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Zia Y, Etyang L, Mwangi M, Njiru R, Mogaka F, June L, Njeru I, Makoyo J, Kimani S, Ngure K, Wanyama I, Bukusi E, Nyerere B, Nyamwaro C, Mugo N, Heffron R. The Effect of Stigma on Family Planning and HIV Pre-exposure Prophylaxis Decisions of Young Women Accessing Post-Abortion Care in Kenya. AIDS Behav 2024; 28:1834-1844. [PMID: 38451448 PMCID: PMC11161434 DOI: 10.1007/s10461-024-04274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/08/2024]
Abstract
Adolescent girls and young women (AGYW) in Eastern and Southern Africa face parallel epidemics of unintended pregnancy and HIV. Their sexual health decisions are often dominated by intersecting stigmas. In an implementation science project integrating delivery of daily, oral pre-exposure prophylaxis (PrEP) for HIV prevention into 14 post-abortion care (PAC) clinics in Kenya, we enrolled a subset of PrEP initiating AGYW (aged 15 to 30 years) into a research cohort. Utilizing log binomial models, we estimated the effect of PrEP stigma on PrEP continuation (measured via self-report and urine assay for tenofovir) and abortion stigma on contraceptive initiation. Between April 2022 and February 2023, 401 AGYW were enrolled after initiating PrEP through their PAC provider, of which 120 (29.9%) initiated highly-effective contraception. Overall, abortion and PrEP stigmas were high in this cohort. Abortion stigma was more prevalent among those that were adolescents, unmarried, and reported social harm. Among 114 AGYW returning for the month 1 follow-up visit, 83.5% reported continuing PrEP and 52.5% had tenofovir detected. In this subset, higher levels of PrEP stigma were significantly associated with greater likelihood of PrEP adherence, but not PrEP continuation. For abortion stigma, greater scores in the subdomain of isolation were significantly associated with greater likelihood of initiating a highly-effective contraception, while greater scores in the subdomain of community condemnation were significantly associated with reduced likelihood of initiating a highly-effective contraception. Given the burden of stigma documented by our work, PAC settings are a pivotal space to integrate stigma-informed counseling and to empower young women to optimize contraceptive and PrEP decisions.
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Affiliation(s)
- Yasaman Zia
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lydia Etyang
- Partners in Health and Research Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Margaret Mwangi
- Partners in Health and Research Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Roy Njiru
- Partners in Health and Research Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Felix Mogaka
- Research Care and Training Program, Kenya Medical Research Institute, Thika, Kenya
| | - Lavender June
- Research Care and Training Program, Kenya Medical Research Institute, Thika, Kenya
| | - Irene Njeru
- Partners in Health and Research Development, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, WA, USA
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, WA, USA
- Research Care and Training Program, Kenya Medical Research Institute, Thika, Kenya
| | - Bernard Nyerere
- Research Care and Training Program, Kenya Medical Research Institute, Thika, Kenya
| | | | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA
- Partners in Health and Research Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Renee Heffron
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
- Department of Global Health, University of Washington, Seattle, WA, USA.
- Department of Medicine, University of Alabama at Birmingham, 845 19th Street South / BBRB 256, Birmingham, AL, 35294-2170, USA.
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Denison JA, Willis K, DeLong SM, Sievwright KM, Agwu AL, Arrington-Sanders R, Kaufman MR, Prabhu S, Williams AM, Fields EL, Alexander KA, Lee L, Yang C. Advancing Adolescent and Young Adult HIV Prevention and Care and Treatment Through Use of Multi-level Theories and Frameworks: A Scoping Review and Adapted HIV Ecological Framework. AIDS Behav 2024; 28:1694-1707. [PMID: 38351279 PMCID: PMC11069483 DOI: 10.1007/s10461-023-04255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 05/05/2024]
Abstract
While multi-level theories and frameworks have become a cornerstone in broader efforts to address HIV inequities, little is known regarding their application in adolescent and young adult (AYA) HIV research. To address this gap, we conducted a scoping review to assess the use and application of multi-level theories and frameworks in AYA HIV prevention and care and treatment empirical research. We systematically searched five databases for articles published between 2010 and May 2020, screened abstracts, and reviewed eligible full-text articles for inclusion. Of the 5890 citations identified, 1706 underwent full-text review and 88 met the inclusion criteria: 70 focused on HIV prevention, with only 14 on care and treatment, 2 on both HIV prevention and care and treatment, and 2 on HIV-affected AYA. Most authors described the theory-based multi-level framework as informing their data analysis, with only 12 describing it as informing/guiding an intervention. More than seventy different multi-level theories were described, with 38% utilizing socio-ecological models or the eco-developmental theory. Findings were used to inform the adaptation of an AYA World Health Organization multi-level framework specifically to guide AYA HIV research.
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Affiliation(s)
- Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA.
| | - Kalai Willis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie M DeLong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kirsty M Sievwright
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, US
| | - Allison L Agwu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Michelle R Kaufman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sandeep Prabhu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
| | - Ashlie M Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
| | - Errol L Fields
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Lana Lee
- Adult Clinical Branch, Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
| | - Cui Yang
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Osei Owusu J, Salifu Yendork J, Osafo J. Home-Based Sexuality Education in Ghana: The Perspectives of Adolescents and Parents. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:550-566. [PMID: 38596389 PMCID: PMC10903590 DOI: 10.1080/19317611.2022.2108532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 04/11/2024]
Abstract
The extant literature has explored sexuality education from the perspectives of the adolescents, but the views of parents are largely neglected. The few studies that have examined the views of both parents and adolescents are selective in scope, coverage, and assessment. There is thus, a dearth of data on the type of topics discussed and the frequency of parent-adolescent sexual communication. The present study sought to explore adolescents' lived experiences of sexuality education and its impact on their sexual and reproductive health. To achieve this, a qualitative research design with a semi-structured interview was employed to gather data from thirty parents and adolescents in Ablekuma South Metropolis. An Interpretative Phenomenological Analysis (IPA) was used in analyzing the data with each theme showing divergence categories of experiences of sexuality education although the views of both parents and adolescents on each category were similar. Parent-adolescent sex communication showed frequently discussed topics and the less discussed ones. Perceptions of sexuality education revealed both positive and negative perceptions. Perceived impact of sexuality education also brought to light both positive and negative impacts. It is recommended that stakeholders ought to institutionalize diverse behavior change interventions such as interpersonal communication and skills training aimed at empowering both parents and adolescents to communicate explicitly about sexuality rather than using euphemisms and timing techniques.
