Impasse & Attachment: Youth, Gender-Transformation, and Staying with the Trouble of Participation in Wentworth

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Introduction: Addressing the vulnerability of young women and girls to stop the HIV epidemic in southern Africa

HIV and Sexual Behavior Among Young People: The South African Paradox

Research has foregrounded the way in which heterosexual practices for many young people are not infrequently bound up with violence and unequal transactional power relations. The Life Orientation sexuality education curriculum in South African schools has been viewed as a potentially valuable space to work with young people on issues of reproductive health, gender and sexual norms and relations. Yet, research has illustrated that such work may not only be failing to impact on more equitable sexual practices between young men and women, but may also serve to reproduce the very discourses and practices that the work aims to challenge. Cultures of violence in youth sexuality are closely connected to prevailing gender norms and practices which, for example, render women as passive victims who are incapable of exercising sexual agency and men as inherently sexually predatory. This paper analyses the talk of Grade 10 learners in nine diverse schools in two South African provinces, the Eastern Cape and the Western Cape, to highlight what ‘lessons’ these young people seem to be learning about sexuality in Life Orientation classes. We find that these lessons foreground cautionary, negative and punitive messages, which reinforce, rather than challenge, normative gender roles. ‘Scare’ messages of danger, damage and disease give rise to presumptions of gendered responsibility for risk and the requirement of female restraint in the face of the assertion of masculine desire and predation. We conclude that the role which sexuality education could play in enabling young women in particular to more successfully negotiate their sexual relationships to serve their own needs, reproductive health and safety, is undermined by regulatory messages directed at controlling young people, and young women in particular – and that instead, young people’s sexual agency has to be acknowledged in any processes of change aimed at gender equality, anti-violence, health and well-being. Keywords : Life Orientation, sex, sexuality education, young people, heterosexual practices, gender equality, violence, health, danger.

BackgroundTransactional sex is believed to be a significant driver of the HIV epidemic among young women in South Africa. This sexual risk behaviour is commonly associated with age mixing, concurrency and unsafe sex. It is often described as a survival- or consumption-driven behaviour. South Africa’s history of political oppression as well as the globalization-related economic policies adopted post-apartheid, are suggested as the underlying contexts within which high risk behaviours occur among Black populations. What remains unclear is how these factors combine to affect the particular ways in which transactional sex is used to negotiate life among young Black women in the country.In this paper we explore the drivers of transactional sex among young women aged 16–24, who reside in a peri-urban community in South Africa. We also interrogate prevailing constructions of the risk behaviour in the context of modernity, widespread availability of commodities, and wealth inequalities in the country.MethodsData were collected through 5 focus group discussions and 6 individual interviews amongst young women, men, and community members of various age groups in a township in the Western Cape, South Africa.FindingsYoung women engaged in transactional sex to meet various needs: some related to survival and others to consumption. In this poverty-stricken community, factors that created a high demand for transactional sex among young women included the pursuit of fashionable images, popular culture, the increased availability of commodities, widespread use of global technologies, poverty and wealth inequalities. Transactional sex encounters were characterized by sexual risk, a casual attitude towards HIV, and male dominance. However, the risk behaviour also allowed women opportunities to adopt new social roles as benefactors in sexual relationships with younger men.ConclusionTransactional sex allows poor, young women to access what young people in many parts of the world also prioritize: fashionable clothing and opportunities for inclusion in popular youth culture. In the context of high HIV prevalence in South Africa, strategies are needed that present young women with safer economic gateways to create and consume alternative symbols of modernity and social inclusion.

BackgroundYoung people constitute a major proportion of the general population and are influenced by a variety of factors, especially in regards to seeking help. An understanding of help-seeking behaviors among young people is important for designing and implementing effective targeted health services.MethodsWe conducted in-depth interviews with 23 young adults aged 21–22 years in Soweto, South Africa, to explore the gender dimensions of social networks and help-seeking behaviors.ResultsWe found that young men had larger peer social networks than young women and that young women's social networks centered on their households. For general health, both young men and young women often sought help from an older, maternal figure. However, for sexual health, young men consulted their group of peers, whereas young women were more likely to seek information from one individual, such as an older female friend or family member.ConclusionThese differences in help-seeking behaviors have important implications for the delivery of health information in South Africa and how health promotion is packaged to young men and women, especially for sexual and reproductive health issues. Peer educators might be very effective at conveying health messages for young men, whereas women might respond better to health information presented in a more confidential setting either through community health workers or mHealth technologies. Provision of or linkage to health services that is consistent with young people's health-seeking behavior, such as using peer educators and community health care workers, may increase the reach and utilization of these services among young people.

