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Objectives: To describe prevalence of childhood experiences of adversity in rural South African youth and their associations with health outcomes. Methods: We analyzed questionnaires and blood specimens collected during a baseline survey for a cluster randomized controlled trial of a behavioral intervention, and also tested blood HIV and herpes simplex type 2 virus at 12- and 24-month follow up; 1,367 male and 1,415 female volunteers were recruited from 70 rural villages. Results: Both women and men before 18 had experienced physical punishment (89.3% and 94.4%), physical hardship (65.8% and 46.8%), emotional abuse (54.7% and 56.4%), emotional neglect (41.6% and 39.6%), and sexual abuse (39.1% and 16.7%). Incident HIV infections were more common in women who experienced emotional abuse (IRR 1.96, 95% CI 1.25, 3.06, p = 0.003), sexual abuse (IRR 1.66 95% CI 1.04, 2.63, p = 0.03), and physical punishment (IRR 2.13 95% CI 1.04, 4.37, p = 0.04). Emotional neglect in women was associated with depression (aOR 1.82, 95% CI 1.15, 2.88, p = 0.01), suicidality (aOR 5.07, 95% CI 2.07, 12.45, p less than 0.0001), alcohol abuse (aOR 2.17, 95% CI 0.99, 4.72, p = 0.05), and incident HSV2 infections (IRR 1.62, 95% CI 1.01, 2.59, p = 0.04). In men emotional neglect was associated with depression (aOR 3.41, 95% CI 1.87, 6.20, p less than 0.0001) and drug use (aOR 1.98, 95% CI 1.37, 2.88, p less than 0.0001). Sexual abuse was associated with alcohol abuse in men (aOR 3.68, 95% CI 2.00, 6.77, p less than 0.0001) and depression (aOR 2.16, 95% CI 1.34, 3.48, p = 0.002) and alcohol abuse in women (aOR 3.94, 95% CI 1.90, 8.17, p less than 0.0001). Practice implications: Childhood exposure to adversity is very common and influences the health of women and men. All forms of adversity, emotional, physical and sexual, enhance the risk of adverse health outcomes in men and women. Prevention of child abuse need to be included as part of the HIV prevention agenda in sub-Saharan Africa. Interventions are needed to prevent emotional, sexual, and physical abuse and responses from health and social systems in Africa to psychologically support exposed children must be strengthened. (Contains 5 tables.)

Background: Psychological factors are often neglected in HIV research, although psychological distress is common in low‐ to middle‐income countries, such as South Africa. There is a need to deepen our understanding of the role of mental health factors in the HIV epidemic. We set out to investigate whether baseline depressive symptomatology was associated with risky sexual behaviour and relationship characteristics of men and women at baseline, as well as those found 12 months later. Methods: We used prospective cohort data from a cluster randomized controlled trial of an HIV prevention intervention in the Eastern Cape Province of South Africa. Our subjects were 1002 female and 976 male volunteers aged 15 to 26. Logistic regression was used to model the cross‐sectional and prospective associations between baseline depressive symptomatology, risky sexual behaviors and relationship characteristics. The analysis adjusted for the clustering effect, study design, intervention and several confounding variables. Results: Prevalence of depressive symptoms was 21.1% among women and 13.6% among men. At baseline, women with depressed symptoms were more likely to report lifetime intimate partner violence (AOR = 2.56, 95% CI 1.89‐3.46) and have dated an older partner (AOR = 1.37, 95% CI 1.03‐1.83). A year later, baseline depressive symptomatology was associated with transactional sex (AOR = 2.60, 95% CI 1.37, 4.92) and intimate partner violence (AOR = 1.67, 95% CI 1.18‐2.36) in the previous 12 months. Men with depressive symptoms were more likely to report ever having had transactional sex (AOR = 1.48, 95% CI 1.01‐2.17), intimate partner violence perpetration (AOR = 1.50, 95% CI 0.98‐2.28) and perpetration of rape (AOR = 1.81, 95% CI 1.14‐2.87). They were less likely to report correct condom use at last sex (AOR = 0.50, 95% CI 0.32‐0.78). A year later, baseline depressive symptomatology was associated with failure to use a condom at last sex among men (AOR = 0.60, 95% CI 0.40‐0.89). Conclusions: Symptoms of depression should be considered as potential markers of increased HIV risk and this association may be causal. HIV prevention needs to encompass promotion of adolescent mental health., Background The HIV epidemic is continuing to expand globally as prevention efforts show limited success in many population groups [1‐3]. Research from southern Africa on risky sexual behaviours and relationships [...]

