Violence in Quilombola women living in rural communities in Brazil.

OBJETIVE: To estimate the prevalence of psychological, physical, and sexual violence perpetrated against women by their intimate partner (IP) in Quilombola communities located in Espírito Santo State, Brazil. METHODS: The data is from a population-based cross-sectional study of Quilombola women conducted from 2017 to 2018. In-person interviews collected information on women's sociodemographic characteristics, behaviors, and their experience of violence perpetrated by their IP. The analysis used chi-square test and hierarchical logistic regression. RESULTS: 219 women (94.8% of the invited ones) agreed to participate in the study. 59.0% (95%CI: 5.25-65.5) reported psychological violence; 41% (95%CI: 34.5-47.5) physical violence; and 8.2% (95%CI: 4.6-11.8) sexual violence. Psychological violence was associated with having three or more sexual partners in life, when compared to those who had up to two partners (p = 0,009), and previous violence involving other people outside of family increased the chance of suffering psychological violence by an IP more than nine times (p ≤ 0.001). Regarding physical violence, the association with use of barrier contraception (p = 0.031) and having a partner with other sexual partners (p = 0.024) were protective factors for IP violence. Having 3 or more sexual partners in the last 12 months (p = 0.006), partner using illicit drugs (p = 0,006), and alcoholism in the family (p = 0,001), increased the chance of suffer physical violence by the partner. Sexual violence perpetrated by the IP was associated with miscarriage (p = 0.016), partner using drugs (p = 0.020), and gynecological symptoms (p = 0.045). CONCLUSIONS: These results showed the high frequency of intimate partner violence in Quilombola women and highlight the importance of reducing social and race inequities for interrupting the culture of violence against women.

Personal beliefs and social norms regarding the sexual exploitation of girls in age-disparate transactional sexual relationships in Brazil: a mixed-methods study.

BACKGROUND: In the global debate around transactional sex little attention has concentrated on Brazil, despite ranking fourth globally in absolute number of girls married or co-habiting by the age of 15 years, and evidence showing that these unions often begin as age-disparate transactional sex (ADTS). This article contributes to filling this gap by exploring the personal beliefs and social norms related to ADTS in urban (favela) communities of Rio de Janeiro, Brazil between adult men (> 18 years) and girls and adolescents (G/A) (< 18 years) with a minimum 5-year age disparity. The primary objective of this study was to identify the social norms that promote and prevent ADTS, and the dynamics between individual beliefs and social norms, to provide contextualized recommendations to prevent ADTS in this setting. METHODS: An exploratory, sequential, mixed-methods design was used, starting with a qualitative phase that included semi-structured, in-depth interviews and focus groups, and a subsequent quantitative phase comprising of a community survey. The items for the quantitative questionnaires were developed based on the qualitative results. RESULTS: Mixed methods results indicate that in these communities ADTS is normalised and not considered exploitative. We identified three themes related to the reasons ADTS occurs: girls' responsibility, male desires and benefits of ADTS. Men's role in ADTS was largely minimised because of a general acceptance of a notion of masculinity characterised by hypersexuality and lack of impulse control. Individual beliefs, however, did not tend to align with these social norms. CONCLUSIONS: In this study, personal beliefs and social norms often did not align, suggesting that initiatives working to change personal or attitudes regarding ADTS may not lead to meaningful change in ADTS behaviours, and social norms interventions may be more effective. Our findings reinforce the need to develop programs tailored to local understandings of ADTS, targeting not only girls but also a wide range of actors. Interventions could also consider the structural factors acting in local and global contexts that promote or prevent ADTS.

This article explores the personal beliefs and social norms related to the exchange of sexual favours or relationships for material favours, gifts and/or support in some form, between adult men (> 18 years) and girls and adolescents (< 18 years) with a minimum 5-year age difference. We used interviews, focus groups and questionnaires to understand the factors that promote and prevent these sexual relationships between men and girls. Motivators for these relationships were often related to girls' responsibilities, male desires and the benefits of these relationships. Men's responsibility for their participation in these relationships with girls were often minimised due to a general acceptance of men as overly sexual and lacking impulse control. In this study, personal beliefs and social norms were often not aligned, suggesting that interventions focused on changing personal beliefs or attitudes about these sexual relationships may not be enough to change social norms. The findings highlight the need to develop solutions that consider a wider range of actors, instead of interventions focused only on girls. The study findings also support the need to further investigate how communities and shared expectations can influence sexual relationships in exchange for goods between adult men and girls and adolescents.