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Affiliation(s)
| | | | - Joseph Osafo
- Department of Psychology, University of Ghana, Legon, Ghana
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Zia Y, Mugo N, Ngure K, Odoyo J, Casmir E, Ayiera E, Bukusi E, Heffron R. Psychosocial Experiences of Adolescent Girls and Young Women Subsequent to an Abortion in Sub-saharan Africa and Globally: A Systematic Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:638013. [PMID: 36303958 PMCID: PMC9580653 DOI: 10.3389/frph.2021.638013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Unmet need for contraception, unintended pregnancy, and access to safe abortion remain global challenges preventing adolescent girls and young women (AGYW) from achieving optimal reproductive health. Furthermore, AGYW face difficulties navigating sexual autonomy, lack of agency or experience negotiating sexual acts, and challenges accessing sexual health information and services. The aim of this systematic review is to assess the psychosocial outcomes of AGYW who have experienced an abortion with particular focus on sub-Saharan Africa, which bears the global burden of unintended pregnancy and risk of death due to unsafe abortion. Materials and Methods: The systematic review was registered and used search terms to identify peer-reviewed articles relevant to “post-abortion,” “psychosocial,” “adolescent girls,” and “young women” from PubMed, Embase, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature. Examples of psychosocial experiences include quality of life, stigma, and mental health outcomes. Rayyan software (Qatar, 2020) was used by two reviewers to assess the relevance of each article to psychosocial outcomes of AGYW any time after an abortion or accessing post-abortion services. Analysis was conducted with a focus on data from Africa and comparisons are made to non-African settings. Results: A total of 2,406 articles were identified and 38 articles fit the criteria. Six selected articles were from Africa, including Ghana, Kenya, Uganda, and Zambia, and the remaining articles were from other regions. Themes around stigma, shame, and abandonment associated with the experience of abortion were prevalent in all regions. Studies of psychosocial outcomes of AGYW in sub-Saharan Africa highlight social isolation as well as learned resilience among young women who abort. Discussion: Navigating abortion as an AGYW involves managing internalized and perceived stigma, fear of violence, secrecy, and growing resilient in order to overcome the significant barriers that society and culture place on access to an essential service in sexual and reproductive health. Post-abortion psychosocial outcomes highlight the need for support services and investigation of contexts that perpetuate and necessitate unsafe abortion. Empowerment of AGYW may present an important opportunity to build self-agency and positive coping mechanisms to withstand social pressures during stigmatizing circumstances associated with abortion.
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Affiliation(s)
- Yasaman Zia
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Josephine Odoyo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edinah Casmir
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- *Correspondence: Renee Heffron
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Owino L, Wangong’u A, Were N, Maleche A. The missing link in Kenya's universal health coverage experiment: a preventive and promotive approach to SRHR. Sex Reprod Health Matters 2020; 28:1851347. [PMID: 33393897 PMCID: PMC7887766 DOI: 10.1080/26410397.2020.1851347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This paper explores the universal health coverage (UHC) roll-out process in Kenya through the lens of its potential to progressively realise the constitutional promise of sexual and reproductive health and rights (SRHR) in Kenya. We argue that SRHR requires significant attention to be paid to preventive and promotive approaches to health and that this requires interrogation of barriers around access to information, norms, and legal and policy frameworks. We then unpack the UHC process in Kenya, its genesis, development and eventual roll-out, focusing on the essential benefits package and its components. We argue that a process of democratic priority-setting cognisant of equity, non-discrimination and transparency will better deliver on an essential benefits package for access to SRHR that is legitimate and acceptable. As a result, we submit that Kenya's UHC process fails to take cognisance of the weight placed on sexual and reproductive health in our Constitution and fails to address historical inequities around accessing health services.
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Affiliation(s)
- Lisa Owino
- Health, Governance and Accountability Advocate, Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Annette Wangong’u
- Health Governance Consultant, Initiative for Strategic Litigation in Africa, Nairobi, Kenya
| | - Nerima Were
- Acting Deputy Executive Director, KELIN, Nairobi, Kenya; Tutorial Fellow, University of Nairobi, Kenya
| | - Allan Maleche
- Executive Director, KELIN, Nairobi, Kenya; Member of the UNAIDS Human Rights Reference Group
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Ronoh M, Chirove F, Wairimu J, Ogana W. Evidence-based modeling of combination control on Kenyan youth HIV/AIDS dynamics. PLoS One 2020; 15:e0242491. [PMID: 33201934 PMCID: PMC7671564 DOI: 10.1371/journal.pone.0242491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
We formulate a sex-structured deterministic model to study the effects of varying HIV testing rates, condom use rates and ART adherence rates among Adolescent Girls and Young Women (AGYW) and, Adolescent Boys and Young Men (ABYM) populations in Kenya. Attitudes influencing the Kenyan youth HIV/AIDS control measures both positively and negatively were considered. Using the 2012 Kenya AIDS Indicator Survey (KAIS) microdata we constructed our model, which we fitted to the UNAIDS-Kenya youth prevalence estimates to understand factors influencing Kenyan youth HIV/AIDS prevalence trends. While highly efficacious combination control approach significantly reduces HIV/AIDS prevalence rates among the youth, the disease remains endemic provided infected unaware sexual interactions persist. Disproportional gender-wise attitudes towards HIV/AIDS control measures play a key role in reducing the Kenyan youth HIV/AIDS prevalence trends. The female youth HIV/AIDS prevalence trend seems to be directly linked to increased male infectivity with decreased female infectivity while the male youth prevalence trend seems to be directly associated with increased female infectivity and reduced male infectivity.
