European Journal of Environment and Public Health

2020, 4(1), em0035

e-ISSN: 2542-4904
https://www.ejeph.com

Comprehensive Sexuality Education (CSE) Curriculum in 10 East

and Southern African Countries and HIV Prevalence among the
Youth
Miracle Ayomikun Adesina 1,2,3,4,5*, Isaac I. Olufadewa 1,6

1
Slum and Rural Health Initiative Research with Purpose Academy, NIGERIA
2
Cephas Health Research Initiative Inc, Ibadan, NIGERIA
3
Mental and Oral Health Development Organization, Kebbi State, NIGERIA
4
Universal Care for Africa Foundation, St. Loius, USA
5
Department of Physiotherapy, University of Ibadan, Ibadan, NIGERIA
6
Pan African University of Life and Earth Sciences Institute, PAULESI, Ibadan, NIGERIA
*Corresponding Author: [email protected]

Citation: Adesina, M. A. and Olufadewa, I. I. (2020). Comprehensive Sexuality Education (CSE) Curriculum in 10 East and Southern African
Countries and HIV Prevalence among the Youth. European Journal of Environment and Public Health, 4(1), em0035.
https://doi.org/10.29333/ejeph/6009

ARTICLE INFO ABSTRACT

Received: 26 Jul. 2019 Introduction: Young people easily fall prey to risky and dangerous practices such as drug abuse, unprotected
Revised: 03 Sep. 2019 sexual intercourse etc. due to lack of knowledge about the implications of these practices. Comprehensive
Sexuality Education (CSE) was developed to solve this problem by educating young minds so that they can avoid
Accepted: 04 Sep. 2019
risky sexual behaviours and live healthy lives.

Methods: The ten countries in East and Southern Africa selected were those whose CSE curriculum had been
reviewed by the United Nations Educational, Scientific and Cultural Organization (UNESCO) and United Nations
Population Fund (UNFPA). We developed a scoring protocol to be able to specifically group a curriculum into
three categories (A, B and C) based on its weakness. The data for HIV was based on the UNAIDS estimation. Data
was analyzed with the Microsoft Excel Version 2010.

Results: Sixty (60%) percent of the countries involved had CSE curriculum with minor to moderate concerns,
while the remaining 40% had moderate to serious gaps. Botswana and Lesotho had high prevalence of HIV among
both young males and females. Majority of the countries with CSE curriculum having minor to moderate gaps
had high prevalence of HIV among males within age 15-24 years. In the female category, one of the countries
using CSE curriculum with moderate to serious gaps had an average HIV prevalence higher than the average of
all the 10 countries involved in the study.

Conclusion: It is recommended that factors responsible for high HIV prevalence as identified in this study be
addressed. This might help reduce the prevalence of HIV.

Keywords: sexuality, education, curriculum, HIV, East Africa, Southern Africa, SIMBIHealth

regards their sexual nd reproductive health however, research

INTRODUCTION shows that majority of them lack adequate knowledge to make
appropriate decisions (UNFPA, 2016). Educational and
It is well established that the young mind is very inquisitive technological innovations such as SIMBIHealth (Sexuality
and the young sometimes experiment to find out about some Information, Mental and Behavioural Initiative for Health)
issues from a personal experience (Kidd and Hayden, 2015). (SIMBIHealth, 2019) and Comprehensive Sexuality Education
Young people therefore easily fall prey to illicit, risky and (CSE) (Panchaud et al., 2018), among others were developed to
dangerous practices which relates to drug use, unprotected solve the problem and educate the young minds.
sexual intercourse etc. (Kohli et al., 2018). Lack of knowledge Comprehensive sexuality education is a curriculum-based
about sexuality issues such as unsex safe among others may be process of teaching and learning about the cognitive,
why a lot of youngsters fall into this (Kyilleh, Tabong and emotional, physical, social and even the spiritual aspects of
Konlaan, 2018). Also, young persons need to make decisions as sexuality. It is delivered in both formal and non-formal

Copyright © 2020 by Author/s and Licensed by Veritas Publications Ltd., UK. This is an open access article distributed under the Creative Commons
Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
2/5 Adesina and Olufadewa / European Journal of Environment and Public Health, 4(1), em0035

