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Abstract Background Promising evidence supports the effectiveness of edutainment interventions in shifting norms to prevent violence against women and girls and other harmful practices, yet further research into mechanisms and pathways of impact is needed to inform intervention development, delivery and scale-up. This exploratory qualitative evaluation examined the feasibility and indications of change in attitudes, beliefs, norms and behaviours following the broadcast of a radio drama aired to prevent age-disparate transactional sex in Kigoma, Tanzania. Methods Over seven weeks, six episodes were broadcast on local radio weekly, between November and December 2021 in Kigoma, targeting adolescent girls (aged 13–15 years) and their caregivers. Reflection sessions were conducted twice a week with 70 girls across seven schools, supplemented by after-school Girls’ Club listening sessions for a subgroup of 30 girls. We conducted seven before and after focus group discussions, five with girls (n = 50), one with men caregivers (n = 9) and one with women caregivers (n = 9) and analysed them using thematic and framework analysis approaches. Results Overall, we found that while girls exhibited significant engagement with the drama, caregiver participation, particularly among men, was low. Thus, no clear changes were detected in men. We did not find any differences in impact based on listening sessions’ attendance vs. home listening. We detected positive changes among girls and women in four thematic areas after listening to the drama: (1) participant’s increasingly challenged perceptions about what kinds of girls and men take part in age-disparate transactional sex, what can be exchanged, and men’s motivations for engaging; (2) there was a shift from attributing blame for age-disparate transactional sex relationships from girls to men; (3) girl’s reported increased agency and confidence to avoid age-disparate transactional sex relationships; and (4) we found a heightened sense of responsibility and recognition for the role of parents, peers and community members in preventing age-disparate transactional sex. Conclusions These findings highlight the need for further implementation research to explore ways to effectively engage men. They also underscore the potential of engaging, evidence-based edutainment interventions in fostering spontaneous critical reflection about complex behaviours such as age-disparate transactional sex, and diffusing key messages among target populations without the use of organised diffusion activities.

Background: Promising evidence supports the effectiveness of edutainment interventions in shifting norms to prevent violence against women and girls and other harmful practices, yet further research into mechanisms and pathways of impact is needed to inform intervention development, delivery and scale-up. This exploratory qualitative evaluation examined the feasibility and indications of change in attitudes, beliefs, norms and behaviours following the broadcast of a radio drama aired to prevent age-disparate transactional sex in Kigoma, Tanzania. Methods: Over seven weeks, six episodes were broadcast on local radio weekly, between November and December 2021 in Kigoma, targeting adolescent girls (aged 13–15 years) and their caregivers. Reflection sessions were conducted twice a week with 70 girls across seven schools, supplemented by after-school Girls' Club listening sessions for a subgroup of 30 girls. We conducted seven before and after focus group discussions, five with girls (n = 50), one with men caregivers (n = 9) and one with women caregivers (n = 9) and analysed them using thematic and framework analysis approaches. Results: Overall, we found that while girls exhibited significant engagement with the drama, caregiver participation, particularly among men, was low. Thus, no clear changes were detected in men. We did not find any differences in impact based on listening sessions' attendance vs. home listening. We detected positive changes among girls and women in four thematic areas after listening to the drama: (1) participant's increasingly challenged perceptions about what kinds of girls and men take part in age-disparate transactional sex, what can be exchanged, and men's motivations for engaging; (2) there was a shift from attributing blame for age-disparate transactional sex relationships from girls to men; (3) girl's reported increased agency and confidence to avoid age-disparate transactional sex relationships; and (4) we found a heightened sense of responsibility and recognition for the role of parents, peers and community members in preventing age-disparate transactional sex. Conclusions: These findings highlight the need for further implementation research to explore ways to effectively engage men. They also underscore the potential of engaging, evidence-based edutainment interventions in fostering spontaneous critical reflection about complex behaviours such as age-disparate transactional sex, and diffusing key messages among target populations without the use of organised diffusion activities. [ABSTRACT FROM AUTHOR]

