Mediating effects of inequitable gender norms on intimate partner violence and contraceptive use in a cluster randomized control trial in Niger.

Previous research has demonstrated that the Reaching Married Adolescents intervention (RMA) was associated with changes in inequitable gender norms, intimate partner violence (IPV), and modern contraceptive use. This study seeks to understand if changes in inequitable gender norms mediate the RMA intervention's effects on contraceptive use and intimate partner violence (IPV). A four-arm cluster randomized control trial was conducted to evaluate effects of the RMA intervention (household visits, small groups, combination, control) on married adolescent girls and their husbands in Dosso, Niger (baseline: 1042 dyads; 24m follow-up: 737 dyads; 2016-2019). Mediation was assessed using inverse odds ratio weighting. In the small group intervention, of the total effect on IPV prevalence (8% reduction), indirect effects via inequitable gender norms is associated with a 2% decrease (95% CI: -0.07, 0.12) and direct effects with a 6% decrease (95% CI: -0.20, -0.02). For household visits, of the total effect on contraceptive use (20% increase), the indirect effect accounts for an 11% decrease (95% CI: -0.18, -0.01) and direct effect, a 32% increase (95% CI: 0.13, 0.44); similar to findings for the combination arm. This experimental evidence informs the value of changing underlying social norms to reduce IPV and increase contraception use.

A secondary gendered analysis of interviews with Latina cisgender women indicated for HIV pre-exposure prophylaxis.

HIV infections disproportionately impact Latinx populations in the United States, yet oral pre-exposure prophylaxis (PrEP) uptake is low. This study was a secondary gendered analysis of interviews with Latina cisgender women (n = 20) recruited from an urban safety net hospital inNew York City between August 2019 and October 2022. All women were indicated for PrEP by the provider. In-depth interviews were conducted with participants in English and Spanish and asked about social determinants of health, sexual partnerships and behaviors, and PrEP-specific enablers and barriers. Secondary thematic content analysis was conducted to identify gender-related factors influencing PrEP uptake. The following themes emerged from the data:structural factors (e.g., employment), partner-related factors, low sexual health knowledge, and resilience and empowerment. Partner-related factors were the most salient; partner infidelity served as reasons for initiating PrEP. Despite being constrained by low power in relationships, women made empowered choices to initiate PrEP and protect themselves. Findings indicated that the impact of gender inequity was an important factor in Latina women's PrEP decision making, pointing to a need to address partner-driven HIV risk, imbalance of power in relationships, and gender norms.

Adolescent boys' aggressive responses to perceived threats to their gender typicality.

When adult men are made to feel gender-atypical, they often lash out with aggression, particularly when they are pressured (vs. autonomously motivated) to be gender-typical. Here, we examined the development of this phenomenon. Specifically, we provided a first experimental test of whether threatening adolescent boys' perceived gender typicality elicits aggression as a function of their pressured (vs. autonomous) motivation to be gender-typical. We also investigated whether this causal link emerges as a function of boys' chronological age versus pubertal development. Participants were a geographically diverse sample of 207 adolescent US boys (ages 10-14; 23.2% boys of color) and one of their parents. Boys played a "game" and received randomly-assigned feedback that their score was atypical versus typical of their gender. For boys in mid-to-late puberty (but not before), feedback that they are gender-atypical predicted an aggressive reaction, particularly among boys whose motivation to be gender-typical was pressured (vs. autonomous). Next, we explored which aspects of boys' social environments predicted their pressured motivation to be gender-typical. Boys' pressured motivation was positively correlated with their perceptions that their parents and peers would be "upset" if they deviated from gender norms, as well as with their parents' endorsement of so-called hegemonic beliefs about masculinity (i.e., that men should hold power over women). Parents with these beliefs resided in more conservative areas, had less formal education, and had lower incomes. Our results inform theorizing on gender identity development and lay the foundation for mitigating the harmful effects of gender typicality threat among adult men. RESEARCH HIGHLIGHTS: Similar to young adult men, adolescent boys in mid-to-late puberty (but not before) responded with aggression to perceived threats to their gender typicality. Aggression was heightened among boys whose motivation to be gender-typical was pressured (i.e., driven by social expectations) rather than autonomous. Which boys showed pressured motivation? Those whose parents endorsed hegemonic beliefs about masculinity (e.g., that men should have more power than people of other genders). Hegemonic beliefs about masculinity were strongest among parents who resided in more conservative US counties, had less formal education, and had lower incomes.

Gender Roles and Mobile Dating Applications: Exploring Links Between User Characteristics and Traditional Gender Expressions in Self-Presentations.

