[Show abstract][Hide abstract] ABSTRACT: South Africa has the highest number of people living with HIV in the world (over 6 million) as well as a rapidly aging population, with 15% of the population aged 50 and over. High HIV prevalence in rural former apartheid homeland areas suggests substantial aging with HIV and acquisition of HIV at older ages. We develop a life course approach to HIV vulnerability, highlighting the rise and fall of risk and protection as people age, as well as the role of contextual density in shaping HIV vulnerability. Using this approach, we draw on an innovative multi-method data set collected within the Agincourt Health and Demographic Surveillance System in South Africa, combining survey data with 60 nested life history interviews and 9 community focus group interviews. We examine HIV risk and protective factors among adults aged 40-80, as well as how and why these factors vary among people at older ages.
Social Science [?] Medicine 09/2015; 143:204-212. DOI:10.1016/j.socscimed.2015.08.023 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Several studies have demonstrated a link between young people’s sexual behavior and levels of parental monitoring, parent-child communication, and parental discipline in Western countries. However, little is known about this association in African settings, especially among young people living in high poverty settings such as urban slums. The objective of the study was to assess the influence of parental factors (monitoring, communication, and discipline) on the transition to first sexual intercourse among unmarried adolescents living in urban slums in Kenya.
Methods: Longitudinal data collected from young people living in two slums in Nairobi, Kenya were used. The sample was restricted to unmarried adolescents aged 12–19 years at Wave 1 (weighted n = 1927). Parental factors at Wave 1 were used to predict adolescents’ transition to first sexual intercourse by Wave 2. Relevant covariates including the adolescents’ age, sex, residence, school enrollment, religiosity, delinquency, and peer models for risk behavior were controlled for. Multivariate logistic regression models were used to assess the associations of interest. All analyses were conducted using Stata version 13.
Results: Approximately 6 % of our sample transitioned to first sexual intercourse within the one-year study period; there was no sex difference in the transition rate. In the multivariate analyses, male adolescents who reported communication with their mothers were less likely to transition to first sexual intercourse compared to those who did not (p < 0.05). This association persisted even after controlling for relevant covariates (OR: ≤0.33; p < 0.05). However, parental monitoring, discipline, and communication with their fathers did not predict transition to first sexual intercourse for male adolescents. For female adolescents, parental monitoring, discipline, and communication with fathers predicted transition to first sexual intercourse; however, only communication with fathers remained statistically significant after controlling for relevant covariates (OR: 0.30; 95 % C.I.: 0.13–0.68).
Conclusion: This study provides evidence that cross-gender communication with parents is associated with a delay in the onset of sexual intercourse among slum-dwelling adolescents. Targeted adolescent sexual and reproductive health programmatic interventions that include parents may have significant impacts on delaying sexual debut, and possibly reducing sexual risk behaviors, among young people in high-risk settings such as slums.
Reproductive Health 08/2015; 12(73). DOI:10.1186/s12978-015-0069-9 · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this paper, I use qualitative data to explore the practices engaged in by Kenyan schoolgirls to participate in modern consuming womanhood, as well as the contradictory implications of these practices for thinking about globalized mediated femininities and their enactment in resource-poor settings. The paper examines the centrality of consumption to valued modern femininity among young women around the world, as well as the structural reality of gendered access to income. I show how the co-optation of the materiality of romantic love and normative expectations of male provision in romantic relationships bridge the gap between consumption desires and economic realities among Kenyan schoolgirls in both powerful and problematic ways. The paper ends with a reflection on the implications of these findings for post-girl power, the post-feminist age and the re-inscription of patriarchy.
[Show abstract][Hide abstract] ABSTRACT: This article draws on ethnographic and interview-based fieldwork to explore accounts of intimate relationships between widowed women and poor young men that emerged in the wake of economic crisis and a devastating HIV epidemic among the Luo ethnic group in western Kenya. I show how the co-optation of widow inheritance practices due to the presence of an overwhelming number of widows during a period of economic crisis has resulted in widows becoming providing women and poor young men becoming kept men. I illustrate how widows in this setting, by performing a set of practices central to what it meant to be a man in this society—pursuing and providing for their partners—were effectively doing masculinity. I also show how young men, rather than being feminized by being kept, deployed other sets of practices to prove their masculinity and live in a manner congruent with cultural ideals. I argue that, ultimately, women’s practice of masculinity in large part seemed to serve patriarchal ends. It not only facilitated the fulfillment of patriarchal expectations of femininity but also served, in the end, to provide a material base for young men’s deployment of legitimizing and culturally valued sets of masculine practices.
Signs Journal of Women in Culture and Society 12/2014; 39(2):341-363. DOI:10.1086/673086 · 0.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Past research provides strong evidence that adverse life events heighten the risk of delinquent behavior among adolescents. Urban informal (slum) settlements in sub-Saharan Africa are marked by extreme adversity. However, the prevalence and consequences of adverse life events as well as protective factors that can mitigate the effects of exposure to these events in slum settlements is largely understudied. We examine two research questions. First, are adverse life events experienced at the individual and household level associated with a higher likelihood of delinquent behavior among adolescents living in two slums in Nairobi, Kenya? Second, are parental monitoring, religiosity, and self-esteem protective against delinquency in a context of high adversity?
We used cross-sectional data from 3,064 males and females aged 12–19 years who participated in the Transitions to Adulthood Study. We examined the extent to which a composite index of adverse life events was associated with delinquent behavior (measured using a composite index derived from nine items). We also examined the direct and moderating effects of three protective factors: parental monitoring, religiosity, and self-esteem.
Fifty-four percent of adolescents reported at least one adverse life event, while 18% reported three or more adverse events. For both males and females, adversity was positively and significantly associated with delinquency in bivariate and multivariate models. Negative associations were observed between the protective factors and delinquency. Significant adverse events × protective factor interaction terms were observed for parental monitoring (females and males), religiosity (males), and self-esteem (females).