Violence in Quilombola women living in rural communities in Brazil

ABSTRACT OBJETIVE To estimate the prevalence of psychological, physical, and sexual violence perpetrated against women by their intimate partner (IP) in Quilombola communities located in Espírito Santo State, Brazil. METHODS The data is from a population-based cross-sectional study of Quilombola women conducted from 2017 to 2018. In-person interviews collected information on women's sociodemographic characteristics, behaviors, and their experience of violence perpetrated by their IP. The analysis used chi-square test and hierarchical logistic regression. RESULTS 219 women (94.8% of the invited ones) agreed to participate in the study. 59.0% (95%CI: 5.25-65.5) reported psychological violence; 41% (95%CI: 34.5-47.5) physical violence; and 8.2% (95%CI: 4.6-11.8) sexual violence. Psychological violence was associated with having three or more sexual partners in life, when compared to those who had up to two partners (p = 0,009), and previous violence involving other people outside of family increased the chance of suffering psychological violence by an IP more than nine times (p ≤ 0.001). Regarding physical violence, the association with use of barrier contraception (p = 0.031) and having a partner with other sexual partners (p = 0.024) were protective factors for IP violence. Having 3 or more sexual partners in the last 12 months (p = 0.006), partner using illicit drugs (p = 0,006), and alcoholism in the family (p = 0,001), increased the chance of suffer physical violence by the partner. Sexual violence perpetrated by the IP was associated with miscarriage (p = 0.016), partner using drugs (p = 0.020), and gynecological symptoms (p = 0.045). CONCLUSIONS These results showed the high frequency of intimate partner violence in Quilombola women and highlight the importance of reducing social and race inequities for interrupting the culture of violence against women.

Adolescent boys and girls learning, reproducing, and resisting gender norms in Colombia and Uganda: a qualitative comparative study.

There is growing interest in studying inequitable gender norms and their impact on health and wellbeing, particularly among adolescents. Studies have shown that discriminatory gender norms limit girls' access to power within their families and communities, reduce their educational and economic opportunities, and alter their own aspiration and ambitions for their lives. This comparative qualitative study sought to understand how gender norms manifest themselves in the lives of adolescents in two distinct settings: Uganda and Colombia. A total of 133 young people aged 13-21 years from Colombia and 109 from Uganda participated in either focus group discussions or individual semi-structured interviews in May 2017. Results reveal similarities and differences in how norms are learned, reinforced and resisted and how intersecting social factors affect the ability of adolescents to facilitate norm change. A key similarity was the primacy of parents and peers in the transmission and reinforcement of gender norms. However, setting-specific material and structural factors shaped the manifestation of power and policing of gender norms as well as the ability of young people to contest them. Lessons are identified for the future design of effective gender transformative interventions with adolescents.

Parent-Related Normative Perceptions of Adolescents and Later Weight Control Behavior: Longitudinal Analysis of Cohort Data From Brazil.

PURPOSE: Body image-related norms can be imposed by parents and can shape adolescents' body satisfaction in consequential ways, yet evidence on long-term effects is scarce. Longitudinal data from a country with strong body image focus provided a unique opportunity to investigate long-term influences of normative parent-related perceptions. METHODS: Multinomial logistic regression was used on data from a 1993 birth cohort in Brazil to investigate the association of normal-body mass index (BMI) adolescents' perception of their parent's opinion of their weight at age 11 years with their weight control attempts at 18 years, testing a mediating role for body dissatisfaction at age 15 years. All models controlled for body dissatisfaction at age 11 years and BMI change between ages 11 and 15 years. RESULTS: A total of 1150 boys and 1336 girls were included. Girls were more likely than boys to diet without nutritionist advice to lose weight (51.5% vs. 34.3% among boys) and use medication to gain weight (12.7% vs. 4.2%). Normal-BMI adolescents who reported at age 11 years that their parents thought they were thin had higher odds of feeling thinner than ideal at age 15 years (odds ratio 2.8, 95% confidence interval 1.8-3.2; and odds ratio 2.0, 95% confidence interval 1.5-2.7) among boys and girls, respectively). Feeling thinner than ideal at age 15 years was associated among girls with higher odds of weight gain attempts at age 18 years. Similar patterns appeared among girls reporting that their parents thought they were fat at age 11 years, feeling fatter than ideal at age 15 years and having higher odds of weight loss attempts at age 18 years. Body dissatisfaction was a statistically significant mediator among girls but not boys. CONCLUSIONS: A long-term influence of parent-related perceptions via a likely trajectory of body dissatisfaction is evident among girls.

Community perceptions of transactional sex with children and adolescent girls, a qualitative study in favelas of Rio de Janeiro.

The sexual exploitation of children and adolescents is a frequently underestimated health problem which includes transactional sex (TS), or the practice of sexual activity based on an expected return of benefits, favours and/or support in some form. This qualitative study focuses on age-disparate transactional sex (ATS) in urban favela communities of Rio de Janeiro between adult men (over 18) and girls and adolescents (G/A) (under 18), involving a minimum 5-year age disparity. We have employed social norms theory as a framework to identify the prevailing social norms contributing to or protecting children and adolescents from these relationships. Data collection utilised semi-structured interviews (n = 30) and ten focus groups with a total of 130 men/boys and women/girls selected through purposive sampling and varying in age from 15 to 65. Overall the findings identify factors, especially the essentialisation of gender, which promote the acceptability of ATS. When ATS surpassed the acceptability threshold, social norms discouraged direct interference. Concluding remarks point to possible strategies for reducing the occurrence of ATS. These must include girls, boys, women and men with community involvement in the deconstruction of social norms involving gender, age and economic consumption.