This linkage study examined the prevalence of traditional gender expressions in the textual and visual profile cues on mobile dating applications (MDA) (nbiographies = 396, npictures = 1352) of 396 young adults' (Mage = 22.39 years, SD = 2.86, 73% women) with attention to users' gender, sexual orientation, and platform type. For 184 users (Mage = 22.10 years, SD = 2.91, 75% women) media content data were linked to self-report survey data. Results showed that individuals aligned their self-presentations with traditional gender roles and expectations, and this link depended on their gender. No significant differences according to individuals' sexual orientation or platform type were found. Individuals' (hyper-) gender orientation also related to engagement in traditional gender expressions. Specifically, women with a stronger feminine gender orientation expressed more traditional femininity in their MDA profiles. For men, no significant associations between (aspects of) a masculine gender orientation and expressing traditional masculinity in their MDA profiles were found. Future research should further disentangle selective gendered self-presentations.

Male Sexual Victimization by Women: Incidence Rates, Mental Health, and Conformity to Gender Norms in a Sample of British Men.

Male sexual victimization by women is often neglected within psychological research (Fisher & Pina, 2013). Not only is the topic understudied, incidence rates and associated psychological impacts are inconsistent across the literature (Depraetere et al., 2020; Peterson et al., 2011). The present study provides an additional estimate of male sexual victimization by women, explores its association with victim mental disorders, and examines the potential moderating role of conformity to gender norms. A sample of 1124 heterosexual British men completed an online survey consisting of a modified CDC National Intimate Partner and Sexual Violence Survey, and measures of anxiety, depression, post-traumatic stress disorder, and conformity to masculine norms. In the present sample, 71% of men experienced some form of sexual victimization by a woman at least once during their lifetime. Sexual victimization was significantly associated with anxiety, depression, and post-traumatic stress disorder. However, conformity to masculine gender norms was not a significant moderator between victimization and mental disorders. These findings further illuminate the occurrence of male sexual victimization by women, as well as the importance of continued research on the topic.

Patterns of Gender Development Across Intersections of Age, Gender, and Ethnicity-Race.

Two components of gender identity are gender similarity, how one's self-concept relates to the major gender collectives (i.e., female, male), and felt pressure to conform to gender norms. The development of these components across ages and contexts has been understudied. The focus of this study was to examine variations in gender similarity and felt pressure across multiple intersecting contexts: developmental stage, gender, and ethnic-racial group. Six data sets were harmonized and means were compared across 2628 participants (51% girls, 49% boys) from four different developmental cohorts (childhood n = 678, early adolescence n = 1322, adolescence n = 415, and young adulthood n = 213) from diverse ethnic-racial backgrounds (45% White, 23% Latinx/Hispanic, 11% Black/African-American, 7% Asian-American, 5% American Indian, and 5% Multiracial). Results revealed nuanced patterns: Gender intensification was supported in early adolescence, primarily for boys. Young adult men reported lower levels of pressure and gender typicality than younger boys, but young adult women's levels were generally not different than younger girls. Surprisingly, young adult women's levels of own-gender similarity and pressure from parents were higher than adolescent girls. Expectations of gender differences in gender typicality and felt pressure were supported for all ages except young adults, with higher levels for boys. Finally, there were more similarities than differences across ethnic-racial groups, though when there were differences, minoritized participants reported heightened gender typicality and pressure (largely accounted for by higher scores for Black and Latinx participants and lower scores for White and Multiracial participants). These results add to what is understood about contextually dependent gender development.

Age-disparate and intergenerational sex partnerships and HIV: the role of gender norms among adolescent girls and young women in Malawi.

