Sexual self-efficacy among adolescent men and women living in an HIV-hyper-endemic setting of South Africa

Adolescent women in South Africa face disproportionate HIV acquisition. In this context, evidence remains mixed on whether sexual self-efficacy (SSE)- one’s perceived control in decision-making regarding safe sex, predicts consistent condom use (CCU). Using cross-sectional survey data from 830 adolescent men and women aged 14-19 living in Soweto, South Africa, this thesis conducted gender-based analyses to examine determinants of high-SSE (study-alpha=0.75) and the association between high-SSE and CCU. Results revealed women have higher SSE than men. High-SSE was associated with CCU use for men, but not women. For women, high-SSE was associated with having an adult in the home, and no history of physical violence. Moreover, lower depressive symptomology among women was more predictive of CCU than SSE, indicating that gender-targeted HIV prevention interventions must move beyond individual-level determinants of behaviour to address socio-structural and relational factors influencing syndemic HIV risk among adolescent women in South Africa

“I feel like it is asking if he is a stalker … but I also feel like it is asking if he cares”: exploring young South African women and men’s perceptions of the Sexual Relationship Power Scale

Background Gender inequity and the subsequent health impacts disproportionately affect communities in the Global South. However, most gender equity measures, such as Pulerwitz’ (2000) Sexual Relationship Power Scale (SRPS), are developed and validated in the Global North and then applied in Global South settings without investigation of context applicability or validity. This study examines the SRPS’ validity evidence, comprehensiveness, and contemporary relevance for young South African women and men. Methods Between 2019 and 2021, 38 cognitive interviews (CIs) were conducted among previous participants of a South African youth cohort study ‘AYAZAZI’ (2015–2017) to explore youth’s perceptions of the SRPS. The SRPS measures women’s perceptions of their partner’s controlling behaviours, and men’s perceptions of their own controlling behaviours. Using CIs, participants responded to a 13-item adaptation of the SRPS for use among South African youth (strongly agree-strongly disagree), and then were asked to think-aloud their reasoning for responses, their understanding and perceived relevance of each item, and made overall suggestions for scale adaptations. An item appraisal coding process was applied, whereby Cognitive Coding assessed the types of cognitive problems youth had with understanding the items, and Question Feature Coding assessed which item features caused problems for participant understandings. Finally, youth recommendations for scale adaptations were summarized. Results Overall, 21 women and 17 men aged 21–30 participated in CIs in Durban and Soweto, South Africa. Cognitive Coding revealed 1. Comprehension issues, and 2. Judgements related to items’ applicability to lived experiences and identities (e.g., being unmarried). Question Feature Coding revealed items’ 1. Lack of clarity or vagueness in wording and 2. Logical problems in assumptions leading to multiple interpretations (e.g., item ‘my partner always need to know where I am’ interpreted as both controlling and caring behaviour). Multiple, overlapping issues revealed how many items failed to “fit” within the present-day living realities of South African youth. Youth recommended several item adaptations and additions, including strength-based items, to existing measures of gender equity and relationship power. Conclusion Given identified issues, several adaptations including revising items to be more inclusive, contemporary, context specific, relational, and strength-based are needed to validly measure gender equity and power dynamics within the relationships of South African youth.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacultyResearche