Too young to have sex: conversations with very young adolescents about sex, dating and related decision-making

Background. Very young adolescents receive little research and pragmatic attention regarding their sexual and reproductive health (SRH) needs. As a result, their experiences are often overlooked. Furthermore, when this age group is included in SRH education, the dominant public health lens tends to focus on health risks associated with sex, with less emphasis on a holistic approach that considers the socio-cultural and relational contexts in which adolescents' decision-making about sex and dating occurs. Objectives. To explore the beliefs, perceptions and decision-making pathways of adolescents about heterosexual sex, dating and relationships. Methods. The sample included 33 girls and 30 boys aged 10 - 14 years attending schools in rural Mpumalanga Province, South Africa. Data collection entailed participatory methodologies of group-based activities and individual interviews. Data were recorded and transcribed verbatim. Transcripts were coded and analysed using thematic analysis. Results. The findings focused on three themes: timing of dating, relationships and sex; gendered depictions of first sex; and agency in sexual decision-making. These themes shed light on the relational context in which adolescents' decision-making takes place and highlight the pervasive influence of wider gendered norms. Conclusion. Very young adolescents are not sexually naive and instead are faced with complex decisions regarding sex and dating. This age group is not, however, fully supported in developing a healthy, positive sexuality when emphasis is on the negative outcomes of sex. The paper concludes with recommendations for adolescent SRH programmes to provide a supportive environment for younger adolescents to make informed choices and develop positive, healthy sexualities

'They tell you about the risks': exploring sources of sexuality education among very young adolescents in rural Mpumalanga

Background. Early adolescence (ages 10 - 14) is a crucial stage of development. The importance of early intervention in improving adolescent sexual and reproductive health (SRH) is increasingly acknowledged. Yet, school-based sexuality education largely focuses on older adolescents, leaving very young adolescents to contend with conflicting information from different sources. This study responds to the need for contextually nuanced research with very young adolescents, which can inform policy and programmes aimed at improving their SRH outcomes. Objectives. To explore very young adolescents' sources of SRH knowledge and investigate the implications of both formal school-based sexuality education and informal sources of information for their SRH rights. Methods. This research was conducted with schoolgoing adolescents (aged 10 - 14) from the Gert Sibande district in rural Mpumalanga. Data were collected qualitatively using individual interviews and group-based participatory workshops, all conducted with the same participants. Transcribed data were analysed using thematic analysis. Results. Findings indicate that while formal transfer of SRH information takes place through school-based sexuality education, learners' sexual knowledge is also shaped by informal sources, including household observations and sexual play. We identify three themes that cut across sources of SRH knowledge and position young adolescents in contradictory ways: prohibitive messaging, the notion of childhood innocence and everyday sexual learning. Conclusion. Recommendations are made for comprehensive sexuality education that is responsive to this age group's needs, draws on their everyday lived experiences and optimises the opportunities offered by foregrounding agency, while remaining cognisant of structural constraints

Ambiguous Diagnosis; Futile Treatments and Temporary Recovery: Meanings of Medical Treatment Among HIV/AIDS Family Caregivers Providing Care without ARVs

The capacity of countries with high HIV and AIDS prevalence to provide antiretroviral treatment and care for all people who need support remains a public health challenge. In Lesotho; there are improvements in this area but the high proportion of people who need ART yet they do not receive treatment suggests that many HIV-infected people continue to depend on medicines that treat opportunistic infections. The objective of the article is to explore caregivers' experiences with diagnostic procedures and outcomes; prescriptions and treatment outcomes when ARVs were unavailable. A phenomenological design using in-depth face-to-face interviews was used to obtain the experiences of 21 family caregivers about caregiving; including access to and use of medical treatments. Caregivers' experiences indicate that most of the consulted health professionals provided vague and inconsistent diagnoses while the medication they prescribed failed to treat most of the symptoms. Unavailability of medicines that control pain and symptoms effectively continues to be a prominent feature of HIV and AIDS home-based caregiving in Lesotho. It is recommended that health professionals should facilitate disclosure of HIV diagnosis to family caregivers to assist them to understand unstable treatment outcomes; and policy makers should strengthen home-based care by developing policies that integrate palliative care into HIV and AIDS care