Oral communication: a gateway to understanding adolescents' sexual risk behaviour

Abstract

Sub-Saharan Africa is predominantly an oral society. Oral communication tools such as songs, proverbs and metaphorical sayings are used to inform and educate people. These communication tools are not usually seen as methods for data collection, more especially in HIV and AIDS research. Oral communication tools are important in the context of Botswana because they produce a descriptive and analytical basis for understanding adolescents' behaviour and sexual worldview. To develop culturally and developmentally appropriate interventions to dissuade adolescents from engaging in sexual risk behaviour, metaphorical language, proverbs and songs were used to solicit data. The paper highlights sexual risk behaviours among adolescents who emanated from using the above methods. Lastly, the importance of mainstreaming culture in the research process to ensure representation of the voices of adolescents and parents in managing HIV and AIDS is emphasised.

Keywords::

• adolescents
• oral communication
• HIV and AIDS
• risk behaviours
• culture
• Botswana

Introduction

Adolescence is a period of physical, biological, emotional and social maturation and transition. An adolescent in Botswana is defined as a person aged 10–19 years (Ministry of Health, 2003). This period is often characterised by the clarification of sexual values and experimentation with sexual behaviours (Kabiru & Ezeh, 2007; Konde-Lule et al., 1997). Decisions taken at this stage can impact positively and negatively on a person's life opportunities, behavioural patterns and health (Lakshmi, Gupta, & Kumar, 2007). On the positive side, peer pressure among teenagers can enhance positive lifestyle choices such as abstinence, condom use and faithfulness. Peer pressure among adolescents often acts within the context of social and cultural influences that encourage sexual risk behaviours (Sutherland & Shepherd, 2001). For example, in some communities in sub-Saharan Africa, social norms often condone or even predispose young people to engage in sexual activity by encouraging early childbearing and male promiscuity and failing to condemn sexual relationships between older men and younger girls (Chilisa, 2006; Chilisa & Preece, 2005; Ntseane & Preece, 2005; Swart-Kruger & Richter, 1997). For example, among the Kalanga ethnic group in Botswana, it is acceptable for a new husband to ask for sexual favours from a younger female sibling of his wife, a practice referred to as nkadzana (Ntseane & Preece, 2005). Among the Bangwato ethnic group in Botswana, mantsala (playful sex) prepares girls to expect requests for sexual favours from blood male cousins, and uncles (Ntseane, 2004). However, the experiences within the two ethnic groups cannot be generalised to all the people because there is a great deal of intermarriage among different cultural groups.

A survey conducted in Kenya, Ghana, Botswana and Liberia in the early 1990s among unmarried females and males aged 15–17 years showed that the percentage of the sexually active was as high as 64%. The results of the study further indicated that 48.6% of males and 38.9% of females aged 15 had experienced sexual debut and by the time they reached 17 years the number of people engaged in sex increased to 74% (Gage-Brandon & Meekers, 1993). In Botswana, 37% of the total population is below the age of 15 years and only 5% are aged 65 years and above (Government of Botswana, 2001); therefore, it is very important to focus on adolescents' health because they are the future adults of the country. Botswana AIDS Impact Survey II (BAIS II) has shown that 55% of the participants had their first sexual experience between 15 and 19 years of age (National AIDS Coordinating Agency [NACA], 2004). BAIS is a national population-based household sexual behavioural survey implemented at a national level to monitor trends in the HIV epidemic. The findings on age at first sexual intercourse compare well with those of other studies. About half of the Batswana youth are sexually active before their 18th birthday and are thus exposed to the risks of HIV infection (Chilisa & Preece, 2005). The 2005 Botswana Global School-Based Health Survey comprising 2197 students aged between 13 and 15 years reported that 17.4% had experienced sexual intercourse (Chilisa, 2005). Early coital debut is said to be a significant independent predictor of HIV infection prevalence (Pettifor, Van der Starten, Dunbar, Shiboski, & Padian, 2004).

