HIV knowledge and risk among Zambian adolescent and younger adolescent girls: challenges and solutions

In sub-Saharan Africa, young women are at the highest risk of HIV infection. Comprehensive sexuality education and open parent–child communication about sex have been shown to mitigate risky sexual practices associated with HIV. This study aimed to identify sources of HIV prevention knowledge among young women aged 10–14 years and community-based strategies to enhance HIV prevention in Zambia. Focus group discussions were conducted with 114 young women in Zambian provinces with the highest rates (~20%) of HIV. Discussions were recorded, transcribed and coded, and addressed perceived HIV risk, knowledge and access to information. Participants reported that limited school-based sexuality education reduced opportunities to gain HIV prevention knowledge, and that cultural and traditional practices promoted negative attitudes regarding condom use. Parent–child communication about sex was perceived to be limited; parents were described as feeling it improper to discuss sex with their children. Initiatives to increase comprehensive sexuality education and stimulate parental communication about sexual behaviour were suggested by participants. Culturally tailored programmes to increase parent–child communication appear warranted. Community-based strategies aimed at enhancing protective sexual behaviour among those most at risk are essential.     

Secret languages of sex: disabled youth’s experiences of sexual and HIV communication with their parents/caregivers in KwaZulu-Natal,South Africa

Various health promotion strategies have been implemented in South Africa aiming to encourage young people to talk about issues of sexuality and HIV with their parents/caregivers. Although parent/caregiver sexual communication may be an effective method of influencing sexual behaviour and curbing the incidence of HIV, very little is known about how young people with disabilities in South Africa communicate about these traditionally difficult subjects with their parents/caregivers. Based on findings from a participatory study conducted amongst 15–20-year-old Zulu-speaking youth with physical and visual disabilities, this paper explores how they perceive youth–parent/caregiver communication about sexuality and HIV. Using Foucauldian discourse analysis, the paper outlines how disabled youth–parent/caregiver sexual communication is governed by cultural customs, sexual secrecy and constructs of innocence. It also argues that the experiences and perceptions of young people with disabilities are critical to the development of future interventions to assist parents/caregivers develop communication strategies that help disabled young people make sense of sexual behaviour.     

Poles apart? Gender differences in proposals for sexuality education content

Are young women and men’s preferences for sexuality education content poles apart? This article explores gender differences in senior school students’ suggestions for issues sexuality education should cover. Findings are analysed in relation to debate about mixed and single sex classrooms and boys’ perceived disinterest in lessons. It is argued that young women and men’s content preferences were largely similar on items that a majority selected for inclusion. Topics less than half of participants named revealed a greater number of gender differences. Employing theoretical insights from feminist post‐structuralism, responses are also examined for how they position young people as sexual subjects and whether these conform to or deviate from perceptions of ‘conventional heterosexualities’. This examination enables an understanding of how young people view themselves as sexual and whether this matches their constitution within sexuality programmes. The implications of students’ content preferences and the way these position them as sexual subjects are considered for the possibilities they present for programme design and delivery.     

‘Due to all this fear,we’re getting less freedom’: young people’s understandings of gender and sexual violence in New Delhi,India

This paper explores young people’s understandings of gender and sexual violence in New Delhi, India, based on multi-method research conducted with young people (aged 15–17) in three co-educational secondary schools. Fieldwork took place shortly after the 2012 Delhi gang rape that sparked widespread debates about violence against women in India, and so sexual violence became an important frame for students’ discussions around gender and sexuality. Young people’s understandings are considered within gender narratives – of ‘can-do’ and ‘vulnerable’ girlhood, and of ‘hero’ and ‘good boy’ masculinities – which already shaped their day-to-day experiences of schooling. Findings suggest that tensions arising from these often contradictory narratives led to frustrations among girls, while the dominance of conversations about sexual violence led to confusions in both girls’ and boys’ understandings of sexuality. Reflections are offered on ways schools can better support young people as they learn about gender and sexuality from diverse and contradictory sources.     

