HIV This Week

Speizer IS, White JS. The unintended consequences of intended pregnancies: youth, condom use, and HIV transmission in Mozambique. AIDS Educ Prev. 2008;20(6):531-46.

Although unwanted pregnancies can cause social and economic problems for sub-Saharan African youth, the consequences of intended adolescent pregnancies have gone unnoticed. Rarely do studies recognize that youth who desire a pregnancy are less likely to practice safe sex and, therefore, are at greater risk of contracting sexually transmitted infections (STIs), including HIV. This study uses data from the 2003 Mozambique Demographic and Health Survey to explore youth fertility desires and condom use. In multivariate analyses, controlling for other factors associated with condom use, female youth who want to get pregnant soon are significantly less likely (odds ratio: 0.35; 95% confidence interval: 0.22-0.55) to use condoms with non-marital partners than youth who want to delay childbearing. Programs for sexually active youth should recognize the importance of fertility desires as a potential moderator of condom use, even if the woman is at risk of HIV or STI. Recommendations are provided for HIV prevention counselling for youth who want to get pregnant and youth who are ambivalent about a future pregnancy.

Editors' note: A common reality in many settings in sub-Saharan Africa is that, in the transition to adulthood, pregnancy (or childbirth) is often a precursor to union formation and marriage/cohabitation. HIV prevention programmes should determine which youth have an unmet need for family planning and condoms to prevent unintended pregnancy and sexually transmitted disease and which youth want to get pregnant in the near future. Strategies that the latter group of young women can use to reduce HIV risks include having sex only in the fertile period, discussing HIV risks with a partner, and undertaking HIV testing and counselling with this partner. This broader HIV prevention programme focus, considering the fertility desires of youth, can help reduce their HIV and unintended pregnancy risks.

This article presents the status of rural Bangladeshi adolescent girls’ awareness about reproductive health. Analysis of data revealed that a sizable proportion of adolescent girls had incorrect knowledge or misconceptions about the fertile period, reproduction, sexually transmitted diseases, and HIV. Age, education either of adolescents or their mothers, residence, and exposure to mass media were the significant predictors of adolescent girls’ knowledge about reproductive health. Strong efforts are needed to improve awareness and to clarify misconceptions about reproductive health. Improved access to mass media and education could improve rural Bangladeshi adolescent girls’ awareness about reproductive health.

Editors' note: Only 7% of the 920 rural adolescent girls, aged 10 to 19 years, participating in this study had correct knowledge about the fertile period and 18 of 20 married adolescents who had given birth in the previous 6 months did not understand why they became pregnant. Only 20% of the girls had heard about sexually transmitted disease and of the 40% who had heard about AIDS, only 22% had correct knowledge about the routes of HIV transmission. These findings underscore the evident need to enhance behaviour change communication with culturally appropriate messages on reproductive health and strengthen access for adolescent girls in Bangladesh to sexual and reproductive health information and services through multiple entry points (school, work, sports, social activities) and settings (home, community, workplace, school or clinic).