Practices and Contributing Factors Related to Risk and Vulnerability
Although previous mapping exercises have been done, this is the first to focus on behaviours and contexts that increase risk and vulnerability
to HIV and AIDS of youth in Kiribati with the intention of providing evidence upon which to base development of interventions and policies.
Examples of groups of adolescents considered to be at higher risk include: injecting drug users (IDU) who share injecting equipment, those
who have unprotected sex with multiple partners, males having sex with males, those exchanging or selling sex, and migrants. In Kiribati,
IDU was not reported personally by those in this sample, but it was reported that girls who sold sex on the ships had injected drugs when
involved with Indonesian seafarers. The potential exists that IDU will be brought in from outside, similar to HIV. The other risk behaviours
were easily found. The increased risks related to commercial and transactional sex, mostly involving Kiribati girls on South Tarawa, were
obviously significant for the individuals and for potential spread, as was the risk of MSM.
The ‘Sexy Island’
When asked why Abemama was called the Sexy Island, a male informant explained that Abemama men had special
techniques for pleasing women. He reported that the tradition started with King Binoka who had sex with all Abemama
girls after their first menstruations and knew how to please ladies. Only the descendants of the King share in the knowledge.
There are very few families who are descendants of the king.
He confirmed that men taught boys. The Abemama mapping workshop group also reported on “educational sex” in which
older women coerced young boys to have sex with them. The research team also interviewed boys who were coerced to
have unprotected MSM after being given kaokioki.
Abemama had higher rates of reported forced sex, including forced MSM, than South Tarawa. Clearly, this heritage has
implications for HIV/AIDS risk and the development of effective risk reduction strategies.
The usual context of higher vulnerability for adolescents includes: poverty, homelessness, sexual violence, incest, lack of community and
family support, being away from home, being out of school, single mothers, pregnant teens, and having STIs. All those contexts were found
in Kiribati; with the exception that homelessness with young people living “on the street” was reported to be rare, except for those who are
mentally ill. Additional contexts that were found to be major factors in increased risk and vulnerability to HIV and AIDS in Kiribati were forced
sex and intoxication due to frequent consumption of alcohol, kaokioki or local toddy, yeast, and kava.
This section focuses on some of the most significant risk and vulnerability practices and contributing factors for Kiribati youth: MSM,
commercial and transaction sex, forced sex, substance abuse and unprotected sex with multiple partners.
51
Men Having Sex with Men (MSM)
Interviews were carried out with individuals and groups of MSM in three well-known and so-called “gay” houses and bars identified by
mapping workshop participants. Routine data collection in schools and communities also included surveys with MSM. There were 55 males in
the sample of 122 sexually active Kiribati males who reported having sex with males or 45.1%, of whom six were interviewed from the schoolbased portion and 49 from the community-based portion of the sample. Figure 36 below shows the comparison between percentages of
South Tarawa males engaging in MSM practice and Abemama Island males reporting having sex with males.
Yes
Man who have sex with men
No
South Tarawa (N=104)
Abemama (N=18)
Total (N=122)
Figure 38. MSM by location
Yes
Man who has had sex with men
No
School (N=24)
Community (N =24)
Total (N =24)
“I have MSM because my
body wants.”
Adolescent (N =51)
Young Person (N =71)
Figure 39. MSM by age group, school-or community-based
52
As shown in Figure 38, sexually active males who reported having sex with males in S. Tarawa comprised 43.3% of the males sampled
there, while in Abemama Island, MSM group comprised 55.6% of all males sampled. Of those reporting sex with men, 25.9% said that they
preferred sex with men, about 35% that the reason they had MSM is that they were male and curious, about 33.3% that they were male and
forced, while 16.7% said they had MSM because of “other” reasons. Eighty-five percent reported having sex in a hidden place.
Figure 39 below shows the percentage of MSM practice among adolescents (15-19 years old) in the sample compared to the percentage
among young people (20-24 years old) from school-based and community-based of interviews.
As shown in Figure 39, the percentage of males who reported having sex with males in the adolescent portion of this sample was 41.2% of
adolescents sampled, while the percentage in the sample of young people comprised 47.9%. The percentage of those reporting ever having
sex with men comprised 25% of the males in the school-based sample and 50% of those in the community-based sample.
There were nine prisoners in the sample. Of those, three reported having sex with men. One of them reported having sex with men for
money. One said he had sex with men because he was drunk and the third said he preferred men. All reported that neither they nor the other
man had used a condom. None of the prisoners reported ever being forced to have sex.
The percentage of those sexually active males who experienced forced sex in this sample was higher for MSM at 60% than for men who do
not have sex with men at 24.3%. Only 35.2% of those males who reported having sex with males said that they or the other male used a
condom, leaving 64.8% who are having unprotected sex with males. Although some reported having sex with one or two men, the number
of MSM sexual partners ranged up to 31.
The percentage of Kiribati MSM that has unprotected sex with multiple partners is clearly an important contributor to HIV and AIDS risk and
vulnerability for Kiribati MSM, as well as a potential source of epidemic spread to the broader community since MSM have also acknowledged
having sex with females. The influence of alcohol, kaokioki, toddy and kava use on decision-making and desire is often reported as the
reason the respondent is unable to use a condom or limit partners.
Forced sex is also a serious issue related to MSM. Although adult MSM in Kiribati reported that they were seldom harassed and did not often
experience discrimination, younger men reported being bullied. Almost one-third of those males reporting ever having had sex with a male
in Kiribati said it was because they were forced, not by choice. In Kiribati as a whole, 46.3% of men having sex with men had experienced
forced sex, but on Abemama, two-thirds had experienced forced sex. As in other forced sex, “no one to tell” was the most frequent reason
given for ongoing vulnerability.
Support and awareness needs to be available to MSM from an early age. Although the age of first sex was 15 years or older for 90.3% of
Kiribati youth as a whole, and for 71.4% of Abemama Island youth, the remaining youth report having sex as young as 9 years of age.
53
Abemama clearly needs to be included in service provision with over 55% of the sexually active males in the sample reporting MSM. Although
the percentage is higher in the community-based than school-based portion of the sample, services will need to be provided in both the
schools and community. Condom use, limiting partners, and controlling alcohol and other substance use are important behavioural changes
to limiting risk and vulnerability due to MSM, and will require policy changes.
The Yum House
One day the team visited the Yum Yum gay male house which housed several men. The house was well decorated. Some tenants
napped, while cooking was in progress. The host agreed to assist as key informant while the younger males were surveyed. He
estimated that there were about 6-8 gay males per 100 males in Kiribati. When asked if people hid their gay status, he said “no”
– and quickly changed to “maybe”. When asked if there were many houses like this one, he mentioned another house where the
research team had also visited. He said none of the MSM he knew were engaged in commercial or transactional sex, or going
to the ships. His first sex himself was forced.
He said forced sex is a common experience for gay young men, who are not sure they are gay until after they are forced. He was
unsure whether young male homosexuals became estranged from their families once they came out of the closet. However,
he said the homosexuals had no problems attending churches, and well-employed. He was not aware of MSM being accosted,
arrested, or hassled. He advocated that gay males be included in awareness workshops.
Summary
There were 54 or 44.2% sexually active males who reported ever having sex with males in the sample of 122 sexually active males. Their
reasons were: 25.9% preferred sex with men; 35% were curious; 33% forced; and 16.7% other reasons. The distribution by place was 43.3%
of South Tarawa sexually active males and 55.6% in Abemama; by age group, 41.2% sexually active adolescents and 47.9% young persons;
and by interview location, 25% school-based and 50% community based.
Among the nine male prisoners interviewed, three reported having sex with males, with one attributing to being drunk, one for money, and
the other preferring sex with males. They did not report forced sex and did not use condoms. Eighty-five percent of men reported having sex
with men in a hidden place and 59.3% reported not using a condom. Their reported number of partners ranged from 1-31. They experienced
a higher percentage of forced sex at 60% compared to 27.2% for the total sample with two-thirds Abemama MSM reporting forced sex. They
cited the influence of substance use for their inability to make decisions for safer sex. Clearly, unprotected MSM with multiple partners has
the potential to contribute to the spread of HIV beyond MSM in Kiribati.
54
Commercial and Transactional Sex
Within the sample of 367 interviewee of whom 233 were sexually active were 30 who reported commercial sex as shown below in Figure 40.
Figure 40 shows the breakdown by gender of those who engaged in commercial sex. There were four males, 3% of sexually active males, and
26 females, 23% of sexually active females in the sample. The chart also shows the breakdown by age group of those engaged in commercial
sex. There were 12 adolescents or 14.6% of sexually active adolescents and 18 young people or 11.9% of sexually active young people in
this sample.
Yes
No
Wheather had sex for money
Male (N =121)
Female (N =117)
Adolescent (N =82)
Young Person (N =151)
Total (N =233)
Figure 40. Commercial sex by gender and age group
As shown in Figure 41, among the 30 youth in the sample who reported having commercial sex, only one or 3.4% of the sexually active
respondents was in the school-based sample and 29 or 14.2% in the community-based portion of the sample.
Yes
No
Whether had sex for money
Schools
Communities
Total(N=233
Figure 41. Commercial sex by school- or community-based
Yes
No
S.Tarawa
Whether had sex for money
Abemama
Total (N=233)
Figure 42. Commercial sex by location
55
Figure 42 displays 26 respondents or 13.3% of the sexually active portion of South Tarawa sample reported that they had sex for money,
while among the Abemama sample of 37 sexually active youth, four or 10.8% reported having sex for money. All but three of those who
engaged in commercial sex also engaged in transactional sex (27) and six only engaged in transactional sex.
As is shown in Figure 43, 15% of those sexually active youth interviewed in South Tarawa reported they had transactional sex and 10.8% of
those in Abemama.
Figure 44 below shows the breakdown of those having transactional sex by gender, age, and school or community-based location. Over
five times as many females as males had sex for gifts, food, or trade. The percentage adolescents at 13.6% and young people at 14.8% was
similar. The percentage of those who had transactional sex in the school-based portion of the sample was one-quarter the percentage in the
community-based portion. Overall the percentage reporting transactional sex was 14.3%.
Whether was given food or gift in exchange for sex
Yes
No
!
25%
S.Tarawa
Abemama
Total (N=230)
Figure 43. Transactional sex by location
Figure 44. Transactional sex by gender, age, school- or community-based
Forty-nine percent of those engaging in commercial or transactional sex reported using a condom the last time and 51% did not. Those who
had sex for money food or gifts did so because they needed money (42%), needed drugs or alcohol (28%), other reasons (22%), forced (5%),
and needed food (3%). They had sex for money, food or gifts in ships (51%), houses or hotels (25%), bush or beach (15%), and clubs (9%).
Abemama has developed a reputation for being the “Sexy Island” where both men and women have special sexual techniques and talk freely
about sex. When asked about commercial sex, Abemama mapping workshop participants said, “We don’t have sex for money, we have sex
for fun”. In contrast to other risk behaviours, Abemama respondents reported a lower percentage of commercial and transactional sex than
South Tarawa.
56
Summary
In summary, the Kiribati survey sample of 367 youth included 30 (12.9% of those who were sexually active) who reported having commercial
ercial
sex of whom 4 (3.3%) were male and 26 (23.2%) female; 14.6% of sexually active adolescents and 11.9% young people; 3.4% interviewed
ewed
in the school-based sample and 14.2% community-based; 13.3% of the sexually active South Tarawa sample and 10.8% Abemama. Most
ost of
those who had commercial sex also had transactional sex (14.3% of sexually active youth). Fifty-one percent of those engaging in commercial
ercial
or transactional sex did not use a condom the last time. Those who had sex for money food or gifts did so because they needed money
(42%), needed drugs or alcohol (28%), other reasons (22%), forced (5%) and needed food (3%). Increased risk and vulnerability related
ted to
unprotected commercial and transactional sex is significant and can be expected to be difficult to reduce in relation to the intransigent
sigent
reasons that compel these youth to engage in it.
