University of Zambia Medical Library

Socio-Behavioural Aspects: Sexual Behaviour (AIDS in Zambia Bibliography #118-128)

(#118) "An Investigation of High-Risk Situations and Environments and Their Potential Role in the Transmission of HIV in Zambia: The Case of the Copperbelt and Luapula Provinces"
Mushingeh, C., Chama, W., Mulikelela, D. (1992) unpublished
Geographical area: Copperbelt, Luapula; Keywords: Health education, high risk situation, gonorrhoea; Location: Ministry of Health

A cross-sectional explorative survey was conducted in both urban and rural settings of Copperbelt and Luapula Provinces. The aim was to determine and identify potential roles of different situations and environments in the spread of HIV in some parts of Zambia. An anthropological approach was applied. Qualitative and quantitative analyses of data were used. Research methods used included questionnaires, focus group discussions, observations, participatory approach, case studies and a review of literature on HIV/AIDS research in Zambia. The study concentrated itself among the fishing camps and trading areas as means of capturing fishermen and fish traders. The sampling procedure applied involved the selection of three provinces (Luapula, Central and the Copperbelt). In each selected area, purposive cluster sampling technique was chosen and this resulted into uneven distribution of clusters for each province. In Luapula, 12 clusters were identified, while Central Province had one (fish traders' resting place) and Copperbelt had five clusters respectively. The study population comprised of men and women fisher people and traders regardless of their marital status in the age range from <15 to >56 years. Two samples were determined for this study. First was a sample of 500, randomly selected from cluster areas and second part was the identification of ten case studies (known as informants - six women and four men) in the villages/fishing camps. The wider sample (500) comprised 340 males and 160 females.

The research findings indicate that the majority of respondents proved to be sexually active people. Results indicate that STDs were prevalent in the area. About 20 respondents mentioned syphilis, gonorrhoea and chancroid, 46 per cent mentioned syphilis, gonorrhoea, chancroid and AIDS. STD trends in the last five years as perceived by the informants increased (73.8 per cent) in the area. Three STDs predominant were syphilis, gonorrhoea and chancroid. There was a high level of awareness among the informants about the four diseases. Generally this indicated that the business was unsafe in the context of AIDS epidemic because of the high degree or extent of sexual activities which have infiltrated it. The process of buying and selling of fish had a great potential for the spread of HIV amongst the people associated with the business. The trader and trader sexual relationship termed as "Bibi ya Kazi" meaning a temporary wife was commonly practised within the fishing camps. Use of condoms as a safety device was disapproved of.

(#119) "A study on knowledge, attitude and sexual practices concerning AIDS among street adolescents in Lusaka"
Chela, M.F., (1992), Paper presented to the University of Zambia, School of Medicine, Department of Post Basic Nursing, 1992.
Geographical area: Lusaka; Keywords: KAPB, street adolescents, awareness, condoms; Location: UNZA Medical Library

Objectives:
1. To determine the HIV knowledge, attitudes and practices of street adolescents. To assess the sexual practices and condom use among street adolescents.

Methods:
The report is based on the opinions of street adolescents who participated in a focus group discussion in a compound area of Lusaka. The age range of the adolescents was 15-19 years.

Results:

• Although there was public awareness about AIDS, only a small number of respondents had moderate knowledge about AIDS. Males possessed more knowledge about AIDS than females. Most of the respondents who were single also had more knowledge than those who were married. Further, the majority of people who had moderate knowledge had a minimum of primary school education.
• Most street adolescents had no access to health education materials in vernacular; and very few respondents had been given health education about AIDS.
• Most of the respondents had negative attitudes towards AIDS. They felt that they were not at any risk of acquiring HIV because they were not prostitutes.
• Most adolescents aged between 15-18 years practiced unsafe sex. Although most of them are aware of free condom distribution in their areas, many said that they do not use them because they interfere with sexual pleasure.
• Males had more sexual partners than females; with heterosexual contact accounting for 39 per cent of female adolescents compared with 29 per cent of female adults. Consequently, about 20 per cent of the respondents gave a history of sexually transmitted diseases (STD).

Conclusions:
There is very poor knowledge about HIV/AIDS among street adolescents who also show misconceptions about who can be infected by HIV. Although condoms are available, most of the street adolescents prefer unsafe sex therefore putting themselves at high risk of acquiring HIV. Efforts should be made to target street adolescents through peer education.

