A pilot program to address the gendered social
and economic precursors of youth HIV risks
By: Hallman, Kelly, Kasthuri Gov...
Formative research:
SES vulnerabilities put youth at risk
• Living in poverty
• Not socially connected
• Orphaned
• Not en...
Poor more likely to sexually debut earlier
Ever had sex: 14-16 years-olds
0
10
20
30
40
Low Mid High
Wealth
percent
Male
F...
Girls with less social capital
more likely to experience physically-forced sex
Ever been : 14-16 year-old females
0
2
4
6
...
Orphans have more
economically-motivated sexual encounters
Ever traded sex: sexually debuted 14-16-year-olds
0
5
10
15
20
...
Non-enrolled have lower rates of condom use
Condom used at last sex: 14-16 year-olds
0
10
20
30
40
50
60
70
80
Not Enrolle...
Durban Program Scan
• Few HIV prevention programs address
social, economic, and cultural
underpinnings of risk behaviors
•...
International Program Scan
• Few programs tackle conceptually links
among HIV and socio-economic-cultural
• Exceptions
– N...
Developing an integrated program
Efforts to enhance enabling environment
 Community forums
 Tribal authorities, young wo...
Reducing social isolation
Bring young people together regularly in
safe community spaces
• Weekly 5 hour sessions
• Groups...
Financial literacy
• Increasing awareness of self and rights
• Numeracy training
– Data collection, Graphs
• Personal and ...
Social and economic bridges
• Starting informal group savings
• Interacting with formal financial insitutions
• Connecting...
Sexuality and STI/HIV/AIDS
knowledge and skills
• Increasing knowledge
• Dispelling myths
• Skills to negotiate with
sexua...
Emerging findings
from pilot project
Recalls discussing contraceptive
use in last 12 months (15-24-yr-olds)
-20
0
20
40
60
80
100
120
140
160
180
%changefromba...
Recalls discussing HIV/AID &
condom use in last 12 months (15-24-yr-olds)
-40
-20
0
20
40
60
80
100
%changefrombaseline
Ma...
Recalls discussing violence or sexual abuse
in last 12 months (15-24-yr-olds)
-20
0
20
40
60
80
100
120
140
%changefrombas...
Has savings/is saving (15-24-yr-olds)
-40
-20
0
20
40
60
80
100
120
140
160
%changefrombaseline
Male-Participants
Male-Com...
Participant views of financial education
“It’s different, in school we learn mathematics and
biology but here we learn thi...
Participant views of health education
“….. I didn’t understand about HIV and AIDS before
but now I do. I didn’t learn that...
Next steps
• Complete evaluation of pilot
• Disseminate results
• Undertake randomized control trial version
– 3-arm study
Implications
Programmatic
• Establish and/or build from an evidence base
• Assess current program landscape
– Models/compo...
Implications
Research
• Consider evaluation early on
– in design phase and program placement plans
• Timing of evaluation ...
Selected resources
• Hallman, Kelly, Kasthuri Govender, Eva Roca, Emmanual Mbatha, Rob Pattman,
and Deevia Bhana. 2008. “E...
Thank you!
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  • Today I will be discussing social and economic factors that place young people at risk
    and possible interventions designed to reduce such risks.
  • Girl’s HIV risk is examined along 4 different dimensions:
  • Sexual activity starts early in South Africa. 26% of boys and 16% of girls aged 14-16 in the sample have had sex.
    In the poorest HHs, 30% of girls have already sexually debuted.
    Even among higher wealth groups, many girls have already had sex.
  • Girls who are less socially connected are more likely to have endured physically-forced sexual encounters.
    ALL girls, not conditioned on eversex
    ZERO for boys
  • Orphans are also more likely to have exchanged sex for money, goods, or favors.
  • Conditional on being sexually active, condom use among non-enrolled is lower.
    Non-enrolled girls are less than half as likely to have used a condom at last sex.
