Young People's Sexual Relationships: Tanzania
This study was initiated by David Ross and Richard Hayes (London School of Hygiene and Tropical Medicine (LSHTM)), and conducted with Mary Plummer (LSHTM and SPHSU) and Joyce Wamoyi and Gerry Mshana (National Institute for Medical Research, Tanzania). Called HALIRA, it complements an RCT of the MEMA kwa Vijana (MkV) adolescent sexual health programme in rural Mwanza, Tanzania, by:
collecting ethnographic data on the programme context, in particular young people's sexual relationships
investigating processes by which MkV components were delivered.
The main outcomes of the MkV trial were that it clearly improved knowledge, attitudes and reported behaviour, but it did not improve biomedical measures of STIs or pregnancy. The HALIRA findings help interpret these outcomes.
Permissive and restrictive sexual norms for young people, plus gender and age power hierarchies, exert conflicting pressures on adolescents. Young people appear to manage the contradictory norms by concealing their sexual relationships, contributing to their short duration and high levels of partner change.
Many villagers perceive condoms negatively for several reasons, e.g. their association with infection or promiscuity, reduced male sexual pleasure, and cultural understandings of meaningful sex. Men control the terms of sexual encounters, and report they would use condoms only with risky partners, but few see their partners as such. Use of condoms appears to be very low, primarily due to limited demand, although barriers to access also exist.
STIs are generally attributed to natural causes, but many people reported belief in both a ‘real' (natural) AIDS, which leads to certain death, and a similar illness caused by witchcraft, which can be cured using traditional medicine. Very few villagers understood that the HIV asymptomatic period lasted longer than a few months.
This extraordinarily large and representative qualitative study resulted in two books. The first, Young People’s Lives and Sexual Relationships in Rural Africa by Mary Plummer and Daniel Wight (2011), examines the variety of young people’s sexual relationships and practices in a region typical of rural Africa. It describes how contradictory social ideals and expectations led to concealment of premarital and extramarital relationships. It then examines how this secrecy, combined with poor understanding of HIV/AIDS and the common practice of material exchange for sex, contributed to short relationships, fast partner change, concurrent partnerships, and related sexual health risks.
Plummer M L, Wight D. Young people's lives and sexual relationships in rural Africa: findings from a large qualitative study in Tanzania. Lanham: Lexington Books, 2011. https://rowman.com/ISBN/9780739135785 http://www.mkukinanyota.com/upcomingbooks.html#
Excerpt from: "Chapter 6: Unmarried Young People's Sexual Relationships", pp. 161-197.
Excerpt from: "Chapter 7: Sexual Negotiation, Exchange, and Coercion", pp. 212-229.
Excerpt from: "Chapter 9: Married Young People's Sexual Relationships", pp. 275-304.
The second book, Promoting Abstinence, Being Faithful, and Condom Use with Young Africans by Mary Plummer (2012), assesses the processes and impact of the MEMA kwa Vijana adolescent sexual health intervention. It examines how the “ABC” behaviours – Abstinence, Being faithful, and Condom use – can be promoted more effectively with young rural Africans and explores the motivations and strategies of youth who practiced low risk behaviours. It concludes with detailed recommendations for school and community programs.
Plummer M. Promoting abstinence, being faithful, and condom use with young Africans: qualitative findings from an intervention trial in rural Tanzania. New York: Lexington Books, 2012. https://rowman.com/ISBN/9780739168448 http://www.mkukinanyota.com/upcomingbooks.html#
Excerpt from: "Chapter 7: Impact of the MEMA kwa Vijana Intervention", pp. 217-254.
Excerpt from: "Chapter 9: “Being Faithful”: Limiting Partner Number and/or Practicing Fidelity", pp. 299-320.
Excerpt from: "Chapter 11: Intervention Recommendations", pp. 370-372 and 381-402.
Plummer M. Promoting abstinence, being faithful, and condom use with young Africans: qualitative findings from an intervention trial in rural Tanzania. New York: Lexington Books, 2012.
Plummer M L, Wight D. Young people's lives and sexual relationships in rural Africa: findings from a large qualitative study in Tanzania. Lanham: Lexington Books, 2011.
Wamoyi J, Wight D, Plummer M, Mshana G, Ross D. Transactional sex amongst young people in rural northern Tanzania: an ethnography of young women's motivations and negotiation. Reproductive Health 2010;7:2pubmed open access
Plummer M, Wamoyi J, Nyalali K, Mshana G, Shigongo ZS, Ross D, Wight D. Aborting and suspending pregnancy in rural Tanzania: An ethnography of young people’s beliefs and practices. Studies in Family Planning 2008;39:281-92pubmed
Weiss H A, Plummer M, Changalucha J, Mshana G, Shigongo ZS, Todd J, Wight D, Hayes R J, Ross D. Circumcision among adolescent boys in rural northwestern Tanzania. Tropical Medicine & International Health 2008;13:1054-61pubmed open access
Mshana G, Plummer M, Wamoyi J, Salamba Z, Ross D, Wight D. 'She was bewitched and caught an illness similar to AIDS' AIDS and sexually transmitted infection causation beliefs in rural Mwanza, Tanzania. Culture, Health & Sexuality 2006;8:45-58.pubmed
Plummer M, Mshana G, Wamoyi J, Salamba Z, Hayes R, Ross D, Wight D. 'The man who believed he had AIDS was cured' AIDS and sexually-transmitted infection treatment-seeking behaviour in rural Mwanza, Tanzania. AIDS Care 2006;18:460-466.pubmed
Plummer M, Wight D, Wamoyi J, Mshana G, Hayes R, Ross D. 'Farming with your hoe in a sack' condom attitudes, access and use in rural Tanzania. Studies in Family Planning 2006;37:29-40pubmed
Wight D, Plummer M, Mshana G, Wamoyi J, Shigongo ZS, Ross DA. Contradictory sexual norms and expectations for young people in rural northern Tanzania. Social Science & Medicine 2006;62:987-997pubmed
Plummer M, Ross D, Wight D, Changalucha J, Mshana G, Wamoyi J, Tood J, Anemona A, Mosha F, Obasi A, Hayes R. 'A bit more truthful' the validity of adolescent sexual behaviour data collected in rural northern Tanzania using five methods. Sexually Transmitted Infections 2004;80:Suppl II; ii49-ii56pubmed open access
Plummer M, Wight D, Ross D, Balira R, Anemona A, Todd J, Salamba Z, Obasi A, Grosskurth H, Changalucha J, Hayes R. Asking semi-literate adolescents about sexual behaviour: The validity of Assisted Self-Completion Questionnaire (ASCQ) data in rural Tanzania. Tropical Medicine & International Health 2004;9:737-754pubmed open access