014.892016</pub-id>
<pub-id pub-id-type="pmid">25174513</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0032">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gupta</surname>
<given-names>G. R.</given-names>
</name>
,
<name>
<surname>Parkhurst</surname>
<given-names>J. O.</given-names>
</name>
,
<name>
<surname>Ogden</surname>
<given-names>J. A.</given-names>
</name>
,
<name>
<surname>Aggleton</surname>
<given-names>P.</given-names>
</name>
, &
<name>
<surname>Mahal</surname>
<given-names>A.</given-names>
</name>
</person-group>
(
<year>2008</year>
).
<article-title>Structural approaches to HIV prevention</article-title>
.
<source>
<italic>The Lancet</italic>
</source>
, ,
<fpage>764</fpage>
<lpage>775</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/S0140-6736(08)60887-9</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0033">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Harrison</surname>
<given-names>A.</given-names>
</name>
,
<name>
<surname>Cleland</surname>
<given-names>J.</given-names>
</name>
,
<name>
<surname>Gouws</surname>
<given-names>E.</given-names>
</name>
, &
<name>
<surname>Frohlich</surname>
<given-names>J.</given-names>
</name>
</person-group>
(
<year>2005</year>
).
<article-title>Early sexual debut among young men in rural South Africa: Heightened vulnerability to sexual risk?</article-title>
<source>
<italic>Sexually Transmitted Infections</italic>
</source>
, ,
<fpage>259</fpage>
<lpage>261</lpage>
. doi:
<pub-id pub-id-type="doi">10.1136/sti.2004.011486</pub-id>
<pub-id pub-id-type="pmid">15923298</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0034">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Harrison</surname>
<given-names>A.</given-names>
</name>
,
<name>
<surname>Newell</surname>
<given-names>M.-L.</given-names>
</name>
,
<name>
<surname>Imrie</surname>
<given-names>J.</given-names>
</name>
, &
<name>
<surname>Hoddinott</surname>
<given-names>G.</given-names>
</name>
</person-group>
(
<year>2010</year>
).
<article-title>HIV prevention for South African youth: Which interventions work? A systematic review of current evidence</article-title>
.
<source>
<italic>BioMed Central Public Health</italic>
</source>
, (
<issue>1</issue>
),
<fpage>931</fpage>
<lpage>112</lpage>
. doi:
<pub-id pub-id-type="doi">10.1186/1471-2458-10-102</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0035">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hendriksen</surname>
<given-names>E. S.</given-names>
</name>
,
<name>
<surname>Pettifor</surname>
<given-names>A.</given-names>
</name>
,
<name>
<surname>Lee</surname>
<given-names>S.-J.</given-names>
</name>
,
<name>
<surname>Coates</surname>
<given-names>T. J.</given-names>
</name>
, &
<name>
<surname>Rees</surname>
<given-names>H. V.</given-names>
</name>
</person-group>
(
<year>2007</year>
).
<article-title>Predictors of condom use among young adults in South Africa: The Reproductive Health and HIV Research unit National Youth Survey</article-title>
.
<source>
<italic>American Journal of Public Health</italic>
</source>
, (
<issue>7</issue>
),
<fpage>1241</fpage>
<lpage>1248</lpage>
. doi:
<pub-id pub-id-type="doi">10.2105/AJPH.2006.086009</pub-id>
<pub-id pub-id-type="pmid">17538062</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0036">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>James</surname>
<given-names>S.</given-names>
</name>
,
<name>
<surname>Reddy</surname>
<given-names>S. P.</given-names>
</name>
,
<name>
<surname>Taylor</surname>
<given-names>M.</given-names>
</name>
, &
<name>
<surname>Jinabhai</surname>
<given-names>C. C.</given-names>
</name>
</person-group>
(
<year>2004</year>
).
<article-title>Young people, HIV/AIDS/STIs and sexuality in South Africa: The gap between awareness and behaviour</article-title>
.
<source>
<italic>Acta Paediatrica</italic>
</source>
, (
<issue>2</issue>
),
<fpage>264</fpage>
<lpage>269</lpage>
. doi:
<pub-id pub-id-type="doi">10.1111/j.1651-2227.2004.tb00718.x</pub-id>
<pub-id pub-id-type="pmid">15046286</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0037">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Jemmott</surname>
<given-names>J. B.</given-names>
<suffix>3rd</suffix>
</name>
,
<name>
<surname>Heeren</surname>
<given-names>G. A.</given-names>
</name>
,
<name>
<surname>Ngwane</surname>
<given-names>Z.</given-names>
</name>
,
<name>
<surname>Hewitt</surname>
<given-names>N.</given-names>
</name>
,
<name>
<surname>Jemmott</surname>
<given-names>L. S.</given-names>
</name>
,
<name>
<surname>Shell</surname>
<given-names>R.</given-names>
</name>
, &
<name>
<surname>O'leary</surname>
<given-names>A.</given-names>
</name>
</person-group>
(
<year>2007</year>
).
