Sexual Risk Behaviors Among Young People In Bamenda, Cameroon By Mburano Rwenge

Africa, sensitization and information pro- Context: Increases in levels of awareness of HIV and greater knowledge about its transmission grams on AIDS have been implemented and prevention have not always been associated with decreases in risky sexual behaviors among along with efforts to promote the use of young people in Cameroon. More information is needed about the factors associated with these condoms. However, these programs have behaviors. had limited results. In fact, in certain so- Methods: Data on social, demographic and economic characteristics and sexual behavior were cial strata, an appreciable increase in the collected from 671 youths living in Bamenda, Cameroon, in 1995. Multivariate techniques were level of awareness about AIDS and pre- used to analyze the effects of these characteristics on early initiation of intercourse, sex with vention methods has not translated into multiple partners, casual sex and nonuse of condoms. adoption of healthy sexual behaviors.4 Results: The average age at first intercourse was 15.6 for males and 15.8 for females. The main The prevalence of AIDS and its rate of reason given for initiating sexual activity was curiosity (53% of males and 42% of females). Some increase are higher in Northwest Province 5 37% of females and 30% of males, however, said their first sexual experience had not been vol- than in the other provinces of Cameroon. untary. The most important factors in initiation of sex before age 16 were father’s ethnicity, at- Bamenda, the capital of the province, had tending school and having a primary or middle-school education. Family composition and house- a population estimated at about 111,000 hold standard of living were the factors most consistently associated with sexual risk behaviors. in the 1987 census; a large proportion of Compared with youths living in a household with a high standard of living, those living in a poor its inhabitants are younger than 25. The household were 1.4 times as likely to be sexually active at the time of the survey and 1.3 times city is home to several ethnic groups. as likely to have had casual sex in the previous year. Young people living with only one parent Some, like the Makon-Banyague, have were 1.6 times as likely as those in two-parent households to be sexually active, 2.8 times as permissive sexual customs. Others, in- likely to have multiple concurrent partners, 1.7 times as likely to have had casual sex in the pre- cluding the Metta, the Bali-Ngemba, the vious year and 1.1 times as likely not to be using condoms. Living with grandparents generally Tikari-Nsoh and the Bamiléké, impose had a protective effect, while living with a sibling, alone or with other persons generally increased strict control of sexual activity. the likelihood of engaging in sexual risk behaviors. This article examines socioeconomic Conclusions: Youths with few economic resources and those with less stable living environ- and demographic characteristics in a sam- ments are more likely than other youths to engage in sexual behaviors that put them at risk of ple of 671 young people in Bamenda to contracting HIV. Improving the living conditions of families, especially those headed by single identify the factors associated with risky women, could help curb the spread of AIDS. sexual activity. It focuses on young peo- International Family Planning Perspectives, 2000, 26(3):118Ð123 & 130 ple because they engage in more frequent sex and have a long period of sexual ac- tivity before them; thus, the future preva- exuality is an area that has long at- do not use modern contraceptive meth- lence of AIDS depends heavily on the di- tracted sociologists and anthropolo- ods, those who are sexually active are at rection that prevention programs take Sgists as well as demographers be- high risk of conception. Thus, in this re- with respect to young people. cause of the identified relationships gion of the world, there is a high risk of between sexual behaviors and certain re- maternal and infant mortality because of Methodology productive health problems. In Sub-Sa- early pregnancy, induced abortion (which, Definition of Concepts haran Africa, the first studies on sexual be- in the many countries where it is illegal, For the purposes of this study, adolescence havior were conducted to determine the is often carried out in unsafe circum- is considered to encompass approximately causes of widespread infertility and steril- stances), short interpregnancy intervals, ages 12–25, a period of transition between ity, especially in Central Africa. Most con- and high and prolonged fertility.3 childhood and adulthood during which cluded that these problems resulted from Despite these risks, little research has the individual assumes his position as an decreased control of elders over young been done in Sub-Saharan Africa to de- active member of society. It is divided into people, economic hardship and the pres- termine the factors affecting sexual be- four overlapping stages: sexual awaken- ence of societies with permissive sexual havior, especially in young people. The ing (12–15), first sexual intercourse customs.1 These factors were considered few studies that have been done have been (14–17), gender role definition (16–19) and to have contributed to the spread of sex- essentially quantitative and descriptive. social role definition (18–25). ually transmitted diseases (STDs) that Among health problems related to sex- cause infertility (gonorrhea, chlamydia uality, AIDS is currently the main concern Mburano Rwenge is an educator and researcher at the and mycoplasma) or disrupt pregnancy of the public authorities in Africa; its Institute for Demographic Education and Research, (syphilis). After the beginning of the AIDS prevalence continues to increase in most Yaoundé, Cameroon. The research on which this article is based received financial support from the Small Grants epidemic in the early 1980s, some STDs of the countries in the region, with disas- Programme of the Union for African Population Stud- were found to increase the probability of trous psychosocial, demographic and so- ies. The author is grateful to Ibrahima L. Diop, coordi- 2 sexual transmission of HIV. cioeconomic repercussions. nator of the program, and to Ngondo A. Pitshandenge, Because the majority of African women In Cameroon, as everywhere else in who supervised this research.

