Article

“ It’s a 50/50 Thing You Know ”: Exploring the Multileveled Intersections of Gender and Power Within the Relationships of Young South African Men and Women

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Efforts to advance sexual health globally require greater understandings of youth intimate relationship dynamics. Among 38 South African youth (21 women/17 men aged 21-30 from Durban and Soweto) we conducted qualitative cognitive interviews to explore how gender and power intersect to shape intimate relationship dynamics (October 2019-March 2021). Participants discussed perceptions and relevance of each of 13 items comprising the Sexual Relationship Power (SRP) scale, a widely used measure of gender equity, and the influence of SRP on youth sexual health. Data analysis was guided by constructivist grounded theory. The findings were organized using the socio-ecological model, revealing how gender and power intersected at multiple levels to influence youth intimate relationships. Key influencing factors included individual-level gender attitudes, male partner expectations, and women's resistance to dominance; intimate relationship-level power dynamics, consent, and intimacy; family-level household configurations and parental monitoring of daughters; and societal-level traditional gender norms. At all levels, women discussed resisting power inequities through communication and rejection of inequitable relationships. While men also displayed resistance to inequitable power structures, most upheld traditional gender norms through institutional affiliation (e.g. church) and deep-rooted socialized beliefs and attitudes. Efforts to improve youth sexual health require multileveled approaches that address inequitable power dynamics.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Background Gender inequity and the subsequent health impacts disproportionately affect communities in the Global South. However, most gender equity measures, such as Pulerwitz’ (2000) Sexual Relationship Power Scale (SRPS), are developed and validated in the Global North and then applied in Global South settings without investigation of context applicability or validity. This study examines the SRPS’ validity evidence, comprehensiveness, and contemporary relevance for young South African women and men. Methods Between 2019 and 2021, 38 cognitive interviews (CIs) were conducted among previous participants of a South African youth cohort study ‘AYAZAZI’ (2015–2017) to explore youth’s perceptions of the SRPS. The SRPS measures women’s perceptions of their partner’s controlling behaviours, and men’s perceptions of their own controlling behaviours. Using CIs, participants responded to a 13-item adaptation of the SRPS for use among South African youth (strongly agree-strongly disagree), and then were asked to think-aloud their reasoning for responses, their understanding and perceived relevance of each item, and made overall suggestions for scale adaptations. An item appraisal coding process was applied, whereby Cognitive Coding assessed the types of cognitive problems youth had with understanding the items, and Question Feature Coding assessed which item features caused problems for participant understandings. Finally, youth recommendations for scale adaptations were summarized. Results Overall, 21 women and 17 men aged 21–30 participated in CIs in Durban and Soweto, South Africa. Cognitive Coding revealed 1. Comprehension issues, and 2. Judgements related to items’ applicability to lived experiences and identities (e.g., being unmarried). Question Feature Coding revealed items’ 1. Lack of clarity or vagueness in wording and 2. Logical problems in assumptions leading to multiple interpretations (e.g., item ‘my partner always need to know where I am’ interpreted as both controlling and caring behaviour). Multiple, overlapping issues revealed how many items failed to “fit” within the present-day living realities of South African youth. Youth recommended several item adaptations and additions, including strength-based items, to existing measures of gender equity and relationship power. Conclusion Given identified issues, several adaptations including revising items to be more inclusive, contemporary, context specific, relational, and strength-based are needed to validly measure gender equity and power dynamics within the relationships of South African youth.
Article
Full-text available
Background The ubiquity of cellular phone (cellphone) use in young people’s daily lives has emerged as a priority area of concern for youth mental health. Objective This study measured the prevalence of depression and its association with high cellphone use among youth in Soweto and Durban, South Africa. Methods We analysed cross-sectional, baseline survey data among youth aged 16–24 who participated in a dual-site cohort study, ‘AYAZAZI’, conducted from 2014 to 2017. The primary outcome was depression using the 10-item Center for Epidemiologic Studies Depression Scale, with a score of ≥ 10 indicating probable depression. Cellphone use was measured via self-reported average number of hours of active use, with ‘high cellphone use’ defined as daily usage of ≥ 8. Multivariable logistic regression models assessed the independent relationship between high cellphone use and probable depression, adjusting for potential confounders. Results Of 425 participants with a median age of 19 years (IQR = 18–21), 59.5% were young women. Overall, 43.3% had probable depression, with a higher prevalence among women (49.0% vs. 34.9%, P = .004). Nearly all (94.6%) owned a cellphone. About one-third (29.5%) reported spending ≥ 8 hours per day using their cellphone (39.3% of women vs. 14.9% of men, P < .001). In the overall adjusted model, youth reporting high daily cellphone use had higher odds of probable depression (aOR: 1.83, 95% CI: 1.16–2.90). In gender-stratified models, high daily cellphone use was associated with probable depression among women (aOR: 2.51, 95% CI: 1.47–4.31), but not among men (aOR: 0.87, 95% CI: 0.35–2.16). Conclusions Among a cohort of South African youth, we found a high prevalence of probable depression and high cellphone use (30%). The findings indicate a need for intersectoral initiatives focused on meaningful mental health support for South African youth to support positive growth and development.
Article
Full-text available
Cellphones have impacted on people's intimate sexual relationships. Using the framework of relationship formation, maintenance and ending, we explore how cellphones and attendant social media have impacted on relationships among a group of young women living in urban informal settlements in Durban, South Africa. We conducted in-depth repeat interviews with 15 women enrolled in the Stepping Stones and Creating Futures trial, as well as group discussions and light-touch participant observation. Our data show that cellphones and social media are central to women's sexual relationships and allow women greater control over relationships - particularly their formation. However, cellphones and social media also enable greater control and monitoring by partners. In this study, cellphones were central in establishing (or not) trust in relationships, as well as being gifts, sometimes given by men to demonstrate love, but often becoming a snare for women who then struggled to end relationships because the phones 'remained' the property of the man. We conclude that while cellphones have created new spaces and opportunities for women's agency, overall the wider social and material forces of women's existence were deeply constraining and were the main driver of patterns in women's relationships.
Article
Full-text available
Young people who have lost parents to the pandemic need urgent support and long-term study to avert the cascade of adversity that can follow. Decades of research into the HIV epidemic provide a solid foundation. Young people who have lost parents to the pandemic need urgent support and long-term study to avert the cascade of adversity that can follow. Decades of research into the HIV epidemic provide a solid foundation.
