An evaluation of male learners’ knowledge, attitudes and practices regarding sexual and reproductive health in rural northern KwaZulu-Natal province

Background: With a disparate HIV prevalence among young men and women, high rates of teenage pregnancies and a lack of responsible fatherhood, issues of reproductive health among young people need to be urgently addressed. The aim of this research was to assess the knowledge, attitudes and practices regarding sexual and reproductive health among young men in the Bethesda Hospital catchment area of northern KwaZulu-Natal province. Methods: This observational, descriptive cross-sectional study was conducted at six randomly selected high schools within the uMkhanyakude district. All grade 12 male learners ≥ 18 years completed a questionnaire regarding their reproductive health knowledge, attitudes and practices. Results: A total of 279 learners participated in the study with a median age of 20.2 years and a mean knowledge score of 63.8%. Only 28.3% of the learners showed good or excellent knowledge on basic sexual and reproductive health questions; 50.9% believed that girls say ‘no’ to sex when they mean ‘yes’, and 46.2% believed that girls were sexually aroused when dominated by a man. Some 156 (55.9%) of those who were sexually active did not know their current sexual partner's HIV status. There were significant associations between being brought up in a female-headed family and early sexual debut but not between early sexual debut and paternalistic attitudes to women. Discussion and conclusions: Basic sexual and reproductive health knowledge among the majority of participants was adequate. Patriarchal attitudes of sexual domination were prominent, and these are probably influenced by sociocultural belief systems of traditional masculinity, which are defined and dominated by men. This perpetuates gender inequality and contributes to poor sexual and reproductive health outcomes. Poor health-seeking behaviour and attitude relating to sexually transmitted infections (STIs), and having concurrent multiple sexual partners, puts them and their sexual partners at risk of HIV/AIDS acquisition. Strategies need to be developed to enhance socially acceptable and comprehensive sexual and reproductive health education and services among young men in this area, foster positive attitudes towards women and encourage gender-equal relationships