CyberSenga Dissemination
Meeting
SESSION 2:
DEVELOPING CYBERSENGA:
DATA INFORMINGTHE CONTENT
*Thank you for your interest ...
UNDERSTANDINGWHY AND HOWYOUTH
MAKE SEXUAL DECISIONS:FINDINGS FROM
INTERVIEWSWITH ADOLESCENTS AND
ADULTSWORKINGWITHYOUTH A
...
Methods
 In 2008, we talked to:
◦ 48 adolescents (24 boys and 24 girls) and
◦ 15 adults (9 women and 6 men) who work
with...
Reasons to play sex: Social pressure
A desire for luxury items
―She told me that she loves that boy – that is
why she had ...
Reasons to play sex: Social pressure
Peer pressure
―There is that peer influence.. Sometimes they
are being laughed at by ...
Reasons to play sex:
Decline of the Senga
―It may be difficult for the parents to talk
about sex with their children. [Sen...
Reasons to play sex:
Barriers to condom use
 Overtly goes against a strong cultural
sanction against premarital sex.
 Co...
Reasons to play sex:
External locus of control
―like when one starts…to watch blue movies -
then you feel like you are the...
Reasons to play sex:
Sexual curiosity
―They say playing sex with a lady is very good
that you feel so much sweetness.‖
Reasons to play sex:
Sexual violence
―He can be having money and he will tell the
girl that [they should] go in town toget...
Reasons not to play sex:
Knowledge of HIV transmission and
modes of prevention
―First and foremost you should avoid having...
Reasons not to play sex:
Knowledge of HIV transmission and
modes of prevention
Despite this, concerning inaccuracies –
par...
Reasons not to play sex:
Moral injunction against playing sex
―If you go [to church] and read the Bible... like
when they ...
Conclusions
 Like young people all over the world, youth
in Uganda are subjected to pressures to
engage in risky sex.
 S...
FINDINGS FROMTHE
DEVELOPMENT SURVEY
DEVELOPING CYBERSENGA:
DATA INFORMINGTHE CONTENT
Methods
 In 2008-2009 we surveyed 5 schools:
◦ 1,508 surveys were completed
◦ 62% were male
◦ Youth ranged in age between...
What do you use the Internet for?
57%
21%
58%
62%
21%
47%
0%
10%
20%
30%
40%
50%
60%
70%
Email Social networking
sites
Pla...
What do you SMS about?
77%
20%
42%
36%
18%
48%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Sports Information about
health and ...
What is your knowledge of HIV
prevention (incorrect answers)
24%
42%
24%
18%
51%
18%
0%
10%
20%
30%
40%
50%
60%
HIV/AIDS i...
The local health center…
52%
63%
75%
40%
47%
60%
65%
48%50% 50%
69%
28%
37%
43%
62%
38%
0%
10%
20%
30%
40%
50%
60%
70%
80%...
Self esteem: positive aspects
65%
62%
39%
65%
56%
61%
39%
68%67%
63%
43%
69%
63% 60%
33%
61%
0%
10%
20%
30%
40%
50%
60%
70...
Self esteem: negative aspects
9% 9%
77%
7%
20%
9%
74%
7%
16%
12%
78%
8%
29%
26%
76%
12%
0%
10%
20%
30%
40%
50%
60%
70%
80%...
Health Concerns
0%
10%
20%
30%
40%
50%
60%
Your health Getting money Getting (someone)
pregnant
Parents' health
Males, no ...
I‟m tired of hearing about HIV
prevention
14%
22%
17%
26%
0%
5%
10%
15%
20%
25%
30%
Males, no sex Males, had sex Females, ...
Top 3 things youth are interested in
hearing about
34%
40% 41% 42%
45%
54%
60% 61%
0%
10%
20%
30%
40%
50%
60%
70%
Attitudes about sex
17%
60%
79%
8%
58%
77%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Having sex before
marriage makes you a
b...
Attitudes about coercive behavior
47%
58%
37%
48%
0%
10%
20%
30%
40%
50%
60%
70%
There's nothing you can say to a boy
who ...