In Botswana one of the major influences on sexual behaviour is the society's perception of sex (Ntseane & Preece, 2005). According to the authors, in Botswana sex is perceived as a tool for reproduction, for healing and cleansing, and as a conjugal right which is recognised by law and religion. It also enhances social interaction and it may be used to control and oppress others. The belief that sex is healing often leads to intergenerational sex in which older men have sex with young girls hoping to cure HIV, and exposing the girls to the risks of HIV infection (Ntseane, 2004). On the other hand some people may forcefully engage in sexual intercourse with others to control and oppress them. Due to the vulnerability of young people to HIV infection, the Botswana National Strategic Framework on HIV and AIDS has identified youth and children as a deserving population that needs priority attention with regard to HIV infection. For this reason it is imperative to develop culturally appropriate and effective interventions to prevent HIV transmission among adolescents. This involves consideration of cultural context across multiple dimensions of the intervention, such as language, metaphors and concepts (Bernal, Bonilla, & Bellido, 1995).

Adolescents as a social group have their own social norms and values that govern their sexual behaviours (Kabiru & Ezeh, 2007; Lakshmi et al., 2007). Culture is very important because it is also gendered. For example, understanding of sexual matters and sexual relationships differs from males to females (Maundeni, 2003). In addition, the language that is used as well as the understanding differs according to age (Maundeni, 2003). Adolescents and teenagers have their own language and modes of communication, hence it is important to understand their unique culture in order to formulate culturally sensitive interventions (Hutchinson et al., 2000).

Studies by Chilisa (2006) and Chilisa, Dube-Shomanah, Tsheko and Bontshetse (2005) investigated sexual risk behaviour and HIV and AIDS related issues among adolescents in Botswana. Chilisa et al. (2005) found that peer norms and behaviours also influence the timing of sexual initiation and condom use, whereas Chilisa (2006) indicated that school dropouts in junior secondary schools rose among adolescents aged 14–17 as a result of pregnancy. The 2004 BAIS II presented HIV prevalence results for the ages 18 months to 75 years, for both men and women, showing infection rates of 3.9% for the 10–14-year-age group, 6.6% for the 15–19-year-age group and 19% for the 20–24-year-age group (NACA 2004). The survey also showed that for every HIV positive boy in the 15–19-year-age group, there were three HIV positive girls. Behaviours indicative of risky sexual practices among adolescents in Botswana are multiple partnering, lack of condom use, early sexual debut, teenage pregnancy, forced sex and rape (Gallant & Maticka-Tyndale, 2004).

None of the prior studies has gone to the extent of undertaking culturally sensitive approaches in the adolescents' own context. The study that this paper is derived from uses proverbs, metaphorical sayings and songs to assist in data collection. They are very helpful in data collection because they inform and educate people and store information (Chilisa & Preece, 2005). They produce a descriptive and analytical basis for understanding adolescents' behaviour and sexual worldview.

Theoretical framework

This article draws on the theory of planned behaviour (TPB). According to TPB, human behaviour is guided by three considerations – behavioural beliefs, normative beliefs and control beliefs. The behavioural beliefs produce a favourable or unfavourable attitude towards the behaviour, normative beliefs result in subjective norms and control beliefs gives rise to perceived behavioural control. Jemmott, Jemmott and Hutchinson (2001) also state that intentions are determined through the internal psychological process of integrating behavioural beliefs about the consequences of the behaviour (attitude), normative beliefs referring to the perceived social pressures to perform or not to perform a behaviour (subjective norms), and control beliefs about how difficult or easy performing the behaviour would be.

The TPB operates on the premise that the best way to predict behaviour is to measure behavioural intention, which in turn is seen to be a function of three independent variables: attitude, subjective norm and perceived behavioural control (Ajzen, 1985). These lead to the formation of a behavioural intention. As a general rule, if the attitude and subjective norm are more favourable to the person concerned or society as a whole, the perceived control will be greater, and the person's intention to perform the behaviour in question should be stronger.

