Discourses on Sexuality and Sexual Health Perspectives among Wachemo University Students, Ethiopia: A Qualitative Study.

BACKGROUND: Sexuality is a central aspect of being human throughout life. Discourse analysis is used to understand discussion, conversation, talk, dialogue, debate, consultation and chat in the people perception and language. Therefore, this study aims to explore sexuality and sexual health perspectives among Wachemo University students in Ethiopia.
METHODS: This qualitative study was conducted in Hosanna Town among Wachemo University students. A criterion related sampling (purposive sampling) was used to select a variety of young people. Eight focus group discussions and four in-depth interviews were used to collect data. Data was transcribed first and translated from Amharic into English. Atlas ti.7 software was used to analyze data. Then, their discourses were stated in narration and direct quotation. RESULT: Discursive explanation of words and languages differ in different sub-cultures and societies. Languages and vocabularies were mostly attached to sexual relationships, love, affiliation and intention to be intimate with the opposite sex on a campus. This affiliation is known as "campus life". The students' perspectives of what constitutes sexuality and sexual health were quite consistent. However, approaching opposite sex with unique languages and words depends on individual talents.
CONCLUSION: Discursive expressions of sexuality issues are becoming complex than ever in this generation. Therefore, further research is needed to reach this group with a variety of interventions through concurrent triangulation of qualitative research and longitudinal studies.

Introduction

Sexuality is a central aspect of human life. It comprises sex, gender identities and roles, sexual orientation, pleasure, intimacy and reproduction (1). Discourse analysis is the study of language communication viewed linguistically through involving the language in use, above and beyond the sentence (2–5).

According to WHO, sexual health is a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not merely the absence of disease or infirmity. It requires a positive and respectful approach to sexuality and sexual relationships (1,6–7). Discourse implies a discussion, conversation, talk, dialogue, debate, consultation and chat about a specific topic in communications with various social groups (8,9). Michel Foucault, a French philosopher, with other scholars and historians of ideas, social theorists, and literary critics, defines discourse as an entity of signs and sequences which may not be congruent with a unit of semiotic signs (10–12).

The advancement of increased adaptation of western culture without contextualizing with existing countries situation is becoming a research question to understand the language (13). Ethiopians are struggling with the globalization introduced western culture and the hidebound traditional culture where sex and sexuality discussion is not open (1,13). Despite these changes, however, traditional discourse and understanding of sexuality and gender dynamics in the family remain unexplored (10). A study in this area is unexpectedly limited or no available study in Ethiopia (14,15). Therefore, the purpose of this research was to explore sexuality and sexual health perspectives among Wachemo University students in Ethiopia. The findings of the study can provide implications for policy makers and implementers to give culturally sensitive and context specific education to enhance the quality of life.

Materials and Methods

Study area and period: This study was conducted in Hosanna Town among Wachemo University students from June to July, 2017. Wachemo University has six colleges and forty nine departments having more than 10,000 students. The students came from all corners of the country.

Study design and sample: Discourse analysis was used as research method for this study. Grounded theory was used as a design. Eight focus group discussions (5 with males and 3 with females) and four in-depth interviews were conducted with students and teachers, respectively. Each group consisted of 7–12 individuals. A criterion related sampling was used to select participants. The criteria were experiences in the HIV/AIDS clubs, being representative of the club and gender issues. Homogeneity for FGD was done based on sex and class year to reduce sensitivity.

Data collection procedure: FGD was used to explore sexuality and sexual health perspectives through group interaction. Each FGD was conducted by experienced data collectors and led by same-sex moderator. For FGD, semi-structured open-ended guide questions were used. FGD was audio recorded using voice recorder. Each FGD lasted 2 hours and took place in a private setting arranged for discussions. Information depth was determined through reaching ‘point of saturation or information redundancy.’ In-depth interviews were conducted with teachers. The researchers undertook the whole research process from participant selection to publication of the results.