57
For Love or Money: Stories of Bar and Ship Girls
Young women having sex on ships with fishermen, mostly Korean fishermen, is common in Kiribati. At least 18 out of 367 youth took part in the Risk and
Vulnerability for youth survey in Kiribati worked in commercial and transactional sex. The targeted age group for this research was 15-24 years, however the
research team observed younger girls, who were under 15 years of age and too young to be interviewed, frequenting bars where prostitution was common
resea
who were very drunk in the middle of the day. One extremely young girl, who was too young and too drunk for the research, seemed frightened and sat
and w
between us while the team waited for interviews to be completed. The age range of those ship and bar girls the team interviewed by KAP questionnaire was
betw
16-24 years. The team also conducted qualitative Key Informant Interviews with parents of one of the girls, with a woman who organized their activities, the
manager of a bar, and a pregnant ship girl.
man
The girls used to be called korekoreas, a term for those having sex on ships with Korean fishermen and also a term for cheap fish, but that label is not
acceptable today. Researchers were told that “prostitute” was more favoured than “sex worker”, because it is not so blatant about their work. Among the
acce
research team the terms “ship girls” and “bar girls” were used.
resea
that little has changed over the past several years, except the ship girls may be more organized. The researchers learned that they had
It appears
ap
several organisations with officers, that their movements were guided by information they received from the wharf on ship schedules, that they were in
seve
communication with police, and that half the girls in a house would go to work on the ships while others babysat. Several girls shifted their work location
com
from Betio wharf while the team was in South Tarawa because a US Navy ship arrived at a different part of the atoll.
the team interviewed had beaten their only child when they learned she was working on the ship. She ran away and did not return. After a year
The family
f
they searched for her and asked her to come home. She is staying near them in a house with other ship girls. Some Kiribati youth saw her as someone who
was leading a free life without constraint by culture or religion.
sex worker the team interviewed in a bar voiced the same thing the team heard many times from the girls, the same thing that the Korean
The young
y
investigating team had noted: that Kiribati ship girls say they are treated far better by Korean fishermen than by local men, that their Korean “boyfriends”
inves
bring them gifts, and love them. This girl said that the amount of money and goods she obtained in a month would total about AUD 1,000 – more than a
teacher or nurse would earn. She said that they had both agreed and wanted to have a baby and that he was “like a spouse and loves me”. She did not discuss
teach
whether he has a family in Korea or whether he will support her child. When asked if he had ever been violent, she said “yes”, but that it was her fault for
whet
dancing with another guy while she was drunk.
danc
The research team spent several days and nights interviewing in and outside the clubs, surveying both bar girls and ship girls. Despite what appeared to be
more stigma to ship girls, they considered themselves to be more fortunate than the bar girls in that they received a significant amount of money, gifts, and
goods – and were not treated as badly as they believed the bar girls to be treated.
Having seen them staggering drunk along the road from the wharf at midday loaded with goods, it was sobering to realise the impact of the limited
opportunities they had – for education, or employment, or support for themselves and, sometimes, their children.
58
Forced Sex
Forced sex is the harsh reality for many Kiribati youth. Forty-three percent of sexually active youth reported that they had been forced to
have sex when they did not want to with 79% saying they were still vulnerable. The percentage who reported forced sex by location is shown
below in Figure 45.
Yes
No
S.Tarawa (N=196)
Abemama (N=35)
Total (N=231)
Figure 45. Forced sex by location
Male
Female
Adolescent
Young Person
School
Community
Total
Figure 46. Forced sex by gender, age, school or community-based
The percent of forced sex was 38.3% in South Tarawa and almost twice as high at 71.4% in Abemama.
As is shown in Figure 46, over half the sexually active females in this sample experienced forced sex as did one-third of the males. Adolescents
had a slightly higher percentage at 46.9% than did young people at 41.3%. Those sampled in schools were about 10% lower at 34.5% than
those sampled in the community at 44.6%, while the overall percentage was 43.3%. The percentage of those who reported forced sex in this
sample was higher for MSM at 47.2% than for other men at 33.3%, but on Abemama Island two-thirds of MSM had experienced forced sex.
As shown in Figure 47, only 3 or 9.4% of mainstream youth have experienced forced sex out of the sample of 231 sexually active youth.
Those at increased risk were 28.6% and in ascending order: MARYP at 53.6%, MARAs at 57.6%, EVAs 66.7%, and EVYPs 72%. Thus, compared
to mainstream youth, those at increased risk reported three times the percentage of forced sex while EVYPs reported over seven times the
forced sex at 72%. Furthermore, first sex was forced for 21.1% of sexually active youth in Kiribati. The percentage of first sex forced by risk
category is shown in the following chart.
59
As shown in Figure 48, only one or 3.2% of the 31 sexually active mainstream youth in this sample reported being physically forced to have
sex the first time. The reported percentage varied by category with the next lowest being 12.7% for increased risk youth and the highest
being 40% for EVAs. The reported percent of forced first sex differed between males, females, and age group as in Figure 49.
Yes
#
No
Whether has been forced to have sex when they did not want to
' ' Figure 47. Forced sex by risk category
Yes
No
Whether physically forced to have sex the first time
' ' Figure 48. First sex forced by risk category
60
Figure 49 shows the percentage of those who reported their first sex was forced were 11.8% for sexually active males and 31% for females.
The next chart presents the percentages of forced first sex by age group, school or community-based, and location.
As illustrated in Figure 50, first sex was forced almost equally for adolescents at 20.5% and young people at 21.5%. Those in school were
almost 10% less likely to have experienced forced first sex than those in the community. Abemama had the highest rate of forced first sex
(36.1%) of all the groups with a percentage twice as high as that of Tarawa (18.4%).
Yes
No
Whether physically forced to have sex the first time
Male (N =119)
Female (N =113)
Total (N =232)
Figure 49. First sex forced by gender
$#
#
!"
Adolescent
Young Person
School
Community
S. Tarawa
Abemama
Total
Figure 50. First sex forced by age, school or community, and location
The percentage of those who reported forced sex in this sample was higher for MSM at 47.2% than for men who do not have sex with men
at 33.3%, but there was little difference in the percentage of those who reported first sex forced between MSM and other men. However, on
Abemama Island, two-thirds of MSM had experienced forced sex.
61
Summary
In summary, 43% of those who are sexually active in this sample reported they had been forced to have sex when they did not want to
with 79% of those saying that they are still vulnerable to being forced. The percentage varied by place from 38.3% in South Tarawa to
71.4% in Abemama and by gender from 33.3% for males to 54.1% for females. There was little variation between age groups and school or
community-based.
By risk category, the percentage varied from 9.4% for mainstream youth to 72% for EVAs. The percentage of those who reported forced sex
in this sample was higher for MSM at 47.2% than for other men at 33.3%, but on Abemama Island two-thirds of MSM had experienced forced
sex.
Furthermore, first sex was forced for 21.1% of sexually active youth in Kiribati, ranging from 3.2% for mainstream to 40% for EVAs and by
gender from 11.8% for males to 31% for females. Abemama had the highest rate of forced first sex of all the groups with a percentage twice
as high at 36.1% as that of Tarawa at 18.1%.
The percentage of those who reported forced sex in this sample was higher for MSM at 47.2% than for men who did not have sex with men
at 33.3%, but there was little difference in the percentage of those who reported first sex forced between MSM and other men. However, on
Abemama Island, two-thirds of MSM had experienced forced sex.
Forced sex has implications for HIV risk and vulnerability in that it is rarely protected sex. In addition the IATT22 cites global research results
indicating that sexual abuse is associated with low self-esteem and often precludes sex work, making it less likely that the young sex worker
will insist on safe sex.
“I get drunk and
can’t resist
the man
who forces me.”
62
Substance Use
One major issue of concern in relation to HIV and AIDS risk and vulnerability in Kiribati is substance use, including
alcohol, kaokioki, and kava. The percentage of the sample using each substance is illustrated in Figure 51 below.
Figure 51. Kiribati substance use
Includes benzene, yeast, marijuana, glue, gas, lime, China tree (Datura metel) seeds
Almost two-thirds of the survey sample use alcohol and over half use kaokioki (toddy). One-quarter use kava and one
quarter smoke tobacco.
As shown in Figure 52, males consistently use these substances at a higher rate than females, except for “other”. A
higher percentage of young people use alcohol, kaokioki, kava, and tobacco, but a higher percentage of adolescents
use betel and “other” substances. A higher percentage of those on Abemama use these substances with the exception
of alcohol.
The percentage of mainstream youth using these substances is consistently lower than for those at risk (Figure
53). The percentage of MARA and MARYP using these substances tends to be higher than EVA and EVYP with the
exception of betel and tobacco.
63
The overall rate of frequent alcohol consumption (more than three times per week) for this sample is 12.2%, but it varies between groups
from 3.6% for the school-based sample to 16.4% for the community-based sample, as illustrated in Figure 54. The rate of alcohol use for
MSM at 15.4% is greater than the overall rate of 12.2% but slightly less than the 15.8% rate for all males. When they had first sex, 43.5% of this
sample had consumed alcohol and 6.3% had taken a drug which made them want to have sex.
As can be seen in Figure 55, neither mainstream nor increased risk youth reported using alcohol more than three times per week. EVAs
report the highest percentage using alcohol frequently at 46.2%, MARYP next at 25.5%, MARA 17.7% and EVYP 16%. Frequent kava use of
more than three times per week was only reported for 8 youth – 1 MARA, 2 MARYP, 1 EVA, 2 EVYP, and 2 at increased risk.
Alcohol
Kaokioki
Kava
Figure 52. Substance use by gender, age, and location
64
Other
Tobacco
Betelnut
Although there was little IDU within this sample, it was reported that some girls were given, but did not buy, injection drugs when partnered
with Indonesians on ships. Of those youth surveyed, 4.5% said that they currently use drugs. The types of drugs they reported using are:
marijuana, glue, sniffing benzenes, gasoline, chew (betel), lime, and China tree (Datura metel) seeds.
Use of alcohol, kaokioki, and kava is clearly of major concern in relation to reducing HIV and AIDS risk and vulnerability in Kiribati. In South
Tarawa, alcohol and kaokioki were available at local bars, on the wharf, and around the roundabout entering Betio where very young girls
and young men are literally falling down drunk and vomiting. In bars, some girls wore revealing clothing, imitated strip club dancing, and
traded sex for a drink. This behaviour is considered outside Kiribati culture for young girls. On Abemama, similar behaviours increasing risk
and vulnerability for youth are played out at kaokioki and kava bars. Kava bars are also a site for unsafe behaviours, including sex for money
or gift, unprotected sex, and multiple partners for youth. One MSM described frequent kaokioki and kava consumption, involving ongoing
MSM with at least 10 partners, specifically linking his unsafe risk behaviour to alcohol.
The percentage of mainstream youth using these substances is consistently lower than for those at risk (Figure 53). The percentage of MARA
and MARYP using these substances tends to be higher than EVA and EVYP with the exception of betel and tobacco.
Alcohol
Kaokioki
Kava
Betelnut
Tobacco
Other
"
"'# !
"'#$ !
!
Figure 53. Substance use by risk category
65
The overall rate of frequent alcohol consumption (more than three times per week) for this sample is 12.2%, but it varies between groups
from 3.6% for the school-based sample to 16.4% for the community-based sample, as illustrated in Figure 54. The rate of alcohol use for MSM
at 15.4% is greater than the overall rate of 12.2% but slightly less than the 15.8% rate for all males. When they had first sex, 43.5% of this
sample had consumed alcohol and 6.3% had taken a drug which made them want to have sex.
Male
Female
Adolescent
Young Person
School
Community
MSM
Figure 54. Frequent alcohol use by gender, age, school or community, and MSM
As can be seen in Figure 55, neither mainstream nor increased risk youth reported using alcohol more than three times per week. EVAs report
the highest percentage using alcohol frequently at 46.2%, MARYP next at 25.5%, MARA 17.7% and EVYP 16%. Frequent kava use of more
than three times per week was only reported for 8 youth – 1 MARA, 2 MARYP, 1 EVA, 2 EVYP, and 2 at increased risk.
Figure 55. Frequent alcohol use by risk category
66
Although there was little IDU within this sample, it was reported that some girls were given, but did not buy, injection drugs when partnered
with Indonesians on ships. Of those youth surveyed, 4.5% said that they currently use drugs. The types of drugs they reported using are:
marijuana, glue, sniffing benzenes, gasoline, chew (betel), lime, and China tree (Datura metel) seeds.
Use of alcohol, kaokioki, and kava is clearly of major concern in relation to reducing HIV and AIDS risk and vulnerability in Kiribati. In South
Tarawa, alcohol and kaokioki were available at local bars, on the wharf, and around the roundabout entering Betio where very young girls
and young men are literally falling down drunk and vomiting. In bars, some girls wore revealing clothing, imitated strip club dancing, and
traded sex for a drink. This behaviour is considered outside Kiribati culture for young girls.
On Abemama, similar behaviours increasing risk and vulnerability for youth are played out at kaokioki and kava bars. Kava bars are also a
site for unsafe behaviours, including sex for money or gift, unprotected sex, and multiple partners for youth. One MSM described frequent
kaokioki and kava consumption, involving ongoing MSM with at least 10 partners, specifically linking his unsafe risk behaviour to alcohol.
Summary
Differences between the mainstream youth and those at higher levels of risk and vulnerability in relation to Substance Use
are:
1. The percentage of mainstream youth using alcohol, kaokioki, kava, tobacco, betel and other substances is consistently
lower than for those at higher risk. The percentage of MARA and MARYP using these substances is reported to be higher
than EVA and EVYP with the exception of betel and tobacco.
2. Neither mainstream nor increased risk youth report using alcohol more than three times per week. EVAs report the highest
percentage at 46.2%, MARYP next at 25.5%, MARA 17.7% and EVYP 16%. Frequent kava use of more than three times per
week was only reported for 8 youth – 1 MARA, 2 MARYP, 1 EVA, 2 EVYP, and 2 at increased risk.
In summary, almost two-thirds of the survey sample used alcohol and over half used kaokioki. One-quarter used kava and one-quarter
smoked tobacco. When they had first sex, 43.5% of this sample had consumed alcohol and 6.3% had taken a drug which made them want
to have sex.
The overall rate of frequent alcohol consumption (more than three times per week) for this sample was 12.2%, but it varied between groups
from 3.6% for the school-based sample to 16.4% for the community sample and by risk category from 0% for mainstream and increased risk
youth to 46.2% for EVA. The rate of alcohol use for MSM at 15.4% was greater than the overall rate of 12.2% but slightly less than the 15.8%
rate for all males. The increased risk related to substance use as a contributing factor appeared to be significant and was cited by youth as a
reason for poor decision making for safer sex.
