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Izudi J, Okello G, Semakula D, Bajunirwe F. Low condom use at the last sexual intercourse among university students in sub-Saharan Africa: Evidence from a systematic review and meta-analysis. PLoS One 2022; 17:e0272692. [PMID: 35947583 PMCID: PMC9365151 DOI: 10.1371/journal.pone.0272692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background There is inconsistent data about condom use at the last sexual intercourse (LSI) among university students in sub-Saharan Africa (SSA) and its association with sex, age, and condom negotiation efficacy. The primary objective of this study was to summarize the proportion of condom use at the LSI among university students in SSA. The secondary objective was to determine the association between condom use at the LSI with sex, age, and condom negotiation efficacy among university students in SSA. Methods In this systematic review and meta-analysis, two reviewers independently searched electronic databases and grey literature for eligible studies published until July 30, 2020, extracted data, and assessed the risk of bias in the included studies. We used the Dersimonian-Liard random-effects model to pool the proportion of condom use at the LSI and the association between condom use at the LSI with sex, age, and condom negotiation efficacy, reported using risk ratio (RR). We assessed publication bias using funnel plot and Egger’s test, and explored sources of heterogeneity using sub-group and meta-regression analyses. Results We meta-analyzed 44 studies with a combined sample size of 27,948 participants.Of 14,778 sexually active participants, 8,744 (pooled proportion, 52.9%; 95% CI, 45.0–60.7; 95% prediction interval, 2.8–98.9; I-squared = 99.0%, p< 0.0001) reported condom use at the LSI and the proportion of condom use at the LSI remained stagnant between 2000 and 2019 (p = 0.512). Condom use at the LSI was not associated with being a female compared to a male (pooled RR, 1.08; 95% CI, 0.68–1.71), being of a younger age (≤24 years old) compared to older age (25 years and more) (pooled RR, 1.16; 95% CI, 0-85-1.57), and having a higher condom negotiation efficacy compared to a lower condom negotiation efficacy (pooled RR, 1.54; 95% CI, 0-81-2.94). Conclusions We found a low and heterogenous use of a condom at the LSI among university students in SSA which was not associated with sex, age, or condom negotiation efficacy. Accordingly, context-relevant interventions are needed to improve condom use at the LSI among university students in SSA.
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Affiliation(s)
- Jonathan Izudi
- Faculty of Medicine, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- * E-mail:
| | - Gerald Okello
- Department of Reproductive Health, Ministry of Health, Kampala, Uganda
| | - Daniel Semakula
- African Centre for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, Kampala, Uganda
| | - Francis Bajunirwe
- Faculty of Medicine, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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The Moderating Power of Impulsivity: A Systematic Literature Review Examining the Theory of Planned Behavior. PHARMACY 2022; 10:pharmacy10040085. [PMID: 35893723 PMCID: PMC9326604 DOI: 10.3390/pharmacy10040085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 01/27/2023] Open
Abstract
The theory of planned behavior (TPB) states that behavioral intention is the best predictor of actual behavior change. However, intention explains only a portion of the variance in behavior. Of specific interest is the question of which moderating or mediating variables can be leveraged to aid health promotion interventions utilizing the tenets of behavioral economics (delay discounting and commitment contracts) in the intention–behavior pathway. Impulsivity has been postulated to fill this role and may be applied to multiple behaviors. We aim to determine if impulsivity moderates the association between intention and actual behavior in the TPB, to discover what other variables may moderate or mediate this association, and to apply the findings to future studies in the field of behavioral economics. To this end, a systematic review was conducted using the PubMed, PsychINFO, and Embase online databases. Eligible studies in peer-reviewed journals published prior to November 2021 were selected. Thirty-three studies were included in the final review, examining physical activity, diet, preventive health, mental health, addiction, and medication adherence behaviors. Three main concepts emerged: (1) impulsivity moderates the association between intention and behavior change; (2) self-efficacy moderates the association between intention and behavior change; and (3) planning and self-efficacy contribute to moderated mediation. This review demonstrates a gap in the literature regarding the application of the TPB to the intention–behavior pathway for health behaviors. Future studies in behavioral economics may leverage the variables of impulsivity, self-efficacy, and planning to predict follow-through in this area and to develop targeted change initiatives.
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Boydell V, Galavotti C. Getting Intentional about Intention to Use: A Scoping Review of Person-Centered Measures of Demand. Stud Fam Plann 2022; 53:61-132. [PMID: 35119110 PMCID: PMC9303959 DOI: 10.1111/sifp.12182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In recent years, there has been much reflection on the measures used to assess and monitor contraceptive programming outcomes. The meaning and measurement of intention‐to‐use (ITU) contraception, however, has had less attention and research despite its widespread inclusion in many major surveys. This paper takes a deeper look at the meaning and measurement of ITU around contraception. We conducted a scoping review guided by the following questions: What is the existing evidence regarding the measurement of ITU contraception? What definitions and measures are used? What do we know about the validity of these measures? We searched databases and found 112 papers to include in our review and combined this with a review of the survey instruments and behavioral theory. Our review found growing evidence around the construct of ITU in family planning programming and research. However there are inconsistencies in how ITU is defined and measured, and this tends not to be informed by advances in behavioral theory and research. Further work is needed to develop and test measures that capture the complexity of intention, examine how intention differently relates to longer‐range goals compared to more immediate implementation, and demonstrate a positive relationship between ITU and contraceptive use.
