Levels of consistent, correct condom use remain low

Adolescent sexual behavior is influenced by school attendance, peer behaviors, community connectedness and communication with sexual partners, according to new analyses of both quantitative and qualitative research findings from Ghana. Although AIDS prevention programs often focus narrowly on knowledge, attitudes and practices specifically related to sexual activity and contraceptive use, these findings indicate a need to consider the broader context of young people's lives.

In "Reproductive Health Risk and Protective Factors Among Unmarried Youth in Ghana," Ali Mehryar Karim of Tulane University et al. assess eight categories of risk-related factors, spanning the individual, family, community and societal levels, that influence young people's sexual behavior and condom use. The study, based on a 1998 survey of 3,739 unmarried 12-24 year olds, finds that youth currently in school, those who believe their friends have not yet initiated intercourse, and those who have not moved to a new community more than once since age 10 are less likely to be sexually experienced.

While sexual experience is associated with these contextual factors, condom use appears to be more strongly influenced by young people's personal characteristics. Both having used a condom at first or most recent sex and consistent use of condoms were most strongly associated with communication with partners concerning pregnancy and STI risks. Those with more egalitarian perceptions of gender roles and greater confidence in being able to negotiate condom use were also more likely to use condoms. The authors report that while Ghanaian youth are knowledgeable about condoms, only 24% of sexually experienced males and 20% of females reported consistent condom use with their current or most recent partner.

In, "Sexual Health Experiences of Adolescents in Three Ghanaian Towns," Evam Kofi Glover of the Planned Parenthood Association of Ghana et al. analyze findings from in-person interviews conducted in 1997 with 704 never-married youth aged 12-24 living in three Ghanaian regional capitals, Takoradi, Sunyani and Tamale. Young people attending school were less likely to be sexually active, compared with those in apprenticeship programs or those unaffiliated with any formal school or training program. They also tended to be less tolerant of violence toward women, more likely to use condoms and less likely to experience unwanted pregnancies.

Overall, more than half of the youth interviewed reported having had sexual intercourse, and sexual experience was more common among older youth, females, and out-of-school youth. Nearly all (99%) knew of condoms, and half of sexually experienced respondents reported having used a condom. When asked more specifically about condoms, however, fewer than half of respondents were able to describe correct use. In addition, there were significant attitudinal barriers to condom use: Two-thirds of all respondents considered it unacceptable for males to carry condoms, and three-quarters considered it unacceptable for females, saying that carrying condoms suggests promiscuity.

These analyses lend support to comprehensive adolescent reproductive health intervention strategies that focus on communication, negotiation and other life skills, and peer education, as well as further research into the effects of living arrangements and school or work status. In particular, both studies indicate that students attending school face fewer sexual health risks than other adolescents. The findings underscore the need for programs that meet the specific needs of different adolescent subgroups, while also better addressing key contextual factors that influence youth behavior.

Both articles appear in the March 2003 International Family Planning Perspectives.

Also in this issue:

"Relationships Between Contraception and Abortion: A Review of Evidence," by Cicely Marston of Imperial College, London and John Cleland of the London School of Hygiene and Tropical Medicine.

"Condom Use and the Accuracy of AIDS Knowledge in Côte d'Ivoire," by Sara L. Zellner.

"Can Women's Childbearing and Contraceptive Intentions Predict Contraceptive Demand? Findings from a Longitudinal Study in Central India," by T.K. Roy, et al. of the International Institute for Population Sciences, Mumbai, India.