Data management and analysis: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups was used for reporting results. In this stage, the researchers undertook data reduction and checked audio-recorded message for transcription. Then, themes emerged out and data analysis was done accordingly by Atlas ti.7 software. The data was coded and the codes were interlinked with main themes across the discussions and interviews. To maintain the trust worthiness and validity of the findings, the researchers developed rapport with participants. Credibility/conformability/dependability was maintained through participant checking during FGDs and in-depth interview.

Ethics: Permission letter was obtained from Wachemo University, college of medicine and health sciences. All the study participants were given detailed information about the study and verbal consent before participation.

Results

General and conceptualizing descriptions: A total of 73 participants were involved in group discussion. The age of the participants for FGD ranged from 19 to 24 years. Four in-depth interviews were conducted with teachers. Before categorizing into different themes, we conceptualized sexuality and sexual health in different ways based on the view of the participants. First, sexuality is conceived as the universal safer sexual action man/woman is shaped. Second, sexuality is more attached to sex and sexual intercourse. Third, sexuality is considered as another essential component of sexual relations and passions. Fourth, sexual health is conceived as being similar to sexuality concept and/or reproductive health concept. These concepts were analyzed in four themes and in various figures of speeches: 1) general languages and vocabularies, 2) socio-cultural and religious contexts, 3) the influence of gender on sexuality and sexual health and 4) the explicit implication of the discourse of sexuality and sexual health. The findings by sub-group have, therefore, been integrated within each theme, and presented as a whole. In-depth interviews from teachers were supplemented in each part of the emerged themes.

General languages, vocabularies, and approaches to sexuality and sexual health: The concept of sexuality and sexual health and the languages used were mostly interlinked with sexual relationships and friendships (boyfriends and girlfriends). This affiliation was known as “campus life.” Concerning approaches, it depends on the individual approaching style and talents; however, the indication of one of the parties may facilitate the process of their counterpart.

Languages and vocabularies used on sexuality and its discourses: Sexuality was mostly attached with sexual intercourse, love, affiliation, intimacy and friendship jokes. To speak more, some words and vocabularies were meaningful in particular language and social contexts whereas some are universal and known throughout the country. The discussions were very funny, and natural demonstration was detailed as it was said by group members (FGD participants). To put the real scenario:

A 28 years old female teacher said, “As to me, this is the age of talking about sexuality and sexual intercourse but they do not care about their own health. I have a reservation to say they were talking about sexual health and worrying about their health.” All the interviewed teachers' ideas were similar to the first one.

An FGD participant said, “It is usual to talk about sexual relationships. However, sexual intercourse and having girlfriend or boyfriends verily rely on the approaching style of the counterpart.” Concerning sexual health issues, “For frankly speaking, students, including me, never discuss sexual health. Once you love her/she loves you, both of them never expect any health problems like sexually transmitted diseases and HIV/AIDS.” All FGD members agreed with his idea without reservation.

A 21 years od female participant said, “We never think about HIV/AIDS and sexually transmitted diseases (STDs) when we love someone. We think love and how to make the loved one to be with us.” When we captured the image of the participants, all laughed together and both sexes agreed in this concept. There are several words/languages concerning male and female organs and the need for sexual actions. Male genital organ, for instance, were referred to as “Jela” or “Jela with two soldiers”, “Abro Adege (childhood friend)”, “Goromisew (grown up)”, “Muz (banana)” and “Medesechaye (My fun)” indicating the structure and functions. All the quoted words to express the name of “penis” are mainly used by campus students and other adolescents. The implication is “I am good enough to talk about sexual relationships and to be affiliated with opposite sex”.

As to females' genital organ, there were several names and metaphors to express sexual feeling attached to the vagina. The vagina was named as, “Emama (my mother)”, “Ekash (your property)”, “Yeabroadegie Maderiya (penis' home)”, and “Dabotera (named from the two labia majora).” Students use sexual metaphors/language to underpin the idea of the female genital organ as a valise or a free opening. Students' association of sex with this figure of speech lightens their functional world-view in favor of this phenomenon.

