Gender Norms and Age-Disparate Sexual Relationships as Predictors of Intimate Partner Violence, Sexual Violence, and Risky Sex among Adolescent Gang Members

Experiences of intimate partner violence (IPV) among females with same-sex partners in South Africa: what is the role of age-disparity?

BACKGROUND

South African women have been exposed to epidemic proportions of intimate partner violence (IPV) amongst heterosexual relationships but not much is known about same-sex partnerships. Sexual minorities are excluded from research but are subject to intimate partner violence as much as heteronormative persons. The purpose of this study is to determine the association between age-disparity and IPV outcomes among females with same-sex partners in South Africa.

METHODS

A cross-sectional study of the nationally representative South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM 2017) is used. A weighted sample of 63,567 female respondents identified as having a same-sex partner are analysed. IPV is measured as ever been physically and/ or sexually abused. Any experience of IPV is included in the dependent variable of this study. Descriptive and inferential statistics are used to estimate the relationship between demographic, socioeconomic, age-disparity and IPV.

RESULTS

Almost 16% of females in same-sex relationships experienced IPV and about 22% from younger partners. In female same-sex partnerships, partner age-disparity (OR: 1.30, CI: 1.18 - 1.51), type of place of residence (OR: 2.27, CI: 1.79 - 3.79), highest level of education (OR: 1.07, CI: 0.97 - 1.17), marital status (OR: 1.60, CI: 1.37 - 1.88), and race (OR: 1.47, CI: 1.41 - 1.54) are associated with an increased likelihood of violence.

CONCLUSION

IPV programs that are specifically targeted for non-heteronormative orientations are needed. These programs should promote health equity and safety for non-confirmative sexual identities in the country.

Sexual health variation among gang-involved youth in Washington state: Social ecological implications for research and practice

INTRODUCTION

Gang-involved youth experience greater disparities in sexual health compared to non-gang-involved youth. Yet, little is known about how and why sexual behaviors vary within the youth gang population. Developing relevant and effective service approaches requires an understanding of this variation and the environmental factors that influence patterns of sexual health risk.

METHODOLOGY AND RESULTS

Using latent class analysis, we identified four sexual behavior classes within a school-based sample of gang-involved youth in Washington State (N = 2060): Non-Sexually Active (54%), Limited Partners with Condom Use (14%), Multiple Partner with Sexting (19%), and High Sexual Vulnerability (13%). These classes were distinguished by age at sexual debut, number of sexual partners, condom use, and sexting. Interpersonal and macrosocial factors differentiated the classes, including multiform violence exposures, limited social support, and socioeconomic instability. We also found differences according to sexual identity and substance use.

DISCUSSION

Findings highlight the need for service approaches that are responsive to both the individual needs of gang-involved youth and the factors that shape their living environments. We discuss the implications for research and practice, including the potential utility of a harm reduction framework to promote sexual health and reduce disparities in the youth gang population.

Prevalence and Factors Associated with Illicit Drug and High-Risk Alcohol Use among Adolescents Living in Urban Slums of Kampala, Uganda

Background

Illicit drug and high risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence, and factors associated with illicit drug and high-risk alcohol consumption.

Methods

We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25-March-2019 to 30-March 2020. Data was collected on social-demographics, sexual behavior and reproductive health using interviewer administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression.

Results

We enrolled 490 participants (60.6% female) with median age 18 (IQR 17-18) years, 91.0% had less than secondary education, 48.4% had their sexual debut before 15years, 47.1% reported paid sex in the past 3 months and 24.7% had a sexually transmitted infection (chlamydia, gonorrhea and/ or active syphilis) at enrolment. The prevalence of illicit drug use was 34.9% while 16.1% were screened as high-risk alcohol users. Illicit drug use was associated with being male (aOR 9.62; 95% CI 5.74-16.11), being married (aOR 2.24; 95%CI 1.07-4.68) and having ≥10 paying sexual partners in the past 3 months (aOR 3.13; 95%CI 1.40-6.98). High risk alcohol use was associated with reporting sex work as the main job (aOR 3.19; 95%CI 1.02-9.94) and having experienced physical (aOR 1.96 95%CI 1.01-3.81) or emotional violence (aOR 2.08; 95%CI 1.14-3.82) from sexual partners.

Conclusion

Illicit drug and high-risk alcohol use are prevalent among adolescents involved in high risk sexual behavior and living in urban slums of Kampala. Comprehensive interventions that target substance use among this group of young people are needed and should include measures against intimate partner violence.

