Institutionen för folkhälsovetenskap / Department of Public Health Sciences
Abstract
Aim: To describe and analyse young Zambian men's sexuality and
implications for sexually transmitted infections (STIs) including
HIV/AIDS in Chiawa rural community and Lusaka urban compound of Misisi.
Methods: Over a period of eight years, 402 men between 16 and 26 years
old have participated in the studies; 205 from Chiawa and 197 from
Misisi. Random and purposive sampling techniques were used to select the
men. Fifty-nine traditional healers were also included in the study.
Twenty-three of the traditional healers came from Chiawa and 36 from
Misisi. Thirty-seven women in Misisi were included in one of the studies.
Data was collected using semi-structured questionnaires, focus group
discussions, in-depth interviews, and observations. The questionnaires
were administered to the young men twice in Chiawa in 1993 (n=98) and
2001 (it= 79); and once in Misisi in 2001(n=153).
Results: The mean age of the young men was 21 in Chiawa and 20 in Misisi.
The majority of the men were not married. Almost all the men in Chiawa
and Misisi had attended formal schooling. In 1993, and 2001, 39% and 44%,
respectively, were formally employed in Chiawa and only 14% were employed
in Misisi.
A real man was considered to be one who was married, had children, had a
decent job, cared for the family, and could sexually satisfy his wife. In
Chiawa, 97% and in Misisi 76% of them considered themselves to be real
men. Four children were considered to be the ideal number during one's
life time due to economic hardships.
Forty-three percent and 25% of the men had current pre- or extra sexual
marital relationships in 1993 and 2001, respectively. In Misisi, 40% had
current pre-or extra marital relationships. Qualitative data revealed
that the main reason for these relationships was the need to prove that
they were real men. In Chiawa, one-fourth of the men in the two surveys
said they had suffered from an STI in the past and most of those in the
second survey had sought treatment from the local health facility. In
Misisi, 26% had suffered from an STI and many of them had gone to the
private clinics for treatment. Majority (91%) of the men in Chiawa,
compared with less than half in Misisi (4 1 %) said they considered
themselves to be at risk of contracting HIV infection. In Chiawa, they
considered themseIves to be at risk because of what they believed to be
their inability as men to control sexual desires; their lack of trust in
the sexual partner; and, unreliability of the condom. In 1993, only six
percent said they used a condom all the time they had sex whilst 27% said
so during the 2001 survey. In Misisi, 19% said they used condoms all the
time. Qualitative data showed that there were misconceptions surrounding
the use of condoms. In Chiawa, the healers reported using up to 19
different species of medicinal plants to treat STIs. Both in Chiawa and
Misisi, the healers were treating impotency and infertility.
Conclusions: Male sexuality is given prominence mainly because of its
role in fertility. Multiple sexual relationships, misconceptions
regarding HIV/AIDS, lack of adequate information, and ambiguities about
and inconsistent use of condoms, all combine to pose major challenges on
the fight against AIDS. The data from Chiawa indicates that sexual
behaviour could be changing. The young men in Chiawa are more
self-asserting. In Misisi the men's confidence is undermined by
unemployment and other social difficulties characteristic of poor urban
settlements. In designing interventions to target men's sexual health, we
must consider their expressed concerns. Notions about real man that
encourage risky behaviours must be targeted. Information, education and
communication remain the most effective strategies. The young men's
economic plight must also be addressed