What information do adolescent girls need to prevent HIV, STIs and unintended pregnancies?

Recently published research with adolescent girls in South Africa suggest they want to know how to deal with the pressure to have sex and would also like in-depth information about how HIV and sexually transmitted infections (STIs) are passed on. And they want to get this information anonymously online or from older peers or non-judgemental adults. 

What is the research about? 

Twenty-five adolescent girls (ages 14-17) from the Mangaung Metropolitan Municipality in the Free State Province were interviewed. They were asked what kind of information adolescent girls want to prevent unintended pregnancies, STIs and HIV, and how they want to receive it. 

Why is this research important? 

In South Africa and across sub-Saharan Africa, adolescent girls are at risk of unintended pregnancies, STIs and HIV. National data suggests around 80% of 15 to 19-year olds are having sex. But only one-third use contraception, and condom use is low. In 2021, 9% of adolescent girls and young women had HIV, three-times the rate of their male peers. 

What did they find out? 

Participants wanted sexual and reproductive health (SRH) information to be more in-depth than it currently is. They wanted to know how HIV and STIs are transmitted and how infections can be prevented.  

Participants also wanted to know how to resist pressure from male partners and female friends to have sex.  

They wanted SRH information to be high quality, non-judgemental and accessible.  

Getting SRH information online was the most popular method. This is because online information is easily accessible, private and confidential.   

Participants said SMS or text messages were also an acceptable way to get SRH information. But some were worried about this method as they were unsure if they would be able to save the information to look at another time. 

Participants were willing to get SRH information from older peers, social workers and teachers. But adults had to be open, relatable, trustworthy and well-informed and give non-biased recommendations. 

Some said they would like to receive SRH information from same-aged peers because they could talk freely. But others felt same-age peers were untrustworthy or would intentionally provide misinformation. Or their lack of experience would make the information inaccurate. 

Participants had mixed views about getting SRH information from parents. Some felt that parents would judge them and would provide biased information. Others felt parents could be a trustworthy source of SRH information if they were open with their child. 

Community sexual health clinics were seen as the best places to get SRH information. Some participants felt they could ask questions anonymously without fear of judgment or stigma in these clinics. They also trusted clinic staff. But others were worried about privacy and being judged if they went to a sexual health clinic. 

Schools were also acceptable places to get SRH information. Participants felt more comfortable discussing sex at school than at home with parents.  

A few participants said adolescent girls like to get SRH information from youth community centres. But some were against this because they did not trust their peers to provide accurate information and respect their confidentiality. 

What does this mean for HIV services? 

It is important to provide SRH interventions for adolescents girls aged 14 to 17 as this is when many start having sex.  

This research found a clear preference for accessible, non-judgemental, and high-quality information. These are a good starting point for anyone developing SRH information. Initiatives have the greatest chance of working if they are co-designed with the adolescent girls they are targeting. A co-design process will help identify what kind of SRH information they want and how best to provide it.  

In terms of how to provide information – online, SMS/text, or delivery by social workers or older, knowledgeable peers, may be good formats to explore in a co-design process. When it comes to using peer educators, it is important to understand what adolescent girls think of peers their own age, whether they need peers to be slightly older to trust them, or if they would prefer to get information from a non-judgemental adult.