Introduction

An estimated 1.7 million people aged 10-24 years are infected with HIV annually in Africa. Globally, more than half of the new HIV cases occur among young men and women aged 15 to 24 years (Population Reference Bureau, 2000).

Sexual debut as early as nine years was reported in Zimbabwe (Mgale, 2000), and at the age of 10 years in Tanzania (Population Reference Bureau, 2000). Adolescents who tend to have sexual debuts early are at a greater risk of HIV/AIDS and STD infection as they often have sex with older people who usually have multiple partners.

Among sexually active primary school boys of Lindi and Dar es Salaam in Tanzania, only 15% and 37% respectively, reported having a single sexual partner (CCBRT, 2001; Pfander, 2000). Social economic inequalities, dependency imposed on women and sexual insubordination to men are major reasons for the HIV/AIDS and STD infection among girls. As a result, girls cannot insist upon condom use or the fidelity of their partners.

Tanzania, like in other developing countries, adolescent sexual activity remains a taboo. However, the traditional institution and structures that regulated adolescent sexual behaviour in the past, have either broken down or have been rendered ineffective under the impact of rapid urbanisation and a decline in the culture influence against early sexual debut. Inadequate knowledge, lack of information, unavailability of resources and poor reproductive health services are factors contributing to adolescent sexual risk taking. Some of the adolescents at high risk may not adopt safe sex because they are passing through a stage of life in which risk taking is particularly attractive, they think they are not vulnerable and have nothing to loose and some cannot resist the peer pressure.

The aim of this study was to identify reasons for risk taking behaviour and together with the youths, develop appropriate strategies that will enable the youths in Kichangani ward to adopt positive sexual practice.

Study Area

Kichangani ward is situated along Dar es Salaam – Mombasa Highway with a population of 11,000 people. Tanga Cement, Lime and Sisal Industries are located in this area. Like other parts of the country, HIV/AIDS and other STDs have affected Kichangani resulting in high numbers of unintended pregnancy and school dropouts. A large number of primary school leavers could not join secondary schools and as a result, most of them are unemployed and spend the majority of their time in groups around the shops, local bars and markets. A few are employed in Sisal, Cement and Lime industries, some own small-scale businesses, are street vendors, food vendors and house workers. A large number of truck drivers from Burundi, Rwanda, Uganda and different parts of the country spend nights in this area while waiting to load their trucks.

Initial Problem

Tanzania is experiencing high population growth, of which 1/3 are youths of the age between 10 to 24 years (NACP, 2000). Youths find themselves indulging in sexual activities very early, which put them at a risk of contracting STDs, HIV/AIDS, unwanted pregnancy, abortion and even death. This is mainly due to unemployment and peer pressure accompanied by little or no parental guidance (Mhondwa, 1992).

According to the Population Reference Bureau (2000) 39% of 18-year-old girls are pregnant with their first pregnancy, some of which are unintended. Some girls drop out of school and some are abandoned by their families which can lead to unemployment and poverty and further exposes them to promiscuity and eventually HIV/AIDS and STD infection.

NACP estimated that 549,000 people would be infected (by HIV/AIDS/STD) by 1999, with the highest prevalence among young women aged 19-22 years (Harder, 2000). Sensitisation and mobilisation have been conducted within the community, particularly for young people. 97% of the boys and 95% of the girls aged 15-19 years know that AIDS exists, 59% of boys and 43% of girls know one or more ways of preventing it, however only 25% of boys and 9% of girls used a condom in their last sexual encounter. According to the Reproductive Health Project (2001) condom use among sexually active primary school pupils in Lindi, Tanzania decreased from 19% in 1999 to 14% in 2000. 22% of unintended pregnancies are from this group and only 12% of unmarried girls use contraceptives (Population Reference Bureau, 2000). This shows that there is an increase of knowledge on HIV/AIDS but risk-taking behaviour still exists.

Justification

Situation analysis shows that AIDS prevention holds the first priority. AIDS affects every family, the population of the highest reproductive and productive age, and the economy of the country, leaving a lot of orphans. If appropriate measures are not taken in the future there will come a time when the nation will have no work force and thus no development.

For this reason, there is a need to gather information and acquire knowledge on HIV/AIDS and STDs that the youths have, the kind of sexual practices which put the youths at risk and their feeling about safe sex practice. This will be crucial in order to develop strategies which will enable them to change their behaviour.

Practical Aim

The practical aim is to acquire knowledge required to develop appropriate strategies with young people which will enable them to develop positive sexual behaviour. The knowledge required could best be acquired by action research, which combines development of knowledge with action to solve practical problems.

