ADOLESCENT RISK PERCEPTION VIS-A-VIS HIV/AIDS IN MALAWI

Psychology & Developing
DOI: 10.1177/097133360802000205
Psychology Developing Societies 2008; 20; 229
Marisen Mwale
Zomba, Malawi
to the HIV/AIDS Pandemic: The Case of Some Selected Schools in
Adolescent Risk-perception Cognition and Self-assessment in Relation
http://pds.sagepub.com/cgi/content/abstract/20/2/229
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Psychology and Developing Societies 20, 2 (2008): 229–240
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DOI: 10.1177/097133360802000205
Please address correspondence concerning this article to Marisen Mwale, Mzuzu University,
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Most researchers, on adolescent reproductive health and associated vulnerability to contracting
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome HIV/AIDS, have
explicitly highlighted the paradoxical misfi t between adolescent knowledge of HIV/AIDS transmission
dynamics and positive change in behaviour. Popular explanation focuses more on socio-cultural
factors such as male chauvinism, peer infl uence and pressure, and stoicism towards death in most
African cultures. An alternative explanation derived from psycho-social theory is that, as a result of
egocentrism and the crisis at adolescence, the period is imbued with confounded perception of risk to
the pandemic. This alternative is tested using survey data from adolescent students from some selected
schools in southern Malawi. Results show that respondents are typifi ed by adolescent egocentrism. This
is consistent with the conception of adolescence as a period of crisis. These results are discussed within
the larger context of the applicability of psychodynamic theory to the AIDS pandemic.
Adolescent Risk-perception
Cognition and Self-assessment
in Relation to the HIV/AIDS
Pandemic: The Case of Some
Selected Schools in Zomba, Malawi
MARISEN MWALE
Mzuzu University, Malawi
Young people have been well documented as a special needs group in the
fi eld of sexual and reproductive health, not least for their combination of
risky sexual behaviours and frequent lack of information and access to services
(Cullen, 2000; McMauley & Salter, 1995). According to Khalokho (2000),
their reasons for being unable or unwilling to adopt safe practices refl ect
a socio-economic and cultural environment that motivates them to begin
having sex at an early age. Some aspects of this environment are universal in
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Psychology and Developing Societies 20, 2 (2008): 229–240
that they are linked to the very nature of adolescence. These include rapid and
uneven physical, psychological, and social growth and development and the
onset of sexual activity that is often combined with a lack of knowledge and
skills with which to make health choices (Gyepi, Garbral, 1985; Ferguson,
1988; Young, 1996).
Adolescence is often characterised by patterns of thinking in which
immediate needs tend to take priority over long-term implications and by
the initiation of behaviours that may be perpetrated over a lifetime (WHO,
2003). This particular poignancy about adolescent attitudes has also been
documented by Awuso-Asare (2003). He argues that the pandemic particularly
hits the adolescents because risk-taking is for them part of identity creation,
particularly in conditions of lengthening adolescence. In South Africa, Varga
(1999) claims that many of the young see no reason for caution because
they already regard themselves as the corrupted and doomed generation.
For adolescents in Malawi, infection with the HIV virus is one of the most
concrete and pernicious risks of unprotected sexual intercourse.
It is quite evident that among the risk-related proclivities and chances
being taken by the youth, indulging in unprotected sex, alcoholism, abuse
of illicit drugs and substances, above all else connote the most dramatic
cases in the continuum of risk-taking. Worth exploring and substantiating
further are the reasons as to why some substantial proportion of youth do
adjust normally with little stress, yet, confounded risk-perception may still
not be overlooked in them.
Research has documented and attributed the dilemma of high incidence
or prevalence of HIV/AIDS cases among adolescents to several factors and
variables. As stipulated by some renowned authorities (Zimba, 1992; Gulure,
2003) from a rather psycho-social perspective, in order to satisfy the need to
belong, to be loved, to be accepted and to experience sex, the youth would
wish to have sex with more than one partner, not want to use condoms, not
perceive to be at risk and would make love under alcohol and drug infl uence.
