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Health Equity in Africa

Breaking the silence: accommodating young people with disabilities in sexuality education through sensitising educators in Southern Africa

Breaking the silence: accommodating young people with disabilities in sexuality education through sensitising educators in Southern Africa


Young people with disabilities, particularly girls, are at an increased risk of sexual violence and exposure to HIV. Despite this fact, very few interventions in Africa target this vulnerable group and none of them are based on evidence. Scholars argue that lack of sexuality education, access to Sexual and Reproductive health and Rights (SRHR) and cultural norms are associated with the increased risk.  This Breaking the Silence study aims to identify challenges and gaps in the current delivery of sexuality education to learners with disabilities in South Africa’s Life Orientation lessons in KwaZulu-Natal, South Africa. The study includes three phases, a) needs assessment b) development of intervention and training toolkit and c) formative evaluation with pilot schools. The needs assessment in phase one informs the development of a training approach, manual and toolkit custom made for South African educators who provide sexuality education to learners with disabilities. This approach is piloted in phase three and is currently being formally evaluated.


The study seeks to identify the needs of teachers in order to provide appropriate sexuality education to learners with disabilities and develop and evaluate an intervention and tools to address the potential gap in skills and practice. In order to achieve this goal the study aims at the following:

  • Develop and pilot a tool/questionnaire to access the knowledge, attitudes, practise and needs of educators in regards to providing sexuality and HIV education to children with disabilities
  • Validate the tool/questionnaire in a first phase of content and face validation
  • Capture the current experiences of educators with sexuality education for people with disabilities
  • Develop a training approach, manual and teaching tools for the classroom based on the needs assessment
  • Pilot and formally evaluate the intervention.

Methodological approach

Phases one and two each involve 100 educators and support staff purposely selected from special schools in KwaZulu-Natal (rural-urban divide and disability type considered in sampling). The needs assessment and formative evaluation use qualitative and quantitative methods of enquiry. The study is guided by an adapted version of the theory of planed behaviour. As a first in Africa this study also has to develop and validate research tools. For this, validation techniques as used by O’Brien are adopted.

Quantitative measures
In order to assess the knowledge, attitudes and practise of teachers, the TSE-questionnaire is developed and validated and is used for a cross-sectional survey. This tool collects demographic data and uses self-development or scales from already validated instruments and adapts these to the South African cultural context.
The TSE-Q is validated using face and content validity and ease of use measures. The tool is piloted with 40 teachers of special schools in KZN (convenient sample), who then fill in a validation questionnaire directly thereafter. The results are discussed and validated in a consultative meeting with the educators.

Qualitative measures
The experience of educators is captured using focus group discussions to inform the needs assessment and individual in-depth interviews to inform the formative evaluation. The experiences of learners with disabilities who were exposed to the pilot interventions are captured using FGD.