Introduction: Age-disparate transactional sex (ADTS) is associated with HIV, unintended pregnancy, school dropout and violence, yet few interventions have successfully prevented it, and none have set ADTS prevention as their primary outcome. This exploratory evaluation aimed to assess indications of change after exposure to the Learning Initiative on Norms, Exploitation and Abuse (LINEA) intervention, a mass-media, gender-transformative social norms intervention aimed at preventing ADTS in Tanzania. Methods: In a condensed implementation 331 participants were instructed to listen to the LINEA radio drama over seven weeks, and 60 were randomly allocated to household discussion sessions about content. In-depth interviews (n = 81) from girls aged 12-16 years, and women and men caregivers were collected at baseline (September 2021), midline (November) and endline (December 2021). Surveys were conducted (n = 120) at baseline and endline using the Norms and Attitudes on ADTS Scale (NAATSS) and the Gender Roles and Male Provision Expectations (GRMPE) scale. Interviews were thematically analyzed using a framework approach. Age-stratified linear regression models adjusted for baseline scores were used to measure association between the intervention and endline scale scores. Results: Longitudinal data were available from 59 qualitative (73%) and 95 quantitative participants (79%). Qualitative evidence revealed the drama facilitated family conversations about adolescent challenges, allowing caregivers to advise daughters. Some girls gained confidence to refuse men's gifts, learning that accepting them could necessitate sexual reciprocation. Some caregivers felt increased responsibility for supporting girls in the community to avoid ADTS. Blame for ADTS shifted for some from girls to men, suggesting increased understanding of inequitable power dynamics and reductions in victim blaming. Marginal quantitative evidence revealed that highly exposed girls had improved gender equitable beliefs on the GRMPE (ß = -6.26; 95% CI: -12.94, 0.42). Moderately exposed men had increased gender inequitable norms on the NAATSS subscale (ß = 0.42 95% CI: 0.05, 0.79), but there was no effect in highly exposed men. Conclusions: Given the small sample results should be interpreted cautiously. Our initial findings indicate high engagement with the LINEA intervention shows promise in shifting knowledge, behaviors, and attitudes, beliefs and social norms driving ADTS in Shinyanga, Tanzania, supporting a robust impact evaluation. [ABSTRACT FROM AUTHOR]

IntroductionAge-disparate transactional sex (ADTS) is associated with HIV, unintended pregnancy, school dropout and violence, yet few interventions have successfully prevented it, and none have set ADTS prevention as their primary outcome. This exploratory evaluation aimed to assess indications of change after exposure to the Learning Initiative on Norms, Exploitation and Abuse (LINEA) intervention, a mass-media, gender-transformative social norms intervention aimed at preventing ADTS in Tanzania.MethodsIn a condensed implementation 331 participants were instructed to listen to the LINEA radio drama over seven weeks, and 60 were randomly allocated to household discussion sessions about content. In-depth interviews (n = 81) from girls aged 12–16 years, and women and men caregivers were collected at baseline (September 2021), midline (November) and endline (December 2021). Surveys were conducted (n = 120) at baseline and endline using the Norms and Attitudes on ADTS Scale (NAATSS) and the Gender Roles and Male Provision Expectations (GRMPE) scale. Interviews were thematically analyzed using a framework approach. Age-stratified linear regression models adjusted for baseline scores were used to measure association between the intervention and endline scale scores.ResultsLongitudinal data were available from 59 qualitative (73%) and 95 quantitative participants (79%). Qualitative evidence revealed the drama facilitated family conversations about adolescent challenges, allowing caregivers to advise daughters. Some girls gained confidence to refuse men's gifts, learning that accepting them could necessitate sexual reciprocation. Some caregivers felt increased responsibility for supporting girls in the community to avoid ADTS. Blame for ADTS shifted for some from girls to men, suggesting increased understanding of inequitable power dynamics and reductions in victim blaming. Marginal quantitative evidence revealed that highly exposed girls had improved gender equitable beliefs on the GRMPE (β = −6.26; 95% CI: −12.94, 0.42). Moderately exposed men had increased gender inequitable norms on the NAATSS subscale (β = 0.42 95% CI: 0.05, 0.79), but there was no effect in highly exposed men.ConclusionsGiven the small sample results should be interpreted cautiously. Our initial findings indicate high engagement with the LINEA intervention shows promise in shifting knowledge, behaviors, and attitudes, beliefs and social norms driving ADTS in Shinyanga, Tanzania, supporting a robust impact evaluation.