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Affiliation(s)
- Victoria Boydell
- School of Health and Social Care, University of Essex, Colchester, UK
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Tsheko GN, Koyabe B, Gabaitiri L, Molebatsi K, Chilisa B, Major TE, Losike-Sedimo N, Jemmott JB, Jemmott LS. Mediation Analysis of a Theory-Based Culture and Age-Appropriate HIV/STI Prevention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 23:865-878. [PMID: 34936044 DOI: 10.1007/s11121-021-01306-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/25/2022]
Abstract
Few studies have investigated mediator effects of HIV prevention interventions on adolescents in sub-Saharan Africa. Herein, we report on a secondary analysis of an intervention that increased intentions to use condoms, abstain from sexual intercourse, and seek safe male circumcision among adolescents in Botswana. In a study conducted in Botswana, 806 grade 9 students from 21 public Junior Secondary Schools were randomly assigned to either the OWN THE FUTURE: Pulling Together We Will" ( PTWW) intervention group or a health promotion control group. Both conditions consisted of 12 1-h modules, with two modules delivered during each of the six sessions on six consecutive school days. The students in both groups completed confidential computer-based surveys at several time points: pre-, immediately post-, 3, 6, and 12 months post-intervention. Mediation was assessed using the product-of-coefficients approach in a generalized estimating equations (GEE) framework. The analyses showed that condom use beliefs were significant mediators of the intervention effect on the intention to consistently use condoms over time. Also, negative socio-cultural beliefs, prevention beliefs, and HIV/STI knowledge were significant mediators of the intervention's effects on the intention to abstain from sex. Additionally, normative beliefs, prevention beliefs, parental negotiation, and circumcision knowledge were significant mediators of the intervention's effect on intention to seek safe male circumcision. The mediation analysis delineated a theoretical model and isolated activities that positively impact condom use, abstinence from sex, and circumcision intentions of Batswana middle school adolescents.
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Affiliation(s)
| | - Bramwell Koyabe
- Educational Foundations, University of Botswana, Gaborone, Botswana
| | | | | | - Bagele Chilisa
- Educational Foundations, University of Botswana, Gaborone, Botswana
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Sun X, Fan L, Chang C, Shi Y. HIV/AIDS related perception and behavior: A comparative study among college students of different majors in China. Int J Nurs Sci 2020; 7:S74-S79. [PMID: 32995383 PMCID: PMC7501480 DOI: 10.1016/j.ijnss.2020.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/28/2020] [Accepted: 07/16/2020] [Indexed: 11/28/2022] Open
Abstract
Objective In order to carry out proper education and intervention of AIDS based on different features and demands of different majors, this study aimed to compare the difference of college students from six majors in China in the aspects of AIDS-related knowledge, attitudes and behaviors. Methods A questionnaire survey was carried out among 18,644 students in 30 colleges/universities from 9 provinces of China, who were recruited through stratified cluster sampling. AIDS-related knowledge, attitude, condom-use intention, self-efficacy and sexual behavior of these students were investigated. Results AIDS-related knowledge level of students majoring in education was the lowest while that of medical students was the highest as well as highest self-efficacy of condom use. Students of music or fine arts had the strongest intention to use condoms, while the students majoring in education had the weakest. The sexually active percentages of male students from different majors ranked as follows: music or fine arts (29.5%), minority nationality (12.2%), science & tech (10.9%), medicine (10.6%), education-major (10.0%), and liberal arts (8.2%). Among female students, the rank was music or fine arts (11.0%), science & tech (6.2%), education-major school (4.5%), minority nationality (4.5%), liberal arts (4.1%), and medicine (2.8%). Conclusion It is urgent to enhance proper AIDS-related education and intervention based on the features and demands of students from different majors or universities, for example, to enhance comprehensive AIDS prevention education among students major in education and to increase behavioral skills to prevent sexually transmitted diseases among students from colleges or faculty of music or fine arts.
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Affiliation(s)
- Xinying Sun
- School of Public Health, Peking University, Beijing, China
| | - Lishi Fan
- School of Public Health, Peking University, Beijing, China
| | - Chun Chang
- School of Public Health, Peking University, Beijing, China
| | - Yuhui Shi
- School of Public Health, Peking University, Beijing, China
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Heeren GA, Jemmott JB, Marange CS, Rumosa Gwaze A, Batidzirai JM, Ngwane Z, Mandeya A, Tyler JC. Health-Promotion Intervention Increases Self-Reported Physical Activity in Sub-Saharan African University Students: A Randomized Controlled Pilot Study. Behav Med 2018; 44:297-305. [PMID: 28682186 PMCID: PMC6292207 DOI: 10.1080/08964289.2017.1350134] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To evaluate the efficacy of a health-promotion intervention in increasing self-reported physical activity among university students in Sub-Saharan Africa. Randomly selected second-year students at a university in South Africa were randomized to an intervention based on social cognitive theory: health-promotion, targeting physical activity and fruit, vegetable, and fat consumption; or HIV risk-reduction, targeting sexual-risk behaviors. Participants completed assessments via audio computer-assisted self-interviewing pre-intervention and 6 and 12 months post-intervention. A total of 176 were randomized with 171 (97.2%) retained 12 months post-intervention. Generalized-estimating-equations analyses indicated that the health-promotion-intervention participants were more likely to meet physical-activity guidelines than were control participants, post-intervention, adjusting for pre-intervention physical activity (odds ratio [OR] = 3.35; 95% CI: 1.33-8.41). Health-promotion participants reported a greater number of days they did vigorous-intensity (risk ratio [RR] = 2.01; 95% CI: 1.43-2.83) and moderate-intensity (RR = 1.40; 95% CI: 1.01-1.95) aerobic activity, but not strength-building activity (RR = 1.37; 95% CI: 0.091-2.07). The intervention reduced self-reported servings of fried foods (mean difference = -0.31; 95% CI: -0.60, -0.02). The findings suggest that theory-based, contextually appropriate interventions may increase physical activity among university students in Sub-Saharan Africa.
