African Population Studies/Etude de la Population Africaine, Vol. 18, No. 2, Oct 2003, pp. 91-104

Poverty and Sexual Risk Behaviour among Young People in Bamenda, Cameroon¹

RWENGE Mburano Jean Robert

Code Number: ep03012

ABSTRACT

Adolescents’ sexual activity is associated with maternal and child health problems, including sexually transmitted diseases and HIV/AIDS. The purpose of this paper is to show that living conditions of families influence sexual behaviours among young people in urban areas in Cameroon. The study hypothesis is that poverty motivates both young males and females to engage in risky sex. The study use data from the survey on the Sexual Behavior of the Young People of Bamenda, which was conducted in August 1995. Multivariate logistic regression analyses were used to highlight the importance of the influence of socio-economic variables on the youths’ ability of being sexually active, of having more than one sex partner, of having had casual sexual relations and of not using condoms. Our findings support the above hypothesis. Indeed, young people whose fathers were unemployed and those who lived in poor households were more likely to have multiple sexual partners or to have had casual sexual relations than others in the year preceding the survey. Multivariate logistic regression analyses highlighted also that young people who had not lived with both parents and had insufficient means to satisfy their needs were more likely than others to have multiple sexual partners or to have had casual sexual relations. Qualitative data validated the above results.

RÉSUMÉ

L’activité sexuelle des adolescents est associée aux problèmes de santé maternelle et infantile, y compris les maladies sexuellement transmissibles et le HIV/SIDA. L’objectif spécifique de cet article est de montrer que les conditions de vie des familles influencent les comportements sexuels des jeunes en milieu urbain au Cameroun. L’hypothèse de travail est que la pauvreté incite aussi bien les jeunes garçons que les jeunes filles à adopter des comportements sexuels « à risque ». Les données utilisées sont issues de l’enquête sur la sexualité des jeunes de Bamenda, qui a été menée en août 1995. Les modèles multivariés de régression logistique ont été utilisés pour mettre en évidence l’effet des variables socio-économiques sur la probabilité d’être sexuellement actif (ve) au moment de l’enquête, d’avoir eu plus d’un (e) partenaire sexuel (le) au cours des douze derniers mois précédant l’enquête, d’avoir eu les rapports sexuels occasionnels au cours de la même période et de ne pas utiliser les condoms au moment de l’enquête. Nos résultats confirment notre hypothèse de travail. En effet, les jeunes dont les pères sont inactifs et ceux qui vivent dans les ménages pauvres courent plus de risque que d’autres d’avoir eu plusieurs partenaires ou d’avoir les rapports sexuels occasionnels au cours de la période de référence. De même, les analyses effectuées ont révélé que les jeunes qui ne vivent pas avec leurs deux parents et qui n’ont pas assez de moyens pour satisfaire leurs besoins courent plus de risque que d’autres d’adopter les mêmes comportements au cours de cette période. Les données qualitatives nous ont permis de valider ces résultats.

INTRODUCTION

The purpose of this paper is to show that living conditions of families influence sexual behaviour among young people in urban areas in Cameroon. The study hypothesis is that poverty motivates both young males and females to engage in risky sex. The study uses data from the survey on Sexual Behaviours of the Young People of Bamenda, which was conducted in August 1995. Multivariate logistic regression analyses were used to highlight the importance of the influence of socio-economic variables on the youths’sexual activors, of having more than one sexual partner, of having had casual sexual relations and of not using condoms. Our findings support the above hypothesis.

Adolescence may be defined as a transitional phase between childhood and adulthood. During this transitional period, the child is amazed by the transformations that lead to the appearance of his secondary sexual characteristics and is buoyed up by a very strong sentiment of autonomy, independence and invulnerability. Suddenly, he tries to take personal decisions without the permission of parents, elders and others. Unfortunately, due to immaturity, which is a characteristic of their age, adolescents easily engage in adventurous sexual activities, which are risky for their health.

