Commuity Influences on sexual behavior in 4 African Countries

Targeting young people is essential in defeating the global HIV/AIDS epidemic and although much attention has been given to the individual and familial factors that influence the sexual behavior of young people, the role of structural elements of the community remains poorly understood.THis paper estimates the influence of several dimensions of the community environment on young people's recent sexual behaviors in four countries: Burkina Faso, Ghana, Malawi and Uganda.The analysis samples are males and females (12-19) from the National Surveys of Adolescents conducted in 2004 in Burkina Faso, Ghana, Malawi and Uganda. Community level variables representing economic prosperity, gender norms, social and cultural participation, demographic characteristics and the health care infrastructure will be examined as factors expected to shape the sexual behavior of young people. A multilevel modeling strategy will be applied to outcomes measuring age at first sex, number of partners, condom use, participation in transactional sex, and alcohol influenced sex. Previous studies of young people's sexual behaviors have focused on individual and household level factors; this research is innovative in it's conceptualization of the community, examining the role of economic, social and normative community characteristics in determining young people's sexual behaviors. This research will provide information on the associations between characteristics of a community's environment and young people's behaviors, providing new information that will directly influence the development of health interventions aimed at young people. In addition to strengthening the scientific field of community influences on health, the research will generate interest in examining community influences on other health outcomes, and will lead to a greater motivation to improve the collection of community level data. The research will also identify community characteristics that can be harnessed in the development of public health interventions, strengthening public health practice for the improvement of program and policy aimed at reducing HIV transmission among young people. The data to be used include a wider age range (12-19) and richer set of data on sexual behavior than is commonly found in nationally representative surveys of adolescents. An additional advantage of this research is therefore a more detailed examination of sexual behaviors for a wider age range of young people.