Adolescent HIV Risk in South Africa: Multiple Perspectives on Sexual Behavior

Open Access
Bediako, Phylicia Twumwaa
Graduate Program:
Health Policy and Administration
Doctor of Philosophy
Document Type:
Date of Defense:
August 17, 2016
Committee Members:
  • Rhonda BeLue, Dissertation Advisor
  • Rhonda Belue, Committee Chair
  • Linda L Caldwell, Committee Member
  • Marianne Messersmith Hillemeier, Committee Member
  • Stephanie Trea Lanza, Outside Member
  • adolescent
  • sexual behavior
  • sexual risk
  • systems science
  • South Africa
  • abstinence
  • transactional sex
Adolescent Black and Coloured South Africans comprise a highly vulnerable segment of the population representing a substantial proportion of individuals with HIV/AIDS, both in their country and worldwide1–4. Although we know that behaviors such as early sexual onset, multiple sexual partners, low rates of condom use, and high rates of substance use are primary causes of HIV infection for this subgroup 3,4, less is known about when, why, or how those behaviors start5,6. Understanding what motivates adolescents to practice safe behaviors in a high-risk context could provide insight for new intervention and prevention strategies for targeting youths before they initiate risky behaviors or soon after they start engaging in those behaviors. This research examines sexual abstinence motives, tracks sexual risk throughout high school, and synthesizes information on sexual risk across adolescence. This dissertation uses a combination of person-centered, variable-centered, and systems science approaches to understand sexual behavior development, accounting for socio-demographic characteristics, substance use behaviors, and a variety of other risk reducing and enhancing exposures and experiences. The first study uses latent class analysis with covariates and grouping variables to create sexual abstinence motive profiles and describe the characteristics associated with each motive profile. The second study estimates the prevalence of sexual activity and transactional sex and uses regression analysis to identify predictors of both behaviors at multiple time points. The third study applies systems thinking perspectives and tools to map out the relevant factors influencing adolescent sexual decision-making and HIV risk behaviors using South Africa as a case study. These studies contribute new information to the sexual risk prevention and intervention literature. The results can be applied to preventing risk behavior development among youths who have not begun engaging in sexual activity but can potentially be extended to protecting sexually active youths from risky sexual behaviors.