Measuring sexual relationship power equity among young women and young men South Africa: Implications for gender-transformative programming

English version

Autoři: Kalysha Closson ^aff001; Janan J. Dietrich ^aff003; Mags Beksinska ^aff004; Andrew Gibbs ^aff005; Stefanie Hornschuh ^aff003; Tricia Smith ^aff001; Jenni Smit ^aff004; Glenda Gray ^aff003; Thumbi Ndung’u ^aff006; Mark Brockman ^aff001; Angela Kaida ^aff001
Působiště autorů: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada ^aff001; BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada ^aff002; Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ^aff003; Maternal Adolescent and Child Health (MatCH) Research Unit (MRU), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa ^aff004; South African Medical Research Council, Cape Town, South Africa ^aff005; HIV Pathogenesis Programme and Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa ^aff006; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, MA United States of America ^aff007; Max Planck Institute for Infection Biology, Berlin, Germany ^aff008
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0221554

Souhrn

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.

Klíčová slova:

Behavior – Schools – Surveys – African people – HIV epidemiology – Intimate partner violence – Human sexual behavior

Zdroje

1. Zembe YZ, Townsend L, Thorson A, Silberschmidt M, Ekstrom AM. Intimate Partner Violence, Relationship Power Inequity and the Role of Sexual and Social Risk Factors in the Production of Violence among Young Women Who Have Multiple Sexual Partners in a Peri-Urban Setting in South Africa: e0139430. PLoS One. 2015;10. doi: 10.1371/journal.pone.0139430 26599394

2. Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363(9419):1415–21. doi: 10.1016/S0140-6736(04)16098-4 15121402.

3. World Health Organization (WHO). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization 2013.

4. Wathuta J. Gender inequality dynamics in the prevention of a heterosexual HIV epidemic in sub-Saharan Africa. Afr J AIDS Res. 2016;15(1):55–66. doi: 10.2989/16085906.2016.1150310 27002358.

5. World Health Organization. The global strategy for women's, children's and adolescents' health (2016–2030). Geneva, Switzerland World Health Organization 2017.

6. United Nations. Progress towards the Sustainable Development Goals. Geneva, Switzerland United Nations, 2017 Contract No.: 17–07553.

7. Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Zungu N, et al. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town: 2014.

8. Chersich MF, Rees HV. Vulnerability of women in southern Africa to infection with HIV: biological determinants and priority health sector interventions. AIDS. 2008;22 Suppl 4:S27–40. doi: 10.1097/01.aids.0000341775.94123.75 19033753.

9. Connell R. Gender and power: society, the person and sexual politics. Cambridge: Polity in association with Blackwell; 1987. xvii, 334 p. p.

10. Jewkes RK, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010;376(9734):41–8. doi: 10.1016/S0140-6736(10)60548-X 20557928.

11. Pulerwitz J, Gortmaker SL, DeJong W. Measuring sexual relationship power in HIV/STD research. Sex Roles. 2000;42(7/8):637–60.

12. Gibbs A, Jewkes R, Willan S, Washington L. Associations between poverty, mental health and substance use, gender power, and intimate partner violence amongst young (18–30) women and men in urban informal settlements in South Africa: A cross-sectional study and structural equation model. PLoS One. 2018;13(10):e0204956. doi: 10.1371/journal.pone.0204956 30281677; PubMed Central PMCID: PMC6169941.

13. Connell R. Gender , health and theory: conceptualizing the issue, in local and world perspective. Soc Sci Med. 2012;74(11):1675–83. doi: 10.1016/j.socscimed.2011.06.006 21764489.

14. Jewkes R, Morrell R. Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. J Int AIDS Soc. 2010;13:6. doi: 10.1186/1758-2652-13-6 20181124; PubMed Central PMCID: PMC2828994.

15. Wood K, Jewkes R. Violence, rape, and sexual coercion: everyday love in a South African township. Gend Dev. 1997;5(2):41–6. 12292615.

