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International Needs (IN) is a Christian International Non-Governmental Organization(NGO) with a mission that crucially includes community development.
In pursuit of its community development mission, International Needs Ghana (ING) andInternational Needs Canada (INC) are collaborating with sponsorship from the CanadianInternational Development Agency (CIDA), to execute the “Education on STDSHIV/AIDS and Reproductive Health Project”, in Akatsi and Ketu Districts, within theVolta Region.
The project is in response to the perceived high-risk sexual and reproductive healthbehavior of the youth in the project area with respect to HIV/AIDS. It seeks to educateand create awareness, build local capacity for guidance and counseling services, andpromote a lifestyle of responsible sexual and reproductive health among young people inthe project area, with particular attention to STIs and HIV/AIDS.
To facilitate effective project implementation and evaluation, there is a need for baselinestudies that would generate the needed data and information for fine tuning projectstrategies as well as indicators for tracking the success or otherwise of the project.
This report is the draft report of the baseline study. It: • Responds to the priority baseline data and information needs of the project, as stated in the baseline study objectives specified in the Terms Of Reference; • Identifies the information gaps that have to be filled by the education and • Provides information that would help in the fine-tuning of the educational and • Provides psychosocial insights into factors that influence the choices and decisions made by young people in the project area regarding their sexualrelationships, reproductive health and susceptibility to STD/HIV/AIDS; and • Establishes indicators for project evaluation.
The first 3 chapters of the report are introductory and sought to explain the relevance ofthe study and how it was carried out. Chapters 4-10, present the results of the study in ananalytical fashion. The subsequent chapters are conclusive as they establish the keyfindings, indicators and recommendations.
2. OBJECTIVES OF THE BASELINE STUDY
The objectives of the baseline study are to: • Collect and analyze data on knowledge attitudes and practices regarding sexual, reproductive health and HIV/AIDS/STIs issues among young people, within theproject communities; • Assess the psycho-social and cultural orientation of adults, opinion, leaders and chiefs in the project communities regarding sexual, reproductive health andHIV/AIDS/STIs issues among young people; • Gather information on the sexual, reproductive health and HIV/AIDS/STI programs, practices and experiences of District and Sub-district level institutionssuch as the district Assembly, Ghana Education Service, Ghana Health Serviceand Non Governmental Organizations and how these institutions could beinvolved in the project; • Help define clearly project beneficiaries; • Help define and establish project progress indicators; and • Make realistic recommendations on how to fine-tune project implementation with particular attention to content, organization and targeting.
3. METHODOLOGY OF THE BASELINE STUDY
The methodology of the baseline study involved desk research, a qualitative study as wellas a quantitative study.
The quantitative study was conducted through the administration of questionnaires toindividual young people in selected project communities. It provided statistics concerningthe research issues and helped establish the baseline indicators.
The qualitative study was carried out mainly through focus group discussions and semi-structured interviews. A field guide was prepared to guide the qualitative study. Thequalitative study generated in-depth information that helped to explain the statistics andcreate the understanding needed for fine-tuning project strategies.
The study was carried out in 10 communities selected by the staff of International NeedsGhana. The communities were Lume, Avega, Metsrikasa, Tadzewu, Akeve Gui, Xavi,Ative, Dzadzepe, Avernorpeme, and Tsigbene.
The quantitative study targeted young people aged 10-24 years both male and femaleincluding those in school and those out of school in each of the ten communities. Two(200) hundred male and female young people were interviewed for the quantitative study.
These were selected through accidental sampling.
In addition to those targeted in the quantitative study, the qualitative study targetedopinion leaders and key informants including those from health and educationalinstitutions.
3.2 Technical Scope of the Study
The study covered the socio-economic context as well as sex, reproductive health andHIV/AIDS related issues.
Briefing from staff of International Needs Ghana indicated that issues related to thesocio-economic context were being covered under separate projects therefore such issueswere mainly studied qualitatively with particular attention to how they relate to andexplain the sexual and reproductive health behavior of young people in the target studycommunities.
Socio-economic context issues mentioned in the project document that were coveredunder qualitative study were poverty, educational status, school dropout and limitedoccupational options.
Being the main area of focus for the study, HIV/AIDS-related issues were studied as partof both the quantitative and the qualitative studies. Issues covered were knowledgeattitudes and practices regarding sexual, reproductive health and HIV/AIDS/STIs amongyoung people; psycho-social and cultural orientation of adults and opinion leaders;sexual, reproductive health and HIV/AIDS/STI services received from District and sub-district level institutions by the communities.
4. THE CONTEXT
The project was based on the assumption that young people behave responsibly whenthey are well informed. Following from this assumption, the project proposed thateducation and counseling are the main mechanisms by which young people can receiveinformation that would enable them to make the right choices and decisions in theessential areas of career development, relationships and reproductive health.
The contextual analysis provided in the present study centers on the socio-economicfactors that affect the ability of young people to access information from education,guidance and counseling that would equip them with desirable knowledge, attitudes andpractices, with respect to career development, sexual relationships, reproductive healthand STDs/HIV/AIDS.
Expected sources of information from education, guidance and counseling with respect tocareer development, sexual relationships, and reproductive health were parents as well asinformal and formal institutions The present study observed a project context that was driven by poverty and a culturalposture that was slow to respond to a changing socio-economic environment. Together,these combined to result in a weak capacity of parents to support their young sons anddaughters to: • Effectively access and utilize educational, career development and more • Respond appropriately to the challenging sex and reproductive culture emerging from a changing socio-economic environment.
As would be seen later in this report, the coping strategies chosen by young people toaccommodate to this context, as at the time of the present study, has been child labor andsexual maneuvers, which together have made them susceptible to high-risk sexual andreproductive health lifestyles and made them vulnerable to STDs/HIV/AIDS.
4.1. School Enrolment
As a result of poverty, parents were unable to cope with their responsibilities towardstheir children in a modernizing socio-economic environment. They largely lost controlover their children and seemed to have resigned to fate.
Many parents were not able to afford their children’s school fees, give them pocketmoney, and provide school uniforms, shoes and books. Many children were therefore notable to enroll in school. Consistently, all the 10 communities studied estimated that overthe years, 5 out of every 20 children of school going age did not enroll.
Many of the children who enrolled did so very late. In different communities it wasexplained that it was possible to find children as old as 10 years in kindergarten, 15 yearsin class one, and 18 years in class 6.It was explained that children who enrolled so late,were likely to be sponsoring themselves in school, having decided to defy the odds ofparental poverty and go to school.
In one community, an out of schoolgirl explained that parents took their school-goingchildren to farm during the rainy season. Such children therefore attended classes once totwice a week. Failure to follow parents to farm as instructed caused the parent not to givethe child chop money to go to school. The child then had to fend for him or herself inschool if he/she insisted on going to school.
Not having enrolled in school, would have deprived the young people in the project area,the information that the school system provided that would have enhanced their capacityto make more informed choices and decisions, with respect to career development, sexualand reproductive health.
4.2. School Drop Out
Under the circumstances of parental poverty and irresponsiveness, it was no surprise thatall the communities studied perceived the rate of school drop out to be high. Like schoolenrollment, school dropout, would have deprived the young people in the project area,access to the information that the school system provided and the capacity to seek,process and utilize such information from other sources, to make more informed choicesand decisions, with respect to career development, sex and reproductive health.
Information from qualitative studies on community perceptions about the rate of schooldrop out, from the different communities studied, suggests that: • Half or less of a cohort of girls that started class one completed JSS; • Between 0 and 3 out of 20 girls that started class one progressed to SSS or a • Three quarters of a cohort of boys, that started class one completed JSS; and • About 5 out of 20 boys that started class one progressed to SSS or a Vocational Consistently across all the 10 communities studied, the rate of school drop out wasperceived to be higher for girls than boys. This perception is supported by data reportedin the Akatsi District Assembly Development Plan (2002-2004). Computations madefrom enrollment data presented in that document suggests that female-male enrollmentratio in class one was approximately 1:1.0, for JSS 1:1.25, and for SSS it was 1:5.0.
Beyond fees (which is no longer an issue of basic education due to the capitation grantunder which Central Government has committed itself to fee-free education) andclassroom needs, the most important need of both boys and girls which could cause themto drop out of school was food or money to buy it, while in school. For the girls, schooluniforms were as important as food.
An in-school participant in one of the discussion sessions remarked, A key informant, a female teacher in the same community also explained that “Many of the girls start school late, by the time they reach class 4, they reachadolescence, become more conscious of their appearance, moreover Children with tornschool uniforms are excluded from school functions and match past and they getembarrassed and unhappy . Some of the boys stole to provide their basic needs or to support their female peer sexualpartners. These boys when caught became a laughing stock, in school, so they quitschool.
Some boys impregnated peer schoolgirls and escaped from the community rather thanface the responsibility and consequences of their action including the rage of parents.
Sometimes children who dropped out of school were able to pull out others through avariety of peer influences. It was explained that school dropouts could earn income tobuy and wear nice dresses, so in schoolgirls were tempted to copy the lifestyle of suchout of schoolgirls.
The circumstances under which many children went to school were not ones likely toproduce good academic outcomes. Many children therefore tended not to perform welland so were mocked at school, got discouraged and therefore decided to quit school orwere withdrawn from school by their parents. During discussions in on of thecommunities, a girl lamented that: “ The same parent who took his school going child to farm during the rainy season,causing the child to attend classes once to twice a week, would withdraw the child fromschool for poor performance . It was also explained that some parents were discouraged from sponsoring theirchildren’s education by many of the young people who completed basic education butwere still around not living profitable lives.
