What does the scientific evidence say about condoms in schools?
In February this year Cardinal Wilfred Napier, head of the Catholic Church in South Africa, said that condoms would not be distributed at Catholic schools. This followed the announcement that the KwaZulu-Natal Department of Education would begin providing condoms at schools in the province.
Napier told the Sunday Times that the province’s plans were ‘short-sighted’ and ‘immoral’. His objections appear to be based on the belief that providing condoms would increase sexual activity among young people. He was quoted as saying, “Once something is distributed by people in authority, children take it as an okay.”
But are Napier’s concerns supported by the available evidence?
What does the evidence say?
Research from various countries supports the distribution of condoms in schools.
- In 2001, the US Institute of Medicine published a report titled, ‘No Time To Lose: Getting More from HIV Prevention’. The authors looked at the available evidence on HIV prevention programmes, noting:
“Studies reviewing the scientific literature, as well as expert panels that have studied this issue, have concluded that comprehensive sex and HIV/AIDS education programs and condom availability programs can be effective in reducing high-risk sexual behaviors among adolescents … In addition, these reviews and … panels conclude that school-based sex education and condom availability programs do not increase sexual activity among adolescents.”
- The report recommended that policymakers remove requirements “that public funds be used for abstinence only education, and that states and local school districts implement and continue to support age appropriate comprehensive sex education and condom availability programs in schools.”
- A meta-analysis of US and international studies on condom availability systematically searched the medical literature. It found 21 high-quality studies on condom interventions, some of which looked at distribution in schools. The report stated:
“This systematic review supports the structural-level … distribution [of condoms] as an efficacious approach to increasing condom use and reducing HIV/STD [infections]. Given the urgency of the HIV epidemic, making condoms more universally available, accessible, and acceptable, particularly in communities or venues reaching high-risk individuals, should be considered in any comprehensive HIV/STD prevention program. Further exploration [of] how best to implement condom distribution programs to maximize their … impact should be considered.
- A highly regarded report in the US titled, ‘Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases’, observed:
“According to a small number of studies of mixed quality, making condoms available in schools does not hasten the onset of sexual intercourse or increase its frequency. Its impact on actual use of condoms is less clear. Using condoms reduces the risk of acquiring and transmitting HIV.”
Controlled trials needed
On balance, the evidence shows that it is not harmful to make condoms available in schools and that it is possibly beneficial. Condoms should be provided in schools, along with comprehensive sex education. This education should have a strong emphasis on how to avoid contracting and transmitting HIV.
Whilst condoms are made available in schools as fast as possible, there should be at the same time a large-scale randomised controlled trial comparing different HIV prevention programmes in schools, including condom availability. The Medical Research Council and the Southern African HIV Clinicians Society, together with the Department of Basic Education and the Department of Health are ideally placed to lead such an important study.
[box] The evidence clearly shows that providing condoms prevents HIV infections and unwanted pregnancies. The evidence does not support the idea that distributing condoms in schools would lead to earlier or more risky sex. Napier’s views are not supported by the evidence. [/box]
This article was adapted from a press statement released by Equal Education and the Treatment Action Campaign on 12 October 2012.