Factors Affecting Sexual Practices in West Africa - A Positive Deviance Approach

1. FACTORS AFFECTING SEXUAL PRACTICES IN WEST AFRICA - A POSITIVE DEVIANCE APPROACH STELLA BABALOLACLAUDIA VONDRASEKJANE BROWNJohns Hopkins University Center For Communication Programs, Baltimore Paper presented at the 2001 APHA Annual Conference, October 21-25, 2001, Atlanta, GA

2. Credits • The research was conducted for the SFPS project with funding from the United States Agency for International Development. The Johns Hopkins University Center for Communication Program (JHU/CCP) provided technical assistance for its implementation. • Dr. Dieneba Ouedraogo was contracted to collect and analyze the data.

3. WHAT IS POSITIVE DEVIANCE? • Normative (objective reality) perspective: • Behavior that is labeled in a superior manner due to a non-adherence to the normative structures of society (Heckert, 1997) • Reactivist (subjective reality) perspective: • A behavior that is positively evaluated and sanctioned

4. RATIONALE FOR A POSITIVE DEVIANCE APPROACH • In every community, there are people who while having access to the same resource base as others yet adopt positive deviant behaviors; • Studying the positive deviants and understanding the motivations for their supra-conformist behaviors should provide useful insights into how to promote safe sex practices.

5. SEXUAL BEHAVIOR AMONG YOUTH IN THE WEST AFRICAN SUB-REGION • Literature review in the study countries reveals the following: • First sexual intercourse typically takes place out of wedlock, especially among urban youth; • Early sexual experimentation: age at fist sex varies between 15 and 18 years in most West African societies;

6. SEXUAL BEHAVIOR… cont. • Sexual abstinence is not a popular option among youth; • Group norms favor multiple sexual partners and many sexually active youth have more than one sexual partner. In Burkina Faso, more than 8 of 10 sexually active youth have had two or more sexual partners (DHS, 1999); • Condom use is low;

7. POSITIVE DEVIANT BEHAVIORS EXAMINED • Delayed sexual initiation; • Consistent condom use

8. METHODOLOGY • Pre-interview screening to identify “authentic” positive deviants • In-depth interviews with identified positive deviants aged 15 - 24 years • In-depth interviews with parents, guardians, youth leaders and community opinion leaders

9. STUDY LOCATIONS • Burkina Faso: • Ouagadougou • Ouahigouya • Côte d’Ivoire • Abidjan • Dabou

10. FINDINGS

11. DELAYED SEXUAL INITIATION

12. Data derived from IDIs with: 12 primary sexually abstinent youth and 12 late starters Primary sexually abstinent youth: 19 years or more, yet to become sexually active Late starters: first sex at 20 years or more Most sexually abstinent youth have a romantic partner All dream of experiencing sexual intercourse one day CHARACTERISTICS OF DELAYED STARTERS

13. INTENDED TIMING OF FIRST SEX • SOME INTEND TO ABSTAIN UNTIL MARRIAGE: • With the help of God, I will hold on until the end, even if I have to wait another 5 or 10 years until marriage” Abstinent female, 23 years, Abidjan. • “Even if I have a boyfriend, I will have no sex until marriage.” Abstinent female 19 years, Ouahigouya, Burkina Faso

14. INTENDED TIMING OF FIRST SEX • SOME HAVE A CERTAIN AGE IN MIND. THEY BELIEVED THAT AT THIS AGE, THEY WOULD BE READY TO COPE WITH THE CONSEQUENCES OF PREMARITAL SEX: • “ At 21 or 22 … because at 22, I should be able to take care of my responsibilities…in case of problems, I should be able to take care of myself, provide for myself.” Abstinent female, 20 years, Dabou, Côte d’Ivoire.

15. INTENDED TIMING OF FIRST SEX • OTHERS ARE WAITING TO FIND A PARTNER WHO INTENDS WEDLOCK: • “If I find someone who is ready to go all the way with me, then I will be willing to have sex with him. I have been with this man for 2 years but I am yet to give myself to him. I am not in a hurry” Abstinent female, 20 years, Dabou, Côte d’Ivoire

16. CORRELATES OF DELAYED SEXUAL INITIATION • COMMITMENT TO THE IDEAL OF SEXUAL ABSTINENCE; • SELF-ESTEEM: mixed findings • generally positive opinions about physical appearance • some demonstrate high self-confidence while others demonstrate low self-confidence.

