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RESEARCH ARTICLES

1. Age at first sex: understanding recent trends in African demographic surveys

2. Communities, opportunities, and adolescents' sexual behavior in KwaZulu-Natal, South Africa

3. Early marriage and HIV risks in sub-Saharan Africa

4. Exploring the socioeconomic dimension of adolescent reproductive health: a multicountry analysis

5. Genre et sexualité des jeunes à Bafoussam et Mbalmayo, Cameroun (Gender and sexuality of youths in Bafoussam and Mbalmayo, Cameroon)

6. The health of young people in a global context

7. The impact of cultural context on Brazilian adolescents' sexual practices

8. Needs and preferences regarding sex education among Chinese college students: a preliminary study

9. Premarital sex, procreation, and HIV risk in Nigeria

10. Reducing risk, increasing protective factors: findings from the Caribbean Youth Health Survey

11. Risk factors for childbearing during adolescence in a population-based birth cohort in southern Brazil

12. Sexual risk attitudes and behaviors among young adult Indonesians

13. Understanding perceptions of HIV risk among adolescents in KwaZulu-Natal

14. Young, unmarried men and sex: do friends and partners shape risk behaviour?

15. Youth, sin and sex in Nigeria: Christianity and HIV/AIDS-related beliefs and behavior among rural-urban migrants

 

 

16. 'Bus fare, please': the economics of sex and gifts among young people in urban South Africa

17. Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda

18. The experience of sexual coercion among young people in Kenya

19. Exploring the association between HIV and violence: young people's experiences with infidelity, violence and forced sex in Dar es Salaam, Tanzania

20. National cross sectional study of views on sexual violence and risk of HIV infection and AIDS among South African school pupils

21. Young people's relationships with sugar daddies and sugar mummies: what do we know and what do we need to know?

 

 

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1. Age at first sex: understanding recent trends in African demographic surveys. Zaba B, Pisani E, Slaymaker E, et al. Sex Transm Infect 2004;80 Suppl 2:ii28-35.
To describe recent trends in age at first sex in African countries, Demographic and Health Surveys (DHS) data from six African countries conducting three or more surveys since 1985 were analyzed using survival analysis techniques, combining information on virginity status and retrospective reporting of age at first sex. Hazard analysis was used to separate the effects of reporting error and compositional change and to estimate true changes in sexual debut over time. A multi-state life table analysis incorporating transition to first marriage allowed cohorts to be classified according to person years spent as virgins, as sexually active unmarried, and married. Inter-survey comparisons generally suggested a slow rise in age at first sex. However, tracing birth cohorts between surveys revealed inconsistencies – median ages reported by female members of a birth cohort in their teens were generally higher than those reported when they reached their twenties, even when allowing for residence and education changes – probably a result of young, sexually active women denying they had ever had sex. Male birth cohorts tend to display the opposite kind of bias. Uganda, Kenya, and Ghana have experienced a more pronounced and unambiguous decline in premarital sexual activity than Tanzania, Zambia, and Zimbabwe, with statistically significant increases in age at first sex. In addition, Uganda has maintained a very short interval between onset of sexual activity and marriage for both sexes.

 

2. Communities, opportunities, and adolescents' sexual behavior in KwaZulu-Natal, South Africa. Kaufman CE, Clark S, Manzini N, et al.  Stud Fam Plann 2004;35(4):261-74.
This study uses data collected from a representative sample of young people living in KwaZulu-Natal, South Africa to understand if the context of adolescents' lives – such as opportunities for schooling, work, and other community activities – make a difference in their sexual behaviors. Logit analyses show that for girls, higher levels of education reduced the probability of having had sex in the 12 months prior to the survey, and average wages were positively associated with condom use. Greater participation in community sports increased risk-taking behaviors among boys but decreased them among girls. Within the household, education of adults had a positive effect on condom use for both boys and girls.

