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Women are most exposed to sexual health risks within their marital relationships, primarily due to the sexually risky behaviours of their spouses. Studies show that expanding agency is critical for women to mitigate both physical and sexual health risks and is linked to increased psycho-social well-being and economic independence. Drawing on qualitative and quantitative primary data collected from a peri-urban community in Zambia, this paper explores how women exert agency in a community where few educational and economic opportunities and substantial food insecurity exacerbate women's risk for HIV within their marital relationships. It also examines how expressions of agency within marital unions can reduce HIV risk exposure and lead to socio-economic benefits. However, expressions of agency can also create physical, psycho-social and sexual health risks, particularly when spouses do not support independent decision-making and actions that women consider necessary to support the household and maintain intimacy. Findings highlight the importance of community involvement and addressing harmful socio-cultural norms to foster the realisation of women's agency. [ABSTRACT FROM AUTHOR]

Adolescent girls and young women have recently gained a central position in gender equality and development. However, little research investigates female experiences of the complex dynamics of both change and resistance to change in gender norms and structures. Drawing on the work of Bourdieu, Connell and Schippers to analyse longitudinal in-depth interviews, this paper explores how girls in northern Uganda learn, challenge and (re)produce patriarchal structures throughout the life-course and across social fields. It highlights the costs, consequences and benefits at stake in expressing hegemonic femininity and expands understanding of how adolescent girls and young women actively strategise to protect their wellbeing and create space for contestation. Findings call for greater attention to the coexistence of resistance to, and reproduction of, gender orders, and offer opportunities for additional research for theory building and programme implementation. [ABSTRACT FROM AUTHOR]

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Research on transactional sexual relationships has largely focused on women's perspectives. Better understanding the men's views—especially regarding relationships with adolescent girls and young women—can inform HIV prevention efforts. In 2017, 134 in-depth interviews were conducted with the male partners of girls and young women aged 19–47 years, 94 in Uganda and 40 in Eswatini. Respondents were recruited at venues such as bars where men and potential partners meet and through other young women. Most respondents believed that providing money/gifts was the way to establish relationships with women in their communities, a context that some found undesirable. Young women were mainly perceived as actively pursuing transactional sex for material goods, but respondents also described economically impoverished women who were manipulated into relationships. Men described conflict with longer term partners as a driver to seeking younger partners, who were more compliant. Transaction dominates the male partners of adolescent girls and young women's understanding of sexual relationships, and inequitable power dynamics are reinforced by seeking younger partners. However, some respondents' discontent with this dynamic suggests an opportunity for change. HIV prevention programmes should directly address the underlying drivers of transactional relationships (e.g. gender norms) and work with men who question the practice. [ABSTRACT FROM AUTHOR]

How do the local cultural politics of secrecy intersect with biomedical and institutionalised global health knowledge and management of HIV? This question was ethnographically researched during a home counselling and testing programme as it was initiated twice in a Kenyan community. The programme was informed by worldwide efforts to organise and control HIV so as to 'end AIDS'. We focused critical attention on the relationship between HIV testing and counselling and contend that local expertise in speaking about (or silencing) sexuality, intimacy and HIV intersected with the home counselling and testing campaign as an instrument in the co-production of local gender dynamics and power arrangements. We demonstrate how the home counselling and testing programme was put to use for local cultural projects aimed at (re)negotiating gender, sexuality, social roles, intimacy and power dynamics and, in consequence, produced uneven experiences with testing, treatment and AIDS-related health outcomes during a period of major social change. [ABSTRACT FROM AUTHOR]

