ABSTRACT
Social and behavioral HIV interventions can more fully address the needs of young people. Previous research recommends programming for adolescents using the socio-ecological theory that comprehensively engages schools, communities, individuals, and families. This chapter seeks to respond to these recommendations by outlining the School-Community Accountability for Girls Education (SAGE) program in Uganda. SAGE was a school-based HIV prevention program for adolescent girls, which used an early warning system to track school attendance and a set of supporting social and behavioral interventions to change social norms around girls’ education. A longitudinal study was conducted in 13 districts of Uganda using cross-sectional baseline and endline surveys between 2016 and 2019. The sample size was 1310 adolescent girls (950 intervention; 360 control) and 672 parents/caregivers (420 intervention; 252 control). The objective was to assess the impact of the intervention in reducing secondary school dropout and the associated risk of HIV infection among 38,750 girls aged 13–19 in 151 schools in Uganda. The longitudinal data indicated adolescent girls who experienced school-related gender-based violence decreased by 7% in the last six months of the project, the number of girls who took an HIV test increased by 10.8%, the number of girls who had sexual intercourse decreased by 7.2%, and rates of corporal punishment in intervention schools decreased by 17.5%. SAGE’s innovative combination approach helped shift social norms and practices around girls’ education, violence against children, reproductive health, and positive discipline. Further, SAGE monitoring data reported an increase of girls retained in school at the end of the project, at 99.7% in 2019 (compared to 88.5% in 2016). The findings suggest that the approach is a potentially effective combination intervention to identify girls at risk of dropping out of school and mitigate the causes of dropout (thus decreasing risk of HIV). The implications of scaling up similar interventions to reduce HIV-related vulnerabilities are discussed.