118 International Family Planning Perspectives Table 1. Percentage distribution of young • Adolescents usually do not obtain in- vey, 31% of the unmarrried young people people in Bamenda, Cameroon, by selected formation about sex from their parents or interviewed had had primary schooling, characteristics, according to gender, Survey guardians. 43% had reached middle school, 16% had on the Sexual Behavior of the Young People • For the most part, they are informed reached high school and 5% had contin- of Bamenda, 1995 about HIV, its main means of transmission ued their education beyond high school; Characteristic All Male Female and its methods of prevention. only 5% had had no schooling (Table 1). (N=646) (N=378) (N=268) • Large proportions have precocious sex- Age ual intercourse and engage in sexual be- Sex Education 12Ð14 20.3 16.4 25.8 havior that may expose them to HIV in- Overall, approximately three of five young 15Ð18 33.2 30.5 37.1 fection. people said they had discussed one or ≥19 46.5 53.1 37.1 • Sociocultural and socioeconomic factors more sexual topics with their schoolmates Currently in school influence their sexual behavior. or friends. On the other hand, fewer than Yes 69.0 63.1 77.2 two of five had discussed such issues in a No 31.0 36.9 22.8 Data family setting. Most of those who said that Employment† To test these hypotheses, the study used they had had such discussions with fam- Not working 24.1 13.9 48.3 data from the Survey on the Sexual Be- ily members had had them either with Agriculture/fishing/ livestock breeding 2.6 3.0 1.7 havior of the Young People of Bamenda, their elders or with their mother. On av- Commerce 22.5 29.1 6.9 which was conducted in August 1995. In erage, the young people in our sample Manager/office the first phase of this two-phase cluster thought that the ideal age for starting sex worker 10.3 11.7 6.9 survey, five neighborhoods were ran- Skilled worker 23.1 22.6 24.1 education was 13.8 years for girls and 15.0 Specialized worker 17.4 19.7 12.1 domly selected in proportion to the size of years for boys. their populations. In the second phase, in- Educational level terviewers followed a preset itinerary from Awareness of AIDS None 4.8 4.8 4.9 Primary 30.6 32.5 27.5 household to household until they reached Overall, 97% of the young people had Middle school 42.9 37.3 50.9 the sample size of young people for a given heard of AIDS (Table 2). About half had High school 16.3 17.3 15.1 neighborhood. obtained information about AIDS from Higher education 5.3 8.1 1.6 The survey collected information on the radio (54%) or television (50%), while Religion participants’ social, economic and demo- smaller proportions had heard about the Catholic 43.5 46.3 39.7 graphic characteristics, on the character- syndrome from friends or school (17% Protestant 43.5 41.4 46.2 Muslim 4.6 4.9 4.2 istics of the households in which they each), newspapers (14%) and health cen- Traditional 4.4 3.8 5.3 lived and on their family environment. It ters or family (9% each, not shown). The Other 4.0 3.5 4.6 also asked questions about the young peo- level of AIDS awareness varied very lit- ple’s sex education by their parents or tle by gender. Father’s job Not working 5.0 5.5 4.6 guardians, their awareness of AIDS, their Sexual intercourse was identified by Agriculture/fishing/ knowledge about methods of preventing livestock breeding 18.9 18.1 19.9 infection with HIV, their sources of infor- Table 2. Percentage of young people giving Commerce 17.5 18.7 15.7 Manager/office mation about AIDS, the measures they specified responses to measures of knowl- worker 37.3 36.0 39.1 had taken to prevent the disease and their edge of HIV and awareness of means of trans- Skilled worker 8.8 8.5 9.2 sexual behaviors. mission and prevention, by gender Specialized worker 8.9 9.1 8.8 Other 3.6 4.1 2.7 Measure All Males Females Analysis Has heard of HIV/AIDS Total 100.0 100.0 100.0 Simple cross-tabulation was used to de- Yes 97.1 96.8 97.4 No 2.9 3.2 2.6 †Among nonstudents only (N=200). termine the proportion of young people who had obtained information about sex Means of HIV transmission known and sexuality from their parents or Sexual intercourse 93.5 93.2 93.9 The first two stages correspond to bio- guardians, the level of awareness about Mother-to-child 13.7 14.2 13.1 Shared needles 38.5 41.0 34.8 logical and physiological adolescence and AIDS and the use of methods of AIDS pre- Infected blood 51.4 52.1 50.4 the latter two to psychological and social vention. Multivariate classification analy- adolescence. In this study, first sexual in- sis was then used to examine the charac- High-risk groups known Prostitutes 66.4 66.9 65.9 tercourse occurring during physiological teristics of young people who had had People who are adolescence (i.e., before age 16) is consid- precocious first sexual intercourse, and lo- unfaithful 39.5 38.6 40.7 ered precocious. gistic regression was used to look at the Everyone 17.9 19.9 15.0 The sexual risk behaviors that we ex- characteristics of those who had engaged Knows a means of prevention amine are those that expose young peo- in risky sexual behaviors. Yes 76.3 80.4 70.6 ple to a greater risk of infection by the No 23.7 19.6 29.4 AIDS virus. They include having multi- Results Means of prevention known ple concurrent sex partners, having had Sample Characteristics Fidelity 15.0 10.1 17.6 sex with a casual partner and failing to use Males were more heavily represented than Abstinence 24.3 23.5 25.2 a condom during sexual intercourse. females in the sample (59% vs. 41%). Near- Condom use 89.2 89.7 88.3 ly all (96%) of the young people were un- Knows condoms are Hypotheses married, so those who were married were effective against HIV Yes 71.7 73.1 69.2 This study is based on the following hy- excluded from further analysis, leaving 646 No 28.3 26.9 30.8 potheses: in the final sample. At the time of the sur-