Behavioural beliefs are influenced by prevention beliefs, hedonistic beliefs and partner reaction beliefs (Jemmott et al., 2001). These are beliefs about the consequences of engaging in the behaviour. Normative beliefs reflect individuals' views of whether significant people in their lives would approve or disapprove of the behaviour (Ajzen & Fishbein, 1980). Significant people include peers, parents and other family members. Lastly, control beliefs have to do with the perceived presence of factors that may facilitate or impede performance of behaviour. These also refer to individuals' beliefs that they possess the necessary resources, skills and opportunities to perform behaviour. This includes judgements about whether or not they have the capabilities to perform the desired behaviour (Madden, Ellen & Azjen, 1992), for example sex behaviour and status among peers.

Methods

Procedures

This article draws information from an exploratory, qualitative study which focused on investigating sexual and health risk behaviours among adolescents. An exploratory design was used because researchers were exploring a new area which helps them to better understand issues (Babbie, 2004; Rubin & Babbie, 2001). Grinnell and Williams (1990) also argued that these designs are utilised in order to build a foundation of general ideas and tentative theory which can be explored more rigorously at a later date. In order to make the process culturally sensitive, proverbs, songs and metaphorical sayings were used to collect data in all the focus group discussions (FGDs). FGDs are effective in eliciting data on the cultural norms of a group and in generating broad overviews of issues of concern to cultural groups represented (Denzin & Lincoln, 2000). Focus groups allowed researchers to gather and understand adolescents' ideas and beliefs about sex, sexuality, HIV, AIDS and sexually transmitted infections from their own perspective (Hutchinson and Wood, 2007). The focus group guides for both parents and students contained questions about the participants' knowledge of adolescents' lifestyle, behavioural, normative and control beliefs regarding sexual behaviour (condom use, abstinence, multiple partners and cultural beliefs).

The Institutional Review Board for the Ministry of Health and the Ministry of Education approved all the protocols. Participant groups were then selected through multi-stage sampling. The first stage entailed selecting districts through purposive sampling from which schools were selected. Three areas (urban, semi-urban and rural) were selected because of accessibility and close monitoring. A total of two junior secondary schools per district were purposively selected considering the geographical location as one of the guiding factors, resulting in six schools overall.

Participants

After informing the principals of the schools about the study, a guidance and counselling teacher was identified in each school to serve as the research liaison. The teacher assisted in the recruitment of participants and in the scheduling of focus group interview sessions. Convenience sampling was used to recruit students. That is, students' selection was based on their ability to articulate issues relating to HIV and AIDS as well as diverse backgrounds and lifestyles. In addition, inclusion and exclusion criteria were age related – 14 and 17 years and class level – forms 1 to 3.

The teacher initially contacted the students to ascertain their interest in participating in the study. The students who wished to participate were asked to take assent forms to their parents so that they could grant them permission to do so. Only students who had expressed interest in participation, met the inclusion criteria and had their parents' consent were scheduled to participate. Students also had to sign a consent form to indicate their personal interest in participating in the focus group sessions before the onset of the interviews. In each school, there were three student FGDs (one female only, one male only and a mixed group). Each focus group had 12 participants equitably distributed along the three form tiers and by gender (for mixed groups), resulting in 216 students participating in the FGDs.

To recruit parents, the teacher-liaisons contacted members of the Parent Teacher Associations (PTA) and informed them about the study. In addition, students who indicated that their parents were interested in participating were given letters that invited their parents to come to school on a particular date for focus group interviews. The PTA members and other parents interested in the study signed consent forms before taking part in the FGDS. One parents' FGD (mixed) was conducted in each school. Each focus group had 12 participants in which females dominated. Parent and student FGDs were conducted on different dates in private settings. Each focus group took one and half to two hours. Measures were taken to ensure participants' confidentiality.

Data analysis

The data were analysed using a thematic approach. Thematic analysis focuses on identifiable themes and patterns of living and/or behaviour. The data from the different groups were combined, and the meaning was captured. From the transcribed conversations, patterns of experience were listed. This came from direct quotes and paraphrasing common ideas (Spradley, 1979).

