Does Community Clustering Mitigate the Negative Effect of Poverty on Adolescent Condom Use in South Africa?

Abstract

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...

Factors Influencing Contraceptive Use in Sub-Saharan Africa: A Systematic Review

“…1 Intra-uterine devices (IUDs) can be used without replacement for up to 5 years; however, many women associated infertility with IUD use and thus were hesitant to use that method. 74 Indeed, reasons for not using certain methods of contraceptives varied highly based on the availability of the method at local health facilities as well as the ease of use and replacing the device(s).…”

“…20 Furthermore, even though some contraceptives such as IUDs are more cost-effective in the long-term, the up-front cost of the device is a deterrent for some individuals. 74 It is important to note, however, that in some sub-Saharan African countries, contraceptives such as the pill, injectables, or condoms can be obtained free of cost through the county’s ministry of health. 74 Although this varies by country, and even within countries, for women without access to subsided contraception, cost can be a tremendous barrier.…”

“…Limited provider skills also negatively impacted contraceptive uptake, as well as the limited number of educational tools for providers and patients, and limited options for contraception. 1 Robinson and Seiber 74 reported interesting results on the impact of provider bias for uptake of IUDs. They found that most providers acknowledged that their personal bias toward contraceptive methods influenced how they counseled patients, leading to incomplete counseling and often eliminating IUDs from the list of available contraceptives.…”

Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: a large population-based study

“…This finding might be due to the free or subsidised CPs offered to clients in some African countries, and is likely to close the differences in the cost of obtaining a CP between clients with and without a health insurance. [47][48][49] Our null finding on the association between perceived domestic violence and modern CP use is unique. To the best of our knowledge, there has not been a large population-based study in the African context that has examined the influence of perceived domestic violence on modern CP use among women of reproductive age, though studies on domestic violence on CPs use more generally have been reported.…”

Understanding the relationship between family planning method choices and modern contraceptive use: an analysis of geographically linked population and health facilities data in Haiti

“…Research found that contraceptive use in low-income countries increases with the share of government facilities that tend to provide services with low cost or no cost 39. While long-acting reversible methods are cost-effective in the long term, it can be challenging for individuals to pay the upfront cost of the services 40. Although in Haiti public health facilities are mandated to provide free family planning service, cost could still be a barrier to contraceptive use when women have to use the private sector due to the lack or stock-out of methods in public facilities 41.…”