Volume 26, Number 3, September 2000 119 Sexual Risk Behaviors Among Young People in Bamenda, Cameroon

age, the young people surveyed thought ing the previous 12 months. Only 25% of Table 3. Percentage distribution of young peo- ple, by characteristics of first sexual experi- that the ideal age to begin having sexual the young people who were sexually ac- ence, according to gender intercourse was 18—approximately two tive at the time of the survey were using and one-half years later than their actual condoms. At every age, the proportion of Characteristic All Male Female mean age at first sexual activity. males who had several concurrent sexu- Age at first sex Most females (81%) had first had sex al partners or who had had casual sex was ≤14 24.3 28.0 18.7 15Ð17 55.2 46.9 67.6 with someone older than themselves, higher than that of females. 18Ð22 20.5 25.1 13.7 while most males had done so with some- These indicators of sexual behavior also one of the same age (40%) or younger than correlated with characteristics of the Age of first partner Same age 31.2 40.1 17.5 themselves (34%). Some 37% of females young people and their families (Table 4). Younger 21.4 34.2 1.4 and 30% of males said their first sexual ex- Compared with sexually experienced Older 47.4 25.7 81.1 perience had not been voluntary. Force young people whose father’s ethnic group First sex was voluntary aside, the main reason cited for initiating was not native to Northwest Province, for Yes 67.2 70.1 62.7 sexual intercourse was curiosity (53% of example, those whose father belonged to No 32.8 29.9 37.3 males and 42% of females), followed by the Bali-Ngemba, Bamiléké, Makon- Intends to continue relationship the influence of friends (12% and 19%, re- Banyague or “other Northwest” groups with first partner spectively). were significantly more likely to be sexu- Yes 69.1 65.6 75.3 A multiple classification analysis (re- ally active at the time of the survey (odds No 30.9 34.4 24.7 sults not shown) indicates that in this ratios of 1.1 each). Sexual activity was sig- Intends to marry first partner group of young people, having had in- nificantly less common among youths Yes 25.6 19.6 36.4 tercourse before age 16 was strongly cor- whose father was a farmer or fisherman No 74.4 80.4 63.6 related with the father’s ethnicity, with than among those whose father was an of- Motivation for first sexual experience school and youth-group attendance and fice worker (0.6). It was more common Forced to have sex 35.2 30.0 40.0 with educational level. All other things among those whose parents did not live Curiosity 48.5 53.0 41.5 Urging of friends 13.2 11.5 18.5 being equal, early sexual intercourse was together (1.5), those whose parents had a Other 3.1 5.5 0.0 most likely to occur among the Tikari- polygamous marriage (1.8) and those liv-

Total 100.0 100.0 100.0 Nsoh and the Bamiléké: Some 54–55% of ing in a poor household (1.4) than among the young people belonging to these youths without those characteristics. In groups had engaged in sexual activity be- addition, compared with young people most of the young people (94%) as a way fore age 16, compared with only 32% of who lived with both parents, those who in which HIV is transmitted, followed by Bali-Ngemba young people. Precocious lived with their grandparents were sig- infected blood (51%), shared needles sexual intercourse was least likely among nificantly less likely to be sexually active (39%) and maternal transmission (14%). young people whose father belonged to (0.3), while those who lived alone, with a Prostitutes (66%) and individuals who are ethnic groups that were not native to brother or sister or with one parent were unfaithful to their sexual partners (40%) Northwest Province (30%). more likely to be sexually active (1.2–1.6). were cited as the groups at greatest risk School attendance was positively cor- Young people who had had intercourse of contracting the virus. The most com- related with precocious entry into sexual before they were 16 were less likely than monly mentioned methods of preventing activity. However, the relationship be- those who had not to be sexually active at AIDS were use of condoms (89%), absti- tween educational level and early first in- the time of the survey (0.7). nence (24%) and fidelity (15%). Again, tercourse was negative, especially after Compared with young people whose there were few differences by gender in middle school. All else being equal, 49% father’s ethnic group was foreign to these responses. of young people with a primary or mid- Northwest Province, those whose father The main measures that these young dle-school education had had intercourse belonged to the Bamiléké were more like- people had taken to prevent AIDS (not before age 16, compared with 