Tradition, Respect and Reputation:
Cultural, Familial, and Personal Risk
Attached to Condom Use for Young People in Tonga
Karen E. McMillan
Within anthropology, literature, and the visual arts the portrayal of Polynesian and other Oceanic peoples has been highly sexualised. Supported by contemporary tourist brochure images of dusky maidens with come-hither smiles, this focus has projected a picture of unrepressed sexuality in the Polynesian islands. In actuality, like many Pacific island countries and territories, the Kingdom of Tonga is a deeply conservative society—more clearly distinguished by the codes of tradition, kinship, and hierarchy, than any sexual abandon. Tonga is also a staunchly Christian country where sexual activity between young people is strongly censured.
Nonetheless, many young people in Tonga are sexually active and both high sexually transmitted infection (STI) rates and available behavioural surveillance survey data indicate that condom use is low. Although the diagnosis of STIs in Tonga is thought to be significantly underreported, the current rate particularly in the 15–24-year age group has been identified as cause for concern. In 2005 the prevalence of Chlamydia among 15–19 year old and 20–24-year-old antenatal mothers tested for STIs was 47 percent and 23.5 percent respectively, while the prevalence of gonorrhoea among the 15–19-year-old antenatal mothers tested was nearly 12 percent. Second Generation Surveillance (SGS) data from Tonga in 2008 found that while HIV awareness was high in the population surveyed, fewer than 20 percent of women had ever used a condom. In addition, while nearly half of the sexually-active youth reported ever having used a condom, less than a quarter had used a condom the last time they had sex and less than 12 percent said they used a condom every time they had sex. These features—ongoing high STI rates and low condom use—in a context of covert sexual activity, signal a vulnerability among young people to HIV transmission and also to a need for improved HIV and other STI prevention efforts in Tonga, and the wider Oceanic region.
Despite a history of scholarly and artistic sexualising of Pacific people, there is a dearth of published data on sexual risk behaviour in contemporary Polynesia, particularly that of young people. In studies of youth and sexual risk internationally, much research emphasis has been on young people as risk takers while the role of adults and other social authorities in creating and sustaining the vulnerabilities of youth has been subject to less scrutiny. There is increasing recognition that social factors as well as individual characteristics impact on young peoples' sexual behaviours, including their condom use. Gender expectations, power dynamics and the symbolic meanings of condoms, have all been identified as influential and should be taken account of when considering facilitators of and barriers to condom use. Furthermore, the perception, and relative prioritisation, of risk associated with sex without a condom needs to be considered in the context of any other competing and potentially more immediate risks as understood by the young people concerned.
Among studies in Melanesia, both Maggie Cummings and Jean Mitchell consider the ways that young people in Vanuatu negotiate tradition in a time of social change, revealing the dissonance between traditional, cultural and more globalised values and messages experienced by young people, largely as a result of development. More generally there is an increasing body of work on sexual risk in Melanesia that is characterised by a strong focus on the impact of wider social and contextual rather than individual factors. However, Melanesian cultures, the political and development context, as well as the HIV response needs of Melanesia are markedly different from those of Polynesian countries. Yet, perhaps because of the absence of data from other areas of Oceania, the Melanesian experience has come to stand for that of the Pacific.
In order to further an understanding of factors impacting on, or limiting, condom use among young people in Tonga, a qualitative investigation was undertaken by researchers from the University of New South Wales and the Papua New Guinea Institute of Medical Research. Many enquiries into the condom use of young people survey their knowledge and behavioural intentions. The relation between knowledge and behavious is complex however and increased knowledge or positive intentions do not simply translate in to practice. Measuring individual level factors does not often shed much light on the context within which sexual safety and other decisions are made. This study, focused on participants' personal experiences, on remembering and relating actual events and expounding on the context of, and background to, participants' beliefs and decision making around condoms, their access and their use.