abstractThe importance of engaging young people on issues of gender and sexuality in research has been widely acknowledged; however, young people of diverse sexualities have largely been excluded from research. Research that has been conducted with lesbian adolescents has mostly focused on risks that they face, for example risks of homophobic victimisation and increased vulnerability to mental health problems. Focusing solely on ‘risk’ makes invisible other dimensions of young people’s lives that may be deemed pleasurable and empowering. In this article we present preliminary findings from a participatory photovoice project with young black lesbian and bisexual women in the Western Cape. The project involved the development of photostories, and the collection of interview and focus group data with 14 young women between the ages of 13 and 17 years who identify as lesbian and bisexual. The young women’s stories and narratives illustrate their ‘speaking back’ to dominant representations of the lives of black lesbian and bisexual women in South Africa. We also discuss the implications of this research, focusing on how photovoice methodology can be used as an empowering method to engage young people who may be stigmatised or marginalised.

Objectives: Psychological stress is an important determinant of health, including for mental well-being and sexual health. However, little is known about the prevalence and psychosocial and sexual health correlates of perceived stress among young people in South Africa, where elevated life-stressors are an important driver of health inequities. This study examines the association between intimate partner violence (IPV), psychosocial and sexual health, and perceived stress, by gender, among South African adolescents and young adults.Methods: Using baseline survey data from AYAZAZI, a cohort study enrolling youth (16–24 years) from Durban and Soweto, we used the 10-item Perceived Stress Scale (PSS-10) to measure the degree to which an individual perceives their life situations as unpredictable, uncontrollable, and overloaded. Possible scores range between 0 and 40; higher scores indicating higher perceived stress. Crude and adjusted gender-stratified linear regression models examined associations between sexual health factors, experiences (young women) and perpetration (young men) of IPV, anxiety (APA 3-item Scale, ≥2 = probable anxiety), and depression (10-item CES-D Scale, ≥10 = probable depression) and perceived stress. Multivariable models adjusted for age, income, sexual orientation, and financial dependents.Results: Of the 425 AYAZAZI participants, 60% were young women. At baseline, 71.5% were students//learners and 77.2% earned ≤ ZAR1600 per month (~$100 USD). The PSS-10 had moderate reliability (α = 0.70 for young women, 0.64 for young men). Young women reported significantly higher mean PSS scores than young men [18.3 (6.3) vs. 16.4 (6.0)]. In adjusted linear regression models, among young women experiences of IPV (β = 4.33; 95% CI: 1.9, 6.8), probable depression (β = 6.63; 95% CI: 5.2, 8.1), and probable anxiety (β = 5.2; 95% CI: 3.6, 6.8) were significantly associated with higher PSS scores. Among young men, ever perpetrating IPV (β = 2.95; 95% CI: 0.3, 5.6), probable depression (β = 6; 95% CI: 4.3, 7.6), and probable anxiety (β = 3.9; 95% CI: 2.1, 5.8) were significantly associated with higher perceived stress.Conclusion: We found that probable depression, anxiety, perpetration of IPV among young men, and experiences of IPV among young women, were associated with higher perceived stress. Critical efforts are needed to address the gendered stressors of young men and women and implement services to address mental health within violence prevention efforts.

South Africa (SA) has the highest burden of childhood HIV infection globally, and has high rates of adolescent and youth pregnancy. To explore risks associated with pregnancy in young HIV-infected women, we compared mother-to-child transmission (MTCT) of HIV and maternal and infant health outcomes according to maternal age categories. A cohort of HIV-positive pregnant women and their infants were followed up at three sentinel surveillance facilities in the Nelson Mandela Bay Metropolitan (NMBM) district, Eastern Cape Province, SA. Young women were defined as 24 years old and adolescents as 19 years. The effect of younger maternal age categories on MTCT and maternal and child health outcomes was assessed using log-binomial and Cox regression controlling for confounding, using women aged > 24 years as the comparison group. Of 956 mothers, 312 (32.6%) were young women; of these, 65 (20.8%) were adolescents. The proportion of young pregnant women increased by 24% between 2009/10 and 2011/12 (from 28.3% to 35.1%). Young women had an increased risk of being unaware of their HIV status when booking (adjusted risk ratio (aRR) 1.37; 95% confidence interval (CI) 1.21 - 1.54), a reduced rate of antenatal antiretroviral therapy (ART) uptake (adjusted hazard ratio 0.46; 95% CI 0.31 - 0.67), reduced early infant HIV diagnosis (aRR 0.94; 95% CI 0.94 - 0.94), and increased MTCT (aRR 3.07; 95% CI 1.18 - 7.96; adjusted for ART use). Of all vertical transmissions, 56% occurred among young women. Additionally, adolescents had increased risks of first presentation during labour (aRR 3.78; 95% CI 1.06 - 13.4); maternal mortality (aRR 35.1; 95% CI 2.89 - 426) and stillbirth (aRR 3.33; 95% CI 1.53 - 7.25). An increasing proportion of pregnant HIV-positive women in NMBM were young, and they had increased MTCT and poorer maternal and infant outcomes than older women. Interventions targeting young women are increasingly needed to reduce pregnancy, HIV infection and MTCT and improve maternal and infant outcomes if SA is to attain its Millennium Development Goals.