"At Least I Didn't Get Raped": A Qualitative Exploration of IPV and Reproductive Coercion among Adolescent Girls Seeking Family Planning in Mexico

Adolescent girls who report intimate partner violence (IPV) are at an increased risk of experiencing reproductive coercion (RC); both these forms of gender-based violence (GBV) are associated with unintended pregnancy. Yet little is known about these experiences among adolescent girls in Mexico. Qualitative data were collected as part of formative research for the adaptation of an evidence-based intervention to address RC and IPV in community health centers in Tijuana, Mexico. From September, 2017 to January, 2018, adolescent girls aged 16 to 20 years old (n = 20) seeking voluntary family planning (FP) services were identified and recruited from two publicly funded community health centers. We conducted semi-structured, in-depth interviews and analyzed the transcripts using inductive and deductive techniques. Participants in this sample commonly described experiencing IPV and RC (including pregnancy coercion and contraceptive sabotage), which many girls reported resulted in unintended pregnancy. Further, participants' narratives and general lack of knowledge on how to cope with IPV or RC illuminated the acceptability of offering GBV prevention intervention within FP clinics serving this population. Findings highlight an urgent need to prevent IPV and RC, and reduce risk for unintended pregnancy among adolescent girls in this region and the potential of FP clinics to serve as a safe space for intervention delivery. Findings contribute to the limited qualitative evidence from Mexico, describing adolescent girl's experiences of IPV and RC, strategies for preventing pregnancy in the context of RC, and opportunities for support from FP providers.

OlaOlorun F, Koffi AK, Radloff S, Ahmed S, O. Tsui A. Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings

BACKGROUND

Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence [IPV], partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/"stealthing", reproductive coercion, ability to refuse sex, and contraceptive confidence).

METHODS

Cross-sectional surveys were conducted with unmarried, currently-partnered AGYW aged 15-24 recruited via respondent-driven sampling in Abidjan, Côte d'Ivoire (n = 555; 2018-19), Nairobi, Kenya (n = 332; 2019), and Lagos, Nigeria (n = 179; 2020). Descriptive statistics, Venn diagrams, and multivariate regression models characterized relationship power imbalances, and associations with reproductive autonomy threats and contraceptive use.

FINDINGS

Relationship power imbalances were complex and concurrent. In current partnerships, partner-related fears were common (50.4%Nairobi; 54.5%Abidjan; 55.7%Lagos) and physical IPV varied (14.5%Nairobi; 22.1%Abidjan; 9.6%Lagos). IPV was associated with reproductive coercion in Nairobi and Abidjan. Age disparate relationships undermined confidence in contraception in Nairobi. In Nairobi and Lagos, transactional sex outside the relationship was associated with condom stealthing.

INTERPRETATION

AGYW face simultaneous gendered power differentials, against the backdrop of gendered social and economic systems. Power imbalances were linked with coercive sexual/reproductive health experiences which are often underrecognized yet represent a potent link between gendered social systems and poor health. Pregnancy prevention efforts for AGYW must address reproductive autonomy threats, and the relational power imbalances and broader gendered systems that enable them.

Good Lives Model: Importance of Interagency Collaboration in Preventing Violent Recidivism

Violence is a complex and multifaceted problem requiring a holistic and individualized response. The Good Lives Model (GLM) suggests violence occurs when an individual experiences internal and external obstacles in the pursuit of universal human needs (termed primary goods). With a twin focus, GLM-consistent interventions aim to promote attainment of primary goods, whilst simultaneously reducing risk of reoffending. This is achieved by improving an individuals’ internal (i.e., skills and abilities) and external capacities (i.e., opportunities, environments, and resources). This paper proposes that collaborations between different agencies (e.g., psychological services, criminal justice systems, social services, education, community organizations, and healthcare) can support the attainment of primary goods through the provision of specialized skills and resources. Recommendations for ensuring interagency collaborations are effective are outlined, including embedding a project lead, regular interagency meetings and training, establishing information sharing procedures, and defining the role each agency plays in client care.

