Ge nde re d Risk: Unde rsta nding the so c ia l c o nte xt o f vulne ra b ility By Ca ro lAnn Da nie l, PhD, Ade lphi Unive rsity, Ca rme n L o g ie , PhD, Unive rsity o f T o ro nto
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 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 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 o 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 o 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
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