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Scaling up an evidence-based HIV curriculum

Pascaline Dupas’ lesson plan for teaching Kenyan teenagers about HIV infection risks in cross-generational relationships has been scaled up in hundreds of schools.

When Pascaline Dupas was conducting field work in western Kenya in the early 2000s, she was surprised at how misinformed teenagers were about who was most at risk of having HIV.

While a man over 25 was six times more likely to have HIV than a 16-year old, it was common for teenagers to believe that rates of infection were lower in older men. They also believed that the wealthier the man, the lower the chance of his being infected. These two misconceptions played a key role in the prevalence of teenage girls dating “sugar daddies” – men at least five to ten years older than them who they assumed were less likely to infect them with HIV and who could financially support them in case of a pregnancy.

Dupas, a Stanford economist and faculty affiliate at the Stanford Center on Global Poverty and Development, realized that the government’s abstinence-based HIV curriculum “didn't touch on the real issues behind the HIV crisis, so I wanted to try something that seemed more grounded in reality,” she explained.

In 2003 she created a lesson plan meant to be presented to 15 year old's as part of the HIV education curriculum they received in school. The lesson plan was straightforward – a ten-minute video followed by a half-hour presentation and discussion about infection rate statistics by age and gender, outlining that older men were more likely to be infected with HIV than younger men. 

pascaline dupas
Pascaline Dupas

The lesson plan was tested in Kenya in over 300 schools against the abstinence-focused anti AIDS curriculum with stunning results. After one year, Dupas found that the girls who had heard the lesson had a 61% decrease in child bearing with a partner who was more than five years her senior. (The rate of pregnancy – an indicator of unprotected sex – was used as a stand in for HIV incidence).

Fifteen years later, Dupas’ “sugar daddy” curriculum has taken on a life of its own, and has been scaled up by several NGOs that have brought the curriculum to hundreds of schools in countries battling high rates of HIV infections, including Botswana, Nigeria, and Togo.

Four of the organizations were supported in their pilot stage by D-Prize, an organization that helps fund “social entrepreneurs who start new ventures that distribute proven life-enhancing technologies.”

Young 1ove, the first of these, was started because an MIT graduate remembered studying Dupas’ findings from Kenya in an undergraduate class, and wanted to apply the curriculum to schools in Botswana, which has the second highest HIV rate in the world. Young 1ove has brought the curriculum to over 30,000 teenagers in Botswana and hopes to reach one million across Southern Africa by 2020.

Jeunes Braves adapted the curriculum in Togo to focus more on preventing teen pregnancy by discouraging “sugar daddy” relationships, using videos based on true stories about teenage girls who became pregnant and were forced to drop out of school.

Power2Girls brought the video-discussion format lesson to schools across Ghana, teaching 10-16 year old's about “the risks associated with sugar-daddies.”

Safe Love International in Nigeria offers “Sugar Daddy Awareness Classes” and has scaled up the curriculum nationwide with the goal of reaching a million teenagers.

D-Prize is just one of the organization that gives seed grants to start awareness programs. The Pollination Project is another one, funding projects like the Female Education Initiative which brings the sugar daddy awareness courses to approximately 500 schools in Cameroon.

As in the United States, sex education in African countries can be fraught with controversy. Many of the communities where a sugar daddy awareness curriculum based on Dupas’ research has been implemented are religiously conservative. This is, for example, why the Kenyan HIV awareness classes that Dupas observed in 2003 only taught abstinence.

However, the success of the initial sugar daddy awareness curriculum made it clear that while it may be difficult to convince teenagers to abstain from sex, it is possible to educate them about lowering their risk of HIV-infection. NGOs can use evidence like Dupas’ to build support for their talking about tricky subjects and overcome resistance to potentially difficult-to-implement changes.

Please note that prior to May 2019, the Stanford King Center on Global Development was known as the Stanford Center on Global Poverty and Development.