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Exploring Sexual Behaviour of Women in Zambia: A Qualitative Study

Article · October 2016

DOI: 10.9734/BJESBS/2016/20387

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 British Journal of Education, Society &
Behavioural Science
12(2): 1-19, 2016, Article no.BJESBS.20387
ISSN: 2278-0998

SCIENCEDOMAIN international
www.sciencedomain.org

Exploring Sexual Behaviour of Women in Zambia:

A Qualitative Study
Catherine M. Ngoma1*, Janetta Roos2 and Seta Siziya3
1
Department of Nursing Sciences, University of Zambia, School of Medicine, P.O.Box 50110,
Lusaka, Zambia.
2
Department of Health Studies, University of South Africa, Pretoria, South Africa.
3
Department of Community Medicine, University of Zambia, School of Medicine, P.O.Box 50110,
Lusaka, Zambia.

Authors’ contributions

This work was carried out in collaboration between all authors. Author CMN designed the study, wrote
the protocol, collected, analysed data and drafted the manuscript. Author JR supervised the protocol
and the research process. Author SS supervised the protocol and managed the analysis of the study.

Article Information

DOI: 10.9734/BJESBS/2016/20387
Editor(s):
(1) Redhwan Ahmed Mohammed Al-Naggar, Management and Science and University,
Malaysia.
Reviewers:
(1) Bernard Lambert, University of Montréal, Canada.
(2) Carol Caico, New York Institute of Technology, USA.
Complete Peer review History: http://sciencedomain.org/review-history/11745

Received 25th July 2015

Original Research Article Accepted 10th September 2015
th
Published 8 October 2015

ABSTRACT

Aim: The aim of the study was to explore sexual behaviour among women aged 15 -25 years.
Study Design: Qualitative study.
Place and Duration of the Study: Nangoma mission hospital catchment area in Central province,
and Chikankata Hospital catchment area in Chikankata district of Southern Province.
Methodology: We conducted 8 focus group discussions with 72 participants. The discussions
were conducted using the same topic guide for all the groups, transcribed and subjected to
framework analysis.
Results: The study findings indicate that many young women were sexually active and initiated
sexual activity at an early age. Factors that contributed to early initiation of sexual activities include
fear of rejection by stable partners, betrothals, coercion into marriages by guardians, incest, lack of
negotiation skills with sexual partners and poverty. Many participants’ sexual partners at first
_____________________________________________________________________________________________________

*Corresponding author: E-mail: catherinengoma@yahoo.com;

 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387

intercourse were more than five years older than themselves. Some of the study participants had
multiple sexual partners due to various factors such as curiosity, fear of partner violence, lack of
assertiveness, sign of beauty and poverty.
Many participants in both groups engaged in unprotected sex due to various reasons. Some had
never seen a condom before, some trusted their sexual partners and thought there was no need to
use a condom, others stated their partners didn’t’ allow them to use a condom. Other participants
didn’t use a condom because it wasn’t available, others couldn’t use it due to misconceptions such
as lack of sexual enjoyment. In some situations, participants couldn’t use a condom because of the
environment in which they found themselves, those with casual sexual partners stated that sexual
intercourse is usually performed in the bush and in hurry for fear of being discovered by passersby.
Some participants couldn’t use the condom on account of their doctrine. A few participants used
the condom for pregnancy protection.
The study revealed that most participants would not initiate condom use with their sexual partners
for fear of rejection, abandonment, infidelity and being suspected of having HIV and AIDS however,
some participants were willing to initiate condom use with their sexual partners for pregnancy
protection. Many participants in didn’t discuss sexual matters nor HIV and AIDS, and sexually
transmitted infections with their sexual partners. A few participants discussed issues on pregnancy
protection with their husbands.
Conclusion: The study shows that women engage in risk sexual behaviour. Continued
sensitization is required in order to prevent women from engaging in risky sexual behaviour.

Keywords: Exploring; sexual behaviour; women; Zambia; qualitative.

1. INTRODUCTION area in Chikankata district of Southern Province.

This was part of the major that was conducted in
Every minute one young woman becomes three phases.
infected with HIV, with sub-Saharan Africa
reporting the percentage of young women aged 2.3 Study Population
15-24 living with HIV being twice that of young
men [1]. Due to their biological make up, women The study population was women aged 15-24
are more likely to become infected with HIV years.
through unprotected heterosexual intercourse
than men because they are not able to negotiate 2.4 Sampling Method
safer sex and may be coerced into non-
consensual sex [2]. Although global estimates The study participants were purposefully
show decline HIV prevalence among young selected.
people, little is known about the burden of HIV
and AIDS and how their needs for HIV 2.5 Ethical Clearance
prevention, care and treatments have been
addressed. In Zambia, HIV and AIDS prevalence Ethical clearance was obtained from the
among the girls is still high (8.8%) compared to University of Zambia Biomedical research ethics
boys of the same age (4.3%) and many young committee, the Hospital directors and village
people women engage in sexually activities very headmen. Informed consent was obtained from
early with partners who are five years their senior the respondents before the commencement of
and who may already have had a number of the study.
sexual partners [3].

2. MATERIALS AND METHODS 2.6 Data Collection and Analysis

2.1 Study Design Data was collected using a similar focus group
discussion guide for all the groups that was pre-
Qualitative study. tested and addressed the key aims of the study.
The information obtained included age at sexual
2.2 Study Area debut, age of partner at first intercourse, ever
used a condom, number of sexual partners,
Nangoma Hospital catchment area in Central condom use with. The interviews lasted 1-1.5
province and Chikankata Hospital catchment hours. Data was transcribed and common

