Sexual violence and reproductive health outcomes among South African female youths: a contextual analysis.
OBJECTIVE
We studied whether female youths from communities with higher sexual violence were at greater risk of negative reproductive health outcomes.


METHODS
We used data from a 2003 nationally representative household survey of youths aged 15-24 years in South Africa. The key independent variable was whether a woman had ever been threatened or forced to have sex. We aggregated this variable to the community level to determine, with control for individual-level experience with violence, whether the community-level prevalence of violence was associated with HIV status and adolescent pregnancy among female, sexually experienced, never-married youths.


RESULTS
Youths from communities with greater sexual violence were significantly more likely to have experienced an adolescent pregnancy or to be HIV-positive than were youths from communities experiencing lower sexual violence. Youths from communities with greater community-level violence were also less likely to have used a condom at their last sexual encounter. Individual-level violence was only associated with condom nonuse.


CONCLUSIONS
Programs to reduce adolescent pregnancies and HIV risk in South Africa and elsewhere in sub-Saharan Africa must address sexual violence as part of effective prevention strategies.
Department of Maternal and Child Health, UNC-Gillings School of Global Public Health, CB 8120, Chapel Hill, NC 27599-8120. ilene_speizer@unc.edu
Ilene S
IS
Speizer
Audrey
A
Pettifor
Stirling
S
Cummings
Catherine
C
Macphail
Immo
I
Kleinschmidt
Helen V
HV
Rees
D000293:Adolescent; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data*; D015995:Prevalence; D011902:Rape / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data; D055815:Young Adult