(#120) "An Investigation of the Behavioural Aspects of "Dry Sex" in Lusaka Urban"
Nyirenda, J.M. (1991) unpublished
Geographical area: Lusaka; Keywords: Dry sex, counselling; Location: UNZA Medical Library

The aim of the study was to explore and document new information related to the behavioural aspects of dry sex practice (DSP) as a factor in the transmission of HIV; to determine the extent of dry sex intercourse; to identify agents used for drying the vagina; to find out whether the respondents practicing dry sex experienced any adverse effects from the agents; to determine whether the dry sex practitioners have the knowledge that vaginal secretions in sexual excitement is a normal physiological process; to determine whether the women would be willing to abandon dry sex practices after they have been informed about the adverse effects of dry sex in relation to HIV transmission.

The study was conducted at the University Teaching Hospital department of Obstetrics and Gynaecology during the period March to April, 1991. The instruments used for the data collection were focus interview schedule; focus group discussion and non-structured interview schedule. The findings revealed that dry sex was practised by 86 per cent of women in Lusaka Urban, for various reasons. Methods used for drying the vagina included herbal porridge and vaginal mopping, etc. Among the adverse effects of drying agents were genital ulceration due to excessive tightness and friction during coitus, and irritating and erosive effects of some herbs used. These adverse effects predisposed the dry sex practitioner to HIV infection if she had intercourse with an HIV-infected man.

Dry sex was widely practised by 86 per cent of women across all socio-economic and ethnic boundaries. Reasons for DSP were:

• Women believes the man enjoys difficult penetration (35%)
• Enhancing mutual satisfaction (30%)
• The man demanded dry sex (19%)

Reported adverse effects include:

• ores on penis/inside vagina (35%)
• Erosive effects of intravaginal insertion (17.6%)

After counselling 67.4 per cent of the women agreed to stop DSP.

Conclusions: Women practicing dry sex stand a higher risk of contracting HIV especially where spouses have other partners. Mass health education through all available means can help to sensitise men and women to reduce DSP.

(#121) "Men's Views on Dry Sex in Relation to HIV/AIDS"
Mwendafilumba, A.M. (1992) unpublished
Geographical area: Lusaka; Keywords: Dry sex; Location: UNZA Medical Library

AIDS educators and public health experts have been handicapped in designing prevention by the separation between sexuality and contraceptive research which has resulted in a lack of knowledge of the relationship between cultural values, sexual norms and actual sexual behaviour in inner city communities where there has been a proliferation of AIDS cases. The traditional order role of behaviour has resulted in women lacking control over sexual decision making. The objective of the study was to explore men's views on traditional sexual practice as a factor in the transmission of HIV. The study involved the systematic collection and presentation of data to give a clear picture of the situation on "dry sex" practice in Lusaka Urban. The researcher employed an exploratory research design because the study was non experimental. The target group were Zambian adult men living in Lusaka urban.

Results:
The results of this study were based on the analysis of responses from 80 adult men.

• 46 per cent of the respondents who were for dry sex practice were from the high density areas.
• Among the married respondents dry sex practice was more common in the 31-40 years group.
• Among the singles, 9 per cent were for dry sex and were 30 years and below.
• Men stated that they preferred dry sex because they had been socialised into accepting that a woman should not have any water', and that the presence of this water is a hinderance to the sexual performance of the male.
• 40 per cent admitted that they played a major role in choosing sexual practice; 13 per cent stated that it was their partner's choice. 47 per cent stated that it was culture as dictated by the elders.
• Age, educational and marital status do not affect the practice.
• Respondents who attended government schools were more in favour of dry sex than those who attended mission schools, although religious affiliation does not seem to affect the practice.

Reasons for perpetuating dry sex practice:

• Sexual pleasure was enhanced.
• It enabled the men to ejaculate within a short time, so allowing greater intercourse frequency, which is traditionally a signal of the man's potency.
• Cultural inertia: the desire to a maintain a long-held practice.