2
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387

themes identified. To explore sexual behaviours, for women is critical because educated women
participants discussed themes such as, sexual are more productive, have decision making
activity, condom use with sexual partners, power over their reproductive health choices and
condom use and religion, condom initiation with do a better job caring for children.
sexual partners, whether they discussed HIV and
AIDS/STI prevention with sexual partners, how Most young women were married indicating that
the problem of HIV and AIDS could be early marriages are common in Zambia. Young
addressed and who in the community should married women often face insurmountable
address the problem of HIV and AIDS. barriers to education, information and health care
including family planning, especially when they
Table 1. Topics addressed with participants are expected to begin bearing children soon after
marriage. Early marriage is a violation of human
Themes Sub themes rights perpetuated by poverty, traditional
Sexual activity Initiation of sexual practices and discrimination [4]. Therefore, much
intercourse effort is needed to address the special
First sexual encounters reproductive health needs of married
Number of sexual adolescents to raise community awareness of
partners the harm early marriage and child bearing can do
Age of the participants’ to young women and to address its underlying
sexual partner at first cause.
sexual intercourse
Condom use with The number of children each woman mothered
sexual partners ranged from one to three. This result shows that
Condom use and most women begin child bearing early. Early
religion pregnancy poses numerous health risks for the
Condom initiation adolescent women for instance pregnancy
with sexual partners related complications are one of the leading
Discussed HIV and causes of death worldwide for 15-19 year olds
AIDS/STI and studies in some countries find them twice as
prevention with likely to die or be injured as women in their 20s
sexual partners [5]. A particular threat to pregnant teenagers is
How the problem of obstetric fistula - a hole between a woman’s
HIV and AIDS could vagina and her urinary bladder and/or rectum
be addressed that results from obstructed labour. An estimated
Who in the 50,000 to 100,000 women develop fistulae each
community should year and almost all of these cases are in
address the developing countries [6].
problem of HIV and
AIDS 3.1 Sexual Activity among the
Participants
3. RESULTS AND DISCUSSION
The research found that almost all the focus
Most participants were aged between 15-19 groups participants were sexually active.
years. This means that two thirds of the study
participants were adolescents who need Young women engage in sexual activities due to
education and information to be able to make various factors. Young women have a confused
right choices regarding their health, future and sense of identity; being between childhood and
personal development for instance choices about womanhood their view of themselves is
sexual intercourse, work and family. ambiguous. Women are seen by males and by
themselves as persons to be taken care of and
The educational background of the participants protected [7]. The other factors are that young
ranged from no education to with primary women engage in sexual relationships with older
education and with lower secondary education. men (Sugar daddies) in exchange for money or
This result shows that a lot still needs to be done gifts and because of peer pressure [8]. Sugar
in terms of providing universal primary education. daddies think that young girls are free from HIV
This is because lack of education limits women’s while the girls and their parents see the sugar
social and economic empowerment. Education daddy as a way of relieving poverty [7].