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Affiliation(s)
- G Anita Heeren
- a St. Joseph's University , Philadelphia , Pennsylvania , USA
| | - John B Jemmott
- a St. Joseph's University , Philadelphia , Pennsylvania , USA
| | | | | | - Jesca Mercy Batidzirai
- b University of Fort Hare , Alice , South Africa
- c University of KwaZulu-Natal , Durban , South Africa
| | - Zolani Ngwane
- d Haverford College , Philadelphia , Pennsylvania , USA
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Protogerou C, Johnson BT, Hagger MS. An integrated model of condom use in Sub-Saharan African youth: A meta-analysis. Health Psychol 2018; 37:586-602. [PMID: 29708390 DOI: 10.1037/hea0000604] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We tested an integrated social-cognitive model derived from multiple theories of the determinants of young people's condom use in Sub-Saharan Africa. The model comprised seven social-cognitive antecedents of condom use: Attitudes, norms, control, risk perceptions, barriers, intentions, and previous condom use. METHOD We conducted a systematic search of studies including effects between at least one model construct and intended or actual condom use in young people from sub-Saharan African countries. Fifty-five studies comprising 72 independent data sets were included and subjected to random-effects meta-analysis. Demographic and methodological variables were coded as moderators. Hypotheses of the integrated model were tested using meta-analytic structural equation modeling. RESULTS The meta-analysis revealed significant nontrivial sample-weighted correlations among most model constructs. Moderator analyses revealed differences in six correlations for studies that included a formative research component relative to studies that did not. There was little evidence of systematic moderation of relations among model constructs by other candidate moderators. Meta-analytic structural equation models revealed significant direct effects of attitudes, norms, and control on condom use intentions, and of intention, control, and barriers on condom use. Including past condom use increased explained variance in condom use intentions and behavior but did not attenuate model effects. There were also significant indirect effects of attitudes, norms, and control on condom use through intentions. CONCLUSIONS Findings provide preliminary evidence to support the integrated condom use model in sub-Saharan African youth. The model provides guidance on potential targets for improving the effectiveness of condom promotion interventions. (PsycINFO Database Record
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Affiliation(s)
| | - Blair T Johnson
- Department of Psychological Sciences, University of Connecticut
| | - Martin S Hagger
- Faculty of Sport and Health Sciences, University of Jyväskylä
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Appiah AB, Tenkorang EY, Maticka-Tyndale E. Modeling Beliefs, Attitudes, and Intentions of Condom Use Among Secondary School Students in Kenya. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1949-1960. [PMID: 28451836 DOI: 10.1007/s10508-017-0966-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 02/06/2017] [Accepted: 02/17/2017] [Indexed: 06/07/2023]
Abstract
As in other parts of sub-Saharan Africa, youth in Kenya report low rates of condom use. Although several studies have explored reasons for the low condom use among Kenyan youth, not many have established linkages between lack of use and normative beliefs and attitudes around condoms. Using the Theory of Planned Behavior (TPB), this article examined whether beliefs and attitudes around condoms influenced intentions and actual condom use. Data for the study were restricted to 1453 sexually active youth during the last school break. Path analysis was used to examine the relationship between the TPB constructs and condom use among Kenyan youth. Results indicated a direct relationship between attitudes and condom use for male respondents and an indirect relationship between these two variables for females. Both males and females who expressed greater intentions to use condoms were significantly more likely to report they used condoms consistently. Also, male and female youth with higher perceived behavioral control were significantly more likely to have used condoms consistently. Males with friends who used condoms were significantly more likely to use condoms consistently. The findings suggest the importance of examining young people's attitudes toward condoms-in particular, those deeply rooted in misconceptions that serve to discourage safer sexual behaviors.
