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Closson K, Zharima C, Kuchena TM, Dietrich JJ, Ogilvie G, Raj A, Beksinska M, Kaida A. Relationship impacts of the COVID-19 pandemic and lockdown restrictions on young women and men in Durban and Soweto, South Africa. CULTURE, HEALTH & SEXUALITY 2024; 26:734-746. [PMID: 37584715 DOI: 10.1080/13691058.2023.2243300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
To deepen our understanding of the impact of the COVID-19 pandemic on intimate and/or sexual relationships, we conducted a qualitative study among 26 South African women and men aged 21-30 years in Durban and Soweto between September 2020 and March 2021. Overall, 13 women and 12 men who had been in an intimate and/or sexual relationship since the start of the COVID-19 pandemic were asked about the impact of COVID-19 on their relationships with their current or most recent primary partners. Data were analysed using reflexive thematic analysis. The three most common impacts of the COVID-19 pandemic on relationships were on (i) communication and connection; (ii) strained relationships; and (iii) job and economic loss. Both women and men discussed how COVID-19-related lockdowns provided opportunities to foster better communication, connection and support to one another. However, too little or too much time together strained relationships. Finally, income loss among young men meant that some young women became the primary income earner, changing relationship power dynamics. Findings highlight the importance of young people's relationships and the need for action to support young people in building positive relationships in challenging times.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Campion Zharima
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - T Michelle Kuchena
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Janan J Dietrich
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Anita Raj
- Center on Gender Equity and Health, University of CA, San Diego, CA, US
- Newcomb Institute, Tulane University, New Orleans, LA, US
| | - Mags Beksinska
- Maternal, Adolescent and Child Health Research Unit, University of the Witwatersrand, Durban, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Thomas D, Nakabugo L, Nambi F, Kibuuka J, Muwonge TR, Feutz E, Thomas KK, Simoni JM, Montgomery ET, Ware N, Wyatt MA, Katz IT, Kadama H, Mujugira A, Heffron R. Intimate Partner Violence and Adherence to PrEP and ART Among Ugandan HIV Serodifferent Couples. J Acquir Immune Defic Syndr 2024; 95:347-354. [PMID: 38133584 PMCID: PMC10896193 DOI: 10.1097/qai.0000000000003368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Intimate partner violence (IPV) is associated with increased risk of HIV acquisition and reduced engagement in HIV care. There is limited understanding of the ways in which IPV exposure and other maladaptive relationship dynamics may influence adherence to antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for individuals in committed, HIV serodifferent partnerships. METHODS We used binomial generalized linear mixed-effect regression models to evaluate the association between IPV exposure and ART/PrEP adherence among members of serodifferent couples in Uganda. Secondarily, we assessed the association between relationship powerlessness and ART/PrEP adherence. RESULTS We enrolled and followed both partners in 149 heterosexual serodifferent couples. The partner living with HIV was female in 64% of couples. IPV exposure was associated with low ART adherence (15% vs. 5% in quarters with no IPV, odds ratio: 4.78, 95% confidence interval: 1.48 to 15.42), but not low PrEP adherence (33% vs. 36%, P = 0.69). Among HIV-negative individuals, those reporting moderate relationship powerlessness were less likely to have poor PrEP adherence compared with those with low relationship powerlessness (20% vs. 30%, odds ratio: 0.57, 95% confidence interval: 0.36 to 0.90). We observed no association between relationship powerlessness and ART adherence. CONCLUSIONS We found that IPV exposure was associated with low adherence to ART and that relationship powerlessness was associated with good adherence to PrEP. These findings contribute to the evidence base outlining the influence of IPV and relationship power on ART/PrEP adherence for individuals in HIV serodifferent unions.
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Affiliation(s)
- Dorothy Thomas
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Florence Nambi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Joseph Kibuuka
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Jane M. Simoni
- Department of Global Health, University of Washington, Seattle, WA
- Department of Psychology, University of Washington, Seattle, WA
| | - Elizabeth T. Montgomery
- Women's Global Health Imperative, RTI International, Berkeley, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Norma Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Monique A. Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Harvard Global, Cambridge, MA
| | | | | | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, WA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
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Logie CH, Okumu M, Admassu Z, Perez-Brumer A, Ahmed R, Luna ML, MacKenzie F, Kortenaar JL, Berry I, Hakiza R, Katisi B, Musoke DK, Nakitende A, Batte S, Kyambadde P, Taing L, Giordana G, Mbuagbaw L. HIV Vulnerabilities Associated with Water Insecurity, Food Insecurity, and Other COVID-19 Impacts Among Urban Refugee Youth in Kampala, Uganda: Multi-method Findings. AIDS Behav 2024; 28:507-523. [PMID: 38048017 DOI: 10.1007/s10461-023-04240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16-24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus groups (n = 4), and a cross-sectional survey (n = 340) with refugee youth, and IDI with key informants (n = 15). Quantitative data was analysed via multivariable logistic and linear regression to assess associations between FI and WI with: reduced pandemic sexual and reproductive health (SRH) access; past 3-month transactional sex (TS); unplanned pandemic pregnancy; condom self-efficacy; and sexual relationship power (SRP). We applied thematic analytic approaches to qualitative data. Among survey participants, FI and WI were commonplace (65% and 47%, respectively) and significantly associated with: reduced SRH access (WI: adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.19-3.08; FI: aOR: 2.31. 95%CI: 1.36-3.93), unplanned pregnancy (WI: aOR: 2.77, 95%CI: 1.24-6.17; FI: aOR: 2.62, 95%CI: 1.03-6.66), and TS (WI: aOR: 3.09, 95%CI: 1.22-7.89; FI: aOR: 3.51, 95%CI: 1.15-10.73). WI participants reported lower condom self-efficacy (adjusted β= -3.98, 95%CI: -5.41, -2.55) and lower SRP (adjusted β= -2.58, 95%CI= -4.79, -0.37). Thematic analyses revealed: (1) contexts of TS, including survival needs and pandemic impacts; (2) intersectional HIV vulnerabilities; (3) reduced HIV prevention/care access; and (4) water insecurity as a co-occurring socio-economic stressor. Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth.