3
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
Only very few participants were not sexually
active. The reason given by the participants for
abstaining was that they did not find right
partners yet.
3.1.1 Initiation of sexual intercourse by the
participants
The initiation of sexual intercourse is a milestone
in the physical and psychological development of
men and women in all societies, and both the
timing of this event and context within which it
occurs can have immediate long-term
consequences for individuals [9]. There are
possible serious health and social consequences
for women who begin to have intercourse while
very young or not married especially if they
become pregnant and have either an unplanned
birth or in some settings an unsafe abortion. In
some instances early sexual intercourse is
involuntary, for example, when a young woman
is raped, a victim of incest or turns to prostitution
because of financial need [9]. Furthermore, first
sexual intercourse exposes young women to the
risk of contracting HIV and possibly also other
sexually transmitted infections.
With regards to the ages at first intercourse, most
participants had their first intercourse between 15
to 19 years, some had their sexual debut
between 12-14 years and a few began sexual
activities between the ages 8 and 19. The mean
age was 15 years. These results show that sex
debut takes place early.
Young women may fear being rejected by the
would-be marriage partner if they do not give in
to his sexual advances and this may make them
indulge in sexual activities. In addition, poverty
could also lead to early initiation of sexual
activities by young women. As indicated in the
following narratives:
“I did it just before puberty with my boy
friend who promised me marriage when I
was about 11 years. I was still in school in
th
the 4 grade. It happened just after school in
the bush as we were proceeding home.
From there on we had sexual intercourse
several times. But the unfortunate thing is we
never married. He went to secondary school
and I failed grade 7 and got married to a
different man who is much older”.
“I had sexual intercourse for the first time at
the age of 12 years with my husband to be.
He called me at his home. He asked me to
4
clean his house and while sweeping he held
me closely and eventually he started
demanding for sexual intercourse. I did not
want, but since I was scared he would not
remain interested in me if I refused, I let him
have sexual intercourse with me”.
“I was forced by my aunt to indulge in sexual
activity after I failed grade 7 and I was 14
years by then. She looked for a married man
for me to teach me how to do it. This man
later became my regular sexual partner. I
tried to refuse but the man was persistent
since he was encouraged to do so by my
aunt. One day, I was going to draw some
water at the well, he called me and asked me
to pick a parcel for my aunt. I went to him
and he lured me into the tall grass and he
forced himself on me. That was how it
started until I got pregnant but he continued
to support our family”.
On the other hand, a few participants
commenced sexual activity between the ages of
8 to 10 years. This could be attributed to the fact
that the group belonged predominantly to the
Tonga tribe which practices the outdated culture
of betrothal where a young girl is given in
marriage before puberty. This practice makes the
girl vulnerable to sexual abuse by the husband
who in most cases are much older than the girl.
Due to imbalance in the relationship and bride
price, the girl is not able to say no to sexual
abuse as men’s needs are expected to dominate
in relationships and violent sexuality is tolerated
[10]. The other factor could be that the girls lack
sexual negotiation skills as reflected in the
responses by these two participants:
“I was betrothed when I was young and I
went to live with my in-laws soon after that.
My husband invited me in his house before
puberty. He told me to lie down. He quickly
and brutally penetrated me and I tried to
scream from pain but he held my mouth”.
“I first slept with a man for the first time when
I was in primary school. I was in grade 4 at
the age of 10 years old. This happened one
afternoon in the bush after school as we
were going home. The boy was 16 years old
and in grade 7. He told me that if I really
loved him, I should do it with him to prove my
love for him. I could not resist him, the next
thing we were making love although it hurt”.
(Free translation).
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
From the findings presented above, one can
deduce that child marriages may no longer be
tolerated but betrothals and coercion of women
by their guardians into marriages against their
wishes are by no means things of the past.
This study has also revealed that incest exist in
the community in Zambia. For example, several
participants narrated that their first sexual
encounters were with their cousins and
grandparents as indicated by the following
participants:
“I used to live with my grandparents, my
parents sent me there so that I could help
them with household chores because
grandmother’s health was failing her. One
day Grandmother went away…. and
Grandpa came to where I was sleeping and
told me that he wanted to teach me how to
do it and that was it. He told me never to tell
anybody. He called it our little secret”.
“My male cousin used to come into our hut
at night when everybody else was asleep
and he sexually molested me on several
occasions. Traditionally, such a thing is
allowed because he is considered as my
natural husband. Cousins are allowed to
marry”.
“I was sexually molested by my cousin when
I went to collect water at the well alone in the
evening. I did not know that he had followed
me to the well…. I just heard him call my
name and I looked up. Then he pulled me by
the hand in the tall grass. I could not tell
anyone because I felt embarrassed at what
happened”.
The data presented in this study indicate that
sexual debut among many young women in
Zambia is early. It also indicates the vulnerability
of girls to incest or other forms of sexual abuse.
The data also shows that early intercourse in
most young women is involuntary. This confirms
the results of a sexual behaviour survey that was
conducted to monitor the extent to which
programmes to reduce the spread of HIV were
succeeding [11]. The main objective of the
survey was to obtain national estimates of a
number of key indicators for the national HIV and
AIDS/STIs programme monitoring process.
In a research study that examined gender
differences in the timing of first intercourse, it
was reported that in most countries more than
5
one third of teenage women have had
intercourse and that sexual intercourse began
during their teenage years [9]. The study also
found that extramarital sexual intercourse for
young men predominantly occurred outside
marriage where as for young women it occurred
within marriage. The study concluded that in
most countries, a high proportion of adolescents
were potentially at risk of a range of poor
reproductive health outcomes. Therefore,
programme planners must find ways to help
sexually active adolescents to consistently use
effective means of protection against both
pregnancy and sexually transmitted infections.
Contrary to the above mentioned study, this
study has found that young women aged 15-24
engage in premarital sex.
The results also suggested that forced sex is
common among females in Zambia [11]. This
shows that sexual violence is prevalent and that
most of the females know the perpetrators of the
violence. It also dispels the notion that sexual
activity among youth, especially females, is
entirely consensual. This phenomenon is not
only common to Zambia, for instance, in
Botswana, it was found that 21% of adolescents
in and out of school in Selibe, Phikwe,
Mahalapye and Kang reported a forced or
coerced sexual experience [12]. In North and
North-East Thailand, three out of 11 sexually
active females reported that their sexual debut
was a result of force or pressure from their
partners [13]. In addition, incest is also prevalent
but it is not reported because it is mistaken to be
correct and normal [14].
3.1.2 Participants’ first sexual encounters
During the focus group discussions participants
revealed that most of their first sexual encounters
were with their boyfriends, fiancée or husbands
as indicated in the following narratives from the
participants:
“I had my first sexual encounter when I was
15 years with a man who was my fiancé at
that time. It happened when I visited him at
his home. At the beginning he just used to
cuddle me. Then he started doing other
things…. I wanted to tell him to stop but
feared he would hate me. He told me that I
must not tell anyone about what happened
between us. After that I started sleeping with
him until I became pregnant. I stopped
school and we got married”.
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
“I had sexual intercourse for the first time
with my boyfriend. I did not want to have a
boyfriend but because my friends had
boyfriends and I didn’t have, they would
laugh and tease me. Then I also got one and
that is how things started. I was about 12
years old”.
“It was just after puberty and I had just
undergone the initiation ceremony at 13
years. During the initiation ceremony girls
are taught many things. For example how to
satisfy a man in bed and we are advised to
at least practice immediately after being
discharged and admitted to adulthood. I slept
with a married man who later became my
regular boyfriend”.
“It happened after an evening party called
“Nkolola”. After the party my husband to be
who lived in the next village offered to escort
me home. He took advantage of me. I was
17 years old. He pushed me into a hut upon
opening the door. He grabbed me and
roughly threw me on the floor, spread my
legs and pulled my panty down and he
forced himself on me”.
“With me I had my first sexual experience in
marriage. I was married off by my guardian
immediately I became of age at 14 years
because they could not afford to keep me
and my siblings when my father died. They
had no money to take me to school. I could
not refuse marriage because my guardian
threatened to throw me out of his house. I
was frightened the first time but I had no
choice I had do it”.
In their discussions, some participants stated that
they could not remember the exact ages at first
sexual intercourse as noted by this participant
who said: “It is difficult to remember exactly how
old I was because it happened when I was very
young before I became of age. It was the boy I
knew very well. It happened in the bush when I
came back from visiting my aunt in the next
village. He told me never to tell anyone otherwise
he would kill me”.
3.1.3 Participants’ number of sexual partners
During focus group discussions many
participants stated that having one sexual partner
but some of them stated that they had more than
two sexual partners. The following responses
6
were given by the participants who had more
than one sexual partner to justify their situations.
“I have many partners because I wanted to
experience how it feels like to have a variety
of acts with different men”.
“It is difficult to say no to men’s persuasive
proposals. So you just accept when they
propose because some even become
violent”.
“When a man proposes me, I find it difficult
to refuse as most times they offer me money