BACKGROUND: Age-mixing (age-disparate [5-9 years difference] and intergenerational [≥ 10 years difference]) partnerships are hypothesized drivers of HIV in adolescent girls and young women (AGYW; 15-24 years). These partnerships are often associated with increased gender inequities which undermine women's agency and assertiveness. We assessed whether age-mixing partnerships were associated with HIV in Malawi and if endorsement of inequitable gender norms modifies this relationship. METHODS: We analyzed data from the Malawi Population-based HIV Impact Assessment, a nationally representative household survey conducted in 2015-2016. Participants underwent HIV testing and completed questionnaires related to actively endorsed gender norms and sexual risk behavior. We used multivariate logistic regression and multiplicative interaction to assess associations among AGYW who reported the age of their primary sex partner from the last year. RESULTS: The analysis included 1,958 AGYW (mean age = 19.9 years, SD = 0.1), 459 (23.4%) and 131 (6.7%) of whom reported age-disparate and intergenerational partnerships, respectively. AGYW in age-mixing partnerships accounted for 13% of all AGYW and were older, more likely to reside in urban areas, to be married or cohabitating with a partner, and to have engaged in riskier sexual behavior compared with AGYW in age-concordant partnerships (p < 0.05). HIV prevalence among AGYW in age-disparate and intergenerational partnerships was 6.1% and 11.9%, respectively, compared with 3.2% in age-concordant partnerships (p < 0.001). After adjusting for residence, age, education, employment, wealth quintile, and ever been married or cohabitated as married, AGYW in age-disparate and intergenerational partnerships had 1.9 (95% CI: 1.1-3.5) and 3.4 (95% CI: 1.6-7.2) greater odds of HIV, respectively, compared with AGYW in age-concordant partnerships. Among the 614 (31% of the study group) who endorsed inequitable gender norms, AGYW in age-disparate and intergenerational partnerships had 3.5 (95% CI: 1.1-11.8) and 6.4 (95% CI: 1.5-27.8) greater odds of HIV, respectively, compared with AGYW in age-concordant partnerships. CONCLUSIONS: In this Malawi general population survey, age-mixing partnerships were associated with increased odds of HIV among AGYW. These findings highlight inequitable gender norms as a potential focus for HIV prevention and could inform interventions targeting structural, cultural, and social constraints of this key group.

'You are looked upon as a luxury tool': Young Tanzanian women's perception of community norms supporting partner violence during transactional sex (kudanga).

This paper explores the definition of, and perceived community attitudes, toward kudanga, a Swahili street term for a type of transactional sex practised in Dar es Salaam, Tanzania. Rooted in economic and gender disparity, transactional sex increases adolescent girls' and young women's vulnerability to HIV and gender-based violence. We sought to understand perceived community attitudes about kudanga, and how the internalisation of norms surrounding gender-based violence relate to the experiences of young women who practise kudanga. Using qualitative data from focus group discussions with 37 young women, we found that community perceptions of kudanga were largely negative, and those who engaged in it were looked down upon and despised. Violence and lack of sexual agency were normalised when doing kudanga. However, young women understood kudanga to often be their best option to obtain economic stability and felt strongly that those who practised kudanga should not be stigmatised. Our research provides further evidence that transactional sex exists on a continuum and highlights the importance of reducing community stigma surrounding transactional sex as a means of decreasing risk of HIV and gender-based violence for young women. To our knowledge, this article is the first to explore kudanga.

Teenage pregnancy in Tambogrande, Peru: causes, consequences and cycles of violence and disadvantage.

Teenage pregnancy carries adverse consequences for health and well-being. In this article, we investigate the perceived causes, consequences and cycles of violence and disadvantage associated with teenage pregnancy in Tambogrande, Peru using an applied anthropological approach. Data were drawn from a larger project investigating the relationship between water insecurity and gender-based violence in Indonesia and Peru. The analysis presented here is derived from 49 semi-structured interviews and 5 focus groups with local community members and stakeholders in Peru. Study participants highlighted two main factors contributing to teenage pregnancy in Tambogrande: machismo and religious deterrents to contraceptive use. Participants described how these factors overlapped, resulting in gendered power imbalances that increased the risk of violence, decreased educational opportunities, and reduced the economic independence of women. However, study participants stated that educational interventions targeting machismo could reduce teenage pregnancy and break the associated cycle of disadvantage. Future research will further investigate local social and gender norms to inform the design of a rights-based educational intervention, targeting upstream factors associated with teenage pregnancy in this area.

Gender role beliefs and adolescent pregnancy in Colombia: findings from the 2015 DHS survey.

This study investigated the association between gender role beliefs and the prevalence and likelihood of experiencing pregnancy among 8525 young women and girls aged 13-19 years in Colombia. The primary outcome of interest was adolescent pregnancy. Retrospective cross-sectional analysis utilised data from the 2015 Demographic and Health Survey (DHS) in Colombia, which included an add-on questionnaire on gender relations. Our analysis measured both pregnancy prevalence and pregnancy likelihood in relation to gender role beliefs. With one exception, young women who disagreed with traditionally conforming gender roles had a lower prevalence of pregnancy and were less likely to experience pregnancy than those who agreed with them. The highest likelihood of pregnancy prevalence and likelihood was found among those who agreed with statements suggesting male dominance and those who agreed with women's homemaking responsibilities. The greater the adherence to traditionally conforming gender role beliefs, the higher the likelihood of experiencing pregnancy during adolescence. Girls' and young women's adherence to traditional gender role beliefs appeared to be a risk factor for adolescent pregnancy. Our findings support Colombia's current sex education policies and practices within the framework of gender equity, and evidence the link between gender equity and girls' and young women's reproductive health.