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Affiliation(s)
- Marilyn Ronoh
- School of Mathematics, University of Nairobi, Nairobi, Kenya
- * E-mail:
| | - Faraimunashe Chirove
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg, South Africa
| | | | - Wandera Ogana
- School of Mathematics, University of Nairobi, Nairobi, Kenya
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Peterson AJ, Allen E, Viner R, Bonell C. Effects of the school environment on early sexual risk behavior: A longitudinal analysis of students in English secondary schools. J Adolesc 2020; 85:106-114. [PMID: 33130414 DOI: 10.1016/j.adolescence.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The theory of human functioning and school organization proposes that schools promote health by strengthening students' educational engagement. Previous studies have relied on proxy measures of engagement and not examined sexual health. This paper addresses these gaps. METHODS Longitudinal data came from the control arm of a randomized trial involving female and male students ages 12-14 in English secondary-schools (n = 3337 students). Exposures measured at baseline included a proxy measure of school-level engagement (value-added education, VAE: the difference between observed absence and attainment rates and those predicted based on student characteristics) and direct measures of school- and student-level engagement (commitment, belonging, relationships and participation). Sexual behavior was measured at 24- and 36-months, including sexual debut and contraception use at first sex. RESULTS Higher school-level VAE was associated with an increased risk of early sexual debut at 24-months. Students attending schools with higher overall levels of commitment and belonging were less likely to report sexual debut at 36 months. Students reporting stronger personal commitment to learning and teacher relationships at baseline were less likely to report sexual debut at both follow-up points. Associations involving participation and contraception use were largely nonsignificant. CONCLUSIONS Direct measures of the school environment are more strongly associated with reduced sexual risk behavior in early adolescence than the proxy measure, VAE. Results provide some support for the theory and suggest that personal disposition towards school as well as attending a school with high levels of student commitment and belonging are important for subsequent sexual decision making.
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Affiliation(s)
- Amy J Peterson
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1H 9SH, UK.
| | - Russell Viner
- UCL Great Ormand Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Ramos-Ortiz J, Strube OL, Kinman N, Meier S, DeMaria AL. Condom-vending machines in Italy: a qualitative exploration of gender differences to improve promotion and use. EUR J CONTRACEP REPR 2020; 25:456-464. [PMID: 32886016 DOI: 10.1080/13625187.2020.1810226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purposes of this study were to explore gender differences in condom purchasing from condom-vending machines (CVMs) and identify ways to improve CVM promotion. METHODS Semi-structured interviews with 42 men and women aged 18-50 years (mean ± standard deviation, 29.1 ± 7.9) and living in or near Florence, Italy, were conducted between May and June 2019. Techniques from expanded grounded theory-guided data analysis allowed for a constant comparative approach to contextualise data and identify emergent themes. RESULTS Three themes emerged: (1) attitudes and barriers towards CVMs; (2) gender-specific purchasing influences and behaviours; and (3) CVM improvement and promotion. Women and men described varied concerns surrounding CVM purchasing, illuminating reasons for hesitancy. Focussing on CVM quality and improving product offerings were suggested by participants to increase use. CONCLUSION Findings offer practical recommendations to guide CVM messaging to increase access to and use of condoms and other personal care items. Men were cited as primary CVM users, expressing practical concerns surrounding CVMs, while, for women, CVM visibility was as much an advantage as a drawback. Reflecting consumer needs via diversified product offerings should be considered a priority for increased CVM use. Working to promote CVMs requires clear messaging that attends to gender norm limitations, details product safety and establishes CVMs as a reliable condom purchase outlet.
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Affiliation(s)
- Jaziel Ramos-Ortiz
- Division of Consumer Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Olivia L Strube
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Nicole Kinman
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Stephanie Meier
- Division of Consumer Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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Tenkorang EY. Sexual behaviours in the context of the Ebola virus disease (EVD) in Ghana. CULTURE, HEALTH & SEXUALITY 2018; 20:746-760. [PMID: 28929904 DOI: 10.1080/13691058.2017.1372633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Evidence suggests that Ebola virus disease can be transmitted through unprotected sexual intercourse, in particular through contact with the semen of an infected person. Yet few studies examine sexual behaviours in the context of Ebola. Using data collected from 460 women and 340 men within 40 selected communities in the Greater Accra Region of Ghana, this study employed hierarchical linear modelling to examine individual and community-level factors that influence willingness to engage in behaviours that protect against the sexual transmission of Ebola. Results indicate that both individual and community-level factors are significant predictors of respondents' willingness to engage in preventive behaviours. Compared with those with no risks, female respondents with low and medium risk perceptions were significantly more likely to indicate they would use condoms to prevent the sexual transmission of Ebola (AOR = 2.23; p < 0.01). Compared with men who were very concerned, those who were not very concerned (AOR = 0.356; p < 0.01) and not at all concerned (AOR = 0.356; p < 0.05) about Ebola were significantly less likely to protect against the sexual transmission of Ebola. Female respondents in communities with high knowledge about Ebola were significantly more likely to engage in behaviours preventing the sexual transmission of Ebola virus disease (AOR = 1.93; p < 0.05).
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Affiliation(s)
- Eric Y Tenkorang
- a Department of Sociology , Memorial University of Newfoundland , St. John's , Canada
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Duell N, Steinberg L, Icenogle G, Chein J, Chaudhary N, Di Giunta L, Dodge KA, Fanti KA, Lansford JE, Oburu P, Pastorelli C, Skinner AT, Sorbring E, Tapanya S, Uribe Tirado LM, Alampay LP, Al-Hassan SM, Takash HMS, Bacchini D, Chang L. Age Patterns in Risk Taking Across the World. J Youth Adolesc 2018; 47:1052-1072. [PMID: 29047004 PMCID: PMC5878702 DOI: 10.1007/s10964-017-0752-y] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/14/2017] [Indexed: 11/29/2022]
Abstract
Epidemiological data indicate that risk behaviors are among the leading causes of adolescent morbidity and mortality worldwide. Consistent with this, laboratory-based studies of age differences in risk behavior allude to a peak in adolescence, suggesting that adolescents demonstrate a heightened propensity, or inherent inclination, to take risks. Unlike epidemiological reports, studies of risk taking propensity have been limited to Western samples, leaving questions about the extent to which heightened risk taking propensity is an inherent or culturally constructed aspect of adolescence. In the present study, age patterns in risk-taking propensity (using two laboratory tasks: the Stoplight and the BART) and real-world risk taking (using self-reports of health and antisocial risk taking) were examined in a sample of 5227 individuals (50.7% female) ages 10-30 (M = 17.05 years, SD = 5.91) from 11 Western and non-Western countries (China, Colombia, Cyprus, India, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the US). Two hypotheses were tested: (1) risk taking follows an inverted-U pattern across age groups, peaking earlier on measures of risk taking propensity than on measures of real-world risk taking, and (2) age patterns in risk taking propensity are more consistent across countries than age patterns in real-world risk taking. Overall, risk taking followed the hypothesized inverted-U pattern across age groups, with health risk taking evincing the latest peak. Age patterns in risk taking propensity were more consistent across countries than age patterns in real-world risk taking. Results suggest that although the association between age and risk taking is sensitive to measurement and culture, around the world, risk taking is generally highest among late adolescents.