Abstract Background Age-disparate sex is associated with increased HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, little has been done to understand the dynamics of such relationships from the perspectives of either AGYW or older men, and the communities in which these relationships are embedded. This article explores the motivations and perceived benefits of such relationships for AGYW and older men, plus the social and sexual and reproductive health (SRH) consequences. Methods This study held 37 participatory focus group discussions and 87 in-depth interviews with young people aged 14–24 and adult community members aged 25–49 in rural and urban Tanzania and Uganda. Participants were sampled using purposive and snowball techniques. Thematic analysis was conducted with the aid of NVIVO 10 software. Results Motivations, perceived benefits and costs for AGYW centred around four main themes: financial motivations, emotional support, meeting social expectations and reflections on sexual health. Specifically, AGYW noted that older partners gave gifts/money of higher value compared with younger men. Men’s perceived benefits and costs revolved around the need to satisfy their sexual desire, the perception that AGYW were capable of engaging in new and creative sexual styles and their desire for prestige among male peers. Both AGYW and men recognised the social and SRH consequences as: risk of violence, social stigma, risk of unplanned pregnancy and risk of sexually transmitted infections including HIV. Conclusion Interventions need to acknowledge the perceived benefits of age-disparate sexual relationships for AGYW and older men and engage them in critical reflection on the medium- to longer-term consequences versus the shorter-term satisfaction of needs, desires and aspirations, as a way to navigate the constrained opportunities they face given existing structural limitations. Interventions should also tackle the structural constraints AGYW face by helping them access resources, become empowered and challenge the expectation of having to depend financially on men. Interventions with men should unpack the assumption that men are naturally hypersexual. The role of peers for both girls and men should be acknowledged, and a shift from individual targeted interventions to changing norms at the community level should be considered.

Evidence indicates that age-disparate sexual partnerships increase a young woman's risk of HIV acquisition. Studies suggest that age-disparate relationships are fuelled by socio-economic disparities, with economically disadvantaged young women in sexual relationships with comparatively wealthier older men. Limited data exists on the socio-economic status of men in age-disparate relationships relative to men in age-similar relationships. This study explores whether men in age-disparate and similar-aged partnerships differ on socio-economic indicators. A 2012 nationally representative cross-sectional survey of 10,034 men was analysed. The sample was restricted to sexually active men older than 24 years old (N = 1330). The survey included information on the men's three most recent sexual partners and three measures of socio-economic status. Multiple regression models were used to compare the socio-economic status of men in age-similar partnerships to men in age-disparate partnerships. Just less than half (44.6%) of the men were involved in only age-similar partnerships. The multiple regression results indicate that household wealth, access to essential services and employment status were not significantly associated with an increased likelihood of men engaging in age-disparate partnerships. Additionally, the relationship between men's wealth and age disparate partnering did not vary according to geographical context. Men engaging in age-disparate partnerships do not differ with regards to their socio-economic status from men in partnerships with women of a similar age. Whilst economic disparity may prevail between males and females within age-disparate relationships, this study reveals that the men in these relationships are not economically advantaged over men in age-similar relationships. [ABSTRACT FROM AUTHOR]

Adolescent girls in sub-Saharan Africa have been deemed one of the most critical populations to address in the campaign for an HIV-free generation. Experiences of intimate partner violence (IPV), harmful gender norms, diminished personal agency, and age-disparate sex have been identified as factors in the increasing rate of new infections among this population. Using baseline data from a cluster-randomized controlled trial in three refugee camps in Benishangul-Gumuz Regional State in Ethiopia, our study quantitatively examined the associations between HIV risk factors, attitudes on gender inequality, IPV acceptability, and self-esteem for female adolescent refugees primarily from Sudan and South Sudan (n = 919). In multivariate models, adjusting for age and education, results showed girls who were more accepting of gender inequitable norms and IPV had greater odds of ever experiencing forced (OR 1.40, CI 1.15-1.70; OR 1.66, CI 1.42-1.94) or transactional sex (OR 1.28, CI 1.05-1.55; OR 1.59, CI 1.37-1.85) compared to girls who demonstrated less approval. Higher self-esteem was associated with increased odds of condom use (OR 1.13, CI 1.02-1.24) as well as decreased odds of adolescent marriage (OR 0.93, CI 0.90-0.95), age-disparate sex (OR 0.90, CI 0.86-0.94), and transactional sex (OR 0.96, CI 0.93-0.99). The findings suggest acceptance of inequitable gender norms (including those that perpetuate violence against women) and low self-esteem to be associated with common HIV risk factors among refugee adolescents living in Ethiopia. Greater attention towards the intersections of gender equality and self-valuation is needed when seeking to understand HIV risk among refugee adolescent girls in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Introduction: Age‐disparate sex has long been considered a factor that increases HIV risk for young women in South Africa. However, recent studies from specific regions in South Africa have found conflicting evidence. Few studies have assessed the association between age‐disparate partnerships (those involving an age gap of 5 years or more) and HIV risk at the national level. This study investigates the relationship between age‐disparate sex and HIV status among young women aged 15–24 in South Africa. Methods: Nationally representative weighted data from the 2002, 2005, 2008, and 2012 South African National HIV Surveys were analysed for young women aged 15–24 years using bivariate analyses and multiple logistic regressions. Results: After conducting multiple logistic regression analyses and controlling for confounders, young women with age‐disparate partners had greater odds of being HIV positive in every survey year: 2002 (aOR = 1.74, 95%CI: 0.81–3.76, p = 0.16); 2005 (aOR = 2.11, 95%CI: 1.22–3.66, p