Multilevel experiences of carceral violence in Los Angeles, California: first-hand accounts from a racially diverse sample of transgender women.

Transgender women face a disproportionate burden of carceral violence, or violence related to policing and the criminal legal system, with transgender women of colour experiencing even greater disparities. Several frameworks conceptualise the mechanisms through which violence impacts transgender women. However, none of them directly explore the role of carceral violence, particularly as it is experienced by transgender women themselves. Sixteen in-depth interviews were conducted with a racially/ethnically diverse sample of transgender women in Los Angeles between May and July 2020. Participants were between 23 - 67 years old. Participants identified as Black (n = 4), Latina (n = 4), white (n = 2), Asian (n = 2), and Native American (n = 2). Interviews assessed experiences of multilevel violence, including from police and law enforcement. Deductive and inductive coding methods were used to identify and explore common themes concerning carceral violence. Experiences of law enforcement-perpetrated interpersonal violence were common and included physical, sexual and verbal abuse. Participants also highlighted structural violence, including misgendering, the non-acceptance of transgender identities, and police intentionally failing to uphold laws that could protect transgender women. These results demonstrate the pervasive, multilevel nature of carceral violence perpetrated against transgender women and suggest avenues for future framework development, trans-specific expansions of carceral theory, and system-wide institutional change.

Can a school health club-based intervention significantly influence the drivers of gendered sexual norms and ideologies among in-school adolescents in southeast Nigeria?

Individual experiences, social policies, and environmental exposure shape beliefs, norms and ideologies about sexuality. The objective of this study was to determine the effectiveness of a school health club training programme in improving adolescents' knowledge and perceptions of gender norms and ideologies about sexuality. This was an intervention study among in-school adolescent boys and girls in 12 secondary schools in Ebonyi State, southeast Nigeria. The intervention was the establishment of school health clubs in six schools (intervention), while the six other schools served as controls that did not have school health clubs. Data was collected using a pre-tested interviewer-administered questionnaire. Bivariate and multivariate logistic regression analyses were used to analyse the data. More than half of the adolescents in the intervention (58.3%) and non-intervention (56.1%) schools believed that men need sex more than women. About 90% of adolescents in school (in both arms) agreed that both boys and girls should remain virgins until marriage. Majority of adolescents in both intervention and non-intervention schools disagreed with the notion that "it is justifiable for a boy to hit his girlfriend". Female gender (OR: 1.6; CI 1.1-2.4), senior secondary school level (OR: 1.6; CI 1.0-2.5), and urban residence (OR: 1.7; CI: 1.1-2.5) were associated with the perception that boys do not respect girls who agree to have sex with them. Working for pay decreases the likelihood of having the perception that girls should remain virgin until they marry (OR: 0.4; CI: 0.2-0.9), while living in the urban area increases the likelihood of having the perception that boys should remain virgins until marriage (OR: 2.1; 1.1-4.1). Female gender (OR: 0.7; CI: 0.5-1.0) and urban residence (OR: 0.6; 0.4-0.9) decrease the likelihood of having the perception that men need sex more frequently than women do. In the intervention arm, female gender was associated with perception that boys do not respect girls who agree to have sex with them (OR: 2.4; CI: 1.3-4.3) while older age was associated with the perception that men need sex more frequently than women in the intervention arm (OR:1.2; CI:1.0-1.4). No predictor was found in the non-intervention arm. Although both intervention and non-intervention arms had positive perceptions of gendered sexual norms and ideologies, a school health club-based intervention could influence the drivers of these norms.

