Primary Submission Category: Gender
Gender norms and Human Immunodeficiency Virus (HIV)-related stigma among adolescents in western Kenya
Authors: Joanne Constantin William Story Beatrice Churu Rima Afifi Abigail Lee Nema Aluku
Presenting Author: Joanne Constantin*
Background: Kenya has one of the world’s largest HIV epidemics. Adolescents are particularly vulnerable; over 50% have sexual intercourse before the age of 18 yet condom use and HIV testing remain low. Stigma is a primary barrier to HIV prevention among youth in Kenya. Young women face more stigma due to patriarchal and cultural gender norms. Identifying factors that enable stigma to persist is critical for prevention strategies to succeed. This study examines the association between gender norms and stigma.
Methods: A survey was administered to 765 randomly selected unmarried girls and boys (ages 15-19) from three counties in western Kenya, including 19 questions about gender norms and 12 questions about HIV-related stigma. Exploratory factor analysis identified three gender norm factors—sexual double standard, adolescent romantic expectations, and girls’ restricted autonomy—and two stigma factors—internalized and attributed stigma. Multivariate analyses were conducted by regressing each form of stigma on the three types of gender norms. Covariates included age, gender, ethnicity, education and wealth. Analyses were also stratified by sex.
Results: Girls’ restricted autonomy is positively associated with internalized stigma, whereas a sexual double standard is inversely associated with internalized stigma after controlling for potential confounders (β = 0.121 and -0.072, respectively; p<0.01). Stratifying by sex, the associations only hold for girls. For attributed stigma, only girls’ restricted autonomy is associated (β = 0.152; p<0.01), which holds for both girls and boys when stratified by sex (p<0.01).
Conclusion: Girls’ lack of autonomy in relationships is related to higher levels of internalized and attributed stigma; however, a sexual double standard appears to be protective of internalized stigma. Since the relationship between gender norms and stigma varies by sex, interventions should be tailored by sex to promote young people’s HIV preventive behaviors.