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Affiliation(s)
- Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada.
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rushdia Ahmed
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Marianne Lahai Luna
- Department of Geography and Planning, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Jean-Luc Kortenaar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | - Brenda Katisi
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | | | - Shamilah Batte
- Organization for Gender Empowerment and Rights Advocacy (OGERA) Uganda, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS Control Program, Ministry of Health, Kampala, Uganda
- Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
| | - Lina Taing
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
| | - Gio Giordana
- World Food Programme East Africa, Nairobi, Kenya
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Closson K, Zharima C, Kuchena M, Dietrich JJ, Gadermann A, Zulu B, Ogilvie G, Beksinska M, Kaida A. " It's a 50/50 Thing You Know": Exploring the Multileveled Intersections of Gender and Power Within the Relationships of Young South African Men and Women. JOURNAL OF SEX RESEARCH 2024; 61:144-159. [PMID: 36260421 DOI: 10.1080/00224499.2022.2129561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Efforts to advance sexual health globally require greater understandings of youth intimate relationship dynamics. Among 38 South African youth (21 women/17 men aged 21-30 from Durban and Soweto) we conducted qualitative cognitive interviews to explore how gender and power intersect to shape intimate relationship dynamics (October 2019-March 2021). Participants discussed perceptions and relevance of each of 13 items comprising the Sexual Relationship Power (SRP) scale, a widely used measure of gender equity, and the influence of SRP on youth sexual health. Data analysis was guided by constructivist grounded theory. The findings were organized using the socio-ecological model, revealing how gender and power intersected at multiple levels to influence youth intimate relationships. Key influencing factors included individual-level gender attitudes, male partner expectations, and women's resistance to dominance; intimate relationship-level power dynamics, consent, and intimacy; family-level household configurations and parental monitoring of daughters; and societal-level traditional gender norms. At all levels, women discussed resisting power inequities through communication and rejection of inequitable relationships. While men also displayed resistance to inequitable power structures, most upheld traditional gender norms through institutional affiliation (e.g. church) and deep-rooted socialized beliefs and attitudes. Efforts to improve youth sexual health require multileveled approaches that address inequitable power dynamics.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia
| | - Campion Zharima
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand
- Centre for Health Policy, School of Public Health, University of the Witwatersrand
| | - Michelle Kuchena
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia
| | - Bongiwe Zulu
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia
| | - Mags Beksinska
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University
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Closson K, Zulu B, Jesson J, Dietrich JJ, Pakhomova T, Basham CA, Beksinska M, Kaida A. Examining gender and sexual orientation differences in physical intimate partner violence experienced and perpetrated by youth living in eThekwini district South Africa during the COVID-19 pandemic. BMC Public Health 2023; 23:2300. [PMID: 37990170 PMCID: PMC10664660 DOI: 10.1186/s12889-023-17199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Young women and Lesbian, Gay, Bisexual, Trans, Non-binary/no gender, or Questioning (LGBTQ+) youth in South Africa face some of the highest global levels of intimate partner violence (IPV). Given limited evidence in the wake of the COVID-19 pandemic, which has fuelled IPV globally, we aimed to describe and compare experiences and perpetration of IPV of youth aged 16-24 by sexual orientation and gender identity (SOGI). METHODS During the study period (December 2021-May 2022), youth aged 16-24 from eThekwini district, South Africa completed an online survey to understand multilevel impacts of the pandemic on youth. Participants were asked about experiences and perpetration of physical IPV since the start of the COVID-19 pandemic (March 2020). Descriptive statistics and adjusted logistic regressions compared the likelihood of experiencing and/or perpetrating physical IPV between cisgender and transgender inclusive heterosexual men; heterosexual women; gay, bisexual, or questioning men [GBQM]; lesbian, gay, bisexual, or questioning women [LGBQW]; or gender/sexual non-conforming youth [non-conforming]. RESULTS Of 1,588 youth (mean age = 21.7 [SD = 2.3]; 71.7% Black) with non-missing SOGI and physical IPV data, 238 (15.0%) were LGBTQ+ (40.3% LGBQW and 36.1% non-conforming). Overall, 14.6% of respondents experienced physical IPV and 9.8% perpetrated physical IPV since the start of the pandemic, which differed by SOGI (12.3% of heterosexual men, 13.9% of heterosexual women, 22.0% of GBQM, 18.2% of LGBQW, and 25.0% of non-conforming youth experienced and 10.3% of heterosexual men; 7.7% of heterosexual women; 10.0% of GBQM; 18.2% of LGBQW; and 16.7% of non-conforming youth perpetrated). In adjusted models, compared to heterosexual women, non-conforming youth had increased odds of experiencing (adjusted odds ratio [aOR] = 2.36; 95%CI, 1.26-4.39) physical IPV and compared to heterosexual men, non-conforming youth had greater odds of perpetrating physical IPV (aOR = 2.19; 95%CI, 1.07-4.48) during the pandemic. CONCLUSION Over one in six youth in our study experienced and one in ten perpetrated physical IPV since the onset of the COVID-19 pandemic, with gender and sexual non-conforming youth experiencing and perpetrating IPV at significantly greater rates than cisgender/heterosexual peers. Our findings highlight the need for gender transformative efforts that move beyond the gender binary to support healthy relationships and IPV prevention for LGBTQ + youth in South Africa and globally.