Attitudes about coercive behavior
47%
58%
37%
48%
0%
10%
20%
30%
40%
50%
60%
70%
There's nothing you can say to a boy
who ...
Physical aggression in romantic
relationships
30%
38%
44%
39%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Hit, slapped, or p...
Gift giving to have sex*
28%
24%
18%
55%
0%
10%
20%
30%
40%
50%
60%
Given money, gifts, clothes, gifts so the
other person...
Percent of youth who have ever had
sex
20%
7%
42%
31%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Males Females
Have never...
% of youth with sexual experience
by age and biological sex
0
21
24
33
39
47
37
64
6
9
16
19
28 28
37
40
0
10
20
30
40
50
...
Conclusions for design
 Given the popularity of online
games, games will be important for
engagement of youth
 Based upo...
Conclusions for content
 We need to making sure that youth know HIV is
not small enough to get through a condom is
import...
Conclusions for content
 HIV prevention fatigue is high
◦ Need to focus on fundamentals of healthy
adolescence: problem s...
Conclusions for content
 Directly address boys‟ assumption that having sex
makes him a better man and a better husband.
...
SEXUAL COERCION IN
ADOLESCENTS:VOICES
FROMYOUNG PEOPLE A
DEVELOPING CYBERSENGA:
DATA INFORMINGTHE CONTENT
A Excerpts from:...
Methods
 Three focus groups were conducted with
„popular opinion leaders‟ at partner schools
◦ Two groups were conducted ...
Verbal pressure is common
‗A situation may happen, like you are attending
a function and you spend a night there, and
when...
Coercion is perpetrated by adults
‗When you are having someone older than
you, you have to give respect to that person.
Th...
…but not by adolescents
‗For adolescents, for them they just fall in love with
each other, but I do not think that they ar...
Men are perceived to be the
coercers, females the victims
‗You would rather go for girls rather than boys
because men have...
Coercion can be achieved through
gifts
‗In most cases you find the adult is the one
approaching the adolescents; like you ...
Coercion can be achieved by
exploiting financial needs
‗Like you find the adult is assisting the
adolescent in some basic ...
Coercion can be facilitated with
alcohol
‗Like you can be there and you get a girl, and
you get her booze and you convince...
Coercion can be facilitated by adults
with authority over the youth
‗There was this girl who was staying with the
stepmoth...
Victims are responsible too
‗I heard about a man who had a daughter. He
used to give her the boda boda man to take her
to ...
It is difficult to talk about (and
therefore report) rape
‗Okay when someone is your parent‘s
friend, your father will beg...
Conclusions for content
 Help youth identify safe places to report
sexual violence
 Foster skills to think critically ab...
Acknowledgements
 We would like to thank the entire
CyberSenga Study team from Center for
Innovative Public Health Resear...
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CyberSenga Dissemination Meeting: Session 2. Developing CyberSenga

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  • Many youth described external pressures that sometimes seemed beyond their control and could ‘force’ them to have sex if they were not vigilant. A woman’s clothing, “blue” (pornographic) movies, and alcohol were the most common influences.
  • Consistent with normative sexual development that occurs in adolescence,  youth described curiosity about sex. They wanted to experience the euphoria described by their peers.
  • While not typically categorized as a reason to have sex, the frequency with which sexual violence was noted by youth suggested that is perceived as a common influence on adolescent sexual activity. Not surprisingly because of the power imbalance within these relationships, narratives of sexual violence sometimes overlapped with those describing sugar daddies and mommies.
  • Just as many youth use the internet to play games as email. Need to integrate games
  • TP - The green bar legend read ‘Females, had no sex’, I’ve changed to “Females, had sex”. Added ‘about’ after Very worried…
  • TP - The green bar legend read ‘Females, had no sex’, I’ve changed to “Females, had sex”.
  • \
  • TP – When you match up the general data with conclusions, I think you should add a slide (or two) to support this slide.
