From ‘sugar daddies’ to ‘sugar babies’: exploring a pathway among age-disparate sexual relationships, condom use and adolescent pregnancy in South Africa

Background: Adolescent pregnancy has been linked to adverse outcomes. Most studies proposing risk pathways for adolescent pregnancy in South Africa are qualitative, hypothesising links among age-disparate relationships, reduced condom use and higher pregnancy rates. No known South African studies have quantitatively explored pathways to adolescent pregnancy. Objectives: This study aimed to: (i) identify the factors associated with adolescent pregnancy and (ii) explore a pathway of risk by assessing whether condom use mediated the relationship between age-disparate sexual relationships and adolescent pregnancy. Methods: A cross-sectional survey of 447 sexually active girls aged 10–19 years was undertaken in six health districts of South Africa. Multivariate logistic regressions controlled for confounders. Mediation tests used bootstrapping. Results: Consistent condom use (ß = –2.148, odds ratio (OR) = 8.566, P = 0.001) and school enrolment (ß = –1.600, OR = 0.202, P = 0.001) were associated with lower pregnancy rates. Age-disparate sex (ß = 1.093, OR = 2.982, P = 0.001) and long-term school absences (ß = 1.402, OR = 4.061, P = 0.001) were associated with higher pregnancy rates. The indirect effect of age-disparate sex on adolescent pregnancy through condom use was significant, irrespective of age, age at sexual initiation, poverty and residential environment (B = 0.4466, s.d. = 0.1303, confidence interval: 0.2323–0.7428). Conclusion: This survey supports hypotheses that inability to negotiate condom use in age-disparate sexual relationships may drive adolescent pregnancy. Interventions addressing these relationships, facilitating condom use and increasing access to sexual health services among adolescents might avert unwanted pregnancies

The dynamics of sexual risk amongst South African youth in age-disparate relationships

Introduction: South Africa has the highest burden of HIV in the world with over 8 million people living with HIV. Young women and girls account for a quarter of new HIV infections while making up only 10% of the population. A key driver of HIV incidence is transactional and survival sex between adolescent girls or young women and older men (the latter referred to as 'sugar-daddies' or 'blessers'). This paper expands on the existing literature on age-disparate and intergenerational relationships to provide social and behavioural interpretations of how young men, commonly omitted from studies on this topic, and women in concurrent relationships with both their peers and older partners perceive and navigate sexual risk. Method: We conducted a qualitative study in a rural setting of uMgungundlovu District, KwaZulu-Natal Province, with purposively selected male and female participants aged 18-24 years old in age-disparate relationships. Semistructured in-depth interviews (IDI) were conducted and analysed using interpretative phenomenological analysis (IPA) to explore existing information, motivations, and behavioural practices around relationships and sexual risk. Results: The themes and related sub-themes found through IPA included the following: (1) navigating dating: narratives that show a strong preference for being in an age-disparate relationship; the challenges that young people face when choosing an older person as a side partner; and social media applications seen as creating opportunities to meet side partners; and (2) the distribution of love and trust in a multi-party sexual network: condom (mis)use differentiates between straights-those in a serious relationship-and sides; and the power of eye-test seroguessing, the praxis of testing people visually for HIV in nullifying existing knowledge about sexual and reproductive health risk. Discussion: This research offers an understanding of how schemas of noncondom use are organised. We observed that while condom-less sex is often viewed as essential to building social capital in a serious relationship, it is not the only factor that determines sexual relationship power. Eye-test seroguessing not only develops consortium (trust, reciprocity, and solidarity), but it fulfils the psycho-social need to belong to a network of serious relationships. Moreover, it is critical to the enactment of masculinities because it consolidates femininity to keep men happy, i.e., by being passive in the sexual encounter, women constrain their self-efficacy to act contrary to the conventions of reputable women. Therefore, it is plausible that in the serosorting that occurs prior to unprotected sexual acts, the power of eye-test seroguessing limits the ability to engage in safe sexual practices.