<article-title>Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa</article-title>
.
<source>
<italic>AIDS Care</italic>
</source>
, (
<issue>5</issue>
),
<fpage>677</fpage>
<lpage>684</lpage>
. doi:
<pub-id pub-id-type="doi">10.1080/09540120601084308</pub-id>
<pub-id pub-id-type="pmid">17505930</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0038">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Jewkes</surname>
<given-names>R.</given-names>
</name>
,
<name>
<surname>Levin</surname>
<given-names>J.</given-names>
</name>
, &
<name>
<surname>Penn-Kekana</surname>
<given-names>L.</given-names>
</name>
</person-group>
(
<year>2002</year>
).
<article-title>Risk factors for domestic violence: Findings from a South African cross-sectional study</article-title>
.
<source>
<italic>Social Science and Medicine</italic>
</source>
, ,
<fpage>1603</fpage>
<lpage>1618</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/S0277-9536(01)00294-5</pub-id>
<pub-id pub-id-type="pmid">12297246</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0039">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Jewkes</surname>
<given-names>R. K.</given-names>
</name>
,
<name>
<surname>Dunkle</surname>
<given-names>K.</given-names>
</name>
,
<name>
<surname>Nduna</surname>
<given-names>M.</given-names>
</name>
, &
<name>
<surname>Shai</surname>
<given-names>N.</given-names>
</name>
</person-group>
(
<year>2010</year>
).
<article-title>Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: A cohort study</article-title>
.
<source>
<italic>Lancet</italic>
</source>
, (
<issue>9734</issue>
),
<fpage>41</fpage>
<lpage>48</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/S0140-6736(10)60548-X</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0040">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kakoko</surname>
<given-names>D. C.</given-names>
</name>
,
<name>
<surname>Astrom</surname>
<given-names>A. N.</given-names>
</name>
,
<name>
<surname>Lugoe</surname>
<given-names>W. L.</given-names>
</name>
, &
<name>
<surname>Lie</surname>
<given-names>G. T.</given-names>
</name>
</person-group>
(
<year>2006</year>
).
<article-title>Predicting intended use of voluntary HIV counselling and testing services among Tanzanian teachers using the theory of planned behaviour</article-title>
.
<source>
<italic>Social Science & Medicine</italic>
</source>
, (
<issue>4</issue>
),
<fpage>991</fpage>
<lpage>999</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/j.socscimed.2006.02.016</pub-id>
<pub-id pub-id-type="pmid">16603299</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0041">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kandel</surname>
<given-names>D. B.</given-names>
</name>
, &
<name>
<surname>Davies</surname>
<given-names>M.</given-names>
</name>
</person-group>
(
<year>1982</year>
).
<article-title>Epidemiology of depression mood in adolescents</article-title>
.
<source>
<italic>Archives of Pediatrics and Adolescent Medicine</italic>
</source>
, ,
<fpage>1205</fpage>
<lpage>1212</lpage>
.</mixed-citation>
</ref>
<ref id="CIT0042">
<mixed-citation publication-type="book">
<person-group person-group-type="editor">
<name>
<surname>Klepp</surname>
<given-names>K-I.</given-names>
</name>
,
<name>
<surname>Flisher</surname>
<given-names>A. J.</given-names>
</name>
, &
<name>
<surname>Kaaya</surname>
<given-names>S. F.</given-names>
</name>
</person-group>
(Eds.). (
<year>2006</year>
).
<source>
<italic>Promoting adolescent sexual and reproductive health in East and Southern Africa</italic>
.</source>
<publisher-loc>
<named-content content-type="city">Cape Town</named-content>
</publisher-loc>
:
<publisher-name>HSRC Press</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0043">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Knerr</surname>
<given-names>W.</given-names>
</name>
,
<name>
<surname>Gardner</surname>
<given-names>F.</given-names>
</name>
, &
<name>
<surname>Cluver</surname>
<given-names>L.</given-names>
</name>
</person-group>
(
<year>2013</year>
).
<article-title>Improving positive parenting skills and reducing harsh and abusive parenting in low- and middle-income countries: A systematic review</article-title>
.
<source>
<italic>Prevention Science</italic>
</source>
, ,
<fpage>352</fpage>
<lpage>363</lpage>
. doi:
<pub-id pub-id-type="doi">10.1007/s11121-012-0314-1</pub-id>
<pub-id pub-id-type="pmid">23315023</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0044">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Leclerc-Madlala</surname>
<given-names>S.</given-names>
</name>
</person-group>
(
<year>2008</year>
).
<article-title>Age-disparate and intergenerational sex in southern Africa: The dynamics of hypervulnerability</article-title>
.