16. Lary H, Maman S, Katebalila M, McCauley A, Mbwambo J. Exploring the association between HIV and violence: young people's experiences with infidelity, violence and forced sex in Dar es Salaam, Tanzania. Int Fam Plan Perspect. 2004;30(4):200–6. doi: 10.1363/ifpp.30.200.04 15590386.

17. Nduna M, Jewkes RK, Dunkle KL, Shai NPJ, Colman I. Prevalence and factors associated with depressive symptoms among young women and men in the Eastern Cape Province, South Africa. Journal of Child and Adolescent Mental Health. 2013;25(1):43–54. doi: 10.2989/17280583.2012.731410 2013-20561-006. 25860306

18. Jama Shai N, Jewkes R, Nduna M, Dunkle K. Masculinities and condom use patterns among young rural South Africa men: a cross-sectional baseline survey. BMC Public Health. 2012;12:462. doi: 10.1186/1471-2458-12-462 22892159; PubMed Central PMCID: PMC3504511.

19. Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I. Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa. J Int AIDS Soc. 2010;13:44. doi: 10.1186/1758-2652-13-44 21078150; PubMed Central PMCID: PMC2992477.

20. Rosenberg M, Pettifor A, Van Rie A, Thirumurthy H, Emch M, Miller WC, et al. The Relationship between Alcohol Outlets, HIV Risk Behavior, and HSV-2 Infection among South African Young Women: A Cross-Sectional Study. PLoS One. 2015;10(5):e0125510. doi: 10.1371/journal.pone.0125510 25954812; PubMed Central PMCID: PMC4425652.

21. Nkosi S, Rich EP, Morojele NK. Alcohol use, sexual relationship power, and unprotected sex among patrons in bars and taverns in rural areas of North West province, South Africa. AIDS Behav. 2014;18(11):2230–9. Epub 2014/04/05. doi: 10.1007/s10461-014-0764-5 24699714.

22. Pitpitan EV, Kalichman SC, Eaton LA, Cain D, Sikkema KJ, Skinner D, et al. Gender-based violence, alcohol use, and sexual risk among female patrons of drinking venues in Cape Town, South Africa. J Behav Med. 2013;36(3):295–304. doi: 10.1007/s10865-012-9423-3 22526526; PubMed Central PMCID: PMC3646073.

23. Smit J, Myer L, Middelkoop K, Seedat S, Wood R, Bekker LG, et al. Mental health and sexual risk behaviours in a South African township: a community-based cross-sectional study. Public Health. 2006;120(6):534–42. doi: 10.1016/j.puhe.2006.01.009 16684549.

24. Wood K, Lambert H, Jewkes R. "Showing roughness in a beautiful way": talk about love, coercion, and rape in South African youth sexual culture. Med Anthropol Q. 2007;21(3):277–300. 17937250.

25. Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet (London, England). 2004;363(9419):1415–21.

26. Pulerwitz J, Mathur S, Woznica D. How empowered are girls/young women in their sexual relationships? Relationship power, HIV risk, and partner violence in Kenya. PLoS One. 2018;13(7):e0199733. doi: 10.1371/journal.pone.0199733 30024908; PubMed Central PMCID: PMC6053148.

27. Pulerwitz J, Amaro H, De Jong W, Gortmaker SL, Rudd R. Relationship power, condom use and HIV risk among women in the USA. AIDS Care. 2002;14(6):789–800. doi: 10.1080/0954012021000031868 12511212.

28. Jama Shai N, Jewkes R, Levin J, Dunkle K, Nduna M. Factors associated with consistent condom use among rural young women in South Africa. AIDS Care. 2010;22(11):1379–85. doi: 10.1080/09540121003758465 20730637.

