Multi-Country Study on Trusted Partners among Youth: Eritrea, Tanzania, Zambia, and Zimbabwe

ObjectivesExplore youth's definitions of "trust"Establish criteria youth use to determine the trustworthiness of partnersIdentify types of individuals youth believe they can and cannot "trust"Examine trust's influence on sexual decision-making and STI/HIV risk perceptionIdentify how sexual partners violate trust and the effects on sexual decision-makingStudy designData were collected in October 2001 as part of a regional Behavior Change Communication (BCC) strategy in East and Southern Africa. Country programs chose to participate in research based on project priorities and levels of interest in participating in a regional BCC strategy. Four county programs agreed to collect and share data, Eritrea, Tanzania, Zambia, and Zimbabwe.A total of 33 focus groups were conducted. Research teams in each country used the same discussion guide and pretested the guide prior to data collection. Discussion groups lasted between an hour and an hour and a half, were audiotaped, and transcribed into English. Each research team conducted two discussion groups in the major urban area composed of the following strata: males 15-19 years, females 15-19 years, males 20-24 years, and females 20-24 years. The Zambia program conducted one additional focus group with males aged 15-19.FindingsExplore youth's definition of "trust" and criteria used to determine trustworthinessThe major components of trust did not vary greatly across countries. Youth in all countries placed a high value on sexual fidelity and its role in trusted partnerships. Youth believed that partners met through family or friends are more trustworthy than those met in bars or nightclubs. In addition, youth in all countries expressed that trusted partners must pass informal assessments, dress appropriately, demonstrate appropriate social conduct, talk sweetly to each other, come from the right neighborhood, meet one another's family, be punctual for appointments/dates, and remain emotionally committed to one another. Eritrean youth appeared to place greater importance on the roles that religion, virginity, and marriage (or intent to marry) play in establishing trust than youth from other countries.Differences in criteria for trust were more apparent by gender. In terms of testing partners' trustworthiness, females discussed passive ways of questioning partners, while males discussed elaborate methods for entrapping females in lies. Males were concerned with partners' sexual reputation and appearance. Females were primarily concerned with partners' emotional commitment, willingness to accept responsibility for pregnancies, and ability to display affection in public in order to demonstrate intimacy and trust.Identify types of individuals youth believe they can and cannot "trust"Across countries, youth place prospective partners into groups that can and cannot be trusted according to key attributes and behaviors. Similar to the findings above, most participants said that youth that come from good families, are well respected in the community, are religious, do not drink, avoid bars and nightclubs, and are faithful can be trusted. Youth believe that they cannot trust anyone outside of committed, monogamous relationships. Male participants added that virgins can be trusted.Examine trust's influence on sexual decision-making and STI/HIV risk perceptionYouth do not appear to take effective preventive measures with trusted partners. Trust can blind them to their risk for STIs/HIV and render them unwilling to explore partners' sexual histories. Sex usually occurs early in relationships and condom use remains low. When youth use condoms, they are more likely to incorporate them into casual than trusted relationships, or use them for pregnancy prevention rather than protection from STIs/HIV. Condoms are usually abandoned once relationships appear to be serious and partners fail to show signs or symptoms of STIs or HIV infection. There were few differences in risk perception and risk behavior across countries; however, male participants in Zambia reported that they discuss their sexual histories, while participants from other countries said that couples rarely discuss their sexual histories.Identify how sexual partners violate trust and the effects on sexual decision-makingInfidelity represents the most serious violation of trust and usually results in the end of relationships. A common theme across all countries was youth's refusal to learn from past experiences and apply them to future sexual decision-making. Even when trust is broken, youth fail to apply lessons learned to new relationships, repeating the same scenarios of trust, infidelity and exposure to STIs/HIV.Programmatic implicationsYouth must understand that partners' trustworthiness and character are independent of their risk for STIs/HIV. Although a checklist may help youth select a good partner, unprotected sex with this or any other person must be perceived as risky. Youth must also personalize their risk for STIs/HIV and avoid thinking that only people outside of their community are at risk for infection. It is likely that interpersonal communication campaigns or other community-level activities will help achieve an improved risk perception. Finally, in order to communicate new and appropriate levels of personal risk assessment, programs should strive to achieve broad social support, if not pressure for, consistent condom use, knowledge of one's own HIV status as well as that of all partners, and delay of sexual activity where possible

Cross-Generational Relationships in Kenya: Couples' Motivations, Risk Perception for STIs/HIV and Condom Use

Objectives: To understand women's and men's motivations for entering into cross-generational relationships and to examine how their risk perception for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) affects sexual decision-making and condom use.Methods: A total of eight focus groups were conducted with women aged 15 -- 19 and 28 indepth interviews were carried out with men aged 30 years and older in Nairobi, Mombasa, Kisumu, and Meru. Participants discussed motivations for entering into non-marital, crossgenerational relationships, perceived risks, relationship dynamics, and circumstances under which older men and younger women meet. Data analysis highlighted common and divergent themes on cross-generational relationships and the risks associated with them. Results: According to study participants, Kenyan men who pursue younger women do not fit a "sugar daddy" stereotype; rather they come from a variety of social and professional backgrounds. Young women actively seek partners who are willing to spend money on them whereas men look for partners who are well mannered, need money and have certain physical attributes. Women's primary incentive for engaging in cross-generational relationships is financial and material gain while men seek younger partners for sexual gratification. Pressure from peers to fit in and some family members to secure financial assistance from older partners can compel women to engage in cross-generational relationships. Although some peer groups support and encourage such relationships, other groups, especially wives, same-aged boyfriends and parents, disapprove of them. As a result, cross-generational couples are often preoccupied by the threat of discovery. Risk perception for STIs/HIV is low and couples rarely use condoms.Conclusions: Most cross-generational couples underestimate their risk for infection from STIs/ HIV. Young women believe that older men are low-risk partners because they are less likely to be promiscuous and more likely to remain faithful to younger partners and wives. Men believe that young partners are innocent and sexually inexperienced. Material gain, emotional factors, sexual gratification, and recognition from peers override the risk for STIs and HIV infection. Condom use is low and young women's ability to negotiate use is compromised by age disparities and economic dependence. Study findings suggest several programmatic strategies for targeting young women and older men. Behavior change communication campaigns should educate women and men about the increased risk of STIs/HIV associated with cross-generational relationships. Programs should also promote safer sexual practices, such as consistent condom use, within relationships. Campaigns could employ positive role models to encourage young women to seek safer alternatives to cross-generational relationships and decrease peer pressure among men to pursue such relationships. Long-term interventions include improving young women's access to educational and career opportunities, and working with communities to determine the best approach for changing social norms and the acceptability of cross-generational relationships

Finding Voice: A Visual Arts Approach to Engaging Social Change

In Finding Voice, Kim Berman demonstrates how she was able to use visual arts training in disenfranchised communities as a tool for political and social transformation in South Africa. Using her own fieldwork as a case study, Berman shows how hands-on work in the arts with learners of all ages and backgrounds can contribute to economic stability by developing new skills, as well as enhancing public health and gender justice within communities. Berman’s work, and the community artwork her book documents, present the visual arts as a crucial channel for citizens to find their individual voices and to become agents for change in the arenas of human rights and democracy

An arts-based collaborative intervention to promote medical male circumcision as a South African HIV and AIDS prevention strategy

This article addresses the extent to and ways in which an arts-based learning intervention can be regarded as transformative specifically with regard to the quality of student learning across the domains of academic enhancement, civic learning, personal growth, and through engaging with social advocacy. This article focuses on a collaborative project between Artist Proof Studio, a community art centre, and Sonke Gender Justice, a gender advocacy organisation, in a series of HIV prevention and advocacy interventions. The project addresses the question: “ Can an advocacy campaign for Medical Male Circumcision (MMC), with its complex messaging, be effective in communicating with South African young men?” This article however, responds to the question “How can the visual arts be used to develop a communication strategy for the promotion of MMC and what influence does this have on the students involved in the project and their uptakeof MMC as an HIV prevention strategy?” The article contends the the 'visual voice' expressed by the students as 'change agents' led to self-reflection and behaviour change with some of the student participants undergoing MMC. It also highlights the value of art-based methods as a catalysing and empowering strategy for social communication

Cultural action for change : a case for cross-cultural, multidisciplinary collaborations

Cultural Action for Change began in 2000 as a joining of artists, educators, and student-researchers to assess sustainability and address the impact of HIV within Phumani Paper; a government-funded poverty alleviation program, establishing hand papermaking and craft enterprises across South Africa. Inspired by ideals of empowerment and self-determination, a series of qualitative, Participatory Action Research (PAR) interventions for HIV awareness and action were introduced at six Phumani papermaking workshop sites. Student researchers and participants, with the collaboration of academics from the University of Michigan, were trained in Photovoice methodology to document with photographs and personal narrative the participants’ struggles for economic independence. Through iterative processes of reflection and sharing, participants identified shared social action objectives. Cultural Action for Change (also termed AIDS Action) consisted of arts-based, multi-disciplinary community interventions conducted over five years, and adopted a PAR framework as an approach that seeks to enhance the lives of the participants. The goal of the AIDS Action Intervention was to provide support to, and increase the agency of, participants of the Phumani Paper craft enterprises affected by the HIV pandemic. The aim was to enable the participants to break the silence, to confront the fear and stigma of HIV, and to seek voluntary counselling and testing (VCT), thereby contributing to reducing the number of deaths in their projects and communities. An additional objective was to achieve an increase in productivity and income for the enterprises as a result of greater group trust, information, networking and agency. The creative strategies that the research teams used for the AIDS Action intervention were Photovoice and Paper Prayers. The impact assessment conducted revealed that members of the Phumani Paper groups see themselves as individuals who have acquired skills that can transform waste into objects of beauty and have understood their own sense of agency to effect personal and organizational change

Reasons for Non-use of Condoms in Eight Countries in Sub-Saharan Africa

Objective: To determine why sexually experienced males and females from multiple countries in sub-Saharan Africa do not use condoms.Methods: We used data from sample surveys conducted in eight countries in sub-Saharan Africa. Respondents were asked about their use of condoms and their reasons for not using a condom in last sex with a marital, a regular (non-marital) or a casual partner. Respondents' reasons for not using a condom are shown by type of partner and by gender. Results: Males and females most frequently reported trusting their partner as the main reason for not using a condom in last sex with a marital or a regular (non-marital) partner. This suggests that low personal risk perception is the most important reason for not using a condom with a marital or a regular partner. A dislike of condoms is the most frequently cited reason for not using a condom with a casual partner. Respondents rarely cited the price of condoms as a barrier to condom use. Lack of condom availability was also rarely cited as a reason for not using a condom, except to some degree by males in casual partnerships. The latter may be because of the unplanned nature of casual sex activity, rather than because condoms are not available. Conclusions: Behavior change campaigns encouraging sexually experienced people to accurately assess their personal risk of acquiring HIV should be complemented with marketing campaigns emphasizing the positive attributes of condoms

Visual graphics for human rights, social justice, democracy and the public good

The value of human rights in a democratic South Africa is constantly threatened and often waived for nefarious reasons. We contend that the use of visual graphics among incoming university visual art students provides a mode of engagement that helps to inculcate awareness of human rights, social responsibility, and the public good in South African higher education. Visual graphics, the subject of the research project which forms a key component of a Masters dissertation by one of the authors, provides an opportunity to counter a noticeable decline in the students’ response and sensitivity to the freedoms entrenched in the South African Bill of Rights. The article presents a study using an action research approach in the classroom between 2005–2010, in order to inculcate awareness of human rights among participating students and deepen their understanding of social responsibility. The method used involved an introduction to specific visual art curricular intervention projects which required incoming first-year students to develop visual responses to address selected human rights violations and, in their second year, to develop their visual voice in order to promote human rights advocacy through civic engagement. The critical outcomes impact positively on the use of graphic images in the curriculum as a visual methodology to re-insert the discourse of human rights as a basic tenet of constitutional democracy in higher education

Working with Employers: Skills and Strategies for Job Development Success - Facilitator Guide

Whatever their job titles -- job developer, employment specialist, business services representative -- staff who balance the competing demands of both job seeker and employer customers face a challenging task. "Working with Employers: Skills and Strategies for Job Development Success" offers ten skill development modules (each 2-1/2 to 3 hours in length) that can strengthen the effectiveness of front-line staffs job placement activities. Participants experience a peer learning community as they practice key concepts, apply those in their daily work, and gain insights from other experienced practitioners

Working with Employers: Skills and Strategies for Job Development Success - Participant Workbook

"Working with Employers: Skills and Strategies for Job Development Success" offers 10 skill development modules (each 2 1/2 to 3 hours in length) that can strengthen the effectiveness of frontline staffs job placement activities. Participants experience a peer learning community as they practice key concepts, apply those in their daily work and gain insights from other experienced practitioners

Doublet method for very fast autocoding

BACKGROUND: Autocoding (or automatic concept indexing) occurs when a software program extracts terms contained within text and maps them to a standard list of concepts contained in a nomenclature. The purpose of autocoding is to provide a way of organizing large documents by the concepts represented in the text. Because textual data accumulates rapidly in biomedical institutions, the computational methods used to autocode text must be very fast. The purpose of this paper is to describe the doublet method, a new algorithm for very fast autocoding. METHODS: An autocoder was written that transforms plain-text into intercalated word doublets (e.g. "The ciliary body produces aqueous humor" becomes "The ciliary, ciliary body, body produces, produces aqueous, aqueous humor"). Each doublet is checked against an index of doublets extracted from a standard nomenclature. Matching doublets are assigned a numeric code specific for each doublet found in the nomenclature. Text doublets that do not match the index of doublets extracted from the nomenclature are not part of valid nomenclature terms. Runs of matching doublets from text are concatenated and matched against nomenclature terms (also represented as runs of doublets). RESULTS: The doublet autocoder was compared for speed and performance against a previously published phrase autocoder. Both autocoders are Perl scripts, and both autocoders used an identical text (a 170+ Megabyte collection of abstracts collected through a PubMed search) and the same nomenclature (neocl.xml, containing over 102,271 unique names of neoplasms). In side-by-side comparison on the same computer, the doublet method autocoder was 8.4 times faster than the phrase autocoder (211 seconds versus 1,776 seconds). The doublet method codes 0.8 Megabytes of text per second on a desktop computer with a 1.6 GHz processor. In addition, the doublet autocoder successfully matched terms that were missed by the phrase autocoder, while the phrase autocoder found no terms that were missed by the doublet autocoder. CONCLUSIONS: The doublet method of autocoding is a novel algorithm for rapid text autocoding. The method will work with any nomenclature and will parse any ascii plain-text. An implementation of the algorithm in Perl is provided with this article. The algorithm, the Perl implementation, the neoplasm nomenclature, and Perl itself, are all open source materials