Delaying Sexual Debut among Uganda's Youth: Evidence and Implications: Delaying Sexual Debut among Uganda's Youth: Evidence and Implications Allison Herling
M.S. in Public Health
Oregon State University
Presented at CCIH, May 2004 My study: objective: My study: objective to conduct a qualitative investigation of Ugandan youth’s attitudes and values towards relationships and sex,
and the ways in which youth’s social environment sends messages and creates perceived norms which shape sexual behavior, especially the behavior of abstinence
The decline of AIDS in Uganda: The decline of AIDS in Uganda Uganda has seen the greatest decline in HIV incidence and prevalence of any country in Africa
HIV prevalence declined from 15% in 1991 to 5% in 2001 (UNAIDS)
Decline in HIV prevalence has been greatest among youth aged 15-24 years
from 20.9% in 1991 to 5.2% in 1998 for youth aged 15-19 years
from 24.9% in 1991 to 10.2% in 1998 for youth aged 20-24 years
AIDS prevention among youth in Uganda: AIDS prevention among youth in Uganda The government has made youth a priority in AIDS prevention
Schools are required to teach AIDS prevention
Having sex with a minor (andlt;18) is a criminal offense (defilement)
NGOs like Straight Talk have targeted youth
The main message for youth has been to abstain/delay sex Behavioral change among youth in Uganda: Behavioral change among youth in Uganda Abstinence and delayed sexual debut have been the behaviors most frequently reported by youth
Median age at first sex (sexual debut) has increased
Median number of years between first sex and first marriage has decreased
Condom use has increased Median age at first sex among Ugandan women and men aged 15-24 years: Median age at first sex among Ugandan women and men aged 15-24 years Median age at first sex among Ugandan women aged 20-49 years by background characteristics: Median age at first sex among Ugandan women aged 20-49 years by background characteristics Median age at first sex among Ugandan men aged 20-54 years by background characteristics: Median age at first sex among Ugandan men aged 20-54 years by background characteristics Median age at first sex and marriage among Ugandan women aged 20-24 years and Ugandan men aged 25-29 years: Median age at first sex and marriage among Ugandan women aged 20-24 years and Ugandan men aged 25-29 years Premarital sex and condom use at last premarital sex among Ugandan women and men aged 15-24 years (2000/01 DHS): Premarital sex and condom use at last premarital sex among Ugandan women and men aged 15-24 years (2000/01 DHS) My study: questions: My study: questions Why are Ugandan youth choosing to be abstinent or delay sex?
What values and attitudes do youth hold regarding relationships and sex?
What messages are youth receiving from their social environment about relationships and sex?
What peer and social norms exist and how do these affect youth?
I was not studying behavior! Methodology: Methodology 12 single-gender focus group discussions with 88 youth between the ages of 13 and 16 years
girls and boys
in-school and out-of-school youth
Research was conducted in Soroti Town and Masaka District
Research was conducted September-November 2003 Focus group discussion questions: Focus group discussion questions Why do boys and girls have relationships? What good and bad things can there be in relationships?
What is a good age for girls and boys to start having relationships?
What messages have you received about sex and relationships from friends, parents and other family members, churches and mosques, teachers, the media, government, etc.
What did you think of what they told you?
What do you think is the best thing for young people to do about sex and relationships? Results: themes: Results: themes There is a clear social norm of youth abstaining from sex until the age of 18 years
This norm is not followed by all youth
Early sex is seen as being very risky
Education and the hope of a ‘bright future’ are the biggest motivating factors for youth to not have sex
The decision of when to have sex is affected by social and family factors
Abstinence is a strategy to avoid risk and achieve goals
Age of first sex: Age of first sex Girls and boys strongly and virtually unanimously believed that the right age to start having sex was 18 years
or when you were married
or when you had completed school
early sex is dangerous
they were not ‘mature’ enough, physically or emotionally
law of Uganda (defilement law) Reasons for having sex: Reasons for having sex Some youth chose to have sex because they ‘needed’ it, because they liked it, or because they were in love
Girls felt that they could be pressured or forced by boys to have sex, and this made some wary of friendships with boys
Boys felt that they could be forced to have sex by their 'need,' and that girls were partly responsible for wearing short skirts or revealing clothes
Boys and girls felt that friendships with members of the opposite sex often led to sex Transactional sexual relationships(‘sugar daddy’ relationships): Transactional sexual relationships (‘sugar daddy’ relationships) Girls and boys discussed these relationships in terms of ‘need’ for both parties
girls (especially orphans) needed school fees, clothes, ‘panties’, or money
boys/men needed to fulfill their sexual desires
Sometimes parents encouraged these relationships
Girl: Girls want to play sex to get money. When the boy tells her, 'After I will give you money for shoes.' And the parents accepted things, and she plays [has sex].
