Determining HIV Risk for Adolescent Girls and Young Women (AGYW) in Relationships with “Blessers” and Age Disparate Partners: A Cross-Sectional Survey in Four Districts in South Africa

George, Gavin; Beckett, Sean; Reddy, Tarylee; Govender, Kaymarlin; Cawood, Cherie; Khanyile, David; Kharsany, Ayesha B. M.

doi:10.21203/rs.3.rs-1199469/v1

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…Our study found that these relationships are prevalent among adolescent girls living in rural regions of Kenya. These findings support available literature, which shows that age-disparate TS has become increasingly common among adolescent girls in low and middle-income countries to provide financial support for themselves and their families (Conroy et al, 2016; Duby et al, 2021; George et al, 2022; Wamoyi et al, 2018). These relationships are increasingly prevalent and pose a significant risk to girls’ physical, mental, and social well-being.…”

Section: Discussionsupporting

confidence: 89%

“Girls Are the Ones Who Save the Family”: Factors and Consequences of Engaging in Age-Disparate Transactional Sex Relationships

Munala

Yewhalawork

Okunna

et al. 2022

J Interpers Violence

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The 2019 Kenya Violence Against Children Survey highlighted the increased prevalence of sexual violence experienced by girls; 62.6% of girls who have experienced childhood sexual violence reported multiple incidents before age 18. Studies have shown that transactional sex (TS) relationships are a source of sexual violence, particularly age-disparate TS. TS is defined as sex that is a nonmarital, noncommercial relationship driven by the assumption that sex is exchanged for material support or other benefits. TS is common among adolescents and young women in sub-Saharan Africa, with the prevalence varying from as low as 5% to as high as 80%. This qualitative study explored the factors influencing age-disparate TS relationships in two rural districts, Mutomo and Ikutha Wards of Kitui South Sub County, Kenya. Four focus group discussions were conducted with primary (12–14 years of age) and secondary schoolgirls (15–18 years of age). The study results identified several main themes, which were grouped into two major themes: influencing factors and consequences. Influencing factors include material/basic needs, school-related influences, parental influence, peer pressure, and perpetrator access, while consequences include health and social consequences. Our study found that girls’ sense of agency, social pressure, and economic vulnerability impacted their decision to engage in age-disparate TS. These relationships’ power dynamics and exploitative nature increase girls’ risk of experiencing gender-based sexual violence and adverse health and social outcomes. Our study suggests that explicitly addressing individual risk behaviors will not effectively reduce the incidence of TS relationships. Interventions should be focused on understanding the social-cultural beliefs of TS and shifting the narrative that has continued to fuel a patriarchal society in which women and girls have limited decision-making power in relationships.

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Section: Discussionsupporting

confidence: 89%

“Girls Are the Ones Who Save the Family”: Factors and Consequences of Engaging in Age-Disparate Transactional Sex Relationships

Munala

Yewhalawork

Okunna

et al. 2022

J Interpers Violence

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“…Prevalence among adolescent girls and young women (AGYW) in this group is particularly high: nearly four times greater than that of young men (1,2). This disparity is largely driven by cross-cutting factors such as poverty and unemployment, age disparate sex (3,4), and transactional sex (4,5), against a background of harmful gender norms and unequal gender power dynamics, where the rights, safety and choices of AGYW are severely compromised (6,7).…”

Section: Introductionmentioning

confidence: 99%

Introduction and integration of PrEP and sexual and reproductive health services for young people: Health provider perspectives from South Africa

Pleaner

Scorgie

Martin

et al. 2023

Front. Reprod. Health

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South Africa has one of the largest HIV epidemics in the world, with particularly high prevalence among adolescent girls and young women (AGYW). Oral PrEP was introduced in the public sector in 2016 in a phased manner. Given the important role played by health providers, research was undertaken to understand their experiences of and attitudes towards introduction of PrEP as a new HIV prevention method, and its integration within broader sexual and reproductive health (SRH) services for youth. A survey was undertaken with 48 purposively sampled health providers working in primary health care facilities and mobile clinics in three provinces in South Africa. Qualitative analysis was performed on free-text responses to open-ended questions in the survey, using an inductive approach to code the data in NVivo v.12 software. Health providers expressed concerns about adding a new service to an already overburdened health system, and worried that young people seeking PrEP would divert staff from other critical services. While most recognised the benefits and opportunities afforded by HIV and SRH service integration, providers highlighted the extra time and resources such integration would require. Many were anxious that PrEP would encourage disinhibition and increase unprotected sex among AGYW, and held judgemental attitudes about young people, seen as largely incapable of taking responsibility for their health. Findings underscore the importance of consulting health providers about implementation design and providing channels for them to express their misgivings and concerns, and training needs to be designed to address provider attitudes and values. Opportunities need to be sought to strengthen the provision of adolescent and youth friendly services—including adolescent-health provider dialogues. Insights from this study can assist in guiding the introduction of new HIV prevention methods into the future.