“Your Vagina Is Not Supposed to Be This Scary Monster”: Young Heterosexual Women's Recommendations for Improving Sexual Satisfaction and Implications for Sexuality Education

Sexual satisfaction is an important component of sexuality, yet rarely discussed in sexuality education. In an effort to better understand young adult women's experiences and thoughts about sexual pleasure and satisfaction, we conducted interviews with heterosexual young women (N = 30, ages 18–25) attending college, asking their recommendations on how to improve women's sexual satisfaction. Two coders utilized grounded theory-based thematic analysis, which revealed three dominant themes: communication with sexual partners, sexual self-awareness and acceptance, and sources of information and education. All three themes fit broadly under women's sexual agency and societal acceptance of women's sexuality. Themes are discussed in relation to their applicability to sexuality education.     

The role of parents and peers in understanding female adolescent sexuality – testing perceived peer norms as mediators between some parental variables and sexuality

Previous research has confirmed peers and parents as significant agents of socialisation with respect to young people’s sexuality. The aim of this cross-sectional cohort study was to examine how parental and peer variables predict young women’s sexual behaviour and sexuality-related thoughts and emotions, and whether perceived peer influences mediate the relationship between parental variables and young person sexuality. A total of 560 female high school students of 1st (mean age 15.56 years) and 3rd grade (mean age 17.55 years), selected by means of two-stage stratified probability sampling participated in the research. Results confirmed that peer variables explained considerably more variance in participant sexuality than parental variables. Indirect parental communication about sexuality was a significant positive predictor of sexual behaviour and sexuality-related thoughts and emotions in both subsamples. The strength of direct and indirect influences of parents and peers on young people’s sexuality is determined by the age of the young person and specific aspects of adolescent sexuality. Perceived percentage of sexually active peers was the only mediator in older participants, while in the younger subsample, additional peer variables mediated the association between some parental and sexuality variables. In the discussion, special attention is given to implications of these results for planning future forms of comprehensive sexual education.     

‘I don’t want to catch it’. Boys,girls and sexualities in an HIV/AIDS environment

This paper examines young South African school children’s understanding of HIV/AIDS. Based on ethnographic work in two schools in Greater Durban, it explores the impact of HIV/AIDS on the ways in which gender and sexuality are articulated against the backdrop of race and class specific contexts. The first part of the paper examines the children’s discourses of sex, sexuality and HIV/AIDS. We show that young children’s meanings of sex, sexuality and are not straightforward and are actively produced and defined through a range of social processes. These processes shape the extent to which young children experience sexuality within discourses of fear and pleasure. Young children’s meanings of HIV/AIDS are explored in the second part of the paper. Here we show how their knowledge of HIV/AIDS is socially structured through class/race and gender and these forms of social relations provide the framing and reference points for children’s constructions of meanings around HIV/AIDS. We finish the paper by raising some theoretical and practical/political questions about the implications of what we have found for HIV/AIDS education in South Africa.     

HIV/AIDS knowledge, attitudes, and risk-behaviors among African-American and Caribbean college women

The HIV/AIDS knowledge, attitudes, and sexualrisk-taking behaviors of a sample ofAfrican-American and Caribbean college wereinvestigated. The study also explored therelationship between the women's self-esteem,self-efficacy, sexual communication, andreligiosity and their HIV knowledge, attitudes,and risk behaviors. Findings revealed thatwhile both groups of women were fairlyknowledgeable about HIV/AIDS transmission andprevention, their sexual risk-taking behaviorswere still relatively high. TheAfrican-American women were more knowledgeableabout HIV/AIDS than were the Caribbean women. Also, the African-American women engaged insignificantly fewer sexual risk-takingbehaviors than their Caribbean femalecounterparts. No significant cultural groupdifferences emerged on attitudes towardHIV/AIDS as a disease, HIV infected persons,and AIDS-related issues. A number ofsignificant correlations were found. The studyconcludes that HIV/AIDS counseling andprevention approaches that are ethnic,cultural, and gender appropriate are vital forincreasing both cognitive and behavioralchanges in culturally diverse young women.     

