Behavioural Surveillance Surveys - The Wisdom of Whores

Youth Indicator 9
Youth using condoms
at first sex
Definition
Numerator :
Number of male/female
respondents who used a
condom the first time they
ever had sex
Denominator : Total number of male/female
respondents who have ever
had sexual intercourse.
Measurement tools
Youth questionnaire
Q202A
What it measures
It is generally believed that it is easier to
maintain safe behaviors established from the
onset of sexual activity than to change risky
behaviors once they have become habitual.
In addition, data from a number of serosurveys
suggest that in high HIV prevalence
areas, very high proportions of young women
become infected with HIV during their first
few acts of sex. The physical trauma caused
by the rupture of the hymen may contribute to
a high likelihood of infection during first sex.
Life skills programs for young people have
therefore concentrated on promoting safe
behavior right from the beginning of young
people’s sex lives. This indicator measures
progress towards establishing safe behavior
from the outset of people’s sexually active
lives. The indicator should of course be
disaggregated by gender. Disaggregation by
age and concentration on 15-19 year-olds will
increase the sensitivity of the indicator to
recent changes in condom use at first sex.
Strengths and limitations
One limitation of this measure is that
where it is high, it may create a false sense
of complacency. HIV and STIs are far from
being the only concern for young people.
Many adolescents are more concerned about
the immediate threat of pregnancy than they
are about HIV and STIs. Integrated life skills
and reproductive health programs for young
people stress avoiding unwanted pregnancies
as much as they stress avoiding STIs, including
HIV. High levels of condom use at first sex
may in fact reflect growing use of condoms as
a use of contraceptives. When sexual activity
becomes more regular, young women may
adopt longer-term forms of contraception,
and abandon condom use. Because of this,
it is important to present this indicator in
conjunction with other indicators of condom
use among young people.
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Chapter H A PTER 9 B EHAV I OR A L S U R V EI L L A NC E S U R V EY S