“Siyakha Nentsha” Enhancing the Economic, Health, and Social Capabilities of Highly Vulnerable Youth by Kelly Hallman, Kasthuri Govender, Eva Roca, Emmanuel Mbatha, Rob Pattman, Deevia Bhana and Mike Rogan Third Annual Research Conference on Population, Reproductive Health, and Economic Development, Dublin, January 2009

Purpose Improve functional capabilities and well-being of adolescents at high risk for HIV and STIs teenage pregnancy, parenthood school dropout actual or potential loss of one or both parents lack of knowledge of FET opps

Formative research: vulnerabilities associated with adol HIV risk behaviors Living in povertyLiving in poverty Not socially connectedNot socially connected OrphanedOrphaned

Poorer more likely to sexually debut earlier Ever had sex: years-olds PoorNon-poor Source: Hallman 2005, 2008a

Those with less social capital more likely to experience forced sex Ever been : year-old females Source: Hallman 2008a, 2008b

Orphans have more economically-motivated sexual encounters Ever traded sex: sexually debuted year-olds Source: Hallman 2008a, 2008c

Durban Program Sc Durban Program Scan Few youth HIV or RH programs address social, economic, and cultural underpinnings of risk behaviors Few livelihood programs make conceptual link to health risk behaviors –Not context-, age-, culture- or gender-specific –Design not evidenced based –Delivery weak –Little monitoring or evaluation

Methods Intervention Intervention Evidence-basedEvidence-based PilotedPiloted Multi-sectoralMulti-sectoral ParticipatoryParticipatory Intensive – multi-sessionIntensive – multi-session

Project components Government-accredited multi-session intervention Increase knowledge and skills for HIV and pregnancy prevention/AIDS mitigation; accessing preventive, treatment and care services Develop skills to manage personal and familial resources; access existing social benefits, education and training opportunities; plan and aspire for the future; build savings/assets over time Build and strengthen social networks and support

Project design Randomized to secondary school classrooms (10 th and 11 th grades) in one school wardRandomized to secondary school classrooms (10 th and 11 th grades) in one school ward Three study armsThree study arms 1.HIV/RH, Social, Financial Education 2.HIV/RH, Social 3.Delayed intervention

Methods Research Longitudinal survey Youth-conducted social mapping with presentations back to community Participatory photo-voice project Youth, parent, mentor focus groups to assess experience with intervention

Measures HIV/AIDS and RH: knowledge, skills and behaviors, including adoption of safer sexual behaviors and service use Economic skills: ability to plan and manage personal and familial finances, identify and access available services, FET opps, social benefits; articulate a plan for pursuing future livelihood-enhancing opportunities Social networks and support: access to friends, adult role models and individuals/groups who can assist with crisis management and provide links to opportunities

Project team Learners Parents Schools Tribal Authority KZN DOE kdkd Isihlangu Health & Development Agency Population Council UKZN (Sociology, Education, HEARD) AccuData Advisory Group

Selected findings from baseline

Saving for something specific, by household wealth quartile Poorest  least poor Females p=.28 Males p=.10

First sex was tricked or forced, by household wealth quartile Females p=.51 Poorest  least poor

Not confident knows how to use a condom, by household wealth quartile Females p=.92 Males p=.10 Poorest  least poor

First sex was forced or tricked, by ever employed by gender: tab q164 friends, col chi2 Females p=.07 Males p=.04

Number of sex partners, lifetime, by belonging to organizations Females p=.02 Males p=.25

Used a condom at last sex, by belonging to organizations Females p=.08 Males p=.09

Partner always or often gives gifts, by orphan status Females p=.24 Males p=.93

Have experienced unwanted sexual touching, by orphan status Females p=.31 Males p=.08

Used a condom at last sex, by orphan status Females p=.02 Males p=.28

Rarely or never uses condoms, by orphan status Females p=.05 Males p=.34

Age at first sex, by having a South African Identification card Females p=.02 Males p=.29

Condom use at last sex, by having a South African Identification card Females p=.87 Males p=.005

Very confident knows how to use a condom, by having a South African Identification card Females p=.009 Males p=.42

Participant views of financial education “It’s different, in school we learn mathematics and biology but here we learn things that we can use in the future.” - female age 16 years, enrolled in school “We learnt about budgeting and saving and all those things, because we only think that when we get money we spend it. This program was like an eye-opener to us, because, we know now when we get some money, we have to save something…” - male age 22 years, not enrolled in school

Participant views of health education “….. I didn’t understand about HIV and AIDS before but now I do. I didn’t learn that in school.” –female age 20 years, not enrolled in school “It changed my attitude, because I know how to use a condom and I know how to trust my partner and I know how to advise my partner, when we are sitting together and talking about, how to have sexual intercourse and I know even to advise the community as a whole about HIV/AIDS…” –male age 22 years, not enrolled in school

Selected resources Hallman, K. 2008a, in press. “Researching the determinants of vulnerability to HIV amongst adolescents,” IDS Bulletin, 39(5), November Hallman, K. 2008b, in press. “Social exclusion: The gendering of adolescent HIV risks in KwaZulu-Natal, South Africa,” in J. Klot and V. Nguyen eds., The Fourth Wave: An Assault on Women - Gender, Culture and HIV in the 21 st Century. Social Science Research Council and UNESCO. Hallman, K. 2008c, under review. "Orphanhood Type and Sexual Debut: A panel study from KwaZulu-Natal, South Africa," Economic Development and Cultural Change. Bruce, J. and Hallman, K “Reaching the girls left behind,” Gender & Development, 16(2): Hallman, K “Nonconsensual sex, school enrollment and educational outcomes in South Africa,” Africa Insight (special issue on Youth in Africa), 37(3): Hallman, K. Gendered socioeconomic conditions and HIV risk behaviours among young people in South Africa African Journal of AIDS Research 4(1): 37– 50. Abstract:

Thank you! Our funders: ESRC/Hewlett Joint Scheme & DFID via the ABBA RPC