  • Orphan girls also less socially connected
    By safe spaces I mean:
    Ability to meet with friends
    Ability to cultivate and maintain social networks
    Ability to have a protective community environment
  • Orphan girls also less socially connected
    By safe spaces I mean:
    Ability to meet with friends
    Ability to cultivate and maintain social networks
    Ability to have a protective community environment
  • Within safe schools and social environments………
    Give girls the skills to function as productive and confident future economic actors
  • Orphan girls also less socially connected
    By safe spaces I mean:
    Ability to meet with friends
    Ability to cultivate and maintain social networks
    Ability to have a protective community environment
  • Basic principles of money management
    Building/retaining/safeguarding assets, especially with respect to orphans
    Learning how to access available opportunities, such as social benefits and job training
    Preparing for predictable events, such as payment of school fees
    Dealing with special challenges, such as death of a parent, or a pregnancy
    Since policies provide an overall context for action,
    these interventions cannot take place without a supportive policy environment.
  • To prevent risky behaviors we know that information and services alone are not enough…..
    We must provide young people with, among other things,
    schooling, social support and financial lifeskills to address their underlying structural vulnerabilities.
    -----------------------------------
    (Among other things: access to condoms and sexual and reproductive health services, gender equitable schooling and work opportunities, freedom from sexual violence, elimination of harmful traditional practices, etc.)
  • Particularly poor and orphaned girls
  • A pilot program to address the gendered social and economic precursors of youth HIV risks

    1. 1. A pilot program to address the gendered social and economic precursors of youth HIV risks By: Hallman, Kelly, Kasthuri Govender, Eva Roca, Emmanuel Mbatha, Rob Pattman, and Deevia Bhana CIES Annual Conference, March 19, 2008, New York, NY
    2. 2. Formative research: SES vulnerabilities put youth at risk • Living in poverty • Not socially connected • Orphaned • Not enrolled in school
    3. 3. Poor more likely to sexually debut earlier Ever had sex: 14-16 years-olds 0 10 20 30 40 Low Mid High Wealth percent Male Female Poor Non-poor Source: Hallman, 2005
    4. 4. Girls with less social capital more likely to experience physically-forced sex Ever been : 14-16 year-old females 0 2 4 6 8 Low Mid High Social Connectedness percent Source: Hallman and Onabanjo, 2005
    5. 5. Orphans have more economically-motivated sexual encounters Ever traded sex: sexually debuted 14-16-year-olds 0 5 10 15 20 Orphan Non-orphan Orphan Status percent Male Female Source: Hallman and Onabanjo, 2005
    6. 6. Non-enrolled have lower rates of condom use Condom used at last sex: 14-16 year-olds 0 10 20 30 40 50 60 70 80 Not Enrolled Enrolled Enrollment Status percent Male Female Source: Hallman and Onabanjo,
    7. 7. Durban Program Scan • Few HIV prevention programs address social, economic, and cultural underpinnings of risk behaviors • Few LH programs make conceptual link to HIV risk – Not context-, age-, or gender-specific – Weak components – Little monitoring or evaluation Source: Swan and Hallman, 2003
    8. 8. International Program Scan • Few programs tackle conceptually links among HIV and socio-economic-cultural • Exceptions – Not evaluated – Evaluation in place but in early stages – Not appropriate to context → increased vulnerability Source: Hallman and Dutt, 2007
    9. 9. Developing an integrated program Efforts to enhance enabling environment  Community forums  Tribal authorities, young women, young men, parents, grandparents  Increase safe spaces; reduce social isolation  Raise context-specific financial literacy  Facilitate ‘bridging’ to opportunities, services  Increase STI/HIV/AIDS knowledge & skills  National accreditation of the program
    10. 10. Reducing social isolation Bring young people together regularly in safe community spaces • Weekly 5 hour sessions • Groups of 10 young people • Young adult facilitators (mentors) • Interaction with peers
    11. 11. Financial literacy • Increasing awareness of self and rights • Numeracy training – Data collection, Graphs • Personal and household financial management – Budgeting, Savings, Accessing grants • Personal income tax and payslip education • Household and business activities
