Gender, Sexual Self-Efficacy and Consistent Condom Use Among Adolescents Living in the HIV Hyper-Endemic Setting of Soweto, South Africa

Impact of a College Sexual Violence Prevention Program on Condom Use: A Mediation Analysis

College-age students are disproportionately impacted by sexually transmitted infections. Campus programs that reduce sexual violence have received recent investment, are increasingly common, and may offer a platform to increase condom use, but this has not yet been investigated. We explore this novel question through a secondary analysis of a randomized control trial of RealConsent, a web-based, sexual assault program for college women, on three college campuses. By estimating single and multiple-mediator models we examine the relationships between study assignment, the hypothesized mediators: self-efficacy to discuss safer sex, and clarity and assertiveness in sexual communication, and consistent condom use at follow-up. In the single mediator models, self-efficacy for safer sex communication (aOR: 1.11, 95% CI: 1.03-1.19, p = .004), assertiveness in sexual communication (aOR: 1.06, 95% CI: 1.02-1.11, p =.004), and clarity in sexual communication (aOR: 1.03, 95% CI: 1.00-1.05, p = .026) demonstrated significant direct effects on condom use. No statistically significant relationships between RealConsent and the mediators, nor indirect effects were found. In the multimediator model, there were no statistically significant associations identified. Self-efficacy, assertiveness, and clarity in communication about sex may have a positive impact on condom use but we did not find evidence that RealConsent impacted these mediators and thus no mediated effect was identified. Additional research is needed to develop and assess college-based sexual violence prevention programs that include an additional focus on skills specifically related to condom negotiation and use to understand if these widespread programs offer an efficient and effective platform to reduce the impact of sexually transmitted infections (STIs) among this high-risk population.

Safe sex negotiation and HIV risk reduction among women: A cross-sectional analysis of Burkina Faso 2021 Demographic and Health Survey

Women are biologically more susceptible to the Human Immunodeficiency Virus (HIV) and other sexually transmitted Infections (STIs) because receptive sex is riskier than insertive. Despite condom use being the staple preventive method for HIV infection (over 80% efficacy), in Sub-Saharan African countries like Burkina Faso, a high burden of HIV and the unmet need for condom use coexist. Moreover, even though women in SSA are disproportionately HIV positive, they are reportedly less capable of negotiating condom use for HIV risk reduction. Thus, using the Health Believe Model (HBM), this study explored the factors that influence condom use among women within the context of HIV prevention, with a key interest in condom use negotiation. Using the women's dataset of the 2021 Burkina Faso Demographic and Health Survey and applying logistic regression models, this study examined the factors associated with condom use for HIV risk reduction. Women who had confidence to negotiate condom use with their partners (OR = 1.57, P<0.001, 95%CI: 1.29, 1.91), those with secondary education (OR = 1.38, P<0.05, 95%CI: 1.07 1.77), from richest households (OR = 1.64, P<0.05, 95%CI: 1.08, 2.47), the employed (OR = 1.23, P<0.05, 95%CI: 1.02, 1.49), women with knowledge of sexually transmitted infections (OR = 1.58, P<0.001, 95%CI: 1.26, 1.97), those who have ever been tested for HIV (OR = 1.85, P<0.001, 95%CI: 1.52 2.24), as well as those who knew that a healthy-looking person can have HIV (OR = 2.64, P<0.001, 95%CI: 2.15, 3.24) were all significantly more likely to practice condom use for HIV risk reduction. Also, religion and geographical location of participants significantly predicted condom use for HIV risk reduction in the study context. The ability to negotiate condom use, knowledge of HIV and STIs, the socioeconomic status of women, as well as their geographical location, influence their practice of safer sex for HIV risk reduction in Burkina Faso.