<source>
<italic>AIDS</italic>
</source>
, (
<issue>4</issue>
),
<fpage>S17</fpage>
<lpage>S25</lpage>
. doi:
<pub-id pub-id-type="doi">10.1097/01.aids.0000341774.86500.53</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0045">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lynch</surname>
<given-names>I.</given-names>
</name>
,
<name>
<surname>Brouard</surname>
<given-names>P.</given-names>
</name>
, &
<name>
<surname>Visser</surname>
<given-names>M.</given-names>
</name>
</person-group>
(
<year>2010</year>
).
<article-title>Constructions of masculinity among a group of South African men living with HIV/AIDS: Reflections on resistance and change</article-title>
.
<source>
<italic>Culture, Health & Sexuality</italic>
</source>
, (
<issue>1</issue>
),
<fpage>15</fpage>
<lpage>27</lpage>
. doi:
<pub-id pub-id-type="doi">10.1080/13691050903082461</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0046">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Manosch</surname>
<given-names>R.</given-names>
</name>
, &
<name>
<surname>Mahy</surname>
<given-names>M.</given-names>
</name>
</person-group>
(
<year>2006</year>
).
<article-title>Young people: The center of the HIV epidemic</article-title>
. In
<person-group person-group-type="editor">
<name>
<surname>Ross</surname>
<given-names>D. A</given-names>
</name>
,
<name>
<surname>Dick</surname>
<given-names>B.</given-names>
</name>
, &
<name>
<surname>Ferguson</surname>
<given-names>J.</given-names>
</name>
</person-group>
(Eds.),
<source>
<italic>Preventing HIV/AIDS in young people. A systematic review of the evidence from developing countries</italic>
</source>
(pp.
<fpage>15</fpage>
<lpage>42</lpage>
).
<publisher-loc>
<named-content content-type="city">Geneva</named-content>
</publisher-loc>
:
<publisher-name>World Health Organisation</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0047">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mantell</surname>
<given-names>J.</given-names>
</name>
,
<name>
<surname>Harrison</surname>
<given-names>A.</given-names>
</name>
,
<name>
<surname>Hoffman</surname>
<given-names>S.</given-names>
</name>
,
<name>
<surname>Smit</surname>
<given-names>J. A.</given-names>
</name>
,
<name>
<surname>Stein</surname>
<given-names>Z. A.</given-names>
</name>
, &
<name>
<surname>Exner</surname>
<given-names>T. M.</given-names>
</name>
</person-group>
(
<year>2006</year>
).
<article-title>The Mpondombili Project: Preventing HIV/AIDS and Unintended Pregnancy among Rural South African School-going Youth</article-title>
.
<source>
<italic>Reproductive Health Matters</italic>
</source>
, (
<issue>28</issue>
),
<fpage>113</fpage>
<lpage>122</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/S0968-8080(06)28269-7</pub-id>
<pub-id pub-id-type="pmid">17101429</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0048">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Mfecane</surname>
<given-names>S.</given-names>
</name>
</person-group>
(
<year>2010</year>
).
<article-title>
<italic>Exploring masculinities in the context of ARV use: A study of men living with HIV in a South African village</italic>
</article-title>
(
<source>Unpublished doctoral thesis</source>
).
<publisher-name>University of Witwatersrand</publisher-name>
,
<publisher-loc>
<named-content content-type="city">Johannesburg</named-content>
</publisher-loc>
.</mixed-citation>
</ref>
<ref id="CIT0049">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Moletsane</surname>
<given-names>R.</given-names>
</name>
</person-group>
(
<year>2011</year>
).
<article-title>Culture, nostalgia, and sexuality education in the age of AIDS in South Africa</article-title>
. In
<person-group person-group-type="editor">
<name>
<surname>Mitchell</surname>
<given-names>C.</given-names>
</name>
,
<name>
<surname>Strong-Wilson</surname>
<given-names>T.</given-names>
</name>
,
<name>
<surname>Pithouse</surname>
<given-names>K.</given-names>
</name>
, &
<name>
<surname>Alnutt</surname>
<given-names>S.</given-names>
</name>
</person-group>
(Eds.),
<source>
<italic>Memory and pedagogy</italic>
</source>
(pp.
<fpage>193</fpage>
<lpage>208</lpage>
).
<publisher-loc>
<named-content content-type="city">New York</named-content>
,
<named-content content-type="state">NY</named-content>
</publisher-loc>
:
<publisher-name>Routledge</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0050">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Morojele</surname>
<given-names>N.</given-names>
</name>
,
<name>
<surname>Myers</surname>
<given-names>B.</given-names>
</name>
,
<name>
<surname>Townsend</surname>
<given-names>L.</given-names>
</name>
,
<name>
<surname>Lombard</surname>
<given-names>C.</given-names>
</name>
,
<name>
<surname>Plüddemann</surname>
<given-names>A.</given-names>
</name>
,
<name>
<surname>Carney</surname>
<given-names>T.</given-names>
</name>
, … 
<name>
<surname>Nkosi</surname>
<given-names>S.</given-names>
</name>
</person-group>
(
<year>2013</year>
).