“(New partners) every night in a
month cause drunk.”
67
Condom Use
Sexually active youth reporting condom use at last high-risk sex (with non-regular partner) were 42.9% of those sampled –40% on South
Tarawa and 56.4% on Abemama as shown in Figure 56 below.
Figure 57 shows that the highest percentage reporting condom use at last high-risk sex were mainstream youth 58.1% followed by MARAs
50%, increased risk 42.9%, MARYP 41.5%, EVA 28.6%, and EVYP 25%. The percentage reporting condom use at last high-risk sex by gender,
age group, and whether schoolschool or community-based
community based is displayed in the following chart.
Yes
No
Figure 56. Condom use at last high-risk sex (CPAP Indicator 1.5) by location
Figure 57. Condom use at last high-risk sex by risk category
68
Yes
Whether used condom the last time they had high-risk sex
No
(
)
)(*
(
Figure 58. Condom use at last high-risk sex by gender, age, and school or community-based
As shown in Figure 58, the percentage of sexually active males reporting condom use at last high-risk sex was 44.4%, while that of females
was 41.1%. The percentages were similar for young people at 40% and adolescents 47.6%. The school-based sample reported 41.9% condom
use at last high-risk sex, while those community-based reported 43%. The overall percentage was 42.9%. There was less than 10% difference
in the range of those reporting condom use at last high-risk sex among these groups.
The highest percentage of adolescents who reported using a condom at last sex by risk category (Figure 59)were mainstream at 57.1%,
followed by increased risk 47.7%, most-at-risk 46.9%, and total 45.2%, with especially vulnerable adolescents reporting the lowest condom
use at last sex at 28.6%.
There was 10% difference in reported condom use at last sex between Tarawa and Abemama as shown in Figure 60.
Yes
No
Condom use at last sex for sexually-active adolescents
Figure 59. Condom use at last sex for sexually active adolescents by risk category
Figure 60. Condom use at last sex (CPAP Indicator 1.6) by interview location
69
Figure 61 shows the percentages of those who report condom use at last sex. Males report over one-third, while females report slightly less
than one-fifth. Young persons are at one-third, while adolescents are slightly under one-fifth. The school-based portion of the sample reports
slightly over 10%, while the community based portion reports 33.2% and the overall sample reports 25.8%.
For those who had used a condom, with more than one answer possible, 88% would do so to prevent pregnancy, 38% to prevent STIs
including HIV, while the 3% who answered “other” included one who did because their girlfriend had her period and someone told them to
use a condom. Two-thirds answered that they had never used a condom.
In Kiribati, attitudes toward condom use involve complicated and strong cultural beliefs. If a girl they know and respect dropped a packet
that they realised was a condom after picking it up, 25% would be impressed that she uses a condom, 20% would feel it was not their
business and give it to her, 17% would be embarrassed and not give it to her, another 12% would be embarrassed but would give it to her,
and 6% would be shocked. The remaining respondents answered “other”.
A review of the reasons they gave indicated the majority would have strongly negative feelings toward the girl, hating her, being angry,
and injuring her, calling her an enemy or prostitute. A lesser number would try to help her and slightly less would laugh at her. A few would
assume she has HIV and avoid her. Some of those with strongly negative reactions are themselves having sex, but the dropped condom
seems to be a public admission that makes it obvious and not culturally acceptable. Issues of religion also are a factor, with many youth
stating that their religion does not allow condoms. Many schools are also “no condom” zones. Nonetheless, many youth were aware of their
risk from not using condoms and having unprotected sex with many partners.
!!"
! ! !
" !
“By having sex with every
man, don’t know about
them, without condom
you slip.”
70
" !
""!
!!
!
Figure 61. Condom use at last sex by gender, age, and school- or community-based
Differences between the mainstream youth and those at higher levels of risk and vulnerability in relation to Condom Use are:
1. Mainstream youth reported the highest percentage of condom use at last high-risk sex at 58.1%. The
reported percentage of use among those at higher levels of risk and vulnerability ranged from EVYPs at
25% up to MARAs reporting 50%.
2. Mainstream youth also reported the highest percentage of condom use at last sex at 57.1%. The reported
percentage of use among those at higher levels of risk and vul
nerability ranged from EVAs at 28.6% to increased risk youth at 47.7%.
In summary, overall reported condom use at last high-risk sex was slightly lower at 42.9% than for last sex at 45.2%. In each case, mainstream
youth reported the highest percentages with only one percent difference between the reported 58.1% for last high-risk sex and 57.1% for
last sex.The lowest percentage reported condom use for increased risk and vulnerability youth was EVYPs at 25% last high risk sex and EVAs
at 28.6% last sex. Likewise, the highest reported percentages among non-mainstream youth was 50% for MARAs at last high-risk sex and
47.7% for increased risk youth at last sex.
The “sometimes but not always” system of condom use leads to increased risk and vulnerability for youth in Kiribati.
Religious beliefs and school rules prevent some youth from having access or using condoms. Many youth believe that sex with condoms
is not as enjoyable or intimate. Attitudes toward condom use in Kiribati involve complicated and strong cultural beliefs which must be
considered when programmes and policies for increasing the percentage of youth practicing safer sex are being developed.
71
Age at First Sex
Those who had first sex before 15 years of age were 13.2% of all 15-19 year olds sampled – 9.7% on South Tarawa and 28.6% on Abemama,
as shown in Figure 62. The percentage of youth having sex before they turned 15 years old was almost three times as high in Abemama as in
South Tarawa.
Figure 63 shows the percentage of
those who reported they had first sex
before 15 years of age by gender and
school- or community-based. Of the
males, 21.3% had first sex before 15
years, while females were almost onethird that percentage at 7.8%. Within
the community-based sample, 19.7%
had first sex before 15 years, compared
to 13.2% of the school-based sample.
Although the age of first sex was
delayed to 15 years or older for 86.8%
of Kiribati youth as a whole, and for
71.4% of Abemama Island youth, the
remaining youth reported having sex
as young as 9 years of age.
As shown in Figure 64, the difference
in percentage of those who had sex
before 15 years of age varied from
2.7% for mainstream youth to 32.4% for
MARAs. Even between those who were
at increased risk (24%) and mainstream
youth (2.7%), the difference in
percentage was marked.
Had first sex at 15 years old or older
Had first sex before 15 years old
Figure 62. Whether delayed age of first sex (CPAP Indicator 1.3)
Figure
63. Earlyy onset sex byy gender,
g
g
, school or community-based
y
72
Figure 64. Sex before 15 years of age by risk category (15-19 years old)
Table 8. Age at first sex
Male
Female
Adolescent
Young Person
School-based
Community-based
South Tarawa
Abemama
MARA
MARYP
EVA
EVYP
Increased Risk
Mainstream
Mean Age
Median Age
Age Range
16.7
17
15.32
17.36
15.48
16.78
16.87
15.32
15.21
16.41
15
17.64
17.2
17.15
17
17
15
17
15
17
17
15
15
17
15
19
17
17
10-21
10-22
22-20
9-23
11-19
9-23
9-23
10-20
11-19
9-23
11-19
11-23
13-21
14-23
Table 8 shows the difference in mean age,
median age, and age range for age at first sex.
It shows that the mean age of first sex ranged
from 15 for EVAs to 17.64 for EVYPs. Median
age varied from 15 for adolescent, schoolbased, Abemama, MARA, and EVAs to 19 for
EVYPs. The broadest age range was from 9-23
for young people, community-based, South
Tarawa and MARYP groups of youth.
Summary
Differences between the mainstream youth and those at higher levels of risk and
vulnerability in relation to Age at First Sex are:
1. There was a dramatic difference in percentage of those who had sex before 15 years of age between mainstream youth and
all those at higher levels of risk and vulnerability from mainstream youth at 2.7% to MARAs at 32.4%. Even between those
who were at increased risk (24%) and mainstream youth (2.7%), the difference in percentage was marked.
2. The youngest age in the age range for age at first sex was lower for those at greater levels of risk and vulnerability and mean
age was lower with the exception of those categorised as increased risk and EVYPs.
In summary, the percentage of those who had sex before they turned 15 years old was almost three times higher in Abemama than in South
Tarawa; almost three times higher for males than females; and over two times higher for community-based than school-based youth. As
mentioned above, the difference in the percentage of those who had sex before 15 between mainstream youth and those at greater risk
and vulnerability was dramatic. Although the age of first sex was delayed to 15 years or older for 86.8% of Kiribati youth as a whole, and for
71.4% of Abemama Island youth, the remaining youth reported having sex as young as 9 years of age. There is obviously a relation between
these findings and those for forced first sex, which was reported by 21.1% of sexually active youth in Kiribati, 40% of EVAs, 31% of females,
and 36.1% of youth in Abemama. Clearly these findings indicate increased risk and vulnerability related to the number of those who have
sex before 15 years of age and have implications for programme and policy development.
73
Health and Social Utilisation
The percentages of South Tarawa, Abemama Atoll, and Kiribati males and females who ever talked to a health worker about HIV and AIDS
are shown in Figure 65.
Kiribati overall
South Tarawa
Abemama
Figure 65. Whether utilized health worker for HIV and AIDS information
If male, whether they ever talked about HIV or AIDS with a health worker
' !"
#$'%
Figure 66. Males who talked to health worker about HIV and AIDS by risk category
74
As shown above, males on Tarawa and Abemama utilized health workers for information at a higher rate than females and a higher
percentage of males and females on Tarawa utilized health workers for HIV and AIDS information than on Abemama. The breakdown of
those who talked with a health worker about HIV and AIDS by risk category is shown in Figure 66.
Figure 66. Males who talked to health worker about HIV and AIDS by risk categoryThe percentage of males talking to a health worker about
HIV and AIDS ranged from 12.5% for EVAs to 50% for EVYPs, but the numbers were so low that these percentages should be discounted.
Otherwise, the difference between utilisation of mainstream youth compared to those at greater risk and vulnerability was small, except for
the 10% difference with those at increased risk.
Yes
No
If female, whether they ever talked about HIV or AIDS with a health worker
Figure 67. Females who talked to health worker about HIV and AIDS by risk category
Figure 67 shows the percentage of females, who utilized health workers for HIV and AIDS information, ranging from 11.1% for EVYPs to
47.6% for MARYPs, but numbers were low and there was no apparent pattern except that males had a slightly higher percentage who report
talking to a health worker about HIV and AIDS.
75
Figure 68 shows the percentages of South Tarawa, Abemama, and Kiribati males and females who had ever obtained and used a condom
from a health clinic. The chart shows that females were half as likely to obtain and use a condom as males, with the exception of Abemama
females who were twice as likely as the other females to do so.
Kiribati overall
South Tarawa
Abemama
Figure 68. Obtained and used condom from health clinic by gender and location
If male, whether obtained and used a condom from health clinic
'!
"#'$%&
Figure 69. Males who obtained and used condom from health clinic by risk category
76
As shown in Figure 69, the breakdown by risk category in percentages of for obtaining condoms ranged from 33.3% for mainstream youth
and EVYPs to 53.3% for increased risk youth. The percentages of most-at-risk youth were higher than for especially vulnerable youth. The
breakdown of females who obtained and used a condom from a health clinic by risk category is shown in the following chart.
Yes
No
If female, whether obtained and used a condom from health clinic
"%&
Figure 70. Females who obtained and used condom from health clinic by risk category
Figure 70 shows the percentages of females who obtained and used a condom from a health clinic range from 4.7% for mainstream youth
to 63.6% for MARYPs. As above, the numbers are low and there is no apparent pattern, except that MARAs and MARYPs reported a higher
percentage of utilising a health clinic for obtaining and using a condom and mainstream females had a much lower percentage obtaining
and using condoms than those at greater risk and vulnerability.
Female utilisation of health clinic as source of information and advice about HIV and AIDS or to obtain condoms was much lower than that
of males as might have been expected. Thirty-three percent males reported talking with a health worker about HIV and AIDS as compared
to 25% females. Forty-three percent males reported obtaining and using a condom from a health clinic while half of the female respondents
did so (22%) .
77
The percentage of males who reported utilisation of a health clinic for obtaining information and advice about HIV and AIDS or obtaining
and using a condom is shown by age group in Figures 71 and 72 below.
Yes
Yes
No
If male, whether talked about HIV and AIDS with health worker
If male, whether obtained and used a condom from health clinic
No
Figure 71. Males utilising health clinic for HIV and AIDS information by age Figure 72. Males utilising health clinic for obtaining condom by age
Yes
No
If Female, whether talked about HIV and AIDS with health worker
Yes
No
If Female, whether obtained and used a condom from health clinic
Figure 73. FFemales
health
by age
l utilising
ili i h
l h clinic
li i ffor HIV and
d AIDS iinformation
f
i b
Figure
74. Females
by age
Fi
F
l utilising
ili i health
h l h clinic
li i for
f obtaining
b i i condom
d
The two charts show the percentage of 20-24 year old males who reported talking to a health worker in a clinic about HIV and AIDS was
about 10% higher than those who were 15-19 years old and the percentage who reported obtaining and using a condom from a health
clinic was about 18% higher for 20-24 year olds than for 15-19 year olds.
