How empowered are girls/young women in their sexual relationships? Relationship power, HIV risk, and partner violence in Kenya

Pulerwitz, Julie; Mathur, Sanyukta; Woznica, Daniel

doi:10.1371/journal.pone.0199733

Cited by 51 publications

(66 citation statements)

References 31 publications

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“…Although not explicitly mentioned by our adolescent participants, issues of gender inequity underlined their reported experiences of discrimination, structural barriers to service access, and economic marginalization. Previous work from sub-Saharan Africa has documented the association between gender inequality for AGYW and their increased risk of intimate partner violence and adverse sexual and reproductive health outcomes, including incident HIV infection [36, 37]. The effectiveness of PMTCT programming for AGYW, particularly during the high-risk post-partum and breastfeeding periods [38], would benefit from comprehensive gender empowerment interventions [37, 39].…”

Section: Discussionmentioning

confidence: 99%

“I would love if there was a young woman to encourage us, to ease our anxiety which we would have if we were alone”: Adapting the Mothers2Mothers Mentor Mother Model for adolescent mothers living with HIV in Malawi

et al. 2019

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Background Pregnant and post-partum adolescent girls and young women (AGYW) living with HIV in sub-Saharan Africa experience inferior outcomes along the prevention of mother-to-child transmission of HIV (PMTCT) cascade compared to their adult counterparts. Yet, despite this inequality in outcomes, scarce data from the region describe AGYW perspectives to inform adolescent-sensitive PMTCT programming. In this paper, we report findings from formative implementation research examining barriers to, and facilitators of, PMTCT care for HIV-infected AGYW in Malawi, and explore strategies for adapting the mothers2mothers (m2m) Mentor Mother Model to better meet AGYW service delivery-related needs and preferences. Methods Qualitative researchers conducted 16 focus group discussions (FGDs) in 4 Malawi districts with HIV-infected adolescent mothers ages 15–19 years categorized into two groups: 1) those who had experience with m2m programming (8 FGDs, n = 38); and 2) those who did not (8 FGDs, n = 34). FGD data were analyzed using thematic analysis to assess major and minor themes and to compare findings between groups. Results Median participant age was 17 years (interquartile range: 2 years). Poverty, stigma, food insecurity, lack of transport, and absence of psychosocial support were crosscutting barriers to PMTCT engagement. While most participants highlighted resilience and self-efficacy as motivating factors to remain in care to protect their own health and that of their children, they also indicated a desire for tailored, age-appropriate services. FGD participants indicated preference for support services delivered by adolescent HIV-infected mentor mothers who have successfully navigated the PMTCT cascade themselves. Conclusions HIV-infected adolescent mothers expressed a preference for peer-led, non-judgmental PMTCT support services that bridge communities and facilities to pragmatically address barriers of stigma, poverty, health system complexity, and food insecurity. Future research should evaluate implementation and health outcomes for adolescent mentor mother services featuring these and other client-centered attributes, such as provision of livelihood assistance and peer-led psychosocial support.

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Section: Discussionmentioning

confidence: 99%

“I would love if there was a young woman to encourage us, to ease our anxiety which we would have if we were alone”: Adapting the Mothers2Mothers Mentor Mother Model for adolescent mothers living with HIV in Malawi

et al. 2019

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“…Gendered community norms set expectations around women's autonomy, ideal or accepted sexual network structures (e.g. concurrency or serial monogamy), gender power and material exchanges within relationships [37][38][39][40][41][42]. Community members can be sanctioned through stigma and shaming (e.g.…”

Section: The Gendered Normative Contextmentioning

confidence: 99%

“…Hyper-endemic HIV risk environments share similar gendered normative contexts characterized by high levels of women's autonomy in entering and exiting relationships, but unequal gender power norms within them that are exacerbated when they are transactional [37][38][39][40]. Transactional sexual relationships are common in many hyper-endemic settings [5,[37][38][39]41].…”

