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By medical reporter Sophie Scott and National Reporting Team's Rebecca Armitage
Posted Thu 29 Jun 2017 at 11:49pmThursday 29 Jun 2017 at 11:49pmThu 29 Jun 2017 at 11:49pm
More Australian teenagers are viewing porn and doing so at a younger age than ever before, according to new research.
Burnet Institute researcher Dr Megan Lim, who did the study, said she was surprised at how commonly pornography was viewed by Australians aged 15-29.
"All the young men in our study said they'd seen pornography, and so did the majority of women," Dr Lim said.
"They also reported seeing pornography at quite high frequency."
The study of more than 940 young people found the typical age for boys to view porn for the first time was 13, and 16 for girls.
"Around 80 per cent of young men said they watched weekly, and among the women who watched pornography, nearly two-thirds viewed at least monthly," Dr Lim said.
Researchers identified a link between pornography use, mental health problems and becoming sexually active at a younger age.
"We're not out to prove that watching porn is a bad thing. But definitely watching pornography more frequently is associated with some negative outcomes such as poor mental health, though we can't say from this study if one is causing the other," Dr Lim said.
They also found young people identifying as lesbian, gay, bisexual, transgender, intersex, and queer watched pornography more frequently and from a younger age.
Dr Lim said the findings of the study had important implications for developing relevant sexuality education.
"While we're not clear on what kind of influence it might be having on [young people's] sexual development, with such high rates of use pornography needs to be considered in teaching people about sex in a changing world," Dr Lim said.
She said appropriate sex education needed to be implemented in high school, if not earlier.
"I'm not suggesting schools provide details about how to have anal sex, but they need to acknowledge it does exist in the real world as well as in porn and to discuss the differences in how it's portrayed in pornography as opposed to how it's practiced in the real world," she said.
"Pornography is designed for entertainment and it's a performance. It doesn't reflect what people necessarily do in the real world."
Researchers also found young people who did not identify as heterosexual often felt excluded from sexual education at school, which is often focused on heterosexual behaviour.
"Our hypothesis is that these teenagers are being missed in traditional sex education and even in the media," Dr Lim said.
"There's very little information out there for diverse groups.
"So young people may be seeking further information about things they're curious about, and one of the only ways they're able to access that is through pornography."
The study, based on an online survey of 941 participants recruited via social media in 2015, is published in the Australian and New Zealand Journal of Public Health.
Posted 29 Jun 201729 Jun 2017Thu 29 Jun 2017 at 11:49pm
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Porn video shows, local brew, and transactional sex: HIV risk among youth in Kisumu, Kenya
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Carolyne Njue, Helene ACM Voeten, and Pieter Remes
Kisumu has shown a rising HIV prevalence over the past sentinel surveillance surveys, and most new infections are occurring among youth. We conducted a qualitative study to explore risk situations that can explain the high HIV prevalence among youth in Kisumu town, Kenya
We conducted in-depth interviews with 150 adolescents aged 15 to 20, held 4 focus group discussions, and made 48 observations at places where youth spend their free time.
Porn video shows and local brew dens were identified as popular events where unprotected multipartner, concurrent, coerced and transactional sex occurs between adolescents. Video halls - rooms with a TV and VCR - often show pornography at night for a very small fee, and minors are allowed. Forced sex, gang rape and multiple concurrent relationships characterised the sexual encounters of youth, frequently facilitated by the abuse of alcohol, which is available for minors at low cost in local brew dens. For many sexually active girls, their vulnerability to STI/HIV infection is enhanced due to financial inequality, gender-related power difference and cultural norms. The desire for love and sexual pleasure also contributed to their multiple concurrent partnerships. A substantial number of girls and young women engaged in transactional sex, often with much older working partners. These partners had a stronger socio-economic position than young women, enabling them to use money/gifts as leverage for sex. Condom use was irregular during all types of sexual encounters.
In Kisumu, local brew dens and porn video halls facilitate risky sexual encounters between youth. These places should be regulated and monitored by the government. Our study strongly points to female vulnerabilities and the role of men in perpetuating the local epidemic. Young men should be targeted in prevention activities, to change their attitudes related to power and control in relationships. Girls should be empowered how to negotiate safe sex, and their poverty should be addressed through income-generating activities.
Globally, the HIV epidemic is increasing faster amongst young women than young men and nowhere is this trend more apparent than in sub-Saharan Africa [1]. Statistics in sub-Saharan Africa remain disturbingly high, with 75% of all young people living with HIV being female [2-4]. The main form of HIV transmission is heterosexual sex. Of the young women aged 15-24, HIV prevalence is three times higher than HIV among their male counterparts. The contrasting HIV prevalence between boys and girls is a pattern observed in many parts of sub-Saharan Africa [4,5].
