Options Consultancy Services and Hope Enterprises Ltd.

From the executive summary:


"This report presents findings from a qualitative study into young women’s sexual relationships in inner-city Kingston, Jamaica, carried out between May and June 2007. The study aimed to explore the social and economic environment in which young women’s relationships take place; to identify opportunities and barriers to behaviour change; and to generate insight into condom use, HIV risk perceptions, and types of sexual relationships... The study used the Participatory Ethnographic Evaluation and Research (PEER) method.... [for which f]ourteen young women from the community were trained as peer researchers and conducted 126 interviews with their peers.

The study provides detailed insights into the context in which young women’s sexual relationships take place. The socio-economic environment shapes the opportunities and motivations of women; some key aspects are:

• Material deprivation, poor housing conditions, and limited opportunities for income generation. High levels of perceived personal insecurity, sexual violence, and ... street violence.
• A vibrant social life...
• Complex and reciprocal systems of social support and loyalty among friends, family, and partners, [including] fragile relationships under constant threat, and fragmented families.
• Public image as central to social well-being, [amid] social judgement, and gossip.
• Acute sense of social hierarchy, on grounds of wealth, race, and social kudos. Low social position having serious consequences for wellbeing.
• Young women compete to acquire status.
• Employment is seen as lacking viability/attractiveness."

Given this environment, the document describes the types of relationships women have with men: a primary partner (called the ‘personal man’ or ‘baby-father’), a financial or (economic) transactional partner (called the ‘boopsy man’), an older and often transactional partner (called the ‘sugar daddy’), and one or more regular partners outside the primary relationship (called ‘man pon the side’ and kept in reserve to fill one of the roles above, if needed). In an environment where high-risk relationships bring high rewards (low-risk relationships, as described by an inner-city woman, leave women a life of petty trading, cleaning, and washing clothes) women often recognise the risks involved in multiple relationships, but continue to choose them. They use them for sustaining their livelihood, having fun, relieving stress, being respected, and having a broad social network. The implication is that, unless economic opportunities for women change, they will continue to choose multiple partners. These is a possible point of behaviour change, as stated here: "[h]owever, it would be possible to work on partner reduction with young women involved in coercive sexual relationships, either by improving their own communication and negotiation skills, or by tackling broader social norms (especially among men) which contribute to young women being in a position where they can be sexually exploited."

After describing the socially and economically complex relationship needs of Jamaican women and the additional complexity of the social role of trust, the document analyses the misunderstandings and myths about identifying HIV and sexually transmitted infections (STIs). It describes misperceptions about HIV/AIDS self- or partner- diagnosis as a locally construed "risk assessment framework" of intuition, stereotypes of social class, and skin condition. It describes condom use as influenced by the type of partner and stage of the relationship (e.g. condom use in first relationships or risky relationships may be acceptable, but in a primary relationship, it is a sign of suspicion of infidelity or lack of trust and is not acceptable). The study recognises that, given this social environment, "condom use represents a sign of infidelity. Introducing condom use could threaten trust, which could threaten the relationship." The implication is that marketing messages that continually connect condom use to HIV prevention foster a "condom use = mistrust" connection. Further, "[t]he ubiquity of multiple partnerships for women, and the strong perceived link between condoms and mistrust, are two central challenges for HIV prevention amongst these young women. These factors fundamentally threaten efforts to promote partner reduction and condom use in primary relationships."

Research-based suggestions for messages to which young women might be receptive include:

• In choosing role models for message delivery, "the PEER data are overwhelmingly full of stories of local people who women admire and look to for inspiration and support" (rather than pop stars and actresses). As for message content, taking into account the short-term concerns of women, "[m]essages should mirror the importance attached to having fun and sex, acknowledging that young women value their confidence in social situations (e.g. messaging similar to ‘with my looks/sexuality and my condom I am invincible/successful/popular/truly ‘hype’…’)".
• Because there is a divide along the line of the 'uptown' (i.e., wealthy) women and the more economically poor (downtown) women, it is suggested that message settings match the group in focus. "For instance, setting an advertisement at a street dance rather than a nightclub is likely to resonate better with this audience."
• Because young women divide themselves into "tribes" by clothing style, "[c]haracters’ appearance should be pre-tested with a sample of the target audience to ensure that they can relate to them."
• Patois is recognised as the language for effective messaging, but it is a changing dialect. Hence, "it is important to keep track of constantly evolving vocabulary and turns of phrase, to make sure that relevant language is used in communications. Field testing with peer researchers would be particularly effective, exploiting their training as ‘immersed’ observers."
• "...[M]essages about consistently using condoms with ‘outside’ partners, as this fits in with existing models of risk about casual partners..." are relevant to existing social norms.
• As stated here, condom use messages must promote more than better health and should be directed to each partner type (without suggesting that one type is more 'risky' than others). They might promote more romance, better sex, and higher status with both peers and men of wealth. They should reinforce current acceptance of use in casual relationships, of STI prevention, of being prepared as a woman (e.g. ‘I always take my cell and my condoms’), and that a superior condom is "thick, i.e. strong" and secure.

The study states that there is a need to de-stigmatise women's purchase of condoms. Also, interventions promoting communication with older, trusted women might be particularly effective, especially coupled with teaching young people the skills of talking openly and honestly with partners and of negotiating with men in relationships of pressure. Reducing stigma of people living with HIV/AIDS is encouraged in this document, as is harnessing the power of street talk and anecdote, because data demonstrate the vital importance of social networks, ‘gossip’, and image.