Sexual violence and reproductive health among young people in three communities in Jamaica

Cultural factors influencing teenage pregnancy in Jamaica

A literature review was undertaken to identify key factors associated with teenage pregnancy in Jamaica. Using the PEN-3 cultural model, we first categorised these factors to develop a theoretical taxonomy that can be used to help health intervention planners to understand and address the phenomenon. Next, we examined the validity of this initial taxonomy by comparing it with cultural factors identified in semi-structured focus group discussions with Jamaican teenage mothers. Cultural factors identified in the initial literature review - such as parental interaction and control, the intergenerational transmission of teenage pregnancy and experiences of sexual abuse - were largely confirmed and built upon. Results highlight promising opportunities for health communication among young women in Jamaica with a focus on self-efficacy, resilience and positive cultural factors.

Associations Between Forced and “Persuaded” First Intercourse and Later Health Outcomes in Women

The effects of nonconsensual first experiences of sexual intercourse in women are understudied. This was investigated in 3,875 adult women of whom 6.7% reported “persuaded” first-sex and 0.8% reported forced first-sex. Compared with willing first-sex, both forced and “persuaded” first-sex occurred earlier, involved a greater age difference between partners, and were associated with more lifetime sexual partners and some measures of worse psychological well-being. In addition, “persuaded” first-sex was associated with worse general physical health. “Persuaded” first-sex and its relation to health need to be better understood, along with how culture influences women’s experiences of first-sex.

Perceptions of Adolescent Pregnancy Among Teenage Girls in Rakai, Uganda

The leading causes of death and disability among Ugandan female adolescents aged 15 to 19 years are pregnancy complications, unsafe abortions, and childbirth. Despite these statistics, our understanding of how girls perceive adolescent pregnancy is limited. This qualitative study explored the social and contextual factors shaping the perceptions of adolescent pregnancy and childbirth among a sample of 12 currently pregnant and 14 never pregnant girls living in the rural Rakai District of Uganda. Interviews were conducted to elicit perceived risk factors for pregnancy, associated community attitudes, and personal opinions on adolescent pregnancy. Findings indicate that notions of adolescent pregnancy are primarily influenced by perceptions of control over getting pregnant and readiness for childbearing. Premarital pregnancy was perceived as negative whereas postmarital pregnancy was regarded as positive. Greater understanding of the individual and contextual factors influencing perceptions can aid in development of salient, culturally appropriate policies and programs to mitigate unintended adolescent pregnancies.

Unmarried male migrants and sexual risk behavior: a cross-sectional study in Shanghai, China

Background

In China, there is increasing concern because of the rapid increase in HIV infection recorded over recent years. Migrant workers are recognized as one of the groups most affected. In this study, HIV/AIDS-related knowledge, attitudes, and behavior among unmarried migrant workers in Shanghai are investigated, with the aim of providing critical information for policy makers and sex educators to reinforce sexual health services and sex health education targeting the behavior and sexual health of unmarried male migrants.

Methods

A cross-sectional survey was conducted among unmarried male migrant workers in Shanghai, China’s largest city and housing the most migrants. A self-administered, anonymous questionnaire was used to collect information on knowledge, attitudes, and behavior associated with increased risk of HIV/AIDS.

Results

A total of 2254 subjects were questioned, with a response rate of 91.3%. Among those interviewed, 63.5% reported sexual activities. Misconceptions regarding HIV transmission, poor perception of HIV infection, and low use of condoms were not uncommon. Among those who had sexual intercourse, 73.7% had not used condoms in their last sexual intercourse, and 28.6% reported having engaged in sexual risk behavior (defined as having at least one non-regular partner). Multivariate logistic regression analyses identified several indicators of sexual risk behavior, including younger age at first sexual intercourse (OR: 0.67, 95% CI: 0.31–0.91 for older age at first sexual intercourse), more cities of migration (OR: 2.91, 95% CI: 2.17–3.81 for high level; OR: 1.15, 95% CI: 1.06–1.29 for medium level), poor perception of acquiring HIV/AIDS (OR: 1.52, 95% CI: 1.33–1.96 for unlikely; OR: 2.38, 95% CI: 1.61–3.70 for impossible), frequent exposure to pornography (OR: 0.33, 95% CI: 0.11–0.43 for never; OR: 0.69, 95% CI: 0.60–1.81 for less frequently), not knowing someone who had or had died of HIV/AIDS and related diseases (OR: 2.13, 95% CI: 1.70–2.53 for no), and having peers who engaged in sex with a non-regular sex partner (OR: 4.40, 95% CI: 3.37–5.56 for yes).