78
As shown in Figures 73 and 74, the utilisation of health clinic by females by age group was similar to that of males in that percentage of 2024 year olds, who reported talking to a health worker in a clinic about HIV and AIDS. It was about 13% higher than the percentage of those
who were 15-19 years old. Meanwhile, the percentage of who reported obtaining and using a condom from a health clinic was about 27%
higher for 20-24 year olds than for 15-19 year olds.Figures 75 and 76 show the number of times males and females reporting having had STIs
in the past year by location. They show that females in Abemama reported the highest percentages (22%) of more than five STIs in the past
year by more than three times higher than females on South Tarawa. South Tarawa males reported the highest percentage of 1-5 STIs in the
past year. Abemama males reported the highest percentage of no STIs. Those males who reported pain or infection in their genitals said they
received treatment by location of interview as shown in Figure 77.
>5
1-5
No STIs
Clinic
Youth clinic
No pain/ infection
!"
Fi
75 Males
M l STIs
STI in
i past year by
b location
l
i
Figure 75.
No treatment
Other
Figure 77. Male STI treatment by location
Figure 76. Females STIs in past year by location
Figure 77 illustrates that more males utilized non-clinical treatment or no treatment for STIs than clinical and that a higher percentage of
Abemama males reported no pain or infection than Tarawa males. Figure 78 below presents STI treatment for symptomatic females by
location of interview.
79
Clinic
Youth clinic
Other
No treatment
No symptoms
As shown in Figure 78, about half of the
females from each location obtained
treatment from a clinic if they were
symptomatic for STIs, while very few chose
symptoma
treatment. Abemama females indicated
no treatm
treatment, but a review of
more alternate
alte
the syntax data indicated that all but one
“other” cases were actually clinical
of the “ot
remaining one “do not know” in the
with the re
acknowledged small sample. The frequency
acknowled
of STIs by risk category for males in the past
year is shown
sho in the next chart.
Figure 78. Female STI treatment by location
None NA
1-5
More than 5
#
If male, how often they had problems or STIs in past year
80
#'$!
#'$
Figure 79. Male frequency of STI in past year by risk category
Figure 79 shows that there were only two
male respondents who reported more
than five STIs in the past year. Those who
experienced 1-5 STIs ranged from 3.8% for
mainstream youth to 54.5% for MARYPs.
Those who had no STIs ranged from 42.4%
of MARYPs to 96.2% of mainstream youth.
Clinic
Figure 80 displays STI treatment utilisation
for symptomatic males by risk category.
About 25% of symptomatic male
mainstream youth would usually choose
clinical treatment (including those who
answer “other”) as would about 60% EVYP,
47% MARYP, and 45% MARA. Twenty-five
percent of a small sample of EVA would
choose no treatment, as would 10% MARA,
6% MARYP, 21.2% increased risk, and 6%
mainstream.
Youth clinic
Other
#'$
#'$!
#
No symptoms
No treatment
Figure 80. Male STI treatment utilisation by risk category
Figure 81 shows the frequency of STIs by risk
category for females in the past year. There
were eight female respondents, one-half of
whom were MARYPs, who reported more
than five STIs in the past year as compared
to two males. The 19 (19.8%) respondents
experiencing 1-5 STIs ranged from none for
mainstream youth to 66.7% for the small EVA
sample. Those who had no STIs ranged from
0% of EVAs to 100% of mainstream youth.
None NA
1-5
More than 5
#
#'$!
#'$
Figure 81. Female frequency of STI in past year by risk category
81
Figure 82. Female STI treatment utilisation by risk category As shown in Figure 82, about 54% of symptomatic female mainstream youth
would usually choose clinical treatment (including those who answer “other”), as would about 80% increased risk, 70% MARYP, 55% MARA,
and 47% EVYP. Only three (1.6%) overall would choose no treatment.
Clinic
Youth clinic
Other
No treatment
#'$!
#'$
#
Figure 82. Female STI treatment utilisation by risk category
82
No pain/ infection
The following chart presents the HIV and AIDS Prevention Workshop coverage for most-at-risk youth.
!"#
!$
%"!
!!
!$#
%
!#
Figure 83.
83 HIV and AIDS Prevention Workshop for most-at-risk coverage
Figure 83 illustrates that 67.1% of those most-at-risk who were surveyed in Kiribati indicated they had attended an HIV prevention workshop
with little variation by age group or school- and community-based location of interview. Males reported almost 10% higher attendance at
72% than females at 63.5% and attendance on Tarawa at 68.6% was almost 10% higher than Abemama at 58.9%.
83
Figure 84 displays the breakdown of those
most at risk that have been reached by HIV
prevention programmes by risk category.
Over 62.5% MARAs and 52.9% MARYPs
had been reached by HIV Prevention
Programmes. However the coverage for
Programme
was only 6.3% and 3.8%
EVAs and EVYPs
E
respectively with increased risk youth at
1.3% coverage.
covera
MARA
52.90%
Inc. Risk
1.30%
EVYP
3.80%
EVA
MARYP
6.3%
62.50%
Most at Risk Reached by HIV prevention
programmes
Figure 84. Most-at-risk reached by HIV prevention programmes by risk category
84
Differences between the mainstream youth and those at higher levels of risk and vulnerability in relation to Health care Utilisation are:
1. The differences in utilisation of health care workers as a source for HIV and AIDS information by both mainstream males and females
compared to those at increased risk varied, but utilisation was lower for mainstream males than for males at greater risk. For females,
numbers were low and there was no apparent pattern.
2. The percentages of males utilising a clinic for obtaining condoms were higher for most-at-risk youth than for especially vulnerable
youth, but numbers were low and there was no clear pattern, except that MARAs and MARYPs reported a higher percentage of utilising
a health clinic for obtaining and using a condom than for EVAs and EVYPs. Mainstream females had a dramatically lower percentage
obtaining and using condoms than those at greater risk and vulnerability.
3. Only two males as opposed to eight females experienced more than five STIs in the past year, while males experiencing 1-5 STIs
ranged from 3.8% for mainstream youth to 54.5% for MARYPs and for females ranged from 0% mainstream youth to 66% for those at
higher risk. Those males who had no STIs ranged from 42.4% for MARYPs to 96.2% for mainstream youth and for females from 60%
MARA to 100% mainstream.
4. Symptomatic males sought clinical treatment for STIs, ranging from 25% for mainstream youth to 60% EVYP. Fifty-four percent of
symptomatic mainstream females sought clinical treatment, while those at greater risk and vulnerability sought clinical treatment
ranging from 47% to 80%.
5. Over 62.5% MARAs and 52.9% MARYPs had been reached by HIV Prevention Programmes but the coverage for EVAs and EVYPs was
only 6.3% and 3.8% respectively with increased risk youth at 1.3% coverage.
85
In summary, males on Tarawa and Abemama utilized health workers for HIV and AIDS information at a higher rate than females and a higher
percentage of males and females on South Tarawa utilized health workers information than on Abemama. Females were half as likely to
obtain and use a condom as males, with the exception of Abemama females who were twice as likely as South Tarawa females to do so.
The 20-24 year olds in this sample were more likely to have talked with a health care worker about HIV and AIDS and obtained and used a
condom than 15-19-year-old adolescents.
Females in Abemama reported the highest percentages of more than five STIs in the past year by more than three times higher than females
Fema
Tarawa. South Tarawa males reported the highest percentage of 1-5 STIs in the past year; and Abemama males reported the highest
on South
So
percentage of no STIs. More males reported utilising non-clinical treatment or no treatment for STIs than clinical and a higher percentage
perce
males reported no pain or infection than Tarawa males. Half of the females reported they would seek treatment from a clinic if
of Abemama
Ab
they were symptomatic for STIs, while very few reported they would choose no treatment.
Sixty-seven percent of those most-at-risk who were surveyed in Kiribati indicated they had attended an HIV prevention workshop with little
Sixty
variation by age group or school and community based location of interview. Males reported almost 10% higher attendance than females
varia
on Tarawa at 68.6% was almost 10% higher than Abemama at 58.9%.
and attendance
a
These findings indicate gaps in health care utilisation, especially for the youth who are especially vulnerable and at increased risk and, as in
Thes
areas, have implications for programme and policy development.
the other
o
86
Newspaper
Forty-eight percent of those who took part in this survey read the newspaper once a week, but they varied by gender and location. By
gender, 51% of males read once a week, 30% every day, and the remaining 19% did not read the newspaper. One-third as many females read
every day and twice as many did not read newspapers. Those who read once a week ranged from MARAs at 27.5% to mainstream at 53.8%.
By type of reading 38% of the sample read news and 24% entertainment.
By gender, the largest number of males chose news and females chose nothing. By location, 51% those from South Tarawa read the
newspaper once a week, 29% not at all, and 20% every day. Thirty-six percent of those on Abemama read the newspaper once a week, 9%
every day, and 55% did not read the newspaper at all. By type of reading, the majority on South Tarawa chose news while 19% on Abemama
chose news, and the majority would choose not to read.
By risk category, about 30% of mainstream, increased risk, and MARYPs did not read newspapers at all, while 43% of EVA and EVYPs did not
read, and 54.5% MARAs. Of those who read, mainstream youth had the highest rate of reading once a week at 54%, with those at increased
risk next at 51.4%, followed by MARYPs at 48.2%, EVAs at 43.8%, EVYPs at 33.3%, and MARAs lowest at 27.3%..
Access
Almost all males and females had access to a working radio whether on South Tarawa or Abemama, and including all risk levels. About onethird of males and females had access to a working TV, with almost all on South Tarawa. By risk level, those with access were about one-third
mainstream youth and between 15% to 38% of those at higher risk and vulnerability with no apparent pattern.
About a quarter had access to a mobile phone, 60% females and 40% males, only one on Abemama. By risk category, those with access were
one-fifth mainstream, EVA and MARA and one-third EVYP, increased risk and MARYP.
Figure 85. Radio listeners by days of the week
87
Radio
Eighty-five percent of these interviewee listened to the radio, including 95% of males and 77% females, 93% on Abemama and 83% on
South Tarawa. By risk category, the percentage was essentially the same, ranging from 83% for EVYP and MARYP to 94% for EVAs. The
majority listened almost every day in the early evening whether male or female, South Tarawa or Abemama, and for all risk categories,
with the exception that the greatest percentage of EVAs and MARAs listened once in two weeks. They had no favourite programmes, but
preferred FM99.5. The listening pattern for all risk levels followed a curve with the largest numbers listening on the weekends and the lowest
preferre
of the week.
in the middle
m
Figure 85.
8 Radio listeners by days of the weekTelevision
Only 45%
45 of interviewee watched TV with 20% watching almost daily, 25% weekly, and 55% not at all. Fifty-eight percent of males and 36%
females watched TV: 45% on South Tarawa and 35% on Abemama. By risk category, about 45% watched TV with the exception of EVAs and
EVYPs of
o whom 27% and 14% watched respectively. The pattern of watching by days of the week was almost identical to that of listening
to radio with the exception that there were only half as many TV watchers and there was a rise in Sunday watching rather than a drop. The
largest numbers watched in early evening with their preference in viewing being news, followed by movies, and then sports or tele-drama,
across aall risk categories.
Figure 86. Current and preferred source of information and advice on HIV and AIDS
88
Source of Information
Current and preferred sources of information and advice on HIV and AIDS for these youth are shown above in Figure 84.
Figure 86 shows their top five current sources were: Clinic/Health facility (67%), Radio (18%), Youth Centre (10%), Peer Educator (6%), and
Nowhere (6%). Their top five preferred sources of information would be: Clinic/health facility (46%), Radio (23%), Drama (16%), Youth Centre
(13%), and Peer Educator (7%). Those at higher risk and vulnerability made essentially the same choices with the exception that they rated
drama at 27% over radio at 24% as a preferred source. There was little difference between their current and preferred sources, except that
they currently received information and advice from clinic/ health facilities at a higher rate than their preference would be in relation to their
preferred source. Their most trusted sources of information were clinic/ health facility (67%), youth centre (6%), and radio (5%).Their trust
level for their top choices varied little except that youth centres were slightly lower at 6% in the level of trust than their rating as a preferred
source at 13%.
Two-thirds of them had attended a program on preventing HIV. Of those who attended, 75% attended 1-4 and 20% 5-10 times. The most
frequent venues were schools, youth programmes, and churches. Seventy-four percent had heard an AIDS programme on radio, 72% had
seen a poster, and 39% had seen a video on HIV or AIDS. Percentages were similar for South Tarawa and Abemama and across all risk
categories.
89
Summary
Differences between the mainstream youth and those at higher levels of risk and vulnerability in relation to Communication are:
1. By risk categories, those who reported reading the newspaper once a week ranged from MARAs at 27.5% to
mainstream at 53.8%.
2. About 30% of those at mainstream, increased risk and MARYP; 43% EVAs and EVYPs; and 54.5% MARAs
reported not reading newspapers at all.
3. Of those who read newspapers, mainstream youth had the highest rate of reading once a week at 54%, with those at increased
risk next at 51.4%, followed by MARYPs at 48.2%, EVAs at 43.8%, EVYPs at 33.3% and MARAs lowest at 27.3%.
