PROJECT
South Africa: Gender, Socioeconomic Status, and Youth HIV Risk

South Africa has been disproportionately affected by the HIV/AIDS epidemic. Prevalence rates are higher for women than for men, with the gender disparity being most striking among young people. Three female youths live with HIV for every one male youth (with prevalence rates of 15.5 vs. 4.8 percent, respectively). Young people residing in slum areas have an HIV prevalence rate nearly double the national youth rate (17.4 vs. 10.2 percent). These figures imply that over one-quarter of young women aged 15–24 years residing in slum areas may be living with HIV. The epidemic is clearly becoming one of young women who are socially and economically marginalized.

Evidence that elucidates the relationship between socioeconomic vulnerability and sexual risks among young people is emerging from a panel survey in KwaZulu-Natal entitled “Transitions to Adulthood in the Context of AIDS in South Africa” and from participatory social mapping exercises at the community level. Findings indicate that poverty, orphanhood, and social isolation are associated with higher HIV and pregnancy risk behaviors. Relative poverty increases the likelihood of early sexual debut and early parenthood and decreases the chances of having discussed condom use with the most recent sexual partner. Among females only, poverty increases the risk of having had nonconsensual sex, having traded sex for goods or favors, and having had multiple sexual partners in the year before the survey. Young people with deceased fathers debut sexually earlier; female paternal orphans have older sex partners; and male paternal orphans have lower odds of practicing secondary abstinence. Social isolation is correlated with earlier sexual debut and, among girls, is associated with a higher risk of nonconsensual sex. Gender-specific social maps with adolescents reveal that girls have access to fewer public spaces in the community due to safety concerns; results from these maps are being presented by adolescents to local development committees, the police, and school boards. These decisionmakers are proving receptive and have pledged to incorporate the findings into local development action plans.

The research results have also inspired the development of an innovative pilot program designed to provide context-specific asset-building and HIV-protection strategies to vulnerable young people residing in poor HIV-affected communities. The program aims to: (1) foster the development of social networks within and beyond the local community; (2) equip youth with skills to better manage personal and family resources and access existing livelihood/training opportunities and financial services; and (3) improve youth knowledge of HIV/AIDS prevention, treatment, and care.

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Population Council researchers

Kelly K. Hallman, Judith Bruce, Cynthia B. Lloyd, Judith A. Diers

Non-Council collaborators

Nick Swan (Isithunzi Consultancy)

Crime Reduction in Schools Project

Empowerment for Success (EFS) Training

Pinetown Highway Child and Family Welfare Society

UNICEF, South Africa

Donors

Empower (The Emerging Markets Foundation)

Bill & Melinda Gates Foundation

The William and Flora Hewlett Foundation

The Andrew W. Mellon Foundation

UK Department for International Development

UNICEF, South Africa

US Agency for International Development

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