  • The second bullet says: “Based upon what youth say they are interested in:” but the bullet points don’t support what youth are interested in, rather they are supporting what is needed in programs based on youth reports (rather than what youth are interested in learning about)
  • adults coerced young people with gifts and money. Not all gifts were coercive; it was culturally appropriate to give and receive gifts within a healthy relationship.  Nonetheless, it was not uncommon to give a gift with the intention of obligating sex. This was particularly true with older sexual partners because they had access to more money and therefore could give more compelling gifts:
  • adults coerced young people with gifts and money. Not all gifts were coercive; it was culturally appropriate to give and receive gifts within a healthy relationship.  Nonetheless, it was not uncommon to give a gift with the intention of obligating sex. This was particularly true with older sexual partners because they had access to more money and therefore could give more compelling gifts:
  • Coercion by adults was by far the most common type of coercion the adolescents discussed. They articulated several different ways in which adults could coerce young people into sex. By ‘adults’ the participants typically referred to persons in their 20s or 30s. The participants mentioned that young people who engaged in relationships with older people would fear their older partner and may end up having sex when they are not ready for it.
  • CyberSenga Dissemination Meeting: Session 2. Developing CyberSenga

    1. 1. CyberSenga Dissemination Meeting SESSION 2: DEVELOPING CYBERSENGA: DATA INFORMINGTHE CONTENT *Thank you for your interest in this presentation. Please note that analyses included herein are preliminary. More recent, finalized analyses may be available by contacting CiPHR for further information. MicheleYbarra MPH PhD Center for Innovative Public Health Research Julius Kiwanuka MD Mbarara University of Science & Technology Conducted at the Acacia Hotel, Mbarara, Uganda, May 29, 2012
    2. 2. UNDERSTANDINGWHY AND HOWYOUTH MAKE SEXUAL DECISIONS:FINDINGS FROM INTERVIEWSWITH ADOLESCENTS AND ADULTSWORKINGWITHYOUTH A DEVELOPING CYBERSENGA: DATA INFORMINGTHE CONTENT A Excerpts from: Katz IT,Ybarra ML,Wyatt M, Bangsberg D, Kiwanuka J,Ware N. Sociocultural and Economic Antecedents of Adolescent Sexual Decision Making in Rural Uganda. Under review.
    3. 3. Methods  In 2008, we talked to: ◦ 48 adolescents (24 boys and 24 girls) and ◦ 15 adults (9 women and 6 men) who work with adolescents  The aim was to understand young people‟s information about HIV, the reasons why young people choose to play sex (or not) and why they use condoms (or not), and the behavioral skills they have to make healthy choices
    4. 4. Reasons to play sex: Social pressure A desire for luxury items ―She told me that she loves that boy – that is why she had sex with him. He takes care of her… Like he can give her everything she asks for... Like if she asks for clothes, he can buy it for her. If she says let‘s go out, he does not refuse, so they go out and enjoy. Like if she wants money the boy can give her such things.‖
    5. 5. Reasons to play sex: Social pressure Peer pressure ―There is that peer influence.. Sometimes they are being laughed at by their fellow friends. There is that saying they have of,‗others are doing it‘ and those who are doing it laugh at those who are not doing it…how can you be there without a boyfriend?‖
    6. 6. Reasons to play sex: Decline of the Senga ―It may be difficult for the parents to talk about sex with their children. [Sengas] are people whom you think are able to talk with your child… And when a young person sees that old person, she will keep on following her. …Traditionally, those are secret things. It is really secret to tell your child about sex.‖
    7. 7. Reasons to play sex: Barriers to condom use  Overtly goes against a strong cultural sanction against premarital sex.  Cost (students do not have enough money)  Embarrassment (being refused by the shopkeeper)  Misunderstanding of the effectiveness of condoms  “Bad manners” - it suggests suspicion of HIV infection, and/or multiple concurrent partnerships.
