Being an ‘adolescent’: The consequences of gendered risks for young people in rural Uganda

Bernays, Sarah; Bukenya, Dominic; Thompson, Claire; Ssembajja, Fatuma; Seeley, Janet

doi:10.1177/0907568217732119

Cited by 13 publications

(15 citation statements)

References 31 publications

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“…This informed the refinement of the topic guides. Our theoretical approach was informed by social constructionism with particular attention paid to relational agency, which is attentive to the restricted agency young people may have and how this is framed by their relationships, but is also fluid and so may be dynamic and transformative [25].…”

Section: Data Collectionmentioning

confidence: 99%

Scaling up peer‐led community‐based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success

Bernays

Tshuma

Willis³

et al. 2020

J Intern AIDS Soc

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Introduction Low rates of viral suppression among adolescents living with HIV (ALHIV) indicate that more effective support is urgently required at scale. The provision of peer support has generated considerable enthusiasm because it has the potential to ameliorate the complex social and relational challenges which underpin suboptimal adherence. Little is known about the impact on young peer supporters themselves, which is the focus of this paper. Methods We present qualitative findings from the Zvandiri trial investigating the impact of a peer support intervention on the viral load for beneficiaries (ALHIV, aged 13 to 19 years) in Zimbabwe. The Zvandiri peer supporters aged 18 to 24 years, known as community adolescent treatment supporters (CATS), are themselves living with HIV. Individual in‐depth interviews were conducted in late 2018 with 17 CATS exploring their experiences of delivering peer support and their own support needs. Interviews were analysed iteratively using thematic analysis. Results The CATS reported that being peer supporters improved their own adherence behaviour and contributed to an improved sense of self‐worth. The social connections between the CATS were a source of comfort and enabled them to develop skills to manage the challenging aspects of their work. Two substantial challenges were identified. First, their work may reveal their HIV status. Second, managing the emotional labour of this caring work; given how commonly the complexity of the beneficiaries’ needs mirrored the circumstances of their own difficult lives. Both challenges were ameliorated by the support the CATS provided to each other and ongoing supervision from the adult mentor. There was variation in whether they felt their roles were appropriately valued through the remuneration they received and within the health system. There was a consensus that their experience meant that they would graduate from being a CATS with transferable skills that could enhance their employability. Conclusions Their experiences illustrate the advantages and opportunities of being a CATS. To minimize potential harms, it is vital to ensure that they feel valued in their role, which can be demonstrated by the provision of appropriate remuneration, recognition and respect, and that there is continued investment in ongoing support through ongoing training and mentoring.

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Section: Data Collectionmentioning

confidence: 99%

Scaling up peer‐led community‐based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success

Bernays

Tshuma

Willis³

et al. 2020

J Intern AIDS Soc

Self Cite

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show abstract

“…The completeness of the scripts were tested by transcribing verbatim some of the interviews and comparing them with draft scripts for detail. Requiring a high degree of training and skill, this is an approach increasingly adopted to facilitate timely analytical attention to emerging data, which can be disrupted by delays in transcription and translation (Bernays et al, 2018). Scripts were coded initially using an open coding approach, then through a coding framework.…”

Section: Discussionmentioning

confidence: 99%

Being young and on the move in South Africa: how ‘waithood’ exacerbates HIV risks and disrupts the success of current HIV prevention interventions

Bernays

Lanyon

Dlamini

et al. 2020

Vulnerable Children and Youth Studies

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The period between childhood and adulthood has been characterised as a period of 'waithood' in which structural conditions may disable young people's access to basic resources to become independent adults. We consider the specific implications of this experience for newly migrant young people in KwaZulu-Natal, South Africa. We conducted repeat in-depth interviews and participatory workshops over a 12-month period with 38 young people on their experiences of migration, employment, sexual relationships and approaches taken to mitigate HIV-risk, in a high HIV-risk periurban setting. The lives of participants within the first year of arriving in a new place were characterised by fluidity and transience, underpinned by the inherent fragility of options and exacerbated by exploitative employers. Conditions of gendered employment opportunities shaped their capacity to source income, including through sexual relationships. Although risks were evident and ongoing, their significance were under-played with exposure conceived as unavoidable and temporary. HIV prevention services were consequently viewed as relevant to 'other' young people. Although navigating an 'adult' world, these 'not yet adults' are exposed to substantial risks. Services should be tailored to address specific and practical support needs of this transient population, alongside provision of harm-reduction and health support. ARTICLE HISTORY