Some children left school because relatives came to take them away to big towns with apromise of sending them to school or some of their friends from the big towns told themthey could get jobs as chop bar keepers in big towns.
Some children left school because their parents had too many (up to 9) children andtherefore had to withdraw the elder child from school to help work to look after theyounger ones.
Capable parents whose children did well were able to send their children to SSS orvocational institutes. Some children did well but parents were unable to sponsor them togo further.
Most girls were not able to progress to SSS or vocational institutes because they gotpregnant before they could finish school or while awaiting results. Others could notmake further progress beyond JSS because parents could not afford to sponsor them orwere unwilling to do so because their fathers perceived that the girls would marry intoother families and be lost.
4.3 Child labor and Sex as Coping Strategies
A coping strategy for children with respect to their education and other needs has beenchild labor. It was found that child labor had a myriad of effects on the psychology ofchildren in school and did incite school drop out.
By inciting school drop out child labor would have prevented children from accessingand utilizing information that the school system provides that would have enhanced theircapacity to make more informed choices and decisions with respect to, careerdevelopment, sex and reproductive health.
Many children were known to be sponsoring themselves in school or supplementingparental support through child labor. The girls would skip school on market days to hawkfor traders to earn money to meet their educational and other personal needs. The boyswould skip school for days, to labor and earn money for their educational and other needsbefore returning to class. The situation was said to be most severe for orphans, childrenliving with single parents, grandmothers and foster parents. As already indicated poorschool attendance caused by child labor did result in poor academic performance andschool drop out.
Whereas some children undertook child labor purely to supplement parental effort, othersbecame obsessed with money and abandoned school completely in chase of money.
The stress of having to combine schooling with work, also caused many children to loseinterest in school and opt for the world of work that was likely to satisfy their immediateneeds, especially food and clothing. They therefore dropped out of school.
It was also indicated that some boys started school late because they had to shepherdcattle for 6 years to receive one cow as a fee before starting school. Children startedshepherding cattle at ages between 8 and 11 after which they started school. Girls did notshepherd cattle. It was not common for young people to drop out of school and shepherdcattle. They would rather do this before starting school.
Beyond different forms of child labor by both sexes, girls adopted the additional copingstrategy of approaching the opposite sex for money, offering themselves for sex, oryielding readily to sexual advances as a way of earning money to deal with theirimmediate educational and other needs.
Girls who participated as respondents in the qualitative study often explained that theboys had more physical strength and were able to labor and earn more income than thegirls. Boys in school or out of school who were engaged in child labor therefore becamethe target of their female peers as a source of money. The evidence from the qualitative studies was that boys and girls, whether in school or out of school, were encouraged bythe income the boys earned from child labor, to initiate and participate in sexualrelationships at an early age, in order to satisfy very immediate needs, but with littleconcern for possible negative consequences.
This coping strategy caused many girls to get pregnant and drop out of school. In- schoolboys involved in such relationships would also sometimes refuse to take punishment fromteachers in the presence of their peer sexual partners and could end up dropping out ofschool.
4.4. Employment Opportunities Accessed By Young People In The Project Area
The information gathered in the project area points to 3 categories of out of school youngpeople comprising those who had never been to school, those who dropped out of basiceducation (Primary School and JSS) and those who could not further their education afterJSS.
Employment opportunities available to these out of school young people, who constitutedthe vast majority of young people in the communities, were generally menial, unskilledand unlikely to enhance the confidence of the young men to marry properly and remain insteady sexual relationships and the girls to resist sex as a money making option.
Out of school girls enrolled in apprenticeship (as hairdressers, seamstresses, Kenteweavers); undertook farming or assisted their parents to do so; undertook food (mainlygari and cassava dough) processing and marketing including cooked food vending;produced and sold charcoal; were taken away by relatives to the big towns to work inchop bars or to operate as sales girls in shops; and joined or were assisted by theirmothers to start trading.
The quantitative data suggests that many out of schoolgirls were likely to be unemployed,farmers or craftsmen. Thirty (30) per cent of out of school girl respondents indicated theywere unemployed, 28 per cent said they were petty traders, 16 per cent said they werefarmers, 12 per cent said they were engaged in food processing especially cooked foodvending, 8 per cent indicated they were craftsmen/artisans, and 6 per cent indicated avariety of other occupations. None of the out of schoolgirl respondents indicated she wasin any form of regular wage employment.
Out of schoolboys in the project area enrolled in apprenticeship to become tailors,masons, carpenters, farmers, welders, drivers, or weavers of Kente or basket. Those outof school young people who could not pursue any of these sources to earn income andwho were therefore unemployed were reported to have resorted to larceny and sometimeshad to flee their communities.
Thirty two (32) per cent of out school boy respondents indicated they were unemployed,26 percent indicated they were farmers, 26 percent indicated they werecraftsmen/artisans, 10 per cent were in a variety of self employment including pettytrading, while 6 per cent were employed by Government or a small business. Thus only 6 percent of young out of schoolboys were likely to be in a form of regular wageemployment.
This was the grim employment or career environment in which the psychosocialdynamics of sex and reproductive health among young people in the project area waslocated. It was also affirmed across communities that most girls who did not proceed intoSSS or apprenticeship, were very likely to get pregnant and possibly enter into a union ofmarriage or co-habitation, within 1 to 2 years.
4.5. Changing Social and economic Environment
There were indications that some elements of modernization in the changing socio-economic environment were having important influences on the choices and decisionsmade by young people in the project area, with regard to sex and reproductive health.
As would be seen later in the report, mobile phones, pornographic films on television andvideo, and offensive but expensive dresses or money to buy these, were some of the toolsused to attract typical rural young girls in the project area to have casual sex. Attendanceof typical western style dance parties in and outside their communities were also reportedduring the qualitative studies to have created platforms of sexual networking for youngpeople.
Supposedly fashionable western style dressing by girls, which often amounted to indecentexposure, was also, affirmed as a sex attractant that most rural young men and someadults including the elderly could not resist.
4.6. Culturally Conservative?
Data from the quantitative studies indicates that most (84 per cent) of the respondentswere Christian, 14 per cent were traditionalist and 1 per cent was Moslem.
Despite the apparent replacement of traditional religion by Christianity, the projectdocument describes the project context as culturally conservative. Though manyexamples of conservatism could be ascribed to communities in the project area, they mostsignificantly were not able to conserve their traditional values of chastity with respect tosex and reproductive health neither have they been able to enforce or live by the samevalues by their current faith Christianity. As would be seen later, their traditionaluncompromising attitude towards indiscriminate sex has broken down in the face of achanging socio-economic environment in which the value of money has tended to drowntraditional moral values.
Most importantly, the evidence suggests that the cultural institution of going throughmarital rites to secure a marriage was under severe stress. A culture of co-habitation afteran accidental pregnancy has emerged.
The studies found that overall, sports, followed by church, traditional cultural activities,and dance parties were the socio-cultural activities patronized by the young people of theproject area. Whereas this pattern was found to be consistent for all the categories ofyoung people studied, out of schoolgirls seemed to patronize dance parties more than anyother socio-cultural activity.
The present study found that the attitude of some parents not valuing formal education isa culture, which has been slow to change. It was variously explained that some parentswould not send their children to school for the simple reason that they the parents didsurvive without having been to school. Others would not send girls to school because thegirls would marry into other families and therefore be lost.
The culture of having many children that could serve as a source of farm labor stillpersisted in the project area.
The evidence suggests that many parents were still unable to discuss sex and reproductivehealth with their sons and daughters for fear the initiative might rather sensitize the youngones to pre-mature and indiscriminate sex.
Some communities still had a conservative outlook towards STDs and HIV/AIDS.
Communities of the project area were generally sensitive to the identification ofHIV/AIDS patients or those who had died from the disease. They were also sensitive tothe identification of herbalists who provided traditional health services to STD patients.
Some communities still ascribed some STDs to spiritual causes.
Community leaders were not able to come up with any initiatives to deal with theemergent culture of indiscriminate sex that had overtaken their communities collapsedthe institution of marriage and rendered their young people vulnerable to pregnancy andparenthood outside marriage, abortions STDs and HIV/AIDS.
The churches, schools and health institutions did have some limited initiatives that thepresent ING project can take advantage of.
5. SEXUAL RELATIONSHIPS ATTITTUDES AND PRACTICES AMONG
YOUNG PEOPLE IN THE PROJECT AREA
The contextual factors-poverty, a cultural posture that has been slow to change in achanging social and economic environment, inability of parents to support their youngsons and daughters to effectively access and utilize educational and career developmentopportunities, sex, and reproductive health have been discussed.
In this section, the effects of these factors on the choices made by young people in theproject area regarding their sexual practices are discussed. At the center of thisdiscussion, is that the lack of adequate, credible, coherent and timely information toyoung people from parental and institutional sources seems to have resulted in theirinability to effectively manage their sexuality in a very challenging and changing socio-economic environment. This has resulted in their susceptibility to high-risk sex andvulnerability to HIV/AIDS.
Traditionally, marriage involving the performance of culturally established marriage ritesushered young people, both male and female, into heterosexual intercourse, relationships,childbirth and parenthood, with the support and approval of their families.
As already indicated all the 10 communities affirmed that the institution of marriage wascurrently under severe strain. Community perception of the extent of collapse of themarital institution (as revealed by the qualitative study) varied, with more than onecommunity estimating that only one of every ten girls got married before having a baby.