    8. 8. Reasons to play sex: External locus of control ―like when one starts…to watch blue movies - then you feel like you are the one doing it so you feel attracted and then you are tempted to go for it.‖
    9. 9. Reasons to play sex: Sexual curiosity ―They say playing sex with a lady is very good that you feel so much sweetness.‖
    10. 10. Reasons to play sex: Sexual violence ―He can be having money and he will tell the girl that [they should] go in town together to cut hair, and when they reach there, you may find that he has convinced the owner of the salon to close her in the shop and they force her to have sex.‖
    11. 11. Reasons not to play sex: Knowledge of HIV transmission and modes of prevention ―First and foremost you should avoid having sex. Secondly, you should avoid sharing sharp things to the people whether infected or not. You can also go and have the test…If they are a wife and husband and they go for a test and they find that one of them is infected, they can advise them to use a condom.‖
    12. 12. Reasons not to play sex: Knowledge of HIV transmission and modes of prevention Despite this, concerning inaccuracies – particularly around anal sex - emerged: …like in men you find that the man puts his penis in the other‘s anus during sex and here he may get the virus or not but is not at a big risk compared to when he is having sex with a woman. For a woman and a woman, these may not get it because they use fingers.‖
    13. 13. Reasons not to play sex: Moral injunction against playing sex ―If you go [to church] and read the Bible... like when they talk about King David who had sex with someone‘s wife and God punished him by making his family commit other crimes and even the death of his son. So when you read such, you know that God does not like that, so you avoid sex such that God does not punish you.‖
    14. 14. Conclusions  Like young people all over the world, youth in Uganda are subjected to pressures to engage in risky sex.  Socio-cultural and economic influences specific to Uganda may foster an environment where social pressure to have sex is particularly strong.  HIV prevention programs should take social, cultural and economic influences and their complex interrelations into account.
    15. 15. FINDINGS FROMTHE DEVELOPMENT SURVEY DEVELOPING CYBERSENGA: DATA INFORMINGTHE CONTENT
    16. 16. Methods  In 2008-2009 we surveyed 5 schools: ◦ 1,508 surveys were completed ◦ 62% were male ◦ Youth ranged in age between 12-19+ years  The aims were to: 1) quantify factors related to HIV information, motivation, and behavioral skills; 2) understand youth profiles based upon their sexual history; and 3) identify „popular opinion leaders‟
    17. 17. What do you use the Internet for? 57% 21% 58% 62% 21% 47% 0% 10% 20% 30% 40% 50% 60% 70% Email Social networking sites Playing games Males Females n=743
    18. 18. What do you SMS about? 77% 20% 42% 36% 18% 48% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Sports Information about health and disease Latest news Males Females n=405
    19. 19. What is your knowledge of HIV prevention (incorrect answers) 24% 42% 24% 18% 51% 18% 0% 10% 20% 30% 40% 50% 60% HIV/AIDS is transmitted throgh sperm/semen If you know a person well, you don't have to use a condom HIV can go through a condom Male Female
    20. 20. The local health center… 52% 63% 75% 40% 47% 60% 65% 48%50% 50% 69% 28% 37% 43% 62% 38% 0% 10% 20% 30% 40% 50% 60% 70% 80% Keeps the information private Is easy to get to Treats you with respect Would give you condoms if you asked Males, no sex Males, had sex Females, no sex Females, had sex All statistically significantly different across the four groups of youth p<0.05
    21. 21. Self esteem: positive aspects 65% 62% 39% 65% 56% 61% 39% 68%67% 63% 43% 69% 63% 60% 33% 61% 0% 10% 20% 30% 40% 50% 60% 70% 80% Satisfied with myself Have a number of good qulities I am a person of worth I am able to do things well Males, no sex Males, had sex Females, no sex Females, had sex
