Sexual learning among East African adolescents in the context of generalized HIV epidemics: A systematic qualitative meta-synthesis

BackgroundAIDS-related illness is the leading cause of mortality for adolescents in sub-Saharan Africa. Together, Kenya, Tanzania, and Uganda account for 21% of HIV-infected adolescents in sub-Saharan Africa. The United Nations framework for addressing the epidemic among adolescents calls for comprehensive sexual and reproductive health education. These HIV prevention efforts could be informed by a synthesis of existing research about the formal and informal sexual education of adolescents in countries experiencing generalized epidemics. The purpose of this study was to describe the process of sexual learning among East African adolescents living in the context of generalized HIV epidemics.MethodsQualitative metasynthesis, a systematic procedure for integrating the results of multiple qualitative studies addressing a similar phenomenon, was used. Thirty-two research reports met study inclusion criteria. The reports were assessed in a four-step analytic process: appraisal, classification of findings, synthesis of findings, and construction of a framework depicting the process of sexual learning in this population.ResultsThe framework includes three phases of sexual learning: 1) being primed for sex, 2) making sense of sex, and 3) having sexual experiences. Adolescents were primed for sex through gender norms, cultural practices, and economic structures as well as through conversations and formal instruction. They made sense of sex by acquiring information about sexual intercourse, reproduction and pregnancy, sexually transmitted infections, and relationships and by developing a variety of beliefs and attitudes about these topics. Some adolescents described having sexual experiences that met wants or needs, but many experienced sex that was coerced or violent. Whether sex was wanted, coerced, or violent, adolescents experienced worry about sexually transmitted infections or premarital pregnancy.ConclusionsThe three phases of sexual learning interact to shape adolescents’ sexual lives and their risk for HIV infection. This framework will contribute to the development of sexual education programs that address HIV risk within the broader context of sexual learning.背景：与艾滋病相关的疾病是撒哈拉以南非洲（sub-Saharan Africa）青少年的首要致死病因。肯尼亚、坦桑尼亚和乌干达三国合计占撒哈拉以南非洲感染人类免疫缺陷病毒（HIV）青少年总数的21%。联合国针对青少年群体的艾滋病防控框架呼吁开展全面的性与生殖健康教育。现有针对艾滋病广泛流行国家中青少年正式与非正式性教育的研究综述，可为艾滋病预防工作提供参考依据。本研究旨在描述身处艾滋病广泛流行环境中的东非青少年的性学习过程。 方法：本研究采用定性元综合（qualitative metasynthesis）方法，这是一种整合多项针对同一相似现象的定性研究结果的系统流程。最终有32篇研究报告符合纳入标准。研究采用四步分析流程对报告进行评估：研究评价、研究结果分类、研究结果综合，以及构建描述该群体性学习过程的理论框架。 结果：该框架包含性学习的三个阶段：1）性启蒙准备，2）理解性认知，3）获得性经验。青少年通过性别规范、文化习俗、经济结构，以及相关对话与正式教学完成性启蒙准备。他们通过获取性交、生殖与妊娠、性传播感染、亲密关系相关知识，并形成针对这些主题的多元信念与态度，完成性认知的构建。部分青少年表示其性经历符合自身意愿或需求，但多数青少年的性经历为强迫或暴力性。无论性经历是自愿、强迫还是暴力，青少年均会担忧感染性传播疾病或婚前妊娠。 结论：性学习的三个阶段相互作用，共同塑造青少年的性生活及其艾滋病感染风险。本研究构建的框架将有助于开发针对性学习整体场景下的艾滋病风险防控的性教育项目。