By Ca ro lAnn Da nie l, PhD, Ade lphi Unive rsity, Ca rme n L o g - - PowerPoint PPT Presentation

By Ca ro lAnn Da nie l, PhD, Ade lphi Unive rsity, Ca rme n L

• g ie , PhD, Unive rsity o f T
• ro nto

Ge nde re d Risk: Unde rsta nding the so c ia l c o nte xt o f vulne ra b ility

Ba c kg ro und

 Histo ric a lly, the c o nc e pt o f vulne ra b ility wa s fre q ue ntly use d to link

pa rtic ula r g ro ups o r po pula tio ns to HI V(F a rme r, De lo r a nd Hub e rt, 2000)

 Ha itia ns we re c o nside re d to b e o ne o f the first risk g ro ups a lo ng with g a y

me n a nd sub sta nc e a b use rs. T his le d to stig ma tiza tio n a nd disc rimina tio n

 Mo re re c e nt a ppro a c he s to unde rsta nding risk ha ve fo c use d o n

unde rsta nding the c o nte xtua l fa c to rs tha t c re a te s vulne ra b ility.

I ssue s with vulne ra b ility

 Vulne ra b ility is the e xpo sure to c o nting e nc ie s a nd stre ss, a nd diffic ulty

c o ping with the m(Wa tts a nd Bo lhe , 1993).

 Altho ug h it is we ll e sta b lishe d tha t individua ls re spo nd diffe re ntly to stre ss

a nd tra uma vulne ra b ility is fre q ue ntly use d a s if it is a sta b le , e sse ntia l c ha ra c te ristic o f individua ls o r g ro ups(De lo r a nd Hub e rt,2000)

 Gro ups tha t a re c ha ra c te rize d a s vulne ra b le to HI

V/ AI DS a re o fte n stig ma tize d, a nd fa c e disc rimina tio n a nd o the r fo rms o f o ppre ssio n

Ba c kg ro und: c o nte xt



Curre nt po pula tio n o f Ha iti is just o ve r 10 millio n. F ifty five pe rc e nt is unde r 24 (Ha iti pa rtne rs.o rg , 2015)



sixty pe rc e nt live o n le ss tha n $2.00 pe r da y. 2.5 millio n live in e xtre me po ve rty (b e lo w $1.25 pe r da y).



Une mplo yme nt is e stima te d a t 40 pe rc e nt with up to 80 pe rc e nt une mplo yme nt a mo ng wo me n

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Mo re tha n ha lf o f the a dult po pula tio n is illite ra te inc luding 57 pe rc e nt o f wo me n

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Ha iti re po rts so me o f the wo rlds wo rse he a lth indic a to rs. Ma te rna l mo rta lity is mo re tha n five time s the Ca rib b e a n a ve ra g e . T he a lre a dy we a k he a lth c a re syste m wa s furthe r de b ilita te d b y the 2010 e a rthq ua ke a nd a c ho le ra o utb re a k le ss tha n a ye a r la te r (pa rtne rs in he a lth, 2014)



Hig h le ve ls o f g e nde r b a se d vio le nc e o fte n o c c ur witho ut punishme nt b e c a use o f po o r le g a l pro te c tio n, fe a r o f re prisa ls a nd stig ma a tta c he d to b e ing a vic tim o f se xua l vio le nc e



Ro ug hly 70 pe rc e nt o f Po rt-a u-Pric e ’ s pre e a rthq ua ke po pula tio n live d in info rma l se ttle me nts with o ut a c c e ss to b a sic se rvic e s. T he c o nditio ns in the se se ttle me nts we re furthe r e xa c e rb a te d b y the 2010 e a rthq ua ke .



