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African Population Studies
Union for African Population Studies
ISSN: 0850-5780
Vol. 12, Num. 2, 1997

African Population Studies/Etude de la Population Africaine, Vol. 12, No. 2, September/septembre 1997

The Determinants of Teenage Sexuality and their Understanding of STDs/HIV/AIDS in Kenya

Cathy TOROITICH-RUTO

African Population Policy Research Centre, A programme of the Population Council, Nairobi, Kenya

Code Number: ep97013

ABSTRACT

In this paper, we used data from a 1991 survey to examine the factors influencing adolescent sexual behaviour and their knowledge and perceptions of the risk of contracting STDs/HIV/AIDS in Kenya. Descriptive data show that sexual activity starts early and is sporadic. The incidence of abortion among adolescents is high. Although adolescents are knowledgeable about STDs/HIV/AIDS, they do not use condoms for prevention of sexually transmitted diseases. Multivariate analysis shows that the factors which influence onset of sexual activity are: age, religion, type of residence, education and career expectations, type of school attended, performance in school, parent’s marital status and correct knowledge of the ovulatory cycle. The study presents evidence that unless society is able to accept the sexuality of adolescents, issues such as unwanted pregnancy, high rate of school drop-out among girls, abortions and STDs/HIV/AIDS infections among adolescents will continue to rise and deprive adolescents of achieving their full potential.

RÉSUMÉ

Dans cette communication, les facteurs influençant le comportement sexuel des adolescentes et leurs connaissances et perceptions du risque de contracter les MST/VIH/SIDA au Kenya sont étudiés en utilisant des données issues d’une étude menée en 1991. Les données descriptives montrent que l’activité sexuelle commence tôt et de manière sporadique. Il y’a une très forte incidence de l’avortement chez les adolescentes. Quoique les adolescentes soient très au fait des MST/VIH/SIDA, ils n’utilisent pas de préservatifs pour se prémunir contre les maladies sexuellement transmissibles. L’analyse multivariée montre que les facteurs qui influencent le début de l’activité sexuelle sont: l’âge, la religion, le type de résidence, l’éducation et les perspectives de carrière, le type d’école fréquenté, la performance à l’école, la situation matrimoniale des parents et une bonne connaissance du cycle d’ovulation. L’étude présente des preuves que la société est bien capable d’accepter la sexualité des adolescentes, ainsi que d’autres phénomènes tels que les grossesses non désirées. Le taux élevé de déperdition scolaire chez les filles, les avortements, et les infections par les MST/VIH/SIDA chez les adolescentes vont continuer à augmenter et les empêcher ainsi d’exploiter pleinement leurs potentialités.

INTRODUCTION

Under the demographic regime of early universal marriage and high fertility that has characterized all of Africa until recently, adolescent reproductive health received scant attention. However, with rapid social changes including the advent of HIV and the onset of fertility transition in countries like Kenya, continued ignorance of the conditions influencing adolescent choices and sexual behaviour can no longer be justified. A number of developments in the last two decades in Kenya have combined to make this study timely and relevant.

Adolescence is a time of emotional, physical, and psychological development and contributes substantially to the well-being of the individual in adulthood. Given the fact that the future size of the Kenyan population will be highly dependent on the population momentum, this group should be a central force to reckon with. Therefore, understanding their sexual and reproductive behaviour is of tremendous policy importance.

Moreover, adolescents are in a critical stage if they have limited knowledge of their body functions and the anxieties or uncertainties about safe sex place them at risk of STDs and HIV infection (Suda, 1993). Therefore, the reproductive health component of general health increases during adolescence, particularly among women entering the reproductive years. Social pressures, especially for low-income girls and young women, influence early marriage and pregnancy, establishing at an early age a pattern of high fertility and poor sexual and reproductive health that severely limits their ability to pursue educational and employment opportunities (Sather and Mason, 1993; Assie-Lumumba, 1995).