17. CORRELATES OF PRIMARY SEXUAL ABSTINENCE • TRADITIONAL VIEWS ABOUT SEX: • sex generally viewed as a serious act, marking the passage to adulthood; • the importance of sexual intercourse goes beyond the pleasure it provides: • “the pleasure, yes! But beyond the pleasure, it is if you are responsible, you should think of making children as a result” Abstinent male, 19 years, Ouagadougou.

18. CORRELATES OF PRIMARY SEXUAL ABSTINENCE • sex should not take place except the persons concerned are ready for responsibility

19. CORRELATES OF PRIMARY SEXUAL ABSTINENCE • Positive attitudes towards premarital chastity: • “it is not good to have sex before marriage but in these days, you just have to…. Few men can wait to be regularly married before having sex” Female late starter, 23 years, Abidjan • Before marriage, sex is not good…a person should remain a virgin until marriage” Abstinent female, 19 years, Ouagadougou

20. CORRELATES OF PRIMARY SEXUAL ABSTINENCE • Traditional views about virginity • a girl’s virginity perceived to be a gift to the person she will eventually marry • virginity is perceived as a sign of respect for parents and the future husband • Virginity is perceived as a source of pride for the girl

21. MOTIVATIONS FOR SEXUAL ABSTINENCE • Religiosity: • fear of God • “only if the person is converted, if he fears God and follows the laws and doctrines of the church…” Late starter, 23 years, Abidjan • Commitment to the teachings of the religion: • “In catechism, they taught us that sex is only for married couple. I grew up with that idea” Abstinent female, Ouagadougou

22. MOTIVATIONS FOR SEXUAL ABSTINENCE • “My behavior is guided by the Word of God. My relationship with God allows me to remain abstinent according to His Word.” Abstinent male, Ouagadougou. • Vicarious experience: • “Three of my friends in school became pregnant and tried to abort.. They became the laughing stock of the school. This made me to lose interest in sexual relations” Abstinent female, 22 years, Abidjan.

23. MOTIVATIONS FOR SEXUAL ABSTINENCE • clear and lofty academic and professional ambitions: • desire for academic success • desire for financial independence • “I want to be free, I do not want to depend on anyone, I want to fly on my own wings.”Female late starter, 23 years, Abidjan • desire for a high professional status • “I want to study aeronautics or physics. Sex is not one of my priorities at this time… I transfer my sexual urges to my academic work.” Abstinent male, 19 years, Ouagadougou

24. MOTIVATIONS FOR SEXUAL ABSTINENCE • Perceived negative consequences of premarital sex • Perception that a pregnancy or HIV/AIDS could jeopardize the attainment of life ambitions • Clear strategies for achieving life goals: • The loftier the ambitions, the more intense the need to avoid pregnancy, the more the need to preserve life is felt, and the less importance sex takes. • Focussing on life goals, sexually abstinent youth endure the difficulties and relentlessly fight the obstacles in the way.

25. MOTIVATIONS FOR SEXUAL ABSTINENCE • Parental influence • little communication about sexuality between parents and children. • Much of the communication consists in advice given to the child, especially the female child from the mother; • Parental control and the fear of the parents is the key family factor motivating sexual deviance:

26. MOTIVATIONS FOR SEXUAL ABSTINENCE • “Often when there is a film on the TV about girls, the old man would say: ‘if a daughter of mine becomes pregnant, she will have to leave the house’ Do you think that if I became pregnant I would have the courage to go and tell him” Abstinent female, Abidjan • “I used to visit this girl, but the father warned me that he should no longer see me with her daughter.” Abstinent male, Ouagadougou

27. THREATS TO SEXUAL ABSTINENCE • Romantic love • “I met him when I was 20. Initially, I did not want to have sex with him. I accepted to have sex with him when I turned 21. I succumbed because I loved him” Late starter, 23 years, Abidjan, Côte d’Ivoire • “Sex is a way of showing love to someone who is worthy of that expression…” Abstinent female, 19 years, Ouagadougou, Burkina Faso

28. THREATS TO SEXUAL ABSTINENCE • Family pressure: After a certain age (in early adulthood) parents tend to encourage their children to become sexually active: • “It is with my mother that I have the most problems…She believes that religion is messing up my life. She is concerned that I am not like the others.” Abstinent female, Abidjan.