29. Cluver LD, Orkin FM, Meinck F, Boyes ME, Sherr L. Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents. Journal of the International AIDS Society. 2016;19:1–9. doi: 10.7448/IAS.19.1.20646 27086838

30. Choe DE, Zimmerman MA, Devnarain B. Youth violence in South Africa: exposure, attitudes, and resilience in Zulu adolescents. Violence Vict. 2012;27(2):166–81. 22594214.

31. Simelela N, Venter WD, Pillay Y, Barron P. A Political and Social History of HIV in South Africa. Curr HIV/AIDS Rep. 2015;12(2):256–61. doi: 10.1007/s11904-015-0259-7 25929959.

32. Hunter M. Love in the time of AIDS: inequality, gender, and rights in South Africa. Bloomington: Indiana University Press; 2010. xii, 303 p. p.

33. Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet. 2009;374(9692):817–34. doi: 10.1016/S0140-6736(09)60951-X 19709728.

34. Connell RW. Hegemonic Masculinity: Rethinking the Concept. Gender & Society. 2005;19(6):829–59. doi: 10.1177/0891243205278639

35. Closson K, Hatcher A, Sikweyiya Y, Washington L, Mkhwanazi S, Jewkes R, et al. Gender role conflict and sexual health and relationship practices amongst young men living in urban informal settlements in South Africa. Cult Health Sex. 2019:1–17. doi: 10.1080/13691058.2019.1568578 30762491.

36. Gottert A, Barrington C, McNaughton-Reyes HL, Maman S, MacPhail C, Lippman SA, et al. Gender Norms, Gender Role Conflict/Stress and HIV Risk Behaviors Among Men in Mpumalanga, South Africa. AIDS and Behavior. 2017. doi: 10.1007/s10461-017-1706-9 28161801.

37. Shai NJ, Jewkes R, Nduna M, Dunkle K. Masculinities and condom use patterns among young rural South Africa men: a cross-sectional baseline survey. BMC Public Health. 2012;12:462. doi: 10.1186/1471-2458-12-462 22892159; PubMed Central PMCID: PMC3504511.

38. Abrahams N, Jewkes R, Lombard C, Mathews S, Campbell J, Meel B. Impact of telephonic psycho-social support on adherence to post-exposure prophylaxis (PEP) after rape. AIDS Care. 2010;22(10):1173–81. doi: 10.1080/09540121003692185 20640949.

39. Jewkes R, Dunkle K, Koss MP, Levin JB, Nduna M, Jama N, et al. Rape perpetration by young, rural South African men: Prevalence, patterns and risk factors. Soc Sci Med. 2006;63(11):2949–61. doi: 10.1016/j.socscimed.2006.07.027 16962222.

40. Gibbs A, Washington L, Willan S, Ntini N, Khumalo T, Mbatha N, et al. The Stepping Stones and Creating Futures intervention to prevent intimate partner violence and HIV-risk behaviours in Durban, South Africa: study protocol for a cluster randomized control trial, and baseline characteristics. BMC Public Health. 2017;17(1):336. doi: 10.1186/s12889-017-4223-x 28427380; PubMed Central PMCID: PMC5397780.

41. Gibbs A, Jacobson J, Kerr Wilson A. A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours. Glob Health Action. 2017;10(sup2):1290427. doi: 10.1080/16549716.2017.1290427 28467193; PubMed Central PMCID: PMC5645712.

42. Viitanen AP, Colvin CJ. Lessons learned: program messaging in gender-transformative work with men and boys in South Africa. Global health action. 2015;8:27860. doi: 10.3402/gha.v8.27860 26350433

43. Dworkin SL, Treves-Kagan S, Lippman SA. Gender-transformative interventions to reduce HIV risks and violence with heterosexually-active men: a review of the global evidence. AIDS Behav. 2013;17(9):2845–63. doi: 10.1007/s10461-013-0565-2 23934267.

44. Gupta GR. Gender, sexuality, and HIV/AIDS: the what, the why, and the how. Can HIV AIDS Policy Law Rev. 2000;5(4):86–93. 11833180.