Similarly, Maluwa-Banda (1999) posits that prominent features of adolescence
such as cognitive immaturity, the struggle for psychological autonomy, susceptibility
to peer infl uence and traumas of physical development heighten
the tendency to engage in risk-taking behaviours.
Santrock (1990) further argues from a more radical perspective that the
combination of risk-taking behaviours, egocentrism, the inability to think
futuristically and an ambivalent contradictory culture makes sex diffi cult for
adolescents to handle. Studies have further chosen the term “optimism” to
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Psychology and Developing Societies 20, 2 (2008): 229–240
express the idea that adolescents frame their view of themselves, the world and
the future in positive terms (Bauman & Siegel, 1987). Often adolescents go
beyond realistic appraisals and fall prey to positive illusions. This unrealistic
optimism pertains to perception of personal invulnerability. It represents a
defensive distortion that could undermine preventive action. Further, it is
documented that risk groups that employ defensive denial as a coping strategy
and are less optimistic about their vulnerability tend to engage in more risky
sexual practices and focus on irrelevant precautions to enhance their feeling of
safety (Bauman & Siegel, 1987). Other authorities also attribute adolescent
engagement in risk-taking sexual behaviours to widespread culturally-based
beliefs and behaviours (Ngugi, 2004).
The evolutionary ideologies include, as quoted by Ngugi, linking male
heterosexual intercourse to overall health and well-being (Orubuloye, 2002);
disdain for condoms (MacPhail and Campbell, 2001); the notion that
one’s time of death is preordained and therefore, unaffected by behaviour
change; and the belief that death occurs from multiple causes, invalidating
the idea that a person could die from a simple virus (Caldwell, 1999). In
addition, culturally condoned sexual behaviours including male preferences
for sexual practices that elevate HIV transmission probabilities, exemplifi ed
by artifi cial vaginal tightening and drying (Brown, 1993; Sandala, 1995),
may be highlighted. In sub-Saharan Africa, Malawi inclusive, where 90%
of HIV transmission results from heterosexual intercourse, these beliefs and
behaviours constitute powerful forces for HIV transmission.
Yet, from a psycho-social or broadly psychodynamic perspective, this
constellation of aforementioned factors embodying the evolutionary, biological
and psycho-social domains may constitute what biologists (Tindbergen,
1963) call intermediate variables, because they lie between higher order
“distal” or “ultimate” variables representing the motivation for behaviour
and fi nal biological results, in this case, HIV transmission via heterosexual
intercourse.
As the study sought to document the possible alternative explanation to
the dilemma of higher incidences of HIV/AIDS cases among adolescents
relative to risk-perception, cognition and self-assessment, in Malawi, in general
and Zomba, in particular, can thus be postulated from the purview of
the crisis at adolescence which might be the true ultimate or distal variable
responsible for sexual risky behaviours among the adolescents per se.
With that as backdrop, it is, however, unfortunate that relatively little
detailed empirical research has been conducted in Malawi that systematically
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investigates the relative high propensity of infection rates among adolescents,
not to mention the unequivocal susceptibility of the age group to the dilemma
per se. What is not apparent in the research literature is a substantive realm
of theoretical dimensions to the case in point, neither have any tangible and
viable interventions been fully and strategically implemented in youth policy,
as to the mitigation of the discrepancy. Most of the interventions tend to
be generic in nature.
Replete in the cases are postulates of apparent solutions that have indefinitely
failed to serve their purpose. This dearth of knowledge and information
about HIV/AIDS etiology among adolescents in Malawi constitutes a major
challenge to the control of this scourge. The need to admit that adolescents
are having sex but perceive themselves as not at risk and thus, shun seeking
risk aversion/reduction behaviours is particularly signifi cant in the war against
the pandemic. Adolescents are at the epicenter and bear a disproportionate
burden of the pandemic.
