| 1. |
- Atkins, Kaitlyn, et al.
(författare)
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"The sky is the limit; I am going there" : experiences of hope among young women receiving a conditional cash transfer in rural South Africa
- 2022
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Ingår i: Culture, Health and Sexuality. - : Taylor & Francis. - 1369-1058 .- 1464-5351. ; 24:8, s. 1077-1091
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Tidskriftsartikel (refereegranskat)abstract
- Young women in South Africa face elevated risk of HIV infection compared to male peers. Cash transfers may mitigate their risk for HIV; however, there is limited understanding of mechanisms of impact. We explored hope as one potential mechanism. Longitudinal qualitative analysis was used to explore how cash transfer recipients in the HPTN 068 study conceptualised hope and how the intervention influenced their hope over time. We found the intervention increased confidence, alleviated financial stressors and instilled in young women the belief that a better life, defined as being educated, independent and supportive to family, was attainable. Findings support hope as a critical outcome of cash transfer and other economic strengthening interventions.
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| 2. |
- Fearon, Elizabeth, et al.
(författare)
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Associations between friendship characteristics and HIV and HSV-2 status amongst young South African women in HPTN-068
- 2017
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Ingår i: Journal of the International AIDS Society. - : John Wiley & Sons. - 1758-2652. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Prevalence of HIV among young women in South Africa remains extremely high. Adolescent peer groups have been found to be an important influence on a range of health behaviours. The characteristics of young women's friendships might influence their sexual health and HIV risk via connections to sexual partners, norms around sexual initiation and condom use, or provision of social support. We investigated associations between young women's friendships and their Herpes Simplex Virus Type 2 (HSV-2) and HIV infection status in rural South Africa. Methods: Our study is a cross-sectional, egocentric network analysis. In 2011 to 2012, we tested 13- to 20-year-old young women for HIV and HSV-2, and collected descriptions of five friendships for each. We generated summary measures describing friend socio-demographic characteristics and the number of friends perceived to have had sex. We used logistic regression to analyse associations between friend characteristics and participant HIV and HSV-2 infection, excluding likely perinatal HIV infections. Results: There were 2326 participants included in the study sample, among whom HIV and HSV-2 prevalence were 3.3% and 4.6% respectively. Adjusted for participant and friend socio-demographic characteristics, each additional friend at least one year older than the participant was associated with raised odds of HIV (odds ratio (OR)=1.37, 95% CI 1.03 to 1.82) and HSV-2 (adjusted OR=1.41, 95% CI 1.18 to 1.69). Each additional friend perceived to have ever had sex also raised the odds of HIV (OR=1.29, 95% CI 1.03 to 1.63) and HSV-2 (OR=1.18, 95% CI 1.03 to 1.35). Discussion: We found good evidence that a greater number of older friends and friends perceived to have had sex were associated with increased risk for HSV-2 and HIV infection among young women. Conclusions: The characteristics of young women's friendships could contribute to their risk of HIV infection. The extent to which policies or programmes influence age-mixing and young women's normative environments should be considered.
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| 3. |
- Fearon, Elizabeth, et al.
(författare)
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Friendships Among Young South African Women, Sexual Behaviours and Connections to Sexual Partners (HPTN 068)
- 2019
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Ingår i: Aids and Behavior. - : Springer. - 1090-7165 .- 1573-3254. ; 23:6, s. 1471-1483
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Tidskriftsartikel (refereegranskat)abstract
- Friends could be influential on young women's sexual health via influences on sexual behaviours and as connections to sexual partners, but are understudied in sub-Saharan Africa. We cross-sectionally surveyed 2326 13-20year-old young women eligible for grades 8-11 in rural South Africa about their sexual behaviour and up to three sexual partners. Participants each described five specific but unidentified friends and the relationships between them in an egocentric' network analysis design. We used logistic regression to investigate associations between friendship characteristics and participants' reports of ever having had sex (n=2326) and recent condom use (n=457). We used linear regression with random effects by participant to investigate friendship characteristics and age differences with sexual partners (n=633 participants, 1051 partners). We found that it was common for friends to introduce young women to those who later became sexual partners, and having older friends was associated with having older sexual partners, (increase of 0.37years per friend at least 1year older, 95% CI 0.21-0.52, adjusted). Young women were more likely to report ever having had sex when more friends were perceived to be sexually active (adjusted OR 1.85, 95% CI 1.72-2.01 per friend) and when they discussed sex, condoms and HIV with friends. Perception of friends' condom use was not associated with participants' reported condom use. While this study is preliminary and unique in this population and further research should be conducted, social connections between friends and sexual partners and perceptions of friend sexual behaviours could be considered in the design of sexual health interventions for young women in South Africa.
