HIV Risk Among Displaced Adolescent Girls in Ethiopia: the Role of Gender Attitudes and Self-Esteem

Abstract

Adolescent girls in sub-Saharan Africa have been deemed one of the most critical populations to address in the campaign for an HIV-free generation. Experiences of intimate partner violence (IPV), harmful gender norms, diminished personal agency, and age-disparate sex have been identified as factors in the increasing rate of new infections among this population. Using baseline data from a cluster-randomized controlled trial in three refugee camps in Benishangul-Gumuz Regional State in Ethiopia, our study quantitatively examined the associations between HIV risk factors, attitudes on gender inequality, IPV acceptability, and self-esteem for female adolescent refugees primarily from Sudan and South Sudan (n = 919). In multivariate models, adjusting for age and education, results showed girls who were more accepting of gender inequitable norms and IPV had greater odds of ever experiencing forced (OR 1.40, CI 1.15-1.70; OR 1.66, CI 1.42-1.94) or transactional sex (OR 1.28, CI 1.05-1.55; OR 1.59, CI 1.37-1.85) compared to girls who demonstrated less approval. Higher self-esteem was associated with increased odds of condom use (OR 1.13, CI 1.02-1.24) as well as decreased odds of adolescent marriage (OR 0.93, CI 0.90-0.95), age-disparate sex (OR 0.90, CI 0.86-0.94), and transactional sex (OR 0.96, CI 0.93-0.99). The findings suggest acceptance of inequitable gender norms (including those that perpetuate violence against women) and low self-esteem to be associated with common HIV risk factors among refugee adolescents living in Ethiopia. Greater attention towards the intersections of gender equality and self-valuation is needed when seeking to understand HIV risk among refugee adolescent girls in sub-Saharan Africa.

Disease Prevention Behavior During the COVID-19 Pandemic and the Role of Self-Esteem: An Extended Parallel Process Model

“…11 Studies have verified that low self-esteem is associated with unhealthy behaviors and practices. For example, Ramiro et al 14 and Bermudez et al 15 reported that people with low self-esteem tend to engage in highrisk sexual behavior. Kima et al 16 also found that people with low self-esteem are more likely to experience mental health problems compared to people with high self-esteem.…”

Attitudes and beliefs of immigrants regarding HIV and AIDS in Mopani district, South Africa

“…The reason was that they wanted many children as this would be an advantage to them in terms of the food supply. This behaviour as well as transactional sex increases the risk of getting the virus, thereby preventing the achievement of healthy lives and the promotion of well-being for all ages (Bermudez et al, 2019 ).…”

Psychological factors associated with adolescent sexual behavior

“…However, risk behavior performance differs between adolescents. Studies have shown that psychological constructs such as self-esteem and self-efficacy may help to understand why some adolescents are more inclined to the performance of risk behaviors than others (Bermúdez et al, 2019;Danielson et al, 2014;Louwet et al, 2018;Xu et al, 2017). This article focuses on the performance of sexual risk behaviors in adolescence, operationalized mainly as the inconsistent use of condoms.…”