Conclusions

Today, it is necessary to reinforce sex health education among unmarried migrants and sexual health services should target vulnerable migrant young people.

A review of risk and protective factors for adolescent sexual and reproductive health in developing countries: an update

PURPOSE

To conduct a literature review of studies that examined risk and protective factors related to adolescent sexual and reproductive health in developing countries.

METHODS

A literature search was conducted using multiple databases, including PubMed, PsycINFO, Scopus, JSTOR, and the Interagency Youth Working Group. Review criteria included publications that: were conducted in a low- or middle-income country; had a sample size of at least 100 young people aged 10-24 years, and used multivariate analysis. All studies that were identified were also conducted between 1990 and 2010, a 20-year time frame. The literature search and initial review yielded a total of 244 studies that met the criteria and analyzed risk and protective factors related to the following outcomes: sexual initiation, number of sexual partners, condom use, contraceptive use, pregnancy and early childbearing, human immunodeficiency virus, sexually transmitted infections, and sexual coercion.

RESULTS

Most studies that were conducted on adolescent sexual and reproductive health in developing countries were largely focused in Sub-Saharan African contexts, and primarily examined factors related to sexual initiation and condom use. Most factors that examined an adolescent sexual and reproductive health outcome were also focused on the individual level, although an increasing number of studies within the past 10 years have focused on family-level factors. Few studies examined factors at the community or neighborhood level, which, to date, has largely been ignored in developing country contexts.

CONCLUSIONS

The review not only summarizes what is currently known in terms of risk and protective factors that relate to adolescent sexual and reproductive health in developing countries, but also highlights the gaps. Implications for future research are discussed.

Informing HIV prevention efforts targeting Liberian youth: a study using the PLACE method in Liberia

Background

Preventing HIV infection among young people is a priority for the Liberian government. Data on the young people in Liberia are scarce but needed to guide HIV programming efforts.

Methods

We used the Priorities for Local AIDS Control Efforts (PLACE) method to gather information on risk behaviors that young people (ages 14 to 24) engage in or are exposed to that increase their vulnerability for HIV infection. Community informants identified 240 unique venues of which 150 were visited and verified by research staff. 89 of the 150 venues comprised our sampling frame and 571 females and 548 males were interviewed in 50 venues using a behavioral survey.

Results

Ninety-one percent of females and 86% of males reported being sexually active. 56% of females and 47% of males reported they initiated sexual activity before the age of 15. Among the sexually active females, 71% reported they had received money or a gift for sex and 56% of males reported they had given money or goods for sex. 20% of females and 6% males reported that their first sexual encounter was forced and 15% of females and 6% of males reported they had been forced to have sex in the past year. Multiple partnerships were common among both sexes with 81% females and 76% males reporting one or more sex partners in the past four weeks. Less than 1% reported having experiences with injecting drugs and only 1% of males reporting have sex with men. While knowledge of HIV/AIDS was high, prevention behaviors including HIV testing and condom use were low.

Conclusion

Youth-focused HIV efforts in Liberia need to address transactional sex and multiple and concurrent partnerships. HIV prevention interventions should include efforts to meet the economic needs of youth.

Using multiple sampling approaches to measure sexual risk-taking among young people in Haiti: programmatic implications

No previous published research has examined the applicability of varying methods for identifying young people who are at high risk of experiencing unintended pregnancy and acquiring HIV infection. This study compares three surveys of young people aged 15-24 in Port-au-Prince, Haiti, in terms of their sociodemographic characteristics and sexual behaviors and the surveys'usefulness for identifying young people at high risk and for program planning. The surveys consist of responses from: a representative sample of young people in the 2005-06 Haiti Demographic and Health Survey (HDHS), a 2004 facility-based study, and a 2006-07 venue-based study that used the Priorities for Local AIDS Control Efforts (PLACE) method. The facility-based and PLACE studies included larger proportions of single, sexually experienced young people and people who knew someone with HIV/ AIDS than did the HDHS. More respondents in the PLACE sample had multiple sex partners in the past year and received money or gifts in return for sex, compared with respondents in the facility study. At first and last sex, more PLACE respondents used contraceptives, including condoms. Experience of pregnancy was most commonly reported in the data from the facility-based sample; however, more ever-pregnant PLACE respondents than others reported ever having terminated a pregnancy. Program managers seeking to implement prevention activities should consider using facility- or venue-based methods to identify and understand the behaviors of young people at high risk.

Protective and risk factors associated with adolescent sexual and reproductive health in the English-speaking Caribbean: a literature review

PURPOSE

To identify risk and protective factors associated with adolescent sexual and reproductive health (ASRH) in the English-speaking Caribbean through a structured literature review.

