Mema kwa Vijana Sexual Health Programme: Tanzania
This process evaluation was initiated by David Ross and Richard Hayes (London School of Hygiene and Tropical Medicine (LSHTM)), and conducted with Mary Plummer (LSHTM and SPHSU) and Joyce Wamoyi and Gerry Mshana (National Institute for Medical Research, Tanzania). The study is called HALIRA and it complements an RCT of the MEMA kwa Vijana (MkV) adolescent sexual health programme in rural Mwanza, Tanzania, by investigating processes by which MkV components were delivered. HALIRA also collected ethnographic data on the social factors shaping young people's sexual behaviour .
Although primary schools are one of the most efficient ways of reaching young people for health promotion, there are serious challenges. These include:
low attendance rates
limited teacher training and teaching resources
practices that may alienate pupils and their parents, e.g. corporal punishment, unpaid work, pregnancy tests, and some teachers' alcohol or sexual abuse.
In the MkV schools programme teachers were good at relaying information but had difficulty adopting less didactic teaching styles. Peer educators performed scripted dramas well, but were limited as informal educators and behavioural models.
The condom promotion and distribution component of MkV was analysed as part of a broader paper on condoms. This found that condoms are perceived negatively for several reasons, e.g. their association with infection or promiscuity, reduced male sexual pleasure, and cultural understandings of meaningful sex. Men control the terms of sexual encounters, and report they would use condoms only with risky partners, but few see their partners as such. Use of condoms appears to be very low, primarily due to limited demand, although barriers to access also exist. The condom promotion initiative of MkV was not cost effective and has been discontinued.
The processes and impact of the MEMA kwa Vijana adolescent sexual health intervention are assessed in Promoting Abstinence, Being Faithful, and Condom Use with Young Africans by Mary Plummer (2012). This examines how the “ABC” behaviours – Abstinence, Being faithful, and Condom use – can be promoted more effectively with young rural Africans. It draws on the extraordinarily large amount of qualitative data collected to complement the randomized controlled trial, and examines the motivations and strategies of youth who practiced low risk behaviours. It concludes with detailed recommendations for school and community programs.
Plummer M. Promoting abstinence, being faithful, and condom use with young Africans: qualitative findings from an intervention trial in rural Tanzania. New York: Lexington Books, 2012. https://rowman.com/ISBN/9780739168448 http://www.mkukinanyota.com/upcomingbooks.html#
Excerpt from: "Chapter 7: Impact of the MEMA kwa Vijana Intervention", pp. 217-254.
Excerpt from: "Chapter 9: “Being Faithful”: Limiting Partner Number and/or Practicing Fidelity", pp. 299-320.
Excerpt from: "Chapter 11: Intervention Recommendations", pp. 370-372 and 381-402.
Plummer M. Promoting abstinence, being faithful, and condom use with young Africans: qualitative findings from an intervention trial in rural Tanzania. New York: Lexington Books, 2012.
Plummer M, Wight D, Obasi A, Wamoyi J, Mshana G, Todd J, Mazige BC, Makokha M, Hayes R, Ross D. A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: The MEMA kwa Vijana programme. Health Education Research 2007;22:500-512pubmed open access
Plummer M, Wight D, Wamoyi J, Nyalali K, Ingall K, Mshana G, Shigongo Z, Obasi A. Are schools a good setting for adolescent sexual health promotion in rural Africa? A qualitative assessment from Tanzania. Health Education Research 2007;22:483-99pubmed open access
Ross DA, Changalucha J, Obasi AIN , Todd J, Plummer ML, Cleophas-Mazige B, Anemona A, Everett D, Weiss HA, Mabey DC, Grosskurth H, Hayes RJ, Balira R, Wight D, Gavyole A, Makokha M, Mosha F, Terris-Prestholt F, Parry J. Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomised trial. AIDS 2007;21:1943-55pubmed
Plummer M, Wight D, Wamoyi J, Mshana G, Hayes R, Ross D. 'Farming with your hoe in a sack' condom attitudes, access and use in rural Tanzania. Studies in Family Planning 2006;37:29-40pubmed
Ross DA, Wight D, Dowsett G, Buvé A, Obasi AIN. The weight of evidence: a method for assessing the strength of evidence on the effectiveness of HIV prevention interventions among young people. In: Ross DA, Dick B, Ferguson J, editors Preventing HIV/AIDS in young people: a systematic review of the evidence from developing countries. (WHO Technical Report Series no. 938). Geneva: World Health Organization, 2006:79-102.open access
Hayes R J, Changalucha J, Ross D, Gavyole A, Todd J, Obasi AIN, Plummer ML, Wight D, Mabey DC, Grosskurth H. The MEMA Kwa Vijana project: design of a community randomised trial of an innovative adolescent sexual health intervention in rural Tanzania. Contemporary Clinical Trials 2005;26:430-42.pubmed
Ross D, Wight D. What is the role of randomised trials in assessing sexual health interventions: developing countries perspective. In: Stephenson J, Imrie J, Bonell C, editors Effective sexual health interventions: issues in experimental evaluation. Oxford: Oxford University Press, 2003:35-48.