Young men's sexuality and sexually transmitted infections in Zambia

Aim: To describe and analyse young Zambian men's sexuality and implications for sexually transmitted infections (STIs) including HIV/AIDS in Chiawa rural community and Lusaka urban compound of Misisi.

Methods: Over a period of eight years, 402 men between 16 and 26 years old have participated in the studies; 205 from Chiawa and 197 from Misisi. Random and purposive sampling techniques were used to select the men. Fifty-nine traditional healers were also included in the study. Twenty-three of the traditional healers came from Chiawa and 36 from Misisi. Thirty-seven women in Misisi were included in one of the studies. Data was collected using semi-structured questionnaires, focus group discussions, in-depth interviews, and observations. The questionnaires were administered to the young men twice in Chiawa in 1993 (n=98) and 2001 (it= 79); and once in Misisi in 2001(n=153).

Results: The mean age of the young men was 21 in Chiawa and 20 in Misisi. The majority of the men were not married. Almost all the men in Chiawa and Misisi had attended formal schooling. In 1993, and 2001, 39% and 44%, respectively, were formally employed in Chiawa and only 14% were employed in Misisi. A real man was considered to be one who was married, had children, had a decent job, cared for the family, and could sexually satisfy his wife. In Chiawa, 97% and in Misisi 76% of them considered themselves to be real men. Four children were considered to be the ideal number during one's life time due to economic hardships. Forty-three percent and 25% of the men had current pre- or extra sexual marital relationships in 1993 and 2001, respectively. In Misisi, 40% had current pre-or extra marital relationships. Qualitative data revealed that the main reason for these relationships was the need to prove that they were real men. In Chiawa, one-fourth of the men in the two surveys said they had suffered from an STI in the past and most of those in the second survey had sought treatment from the local health facility. In Misisi, 26% had suffered from an STI and many of them had gone to the private clinics for treatment. Majority (91%) of the men in Chiawa, compared with less than half in Misisi (4 1 %) said they considered themselves to be at risk of contracting HIV infection. In Chiawa, they considered themseIves to be at risk because of what they believed to be their inability as men to control sexual desires; their lack of trust in the sexual partner; and, unreliability of the condom. In 1993, only six percent said they used a condom all the time they had sex whilst 27% said so during the 2001 survey. In Misisi, 19% said they used condoms all the time. Qualitative data showed that there were misconceptions surrounding the use of condoms. In Chiawa, the healers reported using up to 19 different species of medicinal plants to treat STIs. Both in Chiawa and Misisi, the healers were treating impotency and infertility.

Conclusions: Male sexuality is given prominence mainly because of its role in fertility. Multiple sexual relationships, misconceptions regarding HIV/AIDS, lack of adequate information, and ambiguities about and inconsistent use of condoms, all combine to pose major challenges on the fight against AIDS. The data from Chiawa indicates that sexual behaviour could be changing. The young men in Chiawa are more self-asserting. In Misisi the men's confidence is undermined by unemployment and other social difficulties characteristic of poor urban settlements. In designing interventions to target men's sexual health, we must consider their expressed concerns. Notions about real man that encourage risky behaviours must be targeted. Information, education and communication remain the most effective strategies. The young men's economic plight must also be addressed.

List of scientific papers

I. Ndubani P, Hojer B (2001). "Sexual behaviour and sexually transmitted diseases among young men in Zambia. " Health Policy Plan 16(1): 107-12
https://pubmed.ncbi.nlm.nih.gov/11238437

II. Ndubani P, Hojer B (1999). "Traditional healers and the treatment of sexually transmitted illnesses in rural Zambia. " J Ethnopharmacol 67(1): 15-25
https://pubmed.ncbi.nlm.nih.gov/10616956

III. Ndubani P, Bond VA, Liljestrom R, Hojer B (2002). "Young mens construction of male sexuality and implications for HIV/AIDS in Lusaka urban, Zambia." Journal of Culture, Health and Sexuality (Submitted)

IV. Ndubani P, Bond VA, Liljestrom R, Hojer B (2002). "Young Zambian mens sexual health dilemmas and the central role of traditional healers in the context of HIV/AIDS, poverty and urban density." (Manuscript)

V. Ndubani P, Bond VA, Liljestrom R, Hojer B (2002). "Understanding young mens sexual health and prospects for sexual behaviour change in rural Zambia" Scandinavian Journal of Public Health (Accepted)