Autonomy and susceptibility to HIV/AIDS among young women living in a slum in Belo Horizonte, Brazil

Abstract

In Brazil in the last decade there has been an increase in the susceptibility of young women to HIV. This study explored the link between autonomy, or control over major domains of economic, social and sexual life, and susceptibility to HIV infection among poor young women living in an urban slum area of Brazil. A cross-sectional survey was carried out on a random sample of 356 young women between 15 and 24 years old. The study found that indicators of autonomy that relate to sexuality, mobility and freedom from threat by partners were significantly correlated with practices linked to HIV prevention and with access to health services promoting prevention, especially among adolescents. Young women who talked to their partner about condom use before first intercourse and co-decided with them on condom use were more likely to use condoms. In contrast, those who had ever been victim of physical violence by a partner or whose partners restricted their mobility were less likely to use condoms. The study found that young women were more likely to have accessed health services for gynaecological examinations, family planning services and HIV testing if they had ever been pregnant. The findings indicate that structural gender inequalities translate into unequal relationships and reduced autonomy, increasing young women's susceptibility to HIV. A bias in HIV testing and reproductive health services towards pregnant women leaves many susceptible youth without early access. The study suggests the development of a reproductive health policy that ensures that young women access services before they get pregnant and that also reaches young males.

Violência de gênero, desigualdade social e sexualidade: as experiências de mulheres jovens em Belo Horizonte

“…A fim de aprofundar a compreensão dessa interrelação entre violência de gênero e a saúde sexual e reprodutiva de adolescentes e mulheres jovens de classes sociais distintas residentes em uma grande cidade no Brasil, apresentamos aqui uma análise quantitativa utilizando de alguns indicadores de autonomia da mulher na esfera da sexualidade e de violência de gênero, inspirados no trabalho de Jejeebhoy 6 (2000) e já experimentados em análises anteriores (Chacham et al, 2007;Chacham, Maia, Camargo, 2012). O uso desses indicadores nos possibilitou explorar estatisticamente a associação entre o controle e a violência por parte de um parceiro com o uso do preservativo na primeira e na última relação (e a consequente exposição às ISTs/HIV) entre as jovens entrevistadas.…”

Gender-based violence and sexual and reproductive health among low-income youth in three Brazilian cities

“…Indicators of control and gender-based violence and sexual autonomy Indicators of control and gender-based violence (female respondents) If a partner has ever forbidden her to wear some types of clothes If a partner has ever forbidden her to have contact with some friend(s) If a partner has ever set a time limit for her to arrive home If she ever had a time limit to arrive home set by a partner If a partner has ever forbidden her to go somewhere If she has ever been hit by a partner If she has ever suffered sexual violence from a partner Indicators of control and gender-based violence (male respondents) If he has ever forbidden a partner to wear some types of clothes If he has ever forbidden a partner to have contact with some friend(s) If he ever set a limit for a partner to arrive home If he has ever forbidden a partner to go somewhere If he has ever hit a partner If he has ever forced a partner to have sex against her will If he has ever suffered physical violence from a female partner relationship and more likely to have casual sex, findings that match results from other surveys. 10,11 Almost half (47%) of the female respondents had become pregnant at least once, 25.5% of them before they were 19 years old, and 44% had at least one child. The prevalence of teenage pregnancy was very similar among respondents in all three cities.…”

“…Our results only indicate the presence of statistically significant associations that have been found in our previous studies. 11,12 Data from different Latin American countries from the † The GRAVAD Survey was the biggest study done on adoles- 1990s have also shown that, for many teenage women, violence starts or increases during pregnancy. 21 Nevertheless, our results definitely point to the negative effect of GBV on young women's sexual and reproductive lives, as it leads them to less favourable positions within their relationships, making it difficult for them to negotiate condom use and the timing of sex.…”

“…10 Results from two previous surveys done with adolescents and young women living in Belo Horizonte (the state capital of Minas Gerais) guided us in this process. 11,12 Methods Minas Gerais is the second most populated state in Brazil, with almost 20 million inhabitants in 2010, 13 and is located in the more economically developed region of the country. However, mirroring Brazil's overall inequalities, there is a sharp contrast between the richer south and the poorer north regions of the state.…”

“…11,12,14 In order to examine the relationship between the prevalence of teenage pregnancy and condom use among our respondents, and their experience of GBV, we selected the questions presented in Box 1 as indicators of control and GBV from or towards a partner, and of autonomy in the sexual sphere.…”