Adolescents’ sexual activity leads to early pregnancies. These are associated with maternal and child health problems. It has been demonstrated in health studies that numerous complications are associated with pregnancies among young mothers because of their physiological immaturity. Maternal mortality risk is 5 to 7 times higher before 15 years than between 20-24 years (Stars 1987; cited in Calves 1996). Early pregnancies also have negative consequences on children's health.

It has also been established from EMF and EDS data that infants’ morbidity and mortality risks are higher among young mothers (Akoto and Hill 1988 cited in Rakotondrabe, 1996; Legrand et Mbacke, 1992). One of the explanatory hypotheses for this relation is that early pregnancies are associated with premature births and low weight babies at birth (Cochrane et Farid 1985 cited in Calves, 1996). In societies where illegitimate babies are not welcomed, early pregnancies are also accompanied with a high frequency of clandestine abortions, with often very dramatic consequences.

Young girls are exposed to STD/AIDS when they get involved in sexual activities. Young boys are also concerned with this problem but the former are more vulnerable than the latter. Indeed, it has been observed that young girls have regular sexual relations with older people for economic reasons (Calves, 1996; Rwenge, 2000, 2002, 2003a, 2003b). This kind of sexual activity has also been observed among young boys (Calves, 1996). However, young girls run more risk in contracting STD/AIDS than young boys as generally they do not negotiate and do not insist on the use of condoms because of economic constraints (Worth, 1989; Rwenge, 2002, 2003a).

Besides the well-known STD (syphilis, gonorrhoea…), AIDS occupies a significant position among the consequences of youths' sexual activities. Its rapid propagation is a worry to all social actors. Within two decades only, it has become, with malaria, one of the major causes of mortality in Africa (Bongaarts and Way, 1992). In Cameroon, for example, the prevalence rate increased from 1% in 1985 to 11% in 2001. The rate of HIV infection in sub-Saharan Africa is higher within the age range of 15-19 years than in other continents, particularly among girls (ONUSIDA, 2000).

In focusing on adolescents’ sexual activities and reproductive health, national and international crusades against STD/AIDS aim to bring young people to adopt responsible sexual behaviours. As there is yet no vaccine against AIDS, all effective strategies are based on prevention: abstinence, fidelity and condoms use. Thus, STD/AIDS prevention programmes in Cameroon aim, among other things, to sensitise youths about the raison d'être of sexual abstinence before marriage and the use of condoms. This study was carried out in order to contribute to a profitable orientation of these programmes by providing the relevant data. Its specific objective is to show that poverty is a determinant of risky sexual relations among adolescents in Bamenda, the capital of the Cameroon Northwest province.

Bamenda had a population estimated at about 111,000 in the 1987 census; a large proportion of its inhabitants are younger than 25. The city is home to several ethnic groups: the Makon-Banyague, the Metta, the Bali-Ngemba, the Tikari-Nsoh and the Bamiléké. Since the beginning of the 80s, the Cameroon is going through a serious economic and financial crisis. The devaluation of the CFA franc in comparison with the French franc in a ratio of 1 to 2 has furthermore increased the gravity of the crisis, by reducing the per capita income for large sections of the population and increasing the cost of basic social services. This describes the economic context in which many young people live in Bamenda. It predisposes them to a variety of high-risk encounters of both sexual and non-sexual nature.

Many explanatory studies on factors of adolescents’ sexual behaviours have been carried out in Africa. Three types of factors emerge from these: the socio-cultural, socio-economic and institutional factors.

The most powerful stimuli for the adoption of a safe sexual behaviour are, according to the socio-cultural approach, more external to the individual, or linked to the pressure of the social group, than internal, or resulting from the personal awareness about the risks associated to sexual activity. In other words, the only limits to sexual activity are essentially external constraints, which are imposed on the individual by the society (Rwenge, 1999a, 1999b). Therefore, according to this approach, sexual activity cannot be “disocialized”; sexual acts would be spontaneous and would not be motivated by any particular objective (Diop, 1995). One of the expressions of this approach is based on the thesis according to which the sexual activity of youths in urban areas is explained by "social disorganization", the weakness of social control or the slackening of sexual morals (Calves, 1996). This thesis is part of the general theory of modernization, which is based on the weakening of traditional structures and the loss of control over youths by their elders. The new behaviours that follow are highly oriented towards personal satisfaction and individual gratification than family responsibility (Diop, 1995).