BACKGROUND

Several studies have shown that age at first intercourse is reducing, suggesting that today’s young adults are becoming sexually active at increasingly younger ages. In addition, some studies have shown that few adolescents use contraceptives and are at risk of pregnancy (Kiragu, 1991; McCauley and Salter, 1995; Kiragu and Zabin, 1995). This results in situations such as dropping out of school, poverty, early marriage and contracting sexually transmitted diseases (DHS Chartbook, 1992; Kane et al., 1993; Ilinigumugabo, 1995).

The erosion of traditional means of regulating sexuality and contraception due to rural-urban migration and the worsening of the economy have caused waning of many traditional mechanisms (Lema and Njau, 1991; Oladosu, 1993; Yeboah, 1993; Lema et al., 1991; Suda, 1993). Rural-urban migration has also weakened extended family networks which provided stability and support. Customs such as early marriages and female genital mutilation were used traditionally to curb early sexual practices and avoid adolescent childbearing out of wedlock (Bledsoe and Cohen, 1993). An information gap amongst adolescents concerning sexuality and contraception is one of the factors resulting in premarital sex among adolescents. Parents and adults do not give them information on sex and contraception because it is not considered culturally appropriate, hence they turn to their peers who give them inappropriate and/or inaccurate advice. Adolescents have no difficulty getting books, videos, and magazines which may encourage sexual freedom without giving information about the risks involved with sexual intercourse (Lema, 1990; Baker and Rich, 1990; Ajayi et al., 1991; Sullivan, 1995).

Youri (1993) has shown that among adolescents who got pregnant while still in school, 47 per cent had abortions while 53 per cent gave birth. Rogo (1992) has documented that over 90 per cent of adolescent pregnancies are unwanted. They consequently resort to abortions. According to a study of 1,058 female adolescents carried out by Ilinigumugabo (1995), 9 per cent of them had attempted to have an abortion, 53 per cent of those who attempted fell ill, and 25 per cent had to be hospitalized.

Early and unintended pregnancy is a major cause for discontinuation of education among school-going female adolescents. Consequently, opportunities that would have otherwise been available become foreclosed for the female due to unintended pregnancy during schooling years (Youri, 1993; Assie-Lumumba, 1995; School Drop-out and Adolescent Pregnancy, 1995; The People, 1996). Data has shown that every year 10,000 girls drop out of primary and secondary school because of unwanted pregnancy (Ferguson, 1988; Njau and Radeny, 1994). The majority of these girls do not resume the ir studies. Out of those who do, very few return to their previous schools. Most go to other relatively poor schools.

The DHS Chartbook on Marriage and Childbearing (1992) explains that the adverse consequences of adolescent childbearing fall not only upon the young mothers, but on society at large. In addition to childbearing costs for maternal and child health care, there is loss for an added potential of an educated person. Socioeconomic development is attained by acquiring education. It enables the adolescent to elevate their social status, and to make significant financial contributions to their families and to participate in the development of their societies.

The Data

This study analyses data collected in 1991 in secondary schools in 17 districts of Kenya. The survey collected data on never-married men and women of ages 15-24 years from a sample size of 9,208. The questionnaire was self-administered. Although, there are limitations that accompany the data used, such as the AMREF study - it has been shown by other researchers that sexual behaviour is a sensitive topic and the quality of the data may be poor - these concerns have been proven to be unfounded as the same method of data collection have been used consistently by several researchers over the years. However, one has to take caution and maintain a degree of skepticism when considering the results.

The AMREF study covered segments of the population that are of utmost importance in this study (school-going adolescents). It provides information that is not otherwise available in other data sets such as the Kenya Fertility Survey and Demographic and Health Surveys which do not explore the sexual behaviour of the teenagers in detail.

RESULTS

The basic socioeconomic and demographic characteristics of the respondents are provided in Table 1. Most of the subjects were from rural areas and were young adolescents (15-19 years age group). The majority of them attend day schools which are mixed with both boys and girls.

In Table 2, results show that although over half of the respondents reported that they did not enjoy their first sexual experience, most gave consent to the sexual activity and 24 per cent reported that they were forced into having sexual intercourse. Furthermore, 29 per cent said that they usually plan to have sex and only 10 per cent of the respondents had been involved in sexual activity in the last month.

