‘The not talking is actually what kills you’– young South African women’s communication barriers about sexual health

Conversations about sex and sexual health are often stigmatised and shaped by socio-cultural influences. For young women, lack of adequate communication can influence access to information, knowledge and behaviour and therefore increase vulnerability to negative outcomes such as sexually transmitted infections (STIs) and unintended pregnancy. This qualitative study investigated the barriers young women face when seeking dialogue about sex, their sexual health and relationships. Seven isiXhosa-speaking young women (aged 21-25) participated in a six-session art-based engagement, creating large-format paintings reflecting their sexual health experiences. Data collection included in-depth interviews and a focus group discussion, which were transcribed, translated and thematically analysed. Findings revealed that communication about sex and sexual health was hindered by the attitudes of family, partners, communities and health care providers. The need to please and retain partners also restricted young women's ability to express their sexual health needs and desires. Young women felt that with age and maturity they gained confidence, agency and capacity to navigate difficult conversations. Empowering tools and strategies to improve communication could enhance young women's agency, enabling them to overcome barriers for communication and actively seek sexual health information and services.