BMC Public Health | |
Sexual risk behaviors among youth heads of household in Gikongoro, south province of Rwanda | |
Nancy B Mock1  Lisanne Brown1  Sheila Hosner2  Laura J Hass2  Joseph Ntaganira3  | |
[1] Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA;Tulane University, Rwanda Country Office, No. 22 Avenue des Grands Lacs, B.P. 5266 Kiyovu, Kigali, Rwanda;Department of Epidemiology and Biostatistics, National University of Rwanda, School of Public Health, B.P. 5229 Kicukiro, Kigali, Rwanda | |
关键词: Rwanda; Gender differences; Sexual risk behaviors; HIV/AIDS; Youth Heads of Household; | |
Others : 1163750 DOI : 10.1186/1471-2458-12-225 |
|
received in 2011-03-18, accepted in 2012-03-22, 发布年份 2012 | |
【 摘 要 】
Background
As a result of the 1994 genocide and AIDS, Rwanda has a crisis of orphans. In 2005, the Ministry of Local Governance and Social Affairs of Rwanda has reported one million vulnerable children. Many of these are not only orphans but also youth heads of households (YHH). The purpose of this study was to: (a) identify risk behaviors that expose YHH to HIV infection, (b) determine gender-specific high risk profiles and, (c) determine predictors of sexual onset.
Methods
A household survey was conducted among 692 YHH, aged 12-24, all beneficiaries of a World Vision basic needs program in Gikongoro, Rwanda, from January to March 2004. Participants were interviewed using a structured questionnaire. Data was collected on socio-demographic variables, HIV/AIDS prevention knowledge and sexual risk behaviors. Bivariate analyses of the study variables were performed to examine differences between males and females. A logistic regression analysis was conducted to analyze factors that were independently associated with the debut of having sex.
Results
Forty-one percent of respondents reported sexual onset before age 15. Males were more likely to start earlier than females (50.4% versus 26.7%) but females reported more sexual onset with an older partner. Fifty-eight percent of females had their first intercourse with a partner who was four or more years older than themselves. While sexual activity was low (1.75 mean lifetime sexual partner, 0.45 mean sexual partner last twelve months), sexual experience was related to less social connectedness and use of drugs. Having a close friend also appeared to be protective for sexual debut. The analysis also found that although YHH were aware of some prevention measures against HIV/AIDS, there was low (19.8%) knowledge of the "ABC" prevention program promoted by the government. In addition, despite 85% of respondents knowing someone who had died of AIDS, only 31% perceived themselves at risk of HIV infection, and there was very low (13.2%) condom use among the sexually experienced.
Conclusions
Results suggest the urgent need of HIV prevention programs tailored to YHH that provide knowledge, enhance negotiations skills, and increase the perception of HIV infection risk among YHH in Rwanda.
【 授权许可】
2012 Ntaganira et al; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20150413113745364.pdf | 262KB | download |
【 参考文献 】
- [1]Joint United Nations Programme on HIV/AIDS (UNAIDS) JUNPoHA: Global report: UNAIDS report on the global AIDS epidemic. 2010.
- [2]United Nations Children's Fund: Africa's Orphaned and Vulnerable Generations: Children affected by AIDS. 2006.
- [3]Deininger K, Garcia M, Subbarao K: AIDS-induced Orphanhood as a Systemic Shock: Magnitude, Impact, and Program Interventions in Africa. World Development 2003, 31(7):1201-1220.
- [4]Kirby DB, Laris BA, Rolleri LA: Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world. J Adolesc Health 2007, 40(3):206-217.
- [5]Pettifor AE, van der Straten A, Dunbar MS, Shiboski SC, Padian NS: Early age of first sex: a risk factor for HIV infection among women in Zimbabwe. AIDS 2004, 18(10):1435-1442.
- [6]O'Donnell BL, O'Donnell CR, Stueve A: Early sexual initiation and subsequent sex-related risks among urban minority youth: the reach for health study. Fam Plann Perspect 2001, 33(6):268-275.
- [7]Cerwonka ER, Isbell TR, Hansen CE: Psychosocial factors as predictors of unsafe sexual practices among young adults. AIDS Educ Prev 2000, 12(2):141-153.
- [8]Magnani RJ, Karim AM, Weiss LA, Bond KC, Lemba M, Morgan GT: Reproductive health risk and protective factors among youth in Lusaka, Zambia. J Adolesc Health 2002, 30(1):76-86.
- [9]Zabin LS, Kiragu K: The health consequences of adolescent sexual and fertility behavior in sub-Saharan Africa. Stud Fam Plann 1998, 29(2):210-232.
- [10]Gilborn LZ: The effects of HIV infection and AIDS on children in Africa. West J Med 2002, 176(1):12-14.
- [11]Cote AM, Sobela F, Dzokoto A, Nzambi K, Asamoah-Adu C, Labbe AC, Masse B, Mensah J, Frost E, Pepin J: Transactional sex is the driving force in the dynamics of HIV in Accra, Ghana. AIDS 2004, 18(6):917-925.
- [12]Rwenge MJR: Poverty and sexual risk behaviour among young people in Bamenda, Cameroon. African Population Studies 2003, 18(2):91-104.
- [13]Hargreaves JR, Bonell CP, Morison LA, Kim JC, Phetla G, Porter JD, Watts C, Pronyk PM: Explaining continued high HIV prevalence in South Africa: socioeconomic factors, HIV incidence and sexual behaviour change among a rural cohort, 2001-2004. AIDS 2007, 21(Suppl 7):S39-S48.