Risk-Perception vis-à-vis Vulnerability to HIV/AIDS
Realising some degree of personal vulnerability is a prerequisite for becoming
motivated to counteract threats and avoid risks. Perceived vulnerability to
a disease such as HIV/AIDS is a major causal factor for compliance with a
health regimen (Becker, 1974). In this context, vulnerability can be defi ned
as the subjective probability of becoming the victim of a disease (Schwarzer,
1993). This equals one’s perceived risk of such an event. What one perceives,
however, is often not reality but rather distorted views, because one either
does not acquire the proper knowledge of the actual risks or feels motivated
to play the risks down.
Adolescents are particularly predisposed due to their developmental
period characterised by the identity crisis, to harbour some confounded riskperception.
Whether they adapt positively or negatively, the effect is that they
tend to play down risks exemplifi ed by the threat to contracting HIV/AIDS
This inclination has been subject of empirical research controversy. Elkind
(1984) highlights that adolescents are particularly more likely to harbour
illusions about themselves and he documents the “personal fable”—the
conviction that “I am special; what is true for everyone else is not true for
me” (Elkind, 1984, p. 246).
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Up to a point, Elkind contends that the personal fable may actually
foster psychological well-being and help adolescents to maintain a cheerful,
optimistic outlook on life. However, it becomes detrimental when, as is
typical in most circumstances, it results in adolescents taking foolish chances,
being more drastic and indulging in unprotected premarital sexual debuts.
Elkind also ascribes risk behaviours to adolescence egocentrism. This is a
state of heightened self-awareness, which is manifested in the belief that
other people are interested in the adolescent. The adolescent thus creates
what might be attributed as an imaginary audience, thus, acting as if he/she
is on stage.
Weinstein (1980) has denoted the bias akin to the “personal fable”, a “social
comparison” bias, also coined “optimistic” bias. The prototype statement by
an adolescent in such a dilemma would be, “A negative event like contracting
HIV/AIDS may happen to others but won’t happen to me.”
In the same vein, as the study sought to document, most adolescents are
not willing to acknowledge that their risk of contracting a certain disease like
HIV/AIDS is equivalent to the risk carried by their peers. Weinstein (1980,
1982, 1984) and Perloff and Fertzer (1986) have established evidence for such
a social comparison bias that refl ects the difference between the perceived risk
of oneself and the perceived risk of others within the same referent group.
The Research Setting
The study was conducted in Zomba, a municipality town in southern Malawi.
Most of the student respondents who participated in the study come from
the same Zomba district with the majority of the populace being Yao in
ethnicity. Like any other ethnic grouping, the Yao have their own cultural
practices among which are the jando and msondo initiation ceremonies. These
ceremonies are basically rites of passage geared at preparing adolescent boys
and girls for adult roles and responsibilities as well as a smooth transition
into adulthood. As was expected, most of the respondents had undergone
the ceremonial rites which are unfortunately alleged to indoctrinate some
practices apt to perpetrate the spread of HIV/AIDS. Another characteristic
of the respondent population is that of diverse religiosity with the district
commanding a Christian as well as Islamic populace with the latter not only
dominating but also capturing the wider majority of the Yao.
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Sample and Material
The study applied both the quantitative and qualitative paradigms in a
triangulative approach in order to come up with tangible data that would
explore as many dimensions as there were in the topic of concern, yet, without
pre-empting and militating against future research possibilities in the
area of adolescent sexuality in Malawi. The respondents who participated
in the study were respectively drawn from three secondary schools which
were considered accessible. The research sites, chosen basically on grounds
of proximity to the researcher as well as to cater for the gender disparity and
selected purposively, were:
1. Mulunguzi co-educational secondary school.
2. Zomba Catholic’s boy secondary school.
3. St Mary’s girl secondary school.
Of the three secondary schools, all were conventional secondary schools
with Zomba Catholic being a national secondary school for boys within the
town periphery, enrolling a cross section of students from several districts.
