This article examines the extent to which family and community resources, specifically parental investments of time and money and membership in social clubs, confer protection against sexual risk taking among young people in Cape Town, South Africa. Although there has been substantial examination of the importance of HIV knowledge, attitudes, and educational attainment to HIV-related sexual risk behavior in adolescents in diverse settings, few studies have examined both the family and peer group contexts of HIV risk behavior for African adolescents. Studies from the United States have provided strong indications of the importance of family and peer group relationships to adolescent risk taking, warranting closer examination of these factors elsewhere. For this purpose, we analyzed 2002 baseline data from the Cape Area Panel Study (CAPS), a longitudinal study of the lives of young adults in metropolitan Cape Town, South Africa. The study covers a wide range of youth outcomes, including schooling, the transition from school to work, family living arrangements, family formation, and reproductive health.
Further examination of the family and community resources that affect young people’s sexual risk taking remains an urgent need in the South African setting given the enormity of South Africa’s HIV/AIDS epidemic. South Africa has the world’s fifth highest prevalence, at 21.5% of the adult population, and it has higher absolute numbers of HIV-infected persons than any other country (UNAIDS, 2004
). Population-based survey data from 2005 indicate that more than 10% of 15- to 24-year-olds nationally (16.9% of women, 4.4% of men) are infected with HIV (Shisana et al., 2005
). Risks increase quickly for both genders throughout young adulthood, peaking at 33.3% for women age 25 to 29 and at 23.3% for men age 30 to 34 (Shisana et al., 2005
). Hence, the risks incurred by unprotected sex among young people are substantial, and there is a continuing struggle to enhance the effectiveness of interventions that will reduce sexual risk, particularly for young women.
Knowledge of HIV risks and of condom effectiveness is high among South Africa’s young people but perceived personal susceptibility and condom use is low, and knowledge and attitudes continue to explain little of the variance in sexual behavior (Harrison, Xaba, & Kunene, 2000
; Macintyre, Rutenberg, Brown, & Karim, 2004
; MacPhail & Campbell, 2001
). The 1998 South African Demographic and Health Survey (SADHS) found condom use during the last sexual intercourse to be 19.5% among 15- to 19-year-old women and 7.6% among 20- to 24-year-olds (Department of Health, 2002
). Although South African adolescents’ sexual decision making is influenced by the same desires for romance and attachment (Harrison et al., 2001
) common to adolescents across many cultures, their sexual relationships also are influenced by the conditions of poverty and social discohesion engendered by South Africa’s legacies of colonialism and Apartheid and its continued development challenges. Where other forms of capital are limited, sexual relationships hold a more important, and possibly transactional, value, especially for young women, who may exchange sex for basic subsistence and school fees or for consumer goods (Hallman, 2004
; Hunter, 2002
). In addition, although knowledge of HIV/AIDS and the benefits of condom use is widespread, HIV-related stigma reinforces social power inequities, silence, and shame surrounding the epidemic, hampering prevention efforts (Campbell, Foulis, Maimane, & Sibiya, 2005
The literature on stress, risk, and resilience in adolescents has increasingly examined the processes by which children and adolescents cope with adverse life experiences, examining why some young people do “beat the odds” (Haggerty, Sherrod, Garmezy, & Rutter, 1994
). Although in the public health literature we may refer to behaviors such as unprotected intercourse or sex with multiple partners directly as risk behavior (as they are indeed associated with a heightened risk of infection with HIV and other sexually transmitted diseases [STDs]), this literature more often conceptualizes these practices as specific behavioral consequences of broader environmental risks to adolescent health and development. Concerned with examining the processes by which stressful events and transitions produce negative behavioral and health outcomes, this literature has shown that global indicators of disadvantage, such as poverty and a single-parent environment, are often intercorrelated. In addition, individuals from disadvantaged environments are both more likely to be exposed to chronic and acute stress and to lack the protective factors shown to buffer their effects. Models of stress and resilience generally classify these protective factors into two groups: personal (including factors such as self-esteem and mastery) and environmental (including factors such as family income and ties to a community of supportive social relationships), yet these groups of resources are interrelated. Specifically, a supportive, intimate attachment to parents has been shown to be important for the formation of positive self-concept, which is in turn associated with health-enhancing behaviors. Whereas self-esteem influences one’s ability to garner social support, social support can further protect an individual against environmental insults to one’s self-esteem. Following this literature, we posit that the social support provided through memberships in social clubs and the experience of parental investments work together to promote resiliency and buffer against the stressors to which youth in Cape Town are subjected. We cannot directly measure the mechanism by which these resources help to promote safer sexual behaviors among adolescents in Cape Town; however, the developmental literature points to their importance to the development of a positive self-concept, which would be tantamount for the adoption of safer behaviors such as condom use.
