TOPIC THREE: ADOLESCENCE AND HIV/AIDS

OBJECTIVES
By the end of this unit, you should be able to:
(a). Define the terms: adolescent, teenage, youth and sexuality
(b). Describe the changes that take place in girls and boys during adolescence
(c). Identify the stages of growth in adolescence
(d). Explain challenges associated with adolescent period
(e). Explain ways of coping with these challenges.
Definition of terms
Adolescence
There is no universally accepted definition. However, it is generally accepted that the adolescent
period occurs between childhood and adulthood. There exists a divergence of opinion concerning:
 The time of onset and termination of the period as this is found to differ from one part of
the world to another and from one culture to another.
 Whether it is primarily a biological, social and culturally determined phenomenon.
The beginning of adolescence can be defined by an individual’s biological age but its ending is
defined by a person’s social age.
Chronological age: the number of years a person has lived. WHO has proposed that the age limits
of 15-19 years be used to chronologically describe adolescence.
Biological age: description of an individual’s development based on biomarkers (biological signs)
e.g. onset of puberty and increase of sex hormones. Most societies associate the biological
beginning of adolescence with the time puberty sets in e.g. first menstruation, development of
pubic hair etc.
Social age: the meaning that various cultures give to adolescence differs greatly. The family as an
institution sets the beginning of adolescence when new freedoms and greater responsibility is
expected. In some cultures initiation rites mark adolescence.
Teenagers: young people in the ages between 13 and 19 years.
Youth or young people: the United Nations defines the youth as those persons between 15 and
24 age group. In Kenya the constitution defines a youth as a person aged between 18 years and 34
years.
Young adults: those in the age group 20-24 years.
Puberty: refers to the attainment of sexual maturity and achievement of fertility. During this time
the bodies of both girls and boys change physically.
Self-esteem: refers to the emotional evaluation one has of themselves; how they feel about
themselves.

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Sexuality: it includes feeling, thinking or behaving as a male of female; being attractive; being in
relationships with sexual intimacy and sexual activates. Aspects of sexuality:
 Body image: how one looks and feels about themselves
 Gender roles: the way we express being male or female, and the expectations people have
for us based on our sex
 Relationships: the way we interact and express our feelings with others
 Intimacy: sharing thoughts or feelings in close relationship, with or without physical
closeness
 Love: feelings of affection and how we express those feelings for others
 Sexual arousal: the different things that excite us sexually
 Social roles: how we contribute to and fit into society
 Genitals: the parts of our body that define our sex.

Sexual identity: an individual’s personal sense of having a particular gender; an understanding of

who they are sexually. May also refer to the language and labels people use to define themselves.
It involves four things:
 Gender identity: Gender identity refers to an individual’s own sense of self as a woman,
man, transgender, or none or other gender identities. Gender identity may or may not
conform to an individual’s biological sex

 Gender role: cultural expectations of female and male behaviours.

 Sexual orientation: whom you are attracted to sexually. Sexual orientation refers to an
individual’s enduring romantic, emotional or sexual attractions towards other persons.
It is a complex interaction between sexual attractions, behaviours and self-identity.

 Self-concept: Sexual self-concept refers to an individual’s assessment of their sexual

identity. It also refers to the group of ideas and feelings one has about oneself; and is
related to one’s attitudes about one’s body.

Menarche: the first menstruation a girl experiences

Spermarche: the first production of semen

Stages of Adolescent Development

Early adolescence (10 to 13 years)
It is the beginning of puberty. Children experience a lot of physical growth and increased sexual
interest. They may also be self-conscious about their appearance and afraid of being judged by
their peers.

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Middle adolescence (14 to 17 years)
Puberty changes for both males and females continue. Males may have a growth spurt while
physical changes for females slows and most have menstrual periods by this time. Interest in
romantic and sexual relations may start. Arguments with parents may increase as teens strive for
more independence.
Late adolescence (18 to 21years)
This phase encompasses less physical developments and more cognitive developments. Most will
have grown to their full adult height. The young people are able to think rationally, control their
impulses and delay gratification.
Summary of Changes during Adolescence
Physical changes in Boys Physical changes in Girls Physical changes in Both
Shoulders broaden Hips widen Growth
Facial hair Breasts develop Gain weight
Voice deepens Ovulation and menstruation Pubic and underarm hair
Sperm production and Genitals enlarge
ejaculation Acne
Wet dreams

Emotional Changes
Sexual feelings Better able to reason and solve problems
Changes in mood Rebel against parents and want to be independent
Feel embarrassed easily Concerns about being normal
Feel closer to friends than family Experimentation
Feel shy

Ways of Coping with Physical, Emotional, Sociological and Psychological Changes during
Adolescence
Some of the ways to do so may include:
1. To ensure the young acquire information about themselves and about external reality. This will
include:
 Letting the child see herself/himself as she/he really is. Explain and make them understand
the changes taking place.
 Exploit their natural desire for experience by exposing them - putting them in contact with
things, ideas and people hitherto unknown to them.

