Working to Advance
Health Equity in Africa

Youth Health and Prevention Project (Y-HAPP)

Youth Health and Prevention Project (Y-HAPP)


The findings of the Life Orientation (LO) research project conducted by HEARD that concluded in 2012 indicate that the delivery of the LO curriculum is, in learners’ view, having some positive impact in their lives. Learners’ narratives indicate that positive benefits of LO could include building self-esteem and self-awareness, creating unity and connectedness between learners, increasing knowledge and improving attitudes about HIV/AIDS and sex and, in some cases, even giving rise to safer sexual practices, delayed sexual debut and cessation of substance use. However, we find the potential positive benefits of the LO curriculum are constrained by, amongst other things, a lack of parental involvement in school and LO, poor or inadequate parent-child communication about HIV/AIDS and sex and sexuality, availability of drugs and alcohol in communities and the realities of living in impoverished circumstances. Furthermore, the microsystem of the school through educator-learner interactions and support, school connectedness and belonging and educational ambitions and expectations seem to provide protective effects for learner wellbeing.

The findings of the LO project draw attention to a primary shortcoming of the programme- it remains a single, knowledge-based intervention implemented in one area of learners’ lives. In recent years combination prevention approaches to HIV prevention have risen to the fore with promising results. These approaches advocate for intervening within multiple levels of influence, from behaviours and psychosocial correlates of risk behaviours to structural and community level factors.
School-based interventions provide a key avenue for intervention within combination prevention approaches. There is a definitive body of knowledge showing the effectiveness of school-based interventions for HIV prevention, as well as emerging evidence from multi-component interventions showing that combining school-based interventions with interventions into other areas surrounding adolescents (such as the community) can produce even greater programme gains for HIV prevention among youth.


This research study proposes to use the four components of Bronfenbrenners’ bioecoloical model – Process, Person, Context and Time (PPCT) – alongside a resiliency framework to study the influence of risk and protective processes from multiple microsystems as well as the influence of mesosystems (family-school, family – peer, peer-school) on adolescent sexual and substance use. The associations between these risk and protective factors, as well as community factors and mesosystems, on adolescents’ resilience will also be assessed, but this will constitute a secondary aim of the study. The primary aim of inserting resilience into the study is to assess whether the underlying factor structure of the resilience measure found by other researchers in a large scale resilience study is consistent with the way resilience is conceptualised by South African adolescent youth. The study aims to provide a much more complex and nuanced understanding of how risk, vulnerability and resilience factors – their interactions and effects – coalesce in adolescents’ lives.

Methodological approach:

This study takes the form of a quantitative, repeated measures study to be conducted in two different geographical areas. A repeated measures design enables us to examine the changes occurring in sexual behaviour and problem behaviours in relation to different risk and protective factors as adolescents move through adolescence. The design also enables us to investigate the transactional (reciprocal) effects between micro- and mesosystems and adolescent sexual and risk behaviours over time. For instance, in taking a baseline measure of peer and family relationships at Time 1 we are able to see how peer and family relationship change between adolescents who are highly and less involved in sexual behaviours and substance use between Time 1 and Time 2. Similarly, we are also able to determine how changes in various microsystems between Time 1 and Time 2 influence adolescents’ sexual behaviours and substance use at Time 2.