Factors that facilitate poverty
Participants in all focus groups and interviews described poverty as inability to provide for basic needs, and emphasized it as a key facilitative factor of adolescent sexual risk behaviour. Adolescents, caregivers, community leaders, and service providers discussed this concept extensively. Caregivers described five factors that exacerbated poverty in their communities. First, many AIDS-related deaths among adults that burden their extended families with the care of orphans for whom they could not adequately provide for:
“Parents have really died mainly due to AIDS related illnesses and left many orphans behind for us to care for. We also have our children who are already burdensome. We are unable to care for them well. Education is very expensive; to educate your children and leave the orphans is a challenge. They both need equal opportunities. We parents and caregivers have been unable to care for them well.” (Male caregiver, FGD)
Additional factors include unemployment, low income, high cost of living, low farm produce due to unreliable rainfall and poor farming techniques. Also reported were lack of markets, low prices of farm produce when harvest is good, and poor roads.
“There is starvation in our village. If you are not working and only depend on farming, then there is no way you can survive because farms are not doing well.” (Female caregiver, FGD)
“You can be a farmer but still be poor because we sell what we produce at throwaway prices.” (Male caregiver, FGD)
“Some parents/guardians have farms but they lack farm implements so some of the farms are not cultivated. Such parents should be helped by the government to expand farm production for food security in orphan households.” (Female adolescent, FGD)
Factors that facilitate adolescent sexual risks
Lack of basic needs
Participants across all categories reported poverty as a hindrance to caregivers’ provision of children’s basic needs, which prompted some adolescents to adopt varied survival strategies. The most commonly and extensively discussed basic needs were lack of food, and school requirements such as school fees, uniform, shoes, and stationery. Other basic needs included clothes, underpants, toiletry supplies and poor housing in low income urban areas:
“Many adolescents, both orphans and non-orphans, who live in poor households lack many basic necessities. Many orphan households are poor and this will make them leave their household to seek self support elsewhere.” (Male adolescent, KII)
“Poverty in a family can make an orphaned girls resort to transactional sex to supplement the little food the parents/guardians can afford.” (Female adolescent, FGD)
“Some boys move from one household to another to herd cattle and in order to get food.” (Male adolescent, FGD)
Poor housing
Poor housing in low income urban areas was reported as a sexual risk factor for adolescents especially by female caregivers. They reported that poor housing, had limited audio and visual privacy; exposing children to sexual intimacy by their parents, caregivers or neighbours that motivated sexual experimentation:
“In this place (urban slum) most of us live in one-roomed rental houses mainly joined structures (landi) without ceiling, partition or with poor partition material. You have no choice but to share the single room with the children who sleep on the floor. The children will ‘watch you when you are with their father’, so we usually ask them to play outside until we call them to prepare their sleeping space. In the course of waiting outside, some children end up engaging in unprotected sex, drugs or alcohol.” (Female caregiver)
Housing in urban informal settlements thus posed a challenge to adolescent sexual risk prevention.
School dropout
School dropout as an outcome of poverty, as a survival strategy, and as a sexual risk factor was reported in nearly all adolescent FGDs, a half of caregiver FGDs and at least a half of KIIs. Adolescents dropped out of school due to lack of school requirements, food, and the need to work to support family basic needs:
“Some adolescents, both orphans and non-orphans from poor families drop out of school due to lack of money for school requirements such as school fees, uniform including shoes, inability to concentrate due to hunger, frequent lateness and absenteeism that result in loss of interest and eventual dropout.” (Female Adolescent, FGD)
Adolescents also perceived orphans to be more susceptible to school dropout than non-orphans:
“ Orphans are more at risk of dropping out of school, for example, some paternal orphans are forced by circumstance to drop out of school to help the mother with casual work for the family to get money for household food.” (Male adolescent, FGD)
Caregivers reported many parents’ inability to cater for their children’s secondary school education, resulting in school dropout thus predisposing them to risks faced by out of school adolescents.
“Many parents in this region cannot afford to take children to secondary school. Such children become idle and begin to influence each other into sex.” (Male caregiver, FGD)
Engaging in income generating activities
Adolescents, caregivers and community informants reported that, to meet basic needs, some adolescents engage in varied income generating activities (IGAs). The most commonly discussed IGAs included fishing, bicycle taxi services, herding and casual farm work for boys while girls engaged in domestic live-in work (household chores for pay) away from home.
Adolescents reported that boys who engaged in IGAs used their earnings to entice girls into sex, go to discos and video shows, buy alcohol and drugs, and engage in other behaviours that were thought to increase sexual risk outcomes such as teenage pregnancies, STIs or both.
They described domestic work as increasing girls’ vulnerability to sexual abuse and exploitation by the male members of such households:
“Some parents can remove a child from school to work as a domestic worker to bring money home so that the parent can buy food for the family. This puts the girl at risk of pregnancy or contracting STI/HIV as she may be sexually abused or exploited by some male members of the household she works for.” (Male caregiver, FGD)
Transactional sex
All participants extensively discussed transactional sex as an important sexual risk behaviour associated with poverty. Orphans and non-orphans from poor families were both at risk of engaging in transactional sex to get money to meet their basic needs:
“ Sometimes orphans who live in a poor household and especially the girls who have the responsibility to provide for their daily meals ends up in engaging in sex to get money for food and other basic needs.” (Male Adolescent FGD)
“Adolescents who have parents but live in poverty engage in transactional sex because of the problems they face. They will copy their friends whom they see engaging in sex for money to make ends meet.” (Female adolescent, FGD)
Orphaned and sometimes non-orphaned males were reported to engage in transactional sex with older women and widows to meet basic needs such as food and school fees:
“ A male orphan who lacks school fees or pocket money may decide to stay with a widow who has money so that she pays for his school fees.” (Male Adolescent, FGD)
Transactional sex is also facilitated by the IGA environment in which adolescents operate, such as fish landing beaches, as expressed by male adolescent FGD participant:
“Beaches serve as money minting points where fishermen, fishmongers and middlemen have a lot of money. For boys involved in the fish trade, older female fishmongers, some of whom are widows, entice them with sex so that they can sell to them fish cheaply. This has led to high rates of HIV infection in the beach communities”.
Early marriage
Poverty was reported to motivate orphan and non-orphan girls into early marriage that was either voluntary or forced by caregivers:
“If a family is living in abject poverty and they have daughters, some parents have been reported to marry them off even before age 18 to get dowry to sustain the family economically. Such cases are reported to my office, and do affect both orphans and non-orphans and puts them at risk for early pregnancy or contracting STI/HIV.” (DCO, KII)
Poverty compelled orphan and non-orphan girls to early marriage to escape the challenges they faced such as caregiver inability to cater for their school requirements including other basic needs, with expectations that their spouses would cater for their basic needs. Caregivers and adolescents reported an additional challenge of teenage pregnancy and fear of consequences.
“An orphan or non-orphan girl who is suffering can decide to go and get married to a better off man so that her misery comes to an end” (Male adolescent, FGD)