““Siyakha Nentsha”Siyakha Nentsha”Enhancing the Economic, Enhancing the Economic,

Health, and Social Health, and Social Capabilities of Highly Capabilities of Highly

Vulnerable YouthVulnerable Youth

by Kelly Hallman, Kasthuri Govender, Eva Roca, by Kelly Hallman, Kasthuri Govender, Eva Roca, Emmanuel Mbatha, Rob Pattman, Deevia Bhana and Mike Rogan Emmanuel Mbatha, Rob Pattman, Deevia Bhana and Mike Rogan

Third Annual Research Conference on Population, Reproductive Health, and Economic Third Annual Research Conference on Population, Reproductive Health, and Economic Development, Dublin, January 2009Development, Dublin, January 2009

PurposePurpose

Improve functional capabilities and well-being of adolescents at high risk for

• HIV and STIs• teenage pregnancy, parenthood• school dropout• actual or potential loss of one

or both parents• lack of knowledge of FET opps

Formative research: Formative research: vulnerabilities associated with vulnerabilities associated with

adol HIV risk behaviorsadol HIV risk behaviors

• Living in povertyLiving in poverty

• Not socially connectedNot socially connected

• OrphanedOrphaned

Poorer more likely to sexually debut earlierPoorer more likely to sexually debut earlier

Ever had sex: 14-16 years-olds

Poor Non-poor

Source: Hallman 2005, 2008a

Those with less social capital Those with less social capital more likely to experience forced sexmore likely to experience forced sex

Ever been : 14-16 year-old females

Source: Hallman 2008a, 2008b

Orphans have more Orphans have more economically-motivated sexual encounterseconomically-motivated sexual encounters

Ever traded sex: sexually debuted 14-16-year-olds

Source: Hallman 2008a, 2008c

Durban Program ScDurban Program Scan• Few youth HIV or RH programs address

social, economic, and cultural underpinnings of risk behaviors

• Few livelihood programs make conceptual link to health risk behaviors– Not context-, age-, culture- or gender-specific– Design not evidenced based – Delivery weak– Little monitoring or evaluation

MethodsMethods

InterventionIntervention

• Evidence-basedEvidence-based

• PilotedPiloted

• Multi-sectoralMulti-sectoral

• ParticipatoryParticipatory

• Intensive – multi-sessionIntensive – multi-session

Project componentsProject componentsGovernment-accredited multi-session intervention

• Increase knowledge and skills for HIV and pregnancy prevention/AIDS mitigation; accessing preventive, treatment and care services

• Develop skills to manage personal and familial resources; access existing social benefits, education and training opportunities; plan and aspire for the future; build savings/assets over time

• Build and strengthen social networks and support

Project designProject design

• Randomized to secondary school Randomized to secondary school classrooms (10classrooms (10thth and 11 and 11thth grades) in one grades) in one school wardschool ward

• Three study armsThree study arms1.1. HIV/RH, Social, Financial EducationHIV/RH, Social, Financial Education

2.2. HIV/RH, SocialHIV/RH, Social

3.3. Delayed interventionDelayed intervention

MethodsMethodsResearch

• Longitudinal survey

• Youth-conducted social mapping with presentations back to community

• Participatory photo-voice project

• Youth, parent, mentor focus groups to assess experience with intervention

MeasuresMeasures• HIV/AIDS and RH: knowledge, skills

and behaviors, including adoption of safer sexual behaviors and service use

• Economic skills: ability to plan and manage personal and familial finances, identify and access available services, FET opps, social benefits; articulate a plan for pursuing future livelihood-enhancing opportunities

• Social networks and support: access to friends, adult role models and individuals/groups who can assist with crisis management and provide links to opportunities

Project teamProject team

Selected findings Selected findings from baselinefrom baseline

Saving for something specific,Saving for something specific, by household wealth quartile by household wealth quartile