Of the 1.5 millio n displa c e d fro m the ir ho me s b y the e a rthq ua ke a b o ut 200,00 re ma in in inte rna lly displa c e d pe rso ns (IDP) c a mps

(USAID/ Ha iti 2016;Ce nte r fo r E c o no mic a nd Po lic y Re se a rc h 2014)

HI V/ AI DS a mo ng Ha itia ns

 2.2 pe rc e nt pre va le nc e ra te a mo ng pe o ple a g e 15-49.  Sig nific a nt g e o g ra phic va ria tio n in pre va le nc e a nd inc ide nc e with a lo w o f 0.7

a nd a hig h o f 6.80 (UNAIDS Glo b a l re po rt 2014)

 56% o f g irls a nd 79% o f b o ys ha ve se x b e fo re the a g e o f 15(WHO, 2013)  Hig h pre va le nc e o f multiple pa rtne rs(UNAIDS, 2013 Glo b a l Re po rt)  Girls 15-24 ha ve ra te s do ub le tho se o f yo ung me n  L

• w c o ndo m use . Only 1 in 3 re po rt using a c o ndo m(UNAI

DS Ca rib b e a n 2013)

 Sixty pe rc e nt o f a ll ne w infe c tio ns a mo ng yo ung pe o ple a g e d 15-24 o c c urre d in

yo ung wo me n

 18 pe rc e nt pre va le nc e a mo ng me n who ha ve se x with me n(ma y e ng a g e in

he te ro se xua l o r b ise xua l re la tio nships to re duc e risk o f vio le nc e a nd disc rimina tio n a s a re sult o f ho mo pho b ia

Study Sa mple

24 yo ung wo me n a g e s 18-24 All pa rtic ipa nts live d in te nts 90% o f pa rtic ipa nts we re une mplo ye d b ut e nro lle d in sc ho o l ma jo rity we re unma rrie d Mo re tha n ha lf ha d c hildre n

Study me tho ds

T he re se a rc h re po rte d he re use d a n e thno g ra phic re se a rc h de sig n. I nfo rma tio n wa s c o lle c te d using pa rtic ipa nt o b se rva tio n, in-de pth inte rvie ws a nd fo ur fo c us g ro ups T his a ppro a c h wa s c o mple me nte d b y a la rg e r pho to vo ic e study with 48 te nt dwe lling yo uth- 24 ma le s a nd 24 fe ma le s a g e s 18-24. Pa rtic ipa nts we re g ro upe d b y g e nde r a nd a g e . T he ma in o b je c tive o f the re se a rc h wa s to unde rsta nd HI V pre ve ntio n prio ritie s a mo ng yo ung wo me n a nd me n in L e o g a ne , Ha iti

Ana lysis

Our a ppro a c h to unde rsta nding HIV pre ve ntio n prio ritie s wa s to lo o k a t e ve ry da y b e ha vio rs tha t c re a te s vulne ra b ility T he fo c us he re is o n tra nsa c tio na l se x (T S)(the e xc ha ng e o f mo ne y a nd g ifts fo r se xua l fa vo rs). T he lite ra ture ha s c le a rly ide ntifie d its link to HIV. T he re a re 3 ma in po rtra ya ls: Wo me n a s vic tims o f the la rg e r struc tura l a nd c ultura l fo rc e s tha t sha pe the ir risk b e ha vio r Wo me n a s so c ia l a g e nts who ra tio na lly ne g o tia te the ir se xua l re la tio nships to se c ure re so urc e s the y no rma lly wo uld no t ha ve a c c e ss to a nd Ag e nc y/ struc ture de b a te - wo me n a re no t e ntire ly vic tims b ut the y a re a lso no t in c o ntro l o f the ir se xua l re la tio nships We wa nte d to unde rsta nd the :



T he ma g nitude o f tra nsa c tio na l se x ( the e xc ha ng e o f mo ne y o r g ifts fo r se xua l fa vo rs)



Wha t a re the so c ia l, c ultura l o r e c o no mic me c ha nisms tha t le d yo ung wo me n to e ng a g e in T S



Are the se wo me n vic tims o r a g e nts?

