A baffling report says health workers fail to understand the importance of sex for Tanzanian children.   Yes, children.

Community health organizations working on AIDS prevention projects in Tanzania, frequently fail to understand how children in Tanzania deal with sex, says Miranda van Reeuwijk, who followed groups of children in Tanzania between 2004 and 2008.  

van Reeuwijk followed the children in order to help change this situation and says the children mainly view sex as something from which they can personally benefit, but frequently hide their relationships from parents and health workers. They are more scared of their strict parents than of HIV. 

The Tanzanian children, mainly schoolchildren between the ages of 10 and 16, told Van Reeuwijk that sex was important for their sense of self-esteem, for their status amongst peers and because they wanted to be seen as 'older'. Girls in particular view sex as a way of gaining independence from their parents. As girls have few other opportunities for obtaining money, they find themselves a boyfriend to provide this for them. 

Both the boys and girls court each other and both are active negotiators regarding the costs and benefits of a potential sexual relationship. The boys attempt to persuade the girls of their love and devotion with money and presents, and at the same try to find out if the girl is only after their money. Van Reeuwijk heard from a large number of boys who complained about girls who would take their hard-earned cash, but in the end wanted nothing to do with the boy. 

The girls meanwhile are keen to find out whether a boy is not only interested in getting them into bed but is also suitable for a longer-term relationship. Money plays a fundamental role in these negotiations for both parties. Since new negotiations are required for each sexual encounter, temporary relationships can however quickly follow on one from another, or be formed alongside a long-term relationship. 

These negotiations do not take place in public however. Van Reeuwijk discovered that the most important reasons for not having sex are the fear of being caught by parents and the risk of being expelled from school. Apart from strict parents and teachers, who often tell them that sex is bad, the children are also often warned by health workers of the dangers of sex. However, these messages do not tally with their own experiences and with the things they hear from their peers. 

The numerous conflicting messages the children hear results in them trying to fulfil all expectations; they adjust their outward behaviour in response to the situation and the expectations of others. They also hide their sexual relationships. Consequently there are fewer opportunities for boys and girls to 'date' and to get to know each other better. From the stories told by the children it would appear that they place more value on negative feedback from parents and peers than on the risk of becoming infected with a disease such as HIV. However, teachers and NGOs concentrate almost exclusively on this last aspect. 

Many prevention programs and healthcare intervention projects in Tanzania only achieve limited success. According to Van Reeuwijk this is because they are targeted solely at the possible dangers of sex and not at how children approach sex and relationships. Moreover, teachers are often inadequately trained in giving the children sex education; they are uncomfortable discussing certain subjects, for example. Van Reeuwijk pleads for an approach that involves the children in intervention programs. She also says that prevention should not only target adolescents but younger children as well. 

The work was partly made possible by a grant  from WOTRO Science for Global Development. WOTRO Science for Global Development is a division within NWO that supports scientific research on development issues, in particular poverty alleviation and sustainable development. Van Reeuwijk's thesis will be published in book form by AMB publishers in the autumn of 2009.