“Instead of Asking for Fare, You Ask Her to Pay with Sex”: Male Perspectives on the Factors Influencing Schoolgirls’ Participation in Age-Disparate Transactional Sex Relationships

Age-disparate transactional sex relationships are often coerced and exploitative. The gender and economic disparities between affluent men and economically disadvantaged girls often perpetuate these relationships, resulting in their exploitation. This qualitative study assessed men\u27s understanding of factors influencing schoolgirls\u27 engagement in age-disparate transactional sex relationships in two rural districts in Kenya. Four focus group sessions were conducted with men from two primary professions: motorcycle taxi operators (Boda Boda) and teachers from primary and secondary schools from two districts in Kitui South, Sub County, Kenya. Focus group data were analyzed using conventional content analysis. Several influential factors associated with schoolgirls\u27 engagement in these transactional relationships are discussed in three broad themes: access and coercion, parental influence, and peer-related factors. Study results indicate that schoolgirls in rural areas are more susceptible to predation by men willing to trade sexual favors with underage girls. These findings make it imperative to address the predation of adolescent girls by men involved in these transactional relationships by implementing comprehensive sex education programs that empower schoolgirls to recognize and resist coercion. Additionally, implementing measures involving community leaders, parents, and other stakeholders in a collective effort to combat the exploitation of underage girls is paramount. These measures should be accompanied by the stricter enforcement of laws and regulations to hold perpetrators accountable for their actions

Age differences between sexual partners, behavioural and demographic correlates, and HIV infection on Likoma Island, Malawi

Patterns of age differences between sexual partners-"age-mixing"-may partially explain the magnitude of HIV epidemics in Sub-Saharan Africa. However, evidence of age-disparity as a risk factor for HIV remains mixed. We used data from a socio-centric study of sexual behaviour in Malawi to quantify the age-mixing pattern and to find associations between relationship characteristics and age differences for 1,922 participants. Three age difference measures were explored as predictors of prevalent HIV infection. We found that for each year increase in male participant age, the average age difference with their partners increased by 0.26 years, while among women it remained approximately constant around 5 years. Women in the study had larger within-individual variation in partner ages compared to men. Spousal partnerships and never using a condom during sex were associated with larger age differences in relationships of both men and women. Men who were more than five years younger than their partners had 5.39 times higher odds ( 95% CI: 0.93-31.24) of being HIV-infected than men 0-4 years older. The relationship between HIV-infection and age-asymmetry may be more complex than previously described. The role that women play in HIV transmission should not be underestimated, particularly in populations with large within-individual variation in partner ages

Gerontocratic Betrayals: “Sugar Daddies” in Ngũgĩ wa Thiong’o’s Devil on the Cross

This paper investigates the question of genrontocratic betrayals represented as obstructions to romantic love in Ngũgĩ’s Devil on the Cross. It looks at how Ngũgĩ creates the relationship between “sugar daddies” and “sugar girls” as a perversion of modern love in Devil on the Cross. The heroine, Warĩĩnga enjoys her relationship with her “sugar daddy”, the Rich Old Man, who betrays her love after impregnating her, an affront that nearly causes her death. This article also explores how Ngũgĩ presents idyllic love between the hero and the heroine in Devil on the Cross. The paper juxtaposes romantic love between same-age partners with age-disparate relationships. It exposes the barriers to romantic love which take the form of betrayal, adultery and parental interference. The findings reveal that Ngũgĩ’s representation of love relationship between same-age partners parallels Mikhail Bakhtins’s discussion of the adventure chronotope in Greek romance. Also, the “Waigoko” of Ngũgĩ’s new Kenya lures young girls into love relationships and showers them with gifts, money and a deceptive form of “love” which symbolises the corrupt forms of love and the exploitation of young women, especially under neo-colonial capitalism. Keywords: Ngũgĩ wa Thiong’o, Devil on the Cross, romantic love, genrontocratic betrayal, sugar daddies, age-disparate, adultery. DOI: 10.7176/JLLL/90-04 Publication date:July 31st 202

Is Race a Factor in Disparate Health Problems Associated with Violence Against Women?

Research studies examining the health correlates of violence against women have consistently demonstrated associations between violence and poor health outcomes, but have not examined a disparate impact on racial minorities. Alaska Victimization Survey data (2010) were used to examine whether a disparate relationship between victimization and health problems exists for minority women relative to White women. The Alaska Victimization Survey (AVS) is a cross-sectional survey designed to provide baseline estimates of intimate partner and sexual violence for Alaskan women. Logistic regression was used to assess the odds of experiencing various health problems given race and exposure to violence status while holding age and education constant. This study found that victimization increased the odds of health problems for all women, but significantly more so for minority women. Based on allostatic load theory, minority women who are victims of violence may be more likely to experience poor health outcomes because of the compounding effects of life stressors on neural, endocrine, and immune systems. Policy and practice implications of the study findings suggest preventing and reducing violence against all women, and for informed physicians to screen patients for abuse histories and refer to appropriate counseling and other stress reduction resources.Ye

AIDS

Objective:Cross-sectional and cohort studies draw different conclusions on whether age-disparate partnerships increase HIV-acquisition risk for young women. We investigated whether age-disparities were associated with HIV-infection risk early in relationships. This could result in the exclusion of women who seroconverted during high-risk age-disparate partnerships from cohort studies of HIV-incidence \u2013 which exclude HIV-positive women \u2013 and explain null findings in these studies.Design:Prospective cohort studyMethods:We used data on 15\u201324 year-old, HIV-negative women in heterosexual partnerships (N=830) in KwaZulu-Natal, South Africa. The association between age-disparate partnering (i.e., male partner 655 years older) and subsequent HIV-seroconversion was assessed using Cox hazard models. We examined heterogeneity in HIV-acquisition risk by duration of partnership (defined by quartiles) at cohort enrolment.Results:During 1139 person-years (mean: 1.4 years) of follow-up, 54 (6.5%) women seroconverted, a weighted HIV-incidence estimate of 4.41/100 person-years (95% CI 3.30\u20136.06). HIV-acquisition risk did not differ significantly between women in age-disparate vs. age-similar partnerships (aHR 1.10, 95% CI 0.55\u20132.21). However, for women in the shortest partnership quartile (<1.09 years) at baseline, risk of HIV-seroconversion was higher for women in age-disparate partnerships (aHR 3.13, 95% CI 1.02\u20139.65, p=0.047). HIV-acquisition was not statistically different by partnership type among women in longer partnerships.Conclusions:The association between age-disparate partnerships and HIV-acquisition risk is evident early in young women\u2019s relationships. Results provide a potential explanation for null findings in cohort studies, whose research designs may exclude women in such partnerships, and affirms the elevated risk of HIV acquisition for young women in age-disparate relationships.20202021-01-01T00:00:00ZR01 HD083343/HD/NICHD NIH HHS/United StatesU2G GH000372/GH/CGH CDC HHS/United States31483373PMC7473385835

The Intuitive Appeal of Explainable Machines

Algorithmic decision-making has become synonymous with inexplicable decision-making, but what makes algorithms so difficult to explain? This Article examines what sets machine learning apart from other ways of developing rules for decision-making and the problem these properties pose for explanation. We show that machine learning models can be both inscrutable and nonintuitive and that these are related, but distinct, properties. Calls for explanation have treated these problems as one and the same, but disentangling the two reveals that they demand very different responses. Dealing with inscrutability requires providing a sensible description of the rules; addressing nonintuitiveness requires providing a satisfying explanation for why the rules are what they are. Existing laws like the Fair Credit Reporting Act (FCRA), the Equal Credit Opportunity Act (ECOA), and the General Data Protection Regulation (GDPR), as well as techniques within machine learning, are focused almost entirely on the problem of inscrutability. While such techniques could allow a machine learning system to comply with existing law, doing so may not help if the goal is to assess whether the basis for decision-making is normatively defensible. In most cases, intuition serves as the unacknowledged bridge between a descriptive account and a normative evaluation. But because machine learning is often valued for its ability to uncover statistical relationships that defy intuition, relying on intuition is not a satisfying approach. This Article thus argues for other mechanisms for normative evaluation. To know why the rules are what they are, one must seek explanations of the process behind a model’s development, not just explanations of the model itself