"It's a 50/50 Thing You Know": Exploring the Multileveled Intersections of Gender and Power Within the Relationships of Young South African Men and Women

Efforts to advance sexual health globally require greater understandings of youth intimate relationship dynamics. Among 38 South African youth (21 women/17 men aged 21-30 from Durban and Soweto) we conducted qualitative cognitive interviews to explore how gender and power intersect to shape intimate relationship dynamics (October 2019-March 2021). Participants discussed perceptions and relevance of each of 13 items comprising the Sexual Relationship Power (SRP) scale, a widely used measure of gender equity, and the influence of SRP on youth sexual health. Data analysis was guided by constructivist grounded theory. The findings were organized using the socio-ecological model, revealing how gender and power intersected at multiple levels to influence youth intimate relationships. Key influencing factors included individual-level gender attitudes, male partner expectations, and women's resistance to dominance; intimate relationship-level power dynamics, consent, and intimacy; family-level household configurations and parental monitoring of daughters; and societal-level traditional gender norms. At all levels, women discussed resisting power inequities through communication and rejection of inequitable relationships. While men also displayed resistance to inequitable power structures, most upheld traditional gender norms through institutional affiliation (e.g. church) and deep-rooted socialized beliefs and attitudes. Efforts to improve youth sexual health require multileveled approaches that address inequitable power dynamics.

Sexual health literacy and its related factors among couples: A population-based study in Iran

Sexual health literacy is one of the factors that affect sexual health. Several factors can influence sexual health literacy. As a result, the current study was carried out to determine sexual health literacy and its associated factors among Iranian couples. In 2022, 410 couples of reproductive age were referred to comprehensive health service centers and private clinics in Kerman city for the descriptive-analytical study. The study questionnaires included sexual health literacy for adults, sexual knowledge and attitude scale, marital intimacy scale, sexual intimacy scale, depression anxiety stress scale, sexual self-efficacy, the multidimensional scale of perceived social support, and socioeconomic status. Finally, multiple linear stepwise regression models were used to determine the factors related to sexual health literacy using the SPSS software version 22. According to the findings of this study, the mean(SD) of sexual health literacy in couples was 68.76(12.96), which was a desirable level. Furthermore, the findings revealed that sexual self-efficacy (B = 0.649، P<0.001), sexual knowledge and attitude (B = 0.217، P<0.001), the ability to identify reliable and non-reliable sources (B = -3.116، P<0.001), feelings of shame and embarrassment for obtaining sexual information (B = 1.860، P = 0.011), social support (B = 0.127، P<0.001) and the obscenity of sexual issues in family (B = 1.764، P = 0.015) were the final predictors of sexual health literacy in couples. It is suggested that researchers and health managers consider these factors when designing interventions to promote sexual health literacy.

Condom use self-efficacy centered on sexual experience, cannabis, and CBD use among college students

OBJECTIVES

The goal of this study was to understand how condom use self-efficacy varies based on sexual experience, cannabis and CBD use.

METHODS

A cross-sectional survey was implemented through Qualtrics. A total of 455 undergraduate students were surveyed at a large U.S. northeastern university.

RESULTS

Findings suggested that sexual experience itself and sexual experience with cannabis and CBD are associated with a person's condom use self-efficacy. Precisely, non-sexually active and cannabis or CBD nonusers perceived themselves as less efficacious in their future use of condoms compared with sexually active adolescents.

CONCLUSIONS

Implications for health interventions are discussed, such as the importance of giving attention to non-sexually active adolescents and strengthening their condom use self- efficacy. It is critical to promote healthy sexual behaviors among future sexually active college students and reinforce healthy sexual behaviors among sexually active adolescents.

Analysing intersecting social resources in young people's ability to suggest safer sex - results from a national population-based survey in Sweden

Background

Safer sex is one of the most crucial areas in sexual and reproductive health and rights (SRHR). Drawing on the theory of health promotion where social life generates resources for health our hypothesis is that having control over one’s life situation, affects the ability for safer sex and thereby sexual health. The aim is to explore the association between having control over one’s life and the ability to suggest safer sex among young people aged 16–29, and how this plays out in relation to membership of six constructed social groups based on: gender, transgender experience, sexual identity, economy, being foreign-born, and social welfare recipiency followed by an in-depth analysis of the intersection of gender and sexual identity.

Methods

The data set comprises cross-sectional survey responses from a stratified random sample of 7755 in the total Swedish population of young people. The SRHR-focused questionnaire was developed within the HIV-monitoring program at the Public Health Agency of Sweden. Data collection was conducted by Statistics Sweden between April 15 and June 8 in 2015. The survey had a response rate of 26%, which was in line with the study design. Statistical analysis was used to explore the self-reported outcome variable ability for safer sex and the exposure variable control over one’s life. The methods used comprise multivariate logistic regression and an intersecting multivariate regression exploring 12 intersecting social positions by gender and sexual identity.

Results

The results show that young people’s control over their lives is associated with their ability for safer sex. Due to this, control over one’s life can be seen as a resource for safer sex. The associations in the 12 intersecting social positions showed complex patterns.

Conclusions

The intersections of resources show the complexity and that gender cannot account for all differences in the resources for young people’s ability to suggest safer sex. Implications for policy and practitioners involve both addressing and strengthening the sexual rights of young people from sexual minorities and tailoring interventions in a way that takes the intersections between gender and sexual identity into consideration.

The Mediating Role of Sexual Self-Efficacy on Protected Sex

Background:

Ascribed traditional gender role has rarely been examined in the topical area of protected sex.

Objective:

The purpose of this study was to examine the relationship between HIV knowledge, ascribed cultural gender roles of machismo and marianismo, acculturation, attitudes toward risky sexual behaviors and sexual self-efficacy on protected sex, and the mediating effect of sexual self-efficacy between these predictors and protected sex.

Methods:

Part of a larger study, Hispanic college students from a Hispanic-serving institution in a U.S. southern border city were recruited.

Results and Conclusion:

Sexual self-efficacy was found a significant mitigating factor against sexual risks associated with machismo as well as a positive reinforcing element on attitudes toward protected sex. Study findings have implications toward the development of culturally sensitive evidence-based interventions that promote sexual self-efficacy skills among Hispanic males who strongly identify with culturally ascribed gender roles.

Differential Item Functioning of the Center for Epidemiologic Studies Depression Scale Among Chinese Adolescents

This study examined differential item functioning (DIF) in the Center for Epidemiologic Studies Depression Scale (CES-D) between Chinese and White adolescents (aged 13 to 17 years) living in Canada. A series of ordinal logistic regressions were used to test for uniform and non-uniform DIF on items in the CES-D. The DIF analyses identified non-uniform DIF for Item 7 ("I felt that everything I did was an effort"). Controlling for gender and strength of ethnic identity in the DIF analyses did not alter the DIF results. The results of this study suggest that CES-D Item 7 does not appear to discriminate at higher levels of depression in Chinese adolescents. The results of this study hold notable implications for the use of the CES-D given that Chinese adolescents demonstrated a systematic difference in expression/experience of depression.

Family Matters: The Support of Parents to Change Black Male's Attitudes Towards HIV

This study explored the associations between family (mother and father support), peers, and individual factors (self-efficacy) and how these relationships influence HIV attitudes among African American males 12 to 19 years of age, with an average age of 16 years. For this study, we used restricted data obtained from Wave I of the National Longitudinal Study of Adolescent to Adult Health (ADD Health). Descriptive statistics suggest that most of the sample had negative attitudes towards HIV. Bivariate regression analysis followed by a linear regression analysis was conducted to identify the factors that were associated with HIV attitudes. Major findings from regression analysis indicate that mother support, father support, self-efficacy, and age, predicted HIV attitudes. Mother support positively predicted positive HIV attitudes and surprisingly, father support negatively predicted HIV attitudes. Our findings can be used to better inform HIV prevention and intervention programs to help Black males stay healthy.

