Ugandan adolescent perceptions of
coerced sex and skills in addressing
coercion: Implications for promotion
of safer sexua...
Presenter Disclosures
(1) The following personal financial relationships with
commercial interests relevant to this presen...
Acknowledgments
• Ruth Biringi and Dennis Nambembezi, for
excellence in data collection and analysis
• Michele Ybarra and ...
Objectives
• To describe what is currently known about the
relationship between coercion and HIV risk in Sub
Saharan Afric...
HIV in Africa
• 67% of the worlds’ cases of HIV are in Sub
Saharan Africa; most transmission is due to
heterosexual contac...
Sexual Coercion and HIV in Sub
Saharan Africa
• Coercive sex is defined as forcing an individual
into any sexual act that ...
Sexual Coercion and HIV in Sub
Saharan Africa
• Predictors for Coercion
– Age difference among partners, where one is 5
ye...
Sexual Coercion and HIV in Sub
Saharan Africa
• Interventions for Coercion
– U.S. based programs—”Safe Dates” and “Healthy...
CyberSenga
• CyberSenga is a research project funded by
the U.S. National Institute of Mental Health to
explore the feasib...
CyberSenga
• Youth participating in CyberSenga can access
six modules, each lasting about one hour, that
will offer specif...
Method
• Members of the Youth Advisory Council to
CyberSenga were convened for three focus
group discussions to identify
–...
Method
• Three focus group sessions with YAC members
held at the CyberSenga offices in Mbarara,
Uganda
• Sessions were tap...
Method
• Content analysis
– Code book initially informed by literature
– Three levels of coding
• Open coding
• Axial codi...
Results
Participants Number Percent
Male 13 65%
Female 7 35%
Boarding student 17 85%
Ankole & Bakiga tribe 16 80%
Results
• General perception that coercion must be
obvious and extreme in order to be
considered as such
• Exceptions:
“Me...
Results
• Reporting any coercion is difficult
• “Okay when someone is your parent’s friend,
your father will begin trustin...
Results
• Coercion perceived to be more common
between adults and young people
“When you are having someone older than you...
Results
• Although less commonly acknowledged, a
minority of youth did suggest that coercion
can happen between peers
“For...
Results
• Youth perceive gift giving as common and
potentially coercive
“When someone gives you a gift obviously that
pers...
Results
• Alcohol and drugs influence the likelihood of
coercion
“Like you can be there and you get a girl and
you get her...
Results
• Youth adhere to the perception that some
invite coercion
“even the way girls wear affects boys too
much…because ...
Results
• Youth had specific ideas for integrating
education on coercion into CyberSenga
– Make sure information is releva...
Conclusions
• Epidemiologic data suggests coercion is
common
• Youth don’t receive peer related coercion is
common
• Youth...
Conclusions
• Given limited data on interventions in Sub
Saharan Africa specific to managing and
preventing coercion we ne...
Ugandan adolescent perceptions of coerced sex and skills in addressing coercion: Implications for promotion of safer sexua...
Ugandan adolescent perceptions of coerced sex and skills in addressing coercion: Implications for promotion of safer sexua...
Ugandan adolescent perceptions of coerced sex and skills in addressing coercion: Implications for promotion of safer sexua...
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Ugandan adolescent perceptions of coerced sex and skills in addressing coercion: Implications for promotion of safer sexual behaviors

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  • Re: age--in rural Uganda, HIV infection was two times higher for those reporting a most recent sexual partner 10 or more years older compared to those with a partner of 0-4 years older holding other influential factors constant (Kelly et al., 2001), including consumption of alcohol and drugs prior to intercourse and cultural norms around coercion.Re: Power--MacPhail, William and Campbell (2002) found that sexual refusal or negation may result in suspicion of infidelity and carry the risk of violent outcomes. Another study in South Africa found a pervasive male control over almost every aspect of women’s early sexual experiences enacted through violent and coercive sexual practices
  • Need to add screen shots of Cyber Senga hereDescribe what a Senga is
  • Add some screen shots on coercion here
  • Ugandan adolescent perceptions of coerced sex and skills in addressing coercion: Implications for promotion of safer sexual behaviors