Mulunguzi secondary school was more urban oriented, with most students
being enrolled from primary schools within Zomba and a few from the
surrounding rural primary schools. St Mary’s girl was a secondary school
within the urban milieu, enrolling students from several districts, like
Zomba Catholic. The gender aspect was considered as a criterion for sampling,
with two of the schools being single sex schools (Zomba Catholic
enrolling boys and St Mary’s enrolling girls) and Mulunguzi being a coeducational
school.
The respondent sample consisted of 180 students. Applying systematic
random sampling 60 students from third and fourth forms were selected
from each school.
Thirty students were girls and the other 30 were boys at Mulunguzi
secondary school. This was done so as to have an overall equal number of
boys and girls in the study. Systematic random sampling not only reduced
bias and other extraneous variables that were apt to affect the research process
but also made the fi ndings representative of the entire targeted population
of adolescents in Zomba.
In terms of instrumentation diverse areas concerning HIV/AIDS were
assessed in the students’ questionnaire. Some of the items were solicited from
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a standardised Knowledge, Attitude, and Behavior (KAB) model referred to
in Maluwa-Banda (1999), with others being modifi ed Likert items adopted
from the Protection Motivation model as utilised by Abraham et al. (1994)
in a study conducted in the United States.
The questionnaire was divided into four sections with Part A seeking
to solicit data on students’ socio-demographic characteristics. Questions
concerning age, gender, religion, number of siblings in the family, parental
existence and form of family were advanced. Questions in Part B sought to
gather data on the knowledge domain of the KAB model. The items sought
to solicit information about modes of HIV transmission, prevention as well
as care, and ranged from item 8 through to item 15.
Part C items were designed to gather data on the students’ attitudes
towards HIV/AIDS with most of these items having been adopted from
the Protection Motivation model as applied by Abrahams et al. (1994). The
response items sought to appraise self-effi cacy, response effi cacy as well as
adaptive and maladaptive cognition relative to the HIV/AIDS pandemic. In
all, 9 items were advanced in this section with response items ranging from
item 16 through to item 24.
The last part, with questions ranging from item 38, sought to gather data
on students’ risky sexual behaviours. More of the skein issues unravelled in
this section ranged from aspects of sexual experience across the continuum to
condom use, modes of HIV/AIDS transmission as well as behaviour change
initiatives. Risk-perception, cognition and vulnerability were considered the
crux of this section. The uniqueness of this section can be deduced, in part,
from its consideration of structured items but above all else, unstructured,
open-ended objective items geared at soliciting information on more sensitive
issues of adolescent risky sexual behaviors.
Results and Discussion
Analysis of the adolescent respondents’ threat appraisal, a variable that
was measured through personal and group susceptibility, indicated that
56% of the entire respondent sample did not perceive themselves as being
extremely at risk of contracting HIV/AIDS, with only 10.8% accepting
extreme vulnerability (80–100% chance). This was the case despite the fact
that the majority confi rmed indulgence in unprotected sexual debuts. Further
inquiry on adolescents’ chance of infection within the next fi ve years
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startlingly revealed that 43.9% of all the respondents indicated they were
not at risk, while at the other extreme only 23% affi rmed their risk was
extremely high.
Correlation analysis, seeking to depict the magnitude of relationship
between respondents’ risk-perception and subsequent vulnerability, revealed
the existence of a positive relationship (R = 0.564, p < 0.05). These
fi ndings, though modest, augur well with those by Maluwa-Banda (1999) in
which, despite their fear and concern about their likelihood of contracting
HIV/AIDS, 76.6% of the student respondents indicated they did not see
themselves as very much at risk of contracting AIDS; as well as those by
UNAIDS (2004) that 90% of adolescent boys feel invulnerable to HIV/AIDS.
There is, thus, consistency with the core objective of the current study that
prominent features of adolescence, typifi ed by the identity crisis (cognitive
immaturity, the struggle for psychological autonomy, susceptibility to peer
infl uence, traumas of physical development), do heighten the tendency
to indulge in risk-taking behaviours. Santrock (1985) also posits the inability
to think futuristically and an ambivalent contradictory culture as making sex
especially diffi cult for the adolescent to handle.