4. Almost all males and females in this sample reported having access to a working radio, whether on South Tarawa or
Abemama, and including all risk levels.
5. About one-third mainstream youth, compared to 15% to 38% of those at higher risk and vulnerability with no
apparent pattern, had access to a working TV.
6. One-quarter mainstream youth, EVAs and MARAs and one-third EVYPs, increased risk, and MARYPs had access to a mobile
phone.
7. The percentages for radio listening were essentially the same across all risk categories, ranging from
83% for EVYP and MARYP to 94% for EVAs.
8. The majority listened to the radio almost every day in the early evening whether male or female, South Tarawa or
Abemama, and for all risk categories, with the exception that the greatest percentage of EVAs and MARAs listened once in two
weeks.
9. The listening pattern for all risk levels followed a curve with the largest numbers listening on the weekends and the l
owest in the middle of the week.
10. About 45% respondents watched TV across all risk categories with the exception of EVAs and EVYPs,
of whom 27% and 14% watched respectively.
11. Those at higher risk and vulnerability made essentially the same choices as mainstream youth for current, preferred, and most
trusted sources of information about HIV and AIDS, with the exception that those at higher risk and vulnerability rated drama
at 27%, over radio at 24%, as a preferred source.
12. The percentages of those who reported attending a program on preventing HIV, hearing an AIDS programme on radio, and
seeing a video on HIV or AIDS, including number of programmes attended and venues were across all risk categories.
90
In summary the youth reported on:
1.
2.
3.
4.
Their current access to means of receiving information;
Their patterns and preferences of reading, listening, and viewing;
Their current, preferred, and most trusted sources of information and advice on HIV and AIDS;
Their attendance to HIV prevention programmes by frequency and venue; and whether they have seen a video, heard a radio programme,
and seen a poster on HIV and AIDS.
Communication findings indicated that 48% read the newspaper once a week. Almost all had access to a working radio; about one-third to a
working TV (almost all on South Tarawa); and about a quarter to a mobile phone with only one on Abemama. Eighty-five percent listened to
the radio and 45% watched TV with the listening and viewing pattern following a curve with largest numbers on weekends and lowest midweek. There was little difference between current, preferred, and trusted sources of information on HIV and AIDS. Two-thirds had attended
a program on preventing HIV; 74% had heard an AIDS programme on radio; 72% had seen a poster; and 39% seen a video on HIV or AIDS.
This information should contribute to the basis for development and fine-tuning of programmes aimed at preventing unsafe behaviour,
decreasing vulnerability, and promoting protective factors.
91
General Population Youth and HIV
This section addresses findings and issues related to general population Kiribati youth who are at least risk and vulnerability for HIV AIDS.
These youth are not engaged in high-risk behaviours, such as unprotected MSM, commercial or transactional sex, although some engage in
unprotected sex and/or multiple partners. They are not involved in IDU, which was not reported by this sample. They are neither in vulnerable
situations involving forced sex or frequent substance use, nor in vulnerable settings, such as in prison or living on the street. However, their
mainstream status is fluid and can change in relation to changes in behaviours, setting, support, or vulnerability.
Demographic data revealed that most Kiribati youth in this sample were not married, not employed, not in school, and not living on their
home island where they might receive community and family support. Youth indicated that lack of meaningful activities and support was a
key factor contributing to their involvement with multiple partners and sex at an early age. A higher percentage of Kiribati females (50.7%)
than males (33.1%) were considered to be mainstream or general population. Mainstream youth were found more likely to be living with
their families and enrolled in school and less likely to be employed, married, separated, or divorced than those at higher risk and vulnerability.
Findings related to Knowledge of HIV and AIDS revealed a low level (12.5%) of comprehensive knowledge, lack of belief in their personal risk
(81%), and lack of focus on changing unsafe behaviour. Although two-thirds of them could answer the question correctly about condom
use, only 40% of those who had sex used a condom the last time and 43% of those who had high-risk sex. General population youth had the
lowest scores for comprehensive knowledge of HIV and AIDS and for assessment of their personal risk of HIV infection. The remark “I feel that
I can never be infected” is a clear expression of why influencing behaviour in relation to safer sex for mainstream youth is difficult.
Data on Attitudes elucidated issues related to promoting safer sex for mainstream youth. Only 45% reported ever using a condom although
about two-thirds were sexually active. Both mainstream youth and those at higher risk and vulnerability used condoms to prevent pregnancy
at a higher rate than to prevent STIs, including HIV. “Sometimes, but not always” seemed to be an apt description of their attitude to condom
use. Only one-third said their parents talked with them about their sexuality and prevention of HIV, despite the fact that their parents were
their first choice to talk with them. More parents of mainstream youth talked with them about sexuality and prevention of HIV than those at
higher risk and vulnerability. Although 40% said they would live in the same house with a PLWHA, some expressed strong feelings of hatred,
fear, and embarrassment in relation to a girl dropping a condom or a boy seen leaving an STI clinic. These attitudes seemed culturally based
and are critical factors in the potential for success of interventions.
92
Most-At-Risk Youth and HIV
This section addresses findings and issues related to Kiribati youth who are most-at-risk for HIV and AIDS in South Tarawa and Abemama
Island. These youth are engaged in at least one of the three high-risk behaviours driving spread of HIV and AIDS in Kiribati: unprotected
MSM, male and female commercial or transactional sex, and unprotected sex with those having sex with sex workers, such as seafarers.
IDU was not reported by this sample but was reported to have occurred in relation to sex with seafarers. This section will address MSM, and
commercial and transactional sex. The next section will address issues contributing to vulnerability and risk, including: forced sex, frequent
substance use, unprotected sex, multiple partners and vulnerable settings, such as prison or living on the street. Most-at-risk status can
change in relation to changes in behaviour, setting, support, or vulnerability.
Men Having Sex with Men (MSM)
Survey results indicated that the following types of MSM occurred among Kiribati male youth: men who have sex for curiosity (35%), money
or trade (7.3%), in all-male environments (7.3%), among men who prefer sex with men (26%), transgendered men (18%), and forced MSM
(33%).
Men having sex with men were interviewed purposively in places that were identified in mapping as “gay houses or bars” and were also
included unintentionally in our questionnaire survey sample in schools and communities. Their distribution among sexually active males by
place was 33.6% for South Tarawa and 41.4% Abemama; by age group was 29.9% adolescents and 40.3% young persons; and by interview
location was 13.6% school-based and 43.6% community-based. Among the nine male prisoners interviewed, three reported having sex with
males, with one attributing to being drunk, one for money and the other preferring sex with males. They did not report forced sex and did
not use condoms.
The team also interviewed five trainees at the Fisheries Training Centre (FTC), one of whom reported sex with men, and 12 trainees of the
Marine Training Centre (MTC), none of whom reported MSM. Eighty-five percent of men reported having sex with men in a hidden place
and 83% reported no condom use. Their reported number of partners ranged from 1-31 with a mean of 2.69. They experienced a higher
percentage of forced sex at 47.2% compared to 42.1% for males not having sex with males, with two-thirds of Abemama MSM reporting
forced sex. They cited the influence of substance use for their inability to make decisions for safer sex. MSM was reported by Key Informants
to be not highly stigmatised, but young boys reported being bullied or forced. The low level of stigma may make service provision easier. The
men engaged in MSM have requested that they be included in HIV prevention workshops and have access to substance abuse treatment
programmes.
Kiribati has not had a recent SGS done recently, but was surveyed in the 2004-2005 SGS. That survey did not sample youth, but involved a
survey of pregnant women and seafarers aged 21-54 years of age. There were no MSM reported among those seafarers aged 21-24 years and
only one men practicing MSM out of 302 male seafarers surveyed.23 Considering the fear of stigma, discrimination and embarrassment
related to MSM among seafarers, it is likely that MSM was underreported in the Kiribati SGS.
93
Receptive anal sex is known to be up to 10 times more efficient than vaginal sex in transmitting HIV.24 Some men who had sex with men
reported also having sex with females. Based on the low rate of condom use for MSM (17%), relatively high number of partners ranging from
1-31, and reported sex with females, unprotected MSM with multiple partners has the potential to contribute significantly to the spread of
HIV, not only among the MSM group, but also to the broader Kiribati community. There were no data yet available on whether any recent
Kiribati HIV positive and/or AIDS case was linked to MSM, but the 2006 SGS includes a report from the Director of Public Health Services
Kiriba
Programme Manager, that the mode of transmission for one of 44 cases in 2004 was homosexual/ bisexual.25
Progr
of youth reporting MSM in this survey was 54 out of 120 sexually active males. If the numbers are extrapolated to the entire
The number
n
population of 15-24 year-old males in Kiribati,26 the number could be roughly 6,150. Taking into account the likelihood of under reporting,
popu
contribution of unprotected MSM with multiple partners has the potential to contribute significantly to the spread of HIV beyond MSM
the co
risk and vulnerability to Kiribati youth. Programme and policy development are critical to address this potential spread and
and increasing
i
increased risk and vulnerability.
incre
Commercial and Transactional Sex
Comm
Kiribati participants in each mapping workshop indicated that the research team would find high-risk commercial and transactional sex
Kiriba
in each
eac site that was surveyed. The Kiribati survey sample of 367 youth, of whom 236 were sexually active, included 36 respondents who
practiced commercial and/or transactional sex. Thirty reported having commercial sex, of whom four were male and 26 female. All but three
pract
of those
tho who engaged in commercial sex also engaged in transactional sex (27) and six only engaged in transactional sex for a total of 33.
Those who had sex for money, food, or gifts reported they did so because they needed money (42%), needed drugs or alcohol (28%), other
reasons (22%), forced (5%), and needed food (3%). Increased risk and vulnerability related to unprotected commercial and transactional
reaso
was significant and can be expected to contribute to the spread of HIV and AIDS. Only 49% reported using a condom at last sex and,
sex w
thus, over half were having unprotected sex with multiple partners. The practice of commercial and transactional sex can be expected to be
difficult to reduce in relation to the intransigence of the reasons youth practice it: needing money, food, drugs and alcohol, and sometimes
diffic
force, or family pressure.
force
least 18 of those sampled were young women having commercial sex in bars and on ships with fishermen, mostly Korean fishermen.
At lea
Although youth under 15 years of age could not be interviewed, researchers observed young girls under 15, sometimes extremely drunk, in
Altho
sex was traded and sold; and observed others going to and from the ships. Researchers interviewed the “organiser” of a group
bars where
w
girls as a Key Informant and learned they had several organisations with officers, that their movements were guided by information they
of gir
received from the wharf on ship schedules, and that half the girls in a house would go work on the ships while the other half babysat. The
receiv
team also interviewed the parents of one of the girls working on ships. Although they originally beat and rejected her, they relented and she
with other ship girls next to them.
lives w
94
The issue of Kiribati young women going to ships for commercial sex with fishermen, especially Korean fishermen, has been of concern for
many years.27 In 2003, Kiribati banned Korean fishing boats from coming into its harbour after a Korean newspaper reported 30-50 mostly
underage girls having sex with Korean fishermen. In 2005, a South Korean government team visited Kiribati to investigate why local girls
were having sex with Korean fishermen and concluded that parents encouraged their daughters because they received US dollars, fish, and
expensive items. It was also reported that foreign fishermen were treating the girls better than local men,28 as key informants also reported
ted
during this survey. Once the ban was lifted in 2006, the National Youth Commission reported that the practice had of Kiribati girls selling sex
to Korean seafarers had continued, involving an estimated 40-50 young women, of whom one-third were under 19 and the youngest was
14 years old. Three had reportedly given birth and another two were pregnant because Korean men refused to use condoms.29 The lackk of
a law against prostitution was said to prevent Kiribati police from prosecuting the girls. The discussion of using punitive means to stop the
problem seemed to have involved prosecution of only girls, not customers.
The practice of selling or trading sex has the potential to bring in HIV, as well as injectable drugs from abroad that will increase risk and
vulnerability to local sex workers, their partners and the broader Kiribati community who frequent the same bars and girls.
Vulnerable and Increased Risk Youth
This section will address the findings and issues of Kiribati youth who are in-between those who are general population, or mainstream,
am,
and those who are most-at-risk. For this report, the terms EVA and EVYP have been used to indicate those who are especially vulnerable.
ble.
The report also uses increased risk as a term for those who have more risk and/or vulnerability than mainstream, but are not most-at-risk.
isk.
This section will address issues that contribute to their risk and vulnerability, as well as risk and vulnerability for mainstream and most-at-atrisk youth, including: forced sex, early onset of sex, unprotected sex, and substance use. The youth in this category may be seen as not
necessarily ready to practice MSM or sex work, but these contributing factors may force or influence them to engage in behaviour thatt is
unsafe although not necessarily at the highest risk level. Thus, it includes youth who may have unprotected sex with numerous partners,
ers,
may endure ongoing forced sex, and may not be able to make sound decisions while under the influence of substances. It also includes the
young men in prison or young wives of seafarers who may have unprotected sex that exposes them to HIV.
