TABLE OF CONTENTS
DECLARATION……………………………………………………………………………………………….. ii
TABLE OF CONTENTS…………………………………………………………………………………….. v
LIST OF TABLES…………………………………………………………………………………………….. ix
LIST OF FIGURES…………………………………………………………………………………………….. x
OPERATIONAL DEFINITION OF TERMS………………………………………………………….. xi
ABBREVIATION AND ACRONYMS………………………………………………………………… xii
ABSTRACT…………………………………………………………………………………………………… xiii
CHAPTER ONE: INTRODUCTION…………………………………………………………………. 1
CHAPTER TWO: LITERATURE REVIEW…………………………………………………….. 12
CHAPTER THREE: MATERIALS AND METHODS……………………………………….. 21
- Research Design…………………………………………………………………………………………. 21
CHAPTER FOUR: RESULTS…………………………………………………………………………. 28
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATIONS… 46
- Introduction…………………………………………………………………………………………….. 46
REFERENCES………………………………………………………………………………………………. 61
APPENDICES………………………………………………………………………………………………… 66
Appendix I: Map of Garissa……………………………………………………………………………….. 66
Appendix II: Questionnaire………………………………………………………………………………… 67
LIST OF TABLES
Table 3.1: Secondary schools cluster in Garissa Municipality……………………………………… 23
Table 4. 1 – Socio-demographic characteristics of study population by Abstinence status.. 28
Table 4. 2 – Adolescents sexual abstinence state by educational level of parents……………. 33
Table 4. 3 – Correlation between educational level of parents and having friends from opposite sex 34
Table 4. 4 – Relationship between family gender composition and adolescent’s sexual abstinence state 35
Table 4. 5 – School environment factors and adolescent sexual abstinence……………………. 36
Table 4. 6 – Exposure to HIV prevention messaging by sexual behaviours……………………. 37
Table 4. 7 – Correlation between sexual attempts and exposure to HIV prevention messaging 39
Table 4. 8 – Mass media and sexual abstinence…………………………………………………………. 40
Table 4. 9 – Distribution of respondents according to reason(s) for having friend(s) from opposite sex 42
Table 4. 10 – Correlation between sexual abtinence and reasons for having friends from opposite sex 43
Table 4. 11 – Motivating factors associated with sexual abstinence………………………………. 45
LIST OF FIGURES
Figure 4.1 – Percent of respondents by sexual abstinence state……………………………………. 30
Figure 4.2 – Sexual abstinence by gender…………………………………………………………………. 31
Figure 4.3 – Association between age and sexual abstinence state……………………………….. 32
Figure 4.4 – Educational level of parents…………………………………………………………………. 33
Figure 4.5 – Exposure to HIV prevention and abstinence messaging…………………………….. 38
Figure 4.6 – Most accessed media…………………………………………………………………………… 40
Figure 4.7 – Reasons for not having friends of opposite sex……………………………………….. 44
Figure 5. 1 – Age of respondents by abstinence status………………………………………………… 48
Figure 5. 2 – Motivating factors for sexual abstinence………………………………………………… 55
Figure 5. 3 – Motivating factors for sexual activeness………………………………………………… 56
OPERATIONAL DEFINITION OF TERMS
The concepts relevant to this research include the following:
Sexual Abstinence:
In this research, the term sexual abstinence implies the deliberate and voluntary non- engagement in sexual intercourse by adolescents in secondary schools in Garissa Municipality.
Adolescents:
Adolescents are young people aged 10 – 19 years. In this research, adolescents refer to young people aged between 10 and 19 years and in secondary schools within Garissa Municipality.
Primary abstinence:
Refers to refraining from sexual intercourse by those who are already virgins
Secondary abstinence:
Refers to refraining from sexual activities after having been sexually active in the past.
Sexually active:
Refers to those who had sexual intercourse within the last three months.