The fi ndings are also consistent with Bauman et al. (1987) and Hendrix
(1999) relative to the concept of “optimism”, expressing the idea that adolescents
frame their view of themselves, the world and future in positive terms.
Accordingly, they go beyond realistic appraisal and fall prey to positive
illusions. This unrealistic optimism pertaining to personal invulnerability
represents a defensive distortion that could undermine preventive action.
Further elucidated is the fact that such risk groups, employing defensive
denial as a coping strategy and compounded by optimism about their
vulnerability, tend to engage in more risky sexual practices and focus on
irrelevant precautions to enhance their feeling of safety (Bauman & Siegel,
1987). This may also represent the defence mechanism of rationalisation
relative to cognitive dissonance theory.
Notwithstanding, it is interesting enough that the fi ndings further coincide
with the adolescence ideal of egocentrism and subsequent “personal
fable” in relation to group susceptibility. Quizzed on how they estimate the
chance that an adolescent of their age, chosen at random becomes infected
with the AIDS virus in the next fi ve years, only 14.6% indicated that the
adolescent would have no risk of contracting HIV/AIDS. On the contrary,
an overwhelming 63.3% indicated that the adolescent was extremely at risk.
Comparison across gender lines revealed that 53.6% of the male respondents
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Psychology and Developing Societies 20, 2 (2008): 229–240
vis-à-vis 72.7% of their female counterparts accorded a high-risk option to
their fellow adolescent.
This augurs with the belief that students seem to perceive that what
happens to others cannot happen to them and is akin to the defence mechanism
of projection. This mentality, if coupled with denial of risk, has negative
ramifi cations for any programmes targeted at combating the epidemic among
adolescents. Weinstein (1980, 1982, 1984) also substantiates, relative to the
discrepancy per se that most adolescents are not willing to acknowledge that
their risk of contracting a certain disease like AIDS is equivalent to the risk
carried by their peers. Perloff and Fetzer (1986) have also established evidence
for such a social comparison bias that refl ects the difference between the
perceived risk of oneself and that of others within the same referent group.
Further appraisal of the controversy may be delved into by referencing
Gulure (2003). In his study, conducted in the same site as the current one,
fi ndings revealed denial of risk of infection as a factor rendering adolescents
vulnerable to HIV/AIDS. In the study, a large proportion (more than
60%) was considered invulnerable to HIV-infection because they perceived
themselves at risk of contracting AIDS. On the contrary, those who considered
AIDS as no threat were considered as really vulnerable because they
are unlikely to take precautions against HIV-infection. It is further alluded
that low perception of risk is one reason why secondary school students may
fail to practice safer sex such as condom use.
Last, it would be pertinent to consider risk behaviours exacerbating
adolescents’ susceptibility to contracting HIV/AIDS. Qualitatively, the
current study unravelled several factors from multifaceted domains. These
encompassed factors affi liated to culture, that is, practices prevalent in
the southern region such as fisi, kusasa fumbi, kulowa kufa and chokolo.
Those factors within the social domain included: peer pressure, multiple
sexual partners, prostitution as well as drug and alcohol abuse with poverty
being an antecedent of several such factorial domains. Biological factors
included: blood transfusion, having unprotected sexual intercourse, using
expired condoms, not wearing gloves when treating a patient with AIDS and
sharing of sharp objects such as intravenous drug injections, razor blades
and needles. Without doubt, this appraisal refl ected the depth of knowledge
that adolescents have pertaining to the modes of transmitting HIV/AIDS
and in extension, ways of prevention.
The fi ndings are concomitant with those unravelled by Maluwa-Banda
(1999). Quizzed on why they indulge in casual sex regardless of the spread of
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the HIV/AIDS pandemic, adolescent respondents in Banda’s study confi ded
such factors as, peer pressure, poverty (especially among girls), just for fun, to
experiment, arousal by pornographic material, alcohol and substance abuse,
lack of advice from parents and relationships with sugar daddies.