The data reported on here was gathered from in-depth face-to-face interviews with thirty-two Tongans between 18 and 25 years of age. Interviews took place in March 2008 in and around Nuku'alofa on the island of Tongatapu. Nuku'alofa is the capital of Tonga and two thirds of the Tongan population resides there. Recruitment strategies employed included peer recruitment, chain referrals, introductions via community organisations and training academies, and opportunistic invitations extended through everyday contacts with young people at work, on the streets, and in the surrounding villages. To be eligible for inclusion in the study participants needed to be Tongan, aged between 18 and 25 years, and able to speak English. English is a widely spoken second language in Tonga and no interested potential participants had to be excluded on the basis of language. Having ever had sex or having ever used a condom were not conditions of eligibility for inclusion as the research aimed to investigate perceptions and beliefs about condom use as well as first-hand experiences. The researchers sought and gained ethics approval for this study from the Human Research Ethics Committee of the University of New South Wales and permission from the Tongan Ministry of Health, prior to any data gathering being undertaken.
A purposive sampling approach aimed at the participation of a broad range of young people, in a variety of work and domestic situations. The resultant sample consisted of: female (n=16), male (n=10) and fakaleiti/transgender (n=6),married (n=6), single parents (n=4), unemployed (n=13), students and trainees (n=6). Five female participants and one male participant had never had sex. Of those who were sexually active (n=26) eighteen had used a condom at some time. Of those who were sexually active and had never used a condom (n=8) six were female, one was male and the other a fakaleiti. Both the median and average age of participants was 21 years. Twenty-one was also the median age of the Tongan population at the 2006 census.
The young Tongans in this study expressed predominantly positive attitudes to condoms, however few actually used them consistently, or even sporadically. In addition, scrutiny of the interview narratives shows that condoms are both explicitly and implicitly associated with forbidden sex and social transgression. Consistent with the SGS of the same year, participants were aware of HIV and understood that there are risks associated with sex without a condom. However these data also reveal that, for young people in Tonga, risk is attached to condom use itself at a number of different levels: risk to their person, from family; risk to personal reputation, from community censure; risk to family reputation; and also a more collectively-borne risk to Tongan tradition and identity. The results suggest that responsibilities to family, to community, and to tradition may be experienced as more pressing, or more immediate, priorities than that of individual health concerns.
The words 'safe' and 'safety were used repeatedly when the interviewees were first asked about condoms. One person described condoms as 'essential safety equipment' and another as a 'life preserver.' All but one of the participants recognised that condoms offered protection from HIV and other STIs, and most also noted that condoms could keep young people safe from unwanted pregnancies. One of the participants expressed it thus:
condoms help you live another day, they give you a chance in life. (Jonah, age 18).
Mosesi emphasised the contraceptive function of condoms, explaining that he uses condoms because
it's just that I don't want to ruin anybody's life. I don't want to ruin my reputation. I don't want to ruin my life yet because once you have a child that's something else (Mosesi, age 25).
Thus condoms were described as having the potential to 'save lives' in more ways than one. It is not only HIV that is understood as potentially life threatening, but also the damage to reputation and closing down of options for the future that would result from pregnancy before marriage. However the data also show that this 'safety equipment' is a double edged sword, as the reputation that can be preserved by condom use can also be imperilled by it. Through this paper particular attention is directed to local understandings of risk in relation to condom use, and to both direct and indirect expressions of the various risks as they are played out through the interview narratives.
Embedded in many of the narratives was a belief that young men are more vulnerable to STIs and HIV than young women. Nelly describes condoms as:
a material that is used by the boys for their own protection when they have sex with girls (Nelly, age 19),
and Losanna suggested that most young Tongan women are not at risk of STIs because:
most of the girls they are not like, what can I say, only the boys they get that kind of disease. They are the ones that suffer the most '(Losanna, age 21).
This perception of increased male vulnerability is underwritten by social expectations that young Tongan women will not have sex outside of marriage, or a committed marriage-like relationship, which was conceptualised by these young people as a relationship in which children are planned. At the same time, a male tendency to seek sexual gratification from women before and outside of marriage, while not openly endorsed, is an assumption evident in the narratives of both young men and women alike.
