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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2008.136606v1 99/S2/S425    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Speizer, I. S. Articles by Rees, H. V. PubMed PubMed Citation Articles by Speizer, I. S. Articles by Rees, H. V. Related Collections HIV/AIDS Adolescent Health Pregnancy Sexual Health

Ilene S. Speizer, PhD, Audrey Pettifor, PhD, Stirling Cummings, MPH, Catherine MacPhail, PhD, Immo Kleinschmidt, PhD and Helen V. Rees, MA(Cantab), MRCGP

Ilene S. Speizer is with the Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Audrey Pettifor is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Stirling Cummings is with the Carolina Population Center, University of North Carolina, Chapel Hill. Catherine MacPhail and Helen V. Rees are with the Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa. Immo Kleinschmidt is with the Tropical Epidemiology Group, Department of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, England.

Correspondence: Requests for reprints should be sent to Ilene S. Speizer, PhD, Department of Maternal and Child Health, UNC-Gillings School of Global Public Health, CB 8120, Chapel Hill, NC 27599-8120 (e-mail: ilene_speizer{at}unc.edu).

Objectives. We studied whether female youths from communities with higher sexual violence were at greater risk of negative reproductive health outcomes.

Methods. We used data from a 2003 nationally representative household survey of youths aged 15–24 years in South Africa. The key independent variable was whether a woman had ever been threatened or forced to have sex. We aggregated this variable to the community level to determine, with control for individual-level experience with violence, whether the community-level prevalence of violence was associated with HIV status and adolescent pregnancy among female, sexually experienced, never-married youths.

Results. Youths from communities with greater sexual violence were significantly more likely to have experienced an adolescent pregnancy or to be HIV-positive than were youths from communities experiencing lower sexual violence. Youths from communities with greater community-level violence were also less likely to have used a condom at their last sexual encounter. Individual-level violence was only associated with condom nonuse.

Conclusions. Programs to reduce adolescent pregnancies and HIV risk in South Africa and elsewhere in sub-Saharan Africa must address sexual violence as part of effective prevention strategies.