29% of those ly to have more than one sexual partner shown) were abstaining from sex (64%), with a high school education. Contrary to at the time of the survey (odds ratio of 1.2), being faithful to one partner (55%), using the result expected, youth-group atten- while those whose father belonged to the condoms with casual partners (19%) and dance was negatively correlated with Metta or “other Northwest” groups were limiting the number of partners (13%). Fe- early initiation of sexual activity. less likely to do so (0.7–0.8). The likelihood males were more likely than males to have The relationship between gender and of having multiple partners was signifi- adopted abstinence (71% vs. 60%) and fi- age at first intercourse became highly sig- cantly higher among youths whose father delity (61% vs. 45%), while males were nificant after the effects of other factors was unemployed and those living in a more likely to have adopted condom use were taken into account, with 50% of household with an average standard of (22% vs. 15%). males and 35% of females having had sex living (1.3–1.5); it was significantly lower before age 16. among those whose father worked as a First Sexual Intercourse farmer or fisherman (0.6). For the most part, males and females had Other Sexual Behaviors Compared with those who lived with begun having sexual intercourse before Among young people who had already both parents, youths who lived with their they were 18 (Table 3). However, three had sexual intercourse, 27% had multiple grandparents were significantly less like- males out of 10 (versus two females out sexual partners at the time of the survey, ly to have multiple partners (odds ratio of of 10) had already had sex by age 14. Con- while 16% said that they had no current 0.0), while those who lived alone, with one sequently, the mean age at first sexual in- partner (data not shown). Forty-one per- parent, with a sibling or with other per- tercourse was slightly lower for males cent of sexually experienced young peo- sons were more likely to have more than than for females (15.6 vs. 15.8). On aver- ple had had casual sexual intercourse dur- one partner (1.9–4.0). Females were sig-

120 International Family Planning Perspectives nificantly less likely than males to have was unemployed were Table 4. Odd ratios from logistic regression analyses on the prob- multiple partners at the time of the survey more likely not to be ability of being sexually active at the time of the survey, of having (0.8), and young people who had had sex using condoms (2.0), more than one sex partner at the time of the survey, of having had before age 16 were more likely than those while those whose father casual sexual relations during the 12 months preceding the sur- who had not to have more than one part- worked in commerce or vey and of not using condoms at the time of the survey ner (1.5). was a skilled worker Characteristic Sexually Multiple Casual sex in Nonuse of Youths whose father belonged to the were less likely not to be active partners past 12 months condoms Metta were less likely than those whose using them (0.5 each). Father’s ethnicity father’s ethnic group was not native to Living in a poor Makon-Banyague 1.12* 1.11 1.05 1.16* Bamiléké 1.10* 1.17* 1.07 1.30* Northwest Province to have had a casual household was associat- Bali-Ngemba 1.10* 0.93 0.94 0.93 partner in the 12 months preceding the ed with a reduced likeli- Tikari-Nsoh 0.91 0.71 1.09 1.09 survey (odds ratio of 0.8). Neither the fa- hood of condom nonuse Metta 0.86 0.71* 0.79* 0.87* Other Northwest 1.10* 0.75* 0.93 1.07 ther’s occupation nor the parents’ type of (odds ratio of 0.8). In ad- Foreigners (ref) 1.00 1.00 1.00 1.00 marriage had any effect on this behavior. dition, compared with Father’s job However, young people whose parents youths who had lived Not working 1.35 1.54* 0.86 2.07* did not live together were significantly with their parents dur- Agriculture/fishing/ more likely to have had a casual partner ing childhood, youths livestock 0.61* 0.57* 0.83 0.75 Commerce 1.16 0.76 1.22 0.47* in the previous year (1.2). who had lived with Manager/office Youths from a family with a poor or av- other persons were less worker (ref) 1.00 1.00 1.00 1.00 Skilled worker 1.25 1.00 1.08 0.53* erage standard of living were significant- likely not to be using Specialized worker 0.74 1.12 1.34 1.03 ly more likely than those from a family condoms (0.8). Further- Other 1.17 1.49 0.82 3.94* with a high living standard to have had more, in comparison Parents’ type of marriage casual sex (odds ratios of 1.3–1.4). In com- with young people who Polygamous 1.75* 0.91 1.04 0.86 parison with adolescents who had lived were living with both Monogamous (ref) 1.00 1.00 1.00 1.00 with their parents during childhood, those parents at the time of the Cohabitation by parents who had lived with other persons were survey, those who were Yes (ref) 1.00 1.00 1.00 1.00 more likely to have had a recent casual living alone or with a No 1.54* 0.68 1.19* 1.09 partner (1.3). Compared with those who brother or sister were Household standard of living† lived with both parents at the time of the less likely not to be using Poor 1.43* 0.88 1.29* 0.79* Average 0.94 1.29* 1.35* 0.95 survey, young people who lived with their condoms (0.5–0.7), while High (ref) 1.00 1.00 1.00 1.00 grandparents