Key Social Norms Take-aways This study reveals that prevailing social and cultural norms in Addis Ababa, Ethiopia—especially those stigmatizing adolescent sexuality and condom use—contribute significantly to adolescents’ engagement in risky sexual behavior. Despite general cultural and religious discouragement of premarital sex, community-level norms perpetuate shame, fear, and judgment around seeking sexual and reproductive health (SRH) services or accessing protection. These norms disproportionately affect girls, who face harsher social judgment for sexual activity, leading to secrecy and increased vulnerability. Changing these norms, alongside structural reforms, is essential to promoting safer sexual behaviors among youth.
Objectives The study aimed to explore and describe perceived organizational, community, and societal factors that influence adolescents’ sexual behaviors in Addis Ababa, Ethiopia.
Methods A qualitative descriptive design was used. Data were collected between June 2019 and February 2020 through 12 in-depth interviews with sexually active adolescents, eight key informant interviews with health professionals, and five focus group discussions with adolescents (segregated by sex). Thematic analysis was conducted using ATLAS.ti software, following inductive coding to identify themes related to organizational, community, and societal-level influences.
Results Three key themes emerged: (1) organizational-level barriers, such as lack of youth-friendly health services, unfriendly or judgmental health providers, and limited sexuality education in schools; (2) community-level factors, including strong taboos against premarital sex and widespread stigma and shame associated with condom use; and (3) societal-level drivers, such as poverty, transactional sex, rural-urban migration, and poor enforcement of legal protections for adolescents. Adolescents often face peer pressure, access to substances, and exploitation in unsafe environments like bars and “brothel-like” houses, with girls particularly vulnerable to coercion and societal condemnation.
Conclusions Adolescent sexual behavior in urban Ethiopia is shaped by a complex interplay of inadequate health infrastructure, limited SRH education, restrictive cultural expectations, and socioeconomic vulnerability. To reduce risky sexual behaviors, interventions must go beyond service provision to tackle harmful social norms and stigma, especially those inhibiting open discussion and access to condoms. The study recommends implementing culturally sensitive, age-appropriate comprehensive sexuality education and strengthening health services and legal protections for adolescents. Community-wide engagement—including families, educators, and local leaders—is critical for shifting norms and creating safer environments for youth.