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“…As adolescents transition out of primary school, experiences in new secondary schools, the workplace, and domestic contexts are expected to affect adolescents’ outcomes. While enhanced capabilities may support Ugandan adolescents in navigating risk of violence and collectively advocate for change, this is largely limited by gender-related vulnerabilities within shifting risk environments [ 43 ]. In addition, adolescents’ negotiations and need for support, resources, and services may not be met by family, school, workplace, or the community systems, which are all subject to wider structural factors [ 44 ].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of the Good School Toolkit Primary School Violence Prevention Intervention Among Adolescents: Protocol for a Nonrandomized Quasi-Experimental Study

et al. 2020

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Background Violence against children in schools is a global public health problem. There is growing evidence that school-based interventions can be effective in reducing violence against children in schools. However, there is little evidence on the long-term impact of such interventions. The Good School Toolkit, developed by Raising Voices, a Uganda-based nonprofit organization, is a whole-school violence prevention intervention that aims to change the operational culture of primary schools. In 2014, the Good School Toolkit was evaluated through a cluster randomized controlled trial (Good Schools Study) and found to reduce teacher-to-student and student-to-student violence. Objective This protocol describes quantitative analyses to explore long-term outcomes of the Good School Toolkit intervention among adolescents in Uganda, including the extent to which it is associated with peer-violence victimization (primary outcome) and peer-violence perpetration, intimate-partner violence, acceptance of teacher-violence, equitable gender attitudes, agency, self-regulation, peer connectedness, social assets, psychological assets, and retention in school (secondary outcomes). Methods This is a nonrandomized quasi-experimental 4-year follow-up study of adolescents who attended the 42 Good Schools Study primary schools in 2014; 21 schools initiated the Good School Toolkit intervention during the trial from 2012, and 19 schools initiated the intervention after the trial (during the later delivery phase) from 2015; 2 schools did not implement the intervention. Students in the final school grade (Primary 7) during 2014 of the 19 primary schools in the later delivery phase are expected to have left school prior to toolkit delivery in 2015. Wave 1 data were collected in 2014 from 3431 grade Primary 5 to Primary 7 school students aged 11-14 years; these students were followed up in 2018-2019 when aged 16-19 years and invited to participate in the Wave 2 survey. Data were collected in face-to-face interviews by trained Ugandan field researchers. Toolkit exposure groups are defined as exposed during the Good Schools Study trial (from 2012), as exposed during later delivery (from 2015), or not exposed including those expected to have completed Primary 7 prior to later delivery or from the 2 schools that did not implement the toolkit. Associations between outcomes at Wave 2 and toolkit exposure groups will be analyzed using mixed-effect multivariable logistic and linear regression models for binary and continuous outcomes, respectively. This analysis is exploratory and aims to generate hypotheses on if, and under what circumstances, the toolkit influences later adolescent outcomes. Results Data collection was completed in August 2019. Conclusions To our knowledge, this is the first long-term follow-up study of adolescents exposed to a school-based violence-prevention intervention in sub-Saharan Africa. If the intervention reduces violence and improves other outcomes in later adolescence, then this study supports primary school interventions as key to achieving long-term population impacts. The pattern of effects will inform where reinforced or additional interventions are needed. International Registered Report Identifier (IRRID) DERR1-10.2196/20940

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Being an ‘adolescent’: The consequences of gendered risks for young people in rural Uganda

Cited by 13 publications

References 31 publications

Scaling up peer‐led community‐based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success

Scaling up peer‐led community‐based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success

Being young and on the move in South Africa: how ‘waithood’ exacerbates HIV risks and disrupts the success of current HIV prevention interventions

Long-Term Outcomes of the Good School Toolkit Primary School Violence Prevention Intervention Among Adolescents: Protocol for a Nonrandomized Quasi-Experimental Study

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