Table 3 shows that 35 per cent of the respondents were already sexually active but contraceptive use was low (17 per cent). Pregnancy is high (47 per cent had ever given birth and 11 per cent were pregnant at the time of the survey). About 42 per cent of the respondents also, had had an abortion which was

performed mostly by a qualified doctor. However, 11 per cent of the respondents said that they performed the abortions themselves.

Table 1: Percentage distribution of never married respondents aged 15-24, according to background characteristics

Characteristics

Percentage N=9208

Age

15-19

93.5

20-24

6.5

Total

100

Residence

Rural

58.4

Urban

16.7

Rural/urban

24.9

Total

100

Religion

Protestant

52.6

Catholic

34.2

Muslim

2.1

None

0.6

Other

10.5

Total

100

Type of School

Day

81.9

Boarding

13.2

Both (day & boarding)

4.9

Total

100

Type of School

Mixed

67.7

Girls only

32.3

Total

100

Table 4 gives results of respondents’ perception on the usefulness of religion, parents and health professionals in helping them to cope with sex-related matters. More respondents answered positively that health professionals were fairly useful while parents were rated highest as very useful. Results in Table 5 show that 73 per cent of the respondents correctly indicated that getting a prescription is the best treatment for gonorrhea. About 6 per cent of the respondents reported that AIDS is curable while 4 per cent did not know. Table 5 further shows that many adolescents are not sure of how AIDS is transmitted, and only 35 per cent answered correctly that condoms prevent AIDS infection. It was surprising to find that many respondents said that teenagers are safe from being infected with AIDS.

Results from Table 6 demonstrate that the most significant factors associated with onset of sexual activity are: age, type of school, high career and educational expectations, school performance, type of residence, correct knowledge of ovulatory cycle, and parent’s marital status. Table 6 further shows that respondents who came from families where both parents are still married as well

as those whose fathers were polygamous were more likely of being sexually active compared with those respondents from divorced or single-headed households.

 Table 2: Percentage distribution of respondents according to sexual activity and practice

Variables

Percentage

Reproductive health variables

Age started menstruating by 14 years (n = 4480)

51.7

Had sexual intercourse before menstruation (n = 9056)

24.1

Knew correctly the source of bleeding (n = 1766)

20.0

Had sexual intercourse by 15 years (n = 6931)

54.0

Description of first sexual experience (3048)

Enjoyable

20.3

Not enjoyable

56.5

Other

23.2

Total

100.0

Circumstances of first sex (3038)

Was forced

24.1

Show love

21.3

Cheated

17.6

Wanted to know how it feels

33.1

Wanted to please partner

1.9

Other

2.0

Total

100.0

Do you usually plan to have sex (2740)

Plan every time

29.1

Plan sometimes

24.8

Never plan

46.1

Total

100.0

Length of time from last sex (2911)

1 month

10.0

2 months

12.4

3 months

26.6

4 months

51.0

Total

100.0

Table 3: Percentage of respondents according to sexual activity, pregnancy status, knowledge and use of contraceptives and use of reproductive health services

VariablesPercentage

Reproductive health variables(9056)

Sexually active

34.6

knowledge of ovulatory cycle

29.0

Ever used a contraceptive method

17.2

Ever suffered form STD

4.9

Ever been treated for a STD

2.9

Partner ever used a condom(2857)

Never

47.1

Sometime

20.7

Always

8.0

Don't know

24.2

Total

100.0

pregnancy status(217)

Currently pregnant

11.1

Ever given birth

47.0

Ever had an abortion

41.9

Total

100.0

Person who conducted abortion(179)

Qualified doctor

43.6

Qualified nurse

17.9

Unknown qualification of a medical person

10.0

Non medical person

3.9

Family member

3.9

Myself

11.2

other

9.5

Total

100.0

Table 4: Knowledge and attitudes of respondents according to age group

 

How useful is religion in helping to cope with sex-related matters

How useful are parents in helping to cope with sex related matters

How useful have health professionals been in coping with sex-related matters

15-19(n =8607)

20-24(n = 601)

15-19(n =8607)