(#122) "The Needs and Aspirations of Secondary School Pupils and their Attitudes and Advisors on Selected Issues of Sexuality "
Mudenda, S.J. (1992) Unpublished
Geographical area: National; Keywords: KAPB, adolescents, sex education, counselling;Location: Institute of African Studies, Family Health Trust

Objectives:

• To establish the needs and aspirations of secondary school pupils.
• To investigate their sources of counselling on issues of sexuality.
• To find out how much they know about HIV/AIDS.

Methods:
Six co-educational, five male, and four female secondary schools were selected from Central, Lusaka and Southern Provinces. From each of the schools, 20 Grade 9 and 20 Grade 11 pupils of each sex (except in the case of single sex schools) were randomly selected by numbers from a random number list against class lists. From each group of 20, three pupils were randomly selected to respond to a second questionnaire. The entire sample consisted of 392 female and 400 male pupils. The mean age of the total sample was 17. Of the 392 Grade 9 pupils, 199 were female and 193 were male. The Grade 11 pupils consisted of 193 females and 207 males. There was no significant difference in the distribution. 21 per cent (166) of the sample were first-born children, 85 being females and 81 males. 10 per cent belonged to the Anti-AIDS clubs. This number was almost equally divided between males and females (females = 38, males =40).

Results:

• Adolescents have access to some knowledge and counselling about sexuality through various formal and informal institutions - schools, churches, and various clubs and organisations. The school system teaches about different aspects of sexual development: puberty, reproduction and STDs are covered sometimes in Grade 7 science, but always in science at higher levels.
• Counselling services are available in most secondary schools but they tend to focus on academic and career guidance, neglecting the non-academic problems and needs of the student.
• Various NGOs and other organisations such as the Anti-AIDS Project, Copperbelt Health Education Project and the Family Life Movement, have also taken adolescent problems as their concern in response to the HIV epidemic and are addressing the issues of adolescent sexuality.
• Parents and grandparents were very prominent as advisors to girls on puberty; and parents alone on pregnancy. About 1 in 5 of the girls had also received information on pregnancy from siblings or friends. Many boys said they had received no advice on these matters. Almost 90 per cent of the sample reported not being satisfied with the advice they had received, feeling that they still needed more.
• Although the level of knowledge of Anti-AIDS club members might only be slightly higher than that of non-members, they have actually acted as advisors on questions of puberty. About 1 out of 5 respondents felt that parents would be suitable advisors on issues of puberty and sexuality. Girls however felt that teachers and other elders would also be suitable advisors.
• Only one pupil, out of 123, denied knowledge of AIDS. Over 80 per cent know that there is no cure; 13 per cent were not sure, the majority of this small group being Grade 9 girls and boys. Over half the sample have seen a person suffering from AIDS with most mentioning loss of weight as an indicator.
• There was no differences between boys and girls, Grade 9s and 11s, or rural and urban pupils with regard to how the disease is acquired or who the most likely people to be infected are: sexual intercourse was mentioned by almost all, while contaminated blood transfusion or contaminated sharp instruments were each mentioned by about one-third of the sample. Less than 5 per cent mentioned mother-to-child transmission.
• Misinformation about transmission was similarly, but minimally, given by boys and girls, with coughing, bed-bugs, mosquitoes, shaking hands, saliva, sharing plates and using clothes of an infected person being mentioned.
• About 70 per cent of the respondents felt that boys and girls should be told about AIDS when they are between 10 and 15 years of age.
• Other issues such as beliefs and attitudes about selected aspects of sexuality including: premarital sex, abstinence, condom use are discussed.

Conclusions:

• Information on sexual development and its outcomes is unevenly imparted to the pupils and does not satisfy their expectations about what they should know.
• Although most of the pupils know a lot about HIV transmission and avoidance, there are still important gaps in their knowledge which should be addressed by all relevant agencies.
• Most of the pupils feel they need to know more about condoms.