Article
Full-text available
Background The COVID-19 pandemic priorities have focused on prevention, detection, and response. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, and institutionalisation. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. Methods We used mortality and fertility data to model minimum estimates and rates of COVID-19-associated deaths of primary or secondary caregivers for children younger than 18 years in 21 countries. We considered parents and custodial grandparents as primary caregivers, and co-residing grandparents or older kin (aged 60–84 years) as secondary caregivers. To avoid overcounting, we adjusted for possible clustering of deaths using an estimated secondary attack rate and age-specific infection–fatality ratios for SARS-CoV-2. We used these estimates to model global extrapolations for the number of children who have experienced COVID-19-associated deaths of primary and secondary caregivers. Findings Globally, from March 1, 2020, to April 30, 2021, we estimate 1 134 000 children (95% credible interval 884 000–1 185 000) experienced the death of primary caregivers, including at least one parent or custodial grandparent. 1 562 000 children (1 299 000–1 683 000) experienced the death of at least one primary or secondary caregiver. Countries in our study set with primary caregiver death rates of at least one per 1000 children included Peru (10·2 per 1000 children), South Africa (5·1), Mexico (3·5), Brazil (2·4), Colombia (2·3), Iran (1·7), the USA (1·5), Argentina (1·1), and Russia (1·0). Numbers of children orphaned exceeded numbers of deaths among those aged 15–50 years. Between two and five times more children had deceased fathers than deceased mothers. Interpretation Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children. Funding UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.
Article
Full-text available
The focus of this supplement is on inequalities in the levels and trends of progress on sexual and reproductive health among adolescents in sub-Saharan Africa. Whereas adolescents did not get the attention they deserved in the context of the Millennium Development Goals, there is strong commitment to ensuring that they are not left behind in the context of the Sustainable Development Goals [1]. The need to pay particular attention to their sexual and reproductive health needs was reinforced in the list of key actions for the future implementation of the Programme of Action of the International Conference on Population and Development at the Nairobi Summit [2]. Two recent reports highlight the unequal burden of Sexual and Reproductive Health (SRH) problems in adolescents, and their unequal access to the SRH services. Just-published data suggest that the prevalence of violence against women in relation to intimate partner violence starts early in the lives of girls/young women with nearly one in four of every married/partnered 15–19-year-olds already being subjected to physical and/or sexual violence from an intimate partner at least once, and that the levels of violence in the last 12 months (16%) are higher in this age group [3]. Data released by the Guttmacher Institute stressed that as of 2019, adolescents faced vast unmet needs for sexual and reproductive health services (e.g., 41% of adolescent girls aged 15–19 who wanted to avoid a pregnancy had unmet needs for contraception, whereas the comparable rate in 15–49-year-olds was 24%), and projected that this was likely to worsen in the context of the COVID-19 pandemic’s movement restrictions and service disruptions [4].
Article
Full-text available
Background: Understanding young women and men's perceived barriers and facilitators to participation in biomedical HIV prevention research is important for designing youth friendly services (YFS) and acceptable technologies, which are necessary for preventing high sustained HIV incidence in South Africa. This study explores the multileveled barriers and facilitators to young men and women's willingness to participate in hypothetical biomedical HIV prevention research. Methods: Eight age- (16–18 and 19–24 years) and gender-stratified focus group discussions (FGDs) were conducted using semi-structured interview guides to explore young South African women and men's willingness, perceived barriers, and facilitators to participating in biomedical HIV prevention research. FGD transcripts were uploaded to NVivo and coded collaboratively with youth study team members. Thematic analysis using Bronfenbrenner's ecological model (individual, inter-personal, community, and societal) was used to guide a deductive coding procedure, which was documented and compared by gender. Results: Thirty-one participants from Durban and 34 from Soweto participated in FGDs. Individual facilitators for participation were discussed more by young men and included financial incentives and altruism. Concerns about side-effects of biomedical products were a common barrier. Interpersonal relationships with peers, intimate partners and caregivers influenced young people's willingness to participate in HIV prevention research, more so among young women. For young women, gendered power dynamics and distrust of intimate partners and parents influenced both communication regarding participation and willingness to participate in research that is often stigmatized, due to societal norms around women's sexuality. On a societal level, participants expressed distrust in medical and research institutions, however a sense of community that was developed with the study staff of this project, was a motivator to participate in future studies. Discussion: At each level of the ecological model, we found participants expressed gendered barriers and facilitators for participation. Gender norms as well as distrust of partners, parents, and health care professionals were key barriers that cut across all levels. At each level participants discussed facilitators that were youth-engaged, underscoring the need to implement YFS, establish trust and address gender inequities within future biomedical HIV prevention studies wishing to engage and retain South African youth.
Article
Full-text available
Cognitive interviewing is a qualitative research method for improving the validity of quantitative surveys, which has been underused by academic researchers and monitoring and evaluation teams in global health. Draft survey questions are administered to participants drawn from the same population as the respondent group for the survey itself. The interviewer facilitates a detailed discussion with the participant to assess how the participant interpreted each question and how they formulated their response. Draft survey questions are revised and undergo additional rounds of cognitive interviewing until they achieve high comprehension and cognitive match between the research team’s intent and the target population’s interpretation. This methodology is particularly important in global health when surveys involve translation or are developed by researchers who differ from the population being surveyed in terms of socio-demographic characteristics, worldview, or other aspects of identity. Without cognitive interviewing, surveys risk measurement error by including questions that respondents find incomprehensible, that respondents are unable to accurately answer, or that respondents interpret in unintended ways. This methodological musing seeks to encourage a wider uptake of cognitive interviewing in global public health research, provide practical guidance on its application, and prompt discussion on its value and practice. To this end, we define cognitive interviewing, discuss how cognitive interviewing compares to other forms of survey tool development and validation, and present practical steps for its application. These steps cover defining the scope of cognitive interviews, selecting and training researchers to conduct cognitive interviews, sampling participants, collecting data, debriefing, analysing the emerging findings, and ultimately generating revised, validated survey questions. We close by presenting recommendations to ensure quality in cognitive interviewing.