 

3. Early marriage and HIV risks in sub-Saharan Africa. Clark S. Stud Fam Plann 2004;35(3):149-60.
This article examines the effects of girls' early marriage on their risk of acquiring HIV/AIDS. By comparing several underlying HIV risk factors, it explores the finding that married adolescent girls in urban centers in Kenya and Zambia have higher rates of HIV infection than do sexually active unmarried girls. In both countries, we find that early marriage increases coital frequency, decreases condom use, and virtually eliminates girls' ability to abstain from sex. Moreover, husbands of married girls are about three times more likely to be HIV-positive than are boyfriends of single girls. Although married girls are less likely than single girls to have multiple partners, this protective behavior may be outweighed by their greater exposure via unprotected sex with partners who have higher rates of infection.

 

4. Exploring the socioeconomic dimension of adolescent reproductive health: a multicountry analysis. Rani M, Lule E. Int Fam Plan Perspect 2004;30(3):110-7.
Nationally representative Demographic and Health Survey data for 12 developing countries were used to assess socioeconomic differentials in reproductive health outcomes and service utilization among young women. For each country, chi-square tests were performed to identify statistically significant differences between the poorest and the richest quintiles, which were constructed using a household wealth index. In most countries, young women from the poorest households were more likely than those from the richest households to be married by age 18 and to have had at least one child by that age; they were less likely to report a mistimed birth, to be practicing contraception, to use maternal health services, and to know how to prevent sexual transmission of HIV. Economic autonomy, school enrollment, and regular exposure to mass media were less common among poor than among rich adolescents. Poor adolescents may be overlooked by current service delivery modes that rely solely on mass media, clinics, or schools. Alternative strategies, such as community-based outreach programs, must be implemented to serve the needs of poor young women.

 

5. Genre et sexualité des jeunes à Bafoussam et Mbalmayo, Cameroun (Gender and sexuality of youths in Bafoussam and Mbalmayo, Cameroon). Jean-Robert RM. Afr J Reprod Health 2004;8(2):145-63.
This paper outlines through a gender perspective the social factors that predispose youths to risky sexual practices using data from a survey of culture, gender, sexual behavior, and STD/AIDS carried out in Cameroon, at Bafoussam (Bamileke area) and Mbalmayo (Beti area). Analysis revealed that the ideologies of masculinity and femininity prevail in the populations studied, but in the Bamileke group, where the gender system is unfavorable to women, young people adhere less to these ideologies than their parents. Our data also revealed that the level of the knowledge of the modes of transmission of STD/AIDS and the degree of acceptability of condoms in this group are higher among boys than girls. The young Beti were more inclined to take risks in sexual activities than the Bamileke. It was equally found that boys were more inclined than girls to be unfaithful to their regular partners, while the boys were more inclined to use condoms than girls. Finally, our data revealed that age and other characteristics of the regular sexual partners of young people influence, among others, the probability of being engaged in risky sex, especially among girls. Health education and information programmes can be improved amongst these youth populations by taking into account the totality of these elements.

 

6. The health of young people in a global context. Blum RW, Nelson-Mmari K. J Adolesc Health 2004;35(5):402-18.
To examine the chief causes and influences of morbidity and mortality among young people throughout the world, a comprehensive literature search was conducted that included WHO's Global Burden of Disease, UNFPA's State of the World's Population, Medline, Popline, Sociological Abstracts, as well as data collected from UNICEF, UNAIDS, Population Reference Bureau, and the United Nations Headquarters. Experts in the fields of substance abuse, suicide, and infectious diseases were also contacted for unpublished and published sources. Studies were restricted to those completed after 1985, had a sample size of at least 100, focused primarily on the age group of 10 to 24 years, and examined trends related to unintentional injuries, HIV/AIDS, suicide, homicide, war, maternal mortality, pregnancy, abortion, sexually transmitted infections, substance abuse, and infectious diseases. Trends in adolescent morbidity and mortality have shifted over the past decade from predominantly infectious to social etiologies. Currently, unintentional injury is the leading killer of young people in nearly every region of the world, with homicide, war, and interpersonal violence following closely behind. The changes in population, migration, age of marriage, and education have had a profound impact on the mortality and morbidity among adolescents.

