More than half of Ethiopians are under 15 years of age. Adolescents are particularly vulnerable to HIV and other sexually-transmitted infections (STIs). How much young people know about HIV and STIs may be key to preventing infection.

Most African countries have failed to address the risks of STIs and HIV among adolescents. Reasons include:

• a lack of data on the sexual knowledge, attitudes and behaviour of adolescents
• myths and fears among adults and institutions about these important aspects of adolescent life
• the scarcity of effective sexual and reproductive health programmes for adolescents.

Tackling the first of these problems, the researchers surveyed AIDS-related knowledge, attitudes and behaviours of 260 students from two rural high schools in North West Ethiopia. The average age of the male students is 18 years; for females it is 17 years. (Adolescents are classified as those under 18 years old.)

The study, involving the London School of Hygiene and Tropical Medicine, found that knowledge about HIV is generally good. More than 95 percent of the students know that it is transmitted through unprotected sexual contact, that healthy-looking people can be infected and infectious, and that HIV is a viral infection that can be prevented but has no cure. However, evidence of other misconceptions mean that only 44 percent of adolescent boys and 41 percent of girls have correct knowledge of the virus and its modes of transmission. 82 percent of adolescent males and 37 percent of females have some awareness of other STIs. Males know more than females about condoms, but do not necessarily know how to use them properly. Three quarters of students say that condoms are readily available.

Looking at behaviour, the study found that:

• Among adolescents, 31 percent of males and four percent of females say they are sexually active. For men and women over 18 the figures are 73 and 21 percent, respectively.
• Nearly half of the sexually active male students have had sex with a commercial sex worker.
• Use of condoms among male students is 53 percent, even with sex workers – higher than in many other African settings.
• Almost 20 percent of sexually active males in the study have had an STI. Almost all of these have visited a commercial sex worker.

These results show once again that knowledge does not necessarily translate into safe behaviour. To tackle HIV among adolescents, the researchers recommend that AIDS control programmes should:

• include life skills and sexual health education in the curriculum, as requested by 91 percent of the students
• investigate the sexual knowledge and activity of the majority of young Ethiopians who do not attend high school
• reinforce and capitalise on the apparent readiness of young people to use condoms
• develop and implement educational programmes targeted at adolescents and sex workers, along with accessible and effective STI treatment services for both groups.

Source(s):
‘Adolescent reproductive health and awareness of HIV among rural high school students, North Western Ethiopia’, AIDS Care 16 (1): 57-68, by G. Alene, J. Wheeler and H. Grosskurth, 2004 Full document.
'Age- and sex-specific HIV-1 prevalence in the urban community setting of Addis Ababa, Ethiopia', AIDS 12 (3): 315-322, by A.L. Fontanet et al, 1998
'Antibody to herpes simplex virus type 2 as a marker of sexual risk behaviour in rural Tanzania', Journal of Infectious Disease 179: 16-24, by A. Obasi et al, 1999

id21 Research Highlight: 4 February 2005

Further Information:
Heiner Grosskurth
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Contact the contributor: heiner.grosskurth@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
'Meeting the sexual health needs of young people in northern Uganda'

'Meeting their needs? Discussing young people’s sexual health'

'Adolescent sexual health in Zambia - peer interviews reveal all'

'Clearing up confusion: peer-led AIDS education in Zambia'

See id21's collection of links relevant to sexual and reproductive health.

See id21's collection of links relevant to HIV/AIDS.