Ending the Epidemic: Assessing Sexual Health Communication, Personal Agency, and HIV Stigma among Black and Latino Youth in the U.S

Sexual health communication warrants greater attention as it may help to reduce the rates of HIV incidence among youth. A growing body of literature suggests that conversations about sexual health among Black and Latino youth may serve as a potential strategy for HIV prevention. The current study investigates whether sexual health communication-in particular, conversations about sexual health and HIV-influences Black and Latino youth's personal agency regarding their role in achieving an HIV-free generation. For this secondary data analysis, we used the National Survey of Teens and Young Adults on attitudes towards HIV/AIDS (n = 701). Participants included youth between the ages 15 and 24, and the average was 20 years. We used a multiple regression analysis to examine whether sexual health communication contributed to youth knowledge and awareness of (1) the national plan for EHE, and (2) their role in ending the epidemic". (1) knowledge and awareness of the national plan for EHE, and (2) role in ending the epidemic. The final multiple regression model was statistically significant [R2 = 0.16 F (12, 701) = 001, p < 0.001] for both outcomes. Study results found that sexual health communication was positively related to Black and Latino youth's awareness of efforts to end the HIV epidemic (EHE) and their belief that they could play a role in achieving EHE. In addition, HIV stigma influenced personal agency and whether youth were aware of efforts to achieve EHE. Our results demonstrated that openly communicating about sexual health and HIV may contribute to a sense of personal agency among Black and Latino youth. In addition, understanding whether sexual health communication contributes to a sense of personal agency among youth may inform HIV prevention efforts to achieve the goals set forth by the national EHE plan for the U.S.

Reimaging an AIDS free generation: Examining youth and young adults' personal agency and its association with HIV testing

Exploring youth and young adult's agency may be a way to increase HIV testing and help end the HIV epidemic. We used data from the National Survey of Teens and Young Adults (15-24) on HIV/AIDS (N = 1,437). Data were collected from September 21-October 1, 2012. The sample included 748 girls and 689 boys; and the mean age is 20 years (SD: 3.02). Youth and young adults completed a 40-question survey on attitudes and knowledge about HIV. Using a multivariable logistic regression analysis, study findings suggest that focusing on protective health behaviors like the role youth can play in ending the epidemic and hearing about an AIDS-free generation were both associated with an increase in HIV testing. Our study finds that enhancing the role and influence of personal agency can inform HIV prevention and intervention programs that are specific to youth.

Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, "Passing" Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil

This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, "passing" concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher "passing" concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and "passing" concerns in transgender populations.

"Condoms Are Boring": Navigating Relationship Dynamics, Gendered Power, and Motivations for Condomless Sex Amongst Adolescents and Young People in South Africa

Condoms remain an important method for preventing HIV prevention and unintentional pregnancies, however their use in South Africa is sub-optimal. We analyzed survey data on reported condom use among 3009 sexually active adolescent girls and young women (AGYW) aged 15-24 years, and qualitative data from interviews and focus group discussions with 237 AGYW and 38 male peers. Our findings describe the current condom use landscape among adolescents and young people in South Africa, illustrating relationship dynamics, gendered power and notions of masculinity which influence condom negotiation and use in young heterosexual South Africans' sexual encounters.

Correlates of depression among Black girls exposed to violence

Depression rates for youth remanded to juvenile detention is double that of the general population and Black girls are especially vulnerable. A dearth of literature analyzes the factors that are correlated with depression among system-involved Black girls, ages 12-17 years old. We utilized personal agency to examine the relationship between risk factors (i.e., abuse history, and fear of condom negotiation) and protective factors (i.e., condom self-efficacy, and perceived social support) that might correlate with depression among Black girls exposed to violence. Findings indicate that fear of condom negotiation, abuse history and low condom self-efficacy are correlated with depressive symptomology while self-esteem and perceived social support are protective factors that may serve as a buffer against girls' feelings of helplessness and hopelessness. The findings of this study suggest several implications for prevention and intervention efforts to reduce the depression-related risks among justice-involved Black females, including strategies that promote healing within their social support networks.