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  Stimulate both acceptance of themselves and willingness to request and accept help from
others when necessary. Be able to have confidence in their own abilities and in the help
offered to face the difficulties that arise.
 Ensure that young people communicate with trusted adults as sources of information and
guidance- in addition to their peers.
2. Explaining the correct meaning of freedom and its proper use. This can be done by:
 Explaining the meaning and implications of freedom
 Teach them to see that obedience and acceptance of parental guidance are perfectly
compatible with personal autonomy-choice of friends, use of free time, choice of clothes,
reading and pastime.
 Get the youngsters to think for themselves, to analyze facts objectively and learn to
identify a problem before taking action, to give careful consideration to all the alternatives
before reaching a decision, and to accept consequences of whatever decision taken.
3. Getting on well with others and learning to make good use of free time. This involves
encouraging them to be flexible in their social relations respect for other.
4. Guiding them on how to protect themselves from the harmful influence of the environment such
as sexual matters and questions of right and wrong. This is the time that young people (female
and male) need support and information to take control of their sexual and reproductive lives.

Adolescent Problems and Challenges

Adolescent problems include: sexuality, STIs, pregnancy, abortion, early marriage, and sexual
abuse. In the next section we are going to discuss some of these problems in details in relation to
their health.

Adolescent Sexuality
Sexual activity of adolescents is of great concern today than ever before. Adolescent sexual activity
is on the rise. At age 15 usually 50% of Kenyan adolescents are sexually active and by age 19 this
percent increases to 90%. Almost 60% of the late teens have engaged in unprotected sex which is
by far the most common means that a majority of HIV/AIDS infection. This indicates that a
majority of Kenyan adolescents (15-19) are in fact at risk-and probable at very high risk- of AIDS.

Adolescents and HIV/AIDS and STIs

Early sexual activities put many young people at greater risks of: unwanted pregnancy, unsafe
abortion, births outside marriage, STIs and HIV/AIDS. Young people under age 25 account for
35 % of all new HIV infections in Kenya. Many of those in their twenties became infected while
teenagers.

Young women ages 15–24 post the highest number of HIV infection. Girls are more at risk because
they are likely to be disadvantaged in terms of education, access to information and research and
are more financially dependent. They are also more likely to start sex at an earlier age and with
older and more sexually experienced partners. They are more likely to be abused by older men and
more likely to use sex for financial or other gain. Their biology as women (larger surface areas

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and prolonged duration of contact) makes it easier for infection. The physical immaturity of the
reproductive systems of young women makes HIV transmission more efficient from men to
women than from women to men. Therefore, young women exposed to HIV prior to genital
maturation face a greater risk. In Homa Bay, young people aged 15-24 contribute 13% of the total
number of HIV infections which is attributed to gender inequality, difficulties in accessing services
and poverty.
Several factors contribute to the high prevalence rate for adolescents;
 Adolescents are at high risk of contracting an STI because they tend to engage in short-
term sexual relationships and do not use condoms consistently to protect themselves from
infection.
 In many countries, cultural expectations encourage men to express their masculinity by
initiating sexual activity at a young age, having multiple partners, or visiting prostitutes,
often much older than them.
 Cultures encourage pairing of young women with older men and therefore they are more
likely to become infected because older men have had more partners and young women
are less able to negotiate condom use.
 HIV transmission appears to be greater for both women and men if one of the partners
has another STI. The genital sores caused by some STIs create an entry to the blood
stream, while other STIs that do not produce ulcers, but nonetheless cause inflammation,
may also enhance susceptibility.

Adolescents and Abortion

One of the most drastic reflections of adolescent sexuality is the practice of induced
abortion, which is largely not totally illegal in Kenya. Discussion on abortion is
summarized below.

