1. The Sexual Health Needs of Youth in Tobago Paper presented at the Centre for Caribbean Medicine Conference, Centre for Caribbean Medicine Conference, St. Thomas Hospital, London, 6-7 July 2000 Caroline Allen, Keston McLetchie, Anne-Marie De Gazon Washington and Tristan Chapman-Smith

2. The Sexual Health Needs of Youth in Tobago Sponsored by: The Royal Netherlands Embassy, Trinidad and Tobago With technical support from: Caribbean Epidemiology Centre (CAREC) and the German Technical Cooperation Agency (GTZ)

3. FPATT, TAS, Royal Netherlands Embassy Youth and HIV in Trinidad and Tobago s The Caribbean has the second highest HIV prevalence rates in the world (1.9%) s A cord blood survey in Tobago showed rates of HIV infection of 3.5% in 14-19 year olds and 3.6% in 20- 24 year olds s In Trinidad and Tobago, the number of new cases of HIV has doubled every 3 to 4 years s HIV/ AIDS is projected to cost 4.2% of GDP in the next ten years s In the 15-19 year age group, there are SIX (6) times as many infected females as males

4. FPATT, TAS, Royal Netherlands Embassy New HIV-Infections T&T, 1996 Age & Sex 0 10 20 30 40 50 60 70 80 < 1 1-4 5-14 15-1920-2425-2930-3435-3940-4445-4950-54 55-59 60+ NK Age Male Female Total Number = 937 M:F= 1.4

5. FPATT, TAS, Royal Netherlands Embassy Research questions s What are the features of Tobago youth sexual behaviour? s How are they associated with socio- demographic characteristics, knowledge and attitudes? s What are the implications for youth sexual health promotion strategies?

6. FPATT, TAS, Royal Netherlands Embassy Methods s 676 people aged 10-29 responded to a structured questionnaire survey (of which 3 were over 24) –44% male, 56% female –32.5% out-of-school –31.8% 10-14 year olds in-school –32.5% 15-19 year olds in school

7. FPATT, TAS, Royal Netherlands Embassy Methods s 12 focus groups with young people age 10-24 –6 male focus groups, 6 female –4 out-of-school age 15-24, 4 in-school age 15-19, 4 in-school age 10-14 –Out-of-school focus groups conducted in one rural and one urban village –Schools selected for urban/ rural spread and type of school (secondary/ post-primary)

8. FPATT, TAS, Royal Netherlands Embassy Tobago survey results Percentages who have ever had sex, by gender and sub-sample 14 73 86 12 40 55 0 10 20 30 40 50 60 70 80 90 100 10-14 in-school15-19 in-schoolOut-of-school % Male Female

9. FPATT, TAS, Royal Netherlands Embassy Age at first sex Of the 46% of respondents who had sex: s Average age at first sex was 14 s Half had sex by the age of 15 s A quarter had sex by the age of 12 s 6.5% (1 in 15) had their first sexual experience before the age of 10 s Three-quarters had sex by the age of 16 s Average age at first sex was 15 for girls and 13 for boys

10. FPATT, TAS, Royal Netherlands Embassy Frequency of age at first sex, by gender 0 5 10 15 20 25 30 35 12345678910111213141516171819202122 Age Frequency Male Female

11. FPATT, TAS, Royal Netherlands Embassy Having sex the first time s The partners of males were on average 1 year older than they were s The average age of partners of males was 14 s The partners of females were on average 4 years older than they were s The average age of partners of females was 19

12. FPATT, TAS, Royal Netherlands Embassy Number of sex partners in lifetime "How many people have you had sex with in your life?" by gender 0 10 20 30 40 50 60 12 to 45 to 910 to 20>20Cant remember Male Female Total %

13. FPATT, TAS, Royal Netherlands Embassy How can we explain behaviour? s Quality of care –No one to talk to - need counselling or guidance services –Lack of confidentiality among health care workers –Some workers do not respect young peoples right to choose –Difficult to get condoms

14. FPATT, TAS, Royal Netherlands Embassy How can we explain behaviour? s Culture of silence –People have sex but do not talk about it –Lack of communication between males and females –Lack of communication between parents and children –Religious leaders will not discuss sex –Adults often condemn and criticise without understanding –People bad talk each other

15. FPATT, TAS, Royal Netherlands Embassy The Sexual Health Needs of Youth in Tobago Recommendations Health and social services –Confidential, private, specialised health services for youth –Youth health services should be integrated with other services –Counselling and guidance services should be increased

16. FPATT, TAS, Royal Netherlands Embassy The Sexual Health Needs of Youth in Tobago Recommendations s Males need –outreach, guidance and mentoring –education to improve accuracy of HIV/ AIDS knowledge s Females need –involvement of religious leaders –awareness of the risks of unprotected sex with older men

17. FPATT, TAS, Royal Netherlands Embassy The Sexual Health Needs of Youth in Tobago Recommendations Community participation – Projects should be small-scale – building on existing social networks – employing people who have achieved a position of trust