Click to edit Master title style

Transcription

1 Click to edit Master title style Using Qualitative and Quantitative Studies Click to Better to edit Understand Master text Key styles Drivers of Multiple Concurrent Partnerships in Mozambique Second level Third level Fourth level Fifth level Dvora Joseph, HIV Director, PSI/Mozambique Co-Authors: Benjamim Macuacua, Marcos Chissano, Jennifer Wheeler, Fatima Mussa HIV Implementer s Meeting Namibia, June,

2 Overview Research conducted in Mozambique to inform interventions around multiple concurrent partnerships (MCP) 1. Qualitative PEER study on cross-generational sex among urban women (2005) 2. Quantitative study on MCP and condom use (2008) Synergy between qualitative and quantitative findings MCP program design and implementation Recommendations

3 Formative research on MCP To better understand drivers of sexual networks in Mozambique, PSI partnered with OPTIONS Consulting on qualitative study in Maputo among young women engaged in cross-generational and transactional sex Results helped design a quantitative study on MCP Using study results, interpersonal communication (IPC) program developed to address crossgenerational sex and MCP

4 Phase 1: Qualitative Study Methodology Participatory Ethnographic Evaluation and Research (PEER) Peer researchers were urban women in Maputo (16-25) involved in cross-generational and transactional sex Note: Cross-generational sex was strongly associated with transactional sex in study Women were recruited through peers and trained by OPTIONS and PSI Peers helped identify key topics and developed suggestions for their interviews

5 Phase 1: Qualitative Study, cont. Use of 3rd person during the interview allowed respondents to talk about sensitive, personal topics such as transactional sex Method generated in-depth understanding of cross-generational sex and sexual networking among young urban women Formative research to develop communication strategies targeting hard to reach groups including a community play and IPC

6 Phase 2: Quantitative Study on MCP Quantitative study was among random samples of men and women aged in select districts in Gaza, Sofala and Zambezia Provinces (n=4,180) Analysis of variance and multiple logistic regression to assess the demographic and behavioral determinants of MCP MCP was measured by using dates of first and last sex with up to 5 partners and assessing partner overlap along timeline

7 Consistent Results 1: Social norms that condone MCP and crossgenerational sex Quantitative study showed: Social norms that support cross-generational and transactional sex were correlates of MCP in all provinces (p<.05), corresponding with women s perspectives during the PEER study Qualitative study showed: Social norms support and sanction men s behavior in cross-generational relationships and assume that it is legitimate for men to experiment sexually while women assume a passive role Gender stereotypes present an image of women, and particularly girls, as sexual objects and commodities Most women do not have a good life men think women are merchandise, they have many girlfriends, and they keep it from their wife.

8 Consistent Results 2: Perception of risk and MCP Quantitative research showed: In both Gaza and Sofala men with concurrent partnerships were less likely to agree that having concurrent partnerships is a risk if they trust them (p<.05) Qualitative research showed: Women have high levels of knowledge of HIV and awareness of risks associated with unprotected sex with multiple partners However, economic power in transactional relationships means that women will accept sex without a condom The cost of losing immediate social and economic gain is greater than the risk of dying

9 Surprising and Unexpected Results. Women are active agents in cross-generational and transactional sex, and that they are aware of the risks but choose to take them Young women are involved in different types of partnerships concurrently: boyfriend, date, lover, or sengue. Each relationship has different determinants of condom use: They use a condom in relationships in which there is no trust. With the namorado it is without a condom. With the namorado there is no need. Because each thinks the other is faithful. They use condoms in occasional relationships Synergies between determinants of cross-generational and transactional sex in urban areas and MCP among general population in Mozambique

10 Conclusions The results of the qualitative and quantitative studies were mutually reinforcing PEER studies are good tools to better understand the underlying drivers of stigmatized behaviors such as cross-generational and transactional sex PEER study provided target group insight that permitted more informed interpretation of quantitative findings regarding behavioral drivers of MCP

11 Using research in program design PSI is working with the National AIDS Council, JHUCCP, N weti and FDC to develop and implement a National MCP Campaign. Collaboration to use research and develop interventions to address MCP in the community and via mass media. For example, following PEER study, PSI and partners developed interventions to address cross generational sex in the community: Community theater about cross-generational sex and risk of HIV Target is adults in communities and in-school youth IPC in communities to increase dialogue around MCP Community Agent explaining risk of sexual networks in Zambezia Province Following improved understanding of MCP as a risk (that is not limited to cross-generational sex), PSI developed: Community theater on MCP among married adults A participatory community-based intervention that shows how HIV is spread via sexual networks

12 Recommendations Based on results of both studies, PSI was better able to develop a participatory module to improve risk perception on MCP incorporating critical issues identified by the studies such as social norms around MCP MCP interventions should be preceded by both qualitative and quantitative research to better understand behaviors and behavioral drivers Young men discussing MCP with Community Agent in Zambezia Province Studies showed that there is a lack of gender analysis in relation to HIV transmission in HIV prevention messages, which results in most interventions directed at women, reinforcing gender stereotypes. Prevention messages need to address both men and women and target messages to each group

13 Acknowledgements OPTIONS Consulting and Dr. Kristan Hawkins for collaboration on PEER Study Fatima Mussa, Jennifer Wheeler, PSI/Mozambique Research team All respondents in PEER and household studies in Mozambique Obrigada!