A pilot program to address the gendered social and economic precursors of youth HIV risks
1. A pilot program to address the gendered social
and economic precursors of youth HIV risks
By: Hallman, Kelly, Kasthuri Govender, Eva Roca, Emmanuel Mbatha,
Rob Pattman, and Deevia Bhana
CIES Annual Conference, March 19, 2008, New York, NY
3. Poor more likely to sexually debut earlier
Ever had sex: 14-16 years-olds
0
10
20
30
40
Low Mid High
Wealth
percent
Male
Female
Poor Non-poor
Source: Hallman, 2005
4. Girls with less social capital
more likely to experience physically-forced sex
Ever been : 14-16 year-old females
0
2
4
6
8
Low Mid High
Social Connectedness
percent
Source: Hallman and Onabanjo, 2005
5. Orphans have more
economically-motivated sexual encounters
Ever traded sex: sexually debuted 14-16-year-olds
0
5
10
15
20
Orphan Non-orphan
Orphan Status
percent
Male
Female
Source: Hallman and Onabanjo, 2005
6. Non-enrolled have lower rates of condom use
Condom used at last sex: 14-16 year-olds
0
10
20
30
40
50
60
70
80
Not Enrolled Enrolled
Enrollment Status
percent
Male
Female
Source: Hallman and Onabanjo,
7. Durban Program Scan
• Few HIV prevention programs address
social, economic, and cultural
underpinnings of risk behaviors
• Few LH programs make conceptual link
to HIV risk
– Not context-, age-, or gender-specific
– Weak components
– Little monitoring or evaluation
Source: Swan and Hallman, 2003
8. International Program Scan
• Few programs tackle conceptually links
among HIV and socio-economic-cultural
• Exceptions
– Not evaluated
– Evaluation in place but in early stages
– Not appropriate to context → increased vulnerability
Source: Hallman and Dutt, 2007
9. Developing an integrated program
Efforts to enhance enabling environment
Community forums
Tribal authorities, young women, young men, parents,
grandparents
Increase safe spaces; reduce social isolation
Raise context-specific financial literacy
Facilitate ‘bridging’ to opportunities, services
Increase STI/HIV/AIDS knowledge & skills
National accreditation of the program
10. Reducing social isolation
Bring young people together regularly in
safe community spaces
• Weekly 5 hour sessions
• Groups of 10 young people
• Young adult facilitators
(mentors)
• Interaction with peers
11. Financial literacy
• Increasing awareness of self and rights
• Numeracy training
– Data collection, Graphs
• Personal and household financial management
– Budgeting, Savings, Accessing grants
• Personal income tax and payslip education
• Household and business activities
12. Social and economic bridges
• Starting informal group savings
• Interacting with formal financial insitutions
• Connecting to local role models and mentors
• Learning about local opportunities
– Training and registration in public works tenders
• Accessing learnerships and formal jobs
– Creating/updating resume
– How to link into the system
– Interview skills
13. Sexuality and STI/HIV/AIDS
knowledge and skills
• Increasing knowledge
• Dispelling myths
• Skills to negotiate with
sexual partners
• Healthy lifestyles
19. Participant views of financial education
“It’s different, in school we learn mathematics and
biology but here we learn things that we can use in the
future.” - female age 16 years, enrolled in school
“We learnt about budgeting and saving and all those
things, because we only think that when we get money
we spend it. This program was like an eye-opener to us,
because, we know now when we get some money, we
have to save something…”
- male age 22 years, not enrolled in school
Source: Hallman et al, 2007
20. Participant views of health education
“….. I didn’t understand about HIV and AIDS before
but now I do. I didn’t learn that in school.”
–female age 20 years, not enrolled in school
“It changed my attitude, because I know how to use a
condom and I know how to trust my partner and I know
how to advise my partner, when we are sitting together
and talking about, how to have sexual intercourse and I
know even to advise the community as a whole about
HIV/AIDS…” –male age 22 years, not enrolled in school
Source: Hallman et al, 2007
21.
