Abstract
Inequitable gender norms and beliefs contribute to increased sexual risk behavior, and, among adolescent girls and young women (AGYW), risk of HIV acquisition. We investigated the longitudinal measurement properties of the Gender Equitable Men’s Scale (GEMS) when applied to a cohort of AGYW in rural South Africa (2011–2015). We used item response theory [Person-Item maps, Differential Item Functioning (DIF)] and measurement invariance confirmatory factor analysis models to assess the validity and reliability of the GEMS instrument. Item difficulty and endorsement of gender equitable beliefs both shifted over time. DIF analysis identified item bias for over half of the items; influenced by age, pregnancy, sexual debut, and intimate partner violence. Measurement invariance models revealed strong longitudinal invariance properties. GEMS is a reliable longitudinal measurement of gender equitable beliefs, with notable bias for specific items when administered to subgroups. Additional items specific to the adolescent experience are warranted for a more stable assessment of gender equitable beliefs in a population facing shifting norms as they mature.
Highlights
Gender norms, defined as social expectations for appropriate behaviors for men and women [1], are a significant social determinant of health
We found that a more gender equitable social environment was protective against HIV and HSV-2 acquisition [15]; and, as others have noted, that inequitable held beliefs were associated with intermediaries of HIV risk, consistent with other studies [6, 15]
We evaluated the validity and reliability of the Gender Equitable Men’s Scale (GEMS) instrument in a longitudinal setting among a population in developmental transition from adolescence to young adulthood
Summary
Gender norms, defined as social expectations for appropriate behaviors for men and women [1], are a significant social determinant of health. Studies designed to intervene on gender norms have shown promising short-term results with respect to intermediaries of HIV acquisition (e.g., improved negative attitudes towards women, increased condom use [8]) but the long-term effects of these interventions (e.g., HIV prevention) are less wellestablished because of short follow-up periods and lack of biological measures collected [9] These studies linking gender norms to risk of HIV acquisition contribute to the evidence base that support the U.S President’s Emergency Plan for AIDS Relief (PEPFAR) and other international organizations prioritizing interventions focused on promoting gender equitable norms as a strategy to combat the global HIV epidemic [10,11,12]
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