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Affiliation(s)
- Kalysha Closson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Center on Gender Equity and Health, School of Medicine, University of California, San Diego, California, USA
| | - Bongiwe Zulu
- Maternal Adolescent and Child Health Research Unit (MRU), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Julie Jesson
- Center for Epidemiology and Research in POpulation Health (CERPOP), Université de Toulouse, Toulouse, France
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tatiana Pakhomova
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - C Andrew Basham
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Mags Beksinska
- Maternal Adolescent and Child Health Research Unit (MRU), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
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Rousseau E, Wu L, Heffron R, Baeten JM, Celum CL, Travill D, Delany-Moretlwe S, Bekker LG, Bukusi E, Omollo V, van der Straten A, O’Malley G, Haberer JE, Morton JF, Johnson RE, Roberts ST. Association of sexual relationship power with PrEP persistence and other sexual health outcomes among adolescent and young women in Kenya and South Africa. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1073103. [PMID: 37325240 PMCID: PMC10266091 DOI: 10.3389/frph.2023.1073103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Gendered power inequalities impact adolescent girls' and young women's (AGYW) sexual and reproductive health (SRH) outcomes. We investigated the influence of sexual relationship power on AGYW's SRH outcomes, including HIV pre-exposure prophylaxis (PrEP) persistence. Methods The POWER study in Kisumu, Kenya, and Cape Town and Johannesburg, South Africa provided PrEP to 2,550 AGYW (aged 16-25). AGYW's perceived power in their primary sexual relationship was measured among the first 596 participants enrolled using the Sexual Relationship Power Scale's (SRPS) relationship control sub-scale. Multivariable regression was used to test for (1) key sociodemographic and relationship characteristics associated with relationship power; and (2) the association of relationship power with SRH outcomes including PrEP persistence. Results In this cohort, the mean SRPS score was 2.56 (0.49), 542 (90.9%) initiated PrEP; 192 (35.4%) persisted with PrEP at 1 month of which 46 (24.0% of 192) persisted at 6 months. SRPS were significantly lower among AGYW who cohabited with their sex partner (-0.14, 95% CI: -0.24 to -0.04, p = 0.01), or had ≥1 sex partner (-0.10, 95% CI: -0.19 to -0.00, p = 0.05). AGYW with lower SRPS were more likely to not know their partner's HIV status (aOR 2.05, 95% CI: 1.27 to 3.33, p < 0.01), but SRPS was not associated with PrEP persistence, STI infection, condom, or hormonal contraception use. Discussion AGYW's reasons for initiating PrEP and reasons for continuously using PrEP may be different. While low relationship power was associated with perceived HIV vulnerability, AGYW's PrEP persistence may be influenced by more than relationship power.
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Affiliation(s)
- Elzette Rousseau
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Linxuan Wu
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Renee Heffron
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Jared M. Baeten
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
- Gilead Sciences, Inc., Seattle, WA, United States
| | - Connie L. Celum
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Danielle Travill
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | | | - Ariane van der Straten
- Department of Medicine, Centre for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
- Astra Consulting, Kensington, CA, United States
| | - Gabrielle O’Malley
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Jessica E. Haberer
- Harvard Medical School, Harvard University, Boston, MA, United States
- Centre for Global Health, Massachusetts General Hospital, Boston, MA, United States
| | - Jennifer F. Morton
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Rachel E. Johnson
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Sarah T. Roberts
- RTI International, Women’s Global Health Imperative (WGHI), Berkeley, CA, United States
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Kabir R, Alradie-Mohamed A, Ferdous N, Vinnakota D, Arafat SMY, Mahmud I. Exploring Women's Decision-Making Power and HIV/AIDS Prevention Practices in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16626. [PMID: 36554507 PMCID: PMC9778757 DOI: 10.3390/ijerph192416626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Decisions regarding sexual and reproductive health significantly impact women's health and their protection against HIV/AIDS and other sexually transmitted infections. These decisions also impact females' ability to reach their reproductive goals. Women's autonomy is recognized to be vital to women's access to reproductive healthcare, the use of contraceptives, the capacity to avoid or receive treatment for STIs (including HIV), and other reproductive and sexual health issues. This research investigated the association between the decision-making power of South African women (of reproductive age) and their knowledge and practices regarding HIV/AIDS preventive measures. The present study used data from the South Africa Demographic and Health Survey 2016. A total of 8514 women aged 15-49 years who participated in the survey were used for this research. The mean age of the women was 30.21 years, with an SD of 9.86. Approximately 38.5% of the women decided on contraceptive use, and only 11.7% of women's partners and 49.8% of respondents were jointly involved in the decision-making process of contraceptive use. All HIV preventive measures under study were statistically significantly associated with high decision-making power; the use of a condom by the husband or partner of the women was the most significant; husbands or partners of the women with high autonomy were three times more likely to use condoms.
