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Rationale for the Design and Implementation of Focus on Youth-Grade 6 Bahamas Curriculum (FOY-G6C)

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The Bahamas continues to have challenges with HIV and AIDS despite the success of the National HIV/AIDS Programme.  An estimated 1.6% of the general population was reportedly infected in 2018, a significant decrease from the more than 3% prevalence when FOYC was introduced in the late 1990s. Heterosexual activity is the predominant mode of HIV transmission.  (HIV Surveillance Fact Sheet 2018 & Health Information and Research Unit, Ministry of Health).

In addition to the high rates of HIV infection, high rates of teen pregnancy also provide evidence that a high proportion of youth were engaging in unprotected sex. More than 600 live births occurred to females aged 10-19 each year over the period 1999 to 2008 and an average of 500 during 2009 to 2014. Additionally, teen pregnancy can have significant psycho-social implications in homes where adolescents are parents. Based on the high HIV rates in The Bahamas and risky sexual behaviour among adolescents, the Bahamian Ministry of Health sought to identify an HIV risk prevention programme and conduct a longitudinal randomized study.   

In the late 1990’s, the US researchers who developed Focus on Kids (FOK) with ImPACT collaborated with researchers in Ministry of Health and the Ministry of Education to culturally adapt FOK for use in The Bahamas. FOK is an effective adolescent HIV prevention program that is based on the Protection Motivation Theory or PMT. It is complemented by a parental monitoring program “Informed Parents and Children Together” (ImPACT). Both FOK and ImPACT had been demonstrated through randomized, controlled trials to reduce adolescent risk behavior. Additionally, “Focus on Kids” and “Informed Parents and Children Together” were selected as “Best Evidence Programs” and included in the CDC’s Diffusion of Behavioral Intervention (DEBI) portfolio.

During 2004 and 2009, the US-Bahamian team evaluated the resulting adaptation [a 10-session (plus two booster sessions) adolescent HIV prevention intervention renamed  “Focus on Youth in The Caribbean” (FOYC) and a 1-hour parental monitoring intervention renamed “Caribbean Informed Parents and Children Together” [(CImPACT)] through a randomized, controlled three-celled longitudinal trial (36 months follow-up) involving 15 primary schools in The Bahamas.  FOYC is a life-skills training curriculum emphasizing effective decision-making and effective communication skills.  Based on the effectiveness of the intervention through 36 months, the Ministry of Education incorporated FOYC+CImPACT into the primary school curriculum in grade 6 classes (with booster sessions in grades 7 and 8) throughout The Bahamas. The Ministry of Education continued its collaboration with researchers from the MOH and US to assess the fidelity of intervention implementation at a national level, to explore factors which increase or decrease fidelity, and to assess the relationship of fidelity of implementation with student outcomes.