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  • 1. Fearon, Elizabeth
    et al.
    Wiggins, Richard D.
    Pettifor, Audrey E.
    MacPhail, Catherine
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Selin, Amanda
    Gomez-Olive, F. Xavier
    Hargreaves, James R.
    Friendships Among Young South African Women, Sexual Behaviours and Connections to Sexual Partners (HPTN 068)2019In: Aids and Behavior, ISSN 1090-7165, E-ISSN 1573-3254, Vol. 23, no 6, p. 1471-1483Article in journal (Refereed)
    Abstract [en]

    Friends could be influential on young women's sexual health via influences on sexual behaviours and as connections to sexual partners, but are understudied in sub-Saharan Africa. We cross-sectionally surveyed 2326 13-20year-old young women eligible for grades 8-11 in rural South Africa about their sexual behaviour and up to three sexual partners. Participants each described five specific but unidentified friends and the relationships between them in an egocentric' network analysis design. We used logistic regression to investigate associations between friendship characteristics and participants' reports of ever having had sex (n=2326) and recent condom use (n=457). We used linear regression with random effects by participant to investigate friendship characteristics and age differences with sexual partners (n=633 participants, 1051 partners). We found that it was common for friends to introduce young women to those who later became sexual partners, and having older friends was associated with having older sexual partners, (increase of 0.37years per friend at least 1year older, 95% CI 0.21-0.52, adjusted). Young women were more likely to report ever having had sex when more friends were perceived to be sexually active (adjusted OR 1.85, 95% CI 1.72-2.01 per friend) and when they discussed sex, condoms and HIV with friends. Perception of friends' condom use was not associated with participants' reported condom use. While this study is preliminary and unique in this population and further research should be conducted, social connections between friends and sexual partners and perceptions of friend sexual behaviours could be considered in the design of sexual health interventions for young women in South Africa.

  • 2. Gottert, Ann
    et al.
    Barrington, Clare
    McNaughton-Reyes, Heath Luz
    Maman, Suzanne
    MacPhail, Catherine
    Lippman, Sheri A.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Reproductive Health and HIV Institute (WRHI), University of the Witwatersrand, Johannesburg, South Africa.
    Twine, Rhian
    Pettifor, Audrey
    Gender Norms, Gender Role Conflict/Stress and HIV Risk Behaviors Among Men in Mpumalanga, South Africa2018In: Aids and Behavior, ISSN 1090-7165, E-ISSN 1573-3254, Vol. 22, no 6, p. 1858-1869Article in journal (Refereed)
    Abstract [en]

    Men's gender role conflict and stress (GRC/S), the psychological strain they experience around fulfilling expectations of themselves as men, has been largely unexplored in HIV prevention research. We examined associations between both men's gender norms and GRC/S and three HIV risk behaviors using data from a population-based survey of 579 18-35 year-old men in rural northeast South Africa. Prevalence of sexual partner concurrency and intimate partner violence (IPV) perpetration in the last 12 months were 38.0 and 13.4%, respectively; 19.9% abused alcohol. More inequitable gender norms and higher GRC/S were each significantly associated with an increased odds of concurrency (p = 0.01; p < 0.01, respectively), IPV perpetration (p = 0.03; p < 0.01), and alcohol abuse (p = 0.02; p < 0.001), controlling for demographic characteristics. Ancillary analyses demonstrated significant positive associations between: concurrency and the GRC/S sub-dimension subordination to women; IPV perpetration and restrictive emotionality; and alcohol abuse and success, power, competition. Programs to transform gender norms should be coupled with effective strategies to prevent and reduce men's GRC/S.

  • 3. Gottert, Ann
    et al.
    Barrington, Clare
    Pettifor, Audrey
    McNaughton-Reyes, Heath Luz
    Maman, Suzanne
    MacPhail, Catherine
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Selin, Amanda
    Twine, Rhian
    Lippman, Sheri A.
    Measuring Men's Gender Norms and Gender Role Conflict/Stress in a High HIV-Prevalence South African Setting2016In: Aids and Behavior, ISSN 1090-7165, E-ISSN 1573-3254, Vol. 20, no 8, p. 1785-1795Article in journal (Refereed)
    Abstract [en]

    Gender norms and gender role conflict/stress may influence HIV risk behaviors among men; however scales measuring these constructs need further development and evaluation in African settings. We conducted exploratory and confirmatory factor analyses to evaluate the Gender Equitable Men's Scale (GEMS) and the Gender Role Conflict/Stress (GRC/S) scale among 581 men in rural northeast South Africa. The final 17-item GEMS was unidimensional, with adequate model fit and reliability (alpha = 0.79). Factor loadings were low (0.2-0.3) for items related to violence and sexual relationships. The final 24-item GRC/S scale was multidimensional with four factors: Success, power, competition; Subordination to women; Restrictive emotionality; and Sexual prowess. The scale had adequate model fit and good reliability (alpha = 0.83). While GEMS is a good measure of inequitable gender norms, new or revised scale items may need to be explored in the South African context. Adding the GRC/S scale to capture men's strain related to gender roles could provide important insights into men's risk behaviors.