Sexual relationships: risks: Sexual relationships: risks Girls and boys talked of risks to sexual relationships more than they talked of benefits
Risks and dangers:
early pregnancy (and health risks) and early marriage
dropping out of school
HIV/AIDS and other sexually transmitted diseases
shame and family strife
being thrown into jail (boys)
Pregnancy was seen as a bigger threat than HIV/AIDS Pregnancy and its consequences: Pregnancy and its consequences Girl: You are two girls in the family… when you are in S4 and another one who is in S1, when you get pregnant, you can cause that one who is in S1 to stop studying, because then [your parents] are annoyed, saying, 'Even this one will also become pregnant.'
Girl: You can get pregnant and the boy cannot get money that he can feed you and at the same time you cannot feed yourself, the baby is there, you don’t have enough shelter, the boy can run away, at the same time you can suffer. You can imagine that you had stayed at your home but you can’t go there again. Education and ‘bright futures’: Education and ‘bright futures’ Sex was thought to be a threat to education
Pregnancy could disrupt or end education for boys and girls
Sex was thought to be distracting
Girl: Because if you are into sex, you cannot really perform well in class. Because if you serve two masters at a go you will not manage.
Education was thought to be the key to a ‘bright future’, so early sex was also a threat to these ‘bright futures’
Youth and their social environment: Youth and their social environment Youth are receiving a strong, consistent message from their social environment to abstain from sex, stay in school, and avoid bad consequences
Boy: There is no any people in Uganda… who is full grown, encouraging [youth] to play sex.
Youth reported that their parents and family members talked to them about sex
Boy: I always have my father, brothers, and sisters. So they always advise me that, 'Well, sex is not bad, but you first concentrate on your studies.'... They always advise me that if you hurry in sex, there are very many problems. They always say that, 'Okay, you see our father’s properties. Those are not yours. You also first concentrate on your studies, and you first of all get your properties.'
The social environment (con’t): The social environment (con’t) Teachers could warn youth about specific situations that they observed, such as ‘bad peer groups’
Religious leaders emphasized abstaining until marriage
Boy: On the side of the churches, they also advise students… early to marriage and sex is a crime to God. So you better complete your education. If you want to marry, let her go and get saved, and you marry in church.
Youth received advice to abstain or use condoms from the radio, school education, media such as Straight Talk, and the government Youth and religious faith: Youth and religious faith Some youth expressed that their religious faith motivated them to abstain from sex
Youth referred to the Bible as a guide
Boy: For me I follow the Bible and I can’t, I can’t play sex.
Youth expressed that faith also gave them the patience and courage to abstain and resist the temptations of ‘the world’
Boy: But for me I say that if you pray every day and call the Holy Spirit to help you, I think that He will be able to help you and you will not be able to do the things [sex]. Youth and peer pressure: Youth and peer pressure Youth encountered positive and negative peer pressure
Youth spoke of wanting to be associated with friends with ‘good manners’
Youth were wary of ‘bad peer groups’ who could be ‘dangerous to their lives’
Girls could pressure girls to get sugar daddies
Boys could pressure boys to prove their manhood by having sex Out-of-school youth: Out-of-school youth Most out-of-school youth expressed the same values and attitudes as in-school youth
There was one major exception: one group of out-of-school girls
these girls freely admitted that they were having sex,
and that they liked it
they said the ‘right’ age to start sex was as early as
13 or 14 years
they perceived AIDS and other STDs as threats, but considered getting pregnant a good thing
their sexual relationships were not transactional
they said that they were getting advice (from parents, churches, etc.) to not have sex, but were ignoring this advice Advice to other youth: Advice to other youth Girl: That’s why I advise my fellow students to 'Let’s say no to sex. It is dangerous for our lives.'
Girl: I appeal to my fellow students that avoid sugar daddies because they will deceive us with the money they give us but we shall end up getting HIV…
Boy: The advice [that I give to] my fellow students is that playing sex you will gain nothing. Because as you are playing sex, there are very many problems which I cannot risk.
Boy: For me I think it’s not good because when you play sex at this time, I think that you cannot achieve your goals. Advice to other youth (cont.): Advice to other youth (cont.) Girl: The best thing that I can tell my friends or my sisters is that abstain from sex. Abstain from sex is one of the best things in the world.
Girl: Let’s trust in the Lord, because God knows you better. He knows even the right time to give you a husband. Don’t rush before your time. And don’t die before your time.
Girl: It needs our minds, our hearts, it needs our hearts to be courageous… When we are told a certain piece of advice, it needs us to get that word and put it in mind that if I do bad what will it be, and what situation will I be ending with? Conclusions and implications: Conclusions and implications For many youth the decision to abstain is a pragmatic one, made by weighing risks and benefits of sexual involvement
Keeping youth (especially girls) in school and giving them the hope of a ‘bright future’ is critical to encouraging them to abstain
Girls need support in resisting coerced sex and sugar daddies
Boys need support in resisting sexual desires