Article
Full-text available
Background In South Africa, large increases in early adult mortality during the 1990s and early 2000s have reversed since public HIV treatment rollout in 2004. In a rural population in KwaZulu-Natal, we investigate trends in parental mortality and orphanhood from 2000–2014. Methods Using longitudinal demographic surveillance data for a population of approximately 90,000, we calculated annual incidence and prevalence of maternal, paternal and double orphanhood in children and adolescents (<20 years) and, overall and cause-specific mortality of parents by age. Results The proportion of children and adolescents (<20 years) for whom one or both parents had died rose from 26% in 2000 to peak at 36% in 2010, followed by a decline to 32% in 2014. The burden of orphanhood remains high especially in the oldest age group: in 2014, 53% of adolescents 15–19 years had experienced the death of one or both parents. In all age groups and years, paternal orphan prevalence was three-five times higher than maternal orphan prevalence. Maternal and paternal orphan incidence peaked in 2005 at 17 and 27 per 1,000 person years respectively (<20 years) before declining by half through 2014. The leading cause of parental death throughout the period, HIV/AIDS and TB cause-specific mortality rates declined substantially in mothers and fathers from 2007 and 2009 respectively. Conclusions The survival of parents with children and adolescents <20 years has improved in tandem with earlier initiation and higher coverage of HIV treatment. However, comparatively high levels of parental deaths persist in this rural population in KwaZulu-Natal, particularly among fathers. Community-level surveillance to estimate levels of orphanhood remains important for monitoring and evaluation of targeted state welfare support for orphans and their guardians.
Article
Full-text available
Background: In order to reduce women's exposure to violence and develop culturally appropriate interventions, it is important to gain an understanding of how men who use violence rationalize it. The present study sought to explore the perspectives of men who had used violence on their female partners, specifically their views on intimate partner violence (IPV), gender norms, manhood, their gender attitudes and to understand how these may drive male perpetrated IPV against women in the Central Region of Ghana. Methods: This was a qualitative study involving purposively sampled adult men who had participated in a household-based survey in selected districts in the Central Region of Ghana and who had self-reported perpetration of IPV in the past 12 months. In-depth interviews were conducted with 17 men. Results: Data revealed how a range of social, cultural, and religious factors ̶ stemming from patriarchy ̶ combined to inform the construction of a traditional masculinity. These factors included the notion that decision-making in the home is a man's prerogative, there should be rigid and distinct gender roles, men's perceptions of owning female partners and having the right to have sex with them whenever they desire, and the notion that wife beating is legitimate discipline. Findings suggest that it was through performing, or aspiring to achieve, this form of masculinity that men used varying forms of violence against their female partners. Moreover, data show that the men's use of violence was a tactic for controlling women and emphasizing their authority and power over them. Conclusions: Developers of interventions to prevent IPV need to recognize that there is a coherent configuration of aspirations, social norms and behaviours that is drawn on by some men to justify their use of IPV. Understanding the perspectives of men who have perpetrated IPV against women and their motivations for perpetration is essential for interventions to prevent IPV. This is discussed as drawing authority from 'tradition' and so engaging traditional and religious leaders, as well as men and women throughout the community, in activities to challenge this is likely to be particularly fruitful.
Article
Full-text available
Background The HIV epidemiology in South Africa reveals stark age and gender disparities, with young women being the most vulnerable to HIV acquisition in 2017. Evaluation of HIV exposure is a challenge in HIV prevention research. Intermittent in-clinic interviewer-administered risk behaviour assessments are utilised but may be limited by social desirability and recall biases. We piloted a mobile phone application for daily self-report of sexual risk behaviour in fifty 18–25 year old women at risk of HIV infection enrolled in HIV Vaccine Trials Network 915 (HVTN 915) in Soweto, South Africa. Through a mixed-methods investigation, we explored barriers and facilitators to completing daily mobile phone surveys among HVTN 915 study participants and staff. Methods We analysed quantitative data on barriers and facilitators to mobile phone study completion collected during the larger HVTN 915 study as well as two post-study focus group discussions (FGDs) with fifteen former participants with a median age of 24 years (IQR 23–25) and six individual in-depth interviews (IDIs) with HVTN 915 staff. FGDs and IDIs utilised semi-structured interview guides, were audio-recorded, transcribed verbatim and translated to English. After coding, thematic analysis was performed. Results The main facilitator for daily mobile phone survey completion assessed across 336 follow-up visits for 49 participants was the daily short message system (SMS) reminders (93%, 312/336). Across 336 visits, 31/49 (63%) retained participants reported barriers to completion of daily mobile phone surveys: forgetting (20%, 12/49), being too busy (19%, 11/49) and the survey being an inconvenience (15%, 9/49). Five main themes were identified during the coding of IDIs and FGDs: (1) facilitators of mobile phone survey completion, such as daily SMS reminders and follow up calls for non-completers; (2) barriers to mobile phone survey completion, including partner, time-related and technical barriers; (3) power of incentives; (4) response bias in providing sensitive information, and (5) recommendations for future mobile phone based interventions. Conclusion Despite our enthusiasm to use innovation to optimise sexual risk assessments, technical and practical solutions are required to improve implementation. We recommend further engagement with participants to optimise this approach and to further understand social desirability bias and study incentives in sexual risk reporting.
Article
Full-text available
Purpose: Inequitable gender norms are thought to harm lifelong health and well-being. We explore the process of gender attitude change and the role of schooling in shifting or reinforcing gender norms among adolescent girls in Zambia. Methods: We used longitudinal data collected from unmarried, vulnerable girls (aged 10-19 years) as part of the Adolescent Girls Empowerment Program. We conducted random effects multinomial logistic regression to determine whether schooling-related factors were associated with shifts in adolescent girls' gender attitudes across three survey rounds and explored whether these relationships varied by age. Results: Mean gender attitude scores at the aggregate level remained stable over time among rural girls and improved slightly for urban girls. At the individual level, about half the girls had relatively unchanged scores, whereas the other half shifted to higher or lower scores between rounds. Rural and urban girls currently attending school were more likely to have relatively stable equitable attitudes than stable, inequitable attitudes, or attitudes that shifted to inequitable. Educational attainment was not associated with shifts in gender attitudes among rural girls. Urban girls with higher educational attainment were more likely to have relatively stable equitable attitudes than stable, inequitable attitudes, or attitudes that shifted to inequitable or more equitable. Conclusions: Patterns of gender attitude stability and change differed more for urban girls than rural girls and varied by age and schooling-related factors. In general, schooling appears to be an institutional lever that holds promise for shifting gender attitudes toward greater equality. Our study highlights the importance of looking longitudinally at the effects of social context and reinforces calls for targeted, context-specific interventions for this age group.