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| 4. |
- Gottert, Ann, et al.
(författare)
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Gender Norms, Gender Role Conflict/Stress and HIV Risk Behaviors Among Men in Mpumalanga, South Africa
- 2018
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Ingår i: Aids and Behavior. - : Springer. - 1090-7165 .- 1573-3254. ; 22:6, s. 1858-1869
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Tidskriftsartikel (refereegranskat)abstract
- Men's gender role conflict and stress (GRC/S), the psychological strain they experience around fulfilling expectations of themselves as men, has been largely unexplored in HIV prevention research. We examined associations between both men's gender norms and GRC/S and three HIV risk behaviors using data from a population-based survey of 579 18-35 year-old men in rural northeast South Africa. Prevalence of sexual partner concurrency and intimate partner violence (IPV) perpetration in the last 12 months were 38.0 and 13.4%, respectively; 19.9% abused alcohol. More inequitable gender norms and higher GRC/S were each significantly associated with an increased odds of concurrency (p = 0.01; p < 0.01, respectively), IPV perpetration (p = 0.03; p < 0.01), and alcohol abuse (p = 0.02; p < 0.001), controlling for demographic characteristics. Ancillary analyses demonstrated significant positive associations between: concurrency and the GRC/S sub-dimension subordination to women; IPV perpetration and restrictive emotionality; and alcohol abuse and success, power, competition. Programs to transform gender norms should be coupled with effective strategies to prevent and reduce men's GRC/S.
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| 5. |
- Gottert, Ann, et al.
(författare)
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Measuring Men's Gender Norms and Gender Role Conflict/Stress in a High HIV-Prevalence South African Setting
- 2016
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Ingår i: Aids and Behavior. - : Springer Science and Business Media LLC. - 1090-7165 .- 1573-3254. ; 20:8, s. 1785-1795
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Tidskriftsartikel (refereegranskat)abstract
- Gender norms and gender role conflict/stress may influence HIV risk behaviors among men; however scales measuring these constructs need further development and evaluation in African settings. We conducted exploratory and confirmatory factor analyses to evaluate the Gender Equitable Men's Scale (GEMS) and the Gender Role Conflict/Stress (GRC/S) scale among 581 men in rural northeast South Africa. The final 17-item GEMS was unidimensional, with adequate model fit and reliability (alpha = 0.79). Factor loadings were low (0.2-0.3) for items related to violence and sexual relationships. The final 24-item GRC/S scale was multidimensional with four factors: Success, power, competition; Subordination to women; Restrictive emotionality; and Sexual prowess. The scale had adequate model fit and good reliability (alpha = 0.83). While GEMS is a good measure of inequitable gender norms, new or revised scale items may need to be explored in the South African context. Adding the GRC/S scale to capture men's strain related to gender roles could provide important insights into men's risk behaviors.
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| 6. |
- Jennings, Larissa, et al.
(författare)
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Economic Resources and HIV Preventive Behaviors Among School-Enrolled Young Women in Rural South Africa (HPTN 068)
- 2017
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Ingår i: Aids and Behavior. - : Springer Science and Business Media LLC. - 1090-7165 .- 1573-3254. ; 21:3, s. 665-677
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Tidskriftsartikel (refereegranskat)abstract
- Individual economic resources may have greater influence on school-enrolled young women's sexual decision-making than household wealth measures. However, few studies have investigated the effects of personal income, employment, and other financial assets on young women's sexual behaviors. Using baseline data from the HIV Prevention Trials Network (HPTN) 068 study, we examined the association of ever having sex and adopting sexually-protective practices with individual-level economic resources among school-enrolled women, aged 13-20 years (n = 2533). Age-adjusted results showed that among all women employment was associated with ever having sex (OR 1.56, 95 % CI 1.28-1.90). Among sexually-experienced women, paid work was associated with changes in partner selection practices (OR 2.38, 95 % CI 1.58-3.58) and periodic sexual abstinence to avoid HIV (OR 1.71, 95 % CI 1.07-2.75). Having money to spend on oneself was associated with reducing the number of sexual partners (OR 1.94, 95 % CI 1.08-3.46), discussing HIV testing (OR 2.15, 95 % CI 1.13-4.06), and discussing condom use (OR 1.99, 95 % CI 1.04-3.80). Having a bank account was associated with condom use (OR 1.49, 95 % CI 1.01-2.19). Economic hardship was positively associated with ever having sex, but not with sexually-protective behaviors. Maximizing women's individual economic resources may complement future prevention initiatives.