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Affiliation(s)
- Russell Kabir
- School of Allied Health, Anglia Ruskin University, Chelmsford CM11SQ, UK
| | | | | | - Divya Vinnakota
- Department of Nursing and Public Health, The University of Sunderland, London E14 9SG, UK
| | | | - Ilias Mahmud
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah 52741, Saudi Arabia
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Hill AV, Hill AL, Jackson Z, Gilreath TD, Fields A, Miller E. Adolescent Relationship Abuse, Gender Equitable Attitudes, Condom and Contraception Use Self-Efficacy Among Adolescent Girls. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22329-NP22351. [PMID: 35324369 PMCID: PMC9549914 DOI: 10.1177/08862605221080976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Introduction: Experiencing adolescent relationship abuse (ARA) negatively impacts sexual health and influences risk behaviors of adolescent girls. ARA may be associated with more inequitable gender attitudes among girls, a potentially modifiable factor in violence prevention. This study examines the association among gender equitable attitudes, experiences of ARA, and sexual behaviors among girls participating in Sisterhood 2.0, a community-based violence prevention program implemented in low resource neighborhoods. Methods: Data were from baseline surveys collected for Sisterhood 2.0 implemented in Pittsburgh, PA. Participant demographics, gender equitable attitudes, self-efficacy to use condoms with partners, and self-efficacy to select appropriate contraception were assessed. A latent class analysis (LCA) estimated probability of responses to nine indicators, including sexual behavior self-efficacy and violence. Multigroup LCA by grade (9-12) was also estimated and analyses were performed with SAS V9.4. Results: Female-identified adolescents ages 13-19 (n = 246) were primarily Black (75%) and evenly distributed across grade in school. Sixty-five percent reported emotional relationship abuse and 31% reported physical abuse within the previous nine months. A three-class solution was best fitting for the LCA. Experiences of violence were related to less equitable gender attitudes, being sexually active, and lower condom and contraception self-efficacy. Younger participants who were sexual minorities with less educated heads of household had more experiences with ARA and less equitable gender attitudes. Discussion: Gender equitable attitudes were lower in adolescent girls with greater experiences of ARA and worse condom and contraception self-efficacy. Integrating discussions about healthy sexual relationships and gender equity may be salient factors in violence prevention.
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Affiliation(s)
- Ashley V. Hill
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amber L. Hill
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Zachary Jackson
- Department of Health and Kinesiology, Whitlowe R. Green College of Education, Prairie View A&M University, Prairie View, TX, USA
| | - Tamika D. Gilreath
- Transdisciplinary Center for Health Equity Research, College of Health and Human Development, Texas A&M University, College Station, TX, USA
| | - Alana Fields
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Duby Z, Bergh K, Jonas K, Reddy T, Bunce B, Fowler C, Mathews C. “Men Rule… this is the Normal Thing. We Normalise it and it’s Wrong”: Gendered Power in Decision-Making Around Sex and Condom Use in Heterosexual Relationships Amongst Adolescents and Young People in South Africa. AIDS Behav 2022; 27:2015-2029. [PMID: 36441410 PMCID: PMC10149448 DOI: 10.1007/s10461-022-03935-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/30/2022]
Abstract
AbstractWe examined power and decision-making in heterosexual relationships amongst South African adolescents and young people. A survey conducted with 515 adolescent girls and young women (AGYW) included items from the Sexual Relationship Power Scale (SRPS) adapted for South African women. Qualitative interviews with fifty AGYW aged between 15 and 24, and nine males aged 18 years and above, explored decision-making in heterosexual relationships, particularly relating to timing of sex and condom use. Theories of gendered power, sexual relationship power and sexual scripting were used in interpreting the data. Findings showed that the power AGYW have in sexual relationships determines their ability to use condoms, and that males generally control condom use and timing of sex. Both survey and interview data suggest that male control over female partners’ behaviour also extends beyond the sexual domain. Although while male power is pervasive and enduring, it is simultaneously contested and negotiated. Despite some young people believing that gendered power in decision-making should be equal, it is not always possible for AGYW to enact agency in the dyadic context of heterosexual relationships. Whilst adolescents and young people in South Africa move away from traditional cultural gendered expectations, relationship power inequity and hegemonic masculinities continue to legitimise men’s power over women, constraining the sexual agency of adolescent girls and young women and discouraging them from taking control of their own sexual interests and sexual health.
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Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Brittany Bunce
- Institute for Global Sustainable Development (IGSD), University of Sheffield, Sheffield, UK
| | - Chantal Fowler
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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López-Barranco PJ, Jiménez-Ruiz I, Leal-Costa C, Andina-Díaz E, López-Alonso AI, Jiménez-Barbero JA. Violence in Dating Relationships: Validation of the CADRI Questionnaire in a Young Adult Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11083. [PMID: 36078798 PMCID: PMC9518131 DOI: 10.3390/ijerph191711083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Dating violence in the young adult population is reaching alarming levels. However, the instruments used to measure it and their results are still heterogeneous. The main aim of this study was to validate the Conflict in Adolescent Dating Relationships Inventory questionnaire for a young adult Spanish university population aged between 19 and 25 years old, and to describe the types of violence perpetrated and suffered. MATERIAL AND METHODS Observational, descriptive, cross-sectional study. A validity analysis was carried out through a confirmatory factor analysis. The relative frequencies for each type of violence and the Chi2 test for two dichotomous variables were used to describe the different types of violence perpetrated and suffered. RESULTS The sample consisted of 976 young adults aged 19-25 years old (M = 21.7 years. SD = 1.8). The confirmatory factor analysis had an adequate structure and a good fit to the model. The types of violence perpetrated and suffered were described according to the sex of the participants, with significant differences found for verbal-emotional violence and physical violence exerted. CONCLUSIONS The confirmatory factor analysis allowed us to consider the application of the questionnaire to be correct for the study population.
