Sexual risk behavior and differences among female school drop-outs in the Western Cape of South Africa

Background: Reports indicate HIV prevalence rates as high as 32% among South African childbearing women. Assessing risk behaviors at onset of sexual activity may help direct HIV prevention efforts. In addition, understanding cultural differences with respect to risk behaviors is key to developing effective interventions. Methods: In 2006, a study to determine risk behaviors was conducted among 450 Black and Coloured females who had dropped out of school in Western Cape Province, South Africa. Results: The average age was 17 years old. Significant differences in risk behaviors were observed with Black females reporting higher rates of risk behavior relative to Coloured females in: sex before age 15 (74% among Black females vs 53% among Coloured females), pregnancy (45% among Black females vs 14% among Coloured females), and childbirth (42% among Black females vs 12% among Coloured females). Significant differences were also found with condom use at last sex (Black females 43%; Coloured females 59%), rape (Black females 29%; Coloured females 11%), and STI symptoms (Black females 50%; Coloured females 13%). Differences were found with sexual partnering with Black females involved with males more likely to be 5 years older (49% vs. 26% among Coloured females) but having less multiple partners than Coloured females (25% vs. 36% among Coloured females). Conclusions: Although both groups of females show risk behaviors with lack of condom use, cultural differences were observed in other risk behaviors. It is important to take these cultural differences into account when adapting interventions as well as other prevention efforts.