Transcribed conversations and stories were carefully read to identify the metaphorical sayings and language that described the sexual worldview of adolescents related to their intention to engage in sexual relationships, abstinence, condom use and have multiple partners. The most recurrent expressions, sayings and rhetorical language were examined for the patterns and themes that were communicated. All proverbs and metaphorical sayings mentioned were listed. Salient themes emerged when the transcripts were reviewed. The focus group scripts were then organised for discussion using the TPB (Hutchinson et al., 2000; Hutchinson and Wood, 2007).

Results

Behavioural, normative and control beliefs were identified among the songs, proverbs, stories and metaphorical sayings that were mentioned in the FGDs.

Behavioural beliefs

Students conveyed messages through proverbs and songs which indicated the perceived costs and benefits of abstaining from, and engaging in, sexual relationships. Behavioural beliefs regarding condom use that emerged during the FGDs were hedonistic beliefs that sex would not be pleasurable if a condom is used. Some of the responses that emerged during data collection around male condom use showed hedonistic beliefs such as:

‘A sweet is not supposed to be eaten while it is wrapped.’ (16-year-old male student)

Adolescents also mentioned fears about condom use. One female said:

‘It encourages promiscuity. It can also burn during sexual intercourse.’

Responses also revealed that adolescents are aware of the effectiveness of condom use. For instance:

‘It prevents unplanned and unwanted pregnancies and also prevents sexually transmitted diseases.’

Adolescents reported that messages from music, magazines, television and videos emphasised that sex is good and pleasurable. The discussions revealed that songs influence adolescents' sexual behaviours. Some students said that western popular music that they listen to influenced their sexual behaviour. For example, one 15-year-old female student said that when she listens to love songs the message that she gets is that ‘being in a love relationship is good.’

The adolescents reported that even though they are discouraged from engaging in sexual relationships by elders, their peers give them conflicting messages about sex. One male adolescent commented:

‘In men, there is something called erection and it is painful, so one has to have sex in order to overcome it.’

The boys indicated that they engage in sexual intercourse to avoid painful erection. Female adolescents also reported that it is bad to abstain because they will suffer from ‘virgin disease’, which is associated with girls' failure to have sexual intercourse.

Normative beliefs

When adolescents were asked whose opinions they consider when making decisions they mentioned their peers, parents, teachers and the community.

For example, an old song which goes as ‘setlogolo ntsha ditlhogo’ was cited in the FGDs by adolescents. Ditlhogo is a euphemistic expression used by adults to request for sexual favours from young girls (although in the folksong ditlhogo is restricted to a special sexual relationship between a girl and her maternal uncle). Parents agreed with the adolescents that such songs encourage adults to sexually abuse adolescents.

Other students indicated that some cultural beliefs encourage cousins to have sexual relationships. As an example, they quoted the Setswana saying ‘go ntsha mantsala’, which means to have sexual intercourse with a cousin.

When adolescents were asked who would approve of them using condoms, they had conflicting responses, as indicated below.

One female said:

‘No one approves the use of condoms by adolescents because none of them is expected to condomise but rather encouraged to abstain from sexual activities.’

Another commented:

‘Some adolescents have experienced sex before so they cannot handle or control themselves, so they have to use condoms.’

Adolescents identified peer pressure as the main factor in their decision to have sex. They reported that they have sex to be accepted in their social groups. Females reported that they are mocked or teased about being a virgin.

Control beliefs

Several control beliefs were mentioned by adolescents. These included negotiating beliefs (engaging in sexual intercourse and condom use), technical beliefs (using condoms appropriately) and availability beliefs (accessibility and availability of condoms). Male adolescents reported that they were worried about their ability to use condoms correctly. Some of the male respondents reported that a condom can burst during intercourse and release sperms.

Both female and male respondents reported that they heard stories that male condoms have worms, bad odour, irritate and are greasy and that if they were used both male and female partners may develop rashes on their private parts. A 14-year-old female respondent said:

‘I heard that condom makes people to get AIDS.’

