In Zimbabwe, rape is all too common and negotiating safe sex to prevent infection with HIV is almost impossible for many adolescent girls because involvement with older men in return for material benefits is widespread, according to researchers from UCSF.
“As a fifteen year-old girl from one of the focus groups said: ‘It is girls with no money like me. Big Dharas (sugar daddies) buy you clothes, send you to high school. If you refuse, you stay poor. If you take his money and refuse sex, he will rape you. He will say you ate my money for nothing.’ Seduced into these one-sided sexual relationships by economic need, young women simply have no power to protect themselves against HIV,” said co-author Hazel Chinake, BSc(Social Work), project coordinator at the University of Zimbabwe-UCSF Collaborative Research Programme in Women’s Health.
Chinake is presenting the study at the XIV International AIDS Conference in Barcelona, Spain.
“The phenomenon of intergenerational sex is driving much of the epidemic in Southern Africa-between a quarter and a third of older men are HIV-infected. Given that this is the reason for the spread of HIV, then what is the underlying cause? It’s largely economic, which means that an intervention to promote economic self-sufficiency is an essential element in any plan to reverse the spread of HIV,” said the study’s principal investigator, Nancy Padian, PhD, UCSF professor of obstetrics, gynecology, and reproductive services and director of international programs at UCSF’s AIDS Research Institute (ARI).
The data for the study was collected in eight focus group discussions among seventy-one 16 to 19 year old male and female adolescents in and out of school from two urban Zimbabwe sites. Girls reported that having boyfriends more than five years older was the norm with about two thirds of their peers involved with older partners/“sugar daddies”. The power for these girls to negotiate safe sex was inversely related to the age of the partner. Girls reported that older partners often became violent if the girls suggested condom use or refused sex.
Among boys, the majority reported at least one sexual experience with a woman at least 10 years older. Unlike the experience of adolescent girls, condom use was common among boys in relationships with older women with the women often initiating use.
The high prevalence of intergenerational sex is supported by a longitudinal study from the same research group that is also being presented at Barcelona. That study of 1,326 HIV sero-negative Zimbabwean young women found that forty-two percent had a partner who was 5 to 9 years older and eighteen percent had a partner at least 10 years older. In addition, this study found that having a partner at least 10 years older increased the risk of having never used a male condom.
“Age and power imbalances between partners heighten risk for HIV, especially for young women. Based on these findings we are developing prevention programs that focus on adolescent livelihoods. This approach will combine education-both traditional and reproductive health-with economic programs such as vocational training, job opportunities, and small loans or micro-financing, ” said Padian, who is also director of the Women’s Global Health Imperative at UCSF.
Co-authors of the study are Ariane van der Straten, Ph.D., academic coordinator at UCSF’s department of obstetrics and gynecology; Megan Dunbar, MPH, project director, Batsirai Makunike, MBChB, MPH, Anesu Vere, BSc(Economics), project assistant, all at the University of Zimbabwe-UCSF Collaborative Research Programme in Women’s Health, Harare, Zimbabwe; and Simel Esim, PhD, economist with the Poverty Reduction and Economic Growth team at the International Center for Research on Women, Washington, D.C.
This research was funded by grants from the National Institutes of Health.