Depression symptoms, HIV testing, linkage to ART, and viral suppression among women in a high HIV burden district in KwaZulu-Natal, South Africa: A cross-sectional household study

Achieving the UNAIDS 90-90-90 targets by 2020 is contingent on identifying and addressing mental health challenges that may affect HIV testing and treatment-related behaviors. This study is based on survey data from KwaZulu-Natal, South Africa (2014–2015). HIV positive women who reported higher depression scores had a lower odds of having tested previously for HIV (15–25 years: AOR = 0.90, 95% CI [0.83, 0.98]; 26–49 years: AOR = 0.90, 95% CI [0.84, 0.96]). Because HIV testing behavior represents a gateway to treatment, the findings suggest mental health may be one challenge to attaining the UNAIDS 90-90-90 targets.

Understanding of personal agency among youth to curtail HIV rates

We aimed to discover which social factors influence protective health behaviors among Black youth. We measured study variables based on data from the National Survey of Teens and Young Adults on HIV/AIDS. Participants include youth aged 15 to 24 who completed a 40-question, web-based survey. The analytical sample of participants (n = 270) only comprised African American youth, mean age 20 years (SD: 0.28). Using multiple regression analysis, study findings suggest that focusing on protective health behaviors, such as personal agency among youth, with variables like personal perception and concern and HIV testing could be one way to reduce their risk of HIV transmission. Enhancing the role and influence of personal agency given their testing behaviors can inform HIV prevention and intervention programs that are specific to Black youth. Our findings identify targets for intervention to enhance personal agency in this population, including enhancing HIV risk prevention.

Exploratory and confirmatory factor analyses and invariance assessment of the perceived powerlessness scale among youth in Baltimore

Generalized perceived powerlessness is an important psychosocial construct that determines a wide range of health behaviors and outcomes. This study has two aims: (1) examine the structure of the newly developed perceived powerlessness scale using exploratory and confirmatory factor analyses and (2) assess the scale's invariance across key demographic variables using multi-group confirmatory factor analysis among a random household sample of African American and White youth (aged 15-24 years) residing in Baltimore, MD. Our study results demonstrated that the powerlessness scale is valid among a demographically diverse sample of urban youth, showing promise for use in future health behavior and outcome studies.

Factors Associated with Condom Use Self-Efficacy Among Preparatory School Students in Sodo Town, Southern Ethiopia 2020: A Cross-Sectional Study

BACKGROUND

Condoms are playing a central role in the prevention of sexually transmitted infections, human immune virus, and unintended pregnancy particularly among young peoples. Therefore, this study aimed to assess factors associated with condom use self-efficacy among preparatory school youths in Sodo town, Ethiopia.

METHODS

This institution-based cross-sectional study was conducted among 424 study participants from January 25 to February 20, 2020. Data were collected using a validated pretested structured questionnaire. Descriptive analysis was done and results were presented in texts and tables. Those variables at bivariate analysis with p-value <0.2 at 95% confidence level were moved to a multivariate logistic regression model to control potential confounding variables. Odds ratio with 95% confidence interval was computed to ascertain association during multivariate analysis model. Statistical tests at P-value <0.05 were considered as cutoff point to determine statistical significance.

RESULTS

Out of a total of 424 youths, only 416 had participated in the study yielding a response rate of 98.1%. The prevalence of higher self-efficacy among respondents was 70%. Factors that were independently associated with condom use self-efficacy in multivariate analysis were having sexual experience (AOR=2.047,95% CI:1.141-3.675), having life goals (AOR=1.736, 95% CI: 1.021-2.951), having social support (AOR=2.395,95% CI:1.501-5.458), and having good knowledge about condoms (AOR=2.535,95% CI:1.499-4.282).