20-24 (n = 601)

15-19 (n =8607)

20-24 (n = 601)

Very useful

72.8

75.4

73.2

71.9

70.2

71.4

Fairly useful

13.7

12.6

10.3

10.6

12.6

13.1

Not useful

10.6

9.1

10.9

11.3

10.1

9.0

Don’t know

2.8

2.8

5.6

6.2

7.0

6.5

Total

100.0

100.0

100.0

100.0

100.0

100.0

Table 5: Knowledge and perception of reproductive health issues

Variables

% (n = 9208)

Gonorrhoea is effectively treated by:

Having sex with non-infected person

6.2

Use traditional medicine

4.0

Buy medicine

1.6

Get prescription

73.1

Don’t know

13.1

Other

2.0

Total

100.0

If gonorrhoea is curable

Yes

81.2

No

9.6

Don’t know

9.2

Total

100.0

If AIDS is curable

Yes

5.6

No

90.1

Don’t know

4.3

Total

100.0

Those who have seen an AIDS patient Can get AIDS through the following:

Kissing

19.8

Mosquito bite

20.5

Touching an AIDS victim

5.7

Hugging

3.8

Anal sex

51.8

Oral sex

82.8

Living with AIDS victim

9.8

Condoms prevent AIDS infection

Yes

35.2

No

34.8

Don’t know

30.0

Total

100.0

Teenagers are safe from AIDS

Yes

47.5

No

43.6

Don’t know

8.9

Total

100.0

Only homosexuals can transmit AIDS

Yes

10.5

No

74.1

Don’t know

15.4

Total

100.0

Table 6: Logistic regression results showing the factors that contribute to early onset of sexual practice among adolescents

Ever had sex

b

Exp(b)

Age (15-19)

-0.3968

0.6725**

Religion Protestant

-0.0957

0.9061*

Muslim

-0.8262

0.4378**

School Day

0.1069

1.1128

Both Boarding & day

0.0591

1.0609

Mixed school

0.2686

1.3082**

Govt. School

0.05456

1.056

Mission school

0.0527

1.0541

Private school

0.3107

1.3644**

Repeated a class

0.3465

1.4141**

Career and educational expectations

Wants to complete university

-0.5219

0.5934**

Wants to complete college

-0.3184

0.7273

Wants career-doctor

-0.1534

0.8577

Wants career-nurse

-0.3758

1.0383

School performance

Pergrad a

-0.025

0.9752

Pergrad b

0.1509

1.1629

Pergrad c

0.2029

1.2250**

Pergrad d

0.3732

1.4524**

Residence Rural

-0.2659

0.7665**

Live both rural/urban

-0.0049

0.9951

Marks in class-low

-0.0785

0.9244

Parents' marital status Married

-0.2523

0.7769**

Father-Polygamous

0.2902

1.3569**

Know correctly ovulatory cycle

0.3052

1.3569**

Log likelihood = -3893.13

No of obs. = 6181

Chi2 (24) = 224.44

Prob > chi2 = 0.000

Pseudo R2 = 0.0280

*significant at 0.1 ; ** significant at 0.05

DISCUSSION

The AMREF survey data confirm that adolescent sexual activity is high and modern education exposes adolescents to different value systems. Furthermore, the school environment enables adolescents to interact more with partners of the opposite sex. Different reasons have been shown to be related to the high sexual activity. One such reason is the breakdown of social control by parents and teachers over adolescents (Bledsoe and Cohen, 1993). The other is the changing society where girls are lured into sexual activity for material gain (Suda, 1993; Youri, 1993).

Although adolescents said that religion plays a big role in helping them deal with sex-related issues, results showed that it did not stop them from practicing sexual intercourse. Other interesting data showed that while knowledge of STDs/HIV infection was high, adolescents’ sexual activity was high and sporadic and usually not protective of STDs/HIV/AIDS and pregnancy. Few of them used condoms although they knew that condoms prevent infection of STDs/HIV. The study has also shown that although many adolescents know a method of contraception, they do not use them. The results, therefore, demonstrate that knowledge of a method is not enough for adolescents to use contraceptives.

