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 to conduct a qualitative investigation of Ugandan youth’s attitudesand valuestowards 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 • 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 • The government has made youth a priority in AIDS prevention • Schools are required to teach AIDS prevention • Having sex with a minor (<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 • 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 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 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)
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 • 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 • 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 • 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 • 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 • Reasons included: • early sex is dangerous • they were not ‘mature’ enough, physically or emotionally • law of Uganda (defilement law)
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) • 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 • 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) • economic hardship • Pregnancy was seen as a bigger threat than HIV/AIDS
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’ • 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 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) • 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 • 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 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 • 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 • 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.) • 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 • 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