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1. Kgoa H [Internet]. Reproductive health awareness month. National Department of Health; [updated 2017; cited 2018 April 20]. Available from: http://www.health.gov.za/index.php/gf-tb-program/337-reproductive-health-awareness-month
2. Temmerman M [Internet]. Reproductive health. World Health Organisation; [updated 2015 June; cited 2018 April 20]. Available from: http://www.who.int/topics/reproductive_health/en/

3. Kotecha P.V, Patel S, Baxi R.K, Mazumdar V.S. Reproductive health awareness among rural school going adolescents of Vadodara district. Indian J Sex Transm Dis. [Internet]. 2009 [cited 2018 April 20];30(2):94-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21938128

4. National Department of Health, Statistics South Africa. South Africa Demographic and Health Survey 2016. Stats SA 2017 2017;03-00-09.

5. World Health Organisation. Epidemiological fact sheet on HIV and AIDS: core data on epidemiology and response: Nepal, 2008 2008 Update. Geneva: World Health Organisation;2008. P. 5.

6.Viner R, Tripp J. ABC of adolescence – Sexual health, contraception, and teenage pregnancy. BMJ. [Internet]. 2005 [cited 2018 April 21];330(7491):590-3. Available from:

7. Avert [Internet]. HIV and AIDS in South Africa; 2018 [updated 2018 April 17; cited   2018 April 20]. Available from:  https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/south-africa.

8.Cyril Ramaphosa.Politainment.[video file].2019 Sep 3 [cited 2018 April].Available from https://youtu.be/0eEiPlEzY6o

9. Coates TJ. Behavioral strategies to reduce HIV transmission: how to make them work better. [Internet]. 2008 [cited 2018 April 20];372(9639):669-684. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18687459

10. Steckl C. [Internet]. How Social Norms Affect Our Decisions; [updated 2013 April 26; cited 2018 April 20]. Available from: https://www.mentalhelp.net/blogs/how-social-norms-affect-our-decisions/.

11. Brady SS, Halpern-Felsher BL. Social and Emotional Consequences of Refraining from Sexual Activity Among Sexually Experienced and Inexperienced Youths in California. Am J Public Health. [Internet]. 2008 [cited 2018 April 20];98(1):162-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2156074/

12. Darroch Forrest J, Frost J. Understanding the Impact of Effective Teenage Pregnancy Prevention Programs. Family Planning Perspective. [Internet]. 1995 [cited 2018 April 20];27(5):188-195. Available from: https://www.guttmacher.org/sites/default/files/article_files/2718895.pdf

13. Barry A-M, Yuill C. Understanding the sociology of health. 4th ed. London: Sage; 2016.

14. Dewy S,Zheng T. Ethical research with sex workers: Anthropological approaches [internet].Springer; 2014 [cited 2018 April 20]. Available from : https://ebookcentral-proquest-com.uplib.idm.oclc.org/lib/pretoria-ebooks/detail.action?doclD=1205323&query=Condom+use.

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Video presentation on Reproductive awareness "Max condoms", freely distributed by the national Department of Health.

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Video presentation on Reproductive awareness "Max condoms", freely distributed by the national Department of Health.

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https://www.youtube.com/watch?v=DhgRYy3pgUw

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The national HIV prevention and sexual and reproductive health programme

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5.What role do you play as a citizen and future doctor in this intervention? How could you support it?

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5.What role do you play as a citizen and future doctor in this intervention? How could you support it?

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With the increase in unsafe sexual practices, as citizens and future doctors we have the responsibility to help manage these unsafe sexual practices. Carrie Steckl, who earned a Ph.D. in Counselling Psychology, states that communal values and social norms do deeply affect us and have a great effect on the decisions we make.10 Therefore, as a start, we should have an understanding that values and social norms within our communities shape who we are and observe which ones may lead to such risk behaviour.

Often, risky sexual behaviours begin at adolescence. Therefore, the root of the problem needs to be tackled at the adolescence stage and as a citizen we need to be aware of that. What we observe as we grow up becomes the backbone to how we act when we are older. When a child is exposed to an environment where sexual activity is prevalent such as prostitution or the “blesser-blessee” culture, they may end up engaging in these activities. Citizens and future doctors, therefore, have a significant role to play in the upbringing and education of children. If a community practices unsafe sexual behaviour, citizens should work towards a community that reduces the prevalence of these practices. Children of the community should be protected from being exposed to such risky sexual behaviours. Doctors should make the community aware that certain practices lead to negative results thus passing on knowledge within the community.

Also, as citizens and future doctors of a community, we should teach teenagers that safe sexual practices are important. Research carried in California showed that teenagers often feel pressured to start engaging in sex, particularly unsafe sexual practices. It was noted that teenagers who experience positive consequences such as approval from their friend for abstaining were decreasing along the years and the negative consequences were become more common. However, through programs that taught them about sexual behaviours, teenagers who were sexually active said they would have probably reported positive consequences if they had the information they had acquired through the programs.¹¹ From this research, it is evident that if elders in the community could educate the adolescents about sexual behaviours and the risk of unsafe sexual behaviours, there would be less pressure to carry such risky behaviours. The same study was carried out by Frost JJ and Darroch Forrest¹² in 1995 and there were similar results. Hence, sex education is vital among adolescents.

Doctors should not assume that everyone has the same level of sex education. During consultations, doctors should talk about these issues, particularly, with teenagers. Teenagers are often unaware of the dangers of risky sexual behaviour. Furthermore, doctors should not harbour a judgemental environment as this makes them less comfortable disclosing about their sexual behaviours. As future doctors and citizens, we should be more open minded to the idea that young people now engage in sexual behaviour and change our judgemental attitudes in order to be able to discuss these topics wholeheartedly with teenagers.