Multivariate analysis showed that residence, religion, type of school, age, education and career expectations and school performance, influence adolescents risk of being sexually active. This data supports what other earlier studies have demonstrated.

As has been described at the beginning of this paper, the period of adolescence mostly marks the beginning of varied psycho-social developmental behaviour (for example, experimentation and exploration of their bodies, sex for sale practices, drug use, alcohol and cigarette consumption) and many are caught between the rigid social norms and their own needs and desires to participate in sexual intercourse. As a result, conflicts occur due to the environmental change which has not changed to accommodate ‘western behaviours’ brought about by breakdown in family traditions and increased economic pressure. Previously, adolescents were guided by older adults such as aunts, uncles and grandmothers and traditional practices which reduced high sexual mobility such as early marriage and female circumcision were more common than now.

Adolescents need to be aware about their body functions and the consequences of early sexual intercourse. Sullivan (1995) reports that most adolescents in her study did not know that participating in sexual intercourse at an early age can result in pregnancy. Since most adolescents begin sexual intercourse early, there is need for both boys and girls to know that the first sexual intercourse can result in a pregnancy or when a girl is most fertile. Provision of the right information will assist adolescents make better decisions about their sexual behaviour. Insufficient information and emotional instability creates conditions of unanticipated irregular sexual activity which results in the incorrect use of contraception or failure to use them altogether and this puts them at risk of contracting STDs/HIV (Baudet et al., 1993; Suda, 1995).

It has been mentioned that many adolescents fear that contraceptives have side effects while others fear that they may not return to fecundity (Bongaarts and Bruce, 1995). Jackiewicz and McAnarney (1994) have suggested that early adolescent pregnancy is as a result of reproductive immaturity, inconsistent familial environment, low educational level and religious beliefs. This is supported by results from this study.

CONCLUSION

This investigation gives an in-depth description of previous work by exploring the effects of an array of specific characteristics on use of contraceptives and sexual activity. The results provide further evidence of the importance of these characteristics in shaping the lives of adolescents.

There is therefore need to expand investment services that not only provide contraceptives but also attend closely to related health and social needs of adolescents which will be very beneficial in their development. Service provision to influence and alter the cultural and familial factors that limit voluntary contraceptive use and other reproductive health services will help to meet the reproductive health needs of the adolescents.

A policy issue that might emerge from this study is to open avenues in the community where teachers and parents can guide adolescents on making responsible decisions especially on sexual issues. Further research need to be carried out to demonstrate the weakness in socialization of adolescents in Kenya in view of the changing upbringing and guidance techniques among adolescents in schools as well as at home.