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Affiliation(s)
- Natasha Duell
- Department of Psychology, Temple University, Philadelphia, PA, USA.
| | - Laurence Steinberg
- Department of Psychology, Temple University and King Abdulaziz University, Philadelphia, PA, USA
| | - Grace Icenogle
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Jason Chein
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Nandita Chaudhary
- Department of Human Development and Childhood Studies, Lady Irwin College, University of Delhi, New Delhi, India
| | - Laura Di Giunta
- Department of Psychology, Università di Roma "La Sapienza", Roma, RM, Italy
| | - Kenneth A Dodge
- Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Kostas A Fanti
- Department of Psychology, University of Cyprus, Kallipoleos, Cyprus
| | | | - Paul Oburu
- Department of Educational Psychology, Maseno University, Maseno, Kenya
| | | | - Ann T Skinner
- Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Emma Sorbring
- Department of Psychology, University West, Trollhättan, Sweden
| | - Sombat Tapanya
- Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand
| | | | - Liane Peña Alampay
- Department of Psychology, Ateneo de Manila University, Metro Manila, Philippines
| | - Suha M Al-Hassan
- Hashemite University and Emirates College for Advanced Education, Al Zafranah, Abu Dhabi, United Arab Emirates
| | - Hanan M S Takash
- Queen Rania Faculty for Childhood, Hashemite University, Zarqa, Jordan
| | - Dario Bacchini
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, CE, Italy
| | - Lei Chang
- Department of Psychology, University of Macau, Zhuhai Shi, China
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Closson K, Dietrich JJ, Lachowsky NJ, Nkala B, Palmer A, Cui Z, Beksinska M, Smit JA, Hogg RS, Gray G, Miller CL, Kaida A. Sexual Self-Efficacy and Gender: A Review of Condom Use and Sexual Negotiation Among Young Men and Women in Sub-Saharan Africa. JOURNAL OF SEX RESEARCH 2018; 55:522-539. [PMID: 29466024 DOI: 10.1080/00224499.2017.1421607] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- Kalysha Closson
- a Faculty of Health Sciences , Simon Fraser University
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Janan J Dietrich
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
| | - Nathan J Lachowsky
- b British Columbia Centre for Excellence in HIV/AIDS
- d School of Public Health and Social Policy , University of Victoria
| | - Busiwe Nkala
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
- e Faculty of Humanities , University of the Witwatersrand
| | - Alexis Palmer
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Zishan Cui
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Mags Beksinska
- f MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Faculty of Health Sciences, University of the Witwatersrand
| | - Jennifer A Smit
- f MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Faculty of Health Sciences, University of the Witwatersrand
| | - Robert S Hogg
- a Faculty of Health Sciences , Simon Fraser University
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Glenda Gray
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
| | - Cari L Miller
- a Faculty of Health Sciences , Simon Fraser University
| | - Angela Kaida
- a Faculty of Health Sciences , Simon Fraser University
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Ward-Peterson M, Fennie K, Mauck D, Shakir M, Cosner C, Bhoite P, Trepka MJ, Madhivanan P. Using multilevel models to evaluate the influence of contextual factors on HIV/AIDS, sexually transmitted infections, and risky sexual behavior in sub-Saharan Africa: a systematic review. Ann Epidemiol 2017; 28:119-134. [PMID: 29439782 DOI: 10.1016/j.annepidem.2017.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 11/04/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the use of multilevel models (MLMs) in evaluating the influence of contextual factors on HIV/AIDS, sexually transmitted infections (STIs), and risky sexual behavior (RSB) in sub-Saharan Africa. METHODS Ten databases were searched through May 29, 2016. Two reviewers completed screening and full-text review. Studies examining the influence of contextual factors on HIV/AIDS, STIs, and RSB and using MLMs for analysis were included. The Quality Assessment Tool for Quantitative Studies was used to evaluate study quality. RESULTS A total of 118 studies met inclusion criteria. Seventy-four studies focused on HIV/AIDS-related topics; 46 focused on RSB. No studies related to STIs other than HIV/AIDS met the eligibility criteria. Of five studies examining HIV serostatus and community socioeconomic factors, three found an association between poverty and measures of inequality and increased HIV prevalence. Among studies examining RSB, associations were found with numerous contextual factors, including poverty, education, and gender norms. CONCLUSIONS Studies using MLMs indicate that several contextual factors, including community measures of socioeconomic status and educational attainment, are associated with a number of outcomes related to HIV/AIDS and RSB. Future studies using MLMs should focus on contextual-level interventions to strengthen the evidence base for causality.
