In this paper we sought to present the current “picture” of young people and their sexual risk-taking and protective behaviours in Burkina Faso using recent data from a national survey of adolescents. To achieve the goals set in the National Population Policy and the National HIV/AIDS and STIs programs, the government of Burkina Faso advocates strongly for increased use of reproductive health facilities for adolescents, including youth friendly services. Our findings highlight room for improvement of young people’s awareness and use of condoms to prevent HIV transmission and unwanted pregnancies.
Overall, the use of condoms is low and inconsistent among adolescents. Among those who are using condoms, there are significant differences by social and demographic characteristics. For example, use of condoms for non-cohabiting adolescents is much higher than use within cohabiting unions. This finding is consistent with results from other studies on young adolescents in unions, where the use of condoms is very rare.15–16
On the other hand, one would expect adolescents whose sexual partner is a casual acquaintance to be more likely to use condoms compared to those whose partners are boy/girlfriend but our findings show that they are less likely to use condoms. This finding is consistent with results from an evaluation of a condoms social marketing campaign in urban Mozambique where fewer than half used condoms with casual partners. The authors concluded that the levels of condom use in non-regular partnership were considerably lower than what is needed to stop the HIV epidemic in Mozambique.17
Another recent study on 1300 adolescents of 15–21 years old in a northern hemisphere context (from Miami, Atlanta and Providence in the USA), showed that whether or not they were with a regular or a casual sexual partner, adolescents had similar numbers of unprotected sex acts within a 3-months period.18
A possible interpretation for the low use of condoms among adolescents despite high levels of awareness of HIV/AIDS is that the majority of adolescents do not plan to have sex. Indeed, in the BNAS, a question was asked of the main reason why adolescents had first sex. The finding was that 60% of females aged 12–14 years and 50% of those 15–19 years old said that “it just happened”. The proportions are much higher among males where 74% of those of 12–14 years old and 89% of older adolescents reported that they “just felt like it”. Results from a qualitative study on young people’s sexual behaviour in Burkina Faso also highlight the fact that in many cases sex is not planned but just happens during social events (weddings, birthday parties, special market days)19
so that even if adolescents have positive attitudes about condoms, they may not be readily available to them. Therefore, one can conclude that the majority of adolescents are still engaging in risky behaviours despite their awareness of HIV. This situation has also been shown in another study in Côte d’Ivoire where accuracy of knowledge about AIDS did not significantly predict the use of condoms.15
Our findings also confirm the negative perception of male condoms among adolescents. Indeed, many adolescents continue to state that condoms reduce pleasure during sex. This is consistent with the results of a previous study of 1630 adolescents aged between 13 and 25 years old in Burkina Faso by an NGO in charge of social marketing of condom who found similar levels of 25% of males and 45% of females agreeing that condoms reduce pleasure.20
Even though in the burkinabé context opinions of females are rarely taken into account in decision-making about sexual activity, our findings show that female adolescents’ negative attitudes towards condoms have a negative influence on the use of condoms. Indeed, those who think that using condoms is a sign of lack of trust are less likely to have used a male condom with their partner at last sex. These results are consistent with a study by Lescano et. al. who also reported that adolescents whose partners had negative attitudes towards condoms (for example finding them to be uncomfortable) were less likely to have used them18
. Beliefs that one doesn’t have the same feeling during sex when using a condom are common among adolescents. The use of familiar expressions like “you don’t eat banana with its peel”20
or “you don’t take a shower with an umbrella”7
is illustrative of the situation. These attitudes have strong negative influence on condoms use and there is a great challenge for prevention campaigns to develop efficient strategies to convince adolescents that the non use of condoms can jeopardize their lives.
Another important reason for non-use of condoms is that both sexually-active female and male adolescents reported that they felt safe with their partner. Yet, feeling safe depends very much on the type of partner and whether or not there are other concurrent sexual relationships. HIV prevention programs, while emphasizing fidelity, also need to educate adolescents on the importance of taking personal responsibility to remain negative. From the survey, the cost of condoms did not appear to be a major deterrent to their use. The government made a deliberate effort to keep the price of condoms low since 1991. In 2006, the price of condoms rose by 25 CFA (50%) for a packet of four. The effect of this increase should be identifiable in future studies of this nature.
Use of condoms at last sex within a 12–months period is highly associated with adolescents’ self-efficacy towards condoms especially for females. Indeed, for females, the ability to get a partner to wear condoms is a strong predictor of use. Since this was a cross-sectional study, it is possible that condom use may have happened first and the self-efficacy was built afterwards. Alternatively, female adolescents who overcome social and cultural barriers and are able to communicate their needs with partners are more likely to protect themselves. Males who felt very confident in knowing how to use condoms were more likely to have used condoms at last sex compared to those who did not have these life skills at all. Again, the direction of causation cannot be identified from this cross-sectional survey. Despite this limitation, offering practical demonstration of how to use condoms may give the adolescents the needed self-efficacy to promote higher use of condoms.
Rural/urban differences in condoms use can be explained by a combination of factors. Access to condoms in rural areas is less than in urban areas, as is the case for most developing countries. In addition, in the burkinabé context it may be more difficult for a rural adolescent to buy a condom than a city-dweller. Our argument is that in rural areas there is sometimes only one place where adolescents can buy condoms and adolescents may fear to get condoms from this place for fear of the news spreading to others in the village. From our data, rural adolescents aged 12–14 years were significantly more likely to agree that it is embarrassing to buy or ask for condoms than their urban counterpart. Previous studies have shown that for many adults, adolescents and women, a trip to town is often their only opportunity to obtain male condoms or other contraceptive methods, despite the existence of community-based services.21
This suggests that it is critical to develop youth friendly services in rural areas.
The study found also a positive association between schooling and use of condoms with the odds of condoms use increasing with years of schooling. The converse of this finding suggests that the use of condoms among those who were not in school is very low. Given the low level of education in Burkina Faso, it is important to develop programs and strategies to reach out-of-school adolescents so that they too can protect themselves by using condoms and taking advantage of other preventive services.
Adolescents’ sexual behaviour and attitudes towards condoms may be shaped by a range of social, psychological, and cultural factors. This has been demonstrated in urban Cameroon22
where a supportive social environment was associated with higher use of condoms among youth. Although we were not able to include social environment, psychological, and cultural factors in our analysis, evidence from other studies suggest that socio-cultural factors are the most common barriers to obtaining male condoms among sexually-experienced adolescents in Burkina Faso.12–24
Strong cultural taboos are especially restrictive for sexually active women.