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Article Excerpt
The Problem
Concern with adolescent sexual activity and its consequences continues to spur interventions to reduce sexual activity among young people globally (UNAIDS 2005). In Nigeria, where research for the current paper was conducted, the abstinence-until-marriage policy has emerged as a priority method for promoting sexual and reproductive health among young people. Nigeria is currently one of the largest beneficiaries of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). The program clearly stipulates that "abstinence-only until marriage" should be presented as the sole reproductive option for adolescents. Largely due to this, both Nigeria's official HIV/AIDS Policy (Federal Government of Nigeria [FGN], 2003) and the reviewed National Strategic Framework (2005) endorse abstinence as the best protection against HIV/AIDS among unmarried young people (National Action Committee on HIV and AIDS [NACA], 2005). As recently as 2005, a National Abstinence Leadership Training Workshop, whose publicly enunciated goal was "to build abstinence lifestyle onto the national HIV/AIDS prevention agenda in Nigeria," was held in Lagos. Hosted by the Nigeria Abstinence Coalition, the workshop was fully funded by the Nigerian government and relied on what was termed the "No Apology Abstinence Curriculum" as the training guide (AbstinenceAfrica, 2005).
The curriculum conceptualized abstinence among young people to mean delaying sexual activity until marriage. It noted that sexual activity in and of itself is wrong if the persons are not married and that young people need to hear a single unambiguous message, which is that sex outside marriage is dangerous and often results in negative outcomes. The curriculum depicted adolescent sexual expression as dangerous and framed abstention as the only reliable risk-reduction strategy for preventing the spread of HIV among young people, and as natural, healthy, and biologically, socially, and psychologically beneficial for all young people. It also explained the continuing high incidence of involvement in sexual activity and low rate of uptake of sexual abstinence among adolescents in sub-Saharan Africa as evidence that young people do not appreciate the place of sexual abstinence in their lives and well-being. Currently however, little exists in the literature regarding young people's direct views on abstinence and where it fits in their lives and well-being. The current article is a take on this gap in the literature.
The Literature
The important role of abstinence as a behavioral strategy for preventing the negative outcomes of adolescent sexual activity is not contested. Sexual transmission of infections often is tied to unprotected sex. Jemmott and Collegues (1998) write that there are two approaches to reducing the risk of having unprotected sex among young people. One is the abstinence strategy that focuses on reducing the frequency of sexual intercourse and the other is the safer-sex strategy that focuses on increasing the frequency of condom use. The appeal of the abstinence approach lies in the claim that adolescents often lack good judgment and knowledge to make informed decisions to protect themselves from sexually transmitted infections (STIs) or pregnancies, or to grapple with the adverse consequences of unprotected sex. Santelli and collegues (2006a,b) maintain that there is broad support for abstinence as a necessary and appropriate part of sexuality education for young people, but that controversy often arises when abstinence is provided as a sole choice and where information on other choices is restricted or misrepresented.
The bulk of previous research on abstinence has addressed the efficacy of abstinence and abstinence-only interventions as a reproductive health strategy. The common refrain has been that although it is theoretically fully effective, in actual practice, abstinence and abstinence-only education fail to protect against pregnancy and STIs, and is therefore scientifically and ethically problematic. For instance, based on an in-depth evaluation of abstinence-only adolescent programs, Roosa & Christopher (1990) argue that none of the desired changes in attitudes and behavior occurred for the target sample as a whole and especially for the subgroup who were virgins. A randomized controlled trial of abstinence and HIV risk reduction interventions among African American adolescents by Jemmott and colleagues (1998) also arrived at similar conclusions. While noting that abstinence can, like safer-sex interventions, reduce HIV risk practices especially in the short run, they conclude that the efficacy of abstinence until marriage programs as a sustainable strategy for addressing reproductive risk and vulnerability among young people is inconclusive. Santelli and colleagues (2006a, 2006b) conducted a review of abstinence and abstinence-only education programs in the United States, which showed that they undermine more comprehensive sexuality education, threaten the goal of promoting adolescent reproductive health and wellbeing, lead to the withholding of information, and promote questionable and inaccurate opinions. They argue that while representing a healthy choice for teenagers, abstinence is in practice hardly maintained.