Sexual transaction, or any exchange of financial or material goods for sex, contributes to the disproportionate HIV burden among young women aged 15-24 years in sub-Saharan Africa. We analysed representations of sexual transactions in a sample of 363 narratives about HIV written by young Africans. The narratives were written at 4 time points (1997, 2005, 2008, 2014) by authors aged 10-24 years in urban and rural areas of Senegal, Burkina Faso, South-east Nigeria, Kenya and Eswatini, formerly Swaziland. We combined three analytical approaches: descriptive statistics of quantifiable characteristics of the narratives, thematic data analysis and a narrative-based approach. Representations reflect sexual transaction as a spectrum, with commercial sex work and sexual transactions that include romance at opposite ends. Narratives represent female characters increasingly motivated by a desire for social status symbols and by romantic love over time. Condemnation and stigmatisation of sexual transactions motivated by materialism remain similar across countries. In order to mitigate young women's disproportionate risk of HIV there is a need to combine efforts to address the economic marginalisation and gender inequality that drive sexual transactions with activities to promote skills and reflection and influence harmful norms, potentially drawing on companionate ideologies. [ABSTRACT FROM AUTHOR]

Poverty has widespread impacts on health. In dealing with resource scarcity, individuals' thoughts are narrowed to address immediate resource limitations, thus crowding out other information, a phenomenon called the scarcity mindset. To assess for indication of a scarcity mindset in sexual and reproductive decision making in rural Malawi, a setting with extreme resource scarcity, we collected qualitative data in the form of eight focus group discussions and 28 semi-structured, in-depth interviews with women and men of varying ages and marital status. Participants, who were of low socioeconomic status, described constant tradeoffs that they made to secure their daily needs. They articulated both the challenges of supporting many children and the need to bear many children to guarantee their own future support. While participants described wealthy people as being concerned with preserving resources (often through the practice of limiting childbearing), they described poor people as working to increase their probability of success against an uncertain economic future (without due consideration of contraceptive behaviours). We found qualitative evidence that a scarcity mindset may influence reproductive decision making among women and men in rural Malawi and may preclude the use of contraception in low-resource settings. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The sexual abuse of power is a form of sexual coercion in which individuals - typically male - use their positions of authority to obtain sex. We analysed social representations of sexual abuse of power in a sample of 1,446 narratives about HIV written by young Africans between 2005 and 2014. The narratives were prepared at five different points in time (2005, 2008, 2011, 2013 and 2014) by authors aged 10-24 in urban and rural areas of Swaziland, Kenya, South-East Nigeria, Burkina Faso and Senegal. We combined three analytical approaches: descriptive statistics of quantifiable characteristics of the narratives, thematic data analysis and a narrative-based approach. Analysis revealed two underlying cultural scripts describing the sexual abuse of power between (a) teachers and female students, and (b) male employers and domestic workers. Cross-national variation was evident in the emphasis authors placed on socio-contextual inequalities, particularly poverty, and on individual level blame. While a minority of Nigerian and Burkinabe authors depicted female characters creatively exercising agency and avoiding unwanted sex, overall there was little critique of underlying assumptions of male sexual entitlement and female responsibility for controlling male sexuality in the context of unequal control of resources. We outline recommendations for strategies to deconstruct these harmful scripts. [ABSTRACT FROM AUTHOR]

Child sexual abuse (CSA) is a major global health concern. Although it is prevalent in Kenya, scant literature on factors contributing to CSA vulnerability exists. Using qualitative data from 28 focus groups and ethnographic field notes, we explored and assessed community perceptions of factors contributing to CSA vulnerability in Homa Bay County, Western Kenya. Findings suggest that people living in these communities perceived CSA as being influenced by multiple factors: developmental stage, peer pressure, huge gender disparities exacerbated by negative social norms and cultural practices, the HIV epidemic and social media platforms that circulate sexualised images. From our findings, it was clear that participants also regarded poverty as exacerbating children's vulnerability to CSA. Minors from poor families engaged in transactional sex for survival and social status. Some community members perceived girls dressed in short skirts or tight clothing as warranting unwanted sexual advances. Although poverty and gender roles and relations were viewed as increasing vulnerability to CSA, blame was often placed on survivors' modes of dress or behaviour. There is a need for comprehensive education of the communities on CSA, its consequences and the rights of women and girls. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)