or with other persons were those who were living significantly less likely to have had casu- with one parent or with Persons with whom respondent lived during childhood Parents (ref) 1.00 1.00 1.00 1.00 al sex in the last year (0.5–0.8), while those other persons were more Other 0.97 0.95 1.28* 0.76* who lived with only one parent, with a likely not to be using Persons with whom respondent lived sibling or alone were more likely to have them (1.1–1.7). Failure to at time of survey done so (1.2–2.3). use condoms was also Both parents (ref) 1.00 1.00 1.00 1.00 Casual sex was also more likely among more likely among One parent 1.64* 2.83* 1.65* 1.12* Brother/sister 1.23* 4.02* 1.15* 0.65* youths who did not have sufficient re- youths who did not Grandparents 0.30* 0.00* 0.49* 1.07 sources to meet their needs than among have sufficient resources Alone 1.49* 2.75* 2.26* 0.48* those who did (odds ratio of 1.2). Com- than among those who Other persons 1.23 1.94* 0.84* 1.68* pared with young people with a high did (1.1). Finally, young Sufficient resources school education, those who had a pri- people with a middle- Yes (ref) 1.00 1.00 1.00 1.00 No 0.97 0.95 1.23* 1.12* mary or middle-school education were school education were more likely to have had a casual partner more likely not to be Educational level None 1.41 0.59 1.02 0.74 in the year before the survey (1.3–1.5). Fe- using condoms at the Primary 0.91 1.38 1.46* 0.92 males were less likely than males to have time of the survey than Middle school 1.31 0.91 1.27* 1.27* had a casual partner (0.6), and young peo- were those with a high High school (ref) 1.00 1.00 1.00 1.00 Higher education 0.50 1.38 1.11 0.93 ple who had had sex before they were 16 school education (1.3). were more likely than other youths to Gender Female 1.05 0.78* 0.59* 1.05 have done so (1.5). Conclusions Male (ref) 1.00 1.00 1.00 1.00 Compared with youths whose father’s Like research conducted ethnic group was foreign to Northwest in other regions of First sexual intercourse before age 16 Yes 0.72* 1.53* 1.51* 1.06 Province, those whose father belonged to Cameroon and in other No (ref) 1.00 1.00 1.00 1.00 the Makon-Banyague or the Bamiléké African countries,6 this *p≤.05. †This variable is based on the presence of selected durable goods (television, radio, were more likely not to be using condoms study found that com- etc.) in the household. Note: ref=reference group. at the time of the survey (odds ratios of munications between 1.2–1.3), while those belonging to the adolescents and their Metta were less likely not to be using them parents or guardians on the subject of sex cation that the parents received placed lit- (0.9). Of all sexual risk behaviors exam- were poor. According to one observer, the tle emphasis on explanation and verbal- ined, nonuse of condoms was the one low level of sex education in the family ization.7 These results point to the need for most influenced by the father’s occupa- setting appears to result both from a lack education programs to improve parents’ tion: Compared with youths whose father of adequate parental knowledge about the knowledge of the reproductive health of was an office worker, those whose father subject and because the traditional edu- young people, to prepare them for estab-

Volume 26, Number 3, September 2000 121 Sexual Risk Behaviors Among Young People in Bamenda, Cameroon lishing good and open relationships with haviors involved can only be explained by ual behaviors. their children and to give appropriate ad- a tendency to rebel against traditional sex- As young people who have unem- vice in the area of sex education. These re- ual norms. ployed fathers, live in poor households or sults also bear witness to the need for in- The relationship between precocious have insufficient resources to meet their troducing sex education programs in sexual intercourse and school attendance needs are at greater risk than their peers schools and youth centers. may reflect the fact that school promotes of having several sex partners and of en- The young people surveyed were well the meeting of young people of the op- gaging in casual sexual intercourse, pover- informed about AIDS, its main means of posite sex in an environment that is not ty appears to contribute to risky sexual ac- transmission and methods of prevention, controlled by their family. Indeed, cu- tivity. To satisfy their material needs, they but they continued to have sexual rela- riosity and the influence of schoolmates may engage in sexual activity with mul- tions that could expose them to infection. or friends were mentioned by many of tiple partners or casual partners or agree Thus, informing and educating young them as reasons for their first sexual in- to have sex without a condom. Data de- people about sex and AIDS does not seem tercourse. The negative relationship be- rived from qualitative research conduct- to be sufficient to motivate them to change tween educational level and precocious ed along with our survey confirm these re- their sexual behaviors. first sexual intercourse, which confirms sults, as most of the young women who The results of this study reveal that findings of studies done in Benin10 and in participated in individual interviews de- nearly half of the young people surveyed Cameroon,11 may reflect the fact that re- clared that they had sexual intercourse in had had sexual intercourse before age 16, maining in school for a long time delays exchange for money, gifts or clothing: that most were sexually active at the time social maturation. “Because I have children, I cannot have of the survey and that about one-third had As the results of this study have re- sexual relations with a man if he does several sex partners, but that only one- vealed a strong positive relationship be- not give me something.”