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Affiliation(s)
| | | | | | - Elena Andina-Díaz
- Department of Nursing and Physiotherapy, University of León, 24071 León, Spain
| | - Ana I. López-Alonso
- Department of Nursing and Physiotherapy, University of León, 24071 León, Spain
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11
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Closson K, Zharima C, Kuchena M, Dietrich JJ, Gadermann A, Ogilvie G, Beksinska M, Kaida A. "I feel like it is asking if he is a stalker … but I also feel like it is asking if he cares": exploring young South African women and men's perceptions of the Sexual Relationship Power Scale. BMC Public Health 2022; 22:1368. [PMID: 35842627 PMCID: PMC9288208 DOI: 10.1186/s12889-022-13686-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Gender inequity and the subsequent health impacts disproportionately affect communities in the Global South. However, most gender equity measures, such as Pulerwitz’ (2000) Sexual Relationship Power Scale (SRPS), are developed and validated in the Global North and then applied in Global South settings without investigation of context applicability or validity. This study examines the SRPS’ validity evidence, comprehensiveness, and contemporary relevance for young South African women and men. Methods Between 2019 and 2021, 38 cognitive interviews (CIs) were conducted among previous participants of a South African youth cohort study ‘AYAZAZI’ (2015–2017) to explore youth’s perceptions of the SRPS. The SRPS measures women’s perceptions of their partner’s controlling behaviours, and men’s perceptions of their own controlling behaviours. Using CIs, participants responded to a 13-item adaptation of the SRPS for use among South African youth (strongly agree-strongly disagree), and then were asked to think-aloud their reasoning for responses, their understanding and perceived relevance of each item, and made overall suggestions for scale adaptations. An item appraisal coding process was applied, whereby Cognitive Coding assessed the types of cognitive problems youth had with understanding the items, and Question Feature Coding assessed which item features caused problems for participant understandings. Finally, youth recommendations for scale adaptations were summarized. Results Overall, 21 women and 17 men aged 21–30 participated in CIs in Durban and Soweto, South Africa. Cognitive Coding revealed 1. Comprehension issues, and 2. Judgements related to items’ applicability to lived experiences and identities (e.g., being unmarried). Question Feature Coding revealed items’ 1. Lack of clarity or vagueness in wording and 2. Logical problems in assumptions leading to multiple interpretations (e.g., item ‘my partner always need to know where I am’ interpreted as both controlling and caring behaviour). Multiple, overlapping issues revealed how many items failed to “fit” within the present-day living realities of South African youth. Youth recommended several item adaptations and additions, including strength-based items, to existing measures of gender equity and relationship power. Conclusion Given identified issues, several adaptations including revising items to be more inclusive, contemporary, context specific, relational, and strength-based are needed to validly measure gender equity and power dynamics within the relationships of South African youth. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13686-9.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Campion Zharima
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle Kuchena
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,African Social Sciences Unit of Research and Evaluation (ASSURE), a division of the Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Mags Beksinska
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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12
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Closson K, Ndungu J, Beksinska M, Ogilvie G, Dietrich JJ, Gadermann A, Gibbs A, Nduna M, Smit J, Gray G, Kaida A. Gender, Power, and Health: Measuring and Assessing Sexual Relationship Power Equity Among Young Sub-Saharan African Women and Men, a Systematic Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:920-937. [PMID: 33353490 DOI: 10.1177/1524838020979676] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Gender inequity, including low sexual relationship power (SRP), is an important determinant of intimate partner violence (IPV) and negative sexual, reproductive, and mental health. Different versions of the Sexual Relationship Power Scale (SRPS) are commonly used within youth studies to examine how gender inequities, including controlling behaviors, in heterosexual relationships impact the lives of young people in sub-Saharan Africa. This review aims to (1) describe definitions and measures of SRP within sub-Saharan African youth studies and (2) review and summarize associations between SRP equity, IPV, and sexual, reproductive, and mental health. After searching Pubmed, Ovid Med, Psych info, Web of Science, Google Scholar, and relevant research forums, 304 papers were identified, of which 29 papers based on 15 distinct studies (published 2004-2019) met our criteria for being youth-specific, conducted in sub-Saharan Africa, and including a quantitative measure of SRP. Details of each SRPS are described, including any adaptations and psychometric properties, as well as associations with IPV, sexual, reproductive, and mental health behaviors and outcomes. Results indicate that there are variations to the SRPS, and a paucity of evidence has detailed the psychometric properties of such measures within sub-Saharan African youth studies. Measures of SRP equity are associated with experiences (among women) and perpetration of (among men) IPV as numerous pathways to HIV risk; however, the evidence remains mixed. In order to address overlapping epidemics of violence against women and HIV, efforts are needed to ensure that measures, including the SRPS, are valid and reliable among highly affected populations.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane Ndungu
- School of Behavioural & Lifestyle Sciences, 56723Nelson Mandela University, Port Elizabeth, South Africa
- Office of Engagement and Transformation, 56723Nelson Mandela University, Port Elizabeth, South Africa
| | - Mags Beksinska
- MatCH Research Unit (MRU), 37708Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Gina Ogilvie
