The aim of the survey was to conduct a holistic assessment of adolescents health, with emphasis on HIV and sexual and reproductive health, to inform the development of targeted interventions and to serve as a baseline. Quantitative and qualitative methods were utilised for the study, respectively a self-administered survey and focus groups. The target population for the study in the Cayman Islands was young people in school between the ages of 15-19 years. Out of the 1186 potential participants, 955 youth participated in the survey, representing an 80.5% participation rate.
In the study it was stated that the first sexual experience is of importance as sexual exploitation, coercion and abuse of children can lower self-esteem, mental health and lead to risk-taking behavior in later life. Of the total participants, 51% reported primary abstinence while half of the participants who had ever had sex (49%) said they had it by age 14. The study also revealed that 75% of the sexually active had their first sexual experience before 16.
The study also highlighted concern in the Caribbean about inter-generational sex, usually defined as children having sex with someone 10 or more years their senior. UNAIDS (the Joint United Nations Programme on HIV/AIDS) specifies it as the percentage of young women 15-19 who had their first sexual experience with someone ten or more years older. In the Cayman Islands among 15-19 year olds, 4.3% of the female participants reported their first sexual experience with someone 10 or more years older while none of the males reported having any such experience. In addition, of the females, 53.8% had their first sexual experience with someone 1-5 years older while 22.3% of the males had a first partner 1-5 years older.
Early sexual experience has also led to prevalence of teenage pregnancy in Cayman with around 1 in 8 participants (12.3%) having either been pregnant or gotten someone pregnant. Though the study states that most pregnancies among adolescents are unintended some focus group participants had differing views. Some students seek attention by becoming pregnant or think its cool, said one participant. Another stated that, Most young people have the right information to protect them from pregnancy, but they just want to have a baby. However, the 7.7% of females who reported having an abortion indicates that not all teenagers share this view.
The survey even explored same sex relationships and attraction among adolescents. The study explains that homophobia decreases utilisation of health care and prevention methods, including condom use, and may contribute to the instability of relationships and a high number of partners. Thus a combination of factors may contribute to the vulnerability of males who engage in homosexual activity. Issues of discrimination and poor access to specialised health care may also lead to vulnerability among girls and women who have sex with other females.
Forty-four participants reported having had sex with someone of the same sex, of which 28 were female and 16 were male. Thus same sex intercourse was reported by 4.6% of all participants and 9.3% of those who had ever had sex. Approximately one eighth of participants stated that they were only attracted to the same sex or equally to both sexes. This was almost three times higher than the percentage of participants who stated they had actually had sex with someone of the same sex. Homosexual attraction was stated by 4.2% of respondents; 3.7% of females and 4.6% of males. Bisexual attraction was stated by 8.5% of respondents; 9.1% of females and 8.0% of males. The study indicates same sex or bisexual attraction was slightly higher among older than younger adolescents.
The AHS Survey was developed with the technical support of PAHO and with financial support from the European Commission through the regional project Strengthening the Integration of British and Dutch Overseas Caribbean Territories in the Regional Response to HIV. One of the priorities in the area of prevention is the strengthening of territory capacity to develop and implement HIV/STI prevention programmes for young persons. Given the critical importance of strategic information to facilitate targeted programme planning and development for young people, it was decided to support the implementation of a health study among adolescents, focusing on sexuality and HIV, in the participating territories.