Similar rates were estimated for the boys though there was a general perception that boyswere more likely than girls to get married before becoming parents.
• Overall only 7 per cent of the 200 young people, male and female, interviewed as part of the quantitative study indicated they were married.
• 8 per cent of girl respondents were married, 66 per cent were single, 24 per cent were co-habiting, and 2 per cent were divorcees; • Only one in-school girl out of 50 indicated she was in a co-habiting relationship all the rest were single and none was married; and • Though out of schoolgirl respondents in the quantitative study were of the age group 18-24, and therefore the more likely to have been married, only16 percentwere married, 32 per cent were single; 64 per cent were co-habiting; and 4 percent were divorced.
• 6 per cent of boy respondents were married, 77 per cent were single, 18 per cent were co-habiting, and none was a divorcee; • Only one in schoolboy indicated he was married all the rest were single; • Though out of schoolboy respondents were of the age group 18-24, and therefore the more likely to have been married, only 12 per cent were married, 56 per centwere single, 32 per cent were co-habiting; and none was divorced.
The statistics emerging from the quantitative studies was largely consistent with theobservations made from the qualitative studies. Most importantly, the evidence suggeststhat the cultural institution of going through marital rites to secure a marriage was undersevere stress. A culture of remaining single or in co-habitation after an accidentalpregnancy had emerged.
5.2 Sexual Activity
That there was intense sexual activity among young people in the project area was not atall in doubt. The qualitative studies suggest that sexual activity was likely to be prevalentfrom class 3 onwards and was likely to increase sharply towards and immediately afterthe completion of JSS. The quantitative study suggests a mean age of first sex of 15.
The data from the quantitative studies indicates that: • 98 per cent of 50 out of school girl respondents were sexually active; • 58 per cent of 50 in-school girl respondents were sexually active; • 74 per cent of 50 out of school boy respondents were sexually active; • 54 per cent of 50 in-school boy respondents were sexually active.
• Overall, 78 per cent of 100 girl respondents were sexually active; and • Overall, 64 per cent of 100 boy respondents were sexually active.
• Overall, 71 per cent of all 200 young respondents both male and female were A variety of sexual practices were identified. These include sex in stable marital unions,pre-marital sex with single steady sexual partners or with multiple partners, casual sexand forced sex.
5.3. Pre-Marital Sex
All the 10 communities studied agreed during the qualitative studies that pre-marital sexhad become the norm rather than the exception among their young people and that thepractice was pervasive.
Despite the fact that only 16 per cent of female and 6 per cent of male respondents weremarried, the data from the quantitative studies also indicates that 78 per cent of girl, 64per cent of boy, and 71 per cent of all respondents were sexually active. The quantitativedata affirms community perceptions on pre-marital sex.
Young people opting for the practice of pre-marital sex rather than wait after marriage,was attributed to a number of interrelated factors, key among which were natural desire,fun, and money, all of which were reinforced in one form or another by peer pressure.
5.4. Natural Sexual Desire
The fact that the desire by young people to have sex was natural was agreed in all thecommunities studied. While admitting that most parents were poor and therefore unableto provide the needs of their children, it was also observed that some of the childrenwhose parents were able to provide their needs also had pre-marital sex, and thereforethis must be from their natural sexual desire. At the level of the young people this wasexpressed as “lorlor” meaning love, “dzodzro” meaning, “desire” or “gbegble” meaningbeing spoilt. For the purpose of the present study, the term natural desire is used to coverall these expressions.
In all the communities that had access to electric power, it was agreed by young peopleboth male and female that it was common for boys to use pornographic (what they called“blue” or “pono”) films to seduce or whip up the natural desire of girls.
From the quantitative study, 65 per cent of all respondents, male and female, indicatedthat the last time they had sex, it was to express love, satisfy their own sexual desire orsatisfy the sexual desire of their sexual partner.
5.5 Sex For Money
Beyond the natural desire for sex, which was common to both boys and girls, the mostimportant driver of sexual interactions among young people in the project area wasmoney. An interesting interplay between the contextual challenges of young people, theirnatural sexual desire and money was observed.
The contextual challenges in this regard were poverty, poor parenting, unmet needs andwants of young people, all of which finally found a common resolution in money.
As already indicated, poverty was a major characteristic of the project area.
Predominantly poor parents were unable to provide basic and educational needs of theirchildren neither were they effective in providing information to their children on sex andreproductive health.
Many young people could not enroll in school, had to support themselves in school,dropped out of basic education or could not continue from there. The situation was said tobe particularly severe for young people from broken homes, who were living with asingle parent or a foster parent or was torn between both parents. In the words of an outof schoolgirl during the present study: When the developing adolescent is torn between the paternal and maternal homes, things get to a head, when both parties fail to provide her needs and she now has to thinkof and resort to other options for meeting her personal needs . 5.5.2. Poor parenting
Under the circumstances, many young people lost faith in their parents and would notlisten even if the parents tried to provide some counseling. Parents also lost control overtheir children. Weak parental supervision and control is illustrated by comments capturedfrom girls during the present study: Girls tend to go out without the consent of their parents because they perceive that they are looking after themselves so where they go is nobody s concern . When some parents notice that their adolescent daughters have sexual partners, they begin to neglect to take care of the girls assuming that the sexual partners should carefor them . Our elder siblings brought their sexual partners home and had sex with them without the knowledge of our parents, when we see these things we also wish to try it. Sometimes we run errands for our elder siblings involving relationships so we notice what they do and also want to do it. The qualitative evidence also suggests that the lack of parental supervision alsodegenerated into a situation where the loose sex life of the young people became a sort ofnegative role modeling for their younger peers.
5.5.3. Unmet Needs
Young people were therefore caught in circumstances where their basic material,educational, as well as information needs regarding their sexual and reproductive healthwas unmet.
5.5.4. Coping Strategies
Needy and uniformed young people, with little experience in life therefore had to designcoping strategies by themselves mostly with information from their equally uninformedand inexperienced peers.
Some chose to leave their communities with the help of relatives or peers living outsidethe community. Others (who are the target of the present study) remained and came upwith two main coping strategies- the manipulation of their physical strength in the formof child labor adopted by both sexes, and the manipulation of sexuality through sexualmaneuvers, adopted mainly by girls.
Pre-marital sex therefore happens to be largely but not exclusively a coping strategy thatplays upon the natural sexual desire of both sexes, with the quest for money for basic andeducational needs and wants as its main motivation.
Money as an important motivation for pre-marital sex was affirmed in all thecommunities during the qualitative study and effectively validated by data from thequantitative study.
A variety of comments made during different discussion sessions in the differentcommunities illustrate the role of money in pre-marital sex.
When our parents send us to school, they are not able to provide us with chop money, neither are they able to procure books that we require in school. If there is a boy in classwho is able to earn some income and his parents are also able to provide for him, youare also being caned in school for not having books, and the exams are also being setfrom the books that you do not have, the temptation for the girls is to approach the better-off boys for financial support, which some of the boys are able to provide. After providingthe money for some time he would propose a sexual relationship to you. At this stagewhatever the boy says to you becomes very pleasant . Somehow the children tend to trust and submit to the control of their boyfriends rather The girls keep demanding money from us often and by doing so our minds become attracted and focused on them so a relationship develops. Mostly the young men use money to attract the girls to have sex. Boys or young men in the villages who earn money through child labor often constitute themselves into sex gangs that take advantage of the needs of adolescent girls. Theycould change 5000 cedis into 1000- cedis notes and be doling it out daily and by this,cause adolescent girls to follow them . The qualitative evidence suggests that the girl or the boy would have initiated thetrappings of sex for money.
From the quantitative study, 16 per cent of out of school, 12 percent of in school and 14per cent of all the girl respondents indicated that the last time they had sex it was formoney.
Data from the quantitative study further revealed that 42 per cent of all out of school, 12per cent of in school and 27 per cent of all girl respondents had sex for money over thepast year.
As would be seen later, the quest for money is an important driver of multiple sexualpartner behavior, casual sex, and sometimes coerced sex.
5.6. Sex For Fun
Beyond natural desire and money, young people also indicated they had sex for fun.
Twelve percent of all in-school boys and 12 per cent of in schoolgirls interviewed duringthe quantitative study indicated they had sex for fun as against 2 per cent for out ofschoolboys and 2 per cent for out of schoolgirls. From the quantitative data, it appears itwas the in-school boys and girls who mostly had sex for fun aside other reasons.
5.7. Multiple Sexual Partner Behavior
The unrestrained practice of pre-marital sex and the gradual erosion of the culture ofmarriage seemed to have degenerated into other types of sexual practice including sexwith multiple partners. Multiple sexual partner behavior is of particular significance tothe present study, given its potential for spreading HIV/AIDS.
All the communities contacted during the qualitative studies affirmed that multiple sexualpartner behavior was common among the young people.
Consistent with this observation, the quantitative data indicates that: • 46 per cent of out of school, 8 per cent of in school, and 27 per cent of all girl respondents had sex with more than one partner over the past year; • 14 per cent of out of school, 10 per cent of in school and 12 per cent of all boy respondents indicated they had sex with more than one partner over the past year;and • 18 per cent of all young respondents, of both sexes had sex with multiple sexual The quantitative data also revealed that of those who had sex with multiple sexualpartners over the year, 77 per cent had sex with 2 partners while the rest 23 per cent hadsex with more than 2 with a maximum of 5.
From the data, it was the out of schoolgirls who were most likely to be engaged inmultiple partner sexual practice.