<source>
<italic>Survey on substance use, risk behaviour and mental health among grade 8–10 learners in western cape provincial schools, 2011</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">Cape Town</named-content>
</publisher-loc>
:
<publisher-name>South African Medical Research Council</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0050a">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Ofosu-Amaah</surname>
<given-names>A. W.</given-names>
</name>
,
<name>
<surname>Egamberdi</surname>
<given-names>N.</given-names>
</name>
, &
<name>
<surname>Dhar</surname>
<given-names>A.</given-names>
</name>
</person-group>
(
<year>2009</year>
).
<article-title>Gender and HIV/AIDS</article-title>
. In
<person-group person-group-type="editor">
<name>
<surname>Lule</surname>
<given-names>E. L.</given-names>
</name>
,
<name>
<surname>Seifman</surname>
<given-names>R. M.</given-names>
</name>
, &
<name>
<surname>David</surname>
<given-names>A. C.</given-names>
</name>
</person-group>
(Eds.),
<source>
<italic>The changing HIV/AIDS landscape. Selected papers from World Bank's Agenda for Action in Africa 2007–2011</italic>
</source>
(pp.
<fpage>227</fpage>
<lpage>260</lpage>
).
<publisher-loc>Washington, DC</publisher-loc>
:
<publisher-name>The World Bank</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0051">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Pallant</surname>
<given-names>J.</given-names>
</name>
</person-group>
(
<year>2010</year>
).
<source>
<italic>SPSS survival manual: A step by step guide to data analysis using SPSS</italic>
</source>
(
<edition>4th ed.</edition>
).
<publisher-loc>
<named-content content-type="city">Maidenhead</named-content>
</publisher-loc>
:
<publisher-name>McGraw-Hill</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0052">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pavot</surname>
<given-names>W.</given-names>
</name>
, &
<name>
<surname>Diener</surname>
<given-names>E.</given-names>
</name>
</person-group>
(
<year>2008</year>
).
<article-title>The Satisfaction with Life Scale and the emerging construct of life satisfaction</article-title>
.
<source>
<italic>Journal of Positive Psychology</italic>
</source>
, ,
<fpage>137</fpage>
<lpage>152</lpage>
. doi:
<pub-id pub-id-type="doi">10.1080/17439760701756946</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0053">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pettifor</surname>
<given-names>A.</given-names>
</name>
,
<name>
<surname>O’Brien</surname>
<given-names>K.</given-names>
</name>
,
<name>
<surname>MacPhail</surname>
<given-names>C.</given-names>
</name>
,
<name>
<surname>Miller</surname>
<given-names>W. C.</given-names>
</name>
, &
<name>
<surname>Rees</surname>
<given-names>H.</given-names>
</name>
</person-group>
(
<year>2009</year>
).
<article-title>Early coital debut and associated HIV risk factors among young women and men in South Africa</article-title>
.
<source>
<italic>International Perspectives on Sexual and Reproductive Health</italic>
</source>
, (
<issue>2</issue>
),
<fpage>82</fpage>
<lpage>90</lpage>
. doi:
<pub-id pub-id-type="doi">10.1363/3508209</pub-id>
<pub-id pub-id-type="pmid">19620092</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0054">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Phetla</surname>
<given-names>G.</given-names>
</name>
,
<name>
<surname>Busza</surname>
<given-names>J.</given-names>
</name>
,
<name>
<surname>Hargreaves</surname>
<given-names>J.</given-names>
</name>
,
<name>
<surname>Pronyk</surname>
<given-names>P.</given-names>
</name>
,
<name>
<surname>Kim</surname>
<given-names>J.</given-names>
</name>
,
<name>
<surname>Morison</surname>
<given-names>L.</given-names>
</name>
, … 
<name>
<surname>Porter</surname>
<given-names>J.</given-names>
</name>
</person-group>
(
<year>2008</year>
).
<article-title>‘They have opened our mouths’: Increasing women’s skills and motivation for sexual communication with young people in rural South Africa</article-title>
.
<source>
<italic>AIDS Education and Prevention</italic>
</source>
, (
<issue>6</issue>
),
<fpage>504</fpage>
<lpage>518</lpage>
. doi:
<pub-id pub-id-type="doi">10.1521/aeap.2008.20.6.504</pub-id>
<pub-id pub-id-type="pmid">19072526</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0055">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Reddy</surname>
<given-names>S. P.</given-names>
</name>
,
<name>
<surname>James</surname>
<given-names>S.</given-names>
</name>
,
<name>
<surname>Sewpaul</surname>
<given-names>R.</given-names>
</name>
,
<name>
<surname>Koopman</surname>
<given-names>F.</given-names>
</name>
,
<name>
<surname>Funani</surname>
<given-names>N. I.</given-names>
</name>
,
<name>
<surname>Sifunda</surname>
<given-names>S.</given-names>
</name>
, … 
<name>
<surname>Omardien</surname>
<given-names>R. G.</given-names>
</name>
</person-group>
(
<year>2010</year>
).