‘Learning the basics’: young people’s engagement with sexuality education at secondary schools

School-based sexuality education remains a key response to the HIV epidemic. Drawing on findings from an ethnographic study, this study explores how young people engage with sexuality and HIV- and AIDS-related education as it is delivered through the Life Orientation (LO) learning area in South Africa, in order to understand the dynamics that support or hinder engagement. Focus group discussions were held with Grade 9 and 11 learners (aged 14–18 years) from 16 randomly selected public secondary schools across three provincial districts. Results show that enjoyment of LO education was related to perceived relevance and distinctiveness, informal lesson delivery, subjective assessment standards and seemingly minimal effort. However, the perception of reduced effort tarnished the status of LO and young people’s motivation to participate. Learner engagement is influenced by a variety of cognitive, affective and behavioural pathways including internalised discourse around HIV and AIDS, gender and sexuality; the quality of youth–educator relations and teaching competencies; peer pressures; and broader cultural dynamics. The cultivation of a learning environment in which young people share and debate their views promotes engagement and critical thinking. In-service and pre-service educator training, structured activity plans and monitoring are recommended to advance the content knowledge and pedagogy of educators.     

Young people’s everyday romance and sexual experiences in relation to sex-related conversations with parents: a diary study in the Netherlands

This study builds on existing research into how young people’s emergent sexual development is connected to parent–child sex-related communication through avoidance vs. disclosure. Over the course of one year, a total of 21 young people (age range 12–17.5) reported in longitudinal qualitative diaries their (1) everyday sexual experiences and (2) sex-related conversations with their parents. Using a mixed-methods approach, findings show that less sexually experienced participants reported greater avoidance of parent–child sex-related conversations than more experienced participants. The sex-related conversations of more experienced participants mainly concerned overt experiences in the form of everyday issues with their romantic partner, while the conversations of less experienced participants were characterised by more covert experiences such as opinions about romantic relationships in general. These results suggest that the degree to which young people feel comfortable talking about sexuality with their parents partly depends on when the conversation takes place during a young person’s romantic and sexual development.     

Navigating a bumpy road. Developing sexuality education that supports young people’s sexual agency

The complexity of young people’s strategic negotiation of sexual agency constitutes a challenge for professionals working in the area of sexuality education. This paper explores how comprehensive sexuality education can support young people to develop sexual agency in all its forms: embodied, bonded, narrative and moral. A first step is to base sexuality education on the recognition of the connectedness of young people to different people and to different sexual cultures. This implies that comprehensive sexuality education should provide the tools that can help young people in the process of taking up a position, forming an identity and embodying a sexual self within their own social and cultural context. Moreover, comprehensive sexuality education should not only be aimed at empowering individuals, but should also address different sexual cultures, gender norms and other social norms, to stimulate critical consciousness and collective agency, and thereby create an environment that enables and supports young people’s agency and diminishes inequality and restrictive norms.     

‘Culturespeak’ is everywhere: an analysis of culturalist narratives in approaches to sexuality education in Mozambique

ABSTRACT

Building on postcolonial feminist scholars and critical anthropological work, this paper analyses the frequent deployment of the notion of ‘culture’ by decision-makers, educators, international agency staff and young people in the design, delivery and uptake of sexuality and HIV prevention education in Mozambique. The paper presents qualitative data gathered in Maputo, Mozambique to highlight the essentialising nature of culturalist assumptions underpinning in-school sexuality education. I argue that conceptions of ‘traditional’ and ‘modern’ culture are deployed to explain the epidemic, both of which spectacularise and decontextualise phenomena and practices, and perpetuate the western trope of the Third World Woman. The paper concludes by arguing that a singular emphasis on ‘culture’ – in its various guises – diverts attention from structural causes of young Mozambican women and men’s vulnerability to HIV and AIDS, and crucially, rather than problematise gender relationships, reifies and solidifies these. Thus, while sexuality and HIV prevention education cannot be understood or delivered independently of the cultural context in which it is situated, a more nuanced conception of culture is required – that is, one that is attentive to questions of power and specifically, who is in a position to make meanings ‘stick’.     