Youths in this community that are affected by this problem will be involved in conducting this study, which will help in finding out a workable solution to the problem. The gaps and barriers between knowledge and practice may be related to environmental factors, such as poverty, lack of resources, lack of appropriate reproductive health services, unemployment, unavailability of condoms, social and cultural pressures, attitudes and beliefs. These factors tend to result into high risk sexual behaviour and must be identified. Other factors, including lack of knowledge about HIV/AIDS, STDs and reproductive health, limited access to information, inappropriate information, education and communication, and a lack of skills particularly in condom use should also be properly analysed.

The knowledge gained from assessing these factors may help in developing appropriate strategies for the youths to acquire positive sexual practices. The target group should be fully involved in developing the strategies for they will be able to choose what is best for themselves and how best the strategies can be implemented for better results.

Research Question

General Research Question

What are the factors hindering youths from putting knowledge on prevention of HIV/AIDS, STDs and unwanted pregnancy into practice?

Answers to this question will help to identify the actual situation as to why knowledge on HIV/ AIDS prevention is not put into practice.

Specific Questions

Methodology

Qualitative and quantitative methods of data collection were used in this study. A combination of quantitative and qualitative methods has been found to be very useful, as they compliment each other’s strengths and weaknesses (Tones, 1994). An interviewer administered questionnaires and focus group discussion techniques were also utilised.

The questionnaire was composed of closed and open-ended questions which were designed in a way that sensitive questions appeared as neutral as possible (Lee, 1992). No data on individual characteristics were requested. An interview was used due to its ability to correct misunderstandings, probe inadequate and vague responses, and to attain the highest quality of response. An interview also allows for the establishment of rapport and motivates the respondents to answer questions (Judy, 1991; Skinner, 1991). This is the most common method used for sexual behaviour research in developing countries (Goergen et al., 2000).

Focus group discussions were used to allow the researcher to discover ideas, concerns, attitudes and approaches of people in their own terms. Focus group discussions often stimulate people to talk and to reveal facts and opinions that may not have been revealed otherwise. It may also allow the group to clarify attitudes or beliefs in words that were probably not easy to articulate. The procedure for confidentiality was clearly explained and privacy was maintained.

Sampling And Sample Size

A total number of 475 participants were selected from 6 villages, with approximately 75 participants from each village. Youths in the village are rarely seen at home during the daytime. Some of them run small-scale businesses in the markets, some around the shops, others are vendors in the streets, and some work in the factories. Youths were sampled at different points of the day.

The intention of the study was explained to the youths at the shopping centre and those who were interested could come forward if they were willing to participate. There were ten slips of paper that had “Yes” written on them and ten slips with ‘’No’’. After having explained clearly, all the slips were kept in a small box and each youth was asked to pick a slip of paper from the box. This was done in groups of boys and girls separately to get an equal number from each sex. We acknowledged the ones who got “No” slips and interviewed the ones who had “Yes” slips.

The fingers of the interviewees were marked with an inkpad after interview to avoid repetition. Youths who were at home were selected through random sampling of the households. Care was taken to see that all the characteristics were included such as food vendors, street vendors, etc.

Results

A total number of 475 youths aged 13 to 24 years were involved in the study, 55% boys and 45 % girls.

Figure 1 shows the distribution of the educational background of the sample. 66% completed primary education, 7% completed secondary education of which 25% dropped out of school. 67.4% are unemployed, 22% are assisting parents with farming and 10.6% are managing small-scale businesses.

The age at the first sexual debut is shown in Figure 2. 0.3% girls and 3.2% boys had their first sexual debut by the age of 9 years and 10% by the age of 13 years. The largest group, 55% of girls and 45% of boys, had their first sexual intercourse experience between the ages of 14 to 17 years.

What The Youths Know About HIV/AIDS And STDs

The tables below indicate what the youths know about HIV/AIDS and STDs. Table 1 shows the ways the youths believe HIV/AIDS and STDs are spread. 86% of the youths know that HIV/AIDS is spread through unsafe sex, 3.1% know that it can be spread through sharing of skin piercing instruments and 9% did not know a single way it can be spread. Some misconceptions as to the sharing of eating utensils and shaking of hands still exist.

Table 2 shows what the youths believe are the ways of preventing HIV/AIDS and STD infection. 72% mentioned proper use of condoms, 54.9% mentioned fidelity, 6.9% did not know a single way of prevention of HIV/AIDS and STDs, 1.1% said hand shaking and 28% said abstinence. Use of a condom as a means of preventing pregnancy was mentioned by 45%, 37% said use of contraceptives, 5% said safe days while 13% did not know how pregnancy might be prevented.

