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A 2006 Reproductive Health Matters.
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Reproductive Health Matters 2006;14(28):113–122
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The Mpondombili Project: Preventing HIV/AIDS and
Unintended Pregnancy among Rural South African
School-Going Adolescents
Joanne E Mantell,a Abigail Harrison,b Susie Hoffman,a,c Jennifer A Smit,d
Zena A Stein,a,e Theresa M Exner a
a HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute
and Columbia University, New York NY, USA. E-mail: jem57@columbia.edu
b Brown University, Department of Medicine, Division of Infectious Diseases and
Population Studies and Training Center, Providence RI, USA
c Department of Epidemiology, Mailman School of Public Health, Columbia
University, New York NY, USA
d Reproductive Health and HIV Research Unit, University of the Witwatersrand,
Department of Obstetrics and Gynaecology, Durban, South Africa
e GH Sergievsky Center, Columbia University, New York NY, USA
Abstract: Unintended pregnancy, HIV and other sexually transmitted infections are major threats to
the health of South African youth. Gendered social norms make it difficult for young women to
negotiate safer sex, and sexual coercion and violence are prevalent. Sexual activity among
adolescents is influenced strongly by conservative social norms, which favour abstinence. In reality,
most young people are sexually active by the end of the teen years. Girls’ decision to have sex is
often a passive one, influenced by partners. The Mpondombili Project is a school-based intervention
in rural KwaZulu-Natal that aims to promote delay in the onset of sexual activity and condom use
as complementary strategies for both sexually experienced and inexperienced youth. Interactive
training was carried out with peer educators, teachers and nurses over a 15-month period, and a
manual developed. The intervention was implemented in late 2003 with 670 adolescents in two
schools. Issues covered included HIV/STI transmission, risk behaviours, HIV testing, pregnancy and
contraception, gender inequality, sexual communication and negotiation, managing abusive
situations, fear of AIDS, stigma and discrimination and sexual rights. The diversity of young people’s
relationships and vulnerability to sexual risk call for the promotion of both risk avoidance (delay
in sexual initiation) and risk reduction (condom use) together, regardless of ideology, especially
where HIV is well-established, to protect their health. A 2006 Reproductive Health Matters.
All rights reserved.
Keywords: adolescents, HIV/AIDS, pregnancy, dual protection, abstinence, condoms, sexual
initiation, peer education, South Africa
A
DOLESCENTS in South Africa are at
heightened risk of HIV infection. In a 2003
nationally representative household survey
of youth aged 15–24 years, HIV prevalence was
10.2%. Among young women aged 15–19, 7.3 %
were HIV-infected, compared to 2.5% of men the
same age.1 By the age of 20–24, 24.5% of South
African women are HIV infected, compared to
7.6% of men. HIV prevalence in men peaks later,
with about 20% of men in their 30s infected.
Having an older partner is thus a key factor in
increasing young women’s risk for HIV/AIDS.
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JE Mantell et al / Reproductive Health Matters 2006;14(28):113–122
HIV prevalence was 29.5% among women aged
15–19 who had a partner who was five years
or older than themselves compared to 17% if
partners were within five years of their age.2 The
risk of pregnancy is also high, with one-third
of women reporting pregnancy or a first birth
before the age of 20.3 Most teenage pregnancy in
South Africa is non-marital and unintended.4
Despite these risks, recent national survey data
indicate some positive trends in young South
Africans’ preventive behaviours. Awareness of
HIV and how to prevent it is high, and reported
condom use has increased rapidly over the past
decade.1,2 Thirty-three per cent of sexually active
youth report always using a condom with their
most recent sexual partner, while 57% of sexually
active women report contraceptive use.1 In our
study of adolescents in rural KwaZulu-Natal,
nearly half reported condom use at last sex.5 In
spite of these trends, young people often are not
dually protected against pregnancy and infection. Condoms remain most strongly associated
with HIV prevention: among young women who
use contraception, only 34% report use of the
male condom for contraception, compared to 71%
who use hormonal methods.1
The gender dynamics creating barriers to prevention are powerful, including gender norms
that make it difficult for young women to negotiate safer sex with male partners. They also
encourage men to engage in risky behaviour,
women to have relationships with older male
partners and contribute to the prevalence of
