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 January 2005, Vol. 11, No. 1HIV/AIDS Around the world, HIV infects about 1 percent of 15–24-year-olds, but in KwaZulu-Natal, South Africa, more than 14 percent of people in this age group are infected, according to a 2003 population- based survey by Lovelife and the Reproductive Health Research Unit in Johannesburg. Young women are at particularly high risk of infection. South Africa has three infected 15–24-year-old females for every infected male of the same age. Poverty may play a key role in HIV risk. Approximately 57 percent of people in South Africa were living below the poverty income line in 2001, according to the Southern African Regional Poverty Network. Population Council health economist Kelly Hallman investigated the effect of socioeconomic disadvantage on the sexual behaviors of young women and men in KwaZulu-Natal, the most populated South African province. Hallman is a member of the Council’s “Transitions to Adulthood in the Context of AIDS in South Africa” study team. She found that poverty is more consistently correlated with unhealthy sexual behaviors among females than among males. The team studied two districts within KwaZulu-Natal: Durban Metro and Mtunzini Magisterial District. These districts represent the spectrum between urban and rural areas. The team surveyed all willing young people aged 14–24 years within these districts, using interviewers who were the same ethnicity, gender, and general age as the respondents. The investigators asked young people about many aspects of their lives, including schooling, work, sexual and reproductive health behaviors, HIV/AIDS knowledge, childbearing, and marriage. Researchers also talked to heads of households, usually parents, about family composition, living conditions, economic status, and HIV/AIDS attitudes. “Transitions to Adulthood in the Context of AIDS in South Africa” was the first panel study in South Africa to focus on adolescents. Poverty, gender, and sexual behavior “When discussing risky sexual behaviors that might be influenced by low socioeconomic status, many people think only of exchanging sex for money, goods, or favors,” says Hallman. “The data show, however, that a wide range of risky behaviors is affected by poverty.” Although being from a poorer household does increase the likelihood of a young woman’s exchanging sex, Hallman’s analysis showed that it also raises her chances of experiencing nonconsensual sex. Poverty increases young women’s chances of having multiple sex partners. It lowers a young woman’s chances of abstinence following earlier sexual encounters and condom use at last sex and reduces the age at which young men and women have their first sexual encounter. It also increases the risk of early pregnancy. The data show that impoverished young people, especially young women, are the most disadvantaged in discussing sensitive topics, such as condom use, with their sexual partners. The study suggests that this situation may result from a lack of negotiating skills. Analysis of these data by other members of the team showed that only 82 percent of low-resourced schools, versus 92 and 97 percent of medium and high-resourced schools, had at the time implemented a government-mandated “life skills” program, of which negotiation skills are a key component. Higher levels of education among members of the household generally decrease the odds of risky sexual behavior, particularly the chances that a young woman will exchange sex or experience forced sex. Looking at other variables, Hallman found that poverty was more important than orphanhood in influencing risky sexual behaviors. The study revealed that poorer young women and men—but particularly young women—had less access to television, radio, publications, and other media sources that might contain family planning or safe sex messages. “Even with information and good communication skills, young people living in underprivileged settings may still be more likely to find themselves in situations that are conducive to high-risk behavior,” says Hallman. Investigations by other researchers, for example, have shown that when women in South Africa raise the topic of condom use with a sexual partner, they risk emotional, physical, and “economic” abuse. In this setting, many sexual relationships provide economic security. Poor young women may have much to lose by raising such sensitive issues. Hallman found that gender and income have crucial influences on behavior: the negative effects of poverty were often larger and of greater statistical significance for females than males. “Enhancing poor young women’s negotiation and communication skills is a starting point,” explains Hallman, “but they also need strategies for building economic and social assets so they are in stronger bargaining positions within relationships.” Source Outside funding See Also
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