The different circumstances and factors that influence the decision to opt for the practiceof multiple partner sexual behavior were variously illustrated during discussions withyoung people and opinion leaders as part of the qualitative study.
For the girls, 4 different scenarios were revealed by the qualitative study. Some girlsconsented easily to any boy or man who demanded sex, some had more than one regularsexual partner, others expanded their sexual network when their regular sexual partnerwas unable to meet all or a particular need, and yet some others were promoted for menby their own parents especially their mothers.
5.7.1. Money and Multiple Sexual Partner Behavior
The importance of the quest for money as an important motivator of multiple sexualpartner behavior was affirmed by data from the quantitative studies.
Twenty- two (22) per cent of out of schoolgirl respondents as against 4 percent of in–school girls explained that the reason they had sex with multiple partners was for money.
Some of the comments that came out from discussing multiple partner sexual behaviorwith girls and which illustrate the different circumstances under which the decision to optfor multiple sexual partner behavior took place were as follows: Sometimes the boys create the impression that they have money, after you give yourself to them you find out that they do not have. If you discover this, you will easily yield toanother boy who proposes with better prospects of providing for you. It is often howevernot easy to break the first relationship so you tend to keep the two . Some girls out of greed, were easily induced with money to yield to sexual intercourse with multiple partners, they deliberately go in for many boys so that they can pooltogether financial resources from different sources to buy expensive clothing . The data also suggests that it is the female out of schoolgirls, who were most likely tohave sex with multiple partners for money.
5.7.2. Poor Parenting and Multiple Sexual Partner Behavior
During both the quantitative and the qualitative studies, there were indications that someparents encouraged their daughters to have sex with multiple partners.
While this recurred in the qualitative discussions in different forms, the quantitative dataindicated that six (6) per cent of out of schoolgirls and none of the others indicated theirparents caused them to have sex with multiple partners. An opinion leader said duringone of the discussion sessions that: Some of the weak mothers have become consultants to their daughters in their Much of the evidence from the qualitative studies affirmed that it was the mothers whowere most likely to be promoting their daughters for sex. Such mothers, it was revealed,did receive favors from boys or men and offered their daughters for sexual relationships.
5.7.3. Natural sexual desire, fun and Multiple Sexual Partner Behavior
From the perspective of the boys, the practice of having multiple sexual partners wasapart from satisfying the natural sexual desire, for fun and was also opportunistic andlargely influenced by peer pressure.
Comments that illustrate the male responses were as follows: Sometimes boys know that the girl has a sexual partner or more but they would still go “Some of the boys indicate their awareness about the girl s sexual partner whileaccosting her for a sexual relationship; this makes the girl less sensitive to moving withmore than one partner . Once the girl makes herself so available, why not? Sometimes this practice became a contest between boys where they tried to prove andboast about their conquest among their peers. Peer influence was indicated as playing animportant part in this practice. Boys, deliberately seeking to have sex with girls theyknew had multiple sexual affairs, also show low risk perception, naivety and carelessnessabout their sex life.
5.8 Casual Sex
Casual sex is of particular significance to the present study, given its potential forspreading HIV/AIDS. For the purpose of the present study, casual sex refers to a verytemporary, short term or one shot sexual relationship.
All the communities contacted during the qualitative study affirmed that casual sex was acommon occurrence. As has consistently been the case with data emerging from thepresent study, the quantitative data supports the qualitative observation that casual sexwas common among young people in the project area.
The quantitative data indicated that, 17 per cent of all young people respondents indicatedthey ever had sex with a stranger, 14 per cent indicated they did so over the past year, and4 per cent indicated that the last time they had sex it was with a stranger.
The quantitative data further revealed that it was the out of–schoolgirls who were mostlikely to have sex with strangers. In fact, 40 per cent of out of school girl respondentsindicated they ever had sex with a stranger, 36 per cent indicated they did so over the pastyear, and 10 per cent indicated that the last time they had sex, it was with a stranger.
In schoolgirls were by no means excluded from extending their sexual networks to coverstrangers, as 10 per cent of in-school girl respondents indicated they ever had sex with astranger, 6 per cent indicated they did so over the past year, and 2 per cent indicated thelast time they had sex, it was with a stranger.
Together both the qualitative and quantitative studies provide evidence that describecircumstances under which young people in the project area decided on and actually hadcasual sex.
• Fourteen (14) percent of out of school girls and no (0 per cent) in-schoolgirl indicated they had casual sex with a stranger because of money; • Eight (8) per cent of out of school and 4 per cent of in schoolgirl respondents indicated they had casual sex with a stranger out of love or natural desire; and • Eight (8) per cent of out of school and Eight (8) per cent of in schoolgirl respondents indicated that the reason they had casual sex with a stranger wasbecause they were forced.
Whereas the already mentioned interplay between natural sexual desire, and use ofsexuality as a coping strategy to earn money were evident, social events and forced sex,also emerged as factors that facilitated casual sex with strangers.
5.8. 1. Social Events and Casual Sex
Though casual sex did ordinarily occur, there was evidence from the qualitative studiesthat its occurrence was mostly during social events such as wake- keeping duringfunerals, dance parties, and festivals be they Christian or traditional.
Though casual sex mostly involved local girls, girls from other communities whopatronized such occasions also ended up having casual sex with local boys or withstrangers from big towns. An opinion leader described such occasions as: A sex market to which single girls also brought their wares and the wares were The evidence from discussions during the qualitative study further indicated that manygirls who yielded to casual sex on such occasions would have already purposed that theywould give themselves to a stranger for money so they would consent immediately theproposal was made.
Though the practice of local boys having casual sex with strange girls they hardly met didoccur, the evidence suggests, this was not as common as local girls having casual sexwith male strangers. To buttress the point of local boys having casual sex with femalestrangers, a young female participant in one of the discussion sessions said: There had ever been an incident in which girls from other communities had sex with boys in the community and became stranded as they did not have money to go backbecause the boys involved promised them money but escaped . That local boys also had casual sex with female strangers was corroborated by thequantitative data, as: • Six (6) per cent of out of schoolboy respondents indicated they ever had casual sex with a stranger, 2 per cent indicated they had sex with a female stranger overthe past year, and none indicated his last sexual intercourse was with a stranger;and • Twelve (12) per cent of in-school boy respondents indicated they ever had sex with a stranger, 10 per cent indicated they had sex with a stranger over the pastyear, and 4 per cent indicated the last time they had sex it was with a stranger.
It is apparent from the data that in-schoolboys were more likely to have sex withstrangers out of schoolboys. That more in-school boys had casual sex with strangers thanout-of-school boys is noteworthy. This is consistent with the statistics, which suggeststhat in-schoolboys were more likely to have sex for fun than out of schoolboys. It alsosuggests carelessness or naivety with respect to possible STD or HIV infection.
5.8. 2. Money and Casual Sex
Contributions made by young girls to discussions on casual sex, suggest that girls oftenassumed that male visitors attending social functions had money, so would easily yield toa stranger with expectation of a financial reward. Thus, for the girls, money or itssymbols were major motivations for the decision to partake in casual sex.
In this connection, ostentatious dressing, brandishing of mobile phones, fantasticpromises backed with mobile phone numbers, and arriving in a car, were some of theattractions that moved girls to have casual sex with strangers they had just met.
In his contribution to the subject on casual sex, a male opinion leader said A stranger who fulfilled any of these conditions would no sooner finish proposing than the response would be halleluiah Amen . There was evidence however that some of the casual sex encounters that happened underthe trappings of money, did not happen willingly. Both the quantitative and qualitativestudies indicated that some of the strangers, who had casual sex with local girls, did so byforce. It was explained that strangers invited the girls to come and collect money andwhen the girls went, the strangers raped them. The subject of forced sex is discussedelsewhere in the present report.
5.8. 3. Poor Parenting
The role of parents, particularly mothers in promoting their daughters for sex wascaptured during the qualitative studies in relation with girls having sex with strangers. Inthis connection, it is noteworthy to indicate that 6 per cent of out of schoolgirls indicatedit was their mother, father or both who caused them to have sex with a stranger.
5.9. Forced Sex
The practice of forced sex was captured in all the communities studied. Its practice seemsto be pervasive, involving a wide range of people including strangers, sugar daddies,peers, cousins and ordinary community members including church members, teachersand head teachers and unspecified community members. Teachers and head teacherswere also mentioned as perpetrating forced sex on their female students during thequalitative study though none of the respondents specified this during the quantitativestudy.
In all, about 17 percent all girls interviewed during the quantitative study indicated theywere ever raped or forced to have sex against their will, and 6 per cent indicated theyexperienced this over the past year, suggesting the practice was very current.
Consistent with all the other statistics on sexual activity, it was the out of schoolgirls whowere most likely to have experienced forced sex or rape. Fifty two (52) per cent of out ofschool girls interviewed admitted that they ever had forced sex. While many would notgive the details of how this happened, 10 per cent indicated they were raped once, 6 percent twice, and 10 per cent several times, and 2 per cent indicated they experienced thisover the past year. Thirty six (36) per cent of the out of school girls indicated they wereraped or forced by their peers, 8 per cent by a stranger and 2 per cent by a churchmember. Thirty (30) per cent indicated the forced sex encounter occurred in a house(their own house, the house of the perpetrator or a neutral house) in the community, while10 per cent indicated it happened at a hotel.