Male Perpetration of Adolescent Dating Violence: A Scoping Review

Male violence against females most often occurs within intimate relationships, and when that occurs during youth, it is termed adolescent dating violence (ADV). A scoping review focused on male perpetration of ADV was conducted to synthesize existing evidence and offer insights about what influences male adolescents to perpetrate ADV. The current scoping review explored the findings drawn from 16 research studies conducted in the United States, Spain, South Africa, and Italy, to distil modifiable factors related to male perpetration of ADV. Three themes were extrapolated from the 16 studies: (a) entitlement; (b) adverse childhood experiences (ACE); and (c) ineffective conflict management. Entitlement as a theme was characterized by attitudes and beliefs aligning to violence, hierarchical and marginalizing masculine norms, traditional gender roles, and male superiority, which in various configurations influenced the perpetration of ADV. ACE as a theme highlighted how male adolescents who had experienced, observed, and/or initiated abuse were at increased risk of perpetrating ADV. Male adolescents with ineffective conflict management (theme 3), including alcohol use and/or emotional dysregulation, were also at higher risk of perpetrating ADV. Tailored prevention efforts are often delinked from issues of male entitlement, ACE, and ineffective conflict management; therefore, we make suggestions for trauma-informed care to guide primary care providers (PCPs) in the assessment and management of ADV.

Analysis of Sexual Inhibition and Satisfaction from a Gender Perspective among University Students

University is characterized by a critical stage where students experience their sexuality, across a range of relationships. From these experiences, university students consolidate their personality and their sexual role. Factors such as age, sex, or traumatic experiences of violence or sexual abuse can affect their sexual role. The present study aims to analyze how the variables age, sex and having suffered abuse or violence may predict sexual satisfaction and inhibition. In addition, we analyze the mediating effect that sexual role plays on these relationships. For this purpose, Bem Sex Role Inventory (BSRI-12), Sociosexual Orientation Inventory (SOI-R), Inhibited Sexual Desire Test (ISD) and New Sexual Satisfaction Scale (NESS) were administered to 403 university students. The findings report that sex (β = −0.313), age (β = −0.116) and being a survivor of sexual assault (β = 0.413) are predictive of male role, but not from the female role. Also, people with more male features tend to have lower levels of commitment and inhibition than those who have more female ones.

Sexual Self-Concept in Fertile and Infertile Women: A Comparative Study

Background

Sexual self-concept has a considerable impact on mental and sexual health. However, the relationship between sexual self-concept and infertility is unknown. This study aimed to compare sexual self-concept between fertile and infertile women.

Materials and Methods

This cross-sectional study was conducted on a sample of 250 fertile and 250 infertile women who had referred to 9 health centers affiliated to Medical universities in Tehran and Royan infertility treatment clinics in Tehran, Iran in 2017. Sexual self-concept was measured using the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ) consisting of 20 subscales. Analysis of covariance (ANCOVA) was performed to compare sexual self-concept between the two groups.

Results

The mean age of fertile and infertile women was 34 ± 5.62 and 29.74 ± 5.29 years, respectively. The high- est score in both groups was for the sexual self-schemata subscale (mean score for fertile=3.21 ± 0.68 and for infer- tile=3.42 ± 0.62). The lowest score was for sexual-depression subscale (mean score for fertile=0.59 ± 0.81 and for infertile=0.61 ± 0.76). After adjustment for the age of each subject, the husband's age, duration of marriage, and wom- en’s education, we analyzed the sexual-satisfaction, the power-other sexual control, and the fear-of-sex subscales, which were found to be significantly lower in infertile women (P<0.05). No other significant differences between the fertile and infertile groups were observed.

Conclusion

We observed significant differences between fertile and infertile women in terms of sexual-satisfaction, the power-other sexual control, and the fear-of-sex, but not in other sexual self-concept subscales. These findings sug- gest that there is need to improve sexual self-concept among both fertile and infertile women. Indeed implementation of educational and counseling programs by reproductive health specialists might play an important role in enhancing sexual self-concept among these populations.

Community perceptions of transactional sex with children and adolescent girls, a qualitative study in favelas of Rio de Janeiro

The sexual exploitation of children and adolescents is a frequently underestimated health problem which includes transactional sex (TS), or the practice of sexual activity based on an expected return of benefits, favours and/or support in some form. This qualitative study focuses on age-disparate transactional sex (ATS) in urban favela communities of Rio de Janeiro between adult men (over 18) and girls and adolescents (G/A) (under 18), involving a minimum 5-year age disparity. We have employed social norms theory as a framework to identify the prevailing social norms contributing to or protecting children and adolescents from these relationships. Data collection utilised semi-structured interviews (n = 30) and ten focus groups with a total of 130 men/boys and women/girls selected through purposive sampling and varying in age from 15 to 65. Overall the findings identify factors, especially the essentialisation of gender, which promote the acceptability of ATS. When ATS surpassed the acceptability threshold, social norms discouraged direct interference. Concluding remarks point to possible strategies for reducing the occurrence of ATS. These must include girls, boys, women and men with community involvement in the deconstruction of social norms involving gender, age and economic consumption.