The youths were also asked to name any sexually transmitted diseases that they were aware of, as summarized in Table 3. 89% of the youths know that healthy looking men and women may be HIV positive. 72.1% mentioned Gonorrhoea as one of the STDs, 74% said Syphilis, 63% mentioned AIDS, 20% said Cancroids and 7% could not mention any of the STDs.

What The Youths Feel About Sex

It was gathered from the focus group discussions that youths change partners frequently because they feel it is prestigious to have a different boy/girl each time. Youths also have more time to spend in groups which results in group influence and they cannot resist the peer pressure.

Poverty is another important factor. Girls particularly are looking for money. One of the girls said, “What do I do. I have no work, no money, my mother has nothing to give me. Why can’t I go with someone who can give me 200 Ts. If I get one of the truck drivers they give 1000 Ts. and sometimes I get up to 3000 Ts. Why should I sit down and suffer? This can last me for a week.” Another one said that her mother sometimes asks for money, “Where do they think we get money? It is better to look for someone with a big offer otherwise you will have to have sex with three or four men to get enough to take home!” One of the girls said, “We are really suffering. Our parents cannot assist us properly. I wish I could have some work to earn money.”

Figure 3 shows the youths’ perceived risk of contracting HIV/AIDS and STDs. 11.7% of the participants feel that they are at a high risk of getting HIV/AIDS and STDs, 25% feel they have a very low risk, while 53.1% feel that they are not at risk at all.

Table 4 summarizes the youths’ reasons for the perceived risk of HIV/AIDS and STDs.  7.1% of the participants had never had sex before and 93% are sexually active, of which 72% had made their own decision when they had their first sexual intercourse.   The number of sexual contacts in the previous month, September 2001, is summarized in Figure 4.  32% said they had a single sexual contact, 59% from two to nine times, and some varied from 20 – 30 sexual contacts.

The number of sexual partners the youths have is shown in Table 5.  33% had a single sexual partner while 66% had multiple partners.

The number of youths who have ever used a condom was also recorded and is summarized in Table 6. 49% of the youths reported to have used a condom. The focus group discussions revealed that the boys are ready to use condoms but some of girls are not ready because they have poor knowledge on the use of a condom. The rumours that condoms carry viruses and that a condom may be left in the womb during the sexual act also contribute to a lack condom usage. Some youths feel that it is better to have only one partner then to use a condom every time. One of the boys commented, “I cannot imagine using a condom for the rest of my life. I better have one partner I trust”. Another girl said that boys are not trustworthy, “I do not trust my lover, so I can never have sex without a condom, even with one partner, better use a condom.”

Some of the youths agree that condoms are very useful in preventing diseases, but many people do not have skills in condom use. “I will never use something that I am not comfortable and sure of how to use it. So I am not motivated to use a condom”, said one of the boys.

The youths were also asked for their reasons for using condoms, as summarized in Table 7. 53.8% said condoms are used to prevent sexually transmitted diseases and 29% said they did not know the reason for using condoms.

According to the youths condoms are very expensive in this area. Three condoms cost 100 Ts. (0.10 US$). “I cannot afford to buy and keep some condoms with me. So if I get a girl at night, it is not easy to find one, the shops are closed. Getting a condom at night in this village is a dream, I tell you”, said one of the boys. Figure 5 shows the sources of condoms in the area.

Initiation Rituals

In most of Tanga Communities young girls just before puberty at the age of 10 – 12 years are put together to undergo training of how to become a woman. Parents decide on when to conduct the ritual, which is usually during the school holidays. The initiators are old women from the same village.

Among other things, the girls are taught about hygiene, how to behave in bed, what to do to make a man satisfied during sexual intercourse and that it is her responsibility to see that the man is satisfied sexually to the maximum. After this one month training period, the girls feel that they know everything about sex and they are pressured to put their knowledge into practice without knowing that HIV/AIDS exists and that they do not have enough information on HIV/AIDS prevention. ‘’I wish they could also be taught on how to prevent AIDS’’, commented one of the girls. ‘’Men, on the other hand, feel that they now have a ticket to have sex with the young girls. Particularly the elder men would talk on how eager they are waiting for the initiation period to be over”, said another girl.

Masturbation/Homosexuality

The youths in Kichangani feel that masturbation is safe because it releases sexual tension without causing HIV/AIDS but there is fear that it causes loss of libido. One of the boys said, “I masturbate often but I have not had a problem, it is better then dying of AIDS”. Anal sex is practiced by some homosexuals and mainly for money, but also to a few girls to retain their virginity and avoid pregnancy.