(#123) "Sexual behaviour among male adolescents in Zambian secondary schools"
Feldman, D.A., O'Hara, P., Baboo, K.S., Ndashi-Chitalu, W., Ying Lu, (1993) Paper presented at the IXth International Conference on AIDS, Berlin, 1993.
Geographical area: Lusaka; Keywords: Sexual behaviour, adolescents, school students, condoms ; Location: UNZA Medical Library

An ethnographic study is being carried out among adolescents in Lusaka, Zambia to determine how to reduce HIV-related sexual risk effectively. Among others, males at two secondary schools have been interviewed, individually and in groups, about their sexual behaviour and risk reduction activities. Preliminary data (n=62) suggest that most Zambian public secondary school males are sexually active with one or more girlfriends who are likely to neither be attending school nor working outside the home. Few of the males use condoms or practise other safer sex behaviours, even though HIV seroprevalence indicates a rate of 8.4 per cent among this student population. Condoms are seen as being ineffective in preventing HIV, and US manufactured condoms are generally thought to have holes put into them. A trial peer-led risk reduction training session and workshop was conducted among adolescents. It appears likely that such an approach would be successful in Zambia.

(#124) "Sexual practices among secondary school teenagers in Lusaka and recommendations for safe sexual practices as primary prevention for AIDS"
Malibata, C. (1994) unpublished
Geographical area: Lusaka; Keywords: Dry sex, adolescents, students ; Location: UNZA Medical library

A study was carried out to look at the sexual practices of adolescents in three secondary schools of Lusaka namely Kwacha, Kamwala and David Kaunda Secondary Schools. The aim was to find out which of these sexual practices put them at risk of contracting HIV infection and other STDs and therefore make recommendations on intervention measures. A total of 100 pupils were seen; 51 boys and 49 girls.

The study showed that almost half of both sexes (40.8 per cent girls, 62.7 per cent boys) were involved in penetrating sexual intercourse while oral sex (22.4 per cent girls, 15.7 per cent boys) and anal sex (2 per cent girls, 3.9 per cent boys) were not as popular. Putting fingers into the anus played a very minor role (2 per cent girls, 7.8 per cent of the boys did so). Four per cent of girls place objects into their vaginas.

A significant proportion of the girls practised dry sex by way of using toilet roll or cloth (24.5 per cent). Only 4.8 per cent had heard that it promoted transmission of HIV. 10.2 per cent said they heard it was painful while 8.2 per cent claimed that they were always dry and so did not need to dry their vaginas. 10.2 per cent were virgins. The rest (42.9 per cent) had never heard of dry sex. There appeared to be no relationship between dry sex and having had sex education by a ritual initiator. 42.9 per cent of the girls had a ritual ceremony at puberty but only five had practised dry sex.

(#125) "Dry sex and HIV infection among women attending an STD clinic in Lusaka, Zambia"
Sandala, L.M., Lurie, P., Sunkutu, M.R., Chani, E.M., Hudes, E.S. et al., (1994) Paper presented at the Xth International Conference on AIDS, Yokahama, Japan, August 1994.
Geographical area: Lusaka; Keywords: Dry sex, condoms; Location: UNZA Medical Library

Objectives:
To describe 'dry sex' and other practices intended to decrease vaginal secretions and to determine whether these practices are related to HIV infection.

Design: Cross-sectional study

Setting: A sexually transmitted diseases (STD) clinic in a teaching hospital in Lusaka, Zambia.

Participants:
Three hundred and twenty-nine women aged 15 to 50 who presented for initial evaluation of STD symptoms.

Main Outcome measures:
'Dry sex' practices as assessed by questionnaire, history and physical examination and serological testing for HIV. Results: Fifty per cent of women have ever engaged in at least one 'dry sex' practice. The most common practices were drinking 'porridge' (a liquid or suspension believed to cause drying of the vagina; 11 per cent). For drinking 'porridge', increasing her partner's sexual enjoyment and tightening the vagina were frequent reasons for engaging in the practice, while cleaning the vagina was mentioned often by those using cloth or leaves. Swelling or peeling of the vagina was reported by approximately 10 per cent of women using cloth or leaves. Overall, the HIV seroprevalence in the sample was 58 per cent. In bivariate analysis, no practices were statistically significantly associated with HIV infection, but ever use of condoms was (odds ratio =1.7; 95 per cent confidence interval: 1.1-2.7). Multiple logistic regression had little impact upon these findings.

Conclusions:
Although a variety of practices with potential relevance to HIV transmission were reported, there was no evidence in this study population of a strong relationship between these practices and HIV infection. Women should be counselled about the potential risks of these practices, but prevention efforts should continue to emphasise measures of known effectiveness, particularly limiting the numbers of sexual partners, condom use and STD treatment.