Article
Full-text available
Background: We evaluated Girl Empower - an intervention that aimed to equip adolescent girls with the skills to make healthy, strategic life choices and to stay safe from sexual abuse using a cluster-randomized controlled trial with three arms: control, Girl Empower (GE), and GE+. Methods: GE delivered a life skills curriculum to girls aged 13-14 in Liberia, facilitated by local female mentors. In the GE + variation, a cash incentive payment was offered to caregivers for girls' participation in the program. We evaluated the impact of the program on seven pre-specified domains using standardized indices: sexual violence, schooling, sexual and reproductive health (SRH), psychosocial wellbeing, gender attitudes, life skills, and protective factors. Findings: Participation rates in the program were high in both GE and GE+, with the average participant attending 28 out of 32 sessions. At 24 months, the standardized effects of both GE and GE+, compared to control, on sexual violence, schooling, psychosocial wellbeing, and protective factors were small (β, ≤ 0.11 standard deviations [SD]) and not statistically significant at the 95% level of confidence. However, we found positive standardized effects on Gender Attitudes (GE: β, 0.206 SD, p<0.05; GE+: β, 0.228 SD, p<0.05), Life Skills (GE: β, 0.224 SD, p<0.05; GE+: β, 0.289 SD, p<0.01), and SRH (GE: β, 0.244 SD, p<0.01; GE+: β, 0.372 SD, p<0.01; F-test for GE = GE+: p = 0.075). Interpretation: Girl Empower led to sustained improvements in several important domains, including SRH, but did not reduce sexual violence among the target population.
Article
Full-text available
Quantitative survey findings are important in measuring health-related phenomena, including on sensitive topics such as respectful maternity care (RMC). But how well do survey results truly capture respondent experiences and opinions? Quantitative tool development and piloting often involve translating questions from other settings and assessing the mechanics of implementation, which fails to deeply explore how respondents understand survey questions and response options. To address this gap, we conducted cognitive interviews on survey questions (n = 88) adapted from validated RMC instruments used in Ethiopia, Kenya and elsewhere in India. Cognitive interviews with rural women (n = 21) in Madhya Pradesh, India involved asking the respondent the survey question, recording her response, then interviewing her about what the question and response options meant to her. We analysed the interviews to revise the tool and identify question failures, which we grouped into six areas: issues with sequencing, length and sensitivity; problematic response options; inappropriate vocabulary; temporal and spatial confusion; accessing different cognitive domains; and failure to resonate with the respondent's worldview and reality. Although women tended to provide initial answers to the survey questions, cognitive interviews revealed widespread mismatch between respondent interpretation and question intent. Likert scale response options were generally incomprehensible and questions involving hypothetical scenarios could be interpreted in unexpected ways. Many key terms and concepts from the international RMC literature did not translate well and showed low resonance with respondents, including consent and being involved in decisions about one's care. This study highlights the threat to data quality and the validity of findings when translating quantitative surveys between languages and cultures and showcases the value of cognitive interviews in identifying question failures. While survey tool revision can address many of these issues, further critical discussion is needed on the use of standardized questions to assess the same domains across contexts.
Article
Full-text available
Introduction: Measures used to assess equitable relationship dynamics, including the sexual relationship power scale (SRPS) have previously been associated with lower HIV-risk among young women, and reduced perpetration of intimate partner violence among men. However, few studies describe how the SRPS has been adapted and validated for use within global youth sexual health studies. We examined gender-specific psychometric properties, reliability, and validity of a SRPS used within a South African youth-engaged cohort study. Methods: Young men and women (16-24 years) enrolled in community-based cohorts in Durban and Soweto (2014-2016) reporting a primary partner at 6-month follow-up completed a 13-item (strongly agree/agree/disagree/strongly disagree) South African adaptation of Pulerwitz's SRPS (range 13-52, higher scores indicating greater sexual relationship power [SRP] equity). SRPS modifications were made using gender-specific exploratory factor analyses (EFAs), removing items with factor loadings <0.3. Cronbach alphas were conducted for full and modified scales by gender. Using modified scales, unadjusted and adjusted regression models examined associations between 1. relevant socio-demographic and relationship determinants and SRP equity, and 2. SRP equity and sexual relationship related outcomes. All models adjusted for education, age, site, and current employment. Results: 235 sexually-active youth (66% women, median age = 20) were included. Mean scores across all 13 scale items were 2.71 (SD 0.30) for women and 2.70 (SD 0.4) for men. Scale Cronbach's alphas were 0.63 for women and 0.64 for men. EFAs resulted in two gender-specific single-factor SRPS. Modified SRPS Cronbach alphas increased to 0.67 for women (8-items) and 0.70 for men (9-items). After adjusting for age, site and current employment, higher education remained associated with SRP equity across genders. In adjusted models, correlates of SRP equity included primary partnerships that were age-similar (<5 years older) and <2 years in length for women and living in Soweto and younger age for men. Greater SRP equity among women was also independently associated with no recent partner violence. Conclusions: Results highlight important gender differences in SRP equity measures and associations, highlighting the critically need for future research to examine gendered constructions of SRP equity in order to accurately develop, validate and use appropriate measures within quantitative surveys.
Article
Full-text available
•Agency, a domain of empowerment, is a measurable construct amongst early adolescents age 10-14.•Three sub-scales - Voice, Freedom of Movement, and Behavioral Control and Decision-making - comprise the measurement of agency.•Differences in the Freedom of Movement sub-scale show a growing equity gap between boys and girls across multiple countries.•Users of the scales must consider context when adapting the items to account for differences in culture and environment.
Article
Full-text available
Qualitative research suggests that men’s inability to achieve dominant forms of masculinity may be related to HIV-risk behaviours and intimate partner violence (IPV) perpetration. Using clustered cross-sectional data, we assessed how young men’s gender role conflict was associated with HIV-risk behaviours in urban informal settlements in KwaZulu-Natal, South Africa. Gender Role Conflict and Stress (GRC/S) was measured using a South African adaptation of the GRC/S scale comprising three sub-scales: subordination to women; restrictive emotionality; and success, power and competition. In random-effect models adjusting for socio-demographics, we tested the relationship with GRC/S sub-scales and sexual health behaviours (transactional sex, use of sex workers, ≥2 main partners and ≥2 casual/once off partners), and relationship practices (relationship satisfaction, relationship control, partnership type and perpetration of IPV). Overall, 449 young men (median age = 25, Q1, Q3 = 23–28) were included in the analysis. Higher GRC/S scores, denoting more GRC/S, were associated with increased relationship control and increased odds of having ≥2 casual or one-off partners and engaging in transactional sex. We found differences in associations between each sub-scale and sexual health and relationship practices, highlighting important implications for informing both theoretical understandings of masculinity and gender transformative efforts.