<source>
<italic>Umthenthe Uhlaba Usamila – the South African youth risk behaviour survey 2008</italic>
.</source>
<publisher-loc>
<named-content content-type="city">Cape Town</named-content>
</publisher-loc>
:
<publisher-name>South African Medical Research Council</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0056">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Reddy</surname>
<given-names>S. P.</given-names>
</name>
,
<name>
<surname>James</surname>
<given-names>S.</given-names>
</name>
,
<name>
<surname>Sewpaul</surname>
<given-names>R.</given-names>
</name>
,
<name>
<surname>Sifunda</surname>
<given-names>S.</given-names>
</name>
,
<name>
<surname>Ellahebokus</surname>
<given-names>A.</given-names>
</name>
,
<name>
<surname>Kambaran</surname>
<given-names>N. S.</given-names>
</name>
, &
<name>
<surname>Omardien</surname>
<given-names>R. G.</given-names>
</name>
</person-group>
(
<year>2013</year>
).
<source>
<italic>Umthente Uhlaba Usamila: The 3rd South African national youth risk behaviour survey 2011</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">Cape Town</named-content>
</publisher-loc>
:
<publisher-name>South African Medical Research Council</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0057">
<mixed-citation publication-type="book">
<person-group person-group-type="editor">
<name>
<surname>Ross</surname>
<given-names>D. A.</given-names>
</name>
,
<name>
<surname>Dick</surname>
<given-names>B.</given-names>
</name>
, &
<name>
<surname>Ferguson</surname>
<given-names>J.</given-names>
</name>
</person-group>
(Eds.). (
<year>2006</year>
).
<source>
<italic>Preventing HIV/AIDS in young people. A systematic review of the evidence from developing countries</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">Geneva</named-content>
</publisher-loc>
:
<publisher-name>World Health Organisation</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0058">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rotheram-Borus</surname>
<given-names>M.</given-names>
</name>
,
<name>
<surname>Flannery</surname>
<given-names>D.</given-names>
</name>
,
<name>
<surname>Rice</surname>
<given-names>E.</given-names>
</name>
, &
<name>
<surname>Lester</surname>
<given-names>P.</given-names>
</name>
</person-group>
(
<year>2005</year>
).
<article-title>Families living with HIV</article-title>
.
<source>
<italic>AIDS Care</italic>
</source>
, ,
<fpage>978</fpage>
<lpage>987</lpage>
. doi:
<pub-id pub-id-type="doi">10.1080/09540120500101690</pub-id>
<pub-id pub-id-type="pmid">16176894</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0059">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rotheram-Borus</surname>
<given-names>M. J.</given-names>
</name>
,
<name>
<surname>Swendeman</surname>
<given-names>D.</given-names>
</name>
, &
<name>
<surname>Chovnick</surname>
<given-names>G.</given-names>
</name>
</person-group>
(
<year>2009</year>
).
<article-title>The past, present and future of HIV prevention: Integrating behavioural, biomedical and structural intervention strategies for the next generation of HIV prevention</article-title>
.
<source>
<italic>Annual Review Clinical Psychology</italic>
</source>
, ,
<fpage>143</fpage>
<lpage>167</lpage>
. doi:
<pub-id pub-id-type="doi">10.1146/annurev.clinpsy.032408.153530</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0060">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rotheram-Borus</surname>
<given-names>M. J.</given-names>
</name>
,
<name>
<surname>Swendeman</surname>
<given-names>D.</given-names>
</name>
,
<name>
<surname>Flannery</surname>
<given-names>D.</given-names>
</name>
,
<name>
<surname>Rice</surname>
<given-names>E.</given-names>
</name>
,
<name>
<surname>Adamson</surname>
<given-names>D.</given-names>
</name>
, &
<name>
<surname>Ingram</surname>
<given-names>B.</given-names>
</name>
</person-group>
(
<year>2009</year>
).
<article-title>Common factors in effective HIV prevention programs</article-title>
.
<source>
<italic>AIDS and Behaviour</italic>
</source>
, (
<issue>3</issue>
),
<fpage>399</fpage>
<lpage>408</lpage>
. doi:
<pub-id pub-id-type="doi">10.1007/s10461-008-9464-3</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0061">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schaalma</surname>
<given-names>H.</given-names>
</name>
,
<name>
<surname>Aaro</surname>
<given-names>L. E.</given-names>
</name>
,
<name>
<surname>Flisher</surname>
<given-names>A. J.</given-names>
</name>
,
<name>
<surname>Mathews</surname>
<given-names>C.</given-names>
</name>
,
<name>
<surname>Kaaya</surname>
<given-names>S.</given-names>
</name>
,
<name>
<surname>Onya</surname>
<given-names>H.</given-names>
</name>
, … 
<name>
<surname>Klepp</surname>
<given-names>K.-I.</given-names>
</name>
</person-group>
(
<year>2009</year>
).