Objective To investigate in the South African public health sector where the best services for rape survivors were provided, who provided them, what the providers' attitudes were towards women who had been raped and whether there were problems in delivering care for rape survivors. Methods A cross-sectional study of facilities was carried out. Two district hospitals, a regional hospital and a tertiary hospital (where available) were randomly sampled in each of the nine provinces in South Africa. At each hospital, senior staff identified two doctors and two nurses who regularly provided care for women who had been raped. These doctors and nurses were interviewed using a questionnaire with both open-ended and closed questions. We interviewed 124 providers in 31 hospitals. A checklist that indicated what facilities were available for rape survivors was also completed for each hospital. Findings A total of 32.6% of health workers in hospitals did not consider rape to be a serious medical condition. The mean number of rape survivors seen in the previous six months at each hospital was 27.9 (range = 9.3-46.5). A total of 30.3% of providers had received training in caring for tape survivors. More than three-quarters of regional hospitals (76.9%) had a private exam room designated for use in caring for rape survivors. Multiple regression analysis of practitioner factors associated with better quality of clinical care found these to be a practitioner being older than 40 years (parameter estimate = 2.4; 95% confidence interval (CI) = 0.7-5), having cared for a higher number of rape survivors before (parameter estimate = 0.02; 95% CI = 0.001-0.03), working in a facility that had a clinical management protocol for caring for rape survivors (parameter estimate = 2; 95% CI = 0.12-3.94), having worked for less time in the facility (parameter estimate = -0.2; 95% CI = -0.3 to -0.04) and perceiving rape to be a serious medical problem (parameter estimate = 2.8; 95% CI=1.9-3.8). Conclusion There are many weaknesses in services for rape survivors in South Africa. Our findings suggest that care can be improved by disseminating clinical management guidelines and ensuring that care is provided by motivated providers who are designated to care for survivors. Keywords Rape/rehabilitation; Health services; Quality of health care; Attitude of health personnel; Forensic medicine; Health care surveys; Cross-sectional studies; South Africa (source: MeSH, NLM). Mots cles Viol/reeducation & readaptation; Services sante; Qualite soins; Attitude du personnel soignant; Medecine legale; Enquete systeme de sante; Etude section efficace; Afrique du Sud (source: MeSH, INSERM). Palabras clave Violacion/rehabilitacion; Servicios de salud; Calidad de la atencion de salud; Actitud del personal de salud; Medicina legal; Encuestas de atencion de la salud; Estudios transversales; Sudafrica (fuente: DeCS, BIREME). Bulletin of the World Health Organization 2005;83:495-502., Introduction Rape is an important public health and human rights concern. Its consequences include unwanted pregnancy, unsafe abortion, genital fistulae, pelvic inflammatory disease, sexually transmitted infections such as HIV/AIDS, depression, [...]

Sex workers have long been considered a high-risk group for HIV infection, but to date little quantitative research has explored the association between HIV risk and exchange of sex for material gain by women in the general population. The objective of this study was to estimate the prevalence of such transactional sex among women attending antenatal clinics in Soweto, South Africa, to identify demographic and social variables associated with reporting transactional sex, and to determine the association between transactional sex and HIV serostatus. We conducted a cross-sectional study of women seeking antenatal care in four Soweto health centres who accepted routine antenatal HIV testing. Private face-to-face interviews covered socio-demographics, sexual history and experience of gender-based violence. 21.1% of participants reported having ever had sex with a non-primary male partner in exchange for material goods or money. Women who reported past experience of violence by male intimate partners, problematic substance use, urban residence, ever earning money, or living in substandard housing were more likely to report transactional sex, while women who reported delayed first coitus, were married, or had a post-secondary education were less likely to report transactional sex. Transactional sex was associated with HIV seropositivity after controlling for lifetime number of male sex partners and length of time a woman had been sexually active (OR = 1.54, 95% CI: 1.07, 2.21). Women who reported non-primary partners without transactional sex did not have increased odds of being HIV seropositive (OR = 1.04, 95% CI: 0.75, 1.43). We conclude that transactional sex may place women at increased risk for HIV, and is associated with gender-based violence, substance use and socio-economic disadvantage. Research, policy and programmatic initiatives should consider the role of transactional sex in women's HIV risk, with attention to the intersecting roles of violence, poverty, and substance use in shaping women's sexual behaviour. Keywords: Transactional sex; HIV; Women; Africa; Risk behaviour; Intimate partner violence