 

7. The impact of cultural context on Brazilian adolescents' sexual practices. Levinson RA, Sadigursky C, Erchak GM. Adolescence 2004;39(154):203-27.
This paper reports the findings from our research in Salvador, Brazil, using Levinson's Condom Self-Efficacy Scale (CDSE). The data are derived from six focus groups totaling 76 teenagers from three high schools. The focus group discussions explored cultural and psychological issues involved in condom use. Here we report on the gender dynamics of condom use as revealed by these urban Brazilian teenagers. Three focal points for behavioral change are identified: (1) issues of masculinity, (2) issues of femininity, and (3) condom use skills.

 

8. Needs and preferences regarding sex education among Chinese college students: a preliminary study. Li Y, Cottrell RR, Wagner DI, et al. Int Fam Plan Perspect 2004;30(3):128-33.
In 2002, students at a large Chinese university completed surveys about their history of school-based sex education and their other sources of information on sexuality. The survey also explored students' preferences for topics to be included in a college-level sex education course, comfort level with receiving information on these topics, and views of effective teaching strategies. Before college, 47% of respondents had received no school-based education on sexual behavior; however, all respondents had taken a class covering reproduction, typically beginning in middle school (78%). Reading material, radio, classroom lecture, and parents were more popular sources of information among females than among males; friends, the Internet, and personal sexual experience were more frequent sources for males than for females. Higher proportions of males than females favored including sex therapy and masturbation in a hypothetical course. In addition, males felt more comfortable than females discussing 11 of 20 subjects; the two genders indicated similar levels of comfort in talking about the other topics. Males and females differed on how best to convey information on sexuality, with females generally favoring private methods, such as reading. More comprehensive school-based sex education is needed for Chinese youth. When developing and implementing such programs, health educators should consider differences between males' and females' preferred ways for receiving information on sexuality.

 

9. Premarital sex, procreation, and HIV risk in Nigeria. Smith DJ. Stud Fam Plann 2004;35(4):223-35.
In Nigeria, research has documented a significant disparity between people's knowledge of HIV/AIDS and the extent to which they act to protect themselves. Data from a survey of 863 adolescent and unmarried young adults, in-depth interviews, and participant observation are combined in this study to explain some of this discrepancy. Young migrants appear to make sexual and contraceptive decisions in relation to gender norms and attitudes concerning procreation at least as much as in relation to fear of disease. Assessments of current and potential partners, choices about whether or not to have sex, and decisions about whether or not to use condoms are influenced by shared cultural values regarding the importance of parenthood. These cultural conceptions of parenthood are gender-specific and put men and women in different negotiating positions with regard to sex and contraception.

 

10. Reducing risk, increasing protective factors: findings from the Caribbean Youth Health Survey. Blum RW, Ireland M. J Adolesc Health 2004;35(6):493-500.
To identify the prevalence of health-compromising behaviors, and the risk and protective factors associated with them among youth in the Caribbean, and to predict the likelihood of these outcomes given the presence or absence of the risk and protective factors, analyses were done on the results of a 1997-98 survey of over 15,500 young people in nine Caribbean countries. The four health-compromising behaviors studied included violence involvement, sexual intercourse, tobacco use, and alcohol use. Logistic regression was used to identify the strongest risk and protective factors, and also to create models for predicting the outcomes given combinations of the risk and protective factors. Rage was the strongest risk factor for every health-compromising behavior for both genders, and across all age groups, and school connectedness was the strongest protective factor. For many of the outcomes studied, increased protective factors were associated with as much or more reduction of involvement in health-compromising behaviors than a decrease in risk factors. This research suggests the importance of strengthening the protective factors in the lives of vulnerable youth – not just reducing risk.