  • 4. Jennings, Larissa
    et al.
    Pettifor, Audrey
    Hamilton, Erica
    Ritchwood, Tiarney D.
    Gomez-Olive, F. Xavier
    MacPhail, Catherine
    Hughes, James
    Selin, Amanda
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council Wits Rural Public Health and Health Transitions Research Unit, Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Economic Resources and HIV Preventive Behaviors Among School-Enrolled Young Women in Rural South Africa (HPTN 068)2017In: Aids and Behavior, ISSN 1090-7165, E-ISSN 1573-3254, Vol. 21, no 3, p. 665-677Article in journal (Refereed)
    Abstract [en]

    Individual economic resources may have greater influence on school-enrolled young women's sexual decision-making than household wealth measures. However, few studies have investigated the effects of personal income, employment, and other financial assets on young women's sexual behaviors. Using baseline data from the HIV Prevention Trials Network (HPTN) 068 study, we examined the association of ever having sex and adopting sexually-protective practices with individual-level economic resources among school-enrolled women, aged 13-20 years (n = 2533). Age-adjusted results showed that among all women employment was associated with ever having sex (OR 1.56, 95 % CI 1.28-1.90). Among sexually-experienced women, paid work was associated with changes in partner selection practices (OR 2.38, 95 % CI 1.58-3.58) and periodic sexual abstinence to avoid HIV (OR 1.71, 95 % CI 1.07-2.75). Having money to spend on oneself was associated with reducing the number of sexual partners (OR 1.94, 95 % CI 1.08-3.46), discussing HIV testing (OR 2.15, 95 % CI 1.13-4.06), and discussing condom use (OR 1.99, 95 % CI 1.04-3.80). Having a bank account was associated with condom use (OR 1.49, 95 % CI 1.01-2.19). Economic hardship was positively associated with ever having sex, but not with sexually-protective behaviors. Maximizing women's individual economic resources may complement future prevention initiatives.

  • 5. Kilburn, Kelly
    et al.
    Hughes, James P.
    MacPhail, Catherine
    Wagner, Ryan G.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå Centre for Global Health Research; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Gómez-Olivé, F. Xavier
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Umeå Centre for Global Health Research; INDEPTH Network, Accra, Ghana.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. INDEPTH Network, Accra, Ghana.
    Pettifor, Audrey
    Cash Transfers, Young Women's Economic Well-Being, and HIV Risk: Evidence from HPTN 0682019In: Aids and Behavior, ISSN 1090-7165, E-ISSN 1573-3254, Vol. 23, no 5, p. 1178-1194Article in journal (Refereed)
    Abstract [en]

    Despite the large interest in economic interventions to reduce HIV risk, little research has been done to show whether there are economic gains of these interventions for younger women and what intermediary role economic resources play in changing participants' sexual behavior. This paper contributes to this gap by examining the impacts of a conditional cash transfer (CCT) for young women in South Africa on young women's economic resources and the extent to which they play a role in young women's health and behavior. We used data from HIV Prevention Trials Network 068 study, which provided transfers to young women (in addition to their parents) conditional on the young woman attending at least 80% of school days in the previous month. We found that the CCT increased young women's economic wellbeing in terms of having savings, spending money, being unindebted, and food secure. We also investigated heterogeneous effects of the program by household economic status at baseline because the program was not specifically poverty targeted and found that the results were driven by young women from the poorest families. From these results, we examined heterogeneity by baseline poverty for other outcomes related to HIV risk including sexual behavior and psychosocial well-being. We found psychosocial well-being benefits in young women from the poorest families and that economic wellbeing gains explained much these impacts.

  • 6. Treves-Kagan, Sarah
    et al.
    El Ayadi, Alison M.
    Pettifor, Audrey
    MacPhail, Catherine
    Twine, Rhian
    Maman, Suzanne
    Peacock, Dean
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Lippman, Sheri A.
    Gender, HIV Testing and Stigma: The Association of HIV Testing Behaviors and Community-Level and Individual-Level Stigma in Rural South Africa Differ for Men and Women2017In: Aids and Behavior, ISSN 1090-7165, E-ISSN 1573-3254, Vol. 21, no 9, p. 2579-2588Article in journal (Refereed)
    Abstract [en]

    Stigma remains a significant barrier to HIV testing in South Africa. Despite being a social construct, most HIV-stigma research focuses on individuals; further the intersection of gender, testing and stigma is yet to be fully explored. We examined the relationship between anticipated stigma at individual and community levels and recent testing using a population-based sample (n = 1126) in Mpumalanga, South Africa. We used multi-level regression to estimate the potential effect of reducing community-level stigma on testing uptake using the g-computation algorithm. Men tested less frequently (OR 0.22, 95% CI 0.14-0.33) and reported more anticipated stigma (OR 5.1, 95% CI 2.6-10.1) than women. For men only, testing was higher among those reporting no stigma versus some (OR 1.40, 95% CI 0.97-2.03; p = 0.07). For women only, each percentage point reduction in community-level stigma, the likelihood of testing increased by 3% (p < 0.01). Programming should consider stigma reduction in the context of social norms and gender to tailor activities appropriately.

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