The aim of the paper is to investigate associations between a range of markers of gender inequity, including financial, psychological and physical violence, and two proximal practices in HIV prevention, namely discussion of HIV between partners and the woman suggesting condom use. The paper presents an analysis of data from a cross-sectional study of a representative sample of women from three South African Provinces which was primarily undertaken as an epidemiological study of gender-based violence. A multi-stage sampling design was used with clusters sampled with probability proportional to number of households. Households were randomly selected from within clusters. One randomly selected woman aged 18-49 years was interviewed in each selected home. One thousand three hundred and six women were interviewed (90.3% of eligible women). One thousand one hundred sixty four women had a partner in the previous year and were asked questions related to HIV prevention and gender inequalities in the relationship. The results indicate that discussion of HIV was significantly positively associated with education, living in Mpumalanga Province, the man being a migrant, the woman having multiple partners in the past year and having no confidante. It was significantly negatively associated with living in the Northern Province, the relationship being poor and there being a substantial age difference between partners. The woman suggesting condom use was significantly positively associated with her education, her having multiple partners, domestic violence prior to the past year and financial abuse. It was negatively associated with the relationship being poor. We conclude that this suggests that some indicators of gender inequalities are significantly associated with discussion of HIV and condom use but the direction of association found was both positive and negative. This highlights the need for a more nuanced understanding of gender inequalities and their relationship to HIV risk. Suggestions for key research questions are made. reserved. Keywords: HIV; Gender; Intimate partner violence; South Africa

Introduction: Adolescents having unprotected heterosexual intercourse are at risk of HIV infection and unwanted pregnancy. However, there is little evidence to indicate whether pregnancy in early adolescence increases the risk of subsequent HIV infection. In this paper, we tested the hypothesis that adolescent pregnancy (aged 15 or younger) increases the risk of incident HIV infection in young South African women. Methods: We assessed 1099 HIV-negative women, aged 15-26 years, who were volunteer participants in a cluster- randomized, controlled HIV prevention trial in the predominantly rural Eastern Cape province of South Africa. All of these young women had at least one additional HIV test over two years of follow-up. Outcomes were HIV incidence rates per 100 person years and HIV incidence rate ratios (IRRs) estimated by Poisson multivariate models. Three pregnancy categories were created for the Poisson model: early adolescent pregnancy (a first pregnancy at age 15 years or younger); later adolescent pregnancy (a first pregnancy at age 16 to 19 years); and women who did not report an adolescent pregnancy. Models were adjusted for study design, age, education, time since first sexual experience, socio-economic status, childhood trauma and herpes simplex virus type 2 infection. Results: HIV incidence rates were 6.0 per 100 person years over two years of follow-up. The adjusted IRR was 3.02 (95% CI 1.50-6.09) for a pregnancy occurring at age 15 or younger. Women with pregnancies occurring between 16 and 19 years of age did not have a higher incidence of HIV (IRR 1.08; 95% CI 0.64-1.84). Early adolescent pregnancies were associated with higher partner numbers and a greater age difference with partners. Conclusions: Early adolescent pregnancies increase the incidence of HIV among South African women. The higher risk is associated with sexual risk behaviours such as higher partner numbers and a greater age difference with partners rather than a biological explanation of hormonal changes during pregnancy. Keywords: HIV/AIDS; adolescent pregnancy; South Africa; longitudinal data; sexual risk behaviour., Introduction Adolescents having unprotected heterosexual intercourse are at risk of HIV infection and unwanted pregnancy. Several observational studies from South Africa have reported that the incidence of HIV is higher [...]