The socioeconomic approach considers adolescents as rational actors. This approach is based on the principle that adolescents engage in sexual activity for economic reasons (Cherlin and Riley, 1986; Feyisetan and Bankole, 1991; Meekers, 1995; Calves, 1996; Rwenge, 1999a). Thus, according to this approach, economic conditions contribute to the engagement of youths in sexual activity. The satisfaction of sexual urges can take place among boys in exchange of gifts, clothes, money or paid jobs with married women or female adolescents. Besides money, young girls believe gaining sexual experience to be a useful means of finding a spouse (Muller 1983 cited in Rwenge, 1999a; Calves, 1996).

The third approach suggests that the adoption of a safe sexual behaviour depends both on the legal and political contexts and on the availability of condoms and preventive information (Rwenge, 1999a, 1999b).

None of the three theoretical approaches can fully explain adolescents’ sexual behaviours on their own. There appears to be a close interdependence between them. However, in the African context, we think that the pertinence of each of them varies according to the region and the evolution in time of the prevalence of HIV/AIDS. The socioeconomic approach would be more pertinent in urban areas than in rural ones, at the beginning of the AIDS epidemic; the others the further the AIDS epidemic advances. So, unemployment and poverty may actually be the most important factors of sexual risk behaviour of young people in urban areas of Central and West Africa.

Poverty and Sexual Behaviors

Poverty in all its ramifications does not allow the poor to protect themselves from STD and HIV/AIDS. It is a problem which poor women face in trying to protect themselves from STD and HIV/AIDS infections all along their reproductive life, since they have the responsibility of satisfying their children’s needs as well as those of other members of the households. Furthermore, many women have insatiable material needs and due to the difficult conditions of their life, they depend essentially on men for economic aid. Some spinsters even indulge in prostitution. Indeed, a good number of young girls migrating towards big towns come from villages. Their main objective of going to town is to find a job. In case of failure, they indulge in prostitution as Bledsoe (1989) noted in Zambia:

Thus, rich men benefit from the economic difficulties of poor young women to fully satisfy their sexual desires. The decision to use condoms is a problem as economic constraints reduce young women’s power to insist on condoms use during sexual intercourse (Worth, 1989; Rwenge, 2002, 2003a).

Most married women depend upon their husbands for economic support. When they are not economically satisfied by the latter, some may get into extra-marital lucrative sexual relationships as Bledsoe (1989) once more noted: « Due to economic difficulties, even married women engage in extra-marital sexual activities ». The problem is very serious in urban areas where men contribute significantly to family income. Indeed, generally men are the ones who are in charge of financial problems within households in these areas. In the current context of economic crisis, most of them give priority to the basic needs: lodging, feeding and health. Consequently all women's and children’s personal needs are not met. Housewives have in this context many sexual partners in order to improve their economic situation. In fact, it’s for them the only way of being economically independent. Others decide to be small shopkeepers or traders. As they move every day away from their houses and do not gain enough money from their activities, they are also tempted to have extra-marital sexual partners. In the context of economic constraints, most married women do not negotiate the use of condoms during extra-marital relations; this depends on the willingness of their partners.

Parent’s economic situation considerably affects their children’s sexual behaviour, through sexual behaviours that parents adopt under economic constraints (Lurie, 1976) and through the type of family care that results from these (Rwenge, 1999a). Indeed, due to hard living conditions, certain parents encourage their children to engage in lucrative sexual activities (Abéga et al., 1995). Furthermore, in some African towns, living conditions have become so hard that parents are unable to take care of their children, especially adolescents. Therefore, young people engage themselves in small businesses, like their mothers. As they usually carry out these activities along the streets or in bars, young girls are confronted with several temptations and sexual harassments while boys become delinquents and members of organized gangs (Bangha, 1999). Furthermore, because of poverty, young girls have sexual relations with men who are older than them since these men have sufficient means or the possibilities of satisfying their needs, as Calves (1996) noted in the case of Cameroonian young girls « …older men, often referred to as «sugar daddies » or « sponsors », provide girls with money for food and lodging, as well as school fees, uniforms, books, school supplies, in exchange for sexual favors … ».