sexual coercion and violence.6–8 Such findings
underscore the critical need for comprehensive
sexual health interventions for adolescents that
address both HIV/STIs and unintended pregnancy, as well as the social and contextual factors underlying young people’s risk. Without
aggressive implementation of interventions in
South Africa, there is a 50% probability that young
people will be infected with HIV by age 35.9
A major issue, however, is what types of interventions are appropriate and most effective for
young people. Unfortunately, HIV/AIDS prevention strategies for young people have become
mired in an increasingly polarised global debate
about abstinence versus condom use10 due to ideological, religious and cultural tensions related to
sex and sexuality.11 For instance, the primacy of
abstinence has been promoted in abstinence and
virginity clubs to delay sexual debut for adoles114
cents in Uganda, Kenya, and South Africa,12 and
the US PEPFAR policy requires that at least onethird of funds for HIV prevention be earmarked
for abstinence promotion among young people.13
Although Uganda’s ABC (abstain, be faithful, use
a condom) approach has been widely credited in
the decline of the country’s HIV epidemic, this
claim has been contested.14–16 Evidence regarding
the effectiveness of abstinence-until-marriage
strategies in changing young people’s sexual risk
behaviours is scarce. Most importantly, abstinenceuntil-marriage programmes do not address the
reality that the majority of youth in sub-Saharan
Africa are sexually active by the end of their
teen years, and are at risk for HIV/AIDS and pregnancy as early as age 15.17 In South Africa, where
the average age of marriage is late, at 27 years,
but the median age at first sex is 17 years,3 strategies that promote abstinence-until-marriage are
unrealistic. This stark fact argues for condom promotion as a key prevention strategy.
A major challenge for designers of youth prevention interventions is weighing the expected
public health benefits of delayed sexual initiation, condom promotion or some combination
of the two. In this paper, we describe formative
research that preceded a school-based intervention, the Mpondombili Project, and its participatory development, designed to promote condom
use and delay in the onset of sexual activity
as complementary prevention strategies among
rural South African youth.
Formative research: an initial step in
intervention development
Despite a growing number of studies of adolescent sexual risk in South Africa, relatively few
have been conducted in rural settings. KwaZuluNatal, which is severely affected by HIV/AIDS,
is South Africa’s most populous province and
among the most economically disadvantaged.18
The study area consists of rural scattered homesteads, two small towns and a large trading
centre situated on a national highway. Although
many people live in remote areas, public transport links the rural areas to towns and cities.
Annual average household income in the district
is approximately US$650.19 About one-third of
households are headed by women; there are five
secondary schools, three clinics and one district
hospital. Most residents are ethnically Zulu.
JE Mantell et al / Reproductive Health Matters 2006;14(28):113–122
To gain an understanding of adolescent sexuality and risk behaviours, peer group discussions
(repeat focus groups) with the same participants20
were conducted with 53 adolescents aged 13–19,
in four groups, divided by sex and age.21 The
semi-structured discussions were conducted in
isiZulu by two trained facilitators. Each group
met eight times, exploring a range of topics
related to gender, sexuality, pregnancy, HIV/AIDS
and prevention. The group discussions were audiotaped, translated into English and transcribed.8,21
The formative research identified critical
intervention needs. Study findings showed that
although adolescent girls were concerned about
both pregnancy and HIV/AIDS, the threat of
pregnancy was seen by the girls as more immediate, as they witnessed family and friends having
children during adolescence. However, the consequences of HIV/AIDS were viewed as more serious. In contrast, adolescent boys did not perceive
themselves to be vulnerable to HIV/AIDS, largely
because many used condoms (although not with
steady partners), and thought they could identify
level of risk by a girl’s appearance or behaviour.
Gender, social norms and sexual activity
Similar to findings from other South African
studies,6,7,22–24 the peer group discussions highlighted how gender inequalities contribute to
and reinforce sexual risk behaviours. Adherence
to traditional gender roles limited girls’ ability
for sexual communication and negotiations with
partners. Normative beliefs about gender roles
pervaded discussions of sexual initiation and
decision-making, forced sex and condom use.