While the protective function of condoms was well understood, distinct risks were associated with condom access and use. Participants described their families and communities as ones in which strict obedience is demanded of children. Young adults, especially females, are expected to live at home until marriage; and sex is strictly forbidden for young people. Condoms are unequivocal markers of sexual activity or intent. May summed up the problem of condoms for young people:
There is only one thing that comes through a person's mind when you are carrying a condom around—you are using it. You are using it—meaning you are having sex. Having sex is like a taboo here in Tonga if you are still a youth (May, age 22).
Not only is sexual activity prohibited, talking about sex is generally off-limits too. Numerous participants also pointed out that sex is not a subject that is considered decent to speak about openly in Tonga. They explained that this inhibits discussion even between young people, who do not necessarily admit to having sexual relationships to their friends, let alone discuss it with family or other authorities.
As well as being an indicator of actually engaging in sexual activity, accessing or possessing condoms is a clear marker of an intention to have sex. According to some participants, this intention is even less forgivable than an unpremeditated lapse in behaviour or 'foolishness' that a sexual encounter might constitute. Moreover, to openly buy condoms will be perceived as showing disrespect to the values of the community. Jonah described the physical reactions of the shopkeeper and other people in the store when he bought condoms, as well as his perception of how his actions were being construed:
They were talking, gossiping, talking bad stuff. The way their body moves, you know, the body language and everything, it shows how they hate me, how they think 'Oooh, look at that boy! He hasn't got any respect. He is not even shy or anything. Goes and buys a condom, blah blah blah' (Jonah, age 18).
As portrayed by these young people, life in a Tongan community appears to be one in which anonymity is impossible, confidentiality rare, and privacy highly prized. Gossip is inescapable and indeed considered something of a social obligation. Nelly said that she would
immediately go to the person's family or parents and tell them that I saw your daughter or son went and bought condoms. That's the Tongan way and culture (Nelly, age 19).
Certainly interviewees repeatedly stated that being seen buying or accessing condoms or being found with condoms in their possession would inevitably, and rapidly, become a matter of public knowledge. Like Nelly, Rose also directly ascribes this situation to
the Tongan culture. If somebody knows it, news will spread fast. So that person will be in big trouble. If she or he is attending school I think he will be cast out (Rose, age 18).
Rose expands on the consequences of gossip: condoms carry not only a risk to reputation, but also the threat of punishment by family and other authorities. Young people living in the family home contended that family finding out about condom use would result in arguments, perhaps a beating, and in the most extreme cases, being cast out or disowned. Others believed they would be expelled from school should knowledge of their sexual activity, as signified in the possession of condoms, come to the notice of the school authorities.
The behaviour of young Tongans has profound implications for their families too. May referred to an inseparability of family and individual identity in her description of what happens when a young person's character or behaviour is being discussed:
Oh my gosh, it's like they are already talking about the family. Like, it's someone's, who and who's child, you know (May, age 22).
Any stigma and shame or community censure attached to a young person's condom use—constituting evidence of disrespectful and brazen sexual activity—would be borne by the family as well as the individual. Participants explained that parents are held accountable for the behaviour of their children in the view of the wider community:
it's the parents that mostly get pointed to for how they bring up their children (Hanna, age 21).
Another young woman suggested that when young people are known to use condoms
the neighbours would think 'Ah! Maybe their mother was a prostitute, maybe she was using condoms before. Now she's teaching it to her children' (Poppy, age 25).
Poppy like many other participants invokes a connection here between prostitution and condom use. The contexts and situations that participants in this research associated with condoms indicate that condoms signify illicit and socially irresponsible sex in general. More specifically, while condoms are cast as being necessary for use in teenage sex and typical of prostitution, the interview data also evidence that condom use signifies uncommitted sexual relationships, extra-marital sex, dirty or diseased sex and foreignness.
Young women in particular were wary of the opinions of their peers, as well as that of family and other authorities. Indeed, it was women in this study who expressed the strongest resistance to the idea of condom use within their own relationships. Even while endorsing condom use on the grounds of it being 'good for young people' and stating that condoms could save them from 'ruining their lives,' women most strongly eschewed condoms for their own use. In this way they dissociated themselves from those young people for whom condom use was advocated and from the negative values and relationships that condom use signifies.