In-school girls were not excluded from the forced sex experience. Fourteen (14) per centof in-school girls admitted they were ever raped or forced to have sex against their will;10 per cent indicated they experienced this once, 2 per cent twice, and 2 per cent fourtimes. Six per cent of in schoolgirls indicated they were raped or forced by a stranger, 4per cent by a sugar daddy, 2 per cent by a cousin, and 4 per cent by other unspecifiedcommunity members. Twelve (12) per cent of these incidents occurred in a house (thehouse of the perpetrator or a neutral house) in the community, and 2 per cent in a darkcorner.
The qualitative study revealed a variety of circumstances under which forced sexoccurred. From these, it was clear that the girls were tricked with love, money or a giftand coerced into sex.
The accounts given suggest that the mode of coercion was physical or chemical wherebythe girl was sedated by being served with a soft drink pre-mixed with a drug. Spiritualcoercion was also mentioned in one community.
Two modes of gang rape were also described. Under one scenario, the practice was that aboy arranged with her peers to discipline an unfaithful sexual partner through gang rape.
Under a second scenario a girl who accepted a sexual relationship from a boy andbenefited from the relationship but refused to yield to sexual intercourse, was trapped andrestrained physically by the boy’s peers, for the boy to have sex with her.
5.10. Sexual Networks
Community perceptions during the qualitative study suggest that the sexual network ofyoung people in the project area was very wide. It covered spouses, in school and out ofschool peers, adults including the elderly, strangers, and teachers and partners in othercommunities.
The sexual network of young girls was said to also include old men. According to anopinion leader during discussions on the subject: “These days the young girls tend to come too close .
A girl contributor to one of the discussion sessions during the qualitative study said, “If you continue collecting money from an elderly person, one day what you will hearwill be Elikplim, leke ne ga nya kpopom alea (meaning Elikplim why are you looking sonice these days, she will propose to be your sexual partner and the relationship begins . Teacher-student relations were also reported in more than one community. It, accordingto the evidence, involved teachers and head teachers. Sometimes girls involved in suchrelationships also had in-school peer sexual partners and this resulted in clashes betweenthe male student partner and the teacher. Some boys were reported to have dropped out ofschool because they got entangled in this type of sexual network. Guidance andcounseling programs for in-school boys and girls could touch on this subject.
Of particular relevance to the present study is the carelessness with which multiple sexualpartner sex was practiced without sensitivity to STD/HIV/AIDS. The need for youngpeople to be educated and counseled to become more sensitive to the risks associatedwith having sex with multiple partners is evident. The extension of the sexual network ofyoung girls to teachers and the elderly also meant that teachers and the elderly were alsovulnerable with respect to HIV/AIDS.
6. CONDOM USE AMONG YOUNG PEOPLE IN THE PROJECT AREA
Community knowledge, attitudes, and practices on condom use were also studied by boththe quantitative and qualitative studies. What emerged from these studies was the needfor improvements in the local condom distribution system to facilitate access, andeducation and counseling of young people on the risks associated with the differentchoices they made with respect to condom use.
6.1 Knowledge About Condoms
Almost all young people in the communities had heard about and seen condoms. It ismainly the male condom that they most had ever seen and not the female. Somecommunity opinion leaders indicated they had heard about condoms but some indicatedthey had neither ever seen nor used one and would obviously not have been able toeducate or counsel their young ones about condoms.
6.2. Access to Condoms
Young people in the different communities studied indicated they mainly had access tocondoms from a variety of sources that proved to be inconsistent from community tocommunity.
Sources variously mentioned were chemical shops in their own or neighboringcommunities, drug peddlers, community health nurses on outreach or trained TraditionalBirth Attendants.
Access was however identified as an issue to condom use. Some communities did nothave condom distribution points. In one community, the trained Traditional BirthAttendant, who distributed condoms was said to be too old and mostly left condom salesto his untrained youngsters. These untrained distributors tended to pass insinuativecomments, when children or young people came to buy condoms, so some young peoplefelt shy to buy condoms from them.
The need for interventions to improve the condom distribution system in the project areais evident.
6.3. Use of Condoms
Despite the relatively high levels of sexual activity, casual sex, multiple sexual partnerbehavior and forced sex involving a wide network, attitudes and use of condoms wassuspect. Both the qualitative and the quantitative evidence suggest unprotected sex withrespect to HIV/AIDS was the norm rather than the exception.
Though 71 per cent of all young respondents interviewed in the project area indicated thatthey were sexually active, only 29 per cent of those interviewed indicated they used a condom during their last sexual intercourse, and more importantly, only 17 per centindicated they used condoms consistently whenever they had sex.
• 98 per cent of out of school girl respondents were sexually active, yet 46 per cent indicated they used a condom when they last had sex; • 58 per cent of in-school girl respondents were sexually active yet only 8 per cent indicated they used a condom when they last had sex; • 74 per cent of out of school boy respondents were sexually active, yet only 30 per cent of them indicated they used a condom the last time they had sex; • 54 per cent of in-school boy respondents were sexually active yet only 24 per cent of them indicated they used a condom the last time they had sex; • Overall, 78 per cent of girl respondents were sexually active, yet only 31 per cent of them indicated they used a condom the last time they had sex; • Overall, 64 per cent of boy respondents were sexually active, yet only 27 per cent of them indicated they used a condom the last time they had sex.
The quantitative data suggests that in-school girls and boys were the least likely to usecondoms consistently even though they were active participants in the sexual networks ofthe community.
Explanations given during the qualitative study suggest that the decision or choice not touse condoms was because: • Some partners trusted themselves and did not think condom use was necessary; • Some girls thought the condom could remove, burst, and enter their womb, so • Sometimes the boy wants to impregnate and marry the girl and was not sure the girl would accept so would wish to impregnate her as a way out; and • Some boys did not just like condoms because they said condoms did not make Thus failure to use condoms was either due to misconceptions about its use, difficultiesof access, as well as lack of commitment to its sustained use.
6.4. Inconsistent Use Of Condoms
There was consensus on the inconsistent use of condoms from both the quantitative andqualitative studies. In the quantitative studies: • 98 per cent out of school girl respondents were sexually active, yet only 30 per cent indicated they used condoms consistently whenever they had sex; • 58 per cent of in-school girl respondents were sexually active yet only 4 per cent indicated they used condoms consistently whenever they had sex; • 74 per cent of out of school boy respondents were sexually active, yet only 28 per cent indicated they used condoms consistently whenever they had sex; • 54 per cent of in-school boy respondents were sexually active yet only 6 per cent indicated they used condoms consistently whenever they had sex; • Overall, 78 per cent of girl respondents were sexually active, yet only 17 per cent indicated they used condoms consistently whenever they had sex; and • Overall, 64 per cent of boy respondents were sexually active, yet only 17 per cent indicated they used condoms consistently whenever they had sex.
The following comment by a boy during the qualitative studies illustrates a circumstanceunder which condom use might not be consistent.
“If a girl unexpectedly makes herself available at a time that the boy/man does not have acondom, the man would have to seize the opportunity, condom or no condom . There was evidence from young people across communities that some girls were able tosuccessfully insist on condom use and boys did yield to this demand in a first sexualencounter, but not in subsequent ones.
Though this was not probed, the fact that in-schoolgirls were the least likely to use acondom and also use it consistently could be explained by their lack of power to demand,bargain for, or negotiate effectively for its use. Having to spend time in school meant thatin-schoolgirls, who lacked parental support, were less likely to earn much income ontheir own and would therefore be powerless in cases where their sexual relationship waspurposely for money and their partner refused to use a condom. Out of schoolgirls didhave time to work and at least earn some income from petty trading and other jobs andtherefore would have had a better bargaining power in terms of condom use.
6.5. Condom Abuse
Deliberate abuse of condoms was also reported in more than one community, during thequalitative study. The common story was that a boy would cut the tip of the condom,wear it to show his girl partner that he used a condom, so he can impregnate the girl anddeny paternality. He would do this to punish the girl for infidelity. Condom abusesuggests naivety, frivolity and lack of risk perception with respect to HIV infection.
6.6. Condom Information
The source of information on condoms was said to be radio and television even thoughone community indicated that Health personnel from Dzodze came to give them a talk onthe subject. The mass media, being the major source of information without a means offeedback, is an issue because it does not provide the mechanism to respond to audienceconcerns and therefore would not easily help clear their doubts and misconceptions. Thismay explain why a number of misconceptions persisted in the communities aboutcondom use.
7. PREGNANCY AND PARENTHOOD AMONG YOUNG PEOPLE IN THE
A possible consequence of the practice of unprotected, casual, forced and multiplepartner sex is unplanned pregnancy.
Twenty four (24) per cent of young people interviewed said they already had a child. Thiswas in spite of the fact that only 7 per cent said they were married. Having childrenwithout having been married, would partly explain why many children were unlikely tohave adequate parental care and support.
Consistent with the data on sexual activity, it was the out of schoolgirls who mostlyalready had a child. It was explained recurrently during the qualitative studies that mostJSS girl graduates would get pregnant within one to two years, if they did not furthertheir education or go into apprenticeship. Fifty four (54) per cent of out of schoolgirlrespondents indicated they already had a child. This was in spite of the fact that only 16per cent of them indicated they were married, reinforcing the prospects of weakparenting. The picture was not different for the out of schoolboys, as 36 per cent of themindicated they had a child, when only 6 per cent indicated they were married.
In school young people were not entirely excluded from discussions about pregnancy as 4per cent of in-school boy and 2 per cent of in-school girl respondents indicated theyalready had a child, while 2 per cent of each of these categories of young peopleinterviewed during the quantitative study, indicated they were married.
