How do young people in Zambia respond to their churches' calls for celibacy? Do they entrust their health to government clinics or traditional healers? Researchers from the University of Wales, Swansea, and Care International addressed these questions using the innovative approach of peer interviews.

Interviews conducted by young people revealed a conflict between beliefs and actual sexual behaviour. Although the church preaches abstinence, religion and sexual activity are both central to adolescents' lives. Young people have faith in modern medicine, but the cost of drugs means they often turn to traditional healers or street peddlers.

Young people believe abstinence is the best way to avoid sexually-transmitted infections (STIs). They identify condom use in a monogamous relationship as an acceptable alternative. Yet sexual relationships play a very important role in their lives. Money is central: gifts are seen as an important part of a caring sexual relationship. If a young man expects sex but does not offer gifts, he is considered undesirable and immoral. For many young women, boyfriends provide their only access to consumer goods and money for school fees. Finding a job is important to young men, because it means they can afford to have a girlfriend.

The interviews also showed that adolescents define people not according to their ethnicity but by their church membership and social factors. Descriptions include 'self-employed', 'businessman', 'poor', 'drunkard', 'thief' and 'prostitute'. Attitudes to prostitution differ. Women link commercial sex to poverty and vulnerability. Many young men are afraid of contracting HIV or STIs. Despite engaging the services of commercial sex workers, they publicly condemn prostitution. Young people see witchcraft as belonging to the older generation and feel protected from witchcraft by Christianity.

The interviews also revealed:

• Young people do not go to clinics to get free condoms in case they are seen there or are treated negatively by nurses.
• Condoms sold at bars and nightclubs are too expensive.
• Adolescents believe clinics are the best source of healthcare, but a lack of drugs means they may turn to traditional healers or buy out-of-date medication on the streets.
• Youth-friendly services in clinics do not reach high-risk groups such as prostitutes, out-of-school youth and men who spend their time in bars.

The report suggests that health services could reach young people more successfully by:

• providing free condoms at social venues such as bars and nightclubs
• ensuring that government health clinics have good supplies of free drugs to combat STIs
• encouraging drama and other community-based approaches to target out-of-school youth
• using peers to reach vulnerable groups at venues where young people congregate: bars, nightclubs and bus-stops.

Peer interviews give a much greater understanding of behaviour than large-scale surveys. Adolescents are more likely to discuss sensitive topics with people they can relate to. The same technique could be used successfully with other social groups.

Source(s):
‘Social monitoring: a case study from Zambia of the peer ethnographic method’ in ‘The social context of sexual and reproductive health: a framework for social analysis and monitoring’ by K. Hawkins and N. Price, Centre for Development Studies, University of Wales, Swansea (2000)

Funded by: UK Department for International Development

id21 Research Highlight: 25 May 2001

Further Information:
Neil Price
Centre for Development Studies
University of Wales Swansea
Singleton Park
Swansea
SA2 8PP
Wales
UK

Tel: +44 (0)1792 295975
Fax: +44 (0)1792 295682
Contact the contributor: n.l.price@swansea.ac.uk

University of Wales Swansea

Kirstan Hawkins
c/o address as above

Tel: +44 (0)208 368 5853
Fax: +44 (0)208 368 5853
Contact the contributor: kirstan@globalnet.co.uk

Other related links:
See the Population Council site for research on various aspects of reproductive health.

Check the EngenderHealth website for reproductive health care research and publications.

Refer to Family Health International for more research, education and services relating to reproductive health.

Marie Stopes International covers a range of reproductive health resources.

Reproductive Health Outlook provides information on a range of reproductive health topics.

The Global Reproductive Health Forum hosts on-line discussion on reproductive health issues.