Thus, poor young girls, in particular those who do not go to school, prefer to have sexual relations with well-to-do men, generally married and older than them. To increase their chance of meeting a wealthy man or having enough means to satisfy their needs, most of them have several sexual partners at the same time. So, poverty positively influences the vulnerability of young girls, since in Africa, relationships between young and old people are favourable to the submission of the former to the latter. In this situation, young girls rarely use condoms. Therefore, STD/AIDS are spreading speedily in the general population, as young girls have at the same time sexual relations with young boys.

In case of economic hardship, young boys sometimes abandon their families to live in the streets. The poverty level of their families, the bad treatment and the exploitation they undergo at home push them out, far away. These boys are often victims of sexual cruelty of other street children or their employers subject.

Young boys from poor families can also receive assistance from girls either in the form of work (for example, house services that some boys get from girls) or money (for example, assistance that some boys get from rich young girls or from married women who can clandestinely take care of them in exchange for sexual pleasures) (Rwenge, 2000). This last hypothesis is also supported by Calves (1996): « …young women are not the only ones to use sugar daddies relationships to achieve their financial goals…an increasing number of young men, especially students, are engaged in relationships with older wealthy women ». Thus, some young boys living in hard conditions opt for multipartnership because it increases their opportunities of having sufficient means for survival. Other young boys living in the same conditions rather engage in occasional sexual activity because they are not able to have durable relationships with young girls, which generally necessitate that they regularly satisfy the material needs of their partners.

METHODOLOGY

Hypotheses

The study hypotheses are the following:

(H₁) Poverty motivates young people to engage in risky sexual behaviour.

(H₂) Young people enter into sexual relationships for sexual satisfaction, for economic and marriage purposes.

To test the first hypothesis, quantitative data from the Survey on “the Sexual Behavior of the Young People of Bamenda” carried out in August 1995 were used. The young female were aged 12-20 years and the young male 12-25 years. In the first phase of this two-phase cluster survey, five neighbourhoods were randomly selected in proportion to the size of their populations. In the second phase, interviewers followed a preset itinerary from household to household until they reached the sample size of young people for a given neighbourhood.

This survey collected data on social and economic characteristics of young people and sex education they received from their parents or guardians, knowledge about AIDS, their sources of information about AIDS, the prevention measures they have adopted and their sexual behaviour.

Among the social and economic characteristics of the young people interviewed are: the father’s job, the presence of durable goods (television, radio, etc.) in households, the young people’s means of satisfying their needs and the persons with whom they lived at the time of the survey. These characteristics have been used to evaluate the effects of living conditions on young people’s sexual behaviours. In addition to these, we used a social variable, namely the persons with whom young people lived at the time of the survey, since it is also in the African context, an indicator of their living conditions.

The survey enabled also the gathering of data on age, level of education, father's ethnic group and parents’ type of marriage. There are also data on young people’s sexual behaviour: the age at first sexual intercourse, sexual activity at the time of the survey, the number of sexual partners at the time of the survey, the fact of having had sex with a casual partner during the 12 months preceding the survey and the use of condoms at the time of the survey.

Risky sexual behaviours are those that expose young people to a greater risk of contracting STD/AIDS. These are having multiple concurrent sex partners, having had sex with a casual partner and failing to use condoms during sexual intercourse.

We used data from two focus group discussions among young males, two other ones among young females and in-depth interviews with young females to highlight the second hypothesis.

Sample Characteristics

Table 1 presents the percentage distribution of young people by some of their characteristics. It shows that males (58.5%) were more represented in the sample than females (41.5%). There are in the sample 5% of young people whose fathers were unemployed, 18.9% whose fathers worked in the agricultural sector, 17.5% whose fathers were traders, and 37.3% whose fathers were managers or office workers, 17.7% whose fathers were skilled or specialized workers and 3.6 % whose fathers did other works. The percentage of young people who lived in households where there was no radio was low (9.6%). On the other hand, the percentage of those who lived in households where there was no television was high (62.7%).