- School of Population and Public Health, 8166The University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute (WHRI), BC Women's Health Centre, Vancouver, British Columbia, Canada
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, 37707University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa
| | - Anne Gadermann
- School of Population and Public Health, 8166The University of British Columbia, Vancouver, British Columbia, Canada
- The Human Learning Project, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Gibbs
- 59097South African Medical Research Council, Cape Town, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mzikazi Nduna
- Department of Psychology, 37707University of the Witwatersrand, Johannesburg, South Africa
| | - Jenni Smit
- MatCH Research Unit (MRU), 37708Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, 37707University of the Witwatersrand, Johannesburg, South Africa
- 59097South African Medical Research Council, Cape Town, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada
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13
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Sexual relationship power equity is associated with consistent condom use and fewer experiences of recent violence among women living with HIV in Canada. J Acquir Immune Defic Syndr 2022; 90:482-493. [PMID: 35499522 DOI: 10.1097/qai.0000000000003008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Sexual relationship power (SRP) inequities, including having a controlling partner, have not been widely examined among women living with HIV (WLWH). We measured prevalence, and key outcomes of relationship control among WLWH in Canada. METHODS Baseline data from WLWH (≥16 years), reporting consensual sex in the last month enrolled in a Canadian community-collaborative cohort study in British Columbia, Ontario, and Quebec, included Pulerwitz's (2000) SRP relationship control sub-scale. Scale scores were dichotomized into medium/low [score=1-2.82] vs. high relationship control [score=2.82-4], high scores=greater SRP equity. Cronbach's alpha assessed scale reliability. Bivariate analyses compared women with high vs. medium/low relationship control. Crude and adjusted multinomial regression examined associations between relationship control and condom use (consistent [ref], inconsistent, never), any sexual, physical and/or emotional violence, and physical and/or sexual violence (never [ref], recent [≤3 months ago], and previous [>3 months ago]). RESULTS Overall, 473 sexually active WLWH (33% of cohort), median age=39 (IQR=33-46), 81% on antiretroviral therapy and 78% with viral loads <50copies/mL were included. The sub-scale demonstrated good reliability (Cronbach's alpha=0.92). WLWH with high relationship control (80%) were more likely (p<0.05) to: be in a relationship; have no children; have greater resilience; and report less socio-structural inequities. In adjusted models, high relationship control was associated with lower odds of: inconsistent vs. consistent condom use (aOR:0.39[95%CI:0.18-0.85]); any recent (aOR:0.14[0.04-0.47]); as well as recent physical and/or sexual (aOR=0.05[0.02,0.17]) but not previous violence (vs. never). DISCUSSION Prioritizing relationship equity and support for WLWH is critical for addressing violence and promoting positive health outcomes.
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14
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Atukunda EC, Owembabazi M, Pratt MC, Psaros C, Muyindike W, Chitneni P, Bwana MB, Bangsberg D, Haberer JE, Marrazzo J, Matthews LT. A qualitative exploration to understand barriers and facilitators to daily oral PrEP uptake and sustained adherence among HIV-negative women planning for or with pregnancy in rural Southwestern Uganda. J Int AIDS Soc 2022; 25:e25894. [PMID: 35324081 PMCID: PMC8944216 DOI: 10.1002/jia2.25894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/08/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Antiretroviral pre-exposure prophylaxis (PrEP) may reduce periconception and pregnancy HIV incidence among women in settings, where gender power imbalances limit HIV testing, engagement in care and HIV viral suppression. We conducted qualitative interviews to understand factors influencing periconception and pregnancy PrEP uptake and use in a cohort of women (Trial registration: NCT03832530) offered safer conception counselling in rural Southwestern Uganda, where PrEP uptake was high. METHODS Between March 2018 and January 2019, in-depth interviews informed by conceptual frameworks for periconception risk reduction and PrEP adherence were conducted with 37 women including those with ≥80% and <80% adherence to PrEP doses measured by electronic pill cap, those who never initiated PrEP, and seven of their male partners. Content and dyadic analyses were conducted to identify emergent challenges and facilitators of PrEP use within individual and couple narratives. RESULTS The median age for women was 33 years (IQR 28, 35), 97% felt likely to acquire HIV and 89% initiated PrEP. Individual-level barriers included unwillingness to take daily pills while healthy, side effects and alcohol use. Women overcame these barriers through personal desires to have control over their HIV serostatus, produce HIV-negative children and prevent HIV transmission within partnerships. Couple-level barriers included nondisclosure, mistrust and gender-based violence; facilitators included shared goals and perceived HIV protection, which improved communication, sexual intimacy and emotional support within partnerships through a self-controlled method. Community-level barriers included multi-level stigma related to HIV, ARVs/PrEP and serodifference; facilitators included active peer, family or healthcare provider support as women aspired to safely meet socio-cultural expectations to conceive and preserve serodifferent relationships. Confidence in PrEP effectiveness was promoted by positive peer experiences with PrEP and ongoing HIV testing. CONCLUSIONS Multi-level forms of HIV-, serodifference- and disclosure-related stigma, side effects, pill burden, alcohol use, relationship dynamics, social, professional and partnership support towards adaptation and HIV risk reduction influence PrEP uptake and adherence among HIV-negative women with plans for pregnancy in rural Southwestern Uganda. Confidence in PrEP, individually controlled HIV prevention and improved partnership communication and intimacy promoted PrEP adherence. Supporting individuals to overcome context-specific barriers to PrEP use may be an important approach to improving uptake and prolonged use.
