ArticlesSexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data
Introduction
An aura of disappointment and frustration surrounds global efforts to check the spread of HIV in most low-income and middle-income countries. Despite substantial investment in the promotion of safe sex and marketing of condoms, only Thailand and Uganda have clearly succeeded in stemming epidemics in the general population, though other countries in Africa and the Caribbean also show some signs of progress.1 Even the most intensive interventions, targeted at young people or at specific localities, have not achieved all of their aims.2, 3, 4 Two responses to this perceived impasse have predominated. The first is to conclude that the necessary changes in sexual behaviour will only occur as a result of fundamental changes that reduce poverty and gender inequality.5, 6, 7, 8 The other response is to hope that increased access to drug therapy for AIDS will present new opportunities for effective prevention.9, 10
Abstinence and condom use are two of the three elements promoted by major preventive programmes that emphasise the ABC (abstain, be faithful, and use condoms) approach. The relative importance of abstinence and condom use for HIV control has been controversial. In the USA the issue is further complicated by moral arguments surrounding the President's Emergency Plan for AIDS Relief (PEPFAR), which emphasises abstinence.11, 12, 13, 14 We do not seek to engage with this debate; rather, we examine modification of behaviour in view of the threat of AIDS and the inseparable risk of unwanted pregnancies.
We aimed to assess the evidence for behavioural change by young women in sub-Saharan Africa, which is the region most affected by HIV/AIDS. Our report complements detailed analyses of change in specific countries or small groups of countries, especially those of the MEASURE (Monitoring and Evaluation to Assess and Use Results) project,15 by examining changes in a few behavioural indicators in a large sample of African countries. Specifically, we analysed trends in sexual abstinence, contraception, and condom use by single women aged 15–24 years, in countries that had done two or more comparable surveys between 1990 and 2004.
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Methods
We analysed data from Demographic and Health Surveys (DHS), which use nationally representative samples, and standard instruments and procedures for collection and processing of data. The survey design of DHS is generally stratified, with a first-stage selection of geographical clusters, followed by random selection of households within each cluster to identify women aged 15–49 years. These women, the primary respondents, were interviewed by trained female staff using a structured instrument
Results
Figure 1 shows the standardised trend in the percentage of young single women who reported no experience of sexual intercourse. The median value of all survey estimates remained essentially unchanged, at about 60%, though the dispersion of values contracted over time. The proportion of young women declaring themselves to be virgins rose significantly in seven of 18 countries and fell significantly in six countries. The changes in proportion exceeded 10% only in Cameroon and Ghana (webtable 1).
Discussion
Self-reported sexual behaviour is commonly regarded with scepticism, which is partly justified by the risk that survey respondents censor their answers, especially as public-health messages intensify. We cannot validate the trends we have identified in reported behaviour, because there is no evidence on the incidence of sexually transmitted infections that is disaggregated by marital status, and because of the difficulty of comparing condom sales with reported use.17 Thus an extreme
References (35)
- et al.
Gender inequalities, intimate partner violence and HIV prevention practices: findings of a South Africa cross-sectional study
Soc Sci Med
(2003) The two sides of PEPFAR in Uganda
Lancet
(2005)Uganda AIDS prevention: A, B, C, and politics
J Adolesc Health
(2004)Is abstinence-only threatening Uganda's HIV success story?
Lancet Infect Dis
(2005)- et al.
Age patterns of unsafe abortion in developing country regions
Reprod Health Matters
(2004) - et al.
Periodic abstinence in developing countries: an assessment of failure rates and consequences
Contraception
(2004) - et al.
Sexual and reproductive behaviour among single women aged 15–24 in eight Latin American countries: a comparative analysis
Soc Sci Med
(2005) AIDS Epidemic Update
(2005)- et al.
HIV risk reduction behavioral interventions with heterosexual adolescents
AIDS
(2000) - et al.
Behavioural interventions for HIV/AIDS prevention
AIDS
(1995)
Rigorous trials of sexual behaviour interventions in STD/HIV prevention: what can we learn from them?
AIDS
Gender-based violence, relationship power, and the risk of HIV infection in women attending antenatal clinics in South Africa
Lancet
Gaining a foothold: tackling poverty, gender inequality, and HIV in Africa
BMJ
Structural barriers and facilitators in HIV prevention: a review of international research
AIDS
HIV prevention in the era of expanded treatment access
Intensifying HIV prevention
Condom promotion for AIDS prevention in the developing world: is it working?
Stud Fam Plann
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