Kisumu town is found by the shores of Lake Victoria, is the capital of Nyanza province and the third largest town in Kenya. It is one of the most HIV/AIDS affected areas in Nyanza with a prevalence of 18.5% [6]. Nyanza province, in general, is the most severely affected, with HIV rates as high as 15%, which is double the national average [6,7]. Studies conducted in Kisumu in the late nineties show that HIV prevalence among girls was very high compared to boys (age group 15-19 years 23% versus 4%; age group 20-24 years 40% versus 13%) [6]. HIV prevalence among female sex workers was also very high, at 75% [8]. Although more recent figures for Kisumu are slightly lower, the numbers are still alarmingly high, and higher than in other parts of the country [9,6]. High HIV prevalence rates (30%) as well as very high rates of STIs have been noted among fishing communities along the shores of Lake Victoria [10,11]. These high rates of HIV/AIDS in Luo Nyanza have left 40% of children under 18 without one parent, and 11% without both parents [6,12]. Cultural norms such as wife inheritance and widow cleansing, polygamy, "jaboya" (in which female fishmongers develop sexual relationships with fishermen and middlemen in exchange for fish), and "chira" (a curse that comes from breaking certain taboos and traditions), continue to have a powerful hold on people in this lakeside province [10,13,14].
We conducted a qualitative study on the sexual behaviour of young people in Kisumu, to further explore results from an earlier population survey on factors determining the differential spread of HIV in four African cities: two with a relatively low and stable HIV prevalence (Cotonou and Yaoundé) and two where the spread of HIV has been explosive (Kisumu and Ndola) [15]. This study showed that girls in Kisumu had older sexual partners than boys and higher rates of herpes simplex type 2, which are both risk factors for HIV transmission. But most girls reported very few sexual encounters, and HIV prevalence was very high even among girls reporting one lifetime partner and few episodes of sexual intercourse. This may be due to underreporting, but also may indicate high transmission during loss of virginity [5]. Our aim was to deepen our understanding of the dynamics of sexual interactions of adolescents, in order to explain the high HIV prevalence among Kisumu youth in general and specifically among girls. We triangulated data from in-depth interviews, focus group discussions (FGD), and observations, to generate a holistic description of the contexts and dynamics of sexual interactions among youth.
We conducted 150 in-depth interviews with adolescents aged 15-20 in Kisumu, held 4 FGDs, and performed 48 observations at places where youth spend their free time. The Institute of Tropical Medicine in Antwerp, Belgium, and the Ethical Review Board in Kisumu approved this study.
For the in-depth interviews, a convenience sample of 75 boys and 75 girls aged 15-20 years were interviewed at their households. Using the sampling framework of the multicentre study, quota sampling was used to ensure diversity in age, socio economic status (SES) of household, and education [9]. A qualitative interview guide was developed in English and translated into Swahili and Luo. Trained fieldworkers pre-tested the guide in communities neighboring the study sites. The interviews were held in Luo, Swahili or English by same-sex interviewers, and tape-recorded; they took about 45 minutes to one hour. Prior to the in-depth interviews, verbal informed consent/assent was obtained from all adolescents, in addition to parental consent for minors.
Four focus group discussions (FGDs) were held by same-sex interviewers in preparation for the in-depth interviews (i.e. with in-school males, in-school females, out-of-school males, out-of-school females). A topic guide was used, that was pre-tested for face and construct validity. The FGDs mainly focused on youth's attitudes, risk perception and socio-cultural norms regarding sexuality. Each FGD had 8 to 12 participants aged 15-20, and the discussions took about one and half hour.
We made 48 observations of young people's behaviour at places where youth spend their free time 'hanging around', such as nightclubs/bars, video halls, shopping malls, local brew dens, and funerals. We sought permission from the persons in charge and ensured confidentiality of all collected information. The field workers tried to get an inside view of reality without the participants' knowledge that they were being observed. Short notes were taken during the 2-to-3 hour observations when possible, and detailed notes were compiled afterwards describing the physical setting, the activities taking place, socio-demographics of participants (estimated age, gender), and their verbal and non verbal behaviour.
The audio-taped interviews and FGDs were transcribed verbatim and translated into English where necessary [16]. Data analysis of the in-depth interviews, FGDs and observations followed grounded theory principles, which allows analytical themes to emerge during the process of (re)reading transcripts and exploring and coding responses [17]. This approach is based on inductive analysis and consists of carefully reading/rereading interviews and observations, exploring and coding responses, and allowing new themes, issues and questions to emerge during the process. Using ATLAS.ti 4.1, a qualitative data analysis software program, the first and third author coded the transcripts, categorizing the data into themes, and identified the properties and dimensions of themes and subthemes. The following themes relating to risky sexual behaviour emerged from the interviews, FGDs and observations and are discussed below: young age at first sex, large age difference with male partners, multiple/concurrent partnerships, porn video shows, forced sex, low condom use, local brew/alcohol use and transactional sex. Where quotes are used in the Results section, they are from the in-depth interviews unless indicated otherwise.