The discussions also pointed to many contradictions in young people’s belief systems, signifying that adolescent boys and girls’ normative
beliefs and attitudes were not necessarily consonant with their behaviours. Within youth peer
culture, young women are expected to be sexually available, to defer to male decision-making
authority and to be ‘‘conquered’’. Socio-cultural
expectations, however, dictate that adolescent
girls remain virgins, resist boys’ sexual advances
and avoid pregnancy.21,24 Despite younger girls’
beliefs that it is ideal to delay initiation of sex
until the age of 21 and favourable attitudes about
abstinence, many were sexually active. Fear of
parental disapproval of sexual relationships
meant that sexual activity was often shrouded
in secrecy.25 In contrast, boys are expected to ini-
tiate sex, and often felt pressure from peers and
older men, sometimes their own brothers or
uncles, to uphold an image of masculinity through
engaging in sexual activity. Those who chose to
remain abstinent were often ridiculed. In practice,
however, most of the young men interviewed
rejected the idea of abstinence for themselves.21
Girls feared that their boyfriends would leave
them if they refused to have sex, yet they were
idealistic about their relationships, believing that
if they could establish open communication with
a partner at the onset of the relationship, they
could influence sexual negotiations and their
partners would respect their decision to refuse
sex. Even with some fluidity in their beliefs, the
belief that ‘‘girls don’t propose love to boys’’ was
endorsed by many girls and boys.21 Among girls
who had recently become sexually active, the
decision to have sex was often a passive one,
influenced by their partners’ persuasive powers
and their own sexual naiveté.
Social norms regarding abstinence
National and local surveys in South Africa indicate that about half of young people in their
teens are not sexually experienced.1,2,26 Many
girls expressed positive attitudes about abstinence
in our formative research, citing protection from
STIs and pregnancy as reasons. This perspective
reflects community norms, whereby abstinence is
a culturally meaningful option for many young
women. Among younger girls, the majority view
in the peer group discussions was that sexual
activity was not appropriate until ‘‘older’’ ages.
A minority of the sexually active girls in this age
group supported the concept of ‘‘secondary abstinence’’, i.e. periods of abstinence after having
begun sexual activity, with avoidance of sexual
intercourse as a way to prevent AIDS. Although
these girls were concerned about rejection by
their female peers if they did not have sex, they
experienced even greater pressure to have sex
from their boyfriends. Abstinence was not seen as
a realistic prevention strategy among the older
girls, however, who presumably were part of a peer
group where sexual activity was more common.25
Condom use and prevention
Most girls believed that boys should initiate
male condom use, and therefore rarely discussed
this topic before sex.8 Girls even felt it was
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easier to refuse sex than confront partners about
using condoms, a surprising finding given young
women’s disadvantages in negotiations within
sexual relationships.6
There were many prevalent myths about condoms, including that they contain HIV and are
therefore harmful rather than protective. Other
South African studies have also noted negative
attitudes about condom use, such as condoms
should not be used with steady partners and a
woman who carries condoms may be labeled a
‘‘bitch’’.27 Paradoxically, however, recent data
show notable increases in condom use among
South African youth, probably attesting to the
power of public health education and HIV prevention messages in recent years.2
Developing the school-based intervention
These qualitative research findings were the primary source for shaping the focus and content of
the Mpondombili Project. They highlighted two
important influences on young people’s sexual
risk behaviours: gender-role norms and inequalities, and social norms about sexuality. In order
to achieve the project’s goals of dual protection
through delayed sexual initiation and condom
use, it was clear that the intervention would need
to address these issues up front.
We drew on three other sources in designing
the intervention: evidence from the literature
about adolescent sexual and reproductive health
knowledge, reviews of youth-focused interventions28–30 and existing HIV and pregnancy
prevention interventions in South Africa.31,32
Theoretically, the programme drew on theories of
psychological and community empowerment,33,34
gender and power35 and social learning.36
Although South African schools have been
condemned for high levels of violence37 and
criticised for their limited capability to actively
engage with HIV prevention,27 we decided on a
school-based intervention. A high proportion
of young South Africans attend school, nearly
80% of 15–19 year-olds in this area.18 As a result,
schools can be a major source of HIV/AIDS information and are an important institution for
socialisation of youth, particularly in rural areas,
and potentially for changing sexual behaviour
norms.2 However, sex education in schools has
been inadequate. Despite a national mandate for
Life Skills, teachers often have participated only
116
reluctantly, and there is little oversight regarding
how the programme is implemented in individual schools. School-based programmes pose
further challenges since often they must include
a fairly wide age range of youth with differing
levels of sexual experience, who thus have different intervention needs. The Mpondombili Project’s dual focus on risk avoidance (delay) and risk
reduction (condom use) arose from the need to
address this diversity, as well as to respond to prevailing community norms about youth sexuality.