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Affiliation(s)
- Anna B Appiah
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
| | - Eleanor Maticka-Tyndale
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON, Canada
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Hoffman S, Levasseur M, Mantell JE, Beksinska M, Mabude Z, Ngoloyi C, Kelvin EA, Exner T, Leu CS, Pillay L, Smit JA. Sexual and reproductive health risk behaviours among South African university students: results from a representative campus-wide survey. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2017; 16:1-10. [PMID: 28367750 PMCID: PMC5563261 DOI: 10.2989/16085906.2016.1259171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Among South African university students, HIV prevalence is lower than in age-peers, but at 3.8% it is not negligible. We examined prevalence of factors potentially associated with HIV risk, focusing on partnership characteristics and consistent condom use. We hypothesised that contraceptive-related factors, for example, desire to prevent pregnancy and not using hormonal contraceptives, would be positively associated with consistent condom use. Data were drawn from a representative interviewer-administered survey of 2nd to 4th year students conducted during registration at a university campus in KwaZulu-Natal. Of 576 students, 218 (83 women, 135 men) reported vaginal intercourse in the past 2 months. Of these, 7% of women and 43% of men reported past-year concurrent partnerships, and 24% knew/ suspected partner non-monogamy. Although reported condom use at last intercourse was 90%, 2-month consistent use was 53% (women) and 73% (men). Reported hormonal contraception use was low (women: 36.8%; men: 16.7%), and 68% used condoms for dual protection. In gender-stratified multivariable analyses, consistent condom use was higher for men who reported their partner did not use (vs. used) hormonal contraception (aOR = 5.84; 95%CI = 2.71, 12.57; p < 0.001) and who reported using condoms for dual protection (vs. single protection) (aOR = 2.46; 95%CI = 1.43, 4.25; p = 0.001). No contraception-related factors were associated with consistent condom use among women. Sexual partnership characteristics potentially place sexually active university students at high HIV risk and should be investigated further. Among men, but not women, contraceptive concerns were associated with consistent condom use. Promoting condoms for dual protection may resonate with students and should be continued.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health at Columbia University, New York, NY 10032, USA
| | - Michael Levasseur
- Department of Epidemiology, Drexel University School of Public Health
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Mags Beksinska
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Maternal, Adolescent and Child Health Research (MatCH Research), University of the Witwatersrand, Durban 3629, South Africa
| | - Zonke Mabude
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Maternal, Adolescent and Child Health Research (MatCH Research), University of the Witwatersrand, Durban 3629, South Africa
| | - Claudia Ngoloyi
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Maternal, Adolescent and Child Health Research (MatCH Research), University of the Witwatersrand, Durban 3629, South Africa
| | - Elizabeth A. Kelvin
- Epidemiology and Biostatistics Program, School of Urban Public Health, Hunter College & The CUNY School of Public Health, City University of New York, New York, NY 10035, USA
| | - Theresa Exner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
- Department of Biostatistics, Mailman School of Public Health at Columbia University, New York, NY
| | - Lavanya Pillay
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Maternal, Adolescent and Child Health Research (MatCH Research), University of the Witwatersrand, Durban 3629, South Africa
| | - Jennifer A. Smit
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Maternal, Adolescent and Child Health Research (MatCH Research), University of the Witwatersrand, Durban 3629, South Africa
- School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban 3627, South Africa
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Zhang J, Jemmott JB, Heeren GA. Sub-Saharan African University Students' Beliefs about Abstinence, Condom Use, and Limiting the Number of Sexual Partners. Behav Med 2017; 43:9-20. [PMID: 25864861 DOI: 10.1080/08964289.2015.1028321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Given the high risk of HIV infection among university students in sub-Saharan Africa, there is a need for culturally appropriate risk-reduction interventions specifically targeting this population. Efforts to reduce the risk require an understanding of the modifiable antecedents of sexual-risk behaviors. We report the results of a semi-structured elicitation survey based on the reasoned action approach to identify behavioral, normative, and control beliefs regarding abstinence, condom use, and limiting sexual partners. Two coders classified into 64 belief categories the written responses of 96 sub-Saharan African university students. Most students believed each behavior could reduce risk of HIV infection. The students reported that peer pressure and being in a risky environment made it harder to practice abstinence. Good communication made it easier to use condoms and to limit partners; however, unstable relationships made practicing these protective behaviors harder. The identified beliefs help to inform the development of theory-based HIV risk-reduction interventions.
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Affiliation(s)
- Jingwen Zhang
- a Annenberg School for Communication, University of Pennsylvania
| | - John B Jemmott
- a Annenberg School for Communication, University of Pennsylvania.,b Perelman School of Medicine, University of Pennsylvania
| | - G Anita Heeren
- b Perelman School of Medicine, University of Pennsylvania
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11
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The Role of Condom Use Self-Efficacy on Intended and Actual Condom Use Among University Students in Ghana. J Community Health 2016; 41:97-104. [PMID: 26233713 DOI: 10.1007/s10900-015-0073-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Little attention has been paid to the dimensions that help to predict and understand condom use among university students within an African context. A cross-sectional study involving 518 university students in Accra, Ghana was conducted to determine how the Condom Use self-Efficacy Scale-Ghana (CUSES-G) can predict both actual condom use and future condom use. Of all the participants, 84% were sexually active but less than half of the sample (48%) reported to have used condom during their last sexual intercourse. A hierarchical regression analysis showed that components of the Condom Use Self-Efficacy Scale (CUESE-G) such as appropriation, assertiveness, pleasure and intoxication, and STDs predicted condom use and condom use intentions. Behavioural change campaigns targeting university students should encourage condom use self-efficacy, as this would strengthen condom use, which is economically cheap and practically effective means of preventing STIs including HIV.