The respondents admitted that some of these stories have the potential to discourage adolescents from using condoms. Most of the respondents indicated that boys usually use stories to convince girls not to use condoms. For example one 16-year-old female respondent said:

‘Boys in school always tell us that a condom can remain in the girls' private parts after sexual intercourse.’

Another important control belief mentioned in the FGDs related to negotiation surrounding the use of condoms during sexual activity. Female adolescents reported that coerced sex with peers and older male sexual partners was very common. This was also reinforced by male adolescents and parents. The following proverb emerged consistently from the following discussions:

‘Ga di nke di etelelwa pele ke manamagadi’ ‘They (herds of cattle) are never led by females.’

Adolescent boys invoked this proverb to justify why a boy should initiate a ‘love’ relationship and make decisions on when to have sex, how and whether condoms may be used.

In addition, adolescents and parents indicated that popular sayings among adolescents include those who encourage them to have sexual intercourse with older people. For example, one parent expressed the opinion that nowadays adolescent boys and girls engage in sexual relationships with older people and when parents try to discourage them, they quote proverbs that reinforce their behaviour such as the one below:

‘Mokodua o monate ka fa sebeting’ ‘An old cow or bull has a delicious liver.’

This saying indicates that adolescents may condone relationships with older people and this further justifies their sexual behaviour. Adolescent girls described relationships with older people as those in which they have no power to negotiate condom use. However, the FGDs also revealed that this trend of having sexual relationships with older partners is also growing among the boys.

Control beliefs that were identified were also subject to culture-specific influences. For example, in the FGDs, both students and parents reported that there are Setswana language proverbs and expressions that encourage males to be promiscuous and have multiple partners. This was emphasised by a 17-year-old boy in one of the focus groups who said:

‘Our culture influences men and boys to be promiscuous through proverbs because they encourage them to have multiple partners; for example Monna selepe o a adimanwa, means that as a boy I am not entitled to only one girl.’

Adolescents also related stories of the people they know who have more than one sexual partner. Such people include their peers, friends, family members and people from the community. Female adolescents were of the view that having more than one partner is more secure because one has someone to hold on to should one of the relationships fail.

A 15–year-old female student from a girls' focus group said:

‘If you have one partner when your partner hurts your feelings, there will be no one to turn to. You can't eat only one thing every day – you have to taste all kinds.’

Adolescents also raised concerns that having one partner may not allow them access to the material goods they desire.

Discussion

The qualitative methods used in this study reveal some sexual behaviours (condom use and multiple partners) that adolescents engage in. The methods used also reveal that adolescents receive mixed messages about sexual behaviours. The messages from proverbs, metaphorical sayings, songs and stories communicated by their peers have a potential to encourage sexually risky behaviours although parents discourage such sexual behaviours.

Adolescents have created a culture of their own in which they want to be accepted by their peers and have a feeling of belonging. Even though that is the case, they still feel that they are being pressured by their peers to have sex. Stories have also been coined around the issue of abstinence. For example, students reported that other students in school, especially boys, tell them that if adolescents stay virgins for a long time, by the time they have sexual intercourse it will be painful which will lead to a very good orgasm resulting in death. This story discourages others from abstaining.

Control beliefs

A type of control belief identified is similar to the negotiation belief identified by Hutchinson and Wood (2007) in their study with Jamaican adolescents. The belief is that adolescents will be able to persuade their partners to abstain from sexual activities. It was also evident in the study conducted by Chilisa (2006) that male adolescents construct local narratives on sex to their advantage. For example, female adolescents encountered proverbs that are used to legitimise male power and dominance suggesting that girls cannot have a say on whether they want to abstain or use condoms.

Moreover, adolescent girls highlighted their struggle in dealing with intergenerational sex. The issue of adult uncles and cousins having sexual intercourse with their younger relatives has been explained by Ntseane (2004). This was highlighted in the findings as adolescent girls elaborated on how their maternal uncles expect sexual favours from them. This finding is in line with what was found by Ntseane (2004) in which she describes mantsala as part of the Bangwato ethnic group whose male members expected sexual favours from female cousins. These foster the beliefs that it is alright to have a relationship with someone much older. This is supported by BAIS II (NACA, 2004) and UNICEF (2009) studies that show that girls are more likely than boys to have sexual intercourse with older partners. Ntseane (2004) also argues that the family and societal structures have an influence on how adolescent girls relate to their cousins and uncles. This she argues is seen as a way to provide experience required for a good marriage. Ntseane saw this as sex for social interaction. The adolescents, however, see it as a means of control and oppression.

