3.1.1 Distribution of Respondents by Study Area
A total of 186 adolescent daughters were used for the study. Of these, 56.5% (105 out of 186) were from Rubaga division in Kampala district while 43.5% (81/186) were from Kabulasoke sub-county in Mpigi district.
A total of 183 mothers were interviewed. 56.8% (104/183) were from Rubaga division (Kampala district) while (79/183) were from Kabulasoke sub-county (Mpigi district).
3.1.2 Age Distribution
The age range of most adolescent daughters was 13-19 years, who constituted over 94 % (171/182) of the adolescents interviewed. The mean age was 15.335 + SD 2.015.
The majority of mothers, 83.2 % (144 /173), were between 30-50 years with a mean age of 39.844 + SD 8.082, as shown in fig.2.
3.1.3 Religious Affiliation
Most of the respondents were affiliated to the Catholic faith (81-88%), followed in descending order by Protestants (44-46%), Moslems (44%), Seventh Day Adventist and others.
3.1.4 Educational Status
Most of the adolescent daughters interviewed had attained primary 47% (86/183) or secondary education 47.7% (91/183) while a few 3.3% (6/183) had not gone to school. Similarly, the majority of the mothers had their education levels skewed to primary, 43.7% (80/183) and secondary, 31.1% (57/183) levels with a few having attained tertiary education 10.9% (20/183). 14.2% (26/183) of the mothers had not been to school while over 85% of the adolescents interviewed were currently attending school.
Many of the adolescent daughters were studying in day schools while those in boarding schools were mainly from urban (Rubaga division) families.
3.1.5 Family Background
Fifty percent of the daughters and their mothers were from a monogamous family setting while 25% were from polygamous or single parent families.
3.1.6 Employment Status of the Mothers
The majority of mothers were farmers 44.8% (82/183), followed by housewives 20.8% (38/183), traders 18% (33/183) and professionals 12.6% (23/183).
3.2 Information on Sexuality and HIV/ADIS
3.2.1 Sources of Information
The major sources of information about sexuality and HIV/AIDS for adolescent girls were parents 32.3% (60/186), followed by friends 24.7% (46/183), radio 21.5% (40/186) and teachers 16.6% (31/183). Others were booklets 4.3%(8/186), health workers 3.2% (6/186) and youth club 1.6% (3/186).
3.2.2 Nature of Information Given
A wide range of information about sexuality and HIV/AIDS was given to the adolescent daughters. The information ranged from issues regarding sexually transmitted diseases and HIV/AIDS 61.7% (113/186), to menstruation hygiene 57.5% (107/186), how to avoid men and premarital sex 56.9% (106/186), how to use a condom 32.3% (60/186), having one faithful partner 17.7% (33/186) and family planning methods 15.1% (28/186). Other information obtained concerned sex relationships 7% (137/186) and marriage life 6.5% (12/186).
Many daughters acknowledged that they had learned several lessons from the information obtained, most importantly about HIV/AIDS 41.5% (76/183), avoiding men and sexual abstinence 32.9%(60/183), responsible sexual behaviour 8.2% (15/183), using condoms 6.6% (12/183), avoiding pregnancy 5.5%(10/183), menstruation hygiene 2.5% (5/183) and others 1.1% (2/183). Three adolescents or 1.6% reported that they had not learnt any lesson from information they received.
3.3. Communication with Mothers
3.3.1 Information Received from Mothers
67.9% (125/ 184) daughters acknowledged their mothers' having talked to them on issues about sexuality and HIV/AIDS. However, 32.1% (59/184) or a third of the daughters reported that their mothers had never talked to them on issues about sexuality and HIV/AIDS.
3.3.2 Content of Information Received from Mothers
Adolescents reported that their mothers talked to them on a wide range of sexual issues ranging from avoiding men and pregnancy 72.8% (91/125), to menstruation hygiene 63.2% (79/125), avoiding STDs and HIV/AIDS 60% (75/125), abstinence 22.4% (28/125), married life 13.6 (17/125), how to use a condom 6.4% (8/125) and the use of family planning 6.6%(8/125). During focus group discussions, some adolescents further revealed:
· "That AIDS kills" (12 year old adolescent).
· "Not to associate with men or have sexual relationships" (17 year old adolescent).
· "Not go to discotheques because they are bad" (14 year old adolescent).
