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July 24, 2012

Melissa K. Adams 1 , Hilary Johnson 2 , Rebecka Lundgren 1 1 Georgetown University, Institute for Reproductive Health 2 Georgetown University, Conflict Resolution Program.

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July 24, 2012

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  1. Melissa K. Adams 1, Hilary Johnson 2, Rebecka Lundgren1 1 Georgetown University, Institute for Reproductive Health 2 Georgetown University, Conflict Resolution Program “Condoms are not a family planning Method”: Why efforts to prevent HIV have failed to comprehensively address adolescent sexual and reproductive health GENDER ROLES, EQUALITY AND TRANSFORMATIONS PROJECT INSTITUTE FOR REPRODUCTIVE HEALTH GEORGETOWN UNIVERSITY PATHFINDER INTERNATIONAL SAVE THE CHILDREN July 24, 2012 International AIDS Conference

  2. The GREAT Project: Overview • Goal:Improve gender equity and reproductive health outcomes in Northern Uganda • 5-year USAID funded project • Phase 1: 2010-2011 • Phase 2: 2011-2015 • Location: Northern Uganda • Prime: Georgetown University’s Institute for Reproductive Health (IRH) • Partners: • Pathfinder International • Save the Children • Beneficiary Population: Adolescent boys and girls, ages 10-19

  3. Why Gender Norms? • STIs/HIV/AIDS • Use of family planning • RH decision-making • Parenting practices • Health seeking behaviors • Gender-based violence • Unintended/unplanned pregnancy Photo Credit: Save the Children/Chad Stevens

  4. ASRH in Northern Uganda • Recovering from more than 20 years of conflict • 6.9% HIV prevalence (UAIS, 2011) • 51.7% of women have experienced IPV (Stark, 2010) • Low rates of adolescent condom and contraceptive use • High rates of unintended pregnancy, transactional sex, GBV, and induced abortion among adolescent girls • Photo Credit: Pathfinder

  5. Ethnographic Research Objectives • Understand how gender norms are learned, internalized and passed on; • why individuals would be motivated to change these norms; • and how these norms shape GBV, SRH, and FP behaviors in post-conflict Northern Uganda.

  6. Research Design and Methodology • Ethnographic, participatory, life course-tailored and activity-based • Data collection designed with youth in mind and took place from March 2011-October 2011 • 40 Life Histories collected from adolescents & 40 in-depth interviews with influencing adults • All interviews were translated, transcribed, coded and analyzed using AtlasTi Life histories with 40 adolescents at different stages in the life course Life Course Stages Very Young Adolescents Older Adolescents Newly Married Pregnant with 1st child/ Parenting 1child 40 in-depth interviews with adults selected by life history participants and directly recruited: Siblings Religious/Community Leaders Parents/Guardians Teachers Peers Extended Family

  7. Outline of Key Findings

  8. Key Findings: Gender norms and Fertility • Traditional attitudes toward gender roles held across the life course • Fertility linked to ideal masculinity and femininity • Strong norms for when and how pregnancy occur • Prevailing gender norms significantly shape fertility desires and intentions among young people

  9. Hopes and Dreams I: Among all your hopes, which one is the greatest? You talked of education having a job, and your ability to give birth. P: Giving birth is the most important. In this world if you don’t have a child then your life is worthless and people will insult you. Female, 16, older adolescent

  10. Key Findings: Attitudes toward HIV Services and Youth • HIV prevention services appear widely available • Strong community support for youth access to HIV services • Puberty brings fear of HIV and “falling in love” • HIV testing has become a courting ritual and rite of passage into sexual relationships

  11. Entering relationships “The girl should know the boy’s results and the same for the boy; he should know the girl’s results and the test should be done three times. Then they are free to have a relationship. Female, 55, Community Member

  12. Key Findings: Attitudes toward adolescent contraceptive use • Limited integration of pregnancy prevention into ASRH services • Condoms not associated with FP • Limited community support for youth access to FP services • Gendered barriers to adolescent use of FP include: • Lack of support from male partners • Fear of marital discord • Concern over side effects • Stigma • Fear of sterility

  13. Not Family Planning P: Condom is good. It is because a condom will help your life. Because, if you have sex with a boy with a condom it will prevent the transmission of diseases. Family planning is the one that is bad. I: Condom is also among family planning. P: No. That is not true. Female, 19, Peer

  14. Conclusion • Severe social, economic, and health consequences related to early pregnancy • Failure to comprehensively address ASRH further undermines HIV prevention efforts • Results from study used to design, implement, and test life-course specific interventions that promote dialogue and reflection to challenge inequitable gender norms and improve ASRH

  15. The GREAT Intervention Model

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