Consistent Condom Use by Female Sex Workers in Kolkata, India: Testing Theories of Economic Insecurity, Behavior Change, Life Course Vulnerability and Empowerment

Consistent condom use (CCU) is the primary HIV/STI prevention option available to sex workers globally but may be undermined by economic insecurity, life-course vulnerabilities, behavioral factors, disempowerment, or lack of effective interventions. 

This study examines predictors of CCU in a random household survey of brothel-based female sex workers (n = 200) in two neighborhoods served by Durbar (the Sonagachi Project) in Kolkata, India. 

Multivariate logistic regression analyses indicated that CCU was significantly associated with perceived HIV risk, community mobilization participation, working more days in sex work, and higher proportion of occasional clients to regular clients. 

Exploratory analyses stratifying by economic insecurity indicators (i.e., debt, savings, income, housing security) indicate that perceived HIV risk and community mobilization were only associated with CCU for economically secure FSW. Interventions with FSW must prioritize economic security and access to social protections as economic insecurity may undermine the efficacy of more direct condom use intervention strategies.

Full PDF article at:   http://goo.gl/VBWDCT

By:  Anne E. Fehrenbacher1 • Debasish Chowdhury2 • Toorjo Ghose3 • Dallas Swendeman4,5

1 Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Drive South, Los Angeles, CA 90095, USA

2 Public Health Foundation of India (PHFI), Sector-44, Plot No-47, Gurgaon 122003, India

3 School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Caster D17, Philadelphia 19104, USA

4 Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA

5 Department of Epidemiology, Fielding School of Public Health, 10920 Wilshire Blvd., Suite 350, Los Angeles 90024, USA

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Women’s Religious Authority in a Sub-Saharan Setting: Dialectics of Empowerment & Dependency

Western scholarship on religion and gender has devoted considerable attention to women’s entry into leadership roles across various religious traditions and denominations. However, very little is known about the dynamics of women’s religious authority and leadership in developing settings, especially in sub-Saharan Africa, a region of powerful and diverse religious expressions. This study employs a combination of uniquely rich and diverse data to examine women’s formal religious authority in a predominantly Christian setting in Mozambique. I first use survey data to test hypotheses regarding the prevalence and patterns of women’s formal leadership across different denominational groups. I then support and extend the quantitative results with insights on pathways and consequences of women’s ascent to formal congregation authority drawn from qualitative data. The analysis illustrates how women’s religious authority both defies and reasserts the gendered constraints of the religious marketplace and the broader gender ideology in this developing context....

 As this analysis suggests, similarly to Western settings, sub-Saharan women’s rise to religious leadership roles, as well as the limitations of this rise, reflects the broader societal realities and expectations of (in)equality between women and men (Wessinger 1996, 6). As elsewhere, this process is shaped through “loose coupling” between these broader forces and church internal ideological and organizational priorities (Chaves 1996). And, as in the Western world (Zikmund 1986), this process unfolds gradually in sub-Saharan Africa. 

In this study, women still tended to lead smaller congregations than did men, and women congregation leaders were significantly less likely than men leaders to occupy higher-ranking church offices, even after controlling for theological training. Yet, with almost a third of the district’s religious congregations being headed by women, the process of women’s entry into leadership roles in Chibuto has been more advanced than many outsiders might imagine. 

Women’s ascent through the church leadership ranks increasingly defines the face, identity, and expression of religious organizations in sub-Saharan Africa. However, women leaders must confront and often conform to the gendered world around them. Rarely does their rise to positions of authority explicitly clash with deeply entrenched and omnipresent gender inequalities, and with the pervasive stereotypes about women’s subalternity—the stereotypes to which, incidentally, most women church leaders still readily subscribe. Hence, the expansion of women’s religious leadership roles both challenges and reasserts the patriarchal gender ideology and the social hierarchies and relationships that this ideology cements. 