CONCLUSION

The finding of this study showed that participants who had sexual experience, social support, knowledge of the human immune virus, and having life goals were found to be significantly associated with condom use self-efficacy. These results suggest ways to increase self-efficacy for condom use among youth that can increase the effectiveness of future interventions for youth.

Validation of the Interpersonal Quality of Family Planning Scale in a rural Indian setting

Objectives

The provision of high-quality family planning (FP) counseling can both enhance clients' experience of care and improve their ability to make and act on their contraceptive decisions. The Interpersonal Quality of Family Planning (IQFP) scale measures FP counseling quality and has been validated in the United States. We aimed to explore whether it remains appropriate for use in a low-/middle-income country (LMIC).

Study design

We surveyed 1201 nonsterilized married women ages 18-29 in Maharashtra, India, between September 2018 and June 2019. Respondents rated their FP provider from "poor" (1) to "excellent" (5) across 11 IQFP items. We assessed scale reliability via Cronbach's α test and used exploratory factor analysis to evaluate unidimensionality and regression models of plausibly related outcomes to assess construct validity.

Results

Five hundred four women (42%) had seen an FP provider within the past year, 491 (97%) of whom answered all items. Mean IQFP score was 2.62 out of 5 (SD 0.94, range 1-5). Scale reliability was high (α = 0.97). Exploratory factor analyses support unidimensionality (all factor loadings > 0.4). A 1-point increase in average IQFP score was associated with nearly double the odds of current modern contraceptive use (adjusted odds ratio = 1.73, 95% confidence interval = 1.36-2.19).

Conclusions

The IQFP scale shows good reliability and construct validity in this context, and its use in LMIC settings should be broadly considered. A higher IQFP score was associated with greater odds of contraceptive use. The reported FP counseling quality was low, so future public health efforts should aim to increase counseling quality to better meet the needs of women in low-resource settings like rural India. Measurement tools like IQFP can support success evaluation of the quality of care provided by family planning programs.

Implications

The Interpersonal Quality of Family Planning scale is a useful tool in rural India, a different context than the one in which it was developed. Use of the IQFP scale should be considered in other low-/middle-income countries to better measure the quality of family planning care provided.

Psychosocial correlates of safe sex self-efficacy among in-school adolescent girls in Lagos, Nigeria

BACKGROUND

Adolescent girls in Nigeria are at heightened risk for HIV and other sexually transmitted infections. However, there are limited studies on psychosocial factors that are associated with safe sex intentions among this population. Self-efficacy has been established as an important correlate of behavioral intentions and the actual behavior. The objective of this research was to examine how key psychosocial factors such as social support, parental monitoring, and future orientation influence perceived safe sex self-efficacy among in-school adolescent girls in Nigeria. Furthermore, we assessed the associations between these psychosocial factors and HIV-related knowledge and safe sex self-efficacy.

METHODS

A self-administered questionnaire was distributed to 426 adolescent girls attending public and private school systems in Lagos, Nigeria. Multiple linear regression was used to evaluate the influence of psychosocial and demographic factors on safe sex self-efficacy. Further, stratified analysis was conducted to compare the estimates between participants attending public schools (n = 272) and those attending private schools (n = 154).

FINDINGS

Results from the study show that future orientation (β = 0.17; p < 0.05), participants age (β = 0.14; p < 0.05), and HIV knowledge accuracy (β = 0.17; p < 0.05) were associated with safe sex self-efficacy. Future orientation remained statistically significant in the sub-group analysis among participants attending public (β = 0.13; p < 0.05) and private schools (β = 0.24; p < 0.05). Among participants attending public schools, HIV accuracy (β = 0.2; p < 0.05) remained a significant correlate of safe sex self-efficacy while this association dissipated among private school attendees.

CONCLUSIONS

These findings point to the importance of including future orientation strategies in interventions developed for in-school adolescent girls in Nigeria. School-based interventions that increase positive future orientation outcomes may be beneficial to improve safe sex intentions among adolescent girls in Nigeria.