Background: In sub-Saharan Africa the population prevalence of men who have sex with men (MSM) is unknown, as is the population prevalence of male-on-male sexual violence, and whether male-on-male sexual violence may relate to HIV risk. This paper describes lifetime prevalence of consensual male-male sexual behavior and male-on-male sexual violence (victimization and perpetration) in two South African provinces, socio- demographic factors associated with these experiences, and associations with HIV serostatus. Methods and Findings: In a cross-sectional study conducted in 2008, men aged 18- 49 y from randomly selected households in the Eastern Cape and KwaZulu-Natal provinces provided anonymous survey data and dried blood spots for HIV serostatus assessment. Interviews were completed in 1,737 of 2,298 (75.6%) of enumerated and eligible households. From these households, 1,705 men (97.1%) provided data on lifetime history of same-sex experiences, and 1,220 (70.2%) also provided dried blood spots for HIV testing. 5.4% (n = 92) of participants reported a lifetime history of any consensual sexual activity with another man;9.6% (n = 164) reported any sexual victimization by a man, and 3.0% (n = 51) reported perpetrating sexual violence against another man. 85.0% (n = 79) of men with a history of consensual sex with men reported having a current female partner, and 27.7% (n = 26) reported having a current male partner. Of the latter, 80.6% (n = 21/26) also reported having a female partner. Men reporting a history of consensual male-male sexual behavior are more likely to have been a victim of male-on-male sexual violence (adjusted odds ratio [aOR] = 7.24;95% CI 4.26-12.3), and to have perpetrated sexual violence against another man (aOR = 3.10;95% CI 1.22-7.90). Men reporting consensual oral/anal sex with a man were more likely to be HIV+ than men with no such history (aOR = 3.11;95% CI 1.24-7.80). Men who had raped a man were more likely to be HIV+ than non-perpetrators (aOR = 3.58;95% CI 1.17- 10.9). Conclusions: In this sample, one in 20 men (5.4%) reported lifetime consensual sexual contact with a man, while about one in ten (9.6%) reported experience of male-on-male sexual violence victimization. Men who reported having had sex with men were more likely to be HIV+, as were men who reported perpetrating sexual violence towards other men. Whilst there was no direct measure of male-female concurrency (having overlapping sexual relationships with men and women), the data suggest that this may have been common. These findings suggest that HIV prevention messages regarding male-male sex in South Africa should be mainstreamed with prevention messages for the general population, and sexual health interventions and HIV prevention interventions for South African men should explicitly address male-on-male sexual violence. Please see later in the article for the Editors' Summary., Introduction In the concentrated HIV epidemics of high-income countries, men who have sex with men (MSM) have a higher HIV prevalence than heterosexual men [1-5]. In the generalized epidemics of [...]

Kristin L. Dunkle, Rachel K. Jewkes, Heather C. Brown, Glenda E. Gray, James A. McIntryre, and Sioban D. Harlow 'Gender-based violence, relationship power, and risk of HIV infection in women [...]

Background: Intimate partner violence (IPV) is a serious public health problem among adolescents. This study investigated the prevalence of and factors associated with Grade 8 girls' experience and boys' perpetration of IPV in South Africa. Methods: Participants were interviewed using interviewer-administered questionnaires about IPV, childhood violence, bullying, gender attitudes, alcohol use and risky sexual behaviours. Multiple logistic regression analysis was conducted to assess factors associated with girls' experience and boys' perpetration of IPV. Structural equation modelling (SEM) was conducted to assess the pathways to IPV experience and perpetration. Results: Results show dating relationships are common among girls (52.5%) and boys (70.7%) and high prevalence of sexual or physical IPV experience by girls (30.9%; 95% CI 28.2-33.7) and perpetration by boys (39.5%; 95% CI 36.6-42.3). The logistic regression model showed factors associated with girls' experience of IPV include childhood experience of violence, individual gender inequitable attitudes, corporal punishment at home and in school, alcohol use, wider communication with one's partner and being more negative about school. We found three pathways from childhood trauma to IPV experience and perpetration in both models and these are through inequitable gender attitudes and risky sex, bullying and alcohol use. Conclusions: Prevention of IPV in children needs to encompass prevention of exposure to trauma in childhood and addressing gender attitudes and social norms to encourage positive disciplining approaches. [ABSTRACT FROM AUTHOR]