7.1 Information on the Menstrual Cycle
Other family planning methods apart from condoms were not investigated because thefocus of the study was more on STDs and HIV/AIDS than anything else. Suffice it toindicate however that during the qualitative studies, young people in the differentcommunities indicated they used both traditional and modern family planning methods ofa sort, which might have lessened the rate of pregnancies.
While some might have used these methods successfully, the qualitative data revealedthat the quality of information available to young people on the menstrual cycle wassuspect.
A male participant in one of the discussion sessions during the qualitative study said a menstrual cycle chart circulating in their community, on which many young people Another male participant in discussions on condom use in a different community alsosaid, I used condoms mainly when my sexual partner was having menstruation, in order to It is clear that the young people either depended on the wrong information ormisunderstood what they read and therefore need more accurate information andexplanation on the menstrual cycle through interpersonal communication.
8. ABORTION AMONG YOUNG PEOPLE IN THE PROJECT AREA
Abortion among young people was affirmed to be common in all the communitiesstudied. In general abortion rates were perceived to be high and the methods and servicesreceived notably perilous and secretive. Issues surrounding the decision to terminate apregnancy had to do with lack of credible information on family planning as well as weakpsychosocial support systems.
8.1 Abortion Rates
Estimates made by the young people about the proportion of pregnancies that survived toterm among their peers suggested a unanimous community perception that abortion rateswere high. Overall, the communities perceived that half or more of all pregnanciesamong young people never survived to term, even though they admitted most peopleinvolved in abortion would conceal the practice because of community sensitivities to thesubject.
Being a subject of very high community sensitivity, it was more difficult to discuss at theindividual level than at the group level. Despite this, 7 percent of all, 24 per cent of out ofschoolgirl, 2 per cent of in schoolboy respondents and none of the in-schoolgirlrespondents in the quantitative study, admitted they were ever involved in pregnancytermination. Consistent with the sexual activity data, the abortion data affirms that it wasthe out of schoolgirls who were most likely to be involved in pregnancy termination.
Young people in the project area gave a wide variety of reasons for pregnancytermination. The evidence suggests that a pregnant girl opted for abortion if: • She or her sexual partner was in school and would not want the pregnancy to interfere with his or her education and more especially if the girl had been assuredof support by a well-off relative if she went through basic education successfully; • She was in a multiple partner sexual relationship therefore unable to decide on the paternality of the fetus or obtain the acceptance of a sexual partner to takeresponsibility; • The male sexual partner known to be responsible for the pregnancy was unemployed and therefore the couple assessed that they could not possibly takecare of the responsibilities associated with the pregnancy; • She and the male sexual partner known to be responsible for the pregnancy were from families that were already at conflict with each other, afraid of the hostilereaction of their parents, were already being harassed because of the relationshipand most especially if the girl perceived that her parents might abandon her; and • She feared losing out of the company of her peers as the pregnancy might restrict her movement and make her unable to attend dance parties and enjoy herself.
8.2 Abortion Methods and Services
There was consensus across communities that pregnancies were terminated: • In the house of the pregnant girl through a self-administered concoction that may be herbal or an overdose of a known drug (for example chloroquine); and • A private home or a health facility where the pregnant girl could obtain the services of trained medical personnel (some of whom were retired nurses) for anoperation.
Communities in which private institutional abortion services were procured werementioned as Aflao, Dzodze. Akatsi, Abor, Aflao, Xevi Avernorpeme and Denu.
Those who went through the abortion at home, it was explained, did so because theyknew the concoction and also because it was a much cheaper.
8.3 Psycho-social Support for Abortion
It was explained that if a girl experienced an unwanted pregnancy, she would consult thesexual partner supposedly responsible for the pregnancy, her peers and then her mother.
In many communities, girls who had previous experience in self-induced abortion weresaid to have become “professional abortionists”, who easily counseled their peers into thepractice.
The role of parents in young people deciding on an abortion was explained in twocontrasting ways. Whereas fear of parental hostility was cited as causing young people inthe project area to opt for an abortion, some parents rather supported their daughters tosafely pursue the abortion option.
From the explanations given during the qualitative study, parental support and possiblysponsorship for an abortion occurred if: • The boy supposedly responsible for the pregnancy refused to accept • Parents wished to ensure that their pregnant daughter finished school and pursued • Parents wished to avoid a dishonoring of their family name; • Parents perceived the girl to be too young so the pregnancy might run into • The mother of the girl had been receiving favors from the boy on behalf of her daughter without the knowledge of the girl’s father and therefore bore complicityfor the unplanned pregnancy.
Pressure and sponsorship offered by the sexual partner supposedly responsible for thepregnancy also played a part in a pregnant girl opting for pregnancy termination. Often,the boys sponsored the abortion with money, procured and provided the medicine orconcoction to be used for the abortion, and threatened to deny responsibility for thepregnancy and abandon the girl to her fate if she refused the abortion option.
9. SEXUALLY TRANSMITTED DISEASES AND HIV/AIDS
The practice of casual, multiple partner and forced sex largely without the use ofcondoms within the framework of a wide sexual network, means that young people andpossibly the adults in the project area were living dangerously as regards theirvulnerability to STDs/HIV/AIDS.
The practice of casual, multiple partner and forced sex largely without the use ofcondoms within the framework of a wide sexual network, means that young people andpossibly the adults in the project area were living dangerously as regards theirvulnerability to STDs/HIV/AIDS.
All the communities studied were aware of the existence of STDs and the common localterm used to describe STDs was “nulor”. Beyond HIV/AIDS, the only STD that mostyoung people knew was gonorrhea and to a much less extent syphilis.
The knowledge of the communities including the young and old people about thesymptoms of these 2 STDs particularly syphilis was however suspect. Some mentionedurination of blood, passing of blue-colored urine, growing lean, diarrhea, as symptoms ofgonorrhea, while others attributed syphilis to spiritual causation.
9.1.1 Knowledge about STD-HIV/AIDS Linkages
The fact that not treating STDs could increase the infected person’s chances ofcontracting HIV was not known to many of the young people contacted during thequantitative study. Half or 50 per cent of all respondents did not know this.
There were also variations in this knowledge between the different categories of youngpeople studied. From the quantitative data: • 6 per cent of out of school and 22 per cent of in schoolgirl respondents knew that if girls did not treat their STDs, they were more susceptible to infection withHIV/AIDS; and • 10 per cent of in school and 80 per cent of out of schoolboy respondents knew that if boys did not treat their STDs, they were more susceptible to infection withHIV/AIDS.
The low level of knowledge of out of schoolgirls, in-school girls and in-school boysabout STD-HIV linkages, is remarkable. This statistics seems to follow a pattern similarto that of the propensity to have sex with strangers, suggesting that knowledge aboutSTD-HIV linkages might lower the propensity of young people in the project area to havesex with strangers.
9.1.2. STD infection rates
Admittedly it is very difficult for young people particularly girls to admit to having anSTD. The actual STD infection rates among the population were better obtained frommedical sources than community level. Nevertheless, previous experience suggests that itis extremely difficult to disaggregate medical data to isolate STD cases for specificcommunities. From the quantitative studies, it was possible to capture useful data that hasproved very helpful to the present study.
• 14 per cent of all respondents, admitted that, they had a genital discharge, 14 percent admitted they had lower abdominal or pelvic pains; 10 per cent admittedhaving itchy genitals over the past year, and only 4 per cent indicated theyreceived a form of treatment; • 44 per cent of in-school girl respondents had a genital discharge, 46 per cent had lower abdominal or pelvic pains, 26 per cent had itchy genitals over the past year,and only 2 per cent indicated they received a form of treatment; • 6 per cent of in-school boys indicated they had a discharge, 12 per cent indicated they had painful urination, and 10 per cent indicated they had itchy genitals overthe past year, and only 8 per cent indicated they received a form of treatment; • 4 per cent of out of school girls indicated they had a discharge, 4 per cent had abdominal pains, and 2 per cent had itches around the genitals over the past year,and 4 per cent indicated they received a form of treatment; and • 2 per cent of out -of schoolboys indicated they had a genital discharge, none of the out of schoolboys indicated they experienced painful urination, neither noritches around their genitals, over the past year, and none indicated they receivedany form of treatment.
The data suggests that the young people in the project area were susceptible to STDs andit was the in school girls and their boy peers who were most susceptible, and they werenot likely to treat their STDs.
That STD infection rates were apparently higher among in school rather than out ofschool boys and girls, may be explained by the relatively low consistent condom useamong the in-school boys and girls while participating actively in all the different typesof sexual activity and networks.
Vulnerability between the two groups would have also been exacerbated by the sexualrelationships between them, as the data revealed that the most likely sexual partner of inschool young people at any point in time was their peer. The quantitative data revealedthat sixty five (65) per cent of sexually active in-schoolgirl and 93 per cent of sexuallyactive in-schoolboy respondents indicated the last time they had sex it was with theirpeers.
It may appear that amidst a turbulent sexual environment, it was the youngest, leastmature, least experienced, and ones who protected themselves least through condom usethat finally proved the most vulnerable.
Education and counseling including information on condom use and negotiation skills,screening for STDs with particular attention to in-school girls could prove beneficial.
This is more so because of the potential for STDs to spread among the populationthrough sexual networks earlier described.