A 23 years old third year participant said, “… there are some people who advise the youth to have a single partner (being faithful), etc. but, they don't know whether the person they are advising has not yet reached the age of getting into a sexual relationship. So, it's not good to advise with identifying the real gap in the youth/students.”

The language used to express the intention of sexual intercourse varies in both sexes. When males are in need of sexual intercourse, they use various words, styles and languages. For instance, “I am ill”, “I miss you, why don't you see me”, “I am hungry”, “I want to fill withdrawal because I can't continue my study in such condition” and “Secondary dinner is a must.” The discursive implications of all words are to have sexual intercourse.

When it comes to females, “you don't love me”, “talking about the sexual contact of another girlfriend”, “embrace me when we are walking in the street”, “I want to enjoy with you in the safest place”, “debereh? (Are you alone?)” and “still you didn't ask me for sex; what is wrong with me? I don't believe as you love me or not; am I ugly for you? Tell me!” The words might vary from culture to culture. In anyway, the expressions relate to having sexual intercourse and making someone be with him or her.

A 34 years old teacher in in-depth interview said, “As to me, I am in doubt that the students are talking about sexual health; sorry to say, students are rude and they do have unsafe sex with ‘Sugar Dadi’ who is illiterate.” Another teachers' idea was mostly related to that of the first one.

Social contexts and the languages of conversations with their discourses: Result of interviews with teachers indicated that the social contexts in which students engaged in sexual relationship even sexual intercourse are using the following situations, “Lastenash (let me tutor you)”, “religious uniformity or approaching females with their religion, race, neighborhood”, “going to recreation places like night club, and parks together.” Generally, those who did not want to expose their sexual secret to their neighbor were approaching students from other places rather those who are close to them.

In campus community, females that happen to have sex with multi-sexual partners were common, in terms of their perceived sexual function as submissive in the sexual process, whose only role is to be entered into and exited from. Linguistically, the participants named, those girls who have multi-sexual partners as “Hizb Shintbet (Public Toilet)”, “Asadaj (Hunter)”, “Enku Benetsa (Giving for Free)”, “Cherash (Finisher)” and “Atasafrim (made not to be ashamed) and others. These words were negatively affecting those girls and low credits were given for their future marriage by the society. While this has obvious implications for female sexual activity, it is important to indicate that men are also objectified in the discussion above, being symbolized by their genitals (‘when one goes off, another goes in’).

On the other hand, those who are faithful were named as “Wochegie/Atarifim (she is not modern), “beandie tegeb (she is one shoot satisfied)”, and “Alem Aytayatim (the world is not enlightened for her).” Another important concept is that sex organs, in general, do not appear to be shrouded in mystique among the participants. Additionally, in likening sex to the ordinariness and familiarity of opening and closing, entering and exiting, students routinize sexual activity, constructing it as a normal, everyday life. All the quoted words were meant to lead someone to have a multi-sexual partner. The societal definition (discourse) is to say “mad” but not only “bad”; once someone was deviating from societal norm.

Religious contexts and the languages of conversations with their discourses: There were several ways students use to approach opposite sex in religious institutions. They use spiritual languages and styles like “being shy, behaving as Church/Mosque person (man of God), selecting the team that the needed student is found, we will go to Church/Mosque to night, waiting for him or her in the street, giving verses which were related to marriage, acting as a future husband/wife (pseudo-thinking for marriage).” All related terms and approaches were mostly used as a means to have sexual relationship and intercourse, even though there are situations that will end up with love and infatuation. The discourse of the words and approaches were to get girlfriend/boyfriend. However, there is an exception for those individuals who stick to worship their God together with fellows.

A 32 years old male teacher said, “… students who wants to be engaged in sexual intercourse in religious places shows a sense of spirituality /not actually/ to get him/her. Acts like showing spirituality in front of her, changing worshiping team and appreciating her effort in the team. After getting her, he might not stay/exist in the Church/Mosque since he feels ‘guilty feeling to have this act’.”