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El-Bassel N, Jemmott JB, Bellamy SL, Pequegnat W, Wingood GM, Wyatt GE, Richard Landis J, Remien RH. Mediation Analysis of the Efficacy of the Eban HIV/STD Risk-Reduction Intervention for African American HIV Serodiscordant Couples. AIDS Behav 2016; 20:1197-207. [PMID: 26577402 DOI: 10.1007/s10461-015-1249-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Targeting couples is a promising behavioral HIV risk-reduction strategy, but the mechanisms underlying the effects of such interventions are unknown. We report secondary analyses testing whether Social-Cognitive-Theory variables mediated the Eban HIV-risk-reduction intervention's effects on condom-use outcomes. In a multisite randomized controlled trial conducted in four US cities, 535 African American HIV-serodiscordant couples were randomized to the Eban HIV risk-reduction intervention or attention-matched control intervention. Outcomes were proportion condom-protected sex, consistent condom use, and frequency of unprotected sex measured pre-, immediately post-, and 6 and 12 months post-intervention. Potential mediators included Social-Cognitive-Theory variables: outcome expectancies and self-efficacy. Mediation analyses using the product-of-coefficients approach in a generalized-estimating-equations framework revealed that condom-use outcome expectancy, partner-reaction outcome expectancy, intention, self-efficacy, and safer-sex communication improved post-intervention and mediated intervention-induced improvements in condom-use outcomes. These findings underscore the importance of targeting outcome expectancies, self-efficacy, and safer-sex communication in couples-level HIV risk-reduction interventions.
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Jemmott III JB, Jemmott LS, O’Leary A, Icard LD, Rutledge SE, Stevens R, Hsu J, Stephens AJ. On the Efficacy and Mediation of a One-on-One HIV Risk-Reduction Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial. AIDS Behav 2015; 19:1247-62. [PMID: 25449552 PMCID: PMC4503868 DOI: 10.1007/s10461-014-0961-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We examined the efficacy and mediation of Being Responsible for Ourselves (BRO), an HIV/STI risk-reduction intervention for African American men who have sex with men (MSM), the population with the highest HIV-diagnosis rate in the US. We randomized African American MSM to one of two interventions: BRO HIV/STI risk-reduction, targeting condom use; or attention-matched control, targeting physical activity and healthy diet. The interventions were based on social cognitive theory, the reasoned-action approach, and qualitative research. Men reporting anal intercourse with other men in the past 90 days were eligible and completed pre-intervention, immediately post-intervention, and 6 and 12 months post-intervention surveys. Of 595 participants, 503 (85 %) completed the 12-month follow-up. Generalized-estimating-equations analysis indicated that, compared with the attention-matched control intervention, the BRO intervention did not increase consistent condom use averaged over the 6- and 12-month follow-ups, which was the primary outcome. Although BRO did not affect the proportion of condom-protected intercourse acts, unprotected sexual intercourse, multiple partners, or insertive anal intercourse, it did reduce receptive anal intercourse compared with the control, a behavior linked to incident HIV infection. Mediation analysis using the product-of-coefficients approach revealed that although BRO increased seven of nine theoretical constructs it was designed to affect, it increased only one of three theoretical constructs that predicted consistent condom use: condom-use impulse-control self-efficacy. Thus, BRO indirectly increased consistent condom use through condom-use impulse-control self-efficacy. In conclusion, although BRO increased several theoretical constructs, most of those constructs did not predict consistent condom use; hence, the intervention did not increase it. Theoretical constructs that interventions should target to increase African American MSM’s condom use are discussed.
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Gomes A, Nunes C. Comparative analysis between condom use clusters and risk behaviours among Portuguese university students. SAUDE E SOCIEDADE 2015. [DOI: 10.1590/s0104-12902015000100027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The research on condom use has been focused on high-risk individuals, paying less attention to those who have moderate risk or safe sexual conducts. In order to design accurate interventions, potential differences among the condom use behavior groups must be considered. The goal was to assess possible differences in individuals presenting different types of risk behavior. 140 heterosexual university students answered a self-reported questionnaire about their sexual history, condom use habits, sexual self-esteem, sexual satisfaction, sexual control, attitudes towards condoms, self-efficacy to condom use, and emotions and feelings during sexual intercourse. A cluster analysis was conducted using the results about condom use and risk behaviors. Three groups with different risk levels emerged, presenting differences over sexual self-efficacy, attitudes towards condoms, socio-demographic variables, and sexual history. The results suggest the condom use inconsistency is highly associated with other risk behaviors but the contrary does not necessarily happens. Condom use consistent users also presented risk behaviors as smoking and drinking. The group differences suggest the risks were more affected by the combination of lack of skills with a negative attitude toward condoms than by contextual or personal variables. These differences sustain the need of an intervention adjusted to the individual's risk levels, since they differ on skills and beliefs that may hinder or promote the adoption of health behaviors.
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Heeren GA, Icard LD, O'Leary A, Jemmott JB, Ngwane Z, Mtose X. Protective factors and HIV risk behavior among South African men. AIDS Behav 2014; 18:1991-7. [PMID: 24722765 DOI: 10.1007/s10461-014-0767-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary mode of HIV transmission in South Africa is heterosexual sexual behavior. HIV prevention research specifically focusing on men in South Africa is limited. We assessed self-reported HIV risk behaviors in 1,181 men ages 18 to 45 years in randomly selected neighborhoods in Eastern Cape Province, South Africa. Older men were less likely to report having multiple partners. Religiosity was a protective factor for condom use and unprotected sex with steady partners. Discussing using condoms was a protective factor for condom use and unprotected sex with both steady and casual partners. Having a child was associated with decreased condom use with steady partners and employment was associated with decreased condom use with casual partners. The findings suggest the need for HIV risk-reduction behavioral interventions tailored for South African men with regard to age, religiosity, and types of sexual partners. Implications for the development of such interventions are discussed.
