28-34 Maharaj.qxp

International Family Planning Perspectives Young people in South Africa face high levels of unwanted pregnancy and HIV/AIDS. The South African government has cited the high incidence of unwanted pregnancy among youth as one of the major challenges facing the country.1 More than one-third of women nationally have their first child before age 20.2 The overwhelming majority of these pregnancies occur outside marriage, and most of them are either unwanted or unplanned.3 Evidence from the 1990s suggested that many young women become pregnant intentionally, to demonstrate their fertility, and return to school after the birth of their child.4 However, more recent studies have found that young women often want to avoid pregnancy at an early age.5 South Africa has one of the largest numbers of people living with HIV/AIDS of any country in the world—an estimated 4–6 million.6 The incidence of new HIV infections is highest among young people; more than half of all infected adults acquired the virus before the age of 25.7 Surveillance surveys using blood samples from women attending antenatal clinics have shown that HIV prevalence in this population increased from less than 1% in 1990 to almost 28% in 2003.8 However, the level of infection differs notably across racial groups. In a population-based survey conducted in 2002, HIV prevalence was significantly higher among blacks than among other racial groups.9 That survey also found that the estimated HIV seroprevalence among young people aged 15–24 years in South Africa was 9%; it was 13% among women and 6% among men this age.10 As in other parts of Africa, young women in South Africa are at particularly increased risk of HIV infection. They often become infected at a younger age and at a higher rate than their male counterparts.11 In this context, the promotion of dual protection— simultaneous protection against unwanted pregnancy and against HIV and other sexually transmitted infections (STIs)— plays an important role in public health interventions.12 Apart from sexual abstinence and nonpenetrative sex, dual protection may be achieved in one of three ways: by correct and consistent use of condoms alone, by simultaneous use of condoms with another method of contraception or by use of a contraceptive method other than condoms in the context of a long-term, mutually monogamous relationship in which both partners are known to be HIV-negative (although this option may not be feasible in many settings13). Among countries of Sub-Saharan Africa, South Africa has a high level of contraceptive use. According to the 1998 Demographic and Health Survey, injectables are the most commonly used method of contraception in South Africa; 30% of sexually active women use this method.14 Almost two-thirds of sexually active women aged 15–24 years use a modern contraceptive method. However, only small proportions use condoms—21% of those aged 15–19 and 17% of 20–24-year-olds. Hormonal implants and injectables, IUDs and sterilization are highly effective for preventing Reasons for Condom Use Among Young People In KwaZulu-Natal: Prevention of HIV, Pregnancy or Both?