As observed in Chibuto, formal church leadership does empower women, yet, at the same time, the power that women leaders gain remains mainly limited to “women’s matters” and is exercised largely within the gendered constraints of religious ideologies. This dialectical reality parallels, with appropriate caveats, the findings of a growing number of studies that show how women’s “doing” of religion (Avishai 2008) promotes their empowerment by creatively engaging their faith without fundamentally challenging the ideological and symbolic boundaries of the religious doctrine (e.g., Chong 2008; González 2013; Mahmood 2005; Prickett 2015; Rinaldo 2013; van Doorn-Harder 2006).

Full article at:   http://goo.gl/f0sTqB

By:  Victor Agadjanian, 

Correspondence concerning this article should be addressed to Victor Agadjanian, Foundation Distinguished Professor, Department of Sociology, University of Kansas, Lawrence, KS 60045, USA;

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Sexual Behavior among Young Carers in the Context of a Kenyan Empowerment Program Combining Cash-Transfer, Psychosocial Support, and Entrepreneurship

This study examined associations between sexual initiation, unprotected sex, and having multiple sex partners in the past year with participation in a three-year empowerment program targeting orphan and vulnerable children (OVC). 

The Kenya-based program combines community-conditioned cash transfer, psychosocial empowerment, health education, and microenterprise development. Program participants (n = 1,060) were interviewed in a cross-sectional design. Analyses used gender-stratified hierarchical logit models to assess program participation and other potential predictors. 

Significant predictors of increased female sexual activity included less program exposure, higher age, younger age at most recent parental death, fewer years of schooling, higher food consumption, higher psychological resilience, and lower general self-efficacy. Significant predictors of increased male sexual activity included more program exposure, higher age, better food consumption, not having a living father, and literacy. 

Findings support a nuanced view of current cash transfer programs, where female sexual activity may be reduced through improved financial status but male sexual activity may increase. Targeting of OVC sexual risk behaviors would likely benefit from being tailored according to associations found in this study. 

Data suggest involving fathers in sexual education, targeting women who lost a parent at a younger age, and providing social support for female OVC may decrease risk of human immunodeficiency virus (HIV) transmission.

Purchase full article at:   http://goo.gl/6o5kAl

By:  Goodman ML1,2,3, Selwyn BJ2, Morgan RO2, Lloyd LE2, Mwongera M4, Gitari S4, Keiser PH3.

• 1 Sodzo International.
• 2 Division of Management, Policy and Community Health, School of Public Health , University of Texas , Houston.
• 3 Center for Global Health Education , University of Texas Medical Branch , Galveston.
• 4 Community Health Department , Maua Methodist Hospital , Meru County , Kenya.
• J Sex Res. 2016 Mar-Apr;53(3):331-45. doi: 10.1080/00224499.2015.1035429. Epub 2015 Sep 30. 

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Changing Attitudes & Beliefs Towards a Woman's Right to Protect Against HIV Risk in Malawi

Female empowerment and positive attitudes towards women's rights in sexual relationships have been found to be key elements of successful behaviour-based HIV prevention programmes. However, HIV prevention programmes that do not specifically engage with gender issues may also affect attitudes and beliefs towards women's rights within sexual relationships. 

Using data from the Malawi Longitudinal Study of Families and Health we compare measures of female empowerment and changing gender norms between intervention participants and non-participants. 

Results suggest that female intervention participants were more likely than non-participants to believe that: 

1. women have more rights within sexual relationships in general and 
2. women have the right to protect themselves against HIV risk (indicating possible increases in female self-efficacy in making HIV prevention decisions). 

Male intervention participants showed no substantial positive change in attitudes towards women's rights. 

These results highlight an important positive effect of HIV prevention programmes on women's attitudes towards their own rights.

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By:  Fedor TM1, Kohler HP2, McMahon JM1.

• 1 School of Nursing, University of Rochester Medical Center , Rochester , USA.
• 2 Population Studies Center, University of Pennsylvania , Philadelphia , USA. 
• Cult Health Sex. 2016 Apr;18(4):435-52. doi: 10.1080/13691058.2015.1090016. Epub 2015 Oct 27.