    22. 22. Self esteem: negative aspects 9% 9% 77% 7% 20% 9% 74% 7% 16% 12% 78% 8% 29% 26% 76% 12% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% No good at all Feel useless sometimes Wish I could have more respect for myself I am a failure Males, no sex Males, had sex Females, no sex Females, had sex
    23. 23. Health Concerns 0% 10% 20% 30% 40% 50% 60% Your health Getting money Getting (someone) pregnant Parents' health Males, no sex Males, had sex Females, no sex Females, had sex Very worried about….. All statistically significantly different across the four groups of youth p<0.05
    24. 24. I‟m tired of hearing about HIV prevention 14% 22% 17% 26% 0% 5% 10% 15% 20% 25% 30% Males, no sex Males, had sex Females, no sex Females, had sex Strongly agree
    25. 25. Top 3 things youth are interested in hearing about 34% 40% 41% 42% 45% 54% 60% 61% 0% 10% 20% 30% 40% 50% 60% 70%
    26. 26. Attitudes about sex 17% 60% 79% 8% 58% 77% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Having sex before marriage makes you a better partner You don't plan for sex; it happens You can't control your urges with alcohol Male Female
    27. 27. Attitudes about coercive behavior 47% 58% 37% 48% 0% 10% 20% 30% 40% 50% 60% 70% There's nothing you can say to a boy who wants to play sex Girls just want boys to buy them things Male Female
    28. 28. Attitudes about coercive behavior 47% 58% 37% 48% 0% 10% 20% 30% 40% 50% 60% 70% There's nothing you can say to a boy who wants to play sex Girls just want boys to buy them things Male Female
    29. 29. Physical aggression in romantic relationships 30% 38% 44% 39% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Hit, slapped, or phyiscally hurt by a boy/girlfriend Been hit, slapped, or phyiscally hurt by a boy/girlfriend Male Female Among youth who have had a boyfriend or girlfriend (n=786)
    30. 30. Gift giving to have sex* 28% 24% 18% 55% 0% 10% 20% 30% 40% 50% 60% Given money, gifts, clothes, gifts so the other person will have sex Received money, gifts, clothes, gifts so you will have sex Male Female Among youth who have had sex (n=314; 327)
    31. 31. Percent of youth who have ever had sex 20% 7% 42% 31% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Males Females Have never had sex Have ever had sex
    32. 32. % of youth with sexual experience by age and biological sex 0 21 24 33 39 47 37 64 6 9 16 19 28 28 37 40 0 10 20 30 40 50 60 70 12 13 14 15 16 17 18 19 Youth age (years) Male (n=889) Female (n=549)
    33. 33. Conclusions for design  Given the popularity of online games, games will be important for engagement of youth  Based upon the percent of boys who SMS for information about sports, boys‟ content especially needs to include sports themes
    34. 34. Conclusions for content  We need to making sure that youth know HIV is not small enough to get through a condom is important.  Also, we need to focus on changing norms to use condoms with people youth know as well as do not know well.  Need to start changing norms for accessing health services - especially for girls, giving specific referral information.  Females who have had sex seem to be particularly in need of positive messaging. We need to actively promote their self-worth.
    35. 35. Conclusions for content  HIV prevention fatigue is high ◦ Need to focus on fundamentals of healthy adolescence: problem solving, coping skills, etc  Based upon what youth say they are interested in: ◦ Teaching condom usage skills is not high on their list, so need to „sell‟ the importance of it for everyone ◦ General relationship skills are needed, e.g., how do you end a relationship if it‟s not going well. ◦ Also, refusal skills are important: how do you avoid sex – especially if you have played sex before?
    36. 36. Conclusions for content  Directly address boys‟ assumption that having sex makes him a better man and a better husband.  Talk about how drugs and alcohol impair judgment but that youth still can control their urges (they are responsible for their behavior).  Gift giving is not uncommon to initiate a relationship, but it seems to be particularly common for girls who have had sex and should likely be integrated into their scenarios.  Need to change norms for physical violence perpetration – particularly for girls.