settings (UNESCO and UNFPA, 2012). CSE is a scientifically weakness in it. Category 1, based on UNESCO and UNFPA
accurate, incremental, age- and developmentally appropriate, finding was given a score of 1, category 3 was assigned a score
curriculum based on a human rights approach. It is culturally of 2 and category 4 finding was scored 3. No scoring was
relevant and context appropriate, transformative and able to assigned to category 2 has it was interlinked with the others
develop the life skills needed to support healthy choices and scoring it would lead to tautology. Countries with higher
among young people while promoting gender equality scores have higher gaps or concerns in their CSE curriculum. A
(UNESCO and UNFPA, 2012). score of 12-20 was interpreted as no significant gap (category
Full implementation of comprehensive sexuality education A), score of 21-28, minor to moderate gap/concern (category
curriculum in the Africa continent faces many challenges B) and score of 29-36, moderate to serious gaps/concern
(Keogh et al., 2018). Some individuals and groups believe that (category C).
CSE leads to early sexual initiation and deprives children of The data for HIV was based on the United Nations
their innocence. Some parents object to sexuality education (UNAIDS) estimation (THE WORLD BANK, 2018a; 2018b).
being taught in schools. Some state that CSE is a means of Prevalence data for both gender (male and female) were
recruiting young people towards alternative lifestyles and it is obtained and analyzed using the Microsoft Excel Version 2010.
inappropriate for young children (UNESCO and UNFPA, 2012). Prevalence of HIV was defined as the percentage of the people
This study aims to investigate the association between the with age 15-24 years who were infected with HIV. The average
prevalence of HIV in ten (10) countries in Eastern and prevalence of HIV was obtained by getting the mean value
Southern Africa and the strength or weakness of the CSE from that of 2011 till 2017. The findings are presented in
curriculum been used in those countries. The outcome of the sentences, percentages and charts.
study will serve as additional evidence and support for full
implementation of CSE in Africa.
RESULTS

METHODS Category of Curriculum

Table 1 displays the category the curriculum of the 10
The ten countries in East and Southern Africa selected were countries in East and Southern Africa that were studied falls
those whose comprehensive sexuality education curriculum into. Notably, none of the curriculum fell under the category
had been reviewed by the United Nations Educational, of no significant gap. Therefore, all the curriculums have
Scientific and Cultural Organization (UNESCO) and United significant gap. The bulk of the countries (60%) had minor to
Nations Population Fund (UNFPA). The ten countries that moderate concerns in their curriculum while the remaining
were involved in this study are Botswana, Kenya, Lesotho, 40% had moderate to serious gaps/ concerns.
Malawi, Namibia, South Africa, Swaziland (Eswatini), Uganda,
Zambia and Zimbabwe. The Ministry of Education staffs from
all the ten countries along with other stakeholders were Table 1. Category of CSE curriculum
involved in this review. A scanning instrument was developed Category B Category C
to determine if the countries curriculum meets the standard of Botswana Kenya
CSE (UNESCO and UNFPA, 2012). Lesotho Namibia
Malawi South Africa
A scanning instrument was developed by the collaboration Swaziland (Eswatini) Zambia
of the Population Council, UNESCO and UNFPA regional Uganda
offices for ESA plus the relevant UNESCO and UNFPA Zimbabwe
headquarters offices. The scanning instrument was made to Category B: Minor to moderate gap/concern in curriculum
allow for documenting whether the important content was Category C: Moderate to serious gap/concern in curriculum
included. The instrument also contains various items on
various issues such as age-appropriateness, behavioural goals
the curriculum was aiming to promote, diversity and HIV Prevalence
effectiveness of teaching methods along with sensitivity to The trend of HIV prevalence among the young (15-24
gender and rights across topics (UNESCO and UNFPA, 2012). years) in the ten African countries examined is presented in
The curriculums were reviewed following the standard CSE Figure 1 (males) and Figure 2 (females). The average HIV
topics (6), topics and approach (3) and teaching approach. The prevalence in these countries is displayed in Figure 3.
findings were categorized based on the gaps in the curriculum
in comparison to the Standard CSE. The four categories are
(UNESCO and UNFPA, 2012).
1. No significant gap
2. Topics or areas that are missing or weak
3. Concerns that are minor to moderate
4. Concerns that are moderate to serious
We developed a scoring protocol to be able to specifically
group a curriculum into three categories (A, B and C) based on
Figure 1. HIV prevalence among males within age 15-24 years
 European Journal of Environment and Public Health, 4(1), em0035 3/5