Similar to research in high income countries, adverse life events are associated with an increased likelihood of delinquent behavior among adolescents living in urban slums in Kenya, a low-income country. However, parental monitoring, religiosity, and self-esteem may moderate the effect of adversity on delinquent behavior and pinpoint possible avenues to develop interventions to reduce delinquency in resource-poor settings in low and middle income countries.
Child and Adolescent Psychiatry and Mental Health 08/2014; 8(1):24. DOI:10.1186/1753-2000-8-24
[Show abstract][Hide abstract] ABSTRACT: We explore the concerns, challenges, aspirations, and expectations of sub-Saharan African youth, and investigate how these youth cope with neighborhood constraints to aspiration achievement. We draw on cross-sectional survey data from 4033 12–22-year-olds (50.3% males) from two Kenyan urban slums and subsequent in-depth interviews conducted with a subset of 75 youth when they were 13–24 years old (45.3% males). We observe that despite the challenges characteristic of urban slums, some youth maintain high aspirations and try to achieve them through education, delinquency, residential mobility, and religion. We note that others adjust their aspirations to account for limited opportunities. Overall, our findings highlight positive youth agency and underscore the need to improve the quality of life in urban slums.
Journal of Research on Adolescence 03/2013; 23(1):81 - 94. DOI:10.1111/j.1532-7795.2012.00797.x · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: STDs, including HIV, disproportionately affect individuals who have multiple minority identities. Understanding differences in STD risk factors across racial, ethnic and sexual minority groups, as well as genders, is important for tailoring public health interventions.
Data from Waves 3 (2001-2002) and 4 (2007-2008) of the National Longitudinal Study of Adolescent Health were used to develop population-based estimates of STD and HIV risk factors among 11,045 young adults (mean age, 29 at Wave 4), by gender, race and ethnicity, and sexual orientation (heterosexual, mixed-oriented, gay). Regression analyses were conducted to examine associations between risk factors and young adults' characteristics.
Overall, sexual-minority women in each racial or ethnic group had a higher prevalence of sexual risk behaviors-including a history of multiple partners, forced sex and incarceration-than their heterosexual counterparts. Mixed-oriented women in each racial or ethnic group were more likely than heterosexual white women to have received an STD diagnosis (odds ratios, 1.8-6.4). Black men and sexual-minority men also appeared to be at heightened risk. Gay men in all racial and ethnic groups were significantly more likely than heterosexual white men to report having received an STD diagnosis (2.3-8.3); compared with heterosexual white men, mixed-oriented black men had the highest odds of having received such a diagnosis (15.2).
Taking account of multiple minority identities should be an important part of future research and intervention efforts for STD and HIV prevention.
Perspectives on Sexual and Reproductive Health 06/2012; 44(2):125-33. DOI:10.1363/4412512 · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Why are orphaned girls at particular risk of acquiring HIV infection? Using a transition-to-adulthood framework, this study employs qualitative data from Nyanza Province, Kenya, to explore pathways to HIV risk among orphaned and nonorphaned high-school girls. It shows how simultaneous processes such as leaving their parental home, negotiating financial access, and relationship transitions interact to produce disproportionate risk for orphaned girls. The role of financial provision and parental love in modifying girls' trajectories to risk are also explored. A testable theoretical model is proposed based on the qualitative findings, and policy implications are suggested.
Studies in Family Planning 03/2011; 42(1):29-40. DOI:10.2307/41310706 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper focuses on a neglected factor in literature on the HIV epidemic in sub-Saharan Africa: the role of the eco-social environment in shaping HIV risk. I argue that the changing ecological environment of Lake Victoria, Africa's largest freshwater lake, mapping onto a gendered economy, shaped fisherfolk's sexual relationships and sexual mixing patterns in ways that were consequential for their HIV risk. Specifically, I show how disrupted lake and fish ecology had an impact on fishermen's sexual, domestic and economic partnerships, as well as how it contributed to the "sex for fish" economy in Nyanza Province, Kenya. I also show the consequences of fishermen's relative wealth on transactional relationships with school girls and women in lakeside communities. The paper is based on ethnographic fieldwork over a seven month period among the Luo ethnic group, which has the highest HIV rates in Kenya. The study included 74 individual and focus group interviews in communities around Lake Victoria, as well as 20 key informant interviews. Additionally, literature reviews on fishing and sexual economies as well as on ecological research in Lake Victoria are employed. Exploring linkages between these literatures and fieldwork findings forms the basis of this paper. I argue that solely focusing on individual level HIV prevention strategies is limited without taking into account the eco-social context of individual sexual decision making.
Social Science [?] Medicine 01/2011; 72(2):149-56. DOI:10.1016/j.socscimed.2010.11.006 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dramatic political, economic, and social changes in China over the past several decades have been accompanied by much discussion in popular media and among academics of a fundamental transformation in Chinese sexual behavior. Several studies have examined current Chinese sexual behavior but have been limited to particular provinces or cities and have been based on non-random samples. The potential threat of a generalized HIV epidemic in China highlights the dearth of population-based information on current patterns of sexual behavior that could help design better intervention strategies and prevent misguided ones. This article uses data from the first national probability survey of adult sexual behavior in China completed during 1999-2000, along with a historical and literature review, to address three key questions: 1) Has there been a revolution in sexual behavior in China? 2) Is China unique compared to other countries in these transformations? 3) What are the implications of these findings for China's risk of a generalized HIV epidemic? Copyright 2007 The Population Council, Inc..
Population and Development Review 12/2007; 33(4):729-756. DOI:10.1111/j.1728-4457.2007.00195.x · 2.22 Impact Factor