Speaking through pictures: Canvassing adolescent risk behaviours in a semi-rural community in KwaZulu-Natal Province, South Africa

Background: Adolescent risk behaviours, such as substance abuse and unprotected sex, are leading social and health challenges in South Africa. Objective: While studies continue to investigate the prevalence of adolescent risk behaviours in South Africa, there is a paucity of research on adolescents' perspectives in rural settings. Method: Using a qualitative photo-voice methodology, the current study explored adolescents' perspectives and experiences of living in a semi-rural community in KwaZulu-Natal. KwaZulu-Natal is the epicentre of the South African epidemic, and adolescents especially young girls, are at heightened risk for HIV infection. Male and female participants aged 15-18 years old (N=33) were asked to respond to a series of questions by taking photographs that best describe their perspectives or experiences. Results: The photo-voice methodology encouraged the adolescents to represent their perspectives and experiences as experts on their lives and needs. The participants reported that adolescents in their community engage in various risky behaviours of which risky sexual behaviours and hazardous substance use emerged as significantly problematic. Risky sexual behaviours entailed unprotected sex, having multiple sexual partners, cell-phone sharing of pornography and sex while intoxicated. Problematic substance use involved harmful drinking behaviours like binge drinking as well as engaging in illicit drug use. Conclusion: Contextually relevant interventions aimed at reducing adolescent engagement in risky sexual behaviours and harmful substance use need to be prioritised. Additional recommendations are discussed.