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Community Influences on Married Women's Safer Sex Negotiation Attitudes in Bangladesh: A Multilevel Analysis

The influence of disadvantaged or deprived community on individuals' health risk-behaviors is increasingly being documented in a growing body of literature. However, little is known about the effects of community characteristics on women's sexual attitudes and behaviors. 

To examine community effects on married women's safer sex negotiation attitudes, we analyzed cross-sectional data from the 2011 Bangladesh Demographic and Health Surveys on a sample of 15,134 married women in 600 communities. 

We estimated two multilevel logistic regression models. Model 1, which included only individual-level variables, showed that women's autonomy/empowerment, age, and HIV knowledge had significant associations with their safer sex negotiation attitudes. We did not find any socioeconomic status gradient in safer sex negotiation attitudes at the individual level. Adding community-level variables in Model 2 significantly improved the fit of the model. 

Strikingly, we found that higher community-level poverty was associated with greater positive safer sex negotiation attitudes. Prevailing gender norms and overall women's empowerment in the community also had significant effects. While research on community influences calls for focusing on disadvantaged communities, our research highlights the importance of not underestimating the challenges that married women in economically privileged communities may face in negotiating safer sex. To have sufficient and equitable impact on married women's sexual and reproductive health, sexual and reproductive health promotion policies and programs need to be directed to women in wealthier communities as well.

Purchase full article at:   http://goo.gl/JaI3fp

By:  Jesmin SS1, Cready CM2.

• 1Department of Sociology and Psychology, University of North Texas at Dallas, 7400 University Hills Blvd., Dallas, TX, 75241, USA. syeda.jesmin@untdallas.edu.
• 2Department of Sociology, University of North Texas, Denton, TX, 76203-5017, USA.
• Arch Sex Behav. 2016 Feb;45(2):383-93. doi: 10.1007/s10508-015-0572-7. Epub 2015 Jul 11. 

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Correlates of Gender Characteristics, Health & Empowerment of Women in Ethiopia

Background

The low status of women prevents them from recognizing and voicing their concerns about health needs. This study aimed to examine the relationship between gender characteristics, health and empowerment of women in an attempt to understand between 2005 and 2011.

Methods

Data from the Ethiopia Demographic and Health Survey (EDHS) 2005 and 2011 were used. Bivariate and multivariate analyses were used to determine the relative contribution of the predictor variables. The hypotheses tested in this study were that gender (men and women), health and empowerment of women in region are highly significant with women’s education and work status.

Results

Study findings showed that the low status of women and their disempowerment are highly associated with poor health outcomes. In both 2005 and 2011 men school ages were positively associated with their attainment in primary education, whereas for women it was negatively related with their attainment in some education. In both 2005 and 2011 women in the richest wealth quintile had the highest odds ratio of relating to some education. The results show that the odds ratios of women with some education (within the richest wealth quintile) has improved from 6.39 (in 2005) to 10.90 (in 2011), whereas among men there has been a decrease from 10.33 (in 2005) to 2.13 (in 2011). The results indicated that in 2005 and 2011, when comparing the percentage distribution of both genders on employment status and type of occupation, the percentage of men who were employed was higher than women. The percentage of males who were engaged in the agricultural-type of occupation was higher than that of women. Men and women knowledge about family planning methods have been improved, yet, there are wider gender gaps in family planning users.

Conclusions

The officials such as policy makers, planners, program managers and government and non-government organizations need to addressed. The issue of child marriages in order to minimize the number of girls who never attend school or drop out to become wives Planners should also work on improving family planning to empower women. There was a significant relationship between status of women and quality of healthy life, and this relationship appeared to differ by education and work status.

Full article at:  http://goo.gl/dVjQnj

By:  Yishak Abraham Lailulo, A Sathiya Susuman^* and Renette Blignaut

Department of Statistics & Population Studies, University of the Western Cape, Cape Town, South Africa

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Social Cohesion among Sex Workers and Client Condom Refusal in a Canadian Setting: Implications for Structural and Community-Led Interventions

Community empowerment can be a powerful determinant of HIV risk among sex workers (SWs). This study modeled the impact of social cohesion on client condom refusal among SWs in Vancouver. Longitudinal data were drawn from a prospective cohort of SWs (2010-2013). Lippman and colleagues' Social Cohesion Scale measured SWs' connectedness (i.e., perception of mutual aid, trust, support). 

