Comportements sexuels chez les adolescents en Afrique sub-Saharienne : l’exemple du Burkina Faso, du Ghana, du Malawi et de l’Ouganda

Adolescent girls and boys represent key segments of the population for the future in all societies across the world. The readiness of these young people to assume adult roles and responsibilities in the future, both for themselves and for their countries, depends in large part on how successfully they manage their critical transitions to adulthood and on the support they receive from their families, communities and governments during this period of their lives. Investment in adolescent sexual and reproductive health is likely to be of enormous importance to the development prospects of sub-Saharan Africa and the future wellbeing of African populations, as it enables adolescents to grow into healthy and productive adults. While protecting the health of young Africans is recognized as a priority at the community, national and international levels, policies and programs, if they are to be effective, need to be evidence-based and appropriate to each local context.   This thesis focuses on the sexual and reproductive health of adolescents in four sub-Saharan African countries: Burkina Faso, Ghana, Malawi and Uganda. It aims to expand the knowledge base needed to develop and implement programs and policies that will increase adolescents’ ability to prevent HIV and contribute to the creation of a safe and supportive environment essential to their growth and development. The research is organized around three empirical articles along with introductive chapters and a general conclusion, and is designed to answer a number of questions of policy importance.   The first article deals with the perceptions of HIV risks by adolescents who are not yet sexually active. The topic is of considerable interest because of its potential importance for HIV prevention programs, particularly when sexually inexperienced adolescents report high levels of concern over their likelihood of contracting HIV over time. Findings show that there is no single influence on adolescents’ HIV risk perception, but rather a range of determinants that operate at the individual, environmental and community levels. This finding suggests that programs and policies should take into account factors that extend beyond the characteristics of adolescents when addressing their sexual and reproductive health needs.   The second article of the thesis examines the context in which adolescent girls’ transition to first sexual intercourse occurs in the four countries. Going beyond the usual dichotomy of sexual experienced versus inexperienced adolescents, it analyzes simultaneously the factors associated with sexual initiation before and within the first union for adolescent girls aged 12-19. The results show that a high level parental monitoring is significantly associated with a decreased risk of adolescents’ becoming sexually active prior to marriage. A policy recommendation of this study is that public and nongovernmental organizations need to more fully integrate parents into their programs on adolescent sexual and reproductive health.   The third article examines two specific aspects of sexual risk behaviour among adolescents: multipartnership and condom use. Our findings show that adolescents who report high levels of parental control are less likely to have multiple sexual partners. In terms of policy and programmatic implications, this result again suggests that parents’ influence over their children’s behavior, widely assumed to have declined over time, remains important to reproductive health interventions in diverse contexts in sub-Saharan Africa.

Keyphrases: Adolescents, Adolescents, Sub-saharan Africa, Burkina Faso, Burkina Faso, Ghana, Ghana, Malawi, Malawi, Uganda, HIV/AIDS, Sexual behaviors, Reproductive health