1. UKZN INSPIRING GREATNESS Socio- ecological systems determining sexual risk behaviours of the young people in uMgungundlovu District Municipality, South Africa N. Khuzwayo, N. Jama & M. Taylor PHASA conference 20-22/09/ 2016

2. UKZN INSPIRING GREATNESS Background Prevention of sexual youth risk behaviours continues to be a primary challenge for public health and health promotion Research suggests that most current interventions are conceptualised at an individual level

3. UKZN INSPIRING GREATNESS Background Ecological approaches in Public health can make positive and sustainable changes (Bronfenbrenner, 1979) Young people are surrounded by layers of relationships which should be targeted as well (Bronfenbrenner, 1979) Including, micro-systems, exo-systems and macro- systems

4. UKZN INSPIRING GREATNESS Purpose The purpose of the study was to investigate socio- ecological systems that continue to expose young people to sexual risk behaviours in uMgungundlovu District Municipality KwaZulu-Natal

5. UKZN INSPIRING GREATNESS Methods Study design Cross-sectional study Study site UMgungundlovu District Municipality Sampling Purposive sampling Ethics UKZN, Biomedical Ethics Committee( BREC).

6. UKZN INSPIRING GREATNESS Methods Informed consent Written consent Data collection A guide comprising unstructured, open-ended questions FDGs were conducted in isiZulu A research assistant employed to assist with the recording and note-taking

7. UKZN INSPIRING GREATNESS Methods: Data analysis The FDGs were transcribed verbatim and translated into English by a research assistant We used Nvivo v10 software

8. UKZN INSPIRING GREATNESS Demographics Age of the participants ranged from 19 to 32 years, average age 23 years Both males 25(30%) and females 58(70%) participated in the study

9. UKZN INSPIRING GREATNESS Main results The findings are drawn from the seven FDGs The results are presented as four broad themes. These are: 1) individual factors, 2) micro-system, 3) exo-system and 4) macro-system. The latter three themes are based on Bronfenbrenner’s ecological model (1979).

10. UKZN INSPIRING GREATNESS Individual factors Age, gender and poor decision-making. The majority of the participants reported that both sexes are equally likely to behave in ways that might put their health at risk. A participant explained: “Girls lack backbone; this is what is needed in them. They must learn how to say ‘no’ - not the ‘no’ that opens a way for a boy or a man to convince her”. (Sipho, 21, a youth facilitator ). Boys were said to be controlled by hormones: … When sexually aroused, our brains stop working; we are only directed by our penises. I would sleep with whoever I meet. I am hunting because my penis is erect, not because I am in love with her. (Mandla, 19, a club member )

11. UKZN INSPIRING GREATNESS Microsystem Many sexual risk behaviours are related to the micro-system within which the individual functions. This includes their family, pressure from friends, lack of access to sex education and contraceptives in schools, negative attitude of health workers, substance use and relationship dynamics with partners.

12. UKZN INSPIRING GREATNESS Microsystem Dominant parental behaviour: parents’ strict discipline over their children reported as a major enabler for youth to engage in sex carelessly “Ya, nee, well what I can say is that when she gets a small chance…that chance she gets she will use it because she knows that they are strict at home. So the small opportunity that she gets, she will sleep with him; in that gap she will do it”. (Nomvelo, 26, a youth facilitator)

13. UKZN INSPIRING GREATNESS Microsystem Attitude of the clinic nurses Girls who are sexually active were reported to be not accessing family planning services, due to their fear of being shamed and reported at their homes for engaging in sex. A participant explained: “…so the kids found it difficult to go to the clinic because they would not get any help; instead, they get some questions like, ‘What are you doing?’ and ‘Why are you preventing at your age?’

14. UKZN INSPIRING GREATNESS Microsystem Relationship dynamics The need to gain or prove partners’ trust and sexual satisfaction emerged as one of the main factors. Some of the participants explained When I tell him to use condom he says it tightens him. (Somagadla, 24, club member) Or he asks, don’t you trust me? (Mfundo, 20, club member)

15. UKZN INSPIRING GREATNESS Exo- system Economic status of the community This was mentioned as a reason why youth become involved in transactional sex relationships. “The problem we’re having here is that unemployment rates are high; another thing is that children end up dating these old men because they want food. Because of poverty”. (Songezo, 31, youth facilitator)

16. UKZN INSPIRING GREATNESS Macro system Cultural customs, laws and values and media Some participants mentioned Zulu cultural customs as the core of how youth approach sexual relationships. Participants from FG5 stated this: Our culture has destroyed us as black people. We are playboys. If you have one girlfriend, you are still seen as a bachelor. (Sanele, 33, youth facilitator)

17. UKZN INSPIRING GREATNESS Macro system Another participants said: “Our leaders should be role models, but now how many wives do they have? Through old age, they marry women of similar age to their granddaughters. We have a problem of the culture and the socialisation which produces bad consequences. (Alu, 34, club member)

18. UKZN INSPIRING GREATNESS Discussion In this study we found all the levels ( individual factors, micro-system, exo-systems and macro- system) fostering riskier sexual behaviours. Interventions directed at these multiple levels are needed urgently.

19. UKZN INSPIRING GREATNESS Conclusion Re-engineering of interventions addressing the risk behaviour of the young people in uMgungundlovu Municipality is required since the existing individual interventions have not resulted in the desired health outcomes

20. UKZN INSPIRING GREATNESS Conclusion

21. UKZN INSPIRING GREATNESS Acknowledgements College of Sciences, for providing scholarship Youth Facilitators from AIDS for Foundation Operation Sukuma Sakhe

22. UKZN INSPIRING GREATNESS ` Thank you