45. Jewkes RK. SHARE: a milestone in joint programming for HIV and intimate partner violence. Lancet Glob Health. 2015;3(1):e2–3. doi: 10.1016/S2214-109X(14)70374-2 25539963.

46. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Khuzwayo N, et al. A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Tropical Medicine & Internaltional Health. 2006;11(1):3–16. doi: 10.1111/j.1365-3156.2005.01530.x 16398750.

47. Jewkes RK, Nduna M, N. JP, Levin JB, editors. Measuring relationship power: adaptation of the SRPS for South Africa. XIV International AIDS Conference; 2002 July 7–12; Barcelona, Spain

48. UNFPA. The power of 1.8 billion. 2014.

49. Masite S. Region D: Official website of the city of johannesburg; 2007 [23/05/2016]. Available from: http://joburg.org.za/index.php?option=com_content&view=article&id=174:region-d&catid=49&Itemid=119.

50. Statistics South Africa. General household survey South Africa 2015.

51. Reed SJ, Miller RL, the Adolescent Medicine Trials Network for HIVAI. The Benefits of Youth Engagement in HIV-Preventive Structural Change Interventions. Youth Soc. 2014;46(4):529–47. doi: 10.1177/0044118X12443372 25328252; PubMed Central PMCID: PMC4197976.

52. Kaida A, Dietrich J, Laher F, Beksinska M, Jaggarnath M, Bardsley M, et al. A high burden of asymptomatic genital tract infections undermines the syndromic management approach among adolescents and young adults in South Africa: Implications for HIV prevention efforts. BMC Infectious Diseases 2018;In Press.

53. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Khuzwayo N, et al. A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Trop Med Int Health. 2006;11(1):3–16. doi: 10.1111/j.1365-3156.2005.01530.x 16398750.

54. Gibbs A, Govender K, Jewkes R. An exploratory analysis of factors associated with depression in a vulnerable group of young people living in informal settlements in South Africa. Glob Public Health. 2018;13(7):788–803. doi: 10.1080/17441692.2016.1214281 27533487.

55. Jewkes R, Gibbs A, Jama-Shai N, Willan S, Misselhorn A, Mushinga M, et al. Stepping Stones and Creating Futures intervention: shortened interrupted time series evaluation of a behavioural and structural health promotion and violence prevention intervention for young people in informal settlements in Durban, South Africa. BMC Public Health. 2014;14:1325. doi: 10.1186/1471-2458-14-1325 25544716; PubMed Central PMCID: PMC4320600.

56. Teitelman AM, Jemmott JB, Bellamy SL, Icard LD, O'Leary A, Heeren GA, et al. Partner violence, power, and gender differences in South African adolescents' HIV/sexually transmitted infections risk behaviors. Health Psychol. 2016;35(7):751–60. doi: 10.1037/hea0000351 27111184; PubMed Central PMCID: PMC5079851.

57. de Oliveira T, Khanyile D, editors. Who is infecting who? Community-wide phylogenetic transmissiob network reveal young women's high HIV exposure from older men with low ART coverage 21st Internation AIDS Conference (AIDS 2016); 2016 Tuesday, 19 July, 2016; Durban, South Africa Internation AIDS Society

58. Hair J, Tatham R, Andersen R, Black W. Mutivariate data analysis. 5th ed. Upper Saddle River, NJ: Prentice Hall; 1998.

59. Dunkle KL, Jewkes R, Nduna M, Jama N, Levin J, Sikweyiya Y, et al. Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: prevalence, predictors, and associations with gender-based violence. Soc Sci Med. 2007;65(6):1235–48. doi: 10.1016/j.socscimed.2007.04.029 17560702; PubMed Central PMCID: PMC2709788.

60. Cronbach L. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.

61. Conroy AA. Adapting the Sexual Relationship Power Scale for HIV/AIDS research in Malawi. Population Association of America 2010 Annual Meeting; April 15–17, 2010; Dallas, Texas2010.

