"Protect Your Loved Ones From Fataki": Discouraging Cross-Generational Sex in Tanzania

'I trap her with a CD, then tomorrow find her with a big old man who bought her a smart phone'. Constructions of masculinities and transactional sex: a qualitative study from North-Western Tanzania

Men's role in transactional sex is relatively unexplored, limiting initiatives to prevent exploitative transactional sex and its negative health implications for girls and women. We addressed this literature gap by conducting eight focus group discussions and twenty in-depth-interviews with boys and men aged 14 - 49 years in 2015 in Tanzania. We employed a novel combination of theoretical perspectives - gender and masculinities, and social norms - to understand how transactional sex participation contributes to perpetuating gendered hierarchies, and how reference groups influence men's behaviour. Findings signal two gender norms that men display within transactional sex: the expectation of men's provision in sexual relationships, and the expectation that men should exhibit heightened sexuality and sexual prowess. Adherence to these expectations in transactional sex relationships varied between older and younger men and created hierarchies among men and between men and women and girls. We found that approval of transactional sex was contested. Although young men were likely to object to transactional sex, they occupied a structurally weaker position than older men. Findings suggest that interventions should employ gender synchronised and gender transformative approaches and should prioritise the promotion of alternative positive norms over preventing the exchange of gifts or money in relationships.

Sexual risk behaviors, mental health outcomes and attitudes supportive of wife-beating associated with childhood transactional sex among adolescent girls and young women: Findings from the Uganda Violence Against Children Survey

Compared to young men, Ugandan young women are disproportionately impacted by HIV. Childhood transactional sex may contribute to this disparity. Using data from the 2015 Uganda Violence Against Children Survey, we used logistic regression models to assess the association between childhood transactional sex and negative outcomes. Among 18-24-year-old young women who had sex prior to 18 (n = 982), those who ever engaged in transactional sex had 5.9 times [adjusted odds ratio (AOR); confidence interval (CI): 1.6–22.2] higher odds of having multiple sexual partners in the past year; 5.2 times (AOR; CI: 2.1–12.9) higher odds of infrequent condom use in the past year; 3.0 times (AOR; CI: 1.2–7.9) higher odds of hurting themselves intentionally; and 3.2 times (AOR; CI: 1.3–7.7) higher odds of having attitudes justifying spousal abuse than young women who never engaged in transactional sex. Interventions for transactional sex and HIV in Uganda should consider prioritizing prevention, harm-reduction and continued investment in adolescent girls’ and young women’s futures.

Comprehensive sexuality education is 'not for us': Rethinking 'cultural relevance' through Young Tanzanians' identifications with/against intervention knowledge

The need for comprehensive sexuality education (CSE) to be culturally relevant and inclusive is increasingly recognised as a fundamental aspect of supporting young people to live healthy sexual lives. Nevertheless questions remain about how to represent cultures and difference without subtly reinforcing inequalities. This paper makes a case for the need to explore this issue through analyses of how different gendered and demographic groups of young Tanzanian attendees of culturally relevant CSE, identify with (or against) intervention knowledge[s]. Grounded in dialogical social psychological theorising, we present a methodological approach for exploring how processes of belonging and Othering structure young people's negotiations of culturally relevant CSE amongst other knowledges. An adapted version of the 'story completion' method was used with university students and urban-poor young people (aged 18-34) to instigate dialogues about how a fictional protagonist might think, feel, and act in their relationship, looking to see if, and how, young people incorporated CSE knowledge. Twelve single-gendered focus-group discussions were held in September 2014 with 48 young people, and then findings from these were discussed further with 27 returning young people through three mixed-gendered workshops in August 2015. The analyses highlight how young Tanzanians explicitly Other CSE interventions, positioning their knowledge as 'not for us'. More implicitly, difference is also constructed around ideas about change and gendered development, along with trust and support in relationships. The devices used to Other shifted and differed across demographic groups, ranging from complete denials of intervention knowledge to viewing it as unrealistic, dangerous, or self-stigmatised for not being able to use it. We propose that these findings highlight the need to rethink how both 'culture' and 'relevance' are conceptualised in CSE, most specifically necessitating greater recognitions of poverty, transnationality, and the lasting legacies of colonialism and behaviour change interventions that communicated through fear and morality.

Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents

BACKGROUND

Despite growing interest in the role of social norms in perpetuating the harmful practice of sexual exploitation of children and adolescents (SECA), little is known about the state of the literature on this issue.

OBJECTIVE

This systematic review aims to summarize what associated norms, attitudes and factual beliefs have been identified by the SECA literature worldwide.

METHODS

Multiple database searches were conducted using controlled vocabulary and keywords referring to SECA.

