SEXUAL-BEHAVIOR, CONTRACEPTIVE PRACTICE AND REPRODUCTIVE HEALTH AMONGSCHOOL ADOLESCENTS IN RURAL TRANSKEI

Objectives. To determine the patterns of sexual maturation, sexual beh aviour, contraceptive practice and reproductive health among Transkeia n adolescents. Design. Cross-sectional descriptive study, using self-a dministered questionnaires. Setting. Twenty-six schools in 22 rural di stricts of the Transkei region of the Eastern Cape. Subjects. Standard 5, 6 and 7 pupils of both sexes. Outcome measures. Demographic and so cial characteristics, maturational and sexual behavioural milestones, and the prevalence of contraceptive use, pregnancies and sexually tran smitted diseases (STDs). Results. Data from 1 072 girls and 903 boys w ere analysed. The mean ages (+/- SD) of the girls and boys were 15.29 +/- 1.89 and 16.25 +/- 2.05 years, respectively. Menarche and semenarc he occurred at 13.90 +/- 1.23 and 15.12 +/- 1.58 years in girls and bo ys, respectively, Overall, 76% of the girls and 90.1% of the boys in t his survey were already sexually experienced. The age of initiation of sexual activity was positively correlated with the age of first datin g and the age of menarche and semenarche. The boys initiated sexual ac tivity at an earlier age (13.43 v. 14.86 years, P = 0.0000), had sexua l intercourse more regularly (61.6% v. 42.3%, P = 0.0000) and more fre quently, and had more lifetime sexual partners (mean of 3.27 v. 1.35, P = 0.0000) than the girls did. Nearly twice as many sexually experien ced boys as girls had a history of STD (48% v. 25%, P = 0.0000) and, o f these, 19.1% of the boys and 6.5% of the girls had a history of geni tal ulcer disease. The prevalence of whether contraceptives had ever b een used was only 23% among sexually experienced girls and, of these, only 19.4% used condoms, Surprisingly, 62.1% of the sexually experienc ed enjoyed using them. The prevalence of adolescent schoolgirl pregnan cy was 31.3%.Conclusions: Sexual maturation occurs at an earlier age t han previously among rural Transkeian adolescents, This is associated with early initiation and a high level of sexual activity, low contrac eptive usage, and a high rate of adolescent pregnancy and STDs, which therefore expose adolescents to a high risk of HIV infection.