Amy S.Y. Ho. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 57-58).

D.Litt. et Phil. (Sociology) / Inquiry that seeks to understand young people’s engagement in risk behaviours is numerous. Concern for and interest in young people has stimulated a wide range of debates about what makes young people do the things they do. Despite the plethora of research in this area there are still gaps in our knowledge, primarily because much of the research has sought to understand young people by looking at their decision making from the outside. This study departs from what has gone before by applying a youth development approach to understanding youth risk. In order to do so it sought to delve into the worlds and lives of a few young people living in an informal settlement in Gauteng, South Africa. The key question that the study poses pertains to how young people understand and negotiate risk as an aspect of their everyday identity-work. It is thus important to note that youth in this study is not understood simply as a particular age range or a phase that exists between childhood and adulthood. Rather it is understood as a life stage that carries with it particular experiences, needs and processes. In particular for the purposes of this study identity-work is understood to be an intensive process during the life stage of youth that involves drawing on culturally and socially available labels (McCall, 2003), definitions and markers of identity and testing them in their social networks in a process of reflexivity towards developing a self-identity (Giddens, 1991). In order to generate a deep understanding of the lives and worlds of young people, this study employed a critical ethnographic design, combining the usual methods of ethnography such as observation and interviews, with innovative methods that sought to challenge commonly held perceptions of research that young people might have had, and to encourage them to participate in the research. The study found that risk is understood in multiple ways. Young people understand and internalise the risk prevention messaging that is often targeted at them but they also have other perceptions of risk that ‘experts’ tend to overlook. Most important of these were their perceptions of risk that were influenced by their socio-economic surroundings – risks that were foremost in their lives because of their day-to-day struggles to manage them. The study also demonstrates the ways in which risk is negotiated as a feature of identity-work in three ways – in identity-work that has to do with masculinity and femininity, in identity-work pertaining to who one is within a family, and in identity work that involves their roles in the community. One of the main recommendations arising from this research is the need for integrated interventions that combine the prevention models that are currently employed, with locally specific interventions aimed at enhancing the protection and preparedness of young people in order to reduce their vulnerability. By conceptualising young people and the phase of ‘youth’ differently, and applying a youth development approach to understanding youth risk, it is hoped that an innovative way of considering how young people make decisions regarding risk has been opened for future consideration in research.

BACKGROUND:In Eastern and Southern Africa (ESA), adolescent girls’ and young women’s (AGYW, aged 15-24 years) disproportionate HIV risk is fueled by age-disparate sex (partners >5 years older). Older men typically acquire HIV from same-aged partners; they then transmit HIV to AGYW, who then transmit HIV to older men as they age, creating a cycle of transmission. Adolescent boys and young men (ABYM, aged 15-24 years) have lower HIV incidence rates, and their risk starts increasing around age 20 due to same-aged partners and age-disparate sex. Developing ABYM’s preventative behaviors may proximally and distally reduce their and AGYW’s HIV risk. HIV risk perception (HIV RP) is a theoretical motivator for initiating and using risk-reduction strategies. However, this relationship remains temporally and empirically equivocal in AGYW and ABYM, who are in a developmentally and socially dynamic stage of life. To increase and improve HIV risk-reduction strategies among AGYW and ABYM in ESA, this dissertation aimed to elucidate temporal trends, determinants, and effects of HIV RP. METHODS:This dissertation employed three aims to examine 