- [14]Muula AS, Misiri H, Munthali L, Kalengo S, Kachali F, Mbewe M, Msuku S: The living situations of orphans in periurban Blantyre, Malawi. S Afr Med J 2003, 93(12):920-921.
- [15]Veale A, Dona G: Street children and political violence: a socio-demographic analysis of street children in Rwanda. Child Abuse Negl 2003, 27(3):253-269.
- [16]Swart-Kruger J, Richter LM: AIDS-related knowledge, attitudes and behaviour among South African street youth: reflections on power, sexuality and the autonomous self. Soc Sci Med 1997, 45(6):957-966.
- [17]Oleke C, Blystad A, Rekdal OB: "When the obvious brother is not there": political and cultural contexts of the orphan challenge in northern Uganda. Soc Sci Med 2005, 61(12):2628-2638.
- [18]Blum RW: Youth in sub-Saharan Africa. J Adolesc Health 2007, 41(3):230-238.
- [19]Foster G, Williamson J: A review of current literature on the impact of HIV/AIDS on children in sub-Saharan Africa. AIDS 2000, 14(Suppl 3):S275-S284.
- [20]Ministry of Finance and Economic Planning: 3rd General Census of Population and Housing of Rwanda-August 2002. 2003.
- [21]Gueye M, Castle S, Konate M: Timing of first intercourse among Malian adolescents: implications for contraceptive use. International Family Planning Perspectives 2001, 27:56-62.
- [22]Hargreaves JR, Morison LA, Kim JC, Bonell CP, Porter JD, Watts C, Busza J, Phetla G, Pronyk PM: The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa. J Epidemiol Community Health 2008, 62(2):113-119.
- [23]Irwin CEJ, Rickert VI: Coercive sexual experiences during adolescence and young adulthood: a public health problem. J Adolesc Health 2005, 36(5):359-361.
- [24]World Health Organization (WHO): Guidelines for medico-legal care for victims of sexual violence. Geneva, Switzerland: World Health Organization; 2003.
- [25]Boris N, Thurman T, Snider L, Spencer E, Brown L: Infants in Youth-Headed Households in Rwanda: Implications from emerging data. Infant Mental Health Journal 2006, 27(6):584-602.
- [26]Nyamukapa CA, Gregson S, Lopman B, Saito S, Watts HJ, Monasch R, Jukes MC: HIV-associated orphanhood and children's psychosocial distress: theoretical framework tested with data from Zimbabwe. Am J Public Health 2008, 98(1):133-141.
- [27]Gregson S, Nyamukapa CA, Garnett GP, Mason PR, Zhuwau T, Carael M, Chandiwana SK, Anderson RM: Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. Lancet 2002, 359(9321):1896-1903.
- [28]Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD: Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med 2004, 59(8):1581-1592.
- [29]Karim AM, Magnani RJ, Morgan GT, Bond KC: Reproductive health risk and protective factors among unmarried youth in Ghana. Int Fam Plan Perspect 2003, 29(1):14-24.
- [30]Thurman TR, Snider L, Boris N, Kalisa E, Nkunda Mugarira E, Ntaganira J, Brown L: Psychosocial support and marginalization of youth-headed households in Rwanda. AIDS Care 2006, 18(3):220-229.
- [31]Ministry of Local Government: National Policy for Orphans and Other Vulnerable Children. Kigali, Rwanda; 2003.
- [32]Borgatti S: Elicitation Techniques for Cultural Domain Analysis. Sage edition. Edited by Schensul J. Newbury Park: sage; 1998.
- [33]Thurman TR, Snider LA, Boris NW, Kalisa E, Nyirazinyoye L, Brown L: Barriers to the community support of orphans and vulnerable youth in Rwanda. Soc Sci Med 2008, 66(7):1557-1567.
- [34]Resnick MD, Bearman PS, Blum RW, Bauman KE, Harris KM, Jones J, Tabor J, Beuhring T, Sieving RE, Shew M, et al.: Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA 1997, 278(10):823-832.
- [35]Institut National de la Statistique du Rwanda (INSR) and ORC Macro: Rwanda Demographic and Health Survey 2005. Calverton, Maryland, USA: INSR and ORC Macro; 2006.
- [36]Luke N: Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plann 2003, 34(2):67-86.
- [37]Gregson S, Nyamukapa CA, Garnett GP, Wambe M, Lewis JJ, Mason PR, Chandiwana SK, Anderson RM: HIV infection and reproductive health in teenage women orphaned and made vulnerable by AIDS in Zimbabwe. AIDS Care 2005, 17(7):785-794.
- [38]André C, Platteau J: Land Relations under Unbearable Stress: Rwanda Caught in the Malthusian Trap. Journal of Economic Behavior and Organization 1998, 34:1-47.
- [39]Jessor R, Turbin MS, Costa FM: Protective factors in adolescent health behavior. J Pers Soc Psychol 1998, 75(3):788-800.
- [40]Meekers D, Ahmed G: Contemporary patterns of adolescent sexuality in urban Botswana. J Biosoc Sci 2000, 32(4):467-485.
- [41]Thurman TR, Brown L, Richter L, Maharaj P, Magnani R: Sexual Risk Behavior among South African Adolescents: Is Orphan Status a Factor? AIDS Behav 2006, 10:627-635.
- [42]Kirby D: Effective approaches to reducing adolescent unprotected sex, pregnancy, and childbearing. J Sex Res 2002, 39(1):51-57.
- [43]Nishimura YH, Ono-Kihara M, Mohith JC, Ngmansun R, Homma T, Diclemente RJ, Lang DL, Kihara M: Sexual behaviors and their correlates among young people in Mauritius: a cross-sectional study. BMC Int Health Hum Rights 2007, 7:8. BioMed Central Full Text