Table 1: Percentage Distribution of Young People in Bamenda, Cameroon, by Selected Variables.

We presume that young people’s level of poverty varies with their father’s jobs and the household standard of living. This last variable is based on the presence of selected durable goods. The young people whose fathers were unemployed are poorer than those whose fathers were managers or office workers and those whose fathers were skilled or specialized workers. Along the same lines, the level of poverty was considered to be higher in the last group than in the second one. The young people whose fathers worked in agricultural sector are also very poor but we presume that they did not adopt risky sexual behaviours because their socio-cultural environment influences these negatively.

Only 26.3% of the young people interviewed declared that their parents did not give them enough money to satisfy their needs. The majority of the young people interviewed (53.8%) lived with both parents. The percentage of those who lived only with their mothers (9.7%) is higher than the percentage (1.7%) of those who lived only with their fathers. 12.8% of the young people interviewed lived with either their brothers or sisters and 21.9% lived with other relatives or friends.

Nearly all (96.3%) of the young people interviewed were unmarried. Thus, the study was restricted to single young people. Most of them declared that they were schooling during the survey. The distribution of young people by their educational level shows that 30.6% had had primary schooling, 42.9% had reached middle school and 16.3% high school. Only 4.8% among them had had no schooling and 5.3% attended high school.

STATISTICAL ANALYSIS

In order to test the study hypothesis, the variations of the probability of being sexually active at the time of the survey, of having more than one sexual partner at the same time, of having had casual sexual relations during the 12 months preceding the survey and of not using condoms during sexual intercourse were analyzed. As the dependent variables are dummy variables, we resort to multivariate logistic regression models.

The main independent variables are father’s jobs, the young people’s means to satisfy their needs, the people with whom they lived at the time of the survey and the household standard of living. In order to get the net effects of these independent variables on each dependent variable, sex educational level, father’s ethnic group, parents’ type of marriage and age at first sexual intercourse have been included in all logistic regression models as controlled variables. To analyze qualitative data we used the content analysis method.

Among young people interviewed, 57 % had one sexual partner and 27 % had multiple sexual partners at the time of the survey, while 16 % said that they had no current sexual partner (not shown). The mean age at first sexual intercourse did not vary significantly with gender (15.6 for males vs. 15.8 for females). Forty-one per cent of sexually experienced young people had had casual sexual intercourse during the previous 12 months. Only 25% of young people who were sexually active at the time of the survey were using condoms.

Table 2 highlights from logistic regression analyses the net effects of the indicators of young people’s living conditions on each of the dependent variables.

Table 2: Odds Ratio of the Dependent Variables

(**) p<0.05.
(*) p < 0.10.

Some of the considered indicators of young people’s sexual behaviours were correlated with their fathers’ job. Compared with young people whose fathers were managers or office workers, those whose fathers were farmers or fishermen were 39% less likely to be sexually active at the time of the survey. Sexual activity was more common among young people whose fathers were unemployed (odds ratio 1.35) than among those whose fathers were managers or office workers. In addition, compared with young people whose fathers were managers or office workers, those whose fathers were unemployed were 1.53 times more likely to have more than one sexual partner. On the other hand, young people whose fathers were farmers or fishermen were 43 % less likely than those of the reference group to have more than one sexual partner. The probability of having had casual sexual relations did not vary with father's job.

The probability of not using condoms at the time of the survey was also highly correlated with father’s job. Compared with young people whose fathers were managers or office workers, those whose fathers were unemployed were 2.04 times more likely not to be using condoms at the time of the survey, while those whose fathers were traders or skilled workers were less likely not to be using condoms at the time of the survey (0.47-0.54). Young people whose fathers were farmers or fishermen were 25% less likely not to be using condoms than those of the reference group but the difference was not significant.

Living in a poor household was positively associated with the probability of being sexually active, of having more than one sexual partner and of having had casual sexual relations. It was not associated with the likelihood of condoms non-use.