1) longitudinal HIV RP literature, 2) HIV RP trajectories and predictors, and 3) HIV RP’s association with health outcomes. Secondary analyses used data collected (2010 [T1], 2011 [T2], 2012 [T3]) from the control arm (714 AGYW, 635 ABYM) of a school-based trial in KwaZulu-Natal, South Africa. Aim 1 evaluated longitudinal quantitative studies examining HIV RP among AGYW and ABYM in ESA. A scoping review synthesized data from peer-reviewed articles published between 1995-2022 to elucidate studies’ geo-spatial distributions, temporal data patterns, sample characteristics, and HIV RP definitions, analytic findings, and theoretical underpinnings. A proposed HIV RP conceptual framework was created by synthesizing findings and theories. Aim 2 described gender-specific patterns and determined predictors of HIV RP in AGYW and ABYM. Trajectories were created based on cumulative reports of high HIV RP. After, these trajectories were characterized using sociodemographic, knowledge, attitudinal/perceptual, biological, experiential, and behavioral factors. Using models stratified by ever-sex status, overall predictive analyses explored factors prospectively associated with high HIV RP. Aim 3 tested the hypothesis that high HIV RP increased chances of HIV testing and decreased cumulative acquisition of HIV/HSV-2. Directed acyclic graphs identified potential confounders using current literature. Predictive analyses estimated high HIV RP’s gender-specific confounder-adjusted association with HIV testing and HIV/HSV-2 incidence over 1-year periods. RESULTS:In Aim 1, synthesis of 38 longitudinal studies offered limited insights on AGYW’s and ABYM’s HIV RP due to geographic homogeneity, abundance of intervention-related studies, and minimal reporting of RP definitions and HIV status. Most (~75%) studies analyzed data collected before 2015, highlighting the evidence gap of HIV RP in current epidemic conditions or prevention options. Studies assessed AGYW when their risk is peaking and provided little detail on pre-risk periods; ABYM were rarely included in analyses. Elevated HIV RP was mostly positively associated with AGYW’s self-initiated outcomes, but HIV RP’s formulation was understudied. Aim 2 found HIV RP was temporally dynamic, as most (60% AGYW, 65% ABYM) changed their level of HIV RP at least once. AGYW’s and ABYM’s Persistent (high HIV RP at all timepoints) trajectories were primarily differentiated by negative prevention attitudes. While sexual risk behaviors were relatively high in AGYW’s and ABYM’s Persistent trajectories, HSV-2 and becoming/getting others pregnant increased in lower RP trajectories, implying potential contradictions between actual and perceived risk. Analyses showed sociodemographic factors (grade repetition, mother-led households) mostly predicted high HIV RP in AGYW, while prevention attitudes differentially (i.e., attitudes and associations largely shifted from negative to positive over time) affected ABYM’s high HIV RP. Behaviors (transactional sex, not knowing partners’ status, older partners, alcohol use [ABYM only]) predicted high HIV RP in both groups. Aim 3 highlighted that age, grade, financial insecurity, HIV/pregnancy-related knowledge, attitudes, perceptions, experiences, and service-seeking and risk-taking behaviors potentially confounded relationships between HIV RP and outcomes (HIV testing, HIV/HSV-2 acquisition). AGYW with high HIV RP at T1 were more likely to HIV test (aRR=1.48 [1.12-1.95]) and acquire HIV/HSV-2 (aRR=1.83 [1.03-3.25]) by T2, associations that did not persist in T2-T3’s analyses. There were no significant associations between any factor and HIV RP in ABYM. CONCLUSION:This dissertation highlights the temporal and associative complexities of HIV RP among AGYW and ABYM in ESA. HIV RP in these groups was variable and primarily predicted by sociodemographic (AGYW), attitudinal (ABYM), and behavioral factors, elucidating need and opportunities for multi-level, age- and risk-appropriate interventions. Structural insecurities and age- and gender-driven power differentials may inhibit AGYW’s prevention behaviors. For both groups, earlier intervention would reach AGYW before their risk escalates and reinforce and/or instill ABYM with potentially lasting assets. Additional high-quality, detailed studies are needed to combat the current evidentiary dearth, optimize prevention interventions, and increase the likelihood of ending HIV/AIDS by 2030.

