Abstract:
Background: Fostering adolescents’ communication on sexuality issues with their parents and other significant
adults is often assumed to be an important component of intervention programmes aimed at promoting healthy
adolescent sexual practices. However, there are few studies describing the relationship between such
communication and sexual practices, particularly in sub-Saharan Africa. This study examined the relationships
between adolescents’ communication with significant adults and their condom use in three sites in this region.
Methods: Data stem from a multi-site randomized controlled trial of a school-based HIV prevention intervention
implemented in Cape Town and Mankweng, South Africa and Dar es Salaam, Tanzania. Only data from comparison
schools were used. The design is therefore a prospective panel study with three waves of data collections. Data
were collected in 2004 from 6,251 participants in 40 schools. Associations between adolescents’ communication
with adults about sexuality issues and their use of condoms were analysed cross-sectionally using analysis of
variance, as well as prospectively using multiple ordinal logistic regression analysis.
Results: Cross-sectional analyses showed that consistent condom users had significantly higher mean scores on
communication (across topics and communication partners) than both occasional users and never-users, who had
the lowest scores. After controlling for condom use at the first data collection occasion in each model as well as for
possible confounders, communication scores significantly predicted consistent condom use prospectively in all
three ordinal logistic regression models (Model R2 = .23 to .31).
Conclusion: The findings are consistent with the assertion that communication on sexuality issues between
adolescents and significant adults results in safer sexual practices, as reflected by condom use, among in-school
adolescents. The associations between communication variables and condom use might have been stronger if we
had measured additional aspects of communication such as whether or not it was initiated by the adolescents
themselves, the quality of advice provided by adults, and if it took place in a context of positive adult-adolescent
interaction. Studies with experimental designs are needed in order to provide stronger evidence of causality.
