Experimental Design
We study two programs implemented through a partnership between the non-governmental organization ICS Africa, the Kenyan Ministry of Education, the Kenya Institute of Education, and the Kenya National AIDS Control Council. The first program reduced the cost of education by providing free school uniforms. The second program trained teachers on how to deliver the national HIV/AIDS prevention curriculum to upper primary school students. We also evaluate a small add-on component to the government-run teacher training designed to foster the discussion of condoms, in order to check whether an explicit discussion of condoms in a curriculum otherwise focused on abstinence and fidelity could affect behavior.
The study took place in all 328 public primary schools in 7 divisions of 2 districts of Western Kenya: Butere-Mumias and Bungoma. None of these schools had participated in any prior randomized evaluation that we know of. All schools agreed to participate. Schools were stratified and assigned to one of four arms using a random number generator: (i) Control (82 schools); (ii) Stand-alone education subsidy program (83 schools); (iii) Stand-alone HIV education program (83 schools); (iv) Joint program (80 schools). Between February and July 2003, ICS distributed free school uniforms to boys and girls enrolled in sixth grade at the onset of the school year (January). In fall 2004, ICS distributed a second uniform to the same students, if they were still enrolled in the same school (regardless of their grade). It was announced at the onset of the program that students still enrolled in the same school would be eligible for a second uniform after 18 months. The total education subsidy, delivered over two years, amounted to just around $12 per student, or 2.5 percent of average annual household income in the study area at the time.
In 2002 the Kenya government started a large-scale effort to train teachers on HIV education, based in part on data suggesting that in the absence of training, many teachers were uncomfortable teaching the official HIV/AIDS curriculum. In 2003, ICS Africa helped implement the national training program for 184 primary schools by providing logistical and financial support. The 184 schools selected for the HIV Education program were asked to send three upper primary teachers to participate in a five-day training program. The training sessions were conducted jointly by one facilitator from the AIDS Control Unit of the Ministry of Education (MoE), two facilitators from the Kenya Institute of Education (KIE), and one trained staff member from ICS Africa. Teacher training included basic facts on HIV/AIDS, a condom demonstration, information on voluntary counseling and testing, and HIV/AIDS education methodology. Because training was primarily done by MoE and KIE staff and was based on the officially approved curriculum, the content should be similar to that delivered in other parts of Kenya. At the same time, since the sessions were facilitated and observed by ICS Africa and members of the research team, we do know they were well run and teacher attendance was good.
In addition to receiving training on how to deliver HIV information in the classroom, teachers were advised to set up health clubs to deliver HIV information outside of the classroom. Since the curriculum leaves almost no space for teachers to provide information about condoms, we were interested in testing whether exploiting the existing window to the maximum extent possible would affect the impact of teacher training on student knowledge and behavior. This is important for policy, since only an intervention taking place within the existing curriculum could be potentially scaled up (if effective) without major rethinking. From the perspective of understanding adolescent behavior, it was also important to try to generate exogenous variation in awareness of condoms (a potential way to protect oneself against both STI and pregnancy) without affecting access to condoms. Thus, during the school year 2005, two years after the implementation of the education subsidy and HIV education teacher training, a random subset of schools that had participated in the teacher training were sampled for an additional intervention called “critical thinking” (CT). This add-on was targeted at students in seventh and eighth grades in 2005 (many of whom, given the high repetition rate, were in sixth grade in 2003, i.e., in our study cohort). Schools sampled for CT were encouraged to organize a debate on the motion, “School children should be taught how to use condoms,” a motion suggested in the official Facilitators’ Handbook (KIE 1999, p. 66). The debate was followed by an essay competition on the theme: “Discuss ways in which you can protect yourself from HIV infection now and at later ages in your life.” Both debates and essay writing are established practices in Kenyan schools, and teachers agreed to organize these activities in 95 percent of sampled schools. At the time, none of these schools had previously organized a debate or essay competition on these specific topics, which suggests that these topics were most likely never discussed in non-CT schools, and thus the CT encouragement appears to have created the intended exogenous gap in students exposure.