Ana lytic F ra me wo rk

T

• disc e rn the pro c e sse s o f vulne ra b ility to T

S a mo ng I D yo ung wo me n we use d a typo lo g y a do pte d fro m De lo r a nd Hub e rt(2000) a nd Wa tts a nd Bo lhe (1993 )a nd the ir inte rse c tio ns. T he c a te g o rie s a re :

 so c ia l ide ntity – the fa c to rs tha t c ha ra c te rize s a n individua l’ s so c ia l a nd

a ffe c tive ne e ds

 so c ia l inte ra c tio ns– the c ultura l/ so c ia l no rms g o ve rning se xua l re la tio nships  So c io - struc tura l c o nte xt- T

he po litic a l, e c o no mic a nd symb o lic c o nte xt within whic h se xua l risk ta ke s pla c e .

Ra tio na l fo r this a ppro a c h

De sc rib ing a nd ide ntifying e ve ry da y situa tio ns o f vulne ra b ility is a n impo rta nt pre re q uisite to unde rsta nding risk a nd de ve lo ping c o nte xt a nd a ppro pria te inte rve ntio n pro g ra ms. A fo c us o n the unde rlying pro c e sse s:

 c o mple xifie s the me c ha nisms invo lve d in HI

V risk a nd re duc e s the te nde nc y to pre sc rib e risk to a sing le c a use

 a llo ws fo r unde rsta nding individua l b e ha vio r within the g ro up. Wha t ma ke s

so me individua ls mo re vulne ra b le tha n o the rs a nd wha t a c c o unts fo r the se diffe re nc e s a nd a s De lo r a nd Hub e rt(2000)po ints o ut

 it turns the spo tlig ht a wa y fro m the na rro w sing ula r no tio n o f risk g ro up to

unde rsta nding ho w b e lo ng ing to a g ro up inc re a se s o r de c re a se s vulne ra b ility to a risk.

Ma te ria l e xc ha ng e fo r se x a mo ng yo ung Ha itia n wo me n

T ra nsa c tio na l se x is ve ry c o mmo n. All pa rtic ipa nts a c kno wle dg e tha t the y kno w o f a nd ha ve pa rtic ipa te d in it. T S inc re a se d risk in 3 prima ry wa ys:

 I

t c re a te d furthe r b a rrie rs to c o ndo m use

 I

t pro vide d a ra tio na l fo r c ha ng ing pa rtne rs fre q ue ntly o r ha ving multiple pa rtne rs

 I

t e nc o ura g e d risky se xua l b e ha vio rs Ag e nc y/ struc tura l dyna mic de pe nds o n the le ve l o f a na lysis

Ag e nc y/ struc tura l dyna mic de pe nds o n the le ve l o f a na lysis

We a na lyze d the vulne ra b ility a nd risk a lo ng 3 dime nsio ns

 I

de ntity a nd a ffe c tive ne e ds

 I

nte ra c tio n within se xua l re la tio nships

 So c io struc tura l c o nte xt o f se xua l re la tio nships

I de ntity vulne ra b ility: psyc ho so c ia l b e ne fits o f unpro te c te d se x



Sta tus a nd pre stig e . (judg e b y pe e rs a nd e xpe c te d to lo o k a nd dre ss nic e ly). T he mo re g ifts yo u re c e ive the mo re sta tus yo u ha ve . Sa fe r se x ma y no t se e m wo rth the e ffo rt g ive n the c o nse q ue nc e s invo lve - lo we re d sta tus, da ma g e d se lf e ste e m a nd fina nc ia l je o pa rdy



Ne e d fo r c o mmitme nt. Unpro te c te d se x is ne c e ssa ry fo r ma le suppo rt. I ts a wa y to ple a se a pa rtne r- Ag re e ing to unsa fe se x ma y a lso sig na l a de sire fo r c o mmitme nt a nd/ o r re pre ss kno wle dg e o f a re la tio nships fra g ility



