Although HIV prevalence is high among young people in South Africa, particularly among young women, little is known about how young people perceive their risk of infection or about how these perceptions are related to their sexual behavior. The study by Kermyt Anderson and colleagues in this issue of International Family Planning Perspectives [see article] uses longitudinal data for 2002 and 2005 from the Cape Area Panel Study to explore these issues in a representative sample of young people in Cape Town, South Africa.
In 2005, the authors find, more than eight in 10 young people considered themselves at no or low risk of becoming infected with HIV. For young women, there appeared to be a reciprocal relationship between risk perception and risk behavior: Those who believed in 2002 that they had a relatively high risk of HIV infection were less likely than other young women to have had sex by 2005; likewise, those who had already had sex by 2002 perceived themselves as being at relatively high level of risk in 2005. For young men, having had sex by 2002 heightened perceptions of HIV risk in 2005, but perceptions of higher risk in 2002 were not linked to a delay in sexual debut. Risk perceptions varied by race and gender, with colored young women having the lowest levels of perceived risk and white young men having the highest levels. Many programs in South Africa are trying to reach a broad spectrum of youth; on the basis of their results, the authors suggest that one-size-fits-all interventions may not be as effective as those tailored to gender and race.
Also in This Issue
•Using statistics from 60 countries around the world in which abortion is broadly legal, Gilda Sedgh and colleagues find that the countries in which the abortion rate decreased between 1996 and 2003 outnumbered those in which it increased [see article]. Although the sharpest declines occurred in Eastern Europe and Central Asia, rates in those regions remained among the highest in the world—a legacy of the Soviet era, when abortion was freely available but contraceptive options were limited and in short supply. The highest estimated levels were in Armenia, Azerbaijan and Georgia, where surveys indicate that women will, on average, have three abortions during their reproductive lives.
•Data from nationally representative surveys indicate that contraceptive use among married women of reproductive age rose in all regions of the world between 1980 and 2005, reaching 73% in Latin America and the Caribbean, 66% in Asia and 22% in Sub-Saharan Africa. According to Eric Seiber and colleagues, the overall proportions of users relying on the IUD and the pill declined, while the proportions relying on injectables and tubal sterilization rose. The share of use accounted for by traditional methods declined in all regions; the sharpest decrease—from 56% to 31%—occurred in Sub-Saharan Africa.
•Almost half of young married women in parts of rural India have experienced unwanted marital sex—32% occasionally and 12% frequently—according to a study by K.G. Santhya and colleagues [see article]. The risk of frequent unwanted sex was elevated among women who agreed with norms justifying gender-based violence and those who were Muslim, while it was reduced among those who had proven their fertility, those who had been fairly familiar with their husband before marriage and those whose husband consistently supported them during family conflicts. The authors recommend that programs target newly married couples with interventions aimed at fostering communication, intimacy and understanding of sexual rights.
•The ways in which positive aspects of sexual experience contribute to women's sexual and reproductive health are little understood, according to a Comment by Jenny Higgins and Jennifer Hirsch [see article]. This "pleasure deficit" affects not only women's use of condoms, but also their use of other methods currently on the market. The authors note that few systematic reviews exist of how contraceptive methods affect women's sexual desire, pleasure, lubrication and ability to achieve orgasm, and further, how such effects shape women's adoption and continuation of methods and their consistency of use. In sum, they say, researchers and program developers need to work from the assumption that the way sex feels matters to women, and that recognizing and addressing this aspect of women's lives will positively affect their risk behaviors—and, more broadly, their sexual health and well-being.