Like the other STDs, the young people and opinion leaders contacted during thequalitative study were well aware about HIV/AIDS. All the communities contacted,during the qualitative studies and all those who responded to the relevant question duringthe quantitative studies affirmed their belief in the existence of the disease. The mostcommon local name ascribed to the disease was “dikanaku.” Opinion leaders in some of the communities commonly said, before their awarenessabout HIV/AIDS, the symptoms associated with the disease were commonly attributed to2 diseases-“ngolidor,”meaning ghost disease or “dadidor,” meaning cat disease, both ofwhich were perceived to have spiritual causes.
The need for counseling is further underscored by the fact that 78 per cent of allrespondents of the quantitative study indicated they were willing to undergo voluntarytesting to determine their HIV/AIDS status. Voluntary testing would require counselingsupport.
10. COMMUNICATING HIV/AIDS
Several forms of campaigns have been going on nationwide as regards HIV/AIDSinformation, education and communication. Effective fine-tuning of the InternationalNeeds Initiative would require a cursory assessment of the information education andcommunication environment that has produced the current baseline.
In doing so the study sought among others to find out if the communities openlycommunicated about HIV/AIDS; the knowledge and information needs regardingHIV/AIDS; the sources of HIV/AIDS information to young people; and the impact theinformation system made in terms of risk perception.
10.1. Open Communication About HIV/AIDS
It was found that though open discussions about the disease were said to be unrestrictedall the communities were unwilling to publicly acknowledge cases in their respectivecommunities. Each community indicated they heard of cases in other communities butnot in their own. Yet at the individual level during the quantitative studies, 34 per cent ofall respondents admitted that they knew of somebody in their community who had thedisease or had died from it. Societal stigma concerning the disease was evident.
10.2. Sources Of HIV/AIDS Information
The quantitative study investigated the sources of HIV/AIDS information to the differentcategories of young people studied. It was found that the most important sources of HIVinformation were different for the different categories of young people studied.
The most important sources of information for the out of schoolboys and girls were foundto be radio and television, and in addition newspapers and pamphlets for the boys.
Incidentally these were sources that were unlikely to be responsive to the informationneeds of the audience. Many of these sources were largely uni-directional and thereforedid not provide mechanisms for feedback, clearing of doubts, follow-up andreinforcement that would have enabled the audience to effectively apply the informationto make and sustain personal choices and decisions. Counseling, drama and filmsdelivered in the form of trigger sketches as well as peer education could proveparticularly helpful in this regard.
For the in school boys and girls, teachers emerged as the most important source ofHIV/AIDS information followed by mothers for the girls and radio for the boys. Theremay be the need to work with teachers and mothers to communicate HIV/AIDSinformation. Nevertheless the fact that in-schoolboys and girls emerged as the mostvulnerable despite the acknowledged efforts of teachers and mothers shows that theseefforts might not have been effective as desired. Teachers and parents may need trainingto make their efforts more effective.
Though peers did feature throughout the qualitative studies as influencing school dropout, a variety of sexual practices, and abortions, they did not seem to feature prominentlyas a source of HIV/AIDS information. The strong undesirable influence of peers can be tapped and channeled positively into communicating HIV/AIDS information andinfluencing related sexual choices positively.
10.3. HIV/AIDS Information Needs And Priorities
The information needs and priorities of the young people of the project area regardingHIV/AIDS were investigated from a respondent perspective through both the qualitativeand quantitative studies.
During the qualitative study, community members displayed various degrees ofknowledge about different aspects of the disease. Whereas some people were able to tellmost of the causes and symptoms of the disease, many others seemed to know very little.
During a discussion in one of the communities somebody said, HIV/AIDS is a disease that is all I know . The accuracy of the information available to the people was also an issue as anotherperson also said, Having sex too frequently can cause HIV/AIDS There seems to be some level of confusion about whether a cure exists for HIV/AIDS ornot as much of the information on this aspect of the subject seemed to be coming fromhere-say rather than authentic sources and therefore was a mixture of truths, have truthsand ignorance.
During one of the discussion sessions, a variety of contributions emerged as follows: I have heard that there is a place in Kumasi where AIDS can be cured; I have heard about a medicine that could keep an HIV/AIDS patient alive but would not They say there is a pastor who blesses water for people to drink as a cure; They say some herbalists produce medicine that can cure HIV/AIDS . In fact the data from the quantitative studies reveals that 11 per cent of all respondentsthought that HIV/AIDS had a cure. The quantitative study data suggests that it was the inschool rather than the out-of school who might be having this perception. Sixteen (16)per cent of in school and 5 per cent of out of school respondents expressed the perceptionthat HIV/AIDS had a cure. It is important to note that among the in school, it was mainlythe boys who expressed this perception. Of the 16 in-school young people who expressedthis belief, 13 that is 81 per cent, were boys. In fact 26 per cent of all in-school boysindicated the perception that HIV/AIDS had a cure.
Data from the quantitative studies further revealed that apart from the origin of thedisease, the most important thing all respondents wanted to know about HIV/AIDS wasits cure. Differences were observed in the priority information needs expressed by thedifferent categories of young people studied.
The most important things the out of school girls wished to know which they did notalready know was how the disease was spread and how to prevent themselves fromgetting infected.
For the male out of school, “origin”, “cure” and “causes” of the disease emerged withequal importance as things they wanted to know which they did not already know.
For the in school boys and girls, all they perceived they wanted to know which they didnot already know was the origin of the disease. It is not clear why this was so.
10.4. Risk Perception
Risk perception was investigated through the quantitative study. Overall about 36 percent of all respondents perceived that they could get HIV/AIDS. This overall statistichowever hides the differences in risk perception by the different categories of youngpeople studied. The quantitative data indicates that • Sixty (60) per cent of all out of school girls, perceived that they could get • 40 percent of all out of school boys perceived that they could get HIV/AIDS; • 36 per cent of all in-school boys perceived that they could get HIV/AIDS; • 6 per cent of all in-school girls perceived that they could get HIV/AIDS.
Low risk perception may explain why in-schoolgirls have been so careless in their sexuallife and have turned out to be the most vulnerable to STDs and therefore HIV/AIDS.
Beyond education, counseling may be necessary to assist those who do not perceive therisk to do so and those who perceive the risk but were not able to figure out how to comeout of high risk lifestyles, to make choices and decisions that will help them to do so. Indoing so, care should be taken to ensure that the International Needs Initiative providescurrent, accurate, and relevant information from the most authentic sources to meetidentified information needs.
10.5. Relevant Institutions
The school was identified as an important source of HIV/AIDS information to youngpeople in the project area. Some communities e.g. Lume, Metsrikasa, did not have a JSSthough it is at this level that in-school sexual activity was noted to have peaked.
Though parents were generally described as ineffective in educating their children aboutsex and reproductive life the study found that beyond teachers, in-school girlsacknowledged their mothers as the most important source of HIV/AIDS information. Inthis respect, it is note worthy that in at least one community, it was reported that theSchool Management Committee and PTA ever created a platform for discussing sex andreproductive health in school. School Management Committees and PTAs may be reliedupon, to provide a platform for networking between parents and teachers in sex andreproductive health guidance and counseling for in-school young people in the projectarea. Selected parents and teachers could be appropriately trained as youth reproductivehealth counselors.
Except for one community, where the chief was mentioned as being very enthusiasticabout HIV/AIDS education, the qualitative study found that the chieftaincy institution ofleadership has proved inept in dealing with the breakdown of chastity among youngpeople with respect to sexual activity. ING could encourage the chiefs to create platformsfor HIV/AIDS education during festivals especially Easter and Devinyenyeza, whichwere common to all the communities studied under the auspices of traditional chiefs andthe churches.
Condom use has proved to be an important factor in risk reduction with respect toHIV/AIDS yet some of the communities did not have any condom distribution pointswithin their community e.g. Lume. ING could facilitate the establishment of communitybased condom distribution mechanisms and also link up with the formal health deliverysystem to improve condom access.
In one community, opinion leaders also reported that there had ever been an STIscreening exercise whereby people were issued with cards or referred to visit SogakopeHospital for attention. Medical personnel from Dzodze Hospital were also mentioned inone community as having ever given a talk to one of the communities. ING could link upwith these institutions for resource persons in HIV/AIDS education, work out referralsystems between trained youth counselors and the identified health institutions, and ifpracticable initiate a screening exercise for at least the in-school girls of the project area.
Some young people indicated that Improper scheduling of TV films involving sexualencounters allows children to be exposed to sexual activity, which stimulates their sexualdesire. Advocacy for TV stations to correct this anomaly could become an issue for ING.
Private clinics and some herbalists in the project area were noted to be service providersto young people with respect to abortions and treatment of STDs. These could be ropedinto HIV/AIDS education and counseling programs of ING.
Churches such as the R.C. Church, E.P. Church, Church of Pentecost, ApostlesRevelation Society, and Apostolic Zion were mentioned as churches that ever organizedtalks to give counsel to the youth on HIV/AIDS related topics. These could be roped intoHIV/AIDS education and counseling programs of ING. They could for example nominatecapable youth group leaders to be trained as youth counselors.
From a community and beneficiary perspective, data on sexual, reproductive health andHIV/AIDS/STDs, was successfully collected and analyzed from 10 selected ING projectcommunities, on the knowledge attitudes and practices of young people; the psychosocialand cultural orientation of adults, opinion, leaders and chiefs; and programs of relevantinstitutions. From these it is possible to clearly define project beneficiaries, establishindicators and make recommendations that would help fine-tune project implementation.
