AIDS, Culture, and Africa

6. Factors That Influence Ivorian Women’s Risk Perception of STIs and HIV

6 Factors That Influence Ivorian Women’s Risk Perception of STIs and HIV Kim Longfield Introduction Côte d’Ivoire, a small coastal nation in West Africa, is among the fifteen countries in the world most affected by HIV/AIDS, with an overall estimated infection rate of 9.7 percent. Estimates hold that between 7 and 10 percent of Ivorian females aged fifteen to twenty-four years are infected with HIV, while rates for males in the same cohort are much lower, at 2 to 4 percent (UNAIDS 2002). Several researchers have argued that HIV cannot be considered in isolation from other sexually transmitted infections (STIs) because they share the same modes of transmission and behavioral risk factors, and STIs may increase susceptibility to and transmission of HIV. Consequently, preventing and treating STIs may help curb the HIV/AIDS epidemic (Grosskurth et al. 1995; National Research Council 1996). Young women’s increased risk for infection can be attributed to several factors, including a lack of essential knowledge about STIs and HIV. Zanou and colleagues (1998) found that although 98 percent of Ivorian youth in their sample had heard of AIDS, only 49 percent of females were able to cite two or more methods of prevention. Likewise, 60 percent of females were unable to cite any symptoms of STIs, and 27 percent of young women in Abidjan, the largest city, said they had never heard of STIs (Zanou et al. 1998). Other factors such as early sexual onset, physiological susceptibility, high levels of sexual activity, multiple partnerships, the transitory nature of sexual relationships, and low levels of condom use contribute to young women’s risk for both HIV and STI infection in West Africa (Calvès 1998; Meekers et al. 2001; Monitoring the AIDS Pandemic Network 2002; National Research Council 1996; Njikam Savage 1998). In 1998, the mean age Factors That Influence Ivorian Women’s Risk Perception of STIs and HIV 89 at sexual debut for Ivorian girls was 15.7 years, and for boys it was 15.0 years (Zanou et al. 1998). The same year, close to 70 percent of Ivorians aged fifteen to nineteen years reported having had a sexual experience, and many reported multiple partnerships (Blanc and Way 1998; Zanou et al. 1998). Several researchers contend that early sexual onset for girls puts them at increased risk for HIV/AIDS since their reproductive and immune systems are immature and more susceptible to infection (Monitoring the AIDS Pandemic Network 2002; UNAIDS 2002). Even as the AIDS epidemic becomes more pronounced in Côte d’Ivoire, condom use among youth remains low (Kouye et al. 2000; Kuate-Defo 1997; Yelibi et al. 1993; Zellner 2003). Several studies have found that African youth are more likely to use condoms with certain types of partners than others. This is especially true in casual rather than regular partnerships (Agha et al. 2001; Meekers and Calvès 1997a; Van Rossem et al. 2001). Many youth also report using condoms at the beginning of a relationship, but abandoning use once the union becomes more stable or greater levels of emotional commitment are felt (Calvès 1999). Common reasons cited for inconsistent use are fear that partners will suspect one is unfaithful or HIV positive if condoms are proposed, the belief that condoms reduce sexual pleasure, and a perception that condom use suggests a lack of trust in one’s partner (Agyei et al. 1992; MacPhail and Campbell 2001; Wilson and Lavelle 1992; Yelibi et al. 1993). Past research reveals that a variety of partner types are common among youth in sub-Saharan Africa and that different expectations accompany particular types of relationships, including sexual experience, sexual satisfaction , social networking, and marital prospects (Calvès et al. 1996; Gage and Bledsoe 1994; Meekers and Calvès 1997b). Many relationships contain a financial component in which sexual favors are exchanged for monetary or material support (Caldwell et al. 1989; Mensch et al. 1999; Ulin 1992; UNICEF et al. 2002). Although many young women have relationships with peers, some prefer older partners who are better able to provide them support (Gorgen et al. 1993). Still others maintain a regular relationship with a boyfriend while still “going out” with older men (Dinan 1983; Gregson and Garnett 2002). Similar relationships also exist between young men and older women; however, these liaisons appear to be less common (Calvès et al. 1996; Owuamanam 1995). Little research has been conducted on the influence of relationships and partner choices on sexual decision...