Multivariable logistic regression examined the independent effect of social cohesion on client condom refusal. Of 654 SWs, 22 % reported baseline client condom refusal and 34 % over 3 years. The baseline median social cohesion score was 24 (IQR 20-29, range 4-45). In the final confounding model, for every one-point increase in the social cohesion score, average odds of condom refusal decreased by 3 % (AOR 0.97; 95 % CI 0.95-0.99). 

Community empowerment can have a direct protective effect on HIV risk. These findings highlight the need for a legal framework that enables collectivization and SW-led efforts in the HIV response.

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By:  Argento E1, Duff P1,2, Bingham B1, Chapman J3, Nguyen P1, Strathdee SA4, Shannon K5,6.

• 1Gender & Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
• 2Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
• 3Sex Workers United Against Violence (SWUAV), Vancouver, BC, Canada.
• 4Division of Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA, USA.
• 5Gender & Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. gshi@cfenet.ubc.ca.
• 6Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. gshi@cfenet.ubc.ca.

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The Influence of Perceived Behaviour Control, Attitude & Empowerment on Reported Condom Use & Intention to Use Condoms among Adolescents in Rural Tanzania

Despite the declining trends of Human immunodeficiency virus (HIV) infection in Sub-Saharan Africa (SSA), unsafe sexual behaviours among adolescents still represent a public health challenge. It is important to understand factors acting at different levels to influence sexual behaviour among adolescents. This study examined the influence of perceived behaviour control, subjective norms, attitudes and empowerment on intention to use condoms and reported use of condoms among adolescents in rural Tanzania.

We used a questionnaire to collect data from 403 adolescents aged 14 through 19 years from nine randomly selected secondary schools in the Newala district located in the Southern part of Tanzania. The self-administered questionnaire collected information on sexual practices and factors such as attitudes, subjective norms, perceived behaviour control and empowerment. Binary logistic regression was performed to identify factors associated with intention to use and reported use of condoms.

Sexually active adolescents constituted 40.6 % of the sample, among them 49.7 % did not use a condom at last sexual intercourse and 49.8 % had multiple sex partners. Many (85 %) of sexually active respondents had their sexual debut between the ages of 14 to 17 years. Girls became sexually active earlier than boys. Perceived behaviour control predicted intentions to use condoms, thus demonstrating its importance in the decision to use a condom. Empowerment and a positive attitude predicted reported condom use, thus turning the decision to actions. Subjective norms had only indirect effects on intention and reported use of condoms.

The findings suggest that unsafe sex practices are prevalent among school adolescents in rural areas of Tanzania. Perceived behaviour control and positive attitudes predict intensions to use condoms whereas empowerment predicts reported condom use. The findings may imply that safe sex promotion interventions that simultaneously address socio-cognitive and ecological determinants of sexual behaviours may improve adolescents’ safe sex behaviours.

Purchase full article at:   http://goo.gl/cjSq0t

By: Albino Kalolo^1* and Stephen Matthew Kibusi²

¹Department of Community Health, St. Francis University college of Health and Allied Sciences, Ifakara, Tanzania

²School of Nursing and Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania

  

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Effect of Savings-Led Economic Empowerment on HIV Preventive Practices among Orphaned Adolescents in Rural Uganda: Results from the Suubi-Maka Randomized Experiment

Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. 

Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents' cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10-17 years, to either the control group receiving usual orphan care plus mentoring (n = 167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n = 179). Assessments were conducted at baseline, 12, and 24 months. 

Results indicated that intervention adolescents significantly increased their cash savings over time (b = $US 12.32, ±1.12) compared to adolescents in the control group. At 24 months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control group. The largest changes in savings goals were the proportion of intervention adolescents valuing saving for money to buy a home, pursue vocational training, and start a business. Intervention adolescents also had a significant relative increase over time in HIV-preventive attitudinal scores, most commonly toward perceived risk of HIV (95.8%), sexual abstinence or postponement (91.6%), and consistent condom use (93.4%). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score. 