This dissociation reflected the young women's positioning of their own relationships as legitimate and committed. Few of the young women interviewed believed that condoms were appropriate within marriage. Contraception was identified as the only acceptable function for condom use within marriage and other committed relationships and, for most of the young Tongan women in the study, bearing children was envisaged as the central purpose of marriage.
Apposite to this, married men asserted that if they bought condoms people would consider it evidence of engagement in extra-marital sex. A young married woman who was separated from her husband said that even if she wanted to use a condom with her next partner, she would not pick one up from a clinic or buy one from a shop because she believed that would mark her as promiscuous and that people would then say 'ooh, maybe her husband left her because she went with other men' (Sisilia, age 21). The premise that condoms are primarily used for extramarital sex is also evident in one young man's estimate of the level of condom use in Tonga:
There are more people who don't use condoms [than do] because most of them they just sleep with their wife (Teo, age 25).
Many young people pointed out that Tonga is a society where feminine modesty is very highly valued. That condom use denotes illicit and wanton behaviour, and even a certain sexiness, functions as a specific disincentive to many young women. 'Sexy' is not considered a positive attribute by these young Tongan women. Sisilia, for example, explained that she would not buy or carry condoms herself because 'if my friends knew about it they would say "You! You are a sexy girl!" They'd look down on me' (Sisilia, age 21).
Nevertheless, condoms are frequently available free or handed out in Nuku'alofa nightclubs, and some of the young women told us that their husbands or partners had come home with a condom, asking them to try it out 'for fun.' All had refused. They said it was 'too yucky,' and 'too strange.'
As an association of condom use with uncommitted and non-respectable relationships underpinned many young women's rejection of condom use, so an association with HIV and disease underwrote a vehement rejection of condom use by two of the fakaleiti in the research. Ruby exclaimed:
I am not sick with HIV! When I go with the boys I don't like them to fuck me with the condom
. It's yucky! I don't like to see that. It's garbage! (Ruby, age 18).
The negative connotations of and value assigned to condoms is summed up in Ruby's evaluation of condoms as simply 'yucky'—the same term used by many of the young women. Also there is a sense here in which Ruby's statement also reflects the belief that men are the ones who need condoms to protect themselves from disease. When men use condoms the decency or cleanliness of their partner is impugned. Ruby refuses to be treated as if she was diseased.
In contrast to Ruby, other fakaleiti embraced condom use as an act of caring for and about others because, as Jasmine said, 'when you use a condom, it's for your own safety and for other people's lives, you protect them from diseases' (Jasmine, age 19). Similarly Lulu (age 21) insisted that her condom use was motivated by a concern for 'not only my life [also for] other people's life.' Both Jasmine and Lulu believed that it was a leiti's responsibility to provide the condoms. Lulu said that she felt it was also her responsibility to ensure that condoms were used:
because most guys that I go out with are the drunk one. Because they're drunk they don't really care about the condoms, they're drunk. That's very dangerous
. I think it's my job to carry around the condom. Because I'm the one it depends on, if I really want to go with them. Those guys are dependent on me. It's very good to think about it (Lulu, 21).
Adopting a duty of care was consistent with Lulu's more general depiction of herself as someone who takes care of her male partners' needs. Jasmine also explicitly associated condom use with love and care when she asserted that:
when they use a condom, I think they love their life and other people's lives (Jasmine, 19).
Regardless of their sexuality or their personal stance on condom use, an assertion that condom use was 'not the Tongan way' was reiterated throughout the interview narratives.. The phrase was more than a simple statement of fact — as in an assertion that condoms are not generally used in Tonga. Condoms were considered alien and associated with foreignness, at variance with the Tongan-ness expressed in the phrase 'the Tongan way.'. Condoms were considered to be necessary for sex with foreigners, or when having sex overseas. Concomitant with this, HIV was understood to be a disease that comes from the outside, a virus that has been brought in to Tonga by foreigners, and that the arrival of HIV has also necessitated foreign remedies such as the condom. For some young Tongans, condoms did indeed arrive from overseas, having been sent from cousins in New Zealand and the United States of America. Condoms were also associated with foreigners in statements that condoms were only available at the Chinese shops. Nelly, for instance, asserted that condoms were brought in to Tonga by foreigners and others who had been overseas and that
people here get [condoms] from them. Tongan people here in Tonga keep their culture, but the Chinese they don't mind. So I think when my friend went and bought [a condom] she got it from a Chinese store (Nelly, age 19).
