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Sex and Youth: Contextual Factors Affecting Risk for HIV/AIDS Sex and youth: contextual factors affecting risk for HIV/AIDS Joint United Nations Programme on HIV/AIDS UNICEF • UNDP • UNFPA • UNDCP UNESCO • WHO • WORLD BANK UNAIDS/99.26E (English original, May 1999) © Joint United Nations Programme on HIV/AIDS (UNAIDS) The designations employed and the presentation of the 1999. All rights reserved. This document, which is not a for- material in this work do not imply the expression of any mal publication of UNAIDS may be freely reviewed, quoted, opinion whatsoever on the part of UNAIDS concerning the reproduced or translated, in part or in full, provided the legal status of any country, territory, city or area or of its source is acknowledged. The document may not be sold or authorities, or concerning the delimitation of its frontiers used in conjunction with commercial purposes without and boundaries. prior written approval from UNAIDS (Contact: UNAIDS Information Centre). UNAIDS – 20 avenue Appia – 1211 Geneva 27 – Switzerland Tel.: (+41 22) 791 46 51 – Fax : (+41 22) 791 41 65 e-mail: [email protected] – http://www.unaids.org Sex and youth: contextual factors affecting risk for HIV/AIDS A comparative analysis of multi-site studies in developing countries UNAIDS BEST PRACTICE COLLECTION Young people and risk-taking in sexual relations Community responses to AIDS Use of the female condom: genders relations and sexual negotiation Young people and risk-taking in sexual relations This set of studies presents a comparative analysis of data collected in interviews and discussions with nearly 3000 young people in 7 countries in Africa, Asia and the Americas. Strikingly similar themes and issues emerge, including concepts of youth, the challenge to traditional cultures, modernization and urbanization revealing a complex and heterogeneous situation for young people and no one HIV/STD prevention strategy. Future prevention efforts must take into account the impact of dominant sexuality frameworks, the onset of sexual activity, the impor- tance of the body for young people, mass media, risk assessment and safer sex. Community responses to AIDS A comparative analysis of the resulting data from 5 countries identified local beliefs about HIV/AIDS, the community and household responses and the inter-relations between the two. Key factors influencing the responses include the existing eco- nomic situation, prevailing relations between men and women in the communities and households, local beliefs in health and health care and local levels of stigmati- zation. Recommendations are made for policy and programme development. Use of the female condom: genders relations and sexual negotiation This third set of studies first collected data in 4 countries on gender relations, sexual communication and negotiation followed by an intervention to strengthen womens capacity in these latter areas. The comparative analysis clearly identified economic dependence on men and gender stereotypes as the two major factors constraining women in their sexual behaviour. The report finishes with specific recommendations. This bare summary of these 3 pioneering sets of studies investigations into the determinants of HIV-related vulnerability cannot convey the extraordinary wealth of data and the richness of experiences and feelings reported by the participants with striking frankness. The volume will be read and re-read by national authorities, programme designers and managers, researchers and intervention specialists. In addition it will be of great interest and value to all those who are interested in the issues surrounding young people and HIV/AIDS, sexual behaviour, communica- tion and negotiation, the improvement and strengthening of responses for the benefit of people living with HIV/AIDS, their carers and their communities, gender roles and the options for women who want to protect themselves against HIV and other STDs as well as pregnancy. UNAIDS, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel.: (+41 22) 791 46 51 - Fax: (+41 22) 791 41 65 e-mail: [email protected] Sex and youth: contextual factors affecting risk for HIV/AIDS A comparative analysis of multi-site studies in developing countries Joint United Nations Programme on HIV/AIDS UNICEF • UNDP • UNFPA • UNDCP UNESCO • WHO • WORLD BANK UNAIDS Geneva, Switzerland 1999 Sex and youth: contextual factors affecting risk for HIV/AIDS A comparative analysis of multi-site studies in developing countries Part 1 Young people and risk-taking in sexual relations Gary Dowsett1 and Peter Aggleton2 Part 2 Community responses to AIDS Peter Aggleton and Ian Warwick2 (from an original analysis by Ian Warwick) Part 3 Use of the female condom: gender relations and sexual negotiation Peter Aggleton, Kim Rivers2 and Sue Scott3 (from