Los medios de comunicación como agentes de socialización

Several studies have documented that condoms are effective in reducing STI and HIV transmission (Omokhodion et al, 2007; Okonta et al, 2006; UNFPA, 2004). Despite the fact that condom is protective, the demand for condom use is still low especially among out-of-school adolescents who appear to be sexually more active than their counterparts in school (Rich, 2007).

Many sexually active young people do not use any method of contraceptives as indicated in the findings of previous studies conducted across the world. This has resulted to several attempts made by researchers to conduct intervention activities to promote condom use and demand for different methods of contraceptives especially among adolescents and youths. For example in New York, Miller, Levin and Whitaker (1998) recruited 372 sexually active adolescents aged 14-17 years old and their mothers for promotion of condom use. Overall 70.6% of the adolescents reported having discussed condom use with their mothers. Male adolescents were found to have discussed condoms with their mothers at a younger age (mean 12.9 years), while females (mean 13.5 years) also did the same. The authors observed that adolescents who talked with their mother about condoms before their first sexual experience were likely to use a condom during the first sexual encounter and those adolescents who used a condom whether they had talked with their mothers about condoms or not would be more likely to use a condom during subsequent sexual encounters.

Moreover, regardless of the occurrence or timing of maternal discussions about condom, condom use at first sexual intercourse is associated with a drastic increase in later condom use. This suggests that early maternal discussions about condoms promote condom use at first intercourse and that condom use at first intercourse promotes subsequent use. This study implies that it is of utmost importance that adolescents receive information about condoms before initiating sexual intercourse.

Likewise in Australia, Viser (2005) carried out a study among 53 young women aged 18-25 years who were sexually active. The study was to determine how best to promote condom use for prevention of STIs and unwanted pregnancy. A multi-component condom promotion intervention involved skill building to reduce risky sexual behaviour and STIs among young women. The intervention emphasized on perception about sexuality, beliefs about STIs and self-efficacy for condom use. The young women were shown a video depicting woman’s sexuality in popular media.

Information was given on symptoms, prevalence and transmission of STIs so as to increase the respondent’s perceived susceptibility to STIs. Another video was shown to alleviate apprehension associated with purchasing condoms. The participants were taught how to properly use condoms;

how to be assertive in discussing condom use with their partners and how to deal with partner’s resistance to condoms. Through video presentation, role play, discussion and practice; the young

women learnt how to increase their sense of control over their sexual encounters, increased their STI awareness and perceived susceptibility, thereby they were able to increase their self-efficacy for condom use. However the participants supported multi-faceted condom promotion campaigns by using multi channels of communication and a variety of media which suggest that a variety of different approaches are needed to promote condom use for STI prevention.

In sub-Saharan African countries, Adegbenro (2008) reported that the rate of contraceptives use among adolescents in African countries is considerably lower than the rate reported in developed nations of the world. Wieldant, Boldsen and Knudsen (2002) reported that the rate of contraceptive use among sexually active Danish adolescents was 95% whereas in sub-Saharan Africa countries like Zimbabwe, Kenya, Togo and Ghana the rate was very low (about 20-30%); (Speizer et al, 2002). This was similar to the report of Foss and his colleagues (2007) who reviewed the impact of condom use in sub-Saharan African countries. They observed that interventions targeting youths recorded limited increase in condom use.

In Kenya, (Foss et al, 2007) findings revealed that condom use was highest among young women who were more educated, never married and living in urban areas particularly in Nairobi. In promoting condom use, condom is made available and accessible. About nine condoms per sexually active person are distributed annually in Kenya. The largest number of condom-per-person is distributed in Nairobi and Nyanza provinces. Also most health facilities have condoms available for family planning and STI clients; but it was observed that only one-third of the Health facilities provided training to the community health workers in condom promotion and safe sex. However, exposure to the mass media was associated with the increased knowledge of condoms for both men and women.

In Nigeria Okpani and Okpani, (2000) carried out a survey on sexual activity and contraceptive use among 768 single secondary school girls with a mean age 16.32 years. Among this population, 605 admitted to have been sexually exposed; of these, 24 claimed to have had previous deliveries, and 186 induced abortions had been done in 142. They also reported that there was a high level of awareness (72.4%) of the relationship between sexual activity and STIs among the study population.

