Understanding Adolescent Sexual & Reproductive Health Behavior & Care Access in a Rwandan Community [36A]

INTRODUCTION: The prevalent sexual norms and behaviors of rural Rwandan adolescents, including barriers to accessing and utilizing reproductive healthcare services, were explored qualitatively. METHODS: Focus groups were conducted with adolescents in the rural community of Kibogora, Rwanda. Participants included students from local secondary schools and adolescents not in school. Interview guides were adapted from validated World Health Organization guides. Trained midwives conducted focus groups in the local language. All were recorded, interpreted, transcribed and coded for themes. Interviewers were matched in gender with interviewees. Each subject completed a demographic survey with questions pertaining to sex and personal relationships. RESULTS: One hundred twenty-six adolescents (14-24 years) participated. Fourteen focus groups were conducted. Predominant themes include prevalence of transactional sex, need for sexual and reproductive health knowledge, need for increased access to condoms and services, fear of pregnancy and sexually transmitted infections, and confidentiality issues related to obtaining care. Adolescents correctly identify risks of having unsafe sex (infectious disease and pregnancy) but feel obtaining services is socially prohibitive. Adolescents consistently overestimate the number of sexually active peers when compared to the low number of adolescents reporting sexual activity on anonymous surveys. CONCLUSION: It is not only important to involve the local community, including adolescents, in designing and implementing any sexual and reproductive health educational program but it is also important to create safe and comfortable avenues for adolescents to access confidential services.