 

11. Risk factors for childbearing during adolescence in a population-based birth cohort in southern Brazil. Gigante DP, Victora CG, Goncalves H, et al. Rev Panam Salud Publica 2004;16(1):1-10.
The study used a case-control study to analyze risk factors associated with teenage childbearing among adolescents who were in a birth cohort study that began in 1982 in the city of Pelotas, Rio Grande do Sul, Brazil. Adolescent mothers in Pelotas who gave birth between January 1995 and March 2001 and who had been born in 1982 were identified and compared to adolescents from the same cohort who had not given birth before March 2001. Standardized interviews were used in 2001 to obtain information about socioeconomic, maternal reproductive, demographic, and lifestyle characteristics. This information was combined with data obtained in earlier phases of this 1982 birth cohort study. Unconditional logistic regression was used to analyze the risk factors associated with childbearing during adolescence. A total of 420 parous adolescents were identified and then compared with 408 who had not given birth by March 2001. Higher family income in 1982 and more parental schooling in 1982 were inversely related to childbearing. Cohort girls whose mothers were under age 20 when they gave birth in 1982 had a higher risk of becoming pregnant while still an adolescent. Cohort girls who, during childhood, lived with siblings from different fathers were twice as likely to become an adolescent mother. Compared to cohort adolescents who had not failed during the first four years of school, those girls who had done so had twice the risk of giving birth during adolescence. A positive association was found between younger age at first intercourse and childbearing in adolescence. The results indicate that the educational level of the adolescent mothers must be considered in planning policies that attempt to disrupt successive cycles of socioeconomic deprivation. Early interventions to improve sex education and to increase the motivation of young girls to achieve higher levels of education are needed. The interventions should aim for a reduction in the risk of long-term poverty and poorer educational achievements of teenage mothers and their children.

 

12. Sexual risk attitudes and behaviors among young adult Indonesians. Simon S, Paxton SJ. Cult Health Sex 2004;6(5):393-409.
This research explored the beliefs of 18- to 24-year-old Indonesians of Javanese and Chinese background regarding perceptions of sexual behavior and condom use. Participants were volunteers from ten Surabaya universities. Twenty-five same gender and ethnic background focus groups were conducted. Sex before marriage was believed to be becoming more usual and acceptable among young adults, although parental and religious disapproval were recognized. Boyfriends and girlfriends were considered to be the most usual sex partners. However, sex workers were believed to be moderately frequent partners for Chinese-Indonesian males. Safe sex was mainly associated with pregnancy prevention. The risk of contracting a sexually transmitted infection (STI) was regarded as low, and condoms were believed not to be used often for disease prevention. A number of ineffective strategies were believed to prevent or cure STIs, suggesting that STI prevention interventions in Indonesia still need to emphasize improving knowledge. Ambiguities in condom provision and circumstances for use are likely to make negotiating condom use difficult. Perceptions of the acceptability of use of sex workers amongst more affluent young males, and the negative attitudes towards condom use under these circumstances, suggest prevention interventions should particularly address this dangerous combination.

 

13. Understanding perceptions of HIV risk among adolescents in KwaZulu-Natal. Macintyre K, Rutenberg N, Brown L, et al. AIDS Behav 2004;8(3):237-50.
Risk perception has been theorized to be an important antecedent for adopting protective behavior. It is a key construct of research applying the Health Belief Model and other behavior change models. In relation to HIV, risk perception is an indicator of perceived susceptibility to infection, a measure for one's understanding of AIDS transmission as well as willingness to consider behavioral changes. This study identifies factors that influence the calculation of HIV-risk perception among a group of adolescents in South Africa. Data, collected in 1999 from 2,716 adolescents aged 14 to 22, are used to explore factors predicting risk perception. Logistic regression models suggest connectedness to parents and community for males and females, self-efficacy to use a condom among males, and living in a household with a chronically ill member for females are associated with HIV risk perception. We conclude that a greater understanding of the connection of adolescents to their communities and adults in their lives is needed, and ways in which programs can alter the environments in which adolescents form opinions, make choices, and act should be incorporated into program design.