22. Next steps
• Complete evaluation of pilot
• Disseminate results
• Undertake randomized control trial version
– 3-arm study
23. Implications
Programmatic
• Establish and/or build from an evidence base
• Assess current program landscape
– Models/components
– Target groups
– Evaluation schemes/results
• Stakeholder involvement from beginning
24. Implications
Research
• Consider evaluation early on
– in design phase and program placement plans
• Timing of evaluation (and funding) versus
program time pressures to deliver services
Policy
• Policymaker dialog, input, support from start
• Does program feed into, conflict, or compete with
existing or planned policy
25. Selected resources
• Hallman, Kelly, Kasthuri Govender, Eva Roca, Emmanual Mbatha, Rob Pattman,
and Deevia Bhana. 2008. “Evaluation of an intervention to address the gendered
social and economic precursors of youth HIV risks,” paper prepared for presentation
at PAA Annual Conference, New Orleans, LA, USA.
• Hallman, Kelly and Eva Roca. 2007. “Reducing the social exclusion of girls,”
Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief no. 27.
New York: Population Council.
http://www.popcouncil.org/pdfs/TABriefs/PGY_Brief27_SocialExclusion.pdf
• Hallman, Kelly, Kasthuri Govender, Emmanual Mbatha, Jill Walsh, Rob Pattman,
and Deevia Bhana. June, 2007. “Social capital, socioeconomic aspirations, and HIV
risk behaviors among poor South African youth,” poster presentation. Third South
African AIDS Conference, Durban, South Africa.
http://www.popcouncil.org/mediacenter/events/2007SAAIDS/abstracts/Hallman.ht
ml
• Hallman, Kelly. Gendered socioeconomic conditions and HIV risk behaviours
among young people in South Africa. 2005. African Journal of AIDS Research 4(1):
37–50. Abstract: http://www.popcouncil.org/projects/abstracts/AJAR_4_1.html
• Bruce, Judith. Girls left behind: Redirecting HIV interventions toward the most
vulnerable. Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief
no. 23. New York: Population Council.
http://www.popcouncil.org/pdfs/TABriefs/PGY_Brief23_GirlsLeftBehind.pdf
Today I will be discussing social and economic factors that place young people at risk
and possible interventions designed to reduce such risks.
Girl’s HIV risk is examined along 4 different dimensions:
Sexual activity starts early in South Africa. 26% of boys and 16% of girls aged 14-16 in the sample have had sex.
In the poorest HHs, 30% of girls have already sexually debuted.
Even among higher wealth groups, many girls have already had sex.
Girls who are less socially connected are more likely to have endured physically-forced sexual encounters.
ALL girls, not conditioned on eversex
ZERO for boys
Orphans are also more likely to have exchanged sex for money, goods, or favors.
Conditional on being sexually active, condom use among non-enrolled is lower.
Non-enrolled girls are less than half as likely to have used a condom at last sex.
Orphan girls also less socially connected
By safe spaces I mean:
Ability to meet with friends
Ability to cultivate and maintain social networks
Ability to have a protective community environment
Orphan girls also less socially connected
By safe spaces I mean:
Ability to meet with friends
Ability to cultivate and maintain social networks
Ability to have a protective community environment
Within safe schools and social environments………
Give girls the skills to function as productive and confident future economic actors
Orphan girls also less socially connected
By safe spaces I mean:
Ability to meet with friends
Ability to cultivate and maintain social networks
Ability to have a protective community environment
Basic principles of money management
Building/retaining/safeguarding assets, especially with respect to orphans
Learning how to access available opportunities, such as social benefits and job training
Preparing for predictable events, such as payment of school fees
Dealing with special challenges, such as death of a parent, or a pregnancy
Since policies provide an overall context for action,
these interventions cannot take place without a supportive policy environment.
To prevent risky behaviors we know that information and services alone are not enough…..
We must provide young people with, among other things,
schooling, social support and financial lifeskills to address their underlying structural vulnerabilities.
-----------------------------------
(Among other things: access to condoms and sexual and reproductive health services, gender equitable schooling and work opportunities, freedom from sexual violence, elimination of harmful traditional practices, etc.)