Background: Although teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort. Objective: Teenage girls, aged 15-18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status. Results: Overall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21-0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05-2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07-0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58-0.83 and OR 0.78; 95% CI 0.64-0.96). Believing that the teenage girl and her boyfriend were mutual main partners doubled the odds of reporting both an unplanned and unwanted pregnancy (OR 2.58 95% CI 1.07-6.25, and OR 2.21 95% CI 1.13-4.29). Conclusion: Although some of the measures of gender inequity were not associated with unplanned and unwanted pregnancies, there is evidence of the role of both gender power and socioeconomic status. This was evident in teenage girls who experienced physical violence being more likely to have an unwanted pregnancy. Interventions to prevent teenage pregnancies need to be tailored by socioeconomic status because some teenagers may see having a pregnancy as a way to have a more secure future. Interventions that engage with relationship dynamics of teenagers are essential if unwanted and unplanned pregnancies are to be prevented. [ABSTRACT FROM AUTHOR]

Objective To investigate in the South African public health sector where the best services for rape survivors were provided, who provided them, what the providers' attitudes were towards women who had been raped and whether there were problems in delivering care for rape survivors. Methods A cross-sectional study of facilities was carried out. Two district hospitals, a regional hospital and a tertiary hospital (where available) were randomly sampled in each of the nine provinces in South Africa. At each hospital, senior staff identified two doctors and two nurses who regularly provided care for women who had been raped. These doctors and nurses were interviewed using a questionnaire with both open-ended and closed questions. We interviewed 124 providers in 31 hospitals. A checklist that indicated what facilities were available for rape survivors was also completed for each hospital. Findings A total of 32.6% of health workers in hospitals did not consider rape to be a serious medical condition. The mean number of rape survivors seen in the previous six months at each hospital was 27.9 (range = 9.3-46.5). A total of 30.3% of providers had received training in caring for rape survivors. More than three-quarters of regional hospitals (76.9%) had a private exam room designated for use in caring for rape survivors. Multiple regression analysis of practitioner factors associated with better quality of clinical care found these to be a practitioner being older than 40 years (parameter estimate = 2.4; 95% confidence interval (CI) = 0.7-5), having cared for a higher number of rape survivors before (parameter estimate = 0.02; 95% CI = 0.001-0.03), working in a facility that had a clinical management protocol for caring for rape survivors (parameter estimate = 2; 95% CI = 0.12-3.94), having worked for less time in the facility (parameter estimate = -0.2; 95% CI = -0.3 to -0.04) and perceiving rape to be a serious medical problem (parameter estimate = 2.8; 95% CI = 1.9-3.8). Conclusion There are many weaknesses in services for rape survivors in South Africa. Our findings suggest that care can be improved by disseminating clinical management guidelines and ensuring that care is provided by motivated providers who are designated to care for survivors. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to examine social learning theory (SLT) and teen dating violence (TDV) perpetration. This study aims to determine which predictors have the largest effect sizes, whether they vary for males and females, and whether they differ based on research design and sample characteristics. Methods: This study uses hierarchal meta-analytic methods to examine both within- and between-dataset differences in relationships between a variety of SLT predictors and TDV outcomes. Both bivariate and multivariate effect sizes are computed for a sample of n = 1,157 effect sizes nested in n = 116 studies that used n = 88 unique datasets. Results: Findings indicate that a variety of SLT predictors can explain TDV perpetration. Predictors with the largest effect sizes include anticipated benefits of TDV (Bivariate: r =.254; multivariate: r =.308) and peer TDV perpetration (Bivariate: r =.279; multivariate: r =.205). While most predictors show similar effect sizes for males and females, peer TDV perpetration appears to be a stronger influence for males. Several significant moderators are found. Conclusions: SLT should continue to provide a theoretical framework for TDV research and practice. Future research should examine same-sex teen relationships and sexual minorities. [ABSTRACT FROM AUTHOR]

Social norms that legitimise men as political leaders, and undervalue women's leadership, are a tenacious barrier to women's representation globally. This article explores the circumstances under which women dynasty politicians, whose legacy connections have provided them with an initial pathway into politics, are able to disrupt these norms. We test a proposed typology of normative change – one that progresses from norm acceptance, to norm modification, then norm resistance – among women dynasty politicians in the Pacific Islands. We find that norms of masculinised political leadership are strong, and in many cases the election of wives, widows, daughters and other relatives of male political actors reinforces these norms through their positioning as 'placeholders'. Yet some women dynasty politicians can, and do, challenge and extend social norms of leadership. This is especially the case when the 'legacy advantage' is a springboard from which women demonstrate – and their publics accept – their own articulation of political leadership. [ABSTRACT FROM AUTHOR]