Nelly's assertion also carries the inference that while Tongan identity is unique to Tongan people, Tongan culture and Tongan-ness is diluted when Tongans live overseas.
The phrase, 'the Tongan way,' was repeatedly forwarded by the young people in this research in their attempt to explain behaviour and thinking that impacted on condom use. It was also proffered as an indirect but powerful barrier to condom access and use. Recourse was made to 'the Tongan way' not simply to describe local norms and mores in a general reference to the 'way things are around here'—but more specifically to invoke qualities, beliefs and practices that are essentially and definitively Tongan, and a 'way' that is central to Tongan identity. Concepts of culture, tradition and respect were deeply imbricated within these narratives. Respect is described as entailing obedience, or at least the show of acquiescence. Talking about, or any overt references to, sex would be interpreted as a clear lack of respect.
Many of the young people interviewed scorned what they considered to be unrealistic and anachronistic expectations of young people's behaviour, and most concurred that parents and church authorities 'just don't know what [young people] get up to' (Tony, age 18). However the duty of parents to preserve and instil moral and cultural values was simultaneously acknowledged and upheld. Parents' opposition to sexual activity and therefore to condoms was understood as being proper to the parental role as keepers of the Tongan tradition.
Within these narratives there is evidence that condoms are associated with sexual, social and cultural transgression: not only the transgression of prohibitions against sexual activity, but also of the values of respect, of feminine modesty, and ultimately of tradition and 'the Tongan way.' The transgressive potential is perhaps best summed up in the opportunity that condoms offer to young people to 'live their own lives'— when living one's own, individualistic, life runs directly counter to the ethos of the Tongan social and cultural world.
There were a small number of participants in this study who considered themselves to be consistent or otherwise enthusiastic condom users. Those who adopted condom use in their own lives could be distinguished from a 'mainstream' of other participants by non-normative characteristics other than their condom use.
Prominent among the regular condom users were those young men who were peer educators, especially those who did not have a strong connection with the family home, or who had set up their own home. These young men were most disparaging of aspects of Tongan community life, particularly of the gossip and the 'Tongan telegraph',' a phrase coined by locals in reference to the speed at which news or gossip travels through the community and across land and sea. They were not trying to be renegades however and mused on a changing world as well as on the need to take the lead and, ultimately, to think for oneself. Some invoked the need to be brave. Jonah typified this thoughtful heterodoxy saying:
I look at [what parents say] very closely
. I try not to disrespect them. But when they pass away it's just me in the world so if other people tell me what to do and I just do it, when they die I won't have a life. I do it my way 'cos I will be the one to continue in the world (Jonah, 22).
The few young women who had embraced condom use, did not embrace traditional Tongan feminine identities and described themselves as 'party girls'—meaning that they went out to bars and clubs and were looking for fun rather than a husband and babies. They also readily admitted to having had more than one sexual partner. They were connected to networks in New Zealand through cousins or boyfriends, and these connections tended to provide their condoms. The condom-using women expressed views on sexual relationships, self reliance and individual responsibility that were more in keeping with Western codes of individuality than Tongan communalism. They framed their decisions and the rationality underpinning their condom use in the context of their own intimate relationships, describing a strategic approach to condom use that made no reference to parents or wider Tongan community mores.
Fakaleiti are often considered to be a third gender having been born biologically male but living a feminine life. While fakaleiti is a specifically Tongan gender identity, Niko Besnier contends that the self-representation of Tongan fakaleiti tends to be oriented more toward modernity and the West rather than to Tongan traditions. Fakaleiti who participated in this study were mostly regular condom users and condom advocates who talked about condom use as a sign of caring and loving, and an opportunity to take responsibility for the wellbeing of others. Condom supplies were shared and passed around between friends. The two fakaleiti interviewed who were anti-condom however refused them as 'horrible,' yucky,' and 'ugly' 'garbage' things. Indeed this attitude was very similar to, if more vehemently expressed than, that of the majority of female participants.
