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Condom use and abstinence among unmarried young people in Zimbabwe: Which strategy, whose agenda?
The Population Council
2003

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Abstract
This paper compares the views about abstinence and condom use expressed by young people in Zimbabwe in focus-group discussions with the views underlying national policies and religious and traditional beliefs. Young people’s decisions to adopt one or the other of these risk-reduction strategies may not necessarily indicate genuine individual choices, but rather their deference to adults’ interests as they understand those interests. Policymakers and traditional and Christian leaders promote abstinence as the exclusive strategy for all young people, whereas nongovernmental organizations and the private sector promote condom use. Evidence from the focus-group discussions indicates that adolescents are aware of this conflict between choice of strategy and sometimes conceal their condom use in order not to disappoint adults. In some cases, their moral conflict gives young people limited choices about reproductive behavior. Clear and open policies regarding condom use and abstinence should be promoted as complementary alternatives. Moreover, adults should reconsider their moralizing concerning young people’s sexual activity and support real rather than limited choices with regard to adolescents’ reproductive health. In a country where the level of HIV prevalence among sexually active adults is one of highest in the world, and where a large proportion of HIV infections is believed to occur during adolescence, this message carries an urgency that can no longer be ignored.

In a country where an estimated one in three adults is living with HIV/AIDS (UNAIDS/WHO 2002) and where sexual intercourse frequently takes place between people of widely different ages (Gregson et al. 2002), young people in Zimbabwe are at great risk of acquiring HIV infection. Survey data suggest that a sizable minority of adolescents are sexually active by their late teenage years (CSO and Macro 2000; Marindo et al. 2002). Both sexes are at risk of HIV infection. Young women commonly engage in sex with older men, who, for a variety of reasons, may insist on unprotected sex (Chinake et al. 2002). Some young men have their first sexual encounter with sex workers, and condom use in such encounters often is unreliable (AIDSCAP 1998). Because of the high prevalence rate of HIV in Zimbabwe, any occurrence of sexual intercourse without the use of a condom places a person at risk of infection.

HIV sentinel-surveillance data from women aged 15–19 attending 19 antenatal clinics in 2001 show a prevalence of 20 percent, a decline from the rate of 28 percent recorded in 2000 (MOHCW 2001; Kububa et al. 2002). HIV prevalence rates among 15–19-year-olds in the general population are likely to be lower, however, than those indicated by clinic attendees in the same age groups.1 Further evidence of sexually transmitted infections among young people in Harare (City Health Department 2001) indicate that some young people are sexually active at least as early as age 13.

Under such hazardous conditions, understanding the strategies that adolescents use to try to avoid acquiring HIV infection is imperative for successful implementation of effective HIV-prevention policies. An appreciation of their social environment is critical for providing a better understanding of how much real control young people have over their own decisionmaking. This paper focuses on the two main strategies promoted for HIV prevention among young people in Zimbabwe: condom use and abstinence.

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