Young women in South Africa face an especially daunting transition into adulthood. At the current rate of infection, one in every three will be HIV-positive by age 21. 1 A 2005 nationally representative HIV prevalence study among 15-24-year-olds in South Africa documented an abrupt rise in HIV prevalence among young women: Although only 4% of women 15-19 were HIV-positive, more than one-third of women were infected by age 21. 2 A study conducted in 2000 among university students in KwaZuluNatal-the site of this investigation-found that 26% of women and 12% of men aged 20-24 were already HIVpositive. 3 These data underscore the urgent need to identify HIV risk factors for young women that are either not known, not being effectively addressed or both.It has been widely argued that women bear the brunt of HIV worldwide because of their positions of low social, political and economic power-all of which can be considered types of poverty. 1,2,4 Gender differences in economic status among South Africans support the hypothesis that poverty disproportionately increases women's risk of acquiring HIV over that of men. As many as 60% of South African households are chronically poor,* and women within these households may be affected more than men. 5 For example, greater proportions of women than of men, regardless of racial group, are economically inactive (defined as being 15 years or older and available to work, but currently not working). Similarly, women are more likely than men to be unemployed, regardless of their educational attainment. 6 Much of the literature examining the link between poverty and various health and developmental outcomes suggests a broad base of risk beyond that which can be captured by income-based measures alone. [7][8][9][10] In the last decade, many studies-primarily conducted in the United States-have examined neighborhood effects on healthrelated outcomes among youth. Findings from such studies suggest that elements within the broader social and economic context of communities are associated with various developmental outcomes for youth, even after controlling for family-and individual-level characteristics, including family economic status. [11][12][13][14][15] Although a growing body of evidence suggests an association between community context and youth development, there remains a paucity of research on the social context of HIV/AIDS, especially in developing countries. A common thread in most current literature on research concerning HIV/AIDS and youth, however, is the need to explore and identify a model of behavior change that is not focused solely on the individual. Recent studies, both quantitative and qualitative, describe an intricate net of factors at various levels of adolescents' lives that influence their actions, including young people's sexual risk-taking behaviors. 2,[16][17][18] Perhaps more important, many of these studies have emphasized the heterogeneity of behaviors within a given adolescent population and the fact that very little is known about what factors at which...

BackgroundSmall private-sector health care providers can play an important role in meeting the developing country health care needs, but a lack of credit can prove major constraint to small-provider expansion. This study examines the potential of small, microfinance loans to strengthen the private health sector and improve access to quality preventive and curative health services in Uganda.MethodsThis study estimates logistic regressions using 2,387 client exit interviews to assess the impact of microfinance loans on perceived quality and the viability and sustainability of small, private clinics.ResultsThe study finds perceived quality improved with loan recipients' clients being more likely to choose clinics on the basis of drug availability, fair charges, cleanliness, and confidentiality. In addition, the assessment found evidence of increased client flows, but the changes produced mixed results for sustainability with respondents being only half as likely to "always" visit a particular clinic.ConclusionThe results indicate that the microfinance program improved perceived quality at loan recipient clinics, especially as reliable drug outlets.

The importance of community clustering of neighborhood-level characteristics differs by gender in South Africa. Poverty remains a central risk factor for HIV among young women, regardless of the surrounding context, but not among men.