224977 Allure of a modern social identity and adolescent girls' vulnerability to HIV: Qualitative evidence from Botswana, Malawi, and Mozambique

Monday, November 8, 2010

Carol Underwood, PhD , Dept of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Rosa Said, MS , Independent Consultant, Fortaleza-CE, Brazil
Joanna Skinner, MHS , Center for Communication Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Hilary M. Schwandt, PhD , Center for Communication Programs, Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
In sub-Saharan Africa, adolescent girls compared with adolescent boys are 3-5 times more likely to be living with HIV/AIDS. Girls' vulnerability to HIV is rarely examined from the perspective of community members or girls themselves. Methods: A qualitative study conducted in November-December 2008 relied on 12 focus group discussions in Botswana, 12 in Malawi, and 11 in Mozambique, divided between urban and rural sites and grouped thusly: adolescent girls (ages 10-14; 15-19), adolescent boys (14-19), adult women (20-49), adult men (20-49), and community leaders. Results: Study participants perceived “adolescent girls' vulnerability to HIV” as linked primarily to unprotected sexual relationships, which they described as often transactional and age-disparate. Study participants highlighted the following antecedents to unprotected sex: the desire for consumer goods associated with a modern social identity and, secondarily, poverty (Botswana); poverty and, secondarily, the allure of material goods (Malawi); poverty and adolescent identity formation equally (Mozambique). At times, participants' narratives – including those of adolescent girls – blamed girls for their vulnerability, citing promiscuity, consumerism, and willfulness as causal factors. Yet, community members of all ages also identified social and structural factors (social exclusion of girls living in poverty, non-enforcement of laws that protect minors) as precursors to vulnerability. Conclusions: The findings point unequivocally to the central role of economic disparities in girls' vulnerability, reflect the importance of addressing adolescents' social identity formation concerns, and strongly indicate the need for structural-level interventions to enhance legal protections for minors and provide viable economic opportunities for girls and their families.

Learning Areas:
Planning of health education strategies, interventions, and programs
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. List five extra-individual factors that place adolescent girls at heightened risk of contracting HIV. 2. Compare and contrast economically related factors associated with girls' vulnerability to HIV in Botswana, Malawi, and Mozambique.

Keywords: Economic Analysis, Social Inequalities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a co-author on the formative research report from which the findings for this presentation were drawn.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.