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Affiliation(s)
- G Anita Heeren
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, PA, 19104-3309, USA
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Li J, Li S, Yan H, Xu D, Xiao H, Cao Y, Mao Z. Early sex initiation and subsequent unsafe sexual behaviors and sex-related risks among female undergraduates in Wuhan, China. Asia Pac J Public Health 2014; 27:21S-9S. [PMID: 25208545 DOI: 10.1177/1010539514549186] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to explore the association between early sex initiation and subsequent unsafe sexual behaviors and risks among Chinese female undergraduates. Of 4769 participants, 863 (18.1%) reported ever having sexual intercourse. The mean age of sexual debut was 19.3 (±1.7) years. Females initiating sex earlier were more likely to have first sex with men who were not their "boyfriends" and less likely to take contraception, to use a condom at first encounter, to use contraception consistently in past year, and/or to use condom consistently during the course of a sexual intercourse. They were more likely to have multiple lifetime and concurrent sexual partners, to report pregnancy, and be diagnosed with sexually transmitted diseases. Comprehensive early sex education should be advocated for young people, not only teaching knowledge of physical health but also providing practical skills training for making them consciously delay start of sexual activity or protecting themselves during sexual intercourse.
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Affiliation(s)
- Jiantao Li
- Shanxi Medical University, Taiyuan, People's Republic of China
| | - Shiyue Li
- Wuhan University, Wuhan, Hubei, People's Republic of China Globe Health Center of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Hong Yan
- Wuhan University, Wuhan, Hubei, People's Republic of China Globe Health Center of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Delong Xu
- Wuhan University, Wuhan, Hubei, People's Republic of China Hubei Province Family Planning Technology Service Center, Wuhan, Hubei, Peoples' Republic of China
| | - Han Xiao
- Wuhan University, Wuhan, Hubei, People's Republic of China Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yue Cao
- Wuhan University, Wuhan, Hubei, People's Republic of China Globe Health Center of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Zongfu Mao
- Wuhan University, Wuhan, Hubei, People's Republic of China Globe Health Center of Wuhan University, Wuhan, Hubei, People's Republic of China
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Caregivers' intentions to disclose HIV diagnosis to children living with HIV in South Africa: a theory-based approach. AIDS Behav 2014; 18:1027-36. [PMID: 24310931 DOI: 10.1007/s10461-013-0672-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
When children know their HIV serostatus, they are more likely to cooperate with steps to manage their health and the risk of transmitting HIV to others. Mounting evidence indicates that caregivers often do not disclose to HIV-positive children that the children are living with HIV, but little is known about the modifiable determinants of pediatric HIV disclosure. The present study examined theory-of-planned-behavior predictors of the intention to disclose to children their HIV diagnosis. The participants were 100 caregivers of HIV-positive children in Eastern Cape Province, South Africa. Proportional-odds logistic regression analysis revealed that normative support for disclosure and caregiver-child communication predicted the intention to disclose, whereas behavioral beliefs regarding the consequences of disclosing and self-efficacy to disclose did not. The results suggest that interventions to increase pediatric HIV disclosure in South Africa should help caregivers enlist support for disclosure among important referents and improve communication with their HIV-infected children.
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Jemmott LS, Jemmott JB, Ngwane Z, Icard L, O’Leary A, Gueits L, Brawner B. 'Let Us Protect Our Future' a culturally congruent evidenced-based HIV/STD risk-reduction intervention for young South African adolescents. HEALTH EDUCATION RESEARCH 2014; 29:166-81. [PMID: 23962491 PMCID: PMC3894663 DOI: 10.1093/her/cyt072] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 06/10/2013] [Indexed: 05/31/2023]
Abstract
One of the worst HIV/AIDS epidemics in the world is occurring in South Africa, where heterosexual exposure is the main mode of HIV transmission. Young people 15-24 years of age, particularly women, account for a large share of new infections. Accordingly, there is an urgent need for behavior-change interventions to reduce the incidence of HIV among adolescents in South Africa. However, there are few such interventions with proven efficacy for South African adolescents, especially young adolescents. A recent cluster-randomized controlled trial of the 'Let Us Protect Our Future!' HIV/STD risk-reduction intervention for Grade 6 South African adolescents (mean age = 12.4 years) found significant decreases in self-reported sexual risk behaviors compared with a control intervention. This article describes the intervention, the use of the social cognitive theory and the reasoned action approach to develop the intervention, how formative research informed its development and the acceptability of the intervention. Challenges in designing and implementing HIV/STD risk-reduction interventions for young adolescents in sub-Saharan Africa are discussed.