Based on 25 case studies from the global comparative study ‘GENNOVATE: Enabling gender equality in agricultural and environmental innovation’, this paper explores rural young women’s and men’s occupational aspirations and trajectories in India, Mali, Malawi, Morocco, Mexico, Nigeria, and the Philippines. We draw upon qualitative data from 50 sex-segregated focus groups with the youth to show that across the study’s regional contexts, young rural women and men predominantly aspire for formal blue and white-collar jobs. Yet, they experience an aspirationachievement gap, as the promise of their education for securing the formal employment they seek is unfulfilled, and they continue to farm in their family’s production. Whereas some young men aspired to engage in knowledge-intensive or ‘modern’ agriculture, young women did not express any such interest. Framing our analysis within a relational approach, we contend that various gender norms that discriminate against women in agriculture dissuade young women from aspiring for agriculture-related occupation. We discuss the gendered opportunity spaces of the study sites, the meanings these hold for allowing young women and men to achieve their aspirations and catalyze agricultural innovation, and implications for agricultural policies and research for development. Our findings show that youth and gender issues are inextricably intertwined and cannot be understood in isolation one from the other.

Biomedical and behavioral interventions have led to significant success in the prevention of HIV/AIDS. However, in rural communities, structural violence persists and continues to create barriers to the uptake and utilization of health services, especially among young women. To overcome these barriers, community-led initiatives have provided a range of interventions, including safe spaces (i.e., vetted meeting venues where girls come together to discuss issues affecting their wellbeing and access health services, such as PreP) for young women. Although these spaces provide a safe haven for at-risk girls and young women, the role of community safe spaces in overcoming structural violence remains under-explored in literature. Using the structural violence framework, this study explored how community-led safe spaces for HIV prevention programs can overcome structural forces - policies, norms, or practices - that perpetuate structural violence and prevent access to healthcare services among young girls and women in Kisumu, Kenya. We purposively recruited young women (n = 36) enrolled in the Pamoja Community-Based Organization's DREAMS program in Kisumu, Kenya. Data were collected from the 2022-2023 cohort between June and July 2023 using semi-structured, in-depth interviews (n = 20) and two focused group discussions (n = 16). Guided by thematic analysis, data were analyzed in Atlas.Ti and organized into themes. This study found that community approaches such as safe spaces are instrumental in overcoming structural violence among young women by addressing three forms of barriers - institutional, sociocultural, and economic barriers - that limit HIV support service access. Institutional barriers encompassed distance and time to health facilities and provider attitude, while sociocultural barriers included knowledge gaps, stigma, cultural norms, beliefs, and practices, limiting health service access. Lastly, the socioeconomic barriers highlighted inadequate income, financial literacy, and financial dependency. Community safe spaces are vital for decreasing vulnerability and serve as critical points for accessing services and building capacity for young women. This is particularly important in rural areas where retrogressive societal norms create obstacles to obtaining essential health services. To effectively overcome structural violence, however, government support and a suitable policy environment are essential for implementing interventions to address the underlying root causes of structural violence and sustaining community-based safe spaces.