—A single 21- fourth were using condoms. Moreover, tween early first intercourse and most of year-old woman two out of five had had casual sex during the other sexual behaviors being studied, “I got involved in this sexual life be- the 12 months preceding the survey. Con- actions aimed at delaying entry into sex- cause I lost my parents, I have two chil- sequently, AIDS prevention programs ual activity by young people should also dren and I don’t have a husband to should place a greater emphasis on fi- be part of the content of the AIDS pre- help me resolve my problems and delity, reducing the number of sex part- vention programs in Africa. Parents those of my children....This life pro- ners and using condoms. should monitor their adolescent children’s vides me the wherewithal I need to The fact that the percentage of young choice of friends. The finding that almost solve my little family’s problems, but people using condoms in Bamenda was four in 10 young women said that their if I get married or find a job, I’ll give it far higher than what has been found at the first sexual experience had not been vol- up, because it exposes me to a lot of national level in other studies suggests untary suggests that parents need to mo- risks.”—A single 19-year-old woman that AIDS awareness may have positive- bilize their communities against sexual vi- “I can’t have sexual relations with boys ly influenced condom use in Bamenda. olence toward girls. at all because they don’t have the This awareness may also explain at least Young peoples’ sexual risk behaviors wherewithal. However, responsible part of the difference observed in Ba- are influenced by both cultural factors and men almost all help me when I have menda between the percentage of young economic factors; this means that their en- money problems.”—A single 21-year- people who are sexually active and the vironment and living conditions are ex- old woman percentages who have several partners or tremely important. In addition, it under- Men, on the other hand, frequently engage casual sex. These differences sup- scores the importance of the living adopt risky sexual behavior to procure the port recommendations for AIDS preven- arrangements of parents and their co- maximum gratification of their sexual de- tion programs. habitation with their young children. As sires. However, adolescent males claim Our differential analyses of the sexual noted in a study set in Uganda, “most of that some of their schoolmates and friends behavior of young people showed that the the students’ sexual activities occurred do so for economic reasons. This is par- age at which first sexual intercourse oc- when parents were away or when the stu- ticularly true of boys from poor families, curs is correlated with social and cultur- dents were staying with relatives. Also, al- who may receive aid from girls in the form al factors, while sexual risk behaviors are though numbers were small, generally or- of work (such as domestic help) or money, related both to those factors and to eco- phans and children living with single or assistance from married women who nomic factors. parents were more likely to engage in sex- clandestinely keep single boys in ex- The differences in sexual behavior by ual activities….”12 Young people who live change for sexual gratification. Still, girls ethnicity lend support to the theories of with their parents are less likely to have are particularly likely to engage in risky Murdock,8 whose pertinence has long emotional problems,13 and their behavior sex for economic reasons, which nega- been recognized by other researchers is more likely to be under their parents’ tively influences their power to require use searching for the causes of infertility in control. of condoms during sexual intercourse. Im- Central Africa.9 Consequently, these dif- The results of this study suggest that provement of the living conditions of fam- ferences may reflect differences in sexual noncohabitation by parents, conjugal in- ilies in Bamenda, particularly those of sin- permissiveness among ethnic groups in stability and noncohabitation with chil- gle mothers, might well reduce the Northwest Province. This explanation, dren may raise the risk that adolescents transmission of HIV over the long term. however, seems insufficient, because the will engage in risky sexual activity. Con- positive relationship observed between sequently, sensitization of parents about References membership in the Bamiléké or Tikari- these problems should be included in 1. Romaniuk A, La Fécondité des Populations Congolaises, Paris/La Haye: Mouton, 1967; Laurentin R, Infécondité Nsoh group—the two groups that impose AIDS prevention programs intended to en Afrique Noire: Maladies et Conséquences Sociales, Paris: strict control of sexual mores—and the be- motivate adolescents to avoid risky sex- Maason, 1974; Sala-Diakanda M, Infécondité de certaines