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Affiliation(s)
- Melissa Ward-Peterson
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL.
| | - Kristopher Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Daniel Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Maryam Shakir
- Office of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Chelsea Cosner
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Prasad Bhoite
- Department of Health, Humanities, and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
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13
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Closson K, Dietrich J, Lachowsky NJ, Nkala B, Cui Z, Chia J, Hogg RS, Gray G, Kaida A, Miller CL. Gender differences in prevalence and correlates of high sexual self-efficacy among adolescents in Soweto, South Africa: implications for gender-sensitive research and programming. AIDS Care 2017; 30:435-443. [PMID: 29058527 DOI: 10.1080/09540121.2017.1391983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sexual self-efficacy (SSE) - one's confidence in their ability to perform given sexual behaviours, has been shown to predict adolescents' HIV-prevention practices (e.g., Condom use). Few studies within sub-Saharan Africa, where HIV incidence and prevalence disproportionately affects young women, have examined gendered differences in SSE. We used multivariable logistic regression to identify correlates of high-SSE separately among adolescent men and women (aged 14-19) in Soweto, South Africa using a previously validated SSE scale (high-SSE [>3/6 items]; study-alpha = 0.75). SSE scale items assessed self-efficacy related to sexual refusal and condom use. Adolescent women were significantly more likely to report high-SSE than adolescent men (72.3% versus 49.5%; p < 0.01). High-SSE among adolescent men was associated with more positive beliefs about sexual relationships and negatively associated with probable depression. High-SSE among adolescent women was associated with increased HIV knowledge, more positive beliefs about condom use and sexual relationships, having an adult in the home, and negatively associated with being an older adolescent (16-17 versus ≤15), and ever experiencing physical violence. Differences in prevalence and correlates of SSE among adolescent men and women in South Africa highlight important areas for gender-sensitive interventions. Targeted efforts to reduce negative sexual beliefs, improve HIV knowledge and mental well-being may improve SSE and thus the uptake of HIV-prevention practices among adolescent men. For adolescent women, findings indicate programming should move beyond individual-levels determinants of behaviour to focus on improving enabling environments (e.g., Reduced violence and improved family relationships) in which sexual agency can be enacted.
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Affiliation(s)
- Kalysha Closson
- a Faculty of Health Sciences , Simon Fraser University (SFU) , Burnaby , Canada.,b Department is Epidemiology and Population Health Program , British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Janan Dietrich
- c Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Nathan J Lachowsky
- b Department is Epidemiology and Population Health Program , British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,d School of Public Health and Social Policy , University of Victoria , Victoria , Canada
| | - Busi Nkala
- c Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,e Faculty of Humanities , University of the Witwatersrand , Johannesburg , South Africa
| | - Zishan Cui
- b Department is Epidemiology and Population Health Program , British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Jason Chia
- b Department is Epidemiology and Population Health Program , British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Robert S Hogg
- a Faculty of Health Sciences , Simon Fraser University (SFU) , Burnaby , Canada.,b Department is Epidemiology and Population Health Program , British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Glenda Gray
- c Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Angela Kaida
- a Faculty of Health Sciences , Simon Fraser University (SFU) , Burnaby , Canada
| | - Cari L Miller
- a Faculty of Health Sciences , Simon Fraser University (SFU) , Burnaby , Canada
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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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15
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Mendez Rojas B, Beogo I, Owili PO, Adesanya O, Chen CY. Community social capital on the timing of sexual debut and teen birth in Nicaragua: a multilevel approach. BMC Public Health 2016; 16:991. [PMID: 27634382 PMCID: PMC5025572 DOI: 10.1186/s12889-016-3666-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022] Open
Abstract
Background Community attributes have been gradually recognized as critical determinants shaping sexual behaviors in young population; nevertheless, most of the published studies were conducted in high income countries. The study aims to examine the association between community social capital with the time to sexual onset and to first birth in Central America. Methods Building upon the 2011/12 Demographic and Health Survey conducted in Nicaragua, we identified a sample of 2766 community-dwelling female adolescents aged 15 to 19 years. Multilevel survival analyses were performed to estimate the risks linked with three domains of community social capital (i.e., norms, resource and social network). Results Higher prevalence of female sexual debut (norms) and higher proportion of secondary school or higher education (resource) in the community are associated with an earlier age of sexual debut by 47 % (p < 0.05) and 16 %, respectively (p < 0.001). Living in a community with a high proportion of females having a child increases the hazard of teen birth (p < 0.001) and resource is negatively associated with teen childbearing (p < 0.05). Residential stability and community religious composition (social network) were not linked with teen-onset sex and birth. Conclusions The norm and resource aspects of social capital appeared differentially associated with adolescent sexual and reproductive behaviors. Interventions aiming to tackle unfavorable sexual and reproductive outcomes in young people should be devised and implemented with integration of social process.
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Affiliation(s)
- Bomar Mendez Rojas
- International Health Program, National Yang-Ming University, Taipei, Taiwan
| | - Idrissa Beogo
- École Nationale de Santé Publique, Ouagadougou, Burkina Faso
| | | | | | - Chuan-Yu Chen
- Institute of Public Health, National Yang-Ming University, Medical Building, Rm 210, 155, Sec. 2, Linong Street, Taipei, 112, Taiwan. .,Center of Neuropsychiatric Research, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 350, Taiwan.
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16
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Blignaut RJ, Jacobs J, Vergnani T. Trends in HIV risk behaviour of incoming first-year students at a South African university: 2007-2012. SAHARA J 2016; 12:39-50. [PMID: 26394535 DOI: 10.1080/17290376.2015.1086275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The aim of the research on which this article is based was to understand the behavioural changes of the target student population over time to ensure that future prevention programmes are more effective in changing behaviour. This study reports on quantitative data collected at the University of the Western Cape over a six-year period between 2007 and 2012. All the students attending the orientation sessions and who were willing to complete the anonymous questionnaire during each of the six years were included in the study. Data were collected on the following aspects and subjects: sexual activity, age at first sexual encounter, number of sexual partners, condom usage, knowledge of how to use a condom, perceived ability to discuss condoms usage with a sexual partner, perception of HIV risk and HIV testing as well as the intention to be tested. Reported alcohol and drug usage, as well as depressive symptoms, was also recorded. The percentage of students reporting having had vaginal sex prior to entering university increased from 44% in 2007 to 51% in 2012 but, alarmingly, the consistent use of condoms decreased from 60% in 2007 to 51% in 2012. The average onset age of about 15.6 years for males and 16.7 years for females for vaginal sex did not change over the six-year period. No difference in smoking patterns or drug use was seen over the period of the study, but the number of entering students who indicated that they consumed alcohol increased significantly from 48% in 2007 to 58% in 2012. HIV testing increased from 19% in 2007 to 47% in 2012, whereas the intention to be tested showed no significant change over the period. Although students increasingly reported that they knew enough about HIV/AIDS (63% in 2007 and 69% in 2012), about a third reported suffering from AIDS fatigue. Prevention efforts targeted at those incoming first-year students who are not yet sexually active (about 45% in this study) should be developed and should take into account the multiplicity of factors that appear to influence their sexual debut.