ABBREVIATION AND ACRONYMS
| ABC | Abstain, Be faithful, and Condoms |
| AIDS | Acquired Immune Deficiency Syndrome |
| ANOVA | Analysis of Variance |
| APHIA II | AIDS, Population and Health Integrated Assistance project II |
| ARH | Adolescent Reproductive Health |
| ARH&D | Adolescent Reproductive Health and Development (ARH&D) |
| policy | |
| ASRH | Adolescent Sexual and Reproductive Health |
| BCC | Behaviour Change Communication |
| CBS | Central Bureau of Statistics |
| FGD | Focus Group Discussion |
| HIV | Human Immuno-deficiency Virus |
| ICPD | International Conference on Population and Development |
| KAIS | Kenya AID Indicator Survey |
| KDHS | Kenya Demographic and Health Survey |
| NEP | North Eastern Province |
| NGO | Non-Governmental Organization |
| PSI | Population Services International |
| RH | Reproductive Health |
| SPSS | Statistical Package for Social Sciences |
| STI | Sexually Transmitted Infection |
| UN | United Nations |
| WHO | World Health Organization |
ABSTRACT
Sexual abstinence is an important pillar for HIV prevention amongst adolescents. However, according to 2009 Kenya Demographic and Health Survey (KDHS) almost one in every four men under age 24 had their sexual intercourse before age 15. Comparing with the 2003 KDHS, there was small increase in age at first sex, with median age at first sex among women and men increasing from 17.8 to 18.2 years and 17.1 to 17.6 years respectively. This precisely indicates that school-going adolescents engage in sexual activities. While the society expects adolescents in schools to abstain from sexual activities, little is known about the reasons why some school-adolescents engage in sexual intercourse and others decide to abstain. This study examined factors associated with sexual abstinence and how those factors promote or constrain HIV prevention among secondary school adolescents in Garissa Municipality. It was a cross sectional study carried out in Garissa Municipality in North Eastern Kenya. The variables tested were sexual abstinence state, age, gender, education level of parents, family size and school environments. Data collection was done using structured self-administered questionnaires and focus group discussion guides. A total of 394 students were interviewed and five focus group discussions (3 male and 2 female groups) conducted. Key informants that included club patrons and HIV/AIDS teachers were interviewed to triangulate information. Chi square test was used to show association between variables. Results show that primary abstinence, secondary abstinence and sexual activeness among secondary school adolescents were 83.8%, 8.6% and 7.6% respectively. Primary abstinent adolescents were motivated by religious background (37.1%), school-based abstinence promotion programs (32.2%) and plans for their future (19.4%), while Secondary abstinent and sexually active adolescents were motivated by “love for partner” and desire to prove manhood/womanhood among other reasons. Factors that were significantly associated with sexual behaviours were age (χ2 =24.045, df = 5, p = 0.045), educational level of parents (χ2 =22.325, df = 10, p = 0.014), number of female members in the family (χ2 =52.7, df = 34, p = 0.021), exposure to HIV prevention and abstinence messages in schools (χ2 = 11.633, df = 4, p = 0.020), having opposite-sex friends (χ2 = 34.541, df = 12, p = 0.001) and motivating factors associated with abstinence (χ2 = 29.922, df = 10, p=0.001). From FGDs, it was found that educated parents were more concerned about adolescent sexual behaviours, more so that of female adolescents, than uneducated parents. It was also observed that strength of family ties and inter-dependability and advice amongst family members usually shape adolescent sexual behaviours. FGD participants mentioned that Fourth-form male students hire residential rooms in the pretext of revising for final examinations but also end up engaging sexual intercourse with female colleagues. It was concluded that majority adolescents practice sexual abstinence while some were sexually active and they did so for specific reasons. Religious beliefs and parental effort on understanding adolescent development and discussing sexual behaviours are important in enhancing sexual abstinence for adolescents. The study recommends encouraging adolescents to participate in religious activities to enhance sexual abstinence. Programs that promote sexual abstinence in schools and enhancing good parent-child communication on adolescent sexuality are also recommended.