3.3.3 Occasions of the Discussions
Adolescents were asked to describe the occasions on which mothers initiated the discussion about sexuality and HIV/AIDS. Most mothers, 68% (85/125), initiated the talk when their daughters started menstruation, followed by those who initiated the discussion when they lost a relative due to AIDS 36.8% (46/125). Other occasions on which the talk was initiated were when the mother thought her daughter had a boyfriend 23.2% (29/125), when a friend/relative became pregnant 22.4% (28/125), when the daughter was going away from home 9.6% (12/125), when the daughter became pregnant 4% (5/125), when the daughter wanted to get married 1.6% (2/125) and other occasions 4.8% (6/125). Four daughters or 3.2% (4/125) could not recall the occasion when the discussions were initiated. The mean number of times per month reported by daughters on which mothers talked to them about sex and AIDS was 4.271 + SD 6.378. Some daughters described further the occasions on which such discussions were initiated:
· "When we unexpectedly lost some one from AIDS " (14 year old adolescent).
· "During a capital radio program which encouraged the use of condoms, my mother told me to take heed not to sleep with a man without using a condom" (18 year old adolescent).
· "When a friend got a cut on her finger, my mother advised me to cover my hands with a cloth before dressing the wound because the friend was a suspected HIV infected person" (15 year old adolescent).
3.3.4 Barriers to Communication with Mothers among Daughters
Forty percent (50/125) of the daughters revealed that they found problems talking to their mothers on issues of sexuality and HIV/AIDS.
Adolescent daughters who reported that they experience some problems to talk to their mothers were asked to explain the nature of the problems they faced. Most of the daughters 42%( 21/50) reported that they feared their mothers, followed by those who claimed that their mothers did not want to talk to them about sexual issues 24% (12/50) and that their mothers were too busy with their work 24% (12/50). Other explanations given were that the daughter was feeling shy to ask her mother 8% (4/50), the mother was not educated 4% (2/50) and others 8% (4/50). Adolescents who participated in focus group discussions emphasized their revelations:
· "Some of our mothers grew up promiscuous and out going and as a result they cannot start counseling their daughters on the same issue" (18 year old adolescent).
· "Some mothers feel shy and others have a feeling that we are still young" (12 year old adolescent).
· "Some mothers think that when you discuss HIV and sex to kids you are spoiling her and that the daughter may become inquisitive" (16 year old adolescent).
Adolescents who reported that they never discuss with their mothers on issues of sexuality and HIV/AIDS were asked to explain what hindered them. Most of them, 25.4% (15/59), said they did not know why they could not talk about sex issues. Other reasons given were that the daughter was perceived to be still young to be engaged in such a discussion 22% (13/59), the daughter feared her mother 20.3% (12/59).
3.3.5 Role of Mothers in Accessing Information
68.8% (121/177) of the adolescents reported their mothers' assisting them to obtain information about sexuality and HIV/AIDS while 31.6% (56/177) or one-third of the adolescents said they were not being assisted. Daughters revealed further from focus group discussions:
· "They give us booklets, news papers and magazines to read. They claim that gone are the days of sending daughters to sengas (aunties) since they can read" (16 year old adolescent).
· "My mother encourages me to listen to capital doctor, a radio program on sex education" (15 year old adolescent).
· "She encouraged me to go and watch AIDS drama like Ndiwurila" (18 year old adolescent).
Asked how mothers were assisting them to access the information, the majority, 76 % (92/121), reported that they talked to them directly. Other ways in which mothers helped their daughters were through encouraging them to watch television and listening to radio programmes 38.8% (47/121), provision of reading materials 34.7%( 42/121), sending them to their aunties 24.8% (30/121) and a few to youth clubs 5% (6/121).
3.4.1 Other Sources of Information for Daughters
Daughters acknowledged the presence of several other sources of information about sexuality and HIV/AIDS (Table I). Adolescents revealed that sources outside the family put more emphasis on issues concerning sexually transmitted diseases and HIV/AIDS 53.2% (99/186), avoiding men and sexual abstinence 32.8% (61/186), avoiding teenage pregnancy 9.8% (18/186), use of condoms 5.4% (10/186) and others. Some of these were further emphasized in focus group discussions:
· "Not to allow men to rape and take advantage of me" (14 year old adolescent).
· "Sex abstinence by avoiding discos, dark places and walking alone at night" (17 year old adolescent).
· "To carry condoms wherever one goes and to use condoms whenever one is having sex" (18 year old adolescent).
Adolescents were further asked whom they preferred to provide them with information about sexuality and HIV/AIDS. Most of them, 35.6% (68/186), preferred mothers, followed by aunties 26.9% (50/186), and friends 17.2 % (32/186). Others mentioned were older sister 14% (26/186), grandmother 10.8% (20/186) and teacher 9.8% (18/186). This is illustrated in fig. 5.
Table 1. Other common sources of information about sex and HIV/AIDS (n =186)
|
Other sources of information |
Frequency |
Percentage |
|
Friends |
100 |
53.8 |
Teachers/school club |
89 |
47.8 |
Radio/TV/drama |
84 |
45.2 |
Books/magazines/newspapers |
50 |
26.9 |
Auntie/grandmother |
43 |
23.1 |
Doctor/nurse/clinic |
24 |
12.9 |
None |
24 |
12.9 |
Seminars/ workshop |
12 |
6.5 |
Elder sister |
5 |
2.7 |
Youth club |
3 |
1.6 |
Other |
2 |
1.1 |
There were a number of good and reliable sources of information on sexuality and HIV/AIDS in the community acknowledged by the adolescents. These included health centers and clinics 20.6 % (36/175), mothers 12.4% (23/175), seminars 11.4% (20/175), Radio/ TV 10.3% (18/175), books and reading materials 9.1% (16/175), aunties 9.1% (16/185), school teachers 5.1% (9/175), peers 4%(7/175) and people living with HIV/AIDS 1.7% (3/175). 17.1% (30/175) reported that they do not know of any sources in their communities.
3.5.1 Communication from Mothers
75.8% (138/182) of mothers revealed that they talked to their adolescent daughters about the subject of sexuality and HIV/AIDS while 24.2% (44/182) reported that they did not discuss with them. Mean age at which most mother started to talk to their daughters was 12.881 + SD 1.441.
3.5.2 Content of the Information Given
73.9% (102/138) mothers revealed that they talked to their adolescent daughters on a number of issues concerning menstruation hygiene, avoiding pregnancy 73.1% (101/138), STDs and HIV/AIDS 70.2% (97/138), abstinence 65.9%(91/138), married life 10.1% (14/138), condom use 8% (11/138) and faithfulness 6.5%(9/138). Mothers who participated in focus group discussions further elaborated on the content of their discussions with their daughters:
· "We stress on the dangers of having sex with men and AIDS."
· "I talked to her about family planning and condom use when I learnt that she had an abortion."
3.5.3 Occasions of the Discussions
Mothers revealed that they started to talk to their daughters about sexuality and HIV/AIDS due to a number of reasons. Most mothers initiated the discussion after realizing that their daughters had reached puberty 75.4% (104/138). Other reasons were when the daughter was going away from home 15.9% (22/138), when their daughter was joining a boarding school 15.2% (21/138), when the daughter started to have boy friends 13% (18/138), when they lost a relative due to HIV/AIDS 8.7% (12/138) and when the daughter became pregnant 5.1% (7/138).
Mean number of occasions per month when mothers talked to their daughters about sexuality and HIV/AIDS was 7.833 + SD 10.633. Mothers were further asked to describe the occasions on which they normally initiate such a talk. Many mothers reported that they start the talk any time 21.7% (30/138), followed by those who start the discussion while doing household work 16.7% (23/138). Other occasions reported by mothers were: after seeing a person infected with HIV/AIDS 14.5% (20/138), when the daughter misbehaves 10.4% (14/138), when she is seen with bad peers 8.7% (12/138), when they watch a television or listen to a radio program on AIDS 6.5% (9/138) and on other occasions. Mothers who participated in focus group discussions further described the circumstances as follows:
· "We use relevant circumstances to initiate the talk, say after death of a member in the community, misbehavior or showing the children people living with AIDS."
· "Many of our daughters start their menstruation while at school so we rarely use this occasion to initiate the discussion."
3.5.4 Communication Barriers for Mothers
Mothers were asked if they find any problem to talk to their daughters on issues of sexuality and HIV/AIDS. Most mothers 71.9% (97/135) reported they find no problems while 28.1% (38/135) admitted they find some problems that hinder then from effectively communicating with their daughters.