about four times the prevalence of HIV among young males in

Botswana which has the highest for the male population. The
average HIV prevalence for all the countries for the male
category is 2.78 and 7.56 for the female category.
HIV Prevalence and Category of Curriculum
Three of the six (50%) countries with category B curriculum
i.e. curriculum with minor to moderate gap or concern had
high prevalence of HIV from 2011 till 2017 among young males
Figure 2. HIV prevalence among females age 15-24 years within age 15-24 years. However, only one of the four (25%)
countries with category C curriculum i.e. curriculum with
This trend clearly shows that Botswana has the highest moderate to serious concern, had high prevalence of HIV from
prevalence of HIV among young males (15-24 years). The 2011 to 2017 among young males. Also, two of the countries
countries with peaks are Botswana, Lesotho, South Africa and with category B curriculum had low HIV prevalence among
Zimbabwe. The trend of Kenya, Malawi and Uganda’s HIV young males over the years been considered in this study. Only
prevalence among young males form a valley. These countries one country with category C curriculum had low prevalence of
have low HIV prevalence over years (2011-2017). Of all the HIV from 2011 to 2017.
countries examined, only Botswana had an increasing HIV Findings from analysis of data on the HIV prevalence from
prevalence from 2011 to 2017. Malawi, Namibia and South 2011 to 2017 among young females within age 15-24 based on
Africa’s HIV prevalence among the young male population is the category of curriculum showed that three of the six
almost the same been between 1.9-2.1%, 2.6-2.7%, 3.7-3.9% countries (50%) with category B curriculum had high HIV
respectively. However, Lesotho has been having mixture of prevalence and none among countries with category C
declines and increase in HIV prevalence. It is of note that the curriculum had high HIV prevalence. Also, two of the six
HIV prevalence among young males in Kenya, Swaziland, countries (33%) with category B curriculum had low HIV
Uganda, Zambia and Zimbabwe has been gradually decreasing prevalence and two of the four (50%) countries with category
since 2011. C curriculum had low prevalence of HIV among the young
females.
The average HIV prevalence among young males in
countries with category B curriculum is 2.9 while that of
countries with category C curriculum is 2.6. Also, the average
prevalence of HIV among the young females within age 15 to
24 years in countries with curriculum B is 8.4 and that of the
countries using category C curriculum is 6.3. Only two of the
countries under the category B curriculum have an average
HIV prevalence value lower than the overall average value for
males, while three countries of the four under the category C
Figure 3. Average HIV prevalence among males and females curriculum had an average HIV prevalence lower than the
within age 15-24 years average for all countries. For the female group, 3 countries
using category C curriculum had an average HIV prevalence
The trend above shows that Botswana, Lesotho and below the average for all the countries been studied while
Swaziland have high prevalence of HIV among young females three countries using category C curriculum had an HIV
while Kenya, Malawi, Namibia and Uganda have low prevalence value higher than the total average value.
prevalence. The prevalence of HIV among the young female
population has been increasing from 2011. Botswana is the
DISCUSSION
only country among the 10 studied that has a constantly
increasing prevalence. Most of the countries (8) had declining
prevalence of HIV prevalence from 2011. However, only A good number of countries with comprehensive sexuality
Lesotho had a mixture of decline and increase in its HIV education curriculum that has minor to moderate gaps had
prevalence. The HIV prevalence declined from 2011 till 2015 high prevalence of HIV among males within age 15-24 years. It
after which it increased in 2017. would be expected that countries with better CSE curriculum
would have lower prevalence of HIV (UNESCO and UNFPA,
Swaziland had the highest average young female
2012), however this is not the case here and this finding can be
prevalence (20%) of HIV among the countries studied while
attributed to a number of factors. One of these factors is the
Kenya had the lowest (3%). The country with the highest
perception of some individuals that CSE fuels homosexuality.
average prevalence of HIV among young males within age 15-
Some parents feel that CSE encourages early sexual debut, this
24 years in the 10 African countries examined is Botswana
is another major factor (domestic factor). These exist in
(5.20%) and Uganda, the lowest (1.30%). Therefore, the
Botswana, one of the countries with a relatively better CSE
average prevalence of HIV among the young females range
curriculum but still high HIV prevalence. Also in Botswana, it
between 3-20% and males, 1.30-5.20%. It is noteworthy that
is reported that because CSE as a subject is not examinable
the prevalence of HIV among young females in Swaziland is
therefore teachers and students do not take it serious. Culture
4/5 Adesina and Olufadewa / European Journal of Environment and Public Health, 4(1), em0035