Of the 150 interviewed adolescents, 55% were attending school (18 primary and 64 secondary school) whereas 45% were out-of-school youth (51 were unemployed and 17 were working in small micro-enterprise businesses, in domestic service, or as bicycle taxi operators). Over 85% of adolescents were born in Kisumu or had lived there for 10 years or more. The average age of adolescents interviewed in the study was 17.5 among boys and 17.0 among girls.
Of the youth interviewed, 79% of boys and 49% of girls reported they ever had had sex. Of these, 37% of boys (22/59) and 59% of girls (22/37) had their first sexual intercourse at age 15 or younger. A 15-year-old girl from a low-SES area stated: "In this area of ours, many girls...get pregnant while they are very young because of starting sexual relationships very early, maybe like my age, you will find one has a boyfriend and later on she is made pregnant and then she is left which is not good."
Most girls reported a large age difference with first and current partners. Sixteen of the 28 girls who mentioned the age of their first partner reported that he was 25 years or older. All girls with a current partner had a partner who was over 20 years old (ranging from 2 to 17 years older). One girl stated: "...well if I am 20 I will go for a guy who is older than me by six years or something like three... because you cannot move [date] a guy who is the same age as you...." Older men were preferred, as they proved to be more mature, could provide for their needs, and offer advice to solve problems. During the observations, older men were often seen with girls as young as 15.
Of the sexually active adolescents, over half of the girls reported having had 2-3 partners; over half of the boys indicated having had 3-5 partners and about a third reported more than 10 girlfriends. A few boys found it difficult to count all sexual partners: "Some you can meet, you talk, have sex, then it just ends there so remembering them is difficult". Some of the bicycle taxi transporters reportedly had sex daily, with different partners. Girls mostly reported serial monogamy and rarely stated outright that they had concurrent partners. In contrast, many sexually active boys casually reported having overlapping partnerships: "...the first is the one we talked about, ...the second is the one who was here, and the third is the one I connect with at the video hall." Even among young men with a steady partner, it was common to have brief sexual encounters on the side, for example while at the video halls or attending a disco funeral. These 'disco funerals' are parties held by the relatives of a person recently deceased, in order to raise funds for the funeral. The disco funerals are characterised by loud music, singing, dancing, bidding games and risky sexual behaviour. Because we have described these events (in which Kisumu youth engage in risky sexual behaviour) in a separate paper, we do not elaborate on it here [18].
A third of the youth interviewed (49) report porn video shows either from personal attendance or as an influence on youth sexuality. Some also report watching porn at home or at the home of a friend: "Whenever I used to go to the neighbour's to watch movies, she [a 14-year old domestic worker] could steal some tapes of 'pono', put them on, then try to convince me why don't we try that one" (17 year-old boy). Video show halls are basically rooms with a television and VCR, they are popular leisure spots, where youth pay to watch movies. The fieldworkers did a dozen of random observations in video halls: 8 out of 12 were showing pornography at night. Most attendees were young men, but some girls also attended. The fee ranged from €0.05-0.15, and any youngster with a little money (even a 12-year old) was able to enter. The movies ranged from non-violent to violent pornography, and the scenes revolved around group sex, anal sex, and oral and vaginal intercourse. Youth said that the owner of a video hall most times disguises the announcement of a featured film and writes "on-por": in such a way youth know that "porno" will be shown. During one observation, several adolescents engaged in sex in the darkness of the hall.
Reports of forced sex were many: 15 of 37 sexually active interviewed girls reported some degree of force/persuasion during first sex. Some girls were lured into secluded places such as a boy's cube [separate living quarter for boys], and were forced to have sex: "This boy told me to visit him so when I went, he put the radio on... then later he just held me by force." A 17-year-old boy reported: "Say you've been dancing with her and you've told her that thing [sex] and she has refused, you just hold her and pull her by force till you go with her... to the bush or darkness where people don't go to..." Another girl said that a boy grabbed and pinned her down and forced her to have sex at age 13. Some boys were said to waylay prostitutes and force them to have sex: "Especially when it is night you meet a lot of girls hijacked by a group of men, being pulled to some place... they know these girls are prostitutes, they sell for money. But these groups of boys don't have any cash, they just get them and hijack them yah," (FGD, out-of-school boys).
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