Gender norms and sexual behaviours among Indigenous youth of the Comarca Ngäbe-Buglé, Panama.

The Comarca Ngäbe-Buglé, an administratively autonomous Indigenous region in western Panama, is home to a significant population rural Indigenous people of Ngäbe and Buglé ethnicity. HIV prevalence in the Comarca is two times higher than the national average, and the great majority of cases are concentrated in young men. Yet, there is little data regarding socio-cultural and sexual behaviour factors that may drive this high prevalence. Understanding such factors would enable the development of relevant prevention interventions. We conducted a qualitative study between January and March 2018, consisting of 20 semi-structured interviews with male and female young people aged 14-19 years, complemented with ethnographic observations of one month's duration each in two communities within the Comarca, to identify potential factors that could increase risk of HIV and other sexually transmitted infections (STIs). We suggest that interventions to prevent HIV and other STIs should focus on increasing open communication between sex partners, especially with respect to condom use, as well as facilitating people-driven change in gender norms that are harmful to both young women and young men.

High Prevalence of Sexually Transmitted Infections, and High-Risk Sexual Behaviors Among Indigenous Adolescents of the Comarca Ngäbe-Buglé, Panama.

BACKGROUND: There is scant information on sexually transmitted infection (STI) prevalence and risk factors among Latin American indigenous populations. We investigated STI prevalence and risk factors among adolescents of the Comarca Ngäbe-Buglé indigenous region of Panama. METHODS: A population-based cross-sectional study was conducted among school-going adolescents aged 14 to 19 years. Eligible consenting participants self-completed a questionnaire and provided blood and urine samples. Female participants provided additional self-administered genital swabs. Seroprevalences of human immunodeficiency virus (HIV), syphilis, hepatitis B (HBsAg, anti-HBc), and herpes simplex virus type 2 (HSV-2) were determined in all participants; genital Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) by PCR among participants who reported sexual experience or were seropositive for HIV/syphilis/HSV2/HBsAg; high-risk human papillomavirus (HPV) by qualitative DNA assay and bacterial vaginosis (BV) by Gram-stain among female participants. Risk factors were identified by estimating adjusted odds ratios (AOR) using random-effects logistic regression. RESULTS: We enrolled 700 participants (median age, 17 years [female participants]; 18 years [male participants]) from 20 schools. Sexual experience was reported by 536 participants (76.6%). The HIV/STI prevalences among females and males were: HIV 0.4% and 1.0%, high-titer active syphilis 1.3% and 6.6%, HSV-2 16.1% and 16.1%, HBsAg 1.3% and 1.4%, anti-HBc 3.2% and 1.4%, NG 1.8% and 1.7%, CT 17.5% and 10.7%; among females: BV 42.9% and HPV 33.2%. CT was independently associated with being female (AOR, 2.02; 95% confidence interval [CI], 1.20-3.41); high-titer active syphilis with being male (AOR, 4.51; 95% CI, 1.17-17.40). Bacterial vaginosis was associated with sexual behavior (≥3 lifetime sex partners: AOR, 3.81; 95% CI, 1.29-11.26), HPV with sexual experience (AOR, 4.05; 95% CI, 1.62-10.09). CONCLUSIONS: School-going indigenous adolescents in rural Panama have substantial STI burden. Targeted STI screening is required.

Child Marriages and Unions in Latin America: Understanding the Roles of Agency and Social Norms.

PURPOSE: Child marriages and unions can infringe upon adolescent and youth sexual and reproductive health (AYSRH). Interventions increasingly promote strategies to transform social norms or foster the agency of adolescent girls. Recent empirical studies call for further understanding of how social norms and agency interact in ways that influence these practices, especially in contexts where girls' agency is central. METHODS: A secondary cross-case analysis of three qualitative studies (in Brazil, Guatemala, Honduras) was conducted to inform the investigation of how norms and agency may relate in sustaining or mitigating child marriage. RESULTS: Social norms dictating how girls/young women and how men should act indirectly led to child marriages and unions. The data showed that (1) social norms regulated girls' acceptable actions and contributed to their exercise of "oppositional" agency; (2) social norms promoted girls' "accommodating" agency; and (3) girls exercised "transformative" agency to resist harmful social norms. CONCLUSIONS: Research should advance frameworks to conceptualize how social norms interact with agency in nuanced and context-specific ways. Practitioners should encourage equitable decision-making; offer confidential, adolescent-friendly AYSRH services; and address the social norms of parents, men and boys, and community members.