<article-title>Correlates of intention to use condoms among Sub-Saharan African youth: The applicability of the theory of planned behaviour</article-title>
.
<source>
<italic>Scandinavian Journal of Public Health</italic>
</source>
, (
<issue>Suppl 2</issue>
),
<fpage>87</fpage>
<lpage>91</lpage>
. doi:
<pub-id pub-id-type="doi">10.1177/1403494808090632</pub-id>
<pub-id pub-id-type="pmid">19493985</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0062">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Selikow</surname>
<given-names>T. A.</given-names>
</name>
,
<name>
<surname>Ahmed</surname>
<given-names>N.</given-names>
</name>
,
<name>
<surname>Flisher</surname>
<given-names>A. J.</given-names>
</name>
,
<name>
<surname>Mathews</surname>
<given-names>C.</given-names>
</name>
, &
<name>
<surname>Mukoma</surname>
<given-names>W.</given-names>
</name>
</person-group>
(
<year>2009</year>
).
<article-title>I am not ‘umqwayito’: A qualitative study of peer pressure and sexual risk behaviour among young adolescents in Cape Town, South Africa</article-title>
.
<source>
<italic>Scandinavian Journal of Public Health</italic>
</source>
, (
<issue>Suppl 2</issue>
),
<fpage>107</fpage>
<lpage>112</lpage>
. doi:
<pub-id pub-id-type="doi">10.1177/1403494809103903</pub-id>
<pub-id pub-id-type="pmid">19493988</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0063">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Senderowitz</surname>
<given-names>J.</given-names>
</name>
, &
<name>
<surname>Kirby</surname>
<given-names>D.</given-names>
</name>
</person-group>
(
<year>2006</year>
).
<source>S
<italic>tandards for curriculum-based reproductive health and HIV education programmes</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">Arlington</named-content>
</publisher-loc>
:
<publisher-name>Family Health International/YouthNet</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0065">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shefer</surname>
<given-names>T.</given-names>
</name>
, &
<name>
<surname>MacLeod</surname>
<given-names>C.</given-names>
</name>
</person-group>
(
<year>2015</year>
).
<article-title>Life Orientation sexuality education in South Africa: Gendered norms, justice and transformation</article-title>
.
<source>
<italic>Perspectives in Education</italic>
</source>
, (
<issue>2</issue>
),
<fpage>4</fpage>
<lpage>13</lpage>
.</mixed-citation>
</ref>
<ref id="CIT0066">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Shisana</surname>
<given-names>O.</given-names>
</name>
,
<name>
<surname>Rehle</surname>
<given-names>T.</given-names>
</name>
,
<name>
<surname>Simbayi</surname>
<given-names>L. C.</given-names>
</name>
,
<name>
<surname>Zuma</surname>
<given-names>K.</given-names>
</name>
,
<name>
<surname>Jooste</surname>
<given-names>S.</given-names>
</name>
,
<name>
<surname>Pillay-van-Wyk</surname>
<given-names>V.</given-names>
</name>
, … 
<collab>The SABSSM III Implementation Team</collab>
</person-group>
(
<year>2009</year>
).
<source>
<italic>South African national HIV prevalence, incidence, behaviour and communication survey 2008: A turning tide among teenagers?</italic>
</source>
<publisher-loc>
<named-content content-type="city">Cape Town</named-content>
</publisher-loc>
:
<publisher-name>HSRC Press</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0067">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Shisana</surname>
<given-names>O.</given-names>
</name>
,
<name>
<surname>Rehle</surname>
<given-names>T.</given-names>
</name>
,
<name>
<surname>Simbayi</surname>
<given-names>L. C.</given-names>
</name>
,
<name>
<surname>Zuma</surname>
<given-names>K.</given-names>
</name>
,
<name>
<surname>Jooste</surname>
<given-names>S.</given-names>
</name>
,
<name>
<surname>Zungu</surname>
<given-names>N.</given-names>
</name>
, … 
<name>
<surname>Onoya</surname>
<given-names>D.</given-names>
</name>
</person-group>
(
<year>2014</year>
).
<source>
<italic>South African national HIV prevalence, incidence and behaviour survey, 2012</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">Cape Town</named-content>
</publisher-loc>
:
<publisher-name>HSRC Press</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0068">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Stirling</surname>
<given-names>M.</given-names>
</name>
,
<name>
<surname>Rees</surname>
<given-names>H.</given-names>
</name>
,
<name>
<surname>Kasedde</surname>
<given-names>S.</given-names>
</name>
, &
<name>
<surname>Hankins</surname>
<given-names>C.</given-names>
</name>
</person-group>
(
<year>2008</year>
).