Women's contraceptive decision‐making control is crucial for reproductive autonomy, but research largely relies on the Demographic and Health Survey (DHS) measure which asks who is involved with decision‐making. In India, this typically assesses joint decision‐making or male engagement. Newer measures emphasize female agency. We examined three measures of contraceptive decision‐making, the DHS and two agency‐focused measures, to assess their associations with marital contraceptive communication and use in rural Maharashtra, India. We analyzed follow‐up survey data from women participating in the CHARM2 study (n = 1088), collected in June–December 2020. The survey included the DHS (measure 1), Reproductive Decision‐Making Agency (measure 2), and Contraceptive Final Decision‐Maker measures (measure 3). Only Measure 1 was significantly associated with contraceptive communication (adjusted odds ratio [AOR]: 2.75, 95 percent confidence interval [CI]: 1.69–4.49) and use (AOR: 1.73, 95 percent CI: 1.14–2.63). However, each measure was associated with different types of contraceptive use: Measure 1 with condom (adjusted relative risk ratio [aRRR]: 1.99, 95 percent CI: 1.12–3.51) and intrauterine device (IUD) (aRRR: 4.76, 95 percent CI: 1.80–12.59), Measure 2 with IUD (aRRR: 1.64, 95 percent CI: 1.04–2.60), and Measure 3 with pill (aRRR: 2.00, 95 percent CI: 1.14—3.52). Among married women in Maharashtra, India, male engagement in decision‐making may be a stronger predictor of contraceptive communication and use than women's agency, but agency may be predictive of types of contraceptives used. [ABSTRACT FROM AUTHOR]

Gender roles and imbalances in sexual power contribute to the heightened HIV-1 risk faced by women in Sub-Saharan Africa. This has led prevention research to focus on the development of female controlled methods. Despite the design of products such as vaginal rings to be used autonomously by women, male partners and women's perceptions of relationships influence HIV prevention choices. To understand the influences that male partners and dyadic dynamics had on the use of the Dapivirine Vaginal Ring in the ASPIRE trial, this analysis of qualitative data explored the types of intimate partner relationships that women engaged in. This paper describes how partners facilitated or challenged women's ring use and how women dealt with these challenges within six different types of relationships characterized by power dynamics and commitment levels. We offer insights into how future use of female-initiated HIV prevention products can be promoted through recognition of different relationship types. [ABSTRACT FROM AUTHOR]

Although academics have focused on sugaring in various parts of the globe, sugar relationships in the United States have largely been ignored. The few studies that address these arrangements in the United States often frame them as a form of prostitution. Drawing from 48 in-depth interviews with women in the United States who have been in sugar relationships, I adopt a connected lives approach to explore the structure of these arrangements and to assess the extent to which they are a form of prostitution. Overall, I found that, although there is a dominant, subcultural relationship script that serves as a blueprint for sugar arrangements, they comprise their own unique relational package and take a variety of forms when enacted on an interpersonal level. Specifically, I identified seven types of sugar relationships, only one of which can be considered prostitution. These included sugar prostitution, compensated dating, compensated companionship, sugar dating, sugar friendships, sugar friendships with benefits, and pragmatic love. [ABSTRACT FROM AUTHOR]

Anecdotal evidence suggests that sexual violence varies significantly across cases of election violence and communal conflicts but systematic research is scarce. Post-election violence is particularly likely if electoral mobilization further polarizes longstanding communal conflicts and political elites do not instruct security forces to intervene decisively. I comparatively analyse two prominent cases of post-election violence in Kenya (2007/8) and Nigeria (2008) that exhibit stark variation in sexual violence. Patrimonial networks and norms of violent masculinity that increase the probability of (gang) rape were present in both cases and do not explain variation. Civil war research has identified three explanations for the variation in sexual violence: situational constraints; ordered sexual violence or restraint; and bottom-up dynamics of sexual violence or restraint. I examine these for the context of post-election violence. I argue that the type of communal conflict triggered by electoral mobilization explains variation in sexual violence. In Kenya, pogroms of a majority group against a minority allowed for the time and space to perpetrate widespread sexual violence while in Nigeria, dyadic clashes between similarly strong groups offered less opportunity but produced a significantly higher death toll. These findings have important implications for preventing election violence. They demonstrate that civilian vulnerability is gendered and that high levels of sexual violence do not necessarily correspond to high levels of lethal violence. Ignoring sexual violence means underestimating the real intensity of conflict and its impact on the political process. [ABSTRACT FROM AUTHOR]

