Intended for healthcare professionals


HIV prevention in Mexican schools: prospective randomised evaluation of intervention

BMJ 2006; 332 doi: (Published 18 May 2006) Cite this as: BMJ 2006;332:1189
  1. Dilys Walker, investigator1,
  2. Juan Pablo Gutierrez, investigator (jpgutier{at},
  3. Pilar Torres, investigator2,
  4. Stefano M Bertozzi, director2
  1. 1 Division of Reproductive Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico,
  2. 2 Division of Health Economics and Evaluation, National Institute of Public Health
  1. Correspondence to: J P Gutierrez
  • Accepted 9 March 2006


Objective To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception.

Design Cluster randomised controlled trial.

Setting 40 public high schools in the state of Morelos, Mexico.

Participants 10 954 first year high school students.

Intervention Schools were randomised to one of three arms: an HIV prevention course that promoted condom use, the same course with emergency contraception as back-up, or the existing sex education course. Self administered anonymous questionnaires were completed at baseline, four months, and 16 months. Students at intervention schools received a 30 hour course (over 15 weeks) on HIV prevention and life skills, designed in accordance with guidelines of the joint United Nations programme on HIV/AIDS. Two extra hours of education on emergency contraception were given to students in the condom promotion with contraception arm.

Main outcome measures Primary outcome measure was reported condom use. Other outcomes were reported sexual activity; knowledge and attitudes about HIV and emergency contraception; and attitudes and confidence about condom use.

Results Intervention did not affect reported condom use. Knowledge of HIV improved in both intervention arms and knowledge of emergency contraception improved in the condom promotion with contraception arm. Reported sexual behaviour was similar in the intervention arms and the control group.

Conclusion A rigorously designed, implemented, and evaluated HIV education course based in public high schools did not reduce risk behaviour, so such courses need to be redesigned and evaluated. Addition of emergency contraception did not decrease reported condom use or increase risky sexual behaviour but did increase reported use of emergency contraception.


  • Embedded Image Tables showing the actually treated analysis are on

  • Contributors DW conceived and designed the study and oversaw implementation of the intervention and data collection and analysis. She was primarily responsible for drafting and revising the article. JPG helped design the study and was primarily responsible for data management and analysis. He contributed greatly to the content and revision of the article. PT was primarily responsible for overseeing teacher training, implementing the interventions, and applying the questionnaire. She was the overall field manager and contributed greatly to the writing and revision of the article. SB was the principal investigator for the parent study and helped at every stage of the study. He contributed greatly to the study design, analysis, interpretation of results, and editing and revision of the article. DW is guarantor.

  • Funding World Aids Foundation and Mexican National Institute of Public Health.

  • Competing interests None declared.

  • Ethical approval Mexican National Institute of Public Health ethics and research committees.

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