Poorest------------------------------------least poorFemales p=.28Males p=.10

First sex was tricked or forced,First sex was tricked or forced, by household wealth quartileby household wealth quartile

Females p=.51

Poorest------------------------------------least poor

Not confident knows how to use a Not confident knows how to use a condom,condom,

by household wealth quartileby household wealth quartile

Females p=.92Males p=.10

Poorest------------------------------------least poor

First sex was forced or tricked, First sex was forced or tricked, by ever employedby ever employed

by gender: tab q164 friends, col chi2

Females p=.07Males p=.04

Number of sex partners, Number of sex partners, lifetime,lifetime,

by belonging to organizations by belonging to organizations

Females p=.02Males p=.25

Used a condom at last sex,Used a condom at last sex,by belonging to organizations by belonging to organizations

Females p=.08Males p=.09

Partner always or often gives Partner always or often gives gifts,gifts,

by orphan statusby orphan status

Females p=.24Males p=.93

Have experienced unwanted sexual Have experienced unwanted sexual touching, touching, by orphan statusby orphan status

Females p=.31Males p=.08

Used a condom at last sex,Used a condom at last sex, by orphan statusby orphan status

Females p=.02Males p=.28

Rarely or never uses condoms,Rarely or never uses condoms, by orphan statusby orphan status

Females p=.05Males p=.34

Age at first sex,Age at first sex,by having a South African Identification by having a South African Identification

cardcard

Females p=.02Males p=.29

Condom use at last sex,Condom use at last sex,by having a South African Identification by having a South African Identification

cardcard

Females p=.87Males p=.005

Very confident knows how to use a Very confident knows how to use a condom,condom,

by having a South African Identification by having a South African Identification cardcard

Females p=.009Males p=.42

Participant views of financial educationParticipant views of financial education“It’s different, in school we learn mathematics and biology but here we learn things that we can use in the future.” - female age 16 years, enrolled in school

“We learnt about budgeting and saving and all those things, because we only think that when we get money we spend it. This program was like an eye-opener to us, because, we know now when we get some money, we have to save something…”

- male age 22 years, not enrolled in school

Participant views of health education

“….. I didn’t understand about HIV and AIDS before

but now I do. I didn’t learn that in school.” –female age 20 years, not enrolled in school

“It changed my attitude, because I know how to use a condom and I know how to trust my partner and I know how to advise my partner, when we are sitting together and talking about, how to have sexual intercourse and I know even to advise the community as a whole about HIV/AIDS…” –male age 22 years, not enrolled in school

Selected resources• Hallman, K. 2008a, in press. “Researching the determinants of vulnerability to HIV

amongst adolescents,” IDS Bulletin, 39(5), November 2008.• Hallman, K. 2008b, in press. “Social exclusion: The gendering of adolescent HIV

risks in KwaZulu-Natal, South Africa,” in J. Klot and V. Nguyen eds., The Fourth Wave: An Assault on Women - Gender, Culture and HIV in the 21st Century. Social Science Research Council and UNESCO.

• Hallman, K. 2008c, under review. "Orphanhood Type and Sexual Debut: A panel study from KwaZulu-Natal, South Africa," Economic Development and Cultural Change.

• Bruce, J. and Hallman, K. 2008. “Reaching the girls left behind,” Gender & Development, 16(2): 227-245.

• Hallman, K. 2007. “Nonconsensual sex, school enrollment and educational outcomes in South Africa,” Africa Insight (special issue on Youth in Africa), 37(3): 454-472.

• Hallman, K. Gendered socioeconomic conditions and HIV risk behaviours among young people in South Africa. 2005. African Journal of AIDS Research 4(1): 37–50. Abstract: http://www.popcouncil.org/projects/abstracts/AJAR_4_1.html

Thank you!Thank you!

Our funders: ESRC/Hewlett Joint SchemeOur funders: ESRC/Hewlett Joint Scheme

& DFID via the ABBA RPC& DFID via the ABBA RPC