This was encouraging and was attributed to a recent intensive health education activity using the mass media to promote contraceptive use, stating its dual advantage which is prevention of unplanned pregnancy and STI especially among the sexually active youths. Similarly Okonofua et al (2005) carried out a study in Benin among secondary school youths aged 14-20 years to determine the impact of an intervention: right seeking behaviour among Nigerian youth. At pre-intervention they enrolled 1895 and 1858 youths at post intervention. The intervention consisted of communication participation, peer education, public lectures, and formation of health clubs and

training of STI treatment providers. At post intervention, result showed that youths in the intervention schools compared to control group recorded statistically significant improvement in knowledge of STIs, condom use and right seeking behaviour. The prevalence of reported STI symptoms in the past six months was significantly reduced. Knowledge acquired and accurate information given have been associated with the promotion of condom use among the intervention group.

In addition to educational interventions, many development partners have been engaged in procurement, promotion and distribution of condoms in the country. These include GHAIN/FHI/USAID, Society for Family Health and UNFPA (UNFPA, 2005). In order to ensure even distribution of condoms, UNFPA (2004) highlighted four major approaches to condom promotion and distribution. These include:

 Private sector sales through pharmacies and other retail outlets.

 Social marketing which is the promotion and sale of contraceptives at subsidized price and distribution through commercial and informal channels.

 Community based distribution, another approach which involves free distribution of condoms to poor and vulnerable groups including adolescents and women. This approach has recorded a larger distribution volume than social marketing but both seem to complement each other for greater result.

 Public sector distribution: this is usually through health and Family Planning centers. This sector is an important outlet because it is a component of comprehensive STIs and Family Planning Services. UNFPA (2005) argued that the approach is unlikely to be a major condom distribution channel more so that the adolescents especially those out-of-school rarely seek treatment in public health centers. It is advisable to augment this approach with social marketing and community based distribution approaches.

Another report (Bankole et al, 2007) also argued that if condom distribution targets the most sexually and HIV-vulnerable individuals, the spread of HIV infection is likely to be prevented. The report stated further that despite the effort so far in promoting condom use, young people in Nigeria as in other sub Saharan Africa, still engage in casual unprotected sex and condom use remains relatively low. The reasons given by respondents included: negative attitude- perception of young people to use of condoms; doubt about its effectiveness, and expressed concern about condom safety and breakage. Young people believe that condoms have small holes which can permit leakage of sperm. The respondents also condemned the low quality of condoms especially condoms that are free.

Other reasons that were identified as being responsible for low utilization of condoms include:

complaints by adolescents that wearing a condom reduces sexual enjoyment, and negotiation for its use signifies infidelity or having a sexually transmitted infection (Rich, 2007). Other reports (Guiella and Madise, 2007) also explained the reasons for non-use of condom among adolescents.

These included non affordability, lack of access to purchase condoms, dislikes and embarrassment or stigma associated with the purchase of condom from adult provider due to disapproving attitude of providers to young clients. Negotiation for the use of condom is reported to be difficult particularly by ladies that have received gifts and money for sex.

Lack of information on the correct use of condoms was identified as a barrier to consistent use of condoms by the youths. Rich (2007) suggested formal educational technique such as condom demonstration is likely to improve the knowledge of correct use of condom. Another report (Guiella et al, 2007) found that there is possible association between formal education and use of condoms.

Findings revealed that the use of condom increased with years of schooling. The report argued that low use of condoms among out-of-school is unconnected to low educational background. This was similar to Bankole et al (2007) report which suggested that the strongest predictor to the knowledge of correct condom use among adolescents is exposure to a condom use demonstration. This study however included condom demonstration in the agenda of Peer Educators’ Training.

A FOCUS Report (FHI- Youth-Net Programme, 2002) suggested Social marketing techniques could be adopted to promote and increase the use of socially beneficial health products such as condoms, to increase access to health services, and to bring about changes in health behaviour and practices. The mass media, an important channel of communication in most social marketing interventions, have a major influence on youth norms and values. Social marketing campaigns utilizing mass media can promote services and products to youths through pharmacies, clinics and other community outlets — as well as make those products more available in those out-lets. The report (Youth-NET, 2002) stated that some programmes had sought to take reproductive health and HIV-related services to young people in the community rather than making youths come to programmes through community outreach. The outreach which may include deploying workers from health facilities, linking with programmes in the community that serve youths, and providing services in non clinical settings. Community outreach is a way to channel information through the myriad influences and stimuli that influence young people, such programme strategy has the potential to reach young people who are out-of-school, unmarried, marginalized, or hard-to-reach for other reasons. These programmes also eliminate distance as a barrier to using services and can better overcome the distrust and alienation felt by many hard-to reach youths.