"The Young Ones Are the Condom Generation": Condom Use Amongst Out-of-School Adolescents in Rural Southwest Uganda

Article excerpt

It has long been recognized that adolescents are a group with a particular set of associated risk factors, as has been characterized in many epidemiological studies (Dowsett & Aggleton, 1999; Grunseit, 1997; Hein, Dell, Futterman, Rotheram-Borus, & Shaffer, 1995; Joint United Nations Program, 1997, 1998; Ndyanabangi, Kabagambe, Georgen, & Diesfeld, 1996; Ross, Dick, & Ferguson, 2006; Ross, Wight, Dowsett, Buve, & Obasi, 2006; Wight et al., 2006). As is common in the Sub-Saharan African region, the Ugandan Ministry of Finance (1998) estimated that adolescents make up approximately 20% of the country's entire population. As is also common in the region, 89% of the entire population lives in rural areas (Ministry of Finance, 1998). A more recent national population survey has shown that of all adolescents aged 12 to 19, 90% live in rural areas and only approximately 16% have ever attended secondary school (Neema, Ahmed, Kibombo, & Bankole, 2006), with the other 84% having no secondary schooling at all and most with only limited and interrupted primary schooling or none at all. In raw numbers, out-of-school adolescents living in rural areas constitute the largest group of people to which age-specific biological, social, and economic markers for HIV risk may be attributed (Population Secretariat, 1996). As characterized by Christine Obbo (1995) in a discussion of HIV transmission and age, gender, and class, out-of-school adolescents living in rural areas are the voiceless majority.

Despite the majority status of out-of-school adolescents in this region, the overwhelming majority of research on the sexual health and practices of adolescents in this region has been conducted in school-going adolescents (Abdool Karim, Abdool Karim, Preston Whyte, & Sankar, 1992; Abolfotouh, 1995; Abraham, Rubaale, & Kipp, 1995; Adams & Clemence, 1994; Araoye & Adegoke, 1996; Awusabo-Asare, Abane, Badasu, & Anarfi, 1999; Bandawe & Foster, 1996; Fawole, Asuzu, Oduntan, & Brieger, 1999; Feldman, 1983; Gordon, 1998; Gregson, Terceira, Mushati, Nyamukapa, & Campbell, 2004; Harrison, Xaba, & Kunene, 2001; Kinsman et al., 1999; Klepp, Ndeki, Leshabari, Hannah, & Lyimo, 1997; Matasha et al., 1998; Nakalyoowa et al., 1996; Ndyanabangi, Tumwesigye, Kilian, & Morr, 1998; Nkosana & Rosenthal, 2007; Plummer et al., 2004; Power, Langhaug, & Cowan, 2007; Rodier, Morand, Olson, Watts, & Said, 1993; Shuey, Babishangire, Omiat, & Bagarukayo, 1999; Todd et al., 2004; Twa-Twa, 1997; Uchenna, Adekoya, & Pinneh, 1998).

Several studies cite both in-school and out-of-school adolescent participants (Akinyemi, 1996; D. Feldman, O'Hara, Baboo, Chitalu, & Lu, 1997; Hulton, Cullen, & Khalokho, 2000; Morrow, Sweat, & Morrow, 2004), with no discussion of the differences between the two groups of adolescents; and only a few have focussed solely on out-of-school adolescents (Bohmer & Kirumira, 2000; Konde-Lule, Sewankambo, & Morris, 1997), both from Uganda.

One potential reason that so little effort has been put into researching out-of-school rural adolescents is that they are difficult to study. In-school adolescents are far easier to study because of several fundamental differences: They are literate, which helps with filling out surveys; they are accustomed to being interactive and answering questions, which makes research faster and simpler for the interviewer; and they are localized in one place every school day, which makes them accessible.

By contrast, out-of-school adolescents are more difficult to study because of several factors: They may not be accessible because of their work demands on their time, making appropriate interview times that can afford privacy more difficult to schedule; they may be less accustomed to interactive questioning, making interview times longer and more challenging for interviewers; and they may not be literate and, therefore, may not be capable of filling out a written survey. …