MEASURING GENDER NORMS AMONG EARLY ADOLESCENTS AND YOUNG people IN UGANDA: TOOL VALIDITY AND ASSOCIATIONS WITH HIV Risk factors This presentation provides a brief overview of this study L. Vu, J. Pulerwitz, B. Zieman, C. Banura, J. Okal, E. Yam

Introduction Little is known about how early adolescents (EAs: ages 10-14) perceive gender norms Valid tools are needed to measure EA perceptions of gender norms Methods 2-stage cluster-sampled household survey of 960 participants aged 10-24 Measured support for inequitable gender norms using GEM Scale Assesses sexual relationships, violence, sexual and reproductive health, and domestic chores Scale validated in confirmatory factor analysis; 18 items retained During adolescence views towards gender and social norms become increasingly segregated; adolescent boys become more independent, while girls often become more marginalized. Inequitable norms are often associated with negative outcomes Young males may face peer pressure to have unprotected sex or to have multiple sex partners in order to be viewed or self-perceived as “real men” Whereas, women are often castigated for any perceived sexual infidelity ‘Gender-transformative’ programs have sought to shift inequitable gender norms – most work focused 15+. Early adolescents (EA 10-14) are at an influential age, but few gender-focused programs have specifically tried to reach them For ethical reasons, few studies recruit participants under age 15; hence little is know very little about 10-14 year olds – a valid tool is needed to measure their perceptions of gender norms

Inequitable gender norms were pervasive among both age groups Most agreed to inequitable statements 10-14s held greater inequitable views than 15- 24s (p<0.001) Figure 1: Comparison of inequitable GEMS scores by age Confirmatory factor analysis indicates GEM Scale is valid and reliable among both EAs & AYAs 18 items retained, Maximum score: 18 Items then coded 1=equitable; 0=inequitable

Among 15+, greater inequitable gender norms were significantly associated with: Early sexual debut (first sex before age 15) Lower comprehensive knowledge of HIV transmission and prevention (5-item UNAIDS scale) Non-condom use at last sex Experience of physical or sexual violence (last 12 months) Slide shows average GEM scale scores among AYAs, stratified by whether or not participants had engaged in, or experienced the listed outcome. E.g. Among AYA participants, the average GEM Scale score for those who reported experiencing any physical or sexual violence in the past 12 months (score = 7.16) was 1.15 points lower than those who reported that they had not experienced physical or sexual violence during that period (score = 8.31) Condom use at last sex is among those who had sex in past 1 year (n=413)

Conclusions GEM Scale is a valid measure of gender norms among both 10-14s and 15-24s By early adolescence, the process of internalizing inequitable gender norms has already begun There are opportunities for gender-transformative programming among adolescents as young as 10-14 CFA demonstrates that GEM Scale is a valid measure of support for inequitable gender norms among both EAs and the older group. It can be a powerful evaluation tool for programs intending to shift gender norms towards greater equitability Inequitable perceptions of gender norms are pervasive among Ugandan youth, and views held by 10- to 14-year-olds are less equitable than those of 15- to 24-year-olds Early adolescence may provide window of opportunity for gender-transformative programming