August 14, 2002
ObjectivesExplore youth's definitions of "trust"Establish criteria youth use to determine the trustworthiness of partnersIdentify types of individuals youth believe they can and cannot "trust"Examine trust's influence on sexual decision-making and STI/HIV risk perceptionIdentify how sexual partners violate trust and the effects on sexual decision-makingStudy designData were collected in October 2001 as part of a regional Behavior Change Communication (BCC) strategy in East and Southern Africa. Country programs chose to participate in research based on project priorities and levels of interest in participating in a regional BCC strategy. Four county programs agreed to collect and share data, Eritrea, Tanzania, Zambia, and Zimbabwe.A total of 33 focus groups were conducted. Research teams in each country used the same discussion guide and pretested the guide prior to data collection. Discussion groups lasted between an hour and an hour and a half, were audiotaped, and transcribed into English. Each research team conducted two discussion groups in the major urban area composed of the following strata: males 15-19 years, females 15-19 years, males 20-24 years, and females 20-24 years. The Zambia program conducted one additional focus group with males aged 15-19.FindingsExplore youth's definition of "trust" and criteria used to determine trustworthinessThe major components of trust did not vary greatly across countries. Youth in all countries placed a high value on sexual fidelity and its role in trusted partnerships. Youth believed that partners met through family or friends are more trustworthy than those met in bars or nightclubs. In addition, youth in all countries expressed that trusted partners must pass informal assessments, dress appropriately, demonstrate appropriate social conduct, talk sweetly to each other, come from the right neighborhood, meet one another's family, be punctual for appointments/dates, and remain emotionally committed to one another. Eritrean youth appeared to place greater importance on the roles that religion, virginity, and marriage (or intent to marry) play in establishing trust than youth from other countries.Differences in criteria for trust were more apparent by gender. In terms of testing partners' trustworthiness, females discussed passive ways of questioning partners, while males discussed elaborate methods for entrapping females in lies. Males were concerned with partners' sexual reputation and appearance. Females were primarily concerned with partners' emotional commitment, willingness to accept responsibility for pregnancies, and ability to display affection in public in order to demonstrate intimacy and trust.Identify types of individuals youth believe they can and cannot "trust"Across countries, youth place prospective partners into groups that can and cannot be trusted according to key attributes and behaviors. Similar to the findings above, most participants said that youth that come from good families, are well respected in the community, are religious, do not drink, avoid bars and nightclubs, and are faithful can be trusted. Youth believe that they cannot trust anyone outside of committed, monogamous relationships. Male participants added that virgins can be trusted.Examine trust's influence on sexual decision-making and STI/HIV risk perceptionYouth do not appear to take effective preventive measures with trusted partners. Trust can blind them to their risk for STIs/HIV and render them unwilling to explore partners' sexual histories. Sex usually occurs early in relationships and condom use remains low. When youth use condoms, they are more likely to incorporate them into casual than trusted relationships, or use them for pregnancy prevention rather than protection from STIs/HIV. Condoms are usually abandoned once relationships appear to be serious and partners fail to show signs or symptoms of STIs or HIV infection. There were few differences in risk perception and risk behavior across countries; however, male participants in Zambia reported that they discuss their sexual histories, while participants from other countries said that couples rarely discuss their sexual histories.Identify how sexual partners violate trust and the effects on sexual decision-makingInfidelity represents the most serious violation of trust and usually results in the end of relationships. A common theme across all countries was youth's refusal to learn from past experiences and apply them to future sexual decision-making. Even when trust is broken, youth fail to apply lessons learned to new relationships, repeating the same scenarios of trust, infidelity and exposure to STIs/HIV.Programmatic implicationsYouth must understand that partners' trustworthiness and character are independent of their risk for STIs/HIV. Although a checklist may help youth select a good partner, unprotected sex with this or any other person must be perceived as risky. Youth must also personalize their risk for STIs/HIV and avoid thinking that only people outside of their community are at risk for infection. It is likely that interpersonal communication campaigns or other community-level activities will help achieve an improved risk perception. Finally, in order to communicate new and appropriate levels of personal risk assessment, programs should strive to achieve broad social support, if not pressure for, consistent condom use, knowledge of one's own HIV status as well as that of all partners, and delay of sexual activity where possible.