REFERENCES

  • Assie-Lumumba, N.T. 1995. "Gender and Education in Africa. A New Agenda for Development" Africa Notes. Institute for African Development. Cornell University. 1-4.
  • Ajayi, A.A; Marangu, L.T & Paxman J.M.; 1991. "Adolescent Sexuality and Fertility in Kenya: A Survey of Knowledge, Perceptions, and Practices", Studies in Family Planning. 22 (4) 205-216.
  • Baker, G. and Rich, S. 1990. Adolescent Fertility in Kenya and Nigeria. Final Report for a Study Tour Conducted June-July 1990. Washington DC. The Center for Population Options, and the Population Crisis Committee.
  • Baudet, J.H; Aubard Y.; Grandjean M.H.; Gasq M.; & Cobin L. 1993. Adolescent Contraception. Gaette Medicale De France. 100 (2) 10-12.
  • Bledsoe, C.H. and Cohen, B. 1993. Social Dynamics of Adolescent Fertility in Sub-Sahara Africa. Population Dynamics of Sub-Saharan Africa. National Academy Press. Washington, D.C.
  • Bongaart, S. J. and J Bruce. 1995. "The Causes of Unmet Need for Contraception and the Social Services", Studies in Family Planning. 26 (2) 57-75.
  • DHS Chartbook on Marriage and Childbearing. 1992. Adolescent Women in Sub-Saharan Africa. International Population reference Bureau. Washington. USA.
  • Ferguson, A. 1988. ‘Schoolgirl Pregnancy in Kenya’. Report of a Study of Discontinuation Rates and Associated Factors. Ministry of Health/GTZ Support Unit.
  • Ilinigumugabo, A. 1995. Psycho-Social and Health Consequences of Adolescent Pregnancies Among Out of School Adolescent Girls in Four Rural Communities in Kenya. Center for Family Studies Research Report Series No. 1. CAFS. Kenya.
  • Jaskiewicz, J.A. and McAnerney E.R. 1994. "Pregnancy During Adolescence", Pediatrics in Review. 15 (1). 32-38.
  • Kane, T.T.; De Buysscher, R.; Taylor-Thomas T., Smith, T. and Jeng Momodou. 1993. "Sexual Activity, Family Life Education, and Contraceptive Practice Among Young Adults in Banjul, The Gambia", Studies in Family Planning. 24 (1). 50-61.
  • Kiragu, K. 1 991. Factors Associated with Sexual Contraceptive Behavior Among School Adolescents in Kenya. The Johns Hopkins University School of Hygiene and Public Health. USA.
  • Kiragu, K. and Zabin, L.S. 1995." Contraceptive Use Among High School Students in Kenya" International Family Planning Perspectives. 21 (3) 108-113.
  • Lema, V.M. 1990. "The Determinants of Sexuality Among Adolescent School Girls in Kenya", East African Medical Journal. 191-200.
  • Lema ,V.M.; Makhokha, A.E.; Sanghvi, H.C. and Wanjala, S.H.1991. "A Review of the Medical Aspects of Adolescent Fertility in Kenya", Journal of Obstetrics and Gynecology of Eastern and Central Africa. 9 (1) 37-43.
  • Lema, V.M. and Njau, W.P. 1991. Abortion in Kenya: A Traditional Approach to Unwanted Pregnancy. The Center for the Study of Adolescents. Kenya.
  • McCauley, A.P. and Salter, C.1995. Meeting the Needs of Young Adults. Population Reports J-41.
  • Njau, W. and Radeny, S. 1994. Adolescence in Kenya. The Facts. Center for the Study of Adolescence.
  • Oladosu, M. 1993. "Factors Influencing Adolescent Sexual Activity in Nigeria: Analysis of the 1990 Demographic and Health Survey",. Journal of Population and Social Studies. 4 (1-2) 103-119.
  • Rogo, K.O. 1992. Induced Abortion in Kenya. Paper prepared for the International Planned Parenthood Federation. Center for the study of Adolescence. Nairobi. Kenya.
  • Sather, Z.A. and Mason, K.O. 1993. "How Female Education Affects Reproductive Behaviour in Urban Pakistan", Asian and Pacific Population Forum. 6 (4) 93-103.
  • School Drop-out and Adolescent Pregnancy. 1995. African Education Ministers Count the Cost A report on the Ministerial Consultation held from 15-18 Sept. 1994 in Mauritius. Organised by Forum for African Women Educationalists (FAWE) in Collaboration with The Government of Mauritius.
  • Suda, C. 1993. ‘’Sex Behaviour, Cultural Practices and the Risk of HIV/AIDS in South Nyanza District, Kenya’’. Kenya Journal of Science Series. C 5-18.
  • Sullivan, M.L. 1995. "Teenage Males’ Beliefs and Practices About Contraception: Findings from Contraceptive Ethnographic Research in High-Risk Neighborhoods" Presented to the Annual Meeting of the Population Association of America, San Francisco, CA. April 6-8. Unpublished.
  • The People. 1996. "Towards Saving Student Mothers" February 23-29. iv. Nairobi, Kenya.
  • Yeboah, Y. 1993. Equal Opportunities for Working Women: The Implications of Adolescent Pregnancy and Childbirth in Sub-Saharan Africa for ILO Policies and Programmes .World Employment Program. Working Paper. ILO Geneva.
  • Youri, P. 1993. Female Adolescent Health and Sexuality Study in Kenyan Secondary Schools. An Interim Report. Amref. Kenya.

Copyright 1997 - Union for African Population Studies.

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