Developing a Measure of Hope for Exploring HIV-related Risks among Young South African Women in a High Prevalence Setting

Young women in South Africa are disproportionately affected by HIV. Recent research has focused on how structural factors, including adverse risk environments, increase HIV risk. Hope is a psychosocial strength that may help explain how adverse risk environments influence risk behaviors. The objective of this study is to create and validate a hope measure with young women in South Africa, and then use the measure to explore the relationship between hope, the risk environment and risk behaviors guided by the Hope and HIV Prevention framework. Methods: Hope was studied using mixed-methods research. In-depth interviews with young women who were enrolled in- and dropped-out of school, their parents, and a secondary school teacher were conducted along with focus group discussions with young women to develop the hope scale. The scale was administered within a cross-sectional survey collected from 2135 young women, aged 13-20, enrolled in secondary school. Reliability and validity were evaluated using factor analysis and calculating correlations. Logistic regression was used to test associations between hope, the risk environment and risk behaviors, and whether hope mediates the relationship between the risk environment and risk behaviors. Results: Scale items were developed to measure three domains of hope - anticipation of a positive future, personal motivation to achieve goals, and influence of others on hope. However, factor analysis revealed only one dimension containing items from the three hypothesized domains. Correlations with related constructs showed preliminary support for the validity of the scale. Reliability was high (Cronbach’s =0.95). A majority of young women reported high hope (88.6%). Hope was related to sexual debut, but not to condom use or early sexual debut. Young women in households with more consumption, no biological parent, older average household age, and fewer youth enrolled in school were more likely to report high hope. There was some evidence that hope mediated the relationship between the risk environment and sexual debut. Conclusion: The study provides a promising measure of hope for young women in high prevalence settings. Leveraging hope through improvements to the risk environment should be encouraged to reduce young women's risk for HIV in South Africa.Doctor of Philosoph