Engaging youth and adults in the process
of participatory design
The Mpondombili curriculum was developed using
a participatory process involving 14–17 year-old
secondary school students and teachers, nurses
and local and international researchers. The use of
students as peer educators was intended to empower
youth, foster knowledge-based leadership skills
and self-confidence38 and make the programme
more accessible to youth. Many school-based
programmes in Africa are delivered by teachers,
do not engage youth actively in prevention, and
have been guided by a top-down approach rather
than young people’s self-identified needs.39
As the Youth Peer Educators needed support
to implement the intervention, the idea of ‘‘adult
role models’’ emerged, whereby teachers from
programme schools and nurses from nearby
clinics would participate as mentors. The teachers
felt that the nurses could more effectively address
‘‘technical’’ issues, such as HIV/AIDS, contraception and reproduction. However, nurses are often
judgmental about adolescents having sex and
therefore reluctant to provide contraceptives to
them,40 making it difficult for youth to feel comfortable talking about sex and contraception with
them. The nurses’ participation in Mpondombili
aimed to improve their understanding of young
people’s needs and facilitate access to contraception and quality sexual health counselling at
local clinics.
Interactive training for peer educators,
teachers and nurses
To develop the intervention, project staff conducted interactive training with the peer educators
and adult mentors over a 15-month period
through workshops and consultations. Thirtytwo youth peer educators were selected on the
JE Mantell et al / Reproductive Health Matters 2006;14(28):113–122
basis of their motivation, leadership capacity
and interpersonal skills. A draft intervention
manual was developed by the project staff, and
used as the basis for training. Meeting weekly in
small groups, the peer educators were asked to
discuss and critique the main issues presented:
gender – understanding the perspectives of the
opposite sex, how gender shapes everyday lives,
gender and sexuality, communication of information about safer sex, delay in sexual initiation,
dual protection, sexual negotiation strategies and
joint male–female responsibility for prevention.
This process developed a critical consciousness
through which the main issues of importance to
the intervention emerged. Further, this process
served as an educational tool to instil basic knowledge about HIV and pregnancy prevention, as
well as other sexual health issues, in this group.
At the same time, the youth peer educators were
trained in participatory methods, and how to use
games, role plays and interactive group discussion.
There were advantages and disadvantages to
this process. While the training sessions raised
young people’s confidence and knowledge, the
reality of gender inequalities in the lives of South
African youth became vividly apparent. At first,
social interaction between male and female peer
educators was limited, as they started off and
remained in same-sex groupings. Whereas the
boys participated actively in terms of comments
and questions, the girls were more reserved. Some
boys expressed negative viewpoints about
changing gender roles, e.g.‘‘Things have changed
since women started to wear trousers’’. The need
to counteract male dominance led to doubling the
number of female peer educators, expanding
gender-sensitisation training of the peer educators and adult mentors, and addressing gender
relations more extensively in the intervention.
The six teachers (three male, three female) and
four nurses (all female) who participated in the
project were keenly aware of the importance of
providing HIV prevention and sexuality education to youth. However, the challenges were enormous. As members of the local community, these
adults subscribed to the same beliefs about gender
and sexuality. In particular, talking about sex in
mixed adult–youth groups was difficult. Teachers
and nurses are highly respected and wield power
over youth, and asking both youth and adults to
step out of their roles was initially difficult. Conceptually, the adult participants accepted ideas
about gender equality, but implementation of
these ideas was difficult. The nurses criticised colleagues who ‘‘shouted’’ at youth seeking condoms
and contraception, but many believed that youth
should not have sex and had inadequate knowledge of reproductive health and contraceptive
issues. These issues were addressed through two
one-day workshops on dual protection, gender
and sexuality, and skills for talking to youth
about sex and facilitation. The teachers, in particular, held many common misconceptions about
HIV/AIDS. Ultimately, however, the teachers
became the mainstay of support for the peer
educators, with a formal role in the delivery of the
intervention in classrooms. The nurses provided
technical information about HIV/AIDS, pregnancy and contraception.