to buy what I need. And if I love him I cannot
say no because he will think that I do not
love him”.
This study showed that some women are more
likely to indulge in sexual activity just to satisfy
their curiosity without taking into account the
risks involved. Such kind of behaviour put them
at risk of HIV. This could be attributed to lack of
information on the dangers of HIV and AIDS.
Hence efforts should be made to target this
vulnerable group. Health education through all
available means could help to reduce such kind
of risky behaviour. The study result indicates
consistency with current literature which shows
that young people like experimenting. For
example a study in Mozambique among 1,240
unmarried young youths ages 15 to 24 engaged
in sexual activity due to curiosity [15].
The results of this study revealed that the low
social and economic status of women is an
important contributor to high risk sexual
behaviour and vulnerability. Due to poverty most
women and girls exchange sexual intercourse for
money as a common coping strategy for survival
[16]. In Zambia, males are expected to provide
for their partners periodically and failure to do so
results in curtailment of the relationship or
formation of a new one with someone else [17].
Evidence shows that poverty, violence and lack
of opportunity may force people to have multiple
sexual partners, sequentially or concurrently [18].
Women living in poverty and/or violent situations
may be survivors of forced sexual intercourse or
they may have multiple sexual partners in order
to cement social networks; acquire food, shelter
or other necessities; and/or seek companionship.
This notion is supported [19,20].
The results of this study also show that young
women engage in survival sexual intercourse
due to poverty. The World Bank’s surveys
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
suggest that the number of youths living in
extreme poverty (defined as living on less than
$1 per day) in the developing world is about 325
million and that the highest rates (48%) of
poverty are found in Sub-Saharan Africa
(Population Reference Bureau 2005:2). Poverty
levels are quite high in Zambia. It is estimated
that 73% of Zambian population is poor and the
hardest hit are the rural populations [21]. Other
researchers reported that rural poverty and the
absence of access to sustainable livelihood are
major factors that contribute to the increase in
HIV transmission [19,22].
The other reason that was advanced by some of
the participants for having multiple sexual
partners was their inability to assert themselves
and resist being led into temptation by men for
fear of violence. It was also indicated that girls
are often pressured by boys or men to have
sexual intercourse as a proof of love and
obedience.
“Sometimes I find it difficult to tell men that I
do not want to sleep with them because they
pressure me so much and even threaten to
beat me up, so to avoid that I just give in”.
“ Sometimes if a man proposes you and you
tell him that you do not want to have sex with
him, he will think that you do not love or care
for him”.
In general women’s lack of assertiveness is due
to the fact that they lack control over their lives
because they are taught from early childhood
and in initiation ceremonies to be obedient and
submissive to men especially those men that
command power such as husbands, fathers and
grandfathers [23]. The women’s inability to
control their lives put them at risk of HIV
infection. This is because they are not free to
adopt behaviours that reduce their risk of
infection.
On the other hand, most men, however poor they
are, can choose when and with whom they have
sexual intercourse and what methods, if any they
use to protect themselves. Men are far more
likely to start and control sexual interactions and
reproductive decision making than women.
Some of the focus group participants explained
that having multiple sex partners increased their
chances of getting financial support as indicated
below:
7
“That’s how I make ends meet. I haven’t
been to school and I’m not employed. I have
to find ways of supporting myself. So this is
how I support myself, that’s why I have
multiple partners”.
“These partners I have helped me to buy a
bag of mealie meal to feed myself and my
children. I have no husband to support me
my sister. What else can I do? I tried to
cultivate my field last season but there was
no rain”.
“My sister, don’t think that I’m a bad person
but life can be cruel and unfair. I have two
man friends who provide for me. I’m not in
employment.” It’s better to have two because
if one has no money at least the other one
would come to your aid”.
“I have multiple partners because they
provide for me. If one has one partner it is
not always the case that he would have
money all the time especially if they are
married. Times are hard now”.
“I’m a woman; I cannot sit back and hope
that manna will fall from heaven. I have to do
something to help myself and this is the only
thing I can do”.
Given the high levels of poverty prevailing in the
country, young women are more likely to engage
in sexual relationships with many men especially
older men (sugar daddies). Sugar daddies are
common in Sub-Saharan Africa and are helping
to fuel the spread of HIV [24,25]. This is because
social norms permit men to engage in sexual
intercourse outside marriage and with younger
partners [25]. The stereotypical sugar daddy is
an adult male who exchanges large amounts of
money or gifts for sexual favours from younger
women and such relationships are associated
with reduced levels of condom use because
young women lack power to negotiate safer
sexual behaviour for fear of losing their partners.
Some young women in this study perceive
having multiple sexual partners as a sign of
beauty. This was revealed during the focus group
discussions. For example, participant gave this
account:
“I look pretty you see, very few women are.
Men tell me this. That’s why many men
propose me and this makes me feel proud
because there are very few women who are
pretty out there”.
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
Such kind of beliefs should be discouraged
because they can fuel the spread of HIV
infection. This is because HIV infection knows no
beauty. It can infect any anyone regardless of
her beauty. This could be attributed to lack of
adequate information on HIV transmission.
Few young women stated that they had multiple
partners in order to attain sexual satisfaction
because their men were not able to satisfy them
sexually while others had more partners because
they wanted to compete with their unfaithful
husbands. These young women stated the
following:
“The point is if your husband cannot do it
satisfactorily in bed. Then you are tempted to
find satisfaction else as long as it is done
discretely. And me…. I got other (casual
sexual) partners because he is so abrupt
during the sexual act and immediately after
that he sleeps like a child”.
“Why do I have more partners? I have been
married for 8 years and I have three children.
I have a “shamwali” (casual partner) because
my husband has other sexual partners
younger than me and people tell me. He told
me that he has never slept with anybody else
but I know he is not telling the truth. I know it
is not right but I do it secretly”.
“We are married three of us to one man….
You know how difficulty it is. Our husband
takes turns to visit each household. He stays
for two weeks with each one of us. By the
time he finishes his round a month or more
would have elapsed. In his absence, I fill the
void by getting another sexual partner”.
“Before I married him, I mean, I hadn’t had
many partners before, not many at all. My
husband drinks a lot most times especially
after harvest time. When he comes home he
is unable to perform in bed. He just sleeps
like a child….that is really hard and
upsetting. That’s how I got casual sexual
partners. I know this doesn’t help the
relationship at all but it good while it lasts”.
“I have other sexual partners to prove to my
husband that I can still be loved by other
men…… Because my husband was cheating
on me and he does it openly. I was
compelled to do it”.
In many African societies, the dominant social
view is that women should not enjoy having
8
sexual intercourse but rather enjoy having
children [17]. This often produces a situation
where pleasing women sexually is not
considered to be important especially by men
[26].
Polygamy is an accepted practice in Zambia [17].
Sixteen percent of married women in Zambia are
in polygamous unions [27]. In the past,
polygamous marriages had a potential to limit the
sexually transmitted infections as usually a man
and his wives lived together and had strong
family ties and trust among themselves.
However, it has been observed that partners in
such marriages tend not to have enough sexual
satisfaction, hence the tendency for extra marital
sexual intercourse outside the home [17].
The above findings show that some young
women still engage in risky sexual behaviour by
having multiple sexual partners. Previous studies
have shown that multiple partners account for a
greater level of increased HIV risk among the
youth and that with a number of relationships in
succession put themselves at risk without being
aware of it [15].
3.1.4 Age of the participants’ sexual partner
at first sexual intercourse
During the focus group discussions most
participants reported having partners who were 5
years or more years older at their first sexual
encounter although some participants stated that
they could not remember their partner’s age.
These findings are similar to those of an
American study of black and Latin women aged
14 to 17 years which, found that first intercourse
for 24% of blacks and 55% of Latins occurred
with older men and less likely to use a condom
during the first sexual intercourse or most recent
sexual intercourse or to have used condoms
consistently since becoming sexually active [28].
This suggests a noteworthy level of HIV
transmission from older men to younger women.
This is due to the fact that older male partners
are more likely than adolescent males to have
had multiple partners and varied sexual
experience, concurrent sexual partners and may
already be infected with STIs [29]. In addition,
power inequity and age differences play a role in
the relationship dynamics between an adolescent
female and her older male partner. Research
shows that a young woman, because of trusting
the experience and caring of the older male, may
be less able to negotiate condom use and may
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
rely on her partner for sexual information and/or
may allow her partner to make sexual health
decisions that are not in her best interest [28].
3.2 Condom Use among the Participants
and their Sexual Partners
During the discussions most participants
expressed that they had neither seen nor used a
condom before as described by this participant:
“Condom … what’s that! I have never used it
because I don’t even know how it looks like”.
The above data suggest that rural populations
lack information on the importance of the
condoms and that they are still not widely
distributed in the country especially in the rural
areas.
When the women were asked to talk about
condom use in sexual relations, only a few
participants said that having used a condom with
their sexual partners sometimes as indicated by