an original analysis by Sue Scott) 1 Centre for the Study of Sexually Transmissible Diseases, La Trobe University, Melbourne, Australia 2 Thomas Coram Research Unit, Institute of Education, University of London, UK 3 Department of Applied Social Science, University of Stirling, UK ACKNOWLEDGEMENTS We would also like to thank Roger Ingham who provided valuable advice in relation to protocol design, and Anne Malcolm and Annie George who pro- Part 1 vided technical assistance during the conduct of the studies. In Geneva, Eva Young people and risk-taking in sex- Rodrigues, Penny Ratcliffe, Sylvie ual relations Schaller, Paula Soper and Julie Dew were among those who provided secre- We thank the principal investigators tarial and administrative support. In and research teams in each study site, London, Helen Thomas, Maria Harrison without whom these investigations and Paula Hassett did the same. could never have been conducted: Séverin-Cécile Abega at l’Université de Last but not least we would like to thank Yaoundé, Cameroun; Carol Jenkins at all those who participated in the studies the Papua New Guinea Institute of themselves. Without their involvement Medical Research, Goroka, Papua New and willingness to speak openly about Guinea; Teresa Marshall at the their experiences, this work could never Corporación de Salud y Políticas have been completed. Sociales, Santiago, Chile; Agnes Runganga at the University of Zimbabwe, Harare, Zimbabwe; Jacobo Gary Dowsett and Peter Aggleton Schifter at the Instituto Latinamericano Sydney and London de Prevención y Educación en Salud, San José, Costa Rica; Michael Tan at the Health Action Information Network, Part 2 Quezon City, Philippines; and Chou Community responses to AIDS Meng Tarr at the Cambodian AIDS Social Research Project, Phnom Penh, We thank the principal investigators Cambodia. We would also like to thank and research teams without whom Purnima Mane for her detailed com- these multi-site investigations could ments on an earlier draft of this never have been conducted: Shalini Comparative Analysis. Bharat of the Tata Institute of Social Sciences, Mumbai, India; Melkizedeck The multi-site studies were designed Leshabari of Muhimbili University and implemented according to a College of Health Sciences, Dar es General Research Protocol developed Salaam, the United Republic of by Gary Dowsett, a member of the for- Tanzania; Roberto Castro of the Centro mer Social and Behavioural Studies and Regional de Investigaciones Support Unit of the World Health Multidisciplinarias, Cuernavaca, Organization’s Global Programme on Mexico;4 Rafael Garcia of Universidad AIDS. He is now Deputy Director of the Autónoma de Santo Domingo, Centre for the Study of Sexually República Dominicana; and Anchalee Transmissible Diseases at La Trobe Singhanetra-Renard of Chiang Mai University, Melbourne, Australia. University, Thailand. We would also like 4 Previously of the Instituto Nacional de Salud Pública, Cuernavaca, Mexico. 1 to thank Purnima Mane, Michel Caraël, Enseñanza en Nutrición y Salud Mark Connolly and Binod Mahanty of (INCIENSA) and Gisela Herrera of the UNAIDS for their helpful comments on Departmento Control del SIDA in Costa an earlier draft of this report. Rica. In Mexico, they were coordinated by Griselda Hernandez of the Consejo The protocol for the studies described Nacional de Prevención y Control del here was designed by Jane Verrall SIDA (CONASIDA). In Senegal, they working within the Social Studies and were coordinated by Cheikh Ibrahim Support Unit of the World Health Niang at Université Cheikh Anta Diop Organization’s former Global de Dakar. In Indonesia they were coor- Programme on AIDS. She is now dinated by Bernadette Setiadi, of the Director of the International Union for Lembaga Psikologi Terapan, Fakultas the Scientific Study of Population, Psikologi, Universitas Indonesia. Liège, Belgium. We would also like to thank Susan Kippax and Werasit The studies described in this report Sittitrai for their valuable advice in rela- were developed from a general tion to protocol development, and research protocol designed by Annie George for technical assistance Purnima Mane who is now Programme during the studies. Administrative and and Planning Coordinator with the secretarial support was provided by Joint United Nations Programme on Eva Rodrigues, Penny Ratcliffe, Sylvie HIV/AIDS (UNAIDS). We would also Schaller, Paula Soper and Julie Dew in like to thank Anne Malcolm, Annie Geneva, and by Helen Thomas, Maria George and Jane Verrall who provided Harrison and Paula Hassett in London. technical assistance in the course of the research; Eva Rodrigues, Penny Finally, thank the individuals, families Ratcliffe, Sylvie Schaller and Paula and households that participated in the Soper who provided secretarial and
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