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Affiliation(s)
- L. S. Jemmott
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - J. B. Jemmott
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Z. Ngwane
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - L. Icard
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - A. O’Leary
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - L. Gueits
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - B. Brawner
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Sun X, Liu X, Shi Y, Wang Y, Wang P, Chang C. Determinants of risky sexual behavior and condom use among college students in China. AIDS Care 2013; 25:775-83. [DOI: 10.1080/09540121.2012.748875] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Heeren GA, Jemmott JB, Ngwane Z, Mandeya A, Tyler JC. A randomized controlled pilot study of an HIV risk-reduction intervention for sub-Saharan African university students. AIDS Behav 2013; 17:1105-15. [PMID: 22246515 DOI: 10.1007/s10461-011-0129-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This pilot study used a randomized controlled trial to test the efficacy of an HIV risk-reduction intervention for university students in Eastern Cape Province, South Africa. Randomly selected second-year students were randomized to one of two interventions based on social cognitive theory and qualitative research: HIV risk-reduction, targeting sexual-risk behaviors; health-promotion control, targeting health behaviors unrelated to sexual risks. Participants completed behavioral assessments via audio computer-assisted self-interviewing pre-intervention, 6, and 12 months post intervention, with 97.2% retained at 12-month follow-up. Averaged over the 2 follow-ups, HIV risk-reduction intervention participants reported less unprotected vaginal intercourse and more frequent condom use than control participants, with greater efficacy in non-South Africans than South Africans. Positive changes were also observed on theoretical mediators of condom use that the intervention targeted. Interventions based on social cognitive theory integrated with qualitative information from the population may reduce sexual risk behaviors among university students in sub-Saharan Africa.
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Affiliation(s)
- G Anita Heeren
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, PA 19104-3309, USA
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21
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Tang L, Chen R, Huang D, Wu H, Yan H, Li S, Braun KL. Prevalence of condom use and associated factors among Chinese female undergraduate students in Wuhan, China. AIDS Care 2012; 25:515-23. [DOI: 10.1080/09540121.2012.720360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lijun Tang
- a School of Public Health of Wuhan University , Wuhan , Hubei , People's Republic of China
| | - Rucheng Chen
- a School of Public Health of Wuhan University , Wuhan , Hubei , People's Republic of China
| | - Danqin Huang
- a School of Public Health of Wuhan University , Wuhan , Hubei , People's Republic of China
| | - Haocheng Wu
- a School of Public Health of Wuhan University , Wuhan , Hubei , People's Republic of China
| | - Hong Yan
- a School of Public Health of Wuhan University , Wuhan , Hubei , People's Republic of China
| | - Shiyue Li
- a School of Public Health of Wuhan University , Wuhan , Hubei , People's Republic of China
| | - Kathryn L. Braun
- b Office of Public Health Studies, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
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Condoms "contain worms" and "cause HIV" in Tanzania: Negative Condom Beliefs Scale development and implications for HIV prevention. Soc Sci Med 2012; 75:1685-91. [PMID: 22877934 DOI: 10.1016/j.socscimed.2012.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 05/30/2012] [Accepted: 07/09/2012] [Indexed: 11/21/2022]
Abstract
Condom promotion remains a key component of HIV prevention programs, complimenting recent successes in biomedical HIV prevention. Although condom use has increased in much of East Africa, it remains substantially below optimal levels. Negative rumors about condoms have been documented in East Africa, yet the prevalence and effects of belief in the negative rumors have not been explored. This study evaluated levels of belief in negative rumors about condoms, developed a Negative Condom Beliefs Scale, and assessed its accuracy in predicting willingness to use condoms. A cross-sectional, cluster survey (n = 370) was conducted representing adults in two rural districts in Northern Tanzania in 2008. Item agreement ranged from 35 to 53% for the following rumors regarding condoms: causing cancer, having holes, containing HIV, having worms, and the worms causing HIV. Items loaded on a single latent factor and had high internal consistency and convergent validity. In a multivariate model, negative condom score (AOR = 0.67, 95% CI = 0.6, 0.8) was the strongest single predictor of willingness to use condoms, followed by greater perceived anonymity in acquiring condoms (AOR = 4.36, 95% CI = 2.2, 8.6) and higher condom self-efficacy (AOR = 4.24, 95% CI = 2.0, 8.9). Our findings indicate high levels of subscription to negative beliefs about condoms, with two out of three respondents affirming belief in at least one negative condom rumor. This study highlights the relation between condom rumor beliefs and willingness to use condoms, and indicates avenues for future research and means for improving the design of HIV prevention programs.
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GWANDURE CALVIN, MAYEKISO THOKOZILE. Internal Versus External Control of Reinforcement in Health Risk and HIV and AIDS Prevention. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2012. [DOI: 10.1111/j.1559-1816.2012.00897.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Swartz LHG, Sherman CA, Harvey SM, Blanchard J, Vawter F, Gau J. Midlife women online: evaluation of an internet-based program to prevent unintended pregnancy & STIs. J Women Aging 2012; 23:342-59. [PMID: 22014222 DOI: 10.1080/08952841.2011.613255] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Midlife women are an underserved population in the areas of unintended pregnancy and STI prevention yet remain at risk for both health conditions. METHODS A randomized controlled trial of an Internet-based multimedia program to reduce risk of unintended pregnancy and STIs among midlife women was conducted with 164 women ages 40-55 years of age. RESULTS Women in the treatment condition compared to the control condition reported significant gains in attitudes, self-efficacy, and behavioral intentions at posttest. CONCLUSION Interventions specifically targeted to midlife women can impact constructs known to reduce risk. Implications for future research and intervention development are presented.