Theoretical refinement of the concept of reproductive justice has been called for. In this paper, I propose the use of a supportability reparative justice approach. Drawing on intra-categorical intersectionality, the supportability aspect starts from the event of a pregnancy to unravel the interwoven embodied and social realities implicated in women experiencing pregnancy as personally supportable/unsupportable, and socially supported/unsupported. The reparative justice aspect highlights the need for social repair in the case of unsupportable pregnancies and relies on Ernesto Verdeja's critical theory of reparative justice in which he outlines four reparative dimensions. Using abortion within the South African context, I show how this framework may be put to use: (1) the facilitation of autonomous decision-making (individual material dimension) requires understanding women within context, and less emphasis on individual-driven 'choice'; (2) the provision of legal, safe state-sponsored healthcare resources (collective material dimension) demands political will and abortion service provision to be regarded as a moral as well as a healthcare priority; (3) overcoming stigma and the spoiled identities (collective symbolic dimension) requires significant feminist action to deconstruct negative discourses and to foreground positive narratives; and (4) understanding individual lived experiences (individual symbolic dimension) means deep listening within the social dynamics of particular contexts. [ABSTRACT FROM AUTHOR]

Young men in South Africa experience several adverse socio-structural and psychosocial factors that may contribute HIV risk behaviors. This study applied a syndemic framework to explore whether these syndemic factors are interconnected and work in synergy to increase HIV risk behaviors. Five syndemic factors were assessed including: binge drinking, polydrug use, depressive symptoms, violence and food insecurity on two HIV risk behaviors: multiple sex partners and transactional sex. Participants were (N = 1233) young men aged 18-29 years from a township in Cape Town, South Africa. Bivariate logistic regression analysis demonstrated that many of the syndemic factors were related to one another. Pairwise interactions (on an additive scale) among the syndemic factors revealed significant positive interactions between binge drinking and violence on greater odds of reporting multiple sex partners (aOR = 5.10, 95% CI 3.10, 8.29; p = < .001) compared to reporting neither factor. Also, food insecurity and violence (aOR = 2.89, 95% CI 1.63, 5.11; p = < .001) as well as food insecurity and polydrug use (aOR = 2.73, 95% CI 1.54, 4.84; p = < .001) were significantly associated with greater odds of transactional sex compared to reporting neither factor. Our findings highlight a synergistic relationship between some adverse socio-structural and psychosocial factors on HIV risk behaviors. HIV prevention programs that address multiple syndemic factors simultaneously may achieve greater impact on HIV risk reduction. [ABSTRACT FROM AUTHOR]

More than one-half of all people living with HIV are women and 80 percent of all HIV-positive women in the world live in sub-Saharan Africa. This paper demonstrates that the legal origins of these formerly colonized countries significantly determine current-day female HIV rates. In particular, female HIV rates are significantly higher in common law sub-Saharan African countries compared to civil law ones. This paper explains this relationship by focusing on differences in female property rights under the two codes of law. In sub-Saharan Africa, common law is associated with weaker female marital property laws. As a result, women in these common law countries have lower bargaining power within the household and are less able to negotiate safe sex practices and are thus more vulnerable to HIV, compared to their civil law counterparts. Exploiting the fact that some ethnic groups in sub-Saharan Africa cross country borders with different legal systems, we are able to include ethnicity fixed effects into a regression discontinuity approach. This allows us to control for a large set of cultural, geographical, and environmental factors that could be confounding the estimates. The results of this paper are consistent with gender inequality (the 'feminization' of AIDS), explaining much of its prevalence in sub-Saharan Africa. (JEL I12, J15, J16, K11, K15, O15, O17) [ABSTRACT FROM AUTHOR]