<article-title>Introduction: Addressing the vulnerability of young women and girls to stop the HIV epidemic in southern Africa</article-title>
.
<source>
<italic>AIDS</italic>
</source>
, (
<issue>4</issue>
),
<fpage>S1</fpage>
<lpage>S3</lpage>
. doi:
<pub-id pub-id-type="doi">10.1097/01.aids.0000341772.48382.57</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0069">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Strebel</surname>
<given-names>A.</given-names>
</name>
,
<name>
<surname>Crawford</surname>
<given-names>M.</given-names>
</name>
,
<name>
<surname>Shefer</surname>
<given-names>T.</given-names>
</name>
,
<name>
<surname>Cloete</surname>
<given-names>A.</given-names>
</name>
,
<name>
<surname>Henda</surname>
<given-names>N.</given-names>
</name>
,
<name>
<surname>Kaufman</surname>
<given-names>M.</given-names>
</name>
, … 
<name>
<surname>Kalichman</surname>
<given-names>S.</given-names>
</name>
</person-group>
(
<year>2006</year>
).
<article-title>Social constructions of gender roles, gender-based violence and HIV/AIDS in two communities of the Western Cape, South Africa</article-title>
.
<source>
<italic>SAHARA-J: Journal of Social Aspects of HIV/AIDS</italic>
</source>
, (
<issue>3</issue>
),
<fpage>516</fpage>
<lpage>528</lpage>
. doi:
<pub-id pub-id-type="doi">10.1080/17290376.2006.9724879</pub-id>
<pub-id pub-id-type="pmid">17601339</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0070">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Taylor</surname>
<given-names>M.</given-names>
</name>
,
<name>
<surname>Dlamini</surname>
<given-names>S. B.</given-names>
</name>
,
<name>
<surname>Kagoro</surname>
<given-names>H.</given-names>
</name>
,
<name>
<surname>Jinabhai</surname>
<given-names>C. C.</given-names>
</name>
, &
<name>
<surname>De Vries</surname>
<given-names>H.</given-names>
</name>
</person-group>
(
<year>2003</year>
).
<article-title>Understanding high school students’ risk behaviours to help reduce the HIV/AIDS epidemic in Kwazulu-Natal, South Africa</article-title>
.
<source>
<italic>Journal of School Health</italic>
</source>
, (
<issue>3</issue>
),
<fpage>97</fpage>
<lpage>100</lpage>
. doi:
<pub-id pub-id-type="doi">10.1111/j.1746-1561.2003.tb03580.x</pub-id>
<pub-id pub-id-type="pmid">12677727</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0071">
<mixed-citation publication-type="standard">
<person-group person-group-type="author">
<name>
<surname>Taylor</surname>
<given-names>T. N.</given-names>
</name>
</person-group>
(
<year>2004</year>
).
<comment>
<italic>African sexual culture, AIDS</italic>
. Retrieved from
<ext-link ext-link-type="uri" xlink:href="http://www.sas.upenn.edu/~tonyat/sexualculture.html">www.sas.upenn.edu/~tonyat/sexualculture.html</ext-link>
</comment>
</mixed-citation>
</ref>
<ref id="CIT0072">
<mixed-citation publication-type="standard">
<person-group person-group-type="author">
<collab>UNAIDS</collab>
</person-group>
(
<year>2014a</year>
).
<comment>
<italic>South Africa country statistics</italic>
. Retrieved from
<ext-link ext-link-type="uri" xlink:href="http://www.unaids.org/en/regionscountries/countries/southafrica">http://www.unaids.org/en/regionscountries/countries/southafrica</ext-link>
</comment>
</mixed-citation>
</ref>
<ref id="CIT0073">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<collab>UNAIDS</collab>
</person-group>
(
<year>2014b</year>
).
<source>
<italic>The gap report: Adolescent girls and young women</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">Geneva</named-content>
</publisher-loc>
:
<publisher-name>The Joint United Nations Programme on HIV/AIDS</publisher-name>
<comment>
<ext-link ext-link-type="uri" xlink:href="http://www.unaids.org">http://www.unaids.org</ext-link>
</comment>
</mixed-citation>
</ref>
<ref id="CIT0074">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<collab>United Nations Children’s Fund</collab>
</person-group>
(
<year>2013</year>
).
<source>
<italic>Towards an AIDS-free generation – children and AIDS – sixth stocktaking report</italic>
</source>
.
<publisher-loc>
<named-content content-type="city">New York</named-content>
,
<named-content content-type="state">NY</named-content>
</publisher-loc>
:
<publisher-name>Author</publisher-name>
.</mixed-citation>
</ref>
<ref id="CIT0075">
<mixed-citation publication-type="book">
<person-group person-group-type="author">
<collab>United Nations General Assembly Special Session on HIV/AIDS</collab>
</person-group>
(
<year>2009</year>
).
