ABSTINENCE AMONG SA YOUTH Is there buy-in?
The goals of the five-year Abstinence and Be Faithful Among Youth (ABY) project were to bolster abstinence, faithfulness and the avoidance of unhealthy sexual behaviour among youths. KEITSHEPILE GEOFFREY SETSWE and KHANGELANI ZUMA conducted a quantitative baseline evaluation of the ABY project in five South African cities, with data collected from 1 620 respondents just before the ABY intervention started.
Many young women in sub-Saharan Africa are engaging in premarital sex before age 20. Among young men, sex before marriage is even more common. A significant minority of youths are even engaging in sex before the age of 15. Research also shows that almost half of new HIV cases occur among young people aged 15–24, making efforts to change sexual behaviour among youths a vital component in the fight against the HIV/AIDS pandemic.
In a South African population-based survey, 40% of male and 25% of female South African youths aged 15–24 reported having more than one concurrent sexual partner.
Adolescent sexual behaviour has been found to create social and psychological problems such as an early commitment to a serious relationship, anxiety, guilt and fear, sexually transmitted infections (STIs), abortions, and single parenthood, which often leads to poor developmental outcomes.
The ABY project
HIV/AIDS prevention through sexual abstinence is a cornerstone of HIV-prevention campaigns targeting the youth, as is encouraging safer-sex practices such as condom use, and the distribution of condoms at no cost. Such campaigns often have disappointing results, however, even in areas where condoms are widely available and awareness about STIs is high.
The goals of the Abstinence and Be Faithful Among Youth (ABY) project, implemented by the Olive Leaf Foundation, were to enhance local responses among the youth in South Africa to prevent HIV infection through encouraging abstinence, faithfulness and the avoidance of unhealthy sexual behaviour among youths over a five-year period.
ABY interventions promoted dignity and self-worth, the importance of abstinence in reducing the transmission of HIV, the importance of delaying sexual activity until marriage, the development of skills for practising abstinence (and, where appropriate, secondary abstinence), the elimination of casual sexual partnerships, the importance of marriage and mutual faithfulness in reducing the transmission of HIV among individuals in long-term relationships, and the importance of HIV counselling and testing as a way of significantly reducing the risk of HIV infection.
HIV/AIDS prevention through sexual abstinence is a cornerstone of HIV-prevention campaigns targeting the youth.
This study was conducted using two types of questionnaires, one for learners aged 10–14 years and another for learners/youths aged 15–24 years. Key questions centred on awareness and knowledge of HIV/AIDS, attitudes towards people living with HIV/AIDS, views on dating, relationships, sexuality and pregnancy, views on abstinence and faithfulness, the role of the media, role models and workshops in encouraging abstinence and faithfulness, and the effect of peer-group pressure and violence on abstinence and faithfulness.
Youths indicated that abstinence was a good choice because it protected against STIs and pregnancy.
Evaluatingviews on abstinence
Previous studies on the teaching of abstinence in schools in South Africa which investigated whether abstinence messages were appropriate and effective, found that abstinence levels were 81% (87% in intervention female participants and 75% in intervention male participants) in South Africa. The reasons cited for abstaining from sex were: the individual was not ready; to protect his or her health; and that friends were teasing him or her.
Youths indicated that abstinence was a good choice because it protected against STIs and pregnancy. Another South African study, this time on transitions to adulthood in South Africa, found that adolescents were 3.9 times more likely to practise secondary abstinence in 2001 than in 1999. Girls were 9.3 times more likely to abstain while boys were 2.2 times more likely to abstain. Young people clearly have strong views on and support for abstinence. They also have strong views on and perceptions of remaining faithful to one partner.
In line with these findings, the ABY study found that young people had strong views on abstaining from sexual intercourse (Table 1). A significant number of young people (83%) said that it is possible not to have sex for as long as you are able to. Only 8.8% of the young people thought it is not possible to not have sex for as long as you can. About 8.2% of the respondents were unsure whether it was possible or not to not have sex for as long as you can. The results show that few respondents strongly disagreed that it is possible to not have sex for as long as you can, with a linear increase towards strongly agreeing.
Comparing young men to young women, the ABY study showed a strong association between gender and whether it is possible not to have sex for as long as you can. Young men were more likely than young women to be in agreement. Similarly, the older the respondents, the more likely they were to agree that it is possible to not have sex for as long as you can.
Comparing age, the older the respondents (15–19), the greater the likelihood that they were to support abstinence as a way of preventing HIV infection (Table 2).
72.1% said role models can help young people abstain from sex, while 14.9% said role models cannot help young people to abstain from sex
The impact of media and role models
Current statistics show that the majority of South African youth (78.4%) believe that newspapers, television and radio encourage faithfulness in relationships, while only 10.0% disagreed or strongly disagreed with the statement. In total, 11.7% of the respondents are unsure of the media’s role in encouraging faithfulness in relationships.
In a survey conducted by the Kaizer Family Foundation (KFF) and the South African Broadcasting Corporation (SABC) among nearly 4 000 South Africans aged 15–24 in 2006, an overwhelming majority (96%) said that television and radio are generally doing a good job of communicating about HIV/AIDS, and 89% said that television and radio has had a positive impact on their own understanding of HIV/AIDS and related sexual activity.
In agreement with these findings, this study showed that 68.1% of participants said that the media had a positive influence on encouraging abstinence. In total, 68.7% of young people said that the media encouraged faithfulness in relationships and 84.6% said that life-skills workshops were helpful in encouraging them to remain faithful to one partner.
Role models are also important influences on young people’s sexual behaviour. Of the respondents in the study, 72.1% said role models can help young people abstain from sex, while 14.9% said role models cannot help young people to abstain from sex. A significantly large number of respondents (84.3%) said that leadership and life-skills workshops are helpful in encouraging young people to abstain from sex.
Making abstinence real
The findings of this study are a valuable guide to the views and perceptions of young people. There was strong support for abstinence as a way of preventing infection with HIV. In total, 78.5% of young people believed that not having sex is the best way to prevent HIV infection.
Summary of an article published in Health SA, Journal of Interdisciplinary Health Sciences. This article can be downloaded from www.hsag.co.za.
Professor Keitshepile Geoffrey Setswe, head, School of Public Health, Monash University, South Africa, former director, HSRC; Dr Khangelani Zuma, director, HIV/AIDS, STIs and TB programme, HSRC.