In addition, findings revealed the inability of adolescents to negotiate abstinence, and condom use with their older partners. Such relationships with older partners and other coercive affairs (in the name of culture) are common in Botswana as is indicated by studies done by Ntseane (2004), NACA (2004) and UNICEF (2009). They engage in these relationships for financial and material gain. This behaviour is common among girls having sexual relationships with older men (sugar daddies).

The belief brought about by proverbs, songs and metaphoriacal sayings that one should have multiple partners to strengthen manhood and for one to be secure (should one of the relationships fail) is indeed a dangerous position for adolescents to adopt. Such beliefs influence adolescents' sexual behaviour and shape societal views towards promiscuity. Promiscuous behaviour is reported to be common in communities, and is blamed for fuelling the spread of HIV/AIDS (Ntshebe, Pitso, & Segobye, 2006).

Behavioural beliefs

The results indicate that adolescents call a condom by slang names such as ‘sweets’, ‘CD’ and also create myths about male and female condoms, which discourage condom use. A similar finding was revealed by Chilisa et al. (2005) that girls felt obliged to engage in unprotected sex to prove their love when the partners insisted on unprotected sexual intercourse. The findings of the study tend to underscore the National Strategic Plan for Scaling up HIV prevention in Botswana (2000–2010) to delay sexual debut among adolescents by one year from 18 to 19years. The results also show that Botswana still has a long way to go to achieve the above because adolescents are exposed to sexual intercourse at a younger age.

Kabiru and Ezeh (2007) found out that choosing to be sexually abstinent may be a challenge facing adolescents due to their widespread exposure to sexually explicit material. These materials can include the information they get within their community through proverbs and songs. Old and new songs were identified in the findings as possible influences on adolescents' sexual behaviours and that some of the songs encourage adolescents to engage in risky sexual behaviours. It was also evident in Chilisa (2006) that life-skills education in schools is negated by the myths adolescents learn from peers, parents and in the community, which justify their risky sexual behaviours.

Findings indicate that adolescents' concerns over abstaining from sexual activities include suffering from a painful erection and ‘virgin disease’. Some of the distress mentioned is related to one wanting to be accepted into the peer-social network and to sustain relationships with the opposite sex. Peer pressure has been identified in other studies as very influential in determining adolescents' intentions to engage in sexual intercourse. In Nigeria peers were identified as perpetrators of sexual coercion among adolescents (Ajuwon, Akin-Jimoh, Olley, & Akintola, 2001).

Normative beliefs

The perceptions of adolescents about condoms are an important normative belief that reflects the individuals' views of whether significant people in their lives would approve or disapprove of the behaviour and their motivation to comply with these expectations (Ajzen & Fishbein, 1980). The metaphorical sayings and myths are examples of a normative belief, and these send the message to adolescents that the community does not approve of condom use during sexual intercourse.

Despite the negative perception and myths surrounding condom use, the BIAS II (2004) study reported a high rate (93%) of condom use in the 15–19-age group compared with 49% in the 25–49-year-olds. Negative perceptions on the use of condoms among adolescents in Botswana may, if not addressed, deter adolescents from using condoms (Meekers et al., 2001). In addition, folk songs in the community like the one mentioned in the findings reinforce the normative belief that makes adolescents powerless to refuse to have sex with older people because they believe that the community gives approval.

Even though parents discourage adolescents' risky sexual behaviours, findings indicate that they do not discuss with them issues of sex and sexuality in detail. This, therefore, undermines efforts to address HIV and AIDS risk behaviours. The results indicate that adolescents tend to listen more to, and practice, what their peers say or do. Therefore, in order to develop measures that are culturally sensitive to adolescents, there is a need to use adolescents in developing and disseminating such messages.