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| 7. |
- Kilburn, Kelly, et al.
(författare)
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Cash Transfers, Young Women's Economic Well-Being, and HIV Risk : Evidence from HPTN 068
- 2019
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Ingår i: Aids and Behavior. - : Springer-Verlag New York. - 1090-7165 .- 1573-3254. ; 23:5, s. 1178-1194
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Tidskriftsartikel (refereegranskat)abstract
- Despite the large interest in economic interventions to reduce HIV risk, little research has been done to show whether there are economic gains of these interventions for younger women and what intermediary role economic resources play in changing participants' sexual behavior. This paper contributes to this gap by examining the impacts of a conditional cash transfer (CCT) for young women in South Africa on young women's economic resources and the extent to which they play a role in young women's health and behavior. We used data from HIV Prevention Trials Network 068 study, which provided transfers to young women (in addition to their parents) conditional on the young woman attending at least 80% of school days in the previous month. We found that the CCT increased young women's economic wellbeing in terms of having savings, spending money, being unindebted, and food secure. We also investigated heterogeneous effects of the program by household economic status at baseline because the program was not specifically poverty targeted and found that the results were driven by young women from the poorest families. From these results, we examined heterogeneity by baseline poverty for other outcomes related to HIV risk including sexual behavior and psychosocial well-being. We found psychosocial well-being benefits in young women from the poorest families and that economic wellbeing gains explained much these impacts.
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| 8. |
- Kilburn, Kelly N., et al.
(författare)
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Conditional cash transfers and the reduction in partner violence for young women : an investigation of causal pathways using evidence from a randomized experiment in South Africa (HPTN 068)
- 2018
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Ingår i: Journal of the International AIDS Society. - : JOHN WILEY & SONS LTD. - 1758-2652. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionEvidence has shown that the experience of violence by a partner has important influences on women's risk of HIV acquisition. Using a randomized experiment in northeast South Africa, we found that a conditional cash transfer (CCT) targeted to poor girls in high school reduced the risk of physical intimate partner violence (IPV) in the past 12months by 34%. The purpose of this analysis is to understand the pathways through which the CCT affects IPV. MethodsHPTN 068 was a phase 3, randomized controlled trial in rural Mpumalanga province, South Africa. Eligible young women (aged 13-20) and their parents or guardians were randomly assigned (1:1) to either receive a monthly cash transfer conditional on monthly high school attendance or no cash transfer. Between 2011 and 2015, participants (N=2,448) were interviewed at baseline, then at annual follow-up visits at 12, 24 and 36months. The total effect of the CCT on IPV was estimated using a GEE log-binomial regression model. We then estimated controlled direct effects to examine mediation of direct effects through intermediate pathways. Mediators include sexual partnership measures, the sexual relationship power scale, and household consumption measures. ResultsWe found evidence that the CCT works in part through delaying sexual debut or reducing the number of sexual partners. The intervention interacts with these mediators leading to larger reductions in IPV risk compared to the total effect of the CCT on any physical IPV [RR 0.66, CI(95%):0.59-0.74]. The largest reductions are seen when we estimate the controlled direct effect under no sexual debut [RR 0.57, CI(95%):0.48-0.65] or under no sexual partner in the last 12months [RR 0.53, CI(95%):0.46-0.60]. ConclusionsResults indicate that a CCT for high school girls has protective effects on their experience of IPV and that the effect is due in part to girls choosing not to engage in sexual partnerships, thereby reducing the opportunity for IPV. As a lower exposure to IPV and safer sexual behaviours also protect against HIV acquisition, this study adds to the growing body of evidence on how cash transfers may reduce young women's HIV risk.
