Gender, peer and partner influences on adolescent HIV risk in rural South Africa
Abigail Harrison A E , Jenni Smit B , Susie Hoffman C , Thobile Nzama D , Cheng-Shiun Leu C , Joanne Mantell C , Zena Stein C and Theresa Exner C
+ Author Affiliations
- Author Affiliations
A Population Studies and Training Center, Brown University, 68 Waterman Street, Providence, RI 02912, USA.
B MatCH (Maternal, Adolescent and Child Health), University of the Witwatersrand, 155 Juniper Road, Overport 4091, Durban, South Africa.
C HIV Center for Clinical and Behavioral Studies, NYSPI/Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA.
D Durban University of Technology, Steve Biko Road, PO Box 1334, Berea, Durban 4000, South Africa.
E Corresponding author. Email: Abigail_Harrison@brown.edu
Sexual Health 9(2) 178-186 https://doi.org/10.1071/SH10150
Submitted: 30 November 2010 Accepted: 9 June 2011 Published: 23 November 2011
Abstract
Background and methods: In preparation for a school-based intervention in KwaZulu-Natal, South Africa, a cross-sectional survey of potential HIV risk factors in youth aged 14–17 (n = 983) was conducted. Results: Boys were significantly more likely than girls to report lifetime sexual activity (37.7% v. 13.8%, P < 0.01). Among boys and girls, 46.1% reported condom use at last sex. Discussion of condom use with a partner was the strongest predictor of condom use (boys, odds ratio (OR) = 7.39; girls, OR = 5.58, P < 0.0001). Age was independently associated with sexual activity for boys (OR = 1.49, P < 0.0001) and girls (OR = 1.74, P = 0.02). For boys, perceptions of male peer behaviour were associated with both ever having participated in sexual activity (OR = 1.48, P < 0.01) and condom use at last sex (OR = 1.79, P < 0.01). Girls who equated condom use with having numerous partners were more likely to use them. Among boys, results challenged some expected gender beliefs: support for girls’ initiative in relationship formation and refusal of sex were significant predictors of sexual activity. Among girls, higher pregnancy risk perception (OR = 1.32, P = 0.02) and knowledge (OR = 4.85, P = 0.055) were associated with sexual activity. Conclusions: Creating more gender equitable norms can reduce HIV risk behaviours. HIV prevention interventions should build on existing gender equitable beliefs, and work to promote others, including sexual communication and negotiation skills, and modelling of positive peer norms.
Additional keywords: adolescents, communication, gender, HIV risk behaviour, South Africa, peer influences.
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