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“…As a result, HIV association literature has emerged to interpret how individual choices contribute to collective risk behaviours fuelling gender-disparate HIV prevalence, treatment, and care outcomes between men and women. There are a number of biological, behavioural, social, and structural factors associated with earlier HIV acquisition amongst women, including participation in survival sex and transactional sex with partners between 5 and 10 years older, and sexual relationships with 'blessers' (4,(6)(7)(8)(9)(10). In a manoeuvre to posit women who engage in transactional sex as powerful agents and not mere victims of racialised and gendered poverty, the literature transcends from a narrative of 'real' deprivation to focussing on a sequence of acts that illustrate agency.…”

Section: Introductionmentioning

confidence: 99%

The dynamics of sexual risk amongst South African youth in age-disparate relationships

Qoza

Heerden

Essack

2023

Front. Reprod. Health

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IntroductionSouth Africa has the highest burden of HIV in the world with over 8 million people living with HIV. Young women and girls account for a quarter of new HIV infections while making up only 10% of the population. A key driver of HIV incidence is transactional and survival sex between adolescent girls or young women and older men (the latter referred to as ‘sugar-daddies’ or ‘blessers’). This paper expands on the existing literature on age-disparate and intergenerational relationships to provide social and behavioural interpretations of how young men, commonly omitted from studies on this topic, and women in concurrent relationships with both their peers and older partners perceive and navigate sexual risk.MethodWe conducted a qualitative study in a rural setting of uMgungundlovu District, KwaZulu-Natal Province, with purposively selected male and female participants aged 18–24 years old in age-disparate relationships. Semi-structured in-depth interviews (IDI) were conducted and analysed using interpretative phenomenological analysis (IPA) to explore existing information, motivations, and behavioural practices around relationships and sexual risk.ResultsThe themes and related sub-themes found through IPA included the following: (1) navigating dating: narratives that show a strong preference for being in an age-disparate relationship; the challenges that young people face when choosing an older person as a side partner; and social media applications seen as creating opportunities to meet side partners; and (2) the distribution of love and trust in a multi-party sexual network: condom (mis)use differentiates between straights—those in a serious relationship—and sides; and the power of eye-test seroguessing, the praxis of testing people visually for HIV in nullifying existing knowledge about sexual and reproductive health risk.DiscussionThis research offers an understanding of how schemas of non-condom use are organised. We observed that while condom-less sex is often viewed as essential to building social capital in a serious relationship, it is not the only factor that determines sexual relationship power. Eye-test seroguessing not only develops consortium (trust, reciprocity, and solidarity), but it fulfils the psycho-social need to belong to a network of serious relationships. Moreover, it is critical to the enactment of masculinities because it consolidates femininity to keep men happy, i.e., by being passive in the sexual encounter, women constrain their self-efficacy to act contrary to the conventions of reputable women. Therefore, it is plausible that in the serosorting that occurs prior to unprotected sexual acts, the power of eye-test seroguessing limits the ability to engage in safe sexual practices.

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Determining HIV Risk for Adolescent Girls and Young Women (AGYW) in Relationships with “Blessers” and Age Disparate Partners: A Cross-Sectional Survey in Four Districts in South Africa

Cited by 4 publications

References 19 publications

“Girls Are the Ones Who Save the Family”: Factors and Consequences of Engaging in Age-Disparate Transactional Sex Relationships

“Girls Are the Ones Who Save the Family”: Factors and Consequences of Engaging in Age-Disparate Transactional Sex Relationships

Introduction and integration of PrEP and sexual and reproductive health services for young people: Health provider perspectives from South Africa

The dynamics of sexual risk amongst South African youth in age-disparate relationships

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