Sexual Abstinence As A Hiv Prevention Strategy Among Adolescent Secondary School Students In Garissa Municipality, Garissa County Of Kenya

ABSTRACT

Sexual abstinence is an important pillar for HIV prevention amongst adolescents. However, according to 2009 Kenya Demographic and Health Survey (KDHS) almost one in every four men under age 24 had their sexual intercourse before age 15. Comparing with the 2003 KDHS, there was small increase in age at first sex, with median age at first sex among women and men increasing from 17.8 to 18.2 years and 17.1 to 17.6 years respectively. This precisely indicates that school-going adolescents engage in sexual activities. While the society expects adolescents in schools to abstain from sexual activities, little is known about the reasons why some school-adolescents engage in sexual intercourse and others decide to abstain. This study examined factors associated with sexual abstinence and how those factors promote or constrain HIV prevention among secondary school adolescents in Garissa Municipality. It was a cross sectional study carried out in Garissa Municipality in North Eastern Kenya. The variables tested were sexual abstinence state, age, gender, education level of parents, family size and school environments. Data collection was done using structured self-administered questionnaires and focus group discussion guides. A total of 394 students were interviewed and five focus group discussions (3 male and 2 female groups) conducted. Key informants that included club patrons and HIV/AIDS teachers were interviewed to triangulate information. Chi square test was used to show association between variables. Results show that primary abstinence, secondary abstinence and sexual activeness among secondary school adolescents were 83.8%, 8.6% and 7.6% respectively. Primary abstinent adolescents were motivated by religious background (37.1%), school-based abstinence promotion programs (32.2%) and plans for their future (19.4%), while Secondary abstinent and sexually active adolescents were motivated by “love for partner” and desire to prove manhood/womanhood among other reasons. Factors that were significantly associated with sexual behaviours were age (χ2 =24.045, df = 5, p = 0.045), educational level of parents (χ2 =22.325, df = 10, p = 0.014), number of female members in the family (χ2 =52.7, df = 34, p = 0.021), exposure to HIV prevention and abstinence messages in schools (χ2 = 11.633, df = 4, p = 0.020), having opposite-sex friends (χ2 = 34.541, df = 12, p = 0.001) and motivating factors associated with abstinence (χ2 = 29.922, df = 10, p=0.001). From FGDs, it was found that educated parents were more concerned about adolescent sexual behaviours, more so that of female adolescents, than uneducated parents. It was also observed that strength of family ties and inter-dependability and advice amongst family members usually shape adolescent sexual behaviours. FGD participants mentioned that Fourth-form male students hire residential rooms in the pretext of revising for final examinations but also end up engaging sexual intercourse with female colleagues. It was concluded that majority adolescents practice sexual abstinence while some were sexually active and they did so for specific reasons. Religious beliefs and parental effort on understanding adolescent development and discussing sexual behaviours are important in enhancing sexual abstinence for adolescents. The study recommends encouraging adolescents to participate in religious activities to enhance sexual abstinence. Programs that promote sexual abstinence in schools and enhancing good parent-child communication on adolescent sexuality are also recommended.