one participant “Yes… my partner and I have
used it (condom) before. We use it if get it but if it
is not there, we do without”.
In addition, a few participants stated that having
used a condom during the past month and the
last sexual encounter as pointed out by one
participant “We used it (condom) last month and
we continue to use even now. And we used it in
our last sexual encounter”.
The reported use of condoms among these
young women is a sign that some behavioural
change is taking place in Zambia. It must be
noted however that there are still many young
women who do not use condoms. It is now
known that for condoms to be effective, they
need to be used correctly and consistently [30].
Until this goal is achieved, more efforts need to
be made to spread the messages among the
vulnerable groups to change their sexual
behaviour in order to curtail the growth of HIV
prevalence in Zambia. Furthermore, correct and
consistent condom use and other preventive
behaviours like abstinence and mutual fidelity
should be encouraged.
HIV and AIDS prevention programmes for young
people in and out of school should be expanded
to cover both rural and urban populations. The
aim of HIV and AIDS education is not to
encourage young people to engage in protected
sexual intercourse but to help them form
relationships and make decisions that will make
9
them less vulnerable to contraction the disease
[31].
The focus group discussions revealed that many
of the young women reported having had a
regular sexual partner but did not use a condom
when having sexual intercourse with a regular
partner as indicated by these responses from the
following participants:
“Yes, I have a regular sexual partner. It
shows that you are normal. There is no
normal woman who can stay without a
partner but we do not use condoms”.
“I’m seeing someone… who promises to
marry me and we have been together for
some time, about one year now but we do
not use it and he feels that it is not necessary
to use it because we are faithful to each
other”.
“Using condoms, no! Wow! I’m going steady
with someone and we do not use condoms.
Not at all….. Because we do not like it”.
Focus group data show that most of the married
young women did not use the condom because
they trusted their husbands and that their
husbands will not allow them to us it as
evidenced by these statements:
“No! I can’t use a condom because I am
married and I trust my husband”.
“Haaaah! It can’t happen. My husband and I
trust each other very much, that will not
happen”.
“Look, my husband will say that I do not love
and trust him. He cannot allow that. We are
married you know”.
“I trust him and he trusts me. So why should
we use it. There is no need for that”.
This data suggests that there is the notion that
there is no place for a condom in marriage in
Zambia which should be of great concern to all
the stakeholders involved in the fight against HIV
and AIDS. The use of condoms within marriage
in Zambia seems to be surrounded by
controversy and in some cases deliberate
misleading misinformation [32]. He explains that
in the innumerable HIV and AIDS meetings and
workshops he has attended or spoken to over
the years, male participants have rejected the
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
idea that condoms can, and should, be used in
marriages when necessary. Studies conducted
on condom use within marriage have
demonstrated that men who have multiple
concurrent partners seem more prepared to use
condoms in their sexual relationships outside
marriage and yet would be unwilling to do so with
their wives at home. For example, a Zimbabwean
study investigated different patterns of condom
use by sexually active single and married men.
The findings revealed that only 6% of married
and 50% of single men were currently using
condoms [33].
Another report based on Zimbabwe data found
the same proportion of both married and never
married men (61%) used condoms if they
reported sexual intercourse with someone other
than a spouse in four weeks before the survey
[34].
From the above discussion it could be deduced
that the use of condoms has been stigmatized to
imply that condoms can or should only be used
in illicit sexual intercourse or just in sexual
intercourse outside marriage. Therefore there is
a need to change this kind of mind set. This is
because in a country like Zambia with a high
prevalence of HIV in certain cities and towns,
and where every fourth adult person is infected
with HIV, condoms do have a very important
place in marriage.
Some participants stated categorically that they
didn’t use a condom with a regular partner. They
explained that their partners were not willing to
do so. As reflected in the following statements:
“Men do not entertain such things ……
Otherwise they will leave you and look for
someone else who will do what they want”.
“My partner tells it to me to my face that he
does no want to see or hear anything about
it. I fear to annoy him”.
“My partner does not want anything to do
with it. He has said it several times. And we
do not even talk about it”.
The above results show the need to intensify
information distribution, education and
communication on the benefits of condom use to
both men and women in the community. People
should know that by using a condom, a man or
woman shows his/her partner that he/she cares
about his/her health and welfare. Hence, the
10
need to design an active programme for them to
know its benefits.
Some young women were of the view that sex
without a condom was better than sexual
intercourse with a condom. They explained that
the condom reduces full sexual enjoyment as
indicated by these responses:
“Live sex is better. Having sex with a
condom is not good. You do not feel
anything and I do not like it”.
“You cannot enjoy sex like with a plastic. Its
good live and natural. Then you feel better”.
“You cannot compare live sex to having sex
with a condom. Live is good. Who would not
enjoy it that way? “.
These results show misconceptions regarding
condom use among the young women. However
many couples enjoy sexual relations more when
using condoms because they avoid the fear of
unplanned pregnancy and infections [35].
Condoms also make erections last longer for
some men and help prevent or treat premature
ejaculation as the rim of the condom may have a
slight tourniquet effect [30]. Such misconceptions
are due to ignorance or inadequate information
on the benefits of the condoms. Therefore action
is needed to clarify these misconceptions and to
extensively promote the use of the condom (both
male and female) in rural areas. There should be
emphasis on the fact that every sexual act
carries a potential risk of HIV and AIDS/STIs and
unwanted pregnancy.
A few young women reported having used
condoms with a regular sexual partner. A regular
sexual partner is a non-marital and non-
cohabitating partner. Although the young women
said that they used condoms, they explained that
they only used it sometimes because it was not
available at the health facility all the time. They
also said that they used it for protection from
pregnancy.
“My partner and I feel it is necessary to use
it. We have used it sometimes when it’s
available. But you cannot find it all the time
at the health facility and you cannot find it
near by here”.
“Yes, nowadays, we have to be careful
especially if you are not married because
you can end up getting pregnant so you have
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
to use the it (condom). It doesn’t look good to
get pregnant out of wedlock”.
“Uuh. My husband and I only use it when we
have a small child. Because the child is
small, we do not want to have another one
too soon. We want the child to grow well”.
During the discussions some women revealed
that they had casual sexual partners. A casual
sexual partner is a non-cohabiting partner. Those
with casual sexual partners agreed that they
engaged themselves in unprotected sexual
intercourse as indicated the statement below.
“Sex with casual partners is usually done in a
haste manner in the bush for fear of being
discovered by passersby. Thereby, the
thought of using a condom will delay the act.
So you cannot think of using it”.
Sexual intercourse without a condom increases
the chances of HIV and AIDS/STIs transmission
and possible unwanted pregnancy. Therefore,
there is need to provide information to these
young women on the dangers of unprotected
sexual intercourse and their vulnerability to HIV
and AIDS. Perhaps this will help to reduce such
behaviours that encourage the transmission of
HIV infection. These results support the findings
of the 2001-2002 Zambia Demographic and
Health survey which found that 30% of young
women between the ages 15 -19 and 38%
between the 20-24 years were using condoms
with non-cohabitating partners [27]. However, it
is prudent to point out that this survey was mainly
conducted in a rural setting on the rural
population where as the national demographic
and health survey includes both the urban and
rural settings. In addition, experiences of the
young women in a rural setting may not be
similar to the experiences of the young women in
an urban setting for example, research
participants in this study reported having casual
sexual intercourse in the bush and in a hurry. In
such situations it is not likely that an individual
would use a condom and in most cases access
to condoms may be difficult due to distance to
health facilities. However, more than 60% of the
Zambian population lives in rural areas; it is
therefore likely that the young women’s
experiences are also common in other rural
settings in Zambia.
Research indicates that women are two to four
times more vulnerable to HIV infection than men
during unprotected intercourse because of the
11
large surface areas of mucosa (the thin lining of
the vagina and cervix) exposed to their partner’s
secretions during sexual intercourse [36]. The
same biological factor heightens women’s
susceptibility to other sexually transmitted
infections, the presence of which greatly
enhances the risk of HIV infection [30].
Moreover, when a woman has an STI they
remain asymptomatic for some time because of
their reproductive biology and by the time they
show symptoms the disease has advanced.
Therefore STIs are more likely to remain
undiagnosed in women than in men. Delayed
diagnosis and treatment increase young
women’s risk of HIV by three to five times over
the risk associated with prompt diagnosis and
treatment [30].
In addition, semen infected with HIV contains a
higher concentration of the virus than a woman’s
sexual secretions [37]. Young women are at
higher risk because the physiological maturity of
their reproductive systems provides less a barrier
to HIV transmission. Their cervix is immature and
has scanty vaginal secretions to protect them
from HIV and they are prone to vaginal mucosa
lacerations. Furthermore, tearing and bleeding
during intercourse especially from rough sexual
intercourse such as rape multiply the risk of HIV
infection as does anal intercourse which is
sometimes preferred to vaginal intercourse
because it is thought to preserve virginity and
avoid the risk of pregnancy. Anal intercourse
tears the delicate anal tissue and provides easy
access to the virus [15].
3.3 Participants’ Views on Condom Use
and Religion
Data generated through focus group discussions
revealed that some Catholic participants would
not use the condom because of their religious