62. Teitelman AM, Jemmott JB, Bellamy SL, Icard LD, O'Leary A, Heeren GA, et al. Partner Violence, Power, and Gender Differences in South African Adolescents' HIV/Sexually Transmitted Infections Risk Behaviors. Health Psychol. 2016. doi: 10.1037/hea0000351 27111184.

63. Farre L, Vella F. The intergenerational transmission of gender role attitudes and its implications for female labour force participation. Economica. 2013;80(318):219–47. doi: 10.1111/ecca

64. Leclerc-Madlala S. Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability AIDS. 2008;22:S17–S25.

65. Conroy AA. Gender, power, and intimate partner violence: A study on couples from rural Malawi. Journal of Interpersonal Violence. 2014;29(5):866–88. doi: 10.1177/0886260513505907 2014-03005-005. 24227592

66. Pettifor AE, Measham DM, Rees HV, Padian NS. Sexual power and HIV risk, South Africa. Emerging infectious diseases. 2004;10(11):1996–2004. Epub 2004/11/20. doi: 10.3201/eid1011.040252 15550214; PubMed Central PMCID: PMC3328992.

67. Harrison A, O'Sullivan LF, Hoffman S, Dolezal C, Morrell R. Gender role and relationship norms among young adults in South Africa: measuring the context of masculinity and HIV risk. Journal of urban health: bulletin of the New York Academy of Medicine. 2006;83(4):709–22. Epub 2006/06/08. doi: 10.1007/s11524-006-9077-y 16758334; PubMed Central PMCID: PMC2430491.

68. Fulu E, Jewkes R, Roselli T, Garcia-Moreno C. Prevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific. The Lancet Global health. 2013;1(4):e187–207. Epub 2014/08/12. doi: 10.1016/S2214-109X(13)70074-3 25104345.

69. Mthembu JC, Khan G, Mabaso ML, Simbayi LC. Intimate partner violence as a factor associated with risky sexual behaviours and alcohol misuse amongst men in South Africa. AIDS Care. 2016;28(9):1132–7. Epub 2016/03/01. doi: 10.1080/09540121.2016.1146216 26924767.

70. Christofides NJ, Jewkes RK, Dunkle KL, Nduna M, Shai NJ, Sterk C. Early adolescent pregnancy increases risk of incident HIV infection in the Eastern Cape, South Africa: a longitudinal study. J Int AIDS Soc. 2014;17:18585. doi: 10.7448/IAS.17.1.18585 24650763; PubMed Central PMCID: PMC3962027.

71. Christofides NJ, Jewkes RK, Dunkle KL, McCarty F, Jama Shai N, Nduna M, et al. Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women. Glob Health Action. 2014;7:23719. Epub 2014/08/26. doi: 10.3402/gha.v7.23719 25150027; PubMed Central PMCID: PMC4141943.

72. Nduna M, Jewkes RK, Dunkle KL, Jama Shai NP, Colman I. Prevalence and factors associated with depressive symptoms among young women and men in the Eastern Cape Province, South Africa. J Child Adolesc Ment Health. 2013;25(1):43–54. doi: 10.2989/17280583.2012.731410 25860306.

73. Gleeson HS, Oliveras Rodriguez CA, Hatane L, Hart D. Ending AIDS by 2030: the importance of an interlinked approach and meaningful youth leadership. J Int AIDS Soc. 2018;21 Suppl 1. doi: 10.1002/jia2.25061 29485749; PubMed Central PMCID: PMC5978642.

74. Ruiz-Cantero MT, Vives-Cases C, Artazcoz L, Delgado A, Garcia Calvente MM, Miqueo C, et al. A framework to analyse gender bias in epidemiological research. J Epidemiol Community Health. 2007;61 Suppl 2:ii46–53. doi: 10.1136/jech.2007.062034 18000118; PubMed Central PMCID: PMC2465769.