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| 9. |
- Leddy, Anna M., et al.
(författare)
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Community collective efficacy is associated with reduced physical intimate partner violence (IPV) incidence in the rural province of Mpumalanga, South Africa : findings from HPTN 068
- 2019
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group Ltd. - 0143-005X .- 1470-2738. ; 73:2, s. 176-181
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Tidskriftsartikel (refereegranskat)abstract
- Background Intimate partner violence (IPV) is a human rights violation and is associated with a variety of adverse physical and mental health outcomes. Collective efficacy, defined as mutual trust among community members and willingness to intervene on the behalf of the common good, has been associated with reduced neighbourhood violence. Limited research has explored whether community collective efficacy is associated with reduced incidence of IPV. This is of particular interest among adolescent girls and young women (AGYW) in sub-Saharan Africa, where the burden of HIV is greatest and IPV is common. Methods We collected longitudinal data among 2533 AGYW (ages 13-20) enrolled in the HPTN 068 cohort in Mpumalanga province, South Africa between 2011 and 2016. We included participants from 26 villages where community surveys were collected during the HPTN 068 study. Collective efficacy was measured at the village level via two population-based cross-sectional surveys in 2012 and 2014. Multivariable Poisson generalised estimating equation regression models estimated the relative risk ratio (RR) between village collective efficacy scores and subsequent physical IPV 12 month incidence, adjusting for village-level clustering and covariates. Results Thirty-eight per cent of the cohort (n=950) reported at least one episode of recent physical IPV during follow-up. For every SD higher level of collective efficacy, there was a 6% lower level of physical IPV incidence (adjusted RR: 0.94; 95% CI 0.89 to 0.98) among AGYW after adjusting for covariates. Conclusions Community-level interventions that foster the development of collective efficacy may reduce IPV among AGYW.
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| 10. |
- Lippman, Sheri A., et al.
(författare)
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Communities can mobilize to test : findings from a community randomized trial of a theory-based community mobilization intervention in South Africa
- 2015
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Ingår i: Journal of the International AIDS Society. - : John Wiley & Sons. - 1758-2652. ; 18:S4, s. 94-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: While community mobilization (CM) is a powerful toolto increase and sustain demand for HIV testing services, few rigoroustrials of CM interventions have been conducted. We implementeda theory-driven CM intervention in order to improve HIV outcomesin 22 communities participating in a community randomized trial(CRT) in a rural area of Mpumalanga Province, South Africa. Themobilization activities were designed to improve community collaboration to address HIV and inequitable gender norms.Methods: Cross-sectional surveys were conducted with 5055residents ages 1835 in each village prior to (n=1181; 2012) andfollowing (n=1174; 2014) two years of intensive intervention activities in half of the villages. Intervention activities mapped onto sixdomains of CM: 1) shared concern around HIV, 2) community consciousness, 3) organizational structures, 4) leadership, 5) communitycohesion and 6) collective action. Validated domain measures wereincluded in the surveys and mean community CM scores werecomputed and used to predict HIV testing in the past year for eachdomain and for total CM scores. We used GEE logistic regressionanalysis to assess the effect of village level CM domain scores onindividual-level testing outcomes and included interaction terms toassess intervention effects at follow-up.Results: The overall CM score as well as three of six CM domains,including consciousness, concerns, collective action, were significantlyassociated with HIV testing following the intervention and interactedwith intervention assignment. For example, for every standard deviation increase in community consciousness, the odds of HIV testingincreased for intervention village participants (OR: 1.36, p=<0.01)but not for control village participants. Similar findings for total CMscore (OR: 1.51), shared concerns (OR: 1.62) and collective action (OR:1.45) indicate that the intervention successfully improved HIV testing.Leadership, presence of organizations and community cohesion werenot significantly associated with HIV testing at end line.Conclusions: To our knowledge this is the first CRT assessing atheory-based CM intervention including quantitative measures ofCM domains over time. While not all of the six domains were associated with HIV testing uptake, we found clear evidence that communities can be mobilized and that CM measures are associated withimproved engagement in HIV testing.
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