Harnessing the senga institution of adolescent sex education for the control of HIV and STDs in rural Uganda

Senga (father's sister) is a traditional channel of communication about sexual behaviour for adolescent females in rural Uganda. We evaluated a modification of this approach as an intervention for HIV and STDs in a pilot study in two intervention villages and one control village over 12 months. Eleven adult women and three adolescent girls were chosen and trained to become sengas. Adolescent girls were encouraged to visit the sengas for sexual health information. Adult sengas saw an average of 21 clients; adolescent sengas saw five. Adolescent girls made 45% of visits. The expected reasons for attending the sengas accounted for 51% of visits. Knowledge about HIV/AIDS, sexual communication skills, consistent condom use and family planning service use increased in the intervention group of girls over the study period and compared to control girls. Symptomatic STDs decreased in the intervention group. This intervention was readily accepted by the community; members of all ages and both sexes attended for a wider variety of reasons than anticipated. Adolescent girls in the intervention group showed improved knowledge, attitudes and practices related to HIV and STDs. This promising intervention warrants further testing in larger studies and other settings.