Impact Data - Study to Improve the Health-seeking Behaviour of In-school Adolescents

Results indicated an increase in adolescent knowledge of STI symptoms.

With regard to the sexual experience of young people, the baseline survey revealed that 66% of males and 63% of female adolescents have had sexual intercourse. The mean age at first sexual intercourse was 14.6 years for males and 16.1 years for female adolescents. With regard to the number of lifetime sex partners: 9.8% of males and 22.7% of female adolescents reported having had only one sex partner in their lifetime. 28.7% of males and 11.8% of female adolescents reported having had two or more sex partners in their lifetime. With regard to the number of sex partners in the past 3 months: 18.8% of males and 25.9% of female adolescents reported having had only one sex partner 3 months before the survey. 11.7% of males and 4.7% of female adolescents reported having had 2 or more sex partners 3 months before the survey. With regard to methods used by adolescents to prevent STIs: 29% of the adolescents were unaware that sex while experiencing STI symptoms could spread the infection. While the survey could not assess changes in these long-term trends it did register an increase in the incidence of condom usage by females, but not by males.

Youth attitudes towards public clinics were generally not very positive. Youth gave the following reasons for not using public clinics: 58% cited the high cost of treatment in public clinics 58%, 46% cited a lack of privacy in the clinic, 42% said they were made to feel guilty, and 14% cited long waiting times. 8% also believed that the treatment they received in such clinics was not effective.

The results of the survey revealed that the intervention increased the likelihood that adolescents will report STIs to their sex partners.

Factors affecting care seeking for STIs - results of focus group discussions:

• Confidentiality: Adolescents reported that they prefer traditional healers and private practitioners because they are more likely to guarantee confidentiality of information as compared to public institutions.
• Cost of treatment: Cost of treatment was an important issue in deciding adolescents' use of services for STIs. Adolescents reported that treatment offered by patent medicine dealers and traditional healers were cheaper than those provided in public and private hospitals.
• Attitudes of providers: Adolescents reported that they feel ridiculed and intimidated by the doctors and nurses in both private and public clinics. By contrast, patent medicine dealers and traditional healers were friendlier towards them.
• Accessibility: Adolescents perceived that patent medicine dealers are more accessible to them than doctors and nurses in private and public institutions.
• Perceptions relating to treatment efficacy: Adolescents in the focus group discussions held the view that refractory STIs were better treated with traditional remedies.
• Ignorance: Some participants in the focus group discussions viewed ignorance as an important reason that adolescents use traditional healers for STI treatment.

The study offers the following conclusions:

1. There is a need to include sexuality and reproductive health education into schools' curricula, both formally and informally
2. Reproductive health clubs and peer education are effective methods for promoting adolescents' knowledge and increasing their rationale use of STI prevention and treatment methods. There is a need to institutionalise these forms of interventions in schools.
3. There is a need to integrate adolescent-friendly approaches into health service delivery in the state. In particular, health providers (including both formal and informal service providers) need to be retrained on the special problems of adolescents and methods of meeting their specific needs.
4. Specifically, there is a need to test the effectiveness of properly managed stand-alone adolescent health clinics in meeting adolescents service delivery needs. To reduce any possible stigmatisation, such a clinic should have facilities for sporting and related youth development activities, including guidance and career counseling.