beliefs as pointed out by these participants:
“Well, my doctrine does not allow young
women like me, who are not married to have
sexual intercourse outside marriage or to use
a condom. We Catholics are told to abstain
from sexual intercourse until one is married”.
“Um… I’m Catholic. Being Catholic we do not
believe in the use of condoms because they
do not offer 100% protection against HIV and
AIDS and they encourage young people to
indulge in sexual activities before marriage
which is not right, it’s a sin. My point is, the
only best way to protect one-self is to abstain
from sexual intercourse until marriage”.
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
It is quite clear from the explanations of some of
the study participants who are Catholics that the
church does not encourage the use of condoms
among young people but prefer abstinence only
approach as part of HIV and AIDS prevention
programme. This is because the church believes
in chastity before marriage and that the condom
is not 100% effective in the prevention of HIV
and AIDS as it is porous. The controversy
surrounding the Catholic Church and condom
use could adversely affect the fight against HIV
and AIDS in Zambia. Therefore it is important
that the Catholic Church and other faith-based
organisations understand the effects of the
scourge in the country and that it confronts HIV
and AIDS with the seriousness it deserves to
protect many lives and reduce on the number of
orphans.
Faith-based organisations including the Catholic
Church could play a significant role in reducing
the HIV and AIDS epidemic by building capacity
in religious leaders on comprehensive prevention
strategies in order to mobilize their congregations
to curb the spread of HIV [38]. This is because
religious leaders in Zambia are highly valued,
respected and play a powerful role in shaping the
opinions, attitudes and behaviours of their
followers of faith. Religious leaders are highly
trusted and could be relied upon for transmitting
health-related information.
For married couples, the church should continue
to encourage mutual fidelity and promote
compassion for people living with HIV and AIDS.
The Bush Administration also supporte
abstinence only as an approach and have
registered strong misgivings about the moral and
ethical advisability of providing condoms as part
of HIV and AIDS programmes, arguing that
condoms may encourage early sexual
intercourse and sexual promiscuity [39]. In
addition, United States officials have removed
scientifically accurate information about condom
use effectiveness from the Web sites of several
Federal agencies and have questioned whether
or not condoms provide protection against STIs
including HIV.
The Vatican has also conducted a global
campaign of disinformation about condoms. The
Vatican echo the Bush administration’s concerns
about the effects of condoms on Christian
morality, but many in the church hierarchy have
denigrated condoms as flawed products [40]. In
2003, the President of the Vatican’s pontifical
council for the family, Cardinal Alfonso Lopez
12
Trujillo, told BBC Panorama programme, “The
AIDS virus is roughly 450 times smaller than the
spermatozoon. The virus can easily pass through
the net that is formed by the condom”. However,
the Vatican’s claim was proved wrong by a study
conducted by the United States national Institute
of Health which concluded that intact condoms
are essentially impermeable to particles the size
of sexually transmitted diseases pathogens,
including the smallest sexually transmitted virus.
However, research is needed to determine the
effectiveness of abstinence only programmes as
there is no conclusive evidence to prove that
such programmes have been successful in
reducing HIV transmission in any country.
Therefore, there is a need for all concerned
stakeholders to continue to promote abstinence
and use of condoms in situations where
abstinence fails to work.
3.4 Participants’ Opinion on Condom
Initiation with their Sexual Partners
The results of this study have revealed that not
all the young women would initiate condom use
with their partners. This discrepancy in the
results could be due to many factors such as lack
of information on the benefits of a condom,
misconceptions about the condom, lack of
information on HIV and AIDS prevention,
economic dependency on men and lack of
assertiveness on the part of the young women.
Most young women in this study explained that
they would not initiate condom use with their
sexual partner for fear of rejection, abandonment
and suspecting of having HIV and AIDS by their
partners. This is evidenced in the statements
below:
“You can’t do that otherwise your partner will
leave you for other girls. And you end up
regretting it. You see there are too many
women chasing a few men out there”.
“As a woman, when you say that you want
him to use a condom, the man might think
that you are no longer interested in him.
Then he will go outside marriage and have
sex”.
“A woman cannot do that… if you want
favours from a man. It is not right. The man
will go away to other women. And she will
have no one to support her. Women cannot
go without men”.
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
“I cannot do that. My partner will suspect that
I’m cheating on him or I have a sexually
transmitted infection or HIV and AIDS”.
However, some young women were willing to
initiate condom use with their partners but they
said that they could only do so if it was mainly for
protection from pregnancy. As reflected by this
participant’s comments:
“I can only ask my husband to use a condom
when we have a small baby and he agrees
because we all want our baby to grow well.
Once the baby grows he refuses to use it’’.
These results suggest that women, and
particularly young women, lack complete control
of their lives and have little or no power to
negotiate safer sex. They are expected to leave
initiative and decision making in sexual
intercourse to males whose needs and demands
are expected to dominate. Traditionally, they are
taught from early childhood to be obedient and
submissive to males [41]. Additionally, in sexual
relations a woman is expected to please her
male partner even at the expense of her own
pleasure and well-being. Women are also taught
never to refuse having sexual intercourse with
their husbands regardless of the number of
partners he may have or his unwillingness to use
condoms even if he is suspected of having HIV
or STIs [23]. This male dominance and lack of
assertiveness put women at risk of HIV infection.
Regarding initiation of condom use by women, it
was reported that most women in Zambia had
been reluctant to initiate the idea of condom use
fearing rejection, rebuke and gender based
violence if they did so [32]. He further stated that
he had received a number of correspondences
from women whose partners insist on
unprotected sexual intercourse even under
circumstances when it should be known that this
would place the woman at risk of HIV infection
for example when one member of the married
couple is HIV positive. This shows that harmful
sexual customs and norms are still being
perpetuated in Zambia and these should be
discouraged. By empowering the young women
by combating ignorance through improved
education for women including education about
their bodies, HIV and AIDS, STIs, and skills to
say no to unwanted or unsafe sex and providing
them with controlled methods such as female
condoms and microbicides could perhaps reduce
the transmission of HIV infection [42].
13
3.5 Participants’ Views on whether they
Discussed HIV and AIDS/STI
Prevention with their Sexual Partners
Partner communication about sexual intercourse
is increasingly viewed as essential to HIV and
AIDS prevention strategies because it helps
them to make decisions regarding protection
against unplanned pregnancy, sexually
transmitted infections and HIV and AIDS [43]. In
this study, many focus group participants
confirmed the fact that they neither discussed
sexual matters nor STI/HIV and AIDS prevention
with their regular partners because they feared of
being accused of unfaithfulness by their partners.
As noted in the following remarks by one
participant “I cannot talk about HIV and AIDS
prevention with my husband because he will
think that are I ‘am engaging in risky behaviours.”
The few participants who acknowledged having
had done so, only discussed such issues with
their husbands as this Participant said: “Yes, we
talk about avoiding early pregnancy when we
have a small baby so that we look after it and
give it chance to grow well before we can have
the next baby.”
This study has revealed that the majority of
young women do not discuss sexual matters or
HIV and AIDS and STIs with their sexual
partners. This finding is consistent with research
conducted in Ndola, Zambia indicating that
women found it difficult to raise the issues of HIV
risk and prevention because of fear of being
accused of infidelity [44].
3.6 Participants’ Views on how the
Problem of HIV and AIDS could be
Addressed
The study participants gave one or more of the
following suggestions on how the HIV and AIDS
problem could be addressed. These are listed
according to the order of importance as
mentioned by the participants:
• Sticking to one partner. Faithfulness to one
partner in a monogamous relationship can
help prevent the spread of HIV infection.
Partners need to agree not to have sexual
intercourse with anyone else. Being faithful
requires honesty, and creates a bond of
trust between two people.
• Men should refrain from marrying more
than one wife.
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
• Girls should be discouraged from selling
sexual intercourse. Many young women
engage in commercial sex work due to
poverty.
• Parents and guardians should stop the
trend of marrying off young girls. This
makes girls vulnerable to HIV because in
most instances the girls are married off to
older men who are sexually experienced
and may be infected with HIV. Therefore,
the girl child should remain in school until
she is ready to enter into such a
relationship.
• Harmful traditional practices such as
sexual cleansing of widows and widowers
should be stopped or discarded because of
the HIV and AIDS pandemic.
• Parents should take a lead in educating
their children about HIV and AIDS.
• Parents should not build separate huts for
girls to sleep alone without parental
supervision. This makes men take
advantage of the situation.
• Abolish traditional ceremonies such as
Nkolola which takes place at night where
girls find themselves practising unsafe sex
and end up with HIV and AIDS and
unwanted pregnancies. Nkolola is an
initiation ceremony common among the
people of southern province to celebrate
when girls reach puberty. Before the
ceremony, girls are confined to an area
where no boy may enter. In this place, girls
are prepared and advised about what to
expect during womanhood and marriage.
After instructions, girls celebrate becoming
women with friends and families. There is
also a big celebration with much dancing,
feasting, drumming and singing. Cows,
goats, chickens, pigs are slaughtered for
feasting on and traditional bitter and sweet
types of beer are drunk. The whole
community joins in the celebrations.
However, such traditional ceremonies can
play a central role in sensitising people
about the negative effects of HIV and
AIDS.
• Husbands should stop taking sexual herbs
