title: Gender, peer and partner influences on adolescent HIV risk in rural South Africa.
abstract: METHODS
  In preparation for a school-based intervention in KwaZulu-Natal, South Africa, a cross-sectional survey of potential HIV risk factors in youth aged 14-17 (n=983) was conducted.
  
  
  RESULTS
  Boys were significantly more likely than girls to report lifetime sexual activity (37.7% v. 13.8%, P<0.01). Among boys and girls, 46.1% reported condom use at last sex. Discussion of condom use with a partner was the strongest predictor of condom use (boys, odds ratio (OR)=7.39; girls, OR=5.58, P<0.0001). Age was independently associated with sexual activity for boys (OR=1.49, P<0.0001) and girls (OR=1.74, P=0.02). For boys, perceptions of male peer behaviour were associated with both ever having participated in sexual activity (OR=1.48, P<0.01) and condom use at last sex (OR=1.79, P<0.01). Girls who equated condom use with having numerous partners were more likely to use them. Among boys, results challenged some expected gender beliefs: support for girls' initiative in relationship formation and refusal of sex were significant predictors of sexual activity. Among girls, higher pregnancy risk perception (OR=1.32, P=0.02) and knowledge (OR=4.85, P=0.055) were associated with sexual activity.
  
  
  CONCLUSIONS
  Creating more gender equitable norms can reduce HIV risk behaviours. HIV prevention interventions should build on existing gender equitable beliefs, and work to promote others, including sexual communication and negotiation skills, and modelling of positive peer norms.
authors.affiliation: Population Studies and Training Center, Brown University, Providence, RI 02912, USA. Abigail_Harrison@brown.edu
authors.forename: Abigail
authors.initials: A
authors.lastname: Harrison
authors.forename: Jenni
authors.initials: J
authors.lastname: Smit
authors.forename: Susie
authors.initials: S
authors.lastname: Hoffman
authors.forename: Thobile
authors.initials: T
authors.lastname: Nzama
authors.forename: Cheng-Shiun
authors.initials: CS
authors.lastname: Leu
authors.forename: Joanne
authors.initials: J
authors.lastname: Mantell
authors.forename: Zena
authors.initials: Z
authors.lastname: Stein
authors.forename: Theresa
authors.initials: T
authors.lastname: Exner
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology*; D001294:Attitude to Health / Q000208:ethnology*; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010379:Peer Group; D012309:Risk-Taking; D012424:Rural Population / Q000706:statistics & numerical data*; D021841:Safe Sex / Q000208:ethnology; D017678:Sex Distribution; D012725:Sexual Behavior / Q000208:ethnology*; D012747:Sexual Partners; D013019:South Africa