Gender differences in prevalence and correlates of high sexual self-efficacy among adolescents in Soweto, South Africa: implications for gender-sensitive research and programming

ABSTRACT

Sexual self-efficacy (SSE) – one's confidence in their ability to perform given sexual behaviours, has been shown to predict adolescents’ HIV-prevention practices (e.g., Condom use). Few studies within sub-Saharan Africa, where HIV incidence and prevalence disproportionately affects young women, have examined gendered differences in SSE. We used multivariable logistic regression to identify correlates of high-SSE separately among adolescent men and women (aged 14–19) in Soweto, South Africa using a previously validated SSE scale (high-SSE [>3/6 items]; study-alpha = 0.75). SSE scale items assessed self-efficacy related to sexual refusal and condom use. Adolescent women were significantly more likely to report high-SSE than adolescent men (72.3% versus 49.5%; p < 0.01). High-SSE among adolescent men was associated with more positive beliefs about sexual relationships and negatively associated with probable depression. High-SSE among adolescent women was associated with increased HIV knowledge, more positive beliefs about condom use and sexual relationships, having an adult in the home, and negatively associated with being an older adolescent (16–17 versus ≤15), and ever experiencing physical violence. Differences in prevalence and correlates of SSE among adolescent men and women in South Africa highlight important areas for gender-sensitive interventions. Targeted efforts to reduce negative sexual beliefs, improve HIV knowledge and mental well-being may improve SSE and thus the uptake of HIV-prevention practices among adolescent men. For adolescent women, findings indicate programming should move beyond individual-levels determinants of behaviour to focus on improving enabling environments (e.g., Reduced violence and improved family relationships) in which sexual agency can be enacted.

KEYWORDS:

• Adolescent
• HIV prevention
• Self Efficacy
• Gender
• South Africa

Acknowledgements

The authors thank all of the adolescents who participated in BBAHS for their time and contributions. To the PHRU and KMAC and all the research assistants and community members for providing us with the space and resources to undertake this project and for continued support in ensuring the success of this project. All listed authors contributed significantly to the writing and preparation of this manuscript. AK received salary support from the Canada Research Chair program in Global Perspectives on HIV and Sexual and Reproductive Health.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

BBAHS was funded by the Canadian Institutes of Health Research (CIHR), Institute for Human Development, Child and Youth Health (230513). Initial seed funding was provided by Simon Fraser University through a President Research Award to CLM. The funders of this project did not have any role in the study design, collection interpretation of the data, in the writing of the report or the decision to submit the article for publication.