Compared with young people who lived in households with high standards of living, those who lived in poor households were 1.4 times more likely to be sexually active at the time of the survey. Young people who lived in poor households were 1.25 times more likely to have more than one sexual partner than those from a family with a high living standard. In the case of casual sexual relations, table 2 shows that young people who lived in poor households and those from a family with an average living standard were respectively 1.24 and 1.34 times more likely to have had casual sex than those from a family with a high living standard.

Influence of Young People’s Financial Resources

The probability of being sexually active and of having more than one sexual partner at the time of the survey did not vary significantly with the young people’s financial resources. On the other hand, the probability of having had casual sex and that of not using condoms was influenced by this independent variable.

Compared with young people who had sufficient resources, those who did not were 1.23 times more likely to have had casual sex. On the other hand, the second were 1.11 times more likely not to be using condoms than the first.

Influence of Another Young People’s Families Characteristic

We supposed here that young people living with one parent, alone or with siblings lived in hard economic conditions contrary to those who lived with both parents. This independent variable was associated with all dependent variables. Compared with young people who lived with both parents at the time of the survey, those who had lived with one parent and those who had lived alone were respectively 1.62 and 1.48 times more likely to be sexually active. Those who lived with their siblings were 1.22 times more likely to be sexually active than those of the reference group. On the other hand, young people who lived with their grandparents were 70 % less likely to be sexually active.

Young people who lived alone and those who lived with one parent were respectively 2.75 and 2.76 times more likely to have multiple partners than those who lived with both parents. Young people who lived with their siblings were 3.38 times more likely to have multiple partners than those of the reference group. On the other hand, young people who lived with their grandparents were 99% less likely to have multiple partners than those who lived with both parents.

Compared with young people who lived with both parents, those who lived with one parent and those who lived alone were respectively 1.62 and 2.25 times more likely to have had casual sex. Young people who lived with their siblings were 1.14 times more likely to have had casual sex than those who lived with both parents. Compared with the reference group, young people who lived with their grandparents were 49% less likely to have had casual sex.

Young people who lived with one parent were 1.11 times more likely not to be using condoms than those who lived with both parents. Young people who lived with their siblings and those who lived alone were respectively 34% and 52% less likely not to be using condoms than those who had lived with both parents.

CONCLUSIONS AND RECOMMENDATIONS

The fact that young people whose fathers were unemployed and those who lived in poor households were more likely to have multiple sexual partners or to have had casual sexual relations than others both support the hypothesis that living conditions influence the sexual behaviour of young people and thus the theory of rational adaptation based on the population's poverty. The relations observed between other independent variables considered and the young people’s sexual behaviours also support the above hypothesis since young people who did not live with both parents and had insufficient resources to satisfy their needs were more likely than others to have multiple sexual partners or to have had casual sexual relations.

So, poor young people are more likely than others to have sexual relationships that expose them to STD/AIDS. Data derived from qualitative research conducted along with our survey confirm and explain results from quantitative data. Indeed, most young girls interviewed declared that they had many sexual partners in order to increase their opportunities of finding a husband. The individual interviews conducted have also revealed that some young girls had many sexual partners for economic reasons, but those who prostituted themselves also declared that they undertook prostitution because they had not found other alternatives. This means that some young girls from poor families have regular sexual relations with rich men in order to improve their socioeconomic status and therefore increase their chance of getting a husband later on. They also have sexual relations with young boys among whom they will choose their husbands. Other poor young girls engage in sexual activity in order to have the necessary means of survival. Most young girls said that they do not insist on condoms use because they are afraid of losing their partners if they do so.

Young boys interviewed declared that they have many partners because the society is such that they want to avoid deception, or they think that their partners also have many partners. Some young boys however claimed that their friends do so for economic reasons. Young boys also declared that some of their mates have casual sexual relations either because they lack means of keeping their girlfriends for a long time or because the women they met enabled them to satisfy their sexual desires the ways they wanted. Thus, the reasons for which poor young people engage in “risky” sexual activities differ according to gender; among young girls the reasons are mostly economic.

The results from this study corroborate those of previous studies particularly those of Uwakwe, Mansary and Onwu (1994), Meekers (1995) and Calves (1996).

The following are recommendations for policy and other researchs:

REFERENCES