International article
Reproductive health risk and protective factors among youth in Lusaka, Zambia

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Abstract

Purpose: To: (a) identify risk and protective factors for behaviors that expose Zambian youth to risk of HIV infection and, (b) assess whether research findings from the United States concerning protective factors in “high-risk” environments might apply to other settings.

Methods: A community-based sample of 2328 youth ages 10–24 years residing in Lusaka, Zambia was interviewed. Multivariate statistical methods were used to isolate risk and protective factors for selected sexual and contraceptive behaviors. Seven categories of factors were considered: sociodemographic factors, sexual-reproductive health knowledge and perceptions, nonsexual risk behaviors, peer influence, connections with parents and social institutions, and communication with sexual partners.

Results: A sizeable number of factors were associated with each outcome. Only two factors, school attendance and knowledge of AIDS, were associated with both lower levels of sexual activity and consistent use of condoms, and only engaging in higher-risk social activities with close friends was a risk factor for both. The effects of the other factors considered varied by outcome and gender. As in prior research, strong influences of peers were observed, but connections with parents and social institutions unexpectedly did not emerge as protective.

Conclusion: Because of the number and diverse nature of factors influencing adolescent behaviors, it is unlikely that a single intervention will be found to immediately change sexual risk-taking behaviors in Zambia.

Section snippets

Setting

The setting for the study is Lusaka, the capital city of Zambia. Located in southern Africa, Zambia is a landlocked country covering an area of approximately 753,000 square kilometers. The 1998 population was estimated at just under 10 million persons [4]. Approximately 45% of the country’s population resides in urban areas, primarily in the mining areas of the Copperbelt province and Lusaka [4]. Forty-five percent of Zambia’s population is under age 15 years, and persons ages 10–24 years (the

Results

The mean age of both male and female respondents was 17.9 years. Just under one half (46%) of respondents were currently in school (54% of males and 40% of females), including 86% of 10–14 year-olds and 52% of 15–19 year olds. Most respondents (84%) were single/never married, with marriage being more common among females (22%) than males (7%). Just over one-third of respondents reported living with both of their biological parents, another 11% reporting living with one or the other of their

Discussion

The findings of the present study are consistent with prior research in indicating that sexual and reproductive health-related behaviors of youth in Lusaka are influenced in important ways by a myriad of factors. Some of these are characteristics of adolescents themselves, while others are characteristics of the environment in which they are embedded. This poses a significant challenge for HIV/AIDS prevention efforts. Because of the sizeable number and diverse nature of factors influencing

Limitations

Several limitations of the study should be noted. First, the study was based on self-reports of behaviors, and the data are thus subject to reporting errors/bias. Secondly, it is possible that using personal interviews to gather the data as opposed to self-administered questionnaires may have further contributed to reporting error. Thirdly, because the data are cross-sectional in nature, in some cases the direction of causal relationships between variables cannot be determined. Prospective

Acknowledgements

This research was supported by field support funds from the U.S. Agency for International Development/Africa Bureau provided to the FOCUS on Young Adults Program/Pathfinder International under Cooperative Agreement No. CCP-A-00-96-90002-00.

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