Implementing the intervention
The Mpondombili intervention was implemented
in late 2003 with 670 adolescent girls and boys
aged 14–17 in Grades 8–10 in two schools, in
40-minute sessions over a four-month period.
These schools were not the same ones in which
the formative research was conducted. Two
additional schools served at comparison sites
(n=313) for the formal quantitative evaluation.
The intervention was approved by the Institutional Review Boards of the University of Natal
(now KwaZulu-Natal) and New York State Psychiatric Institute, Columbia University. The curriculum included 15 sessions designed to create
a positive approach to gender relations and build
prevention skills. It focused on issues of gender,
empowerment and sexuality as mechanisms to
promote condom use and delay in initiation of
sexual debut, and approached these goals by:
providing factual and realistic information on
HIV/STI transmission and risk behaviours,
HIV testing and rights, pregnancy and contraception, and substance use; and
addressing the social factors underlying sexual
risk, including gender roles and inequalities,
sexual partners, sexual communication and
negotiation within relationships, sexual violence and coercion and managing abusive
situations, fear of HIV/AIDS, stigma and discrimination, and sexual rights.
The intervention also addressed well-known
barriers to condom use, such as beliefs in the
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JE Mantell et al / Reproductive Health Matters 2006;14(28):113–122
ability to assess a partner’s HIV/AIDS risk based
on appearance, the association of condom use
with partner mistrust, promiscuity and infidelity,21,41 sexual communication and condom skills
negotiation. A combination of methodologies –
didactic and interactive teaching, small group
discussion, scripting peer behaviour through
vignettes and role plays, proverbs, songs, stories,
and games – was used to engage youth and facilitate skills development.
In response to issues raised during the participatory development process, fostering positive
norms about gender and sexuality became a
main theme of the intervention. The programme
also aimed to increase adolescents’ comfort in
talking about sex and to create a concept of
healthy sexuality, whereby young people understood that being in a sexual relationship was
okay, as long as they were ‘‘safe’’. Gendered
sexual expectations were challenged (e.g. a girl
cannot ask a boy to use a condom, men who are
virgins are not real men), and gender-equitable
sexual relations were modelled. The tension
between gender role expectations and cultural
norms about sexual behaviour was repeatedly
addressed, and students discussed the conflicts
that girls in particular face in maintaining virginity and saving face with parents, while fulfilling the expectation to please boys.
The Mpondombili project stressed choices –
delaying sexual initiation is the best way to
prevent STIs and pregnancy, but if you have sex,
condom use alone or in conjunction with another
contraceptive is the only way to be protected. The
intervention offered a wide range of safer sex
options, including condom use and other intimate
prevention strategies, such as kissing, cuddling,
massage and touching yourself and your partner’s
body and genitals. In addition, non-sexual means
of obtaining pleasure, such as playing sports or
cooking, were stressed.
The intervention also emphasised that choosing not to be in a relationship was okay, and
that being in a relationship did not mean you
had to have sex. Refusal skills, i.e. saying no to
sexual intercourse, were modelled in role plays.
For example, a vignette was used to stimulate
discussion about the choice to wait before having sex, whether boys feel pressured to have sex
before they are ready, what a couple should do if
they cannot agree and how long they should wait
before having sex. The youth participants offered
118
the perspective that each couple should discuss
sexual activity before a relationship becomes
sexual, obtain their partner’s support and decide
what is right for them.
The Mpondombili Project’s message about
delay in sexual activity was linked to individual
readiness, not to a specific time frame or marker
like marriage. Strategies for delaying sexual activity, such as pledging not to have sex until matriculation or marriage, enlisting support from
friends, avoiding friends who are unsupportive
and engaging in alternatives to sexual intercourse were presented as options. However, to
address the reality that most youth are unable to
delay sex for more than a short period of time,
the intervention focused on skills in negotiation,
self-efficacy and empowerment. Throughout, the
intervention emphasised the links between negotiating condom use and other aspects of sexual
relationships, and gender beliefs and attitudes.