RESULTS

Our searches identified 3690 unique references. After applying our exclusion criteria, 49 studies, including over 14,000 participants from 37 countries and most world regions, were included. Across studies we identified six injunctive norms perpetuating SECA: owning goods as a social status marker ; being sexually active; exchanging sex for favors; contributing financially to the household; stigma and discrimination against young people who experienced SECA; and lack of social sanctions for SECA perpetrators. These norms were supported by enhanced tolerance of SECA when it involved older or more physically developed adolescents and when it occurred in poverty-affected contexts. Beliefs around markers that denote adolescents' readiness for sex; men's entitlement to sex; and the perceived benefits of intergenerational relationships, also contributed to the maintenance and reproduction of SECA. Findings from all regions suggested that marginalized young people are particularly vulnerable to SECA.

CONCLUSIONS

Interventions to reduce SECA must consider individual, social, and structural factors and how they interrelate. Context-specific social norms interventions are needed to address harmful norms, promote protective norms, and improve services for those who have experienced SECA.

"Eat and you will be eaten": a qualitative study exploring costs and benefits of age-disparate sexual relationships in Tanzania and Uganda: implications for girls' sexual and reproductive health interventions

BACKGROUND

Age-disparate sex is associated with increased HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, little has been done to understand the dynamics of such relationships from the perspectives of either AGYW or older men, and the communities in which these relationships are embedded. This article explores the motivations and perceived benefits of such relationships for AGYW and older men, plus the social and sexual and reproductive health (SRH) consequences.

METHODS

This study held 37 participatory focus group discussions and 87 in-depth interviews with young people aged 14-24 and adult community members aged 25-49 in rural and urban Tanzania and Uganda. Participants were sampled using purposive and snowball techniques. Thematic analysis was conducted with the aid of NVIVO 10 software.

RESULTS

Motivations, perceived benefits and costs for AGYW centred around four main themes: financial motivations, emotional support, meeting social expectations and reflections on sexual health. Specifically, AGYW noted that older partners gave gifts/money of higher value compared with younger men. Men's perceived benefits and costs revolved around the need to satisfy their sexual desire, the perception that AGYW were capable of engaging in new and creative sexual styles and their desire for prestige among male peers. Both AGYW and men recognised the social and SRH consequences as: risk of violence, social stigma, risk of unplanned pregnancy and risk of sexually transmitted infections including HIV.

CONCLUSION

Interventions need to acknowledge the perceived benefits of age-disparate sexual relationships for AGYW and older men and engage them in critical reflection on the medium- to longer-term consequences versus the shorter-term satisfaction of needs, desires and aspirations, as a way to navigate the constrained opportunities they face given existing structural limitations. Interventions should also tackle the structural constraints AGYW face by helping them access resources, become empowered and challenge the expectation of having to depend financially on men. Interventions with men should unpack the assumption that men are naturally hypersexual. The role of peers for both girls and men should be acknowledged, and a shift from individual targeted interventions to changing norms at the community level should be considered.

A community-based intervention for improving health-seeking behavior among sexual violence survivors: a controlled before and after design study in rural Tanzania

BACKGROUND

Despite global recognition that sexual violence is a violation of human rights, evidence still shows it is a pervasive problem across all societies. Promising community intervention studies in the low- and middle-income countries are limited.

OBJECTIVE

This study assessed the impact of a community-based intervention, focusing on improving the community's knowledge and reducing social acceptability of violence against women norms with the goal to prevent and respond to sexual violence.

DESIGN

The strategies used to create awareness included radio programs, information, education communication materials, and advocacy meetings with local leaders. The intervention took place in Morogoro region in Tanzania. The evaluation used a quasi-experimental design including cross-sectional surveys at baseline (2012) and endline (2014) with men and women aged 18-49 years. Main outcome measures were number of reported rape cases at health facilities and the community's knowledge and attitudes toward sexual violence.

RESULTS

The number of reported rape events increased by more than 50% at health facilities during the intervention. Knowledge on sexual violence increased significantly in both areas over the study period (from 57.3 to 80.6% in the intervention area and from 55.5 to 71.9% in the comparison area; p<0.001), and the net effect of the intervention between the two areas was statistically significant (6.9, 95% CI 0.2-13.5, p=0.03). There was significant improvement in most of the attitude indicators in the intervention area, but not in the comparison area. However, the intervention had no significant effect on the overall scores of acceptance attitudes in the final assessment when comparing the two areas (-2.4, 95% CI: -8.4 to 3.6, p=0.42).

CONCLUSIONS

The intervention had an effect on some indicators on knowledge and attitudes toward sexual violence even after a short period of intervention. This finding informs the public health practitioners of the importance of combined strategies in achieving changes.