Les expériences individuelles, les politiques sociales et l'exposition à l'environnement façonnent les croyances, les normes et les idéologies en matière de sexualité. L'objectif de cette étude était de déterminer l'efficacité d'un programme de formation d'un club de santé scolaire pour améliorer les connaissances et les perceptions des adolescents concernant les normes de genre et les idéologies en matière de sexualité. Il s'agissait d'une étude d'intervention auprès d'adolescents, garçons et filles, scolarisés dans 12 écoles secondaires de l'État d'Ebonyi, au sud-est du Nigeria. L'intervention consistait en la création de clubs de santé scolaire dans six écoles (intervention), tandis que les six autres écoles servaient de contrôles qui ne disposaient pas de clubs de santé scolaire. Les données ont été collectées à l'aide d'un questionnaire pré-testé administré par l'intervieweur. Des analyses de régression logistique bivariées et multivariées ont été utilisées pour analyser les données. Plus de la moitié des adolescents des écoles d'intervention (58,3 %) et de non-intervention (56,1 %) pensaient que les hommes avaient plus besoin de relations sexuelles que les femmes. Environ 90 % des adolescents scolarisés (dans les deux bras) étaient d'accord sur le fait que les garçons et les filles devraient rester vierges jusqu'au mariage. La majorité des adolescents des écoles d'intervention et des écoles non-interventionnelles étaient en désaccord avec l'idée selon laquelle « il est justifiable qu'un garçon frappe sa petite amie ¼. Le sexe féminin (OR : 1,6 ; IC 1,1-2,4), le niveau d'études secondaires de deuxième cycle (OR : 1,6 ; IC 1,0-2,5) et la résidence urbaine (OR : 1,7 ; IC : 1,1 2,5) étaient associés à la perception que les garçons font ne respecte pas les filles qui acceptent d'avoir des relations sexuelles avec elles. Travailler contre rémunération diminue la probabilité d'avoir l'impression que les filles devraient rester vierges jusqu'à leur mariage (OR : 0,4 ; IC : 0,2-0,9), tandis que vivre en zone urbaine augmente la probabilité d'avoir l'impression que les garçons devraient rester vierges jusqu'au mariage. (OU : 2.1 ; 1.1-4.1). Le sexe féminin (OR : 0,7 ; IC : 0,5-1,0) et la résidence urbaine (OR : 0,6 ; 0,4-0,9) diminuent la probabilité d'avoir la perception que les hommes ont besoin de relations sexuelles plus fréquemment que les femmes. Dans le groupe d'intervention, le sexe féminin était associé à la perception que les garçons ne respectent pas les filles qui acceptent d'avoir des relations sexuelles avec eux (OR : 2,4 ; IC : 1,3-4,3), tandis que l'âge plus avancé était associé à la perception que les hommes avaient besoin de relations sexuelles plus fréquemment que les hommes. femmes dans le bras d'intervention (OR : 1,2 ; IC : 1,0-1,4). Aucun prédicteur n'a été trouvé dans le bras sans intervention. Même si les groupes d'intervention et de non-intervention avaient des perceptions positives des normes et idéologies sexuelles sexistes, une intervention basée sur un club de santé scolaire pourrait influencer les moteurs de ces normes.

Child marriages in Senegal: Qualitative study on the perceptions of adolescents in Kaolack and Gossas.

An estimated 650 million girls worldwide are married before their 18th birthday. The phenomenon is recurrent in sub-Saharan Africa with a prevalence of 18% and particularly in Senegal where one in three girls is married before the age of 18, i.e. a prevalence of 31%. Despite the legislative and legal arsenals, the laws on the legal age of marriage are not respected. The general objective of this study is to document the way in which gender norms define and influence the perceptions of adolescents in Gossas and Kaolack on child marriages and to collect possible solutions proposed to prevent/ reduce the practice. We used qualitative data collected in the two study sites. These were individual interviews with adolescents aged 10-19 (n=30) and focus groups (n=8) with the same target. The interviews were conducted in Wolof and transcribed into French then coded using Dedoose software. The results are presented for each age group and each gender then triangulated in order to highlight similarities and divergences according to the different perspectives. The results show that child marriages are rooted in patriarchal social and cultural norms, while reflecting gender inequalities. Thus, adolescents' arguments regarding the causes of child marriage align with those described in the literature on gender norms. Most adolescents cited poverty, tradition, fear of early pregnancy, and concern to preserve the girl's honor as the main factors contributing to the persistence of child marriages.