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Affiliation(s)
- Rénette J Blignaut
- a PhD, is a Professor at the Department of Statistics and Population Studies , UWC , Bellville , South Africa
| | - Joachim Jacobs
- b MA, is a Director of HIV & AIDS Programme, UWC , Bellville , South Africa
| | - Tania Vergnani
- c PhD, is a Retired Director of HIV and AIDS Programme, c/o HIV & AIDS Programme, UWC , Private Bag X17, Bellville , South Africa
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17
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Ybarra ML, Korchmaros JD, Prescott TL, Birungi R. A Randomized Controlled Trial to Increase HIV Preventive Information, Motivation, and Behavioral Skills in Ugandan Adolescents. Ann Behav Med 2016; 49:473-85. [PMID: 25633626 DOI: 10.1007/s12160-014-9673-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND One in 25 Ugandan adolescents is HIV positive. PURPOSE The aim of this study is to examine the impact of an Internet-based HIV prevention program on Information-Motivation-Behavioral skills (IMB) Model-related constructs. METHODS Three hundred and sixty-six sexually experienced and inexperienced students 13-18+years old in Mbarara, Uganda, were randomly assigned to the five-lesson CyberSenga program or the treatment-as-usual control group. Half of the intervention participants were further randomized to a booster session. Assessments were collected at 3 and 6 months post-baseline. RESULTS Participants' HIV-related information improved over time at a greater rate for the intervention groups compared to the control group. Motivation for condom use changed to a greater degree over time for the intervention group--especially those in the intervention+booster group--compared to the control group. Behavioral skills for condom use, and motivation and behavioral skills for abstinence were statistically similar over time for both groups. CONCLUSIONS CyberSenga improves HIV preventive information and motivation to use condoms.
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Affiliation(s)
- Michele L Ybarra
- Center for Innovative Public Health Research, San Clemente, CA, USA,
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18
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Van Huy N, P Dunne M, Debattista J. Predictors of condom use behaviour among male street labourers in urban Vietnam using a modified Information-Motivation-Behavioral Skills (IMB) model. CULTURE, HEALTH & SEXUALITY 2015; 18:321-336. [PMID: 26416016 DOI: 10.1080/13691058.2015.1084375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
HIV risk in vulnerable groups such as itinerant male street labourers is often examined via a focus on individual determinants. This study provides a test of a modified Information-Motivation-Behavioral Skills (IMB) model to predict condom use behaviour among male street workers in urban Vietnam. In a cross-sectional survey using a social mapping technique, 450 male street labourers from 13 districts of Hanoi, Vietnam were recruited and interviewed. Collected data were first examined for completeness; structural equation modelling was then employed to test the model fit. Condoms were used inconsistently by many of these men, and usage varied in relation to a number of factors. A modified IMB model had a better fit than the original IMB model in predicting condom use behaviour. This modified model accounted for 49% of the variance, versus 10% by the original version. In the modified model, the influence of psychosocial factors was moderately high, whilst the influence of HIV prevention information, motivation and perceived behavioural skills was moderately low, explaining in part the limited level of condom use behaviour. This study provides insights into social factors that should be taken into account in public health planning to promote safer sexual behaviour among Asian male street labourers.
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Affiliation(s)
- Nguyen Van Huy
- a Department of Health Management, Institute for Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam
| | - Michael P Dunne
- b School of Public Health and Social Work, Faculty of Health , Queensland University of Technology , Brisbane , Australia
- c Institute for Community Health Research , Hue University of Medicine and Pharmacy , Hue , Vietnam
| | - Joseph Debattista
- d Metro North Public Health Unit , Metro North Hospital and Health Service , Brisbane , Australia
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Miller AN, Ngula KW. The impact of church contextual factors on church-going youth's HIV prevention behaviour in Nairobi, Kenya: A cross-denominational study. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 12:131-40. [PMID: 25860319 DOI: 10.2989/16085906.2013.863213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Church doctrine about sexual behaviour has long been assumed to have an impact on aspects of the sub-Saharan AIDS epidemic, and evidence suggests that Pentecostal churches have a stronger influence THAN? on the sexual behaviour of their adherents. However, few studies have investigated the denominational differences in sexual attitudes and behaviour of youths, and virtually no empirical evidence is available regarding what specific aspects of the church environment are associated with differences in the response of youths to church messaging about sexual behaviour. This study examined those factors among church-going youth in Nairobi, Kenya. Separate focus groups with male and female youths were conducted in four mainline and three Pentecostal/evangelical (P/E) churches, and in-depth interviews were conducted with youth pastors or pastors of five of those churches. Content of church teaching as reported by youths and pastors did not differ between denominations. However, amount and context of teaching did vary, with P/E churches reportedly offering more teaching about sex to their youth. In addition, P/E churches appeared to provide a more intense experience of community than mainline churches, a situation that may create a context within which abstinence appears to be a reasonable life choice.
