Gender Differences and Relationship Power Could be Key in Preventing HIV Among South African Adolescents

Millions of those infected with HIV worldwide are young women, ages 15-24, according to the World Health Organization. Because the HIV epidemic overlaps with an epidemic of intimate partner violence (IPV) against women and girls, researchers have suspected a correlation between inequities in relationship power and the risky sexual behavior that can lead to HIV transmission.

A new research study from the University of Pennsylvania’s School of Nursing (Penn Nursing), Annenberg School for Communication, and Perelman School of Medicine investigated and confirmed those associations of intimate partner violence (IPV) and relationship power with sexual-risk behaviors in adolescents. The researchers identified promising pathways to reduce IPV and help prevent HIV infection, including promotion of gender equity as a social norm. The findings are set for publication in an upcoming issue of Health Psychology.

The research was conducted in South Africa, where the prevalence of both HIV and IPV is high and men often have more power in relationships than women. The team assessed data from more than 700 sexually experienced adolescents in Eastern Cape Province, South Africa who had been followed at regular intervals for 54 months as part of a separate NIH-funded trial.

The researchers focused on HIV sexual risk-related behaviors including condom use and having multiple sex partners, and instances of intimate partner violence as well as relationship power.

Overall, 83 percent of the participants had experienced at least one type of IPV within the past year. Girls who reported suffering more instances of intimate partner violence were less likely to use condoms the last time they had sex. In addition, both boys and girls with less power in their relationship were more likely to report sex with multiple partners in the past 3 months.

“For girls, IPV and lower relationship power affect interpersonal dynamics, which increase sexual risk through condom nonuse. In addition, girls with higher levels of relationship power are less likely to have multiple partners,” explains the article’s lead author Anne M. Teitelman, Ph.D., F.N.P-B..C, F.A.A.N.P., F.A.A.N. the Patricia Bleznak Silverstein and Howard A. Silverstein Endowed Term Chair in Global Women's Health and Associate Professor at Penn Nursing.

The research is the first known study to examine IPV and relationship power among adolescent boys in South Africa. It found that boys who reported experiencing more victimization were more likely to report having multiple partners. It also showed that boys who experience IPV and who have lower relationship power are more likely to use condoms.

The findings indicate that the impact of IPV and relationship power on sexual risk behaviors differs significantly by gender; therefore, an important consideration is how sexual risk-reduction interventions for adolescents in South Africa should be implemented.

“Our findings suggest that HIV prevention interventions should incorporate gender-specific components and not only address individual attitudes about IPV and interpersonal gender power dynamics, but use community-level approaches to change harmful social gender norms that perpetuate inequalities,” says Teitelman.

This research drew on a separate NIH-funded HIV/sexually transmitted infection (STI) risk-reduction intervention trial led by John B. Jemmott III, Ph.D., Kenneth B. Clark Professor of Communication and Psychiatry at the Penn Annenberg School for Communication and the Perelman School of Medicine at the University of Pennsylvania. That eight-year study interviewed South African adolescents at 3, 6, 12, 42, and 54 month intervals following an initial intervention. Jemmott is also an author on the current study.

In addition to Teitelman and Jemmott, the research team included Scarlett L. Bellamy, Sc.D., Penn Medicine; Larry D. Icard, Ph.D., Temple University; Ann O’Leary, Ph.D., Centers for Disease Control and Prevention; G. Anita Heeren, Ph.D., Annenberg School for Communication, University of Pennsylvania; Zolani Ngwane, Ph.D., Haverford College; and Sarah J. Ratcliffe, Ph.D., Penn Medicine.

This research was supported by National Institute of Mental Health Grants R01 MH065867 and K01 MH080649, with additional support from the Penn Center for AIDS Research, funded by National Institute of Allergy and Infectious Diseases Grant P30 AI045008.

Editor’s Note: The team of researchers report no conflicts of interest.