我們身處於一個充滿風險的社會。金融海嘯、核能危機、全球暖化、食品問題等，在說明社會步向現代化的後遺症，正如何為人類帶來更難預測的風險，並無孔不入般影響我們的日常生活(Beck, 1992)。在這理論基礎上，本文將探究新聞製作於建構風險的角色，並提出一個名為「客觀化」(objectification) 的過程---新聞媒體如何在科學專家的意見眾說紛紜、對風險難有最終定案之下，把有關社會風險的新聞論述詮釋為客觀的社會事實。我尤其探討風險範例的建構---一些有關風險的新聞事件其後演變為重要範例，並影響日後類似事件的新聞論述。 / 為求以實證方法探究風險「合理化」的過程，我將以香港(中華人民共和國的特別行政區) 的新聞論述如何回應2009年全球豬流感危機作為案例。豬流感是香港經歷2003年非典型肺炎危機(又稱「沙士」) 的重創後，首次面對的全球疫症危機。香港新聞如何呈現豬流感疫情，亦深受「沙士」時的歷史回憶、經驗及後遺所影響。故此，這案例有助我研究風險範例於風險「合理化」時的作用。我從香港報章隨機抽樣出有關豬流感的新聞論述的樣本，並透過內容分析和文本分析，研究香港新聞如何敍述豬流感危機，以及相關敍述所包含的意識形態。我亦走訪了當年採訪豬流感新聞的新聞工作者、有份向傳媒提供專家意見的醫學專家、以及負責制定香港政府防控豬流感政策的官員，以了解建構豬流感風險背後的社會互動。 / 本文的研究顯示，香港有關豬流感危機的新聞論述，是如何奠基於「沙士」這風險範例而建構。豬流感起來襲初時，新聞論述廣泛地藉「沙士」的經驗去詮釋豬流感可能帶給香港的後果。新聞工作者於「沙士」時的採訪經歷，亦成為他們報道豬流感新聞時尋找醫學專家意見的參照經驗，尤其是當醫學專家意見紛紜、新聞工作者要判斷誰人的意見較有權威去界定健康風險之時。本文主要闡述新聞的建構於社會回應風險時所起的關鍵作用，從而帶出這於風險社會理論、以及當我們探究新聞媒體及傳播於現代風險社會的角色時，仍未受足夠重視的重要層面。 / We are witnessing the formation of a risk society, with financial instability, nuclear catastrophes, global warming, and food crises, and just to give a few examples, becoming parts of our everyday life in an age of risk characterized by uncertainties stemming from system failure of modernization (Beck, 1992). In the light of this theoretical concern, in this study I shall scrutinize how news making plays its role in the construction of risk. This, I suggest, is a process of risk objectification ---how news media justifies its discourse of social risk by making social facts upon uncertainties and inconclusive scientific opinions. Specifically, I shall focus on the creation of risk exemplar. That is, some news events become critical exemplar that would shape the news construction of subsequent crises of similar sources. / To look into the process of risk objectification empirically, I shall examine what were the main features of the news discourse in Hong Kong, a Special Administrative Region of China, in reaction to the global health crisis of Swine Flu in 2009. Swine Flu was the first pandemic crisis encountered by Hong Kong after its devastating suffering from the epidemic of Severe Acute Respiratory Syndrome (SARS) in 2003. The news representation of Swine Flu was influenced by the historical memory, experience and legacies of SARS and this helps illustrate how risk exemplar contributes to risk legitimization. I carried out content and textual analysis respectively on a random sample of Hong Kong’s newspapers for the purpose of analyzing the key narrations of Swine Flu and the underlying ideological packages of such narrations. I also conducted in-depth interviews with journalists, medical experts and public officials who were deeply involved in the news making of Swine Flu so as to uncover the social dynamics in the process of risk construction. / Key findings of this thesis highlight how the health crisis of Swine Flu was staged by the risk exemplar of SARS. Experience of SARS was widely drawn upon for making sense of the potential impacts of Swine Flu when it first broke out. It was also the key reference for journalists when seeking expert advices, particularly when identifying those who are more authoritative among different opinions in defining the nature of the risk. It is my argument that news making plays a critical role in the shaping of the social reactions to a risk. My analysis thus adds an important, but somehow unduly neglected, dimension to theory of risk society and our understanding of the role of news media and communication in contemporary risk society. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chan, Chi Kit. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 240-250). / Abstracts also in Chinese. / Chan, Chi Kit.