Article
Full-text available
This paper explores young women’s experiences and constructions of love-relationships and intimate partner violence in South Africa, and the role of agency in women’s decisions to remain in or leave violent love-relationships. Understanding why young women stay in or leave violent love-relationships is key to developing nuanced understandings of agency and informing intimate partner violence prevention interventions. Data were collected from 15 young women in informal settlements in eThekwini Municipality, South Africa, via in-depth interviews, photovoice and participant observation, and were analysed inductively. While women’s love-relationships were frequently violent, they often stayed in them for long periods, usually because the relationships met other important aspirations, including the desire for respect and dignity. Nonetheless, many women left when they no longer felt loved and respected, which they believed was shown by men’s behaviours, specifically: indiscreet affairs; not spending time together; not spending money on her and any child(ren); and public (and humiliating) violence. Emotional and economic support from families also influenced women’s decisions about leaving or staying. These data demonstrate that agency goes beyond definitive acts of leaving violent relationships; rather it is fluid, contested and contextual, with many factors influencing young women’s goals and actions.
Article
Full-text available
Background: Youth in southern Africa, particularly adolescent girls and young women, are a key population for HIV prevention interventions. Untreated genital tract infections (GTIs) increase both HIV transmission and acquisition risks. South African GTI treatment guidelines employ syndromic management, which relies on individuals to report GTI signs and symptoms. Syndromic management may, however, underestimate cases, particularly among youth. We compared genital tract infection (GTI) prevalence by symptom-based and laboratory assessment among sexually-experienced youth in South Africa, overall and stratified by sex. Methods: Interviewer-administered surveys assessed socio-demographics, behaviors, and GTI symptoms among 352 youth (16-24 yrs., HIV-negative or unknown HIV status at enrollment) enrolled in community-based cohorts in Durban and Soweto (2014-2016). Laboratory tests assessed HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV) infections and, among females, bacterial vaginosis (BV) and Candida species. Youth with genital ulcers were tested for HSV-2 and syphilis. We assessed sensitivity (and specificity) of symptom-based reporting in identifying laboratory-confirmed GTIs. Results: At baseline, 16.2% of females (32/198) and < 1% (1/154) of males reported ≥1 GTI symptom. However, laboratory tests identified ≥1 GTI in 70.2% and 10.4%, respectively. Female CT prevalence was 18.2%, NG 7.1%, MG 9.6%, TV 8.1%, and 5.1% were newly diagnosed with HIV. BV prevalence was 53.0% and candidiasis 9.6%. One female case of herpes was identified (0 syphilis). Male CT prevalence was 7.8%, NG 1.3%, MG 3.3%, TV < 1%, and 2.0% were newly diagnosed with HIV. Overall, 77.8% of females and 100% of males with laboratory-diagnosed GTIs reported no symptoms or were asymptomatic. Sensitivity (and specificity) of symptom-based reporting was 14% (97%) among females and 0% (99%) among males. Conclusion: A high prevalence of asymptomatic GTIs and very poor sensitivity of symptom-based reporting undermines the applicability of syndromic GTI management, thus compromising GTI control and HIV prevention efforts among youth. Syndromic GTI management does not meet the sexual health needs of young people. Policy changes incorporating innovations in GTI diagnostic testing are needed to reduce GTIs and HIV-associated risks among youth.
Article
Full-text available
Introduction: This commentary by authors from the Adolescent HIV Treatment Coalition calls for action to improve advocacy and service delivery for young people by leveraging the interlinkages between HIV and the broader development agenda. The 2030 Agenda for Sustainable Development includes target 3.3 on ending the AIDS epidemic by 2030, and along with the 2016 Political Declaration on HIV and AIDS, this has led to a global renewal of political commitment to the HIV response. However, young people are still being left behind, and to provide an equitable and sustainable response to HIV we must ensure that we are meeting the needs of the 3.9 million young people living with HIV, and the millions more at risk. Discussion: While HIV has its own target within the 2030 Agenda, efforts to end AIDS are inextricable from other goals and targets, such as on poverty eradication, education, gender equality and peace. To tackle HIV we must work beyond target 3.3 and provide a comprehensive response that addresses the underlying structural inequalities that impact adolescents and young people, ensuring that we enable the meaningful engagement of youth and adolescents as partners and leaders of sustainable development and the HIV response. Finally, it is necessary to collect better disaggregated data and evidence on the HIV epidemic among adolescents, as well as on best practices for supporting them. Conclusions: Ending the AIDS epidemic among adolescents and young people (aged 10 to 24) by 2030 is possible. However, it requires an integrated, multi-sectoral response to HIV which pays attention to the social determinants that put adolescents at risk and fuel the epidemic. Positioning efforts to end AIDS among young people within the broader 2030 Agenda and building youth leadership will contribute to building a more healthy, equitable and sustainable society for all.
Article
Full-text available
Background Evidence suggests that gender-integrated interventions, which actively seek to identify and integrate activities that address the role of gender norms and dynamics, improve family planning (FP) and maternal health (MH). To understand the link between the gender components of interventions and FP and MH outcomes, it is critical to examine the gender measures used in evaluations. Methods We conducted a systematic review of evaluations of gender-integrated FP and MH interventions in low- and middle-income countries. We examine characteristics of the interventions and their evaluations, and summarize women’s empowerment and related gender measures. Results Out of 16 evaluation articles, five reported the theoretical or conceptual model that guided the intervention. Twelve described how gender was quantitatively measured and identified 13 women’s empowerment and related gender constructs. Gender scales or indexes were used in five evaluations, three of which noted that their scales had been validated. Less than one third of articles reported examining the effect of gender on FP or MH. Conclusions Evaluations of gender-integrated FP and MH interventions do not consistently describe how gender influences FP and MH outcomes or include validated gender measures within their studies. As a result, examining the pathways through which interventions empower women and the manner in which women’s empowerment leads to changes in FP and MH outcomes remains a challenge. Valid measures of commonly reported women’s empowerment and gender constructs, such as gender-equitable attitudes and women’s decision-making power, must be adapted and used within evaluations to examine how empowerment and improvements in gender-related factors can produce positive FP and MH outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1500-8) contains supplementary material, which is available to authorized users.
Article
Full-text available
Within HIV-endemic settings, few studies have examined gendered associations between sexual self-efficacy (SSE), one’s confidence or perceived control over sexual behavior, and uptake of HIV prevention behaviors. Using cross-sectional survey data from 417 sexually-experienced adolescents (aged 14–19, median age = 18, 60% female) in Soweto, South Africa, we measured SSE using a 6-item scale (range:0–6) with ‘high-SSE’ = score > 3 (study alpha = 0.75). Gender-stratified logistic regression models assessed associations between high-SSE and lifetime consistent condom use. A higher proportion of women reported high-SSE (68.7%) than men (49.5%, p < 0.001). We observed no difference in reported consistent condom use by gender (45.5% among women, 45.8% among men; p = 0.943). In confounder models, high-SSE was associated with consistent condom use among men (aOR = 3.51, 95%CI = 1.86–6.64), but not women (aOR = 1.43, 95%CI = 0.74–2.77). Findings highlight that individual-level psychosocial factors are insufficient for understanding condom use and must be considered alongside the relational, social, and structural environments within which young women navigate their sexual lives.
Article
Full-text available
South Africa leads the world with the number of people infected with HIV. Even with all attempts that have been made to curb HIV, it is still evident that new infections are on the rise. Condom use remains one of the best tools against this challenge yet a small number of sexually active men use them. This study investigates the psychosocial correlates of the intention to use condoms among young men in KwaZulu-Natal province. Using the Theory of Planned Behaviour as a framework, hierarchical linear regression models were used to determine the unique contribution of the study measures in explaining the overall variance of intention to consistently use condoms. Subjective norms and perceived behavioural control towards consistent condom use explained 46% of the variance in the intention to use a condom, suggesting that health behaviour interventions should focus on targeting the normative beliefs as well as control beliefs of the target population. Furthermore, subjective norms and intentions towards reducing alcohol and marijuana use explained an additional 7% to the final model in intentions to condom use, implying that substance use and condom usage may influence each other. No significant contributions were found for beliefs underlying cultural aspects of responsible manhood.
Article
Full-text available
http://www.tandfonline.com/eprint/ec65SCQXIitBqfuMA88V/full Men are less likely than women to test for HIV and engage in HIV care and treatment. We conducted in-depth interviews with men participating in One Man Can (OMC) – a rights-based gender equality and health programme intervention conducted in rural Limpopo and Eastern Cape, South Africa – to explore masculinity-related barriers to HIV testing/care/treatment and how participation in OMC impacted on these. Men who participated in OMC reported an increased capability to overcome masculinity-related barriers to testing/care/treatment. They also reported increased ability to express vulnerability and discuss HIV openly with others, which led to greater willingness to be tested for HIV and receive HIV care and treatment for those who were living with HIV. Interventions that challenge masculine norms and promote gender equality (i.e. gender-transformative interventions) represent a promising new approach to address men’s barriers to testing, care and treatment.
Article
Full-text available
Engaging men and boys as participants and stakeholders in gender-based violence (GBV) prevention initiatives is an increasingly institutionalized component of global efforts to end GBV. Accordingly, evidence of the impact of men’s engagement endeavors is beginning to emerge, particularly regarding interventions aimed at fostering gender equitable and nonviolent attitudes and behaviors among men. This developing evidence base suggests that prevention programs with a “gender transformative” approach, or an explicit focus on questioning gender norms and expectations, show particular promise in achieving GBV prevention outcomes. Interventions targeting attitude and behavior change, however, represent just one kind of approach within a heterogeneous collection of prevention efforts around the globe, which can also include community mobilization, policy change, and social activism. The degree to which gender transformative principles inform this broader spectrum of men’s engagement work is unclear. The goals of this article are twofold. First, we offer a conceptual model that captures and organizes a broader array of men’s antiviolence activities in three distinct but interrelated domains: (1) initial outreach and recruitment of previously unengaged males, (2) interventions intended to promote gender-equitable attitudes and behavior among men, and (3) gender equity-related social action aimed at eradicating GBV, inclusive of all genders’ contributions. Second, we review empirical literature in each of these domains. Across these two goals, we critically assess the degree to which gender transformative principles inform efforts within each domain, and we offer implications for the continuing conceptualization and assessment of efforts to increase men’s participation in ending GBV.
Article
Full-text available
Adolescents and young people account for 40% of all new HIV infections each year, with South Africa one of the hardest hit countries, and having the largest population of people living with HIV. Although adolescent HIV prevention has been delivered through diverse modalities in South Africa, and although family-based approaches for adolescent HIV prevention have great potential for highly affected settings such as South Africa, there is a scarcity of empirically tested family-based adolescent HIV preventive interventions in this setting. We therefore conducted focus groups and in-depth interviews with key informants including clinicians, researchers, and other individuals representing organizations providing HIV and related health services to adolescents and parents (N = 82). We explored family perspectives and interactions around topics such as communication about sex, HIV, and relationships. Participants described aspects of family interactions that presented both challenges and opportunities for family-based adolescent HIV prevention. Parent-child communication on sexual topics were taboo, with these conversations perceived by some adults as an invitation for children to engage in HIV risk behavior. Parents experienced social sanctions for discussing sex and adolescents who asked about sex were often viewed as disrespectful and needing discipline. However, participants also identified context-appropriate strategies for addressing family challenges around HIV prevention including family meetings, communal parenting, building efficacy around parent-adolescent communication around sexual topics, and the need to strengthen family bonding and positive parenting. Findings indicate the need for a family intervention and identify strategies for development of family-based interventions for adolescent HIV prevention. These findings will inform design of a family intervention to be tested in a randomized pilot trial (ClinicalTrials.gov #NCT02432352).
Article
Full-text available
Editorial Available: http://www.perspectives-in-education.com/ViewPublication.aspx?PublicationID=29
Article
Full-text available
South African researchers have stressed the importance of gender and relationship dynamics underlying sexual risk, particularly among 15- to 19-year-olds. Nevertheless, we know little about these factors among young girls, who are especially at risk of HIV. The main objective in this study was to explore the ways that young girls aged 16 to 17 years give meaning to boys and boyfriends and the processes through which these relationship dynamics are shaped. In-depth interviews were conducted with a group of black girls in a working class context in Durban about their sexual relationships with boys. Dominant gender norms underlined the ways in which girls discussed these sexual relationships in relation to their lack of power and condom use. Factors such as their class, race and gender interacted with girls' vulnerability to risk of HIV. While girls were complicit in their subordination, particularly in relation to cheating boyfriends, many were critical of boys who displayed patterns of sexual domination. Efforts aimed at reducing sexual risk must work toward shifting dominant patterns of masculinity over femininity to broaden pathways of love, trust, loyalty and understanding.