On estime à 650 millions le nombre de filles mariées dans le monde avant leur 18e anniversaire. Le phénomène est récurrent en Afrique subsaharienne avec une prévalence de 18% et particulièrement au Sénégal où, une fille sur trois est mariée avant l'âge de 18 ans, soit une prévalence de 31%. Malgré l'arsenal juridique législatif, les lois sur l'âge légal du mariage ne sont pas respectées. L'objectif général de cette étude est de documenter la manière dont les normes de genre définissent et influencent les perceptions des adolescent(e)s de Gossas et de Kaolack sur les mariages d'enfants et de recueillir les pistes de solutions proposées pour prévenir/réduire la pratique. Nous avons utilisé les données qualitatives collectées dans les deux sites de l'étude. Il s'agit d'entretiens individuels avec des adolescent(e)s de 10-19 ans (n=30) et de groupes de discussion (n=8) avec la même cible. Les entretiens ont été conduits en wolof et transcrits en Français puis codés à l'aide du logiciel Dedoose. Les résultats sont présentés pour chaque groupe d'âge et chaque sexe puis triangulés afin de ressortir les similarités et divergences selon les différentes perspectives. Les résultats montrent que les mariages d'enfants sont ancrés dans des normes sociales et culturelles patriarcales, tout en reflétant les inégalités de genre. Ainsi, les arguments des adolescent(e)s par rapport aux causes des mariages d'enfants s'alignent avec celles décrites dans la littérature sur les normes de genre. La plupart des adolescent(e)s ont évoqué la pauvreté, la tradition, la peur d'une grossesse précoce, le souci de préserver l'honneur de la fille comme étant les principaux facteurs contribuant à la persistance des mariages d'enfants.

Positive masculinity programmes and attitudes towards nonconforming gender identities among young males in urban Democratic Republic of Congo, Nigeria, and Rwanda.

Implementing programmes on sexual and reproductive health and rights (SRHR) in sub-Saharan Africa often involves promoting inclusive sexual identity/orientation. However, whether and how the programmes are changing gender norms in the target populations have not been established. This study was designed to determine whether participation in Positive Masculinity (PM) programmes can change attitudes associated with prevailing gender norms. We explored attitudes towards nonconforming sexual identity/orientation among young males in selected informal settlements in Democratic Republic of the Congo (DRC), Nigeria and Rwanda. The key variables we tested included "country of participation" and other socio-demographics such as "education", "marital status" and "prior residential location" (rural or urban). We found no significant association between participation in PM programmes with attitudes towards nonconforming sexual identities/orientations across our target populations irrespective of educational qualification, marital status, and previous location of residence. By contrast, religious teachings showed up in the qualitative responses as a significant factor influencing young people's resistance to PM programmes' advocating for inclusive sexuality. Additionally, negative masculinity attributes had significant negative association with attitudes towards nonconforming sexual identity, while respondents with violent tendencies showed significant positive attitudes. We conclude that current PM interventions do not significantly contribute to positive attitudes towards inclusive sexuality in DRC, Nigeria, and Rwanda.

La mise en œuvre de programmes sur la santé et les droits sexuels et reproductifs (SDSR) en Afrique subsaharienne implique souvent la promotion d'une identité/orientation sexuelle inclusive. Cependant, il n'a pas été établi si et comment les programmes modifient les normes de genre dans les populations cibles. Cette étude a été conçue pour déterminer si la participation à des programmes de masculinité positive (PM) peut changer les attitudes associées aux normes de genre dominantes. Nous avons exploré les attitudes à l'égard de l'identité/orientation sexuelle non conforme chez les jeunes hommes dans des quartiers informels sélectionnés en République démocratique du Congo (RDC), au Nigeria et au Rwanda. Les variables clés que nous avons testées comprenaient le « pays de participation ¼ et d'autres données sociodémographiques telles que « l'éducation ¼, « l'état civil ¼ et « le lieu de résidence antérieur ¼ (rural ou urbain). Nous n'avons trouvé aucune association significative entre la participation à des programmes de PM et les attitudes à l'égard des identités/orientations sexuelles non conformes au sein de nos populations cibles, indépendamment du diplôme, de l'état civil et du lieu de résidence précédent. En revanche, les enseignements religieux sont apparus dans les réponses qualitatives comme un facteur important influençant la résistance des jeunes aux programmes PM prônant une sexualité inclusive. De plus, les attributs négatifs de la masculinité présentaient une association négative significative avec les attitudes à l'égard d'une identité sexuelle non conforme, tandis que les répondants ayant des tendances violentes montraient des attitudes positives significatives. Nous concluons que les interventions actuelles de PM ne contribuent pas de manière significative à des attitudes positives envers une sexualité inclusive en RDC, au Nigeria et au Rwanda.

Gender transformative innovation: Women's inclusion in livestock vaccine systems in northern Ghana.