(#126) "What are young women looking for in a sexual relationship in and around a migrant labour camp?"
Bond, V. (1995) Paper presented at the Vth National AIDS Conference, Lusaka, 1995.
Geographical area: Chiawa, Lusaka Rural; Keywords: Migrant workers, high risk situation, commercial sex work, dry sex, condoms; Location: Family Health Trust, UNICEF

This anthropological study is a part of an applied research programme which aims to evaluate a model specially designed for a migrant labour context. The large commercial farm in Chiawa employs seasonal labour: 3000 expected in 1995. 215 of these workers in 1994 were women. Their ages ranged from 12 to 45, with 67 per cent under the age of 25. Men outnumber the women by a factor of three. 69 per cent of the women were single. Informal trading occurs near the farm and the camps and on pay day young women from the area flock to the bars. These women are described as being movious' and too promiscuous, and are blamed for the spread of STDs. These girls are seen to be beyond control and local men say it is hard for them to find steady girlfriends.

There are types of sexual strategies adopted by the women: abstinence and/or self control - due to parental control, fear of diseases: multiple partners - there are some open prostitutes who have many partners, charging 3,000-5,000 kwacha per round'; serial boyfriends and casual contacts - this is more common, and girls and young women aim to have one boyfriend at a time, also steady boyfriends, husbands and lovers, which are more common for older women.

Beliefs regarding the relationship between extra marital sex and sickness are described. The traditional 2 year post-partum abstinence is described as discouraging pregnancy as it prohibits girls from having boyfriends and making money. Sexual favours between the women and the work supervisors are common and are described. 39 per cent of women stated that they brew beer in their spare time. Young women expect men to give financial support, in the form of money (which is often collected on pay day), food, biscuits, blankets, combs, hairbands etc. Accepting gifts is considered a sign that the woman has consented to sex. Lack of gifts indicates a lack of respect. Dry sex is discussed - agents include porridge', salt, cold water, tealeaves and pounded herbs. Few women say that dry sex is painful, and some men complain if the woman is too wet'. Women say that they expect at least two ejaculations from the male in one session, or two rounds'. Condoms are often rejected because the lubricating action of the condom negates the aims of dry sex. Married women often associate condoms with prostitution.

(#127) "High-risk sexual behaviour among some female Zambian out-of school adolescents: a possible future application of the value utilization/norm change model"
Feldman, D.A.,(1995) Paper presented at the Society for Applied Anthropology Meeting, Albuquerque, 1995.
Geographical area: Lusaka; Keywords: Adolescents, KAPB, condoms; Location: UNICEF

Objectives:
To assess the level of unsafe sexual behaviour in the area of high HIV seropositivity among adolescents in Lusaka, Zambia.

Methods:
In-depth interviews were conducted with 276 adolescents between the ages of 14 and 20. Participant observation, Focus Group Discussions (FGDs) and other research models were utilised during the study which was carried out during a 14 month period in 1992-1993.

Results:

• A subset of the 60 out-of-school females interviewed, but generally not the in-school males, the in-school females, or the out-of-school males, were found to be having atypical high risk sex, including unprotected anal intercourse. These adolescents were having sex primarily with middle-aged Zambian men, who were much more likely to be HIV seropositive than adolescent males and more likely to involve the girls in very risky sex.
• Among those who were sexually active in the previous 12 months with someone other than their boyfriend, 90 per cent of the girls (36 out of 42 out-of-school females and 9 of 10 in-school females) had received money or gifts for sex.
• . Fifty of the 60 out-of-school females have been sexually active. Female masturbation was extremely rare, occurring among only 3 out-of-school girls and 9 in-school girls.
• Vaginal intercourse was fairly common among these adolescents, who averaged in the age of 17.2 years among the boys and 16.5 years among the girls. Nearly half of the out-of-school girls, but only 19 per cent of the others engaged in fellatio (oral sex). Of the 16 girls who reportedly swallowed semen of their partner, 14 were not school girls. 24 of the 29 female adolescents (out-of-school) received cunnilingus; only 3 of the boys ever performed cunnilingus.
• Twenty-one of the 28 adolescents who engaged in anal intercourse were out-of-school girls. Only 4 of the 21 out-of-school girls, and none of the 7 other adolescents ever used condoms while engaging in anal sex. 7 adolescents (all out-of-school girls) performed anilingus (mouth to anus contact); while 4 adolescents (again all out-of-school girls) received anilingus.