A critical evaluation of U.S. abstinence programs (Success Express, Project Taking Charge, Sex Respect, Teen Aid, Values and Choices, Facts and Feelings, Reducing the Risk, Postponing Sexual Involvement, Project Education Now, and Babies Later) by Thomas (2000) showed that while they may positively influence sexual attitudes among adolescents, their impact on sexual behavior is neither often sustainable nor significant. Thomas suggested the exploration of new approaches to address teen pregnancy and the increasing incidence of STIs among adolescents. Kirby's (2001) analysis of programs to reduce teen pregnancy in the United States and Canada reached the conclusion that, overall, abstinence-only programs do not positively affect sexual behavior. This finding also resonates in the recently released Mathematica Report on Abstinence Education (Mathematica Policy Research, 2007). The report maintains that youth in abstinence-only programs do not appear more likely than their counterparts receiving other forms of sexuality programs to abstain from sex. Sexually active youth in abstinence-only and other programs had similar numbers of sexual partners and also initiated sex at the same age. Also, both the consequences of teen sex for youth and the likelihood that youth will engage in unprotected sex did not significantly vary on the basis of type of sex education program to which they have been exposed.
In "What's Wrong With Abstinence-Only Sexuality Education Programs?", Haffner (1997) makes the point that abstinence programs sometimes deliver negative results, as exemplified in a $5 million abstinence-only initiative in California, which actually increased the number of young people engaging in sexual intercourse. Haffner contends that the view that abstinence is "the only certain way to avoid" such "health problems" as pregnancy and sexually transmitted diseases (STDs) gives the impression that condoms and other contraceptives are ineffective. Other studies or reviews that have recognized the limitations of the abstinence-only strategy include those by O'Reilly, Medley, Dennison, and Sweat (2006); Manlove, Pappillio, & Ikramullah (2004); Haignere (1999); Underwood, Hachonda, Serlemitsos, & Kumar and Bharath (2006); Brfickner & Bearman (2005); Denny, Young, Rausch, & Spear (2002); Doniger, Adams, Utter & Riley (2001); Borawski, Trapl, Lovegreen, Colabianchi, & Block (2005); Arnold, Smith, Harrison, & Springer (1999); Goodson & Edmundson (1994); Underhill, Montgomery, & Operario (2007); Fortenberry (2005); and Cabezon, Vigil, Rojas, Leiva, Riquelme, Aranda, & Garcia (2005).
Attitudes toward abstinence and the impact of sexual health interventions on them also have been extensively interrogated in the literature (see Carter-Jessop, Franklin, Heath, Jimenez-Irizarry, & Peace, 2000; Olsen, Weed, Ritz, & Jensen, 1991; Smith, Steen, Schwendinger, Spaulding-Givens, & Brooks, 2005). The literature on this, however, also is very inconclusive. Sather & Zinn (2002) analyzed the values and attitudes of two groups of seventh and eighth grade adolescents toward premarital sexual activity (one group received state-funded, abstinence-only education, while the other group did not receive that education) and found that abstinence-only education did not significantly change adolescents' values and attitudes about premarital sexual activity, nor their intentions to engage in premarital sexual activity. They argue that there is very little evidence for the view that abstinence-only programs hold much promise in the fight to promote adolescent sexual health. Agha & Rossem's (2004) study in Zambia confirmed that while positive attitudes toward abstinence can be fostered through peer-led sexuality education, there is usually no guarantee of any sustainable long-term effect regarding these, suggesting the danger in touting abstinence as a sole choice and of withholding, restricting, and misrepresenting information on other choices. Kaljee and colleagues (2007) arrived at similar conclusions in Vietnam where they investigated sexual stigma, sexual behavior, and abstinence relying on in-depth individual qualitative interviews with 159 adolescents living in Hanoi, Nha Trang City, and Ninh Hoa District and a survey of 886 adolescents in these same three sites. Their work suggests that while the promotion of abstinence as a policy may encourage positive ideals and values, it often hinders the ability of adolescents to obtain accurate information about sexuality, HIV, and STIs and to engage in safe sex. Research by Shuey, Babishangire, Omiat, & Bagarukayo (1999) in Uganda however, showed how aprimary school based abstinence-only education program succeeded in increasing sexual abstinence among in-school adolescents by emphasizing a rational decision-making model rather than a punishment model.