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Affiliation(s)
| | | | - Madeline Claire Pratt
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Pooja Chitneni
- Division of Infectious Diseases and General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - David Bangsberg
- School of Public Health, Oregon Health Sciences University - Portland State University, Portland, Oregon, USA
| | - Jessica Elizabeth Haberer
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeanne Marrazzo
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lynn Turner Matthews
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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15
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Vizheh M, Muhidin S, Behboodi Moghadam Z, Zareiyan A. Women empowerment in reproductive health: a systematic review of measurement properties. BMC Womens Health 2021; 21:424. [PMID: 34930243 PMCID: PMC8690621 DOI: 10.1186/s12905-021-01566-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/09/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION There is a considerable dearth of official metrics for women empowerment, which is pivotal to observe universal progress towards Sustainable Development Goals 5, targeting "achieve gender equality and empower all women and girls." This study aimed to introduce, critically appraise, and summarize the measurement properties of women empowerment scales in sexual and reproductive health. METHODS A comprehensive systematic literature search through several international electronic databases, including PubMed, Scopus, Embase, ProQuest, and Science Direct was performed on September 2020, without a time limit. All studies aimed to develop and validate a measurement of women empowerment in sexual and reproductive health were included. The quality assessment was performed through a rating scale addressing the six criteria, including: a priori explicit theoretical framework, evaluating content validity, internal consistency, and factor analysis to assess structural validity. RESULTS Of 5234 identified studies, fifteen were included. The majority of the studies were conducted in the United States. All studies but one used a standardized measure. Total items of each scale ranged from 8 to 23. The most common domains investigated were decision-making, freedom of coercion, and communication with the partner. Four studies did not use any conceptual framework. The individual agency followed by immediate relational agency were the main focus of included studies. Of the included studies, seven applied either literature review, expert panels, or empirical methods to develop the item pool. Cronbach's alpha coefficient reported in nine studies ranged from α = 0.56 to 0.87. Most of the studies but three lack reporting test-retest reliability ranging r = 0.69-0.87. Nine studies proved content validity. Six criteria were applied to scoring the scales, by which nine of fifteen articles were rated as medium quality, two rated as poor quality, and four rated as high quality. CONCLUSION Most scales assessed various types of validity and Internal consistency for the reliability. Applying a theoretical framework, more rigorous validation of scales, and assessing the various dimensions of women empowerment in diverse contexts and different levels, namely structural agency, are needed to develop effective and representing scales.
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Affiliation(s)
- Maryam Vizheh
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Department of Management, Macquarie Business School, Macquarie University, Sydney, NSW 2109 Australia
| | - Salut Muhidin
- Department of Management, Macquarie Business School, Macquarie University, Sydney, NSW 2109 Australia
| | - Zahra Behboodi Moghadam
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Armin Zareiyan
- Public Health Department, Health in Disaster & Emergencies Department, Nursing Faculty, Aja University of Medical Sciences, Tehran, Iran
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16
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Closson K, Lee L, Dietrich JJ, Beksinska ME, Hornschuh S, Smith P, Smit JA, Ndung'u T, Brockman M, Gray G, Kaida A. Gender and Power Dynamics of Social Relationships Shape Willingness to Participate in Biomedical HIV Prevention Research Among South African Adolescents and Young Adults. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:639391. [PMID: 36304054 PMCID: PMC9580742 DOI: 10.3389/frph.2021.639391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding young women and men's perceived barriers and facilitators to participation in biomedical HIV prevention research is important for designing youth friendly services (YFS) and acceptable technologies, which are necessary for preventing high sustained HIV incidence in South Africa. This study explores the multileveled barriers and facilitators to young men and women's willingness to participate in hypothetical biomedical HIV prevention research. Methods: Eight age- (16-18 and 19-24 years) and gender-stratified focus group discussions (FGDs) were conducted using semi-structured interview guides to explore young South African women and men's willingness, perceived barriers, and facilitators to participating in biomedical HIV prevention research. FGD transcripts were uploaded to NVivo and coded collaboratively with youth study team members. Thematic analysis using Bronfenbrenner's ecological model (individual, inter-personal, community, and societal) was used to guide a deductive coding procedure, which was documented and compared by gender. Results: Thirty-one participants from Durban and 34 from Soweto participated in FGDs. Individual facilitators for participation were discussed more by young men and included financial incentives and altruism. Concerns about side-effects of biomedical products were a common barrier. Interpersonal relationships with peers, intimate partners and caregivers influenced young people's willingness to participate in HIV prevention research, more so among young women. For young women, gendered power dynamics and distrust of intimate partners and parents influenced both communication regarding participation and willingness to participate in research that is often stigmatized, due to societal norms around women's sexuality. On a societal level, participants expressed distrust in medical and research institutions, however a sense of community that was developed with the study staff of this project, was a motivator to participate in future studies. Discussion: At each level of the ecological model, we found participants expressed gendered barriers and facilitators for participation. Gender norms as well as distrust of partners, parents, and health care professionals were key barriers that cut across all levels. At each level participants discussed facilitators that were youth-engaged, underscoring the need to implement YFS, establish trust and address gender inequities within future biomedical HIV prevention studies wishing to engage and retain South African youth.