    1. 1. Ugandan adolescent perceptions of coerced sex and skills in addressing coercion: Implications for promotion of safer sexual behaviors Sheana Bull, Ruth Biringi, Dennis Nambembezi, Michele Ybarra, Julius Kiwanuka * Thank you for your interest in this presentation. Please note that analyses included herein are preliminary. More recent, finalized analyses may be available by contacting CiPHR for further information. 138th Annual Meeting of the American Public Health Association Denver, CO November 9, 2010
    2. 2. Presenter Disclosures (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Sheana Bull No relationships to disclose
    3. 3. Acknowledgments • Ruth Biringi and Dennis Nambembezi, for excellence in data collection and analysis • Michele Ybarra and Julius Kiwanuka for their leadership on the CyberSenga research project
    4. 4. Objectives • To describe what is currently known about the relationship between coercion and HIV risk in Sub Saharan Africa • To briefly describe the CyberSenga research project and purpose for this work • To discuss findings from a qualitative investigation of youth perceptions of and experiences with coercion • To consider implications of these findings for HIV prevention
    5. 5. HIV in Africa • 67% of the worlds’ cases of HIV are in Sub Saharan Africa; most transmission is due to heterosexual contact – Infection rates are higher for women than men; for teenage girls rates in some countries are 5X that of teen boys; women in their 20’s have rates 3X that of men. • Coerced sex is one of the major contributors to HIV infection
    6. 6. Sexual Coercion and HIV in Sub Saharan Africa • Coercive sex is defined as forcing an individual into any sexual act that is involuntary, whether through “threats, intimidation, trickery or some other form of pressure or force”* • Description of coercive sexual debut is common for women, and documented in Mali, Uganda and Kenya. *Farris Treat, Vicken &Mcfall, 2008
    7. 7. Sexual Coercion and HIV in Sub Saharan Africa • Predictors for Coercion – Age difference among partners, where one is 5 years or older than another – Gender power differential – Alcohol and drug use (often facilitates coercion)
    8. 8. Sexual Coercion and HIV in Sub Saharan Africa • Interventions for Coercion – U.S. based programs—”Safe Dates” and “Healthy Relationships” aim to change norms and attitudes towards coercion – South Africa (see info on Pop and Miguel Sabido on Soul City?) – East Africa—little documented on successful interventions to address coercion
    9. 9. CyberSenga • CyberSenga is a research project funded by the U.S. National Institute of Mental Health to explore the feasibility and efficacy of using the Internet to deliver comprehensive HIV prevention education to Ugandan youth – Internet use is widespread and continually growing in Uganda* – Youth have limited resources for comprehensive sexuality education as their access to the Senga diminishes *Ybarra et al., 2008
    10. 10. CyberSenga • Youth participating in CyberSenga can access six modules, each lasting about one hour, that will offer specific and detailed prevention information and skills building
    11. 11. Method • Members of the Youth Advisory Council to CyberSenga were convened for three focus group discussions to identify – Awareness and familiarity with coercion; – Perceptions of how common coercion was among their peers – Ideas for how to educate peers about coercion and skills to prevent it using CyberSenga
    12. 12. Method • Three focus group sessions with YAC members held at the CyberSenga offices in Mbarara, Uganda • Sessions were taped and tapes transcribed; all participant identifiers were removed at transcription, and tapes destroyed.
    13. 13. Method • Content analysis – Code book initially informed by literature – Three levels of coding • Open coding • Axial coding • Summary coding – Three coders; two RA’s conduct principle coding; randomly selected sections of text recoded by co- investigator and reviewed for inter-rater reliability (86%)
    14. 14. Results Participants Number Percent Male 13 65% Female 7 35% Boarding student 17 85% Ankole & Bakiga tribe 16 80%
    15. 15. Results • General perception that coercion must be obvious and extreme in order to be considered as such • Exceptions: “Me I think that forcing does not mean that someone will come and tie a rope around your neck, you can be forced mentally”,
    16. 16. Results • Reporting any coercion is difficult • “Okay when someone is your parent’s friend, your father will begin trusting him. He can even trust him to take you to school so through that, the friend tells you something and you wonder how you are going to tell your father so you just keep it and in the long run you find yourself in a relationship.”
    17. 17. Results • Coercion perceived to be more common between adults and young people “When you are having someone older than you, you have to give respect to that person. That person is going to fear the age of the person and then they will keep quiet. That is where that kind of thing is going to come from…”
    18. 18. Results • Although less commonly acknowledged, a minority of youth did suggest that coercion can happen between peers “For me what I think even there are some adolescents boys who take girls to some extent they force them to have sex with them”
    19. 19. Results • Youth perceive gift giving as common and potentially coercive “When someone gives you a gift obviously that person loves you then now you think that the next thing has to be that. You think that, okay this person has given me a gift because he loves me, he cares about me and now there are two people in a relationship you know that love is sex, the next thing will be having sex”,
    20. 20. Results • Alcohol and drugs influence the likelihood of coercion “Like you can be there and you get a girl and you get her booze and you convince her and at the end of it all you find that they are drunk. So due to that influence of alcohol, you find that they end up playing sex”.
    21. 21. Results • Youth adhere to the perception that some invite coercion “even the way girls wear affects boys too much…because when you see a girl putting on a short skirt, it makes them feel like dying, it then makes them feel like having sex.”
    22. 22. Results • Youth had specific ideas for integrating education on coercion into CyberSenga – Make sure information is relevant and youth focused – Give specific information on what to do if coerced and especially if raped – Motivate youth and give them skills to refuse gifts; phones, air time, books – Educate parents and family members that coercion happens
    23. 23. Conclusions • Epidemiologic data suggests coercion is common • Youth don’t receive peer related coercion is common • Youth feel vulnerable and inexperienced in dealing with coercion, especially in connection with adults and with people who they perceive have power over them
    24. 24. Conclusions • Given limited data on interventions in Sub Saharan Africa specific to managing and preventing coercion we need strategies that are effective for youth to prevent it • The CyberSenga YAC also suggested that adults need to be integrated into coercion prevention programs • HIV prevention programs need to explicitly integrate attention to coercion—for youth and adults—in educational efforts

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