Article
Full-text available
Gender inequity is a pervasive global challenge to health equity. Health promotion, as a field, has paid only limited attention to gender inequity to date, but could be an active agent of change if gender equity became an explicit goal of health promotion research, policy and programmes. As an aspect of gendered health systems, health promotion interventions may maintain, exacerbate or reduce gender-related health inequities, depending upon the degree and quality of gender-responsiveness within the programme or policy. This article introduces a framework for gender-transformative health promotion that builds on understanding gender as a determinant of health and outlines a continuum of actions to address gender and health. Gender-transformative health promotion interventions could play a significant role in improving the lives of millions of girls and women worldwide. Gender-related principles of action are identified that extend the core principles of health promotion but reflect the significance of attending to gender in the development and use of evidence, engagement of stakeholders and selection of interventions. We illustrate the framework with examples from a range of women's health promotion activities, including cardiovascular disease prevention, tobacco control, and alcohol use. The literature suggests that gender-responsiveness will enhance the acceptance, relevance and effectiveness of health promotion interventions. By moving beyond responsiveness to transformation, gender-transformative health promotion could enhance both health and social outcomes for large numbers of women and men, girls and boys.
Article
In April of 2017, individuals utilised the hashtag #MenAreTrash to comment on the murder of Karabo Mokoena in South Africa, fostering a broader dialogue of men’s engagement in violence against women. The present study conducted a thematic analysis of a sample of 2035 tweets with the hashtag #MenAreTrash. Comments that expressed support for the hashtag commented on men’s engagement in violence and non-violent mistreatment towards women, highlighted the importance of holding men accountable for misconduct, and called attention to defensive reactions to the hashtag itself. Other users critiqued the use of the hashtag, suggesting that the hashtag was ineffective in engaging men as allies in preventing violence against women, criticising users of the hashtag, or minimising the seriousness of men’s violence against women. The dialogue highlights the challenges of raising awareness regarding men’s perpetration of violence against women while also engaging men as allies in violence prevention efforts. Trial registration: ClinicalTrials.gov identifier: NCT03179982.
Article
The World Health Organization encourages a “gender transformative” paradigm for preventing violence against women and girls. Gender transformative interventions engage men and boys to reflect critically on—and then to challenge and change—gender-inequitable attitudes and behaviors. To interpret the mixed findings of research evaluating such programs, we review the “social norms” model that informs the paradigm. We bolster the paradigmatic conceptualization of social norms through insights about how exposure to trauma shapes gendered patterns of victimization and perpetration, about gendered violence from research on homophobic bullying, and about transforming local regimes of gender accountability.
Article
Gender-transformative health promotion addresses the reciprocal transactions between the socio-cultural contexts that shape gender-based values and the gender-normative behaviors and health experiences of individuals. A scoping review was conducted to (a) highlight how, when and under what circumstances gender-transformative health promotion is applied in practice, and (b) critically assess the operationalization of gender-transformative health promotion principles in practice to develop a clearer understanding of potential barriers (both conceptual and practical) that may detract from the broader employment of gender-transformative health promotion as a mainstream programming approach. Specific recommendations, based on the findings of this review, are made in an effort to further the operationalization of gender-transformative health promotion as a mainstream health promotion approach, globally.
Article
The Sustainable Development Goals offer the global health community a strategic opportunity to promote human rights, advance gender equality, and achieve health for all. The inability of the health sector to accelerate progress on a range of health outcomes brings into sharp focus the substantial impact of gender inequalities and restrictive gender norms on health risks and behaviours. In this paper, the fifth in a Series on gender equality, norms, and health, we draw on evidence to dispel three myths on gender and health and describe persistent barriers to progress. We propose an agenda for action to reduce gender inequality and shift gender norms for improved health outcomes, calling on leaders in national governments, global health institutions, civil society organisations, academic settings, and the corporate sector to focus on health outcomes and engage actors across sectors to achieve them; reform the workplace and workforce to be more gender-equitable; fill gaps in data and eliminate gender bias in research; fund civil-society actors and social movements; and strengthen accountability mechanisms.
Article
Gender is not accurately captured by the traditional male and female dichotomy of sex. Instead, it is a complex social system that structures the life experience of all human beings. This paper, the first in a Series of five papers, investigates the relationships between gender inequality, restrictive gender norms, and health and wellbeing. Building upon past work, we offer a consolidated conceptual framework that shows how individuals born biologically male or female develop into gendered beings, and how sexism and patriarchy intersect with other forms of discrimination, such as racism, classism, and homophobia, to structure pathways to poor health. We discuss the ample evidence showing the far-reaching consequences of these pathways, including how gender inequality and restrictive gender norms impact health through differential exposures, health-related behaviours and access to care, as well as how gender-biased health research and health-care systems reinforce and reproduce gender inequalities, with serious implications for health. The cumulative consequences of structured disadvantage, mediated through discriminatory laws, policies, and institutions, as well as diet, stress, substance use, and environmental toxins, have triggered important discussions about the role of social injustice in the creation and maintenance of health inequities, especially along racial and socioeconomic lines. This Series paper raises the parallel question of whether discrimination based on gender likewise becomes embodied, with negative consequences for health. For decades, advocates have worked to eliminate gender discrimination in global health, with only modest success. A new plan and new political commitment are needed if these global health aspirations and the wider Sustainable Development Goals of the UN are to be achieved.
Article
Drawing on interviews conducted with young men residing in a hostel in a tertiary institution in KwaZulu-Natal, South Africa, in 2016, this article explores young black men’s construction of masculine sexuality, their approaches to romantic relationships, and responsibility within them. Through the use of semi-structured interviews conducted with young black men, the study investigated the relationship between the social construction of masculinities and the way in which these young men understood, talked about, and explained their views and actions regarding romance and sexuality. The study focuses on the voices of acceptance and resistance to traditional, patriarchal versions of manhood and the variations in men’s discourses and ways of being. It highlights through these voices that heterosexual masculinities are not inherently reckless, impassive, and uncaring, but are situationally and contextually constructed. The findings reveal that while the young men inhabited subject positions offered by traditional discourses of heterosexual masculinity, at the same time they also contested these dominant discourses in the complex and multifarious processes through which these young men constituted their identity.