Forced Sex
Forced sex is the harsh reality for Kiribati youth. Forty-three percent of the sexually active youth in the survey sample reported forced sex
with ongoing vulnerability for 79% and variation by place from 38.3% in South Tarawa to 71.4% in Abemama, and by gender from 33.3% for
males to 54.1% for females. First sex was forced for 21.1% of sexually active youth and for 36% on Abemama. The most frequent reasons for
ongoing vulnerability were that the forcer was in their household or neighbourhood, or that there was no one to tell. Additionally, strong
ong
cultural taboos made it difficult for them to divulge that they were being forced by a family member of someone with power over them. Key
informants said that police tended to avoid prosecuting such cases.
95
Only three mainstream youth among the sample of 231 sexually active youth had experienced forced sex. However, those categorised at
increased risk reported 28.6% and in ascending order: MARYP at 53.6%, MARAs at 57.6%, EVAs 66.7%, and EVYPs 72%. Thus, compared to
mainstream youth, those at increased risk reported three times the percentage of forced sex while EVYPs reported over seven times the
forced sex at 72%.
Forced sex has implications for HIV risk and vulnerability in that it is rarely protected sex. In addition the IATT cites global research results
Force
indicating that sexual abuse is associated with low self-esteem and often precludes sex work,30 making it less likely that the young sex
indic
worker will insist on safe sex. Thus, even these at the intermediate level of risk and vulnerability experienced significant potential exposure
work
to HIV as well as a significant contributing factor to engaging in unsafe behaviour.
Early Onset Sex
of those who had first sex before 15 years of age was almost three times higher in Abemama than in South Tarawa; almost
The percentage
p
three times higher for males than for females; and over two times higher for community-based than for school-based youth. Those who had
first sex
s before 15 years of age were 13.2% of all 15-19 year olds sampled. Although the age of first sex was delayed to 15 years or older for
86.8% of Kiribati youth as a whole, and for 71.4% of Abemama Island youth, the remaining youth reported having sex as young as 9 years
age.
of ag
Those having sex before 15 who were forced were 21% overall, 33% for females, and 44% of those in Abemama. Forced sex is usually
unprotected sex. Youth expressed their inability to elude their forcers. Clearly these findings indicate increased risk and vulnerability related
unpro
to the number of those who have sex before 15 years of age and have implications for programme and policy development in that messages
delay first sex may be irrelevant to their risk and vulnerability.
to de
Unprotected Sex
Unpr
Kiribati, attitudes toward condom use involve complicated and strong cultural beliefs. If a girl they knew and respected dropped a packet
In Kir
that tthey realised was a condom after picking it up, 25% would be impressed that she used a condom, 20% would feel it was not their
business and would give it to her, 17% would be embarrassed and not give it to her, another 12% would also be embarrassed but would
busin
give it
i to her, and 6% would be shocked. The remaining respondents answered “other”. A review of the reasons they gave indicated that the
majority would have strongly negative feelings toward the girl, hating her, being angry, and injuring her, calling her an enemy or prostitute.
majo
A lesser
less number would try to help her and slightly less would laugh at her. A few would assume she has HIV and avoid her. Some of those
with
h strongly negative reactions are themselves having sex, but the dropped condom seems to be a public admission that makes it obvious
and not culturally acceptable.
96
Overall reported condom use at last high-risk sex was slightly lower at 42.9% than for last sex at 45.2%. In each case, mainstream youth
reported the highest percentages of use and EVYPs reported the lowest percentage of condom use for those at increased risk and vulnerability.
Likewise, the highest reported percentage among non-mainstream youth was 50% for MARAs at last high-risk sex.
The “sometimes but not always” system of condom use leads to increased risk and vulnerability for youth in Kiribati. Religious beliefs and
school rules prevent some youth from having access or using condoms. Youth face barriers to obtaining condoms and to using them. Youth
have problems travelling far to obtain condoms, but most are deterred by embarrassment and fear that someone might see or know them.
Some health workers are judgemental to youth and may divulge that they are having sex. Even when youth have obtained condoms, they
may not use them. Many youth believe that sex with condoms is not as enjoyable or intimate. Some do not want to use condoms with the
“one they love”.
Attitudes toward condom use in Kiribati involve complicated and strong cultural beliefs which must be considered when programmes and
policies for increasing the percentage of youth practicing safer sex are being developed. Youth have strong opinions about condoms and
condom distribution. Their participation in programme development and implementation should facilitate increased condom use.
Substance Use
One major issue of concern in relation to HIV and AIDS risk and vulnerability in Kiribati is substance use. Increased risk related to substance
use is significant. The rate of frequent alcohol consumption (more than three times per week) was 12.2% overall and 46.2% for EVAs. In
South Tarawa, the seriousness of alcohol and kaokioki use could clearly be seen at local bars, on the wharf, and on the roundabout entering
Betio where very young girls and young men are literally falling down drunk and vomiting. Youth also report clearly that their alcohol use
contributes to their failure to make decisions for safer sex or limiting partners.
Although there was little IDU within this sample, it was reported that some girls were given, but did not buy, injection drugs when partnered
with Indonesians on ships. Of those youth surveyed 4.5% said that they currently use drugs. The types of drugs they reported using are:
marijuana, glue, sniffing benzenes, gasoline, chew (betel), lime, and China tree (Datura metel) seeds.
Although the above drugs can have serious health consequences, it appears that alcohol or kaokioki may have the most impact on
increasing risk and vulnerability to HIV. A combination of factors favour alcohol use, including: lack of activities for youth; an apparent lack
of restrictions and/ or enforcement regarding youth entering bars and drinking; and use of alcohol to purposefully increase desire for sex
by both young persons and potential partners. Dependence on alcohol also leads to transactional sex for drinks or commercial sex to buy
drinks. In addition, alcohol consumption seems to fuel unsafe sex in Kiribati.
97
Settings of Vulnerability
Certain settings such as juvenile detention facilities and prisons, living without parental care or on the street can cause youth to be vulnerable.
Although there were no juvenile detention facilities in Kiribati, youth were placed in prisons. The nine male31 prisoners we interviewed did
not report forced sex, but three reported unprotected sex. Those sampled at the Marine Training Centre and Fisheries Training Centre lived
in dormitories, but only one of the 17 interviewed reported MSM.
Only one of the sample reported living on the street. The only “homeless” person observed during data collection was a mentally-ill girl. Key
informants reported that it was shame to a family for their youth to be on the street, except, as in this case, because of mental illness. Instead
youth would leave home and go to a relative. Clearly, those who are mentally-ill are at serious risk for mistreatment in that they are living on
the street, do not have the protection of their family, and may not be able to protect themselves from physical or sexual abuse.
TThe above portions of this section have presented findings and issues related to general population, most-at-risk and vulnerable and
increased risk youth and HIV in Kiribati. The next portion addresses findings and issues of health care utilisation and communication related
to HIV.
Health Service Utilisation
Health and social services utilisation was relatively low for youth who would obtain HIV and AIDS information from a health worker and/ or
access condoms, especially since it is their major source for both information and condoms.
TThe differences in utilisation of health care workers as a source for HIV and AIDS information by both mainstream males and females
compared to those at increased risk varied, but mainstream utilisation was lower for mainstream males (29.2%) than for males at greater risk
(31.8%-50%). For females, numbers were low (25.5%) overall and there was no apparent pattern.
TThe percentages of males utilising a clinic for obtaining condoms were higher for most at risk youth (50%) than for especially vulnerable
youth (35.4%). Mainstream females had a dramatically lower percentage obtaining and using condoms (4.7%) than those at greater risk and
vulnerability (25-63.6%). For both males and females, more young people utilized clinical services for information and condoms than did
adolescents.
Males on South Tarawa and Abemama utilized health workers for HIV and AIDS information at a higher rate than females and a higher
percentage of males and females on South Tarawa utilized health workers information than on Abemama. Females were half as likely to
obtain and use a condom as males, with the exception of Abemama females who were twice as likely as the Tarawa females to do so. The 2024 year olds in this sample were more likely to have talked with a health care worker about HIV and AIDS and obtained and used a condom
than 15-19 year old adolescents.
98
Females in Abemama reported the highest percentages of more than five STIs in the past year by more than three times higher than females
on South Tarawa. South Tarawa males reported the highest percentage of 1-5 STIs in the past year and Abemama males reported the highest
percentage of no STIs.
More males reported utilising non-clinical treatment or no treatment for STIs than clinical. A higher percentage of Abemama males reported
no pain or infection than South Tarawa males. Symptomatic males sought clinical treatment for STIs, ranging from 25% for mainstream
youth to 60% EVYP, but more chose non-clinical treatment or no treatment than clinical. Fifty-four percent of symptomatic mainstream
females sought clinical treatment, while those at greater risk and vulnerability sought clinical treatment ranging from 47% to 80%. Half of
the females would seek treatment from a clinic if they were symptomatic for STIs, while very few would choose no treatment.
Over 62.5% MARAs and 52.9% MARYPs had been reached by HIV Prevention Programmes but the coverage for EVAs and EVYPs was only
6.3% and 3.8% respectively with increased risk youth at 1.3% coverage. Sixty-seven percent of those most-at-risk who were surveyed in
Kiribati indicated they had attended an HIV prevention workshop with little variation by age group or school and community based location
of interview. Males reported almost 10% higher attendance than females, and attendance on Tarawa at 68.6% was almost 10% higher than
Abemama at 58.9%.
With few exceptions, health care utilisation was unacceptably low. Respondents expressed their discomfort at going to clinics and the
hospital for advice or to obtain condoms because they are embarrassed, someone might see them, someone might know them, and some
health care providers are unfriendly.
These findings indicate significant and serious gaps in health care utilisation, especially for those youth who are especially vulnerable and
at increased risk and, as in the other areas, have implications for programme and policy development.
Communication
Lack of access limits the types of communication modes that would be most effective. Almost all have access to a working radio. Only onethird have access to a working TV with very few on Abemama where TV is likely used for video. Only one-quarter have access to mobile
phones, almost all on South Tarawa.
Radio and newspapers provide the broadest coverage. Communication findings indicated that 48% read the newspaper once a week. Eightyfive percent listen to the radio and 45% watch TV. Listening and viewing patterns follow a curve with the largest numbers on weekends and
lowest mid-week. Their preferred sources favour personal contact over media, except for radio. Radio is one of the most preferred sources of
information for these youth. They have been particularly impressed by presentations of PLWHA.
There is little difference between current, preferred, and trusted sources of information on HIV and AIDS. Two-thirds have attended a
program on preventing HIV; 74% have heard an AIDS programme on radio; 72% have seen a poster; and 39% seen a video on HIV or AIDS.
99
Knowledge of HIV and AIDS
Knowledge of HIV and AIDS
Review of Findings
Recommendations
Policy Implications
Youth had strong feelings about HIV awareness and
prevention programmes, issues of condom use, and
testing. They expressed the need for more programmes
that were coordinated rather than episodic, often
once a year. They advocated for inclusion of PLWHA in
presenting information to them. And they advocated for
better access to awareness and prevention programmes,
condom distribution, and HIV testing. Their answers to
questions relating to their attitudes provided additional
information of importance in programming.
Youth recommended ongoing HIV and
AIDS awareness activities, rather than
once or twice a year.
1.1 Assure that HIV and AIDS awareness is
addressed in a comprehensive, rather than
an episodic manner. Include presentations
by PLWHA.
Youth reported that awareness activities
are most effectively presented by
PLWHA.
1.2 Find ways to link awareness activities to
behaviour change. Monitor improvements
in knowledge level and safe behaviours.
Work with schools and communities
to assure that ongoing comprehensive
programmes are developed and
implemented for all groups, including
awareness activities and youth-friendly
condom distribution.
Knowledge does not appear to be
translated to safe sex behaviour by
youth.
1.3 Be sure that activities are available in
schools as well as communities, to females
as well as males, to adolescents as well as
young people, and to MSM as well as those
not having MSM.
For some, religion was a factor – they would not use a
condom even though they might be having sex.
For those explaining why they chose not to use a
condom, the most frequent answer was that they were
too young or not having sex. Next in descending order
were that their partner did not want, they had sex with
their regular partner, they were embarrassed to use,
they did not know how to use, they were unable to
obtain one, with the remainder that they were ashamed
of the nurse, wanted a baby, condoms were boring, they
forgot, religious belief, and the clinic supply was out.
Many choose not to get a condom. Issues of
embarrassment were key. The most frequent reasons
no matter their age, sex, or location were that they
were “embarrassed to ask”, followed by “someone might
know you”, or “someone might see you”. Distance was
more important than unfriendly staff.
Two-thirds of those questioned about whether they
wanted to use a condom at next sex said yes.
100
Survey results demonstrate that
awareness activities are needed by
all groups, as lack of comprehensive
knowledge and unsafe behaviours are
apparent within all groups. MSM have
not often been included and have asked
that they participate in workshops.
IATT advocated youth participation in
planning and decision-making regarding
HIV interventions.
1.4 Engage youth in designing and
implementing programs to achieve active
instead of passive learning.
Develop activities for youth, including
sports for all and volunteer work, to
engage them in productive activities
and build protective factors.
Should a policy of HIV testing and
delivery of results is to be followed,
adequate funding need to be allocated
to follow this policy, accountability and
utilisation of results.
Monitoring will be a key activity, as
previously people who tested HIV
HIV Testing
Review of Findings
Only 23% of young people surveyed
in Kiribati have been tested and 19%
received results. In the past, HIV positive
persons were lost to follow-up, especially
to outer islands.