Limitations of the study and areas for future research

The study does not represent the views of all the school-going adolescents in Botswana. It only covered adolescents around the city. For future research, there is need for a national study to represent adolescents across the diverse culture and socio-economic backgrounds in the country. Because the teachers assisted in the selection of the sample, there is a possibility of bias in terms of adolescents selected to be part of the study.

Conclusion

The paper drew from the TPB and demonstrated that adolescents are influenced by behavioural, normative and control beliefs to enagage in risky sexual behaviours. Through this model, multiple potential influences of HIV related sexual risk behaviours that exist with adolescents' proximal and distal environments were identified. Also, there were myths that were identified that adolescents adhere to. Such myths include having multiple partners to strengthen manhood, and suffering from virgin disease and painful erection due to lack of sexual intercourse. From the findings of the study, one can conclude the following.

Adolescents' sexual behaviour in contemporary Botswana is still highly influenced by traditional and cultural ways of communication. For example, oral communication tools such as proverbs and metaphorical language can contribute negatively or positively towards adolescents' sexual health. The negative factors include proverbs and metaphorical language as drivers of adolescents increased vulnerability to HIV and oral communication as a significant factor in influencing adolescents' early sexual debut. From a positive point of view, oral communication tools can be used as educational materials to help adolescents learn how the misinterpretation of cultural communication can expose them to risky sexual behaviours.

Moreover, the study concludes that peer pressure is still one of the primary drivers of risky sexual behaviours and it cannot be divorced from HIV and AIDS education for adolescents. Stigmatisation and discrimination as a result of one's sexual status are also evident among adolescents. Peers who have not lost their virginity and those who abstain from sexual activities are given outrageous labels.

Recommendations

On the basis of the findings and conclusions stated above, the following are some of the key issues that need to be considered in addressing adolescents' sexual and reproductive health issues.

First, the Ministry of Education needs to strengthen parent–child communication by introducing extra curriculum programmes for parents and children in schools and communities. Village development committees should play a major role in establishing programmes to enhance communication between parents and children at community level. This will help children to become free to communicate with their parents about sexual and reproductive health issues.

Second, the Ministry of Education should strengthen sexual and reproductive health subjects at primary and junior secondary school levels to ensure that they include curriculum on the role of oral/traditional ways of communication in behaviour modification and how they contribute to risky sexual behaviours.

Third, there is need for interventions that target adolescents as a response to the multiple system level factors that influence adolescents' sexual risk behaviours. The government of Botswana should establish adolescents friendly health centres in the communities so that they can freely access relevant and adequate information about sexual and reproductive health issues. This study revealed that adolescents are influenced by age disparate relationships and gender power relationships. Therefore, HIV risk reduction interventions and programmes should address myths regarding virgin disease and ensure that adolescents are empowered with negotiation skills to enhance intentions to use condoms and to abstain from sexual activities.

Fourth, there is a need for further research on how oral communication tools can be used positively for prevention of risky sexual behaviours. Research is also required to investigate adolescent sexualities in schools, with specific focus on their communication styles and the meaning attached to sexual relationships. For example, there is need for further exploration on what virginity and abstenience means to adolescents in Botswana.

Acknowledgements

The authors acknowledge support from the University of Pennsylvania and University of Botswana Capacity building for HIV/STD Prevention Research on Batswana Adolescents aged 14–17 years, which was funded by National Institute of Health Sciences (NIH). The authors are also beholden to Prof. B. Chilisa at the University of Botswana who provided support during the research study.

Additional information

Notes on contributors

Poloko N. Ntshwarang

Poloko N. Ntshwarang, MSW, is a lecturer in the Social Work Department at the University of Botswana. Her research interests are child welfare, gender issues, behavioural health, as well as life skills.

Tumani Malinga–Musamba

Tumani Malinga–Musamba, MSW, is a lecturer in the Social Work Department at the University of Botswana. Her research interests are HIV and AIDS; adolescents; social work in health services; mental health; social reasearch and life skills.