 

14. Young, unmarried men and sex: do friends and partners shape risk behaviour? Marston C, Juarez F, Izazola JA. Cult Health Sex 2004;6(5):411-24.
This study focuses on interaction-orientated approaches, including young people's partners and the social context, rather than on the individual alone. It describes a study of 8,068 men in Mexico City using multivariate techniques to examine use of contraception for pregnancy prevention and for sexually transmitted infection prophylaxis among unmarried, heterosexually active men aged 15 to 24. Friends and sexual partners were found to play an important role in shaping risk behavior. To explain such behaviors adequately, we need to take account of more than the characteristics of individuals isolated from their social contexts.

 

15. Youth, sin and sex in Nigeria: Christianity and HIV/AIDS-related beliefs and behavior among rural-urban migrants. Smith DJ. Cult Health Sex 2004;6(5):425-37.
In Nigeria, popular understandings of HIV/AIDS and individual risk assessment and behavior unfold within an interpretive grid that draws on a religious moral framework. This paper reports on a two-year study of HIV/AIDS-related beliefs and behavior among adolescent and young adult rural-urban migrants in two Nigerian cities. The youth almost uniformly identify themselves as Christian; and they commonly situate their understandings and explain their behaviors in response to the HIV/AIDS epidemic in terms of religion, especially in relation to the increasingly popular and dominant religious discourses of evangelical and Pentecostal Christianity. Findings suggest that popular religious interpretations of HIV risk pose real dangers, leading many young migrants to imagine themselves as at little or no risk, and contributing to inconsistent protective practices. The study highlights the limitations of intervention strategies that ignore the extent to which religion, health, sexuality, and morality intersect in people's everyday lives.

 

16. 'Bus fare, please': the economics of sex and gifts among young people in urban South Africa. Kaufman CE, Stavrou SE. Cult Health Sex 2004;6(5):377-91.
In South Africa, young people's sexual relationships are often underpinned by an economic exchange: gifts or favors for sex. While studies have pointed out the negative consequences of the exchanges that are often characterized by large age differences or power imbalances, less attention has been given to gift giving in like-age relationships. Using focus group discussions collected in the Durban metropolitan area among young people aged 14 to 22, this paper examines the economic context of gift giving or receiving and its relationship to patterns of risky sexual behavior. Findings suggest that gift giving among like-age adolescents is common and important in shaping sexual relationships. Young people associate money or cash with prostitution, but do not consider gifts as such. Types of gifts and their meaning varied considerably by racial group and by gender.

 

17. Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda. Koenig MA, Zablotska I, Lutalo T, et al. Int Fam Plann Perspect 2004;30(4):156-63.
Although there is increasing recognition of the scope and significance of sexual coercion experienced by adolescent women in developing countries, evidence on its consequences for reproductive health remains limited. A sample of 575 sexually experienced 15- to 19-year-old women were interviewed in 2001-2002 as part of the ongoing Rakai surveillance project in rural Uganda. Chi-square tests and logistic regressions were used to investigate associations between coerced first intercourse and selected reproductive health behaviors and outcomes. Fourteen percent of young women reported that their first sexual intercourse had been coerced. After the effects of respondents' demographic characteristics were accounted for, young women who reported coerced first intercourse were significantly less likely than those who did not to be currently using modern contraceptives, to have used condoms at last intercourse, and to have used them consistently during the preceding six months; they were more likely to report their current or most recent pregnancy as unintended (among ever-pregnant women) and to report one or more genital tract symptoms. Coerced first intercourse is an important social and public health problem that has potentially serious repercussions for young women's reproductive health and well-being. Interventions to improve adolescent women's reproductive health should directly address the issue of sexual coercion.