To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions.

Purchase full article at:  http://goo.gl/ghiOMJ

By:  Jennings L1, Ssewamala FM2, Nabunya P3.

• 1 Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
• 2 International Center for Child Health and Asset Development , Columbia University School of Social Work , New York , NY , USA.
• 3 School of Social Service Administration , University of Chicago , Chicago , IL , USA.

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Sexual Behavior among Young Carers in the Context of a Kenyan Empowerment Program Combining Cash-Transfer, Psychosocial Support, and Entrepreneurship

This study examined associations between sexual initiation, unprotected sex, and having multiple sex partners in the past year with participation in a three-year empowerment program targeting orphan and vulnerable children (OVC). The Kenya-based program combines community-conditioned cash transfer, psychosocial empowerment, health education, and microenterprise development. 

Program participants (n = 1,060) were interviewed in a cross-sectional design. Analyses used gender-stratified hierarchical logit models to assess program participation and other potential predictors. 

• Significant predictors of increased female sexual activity included 
• less program exposure, 
• higher age, 
• younger age at most recent parental death, 
• fewer years of schooling, 
• higher food consumption, 
• higher psychological resilience, 
• and lower general self-efficacy. 
• Significant predictors of increased male sexual activity included 
• more program exposure, 
• higher age, 
• better food consumption, 
• having a living father, 
• and literacy. 

Findings support a nuanced view of current cash transfer programs, where female sexual activity may be reduced through improved financial status but male sexual activity may increase. Targeting of OVC sexual risk behaviors would likely benefit from being tailored according to associations found in this study. 

Data suggest involving fathers in sexual education, targeting women who lost a parent at a younger age, and providing social support for female OVC may decrease risk of human immunodeficiency virus (HIV) transmission.

Via: http://goo.gl/680j1q  Purchase full article at: http://goo.gl/Sjuxg6

By: Goodman ML1,2,3, Selwyn BJ2, Morgan RO2, Lloyd LE2, Mwongera M4, Gitari S4, Keiser PH3.

• 1a Sodzo International.
• 2b Division of Management, Policy and Community Health, School of Public Health , University of Texas , Houston.
• 3c Center for Global Health Education , University of Texas Medical Branch , Galveston.
• 4d Community Health Department , Maua Methodist Hospital , Meru County , Kenya 

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‘‘Whatever I Have, I Have Made by Coming into this Profession’’: The Intersection of Resources, Agency, and Achievements in Pathways to Sex Work in Kolkata, India

Below:  Resources, agency, and achievements among sex workers in durbar intervention

This article investigated the complex interplay of choice, socioeconomic structural factors, and empowerment influencing engagement in sex work. The analysis was focused on pathways into and reasons for staying in sex work from in-depth qualitative interviews with participants (n=37) recruited from the Durbar community-led structural intervention in Kolkata, India. Kabeer’s theory of empowerment focused on resources, agency, and achievements was utilized to interpret the results. Results identified that contexts of disempowerment constraining resources and agency set the stage for initiating sex work, typically due to familial poverty, loss of a father or husband as a breadwinner, and lack of economic opportunities for women in India. Labor force participation in informal sectors was common, specifically in domestic, construction, and manufacturing work, but was typically insufficient to provide for families and also often contingent on sexual favors. The availability of an urban market for sex work served as a catalyst or resource, in conjunction with Durbar’s programmatic resources, for women to find and exercise agency and achieve financial and personal autonomy not possible in other work or as dependents on male partners. Resources lost in becoming a sex worker due to stigma, discrimination, and rejection by family and communities were compensated for by achievements in gaining financial and social resources, personal autonomy and independence, and the ability to support children and extended family. Durbar’s programs and activities (e.g., savings and lending cooperative, community mobilization, advocacy) function as empowering resources that are tightly linked to sex workers’ agency, achievements, and sex work pathways.

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