Stereotyped attitudes about condoms were also
challenged, for example that only boys have negative attitudes toward condoms. Young people’s
own contributions to the discussion were that
talking about condoms when you are about to
have sex is not the best time and that talking to a
partner before sex makes it easier to protect
yourself later. The intervention included demonstration of correct male condom use, followed
by practice on a model, and male condoms were
available at each session, an unusual benefit for
a school-based intervention.
What did young people think
about Mpondombili?
Young people’s reactions to the programme
were very positive. The programme filled a huge
need for quality sexuality and HIV prevention
education. Perhaps most importantly, the presence of the intervention team provided a forum
for young people to ask questions and obtain
needed information and resources, including condoms, to enable self-protection. One of the main
strengths of the programme was being able
to directly address local ideas and stereotypes
about gender, sexuality and HIV/AIDS. For the
youth peer educators, involvement in the programme was clearly empowering. The female
peer educators, especially, reported that they
became a source of advice and guidance for
many of their classmates. The impact also seemed
GUEORGUI PINKHASSOV / MAGNUM PHOTOS
JE Mantell et al / Reproductive Health Matters 2006;14(28):113–122
Hannover, South Africa, 1999
to be positive for the young people who attended
intervention sessions. A qualitative evaluation
based on in-depth interviews with 41 students,42
suggested that the intervention had positive
effects on beliefs and attitudes. Students primarily identified the intervention with HIV
prevention and condom use, and less so with
pregnancy prevention and delayed sexual initiation. Nearly all of them understood the main
messages regarding dual protection. Many had
positive attitudes about male condoms and indicated they wanted to practise dual protection;
some attributed this to the intervention. Learning how to use condoms correctly was another
perceived benefit. The freedom to talk about
sex and relationships and to learn about selfprotection were also seen as programme benefits
since most adolescents were unable to discuss
these issues with their parents. For some, there
was greater understanding of the need to shift
from traditional to more egalitarian gender roles,
especially with respect to refusal of unsafe sex
and partner violence.
Conclusion
The Mpondombili Project used youth peer educators along with teachers and nurses as adult
mentors to deliver a gender and empowerment
intervention with adolescent boys and girls in
mixed-sex groups in schools. We incorporated
young people’s issues regarding gender role norms
with a standard HIV and pregnancy prevention
approach that addressed consistent condom use,
promotion of other contraceptive methods and
open discussion between partners.
Our experience demonstrates the feasibility of
developing a state-of-the-art intervention in an
under-resourced setting, with substantial involvement of the target population of youth. The
formal programme evaluation will be completed
in early 2007, but observations from our process
evaluation suggest a number of lessons learned –
the intervention was labour- and time-intensive;
schools are difficult environments in which to
work; and changing norms and attitudes of
youth, teachers and nurses entails great effort.
Future interventions need to consider the gendered
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JE Mantell et al / Reproductive Health Matters 2006;14(28):113–122
organisation and prevailing norms about sexuality that intersect the lives of these young people.
Unequal gender norms persisted among the peer
educators and the students and may have inhibited candid communication in a mixed-sex classroom setting. Holding same-sex groups could
allow young people more opportunities to voice
concerns about gender and sexuality and begin
to break down gender barriers before a mixed-sex
intervention is implemented. The Mpondombili
Project’s lead teacher is working to establish
Mpondombili as an NGO so as to expand the
programme to other schools and to the community more broadly.
Regardless of programme structure, the complexity and diversity of young people’s relationships and vulnerability to sexual risk need to be
considered in sexual and reproductive health
programmes. This entails embracing risk avoidance (delay in sexual initiation) and risk reduction (condom use) as complementary alternatives,
despite personal ideology or political agenda. Failure to address condom use and delay of sexual
initiation simultaneously, especially in countries
where HIV is well-established, will place young
people at risk, denying them choices to protect
their health.