Recommendations
2.1 Make a clear decision whether widespread population-based HIV testing is a
priority at this level of the HIV epidemic
in Kiribati. If the answer is “yes”, plan
and monitor how testing will be carried
out, how the programme will assure
delivery of results and engage schools,
communities and health providers in the
planning process. If the answer is “no”,
plan and monitor the same issues for the
subsection of young people who feel they
have reason to be tested.
Only 12% of youth surveyed in Abemama
have been tested and received results
compared to 21% in South Tarawa. Only
13% of adolescents compared to 27%
young people, and only 7% schoolbased, compared to 26% communitybased.
2.2 If HIV testing is to take place on a
comprehensive basis, plan and monitor
how services will be provided to those in
Abemama, for adolescents, and schoolbased youth.
Of the 23% who reported to have been
tested in Kiribati, only 20% had received
their results.
2.3 If HIV testing is to take place, plan and
monitor whether those who have been
tested receive their results and whether
those who test positive are lost to followup.
Policy Implications
positive were not always informed of
results and those who were HIV+ were
lost to follow-up when they left South
Tarawa.
Planning need to involve all those
who will be expected to contribute to
carrying out testing activities as well as
input by intended recipients.
101
Attitudes
Attitudes
Youth had strong attitudes related to condom use
involving shyness, discomfort, negative attitudes,
and frustration at inadequate supplies, and
unfriendly attitudes of health providers. Additionally,
their strong feelings of hatred and fear expressed in
response to the simulated situations of a dropped
condom packet or finding out that a boy they know
is leaving a clinic for STI and HIV treatment must be
further explored and addressed.
Several youth told the research team they did not
know how to use a condom, while data collectors
expressed their concern at the lack of knowledge
youth had in relation to using condoms.
102
Review of Findings
Recommendations
Many of those who did not use a condom
said they did not know how, they were
unable to get one, they did not want to
use, and that condoms were boring.
Recommendations
1.1 Attitudes on condom use
Address the issues of young males and
females who do not know how to use a
condom. Develop activities to show them
what a condom looks like, have someone
tell them where to get it, have nurse
or whomever is distributing condoms
reinforce the information.
Only one-third of the parents of the
interviewee talk to their children about
issues of their sexuality and prevention
of STIs including HIV.
1.2 Attitudes on parents talking to
children
Plan activities and workshops for parents,
or, if acceptable, for parents and their
children together to share results of
the survey. Teach parents how to talk to
their children about their sexuality and
prevention of STIs including HIV, and have
practice sessions. Have the youth speak
to their parents about the importance of
being able to talk with them.
Forty percent of those surveyed were
willing to live in the same house with
PLWHA.
1.3 Attitudes on risk of living in the same
house with PLWHA
Include information in awareness
activities about lack of risks involved in
living in the same house with PLWHA
and similar scenarios. Involving PLWHA
and their housemates in these awareness
activities would add to the impact.
Policy Implications
Attitudes
Review of Findings
Recommendations
If they were out with friends who offered them marijuana,
75% would refuse, 10% would accept, 10% do not know, and
3% would be shocked.
1.4 Attitudes on marijuana use
Although the potential for marijuana use appears
to be low at this time, it is important to continually
monitor what substances youth are using in relation
to the outside influences that can introduce new
substances. Assure that youth are aware of the
potential negative impacts of marijuana use.
Regarding the situation where a girl dropped a packet
containing a condom, several respondents said they would
“hate” her, injure her, call her a prostitute, or fear her as she
might have HIV. These attitudes must be considered in
developing effective programmes to increase condom use.
1.5 Attitudes on condoms and treatment of STIs,
including HIV
Meet with young people to gain a better
understanding of why they would fear, hate, injure,
and feel embarrassment about someone who uses a
condom or gets treatment for STIs. Ask for their advice
in overcoming these attitudes. Take these intense
attitudes into account in developing programmes for
increasing condom use or preventing and treating
STIs, including HIV.
Similar responses were elicited by the question about a boy
coming out of an STI treatment clinic, with perhaps less
intensity.
Their responses to the advice they would give a girl they know
and respect about being pregnant, would overwhelmingly be
to talk to her mother. For a boy asking for the same advice, the
most frequent response would be to talk to his father.
Focus group discussions have revealed that the attitudes of
parents are so strong about talking to their children about sex
that they do not do so even when they understand clearly that
they should.
Likewise, youth are very threatened about getting help or
advice or a condom that they do not do so even when they
would like to use a condom the next time they have sex.
1.6 Attitudes on who they would prefer to talk to
During meetings with parents, let them know that
their children want and need to be able talk with
them. Provide assistance to parents to learn how to
talk to their children.
Policy Implications
Impacting these strong attitudes
and emotions will require deliberate
programme planning and evaluation,
dedicated funding and accountability
to
develop
and
implement
programmes to provide a safe,
friendly place for youth to get advice,
help and condoms; workshops to
train parents to interact with their
children; sessions with youth to get
their input on dealing with negative
attitudes toward condom use and STI
treatment; monitoring marijuana and
other substance use; and effective
awareness programmes to teach
youth about relative risk of HIV and
to teach them how to use condoms.
Purposively strengthen protective
factors for supporting vulnerable and
at risk youth.
Set up a safe place where youth can talk to someone
for those cases where parents cannot overcome their
avoidance of talking to their children about sex. The
place should be friendly, unthreatening, and safe.
103
Practices
1. MSM
Those MSM who were interviewed recommended that
MSM be included as invitees to HIV prevention workshops.
One of the young female data collectors made the
same recommendation during the national feedback to
mapping workshop participants and stakeholders.
The issue of alcohol contributing to unsafe behaviour, led
to recommendations for regulating alcohol use by youth,
alcohol awareness, and assistance to stop drinking. Some
recommended that condoms be available in all bars.
Review of Findings
MSM have indicated a lack of service
programmes available to meet their needs
for information pertaining to safe sex and
HIV prevention.
Their overall knowledge of HIV, as well as
that of all Kiribati youth, is quite low and
their practice does not even adhere to
their limited knowledge of safer sex.
Young people, including MSM, cited “no
one to tell” as the reason they are unable
to end their vulnerability to forced sex.
Young MSM have indicated that they
are bullied by other youth. Of the nine
prisoners interviewed, three reported
having unprotected MSM.
2. Commercial and transactional sex
Young people engaged in commercial or transactional
sex did not talk much about it, except those engaged on
the ships seemed eager to explain that they were treated
well, received generous “gifts” and their partners loved
them. Some said a policeman had told them that it was
their human right to have sex with anyone they wanted.
The issues related to the opportunity for
youth to earn what seem to them as very
high amounts of money and to experience
less violence have been powerful
motivators for most of the girls who
engage in commercial and transactional
sex on the ships.
Recommendations
1.1 Bring together a small group of mixed
age MSM to participate in developing
programmes to serve their needs for
support and awareness and facilitate their
participation in existing programmes.
Address the serious needs of youth,
including MSM, related to frequent
alcohol and other substance abuse
by developing and enforcing policies
and legislation that prevent supply of
alcohol and other substances and access
1.2 As part of support provided to young to drinking establishments to underage
MSM, establish a safe place where both in- youth, and provide meaningful
and out-of-school youth, including MSM, penalties to those who do not adhere to
can report forced sex, get a condom, or these policies.
have their questions answered.
Seriously address the problem of
1.3 Ensure that MSM can participate in forced sex in Kiribati, including youth
other activities developed to serve youth and MSM. Enforce a system providing
without bullying.
meaningful consequences to those who
harm others.
1.4 Ensure that condoms and information
about HIV and AIDS are available in
prisons.
2.1 Bring together a task force to address
the complex issues of commercial and
transactional sex in Kiribati.
2.2 Engage youth in developing solutions
to underage alcohol abuse and violence.
2.3 Develop and enforce legislations that
prevent underage youth from being in
bars and buying drinks.
104
Policy Implications
Practices
Review of Findings
Likewise a girl who had reunited with her parents but
continued to have commercial sex on the ships was seen
by some as having a free life without being constrained
by culture or religion.
There is clearly a large cultural gap between those
having commercial and transactional sex and the youth
who hated the fictional girl who dropped a condom or
the boy who got treatment for an STI.
Becoming drunk to the point of vomiting
and passing out, and fights, are common
occurrences in the bars where sex is sold
and traded. It is obvious that underage
girls cannot protect themselves or decide
on safer sex when falling down drunk.
3. Forced sex
Youth do not easily talk about their forced sex, but the
main reason they give for their ongoing vulnerability
is “no one to tell”. It is important to note that they did
tell the young data collectors. They also expressed their
desire for a place where they can get help.
In Kiribati culture, it is extremely difficult for youth to tell
someone if the forcer is one of their family or someone
who has power over them.
Many youth do not feel they have any
option to escape their forced sex.
Recommendations
Policy Implications
2.4 Consider preventive activities
addressing men who buy sex, and ships
where the sex is taking place.
Prior efforts have focused on trying to
stop the girls and have not addressed the
larger dynamics.
The extent of forced sex and first
sex forced is extreme, especially for
Abemama Island. Forty-three percent
of sexually active youth reported that
they had been forced to have sex when
they did not want to, with 79% saying
they are still vulnerable. The percentage
by place ranged from 38.3% in South
Tarawa to almost twice as high at 71.4%
in Abemama.
3.1 Develop a safe place where youth
can go to talk with someone and receive
help in dealing with their forced sex –with
sensitivity to prevent others from knowing.
3.2 Seriously address the alarming extent
of forced sex by treating it as the urgent
issue that it is for the wellbeing of Kiribati
youth. Develop protective factors for
vulnerable youth.
Legislation must be developed to
deal with those who are forcing youth
to have sex when they do not want to.
Developing services for a “safe
place” will require dedicated budget,
accountability,
planning
and
evaluation to address this serious
problem.
Cultural taboos on reporting crimes of
rape and police attitudes encouraging
reconciliation over prosecution lead
to infrequent prosecution. (DOS
Country Report)
The implications for lost virginity are
serious in Kiribati culture, even for those
victims of forced sex.
105
Practices
Review of Findings
Recommendations
4. Substance Use
The youth in Kiribati who contributed to this research
were concerned about loss of control and decisionmaking by those who used too much alcohol, kava
or marijuana.
Some said they could not think of
condoms when drunk and could only get protection
if they stopped drinking. Some also said they were
drunk every night with different sexual partners.
Others said they had sex for money or a drink or
drugs to obtain alcohol or drugs.
Many youth have attributed their failure to
make sound decisions for safer sex to alcohol,
kaokioki or kava.
4.1 Provide substance abuse treatment
programmes for those who have
requested and cannot stop on their own.
Youth who struggle with drinking problems
recommended
that
regulations
be
developed and enforced.
4.2 Develop policy to address the issues
of youth who are unable to control
their drinking, including regulations
on age limits for entering drinking
establishments and purchasing liquor.
5. Condom Use
Youth were discouraged from going to a hospital to
obtain condoms, especially if the atmosphere was
unfriendly. They were not able to travel far distances,
especially when they sometimes found on arrival
that the supply of condoms had been depleted.
They expressed their shyness, embarrassment, and
fear to approach health workers, especially if the
latter were of the opposite sex.
They wanted to have youth distribute condoms in
their villages and for condoms to be available in their
local shops.
Kiribati youth said they were prevented
from getting a condom by distance, being
embarrassed to ask, people might see them,
people might know them, and the providers
are unfriendly.
5.1 Convene an advisory group of young
people to make recommendations from
the perspective of youth to lower the
risk of unprotected sex by increasing
condom use. Convene a group of health,
education, and religious stakeholders to
review recommendations of youth.
Youth and partners said they did not use
condoms because they did not like the lack
of feeling.
5.2 Explore the possibilities of obtaining
condoms that can be marketed as being
more pleasurable with consideration
given to colour, texture, and scent.
Actively involve youth in the planning.
When asked for their recommendations for
lowering risk in the qualitative questionnaires,
youth consistently suggested that youth be
appointed to distribute condoms and that
they be available in the villages as opposed
to a hospital or clinic.
5.3 Consider the recommendations by
many youth in this research that youth be
appointed to distribute condoms and that
condoms be available in the community.
106
Policy Implications
Ask the group of health, education,
and religious stakeholders to come
to acceptable solutions to issues of
condoms not being allowed in schools
and by their religion.
Review of Findings
6. Early onset sex
The percentage of those who had first sex
before 15 years of age was 9.7% on South
Tarawa, but three times higher at 28.6% on
Abemama; 7.8% for females but 21.3% for
males; and 8.8% in the school-based sample
and 19.7% for those community-based.
6.1 Ensure that coverage of programmes
to address early onset of first sex covers all
subgroups, especially youth on Abemama.
Age at first sex for this sample ranged from 9
years of age to 23 years old while that of their
partners ranged from aged 10 to 50.
6.2 Develop programmes to prevent forced
sex of youth and to address perpetrators.
Twenty-one percent said their first sex were
forced before age 15 and the early onset was
not by their choice.
6.3 Develop educational programmes for
young children that teach them the type of
touching that must be avoided, that they
have the right to say “No” to se and where
they can go for help when needed.
Programmes that begin at adolescence would
be too late for one-third of respondents.