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Affiliation(s)
- Lynne H G Swartz
- Oregon Center for Applied Science, Inc. , Eugene, OR 97401, USA.
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25
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Maticka-Tyndale E. Condoms in sub-Saharan Africa. Sex Health 2012; 9:59-72. [DOI: 10.1071/sh11033] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 11/16/2011] [Indexed: 11/23/2022]
Abstract
Sub-Saharan Africa (SSA) is the region with the world’s highest rates of HIV and other sexually transmissible infections (STIs), yet numerous studies show that condom use is generally rare. This suggests a need for a better understanding of how condoms fit within sexual practices and relationships in SSA. This paper seeks to address this need by reviewing research published between the late 1980s and 2011 on use and factors influencing use of male condoms in SSA. What is evident from this research is that condom use involves complex social and interpersonal dynamics, with structural and cultural conditions exerting an influence through framing social cognitions and setting boundaries on autonomy that make the apparently irrational choice of eschewing condoms a rational decision. The influences of poverty; relationships with parents, peers and partners; limited, insufficient or absent information especially in rural areas and among men who have sex with men; gender and sexual norms, and the dynamics of gendered power; and beliefs and attitudes about HIV, condoms and sexuality all have been shown to work against condom use for a large proportion of Africa’s people. However, promising results are shown in trends towards increased condom use among single women in numerous countries, increasing acceptance and use of condoms among some university students, successes in producing potentially sustainable condom use resulting from select interventions, and resistance to succumbing to the dominant gender–power dynamics and structural–cultural impediments that women in groups have mobilised.
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Heeren GA, Jemmott JB, Mandeya A, Tyler JC. Sexual attitudes and behaviour of university students at a rural South African University: Results of a Pilot Survey. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2012; 22:1021-1032. [PMID: 24634577 PMCID: PMC3954693 DOI: 10.1080/10911359.2012.720909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A cross sectional qualitative and quantitative pilot survey, using self administered questionnaire and focus group discussions, was conducted to assess the need for, and feasibility of, a health promotion programme for university students at a South African University. We examined the gender and cultural effects on sexual attitudes and behaviour, as well as condom use. A total of 73 students, age's between 18 and 30 years, participated in the pilot survey. The results suggest that females compared to the males are more likely to abstain until they find a partner with whom they intend to settle. There was a strong belief that unprotected sex can lead to pregnancy and STIs. Overall participants were not sure if condom use had any negative effects, although female respondents felt that condoms affect the pleasure of sexual intercourse. The results suggest that there is a clear need for health promotion programmes aimed at young adults, who attend university. The programme would need to aim at improving general health knowledge, targeting health promotion and sexual risk behaviour among university students. Such a programme would have to consider gender, socio-economic circumstances as well as national and cultural background of the target population.
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Affiliation(s)
- G Anita Heeren
- Senior Research Associate, Center for Health Behavior and Communication Research Department of Psychiatry Perelman School of Medicine University of Pennsylvania 3535 Market Street, Suite 520 Philadelphia, PA 19104-3309
| | - John B Jemmott
- The Kenneth B. Clark Professor of Communication; Annenberg School for Communication; Professor of Communication in Psychiatry, Director, Center for Health Behavior and Communication Research, Department of Psychiatry Perelman School of Medicine University of Pennsylvania 3535, Market Street, Suite 520, Philadelphia, PA 19104-3309
| | - Andrew Mandeya
- Department of Statistics and Biostatistics, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa
| | - Joanne C Tyler
- Proefessor and Head of the Department of Statistics and Biostatistics, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa
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Winskell K, Obyerodhyambo O, Stephenson R. Making sense of condoms: social representations in young people's HIV-related narratives from six African countries. Soc Sci Med 2011; 72:953-61. [PMID: 21388731 DOI: 10.1016/j.socscimed.2011.01.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 01/16/2011] [Accepted: 01/17/2011] [Indexed: 11/18/2022]
Abstract
Condoms are an essential component of comprehensive efforts to control the HIV epidemic, both for those who know their status and for those who do not. Although young people account for almost half of all new HIV infections, reported condom use among them remains low in many sub-Saharan African countries. In order to inform education and communication efforts to increase condom use, we examined social representations of condoms among young people aged 10-24 in six African countries/regions with diverse HIV prevalence rates: Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso, and Senegal. We used a unique data source, namely 11,354 creative ideas contributed from these countries to a continent-wide scriptwriting contest, held from 1(st) February to 15(th) April 2005, on the theme of HIV/AIDS. We stratified each country sample by the sex, age (10-14, 15-19, 20-24), and urban/rural location of the author and randomly selected up to 10 narratives for each of the 12 resulting strata, netting a total sample of 586 texts for the six countries. We analyzed the narratives qualitatively using thematic data analysis and narrative-based methodologies. Differences were observed across settings in the prominence accorded to condoms, the assessment of their effectiveness, and certain barriers to and facilitators of their use. Moralization emerged as a key impediment to positive representations of condoms, while humour was an appealing means to normalize them. The social representations in the narratives identify communication needs in and across settings and provide youth-focused ideas and perspectives to inform future intervention efforts.
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Affiliation(s)
- Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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