Introduction. We analyse the collaboration and co-citation networks at the international level in scientific articles about violence against women. The aim is to identify who are writing about this subject, if they are women and/or men, who the most influential authors are and which institutions they belong to, and finally which authors are cited most frequently. Method. As a source of information we have consulted the Web of Science database, from which we recovered and analysed a total of 8,448 articles. Analysis. We analysed a simple of 5,219 authors. For the social network analysis and the visualization of centrality measures, collaboration and cocitation we used the software programme Pajek. The collaboration density maps were visualised using VOSViewer. Results. A total of 8,448 publications were analysed, showcasing the authors with a higher collaboration and cocitation centrality as well as their gender. We also present most influencial authors, their collaboration networks and the institutions to which they are affiliated. Conclusions.The results show that research into violence against women is led by women; they publish more articles than men; they collaborate more closely; they hold positions that enable them to channel and disseminate flows of information and collaboration groups; and they have closer links to other authors. [ABSTRACT FROM AUTHOR]

this article describes an adapted rapid situational analysis that was used to investigate the hIV-related environment that teenage girls and young women negotiate in the rural province of limpopo in South Africa. this research contributed to the development of a sex and relationships educational programme to improve the skill sets young women use to negotiate the hIV and AIDS epidemic. Conceptually, the methodology was informed by the social drivers of HIV debate and was designed to illuminate both the hIV-related risk environments that the young women encountered, as well as the resilience strategies they used to negotiate these contexts. the qualitative design included an Archetype extraction technique and focus group discussions, with the former guiding the structure of the latter. The findings suggest that (a) young women negotiate multiple hIV risks, (b) are aware of these risks and (c) have developed resilience strategies to negotiate these types of environment. however, the reported risk factors were more dominant than the reported resilience strategies. the adapted rapid situational analysis was found to be fit for purpose and contributed to the community partner's ambition of updating its sex and relationships education programme. [ABSTRACT FROM AUTHOR]

Past research has shown that sexual abuse increases vulnerability to HIV/AIDS. However, little is known about the context of different cultural traditions and how they affect women's risk. This study used data from two studies conducted in the United States and West Africa, and purposefully selected semi-structured interviews of those reporting sexual abuse. Data were collected from 2006 to 2009 (United States) and 2014 to 2015 (West Africa), and analyzed using an interpretive team approach. Findings revealed that most study participants lived with personal shame and stigma; they were silent about the abuse they suffered to protect themselves and their families. Those providing mental and physical health services to women with HIV/AIDS must be cognizant of these cultural issues and the continuing cycle of poverty and abuse that put these women at risk. [ABSTRACT FROM AUTHOR]

From around 1970, critics of the medicalisation of women’s bodies drew attention to the centring of the foetus and neonate in ‘maternal’ and child health, as medical researchers and public programs sought to drive down foetal and infant mortality rates. This stimulated both scholarship and advocacy around women’s agency in reproduction. In recent years, there has been renewed interest in pregnancy and foetal outcomes, now on the risks that overweight and obese women pose to their children once adult, and through them, to later generations. In association with this concern with epigenetics and maternal risk factors, there has been growing emphasis on the need for interventions pre-conception and in early pregnancy to prevent cardiometabolic disease. In this article, I draw particularly on examples from South Africa. I describe first how the continued idea of a ‘normal’ birth ignores the ways in which race, class and poverty shape reproductive possibilities. I then analyse the logic that positions women as ‘foetal containers’ and so as vehicles of poor intergenerational health. Such approaches to women, and their pregnant bodies, ignore the structural factors that influence body size, diet and health. [ABSTRACT FROM PUBLISHER]

Sexual exploitation and abuse (SEA) is an endemic problem in UN peacekeeping missions. It is not only a gross human rights violation, but also threatens to challenge the legitimacy of the peacekeeping mission and undermines the promotion of gender equality in host countries. We examine if the composition of peacekeeping forces along two dimensions – the proportion of women and the records of gender (in)equality in the contributing countries – helps explain variation in SEA allegations. Analysis of mission-level information from 2009 to 2013 indicates that including higher proportions of both female peacekeepers and personnel from countries with better records of gender equality is associated with lower levels of SEA allegations reported against military contingents. We conclude that substantial reductions in SEA perpetrated by peacekeepers requires cultivation of a value for gender equality among all peacekeepers – improving the representation of women may help but still stops short of addressing the root of the problem. [ABSTRACT FROM AUTHOR]