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Affiliation(s)
- Kalysha Closson
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Laura Lee
- Branch for International Surgical Care, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janan J. Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa
| | - Mags E. Beksinska
- Maternal Adolescent and Child Health Research Unit (MRU), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jenni A. Smit
- Maternal Adolescent and Child Health Research Unit (MRU), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Thumbi Ndung'u
- HIV Pathogenesis Programme and Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Ragon Institute of Massachusetts General Hospital, Massachusetts, Institute of Technology and Harvard University, Cambridge, MA, United States
- Max Planck Institute for Infection Biology, Berlin, Germany
| | - Mark Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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17
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Pakhomova TE, Dietrich JJ, Closson K, Smit J, Hornschuh S, Smith P, Beksinska M, Ndung'u T, Brockman M, Gray G, Kaida A. Intimate Partner Violence, Depression, and Anxiety Are Associated With Higher Perceived Stress Among Both Young Men and Women in Soweto and Durban, South Africa. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:638116. [PMID: 36304031 PMCID: PMC9580652 DOI: 10.3389/frph.2021.638116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives: Psychological stress is an important determinant of health, including for mental well-being and sexual health. However, little is known about the prevalence and psychosocial and sexual health correlates of perceived stress among young people in South Africa, where elevated life-stressors are an important driver of health inequities. This study examines the association between intimate partner violence (IPV), psychosocial and sexual health, and perceived stress, by gender, among South African adolescents and young adults. Methods: Using baseline survey data from AYAZAZI, a cohort study enrolling youth (16–24 years) from Durban and Soweto, we used the 10-item Perceived Stress Scale (PSS-10) to measure the degree to which an individual perceives their life situations as unpredictable, uncontrollable, and overloaded. Possible scores range between 0 and 40; higher scores indicating higher perceived stress. Crude and adjusted gender-stratified linear regression models examined associations between sexual health factors, experiences (young women) and perpetration (young men) of IPV, anxiety (APA 3-item Scale, ≥2 = probable anxiety), and depression (10-item CES-D Scale, ≥10 = probable depression) and perceived stress. Multivariable models adjusted for age, income, sexual orientation, and financial dependents. Results: Of the 425 AYAZAZI participants, 60% were young women. At baseline, 71.5% were students//learners and 77.2% earned ≤ ZAR1600 per month (~$100 USD). The PSS-10 had moderate reliability (α = 0.70 for young women, 0.64 for young men). Young women reported significantly higher mean PSS scores than young men [18.3 (6.3) vs. 16.4 (6.0)]. In adjusted linear regression models, among young women experiences of IPV (β = 4.33; 95% CI: 1.9, 6.8), probable depression (β = 6.63; 95% CI: 5.2, 8.1), and probable anxiety (β = 5.2; 95% CI: 3.6, 6.8) were significantly associated with higher PSS scores. Among young men, ever perpetrating IPV (β = 2.95; 95% CI: 0.3, 5.6), probable depression (β = 6; 95% CI: 4.3, 7.6), and probable anxiety (β = 3.9; 95% CI: 2.1, 5.8) were significantly associated with higher perceived stress. Conclusion: We found that probable depression, anxiety, perpetration of IPV among young men, and experiences of IPV among young women, were associated with higher perceived stress. Critical efforts are needed to address the gendered stressors of young men and women and implement services to address mental health within violence prevention efforts.
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Affiliation(s)
| | - Janan Janine Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jenni Smit
- Maternal Adolescent and Child Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mags Beksinska
- Maternal Adolescent and Child Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Thumbi Ndung'u
- Africa Health Research Institute, Durban, South Africa
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Max Planck Institute for Infection Biology, Berlin, Germany
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Mark Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- *Correspondence: Angela Kaida
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Chitneni P, Bwana MB, Muyindike W, Owembabazi M, Kalyebara PK, Byamukama A, Mbalibulha Y, Smith PM, Hsu KK, Haberer JE, Kaida A, Matthews LT. STI prevalence among men living with HIV engaged in safer conception care in rural, southwestern Uganda. PLoS One 2021; 16:e0246629. [PMID: 33657120 PMCID: PMC7928454 DOI: 10.1371/journal.pone.0246629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/22/2021] [Indexed: 11/18/2022] Open
Abstract
HIV care provides an opportunity to integrate comprehensive sexual and reproductive healthcare, including sexually transmitted infection (STI) management. We describe STI prevalence and correlates among men living with HIV (MLWH) accessing safer conception care to conceive a child with an HIV-uninfected partner while minimizing HIV transmission risks. This study reflects an ongoing safer conception program embedded within a regional referral hospital HIV clinic in southwestern Uganda. We enrolled MLWH, planning for pregnancy with an HIV-uninfected partner and accessing safer conception care. Participants completed interviewer-administered questionnaires detailing socio-demographics, gender dynamics, and sexual history. Participants also completed STI laboratory screening for syphilis (immunochromatographic testing confirmed by rapid plasma reagin), and chlamydia, gonorrhea, trichomoniasis, and HIV-RNA via GeneXpert nucleic acid amplification testing. Bivariable associations of STI covariates were assessed using Fisher's exact test. Among the 50 men who completed STI screening, median age was 33 (IQR 31-37) years, 13/50 (26%) had ≥2 sexual partners in the prior three months, and 46/50 (92%) had HIV-RNA <400 copies/mL. Overall, 11/50 (22%) had STIs: 16% active syphilis, 6% chlamydia. All participants initiated STI treatment. STI prevalence was associated with the use of threats/intimidation to coerce partners into sex (27% vs 3%; p = 0.03), although absolute numbers were small. We describe a 22% curable STI prevalence among a priority population at higher risk for transmission to partners and neonates. STI screening and treatment as a part of comprehensive sexual and reproductive healthcare should be integrated into HIV care to maximize the health of men, women, and children.
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Affiliation(s)
- Pooja Chitneni
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Infectious Diseases and General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Global Health Collaborative, Mbarara, Uganda
- * E-mail:
| | - Mwebesa Bosco Bwana
- Global Health Collaborative, Mbarara, Uganda
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | - Winnie Muyindike
- Global Health Collaborative, Mbarara, Uganda
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Paul Kato Kalyebara
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adolf Byamukama
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
- Epicentre, Médecins Sans Frontières (MSF), Mbarara, Uganda
| | - Yona Mbalibulha
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patricia M. Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Katherine K. Hsu
- Division of STD Prevention, Massachusetts Department of Public Health, Boston, MA, United States of America
- Section of Pediatric Infectious Disease, Boston University Medical Center, Boston, MA, United States of America
| | - Jessica E. Haberer
- Global Health Collaborative, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Angela Kaida
- Global Health Collaborative, Mbarara, Uganda
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lynn T. Matthews
- Global Health Collaborative, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States of America
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