<source>
<italic>Guidelines on construction of core indicators for 2010 Reporting</italic>
</source>
.
<comment>UNAIDS/09.10E / JC1676E</comment>
<publisher-loc>Geneva</publisher-loc>
:
<publisher-name>Joint United Nations Programme on HIV/AIDS (UNAIDS)</publisher-name>
</mixed-citation>
</ref>
<ref id="CIT0076">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Visser</surname>
<given-names>M. J.</given-names>
</name>
</person-group>
(
<year>2005</year>
).
<article-title>Life skills training as HIV/AIDS preventive strategy in secondary schools: Evaluation of a large-scale implementation process</article-title>
.
<source>
<italic>SAHARA-J: Journal of Social Aspects of HIV/AIDS</italic>
</source>
, (
<issue>1</issue>
),
<fpage>203</fpage>
<lpage>216</lpage>
. doi:
<pub-id pub-id-type="doi">10.1080/17290376.2005.9724843</pub-id>
<pub-id pub-id-type="pmid">17601024</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0078">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Webb</surname>
<given-names>T. L.</given-names>
</name>
,
<name>
<surname>Joseph</surname>
<given-names>J.</given-names>
</name>
,
<name>
<surname>Yardley</surname>
<given-names>L.</given-names>
</name>
, &
<name>
<surname>Michie</surname>
<given-names>S.</given-names>
</name>
</person-group>
(
<year>2010</year>
).
<article-title>Using the internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy</article-title>
.
<source>
<italic>Journal of Medical Internet Research</italic>
</source>
, (
<issue>1</issue>
),
<fpage>1</fpage>
<lpage>4</lpage>
. doi:
<pub-id pub-id-type="doi">10.2196/jmir.1376</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0079">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Webb</surname>
<given-names>T. L.</given-names>
</name>
, &
<name>
<surname>Sheeran</surname>
<given-names>P.</given-names>
</name>
</person-group>
(
<year>2006</year>
).
<article-title>Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence</article-title>
.
<source>
<italic>Psychological Bulletin</italic>
</source>
, (
<issue>2</issue>
),
<fpage>249</fpage>
<lpage>268</lpage>
. doi:
<pub-id pub-id-type="doi">10.1037/0033-2909.132.2.249</pub-id>
<pub-id pub-id-type="pmid">16536643</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0080">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wight</surname>
<given-names>D.</given-names>
</name>
,
<name>
<surname>Plummer</surname>
<given-names>M. L.</given-names>
</name>
,
<name>
<surname>Mshana</surname>
<given-names>G.</given-names>
</name>
,
<name>
<surname>Wamoyi</surname>
<given-names>J.</given-names>
</name>
,
<name>
<surname>Shigongo</surname>
<given-names>Z. S.</given-names>
</name>
, &
<name>
<surname>Ross</surname>
<given-names>D. A.</given-names>
</name>
</person-group>
(
<year>2006</year>
).
<article-title>Contradictory sexual norms and expectations for young people in rural Northern Tanzania</article-title>
.
<source>
<italic>Social Science & Medicine</italic>
</source>
, ,
<fpage>987</fpage>
<lpage>997</lpage>
. doi:
<pub-id pub-id-type="doi">10.1016/j.socscimed.2005.06.052</pub-id>
<pub-id pub-id-type="pmid">16139937</pub-id>
</mixed-citation>
</ref>
<ref id="CIT0081">
<mixed-citation publication-type="standard">
<person-group person-group-type="author">
<name>
<surname>Wislar</surname>
<given-names>J. S.</given-names>
</name>
, &
<name>
<surname>Fendrich</surname>
<given-names>M.</given-names>
</name>
</person-group>
(
<year>2000</year>
).
<comment>
<italic>Can self-reported drug use data be used to assess sex risk behavior in adolescents?</italic>
Retrieved from
<ext-link ext-link-type="uri" xlink:href="http://www.popcouncil.org/pdfs/wp/182.pdf">www.popcouncil.org/pdfs/wp/182.pdf</ext-link>
</comment>
</mixed-citation>
</ref>
<ref id="CIT0082">
<mixed-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Woolf-King</surname>
<given-names>S. E.</given-names>
</name>
, &
<name>
<surname>Maisto</surname>
<given-names>S. A.</given-names>
</name>
</person-group>
(
<year>2011</year>
).
<article-title>Alcohol use and high-risk sexual behavior in sub-Saharan Africa: A Narrative Review</article-title>
.
<source>
<italic>Archive of Sexual Behaviour</italic>
</source>
, ,
<fpage>17</fpage>
<lpage>42</lpage>
. doi:
<pub-id pub-id-type="doi">10.1007/s10508-009-9516-4</pub-id>
</mixed-citation>
</ref>
</ref-list>
</back>
</pmc>
</record>

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