Improving HIV prevention programs: the role of identity in shaping healthy sexual behavior of rural adolescents in South Africa

A large body of literature highlights the role of culture and identity in how individuals manage and maintain health. Disappointingly there was no statistically significant decline in HIV prevalence in the 15–24 years age group in South Africa since 2007, Millennium Development Goal 6 indicator. This warrants a new approach to youth HIV prevention, which considers identity and culture, in male-dominant environments. We used identity-based motivation theory, which predicts that possible identities have a crucial influence on health-promoting behavior, to argue that girls are not currently attaining their low risk possible identities because sociocultural factors influence their behavior and compromise their health and economic outcomes. This study employed a cross-sectional survey among 285 rural black South African adolescents (mean age 16.7 years; 48.8% boys) to determine the salient social identity and the associated possible identities. We then tested whether youth behave in accordance with their possible identities. The dependent variables are non-risky behavior, risky behavior, and confidence to discuss sex. The independent variables are age, previous sex experience, and poverty. The adolescents chose gender as the most prominent social identity. Girls chose a safer possible identity than boys did, and girls do not actualize their possible identities while boys do. For girls, no dependent variables were significant. These results show that sociocultural barriers prevent the girls from actualizing their non-risky possible identity. Future adolescent HIV prevention programs aimed at reducing HIV should promote rights and responsibilities and consider cultural norms and beliefs to create a more gender-equal society that embraces less risky sexual behavior, in line with the idealized identity of girls. This to convince both male and female adolescents of the benefits, risks, and social harms embedded in certain traditional practices in a high HIV-prevalent environment.