Mapping sexuality : understanding the knowledge, attitudes and perceptions of adolescent females towards sexuality and sexual and reproductive health in KwaZulu-Natal, South Africa.

Abstract

Within sub-Sahara Africa, adolescent girls bear a disproportionate burden of sexual and reproductive health (SRH) risks, where the dual risk of HIV infection and adolescent fertility is faced. Specifically in South Africa, it is estimated that nearly 2 000 adolescent girls and young women between the ages of 15 and 24 years are infected by HIV every week. Furthermore, it was estimated that, by 2016, 15,6% of females between the ages of 15 and 19 years old in South Africa had begun childbearing. It is for these reasons that adolescent girls have been identified as a key population. This study was located at Mayville Secondary School, in the eThekwini district of KwaZulu-Natal (KZN). This area reports high levels of HIV infection, with notably high adolescent fertility rates at this school. This study had three aims: to understand the influences on adolescent female sexuality, to outline the perceptions of SRH self-care among adolescent females, and to understand the perceptions of artbased methodologies in researching sensitive topics. By understanding adolescent sexuality, this study aimed to highlight the influence this had on the self-care capabilities of adolescent females in maintaining their SRH. A culture-centred understanding of Orem’s self-care model guided the study. A participatory action research design was adopted, where data collection was threefold: a bodymapping workshop, group discussion and individual interviews. Key findings highlighted parental relationships and SRH-specific health communication programmes as the most influential in the understanding of sexuality among adolescent females. However, lack of agency in preventing risk, such as rape, and the negative perceptions of health care workers were identified as the main self-care deficits among adolescent females. Furthermore, this study identifies the effectiveness of art-based methodologies in researching and communicating with adolescent females about sexuality. This study highlighted the need for greater understanding of the socio-cultural perceptions of health care workers’ understanding of adolescent sexuality, and the provision of SRH services. This study emphasises the need to reduce significant socio-cultural barriers to SRH, in order to ensure adolescent females have the ability to be effective self-care agents in maintaining good SRH.