The fi ndings aptly revealed that stoicism towards death and the culture
of silence were qualitatively prominent reasons for the mismatch between
risk-reduction and the unprecedented knowledge of the dynamics of HIV/
AIDS transmission as well as prevention. This augurs well with fi ndings
documented by research (Abrahams, 1994; Caldwell, 1994; Gulure, 2003;
Ngugi, 2003).
The silence posited owes something to fear of being shunned and isolated,
and something to those religious fi gures who preach that the epidemic is
a punishment for sexual sin. Caldwell (1994) argues that stigmatisation
does not warrant an absolute appraisal of the misfi t per se. He substantiates
that the silence in relation to the HIV/AIDS pandemic among Africans, in
general, owes a great deal to suspicions that AIDS is more than an ordinary
disease, that it has supernatural elements or that it is caused or manipulated
by witchcraft. Consequently, individuals seem not to demand more from
government because of a sense of guilt, a feeling that they brought the
calamity upon themselves, compounded in many by a feeling that death is
inevitable, perhaps predestined.
Suffi ce to say, concerning adolescent risk-perception in relation to
subsequent vulnerability to contracting HIV/AIDS there is some wealth
of evidence that unless individuals feel susceptible to the threat, they are
unlikely to form the intention to act on the recommendations portrayed
in AIDS messages and least of all, adopt risk-reduction practices such as
condom use.
Conclusion
The whole piece of work warranted being construed and rendered futile
if it were not for skein paradoxes unravelled and proven non-wanting and
suspect. It has been established by the results and discussion that riskperception,
cognition and assessment display an interplay and relatedness
with adolescent risk-behaviour and in extension, sexuality. It can, therefore,
be concluded and alluded to from a proactive angle that the crisis typical
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of the stage of adolescence as hypothesised by Erickson (1968) in his lifespan
developmental theory, though varying in severity among individual
adolescents and irrespective of ontological and epistemological disparities and
dichotomies, is unequivocal and has a stake in determining the susceptibility,
vulnerability to and subsequent culmination in adolescent contraction of
the HIV/AIDS virus.
The study refl ected that adolescents are typifi ed by personal fables,
egocentrism and tendencies to play down risks; all of which exacerbate
their susceptibility to HIV contraction. All these are peculiarities of the
identity crisis. For adolescents in Malawi, vulnerability due to the turmoil
at adolescence is further compounded by cultural and sociological domains
and as recommendation for further research, the role played by socio-cultural
factors in expediting the susceptibility of the age group to the HIV/AIDS
pandemic need not be overlooked. This can better be grappled with in the
purview of Evolutionary Psychology.
REFERENCES
Abraham, C. (1994). Exploring teenagers’ adaptive and maladaptive thinking in relation to
the threat of HIV infection. Psychology and Health, 9(6), 253–269.
Anderson, R. (1991). The spread of HIV-1 in Africa: Sexual contact pattern and the predicted
demographic impact of AIDS. Nature, 352, 581–589.
Awusebo-Asare, K. (1997). Evidence of the socio-demographic impact of AIDS in Africa.
Health Transition Review, 2, 210–232.
Bauman, C., & Siegel, A. (1987). Factors distinguishing male risky and safer sex. Social science
and Medicine, 28, 561–569.
Becker, A., & Rosenstock, R. (1974). Social learning theory and the health belief model.
Health Education Quarterly, 15, 175–183.
Brown, D. (1993). Dry and tight: Sexual practices and AIDS risk in Zaire. Social Science and
Medicine, 37(8), 989–994.
Caldwell, J. (1989). The social context of AIDS in sub-Saharan Africa. Population and
Development Review, 15(2), 185–234.
Caldwell, J. (1999). Resistances to behavioural change to reduce HIV/AIDS infection in
predominantly heterosexual epidemics in Third World Countries. Canberra: Australian
National University.