Based on a quantitative survey in Nepal, Iiryama, and colleagues (2007) gauged intentions for abstinence among young people, focusing on the role of perceived susceptibility and severity, and noted that many young people share the ideal of abstinence and agree with abstinence intention. Their data show, however, that young people's abstinence intentions tend to be more positively influenced by perceived severity of the risk of HIV infection than by perceived susceptibility. Other issues that have been investigated in the available literature include why abstinent adolescents refuse to have sex (Binn-Pike, 1999); views of directors, participants, and instructors in selected abstinence-only-until-marriage programs (Bowden, Lanning, Pippin, & Tanner Jr., 2003; Goodson, Suther, Pruitt, & Wilson, 2003); and definitions of what constitutes abstinence (Haglund, 2003; Horan, Phillips, & Hagan, 1998; Kantor & Bacon, 2002; Ott, Pfeiffer, & Fortenberry, 2006; Remez, 2000). Representations of sexual abstinence among adolescents also have been investigated. Izugbara's (2007) study in Nigeria shows that abstinence occupies a variable position in the lives and minds of youth, and beliefs about sexual abstinence being moral and healthy and signifying decency, propriety, and decorum existed alongside narratives depicting it both as dangerous and unhealthy and also as an imposition and a sign of disempowerment and powerlessness. Studies also exist on the ethical issues and questions that abstinence-only education raises (Wiley, 2002), lay evaluations and perceptions of the content of abstinence-only programs (Wilson, Goodson, Pruitt, Buhi, & Davis-Gunnels, 2005), and on the perceived benefits of abstinence-only programs for young people (Epstein, 2006; Santelli et al., 2006b). Researchers such as Marindo, Pearson, & Casterline (2003) also have investigated patterns of uptake of abstinence among young people.
Judging by the review presented above, a great deal of abstinence research (whether conducted in the global north or in the south--two regions marked by contrasting adolescent cultures, HIV incidence and prevalence rates, abstinence programming strategies, and levels of access to sexual health resources) has tended to occur in relation to social norms that stigmatize sexual activity in young people and in the context of efforts to ensure young people's adherence to abstinence until marriage. Very little attention has been paid to young people's own views of, reactions to, and struggles with abstinence as a reproductive health promotion strategy. In the present study, we interrogate the direct perspectives of male youth in rural Nigeria on the preventive practice of "abstinence until marriage," focusing primarily on their views of where it fits in their lives and well-being as young men. Building on an earlier work that spoke to the fluctuating, situational nature of adolescent Nigerian males' beliefs about abstinence, we examine talk about the pros and cons of abstinence for adolescent males. In the main, we show how norms of masculinity suffuse young males' narratives and views regarding the pros and cons of practicing abstinence. The current article thus contributes to the literature by calling attention to the implications of notions of maleness for adolescent males' abstinence-related beliefs and attitudes, and by extension for the abstinence-only intervention strategy.
Why Focus on Young Males?
The importance of work with younger males, particularly in the fields of reproductive health and sexuality, increasingly is being recognized and hailed (Izugbara, 2001; Mundigo, 1998; Social Science and Reproductive Health Research Network [SSRHRN], 1999, 2001; United Nations Population Fund, 1995; Wainerman, 1998). Such work is viewed as critical to the creation of enlightenment and the promotion of self-actualization and positive thinking among male youth. It also has been noted that emic (insider) perspectives of male adolescents on sexual health issues is not only crucial to the creation of policies that will suit their needs, but also can furnish insights on the basis of which some of the world's most pressing...
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