PLACE Swaziland Adolescent Girls and Young Women, Their Partners, and Men Ages 20–34
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PLACE Swaziland Adolescent Girls and Young Women, Their Partners, and Men Ages 20–34 May 2017 TR-17-168 PLACE Swaziland Adolescent Girls and Young Women, Their Partners, and Men Ages 20–34 Zahra Reynolds, MPH Bheki Mamba, AHMP Ireen Hakasenke, BA May 2017 MEASURE Evaluation This publication was produced with the support of the United States Agency for International Development (USAID) under University of North Carolina at Chapel Hill the terms of MEASURE Evaluation cooperative agreement 400 Meadowmont Village Circle, 3rd Floor AID-OAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina Chapel Hill, NC 27517 USA at Chapel Hill in partnership with ICF International; John Phone: +1 919-445-9350 Snow, Inc.; Management Sciences for Health; Palladium; [email protected] and Tulane University. Views expressed are not necessarily those of USAID or the United States government. TR-17-168 www.measureevaluation.org ISBN: 978-1-9433-6456-5 ACKNOWLEDGMENTS This study was a tremendous effort on the part of many individuals and organizations. We would like to acknowledge the technical support and oversight of the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in Swaziland and Washington, DC. The primary research team consisted of representatives of Swaziland’s National Emergency Response Council on HIV and AIDS, the USAID- and PEPFAR-funded MEASURE Evaluation, and the Institute for Health Measurement (IHM) Southern Africa. We also received support and input from the Ministry of Health as well as other partners and stakeholders of the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) Initiative in Swaziland and globally. IHM Southern Africa provided management and oversight of the fieldwork as well and contributing significantly to the analysis and report writing with MEASURE Evaluation. The fieldwork could not have been completed without the approval and support of the 19 tinkhundla councils where the survey was conducted as well as the tireless effort of the interviewers and the people they interviewed. Cover photo: Young women participate in a reed dance ceremony in Mbabane, Swaziland. © 2013, Arturo Sanabria, courtesy of Photoshare 4 PLACE Swaziland CONTENTS ACKNOWLEDGMENTS ........................................................................................................................ 4 CONTENTS ................................................................................................................................................ 5 ABBREVIATIONS ..................................................................................................................................... 8 EXECUTIVE SUMMARY ........................................................................................................................ 9 INTRODUCTION .................................................................................................................................. 11 METHODS ............................................................................................................................................... 12 Preparation and Tinkhundla Entry Meetings ................................................................................... 12 Community Informant Interviews ..................................................................................................... 14 Spot Verification and Mapping .......................................................................................................... 15 Interviews with AGYW, Their Partners, and Men Ages 20 to 34 ................................................ 15 Selecting Individuals at Sites ........................................................................................................... 18 RESULTS ................................................................................................................................................... 20 Spot Verification ................................................................................................................................... 20 Individual Patron and Worker Interviews ........................................................................................ 26 DISCUSSION ........................................................................................................................................... 64 CONCLUSION ........................................................................................................................................ 65 APPENDIX A. SPOT AND IDENTIFICATION FORM ............................................................. 66 APPENDIX B. SPOT VERIFICATION FORM .............................................................................. 69 APPENDIX C. PATRON AND WORKER INTERVIEW FORM .............................................. 73 PLACE Swaziland 5 FIGURES Figure 1. Map of selected tinkhundla for data collection ................................................................................. 14 Figure 2. Sites for individual interviews sampling ............................................................................................. 18 TABLES Table 1. DREAMS priority tinkhundla ............................................................................................................... 13 Table 2. Summary of spot verification fieldwork .............................................................................................. 21 Table 3. Characteristics of found and verified spots ......................................................................................... 22 Table 4. Characteristics of found and verified spots ......................................................................................... 23 Table 5. AGYW and young men at spots ........................................................................................................... 24 Table 6. HIV prevention activities at spots ........................................................................................................ 25 Table 7. Summary of fieldwork for interviews with individuals at sites ........................................................ 26 Table 8. Self-reported sociodemographic characteristics ................................................................................ 27 Table 9. Self-reported employment and resource characteristics .................................................................... 28 Table 10. Self-reported relationship status, fertility, and family characteristics ............................................ 29 Table 11. Self-reported residence characteristics ............................................................................................... 30 Table 12. Self-reported spot-visiting behavior ................................................................................................... 31 Table 13. Alcohol, drug use, and high-risk behaviors ....................................................................................... 32 Table 14. Other health service utilization ........................................................................................................... 33 Table 15. Ever had sex and age at first sex ......................................................................................................... 34 Table 16. Sexual partnership, among those who have ever had sex ............................................................... 35 Table 17. Sexual partnerships in the past 12 months, continued .................................................................... 36 Table 18. Transactional sex, among those who have ever had sex ................................................................. 37 Table 19. Characteristics of most recent partner in the past 12 months ....................................................... 38 Table 20. Age differences with sexual partners, among those with a sex partner in the past 12 months ................................................................................................................................................. 39 Table 21. HIV risk behaviors, by number of partners ...................................................................................... 40 Table 22. Condom acquisition and education .................................................................................................... 41 Table 23. Exposure to HIV information and testing ........................................................................................ 42 Table 24. HIV testing among those ever tested ................................................................................................. 43 Table 25. HIV treatment, among those ever tested ......................................................................................... 44 Table 26. Male circumcision .................................................................................................................................. 45 Table 27. Perceived risk of getting infected with HIV ..................................................................................... 45 Table 28. Perceptions of gender norms .............................................................................................................. 46 6 PLACE Swaziland Table 29. Self-reported sociodemographic characteristics ............................................................................... 47 Table 30. Self-reported employment