Elkind, D. (1984). Egocentrism in adolescence. Child Development, 38, 1025–1034.
Erickson, E. (1968). Identity: Youth and crisis. New York: W.W. Norton.
Gulure, M. (2003). A study of AIDS education programmes and activities in secondary schools.
The case of selected schools in Zomba, Malawi. University of Malawi.
Gyepi, Garbral, (1985). Identity development and crisis. Englewood Cliffs, NJ: Prentice-
Hall.
Downloaded from http://pds.sagepub.com/ at Mzuzu University on July 20, 2009
240 / MARISEN MWALE
Psychology and Developing Societies 20, 2 (2008): 229–240
Hendry, I., & Kloep, M. (1999). Adolescence in Europe—an important life phase? In D. Messer
(Ed.), Exploring Developmental Psychology: From Infancy to Adolescence. London: Arnold.
Khaloko, S., & Cullen, R. (2000). Perception of the risk of sexual activity and their consequences
among Ugandan adolescents. Studies in Family Planning, 33(1), 35–46.
Mac Phail, C., & Campbell, C. (2001). I think condoms are good, aai, I hate those things.
Condom use among adolescents and young people in South African townships. Social
Science and Medicine, 52, 1613–1627.
Maluwa-Banda, D. (1999). Adolescent sexuality and HIV/AIDS in Malawi: Knowledge, attitudes
and behavior of secondary school students. Canada: University of Alberta.
McMauley, R., & Salter, M. (1993). Gender Identifi cation. In J.E. Marcia and A.S. Waterman
(Eds), Ego identity: A handbook for psychological research. New York: Springer.
Ngugi, E. (2000). Self-deception in HIV/AIDS risk-assessment? A test on sexual behavior data
from Northern Kenya. Journal of Infectious Diseases (supp 2): S240–242.
Ngugi, E. (2001). Female education, adolescent sexuality and the risk sexually transmitted
infection in Ariaal Rendille culture. Culture, Health and Sexuality, 3, 35–48.
Orubuloye, O. (2002). The destabilisation of the traditional Yoruba sexual system. Population
and Development Review, 17(2), 229–262.
Perloff, M., & Fertzer, R. (1986). Theory of reasoned action. London: Penguin.
Sandala, L. (1995). Dry sex and HIV infection among women attending a sexually transmitted
disease clinic in Lusaka, Zambia. AIDS, 9, supp. 1: S61–S68.
Santrock, J. (1990). Adolescence. Dubuque: Wm. C. Brown.
Schwarzer, M., & Stroebe, W. (1993). Social psychology and health. Buckingham: Open
University Press.
Tinbergen, G. (1963). On the aims and methods and ethology. Zeltscrift, Fujrtierpsychologie,
20, 410–433.
UNAIDS (2004). Report on the global HIV/AIDS epidemic. Geneva: United Nations.
Varga, C. (1999). South African young people’s sexual dynamics: Implications for behavioral
responses on HIV/AIDS. Resistances to Behavioral Change to Reduce HIV/AIDS Infection,
10(3), 13–34.
Weinstein, A. (1984). Why it won’t happen to me: Perception of risk factors and susceptibility.
Health Psychology, 3, 431–457.
WHO. (1999). Programming for Adolescent Health and Development, WHO Technical Report
Series 886, Geneva: WHO.
Young, A. (1996). Child development. New York: Macmillan.
Zimba, R. (1993, 12 –16 July). Namibian school students’ risk-behaviors that promote HIV infection
and the spread of AIDS. Paper presented at The 5th Boleswa International Symposium on
Educational Research, 1993, Lesotho: Maseru.
Marisen Mwale is holder of a Masters degree in Education with specialty in Adolescent Psychology. He
is a graduate of the University of Malawi and his research affi liation is adolescent sexuality, reproductive
healthy and HIV/AIDS. He is a lecturer in Psychology at Mzuzu University in Malawi.
Downloaded from http://pds.sagepub.com/ at Mzuzu University on July 20, 2009