The association of the built environment and sexual risk-taking behavior among youth in Cape Town, South Africa.

摘要

Background. South African society continues to be dominated by the multiple legacies of colonialism, Apartheid, and sexism which are elaborated in space in the form racialized, segregated townships inhabited primarily, by poor, Black South Africans. Youth are the fastest growing population affected by HIV/AIDS. It is estimated the HIV prevalence rate for Black youth is over 10 times that of White youth. No studies have examined the contextual effects of urban municipal services in explaining sexual risk-taking behavior in South Africa. Methods. Using logistic and multilevel analysis this study examines the structural neighborhood-level variations in youth sexual behavior by combining both individual and census tract data from the Cape Area Panel Study and the 2001 South African Census. Also, a theory of degraded spaces is presented to illuminate the causal mechanism through which the built environment may have negative effects on health behavior. To identify spatially disadvantaged individuals, an index of the built environment was constructed. Results. Overall, the study supports the hypothesis that access to basic services both at the individual and neighborhood-level are significant determinants of sexual risk-taking behavior among youth. The results indicate modest, but statistically significant, effects of the built environment index (OR=0.60, 95% CI 0.34,0.89) on the risk of using a condom at last sex, net of socio-demographic indicators; and on the risk of multiple sexual partners (OR=0.89, 95% CI 0.34,0.93). Specifically, access to electricity was found to be a significant predictor of condom use at last sex at the neighborhood-level (OR=0.76, 95% 0.61,0.98). For risk of multiple sexual partners, the study found access to water (OR=0.67 95% CI 0.46,0.98) was a significant predictor. These findings highlight the importance of the built environment and its potential use as a HIV/AIDS prevention strategy by linking its impact on youth's sexual risk behavior and practices.