Conclusions:

• A subset of the out-of-school girls are having sex with older men who are introducing the young females to a variety of sexual behaviours, including unprotected anal intercourse, receiving cunnilingus, performing unprotected fellatio and swallowing semen, and engaging in anilingus. These older men are substantially more likely to be HIV infected than are the adolescent males, and undoubtedly function to increase HIV seropositivity in sexually active out-of-school girls.
• An effective method to change behaviour in general for HIV prevention among Zambian adolescents would be through developing peer-led risk reduction workshops.
• The value utilization/norm change (VUNC) model may be of value in explicating change at the sociocultural level.

(#128) "HIV prevention among Zambian adolescents: developing a value utilization/norm change model"
Feldman, D.A., O'Hara, P., Baboo, K.S., Chitalu, N.W., (1995) unpublished.
Geographical area: Lusaka; Keywords: Adolescents, behavioural change; Location: UNICEF

Peer-led interventions are effective in reducing risk for HIV among adolescents. A study was conducted to determine how to successfully carry out such an intervention in urban Zambia. Ethnographic and sexual data were collected on males and females both attending and not attending secondary school. This paper reviews the cultural background of Zambian adolescents and presents an overview of the study results. A value utilization/norm change (VUNC) model is developed which is intended to provide a conceptual framework for understanding how to utilise selected core values of the adolescents to strengthen or alter norms within the social networks to elicit desired HIV risk reduction.

Objective:
To determine whether and how a proposed peer-led behavioural intervention project to reduce risk for HIV among Zambian adolescents could be successfully achieved.

Methods:
During May 1992- June 1993, we conducted a study at several locations in Lusaka: a co-ed public secondary school, an all-male secondary school, an all-female secondary school, a community centre at a residential compound, and a few adolescents were interviewed at community centres in other compounds in Lusaka. An equal number of in-school and out-of-school adolescents (14-20 years old) were systematically interviewed. A few interviews were also conducted in three rural villages. A total of 276 interviews (78 out-of-school boys, 76 in-school boys, 60 out-of-school girls, and 62 in-school girls) were interviewed. The interviews probed into the knowledge, attitudes, beliefs, values, social behaviour, and sexual practices of the Zambian adolescents. Ethnographic observation occurred in various sites throughout Lusaka. These included observing and having casual conversations with adolescents at discos and shopping areas. Detailed field notes were maintained daily. 12 FGDs of students, out-of-school youth, and ritual initiators, were conducted. A group discussion with teachers at one school was held. Discussions were held with health and education planners and officials in Zambia. A written assessment of HIV-related printed materials were made by 20 students. An exercise where 16 students were asked to select what they value most in life was conducted, and compared with comparable data from a group of high school students in an American city. In addition, a peer-led trial risk reduction training session and workshop was conducted over a two-day period.

Results:

• The mean age of the adolescents interviewed was 16.9, with a range of 14 to 20. Males were slightly older at 17.2 years than females at 16.5 years. The mean number of years of education was 8.6, with a range of 0 to 12. The out-of-school youth had a mean of 6.4 years of education, while the in-school youth had a mean of 10.8 years. Out-of-school males had somewhat more schooling (7.4 years) than out-of-school females (5.2 years).
• Religion was very important to most adolescents (91 per cent); it was not important to only eight (3 per cent). Evangelical churches have played an important role in Zambia in promoting fidelity in marriage and attacking pre-marital sex in Zambia. However, their emphasis against condoms has perpetuated the widespread view in Zambia that condoms do not work at all (i.e. it is believed that they are totally ineffective in HIV prevention).
• 87 per cent of the subjects have had a girlfriend or boyfriend, including those who were self-identified virgins. Most (74 per cent) actively had a girlfriend or boyfriend at the time of the interview. Forty-five (17 per cent) had two or more partners simultaneously, though only two of the school girls had more than one partner. Only one subject was married. Fifty-seven adolescents (21 per cent), including over half (53 per cent) of the school girls, claimed to be virgins.
• Most (71 per cent) of the compound boys who were sexually active during the previous 12 months gave either money or gifts for sex at least on some occasions. Only three of 51 (6 per cent) adolescent females gave either money or gifts, and then only rarely or sometimes. Most (90 per cent) of the girls who were sexually active during the same time period received money or gifts for sex at least on some occasions. 13 of the boys reported that they sometimes received money or gifts for sex from females.
• Most of the adolescents (76 per cent) knew someone with AIDS, or someone who has died of AIDS. They often have family members living in their household with AIDS. Most (88 per cent) see AIDS as a serious threat to their local community. The majority are very worried about themselves getting AIDS, especially the out-of-school youths when compared to the in-school youth (p =0.000). Compound girls were most worried, while school girls are the least worried. However, more than half (55 per cent) believe that their chances of getting AIDS are nil or very small, especially among the in-school youths when compared to the out-of-school youths (p=0.000); 25 per cent of the adolescents, mostly out-of-school girls, believe that their chances of getting AIDS are strong/very strong.
• Most adolescents were aware that shaking hands with a person with AIDS was not a risk for AIDS. Only 8 per cent of the adolescents (mostly the compound boys) thought it was a very great risk.
• Over half of the informants (55 per cent) agree that they need to change their behaviours to prevent AIDS. The majority (59 per cent) admit that they have not changed their behaviours, though about half of the compound girls (52 per cent) say that they have changed. Only 64 (40 per cent) of the 156 informants who have not changed their behaviours intend to do so in the future. Most (86 per cent) feel that they are capable of changing their behaviours, although the majority (22 of 38) of those who were not sure if they could change, or were certain that they could not change, were compound boys.
• Over half of the sexually active adolescents (53 per cent) had never used a condom. Most (76 per cent) agreed that they would use a condom if their partner asked them. But 36 adolescents (13 per cent) adamantly said they would refuse to do so. 13 informants claimed that they experienced breakage or slippage with condoms in the last 12 months. Most informants with a regular partner (149 of 189, 79 per cent) had had sex with their girlfriend or boyfriend in the previous four weeks, except for school girls (14 of 30, 47 per cent). Only 11 of 149 informants (7 per cent) had used a condom with their boyfriend in the previous four weeks each time they had sex; 49 informants (33 per cent) sometimes used a condom; 89 (60 per cent) did not use one at all. Only 4 of the 109 informants (4 per cent) used a condom with a sex partner other than their boyfriend or girlfriend in the previous four weeks each time they had sex; 42 informants (39 per cent) sometimes used a condom; 63 (58 per cent) did not use one at all.

Conclusions:
In order to change the sexual behaviours of adolescents, a value utilization/norm change (VUNC) model may be of additional heuristic value in explicating change at the sociocultural level. The elements of this approach include:

• ethnographic field work - establishing the salient aspects of cultural thought and behaviour in a social environment or network;
• domain/consensus analysis - determining through systematic data collection the core values, social norms, and other beliefs, and the level of consensus within the social network;
• analysis and selection of core values and social norms - evaluating and selecting pertinent core values which would support the existing social norms which could be utilised to bolster desired behaviours, which would contradict those existing social norms that mitigate against the desired behaviours, or which would be useful in strengthening weak social norms to produce the desired behaviours;
• peer leader training - train peer leaders to utilise the selected core values and social norms to produce desired behavioural change;
• intervention - within a social network or group setting, reassert the selected core values and social norms to demonstrate the connectivity of these values and the existing or new norms to the desired behaviours; f) assessment - assessing the direction and magnitude of behaviour change.

[Table of Contents] [AIDS/Zambia Index] [Bibl. Contents] [Alphabetical Index] [Zamnet] [UNZA] [UNZA Library]

Last updated February 4, 1999

UNIVERSITY OF ZAMBIA Med Guide      Index    Zamnet    UNIVERSITY OF ZAMBIA    UNIVERSITY OF ZAMBIA Library 

CONTACTING SCHOOL OF MEDICINE     OTHER INSTITUTIONS   BACK TO SOM HOME PAGE     DEPARTMENTS    Central Board of Health 

Send comments and/or suggestions to: Stan chewe 
Copyright © 1996-2001, The University of Zambia Medical Library and Stan Chewe
Guide to Medical Resources WWW site: http://www.medguide.org.zm/