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Affiliation(s)
- Ann Neville Miller
- a University of Central Florida , PO Box 161344, Orlando, Florida 32816-1344 , USA
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20
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Farmer DB, Berman L, Ryan G, Habumugisha L, Basinga P, Nutt C, Kamali F, Ngizwenayo E, St Fleur J, Niyigena P, Ngabo F, Farmer PE, Rich ML. Motivations and Constraints to Family Planning: A Qualitative Study in Rwanda's Southern Kayonza District. GLOBAL HEALTH: SCIENCE AND PRACTICE 2015; 3:242-54. [PMID: 26085021 PMCID: PMC4476862 DOI: 10.9745/ghsp-d-14-00198] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 02/11/2015] [Indexed: 12/03/2022]
Abstract
Community members and health workers recognized the value of spacing and limiting births but a variety of traditional and gender norms constrain their use of contraception. Limited method choice, persistent side effects, transportation fees, stock-outs, long wait times, and hidden service costs also inhibit contraceptive use. Background: While Rwanda has achieved impressive gains in contraceptive coverage, unmet need for family planning is high, and barriers to accessing quality reproductive health services remain. Few studies in Rwanda have qualitatively investigated factors that contribute to family planning use, barriers to care, and quality of services from the community perspective. Methods: We undertook a qualitative study of community perceptions of reproductive health and family planning in Rwanda’s southern Kayonza district, which has the country’s highest total fertility rate. From October 2011 to December 2012, we conducted interviews with randomly selected male and female community members (n = 96), community health workers (n = 48), and health facility nurses (n = 15), representing all 8 health centers’ catchment areas in the overall catchment area of the district’s Rwinkwavu Hospital. We then carried out a directed content analysis to identify key themes and triangulate findings across methods and informant groups. Results: Key themes emerged across interviews surrounding: (1) fertility beliefs: participants recognized the benefits of family planning but often desired larger families for cultural and historical reasons; (2) social pressures and gender roles: young and unmarried women faced significant stigma and husbands exerted decision-making power, but many husbands did not have a good understanding of family planning because they perceived it as a woman’s matter; (3) barriers to accessing high-quality services: out-of-pocket costs, stock-outs, limited method choice, and long waiting times but short consultations at facilities were common complaints; (4) side effects: poor management and rumors and fears of side effects affected contraceptive use. These themes recurred throughout many participant narratives and influenced reproductive health decision making, including enrollment and retention in family planning programs. Conclusions: As Rwanda continues to refine its family planning policies and programs, it will be critical to address community perceptions around fertility and desired family size, health worker shortages, and stock-outs, as well as to engage men and boys, improve training and mentorship of health workers to provide quality services, and clarify and enforce national policies about payment for services at the local level.
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Affiliation(s)
| | - Leslie Berman
- Partners In Health-Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Grace Ryan
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, UK
| | | | - Paulin Basinga
- National University of Rwanda School of Public Health, Kigali, Rwanda
| | | | | | | | | | | | | | - Paul E Farmer
- Partners In Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
| | - Michael L Rich
- Partners In Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
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21
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Tenkorang EY. Perceived vulnerability and HIV testing among youth in Cape Town, South Africa. Health Promot Int 2014; 31:270-9. [PMID: 25524472 DOI: 10.1093/heapro/dau113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The importance of perceived vulnerability to risk-reducing behaviors, including HIV testing, is fairly established, especially among youth in sub-Saharan Africa. Yet, the majority of studies that examined this important relationship used cross-sectional data that inherently assume that perceived vulnerability does not change. While these studies have been useful, the assumption of perceived vulnerability as time invariant is a major flaw and has largely limited the practical usefulness of this variable in AIDS prevention and programing. Using longitudinal data and applying random-effects logit models, this study makes a major contribution to scholarship by examining if changes in perceived vulnerability associate with a change to test for HIV among 857 young people in Cape Town, South Africa. Results show that female youth who changed their risk perceptions were more likely to also change to test for HIV, but the effects were completely attenuated after controlling for theoretically relevant variables. No significant relationships were observed for males. Also, females who were virgins at wave 2 but had sex between waves were significantly more likely to have changed to test for HIV. Of most importance was that sexual behavior eliminated the effects of change in risk perceptions suggesting that a change in perception may have occurred as a result of changes in sexual behavior. AIDS prevention programs must pay particular attention to helping youth become aware of their vulnerability to HIV risks, especially as these have implications for risk-reducing behaviors, especially for females who are burdened.
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Affiliation(s)
- Eric Y Tenkorang
- Department of Sociology, Memorial University, St. John's, NL A1C 5S7, Canada
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Maticka-Tyndale E, Mungwete R, Jayeoba O. Replicating impact of a primary school HIV prevention programme: primary school action for better health, Kenya. HEALTH EDUCATION RESEARCH 2014; 29:611-623. [PMID: 23962492 DOI: 10.1093/her/cyt088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
School-based programmes to combat the spread of HIV have been demonstrated to be effective over the short-term when delivered on a small scale. The question addressed here is whether results obtained with small-scale delivery are replicable in large-scale roll-out. Primary School Action for Better Health (PSABH), a programme to train teachers to deliver HIV-prevention education in upper primary-school grades in Kenya demonstrated positive impact when tested in Nyanza Province. This article reports pre-, 10-month post- and 22-month post-training results as PSABH was delivered in five additional regions of the country. A total of 26 461 students from 110 primary schools in urban and rural, middle- and low-income settings participated in this repeated cross-sectional study. Students ranged in age from 11 to 16 years, were predominantly Christian (10% Muslim), and the majority were from five different ethnic groups. Results demonstrated positive gains in knowledge, self-efficacy related to changes in sexual behaviours and condom use, acceptance of HIV+ students, endorsement of HIV-testing and behaviours to post-pone sexual debut or decrease sexual activity. These results are as strong as or stronger than those demonstrated in the original impact evaluation conducted in Nyanza Province. They support the roll-out of the programme across Kenyan primary schools.
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Affiliation(s)
- E Maticka-Tyndale
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Ontario, N9B 3P4, Canada and Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0W8, Canada
| | - R Mungwete
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Ontario, N9B 3P4, Canada and Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0W8, Canada
| | - O Jayeoba
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Ontario, N9B 3P4, Canada and Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0W8, Canada
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Abstract
This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.
