"If she was a man, none of this could have happened to her": Social representations of gendered vulnerability to HIV in narratives written by female and male Kenyan youth Open Access

Abstract

Background: Young Kenyan women aged 15-24 years are more than twice as likely to have HIV than young men of the same age. HIV prevention efforts have yet to eliminate this gender disparity, as they have largely focused on individual-level strategies that fail to adequately address the underlying structural and cultural vulnerabilities that put young women at increased risk.

Objective: This research sought to better understand the contextual factors and cultural meanings that inform gendered vulnerability to HIV in Kenya by analyzing youth-written narratives from the 2014 Global Dialogues contest. Global Dialogues is an international script-writing contest that invites youth to write scripts for short films to educate their communities about HIV/AIDS.

Methods: A random sample of 110 narratives, stratified by age, place of residence, and sex of author, was analyzed. Descriptive statistics of quantifiable narrative elements (e.g. sex of character contracting HIV) were generated, and narratives from the 15-19 year-old strata (n=40) were analyzed qualitatively to better understand representations of female and male characters, gendered risk factors, and blame for HIV infection. Texts by male and female authors were compared.

Results: Representations of female protagonists were overwhelmingly negative, falling into one of three categories: a good girl gone 'bad', a scheming or unfaithful woman, or a victim of gendered socio-cultural norms and structural constraints. All contracted HIV and, with little exception, were blamed for their infections, and experienced tragic outcomes. Representations of male protagonists were less easily categorized and mitigating circumstances were often presented for their HIV infections. Tragic outcomes occurred less for male protagonists, and they were more likely to access ARVs. Peer pressure was an important risk factor for male and female characters. Female characters were additionally subject to: partner pressure for sex, poverty, and economic dependence on men. Finally, male authors blamed female protagonists for their HIV infections more than female authors.

Conclusion: The lack of agency and stigmatizing representations of female characters points to larger socio-cultural norms and structural barriers that are placing young women at increased risk for HIV. It is recommended that youth prevention efforts adopt a gender-transformative approach. Use of combined microfinance-mentorship programs for young women should be also explored.

Table of Contents

I. Introduction……………………………………………………………………1

Problem Statement……………………………………………………………..2

Purpose Statement……………………………………………………………...3

Research Questions……………………………………………………………..3

Significance Statement……………………………………………………......4

II. Literature Review…………………………………………………………….6

HIV/AIDS and Gender Inequity…………………………….…………........6

Need for Social Structural HIV/AIDS Interventions Focusing on Gender…………12

HIV/AIDS and Gender Inequity in Kenya…………………………………13

Risk Factors for HIV/AIDS for Youth in Kenya…………………………..17

Summary…………………………………………………………………………21

III. Methods……………………………………………………………………..22

Introduction…………………………………………………………………….22

Study Population and Sample……………………………………………….23

Data Processing and Analysis……………………………………………….24

Ethical Considerations…………………………………………..……...…...26

Limitations and Delimitations………………………………………………26

IV. Results………………………………………………………………………..28

Section I. Quantitative Results………………………………….……….....28

Sex of Protagonist……………………………………………….……………..28

Narrative Subtopics…………………………………………………………....29

Who Becomes Infected with HIV?..................................................30

Mode of Transmission………………………………………………………….31

Hopefulness Post-Positive HIV Diagnosis…………………………………32

Blame for Actual or Potential HIV Infection………………………………34

Section II. Qualitative Results………………………………………………..37

Representations of Female Characters……………………………………..37

Representations of Male Characters…………………………………………40

Female and Male Risk for HIV…………………………………………………43

Blame for HIV…………………………………………………………….......….49

Positive Deviants………………………………………………………………...57

V. Discussion and Conclusion…………………………………………………61

Limitations………………………………………………………………………..74

Conclusion…………………………………………………………………………74

VI. Implications/Recommendations…………………………………………77

References…………………………………………………………………………78

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Psychology, Behavioral
Keyword	Social representations HIV/AIDS risk factors Youth Gender inequities Kenya HIV/AIDS
Committee Chair / Thesis Advisor	Winskell Enger, Kate, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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