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PEPFAR Gender Initiative on Girls

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Go Girls! Initiative Carol Underwood, Ph.D. Formative research findings: Vulnerability factors Sexual violence Coercion Men sometimes see the girl and they ... – PowerPoint PPT presentation

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Title: PEPFAR Gender Initiative on Girls


1
  • PEPFAR Gender Initiative on Girls Vulnerability
    to HIV/AIDS
  • Go Girls! Initiative

Carol Underwood, Ph.D.
2
Conceptual framework
  • Social ecological
  • approach

3
Two key features of social ecology (SE)
  • Embeddedness
  • One system is nested in hierarchy of other
    systems at different levels of analysis
  • Emergence
  • System at each level is greater than the sum of
    its parts

4
Key ideas behind SE model
  • Factors at multiple levels affect human behavior
  • Essential to understand and address barriers and
    constraints to change at multiple levels
  • Unrealistic to expect individuals to change
    health practices or take action if barriers at
    higher levels are insurmountable

5
Implications of the SE approach for changes in
girls vulnerability
  • Interventions for planned change should address
    all levels to be effective
  • Individual
  • Family/Social network
  • Community
  • Institutional
  • Societal
  • Communication interventions
  • Can overcome barriers at each level
  • Articulate efforts across levels
  • Facilitate change

6
Goal objectives
  • GOAL To reduce HIV prevalence among adolescent
    girls aged 10-17.
  • OBJECTIVES
  • 1. To identify and expand promising new and
    existing program approaches for addressing the
    contextual factors which place some adolescent
    girls at especially high risk of HIV
  • 2. To evaluate the feasibility, sustainability
    and effectiveness of these interventions and
    their potential for adaptation and scale-up to
    other settings.

7
Project scope
  • Timeline 2007-2010
  • Project countries
  • Botswana (4 communities)
  • Malawi (4 communities)
  • Mozambique (8 communities)

8
Programmatic approaches
  • Work at multiple levels
  • (1) Structural interventions to improve access to
    resources for adolescent girls, such as a safe
    school environment economic strengthening.
  • (2) Community interventions to give community
    members the skills and motivation to organize for
    collective action to safeguard adolescent girls.
  • (3) Family/peer/individual-level interventions to
    change social norms enhance life skills.

9
Formative work
  • Literature Review of vulnerable girls related
    terms
  • Vulnerability rarely defined
  • Multifaceted
  • No study from community perspective

10
Understanding the local context
  • Formative research (Focus groups to understand
    community perspectives on girls vulnerability)
  • Stakeholder meetings (Government officials
    community leaders NGO/CBO representatives)
  • Community mapping (identifying resources and
    potential partners selecting communities)

11
Formative research findings Vulnerability factors
  • Economic factors
  • Consumerism, peer/social pressureagency
  • Need to meet basic survival needs
  • Sexual violence
  • Coercion
  • Forced sex

12
Formative research findings Vulnerability factors
  • Alcohol disinhibition
  • Access to alcohol easy
  • At Zithere pub they want money and they dont
    discourage children to drink beer. (Semi-urban,
    opinion leader, Malawi)
  • Sexual violence linked to alcohol consumption by
    both perpetrator victim
  • These adolescent girls who go to bars get drunk
    and men harass and rape them and this puts them
    at risk. (Rural, adult woman, Botswana)

13
Formative research findings Vulnerability factors
  • Other socio-cultural factors
  • Decline in authority
  • Perceived deterioration in adult/child
    communication
  • Initiation ritespresence of in Malawi, absence
    of in Botswana
  • Exposure to sexually explicit or sexually
    suggestive materialvideo houses, TV, media
  • Earlier sexual debut, early marriage (Mal, Mzq)

14
Definition vulnerable girls
  • Based upon the literature review and
    conceptualization of vulnerability, GGIs working
    definition of vulnerable girls is
  • girls who are, or are likely to be, exposed to
    unsafe sexual encounters due to weaknesses in
    ideational, social, economic, or legal support
    and protection.

15
Implications of the SE approach to measure
vulnerability
  • Individual domains Marriage and sexual activity
    alcohol and drug use
  • Peer/Family domains Social ties household/
    family status (incl. orphanhood alcohol use in
    family and relationship with caregivers)
  • Societal domains Poverty and food security
    education work violence and safety alcohol
    laws, regulations, enforcement
    initiation/traditional practices

16
Program design
  • Testing 2 Intervention Models
  • Model I (Individual peer/family community)
  • Community mobilization
  • Community-based life skills for girls
  • Adult-child communication
  • Radio program

17
Program design
  • Model II (All of Model I societal)
  • School personnel training to provide safe school
    environment
  • School-based life skills
  • Economic strengthening for vulnerable girls
    and/or their families

18
Community mobilization
  • Audience Entire community
  • Key components Assisting communities to form a
    task force for girls vulnerability develop an
    action plan and put plan into action.
  • Expected outcomes Communities take collective
    action to protect girls and ensure a safe
    environment for girls to thrive

19
Community Mobilization--Malawi
20
Community-based life skills
  • Audience Out-of-school girls
  • Key components Developing a curriculum to
    address key factors of girls vulnerability form
    girls clubs teach life skills
  • Expected outcomes Girls build life skills and
    increase self-efficacy to protect themselves from
    HIV infection

