Speaking through pictures: Canvassing adolescent risk behaviours in a semi-rural community in KwaZulu-Natal

Abstract

Adolescent health and behaviours have received increasing attention in the last decade, with several studies considering the impact of risk behaviours on adolescent health and wellbeing. [1,2] Adolescents are defined by the World Health Organization as young persons between 10 and 19 years old. [3] Two issues of particular concern in South Africa include the harmful use of alcohol and illicit drugs, and risky sexual practices, by adolescents. Surveillance statistics indicate that 49.2% of South African school-going youth have used alcohol and 25.1% of these youth have engaged in binge drinking. [4] Furthermore, 26% of all persons admitted to substance abuse rehabilitation facilities in 2016 were under the age of 20 years. [5] Risky sexual behaviour is defined as sexual activities that potentially expose an individual to sexually transmitted infections (STIs), including the human immunodeficiency virus (HIV), and unplanned pregnancy. [6] These include unprotected sex, early sexual debut, inconsistent condom use, alcohol or drug use before sexual intercourse, multiple sexual partners, forced or coerced sexual intercourse for reward, and low frequency of contraceptive use. [7,8] More than a quarter of South African school-going youth have had sex, 12% of whom had sexual debut before 14 years of age. [4] Early sexual debut increases the risk of HIV infection at a very early age. [9] Of those who had sex, only 32.9% reported consistent condom use and 18% indicated that they had been pregnant or had made someone pregnant. [4] Almost half of those who had sex reported having had multiple sexual partners, while 17% reported having used alcohol and 13% having used drugs prior to having sex. [4] In South Africa, KwaZulu-Natal Province has the highest prevalence of HIV, consistent across all age categories, including 15-24-year-olds. [10] KwaZulu-Natal is often characterised as the epicentre of the South African HIV epidemic. While studies have explored the epidemiology of adolescent risk behaviours in South Africa, [11] fewer studies have canvassed the opinions of adolescents in peri-urban communities. A previous longitudinal study on the wellbeing of children conducted in Vulindlela, KwaZulu-Natal, [12] identified serious overlapping risk behaviours, particularly drug use and sexual behaviour among children. These observations highlighted the need for a more comprehensive understanding of how adolescents assess and negotiate risk in high-poverty, high-HIV-prevalence communities. Using a photovoice methodology, the current paper describes adolescents' representations of substance misuse and risky sexual practices in a low-resource, high-HIVprevalence peri-urban community (Vulindlela) in KwaZulu-Natal. Background. Adolescent risk behaviours, such as substance abuse and unprotected sex, are leading social and health challenges in South Africa (SA). Objective. To investigate adolescents' perspectives on the prevalence of adolescent risk behaviours in rural settings in SA. Method. Using a qualitative photovoice methodology, th...

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‘If I am playing football, I forget that I have this virus’: The challenges and coping strategies of adolescents with perinatally acquired HIV in KwaZulu-Natal, South Africa

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‘If I am playing football, I forget that I have this virus’: the challenges and coping strategies of adolescents with perinatally acquired HIV in KwaZulu-Natal, South Africa

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