HIV Risk Behavior Among Adolescents and Young Adults in Cape Town, South Africa: the Role of Economic Support and Employment

This three-paper dissertation examined the association between social and economic factors and HIV risk behavior among adolescents and young adults in Cape Town, South Africa. Studies in South Africa have demonstrated an important association between receiving financial or material resources and sexual risk behaviors. Most research has focused on economic exchanges that occur as part of transactional sex, and not economic support in main partnerships—which may not be transactional. Furthermore, little research has focused on men. For the first paper, cross-sectional data from Black African and Coloured substance-using women (N = 671) were analyzed to examine the association between the frequency of economic support and unprotected sex in main partnerships. Negative binomial and multinomial logistic regression analyses were conducted to model the number of unprotected sex acts and the consistency of condom use, respectively. Results indicated that receiving daily or almost daily support was positively associated with the number of unprotected sex acts; an association was not observed with consistency of condom use. For the second paper, binomial logistic regression was used to examine whether receiving economic support from a main partner was associated with unprotected last sex, and to test whether gender modified this association among young Black African and Coloured women and men (N = 1,456). Economic support from a main partner was not associated with sexual risk; however, receiving economic support from someone in the household other than a main partner was protective for women. Employment was protective for men and women. The third paper used discrete-time hazard analyses to examine whether employment and schooling were associated with sexual initiation among Black African, Coloured, and White adolescents (N = 1,326). Results indicated that although employment was not associated with sexual initiation, working while in school was associated with greater odds of sexual initiation. These papers provide a better understanding of the social and economic factors that may impact sexual risk behavior. The association between employment and risk behavior is complex, and how sexual risk is defined and measured matters. Findings also suggest the importance of assessing multiple sources of economic support, including frequency of support