Bøker av Mary Louisa Plummer

Promotion of the low risk ';ABC' behaviorsAbstinence, Being faithful, and Condom usehas had only limited success in Africa. This book draws on a large qualitative study affiliated with an adolescent intervention trial to examine how ABC promotion can be improved. It evaluates the MEMA kwa Vijana sexual health program, which was implemented in 62 primary schools and 18 health facilities in rural Tanzania, scrutinizing its teacher-led curriculum, peer education, youth-friendly health services, youth condom distribution, and community mobilization components. The book examines how implementing such a low-cost, large-scale program involved many compromises, including those between national policies and international ';best practice' recommendations, between the most desirable intervention design and one that was affordable and sustainable at a large scale, between optimal teaching methods and real-world teaching capacity, between ideal curriculum content and what was acceptable to the local community, and between adults' values and youths' realities. The program's impact is evaluated by triangulating findings from three person-years of participant observation, in-depth interviews, survey interviews, and biomedical tests.The book also provides in-depth case studies to examine the motivations and strategies of extraordinary young people who practiced ABC behaviors. It outlines broad principles for ABC promotion, including: acknowledging existing youth sexual relationships; promoting each low risk behavior in complexity and depth; working with preexisting, culturally compelling motivations; and intervening at individual, interpersonal, community, and structural levels. Many recommendations for the promotion of specific ABC behaviors are discussed, such as reducing pressures and incentives for girls to have sex; targeting male risk-perception and self-preservation; promoting alternative forms of masculinity than sexual conquest; strengthening premarital and marital relationships; tailoring fidelity programs for hidden couples, couples planning to marry, and monogamous and polygynous married partners; and addressing pleasure, trust, pregnancy prevention, and fertility protection in condom promotion. The book concludes with additional recommendations specific to school programs, and a review of promising complementary interventions for out-of-school youth, women, men, couples, and parents.

This book examines young African's sexual relationships in the context of village life. It is based on a large in-depth qualitative study in Tanzania, in a region typical of rural sub-Saharan Africa. It describes how dominant community values both discouraged and encouraged adolescent sexual activity. Young people managed these contradictions by concealing their sexual activity, contributing to short-term and/or overlapping relationships. Most adolescents had sex by age 15, but girls were often 5-10 years younger than their partners, and their relationships typically involved more frequent sexual encounters than those of same-aged boys. Motivations to have sex are examined, particularly its importance to masculine identity and its role in meeting young women's basic material needs, such as soap or respectable clothing. By their late teens most young people had experienced three types of sexual relationship: one-time sexual encounters; open-ended relationships involving occasional encounters; and 'main' semi-public partnerships involving frequent sexual contact. Relationships could involve desire, possessiveness, and affection, but romantic idealization of a partner was rare. Many young people expected their partners to be monogamous, but themselves had had concurrent relationships by age 20. Women generally married by age 20 and men by 25, with couples often having met about one month earlier. Marital couples usually spent little time together, and emotional intimacy was not highly valued. About one-third of marriages involved one husband and multiple wives. Extramarital sex, separation and divorce were fairly common. This book details factors shaping young people's sexual health, including access to, and beliefs about, condoms and other contraception. Condoms were rarely used because they were associated with reduced pleasure, infection and promiscuity. Sexually transmitted infections were fairly common, but several factors hindered young people from seeking biomedical treatment for them. Many instead relied on traditional medicine, as they did for contraception, induced abortion, and fertility promotion. Understanding of the biology of HIV/AIDS was very limited, and people with AIDS were sometimes believed to be bewitched with a non-infectious, curable illness. The book concludes by identifying key economic and cultural barriers to reducing sexual risk behavior, as well as factors that potentially facilitate risk reduction.