CHAPTER ONE: INTRODUCTION
Background to the Study
The environment in which adolescents are growing up today is very different from that in which their parents grew in. Young people are entering adolescence earlier and are more likely to spend more years in school than previous generations. Consequently, marriage and childbearing are now occurring later than they did in previous generations, and this postponement may literally mean that sex before marriage is becoming more common (Michelle and Adesegun, 2009)
Helping adolescents protect their health is an important public health priority. Besides benefitting young people, increased investment in Adolescent Sexual and Reproductive Health (ASRH) contributes to overall development goals, nationally and globally. In every developing country, early sexual initiation amongst young people is very common. This is further complicated by risks of STIs, inadequate knowledge about contraception, media influences and how to obtain health services, making them more vulnerable to ill health (Guttmacher and IPPF, 2010).
There are an estimated 260 million women and 280 million men aged 15 – 19 in developing countries (UN, 2009). An estimated 25% of these adolescents live in Sub- Saharan Africa. In Kenya, there are about 8 million young people aged 15 to 24 years in Kenya by 2010 according to the 2009 Census. However, this important segment of Kenyan population faces a myriad of health problems. With the average age of sexual debut standing at 17 years according to Kenya Demographic and Health Survey (KDHS) 2008, no health threat is more pronounced to youth than that related to their sexual and
reproductive health. More importantly, the youth remain at the epicentre of HIV crisis in Kenya today.
In the face of HIV threat, young people aged 15 – 24 account for 40% all new cases of HIV (Boonstra, 2010). This indicates that most men and women begin to have sex during teenage years. While the world’s response to HIV and AIDS is now at crossroads, due to rapid expansion of treatment services and climbing rate of new HIV infections outpacing capacity to treat people living with HIV, there are calls to renew focus on HIV prevention. With nearly three million people each year losing their lives to HIV, and four million newly infected, the imperative to stem the pandemic by jointly scaling up prevention and treatment efforts is now a reality. Effectively reinvigorating the global HIV prevention agenda cannot overlook the particularly vulnerable population of the youth (Boonstra, 2007).
According to the Joint United Programme on HIV and AIDS (UNAIDS), young people are the “most threatened” by AIDS and the “greatest hope for turning the tide against AIDS”. UNAIDS further estimates that approximately 10 million young people aged 15 – 24 are living with HIV, of those, most are in sub-Saharan Africa. In countries where HIV is spreading throughout the general population, the vulnerability of youth depends to a large extent on their sexual behaviour. Few very young teens may be sexually experienced, but adolescence is definitely a time of rapid change, and sexual experience is common by late teen years. By their 20th birthday, roughly three in four young women and six in 10 young men in sub-Saharan Africa (the region of the world with highest levels of HIV) have had sex (Boonstra, 2007).
Sexual abstinence for youth has gained much prominence in the advent of HIV prevention programmes. Engagement in early sexual activities amongst young people has been identified as one of the risky behaviours for HIV spread and harmful reproductive health outcomes among adolescents, who are characterized by transitional period of emotional and physical changes. The dire need to protect adolescents from negative effects of sexual and reproductive health, including contraction of STIs, has stimulated execution of sexual abstinence programs for prevention of STIs, particularly HIV, and other detrimental outcomes such as teenage pregnancies (Winskell et al, 2011)..
Abstinence for unmarried youth is an important pillar for the ABC (Abstain, Be Faithful and Condoms) model of HIV prevention. However, the characteristics of adolescents who choose to abstain sexually till marriage and the reasons for abstaining are not much understood. The young people may choose to abstain from pre-marital sex for a variety of grounds including individual, faith factors, and socio-cultural contexts. Different individuals in the target cohort may abstain for different reasons. Such differences, if they exist, are powerful information to guide the designing and execution of appropriate and acceptable programs to advance adolescent sexual and reproductive health. These factors if better understood can significantly contribute to informing adolescent sexual health programming including HIV, STI and early pregnancy prevention (Kabiru, 2007).
Today, young people are exposed to a variety of media that influences their sexual attitudes and behaviours. Televisions, internet and print media are some of the highly influential channels can be both part of the solution and part of the problem in the area of
sex and youth. The question, however, is how to prevent the young people from contracting STIs.
In sub-Saharan Africa, there is remarkable concern about the consequences of premarital sexual intercourses, which include illegal abortions, risks of HIV infection and dropping out of school as a result of teenage pregnancies. This has increased the interest in adolescent fertility because of recognition of the importance of young people to the nation’s socio-economic wellbeing.