Framing gender identity and sexual orientation: media influence on young men who have sex with men’s health

Sex education takes place in a wide range of contexts including through the media. Media use among young men who have sex with men is high and gender identity and sexual orientation are topics often integrated into today’s media. Little is known about young men who have sex with men’s perceptions of how the media frames messages about gender identity and sexual orientation and the implications these messages have on HIV prevention. A greater understanding of young men who have sex with men’s perceptions of media framing about gender identity and sexual orientation is needed to ensure prevention efforts reach those most impacted by HIV. Focus groups were conducted with forty-two African American men who have sex with men, aged 18–21, living in the Southeastern USA. Thematic analysis revealed that participants reported using the Internet and television to access gender identity and sexual orientation information. Participants felt that the media’s framing of gender identity and sexual orientation only worsened HIV-related stigma and discrimination. Findings illustrate the important role that media can play in educating about gender identity and sexual orientation and the implications this framing has for HIV prevention.     

Sexual behaviour profiles of HIV-positive youth in the Netherlands

Young people living with HIV are challenged when it comes to exploring their sexuality. Their sex education is hampered by the fact that their preferences and attitudes towards sexual behaviour are little known about. In this study from the Netherlands, Q-methodology was used to identify sizeable and meaningful sub-groups sharing common attitudes and viewpoints. Thirty of 48 eligible HIV-positive young people aged 12–21 years treated in one of the four Dutch HIV centres rank-ordered 45 statements on the topic. Thereafter, they explained their ranking. By-person factor analysis identified five distinct sexual behaviour profiles (SBPs): (a) safer sex & disclosure to steady partner; (b) motivated by faith and culture; (c) disclosure to good friends, values peer support; (d) conscientious, worries about disclosure and future; (e) self-confident, faith and family are important. Profiles differ in terms of the roles of culture and religion, the influence of family and friends, personal views about disclosure of HIV status, knowing the transmission mode, and viral load. Study results indicate that different approaches to sexual health education are required based on these different orientations. Q-sorts and SBPs may be helpful in discussing sexual behaviour with HIV-positive young people and in developing tailored strategies to meet their interests and needs.     

Learning to negotiate sexual relationships: a girls’ school in Tanzania as a restrictive and agentic site

Literature on schooling in Africa often frames sexual relationships as threatening girls’ educational participation, health, and general well-being. Schooling practices aimed at sheltering girls reflect the prevalence of discourses emphasising danger and abstinence. This article presents the case of one all-girls school in Tanzania which provides a protective environment while also teaching young women strategies to negotiate sexual and romantic relationships. Drawing on classroom observations and in-depth interviews, we examine how the school's policies, practices, and lifeskills curriculum offer students a supportive environment in which to learn about relationships. Our analysis reveals that young women find this space simultaneously restrictive and freeing, and that their learning has supported their ability to imagine equitable relationships for themselves. This case contributes to our understanding of how schools can serve as sites that foster young women's agency when curriculum and pedagogy create space for open discussion of sexual relationships.     

“Looking at the Real Thing”: Young men,pornography, and sexuality education

This article examines the sexually explicit comments and references to pornography in young men's answers to a survey about sexuality education. Instead of viewing these remarks as simply impertinent and therefore discountable, I argue that they offer insights into the constitution of masculine identity and an erotic deficit in sexuality education. Many of these comments make requests for the inclusion of enfleshed (female) bodies in sexuality programmes and the use of pornographic materials (i.e. videos, magazines). These responses can be seen to represent a challenge to school authority in the way they are laden with “shock” value and push at the discursive limits of “sexual respectability”. In a school environment that seeks to deny the sexual and contain student sexuality, these statements symbolise an assertion of young men's sexual agency. Young men's remarks also offer a critique of sexuality education that is de-eroticised and which denies them as positive and legitimate sexual subjects. The implications of these comments for how sexuality education might be conceptualised are considered.     