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Tenkorang EY, Maticka-Tyndale E. Assessing young people's perceptions of HIV risks in Nyanza, Kenya: are school and community level factors relevant? Soc Sci Med 2014; 116:93-101. [PMID: 24992480 DOI: 10.1016/j.socscimed.2014.06.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 05/19/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Abstract
The majority of cognitive models used in HIV prevention identify risk perception as essential, and the first step towards safer sexual behaviors. Yet, previous studies have rarely examined risk perceptions as an outcome variable, and the few that have, limited their analysis to individual-level determinants. Conspicuously missing in the literature is how school/community level factors affect risk perceptions among school-going youth. Using data collected from primary school youth in Nyanza, Kenya and employing hierarchical linear modeling, this study examines how both individual and community level factors shape individuals' perceived risks of contracting HIV. Results indicate that measures captured at both individual and school/community levels were significantly associated with risk perception. At the individual level, and for boys, high risk perception was associated with higher knowledge about HIV, rejection of myths surrounding HIV transmission, higher condom use self-efficacy and having engaged in risky sexual behaviors. For girls, it was pressure from others to engage in sexual activity, having engaged in risky sexual behaviors and knowing someone infected with HIV that resulted in increased risk perceptions. Beyond individual level variables, some school/community level factors are significantly associated with risk perception. For instance, boys and girls in communities with higher estimates of AIDS deaths reported higher risk perceptions. Boys in communities where AIDS was acknowledged as the cause of death at funerals were less likely to report high risk perceptions. The findings suggest that interventions targeting HIV prevention among young people in Nyanza, Kenya could benefit immensely from an understanding of how schools and communities affect risk perceptions and behavioral change.
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Affiliation(s)
- Eric Y Tenkorang
- Department of Sociology, Memorial University, St. John's, NL, A1C 5S7, Canada.
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Valadez JJ, Jeffery C, Davis R, Ouma J, Lwanga SK, Moxon S. Putting the C back into the ABCs: a multi-year, multi-region investigation of condom use by Ugandan youths 2003-2010. PLoS One 2014; 9:e93083. [PMID: 24705381 PMCID: PMC3976401 DOI: 10.1371/journal.pone.0093083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/03/2014] [Indexed: 11/28/2022] Open
Abstract
A major strategy for preventing transmission of HIV and other STIs is the consistent use of condoms during sexual intercourse. Condom use among youths is particularly important to reduce the number of new cases and the national prevalence. Condom use has been often promoted by the Uganda National AIDS Commission. Although a number of studies have established an association between condom use at one’s sexual debut and future condom use, few studies have explored this association over time, and whether the results are generalizable across multiple locations. This multi time point, multi district study assesses the relationship between sexual debut and condom use and consistent use of condoms thereafter. Uganda has used Lot Quality Assurance Sampling surveys since 2003 to monitor district level HIV programs and improve access to HIV health services. This study includes 4518 sexually active youths interviewed at five time points (2003–2010) in up to 23 districts located across Uganda. Using logistic regression, we measured the association of condom use at first sexual intercourse on recent condom usage, controlling for several factors including: age, sex, education, marital status, age at first intercourse, geographical location, and survey year. The odds of condom use at last intercourse, using a condom at last intercourse with a non-regular partner, and consistently using a condom are, respectively, 9.63 (95%WaldCI = 8.03–11.56), 3.48 (95%WaldCI = 2.27–5.33), and 11.12 (95%WaldCI = 8.95–13.81) times more likely for those individuals using condoms during their sexual debut. These values did not decrease by more than 20% when controlling for potential confounders. The results suggest that HIV prevention programs should encourage condom use among youth during sexual debut. Success with this outcome may have a lasting influence on preventing HIV and other STIs later in life.
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Affiliation(s)
- Joseph J. Valadez
- Liverpool School of Tropical Medicine, Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool, United Kingdom
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
| | - Caroline Jeffery
- Liverpool School of Tropical Medicine, Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool, United Kingdom
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
- * E-mail:
| | - Rosemary Davis
- Liverpool School of Tropical Medicine, Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool, United Kingdom
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
| | - Joseph Ouma
- Management Sciences for Health, Kampala, Uganda
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
| | - Stephen K. Lwanga
- Management Sciences for Health, Kampala, Uganda
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
| | - Sarah Moxon
- Liverpool School of Tropical Medicine, Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool, United Kingdom
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
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Tarkang EE. Perceived family support regarding condom use and condom use among secondary school female students in Limbe urban city of Cameroon. BMC Public Health 2014; 14:173. [PMID: 24533616 PMCID: PMC3933031 DOI: 10.1186/1471-2458-14-173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 02/11/2014] [Indexed: 11/18/2022] Open
Abstract
Background HIV/AIDS prevention programs rooted in the social cognitive models are based on the theoretical assumptions that adoption of preventive behaviour (condom use) depends on the individual’s perceptions of their susceptibility to HIV/AIDS and the benefits of condom use. However some studies contend that applying such models in the African setting may not be that simple considering that in many societies, people’s capacity to initiate health enhancing behaviour are mediated by power relations (parents/guardians) and socialisation processes that are beyond the control of individuals. The relative influence of these family forces on condom use is however unknown in Cameroon. In this study it is hypothesized that adolescents’ perceptions of family support for condom use, would encourage condom use among female students in Limbe urban city of Cameroon. Methods A cross-sectional study of a probability sample of 210 female students selected from three participating secondary school was adopted, using a self-administered questionnaire to collect data. Pearson Chi-square statistics was used to test association between perceived family support for condom use and condom use. Statistics were calculated using SPSS version 20 software program. Results Of the respondents, 56.2% reported being sexually active. Of these, 27.4% reported using condoms consistently; 39.1% reported having used condoms during their first sexual intercourse, while 48.7% reported having used condoms during their last sexual intercourse. Majority of the female students exhibited positive perceptions regarding family support for condom use. Respondents who agreed that they feel themselves free to discuss condom use with their parents or any adult member of the family, reported more condom use during first sex than those who disagreed (X2 = 13.021; df = 6; p = 0.043). Likewise respondents who agreed that they feel themselves free to discuss condom use with their parents or any adult member of the family, reported more condom use at least once, than those who disagreed (X2 = 8.755; df = 3; p = 0.033). Conclusion Significant associations between perceptions of family support for condom use and condom use were established in this study. This finding suggests that regardless of the sexual communication patterns within the family, techniques that increase the occurrence of parent and female student’s discussion concerning condoms and HIV/AIDS will prove useful in preventing HIV/AIDS among female students in Limbe Urban City of Cameroon.
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Affiliation(s)
- Elvis E Tarkang
- HIV/AIDS Prevention Research Network, Cameroon (HIVPREC), Opposite Premier Pharmacy, Commonwealth Avenue, P,O Box 36, