Development of the Gender Roles and Male Provision Expectations Scale.

Existing composite measures assess the extent to which women and men support masculinity ideals concerning the expectation that men should provide for their partners and families. In many contexts across sub-Saharan Africa, the male provider role is taken as given. This core masculinity tenet may be associated with related gender role expectations that result in increasing young women's risk of HIV, especially within the context of transactional sex relationships. Extant literature points to five domains potentially associated with male provider role expectations: male authority, men's sexual decision-making control, women's sexual agency, women's economic dependence, and love. The goal of this study was to develop the Gender Roles and Male Provision Expectations (GRMPE) scale toward understanding whether beliefs attached to male provider role expectations increase HIV risk. We developed the GRMPE across three research phases with young women (ages 15-24) in Central Uganda that (1) used qualitative data to refine domains and develop scale items; (2) cognitively tested the refined items; and (3) pilot tested a 26-item scale across five domains with 108 young women. Using confirmatory factor analyses, we retained 15 items across four factors, corresponding to the domains of male authority, sexual decision-making, women's sexual agency, and love; which we then modeled as indicators in a single second-order factor model. The GRMPE demonstrated initial reliability and validity, and tests of criterion validity found significant associations with known HIV risk behaviors. The GRMPE scale shows promise for better examining the determinants of HIV risk and assessing gender norm change interventions.

Pacing Forward in the Face of Fragility: Lessons From African Institutions and Governments' Response to Public Health Emergencies.

Africa is home to 54 United Nation member states, each possessing a wealth of ethno-cultural, physiographic, and economic diversity. While Africa is credited as having the youngest population in the world, it also exhibits a unique set of "unfortunate realties" ranging from famine and poverty to volatile politics, conflicts, and diseases. These unfortunate realities all converge around social inequalities in health, that are compounded by fragile healthcare systems and a lack of political will by the continent's leaders to improve smart investment and infrastructure planning for the benefit of its people. Noteworthy are the disparities in responsive approaches to crises and emergencies that exist across African governments and institutions. In this context, the present article draws attention to 3 distinct public health emergencies (PHEs) that have occurred in Africa since 2010. We focus on the 2013-2016 Ebola outbreak in Western Africa, the ongoing COVID-19 pandemic which continues to spread throughout the continent, and the destructive locust swarms that ravaged crops across East Africa in 2020. Our aim is to provide an integrated perspective on how governments and institutions handled these PHEs and how scientific and technological innovation, along with educational response played a role in the decision-making process. We conclude by touching on public health policies and strategies to address the development of sustainable health care systems with the potential to improve the health and well-being of the African people.

Which Factors Are Associated With Adolescent Reports of Experiencing Various Forms of Abuse at the Family Level in Post-Conflict Northern Uganda?

Research assessing familial violence against adolescents, using caregiver-adolescent dyads, is limited in post-conflict settings. This study aimed to determine the prevalence and factors associated with adolescent-reported familial abuse in post-conflict northern Uganda. It also assessed the relationship between abuse subtypes and (a) beliefs supporting aggression and (b) adolescent well-being and life satisfaction. A randomly selected community-based sample of 10- to 17-year-old adolescents (54% girls) and their caregivers (N = 427 dyads) in two northern Uganda districts was used. Abuse outcomes were adolescent reported. All measures used standardized tools that have been adapted for research in resource-limited settings. Analyses used multivariable linear regressions in Stata 14/IC. Overall, physical, emotional, and sexual abuse rates were 70% (confidence interval [CI] = [65.7, 74.4]), 72% (CI = [67.4, 76.0]), and 18.0% (CI = [14.0, 21.2]), respectively. Polyvictimization was 61% (CI = [55.4, 64.7]). There were no gender differences regarding adolescent reports of physical and emotional abuse, but adolescent girls were more likely to report sexual abuse and polyvictimization than adolescent boys. All forms of adolescent-reported abuse (except sexual abuse) were associated with caregiver reports of harsh disciplinary practices. In addition, emotional abuse was associated with physical and sexual abuse. Physical abuse was associated with being an orphan and emotional abuse. Sexual abuse was associated with being a girl, older adolescent age, living in a larger household, and emotional abuse. Polyvictimization was positively associated with being an orphan, younger caregiver age, caregiver-reported poor monitoring and supervision, and higher household socioeconomic status, but negatively associated with lower parental role satisfaction. Physical and emotional (but not sexual) abuse and polyvictimization were associated with beliefs supporting aggression among adolescents. All abuse subtypes were associated with lower levels of perceived well-being and life satisfaction among adolescents in this study. Child abuse prevention programs have the potential to improve adolescent-caregiver interaction and interrupt the violence transmission cycle in this setting.

Developing Experimental Vignettes to Identify Gender Norms Associated With Transactional Sex for Adolescent Girls and Young Women in Central Uganda.

PURPOSE: Transactional sex or informal sexual exchange relationships increase adolescent girls' and young women's (AGYW) HIV and pregnancy risk in sub-Saharan Africa. These relationships are grounded in the shared expectation that men should provide financial support to their partners. We built a vignette experiment to assess whether gender norms influenced by expectations of provision help to explain how transactional sex increases AGYW's sexual and reproductive health risks. METHODS: We used mixed methods to develop a vignette experiment in Central Uganda with AGYW including 10 focus group discussions, 32 cognitive interviews, and a pilot survey experiment with 108 sexually active unmarried AGYW. Respondents were randomly assigned to one of the two manipulations for three vignettes. The vignettes examined whether the amount a man provided changed perceived social approval of men's authority in relationships, sexual decision-making power, or women having multiple partners. RESULTS: We find that a higher level of male provision is associated with higher levels of perceived community approval for his sexual decision-making power (p < .001) and lower levels of perceived peer approval for AGYW's to seek a second partner (p < .05). We also find that higher levels of male provision are associated with respondent's own approval of male authority and sexual decision-making. CONCLUSION: Our findings suggest that approval of men's sexual decision-making power increases when they provide more and that girls who seek a second partner find higher levels of social approval for this behavior when their primary partner provides less. Vignette experiments may be valuable for identifying social norms that put AGYW's sexual and reproductive health at risk.

Barriers to communication between HIV care providers (HCPs) and women living with HIV about child bearing: A qualitative study.

OBJECTIVES: In the context of HIV clinical care, open discussion regarding sexual health and reproductive plans has become increasingly relevant. The aim of this paper is to explore barriers to communication between providers and women living with HIV regarding childbearing. METHODS: In-depth interviews (IDIs) were conducted with 48 HIV infected women receiving ART at 7 different HIV clinics providing comprehensive HIV care services in four districts in Uganda, between July and August 2012. All women were aware of their HIV diagnosis prior to pregnancy or had given birth while living with HIV. RESULTS: Four themes emerged describing barriers to communication, from the HIV-positive women's point of view: (i) provider indifference or opposition to childbearing post HIV diagnosis, (ii) anticipation of negative response from provider, (iii) provider's emphasis on 'scientific' facts, (iv) 'accidental pregnancy'. CONCLUSION: Existing evidence regarding effective provider-patient communication should be considered for its application for reproductive counseling among HIV infected women. PRACTICE IMPLICATIONS: These data demonstrate the need for current counseling guidelines to explore approaches that encourage open, non-judgmental, non-directive discussions with HIV positive individuals around their reproductive desires and intentions in a health care setting.