Wo me n de pe nd o n me n fo r sta tus a nd va lida tio n. Unsa fe se x is pre fe ra b le to ruining o ne s se lf e ste e m a nd so c ia l sta nding



F e rtility a s so c ia l suppo rt a nd e c o no mic fe rtility. Ha ving a c hild is a n impo rta nt pa rt o f b e ing a wo ma n a nd me mb e rship in the fe ma le ne two rk. Ha ving a c hild a lso b inds yo u to a ma n fo r life . I t’ s a wa y to e sta b lish a struc tura l link to me n a nd se c ure future fina nc ia l ne e d. Sa fe witho ut a c o ndo m is ne c e ssa ry to ha ve a c hild



Pe e r pre ssure to e ng a g e in T S



Ne e d fo r c o nsumptive a nd ma te ria l g o o ds

I nte ra c tio na l vulne ra b ility: Ra tio na l fo r ha ving multiple pa rtne rs



Co ndo m use is no t pa rt o f the se xua l re pe rto ire . Ma ny do no t kno w ho w to use the m. Whe n pa rtic ipa nts spo ke o f using a c o ndo m it wa s to a vo id pre g na nc y



Pa rtne r re fusa l- Ac c o rding to pa rtic ipa nts me n wo uld do a nd sa y a nything to a vo id using a c o ndo m



Pa rtic ipa nts re a dily a c kno wle dg e tha t me n wo uld b e a t the m if the y insist o n c o ndo m use



Co ndo ms imply infide lity a nd pro misc uity



Culture o f wo me n a c q uie sc ing to me n’ s se xua l ne e ds

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Me n who g ive g ifts do no t wa nt to use a c o ndo m



Co ndo m le ss se x o utwe ig hs the risk o f insisting o n sa fe se x whic h c o uld le a d to a b use , lo ss o f a pa rtne r

• f, c hildle ssne ss



Mo ne y a nd g ifts re c e ive d a re sha pe d b y the b a rg a ining po we r o f the pa rtne rs (me n ta ke a dva nta g e o f g irls who ha ve no inc o me )



Pa rtic ipa nts suppo rte d the b e lie f tha t mo st wo me n a re de pe nde nt o n me n fo r fina nc ia l ne e d a nd must a c q uie sc e whe n me n re fuse to use a c o ndo m.



Se xua l c o e rc io n. (if the y ta ke a g ift a nd re fuse to ha ve se x the y c o uld b e b e a te n. Wo me n who ta ke g ifs a nd the n re ne g e s a re no t suppo rte d b y the c o mmunity. Gifts to fa mily a lso e nsure o b lig a tio n )

so c io -struc tura l vulne ra b ility: T he b e ne fits o f se xua l risk

 Surviva l ne e ds- la c k o f o ppo rtunitie s to me e t o ne ’ s surviva l ne e ds  Ge nde r ine q ua lity- hig h une mplo yme nt, lo w lite ra c y, hig h ra te s o f

unpunishe d g e nde r b a se d vio le nc e

 L

a c k o f pa re nta l suppo rt- Pa re nts c a nno t pro vide fo r the m

 Upwa rd mo b ility- So me time s ta king risk is the o nly wa y to impro ve fina nc ia l

sta nding

 E

xtre me po ve rty- HI V is just o ne o f the ma ny risks yo ung pe o ple fa c e in c o nditio ns o f e xtre me po ve rty. la c k o f se xua l a nd re pro duc tive he a lth se rvic e s fo r e xa mple .

Disc ussio n

 Yo ung wo me n's po we r in se xua l re la tio nships de pe nds o n the le ve l o f

a na lysis

 So me a g e nc y a t the so c ia l ide ntity le ve l. Wo me n c ho se the ir pa rtne rs a nd

c a n re fuse a ma n b ut the ir so c ia l a nd a ffe c t ne e ds o fte n le a d to hig h risk b e ha vio r

 At the inte ra c tio na l le ve l, wo me n ha ve so me po we r de pe nding o n he r

a c c e ss to e c o no mic re so urc e s a nd fa mily suppo rt. c ultura l no rms a lso sha pe re la tio nship po we r.

