Cultural Scripts Surrounding Young People's Sexual & Romantic Relationships in the Western Highlands of Guatemala

Guatemala has one of the world's highest teenage pregnancy rates and 92% of young people report not using contraception for first sex. 

We conducted narrative-based thematic analysis of a sample of narratives (n = 40; 15 male-authored, 25 female-authored) on HIV and sexuality, submitted to a 2013 scriptwriting competition by young people aged 15-19 years from Guatemala's Western Highlands. Our objective was to identify dominant cultural scripts and narratives that deviated positively from that norm with a view to informing the development of educational curricula and communication materials promoting youth sexual and reproductive health. 

The narratives are characterised by romantic themes and melodramatic plotlines: three in four had tragic endings. Rigid gender norms and ideologies of enduring love make female characters blind to the potential consequences of unprotected sex and vulnerable to betrayal and abandonment. 

Unprotected sex is the norm, with contraception and sexually transmitted infection protection mentioned rarely. In the four positively deviant narratives, female and male characters' interaction is based on mutual respect, dialogue and genuine affection. 

The narratives reveal opportunities for action to increase sexual health knowledge and access to services and to challenge harmful cultural scripts, potentially by leveraging the positive value attached to romantic love by authors of both sexes.

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By:  Singleton R1, Schroffel H1, Findlay T1, Winskell K1.

• 1 Hubert Department of Global Health , Rollins School of Public Health, Emory University , Atlanta, GA , USA. 
• Cult Health Sex. 2016 Mar 17:1-15. 

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Power & the Association with Relationship Quality in South African Couples: Implications for HIV/AIDS Interventions

INTRODUCTION:

Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS.

METHODS:

This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012 to 2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners' perceptions of power influences their own (i.e., actor effect) and their partner's reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict).

RESULTS:

For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women's reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men's reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women's reports of intimacy and negatively associated with women's reports of conflict.

CONCLUSIONS:

Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level. Efforts solely focused on empowering women should also take the dyadic environment and men's perspectives into account to ensure positive relationship outcomes.

Below:  Hypothesized pathways between female power, male gender norms, shared power, and relationship quality using an actor-partner independence model

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By:  Conroy AA1, McGrath N2, van Rooyen H3, Hosegood V4, Johnson MO5, Fritz K6, Marr A7, Ngubane T8, Darbes LA9.

• 1Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Amy.Conroy@ucsf.edu.
• 2Faculty of Medicine, University of Southampton, Southampton General Hospital, Mailpoint 805, South Academic Block, Level C Room AC23, Tremona Road, Southampton SO16 6YD, UK; Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa. Electronic address: n.mcgrath@soton.ac.uk.
• 3Social, Behavioural and Biomedical Interventions Unit, HIV/AIDS, STIs and Tuberculosis Programme, Human Sciences Research Council, P.O Box 90, Msunduzi 3200, South Africa. Electronic address: hvanrooyen@hsrc.ac.za.
• 4Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa; Division of Social Statistics and Demography, University of Southampton, Southampton SO17 1BJ, UK. Electronic address: v.hosegood@soton.ac.uk.
• 5Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Mallory.Johnson@ucsf.edu.
• 6Global Health, International Center for Research on Women, 1120 20th Street NW, Suite 500 North, Washington, D.C., USA. Electronic address: kfritz@icrw.org.
• 7Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Alexander.Marr@ucsf.edu.
• 8Social, Behavioural and Biomedical Interventions Unit, HIV/AIDS, STIs and Tuberculosis Programme, Human Sciences Research Council, P.O Box 90, Msunduzi 3200, South Africa. Electronic address: tngubane@hsrc.ac.za.
• 9Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Lynae.Darbes@ucsf.edu. 
• Soc Sci Med. 2016 Jan 28;153:1-11. doi: 10.1016/j.socscimed.2016.01.035.

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Johnny Depp, Reconsidered: How Category-Relative Processing Fluency Determines the Appeal of Gender Ambiguity

Individuals that combine features of both genders–gender blends–are sometimes appealing and sometimes not. Heretofore, this difference was explained entirely in terms of sexual selection. 

In contrast, we propose that part of individuals’ preference for gender blends is due to the cognitive effort required to classify them, and that such effort depends on the context in which a blend is judged. In two studies, participants judged the attractiveness of male-female morphs. Participants did so after classifying each face in terms of its gender, which was selectively more effortful for gender blends, or classifying faces on a gender-irrelevant dimension, which was equally effortful for gender blends. In both studies, gender blends were disliked when, and only when, the faces were first classified by gender, despite an overall preference for feminine features in all conditions. Critically, the preferences were mediated by the effort of stimulus classification. 