Depressive symptoms as a longitudinal predictor of sexual risk behaviors among African-American adolescents

OBJECTIVE

Understanding individual level factors associated with sexual risk behaviors among African-American adolescents remains an important public health priority. The current secondary data analysis examined the longitudinal association between a baseline assessment of depressive symptoms and sexual risk behaviors reported 6 months later; the purpose was to determine whether the association of depressive symptoms to risky sex varies as a function of gender. A secondary aim was to examine self-efficacy for sex refusal and condom use assessed at a 3-month follow-up as mediators of the depressive symptoms-sexual risk relationship.

METHODS

The sample consisted of 782 sexually active African-American adolescents (Mage = 15.3 years, SD = 1.08; 54% female) recruited to participate in a sexual health intervention trial. Data analyses focused on vaginal sex, and outcomes included: (a) sexual activity with 2 or more partners in the previous 3 months; (b) the relative frequency of condom use in the previous 3 months; (c) noncondom use at last occasion of sex; and (d) positive sexually transmitted infection (STI) screening.

RESULTS

Depressive symptoms predicted sex with 2 more partners for female participants, but no other risk markers for the sample as a whole. However, there was a significant indirect effect of depressive symptoms on condomless sex via decreased condom use self-efficacy for both male and female adolescents.

CONCLUSIONS

These findings have important implications for HIV/STI prevention, in which behavioral interventions may benefit from modules that include a focus on the influence of mood on self-efficacy for safer sex practices. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

What predicts self-efficacy? Understanding the role of sociodemographic, behavioural and parental factors on condom use self-efficacy among university students in Nigeria

BACKGROUND

Risky sexual behaviours are not uncommon among young adults particularly those in the higher levels of education. It is known that higher self-efficacy could contribute to better sexual and reproductive health outcomes including the use of condoms. However, there is limited research on the role of socio-demographic, behavioural and parental factors as predictors of condom-use self-efficacy. As a result, this exploratory study was designed to assess the predictors of self-efficacy for condom use among university students in Nigeria.

METHODS

A cross-sectional survey was conducted with 755 university students in Nigeria from February to April 2018. Self-efficacy for condom use was assessed by combining responses to 11-items measures of condom self-efficacy drawn from the work of Barkley and colleagues. We fitted a structural equation model to identify the pathways through which socio-demographic, behavioural and parental factors predict two constructs of condom-use self-efficacy (self-efficacy for condom purchase and use and partner communication self-efficacy) in the sample.

RESULTS

Demographic factors such as age (β = -0.29, p<0.05) and sex (β = 0.42, p<0.05), as well as ratings on religious importance (β = -0.08, p<0.05) were directly associated with self-efficacy for condom purchase and use. These factors showed significantly mediated effects through sexual experience which also had a direct positive relationship (β = 0.73, p<0.05) with self-efficacy for condom purchase and use. The receipt of parental support, on the other hand, was directly associated with higher partner communication efficacy for condom use (β = 0.07, p<0.05). We found no evidence that the level of partner communication efficacy was directly associated with any of the behavioural, demographic or parental factors.

CONCLUSION

The findings of this study affirm that sex, or age or having higher ratings on religious importance alone does not increases self-efficacy but also exposure to sexual activity through which these factors affect self-efficacy for condom purchase and use. These findings also highlight the need to address and strengthen condom use self-efficacy among young adults, particularly the sexually inexperienced, highly religious and young adults with limited support from their parent.

Syndemic Factors Associated with Safer Sex Efficacy Among Northern and Indigenous Adolescents in Arctic Canada

BACKGROUND

Syndemic approaches explore the synergistic relationships between social and health inequities. Such approaches are particularly salient for the Northwest Territories, Canada, that experiences national social (food insecurity, intimate partner violence [IPV]) and health (sexually transmitted infections [STI]) disparities. Safer sex efficacy (SSE) includes knowledge, intention, and relationship dynamics that facilitate safer sex negotiation. We examined factors associated with SSE among NWT adolescents.