Importantly, as future doctors we need to understand that we do not work in isolation. We have profound knowledge about the effects of risky sexual behaviour. However, it is not a lot of people who come to our consultation rooms, hence we cannot reach a wide audience. We need to start working closely with the government, marketing and educational institutions and activists. There are many factors that lead to people practicing unhealthy sexual behaviours ranging from exposure to risky behaviour to being in abusive relationships. Therefore, we could work with the above-mentioned groups to reach out to a wider audience and adapt the sex education to the causation. Thus, correcting the behaviour by removing the factors influencing it. We could carry out projects such condom distribution, empowerment and sex talks and advertisements.

Lastly, we need to be aware that it is not only the teenagers in the community who are engaging in sexual behaviour but also the adults. Again, values and norms play a significant role in our practices. As community members, we should stop normalising risky sexual behaviour. We tend to observe risky sexual behaviour among teenagers and be more lenient to adults engaging in it. People should maintain the same strict standards throughout all the ages.

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4.What is the amount of evidence for causation between your selected intervention and the health concern it is trying to address/solve? 

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4.What is the amount of evidence for causation between your selected intervention and the health concern it is trying to address/solve? 

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South Africa has one of the largest and most established male and female condom distribution campaigns in the world. This is largely due to the fact that the number of HIV persons living in South Africa has increased from 4.98 million in 2005 to just above 7 million in 2017. The department of health and private companies are continuously trying to decrease the number of newly infected people and one of their most extensive campaigns has been to distribute free condoms in areas that easily accessible to the public, like in shebeens, shops and clinics. In 2010 alone  495 million male condoms and 26 million female condoms were distributed.

Although condom accessibility in South Africa is high and convenient, the use of condoms is on a decline. A study revealed that in 2012 68% of men between the ages of 15-24 said they used condoms during their last sexual encounter as opposed to 86% in 2008.Condom use declined from 44% to 36% in men aged 25-49.⁷

One might expect an increase in the number of new HIV cases and unplanned pregnancies since South Africans are failing to use condoms consistently, but studies show that the number of unplanned pregnancies and abortions has declined since 1999, but this can largely be attributed to other forms of contraceptives that are more convenient.

The government’s efforts in targeting behavioural strategies to reduce HIV include, but are not limited to, promoting condom use. Promotion of males’ circumcision, limited sexual partners and preventing mother to child transmission, have played a significant role in reducing the number of new HIV cases.

Problems with the government issued condoms were that they made a noise during intercourse and had an unpleasant smell.⁸ These issues pushed the Government to re-brand their condoms and come up with the new maximum pleasure, maximum protection which comes in four different scents strawberry, banana, grape and original and is said to be scientifically engineered to not make a noise. The government hopes to encourage South Africans to use condoms correctly and consistently, to decrease the number of unwanted pregnancies and abortions, and also decrease the number of new HIV cases.⁹

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3.What level of prevention would you consider it to be? Why/not? 

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3.What level of prevention would you consider it to be? Why/not? 

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The intervention may be argued as primary prevention as it targets the whole population, designated groups i.e. adolescents and healthy individuals of South Africa. The intervention follows a population (mass) targeting strategy as advised by the WHO², no matter their socio-economic, gender, racial background or health status.⁵ The intervention aims at minimising the adverse health outcomes of unsafe sex, on the population level, such as HIV, teenage pregnancy, maternal mortality or STIs¹ that are perpetuated by risk factors such as “poverty, poor parental supervision, myths about condoms among african communities, low educational expectations and lack of access to health services”.⁶

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2.What health concern is your selected intervention trying to address/solve?How big is the health concern in South Africa and/or globally? 

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2.What health concern is your selected intervention trying to address/solve?How big is the health concern in South Africa and/or globally? 

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Reproductive health awareness month in South Africa mainly “aims to raise awareness about the importance of contraception and the prevention of HIV/AIDS infection”.¹ Reproductive health refers to people being able to have a “responsible, safe and satisfying sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so”.² So this public health intervention encompasses all factors related to one’s reproductive health, such as contraception, regardless of their age. In raising awareness about reproductive health, this intervention also educates people on how to have and maintain a healthy sex life to prevent the rash consequences of ignorance pertaining sex.  By raising awareness about reproductive health, it is easier for people to realise when they have a reproductive problem and also easier to prevent the problem from arising.

In a survey done in Vadodara, India, it was reported that only about 30% of adolescents know about contraception.³ Surveys from Statistics South Africa⁴ show that the use of female birth control pills and injections has declined since 1998 while the use of male condoms have increased from 1998 to 2008. With that being said, only 60% of women and 68% of men aged 15-49 years use a condom when they are having sexual intercourse, which signals that there is a significant number of people who do not use any contraceptive method even though they are sexually active. Teenage pregnancy statistics from South Africa’s Health and Demographic survey in 2016 are as follows: “16% of women aged 15-19 years have begun childbearing, 12% have given birth, and another 3% were pregnant with their first child at the time of the survey”.⁴ This information gives us an idea of how big a problem contraception and reproductive health awareness is, not only in South Africa, but in other developing countries too; because if many teenagers and adults do not use contraception, and do not know about it, they are more susceptible to consequences such as STIs, unwanted pregnancies and HIV.

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1.Joseph Okello, u12025420
2.Gaopalelwe Kungwane u17016577
3. Khethokwakhe Z Mayisela u17147094
4.Luyanda Ndlovu, u14124093