7. Health and Social Services Utilisation
Youth have been clear about being embarrassed
to utilise clinic-based services to discuss HIV and
AIDS information or to obtain condoms. They are
worried that they might be seen or that someone
in the clinic will know them or that the staff will be
unfriendly.
They tend to ignore the risk of HIV and AIDS which
further reduce the likelihood that they will access
information or condoms at the clinic.
Recommendations
Youth have been quite clear that although
they do trust clinical services they find most
of them to be threatening or embarrassing
to access with some exceptions involving
individual nurses who have been helpful in
providing them information or condoms.
Even when individual providers have been
friendly, most services are difficult for youth
to access due to distance and waiting time. A
youth-friendly clinic or drop-in centre provides
the opportunity to build protective factors
while providing services for vulnerable and at
risk youth.
7.1 Engage youth from both South Tarawa
and Abemama, adolescents, and young
people, school- and community-based
to provide advice to leaders in designing
services that will be youth-friendly, villageand school-based, have easy access and
ensure confidentiality.
7.2 Decide if and when Kiribati can develop
youth-friendly and accessible clinical
services.
Policy Implications
Implementation
of
these
recommendations will require a
dedicated budget, accountability,
programme development and
monitoring of implementation.
Development of programming
for very young children at risk will
require involvement of schools and
communities, churches and all who
can build support.
Provision
of
youth-friendly
and appropriate services will
require dedicated funding, a
planning process involving youth,
accountability
and
ongoing
monitoring.
Successful implementation would
require involvement of all sectors,
including
church,
education,
health, NGOs, and especially youth
themselves.
107
Review of Findings
8. HIV and AIDS Prevention Workshop
Coverage for MAR
9. Communication
Youth consistently asked for more awareness.
The impact of drama and stories by PLWHA
was most vivid for them and seems to have
more potential for changing their behaviour.
They trust health facilities and personnel as
sources of information, but do not always
find them friendly and often will not seek
information from them.
They like technology but do not have much
access. Although almost all have access to a
working radio, only one-third have access to a
working TV with the majority in South Tarawa,
and about a quarter have access to a mobile
phone, but only one on Abemama.
108
Recommendations
Youth perceive awareness programmes to be
episodic and recommended that they should
be systematic.
8.1 Ensure that awareness workshops are
carefully planned to be an ongoing part
of a systematic HIV and AIDS education
programme.
Current practices, such as condom use data,
as reported in this survey, do not necessarily
match the level of knowledge.
8.2 Monitor the effectiveness of workshops
in changing reported behaviour as well as
the level of knowledge about HIV and AIDS.
There is not a large difference in coverage
currently, but it is likely that Abemama
performance level was influenced by a recent
awareness workshop.
8.3 Ensure that all groups are covered,
whether on South Tarawa or Abemama,
male or female, school or communitybased, and adolescent or young people.
None of the youth interviewed mentioned
having had any input to awareness or
communication programming.
9.1 Engage youth on South Tarawa and
Abemama to help develop a programme
for communicating to youth.
Youth did not like having awareness available
to them at rare intervals. They wanted ongoing
communication.
9.2 Ensure that awareness and
communication programmes are not
episodic.
Youth have expressed shyness to approach
health facilities despite the trust they have in
the information.
9.3 Involve youth in presentations, whether
workshops, radio programmes, print media
or any other communication. Have youth
trained to be sources for other youth at
youth-friendly clinics or drop-in centres.
Involvement of youth has the potential to
increase the potential for knowledge leading
to behaviour change for both those who are
presenting and the audience.
Policy Implications
Successful implementation of these
recommendations
will
require
dedicated budget, accountability,
comprehensive
planning
and
monitoring of results to build
protective factors for those at risk.
This study set out to address three formative research questions:
Research Questions
Conclusions
What is the spatial and contextual nature
of risk and vulnerability to HIV and AIDS
among young people aged 15-24 years
in selected areas of Kiribati?
Findings from mapping workshops, KAP survey questionnaires, FGDs and KIIs
demonstrated that 15- 24 year olds in all Kiribati survey locations were at increased risk
and vulnerability, but that the level of risk and vulnerability varied by place, gender, age,
and school or community-base of interview as described in the Findings and Discussion
sections of this report.
The major risk behaviours were commercial and transactional sex (especially for South
Tarawa); MSM; unprotected sex with multiple partners; and limited IDU. Although limited,
IDU has the potential to contribute to the level of risk and vulnerability due to outside
influences.
Contexts increasing vulnerability in Kiribati included: forced sex including gang rape;
frequent use of alcohol and kaokioki; seafarers giving neglected girls money and good
treatment; incest; pornography; and youth in prison with no access to condoms.
What
factors
influence
current
behaviours and could influence future
interventions for those Most-at-Risk,
Especially Vulnerable and the general
youth population?
Contributing factors influencing current behaviours and potentially influencing future
interventions include: broken homes, poverty, boarding, lack of employment, lack of
activities, outside influences, and changing lifestyles. Strong traditional and religious
beliefs related to condom use, virginity, and the status of women and youth also complicate
implementation of interventions to reduce risk and vulnerability.
Current youth beliefs about condoms not feeling good, inadequate condom supply, and
lack of youth-friendly services contribute to the practice of unprotected sex.
How do these youth currently receive
information and advice and what
communication methods are likely to be
most effective in reaching them?
Youth consistently asked for more awareness, especially presentations by PLWHA,
and involvement of youth. They trusted health facilities and personnel as sources of
information, but did not find them friendly and often would not go to them for advice or
condoms. They liked technology but had limited access, especially on Abemama, except
for radio.
109
Among the most critical issues related to risk and vulnerability of youth in Kiribati were the following:
O
Most of the youth were not married, not employed, and not enrolled in school. Youth cited lack of
activity and support as contributing factors for involvement with multiple partners and commercial
and transactional sex at an early age.
O The ability to be get good treatment, avoid violence from local men, and receive large amounts
of money also influenced girls to consider commercial sex and may influence family and community
members not to stop the practice. Even though some experienced violence from foreign seamen, they
considered it to be their fault, the money to be a gift from his heart, and his relationship with them to
be “like my husband.”
O
Their level of comprehensive knowledge of HIV and AIDS was low (12.5%) and should be of concern.
O
One-third of sexually active males on South Tarawa and 41% on Abemama reported MSM, including
three of nine young prisoners interviewed. Unprotected sex for MSM was 1.5 times higher (83%) than
for non-MSM. Those reporting MSM cited frequent use of alcohol, kava, and drug as contributing to
their inability to limit partners and practice safer sex. Forty-seven percent of MSM experienced forced
sex in comparison to 42% non-MSM.
O
The percentage of sexually active females practicing commercial sex (23%) was seven times as high
as for males. The percentage practicing transactional sex by gender was about the same.
O
Fifty-four percent of sexually active females had ever been forced to have sex when they did not
want to in comparison to 33% males with the highest percentage by location in Abemama (71%). First
sex was forced for 31% females in relation to 12% males.
O
Frequent alcohol use (over three times per week) was 12.2% overall and by gender was almost three
times higher for males at 15.8% as for females at 5.8%.
O
First sex was forced for 31% females and 11.8% males. Thirty-three percent of females whose age of
first sex was below 15 years of age had been forced in comparison to 15% of males.
110
O
Exposure to outside influences and poverty were reported to lead youth and their parents to perceive
an increased need for money that led to sex for money or trade. Some girls selling sex on ships reported
an income in goods and cash that was higher than that of a teacher or nurse.
O
Child prostitution, child pornography, and child sex tourism and trafficking in Kiribati were reported by
a separate UNICEF study. Child prostitution and pornography were reported by respondents in this study.
O
A dramatic level of commercial sex of female children in South Tarawa was reported and observed, as
well as disturbing issues of forced sex, unprotected sex, and early onset sex.
O
Several safe sex myths increase youth risk and vulnerability, including the “one inch” method, staying
just outside, not using your brother’s towel, safe sex if only one time, and having the male put semen on a
coin and if it turns cloudy, he is infected by HIV.
O
Ongoing problems related to commercial sex with foreign seafarers on ships and mostly transactional
sex with local men in bars by very young girls consuming large amounts of alcohol contribute substantially
to risk and vulnerability for Kiribati youth.
Observations of local, youth data collectors have been woven into this report, but some are included in this conclusion due to their unique
perspective based on having interviewed survey respondents. They observed that youth gained awareness of their risk through the interview
survey process. However, they observed that high-risk youth thought they were safe and continued their behaviours. They said that despite
the fact that youth could repeat HIV prevention slogans, they did not really understand issues such as how HIV was transmitted or how to
put on a condom and therefore prevent them from changing their behaviours.
Some facts that surprised the data collectors were: that respondents were unaware of the need or how to use condoms, unaware of their
risk, were embarrassed to get condoms, and did not trust confidentiality of health care providers; the young age their respondents initiated
sex and utilized substances such as alcohol, homebrew, kava and marijuana; the high numbers of respondents who are raped and practice
MSM; that youth are using alcohol for relaxation; and that boys were also forced. They recommended that families and communities work
together to lower risk and vulnerability of their youth to HIV and AIDS.
111
VII. The Way Forward
Model for Next Steps
Health And Social Services
Attitudes
Health And Social Services
Risk Behaviour
Knowledge
Next Steps
This study has assessed knowledge, attitudes, utilisation of health and social services, family and community support, risk behaviours,
preferences for receiving information, and what Kiribati youth recommend as most effective interventions to help them reduce their risk
and vulnerability to HIV and AIDS. The needs and their recommendations are clear. The next steps should be active involvement of all youth
in planning and implementing services, accountability and monitoring of evidence-based services, a focus on protective factors as well as
prevention and action by those who have the authority to reduce the context of vulnerability over which youth have no control. This report
will have no potential to contribute to reduction of risk and vulnerability for HIV and AIDS among Kiribati youth unless this evidence leads to
action and those next steps are taken.
112
Annex 1 : DEFINITIONS, ACRONYMS USED IN THIS REPORT
Annex 2 : References
Annex 3 : Overview of Baseline Survey Methodology
Annex 4 : CPAP Indicators for Kiribati
Comprehensive Knowledge of HIV and AIDS
HIV Test and Result Distribution
Condom Use at Last High-Risk Sex
Condom Use at Last Sex (15-19 years old)
Age at First Sex
HIV and AIDS Prevention Workshop Coverage
Annex 5 : Kiribati Tools
National Mapping Workshop Agenda
KAP Survey Questionnaire (English and Kiribati)
Focus Group Discussion Prompts (Stakeholders and Youth)
Annex 6 : Mapping Workshop Results
National Consultative Mapping Workshop Results
Abemama Island Mapping Workshop Results
Annex 7 : Survey Sites Selection
South Tarawa area survey sites and reasons for selection
Abemama area survey sites and reasons for selection
Annex 8 : Research Team
113
Annex 1: Definitions, Acronyms used in this report
TERMS
Adolescent
Young Person
Youth
MARA
MARYP
EVA
EVYP
Increased Risk
DEFINITIONS
15-19 years of age
20-24 years of age
15-24 years of age
Most at Risk Adolescent
Most at Risk Young Person
Especially Vulnerable Person
Especially Vulnerable Young Person
At more risk or vulnerability
than most mainstream youth.
Most-at-risk young people are defined* as those who are:
Mo
O
IDUs who use non-sterile injecting equipment
OMales who have unprotected anal sex with other males
OFemales and males who are involved in sex work, including those who are
trafficked for the purpose of sexual exploitation and have unprotected (often
exploitative) transactional sex
OMales who have unprotected sex with sex workers.
Especially Vulnerable Young People are defined* as those who are “one step away from
Esp
engaging in high-risk behaviour”, because of such factors as:
eng
ODisplacement;
OEthnicity and social exclusion;
OHaving parents, siblings, or peers who inject drugs;
OMigration (internal and external);
OFamily breakdown and abuse;
OHarmful cultural practices; and
OPoverty.
They also describe settings such as:
Juvenile detention facilities and prisons; as well as situations such as living without parental
care or on the street that cause young people to be Especially Vulnerable.
* Inter-Agency Task Team (IATT) on HIV and Young People
114
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115
Methodology
Description
1PQVMBUJPO
4VSWFZUZQF
4BNQMJOHNFUIPE
*ODMVTJPODSJUFSJB Target/final sample sizes
*OUFSWJFXMPDBUJPOT
"ENJOJTUSBUPSTPGRVFTUJPOOBJSF
Consent
Time required
Data collection period
116
t:PVUIZFBST
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interviewee – random selection from non-random purposive school site selection
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or influence over HIV AIDS programmes
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South Tarawa – 300/310, Abemama – 50/57
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Average 45 minutes
August 25 – September 15, 2009
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1.2
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1.5
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Young people (15-24) who correctly identify ways of preventing sexual transmission of HIV –
including delaying sexual debut, reducing partners, and use of condoms and reject major
misconceptions.
Young people (15-24) who have been tested and know their HIV status.
Young people (15-19) who had first sex before age 15 and percent who delay age of
sexual initiation.
Condom use at last high-risk sex for males and females 15-24 (at risk groups).
Condom use at last sex for sexually active adolescents (15-19).
Most-at-risk population reached by HIV Prevention Programmes
12.5%
19.3%
13.2% <15 years
43%
45.2%
65.3%
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