The main communication problem faced by mothers was shyness to talk to the daughter 68.4% (26/38), followed by those who reported that their daughters were stubborn and would not listen to them 34.2% (13/38). Other hindrances reported were that mother and daughter were not staying together 18.4% (7/38), mother did not know what to tell the daughter 15.8% (6/38), mother was very busy 10.5% (4/38) and others 5.3% (2/38). Mothers who participated in focus group discussions further revealed the problems they experienced:
· "Most parents are shy and find it difficult to talk and open up to their children."
· "We fear to break our children's innocence which may be a disadvantage because if exposed the child may be inquisitive to try and experiment."
Mothers who reported that they never talked to their daughters were asked why they did not do so. Most of the mothers believed that their daughters were still young 38.6% (17/44). Others reported that they felt shy about such a discussion 11.4% (5/44), mother and daughter were not living together 9.1% (4/44), that it was not culturally permissible 4.5% (2/44), mother was very busy 4.5% (2/44) or mother trusted her daughter 4.5% (2/44), 9.1% (4/44) gave other reasons.
3.6.1 Role Played by Mothers
Mothers reported that they assist their adolescent daughters in a number of ways to access information about sexuality and HIV/AIDS. The several approaches which they used included encouraging their daughters to listen to radio and television programs about sexuality and HIV/AIDS 46.7% (85/182), sending them to their aunties for sex education 35.7% (65/182), providing them with relevant books and magazines 26.9% (49/182), talking to them directly 13.2% (24/182), sending the daughter to a counselor 7.1% (13/182), sending her to women's club 5.5% (10/182), sending her to a health worker 1.1% (2/182), sending her to a pastor 1.1% (2/182) and others 4.4% (8/182). 12.1% (22/182) mothers reported that they did nothing to assist their daughters get the necessary information.
3.6.2 Information Provided
Mothers were further asked what they thought their daughters learnt from these sources. Many of the mothers 50% (80/160) reported that their daughters learn a lot on issues ranging from STDs and HIV/AIDS, sexual abstinence 31.3% (50/160), good morals 21.9% (35/160), avoiding unwanted pregnancy 16.3% (26/160), hygiene 4.4% (7/160), condom use 0.6% (1/160) and others 6.15% (10/160). 5.6% (9/160) did not know what their daughters learn from these sources. Mothers who participated in focus groups further emphasized these: "Emphasis on the radio is put on HIV/AIDS and condom use and that AIDS is a disease without cure."
Most of the mothers 98.6% (137/139) were satisfied that their daughters received the right information from these sources:
· "At Namirembe cathedral the sengas (counselors) provide enough sex education."
· "They learn how AIDS is contracted and how to avoid contracting it."
Mothers gave reasons why they thought that their daughters had received the right information from sources outside the family. Most of them 34.3% (47/137) reported that their daughters were disciplined, while 17.5% (24/137) said the sources are professional or have experience in sex education 12.4% (17/137). 13.8%(19/137) mothers said that they talked directly to their daughters, 5.8% (8/137) reported that their daughters now talked to them when they have a problem, 5.1% (7/137) reported that their daughters are interested in radio and television programmes about sex education while 3.6% (5/137) reported that their daughters tell them they are not interested in boyfriends, 9.5% (13/137) gave other reasons.
3.6.3 Sources of Information Trusted by Mother
Mothers were asked whom they recommended to give their daughters sex education. 72.5% (100/137) said they trusted the auntie, followed by the teacher 52.6% (72/137), the pastor 27.7% (38/137), and the counselor 24.1% (33/137). Other trusted persons mentioned included peers 7.3 % (10/137), the older sister 7.3% (10/137), health worker 5.1% (7/137) and others 2.9% (4/137). 5.8% (8/137) of the mothers said they did not trust anyone with their daughter. A mother who participated in focus group interviews further elaborated on their views:
"The topic of condom use should be left to the teachers in school to teach about their use so that the child can remain with some respect for the mother, because if the parent talks about it the child may view condom use (sex) as legitimate since the mother has advised its use."
3.6.4 Recommendations for Improving Mothers' Communication.
Mothers made recommendations on how they could be assisted to better communicate with their adolescent daughters on the subject of sexuality and HIV/AIDS. 50.7% (70/138) recommended organizing training seminars and workshops for them in their communities, followed by those who suggested the provision of reading materials like booklets and pamphlets 23.2% (32/138). 8.7% (12/138) suggested introduction of educational radio and television programmes for them, 7.2% (10/138) suggested to be assisted by counselors or teachers 2.9% (4/138), 2.9% (4/138) suggested drama activities. 6.5% (9/138) did not have any suggestion to get assistance.