 

18. The experience of sexual coercion among young people in Kenya. Erulkar AS. Int Fam Plann Perspect 2004;30(4):182-9.
A 2001 population-based survey of young people in Nyeri, Kenya included a special module on sexual coercion. Descriptive data and multivariate analysis were used to explore the prevalence and patterns of sexual coercion among married and unmarried males and females aged 10 to 24.  Among the sexually experienced respondents, 21% of females and 11% of males had experienced sex under coercive conditions. Most of the perpetrators were intimate partners, including boyfriends, girlfriends and husbands. In a multivariate logistic regression, females who had ever been married and those who did not live with a parent or spouse had a significantly elevated risk of sexual coercion (odds ratios, 2.6 and 3.1, respectively); sexual coercion was associated with having had multiple sexual partners and with having had a reproductive tract infection (2.2 and 2.5). Males who had been coerced into sex were significantly more likely than those who had not to have had a first partner who was older by at least five years (82.9). Reproductive health programs for young people need to address nonconsensual sex, including the special needs of males and of married females.

 

19. Exploring the association between HIV and violence: young people's experiences with infidelity, violence and forced sex in Dar es Salaam, Tanzania. Maman S, Lary H, Katebalila M, et al. Int Fam Plan Perspect 2004;30(4):200-6.
Locally trained interviewers conducted semi-structured interviews with 40 young men and 20 young women aged 16 to 24 who were recruited from public venues in Dar es Salaam, Tanzania.  The participants described complex interactions among violence, forced sex, and infidelity in their sexual relationships. Men who were violent toward female partners also frequently described forced sex and sexual infidelity in these partnerships. Men with multiple concurrent sexual partners reported becoming violent when their female partners questioned their fidelity, and reported forcing regular partners to have sex when these partners resisted their sexual advances. Youth who felt that violence and forced sex could not be justified under any circumstances were often those who had not yet initiated sexual relationships or who were in monogamous partnerships. The association between HIV and violence identified among young people in prior research may be partially explained by their experiences with infidelity and forced sex in their intimate partnerships. HIV prevention interventions that fail to take into account the infidelity, violence, and forced sex frequently involved in youth's sexual relationships will have a limited impact.

 

20. National cross sectional study of views on sexual violence and risk of HIV infection and AIDS among South African school pupils. Andersson N, Ho-Foster A, Matthis J, et al. BMJ 2004;329(7472):952-4.
To investigate the views of school pupils on sexual violence, the risk of HIV/AIDS, and their experiences of sexual violence, a national cross sectional study of 5,162 classes in 1,418 South African schools was conducted with 269,705 school pupils aged 10 to 19 years in grades 6 to 11. Misconceptions about sexual violence were common among both sexes, but more females held views that would put them at high risk of HIV infection. One third of the respondents thought they might be HIV-positive. This was associated with misconceptions about sexual violence and about the risk of HIV infection and AIDS. Around 11% of males and 4% of females claimed to have forced someone else to have sex; 66% of these males and 71% of these females had themselves been forced to have sex. A history of forced sex was a powerful determinant of views on sexual violence and risk of HIV infection. The views of South African youth on sexual violence and on the risk of HIV infection and AIDS were compatible with acceptance of sexual coercion and "adaptive" attitudes to survival in a violent society. Views differed little between the sexes.

 

21. Young people's relationships with sugar daddies and sugar mummies: what do we know and what do we need to know? Kuate-Defo B. Afr J Reprod Health 2004;8(2):13-37.
This paper critically synthesizes available research that examines young people's relationships with sugar daddies and mummies. It considers definitional, measurement, and analytical issues involved in assessing these relationships, their magnitude, patterns, determinants, and consequences. The review compares and contrasts the experiences of young people in a variety of settings in developing countries versus developed countries and identifies key associated factors perpetuating those relationships. The implications are discussed within the contexts of globalization and localization and recommendations for dealing with these experiences.