21
Adult-child communication
  • Audience Parents/caregivers of adolescent girls
  • Key components Developing a curriculum for key
    adult-child relationship factors holding
    sessions with adults
  • Expected outcomes Adults build skills and
    increase self-efficacy to improve relationship
    with girls and protect them from HIV infection

22
Reality radio programming
  • Audience Extended families
  • Key components Regional country-specific
    design documents production and airing of
    reality program
  • Expected outcomes Ties together all GGI
    activities stimulates family community
    dialogue and a collective response to addressing
    girls vulnerability to HIV

23
School personnel training
Model II
  • Audience Teachers, heads, administrators and
    support staff
  • Key components Training workshop follow-up
    meetings
  • Expected outcomes Safe and supportive school
    environment for girls

24
School-based life skills
Model II
  • Audience Girls and boys at school
  • Key components Curriculum development
    orientation for teachers integration into
    existing life skills program
  • Expected outcomes Girls and boys build life
    skills and increase self-efficacy to protect
    themselves from HIV infection

25
Economic strengthening
Model II
  • Audience Vulnerable girls and their families
  • Key components Situational analysis developing
    partnerships facilitating linkages to existing
    services and programs
  • Expected outcomes Girls and/or their families
    have increased access to skills-building,
    microfinance and income-generation activities

26
Lessons learned
  • Allocate sufficient time for start-up
  • Multi-country, multi-level, multi-faceted,
    multi-sector multiple challenges
  • Be realistic about what can be accomplished in
    the given time frame
  • Understanding the local context is time
    consuming, particularly in multiple settings

27
Lessons learned
  • Much of the formative work is sequential, not
    concurrent
  • Literature review ? formative research studies ?
    program development baseline instruments
  • Multiple sites, multiple IRBs
  • Anticipate (unanticipated) delays
  • Start up of multiple interventions need to work
    across sectors

28
Lessons learned
  • Differences across countries require flexibility
    and adaption
  • Delivery of school-based life skills
  • Structural interventions challenging
  • Economic strengthening for minors
  • No matter how fine or innovative an idea, it is
    manifested over time and space

29
Lessons learned promising practices
  • The whole community approach to gender-based
    programming
  • Community mobilization radio program
    (involvement from everyone in the community) Go
    communities!
  • Adult-child (encouraging fathers/male caregivers
    to participate) Go families!
  • School-based life skills (teaching girls and boys
    together) Go students!
  • School personnel (male and female teachers
    administrators Go schools!

30
Contact details
  • Carol Underwood, PhD
  • Johns Hopkins Bloomberg School of Public Health
  • Center for Communication Programs
  • 111 Market Place, Suite 310
  • Baltimore, MD 21202, USA
  • Tel 410-659-6300
  • Fax 410-659-6266
  • Web http//www.jhuccp.org
  • Email cunderwo_at_jhuccp.org

31
Additional slideson Formative Research
Findings
32
Formative research findings Vulnerability factors
  • Economic factors
  • Consumerism, peer/social pressureagency
  • For example, nowadays, girls like/want a lot of
    things that her friends have from the shops, as
    you know, life now is different from the past,
    they like to have nice things like we all know.
    (Peri-urban, opinion leader, Mozambique)
  • Need to meet basic survival needs
  • When the parents are poor, they force the girls
    to sleep with men so that she can get money to
    buy soap, salt and other things at home.
    (Semi-urban, adolescent boy 15-19 years, Malawi)

33
Formative research findings Vulnerability factors
  • Alcohol disinhibition
  • Access to alcohol easy
  • At Zithere pub they want money and they dont
    discourage children to drink beer. (Semi-urban,
    opinion leader, Malawi)
  • Sexual violence linked to alcohol consumption by
    both perpetrator victim
  • These adolescent girls who go to bars get drunk
    and men harass and rape them and this puts them
    at risk. (Rural, adult woman, Botswana)

34
Formative research findings Vulnerability factors
  • Sexual violence
  • Coercion
  • Men sometimes see the girl and they start
    giving her a lot of things, like 3 times, and in
    the end they say lets have sex because I have
    given you a lot of things, and she accepts
    because she doesnt want to loose the cookies
    (Rural, adolescent girl 15-19 years, Mozambique)
  • Forced sex
  • Other times you meet a man he rapes you after
    you have refused his advances. In so doing he
    can infect you with the virus if he has it.
    (Rural, pre-adolescent girl 10-14 years, Malawi)
  • There are children who are abused sexually and
    when a parent realizes this she will just ignore
    this situation. Most girls are sexually abused by
    their uncles and stepfathers. (Semi-urban,
    opinion leader, Botswana)

35
Formative research findings Vulnerability factors
  • Other socio-cultural factors
  • Decline in authority
  • Perceived deterioration in adult/child
    communication
  • Initiation ritespresence of in Malawi, absence
    of in Botswana
  • Exposure to sexually explicit or sexually
    suggestive materialvideo houses, TV, media
  • Earlier sexual debut, early marriage (Mal, Mzq)

36
Formative research findings Safe and unsafe
spaces
  • Safe spaces
  • Hospitals
  • Churches (though mixed), mosques
  • Schools (mixed)
  • Police stations (mixed)
  • Chiefs house
  • Unsafe spaces
  • Bars
  • Video houses (MZQ)
  • Guest houses
  • Schools (sometimes)
  • Churches
  • Unregulated or public places--mill, water tap,
    lake shore/river/field
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