Yasmin Williams - HEALTH-WISEEARLY LAST year, the Caribbean Health Research Council (CHRC) funded a number of proposals for research investigating factors related to the HIV pandemic. I was fortunate to receive a grant to examine some of the adolescent related issues.
This examination led to the investigation of factors influencing early initiation of sexual activity in 14 -15 years olds in Kingston, Jamaica, to inform HIV prevention strategies. Thirty secondary schools were selected by proportional random sampling to represent the types of secondary schools defined by the Ministry of Education. Information was obtained from 874 Grade 9 students by self administered questionnaires.
The results indicated that 47.8 per cent of the students were boys and 52 per cent were girls. The mean age of the students was 14.6 years with a range of 13 - 17 years. Forty-seven per cent of all students said they had sex. Seventy-three per cent of the boys and 23 per cent of the girls reported having had sex.
Of the 48 per cent of the students who have been sexually active, 18 per cent indicated that they had been forced to have sex on the first occasion. Older adolescents were more likely to have had sex, and boys were more likely to have had sex than girls. Household crowding was significant for girls who were sexually active. For the 453 students who were not sexually active, the main reason for not being sexually active was that students wanted to wait until they were older. Fear of getting pregnant ranked second for girls and getting a girl pregnant ranked fifth for boys.
Fear of contracting disease was the next most frequently given reason by girls and boys. 'Am not ready for sex' and 'parental disapproval' were also frequently given as reasons for delaying sex. Almost half (47 per cent) of the students abstaining from sex said that they abstained because of religious reasons. A girl who lived with her father and mother or grandmother was less likely to be sexually active.
Parental connectedness (connectedness with primary caregiver) was protective for both boys and girls although it appeared to be more important for girls. Boys who said that they often spend happy times with their parents were more likely to abstain from sexual activity whereas girls who felt that their parents cared about their feelings, girls whose parents indicated that they were important, as well as girls who had parents who helped them with their homework, were more likely to delay sexual initiation.
For boys, independent predictors of sexual activity were marijuana use, significant alcohol consumption and involvement in violence. Older girls, girls who used marijuana and those who consumed significant amount of alcohol were more likely to be sexually active.
HIV prevention programmes for adolescents have focused on the promotion of abstinence (delaying sexual initiation) and condom use for the sexually active. However, the study results suggest that the development and implementation of programmes to improve parenting skills and targeting adolescents involved in other risk behaviours should be part of the strategy.
In closing, I wish to express my appreciation to my co-investigator, Susan Walker, my research assistants, Samora, Cass and Robin and to all the teachers, guidance counsellors and students who helped to shed a little more light on this complex problem.
Dr. Yasmin Williams is a Family Doctor and Public Health Specialist.
