title: Community Support and Adolescent Girls' Vulnerability to HIV/AIDS: Evidence From Botswana, Malawi, and Mozambique.
abstract: Girls are vulnerable to HIV in part because the social systems in which they live have failed to support and protect them. The goal of this research was to develop a viable supportive community index and test its association with intermediate variables associated with HIV risk across 16 communities in Botswana, Malawi, and Mozambique. This cross-sectional survey with separate samples randomly drawn in each country (2010) yielded a total sample of 1,418 adolescent girls (aged 11-18). Multilevel, multivariate logistic regression, while controlling for vulnerability, age, religion, and residence, found that an increase in supportive community index is positively associated with the odds of indicating improved community support for girls and with the confidence to refuse unwanted sex with a boyfriend across the three countries, as well as with self-efficacy to insist on condom use in Botswana and Mozambique. Program implementers and decision makers alike can use the supportive community index to identify and measure structural factors associated with girls' vulnerability to HIV/AIDS; this will potentially contribute to judicious decision making regarding resource allocation to enhance community-level, protective factors for adolescent girls.
authors.affiliation: Center for Communication Programs, Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA carol.underwood@jhu.edu.
authors.forename: Carol
authors.initials: C
authors.lastname: Underwood
authors.affiliation: Center for Communication Programs, Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA Fairhaven College, Western Washington University, Bellingham, WA, USA.
authors.forename: Hilary M
authors.initials: HM
authors.lastname: Schwandt
mesh_terms: D000293:Adolescent; D001902:Botswana / Q000453:epidemiology; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D009073:Mozambique / Q000453:epidemiology; D012307:Risk Factors; D021841:Safe Sex; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations
keywords: Botswana; HIV; Malawi; Mozambique; community support; structural interventions; vulnerable girls