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HIV Risk Among Displaced Adolescent Girls in Ethiopia: the Role of Gender Attitudes and Self-Esteem

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Abstract

Adolescent girls in sub-Saharan Africa have been deemed one of the most critical populations to address in the campaign for an HIV-free generation. Experiences of intimate partner violence (IPV), harmful gender norms, diminished personal agency, and age-disparate sex have been identified as factors in the increasing rate of new infections among this population. Using baseline data from a cluster-randomized controlled trial in three refugee camps in Benishangul-Gumuz Regional State in Ethiopia, our study quantitatively examined the associations between HIV risk factors, attitudes on gender inequality, IPV acceptability, and self-esteem for female adolescent refugees primarily from Sudan and South Sudan (n = 919). In multivariate models, adjusting for age and education, results showed girls who were more accepting of gender inequitable norms and IPV had greater odds of ever experiencing forced (OR 1.40, CI 1.15–1.70; OR 1.66, CI 1.42–1.94) or transactional sex (OR 1.28, CI 1.05–1.55; OR 1.59, CI 1.37–1.85) compared to girls who demonstrated less approval. Higher self-esteem was associated with increased odds of condom use (OR 1.13, CI 1.02–1.24) as well as decreased odds of adolescent marriage (OR 0.93, CI 0.90–0.95), age-disparate sex (OR 0.90, CI 0.86–0.94), and transactional sex (OR 0.96, CI 0.93–0.99). The findings suggest acceptance of inequitable gender norms (including those that perpetuate violence against women) and low self-esteem to be associated with common HIV risk factors among refugee adolescents living in Ethiopia. Greater attention towards the intersections of gender equality and self-valuation is needed when seeking to understand HIV risk among refugee adolescent girls in sub-Saharan Africa.

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Acknowledgements

The authors wish to thank the collaborators from Columbia University, IRC Ethiopia, and IRC headquarters. We are also grateful to the adolescent girls who are participating in the COMPASS research study.

Funding

This document is an output from a project funded with UK aid from the UK Department for International Development (DFID) for the benefit of developing countries (grant #40080602). However, the views expressed and information contained in it are not necessarily those of or endorsed by DFID, which can accept no responsibility for such views or information or for any reliance placed on them.

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Authors and Affiliations

  1. Columbia University School of Social Work , 1255 Amsterdam Ave., New York, NY, 10027, USA

    Laura Gauer Bermudez & Gary Yu

  2. Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, NY, 10032, USA

    Gary Yu, Lily Lu & Lindsay Stark

  3. NYU Rory Meyers College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA

    Gary Yu

  4. The International Rescue Committee, 1730 M St NW, Washington, DC, 20036, USA

    Kathryn Falb

  5. The International Rescue Committee, TK International Bldg. 6th Floor, Bole Rd, Addis Ababa, Ethiopia

    Jennate Eoomkham & Gizman Abdella

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  1. Laura Gauer Bermudez
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Contributions

LGB conceptualized the paper topic and drafted the manuscript. GY led data analysis for the paper. LL contributed to drafting of the manuscript. LS is the PI for the COMPASS study, the parent grant on which the results presented here are based. LS, KF (co-I of the study), JE, and GA reviewed and contributed to the draft. All authors approved the final version of the manuscript.

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Correspondence to Lindsay Stark.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and it slater amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Bermudez, L.G., Yu, G., Lu, L. et al. HIV Risk Among Displaced Adolescent Girls in Ethiopia: the Role of Gender Attitudes and Self-Esteem. Prev Sci 20, 137–146 (2019). https://doi.org/10.1007/s11121-018-0902-9

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