    37. 37. SEXUAL COERCION IN ADOLESCENTS:VOICES FROMYOUNG PEOPLE A DEVELOPING CYBERSENGA: DATA INFORMINGTHE CONTENT A Excerpts from: Birungi R, Nabembezi D, Kiwankua J, Ybarra M, Bull S (2012).Adolescents‟ perceptions of sexual coercion in Uganda. American. East African Journal of Public Health. 7(1): 58-63
    38. 38. Methods  Three focus groups were conducted with „popular opinion leaders‟ at partner schools ◦ Two groups were conducted with boys (n=13) ◦ One group was conducted with girls (n=7)  All groups were asked the same questions  The aim of the groups was to understand youth‟s experience and perceptions of coercive sex, and understand how we should address this issue in the CS content
    39. 39. Verbal pressure is common ‗A situation may happen, like you are attending a function and you spend a night there, and when you are there in the night the boy tells you that — I am badly off, you need to help me — and you finally give in against your will…you have come without the intention of having sex, but you reach [there and] the person starts demanding.‘
    40. 40. Coercion is perpetrated by adults ‗When you are having someone older than you, you have to give respect to that person. That person is going to fear the age of the person, and then they will keep quiet.That is where that kind of thing is going to come from…‘
    41. 41. …but not by adolescents ‗For adolescents, for them they just fall in love with each other, but I do not think that they are forced.The forced sex I know is between the adult and the young people.That one I know is where there is forced sex.‘ A few disagreed however... ‗For me, what I think even there are some adolescent boys who take girls to some extent, they force them to have sex with them.‘
    42. 42. Men are perceived to be the coercers, females the victims ‗You would rather go for girls rather than boys because men have this mentality that these young girls are not infected with HIV, and then he wants to infect that girl.‘ ‗For example, if you are talking to sugar mummies and sugar daddies, you find that the information [mostly] applies to girls; you should put more emphasis on [the risks that young girls face from men].‘
    43. 43. Coercion can be achieved through gifts ‗In most cases you find the adult is the one approaching the adolescents; like you find that they give them small gifts like money and other gifts in order to seduce these young people.‘ ‗When someone gives you a gift, obviously that person loves you, then, now you think that the next thing has to be that [sex].You think that okay this person has given me a gift because he loves me, he cares about me, and now there are two people in a relationship; you know that love is sex — the next thing will be having sex.‘
    44. 44. Coercion can be achieved by exploiting financial needs ‗Like you find the adult is assisting the adolescent in some basic needs…. So you find the adolescent plays sex with an adult so that they can keep getting assistance from the adults.‘
    45. 45. Coercion can be facilitated with alcohol ‗Like you can be there and you get a girl, and you get her booze and you convince her and at the end of it all, you find that they are drunk. So due to that influence of alcohol, you find that they end up playing sex.‘
    46. 46. Coercion can be facilitated by adults with authority over the youth ‗There was this girl who was staying with the stepmother and the stepmother had a friend who was a man.Those people had a belief that sleeping with a young virgin girl can cure AIDS.That man has AIDS and he was a close friend to the stepmother. So the stepmother decided to give her that one whose mother is dead. She was then raped and she got infected.‘
    47. 47. Victims are responsible too ‗I heard about a man who had a daughter. He used to give her the boda boda man to take her to school; so one time…the man had no time to pick the girl from school, and he sent the boda boda man to pick her [up], and the boda boda man raped the girl.‘ Even the way girls wear [clothes] affects boys too much…because when you see a girl putting on a short skirt, it makes them feel like dying.‘
    48. 48. It is difficult to talk about (and therefore report) rape ‗Okay when someone is your parent‘s friend, your father will begin trusting him. He can even trust him to take you to school, so through that, the friend tells you something and you wonder how you are going to tell your father, so you just keep it and in the long run you find yourself in a relationship.‘
    49. 49. Conclusions for content  Help youth identify safe places to report sexual violence  Foster skills to think critically about the intention behind gifts, and skills to refuse unsafe gifts  Address misconceptions: ◦ Both boys and girls can be perpetrators ◦ Adolescents can perpetrate and are more likely to be involved than adults
    50. 50. Acknowledgements  We would like to thank the entire CyberSenga Study team from Center for Innovative Public Health Research, Internet Solutions for Kids – Uganda, Mbarara University of Science andTechnology, the University of Colorado, and Harvard University, who contributed to the planning and implementation of the study. Finally, we thank the schools and the students their time and willingness to participate in this study.
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