BackgroundStudies exploring the sexual and reproductive health (SRH) of refugee women have focused primarily on first generation refugees in humanitarian and crisis settings. There is a paucity of research exploring the reproductive health of girls and young women who are born to refugee parents in a host country or who have migrated with their parents at a very young age and who have since reached sexual maturity. We conducted a qualitative study which aimed to explore the reproductive health and rights’ needs and challenges amongst young refugee women in South Africa.MethodsThe study was carried out in the city of eThekwini (Durban) in South Africa in 2021 and 2022. A total of 35 semi-structured, in person interviews were conducted amongst young refugee women between the ages of 18 and 24 years living in the city centre.ResultsTwenty-five participants were 17 years or younger on arriving in South Africa, one of whom was born in South Africa. Eleven of these women had experienced one or more pregnancies while living in South Africa and all of these women had experienced at least one unintended pregnancy. Participants had poor reproductive health knowledge of the role of menstruation and how conception occurs. Economic, social, and legal insecurities intersected in complex ways as determinants of poor reproductive health outcomes. Despite availability, contraceptive use was poor and linked to lack of knowledge, myths and unwanted side effects. There were negative economic and social impacts for young refugee women experiencing early pregnancies irrespective of whether they were intended or not. Being unable to conceive or experiencing an unintended pregnancy negatively impacted sexual relationships which were entered primarily for material support. Desire for confidentiality shaped lack of access to legal termination of pregnancy in the public health sector.ConclusionParticipants experienced specific vulnerabilities resulting from their position as refugees despite length of stay in South Africa. It is important to better understand these specificities in the design of programmes and policies aimed at ensuring positive health outcomes for these young women. Peer education amongst refugee communities may be an important tool in the provision of culturally acceptable SRH education.

This community case study highlights how Khmer Girls in Action (KGA), a Southeast Asian young women-led organizing group in Long Beach, California, enacts healing justice. Healing justice is a framework for both transforming structures at the crux of health inequities and healing emotional, spiritual, and psychological wounds inflicted by structural violence. KGA also anchors the cross-racial and intersectional Invest in Youth (IIY-LB) coalition. IIY-LB youth leaders have successfully fought to increase the city's investments in the social determinants of health, especially young people's well-being. Meanwhile, the coalition has critiqued over-investments in criminalization and policing as devastating Black, Brown, queer, low-income, immigrant, and refugee youth and communities. This case study highlights how KGA's work expands understandings of both anti-Asian racism and public health solutions in the following ways: First, KGA cultivates youth leaders' critical analyses to define root causes of health inequities impacting Southeast Asian refugees as rooted in imperialism, disinvestment, and increased criminalization. Furthermore, youth leaders come to understand how their communities' struggles and liberation necessitate intersectional and cross-racial coalitions. Second, youth leaders forge public health solutions that involve divesting from criminalization and institutionalizing an Office of Youth Development, as co-created with young people. Third, KGA and other IIY-LB organizations cultivate youth's leadership skills and community's political power to move hearts and minds of decision-makers and community members. For example, youth leaders have passed a ballot measure funding youth, climate, and health programs in addition to the city-based Office of Youth Development. Fourth, KGA engages in a wide range of "inward" healing practices to salve wounds caused by intergenerational trauma. This case study contributes to Asian American health equity by highlighting the specific importance of organizing, while illuminating abolitionist perspectives on public health solutions- both of which are under-discussed in discourse about anti-Asian racism. KGA's work thus illustrates the importance of centering critical analyses and leadership of communities most impacted by structural violence in forging transformative public health solutions to anti-Asian racism.

This chapter explores the mobilization and participation of young men and women in the 1980s township uprisings in South Africa—a period of unprecedented protest and political violence that preceded the country’s transition to democracy in 1994. Much of the existing research on the young ‘comrades’ who became the shock-troops of the country’s liberation struggle during these years focuses on boys and young men, taking males as the default agents of protest and political violence. This is something common to many studies of insurgency, which often take male experience as the norm in theorizing why people join rebel groups or participate in conflict. Drawing on oral history interviews with former young activists from South Africa, this chapter asks what motivated girls and young women in the country’s townships to make the unconventional decision to become a ‘comrade’. It argues that while both young men and women shared many grievances that drew them towards the liberation movement, and shared similar emotional benefits from their participation, both these push and pull factors were shaped by and experienced through young people’s gender. While young women did not generally join the struggle in the hopes of advancing gender equality, they nevertheless found that engaging in activism and violence provided them a means of challenging the gendered inequality and victimization they experienced as girls.

Using a social ecological approach (Bronfenbrenner) to violence and including Hobsbawm’s historical analysis of the collective uses of violence, this article shows how gender-based violence is experienced and used. Drawing on three distinct studies in Ghana, Kenya and South Africa, it shows the commonalities and divergence of young people’s experiences of violence. It links the microsystems of school, community, street and family with the larger macrosystems of poverty, government policies, power relations and structural violence. This approach highlights the relationship between the forms of gender-based violence, youth experience, and the marginalized and deprived habitats in which our research was conducted. Violence experienced by young women is shown to be linked to the ways in which young men use violence as vehicles of revenge and retribution, a desire for respect, expression of love of a mother, control over female sexuality and, ultimately, assertion of collective notions of masculinity on the street and in sprawling urban settlements. We conclude by attempting to identify what is needed to challenge the violence inflicted by poverty on young people, especially young women, the denial of their rights, and the violence they inflict on themselves and others.