Attitudes towards sexuality information for adolescents: what parents should and should not say

The goal of this study was to investigate the attitudes of Colombians with respect to what can and what must not be said to young people of different ages and genders regarding sexuality. A convenience sample of 329 adults, aged 18–64 years, living in Bogotá participated in the study. They were presented with a set of 36 vignettes describing situations in which either a young girl or a young boy seemed to be concerned about sexuality and sexual relationships. Each scenario contained three items of information: the child’s gender, age and the parent’s decision (e.g. not to say anything regarding sexuality). Through cluster analysis, seven qualitatively different sets of attitudes were found. The five most common ones were: (i) it is never appropriate to talk about sexual matters (6%); (ii) delegate this responsibility to the school nurse (4%); (iii) provide incomplete information restricted to the biology of sexuality (11%); (iv) provide comprehensive information but with a recommendation of abstinence (28%); and (v) provide comprehensive information and a recommendation of pre-marital sexual experience (36%). Although it was expected that attitudes would vary as a function of the young person’s gender and age, such variations proved to be limited in their extent.     

Globalization,public policy,and ‘knowledge gap’: Ethiopian youth and the HIV/AIDS pandemic

Set against trans‐ or supra‐national policy initiatives which have framed the HIV/AIDS pandemic as in part a pedagogical issue, this paper critically explores local understandings of sexual practices (generally) as well as of HIV/AIDS (more specifically) among young people in the sub‐Saharan African country of Ethiopia. Ethiopia has the third largest number of HIV/AIDS infections in the world, behind only South Africa and India. Like many countries dealing with this pandemic, the Ethiopian government has articulated its response to a broader set of global presses, including those around information and education. Such responses, we will argue, are helpful but have important limitations. As this study shows, knowledge about safer sex practices and the dangers of HIV/AIDS are by now well known among many Ethiopian youth. Yet, this knowledge does not always effect behavioral change. Taking condom use as a key exemplar, we will look at how Ethiopian youth narrate their own sexual experiences, conduct, and practices. Deeply informed by the work of Pierre Bourdieu, we look to open new ‘thinking tools’ for a range of actors addressing this global pandemic in situated contexts. In particular, we challenge the ‘pedagogical subject’ – a subject lacking key information – interpolated into many of these policies. We highlight, instead, new disjunctures between emergent discourses around sex and sexuality as well as long‐standing, conservative attitudes toward gender.     

Notions of sex,sexuality and relationships among adolescent boys in rural southeastern Nigeria

Although young people in Nigeria become sexually active at a very early age, little is known about how they view sex, sexuality, and relationships with the opposite sex. Yet knowledge of their notions and expectations regarding these issues has the potential to improve care and inform the development of sexuality education programmes. This paper reports the findings of a study which relied on in‐depth individual interviews and focus group discussions to investigate notions of sex, sexuality, and relationships among 120 boys aged 10–21 in rural southeastern Nigeria. Emerging data suggest that the popular images of sex, sexuality, and relationship among the boys support the notion of the cult of the male, which consists in a heady mixture of paternalism, systematic subordination of girls, and the glorification and idolization of male sexuality and sexual prowess. Boys generally held a penis‐centred view of sex and tended to liken sexual intercourse and relationships with girls to encounters during which girls were conquered, subdued, and demystified. The ideology of a double standard, in which males feel morally and physically edified by multiple sex encounters and viewed females as morally demeaned by the same, was observed among the boys. The findings show the need for approaches to sexuality education to be sensitive to the cultural contexts within which these notions are formed and sustained among boys in local communities.     

Gender differences in South African men and women's access to and evaluation of informal sources of sexual and reproductive health (SRH) information

While much research has documented unsatisfactory sexual and reproductive health (SRH) awareness among young people in South Africa, understanding of gender differences in access to and evaluation of SRH information is limited. This paper concerned itself with men and women's informal sources and content of SRH, and gendered divergences around accessibility, evaluation, and impact of such information. Fifty sexual history narrative interviews and twenty-five narrative interviews with women were conducted with participants purposively sampled from a range of ages, cultural and racial backgrounds, and in urban and rural sites across five provinces in South Africa. Data were analysed using thematic analysis. While young women were more likely to learn about SRH information from family members, they also reported greater regulation concerning their sexuality. This could enhance stigma surrounding women's sexuality and hinder open communication. Men predominantly learned about sex through pornography and peers, which was reported to encourage sexual prowess to the neglect of practising safer sex. Lack of adequate SRH instruction for young people as revealed through the narratives had significant and often negative implications for men and women's early safer sex behaviours. In response to these insights, recommendations are offered to strengthen informal sources of SRH awareness.