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RESEARCH: Dilys Walker, Juan Pablo Gutierrez, Pilar Torres, and Stefano M Bertozzi HIV prevention in Mexican schools: prospective randomised evaluation of intervention BMJ 2006; 332: 1189-1194 [Abstract] [Full text]

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Positive directions for HIV prevention in developing countries

Ruth V Reed, Malid Molloholli   (23 May 2006)

Risky sexual behaviour

Jose Murtinho-Braga   (30 May 2006)

Positive directions for HIV prevention in developing countries 23 May 2006
Ruth V Reed, Senior House Officer, Psychiatry Camden and Islington Mental Health and Social Care NHS Trust, London NW3 2QZ, Malid Molloholli Send response to journal: Re: Positive directions for HIV prevention in developing countries	Editor – Walker et al’s study of HIV prevention in Mexican schools involved a very time-consuming and labour-intensive programme of education followed by extensive evaluation, yet there was some basic yet vital information which appeared to be missing. They report having evaluated ‘attitudes towards condom use’ but there was no clear assessment of what motivated the teenagers’ decisions regarding condoms – did they find them too expensive, were they difficult or embarrassing to obtain, did they risk being ‘found out’ by buying them from local shops in small communities? Furthermore, the possible influence of religion on their attitudes was not discussed. One must also wonder how the teenagers and their teachers felt about the course itself, and what their own suggestions would have been to improve it. 30 hours discussing sex and related issues is quite a demand to place upon a teacher who had had only slightly more training than this themselves on their 40-hour course. We do not know whether these teachers were willing and enthusiastic volunteers, whether they had a scientific background, and how well they actually understood the subject themselves. Condom promotion by health professionals or young people may have been far more acceptable and effective - if the authors’ comments that ‘teachers rarely change their preconceptions about adolescent sexuality’ are to be believed, then teachers were a strange choice to deliver this programme. In Albania, where there are also economic difficulties and relatively traditional attitudes to pre-marital sex, a programme has been started whereby young doctors visit schools on World AIDS Day to speak to teenagers. One of us (MM) gave such lectures recently and they were very positively received by staff and students, who requested that further classes be given. Unfortunately this study seems to have missed these opportunities to gain insight into why the programme was unsuccessful and thus to seek positive directions for new research. Competing interests: None declared
Risky sexual behaviour 30 May 2006
Jose Murtinho-Braga, G.P. Northdown Surgery CT9 2TR Send response to journal: Re: Risky sexual behaviour	It is untenable to claim that condom and contraception education do not increase risky sexual behaviour from the evidence presented in the paper.85% of the males in the condom arm of the study had sex with sexworkers or a casual partner compared to 71% of males in the other arm. Also the females in the condom arm were more likely to have much older partners which may suggest exploitation- a question not directly looked at in this study.The increased in sex with casual partners and sexworkers and coupled with acknowledged high incidence of condom slippage and breakage found in the study is clearly evidence of risky sexual behaviour facilitated by this intervention which was promoting condom use. Competing interests: None declared