A substantial body of South African research describes the importance of gender dynamics within sexual relationships as factors underlying HIV risk, yet we know little about these factors among young adults-a group at exceptionally high risk of infection. Our primary objective was to explore the ways that young adult men and women interpret and enact gender roles within their established primary partnerships, and how these dynamics influence sexual behaviour in relation to HIV risk. We employed script theory to frame our analysis of the dynamics of gender. Fifty students (25 women, 25 men) at secondary schools in a rural district of KwaZulu/Natal, South Africa completed in-depth interviews about sexual interactions with their primary partner. While many participants indicated that the standards of sexual conduct within relationships reflect dominant gender role norms, our findings indicate that there are important variations in these roles with some male and female respondents accepting and reinforcing the rights of women to determine the nature of sexual interactions. Efforts aimed at improving acceptance and adoption of alternative scripts for women and men may help to broaden young people's repertoire of HIV prevention options.
BackgroundThis qualitative study investigated gender power inequalities as they contribute to relationship dynamics and HIV-serostatus disclosure among men and women living with HIV in Durban, South Africa. HIV serodiscordance among men and women within stable partnerships contributes to high HIV incidence in southern Africa, yet disclosure rates remain low. Given the emphasis on prevention for HIV-serodiscordant couples, this research supports the urgent need to explore how best to support couples to recognize that they are part of this priority population and to access appropriate prevention and treatment.MethodsThirty-five in-depth individual interviews were conducted with 15 HIV-positive men and 20 HIV-positive women (not couples) receiving care at public-sector clinics near Durban. A structured coding scheme was developed to investigate men’s and women’s attitudes toward HIV-serostatus disclosure and behaviors of sharing (or not sharing) HIV serostatus with a partner. Narratives were analyzed for barriers and facilitators of disclosure through the lens of sociocultural gender inequality, focusing on reasons for non-disclosure.ResultsAmong 35 participants: median age was 33 years (men) and 30 years (women); average years since HIV diagnosis was 1 (men) and 1.5 (women). Four themes related to gender inequality and HIV-serostatus disclosure emerged: (1) Men and women fear disclosing to partners due to concerns about stigma and relationship dissolution, (2) suspicions and mistrust between partners underlies decisions for non-disclosure, (3) unequal, gendered power in relationships causes differential likelihood and safety of disclosure among men and women, and (4) incomplete or implicit disclosure are strategies to navigate disclosure challenges. Findings illustrate HIV-serostatus disclosure as a complex process evolving over time, rather than a one-time event.ConclusionPartner communication about HIV serostatus is infrequent and complicated, with gender inequalities contributing to fear, mistrust, and partial or implicit disclosure. Relationship dynamics and gender roles shape the environment within which men and women can engage successfully in the HIV-serostatus disclosure process. Integrated interventions to reduce barriers to trustful and effective communication are needed for HIV-affected men and women in partnerships in which seeking couples-based HIV counseling and testing (CHCT) is challenging or unlikely. These data offer insights to support HIV-serostatus disclosure strategies within relationships over time.
In a society overwhelmed by HIV/AIDS, a particularly compelling public health question in South Africa is how young people integrate the scientific discourse of HIV/AIDS and pregnancy/contraception with lay beliefs and practices. Our objective was to conduct a preliminary exploration of concepts and related beliefs among young women and men regarding the body, disease and pregnancy. In-depth interviews were conducted with 50 sexually active students recruited from two high schools in a rural region of South Africa. Four primary themes emerged from the interviews. These were (1) sexual activity damages the body, (2) contraceptive use has deleterious effects, (3) menstruation causes physical and moral weakness, and (4) women's bodies are repositories of disease. Their discourses revealed beliefs that sexual activity can have severe physical consequences. A gendered difference emerged through the association of women's bodies with disfiguring, unclean, or immoral behaviors in juxtaposition to men's bodies. Women continue to be linked more closely to concepts of infection than were men. Men assume the role of authorities regarding condom and contraception use in their relationships with women. Findings are discussed in terms of improving young South Africans sexual health, in particular, the health status of women in sexual relationships with men.
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