The results suggest that the variation in attractiveness of gender-ambiguous faces may derive from context-dependent requirements to determine gender membership. More generally, the results show that the difficulty of resolving social category membership–not just attitudes toward a social category–feed into perceivers’ overall evaluations toward category members.

Below:  Examples of stimuli used in Study 1 as a percentage of the female parent

Below:  Examples of face blends used in Study 2

Full article at:   http://goo.gl/RE2YqJ

By:  Helen E. Owen,1 Jamin Halberstadt,1,* Evan W. Carr,2 and Piotr Winkielman2,3,4,*

¹Department of Psychology, University of Otago, Dunedin, New Zealand

²Department of Psychology, University of California San Diego, La Jolla, California, United States of America

³Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, United Kingdom

⁴Department of Psychology, University of Social Sciences and Humanities, Warsaw, Poland

Brock University, CANADA

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: HO JH PW. Performed the experiments: HO JH PW. Analyzed the data: HO JH PW EC. Contributed reagents/materials/analysis tools: HO JH PW EC. Wrote the paper: HO JH PW EC.

* E-mail: zn.ca.ogato.ysp@sreblahj; Email: ude.dscu@namleikniwp

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Optimizing HIV Prevention for Women: A Review of Evidence from Microbicide Studies & Considerations for Gender-Sensitive Microbicide Introduction

Introduction

Microbicides were conceptualized as a product that could give women increased agency over HIV prevention. However, gender-related norms and inequalities that place women and girls at risk of acquiring HIV are also likely to affect their ability to use microbicides. Understanding how gendered norms and inequalities may pose obstacles to women's microbicide use is important to inform product design, microbicide trial implementation and eventually microbicide and other antiretroviral-based prevention programmes. We reviewed published vaginal microbicide studies to identify gender-related factors that are likely to affect microbicide acceptability, access and adherence. We make recommendations on product design, trial implementation, positioning, marketing and delivery of microbicides in a way that takes into account the gender-related norms and inequalities identified in the review.

Methods

We conducted PubMed searches for microbicide studies published in journals between 2000 and 2013. Search terms included trial names (e.g. “MDP301”), microbicide product names (e.g. “BufferGel”), researchers’ names (e.g. “van der Straten”) and other relevant terms (e.g. “microbicide”). We included microbicide clinical trials; surrogate studies in which a vaginal gel, ring or diaphragm was used without an active ingredient; and hypothetical studies in which no product was used. Social and behavioural studies implemented in conjunction with clinical trials and surrogate studies were also included. Although we recognize the importance of rectal microbicides to women, we did not include studies of rectal microbicides, as most of them focused on men who have sex with men. Using a standardized review template, three reviewers read the articles and looked for gender-related findings in key domains (e.g. product acceptability, sexual pleasure, partner communication, microbicide access and adherence).

Results and discussion

The gendered norms, roles and relations that will likely affect women's ability to access and use microbicides are related to two broad categories: norms regulating women's and men's sexuality and power dynamics within intimate relationships. Though norms about women's and men's sexuality vary among cultural contexts, women's sexual behaviour and pleasure are typically less socially acceptable and more restricted than men's. These norms drive the need for woman-initiated HIV prevention, but also have implications for microbicide acceptability and how they are likely to be used by women of different ages and relationship types. Women's limited power to negotiate the circumstances of their intimate relationships and sex lives will impact their ability to access and use microbicides. Men's role in women's effective microbicide use can range from opposition to non-interference to active support.

Conclusions

Identifying an effective microbicide that women can use consistently is vital to the future of HIV prevention for women. Once such a microbicide is identified and licensed, positioning, marketing and delivering microbicides in a way that takes into account the gendered norms and inequalities we have identified would help maximize access and adherence. It also has the potential to improve communication about sexuality, strengthen relationships between women and men and increase women's agency over their bodies and their health.