29. THREATS TO SEXUAL ABSTINENCE • “It was my father that made me to date this man. He said that all my friends had boyfriends…” Late starter, Abidjan • In response to the pressure from the parents, the abstinent youth committed to the ideal of abstinence may decide to take a boyfriend or girlfriend without necessarily engaging in sexual intercourse

30. THREATS TO SEXUAL ABSTINENCE • Peer pressure - sexually abstinent youth are the object of mockery and disdain by peers: • “Often, they say that I am not normal” • “They make fun of me, they say that I am strange”

31. THREATS TO SEXUAL ABSTINENCE • Peer pressure can result in negative behavior change • “When I was in school, the girls would come and tell me about their adventures, what they did the previous night whereas I did not even have a boyfriend. Finally, I gave in” Female late starter, 22 years

32. THREATS TO SEXUAL ABSTINENCE • Economic dependence on romantic partner: • “I often wish I had a boyfriend to help me out financially but wonder if it is possible to have one who would be willing to help without asking for sex in return. When I think of this, I refrain myself ‘cause I have no intention of losing my virginity.” Abstinent female, 19 years, Abidjan

33. CONSISTENT CONDOM USE

34. CHARACTERISTICS OF CONSISTENT CONDOM USERS • Data derived from 12 IDI; • Consistent condom users are knowledgeable about the benefits of condom • Condom rarely used for the first sexual intercourse due to lack of knowledge, non-availability of condom and lack of skills

35. CORRELATES OF CONSISTENT CONDOM USE • HIGH SELF-ETEEM • Positive perceptions about physical appearance • “I am handsome, I have a nice physique. They say that I have the physique of an executive” Consistent user, 21 years, Abidjan • High self-confidence • “There are many things that I do better than my peers” • “When it comes to ‘toasting’ girls, I may not be the best but I do hold my own”

36. CORRELATES OF CONSISTENT CONDOM USE • Liberal views about premarital sex • Low perceived self-efficacy for sexual abstinence • Low tolerance for (or doubts about) mutual faithfulness • Limited religious involvement, low religiosity

37. MOTIVATIONS FOR CONSISTENT CONDOM USE • Life preservation: • “I always use a condom because there are diseases out there. Seeing people lose weight with their hair turning yellow… that is not for me. If I have to die of a disease, certainly not of AIDS.” Consistent user, 24 years, Ouagadougou • Pregnancy avoidance • Vicarious experience

38. Subtle parental influence: • “I had a classmate who put a girl in the family way. His father stopped paying his school fees, so he had to stop schooling. Since I am afraid of my own father, I cannot afford to take chances.” Consistent condom user, 21 years, Abidjan. • Life ambitions and the perceived negative effects of pregnancy and HIV/AIDS on the achievement of life goals

39. THREATS TO CONSISTENT CONDOM USE • Unwarranted trust in the partner that comes with length of the relationship: • “I stopped using the condom with him because after going out with him for six months, I felt I could trust him.” Lapsed consistent user, 22 years, Abidjan

40. THREATS TO CONSISTENT CONDOM USE • Economic dependence on partner leading to reduced power in relationships; • Peer pressure: • “..they say that you cannot eat a banana with the skin…” Consistent user, 17 years, Abidjan

41. THREATS TO CONSISTENT CONDOM USE • Pressure from the partner: • “Some of my girlfriends have told me: ‘if you insist on using a condom, that means you go not trust me, do you think I am fooling around?’. My response is to ask them to show me the results of their HIV test or the absolute proof that they are not fooling around.”

42. THREATS TO CONSISTENT CONDOM USE • Non-availability of condom: • “One night, I was seeing off a friend and met a girlfriend of mine. It was the only opportunity I would have had to make love with her. But because it was late at night all the shops were closed and I had no condom on me. It was very hard….” Consistent user, 20 years, Abidjan.

43. CONCLUSIONS • There are many youth who deviate positively from unhealthy group norms concerning sexuality; Using the positive deviants to promote safe sex practices should be a viable programmatic approach

44. CONCLUSIONS • The choice of a positive deviant lifestyle is influenced by family and contextual factors upon which the actor has little or no influence. However, the choice also depends on some psychosocial ideational factors that are subject to volitional control on the part of the positive deviant, including:

45. CONCLUSIONS • Self-confidence • lofty life ambitions; • perceptions about sex; • risk perceptions; • perceived self-efficacy; • perceived severity of HIV/AIDS • Programs should design appropriate strategies based on these ideational factors.