and tradition (socio-cultural factor) makes it difficult for some comprehensive sexuality education, and many more
teachers to speak about sexuality in the classroom as they (Pauchaud et al., 2018; UNESCO, 2017).
believe it is not an appropriate discussion (UNESCO, 2017). In the female category, one of the country using CSE
Lesotho is another country in this category with a relatively curriculum with moderate to serious gaps had an average HIV
better CSE curriculum and yet high HIV prevalence. This prevalence higher than the average of all the 10 countries
finding can be attributed to inadequate financial resources to involved in the study. In this particular country (South Africa),
train teachers and inspectors in CSE. Also, there are this finding might be due to a number of reasons. One, CSE is
inadequate human resources, especially teachers well trained taught for only two hours in a week. This is too short for all
to teach CSE (Mathabo, 2012). It is also reported that the topics to be covered (UNESCO, 2017). Also, some teachers are
teachers training institute did not prepare teachers adequately reluctant to teach their students about comprehensive
to teach comprehensive sexuality education (UNESCO, 2017). sexuality education because of their values, cultures and
None of the countries with CSE curriculum with moderate tradition. A very strong reason for the high prevalence of HIV
to serious gaps had high prevalence of HIV among young among the young females in South Africa is the relatively weak
females (15-24 years). This finding can be because relatively CSE curriculum although these is been worked on (Badenhorst,
more extensive works on implementing CSE has been done in 2018; UNESCO, 2017). The finding from South Africa seems to
these countries. Kenya is a country in this category and it is clearly show that poor CSE curriculum is related to high HIV
estimated that in Kenya, more than 2 million adolescents have prevalence.
been educated on CSE via digital platforms and also, more than
100 religious institutions have been properly educated on CSE.
Additionally, as at 2014, more than 25,000 parents have been
CONCLUSION
educated on CSE by the Centre for Adolescent Studies
(UNESCO, 2017). Namibia also belongs to this category and The comprehensive sexuality education curriculum was
there are full time teachers in place to implement CSE developed to educate young minds about all components of
(UNESCO, 2017). South Africa, which is also in this category, sexuality namely emotional, cognitive, physical and
has extended CSE to out-of-school youth (UNESCO, 2017). emotional. The use of a curriculum following the guidelines for
With all these in place in these countries, the reasons behind the standard CSE is expected to positively affect the young
their lower prevalence of HIV can be easily understood. males and females in these countries. However, this is not the
finding in this study. The higher prevalence of HIV in countries
In the male group, the average HIV prevalence between
with better CSE curriculum may be due to poor
both categories (i.e. CSE category with minor to moderate gaps
implementation, culture and tradition, poor funding, among
and the other with moderate to serious gaps) was very close
many others. It is therefore recommended that the factors
with a difference of 0.3. Although, countries with better CSE
responsible for these findings in those countries be addressed
curriculum have higher HIV prevalence, a lot of organizations
and this may help reduce the prevalence and burden of HIV.
are working to tackle this challenge. This is responsible for the
small difference in average HIV prevalence over years, from
2011 to 2015. In those countries with the relatively better CSE LIMITATIONS
and high HIV prevalence, some success has been recorded. In
Botswana for example, forty teachers training college teachers
1. The curriculum review was carried out in 2011 and
and some lecturers from the University of Botswana have been
there might have been changes in the curriculum.
trained on the CSE pre-service curriculum. Through these
training, more than 600 teachers have been trained in CSE. 2. The presence of a curriculum does not necessarily
Also, an online course was delivered to 110 teachers from the translate to implementation of CSE curriculum. This
10 education regions and these teachers have been able to might limit the accuracy of the findings of this study.
educate about 11,000 people (UNESCO, 2017). It is very 3. The HIV prevalence used was among young males and
possible that very soon, the difference in HIV prevalence in females within age 15-24 years. This might limit
these two categories will be equal and that of countries with accuracy of the findings of this study as most of the
better comprehensive sexuality curriculum might even school aged children are within age 8-20 years.
become lower than what exist in countries with poorer CSE
curriculum.
RECOMMENDATIONS
This study found out that majority (4 out of 6) of the
countries using CSE curriculum with minor to moderate gap
1. A review should be carried out to assess the CSE
had an average HIV prevalence among young males (15-24
curriculum in all African countries in line with the
years) higher than the average of all the 10 countries involved
standard CSE curriculum. The latest one available is
in the study. This finding can be attributed to a number of
for only ten countries in Africa and it was carried out
factors cross country across years. These factors include;
8 years ago.
culture and tradition, poor funding, inadequate training on
teachers, lack of seriousness of students and teachers with 2. An African wide study should be carried out to
CSE, inadequate number of teachers trained on comprehensive investigate the implementation of CSE curriculum.
sexuality education, weak training of inspectors to monitor The findings from such study would be helpful in
implementation of CSE in schools, misconceptions of some finding connections between CSE implantation and
parents, elders, teachers and other individuals about
 European Journal of Environment and Public Health, 4(1), em0035 5/5

various variables and indicators of significance or Kyilleh, J. M., Tabong, P. T. and Konlaan, B. B. (2018).
interest. Adolescents’ reproductive health knowledge, choices and
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increased. The number of hours used presently is too study in the West Gonja District in Northern region, Ghana.
little and not enough to cover the curriculum. BMC Intl Health Hum Rights, 18(6), 1-12. https://doi.org/
10.1186/s12914-018-0147-5
Mathabo, K. (2012). Sexuality education in rural Lesotho
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