Adolescent behavior in the context of AIDS in South Africa. (Transitions To Adulthood).

South Africa is one of the countries hardest hit by HIV. Nearly 25 percent of the women who obtain antenatal care in South Africa are infected with HIV; in the country's most populous province, KwaZulu-Natal, the figure is 34 percent. Risky sexual behavior among youth is common; more than 35 percent of 19-year-old South African girls have been pregnant at least once.

The "Transitions to Adulthood in the Context of AIDS in South Africa" study investigates factors that may influence the lives and sexual behavior of young people in KwaZulu-Natal. This longitudinal study is a collaboration among the Population Council, Tulane University, the University of Natal-Durban, and Development Research Africa (a South African research organization). The working papers discussed in this article analyze evidence from the first round of data collection.

Opportunities for adolescents

Researchers assessed the association between risk-taking behavior and opportunities for schooling, work, and other activities. They looked at information collected from a representative sample of 2,992 young people aged 14-22 years who live in Durban Metro and Mtunzini Districts of KwaZulu-Natal Province. The population of KwaZulu-Natal comprises four main population groups: African (80 percent), Indian (10 percent), white (7 percent), and a population group of mixed ancestry known as coloured (3 percent).

This study revealed that gender is far more important than population group in predicting adolescent risk taking. For example, girls who live in communities where there is a high level of sports activity or who live where schooling is easily obtained tended to report that they had not had sex in the past year. These factors do not significantly influence whether boys reported having had sex in the past year.

One factor, the prospect of employment, was correlated with less risk-taking behavior among both boys and girls. Girls in areas where earning potential was high were almost two and a half times more likely to report having used a condom the last time they had sex than were girls living in communities where fewer adolescents were working. Boys from higher-wage communities were about 50 percent more likely to report having used a condom the last time they had sex than were boys from lower-wage areas.

"This is an area that deserves more research," says former Population Council research associate Carol E. Kaufman. "Because this analysis was based on a single round of data collection, it is not possible to determine cause-and-effect relationships. However, it's possible that when young people have more opportunities for education or work, they may be more likely to forgo sexual activity or to engage in safer sex practices when they do have sex." Kaufman, now at the University of Colorado, is a Council consultant.

Attitudes toward pregnancy

In communities where early age of childbearing is common and HIV prevalence is high, adolescent boys and girls may place themselves at risk of HIV to realize their childbearing preferences. Researchers wondered whether adolescents' attitudes toward pregnancy were affected by perceptions of the risk of HIV transmission in their communities and among their peers. Investigators used evidence gathered during the first round of data collection from 1,426 sexually active young people. They found that boys were more concerned about how having a child would affect their opportunities for schooling, job training, and personal development than they were about the fact that unprotected sex might expose them to HIV. But where adults expressed concern about HIV risk among adolescents, boys reported an increased desire to avoid parenthood.

Among girls, the higher the level of school enrollment in their community, the more likely they were to want to delay pregnancy. African girls were more than three times as likely as white or Indian girls to say pregnancy would be a big problem. Even after controlling for income, girls' childbearing preferences were significantly correlated with the perceived risk of HIV infection among their peers.

"It appears that for some adolescents--and for girls more than boys--the danger of HIV infection is becoming part of the calculus as they determine the desirability of becoming parents," says Naomi Rutenberg, senior program associate with the Population Council's Horizons program. Research under the Horizons program attempts to determine the types of interventions that work to prevent HIV transmission, deliver care and support, and reduce the suffering caused by AIDS.

Although it is not possible to determine cause-and-effect relationships from this research, the data highlight points of opportunity for interventions. Programs focusing on increasing livelihood opportunities for boys and girls could be important in encouraging safer sex practices--for example, abstinence, being faithful, and condom use. Programs that assist adolescents in making an accurate assessment of their HIV risk would also be beneficial. Analyses comparing the first and second rounds of data collection are expected in mid-2003.

SOURCES

Kaufman, Carol E., Shelley Clark, Ntsiki Manzini, and Julian May. 2002. "How community structures of time and opportunity shape adolescent sexual behavior in South Africa," Policy Research Division Working Paper no. 159. New York: Population Council.

Rutenberg, Naomi, Carol E. Kaufman, Kate Macintyre, Lisanne Brown, and Ali Karim. 2002. "Pregnant or positive: Adolescent childbearing and HIV risk in South Africa," Policy Research Division Working Paper no. 162. New York: Population Council.

OUTSIDE FUNDING

The Andrew W. Mellon Foundation, the Rockefeller Foundation, the United Kingdom Department for International Development, and the United States Agency for International Development (through the Population Council's Programmatic Cooperative Agreement, the Council's Horizons program, the Focus on Young Adults project, and the MEASURE-Evaluation project)

USAID-funded Horizons research is conducted in collaboration with the International Center for Research on Women, the International HIV/AIDS Alliance, the Program for Appropriate Technology in Health, Tulane University, Johns Hopkins University, and Family Health International.