Furthermore, an extensive U.S.-based literature suggests that parental characteristics, including marital and cohabitation patterns, attitudes, coresidence and closeness (Axinn & Thornton, 1992
; Donenberg, Wilson, Emerson, & Bryant, 2002
; Thornton & Camburn, 1987
); communication (Hutchinson, Jemmott, Jemmott, Braverman, & Fong, 2003
; Miller, Levin, Whitaker, & Xu, 1998
); and monitoring (Donenberg et al., 2002
; Li, Stanton, & Feigelman, 2000
; Rai et al., 2003
; Romer et al., 1994
), influence adolescent attitudes toward intimate relationships and sexual risk taking. Family and household influences on adolescent risk behavior in South Africa have only recently been explored (Brook, Morojele, Zhang, & Brook, 2006
; Giles, Liddell, & Bydawell, 2005
) and suggest the importance of parents and family in influencing adolescent sexual behavior, particularly in rural areas. Poverty has been found to be associated with a more fragile parent-child relationship, which influences risky sexual behavior (via vulnerable personality attributes and associations with deviant peers; Brook et al., 2006
). Building on this literature, we have examined the direct role of parental coresidence, time spent with the child, and financial support of the child (controlling for household income) to sexual risk behaviors among urban South African adolescents. We further examine whether these social resources, termed parental investment in this article, are differentially associated with safer sexual behavior among young women and men; we hypothesize that the protective effects of parental investment may be more pronounced for young women.
This article also draws on a literature of social capital that posits that membership in a social group confers benefits and obligations on individuals (Bourdieu, 1986
; Hawe & Shiell, 2000
) and that behavioral norms circulating within social groups can influence health outcomes of members of those groups (Coleman, 1988
; Kawachi, Kennedy, & Glass, 1999
; Putnam, 1993
). The concept is understood to have both a relational component residing in the social group of which the individual is a member and a material component that relates to the resources (e.g., favors, information, social support, opportunities) conferred to group members (Hawe & Shiell, 2000
). In the public health literature on links between social capital and health outcomes, distinctions are made between bonding social capital (of individuals with similar characteristics) and bridging social capital (of individuals with different characteristics but usually a similar social status); an expansion of the concept includes linking social capital or the mechanisms by which links are produced between individuals interacting across power or authority gradients in a society (Szreter & Woolcock, 2004
). Empirical studies in Africa in the public health literature have focused on social capital of the bonding type, operationalized as community or social group membership. Research on the importance of bonding social capital for safer sexual behavior is promising; in Zimbabwe, participation in local community groups was positively associated with women’s successful avoidance of HIV (Gregson, Terceira, Mushati, Nyamukapa, & Campbell, 2004
). Participation in groups may be linked to other opportunities, with enhanced effects; young women with secondary education participate disproportionately in well-functioning community groups and are more likely to avoid HIV when they do participate (Gregson et al., 2004
). In this study, we use a measure of adolescents’ associational membership (participation in social organizations, including sports and music clubs, church groups, and community organization) similar to measures of bonding social capital used in previous studies.
In the present analysis, we examine whether specific sexual behaviors among South African adolescents are associated not only with membership in peer networks (clubs and organizations) but also with the extent of their relationship with parents—the parental investments of time, intimacy, and emotional and financial support. We have examined whether use of condoms at (1) first sexual intercourse and (2) most recent sexual intercourse are a function of gender, age, population group, education level, household income, HIV knowledge, maternal coresidence and investment, paternal coresidence and investment, and associational membership. This study is the first, to our knowledge, to examine whether specific sexual behaviors among South African youth are associated not only with membership in peer networks but also with specific dimensions of their relationship to parents, that is, parental investments of time, intimacy, and financial support.