Why the practice: Methods

Fear or hostile reaction from Modern drugs
parents Expulsion from school Herbal
Loss of career abortifacients
opportunity Guilt and Use of foreign objects
embarrassment Rejection Chemical and
by a boyfriend concoctions Uterine
Poverty aspirations
Who provides abortions When is abortion safe
Physicians The extent of training and
Clinical experience of the provider
officers Nurses The setting in which the service is
Herbalist provided in terms of equipment,
Traditional birth attendants cleanliness and space.
Community based distributors The gestational age at which the
(CBDS) Other hospital staff and pregnancy is being terminated.
quacks.
Consequences of abortion

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 Social and Psychological Physical consequences
Consequences Death- through infection
Guilt of committing murder, Infertility
Feeling of Chronic ill health including
shame Inability symptoms that resemble AIDS.
to marry Feeling
of relief
Adolescent Pregnancy and Child Bearing
Kenya has the highest rates for adolescent pregnancy in East Africa. About 1 in every 5 girls
between 15-19 years are reported to be pregnant or have already had a child. High levels of
teenage pregnancy outside marriage, do tell us three things.
 Young people are healthy and very sexually active
 Few of them use condoms
 Many engage in pre-marital sex at an age when they can’t full appreciate the
consequences of their actions.
Causes of adolescent pregnancy:
 Lack of information about sexual and reproductive health and rights.
 Inadequate access to services tailored to young people.
 Sexual violence
 Lack of education or dropping out of school.
 Family, community and social pressure to get married.
 Child, early or forced marriages, which are both a cause and a consequence.

Effects and Risks Associated with Teen Pregnancy

These risks include:
 The leading cause of death among girls aged 15 to 19 worldwide is pregnancy and
childbirth.
 Young women are more likely to experience premature labour, miscarriages and
stillbirths.
 Infant death rates are higher for adolescent mothers than for older women.
 Adolescent girls who get pregnant are at risk of child marriages and can face life-
threatening complications during childbirth, because they bodies are not yet ready to give
birth.
 Deaths from unsafe abortions.
 School dropouts
 Negative social and economic effects on the girls, their families and communities.

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Sexual abuse and coercion
Types of sexual abuse and coercion include: defilement, rape, sexual assault, exploitation, sexual
harassment, economic exchange for sex, incest, sex trafficking and partner violence.
 Sexual assault refers to an act where a person intentionally sexually touches another
person without their consent or behaviour that occurs without explicit consent of the
victim e.g. rape, attempted rape, forcing the victim to perform sexual acts, such as oral
sex.
 Rape is a form of sexual assault, refers to sexual penetration without consent or if
coerced.
 Sexual exploitation is when someone takes advantage of the power, trust or victim’s
vulnerability to have sexual contact without their consent for their own (perpetrator’s)
gain.
Because sexual violence and exploitation are abuse of power, young people are especially at risk
and the violation can have devastating and long lasting consequences. Women are more
vulnerable than men to violence and abuse at all ages of life through infanticide, incest, child
prostitution, sex trafficking, rape, partner violence, psychological abuse, sexual harassment,
harmful practices e.g. forced early marriages, female genital mutilation and bride burning.
Sexual exploitation of children and adolescent is a multimillion- dollar illegal industry in
places such as Bangladesh, Brazil, Nepal, Philippines and Thailand. Aids orphans under the
case of relatives experience sexual violence, rapes within families by brother, uncles, and fathers
have been reported.

Female Genital Mutilation (FGM)

On the African continent, between 100million and 180million women around the world have
undergone female genital cutting. F.G.M is a serious health issue, its effects include:
hemorrhage, shock, pain, and other complications that can damage one’s lifetime. Recently there
has been some progress towards the internationally agreed upon goal of eradicating FGM.
Efforts made include: developing alternative rites of passage for adolescent girls. Public
declarations against FGM by families and community members, empowerment and advocacy,
including programs for women and girls.

Summary
Adolescents make up a large proportion of the population of almost every country. They also
form a very large proportion of the population already infected with the virus HIV and at the
same time they form the group which are currently at a very high risk of contracting the disease –
AIDS. Their sexuality, abortion, premarital sex, pregnancy out-of-wedlock to mention a few are
pertinent and are the forefront of public health discussions since these are taking place in a
changing environment. Their ignorance, lack of sexual and reproductive health information
poses a major problem in this error of HIV/AIDS pandemic.

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