METHODS

Peer-reviewed articles published between January 1998 and December 2009 focused on the sexual and reproductive health of adolescents, aged 10-19 years, were included in this review. Articles were organized according to Bronfenbrenner's ecological systems theory. Research gaps were also identified.

RESULTS

A total of 30 studies assessed ASRH. At the individual level, gender, psychosocial well-being, and mental health were key factors associated with ASRH. Within the microsystem, the quality of the parent-adolescent relationship, the presence of violence, substance abuse or mental health problems in the family, and peer relationships were important determinants of ASRH. Within the macrosystem, cultural attitudes had an effect on youth's sexual behavior and generally, safer sex practices appear to be increasing. Within the chronosystem, a history of physical and sexual abuse was associated with several ASRH outcomes.

CONCLUSION

A research agenda that incorporates a multisystem approach and advocates for the inclusion of socially marginalized youth is needed to fully understand and adequately address ASRH in the Caribbean.

Really not even a decision any more: Late adolescent narratives of implied sexual consent

Sexual activity without clear consent, as one aspect of violence against women, is a significant global issue, especially during adolescence when young people are developing their values and beliefs about sexual activity and sexual norms. This narrative inquiry was performed to investigate influences on the sexual decision-making of late adolescents. Ten late adolescent females between the ages of 18 and 22 comprised the final sample. The results included the main finding that in the majority of these adolescents' sexual encounters, sexual consent was implied by the situation instead of being clearly stated. Inability to communicate with partners and the influence of alcohol were identified as contributing factors to implied sexual consent. Additionally, there was a pervasive normalization and acceptance of this type of nonconsensual sexual activity, and no one labeled these actions as rape or assault.

IMPLICATIONS

Providers who work with adolescents need to assess sexual behaviors in greater detail and recognize that complex social factors and individual characteristics may contribute to an environment in which adolescents are at risk for nonconsensual sexual activity. Sexual violence education programs need to include information on negotiation and communication skills that will help adolescents mediate complicated interpersonal situations.

Experiences of sexual coercion among adolescent women: qualitative findings from Rakai district, Uganda

Limited data from low-income countries are available on the continuum of coercive experiences, the contexts in which they occur, and how adolescent women perceive and respond to coercion. This article presents results from focus group discussions and in-depth interviews with pregnant and never pregnant sexually active female adolescents, aged 15 to 17, residing in Rakai District, Uganda, to examine sexual coercion, its context, and the links between coercion and adolescent reproductive health outcomes, including early sexual debut and pregnancy. Informants described multiple forms of sexual coercion, including coerced or forced intercourse, unwanted sexual touching, verbal harassment, and transactional sex. Sexual coercion was perceived to be a normal part of intimate relationships; in particular, informants felt that a woman's lack of decision-making authority, including choices on sexual encounters, was implicit to marriage. This information may help violence prevention programs develop a range of strategies for addressing sexual coercion among adolescents.

Nonconsensual sexual experiences of adolescents in urban India

PURPOSE

Research from developing countries suggests that nonconsensual sexual experiences are common, yet these experiences remain understudied.

METHODS

We describe the prevalence and factors associated with nonconsensual sexual experiences of unmarried adolescents (583 boys and 474 girls), ages 15-19 years, from economically disadvantaged neighborhoods in Delhi, India. We also describe their reports of perpetrators.

RESULTS

Thirty-two percent of boys and 42% of girls reported being touched against their will. After multivariate adjustment, both boys and girls who had ever worked (odds ratio [OR] = 1.76, p = .05 and OR = 1.79, p = .004, respectively) and those who had a friend of the opposite gender (OR = 3.64, p = .0001 and OR = 2.19, p = .0001, respectively) were more likely to report the experience. The most commonly reported perpetrators were female friends for boys (60%) and strangers for girls (93%). Fifteen percent of boys and 3% of girls reported that someone forcibly tried to have a physical relationship with them. Boys who had ever worked (OR = 3.73, p = .007) were more likely to report the experience. Both boys and girls who had a friend of the opposite sex were more likely to report attempted forced physical relationship (OR = 3.73, p = .0001 and OR = 3.41, p = .03, respectively). The most commonly reported perpetrators were female friends for boys (72%) and neighbors (60%) for girls.

CONCLUSIONS

Nonconsensual sex is a common experience for these adolescents and there are important gender differences in experience and type of perpetrator. The findings underscore the need to develop programs that enable young people to prevent and cope with nonconsensual sexual experiences.