122 International Family Planning Perspectives ethnies, in: Tabutin D, ed., Population et Sociétés en Afrique ISANTE, 1990; Tchuppo JP et al., Résistance au change- mayor información acerca de los factores rela- au Sud du Sahara, Paris: L’Harmattan, 1988, pp. 191–216; ment des conduites sexuelles face au sida: une étude psy- cionados con estas conductas. and Evina A, Infécondité et sous-fécondité: evaluation chologique des obstacles à l’utilisation des préservatifs Métodos: En 1995, se recopilaron datos sobre et recherche des facteurs. Le cas du Cameroun, Cahiers (le cas des étudiants de l’Université de Yaoundé), study de l’IFORD (Institut de Formation et de Recherche Dé- report, Yaoundé, Cameroon: University of Yaoundé I, la conducta sexual y las características socia- mographiques), No. 1, Yaoundé, Cameroon: IFORD, 1990. 1990; Garcia-Calleja J et al., KABP and HIV seropreva- les, demográficas y económicas de 671 jóvenes 2. Cameron DW et al., Female to male transmission of lence study in Yabassi district (Littoral Cameroon), residentes en Bamenda, Camerún. Se utiliza- human immunodeficiency virus type 1: risk factors for Yaoundé, Cameroon: ULS/GTZ/WHO, 1992; Chambon ron técnicas de análisis de multivariables para seroconversion in men, Lancet, 1989, 2(8660):403–407; R et al., MST et SIDA dans un marché frontalier au analizar los efectos de estas características con Plummer FA et al., Cofactors in male-female transmis- Cameroun: Enquête sur les Connaissances, Attitudes, respecto a los siguientes factores: iniciación tem- sion of human immunodeficiency virus type 2, Journal Croyances et Pratiques et de séroprévalence à Mbaïm- of Infectious Diseases, 1991, 163(2):233–239; Laga M, Nzila boumn, Yaoundé, Cameroon: OCEAC/Association prana de las relaciones sexuales, las relaciones N and Goeman J, The interrelationship of sexually trans- Française des Volontaires du Progrès/Centre Pas- sexuales con varias personas, las relaciones se- mitted diseases and HIV infection: implications for the teur/ULS, Projet Fac Nord, 1993; Tchuppo JP et al., Les xuales casuales y la falta de uso del condón. control of both epidemics in Africa, AIDS, 1991, 5(Suppl étudiants des universités de Douala et Yaoundé face au 1):S55–S63; Laga M et al., Non-ulcerative sexually trans- Resultados: La edad promedio de la primera SIDA et aux MST: données qualitatives sur les connais- relación sexual fue de 15,6 años entre los va- mitted diseases as risk factors for HIV-1 transmission in sances, attitudes et pratiques, Yaoundé, Cameroon: AIDS- women: results from a cohort study, AIDS, 1993, CAP/Population Services International, 1993; and Cheta rones y 15,8 entre las mujeres. La principal 7(1):95–102; Auvert B, Epidémiologie du sida en Afrique, C et al., Evaluation du projet de prévention des razón para iniciar las relaciones sexuales fue in: Vallin J, ed., Populations Africaines et SIDA, Paris: La MST/SIDA à base communautaire dans quatre dé- la curiosidad (53% de los varones y 42% de Découverte, 1994, pp. 63–118; and Grosskurth H et al., partements de la province de l’Extrême-Nord du Camer- Impact of improved treatment of sexually transmitted las mujeres). Sin embargo, aproximadamente oun, Yaoundé, Cameroon: Institut de recherche et des diseases on HIV infection in rural Tanzania: randomised el 37% de las mujeres y el 30% de los varones études de comportement–Save the Children, 1996. controlled trial, Lancet, 1995, 346(8974):530–536. indicaron que su primera relación sexual no 5. Cheta C and Rwenge M, Recension des travaux réa- 3. Oum T, Maternité et paternité précoces au Cameroun, fue voluntaria. Los factores más importantes lisés au Cameroun dans le domaine de la santé repro- research report, Yaoundé, Cameroon: Project Women, ductive, study report, Projet AID:N/A/Santé Familiale que incidían en la iniciación sexual antes de Health and Development, 1993; Ilinimugabo A, Walla G et Prévention du Sida/OR, Yaoundé, Cameroon: IFORD, los 16 años fueron la etnicidad del padre, haber and Azombo M, Causes et conséquences des grossesses 1997. asistido a la escuela y haber completado ense- chez les adolescentes au Cameroun, research report, Se- ries 3, Yaoundé, Cameroon: Center for African Family 6. Ilinimugabo A, Walla G and Azombo M, 1996, op. cit. ñanza primaria o los primeros años de secun- Studies and Cameroon National Association for Family (see reference 3); Barker G and Rich S, Influences on ado- daria. 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Al comparar a los Yaoundé I, 1983; Boerma JF, Maternal mortality in sub- ning services in Dakar (Senegal), African Journal of Re- jóvenes que vivían en un hogar con un eleva- Saharan Africa: levels, causes and interventions, Annales productive Health, 1997, 1(2):15–25; and Madzouka J, La do nivel socioeconómico con sus pares de ho- de l’IFORD, 1988, 12(1):49–68; Dackam N, Mfoulou R and transmission des normes aux jeunes: quels modes gares de bajos recursos se verificó que los úl- Sala-Diakanda M, Population et Santé Familiale en Afrique, préférentiels? in: Union for African Population Studies timos eran 1,4 veces más proclives a ser London: International Planned Parenthood Federation, (UAPS), Femme, Famille et Population, Vol. 1. Communi- 1990; Akoto E, Déterminants Socio-Culturels de la Mortal- cations sollicitées, Dakar, Senegal: UAPS, 1991, pp. sexualmente activos y 1,3 veces más proclives ité des Enfants en Afrique Noire. 