Section: The Gendered Normative Contextmentioning

confidence: 99%

Contextual drivers of HIV risk among young African women

Mojola

Wamoyi

2019

J Intern AIDS Soc

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Introduction Significant progress has been made in the African HIV pandemic; however, the pace of incidence decline has slowed or stalled in many East and Southern African countries, especially among young women. This stall is worrying because many countries have burgeoning youth populations. There is an important window of opportunity to halt the epidemic as well as the potential for millions more infections if primary prevention efforts are not strengthened. Discussion Many hyper‐endemic settings have been exposed to numerous interventions; however, HIV incidence among young women has remained high. In this paper, we characterize the intervention context and examine how it can be strategically utilized to maximize HIV prevention interventions among young women. We begin by examining how contextual dynamics drive HIV risk. We illustrate how epidemiological contexts, gendered normative and economic contexts, and environmental contexts work synergistically to make young women especially vulnerable to HIV infection. We then examine how these contexts can undermine HIV prevention interventions. Finally, we discuss the importance of fully mapping out the intervention context to enhance the effectiveness of HIV prevention interventions. Conclusions Understanding an intervention context, and how its features work together to amplify young women's risk in hyper‐endemic settings can contribute to sustained momentum in reducing HIV incidence among young women and help to limit the reach of the HIV pandemic into new generations of Africans.

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“…With concurrent sexual debut in girls during adolescence, critical sound judgments about both sexual relationships and psychosocial transitions to adulthood are limited [13]. For this reason, blind securities among the adolescent girls in the hands of intimate sexual partners and relational power dynamics that are skewed towards the man results in diverse forms of violence meted to the girls [14]. Consequently, the girls experience stress and other mental and social suffering on which they may medicate with licit and or illicit drugs [15].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Retrospective and Current Substance Use in Women Who Inject Drugs in Low-Income Urban Settings in Kenya

Mwangi¹,

Karanja²,

Gachohi³

et al. 2019

J Alcohol Drug Depend

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Women who inject drugs (WWIDs) continue to experience challenges that accumulate their risk to HIV transmission and other co-morbidities. However, data that conceptually link diverse substance use dimensions in WWIDs are lacking particularly in developing countries. We assessed retrospective and current substance use among 306 WWIDs in low-income urban settings in Kenya using mixed methods. Descriptive analyses were performed on quantitative data while qualitative narratives revealed insights from quantitative findings. The mean age of the study participants was 17 (range 11, 30) years. Out of the 306 WWIDs 57% commenced with substance use by combining both licit and illicit drugs. Intimate sexual partners including spouses and casual sex partners introduced seventy-four percent of WWIDs to substance use. Majority of the WWIDs (39.9%) commenced with 2way substance combination with bhang and cigarette having the highest usage. However, 4-way substance combinations containing heroin, cigarette, bhang, valium, Rohypnol had the highest frequency (12.8%) at the time of the survey. Varied routes of heroin administration were mentioned including injection, smoking and sniffing as separate routes and as 2-way or 3-way mode combinations of these. To inform policies targeting the health and rights of girls and women in low income settings, this study recommends urgent upstream policies targeting the girl adolescent life in form of a multifunctional package composed of identifying girls at risk, substance use interventions, sexual health education, improved educational attainment, and progressive social policies that target low social economic status in the adolescent phase. Harm reduction programs in Kenya should target people who use heroin through both injection and non-injection modes of administration.

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How empowered are girls/young women in their sexual relationships? Relationship power, HIV risk, and partner violence in Kenya

Cited by 51 publications

References 31 publications

“I would love if there was a young woman to encourage us, to ease our anxiety which we would have if we were alone”: Adapting the Mothers2Mothers Mentor Mother Model for adolescent mothers living with HIV in Malawi

“I would love if there was a young woman to encourage us, to ease our anxiety which we would have if we were alone”: Adapting the Mothers2Mothers Mentor Mother Model for adolescent mothers living with HIV in Malawi

Contextual drivers of HIV risk among young African women

Assessment of Retrospective and Current Substance Use in Women Who Inject Drugs in Low-Income Urban Settings in Kenya

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