Article
The Mentors in Violence Prevention (MVP) model seeks to address the root causes of gender violence using a bystander approach and leadership training to challenge structures of patriarchy. Emerging research on adolescent relationship abuse and sexual violence points to key modifiable targets—transforming gender norms, addressing homophobia, integrating with comprehensive sexuality education, and acknowledging the needs of youth already exposed to violence. A social justice–based bystander approach such as the MVP model should be part of a multi-level approach to sexual violence prevention that addresses gender and power, encourages healthy sexuality conversations, and provides safety and support for survivors.
Article
Background: Intimate partner violence (IPV) and HIV are co-occurring global epidemics, with similar root causes of gender and economic inequalities. Economic interventions have become a central approach to preventing IPV and HIV. Objective/methods: We undertook a comprehensive scoping review of published evaluations of economic interventions that sought to prevent IPV and/or HIV risk behaviours. Results: Forty-five separate analyses of interventions met our criteria. Broadly, unconditional cash transfer interventions showed either flat or positive outcomes; economic strengthening interventions had mixed outcomes, with some negative, flat and positive results reported; interventions combining economic strengthening and gender transformative interventions tended to have positive outcomes. Conclusions: The review highlighted a number of gaps. Specifically, there were limited studies evaluating the impact of economic interventions on female sex workers, young women, and men. In addition, there were missed opportunities, with many evaluations only reporting either IPV- or HIV-related outcomes, rather than both, despite overlaps.
Article
How do teenagers located in the KwaZulu-Natal province of South Africa, the epicentre of the HIV pandemic, give meaning to sexuality? This paper examines teenage black Africans investments in sex and sexuality and the gendered dynamics through which sexuality is articulated. Whilst unequal gender relations of power continue to feature prominently within relationship dynamics fuelling the gendering of HIV, attention to the micro-processes through which relationships are forged remain significant in illustrating the complex connections between love, sex and gender. Drawing on empirical findings with teenagers between the ages of 16 and 17 years old, the paper shows how relationships are conceptualised based on discourses of love. Love is inextricably bound up with sex and when teenagers talk about love and sex they also talk about condom use, multiple sexual partners and gender inequalities. What teenagers were interested in for their sexual relationships was not raised in sex education programmes at school. Implications for addressing teenage constructions of sexuality are discussed in the conclusion.
Chapter
This chapter outlines the interpretivist approach that serves as the theoretical framework for the cognitive aspects of survey methodology (CASM). It describes implications for question response and question evaluation as well as recent directions in the study of interpretation and cognition as it pertains to cognitive interviewing. The chapter focuses on an emerging subfield of interpretivism: cognitive sociology. It examines three key methodological concepts central to this tradition (narrative, Verstehen, and thick description) in relationship to cognitive interviewing methodology. Interpretivist approaches attempt to not only identify but also to understand the different realities that social actors construct. The aim of cognitive sociology is to demonstrate the numerous ways in which cognitive processes can be understood from a sociological perspective, suggesting, above all, that cognitive processes are shaped by cultural phenomena. Analytic efforts to make sense of narrative data are commonly referred to as “narrative analysis”.
Book
In some parts of South Africa, more than one in three people are HIV positive. Love in the Time of AIDS explores transformations in notions of gender and intimacy to try to understand the roots of this virulent epidemic. By living in an informal settlement and collecting love letters, cell phone text messages, oral histories, and archival materials, Mark Hunter details the everyday social inequalities that have resulted in untimely deaths. Hunter shows how first apartheid and then chronic unemployment have become entangled with ideas about femininity, masculinity, love, and sex and have created an economy of exchange that perpetuates the transmission of HIV/AIDS. This sobering ethnography challenges conventional understandings of HIV/AIDS in South Africa.
Article
Criteria for determining the trustworthiness of qualitative research were introduced by Guba and Lincoln in the 1980s when they replaced terminology for achieving rigor, reliability, validity, and generalizability with dependability, credibility, and transferability. Strategies for achieving trustworthiness were also introduced. This landmark contribution to qualitative research remains in use today, with only minor modifications in format. Despite the significance of this contribution over the past four decades, the strategies recommended to achieve trustworthiness have not been critically examined. Recommendations for where, why, and how to use these strategies have not been developed, and how well they achieve their intended goal has not been examined. We do not know, for example, what impact these strategies have on the completed research. In this article, I critique these strategies. I recommend that qualitative researchers return to the terminology of social sciences, using rigor, reliability, validity, and generalizability. I then make recommendations for the appropriate use of the strategies recommended to achieve rigor: prolonged engagement, persistent observation, and thick, rich description; inter-rater reliability, negative case analysis; peer review or debriefing; clarifying researcher bias; member checking; external audits; and triangulation. © The Author(s) 2015.
Article
The last 20 years have seen a proliferation of research, spurred by the imperatives of the HIV epidemic and reportedly high rates of gender-based violence, on heterosexual practices in the South African context. Research has focused on how poverty, age and gender within specific cultural contexts shape sexual agency and provide a context for unequal, coercive and violent practices for young women. This paper takes stock of what we currently 'know' about heterosex and critically reflects on the political and ideological effects of such research, specifically in the light of young women's agency. A primary concern is that efforts to address gender inequality and the normative gender practices that shape inequitable heterosexual practices may have functioned to reproduce the very discourses that underpin such inequalities. The paper 'troubles' the victim-agency binarism as it has been played out in South African research on heterosex, raising concerns about how the research may reproduce gendered, classed and raced othering practices and discourses and bolstered regulatory and disciplinary responses to young women's sexualities. The paper argues for critical, feminist self-reflexivity that should extend to re-thinking methodologies entrenched in frameworks of authority and surveillance.
Book
As with other methods that rely on qualitative data, cognitive interviewing has increasingly been criticized for being lax in the critical area of the development of systematic methods for data reduction, analysis, and reporting of results. . . Dr. Willis' book is designed to address this problem by systematically describing analysis procedures for cognitive interviews, and suggesting the conditions under which each is the most effective. The book also describes a systematic, checklist-based approach to the comprehensive reporting of cognitive testing results.