Acknowledgements
This study was supported by NICHD R01
HD037343 OAR Supplement ‘‘Promoting Dual
Protection among Rural South African Youth’’,
Theresa M Exner, Principal Investigator. The
HIV Center for Clinical and Behavioral Studies
is supported by a Center Grant from the National
Institute of Mental Health (P30-MH-43520,
Anke A Ehrhardt, Principal Investigator). Abigail
Harrison is supported by NIH training grant NIDA
5T32DA13911. In South Africa, we acknowledge
support from the Medical Research Council, Gita
Ramjee, Director, HIV Prevention Research Unit,
Durban, and especially the study team: Thobile
Nzama, Pinky Kunene, Musa Mpanza, Muriel
Kubeka and Mdu Gumede. Sincere thanks are due
to the principals, teachers, nursing sisters and
youth peer educators whose efforts made this
project possible. Finally, we dedicate this article
and the future of the Mpondombili Project to the
memory of our colleague and friend, Nelly Ntuli
(1962–2005), Project Director from 2000–2003.
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121
JE Mantell et al / Reproductive Health Matters 2006;14(28):113–122
Résumé
Les grossesses non désirées, le VIH et d’autres
IST sont les principales menaces pour la santé
des jeunes Sud-Africains. Les normes sociales
différentes selon les sexes rendent difficile
aux jeunes femmes de négocier des relations
sexuelles protégées, et la coercition et la violence
sexuelles sont fréquentes. Des normes sociales
conservatrices recommandent l’abstinence aux
adolescents. En réalité, la plupart des jeunes sont
sexuellement actifs à la fin de l’adolescence. La
décision des filles de passer à l’acte est souvent
passive, influencée par leurs partenaires. Le projet
Mpondombili, mené dans le KwaZulu-Natal rural,
conseille comme stratégies complémentaires
de retarder le premier rapport et d’utiliser des
préservatifs aux jeunes sexuellement expérimentés
ou non. En 2003, des jeunes, des enseignants
et des infirmières ont dispensé une formation
interactive sur 15 mois à 670 adolescents de deux
écoles et ont préparé un manuel. La formation
a abordé la transmission du VIH/des IST, les
comportements à risque, le dépistage du VIH, la
grossesse et la contraception, les inégalités sexuelles,
la communication et la négociation sexuelles, la
gestion des situations d’abus, la peur du SIDA,
la stigmatisation, la discrimination et les droits
génésiques. La diversité des relations entre jeunes
et leur vulnérabilité exigent de promouvoir
conjointement des stratégies destinées à éviter
le risque (retard de l’initiation sexuelle) et le
réduire (utilisation de préservatifs), sans souci
d’idéologie, particulièrement là où le VIH a une
forte prévalence.
122
Resumen
El embarazo imprevisto, el VIH y otras infecciones
de transmisión sexual ponen en alto riesgo la
salud de la juventud de Sudáfrica, donde las
normas sociales basadas en género dificultan
que las jóvenes negocien el sexo más seguro, y
donde cunden la coerción y la violencia sexual.
La actividad sexual de la adolescencia es muy
influenciada por las normas sociales conservadoras,
que favorecen la abstinencia. En realidad, la mayorı́a
de la juventud es sexualmente activa antes de
cumplir los 20 años. La decisión de las jóvenes
de tener relaciones sexuales suele ser pasiva,
influenciada por sus parejas. El proyecto de
Mpondombili es una intervención escolar en
la zona rural de KwaZulu-Natal, cuyo objetivo
es postergar el inicio de la actividad sexual y
promover el uso del condón como estrategias
complementarias tanto para la juventud con
experiencia sexual como para la inexperimentada.
Se realizó capacitación interactiva con educadores
de pares, profesores y enfermeras durante 15
meses, y se elaboró un manual. La intervención
fue ejecutada en 2003 con 670 adolescentes en
dos colegios. Los temas abarcados fueron: la
transmisión del VIH/ITS, comportamientos de
riesgo, pruebas de VIH, embarazo y anticoncepción,
desigualdad de género, comunicación y negociación
sexual, manejo de situaciones abusivas, temor del
SIDA, estigma y discriminación y derechos sexuales.
Debido a las diversas relaciones de la juventud y su
vulnerabilidad al riesgo sexual, se debe promover
tanto la prevención del riesgo (postergar el inicio
de la actividad sexual) como su disminución (uso
del condón), independientemente de ideologı́as,
especialmente donde el VIH está bien establecido,
a fin de proteger su salud.