The risk of condom use borne by young people and their families requires little explanation beyond that supplied in the statements of participants. Young people who used or carried condoms would be considered disrespectful, immodest and disobedient. The individuals concerned, along with their families, would be shamed and their reputations impugned. Because of this many young people would expect to incur severe punishment.
Appreciation of the significance of the repeated invocation of 'the Tongan way, and the consequent instatement of condom use as a more collectively borne risk to Tongan tradition, may benefit from further contextualisation.'The Tongan way' is the direct English translation of faka Tonga—a phrase with great power in the Kingdom. It means not simply the way things are done or understood as a matter of course, but is deeply imbricated in issues of national identity.
Tongan society is one in which principles of hierarchy, tradition and kinship are inextricably interwoven and central to the ethos of daily life, politics, and identity. However the matter and primacy of tradition is not uncontested, and 'the Tongan way' is regularly invoked in contemporary political wrangling over democratic reform and debates around the relative benefits of modernity and participation in a global economy. These ongoing arguments frequently turn on issues of national identity, with both sides citing the preservation of tradition and the threat posed by 'alien elements.' Nor are the terms of these debates restricted to academic or highbrow political commentators in Tonga, they circulate through the whole of Tongan society and are played out routinely in daily politics and discussions.
The phrase 'the Tongan way' was one introduced by the participants themselves as a device to refer to Tongan-ness and to what it is to be Tongan. While the phrase, as it appears through these narratives, is something of a catchall device where meaning can never be explained exactly and application is shifting and fluid, 'the Tongan way' clearly centres on respect and the maintenance of proper social relationships. It is important to note however that the analysis, on which this paper is based, is grounded in the participants' own expressions of their experiences and understandings. Consequently the reporting here is concerned with illustrating the various ways that the young people cited aspects of Tongan-ness as barriers and disincentives to condom use, and is not an attempt to define Tongan culture.
The participants' overwhelming belief in the need for condoms to be used by a generalised and abstract category of young people, alongside a personal eschewing of their use by most of those interviewed, can best be explained by considering the social risks attached to condom use. For the young people interviewed in this research, these social risks are specifically framed in terms of the lived realities of being Tongan. The recognition of the safety afforded by condoms in principle is overshadowed by the recognition of the risks associated with condoms in practice. The advantages of condom use, as understood and expressed by the participants, relate to individual responsibility and afford freedoms and security at the level of the individual, dissociated from wider community concerns and values. Herein lays a specific caution for condom promotion programs: these findings indicate that condom promotion messages have been received, but that responsibility which is invoked in an individualistic way is incommensurate with the wider Tongan ethos.
In addition, the need for condoms remains a negative marker of the status of the sexual relationship in which they are used. Condom use is inconsistent with sanctioned relationships and feminine virtue. Further, condoms themselves are markers of disrespect or social transgression, and of foreignness. While the use of condoms is understood to pose serious social risks for the individual and also for their family, it also constitutes the introduction of a foreign practice, one inconsistent with Tongan-ness. Consequently, the issue of the condom is freighted with other discourses on modernity, alien influences and the threat these pose to Tongan tradition and Tongan identity.
 Lee Wallace, Sexual Encounters; Pacific Texts, Modern Sexualities, Ithaca: Cornell University Press, 2003.
 Tonga Country Coordinating Mechanism, The Kingdom of Tonga National Strategic Plan for HIV and STIs 2009–2013, Nuku'alofa, Tonga, 2009, p. 14, online: http://www.pacifly.org/hiv/index.php?option=com_docman&task=cat_view&gid=119&Itemid=99999999, accessed 2/3/2011.
 Tonga Country Coordinating Mechanism, National Strategic Plan, p. 14.