Another 29 years female teacher, “… the approaching style varies from person to person. For instance, males need to approach by giving phone call….have you been in church today? Or how was it? In which team do you want to serve? I will take the notes and songs from you ….then appreciate her existence in a Church/Mosque in spiritual mood and give blessings accordingly.” The discourse of all the approach is to have sexual relationship and friendship through joining the same team.

Gender influence on sexuality and sexual health and their discourses: Participants said that, in Ethiopian context, it is common to raise sexuality issues from the male side. There were several words/phrases and dressing styles used mostly by male groups to influence the conversation of females in a campus and its surroundings.

Males used the following words while influencing females: “fitish tebelashtoal (what happen to your face?)”, “In case, if you go to someone, you will get your consequences”, and “do you love me or not?” While females used languages like “Why do you look for another girl?”, “bitarf yishalal (be careful!)” All the quoted words imply how to make someone to influence/stick in the given boy or girlfriend. Most importantly, all the expressions were repeatedly used by students in different FGDs.

The reason for having multi-sexual partner and influence was expressed in the following words and languages. For instance, those who early ejaculate, not satisfying the female were expressed as “ATM new (Withdraws as ATM within a second)”, “Awura Doro (coke)”, “Zim Blo Yishenal (Just start and finish or for the sake having sex” and “Tesafari (Passenger).” The discursive implication of all quoted words led some to have multi-sexual partners as a result of sexual dissatisfaction mainly during sexual intercourse with his/her ex-friends. In male gender, having a sexual relationship was considered as modernity whereas in females, it was considered as a celebrity and also as modernity. In general, all participants agreed that the dimension of tackling a sexual health problem should be diverse since the dimensions are many.

Discussion

The results of this study revealed that there were several metaphors or words and languages which students used to express sexuality and sexual health in general and sexual relationships and feelings in particular. This study is similar to the study conducted in USA (2,16). Concerning social and peer influences, the campus culture either negatively or positively influenced the students to be engaged on sexual health and sexuality. This is in agreement with studies in some African countries and USA (6,11,12,17,18).

Religious places relationship was more complex than ever since every individual who needs to be with a girl/boyfriend acts as spiritual man in the Ethiopian context. Students in their fellowships and different worshipping teams approach the opposite sex under the guise of being spiritual until he/she gets her/him. This varies in most part of the world (1). Concerning family exposure of students for sexuality discussion, almost all the students do not disclose or discuss sexuality issues. This is similar to studies conducted in USA (9,19).

In this study, gender influence and its discourses were positively and negatively influenced by male gender throughout the country. This idea is similar to many researches in western countries and few African and Asian countries (10,13,20–22). The explicit implication occurred through time in wording (metaphors) and approaches to opposite sex to make sexual encounters by putting themselves as a modern man and talking about sexual relationships as “play politics”. These individuals were called “sex politicians or mouth politics for vagina (individuals who were talking about sexual intercourse only).” This is similar to the study conducted in different parts of the world in their meaning (10,23). Early ejaculation and not satisfying a sexual relationship particularly during sexual intercourse and comparison with ex-friends who is either more sexually active were some factors that lead to look for multi-sexual partner. This idea is congruent with the study conducted in different parts of the world (1,24).

In conclusion, discursive expression of sexuality issues was becoming complex words than ever in this generation. On the other hand, there is no trend to comfortably discuss about such issues even with parents. In our quest to understand better about the young people, we have to consider language as one of its entry points. As this study demonstrates, language can serve as a critical evidence-base for sexuality-related research and prevention efforts and can be useful for informing sexuality education. Indeed, a reflective discussion of words could also help sexuality education teachers with acknowledging and addressing their own biases and assumptions. Further research is needed to assess whether the metaphors analyzed here provide an incomplete picture of students' conceptualizations of sexuality and sexual health. As strength, this study is the first in its kind in Ethiopia; it can be used as baseline to explore further words and languages. The other importance is that it shows unfolded natural setting as it is. However, as a limitation, since the study is purely qualitative, it cannot be generalized for the total population. There were no local literatures for discussion and comparison.