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Ilinimugabo A, Walla G and Azombo M, 1996, op. la probabilidad de involucrarse en conductas 1988; Ngoule D, Les infections VIH et les femmes au cit. (see reference 3). sexuales riesgosas. Cameroun: enquête sur les connaissances, attitudes, croy- 12. Twa-Twa JM, The role of the environment in the sex- Conclusiones: Los jóvenes de bajos recursos ances et pratiques dans les localités de Yaoundé et ual activity of school students in Tororo and Pallisa dis- Ebolowa, Yaoundé, Cameroon: CUSS, 1989; Houe- económicos y aquellos que viven en ambientes tricts of Uganda, Health Transition Review, 1997, houegbe A, Evina A and Rafalimanana H, Enquête sur familiares menos estables son más proclives que 7(Suppl):67–82. les connaissances, attitudes, pratiques et croyances re- otros jóvenes a observar conductas sexuales que latives au sida dans les provinces du sud-ouest et nord- 13. Caldwell JC et al., African families and AIDS: con- les exponen al riesgo de contraer el SIDA. Me- ouest Cameroun, Yaoundé, Cameroon: IFORD/German text, reactions and potential interventions, Health Tran- jorar las condiciones de vida de las familias, es- sition Review, 1993, 3(Suppl):1–16. Technical Corporation (GTZ)/MINISANTE, 1990; Louis pecialmente las de aquellas familias encabeza- JP et al., Comportements sexuels et risque d’infection à VIH: enquête (sur les connaissances, attitudes, croyances das por una mujer soltera, podría ayudar a et pratiques) en milieu scolaire à Yaoundé, Yaoundé, Resumen desalentar el contagio de esta enfermedad. Cameroon: OCEAC/Institut français de recherche sci- Contexto: Los aumentos de los niveles de co- entifique pour le développement en coopération nocimiento del problema del VIH y de infor- Résumé (ORSTOM)/Unité de lutte contre le sida (ULS), 1990; mación acerca de su transmisión y prevención, Contexte: L’augmentation du niveau de sen- Songue P, Etude anthropologique portant sur les con- naissances et comportements des prostituées et leurs son factores que no siempre están asociados con sibilisation au VIH et de connaissance quant clients en matière de sexualité et sida à Yaoundé, study la disminución de una conducta sexual de ries- à sa transmission et à sa prévention n’a pas tou- report, Family Health International/AIDSTECH/MIN- go entre los jóvenes de Camerún. Se necesita (continued on page 130)

Volume 26, Number 3, September 2000 123 Sexual Risk Behaviors Among Young People in Bamenda, Cameroon

Sexual Risk Behaviors Among... son principale de ces premiers rapports était membres d’un foyer comprenant deux parents (continued from page 123) une question de curiosité (53% des garçons et d’être sexuellement actifs, 2,8 fois plus sus- 42% des filles). Environ 37% des filles et 30% ceptibles d’avoir plusieurs partenaires, 1,7 fois jours été associée à une diminution des com- des garçons ont toutefois indiqué que leurs pre- plus susceptibles d’avoir eu des rapports de portements sexuels à risques parmi les jeunes miers rapports sexuels n’avaient pas été vo- passage durant l’année précédente et 1,1 fois Camerounais. Les facteurs associés à ces com- lontaires. Les facteurs les plus importants plus susceptibles de ne pas utiliser le préser- portements ne sont pas suffisamment docu- d’initiation sexuelle avant l’âge de 16 ans vatif. Le partage du foyer des grands-parents mentés. étaient l’origine ethnique du père, la scolari- avait généralement un effet protecteur, tandis Méthodes: Des données relatives aux carac- sation et l’instruction au niveau primaire ou que la vie avec un frère ou une sœur, seul ou téristiques socio-économiques et démogra- du premier cycle secondaire. La composition seule ou avec d’autres personnes accroissait phiques et aux comportements sexuels ont été de la famille et le niveau de vie du foyer se sont généralement la probabilité d’adoption de com- recueillies auprès de 671 jeunes résidents de avérés les facteurs le plus régulièrement asso- portements sexuels à risques. Bamenda, au Cameroun, en 1995. Les effets ciés aux comportements sexuels à risques. Par Conclusions: Les jeunes économiquement dé- de ces caractéristiques sur les rapports sexuels rapport aux jeunes vivant dans un foyer jouis- munis et ceux vivant dans des milieux moins précoces, avec plusieurs partenaires et de pas- sant d’un niveau de vie élevé, les plus pauvres stables sont plus susceptibles que les autres sage et la non-utilisation du préservatif ont étaient 1,4 fois plus susceptibles d’être sexuel- d’adopter des comportements sexuels leur fai- été analysés au moyen de techniques multi- lement actifs au moment de l’enquête et 1,3 fois sant courir le risque de contracter le sida. variées. plus susceptibles d’avoir eu des rapports L’amélioration des conditions de vie des fa- Résultats: L’âge moyen au moment des pre- sexuels de passage au cours de l’année précé- milles—celles dirigées par des femmes céliba- miers rapports sexuels était de 15,6 ans pour dente. Les jeunes vivant avec un seul parent taires, surtout—pourrait aider à ralentir la les garçons, et 15,8 ans pour les filles. La rai- étaient 1,6 fois plus susceptibles que ceux propagation de la maladie.

130 International Family Planning Perspectives