Barcelona 2013
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| Abstract #390 - Risk | ||||
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Session: 18.7: Risk (Symposium) on Monday @ 16.30-18.30 in Teatre Chaired by Susan Kiene, Olivia Castillo Authors: Presenting Author: Dr Rachel Kidman - Tulane School of Public Health and Tropical Medicine, United States |
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| Additional Authors: Professor Edwin Wouters , Mrs. Caroline Masquiller, | ||||
| Aim: South Africa has the largest HIV epidemic worldwide. Within this context, young women are 2-3 times more likely to be HIV-infected than male counterparts; orphanhood confers risk of equal magnitude. Reducing risk among female orphans requires identifying modifiable pathways of vulnerability. To this end, we examine power imbalances in intimate relationships, a strong predictor of HIV infection. Prevailing gender norms assign decision-making power to males; as a result, young women are less able to negotiate sexual initiation, condom use, and sexual exclusivity. Moreover, female orphans and other vulnerable children (OVC) experience socioeconomic vulnerability (e.g., marginalization, impoverishment) that may exacerbate this power imbalance. Interventions that challenge prevailing gender norms and encourage equity in sexual decision-making have the potential to reduce risk in this key population. | ||||
| Method / Issue: Data are from a community-randomized controlled trial of two interventions (on HIV and depression respectively) in South Africa. The Vhutshilo HIV Prevention and Support Program was designed to address risk factors particularly relevant for OVC. Small group sessions held over 14 weeks provided opportunity for reflection and skills-based learning on healthy sexual partnerships, sexual violence, and HIV/AIDS. The sample included 1016 OVC aged 14-17 at baseline; 1003 completed a follow-up survey after the intervention period. A third survey will be conducted in 2013 to measure changes in sexual behavior one year post-intervention. To minimize response bias, adolescents completed survey sections on sexual behaviour using audio computer-assisted self-interview technology. For this study, we present descriptive statistics on female?s reported sexual self-efficacy and coercive sexual experiences. Multivariate regressions capture the impact of Vhutshilo on a composite of four indicators measuring self-efficacy to refuse sex (alpha=0.85). | ||||
| Results / Comments: Overall, 38% of female OVC rated their ability to refuse sex with a partner if they did not feel like having sex as low or very low; 44% similarly rated their ability as low or very low if the partner offered to buy a gift, 39% if the partner didn?t want to use a condom, and 35% if the partner was drunk. Almost a third did not believe a girl should suggest condom use to a sexual partner. Within sexually active adolescents, 35% reported their first sexual encounter was unwanted (i.e., tricked or forced); however, only 7% reported they had sex because the man threatened to end the relationship otherwise and only 3% because they were afraid of losing the money or gifts provided. Multivariate regressions showed significant improvement in self-efficacy to refuse sex as a result of exposure to the Vhutshilo program (p<0.05). Future analyses will evaluate its impact on behavioral outcomes using the third wave of data. | ||||
| Discussion: In our study, a third of female OVC reported low self-efficacy to refuse sex and correspondingly high levels of unwanted sexual activity. Importantly, we found encouraging evidence that a theory-based HIV program could build self-efficacy; whether this translates into behaviour change will be evaluated in subsequent analyses. Individually-focused interventions encouraging sexual agency will ultimately need to be coupled with structural interventions that modify the social space in which youth negotiate intimate relationships. | ||||
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