Introduction: Age-disparate sex has long been considered a factor that increases HIV risk for young women in South Africa. However, recent studies from specific regions in South Africa have found conflicting evidence. Few studies have assessed the association between age-disparate partnerships (those involving an age gap of 5 years or more) and HIV risk at the national level. This study investigates the relationship between age-disparate sex and HIV status among young women aged 15–24 in South Africa. Methods: Nationally representative weighted data from the 2002, 2005, 2008, and 2012 South African National HIV Surveys were analysed for young women aged 15–24 years using bivariate analyses and multiple logistic regressions. Results: After conducting multiple logistic regression analyses and controlling for confounders, young women with age-disparate partners had greater odds of being HIV positive in every survey year: 2002 (aOR = 1.74, 95%CI: 0.81–3.76, p = 0.16); 2005 (aOR = 2.11, 95%CI: 1.22–3.66, p < 0.01); 2008 (aOR = 2.02, 95%CI: 1.24–3.29, p < 0.01); 2012 (aOR = 1.53, 95%CI: 0.92– 2.54, p < 0.1). The odds of being HIV positive increased for each year increase in their male partner’s age in 2002 (aOR = 1.10, 95%CI: 0.98–1.22, p = 0.11), 2005 (aOR = 1.10, 95%CI: 1.03–1.17, p < 0.01), 2008 (aOR = 1.08, 95%CI: 1.01– 1.15, p < 0.05), and 2012 (aOR = 1.08, 95%CI: 1.01–1.16, p < 0.05). Findings were statistically significant (p < 0.1) for the years 2005, 2008, and 2012. Conclusions: Our findings suggest that age-disparate sex continues to be a risk factor for young women aged 15–24 in South Africa at a national level. These results may reflect variation in HIV risk at the national level compared to the differing results from recent studies in a demographic surveillance system and trial contexts. In light of recent contradictory study results, further research is required on the relationship between age-disparate sex and HIV for a more nuanced understanding of young women’s HIV risk. [ABSTRACT FROM AUTHOR]

Background: Age-disparate sex is associated with increased HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, little has been done to understand the dynamics of such relationships from the perspectives of either AGYW or older men, and the communities in which these relationships are embedded. This article explores the motivations and perceived benefits of such relationships for AGYW and older men, plus the social and sexual and reproductive health (SRH) consequences. Methods: This study held 37 participatory focus group discussions and 87 in-depth interviews with young people aged 14–24 and adult community members aged 25–49 in rural and urban Tanzania and Uganda. Participants were sampled using purposive and snowball techniques. Thematic analysis was conducted with the aid of NVIVO 10 software. Results: Motivations, perceived benefits and costs for AGYW centred around four main themes: financial motivations, emotional support, meeting social expectations and reflections on sexual health. Specifically, AGYW noted that older partners gave gifts/money of higher value compared with younger men. Men's perceived benefits and costs revolved around the need to satisfy their sexual desire, the perception that AGYW were capable of engaging in new and creative sexual styles and their desire for prestige among male peers. Both AGYW and men recognised the social and SRH consequences as: risk of violence, social stigma, risk of unplanned pregnancy and risk of sexually transmitted infections including HIV. Conclusion: Interventions need to acknowledge the perceived benefits of age-disparate sexual relationships for AGYW and older men and engage them in critical reflection on the medium- to longer-term consequences versus the shorter-term satisfaction of needs, desires and aspirations, as a way to navigate the constrained opportunities they face given existing structural limitations. Interventions should also tackle the structural constraints AGYW face by helping them access resources, become empowered and challenge the expectation of having to depend financially on men. Interventions with men should unpack the assumption that men are naturally hypersexual. The role of peers for both girls and men should be acknowledged, and a shift from individual targeted interventions to changing norms at the community level should be considered. [ABSTRACT FROM AUTHOR]