or aphrodisiac (herbs arousing sexual
desire) that force them to look for other
women to satisfy them sexually. In some
tribes in Zambia, men consult traditional
healers for herbs that arouse sexual
14
desires so that they able to satisfy their
women sexually.
• Mounting HIV and AIDS awareness
campaigns on radio and through drama.
• Health care providers should continue to
give talks on HIV and AIDS at the health
centres.
• By establishing more youth clubs where
youths could share ideas and information
on HIV and AIDS and its prevention.
• By abstaining from sexual intercourse.
Abstinence is delaying sexual intercourse
until a future time, such as marriage,
completing school, getting employment or
in cases where one or more partners is
HIV-positive. Sometimes people who have
been sexually active at one time may
decide to abstain. Abstinence is the only
method that ensures 100% protection
against HIV transmission.
• Using a condom each time one has sexual
intercourse or with every act of sexual
intercourse. This includes condoms for
anal intercourse. When used consistently
and correctly, both male and female
condoms reduce the risks of pregnancy,
HIV and other sexually transmitted
infections.
• Avoiding exchanging sharp instruments
such as a needles and syringes.
Contaminated sharp instruments can
harbour the virus which can be easily
transmitted to the next user.
• Going for Voluntary Counseling and
Testing (VCT). This refers to HIV testing
with pre and post-test counseling, which is
voluntary, with fully informed consent and
is confidential. Knowing one’s status can
help one to live positively by preventing re-
infection or infecting others, having a
nutritious diet and to plan for the future. It
is also the first step to getting care and
treatment for HIV. Pre-test counseling
prepares one for the test. A counselor
guides the VCT process and explains
about HIV and AIDS and the process of
testing. Post-test counseling takes place
once the test is complete. During this time,
the counselor helps the individual to
explore her feelings and addresses any
concerns they may have. The counselor
gives advice on how to stay negative or
live positively with HIV.
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
3.7 Participants’ Opinions on who in the
Community should Address the
Problem of HIV and AIDS
Community intervention in HIV education is
crucial. When asked to describe people in the
community who should try and do something
about the HIV and AIDS problem, the
participants discussed that the youth, parents,
teachers, community and religious leaders,
couples and individuals should come together
and address this problem. Only a few
participants said that they did not know who
should address this problem in the community.
Most of the focus group participants stated that
the youth should be in the fore front in the fight
against HIV and AIDS because they are the ones
that are faced with the problem more, so there is
no one else that can stop this scourge other than
themselves.
The other reason stated by the youth was that
youth will listen to their fellow youths better than
adults who are intimidating:
“For me, I feel youth should be involved in
HIV and AIDS prevention because if we are
ignorant it’s bad. We will all perish and the
country will have no future. So youth should
not be ignorant. We should not be left
behind. Its better we know and act
responsibly”.
“Its better youth are involved in solving the
problem of HIV and AIDS because it affects
them. I love to have more youth involved as
we are better able to listen to fellow youth
because you are free with them than adults.
You cannot ask sensitive questions to an
adult you know you feel ashamed”.
This suggestion is plausible because young
people are the greatest asset the continent is
counting on and have the highest HIV
prevalence. Therefore, they are the key to
overcoming HIV and AIDS. When the youth are
involved, they will be able to have frank
discussions about sexual practices and other at
risk behaviours are more likely to be exposed
and understood without intimidation. Youth
programmes run by youth have been successful
in promoting behaviours that lead to reduction in
HIV transmission. For example peer education
has been used extensively in Zambia where a
project called “Behaviour change - an education
for life process” was a renowned success [45].
15
Peer education typically involves members of a
given group striving to effect change in other
members of the same group. Similarly, in
Botswana, a youth peer education group was
established in Kanye district [46].
With regards to the involvement of parents, the
participants mentioned that they would like them
to support HIV education because if they talk
about this problem their children will listen to
them and they will stop engaging in vices such
as exchanging sexual intercourse for money and
gifts. They also explained that perhaps this would
deter parents from marrying off their daughters at
a tender age to older men.
“Parents should be involved in the fight
against HIV and AIDS because they have
authority over us and we listen to them when
they talk. Parents are the key factor in
determining values. If they continue to talk
about HIV and AIDS this will help us youth to
turn away from bad things such as keeping
away from sexual intercourse.” And it will
also prevent them from forcing their
daughters into early marriages”.
Parents can play a pivotal role in shaping their
children’s values and goals. Therefore, they
should not be complacent in the fight against the
scourge. They should not let the demands of life
crowd out precious opportunities to talk with their
children about HIV and AIDS.
However, the fight against HIV and AIDS cannot
be successful without involvement of religious
leaders as some focus group participants pointed
out. These participants were of the view that
religious leaders should be involved in HIV and
AIDS prevention because Zambia is a Christian
nation and most people are Christians.
Moreover, church leaders are respected in their
communities and are perceived as both spiritual
and social leaders and they also exert an
influence on how people think and behave.
Therefore if they are involved in HIV and AIDS
prevention, communities including young women
would listen to them.
“Church leaders should be involved in HIV
and AIDS prevention. Because they can
preach to young people in their
congregations regarding issues of immorality
such as illicit sexual activities carried out
outside marriage bond. I think it could deter
them from engaging in such behaviour if they
are true believers. If they do it, it means they
are committing fornication which is a sin”.
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387
Building alliances and involving religious leaders
in HIV prevention programme is likely to make it
successful [47]. He states that religion is a
powerful motivating force because it teaches
moral values and most people derive their values
from religious beliefs and it is a way of trying to
bring order and meaning to the chaos of rapid
changes that are taking place. In addition,
religion is widely spread in the communities in
both urban and rural areas and provides much
needed services to the poor, the disadvantaged
and the excluded. Therefore, churches and other
religious organisations are in a unique position to
influence HIV and AIDS policy and develop
specific programmes. Religious organisations
can also work with one another in the struggle
against the epidemic. For instance, in Zambia
Christians from several denominations along with
representatives from the Bahai and Islamic
communities formed an interfaith networking
group to collaborate in the fight against HIV and
AIDS in 1997 [41].
Church leaders can integrate HIV and AIDS and
psychosocial counseling into youth and adult
programmes. They can disseminate messages
on ABCs of HIV prevention - abstinence; be
faithful to one partner or in the absence of the
first two, use condoms. Church leaders can
discourage acts of discrimination or
stigmatization against people living with HIV and
AIDS and persons living in AIDS affected
households. They can cooperate with NGOs,
community-based groups and other churches in
the community to support home-based care
programmes and can develop a programme of
care and support for orphans, widows and
widowers.
Participants were also of the view that
community leaders (such as village chiefs,
headmen and local political leaders) should be
involved in the prevention of HIV and AIDS in the
community as one participant in one focus group
stated: “OK. Lack of involvement of community
leaders can work against HIV prevention as good
leadership is a key to combating HIV because
they have control the country’s resources”.
The role of community leaders in HIV and AIDS
prevention efforts is vital because HIV should be
a national priority. Community leaders can
control the spread of HIV by:
• Integrating messages and information
about prevention, care and support into
ongoing activities such as youth and adult
education.
16
• Identifying and serving as an advocate for
vulnerable groups. For example young
women and orphans subject to sexual
exploitation or abuse.
• Developing IEC messages and
programmes that stress the importance of
family and moral values in stopping the
spread of HIV, for example, remaining
faithful to one partner or encouraging
delays in the onset of adolescent sexual
activity.
• Participating in care and support
programmes for HIV infected people.
• Participating in planning HIV and AIDS
prevention activities at district level.
When asked who in the community should be
involved in the HIV and AIDS prevention, some
participants stated that community leaders
should be involved. This is because these
command authority in the community and they
would listen to them. This is reflected in this
response by one Participant “Well, I think our
leaders in the communities should be involved in
HIV and AIDS prevention. When they talk
everybody listens. They can do this at any time
especially when they call for meetings as they do
most times when there is problem in the village”.
Lack of political commitment can work against
prevention, as good political leadership is a key
to combating HIV. Political leaders should be
involved in HIV prevention because people could
listen to them. They could create an environment
in which open discussion of HIV transmission
permit discussions about sexuality at the
community, family and couple levels.
Evidence from Uganda suggests that the spread
or diffusion of information about the epidemic
throughout the population is a key to achieving
widespread changes in high-risk behaviour [48].
Political leaders can share information on the
extent, the nature of the disease, how it is
spread, the fatal consequences and how
individuals can protect themselves and their
loved ones. Political leaders can also contribute
to a policy dialogue on the HIV and AIDS
epidemic that keeps the issue high on the
national agenda. They can speak out often about
the HIV and AIDS epidemic and state open and
strong support for intervention programmes. This
gives both visibility and credibility to HIV and
AIDS intervention programmes and helps
develop a consensus about the most effective
and acceptable prevention and mitigation
strategies. HIV and AIDS statements can be
 Ngoma et al.; BJESBS, 12(2): 1-19, 2016; Article no.BJESBS.20387

