TY - JOUR

T1 - Gender Norms and Structural Barriers to Use of HIV Prevention in Unmarried and Married Young Women in Manicaland, Zimbabwe

T2 - An HIV Prevention Cascade Analysis

AU - Gregson, S

AU - Moorhouse, L

AU - Maswera, R

AU - Dadirai, T

AU - Mandizvidza, P

AU - Skovdal, M

AU - Nyamukapa, C

PY - 2024

Y1 - 2024

N2 - BackgroundGender norms against adolescent girls and young women (AGYW)’s having pre-marital sex and using condoms in marriage are included as barriers to motivation to use condoms in HIV prevention cascades. Representative survey data on gender norms are needed to test this assumption.MethodsGeneral-population survey participants in Manicaland, Zimbabwe (ages≥15, N=9803) were asked if they agreed/disagreed with statements on gender norms. AGYW at risk of HIV infection were asked whether community views discouraged condom use. Multivariable logistic regression was used to measure variations in community members’ views and associations between AGYW’s perceiving negative gender norms and condom HIV prevention cascades.Results57% of men and 70% of women disagreed that ‘If I have a teenage daughter and she has sex before marriage, I would be ok with this’; and 41% of men and 57% of women disagreed that ‘If I have a teenage daughter, I would tell her about condoms’. 32% and 69% of sexually-active HIV-negative unmarried AGYW, respectively, said negative community views were important in decisions to use condoms and their friends were not using condoms. In each case, those who agreed had lower motivation to use condoms. Fewer of those with friends not using condoms reported using condoms themselves (39% vs. 68%; p<0.001). 21% of men and 32.5% of women found condom use in marriage acceptable. 74% and 93% of married AGYW at risk, respectively, said negative community views influenced their decisions to use condoms and their friends did not use condoms. Fewer married AGYW reporting friends not using condoms were motivated to use condoms but there was no difference in reported condom use (4.1% vs. 6.9%; p=0.48).ConclusionsNegative gender norms can form a barrier to motivation to use condoms in unmarried and married AGYW at risk of HIV infection, and, for unmarried AGYW, to condom use.

AB - BackgroundGender norms against adolescent girls and young women (AGYW)’s having pre-marital sex and using condoms in marriage are included as barriers to motivation to use condoms in HIV prevention cascades. Representative survey data on gender norms are needed to test this assumption.MethodsGeneral-population survey participants in Manicaland, Zimbabwe (ages≥15, N=9803) were asked if they agreed/disagreed with statements on gender norms. AGYW at risk of HIV infection were asked whether community views discouraged condom use. Multivariable logistic regression was used to measure variations in community members’ views and associations between AGYW’s perceiving negative gender norms and condom HIV prevention cascades.Results57% of men and 70% of women disagreed that ‘If I have a teenage daughter and she has sex before marriage, I would be ok with this’; and 41% of men and 57% of women disagreed that ‘If I have a teenage daughter, I would tell her about condoms’. 32% and 69% of sexually-active HIV-negative unmarried AGYW, respectively, said negative community views were important in decisions to use condoms and their friends were not using condoms. In each case, those who agreed had lower motivation to use condoms. Fewer of those with friends not using condoms reported using condoms themselves (39% vs. 68%; p<0.001). 21% of men and 32.5% of women found condom use in marriage acceptable. 74% and 93% of married AGYW at risk, respectively, said negative community views influenced their decisions to use condoms and their friends did not use condoms. Fewer married AGYW reporting friends not using condoms were motivated to use condoms but there was no difference in reported condom use (4.1% vs. 6.9%; p=0.48).ConclusionsNegative gender norms can form a barrier to motivation to use condoms in unmarried and married AGYW at risk of HIV infection, and, for unmarried AGYW, to condom use.

U2 - 10.12688/gatesopenres.15127.1

DO - 10.12688/gatesopenres.15127.1

M3 - Journal article

VL - 8

JO - Gates Open Research

JF - Gates Open Research

IS - 22

ER -