Starting Young: Sexual Initiation and HIV Prevention in Early Adolescence

Ruth Dixon-Mueller


AIDS and Behavior. 2009;13(1):100-109. 

In This Article

Approaches to Interviewing Young Adolescents About Sex

Interviewing 10-14 or 12-14-year-olds about sexual topics poses many challenges (Bankole et al. 2007; Chong et al. 2006; Eggelston et al. 2000; Helitzer et al. 1994). Parents, teachers and community or state representatives may strongly oppose such inquiries. Ethical standards in most cases require permission from parents or guardians as well as from young people themselves, yet some will withhold their consent, thus biasing the results. Terms used in questionnaires or interviews, such as sexual intercourse, anal or oral sex, or even masturbation may not be understood by some young respondents-if such questions are asked at all-yet explicit descriptions can be shocking. (Investigators may be unaware of the local names for these and other practices, of course.) Behaviors that are considered shameful or taboo are likely to be underreported while those viewed as "masculine" are often exaggerated by boys, thus making gender contrasts appear sharper than they are.

Some of these difficulties can be overcome by adapting questions to local cultural contexts and to respondents' personal situations (Marston and King 2006; Obermeyer 2005), although such adjustments hinder cross-cultural comparability. To avoid questioning young adolescents directly, older teenagers can be asked about their sexual experiences when they were younger and the age at which particular events first occurred (Albert et al. 2003; Chong et al. 2006). Younger boys and girls can be asked individually or in focus groups about their perceptions of their peers' or best friends' behaviors rather than their own knowledge or experiences (Bankole et al. 2007; Gueye et al. 2001; Temin et al. 1999). Different modes of interviewing, the use of self-administered questionnaires (pencil-and-paper or computer), and other approaches such as thematic word sorting can be tested to see what works best for particular topics and groups (Mensch et al. 2003; Plummer et al. 2004; Ramakrishna et al. 2003), recognizing that diverse approaches are bound to elicit different results in different contexts.

The World Health Organization (WHO) has produced sample core instruments for surveys, in-depth interviews, and focus group discussions on sexual topics designed for young people who have reached puberty but are not yet married or living with a sexual partner (Cleland et al. 2003). The standard WHO questionnaire, which can be adapted to a variety of settings, asks male and female adolescents about their main sources of information on puberty, sex, and reproduction; their knowledge of sexual and reproductive health issues; dating relationships and types of sexual partnerships; experiences of heterosexual and homosexual intimacies and sexual intercourse; knowledge and use of condoms and contraception; and sexual outcomes such as STIs, pregnancy and abortion. The Pan American Health Organization (PAHO) has also created questionnaires for male adolescents (Lundgren 2000).

Unlike the 2002 U.S. National Survey of Family Growth which contains very explicit questions on penetrative sexual practices for 15-24-year-olds (Mosher et al. 2005:9), neither the WHO nor the PAHO protocols contains a clear line of inquiry about insertive and receptive oral or anal intercourse in male-male or male-female sexual encounters. This gap is especially problematic given the hypothesis in the PAHO report that a "significant percentage of adolescents (in Latin America and the Caribbean) engage in (heterosexual) anal sex in order to prevent pregnancy and preserve a young woman's virginity" and the recommendation of further research on this topic (Lundgren 2000:37).


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