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Elke Mitchell Doctoral Thesis 2017

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Elke Mitchell Doctoral Thesis 2017 Risk, resilience and youth sexuality: Negotiations of sexual risk among iTaukei women university students in Suva, Fiji Elke Celeste Mitchell Submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy February 2017 Nossal Institute for Global Health School of Population and Global Health The University of Melbourne Abstract This thesis explores youth sexuality, sexual risk and sexual resilience among young indigenous Fijians (iTaukei), with a particular focus on young iTaukei women. Specifically, it focuses on iTaukei women attending university in Suva and the sexual and social risks they negotiate in their daily lives. Over the last twenty years Fiji has experienced significant political, economic and social change, including women’s increasing participation in education, changing courtship and marriage norms and declining fertility rates. Simultaneously, an escalation in sexually transmitted infection (STI) rates and recorded rates of sexual violence has occurred. Young iTaukei women are considered to be particularly vulnerable to sexual risks, including unplanned pregnancy, sexual violence and STIs, and increasing human immunodeficiency virus (HIV) infection rates have been documented among this group. A hierarchy of sexual risks is scrutinised to develop a culturally grounded and gender sensitive understanding of sexual risk that is relevant to the lives of iTaukei women university students. Sexual resilience factors are also examined to identify influences that may promote more equal sexual relationships and positive sexual and reproductive health (SRH) outcomes among young people in Fiji. In order to construct a comprehensive understanding of sexual risk and sexual resilience, this thesis explores youth cultures and social experiences, sexual geographies, and young iTaukei women’s negotiations of casual sexual encounters and romantic relationships. It also examines young people’s SRH knowledge, attitudes and beliefs and critiques Fiji’s national response to HIV/STIs. An adapted ecological model is developed to theorise sexual risk and sexual resilience in young iTaukei women’s lives as determined by multiple and overlapping influences in their society. A mixed methods, youth-centred approach with multiple groups of informants was utilised in the research. This included in-depth interviews, focus group discussions, participant observation, secondary data and policy analysis, and a quantitative survey. This created robust data sets that were then triangulated. iii This thesis contributes to current theoretical discussions regarding SRH and HIV/STI prevention in Fiji and the wider Pacific region. This thesis also adds to the theoretical body of knowledge in the field of global health in the area of youth SRH and builds on the intellectual lineage of HIV scholarship. Research findings illustrate how young iTaukei women’s sexual risk and sexual resilience are produced through complex intersections of local culture, sex and gender ideologies, global processes, and varied sexual subjectivities and desires. The thesis reveals how sexual risk and sexual resilience among young iTaukei women are complex, dynamic and constantly shifting, as they are influenced by the complex interplay between multiple levels of influence. The thesis demonstrates the need for a multi-level ecological analysis to inform effective STI/HIV prevention strategies in Fiji. It argues that in order to address the complex nature of sexual risk and promote sexual resilience an equally complex and multifaceted approach must be utilised. This response must take place at multiple levels, communities must drive this response, and men must be included in initiatives and as advocates for women’s sexual and reproductive rights. In addition, existing currents of change that are challenging unequal gender relations need to be supported, and culturally appropriate and ‘youth-friendly’ health services and interventions are needed. iv Declaration I declare that: I. the thesis comprises only my original work towards the Doctor of Philosophy II. due acknowledgment has been made in the text to all other material used III. the thesis is less than 100,000 words in length, exclusive of tables, maps, bibliographies and appendices Signed: Date: 17/2/17 v Acknowledgements Firstly, to the young iTaukei women who entrusted to me their life stories I am extraordinarily grateful. I feel honoured that you shared your experiences, hopes and dreams and gave me the opportunity to be a part of your life for a short while. To the young iTaukei men and USP students who also took part in my research I am eternally grateful. Vinaka Vakalevu. I am indebted to my research assistants Vilisi, Alesi, Sairusi and Uate, without whom the fruitfulness of my data collection would not have been possible. Vinaka Vakalevu. The friendship and support extended to me throughout my fieldwork and the laughter we shared will never be forgotten. I dedicate this thesis to you and to your fellow USP peer educators. Keep up the great work! I am enormously grateful to my primary PhD supervisor Dr Linda Rae Bennett. The patience, guidance and support she provided throughout my candidature and her passion for my research was extraordinary. Put simply Linda was amazing. Not only was she a true mentor but also, she was a thoughtful friend. I will forever be appreciative of the knowledge, skills and wisdom she imparted to me. I am thankful to Dr Larissa Sandy who provided guidance in the early formation of my research topic and methodology. I am grateful for the rigorous feedback and Pacific expertise provided by Dr Kalissa Alexeyeff during my thesis write up. The support provided by Dr Lynda Newland at USP during my fieldwork was also greatly appreciated. The support and encouragement of my colleagues at the Nossal Institute for Global Health assisted in the completion of my research. In particular, I would like to thank Associate Professor Jim Black, Lauren Bell and Dr Greg Armstrong. I also thank Dr Janene Carey for editorial assistance with this thesis, which took the form of copyediting as specified in Standards D and E of the Australian Standards for Editing Practice. My PhD Candidature and the research I undertook for this degree were supported by scholarships from the Nossal Institute for Global Health, the Australian Awards– Endeavour Research Fellowship and Graduate Women Victoria. I am very grateful to these organisations for providing me with this assistance. vi To my friends in Fiji and Australia, I thank you for your support over the last six years and for putting up with my recurring absence and my obsessive focus on my research. Your constant emails, phone calls, support and visits throughout my research kept me going. Special thanks go out to Dad, Mum, Anna, Emma, Mikala, Pia and the Suva Splinters. Finally, a special thank you is reserved for my partner Michael. The unwavering support, understanding, encouragement and love he provided is what kept me going, especially during the final months before submission. He was, and remains, the greatest gift Fiji gave me. Au domoni iko. vii Table of contents Abstract..................................................................................................................................... iii Declaration ................................................................................................................................. v Acknowledgements ..................................................................................................................vi List of illustrations, figures and tables ............................................................................. xii List of publications ............................................................................................................... xiii Glossary of terms .................................................................................................................. xiv List of abbreviations ........................................................................................................... xvii Introduction ............................................................................................................................... 1 YOUNG PEOPLE AND SEXUAL RISK .................................................................................... 7 SITUATING RISK IN FIJI ............................................................................................................. 8 THE RESEARCH PROCESS ....................................................................................................... 13 The fieldwork setting .................................................................................................................................. 13 Methodology: A mixed methods approach .......................................................................................... 15 Data analysis ................................................................................................................................................ 24 Ethical considerations ............................................................................................................................... 24 CHAPTER OVERVIEW ............................................................................................................... 25 Chapter 1 Gender, sexuality and social change in Fiji: The sociocultural context of sexual risk for young urban iTaukei ............................................................................ 29
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