CONTEXT: Owning livestock can support women's empowerment and progress toward gender-equitable agri-food systems. Gender inequality, however, can reduce women's ownership of livestock and access to animal vaccines. Gender accommodative approaches (GAAs), and more recently gender transformative approaches (GTAs), are increasingly implemented in development interventions. However, their impact on women's empowerment has not been systematically tested. Here, we describe the 'Women Rear Project', implemented in northern Ghana between 2019 and 2023, and assess the impact of GTAs and GAAs on women's empowerment, ownership of livestock, and access to animal vaccines. OBJECTIVE: We sought to systematically assess changes conferred by GAAs and GTAs on gender norms and women's empowerment and access to animal vaccines. METHODS: Using a mixed-methods approach, in 2021 and 2023 we collected quantitative and qualitative data regarding women's empowerment, gender norms, and access to animal vaccines. Qualitative data regarding women's and men's conceptualizations of gender norms and women's empowerment were obtained via focus group discussions and key informant interviews. Quantitative survey data were obtained from 500 households, using the Women's Empowerment in Livestock Index (WELI). Quantitative data on livelihood indicators were also collected, using the Rural Household Multi-Indicator Survey (RHoMIS) tool. We systematically assessed changes between baseline (2021) and endline (2023) in local conceptualizations of empowerment in the livestock sector, the effects of GTAs and GAAs on such conceptualizations, and how empowerment was experienced by women and men and the implications for women's access to animal vaccines. RESULTS AND CONCLUSION: Local conceptualizations of empowerment in 2021, among both women and men, emphasized financial independence, decision-making autonomy, self-reliance, and problem-solving skills. In 2023, this conceptualization of empowerment had expanded to include the ability to act without external restrictions; women were empowered by managing resources, running successful businesses, and making decisions in consultation with their husbands. Furthermore, women in communities where GTAs had been enacted scored significantly higher in empowerment compared with women in communities where only GAAs had been introduced. Gender norms impacted empowerment indicators, with respect among household members and autonomy in income both contributing to disempowerment. Gender norms also affected respondents' reporting. Women's access to livestock vaccines was more positive in GTA/GAA communities. We recommend efforts are made to reduce restrictive gender norms and enhance women's empowerment and access to resources such as animal vaccines. SIGNIFICANCE: We offer recommendations for pathways toward women's empowerment and healthy livestock via inclusive innovations in agri-food systems.

Men's Endorsement of Intimate Partner Violence and HIV Testing Behavior Across Sub-Saharan Africa.

Despite an upward trend in HIV testing across sub-Saharan Africa, men continue to lag women in the use of HIV testing services. Inequitable gender attitudes held by some men may be implicated in their suboptimal HIV testing behaviors. We sought to ascertain the relationship between men?s endorsement of intimate partner violence (IPV), which is one manifestation of inequitable gender attitudes, and their lifetime and recent HIV testing, using nationally representative Demographic and Health Survey data from 23 sub-Saharan African countries. In a pooled analysis, we found that a unit increase in the IPV index scale is associated with 8% lower odds of lifetime HIV testing, and 6% lower odds of recent HIV testing. The strength of this relationship, however, varied across countries and regions. Our findings suggest that efforts to increase men?s HIV testing in the region should address the inequitable gender attitudes underpinning men?s endorsement of IPV, but that it is important to consider contextual variation.

An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa.

BACKGROUND: Binge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked. This study aims to model the potential effect of alcohol counselling interventions (in men and women) and gender-transformative interventions (in men) as strategies to reduce HIV transmission. METHODS: We developed an agent-based model of HIV and other sexually transmitted infections, allowing for effects of binge drinking on sexual risk behaviour, and effects of inequitable gender norms (in men) on sexual risk behaviour and binge drinking. The model was applied to South Africa and was calibrated using data from randomized controlled trials of alcohol counselling interventions (n = 9) and gender-transformative interventions (n = 4) in sub-Saharan Africa. The model was also calibrated to South African data on alcohol consumption and acceptance of inequitable gender norms. Binge drinking was defined as five or more drinks on a single day, in the last month. RESULTS: Binge drinking is estimated to be highly prevalent in South Africa (54% in men and 35% in women, in 2021), and over the 2000-2021 period 54% (95% CI: 34-74%) of new HIV infections occurred in binge drinkers. Binge drinking accounted for 6.8% of new HIV infections (0.0-32.1%) over the same period, which was mediated mainly by an effect of binge drinking in women on engaging in casual sex. Inequitable gender norms accounted for 17.5% of incident HIV infections (0.0-68.3%), which was mediated mainly by an effect of inequitable gender norms on male partner concurrency. A multi-session alcohol counselling intervention that reaches all binge drinkers would reduce HIV incidence by 1.2% (0.0-2.5%) over a 5-year period, while a community-based gender-transformative intervention would reduce incidence by 3.2% (0.8-7.2%) or by 7.3% (0.6-21.2%) if there was no waning of intervention impact. CONCLUSIONS: Although binge drinking and inequitable gender norms contribute substantially to HIV transmission in South Africa, recently-trialled alcohol counselling and gender-transformative interventions are likely to have only modest effects on HIV incidence. Further innovation in developing locally-relevant interventions to address binge drinking and inequitable gender norms is needed.