included in speeches at all opportunities. Political
leaders should draft necessary legislation to
address issues including discrimination,
employment, violence against people living with
HIV and sexual violence.
One of the most common problems in addressing
the HIV and AIDS epidemic is that persons have
often avoided learning about or admitting to
being infected with HIV because of the stigma
attached to the disease and because of fear of
discrimination. However, avoidance limits
diffusion of knowledge about HIV in the general
population and it increases the risk of
transmission to loved ones and others. Political
leaders and other leaders can help by publicly
acknowledging the need to care for and support
persons living with AIDS and HIV infection and
work against discrimination. They should lead by
example as their personal example can
transform the moral and social climate in which
HIV and AIDS can be discussed and addressed
openly and denial and stigma can be overcome.
In addition, public motivation and mobilization of
domestic and international resources are critical
in HIV prevention.
think this HIV and AIDS affects us all either
individually, as couples and families. Either
ourselves or a relative have HIV and AIDS. A lot
of people are aware of it and everyone should do
something about it because no one can do it for
us”.
Involving individuals, groups and communities in
addressing their own health concerns and finding
solutions to their problems promotes
empowerment. People who are empowered are
more likely to implement effective HIV
prevention.
4. CONCLUSION
The results of this study demonstrated that
several knowledge gaps existed among young
women in relation to HIV and AIDS and that
some young women engage in risky sexual
behaviour such as having multiple sexual and
having unprotected sex. There is need therefore
to intensify community-based Information,
Education and Communication to youth through
their peers may reduce high risky sexual
behaviours.

Lastly, some participants expressed the views ACKNOWLEDGEMENTS

that individuals, families and couples should
come together and address the problem of HIV
The others wish to acknowledge the University of
and AIDS because it affects everybody. They
Zambia for partial sponsorship.
expressed that individuals or couples in the
community are either affected or infected,
therefore it is everyone‘s problem and they need COMPETING INTERESTS
to be involved as pointed out by one participant
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individually, as couples and families. Either interests exist.
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