 Tonga Ministry of Health and the Secretariat of the Pacific Community, Second Generation Surveillance in Antenatal Clinic Attendees and Youth, Tonga: Ministry of Health, Government of Tonga, 2008, p. 5, online: http://www.spc.int/hiv/index.php?option=com_docman&task=cat_view&gid=76&Itemid=148, accessed 2/3/2011.
 Tonga Ministry of Health, Second Generation Surveillance, p. 24.
 Holly Buchanan-Arawafu, 'An integrated picture HIV risk and vulnerability in the Pacific,' in Secretariat of the Pacific Community, 2007, online: http://www.spc.int/hiv/images/stories/review%20risk%20and%20vulnerability%20integrated%20picture%20adjusted1.pdf, accessed 3 February 2010.
 Roger Ingham, 'The importance of context in understanding and seeking to promote sexual health,' in Promoting Young People's Sexual Health, ed. R. Ingham and P. Aggleton, Abington: Routledge, 2006, pp. 41–60.
 Cicely Marston. 'Factors that shape young people's sexual behaviour: a systematic review,' The Lancet 368(9547) (2004): 1581–86.
 Cicely Marston, Eleanor King and Roger Ingham, 'Young people and condom use findings from qualitative research,' in Promoting Young People's Sexual Health, ed. R. Ingham and P. Aggleton, Abingdon: Routledge, 2006, pp. 27–40.
 Kwadwo Bosompra, 'Determinants of condom use intentions of university students in Ghana: an application of the theory of reasoned action,' Social Science & Medicine 52 (2001): 1057–69.
 Maggie Cummings, 'The trouble with trousers: gossip, kastom, and sexual culture in Vanuatu,' in AIDS in Oceania: Culture, Politics and the Global Pandemic, ed. L. Butt, L. and R. Eves, Honolulu: University of Hawai'i Press, 2008, pp. 168–86; Jean Mitchell, '"Killing time" in a postcolonial town: young people and settlements in Port Vila, Vanuatu,' in Pacific Island Societies in a Global World, ed. V. Lockwood, New York: Prentice-Hall, 2003, pp. 358–76.
 See for example, Carol Jenkins and Holly Buchanan, Cultures and Contexts Matter: Understanding and Preventing HIV in the Pacific, Manila: Asian Development Bank, 2007; also, Leslie Butt and Richard Eves, AIDS in Oceania: Culture, Politics and the Global Pandemic,, Honolulu: University of Hawai'i Press, 2008; and Lawrence Hammer, Sin, Sex and Stigma: A Pacific Response to HIV and AIDS, London: Sean Kingston, 2010.
 The interviews reported on here were part of a larger study of condom use by young people in Tonga and Vanautu. See Karen McMillan, Access to Condoms and their Use Among Young people in Tonga and Vanuatu, Monograph 3, Sydney: National Centre in HIV Social Research, UNSW, 2008, funded by the Global Fund for HIV, TB and Malaria, online: http://www.sphcm.med.unsw.edu.au/SPHCMWeb.nsf/resources/Tonga_Condom_Report.pdf/$file/Tonga_Condom_Report.pdf, accessed 2/3/2011.
 See, for example, Natalia Jones and Robin Haynes, 'The association between young people's knowledge of sexually transmitted diseases and their behaviour: a mixed methods study,' Health, Risk and Society, 8(3) (2006): 293–303.
 Fakaleiti means 'in the manner of a lady' in Tongan, and refers to people who were born male but adopt womanly attributes or roles and are identified in the community as woman-like. Fakaleiti refer to themselves as simply leiti or ladies.
 Not his real name, all participant names have been changed.
 Niko Besnier, 'Sluts and superwomen: the politics of gender liminality in urban Tonga,' Ethnos 62(1 –2) (1997): 5–31.
 Marie-Claire Bataille and Georges Benguigui, 'Identity at stake in the present day Kingdom of Tonga,' in The Changing South Pacific: Identities and Transformations, ed. Serge Tcherkézoff and Françoise Douaire-Marsaudo, trans. Nora Scott, Pandanus Books: Australian National University, 2005, pp. 230–244, p. 240.