Gender norms and access to sexual and reproductive health services among women in the Marrakech-Safi region of Morocco: a qualitative study.

INTRODUCTION: Improving access to sexual and reproductive health remains a public health challenge, especially for women, whose access is affected by several determinants, such as gender inequality, which is the underlying barrier to all other determinants. Many actions have been carried out, but much remains to be done before all women and girls can exercise their rights. This study aimed to explore how gender norms influence access to sexual and reproductive health services. METHOD: A qualitative study was conducted from November 2021 to July 2022. The inclusion criteria were women and men aged over 18 years old, living in the urban and rural areas of the Marrakech-Safi region in Morocco. A purposive sampling method was used to select participants. Data were obtained through semi-structured interviews and focus groups with selected participants. The data were coded and classified using thematic content analysis. RESULTS: The study highlighted inequitable, restrictive gender norms that lead to stigmatization and affect the sexual and reproductive healthcare-seeking behavior and access of girls and women in the Marrakech-Safi region. These most common gender norms for women include parental refusal, stigmatization, and social exclusion of girls from sexual and reproductive health education services; strong decision-making power of family members over contraceptive use and women's adherence to pregnancy monitoring and access to supervised delivery; and culturally constructed role allocation, assigning a reproductive role to women and making them responsible for the health of new-borns. CONCLUSION: Sexual and reproductive health projects must strive to be gender sensitive. Gender-blind projects are missed opportunities to improve health outcomes and advance gender equality.

Community gender norms, mental health, and suicide ideation and attempts among older Japanese adults: a cross-sectional study.

OBJECTIVES: Gender norms embedded in communities may restrict opportunities and harm the mental health of older adults, yet this phenomenon has received little attention. This study investigates the connection between older adults' perceptions of community gender norms and mental health and suicide-related outcomes. DESIGN: Cross-sectional. SETTING: This study analyzed data from the 2019 wave of the Japan Gerontological Evaluation Study. PARTICIPANTS: In total, 25,937 participants aged 65 years or older in 61 municipalities. MEASUREMENTS: Perceptions of community gender norms were assessed by the respondents' perceptions of the gender-differentiating language used by those around them such as "You should/should not do XXX, because you are a man/woman." RESULTS: The prevalence of all mental health outcomes was higher among both men and women who perceived community gender norms as restrictive. These associations remained in fully adjusted multivariable analyses. Prevalence ratios for men were 1.36 [95% confidence interval: 1.13, 1.65] for psychological resistance to obtaining help, 1.85 [1.54, 2.23] for depressive symptoms, 1.99 [1.34, 2.96] for suicidal ideation, and 2.15 [1.21, 3.80] for suicide attempts. The corresponding figures for women were 1.39 [1.17, 1.65], 1.80 [1.55, 2.10], 2.13 [1.65, 2.74], 2.62 [1.78, 3.87]. There was a more pronounced association between perceiving community gender norms as restrictive and depressive symptoms and suicidal behaviors among those with nonconventional gender role attitudes compared to those with conventional attitudes. CONCLUSIONS: Considering the effects of community gender norms, in addition to individual gender role attitudes, may be critical in designing effective public health interventions for improving mental health.

No clitting! We need to talk about clitoris transplantation.

In the last two decades, genital transplants have emerged as another type of quality-of-life transplants. Successful allogenic transplantations of the uterus, ovary, testicle, and penis have all been reported. Yet, there is no discussion of clitoris transplantation in the medical literature, mass media, and everywhere else I searched. This surgery could be used for cisgender women who have a clitoral injury or disease or who have undergone female genital cutting. I examine the gender norms regarding sexuality and reproduction to show how they shape surgical advancements. My point in this paper is not to take a normative position on status of current genital transplantations. Rather, I highlight that their existence is due, at least in part, because they align with dominant gender norms: penis and testicle transplantations reinforce the importance of men's virility and the existence of "normal" male genitalia, whereas uterus and ovary transplantations uphold the conflation of women and reproduction and the strong valuing of women's fertility. That medical advances reflect cultural values is not a new claim. What is new in this paper is the discussion of how sexism norms-regarding the invisibility of the clitoris and the devaluing of women's sexual pleasure- has engendered various types of genital transplants, but not clitoris transplantation.