    12. 12. Social and economic bridges • Starting informal group savings • Interacting with formal financial insitutions • Connecting to local role models and mentors • Learning about local opportunities – Training and registration in public works tenders • Accessing learnerships and formal jobs – Creating/updating resume – How to link into the system – Interview skills
    13. 13. Sexuality and STI/HIV/AIDS knowledge and skills • Increasing knowledge • Dispelling myths • Skills to negotiate with sexual partners • Healthy lifestyles
    14. 14. Emerging findings from pilot project
    15. 15. Recalls discussing contraceptive use in last 12 months (15-24-yr-olds) -20 0 20 40 60 80 100 120 140 160 180 %changefrombaseline Male-Participants Male-Comparisons Female-Participants Female-Comparisons Source: Hallman, Govender, Roca, et al., 2008
    16. 16. Recalls discussing HIV/AID & condom use in last 12 months (15-24-yr-olds) -40 -20 0 20 40 60 80 100 %changefrombaseline Male-Participants Male-Comparisons Female-Participants Female-Comparisons Source: Hallman, Govender, Roca, et al., 2008
    17. 17. Recalls discussing violence or sexual abuse in last 12 months (15-24-yr-olds) -20 0 20 40 60 80 100 120 140 %changefrombaseline Male-Participants Male-Comparisons Female-Participants Female-Comparisons Source: Hallman, Govender, Roca, et al., 2008
    18. 18. Has savings/is saving (15-24-yr-olds) -40 -20 0 20 40 60 80 100 120 140 160 %changefrombaseline Male-Participants Male-Comparisons Female-Participants Female-Comparisons Source: Hallman, Govender, Roca, et al., 2008
    19. 19. Participant views of financial education “It’s different, in school we learn mathematics and biology but here we learn things that we can use in the future.” - female age 16 years, enrolled in school “We learnt about budgeting and saving and all those things, because we only think that when we get money we spend it. This program was like an eye-opener to us, because, we know now when we get some money, we have to save something…” - male age 22 years, not enrolled in school Source: Hallman et al, 2007
    20. 20. Participant views of health education “….. I didn’t understand about HIV and AIDS before but now I do. I didn’t learn that in school.” –female age 20 years, not enrolled in school “It changed my attitude, because I know how to use a condom and I know how to trust my partner and I know how to advise my partner, when we are sitting together and talking about, how to have sexual intercourse and I know even to advise the community as a whole about HIV/AIDS…” –male age 22 years, not enrolled in school Source: Hallman et al, 2007
    21. 21. Next steps • Complete evaluation of pilot • Disseminate results • Undertake randomized control trial version – 3-arm study
    22. 22. Implications Programmatic • Establish and/or build from an evidence base • Assess current program landscape – Models/components – Target groups – Evaluation schemes/results • Stakeholder involvement from beginning
    23. 23. Implications Research • Consider evaluation early on – in design phase and program placement plans • Timing of evaluation (and funding) versus program time pressures to deliver services Policy • Policymaker dialog, input, support from start • Does program feed into, conflict, or compete with existing or planned policy
    24. 24. Selected resources • Hallman, Kelly, Kasthuri Govender, Eva Roca, Emmanual Mbatha, Rob Pattman, and Deevia Bhana. 2008. “Evaluation of an intervention to address the gendered social and economic precursors of youth HIV risks,” paper prepared for presentation at PAA Annual Conference, New Orleans, LA, USA. • Hallman, Kelly and Eva Roca. 2007. “Reducing the social exclusion of girls,” Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief no. 27. New York: Population Council. http://www.popcouncil.org/pdfs/TABriefs/PGY_Brief27_SocialExclusion.pdf • Hallman, Kelly, Kasthuri Govender, Emmanual Mbatha, Jill Walsh, Rob Pattman, and Deevia Bhana. June, 2007. “Social capital, socioeconomic aspirations, and HIV risk behaviors among poor South African youth,” poster presentation. Third South African AIDS Conference, Durban, South Africa. http://www.popcouncil.org/mediacenter/events/2007SAAIDS/abstracts/Hallman.ht ml • Hallman, Kelly. Gendered socioeconomic conditions and HIV risk behaviours among young people in South Africa. 2005. African Journal of AIDS Research 4(1): 37–50. Abstract: http://www.popcouncil.org/projects/abstracts/AJAR_4_1.html • Bruce, Judith. Girls left behind: Redirecting HIV interventions toward the most vulnerable. Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief no. 23. New York: Population Council. http://www.popcouncil.org/pdfs/TABriefs/PGY_Brief23_GirlsLeftBehind.pdf
    25. 25. Thank you!
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