11.1. The Context
The study observed a project context that was driven by poverty and a cultural posturethat was slow to respond to a changing socio-economic environment. Together, thesecombined to result in a weak capacity of parents to support their young sons anddaughters to effectively access and utilize educational and career developmentopportunities and respond appropriately to the challenging sex and reproductive healthculture emerging from a changing socio-economic environment.
11.2. Career Guidance And Counseling
From the qualitative studies the most apparent source of information on career optionsafter school were peers, elder siblings, and relatives living in the bigger towns who camehome once a while to visit. That local girls were likely to be more sexually active, verylikely to get pregnant getting close to their completing JSS awaiting results or 1 to 2 yearsafter completing JSS, was an indication of low or no serious career aspirations. The needfor counseling to improve career aspirations of young people in the project area,particularly the girl was evident. Exposure tours for in-schoolgirls were suggested in onecommunity in this regard. Selected teachers could also be trained in career counseling.
11.3. The Work Environment
The need to intervene in the work environment itself was equally important because thejob environment did not give much hope and would not have inspired much personalaspirations, as most young people who completed JSS ended up unemployed or in veryunattractive occupations that made them susceptible to sex for money in its variousforms. It is worth noting that the undesirable sexual lifestyles of the out of schoolgirls didbecome a form of negative role modeling for their younger siblings. There was evidencethat ING was already intervening in enhancing income-earning capacities in the projectarea.
11.4. Sexual Activity, Condom Use And Vulnerability To STDs/HIV/AIDS
From the available evidence, it is clear that only the sexually inactive, represented in thesample by 29 percent of young people respondents, could be said to be living their sexlife with minimum risk, regarding HIV infection.
However, the study found that the majority of young people, represented by 71 per centof young people respondents, who were sexually active, could be considered to be at risk.
The intricate mix of sexual activity (forced, casual, multiple partner sex), triggered bymultiple forms of motivation (sexual desire, money, and fun), involving a wide sexualnetwork (peers, adults and strangers who could be anybody from anywhere), exacerbatethe level of risk.
Despite the fact that higher proportions of out of schoolgirls were sexually active andthey were mostly engaged in the different forms of sexual practice, (casual, multiplepartner, forced except sex for fun), their risk perception tended to be higher, were morelikely to use condoms and use them more consistently, and were less susceptible to STDsthan the much younger in-school girls.
Using susceptibility to STDs as a proxy indicator for vulnerability to HIV/AIDS, it mayappear that amidst a turbulent sexual environment, it was the in-school girls, who wereyoungest, least mature, least experienced, who perceived the least risk, had sex for fun,and used condoms least consistently, who were most susceptible to STDs and were alsoleast likely to treat their STDs. They could therefore be considered the most vulnerable.
By not treating their STDs, they would have become carriers of STIs with a potential forspreading the diseases through the intricate sexual networks in which they participate.
They would also be the most susceptible to HIV infection through heterosexualtransmission.
Next to the in-schoolgirls, were in-school boys, it was clearly the in-school boys thatreported having experienced STD symptoms over the past year and not to receivetreatment. They actually followed their in-school peers consistently in having the leastrisk perception, the inconsistent use of condoms, and were at par with their in-schoolpeers in having sex for fun. For the in-schoolboys, low risk perception was likely to beexacerbated by important gaps in their knowledge about HIV/AIDS in particular theperception that HIV/AIDS had a cure and the lack of knowledge about the relationshipbetween other STDs and HIV/AIDS. Vulnerability of in-school boys were also likely tobe exacerbated by the fact that beyond out of school girls, they were the ones most likelyto have sex with strangers.
Thus the common characteristics that made in-school young people the most vulnerablewith respect to HIV/AIDS were their susceptibility to STDs, not treating their STDs, lowrisk perception, having sex for fun and inconsistent use of condoms. Vulnerability of thetwo groups would have also been exacerbated by the sexual relationships between them,as the data revealed that the most likely sexual partner of in-school boys and girls at anypoint in time was their peer.
11.5. HIV/AIDS Information Education and Communication
Whereas the school system could easily be assumed to be an important source of qualityinformation on career, sex, reproductive health and STDs/HIV/AIDS, the evidence fromthe study did not necessarily affirm it to be so. On the contrary, in-school girls and boysrather turned out to be the most vulnerable. The need to strengthen the capacity of theschools to deliver quality, sexual, reproductive health and STDs/HIV/AIDS educationand counseling as expected is evident.
Given that parents did not prove to be any better alternative to the school in providingsuch crucial education and counseling, ING, could in such capacity building effort,consider seriously working with school management committees and PTAs, so that thecapacities of selected teachers and parents could be built simultaneously, throughtraining, to offer such services. Information gaps, needs and misconceptions of youngpeople that made them have low risk perception and which caused them to make carelesschoices with respect to their sexual life should be the focus of such capacity building.
Condom negotiation skills under their circumstances of powerlessness could also be asubject of capacity building.
Education and counseling, including information on condom use and condom negotiationskills, as well as screening for STDs with particular attention to in-school girls, couldprove beneficial.
From the data and analysis presented in the present report, the following indicators aresuggested for assessing improvements made in the sexual and reproductive life of youngpeople in the ING project area: 12.1 Percentage of young people who indicated having experienced an STD symptomover the previous year; 12.2. Percentage of in-school girls who indicated having experienced an STD symptomover the past year; 12.3. Percentage of young people experiencing an STD symptom over the past year, whoindicated they received treatment for the STD; 12.4. Percentage of in-school girls experiencing an STD symptom over the past year, whoindicated they received treatment for the STD; 12.5. Percentage of young people who indicated they used a condom during their lastsexual encounter; 12.6. Percentage of in-school girls who indicated they used a condom during their lastsexual encounter; 12.7. Percentage of young people who indicated they had sex with more than one partnerover the past year; 12.8. Percentage of young people who indicated they had sex with a stranger over thepast year; and 12.9. Percentage of young people who indicated the knowledge that not treating an STDmade one more susceptible to HIV/AIDS.
13. BASELINE INDICATORS
13.1. Percentage of young people who indicated having experienced an STD symptomover the previous year was 14 per cent.
13.2. Percentage of in-school girls who indicated having experienced an STD symptomover the previous year was 46 per cent.
13.3. Percentage of young people experiencing an STD symptom over the previous year,who indicated they received treatment for the STD, was 14 per cent.
13.4. Percentage of in-school girls experiencing an STD symptom over the previous year,who indicated they received treatment for the STD, was 5 per cent.
13.5. Percentage of young people who indicated they used a condom during their lastsexual encounter was 29 per cent and of the sexually active it was 40 per cent.
13.6. Percentage of in-school girls who indicated they used a condom during their lastsexual encounter was 8 per cent and of the sexually active it was 14 per cent.
13.7. Percentage of young people who indicated they had sex with more than one partnerover the previous year was 18 per cent and of the sexually active it was 25 per cent.
13.8.Percentage of out of schoolgirls who indicated they had sex with more than onepartner over the past year was 46 percent and for the sexually active 47 per cent.
13.9. Percentage of young people who indicated the knowledge that not treating an STDmade one more susceptible to HIV/AIDS was 50 per cent.
The ING education and counseling project was based on the assumption that youngpeople behaved responsibly when they were well informed.
Following from this assumption, the project document observed that education andcounseling were the main mechanisms by which young people could receive informationthat would enable them to make the right choices and decisions in the essential areas ofcareer development, relationships and reproductive health.
The ING education and counseling project sought to educate and create awareness, buildlocal capacity for guidance and counseling services and promote a lifestyle of responsiblesexual and reproductive health among young people in the project area, with particularattention to STIs and HIV/AIDS.
Apart from suggesting and establishing baseline indicators, the Terms of Reference of thepresent study stipulates that the consultant makes realistic recommendations on how tofine-tune project implementation with particular attention to content, targeting, andorganization.
The scope of information that will be delivered to the project community would focus onthe context; career aspirations and career development; information gaps, needs andmisconceptions; low risk perception; careless choices in sex life; unsafe abortions, STDsand HIV/AIDS.
More specifically the content of the educational and counseling program to be deliveredunder the project could include: • Contextual factors that underpin the choices and decisions that young people in the study communities make concerning their sexual and reproductive health life; • Career development options and opportunities under the challenging socio- economic circumstances of the project communities; • The importance of sexual abstinence while in school including how to love without sex and the need to avoid sex for fun; • Risks associated with casual and multiple partner sexual practices without • Risks associated with forced sex and how to avoid forced sexual encounters; • The importance of proper and consistent use of condoms if sexually active, condom negotiation skills, and the dangers of condom abuse; • Sexually Transmitted Diseases, the need for their prompt and effective treatment and how they increase susceptibility to HIV/AIDS; • HIV/AIDS- it’s origin, spread, and links with STDs, the fact that it has no cure 14.2. Targeting
The study did find out that the counseling and educational needs differed for differentcategories of young people studied in the selected project communities. Effectivedelivery of education and counseling would therefore require effective definition of targetgroups and the selection and adaptation of the content to the needs of the groups.
From the study, 4 categories of beneficiaries could be targeted in order of priority asfollows: • Religious and community opinion leaders.
Les médicaments ototoxiques Les médicaments ototoxiques sont des produits pharmaceutiques qui ont l'inconvénient de pouvoir léser les structures de l'oreille interne (atteinte cochléaire ou vestibulaire) ou du nerf auditif. Il n'y a jamais atteinte de l'oreille externe ni de l'oreille moyenne. Plus de 130 médicaments et produits chimiques ont été répertoriés comme étant ot