Sexual and reproductive health interventions to build resilience in youth

Summary

Despite the declining HIV/AIDS prevalence globally, nearly half of all new HIV infections still occur among the youth, especially in sub-Saharan Africa. This blog explores what protects youth from engaging in risky sexual behaviours.

We humans find it easy to get stuck on the negative: what is wrong and what’s lacking. This may be a reason why, when exploring the risky sexual behaviours of youth, many studies seek to identify the reasons that youth engage in these behaviours. For example, many studies have investigated the association between family poverty and the failure to use condoms. Yet, some youth who come from poor families do use condoms for their own reasons or due to protective influences in their environment.  An understanding of what puts youth at risk only provides a partial picture of the sexual and reproductive health of this population.

In my doctoral dissertation, I focused on what protects youth from engaging in risky behaviours, which has rarely been studied. Specifically, I looked at how risk factors interact with protective factors in the lives of youth to influence their sexual behaviours. This research framework was designed to contribute to the gap in resilience research among Nigerian youth by revealing the characteristics of youth who show resilience and manage sexual risk effectively.

Four states in Nigeria were selected as representative of the major ethnic groups and a range of socio-economic status in the country. Over eighty youth (male and female aged 15-24 years) participated in focus group discussions and in-depth interviews divided by gender, place of residence (rural, urban, and semi-urban) and educational attainment.

Subjects were unanimous on the importance of condoms for the prevention of unplanned pregnancies and sexually transmitted infections (STIs), including HIV and AIDS. Most of the males and females knew about condoms and were confident about their use. They also had high aspirations regardless of their place of residence or educational achievement at the time of the interview and wanted to avoid unwanted pregnancies, mostly because of the stigma associated with them. Several of the young women said they avoided going home with their boyfriends after drinking as they knew they may be too drunk to negotiate the use of condoms. Others believed that discussing the use of condoms before starting a relationship ensured that the relationship would be based on an ability to discuss sensitive issues reasonably. Compared to youth in school, young women who were learning a trade sometimes found it difficult to negotiate condom use, but those that did, stated that they didn’t want to end up with an unwanted pregnancy that would hinder their ambitions like some of the women in their communities.

When discussing abstinence, majority of youth defined sex narrowly, as “vaginal penetration”. Although, several participants engaged in other sexual activities apart from penetrative sex, including kissing, holding hands, masturbation and oral sex, to avoid pregnancies and STIs.

Some of the participants stated that they reached agreements with their partners to wait until marriage to engage in sex before starting relationships. They reported that they avoided being alone in the same room which could lead them to sex. They spent their free time watching movies and hanging out in public places such as cinemas.

A sizeable number of male subjects were engaging in protective sexual behaviours, but their reasons differed. Fear of early fatherhood was a key factor influencing their sexual risk negotiation. A key finding was that messages given to youth about the prevention of sexually transmitted diseases (including HIV/AIDS) and pregnancy has resulted in some confusion. For instance, some youth were told that sex is scary, and some believed that having sex always resulted in pregnancy. This reflects the tendency to use fear-based tactics to educate Nigerian youth about sexual health, which can result in negative outcomes. While some of the participants felt that they were better negotiators of condom use as a result of talking to their parents about sex, several reported that their family environment was not conducive to have conversations on sex.

These findings suggest that fear-based public health campaigns are misguided and unethical and may prevent youth from discussing sexual health issues with their parents, who may be in the best position to guide them. For instance, knowledge about condom use for safer sex practices may be unavailable to youth if program planners concentrate on fear-based messages that result in youth not wanting to talk about sex with their parents.

Youth sexual and reproductive health media messages should also be “cool” enough to effectively convey protective behaviours such as condom use and abstinence to this audience.

Program planners must be trained to promote effective communication and dialogue about sexual and reproductive health to youth. The sexual behaviour of youth needs to be addressed through a multi-faceted approach, and consider different cohorts across different neighbourhoods, tailoring messages that take into account age and other factors of the intended audience. Program planners must also consider parents when designing interventions to encourage open communication and “uncomfortable conversations” about sexual behaviour.

About Somefun Oluwaseyi Dolapo

Somefun Oluwaseyi Dolapo is a Nigerian Population Scientist and a CARTA Fellow. She holds a PhD from the University of the Witwatersrand in South Africa and is currently a postdoctoral fellow at the University of Western Cape.  CARTA (Consortium for Advanced Research Training in Africa) is one of the 11 Developing Excellence, Leadership, and Training in Science in Africa (DELTAS Africa) programmes. DELTAS Africa funds collaborative consortia led by Africa-based scientists to amplify Africa-led development of world-class research and scientific leaders on the continent, while strengthening African institutions. DELTAS Africa is implemented through the AESA Platform. AESA (Alliance for Accelerating Excellence in Science in Africa) is a funding, agenda-setting, programme management initiative of the African Academy of Sciences (AAS), the African Union Development Agency (AUDA-NEPAD), founding and funding global partners, and through a resolution of the summit of African Union Heads of Governments. DELTAS Africa is supported by Wellcome and the United Kingdom Foreign, Commonwealth and Development Office (FCDO formerly DFID).