Multiple Marginality and the Variation in Delinquency and Substance use Among Adolescent Gang Members

BACKGROUND

Gang membership is a significant contributor to delinquency and violent victimization among adolescents. Yet, there is considerable variability in the extent to which gang members engage in delinquency and substance use, and previous research suggests factors beyond the individual level are important to consider.

OBJECTIVES

Using the multiple marginality framework, this study examines the factors related to the family, school, and neighborhood contexts that may contribute to delinquency and substance use among current gang members.

METHODS

Between 2013 and 2015, we conducted quantitative surveys with 449 self-identified gang members between the ages of 14 and 19 years old in Milwaukee, Wisconsin. Surveys included measures to assess delinquency, substance use, parental involvement, educational attainment, drug distribution, and police involvement. We ran simple and multiple regressions to assess the relationship between family, school, and neighborhood factors and delinquency and substance use.

RESULTS

Regression analyses revealed several significant predictors of delinquency and substance use among adolescent gang members including parental substance use and incarceration, school safety, police contact, and neighborhood disorder.

CONCLUSIONS

Family and school factors are likely important protective factors against delinquency and substance use among gang members. Interventions at the family and community level may be particularly important in reducing poor health and social outcomes for adolescent gang members.

Food insecurity, sexual risk taking, and sexual victimization in Ghanaian adolescents and young South African adults

OBJECTIVES

The objectives of this study were to examine whether food insecurity is associated with sexual risk taking and victimization in young people (aged 16-24); and to investigate whether the relationship of food insecurity with sexual risk taking and victimization is moderated by gender.

METHODS

Cross-sectional data were obtained in 2014 from a sample of Ghanaian adolescents (n = 773) and in 2015 from young South African adults (n = 823). We used multilevel logistic regression given the study's binary outcome and clustered data. We tested a moderation effect of gender by including an interaction between gender and food insecurity.

RESULTS

Food insecurity was highly prevalent (72% in Ghana and 83% in South Africa). Food insecurity was significantly associated with unwanted sexual contact among Ghanaian adolescents (OR 1.05, 95% CI 1.02, 1.08) and age-disparate sex among young South African adults (OR 1.03, 95% CI 1.00, 1.06). Results indicated no moderating effect of gender.

CONCLUSIONS

Our findings underscore the importance of food access on young people's sexual health, regardless of gender. Prevention efforts may be more relevant when integrated with food security interventions that target vulnerable adolescents and young adults, irrespective of gender.

Gender role attitudes, awareness and experiences of non-consensual sex among university students in Shanghai, China

BACKGROUND

Non-consensual sex (NCS) among young people, an important subject with public health and human rights implications, was less studied in China. This study is to investigate the NCS awareness and victimization of university students in Shanghai, China and whether they were associated with adolescent gender-role attitudes.

METHODS

Gender-role attitudes, awareness and victimization of different forms of NCS were examined among 1099 undergraduates (430 males and 669 females) in four universities in Shanghai using computer-assisted self-interview approach.

RESULTS

University students held relatively egalitarian attitude to gender roles. Gender difference existed that girls desired to be more equal in social status and resource sharing while more endorsed the submissiveness for women in sexual interaction than boys. They held low vigilance on the risk of various forms of NCS, with the mean score on perception of NCS among boys (5.67) lower than that among girls (6.37). Boys who adhered to traditional gender norms were less likely to aware the nature of NCS (β = - 0.6107, p = 0.0389). Compared with boys, higher proportion of girls had been the victims of verbal harassment, unwanted touch, fondling, and penetrative sexual intercourse. Multivariable analysis revealed that girls who held more traditional gender-role attitudes were more vulnerable to physical NCS (OR = 1.41, p = 0.0558).

CONCLUSIONS

The weakening but still existing traditional gender norms had contributions in explaining the gender difference on the low vigilance of NCS and higher prevalence of victimization among university students in Shanghai, China. Interventions should be taken to challenge the traditional gender norms in individual and structural level, and promote the society to understand the nature of NCS better as well as enhance negotiation skills of adolescents and young people that prevent them from potentially risky situations or relationships.