Mary Louisa Plummer – författare

Promotion of the low risk “ABC” behaviors—Abstinence, Being faithful, and Condom use—has had only limited success in Africa. This book draws on a large qualitative study affiliated with an adolescent intervention trial to examine how ABC promotion can be improved. It evaluates the MEMA kwa Vijana sexual health program, which was implemented in 62 primary schools and 18 health facilities in rural Tanzania, scrutinizing its teacher-led curriculum, peer education, youth-friendly health services, youth condom distribution, and community mobilization components. The book examines how implementing such a low-cost, large-scale program involved many compromises, including those between national policies and international “best practice” recommendations, between the most desirable intervention design and one that was affordable and sustainable at a large scale, between optimal teaching methods and real-world teaching capacity, between ideal curriculum content and what was acceptable to the local community, and between adults’ values and youths’ realities. The program’s impact is evaluated by triangulating findings from three person-years of participant observation, in-depth interviews, survey interviews, and biomedical tests.The book also provides in-depth case studies to examine the motivations and strategies of extraordinary young people who practiced ABC behaviors. It outlines broad principles for ABC promotion, including: acknowledging existing youth sexual relationships; promoting each low risk behavior in complexity and depth; working with preexisting, culturally compelling motivations; and intervening at individual, interpersonal, community, and structural levels. Many recommendations for the promotion of specific ABC behaviors are discussed, such as reducing pressures and incentives for girls to have sex; targeting male risk-perception and self-preservation; promoting alternative forms of masculinity than sexual conquest; strengthening premarital and marital relationships; tailoring fidelity programs for hidden couples, couples planning to marry, and monogamous and polygynous married partners; and addressing pleasure, trust, pregnancy prevention, and fertility protection in condom promotion. The book concludes with additional recommendations specific to school programs, and a review of promising complementary interventions for out-of-school youth, women, men, couples, and parents.

New infections with HIV remain an urgent problem among young people in Africa, but many young Africans pursue sexual relationships with little thought about the epidemic. This book examines young people's sexual relationships in a region typical of rural sub-Saharan Africa and investigates why the risk of HIV infection generally was not a salient concern for them. It is based on an extraordinarily large and representative qualitative study that was affiliated with an adolescent sexual health intervention trial and included three person-years of participant observation conducted by young East Africans in nine Tanzanian villages.The book describes typical patterns of sexual relationship formation in adolescence and early adult life, the variety of young people's relationships and practices, and the contradictory social ideals and expectations that led premarital and extramarital relationships to be concealed. Young men's main motivations for sex were pleasure and masculine identity, while young women's was to receive money or materials to meet their basic needs, such as soap or a daytime meal. By their late teens most young people had experienced one-time sexual encounters, open-ended opportunistic relationships, and "main" sometimes semi-public partnerships. Relationships could involve desire, possessiveness, and affection, but romantic idealization of a partner was rare. Many young people expected their partners to be monogamous, but themselves had had concurrent relationships by age 20. The practice of hiding premarital sexual relationships from adults often also concealed them from other sexual partners, which helped maintain concurrency and inhibited realistic risk perception. Understanding of the biology of HIV/AIDS was very limited. Condoms were rarely used because they were associated with reduced pleasure, infection and promiscuity. Sexually transmitted infections were common, but several factors hindered young people from seeking biomedical treatment for them. Many instead relied on tradit