 On the so c io / struc tura l le ve l the fa c to rs sha ping T

S o ve rwhe lming ly fa vo rs me n( wo me n’ s la c k o f so c io e c o no mic po we r, hig h une mplo yme nt, g e nde r ine q ua lity a nd e c o no mic de pe nde nc e o n me n)

F unding

T ha nks to Ca na dia n I nstitute s o f He a lth Re se a rc h (CI HR) Pla nning Gra nt who se funding ma de this re se a rc h po ssib le T he pe e r re se a rc he rs Pa rtic ipa nts

Quo te s

“T he re a re no jo b s, pa re nt a re no t a b le to he lp. T ha t is wha t yo u find a lo t a ro und he re so the ma jo rity o f wo me n a re sle e ping with me n fo r so me thing ” “T he re so me who do this fo r so me thing po sitive like pa ying fo r the ir sc ho o l, b ut the re a re so me who just ma ke a life style o f it. “F

• r so me g irls yo u just g ive the m a suit c a se full o f c lo the s a nd the y a re ha ppy. T

he will te ll tha t the ir c irc umsta nc e s ha ve le a d the m to this. T he y ha ve kids to fe e d b ut the y a lso g e t c a ug ht up in this kind o f life b e c a use o f frie nds” (Girl 18-19) “A lo t o f pa re nts g e t tire d o f he lping o lde r kids, the y te ll the m the y a re o ld e no ug h to c a re fo r the mse lve s. I ha ve a frie nd who ha d this o lde r ma n c ha sing he r. She didn’ t like him so ne ve r a g re e d to da te him, b ut he r pa re nts a re ta king mo ne y fro m him o n he r b e ha lf. T he n o ne nig ht the mo the r tie d he r do wn a nd le t the ma n ha ve se x with he r ” (Girl 20-22)

 I

think yo ung pe o ple suffe r a lo t fro m vio le nc e . So me time s yo u me e t a g uy a nd he sa ys he will do suc h a nd suc h fo r yo u b ut yo u ha ve to sle e p with him e ve n if yo u do n’ t wa nt to . I f yo u ta ke the g ifts yo u ha ve to do it.

 No t b e c a use yo u a re living in a te nt. Yo u ha ve to lo o k g o o d.Whe n yo u

re a c h 18-20 ye a rs o ld so me pa re nts will te ll yo u tha t yo u a re a yo ung wo ma n no w. So yo u ha ve to hustle to g ive yo urse lf wha t yo u ne e d. Yo u ha ve to find a ma n to g ive yo u wha t yo u ne e d. So yo u a re o b lig e d to do this.

 T

he y a lwa ys sa y a wo ma n is b o rn with he r we a lth.

“T he re a re no jo b s, pa re nt a re no t a b le to he lp T ha t is wha t yo u find a lo t a ro und he re . T he ma jo rity o f wo me n a re sle e ping with me n fo r so me thing ” “T he re so me who do e s tha t fo r so me thing po sitive like pa ying fo r the ir sc ho o l, b ut the re a re so me who just ma ke a life style o f it. T he y a lso sta rt to use drug ” “F

• r so me g irls yo u just g ive the m a suit c a se full o f nic e c lo the s a nd the y a re

ha ppy” “If yo u a re o ne in ne e d yo u c a nno t a sk a ma n to use a c o ndo m” (Girl 18-19). “T he re a re g uys who a re ta king c a re o f yo u a nd the y insist o n ha ving se x witho ut a c o ndo m. If yo u do n’ t ha ve the me a ns, yo u will” (Girl 20-21) “A lo t o f g irls, e spe c ia lly tho se who a re sle e ping with so me o ne fo r mo ne y, think the y do n’ t ha ve a ny rig hts. T he y must do wha t the ma n wa nts” (g irl 24).