METHODS

We conducted a cross-sectional survey with a venue-based sample of adolescents aged 13-17 in 17 NWT communities from 2016 to 2017. Summary statistics and statistical comparisons were conducted, followed by crude and adjusted multivariable regression models to assess factors associated with SSE.

RESULTS

Among participants (n = 610; mean age 14.2 years [SD 1.5]; 49.5% cisgender women, 48.9% cisgender men, 1.6% transgender persons; 73.3% Indigenous), one-quarter (n = 144; 23.6%) reported food insecurity and nearly one-fifth (n = 111; 18.2%) IPV. In adjusted analyses, among young women, food insecurity (β - 1.89[CI - 2.98, - 0.80], p = 0.001) and IPV (β - 1.31[CI - 2.53, - 0.09], p = 0.036) were associated with lower SSE, and currently dating was associated with increased SSE (β 1.17[CI 0.15, 2.19], p = 0.024). Among young men, food insecurity (β - 2.27[CI - 3.39, - 1.15], p = 0.014) was associated with reduced SSE. Among sexually active participants (n = 115), increased SSE was associated with consistent condom use among young women (β 1.40[0.19, 2.61], p = 0.024) and men (β 2.14[0.14, 4.14], p = 0.036).

CONCLUSIONS

Food insecurity and IPV were associated with lower SSE-a protective factor associated with consistent condom use-underscoring the need to address poverty and violence to advance adolescent sexual health in the NWT.

The Effect of HIV Self-Testing Delivery Models on Female Sex Workers' Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda

HIV self-testing increases recent and frequent HIV testing among female sex workers (FSWs) in urban Uganda. Using results from a randomized controlled trial, we aim to establish the effect of HIV self-testing delivery models on FSWs’ sexual behaviors in this setting. Clusters of one peer educator and eight participants were 1:1:1 randomized to: (1) direct provision of an HIV self-test, (2) provision of a coupon for facility collection of an HIV self-test, or (3) referral to standard-of-care HIV testing services. Sexual behaviors were self-reported at 1 and 4 months. From October to November 2016, 960 participants were enrolled and randomized. At 4 months, there were no statistically significant differences in participants’ sexual behaviors, including inconsistent condom use, across study arms. We do not find any changes in sexual risk-taking among FSWs in response to the delivery of HIV self-tests. Routine policies for HIV self-testing are likely a behaviorally safe component of comprehensive HIV prevention strategies.

Sexual Self-Efficacy and Gender: A Review of Condom Use and Sexual Negotiation Among Young Men and Women in Sub-Saharan Africa

Sexual self-efficacy (SSE), one's perceived control of or confidence in the ability to perform a given sexual outcome, predicts sexual behavior; however, important questions remain regarding whether gender modifies observed associations. In a comprehensive review of peer-reviewed HIV-prevention literature focusing on youth (ages 10 to 25) in sub-Saharan Africa, we measured and assessed the influence of SSE on condom use and sexual refusal, overall and by gender. Our results, after reviewing 63 publications, show that SSE is inconsistently measured. Most studies measured condom use self-efficacy (CUSE) (96.8%) and/or sexual refusal self-efficacy (SRSE) (63.5%). On average, young men had higher CUSE than young women, while young women had higher SRSE than young men. While cross-sectional studies reported an association between high SSE and sexual behaviors, this association was not observed in interventions, particularly among young women who face a disproportionate risk of HIV acquisition. In all, 25% of intervention studies demonstrated that fostering CUSE increased condom use among young men only, and one of two studies demonstrated that higher SRSE led to reduced frequency of sexual activity for both men and women. Future research and HIV-prevention interventions must be gender targeted, consider improving CUSE for young men, and move beyond limited individual-level sexual behavior change frameworks.