title: Sexual learning among East African adolescents in the context of generalized HIV epidemics: A systematic qualitative meta-synthesis.
abstract: BACKGROUND
  AIDS-related illness is the leading cause of mortality for adolescents in sub-Saharan Africa. Together, Kenya, Tanzania, and Uganda account for 21% of HIV-infected adolescents in sub-Saharan Africa. The United Nations framework for addressing the epidemic among adolescents calls for comprehensive sexual and reproductive health education. These HIV prevention efforts could be informed by a synthesis of existing research about the formal and informal sexual education of adolescents in countries experiencing generalized epidemics. The purpose of this study was to describe the process of sexual learning among East African adolescents living in the context of generalized HIV epidemics.
  
  
  METHODS
  Qualitative metasynthesis, a systematic procedure for integrating the results of multiple qualitative studies addressing a similar phenomenon, was used. Thirty-two research reports met study inclusion criteria. The reports were assessed in a four-step analytic process: appraisal, classification of findings, synthesis of findings, and construction of a framework depicting the process of sexual learning in this population.
  
  
  RESULTS
  The framework includes three phases of sexual learning: 1) being primed for sex, 2) making sense of sex, and 3) having sexual experiences. Adolescents were primed for sex through gender norms, cultural practices, and economic structures as well as through conversations and formal instruction. They made sense of sex by acquiring information about sexual intercourse, reproduction and pregnancy, sexually transmitted infections, and relationships and by developing a variety of beliefs and attitudes about these topics. Some adolescents described having sexual experiences that met wants or needs, but many experienced sex that was coerced or violent. Whether sex was wanted, coerced, or violent, adolescents experienced worry about sexually transmitted infections or premarital pregnancy.
  
  
  CONCLUSIONS
  The three phases of sexual learning interact to shape adolescents' sexual lives and their risk for HIV infection. This framework will contribute to the development of sexual education programs that address HIV risk within the broader context of sexual learning.
authors.affiliation: School of Nursing, Indiana University, Indianapolis, Indiana, United States of America.
authors.forename: Amelia S
authors.identifier: http://orcid.org/0000-0003-2557-4556
authors.initials: AS
authors.lastname: Knopf
authors.affiliation: School of Nursing, Indiana University, Indianapolis, Indiana, United States of America.
authors.forename: Kim R
authors.initials: KR
authors.lastname: McNealy
authors.affiliation: School of Nursing, Indiana University, Indianapolis, Indiana, United States of America.
authors.forename: Halima
authors.initials: H
authors.lastname: Al-Khattab
authors.affiliation: School of Nursing, Indiana University, Indianapolis, Indiana, United States of America.
authors.forename: Lisa
authors.initials: L
authors.lastname: Carter-Harris
authors.affiliation: School of Nursing, Indiana University, Indianapolis, Indiana, United States of America.
authors.forename: Ukamaka Marian
authors.initials: UM
authors.lastname: Oruche
authors.affiliation: Moi University School of Medicine, Eldoret, Rift Valley Province, Kenya.
authors.forename: Violet
authors.initials: V
authors.lastname: Naanyu
authors.affiliation: School of Nursing, Indiana University, Indianapolis, Indiana, United States of America.
authors.forename: Claire Burke
authors.initials: CB
authors.lastname: Draucker
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D001290:Attitude; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology* / Q000821:virology; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D012736:Sex Education / Q000379:methods*; D012725:Sexual Behavior / Q000523:psychology*