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

By:   Elizabeth G Doggett,^§,1 Michele Lanham,² Rose Wilcher,¹ Mitzy Gafos,³ Quarraisha A Karim,^4,5 and Lori Heise⁶

¹Research Utilization Department, FHI 360, Durham, NC, USA

²Social and Behavioral Health Sciences Department, FHI 360, Durham, NC, USA

³Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London, UK

⁴CAPRISA, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

⁵Department of Epidemiology, Columbia University, New York, NY, USA

⁶Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK

^§Corresponding author: Elizabeth G Doggett, 359 Blackwell St., Durham, NC 27707, USA. Tel: +1 919 944 7040. (Email:gro.063ihf@tteggode)

  

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Household Debt and Relation to Intimate Partner Violence and Husbands' Attitudes Toward Gender Norms: A Study among Young Married Couples in Rural Maharashtra, India

Evidence has linked economic hardship with increased intimate partner violence (IPV) perpetration among males. However, less is known about how economic debt or gender norms related to men's roles in relationships or the household, which often underlie IPV perpetration, intersect in or may explain these associations. We assessed the intersection of economic debt, attitudes toward gender norms, and IPV perpetration among married men in India.

Data were from the evaluation of a family planning intervention among young married couples (n=1,081) in rural Maharashtra, India. Crude and adjusted logistic regression models for dichotomous outcome variables and linear regression models for continuous outcomes were used to examine debt in relation to husbands' attitudes toward gender-based norms (i.e., beliefs supporting IPV and beliefs regarding male dominance in relationships and the household), as well as sexual and physical IPV perpetration.

Twenty percent of husbands reported debt. In adjusted linear regression models, debt was associated with husbands' attitudes supportive of IPV (b=0.015, p=0.004) and norms supporting male dominance in relationships and the household (b=0.006, p=0.003). In logistic regression models adjusted for relevant demographics, debt was associated with perpetration of physical IPV (adjusted odds ratio [AOR] = 1.4, 95% confidence interval [CI] 1.1, 1.9) and sexual IPV (AOR=1.6, 95% CI 1.1, 2.1) from husbands. These findings related to debt and relation to IPV were slightly attenuated when further adjusted for men's attitudes toward gender norms.

Findings suggest the need for combined gender equity and economic promotion interventions to address high levels of debt and related IPV reported among married couples in rural India.

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By: Reed E1, Donta B2, Dasgupta A1, Ghule M2, Battala M3, Nair S4, Silverman JG1, Jadhav A2, Palaye P2, Saggurti N5, Raj A1.

• 1University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA ; University of California, San Diego, Center on Gender Equity and Health, La Jolla, CA.
• 2National Institute for Research in Reproductive Health, Mumbai, India.
• 3Population Council, New Delhi, India.
• 4National Institute for Research in Reproductive Health, Mumbai, India ; National Institute of Medical Statistics, Indian Council of Medical Research, Ansari Nagar, New Delhi.
• 5Bill & Melinda Gates Foundation, New Delhi, India. 

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'They Can't Report Abuse, They Can't Move Out. They Are at the Mercy of These Men': Exploring Connections Between Intimate Partner Violence, Gender & HIV in South African Clinical Settings

This qualitative study captured South African female health provider perspectives of intimate partner violence in female patients, gender norms and consequences for patients' health. 

Findings indicated female patients' health behaviours were predicated on sociocultural norms of submission to men's authority and economic dependence on their partners. Respondents described how men's preferences and health decision-making in clinics affected their patients' health. Adverse gender norms and gender inequalities affected women's opportunities to be healthy, contributing to HIV risk and undermining effective HIV management in this context. 

Some providers, seeking to deliver a standard of quality healthcare to their female patients, demonstrated a willingness to challenge patriarchal gender relations. Findings enhance understanding of how socially-sanctioned gender norms, intimate partner violence and HIV are synergistic, also reaffirming the need for integrated HIV-intimate partner violence responses in multi-sector national strategic plans. 

Health providers' intimate knowledge of the lived experiences of female patients with intimate partner violence and/or HIV deepens understanding of how adverse gender norms generate health risks for women in ways that may inform policy and clinical practice in South Africa and other high-HIV prevalence settings.

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By: Sprague C1,2,3, Hatcher AM3,4, Woollett N3, Sommers T1, Black V3.

• 1a Department of Conflict Resolution, Human Security & Global Governance , McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston , Boston , USA.
• 2b Department of Nursing , College of Nursing and Health Sciences, University of Massachusetts Boston , Boston , USA.
• 3c Wits Reproductive Health and HIV Institute, Faculty of Health Sciences , University of the Witwatersrand , Hillbrow Johannesburg , South Africa.
• 4d Bixby Center for Global Reproductive Health , University of California San Francisco , San Francisco , USA.  

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