Discussion

It is alarming to see that the youths have multiple partners in spite of such a high knowledge of the risks. 47% mentioned use of condom and 37% mentioned use of oral contraceptives as ways of preventing pregnancy, while only 17% claim not to be at risk of getting HIV/AIDS because they use condoms during sexual intercourse.

11.7% perceived that there is a high risk of getting HIV/AIDS and STDs which may motivate the youths to practice safe sex. 26% feel that they have low risk while 53% feels they are not at risk at all. This kind of attitude may prevent an individual from using the knowledge he/she has, because they do not feel they are in danger and this can therefore lead to infection. The reasons they have given for not perceiving the risk are misleading, such as, “I trust my partner”, who is a truck driver or, “I have only one sexual partner” yet he/she does not know if his/her partner has other sexual partners. One has to be very careful before making such a conclusion.

There is an indication that most youths know the importance of using condoms even with a single partner, but only 49% used condom in this village. Some cannot use condoms possibly because the enabling factors are not existing, they are not confident in condom use, condoms are not easily accessible, or they are unavailable and unaffordable to some youths. This may be a major barrier in utilizing the knowledge they have, especially if condoms cannot be found at night while youths in this village have casual sex with the truck drivers.

The fact that only 10% of the youth get condoms from the clinic, which offers free condoms, may indicate that it is possible that this clinic is not youth–friendly, otherwise more youths would have used it. Youths need to be accepted and recognized as individuals with needs and problems.

55% of girls had their first sexual intercourse from the age of 14 years, 61% had multiple partners of which 62% of the girls had up to nine sexual contacts in the previous month. This indicates that the youths are at a great risk of contracting HIV/AIDS and other STDs.

Some of the traditions contribute to the spread of HIV/AIDS. The initiation rituals that occur at the age of 12 years, in turn open the girls’ eyes for sex with inadequate knowledge and information on HIV/AIDS. This may possibly be the cause of early sex in this village. Girls also opt to have sex with the truck drivers for money, which puts them at a greater risk of getting HIV/AIDS and STDs.

Since some of the parents are expecting money from the girls yet they are unemployed, they are indirectly forced into commercial sex. Parents need to know the impact of what they are doing to their daughters. Parents should also be given information on AIDS to be able to assist their children. Although Muslims and Roman Catholic religions dominate Kichangani area, there is no evidence that religious belief is a barrier.

Practical Implications

This study suggests that agencies providing AIDS education programs for youths should put emphasis on developing life skills and counseling to enable a change of attitudes and to initiate income generating activities at a small scale to empower youths to avoid HIV/AIDS. Programs should also emphasize and encourage indoor and outdoor games for proper utilisation of time and encourage the formation of small youth groups guided by trained peer educators to allow individual participation and dissemination of information.

It may also be beneficial for the Reproductive Health Project to negotiate with PSI to assist youths to establish condom selling points using the kiosks currently owned by youths. In addition, information, education and communication programmes should be established with the initiators and emphasis should be put on reproductive health in order to encourage the youths to delay sex and negotiate condom use or fidelity during the initiation ritual periods.

Information, education and communication should also be provided to the existing groups in the community, such as the Women’s groups and Church groups, to help parents guide their children to avoid HIV/AIDS and STDs. Further, as many of the youths do not currently go to the existing clinics, the Municipal Authority should attempt to make these clinics more youth-friendly.

Conclusion

This study shows that in spite of the high knowledge the youths have on HIV/AIDS, STDs and pregnancy, they still engage in high-risk sexual behaviour. The age at the first sexual debut is very young. More then two-thirds of the participants are sexually active of which 67% have sex multiple sexual partners and some have casual sex with the truck drivers.

Youths do not perceive themselves as being at risk of getting HIV/AIDS and STDs. The reasons given for not perceiving the risk may not allow them to protect themselves from infections. This situation is predisposed by the fact that the knowledge the youths have on condom use is poor, the beliefs they have on condom use are very demotivating, condoms are not easily accessible, are unaffordable and unavailable. Poverty is a major contributing factor. Youths cannot utilise their time effectively and therefore they opt for commercial sex. Since they lack life skills, they cannot resist peer pressure.

Some traditional practices contribute to the spread of HIV/AIDS. Youths are given inadequate information which does not empower them fully to avoid contacting HIV/AIDS. Another major contributing factor is that parents are not taking their responsibility in guiding the youths to avoid the risk of contacting the disease. By increasing knowledge, awareness and resources available to the youths and their parents, hopefully more positive sexual practices will result with a decreased prevalence of HIV/AIDS, STDs and unwanted pregnancies.

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