**6. Conclusions**

The limited understanding of adherence to HIV/AIDS treatment, which is traditionally defined in an individual, biomedical and psychosocial context, and the evidence of the rates of low adherence which still occur in some populations affected by the virus, indicate that an approximation of adherence in relation to other categories of social analysis, and integrated with individual categories, could be useful to advance in the arguments of the negative effects of non-adherence. It is probable that if this concept is understood from the point of view of social determinants of health, new interventions could be proposed and better policies and plans for attention could be developed, with strategies aimed at social and gender-based equity.

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**3** 

*Nigeria* 

**Intergenerational Sexual Relationship** 

*MEASURE Evaluation/JSI, World Bank/Nigeria and USAID/Nigeria* 

In Nigeria, young people aged 15-24 years old contribute significant number to the new HIV infections with the majority of those infections occurring in young women and girls. From NARHS 2007, HIV prevalence rate among young women is approximately 2.5 times that of young men within the age group. This disproportionate rate of HIV infection in young women is similarly found in many other countries in sub-Saharan Africa. For instance, data show that in general young women age 15-24 in sub-Saharan Africa are three times more likely to be infected with HIV than young men of the same age (UNAIDS, 2006). In Zambia and Zimbabwe, young women are four and five times respectively more likely to have HIV infection compared to their male counterparts (UNAIDS 2004). While biological factors may account for women's greater susceptibility to HIV; the difference is marked and cannot be explained on the basis of biology alone. It therefore raises the question of differences in sexual behaviour among the group within the context of cultures; lifestyle; and structural and environmental factors. As a result of this alarming HIV infection, the sexual behavior of

Within this premise and in order to understand the sexual behaviour of young women, intergenerational sex has been widely explored in literature. There is clear empirical evidence that age-mixing between young women and older men plays an important role in the differences in the observed epidemiological pattern (Gregson et al., 2002). Studies indicate that relationships between young women and older men are common in many parts of sub-Saharan Africa and are significantly related with unsafe sexual behaviour and increased vulnerability to HIV infection (Glynn et al., 2001; Kelly et al., 2003; Longfield et al., 2004). For instance, Langeni (2007) in the study of 800 men in Botswana found that for every year's increase in the age difference between partners there was a 28 percent increase in the odds of having unprotected sex. Similar studies reveal that such relationships are largely premised upon material gains, the greater the economic asymmetries between partners and the greater the value of a gift, service, or money exchanged for sex, the less likely the practice of safer sex (Luke, 2003; Wojciki, 2005). In this regard, intergenerational sex is similar to transactional sex because sex is exchanged for money and other materials, but the concept of intergenerational sex is clearly differentiated from commercial sex or

**1. Introduction** 

this population is of great public health concern.

Oyediran, K.A., Odutolu, O. and Atobatele, A.O.

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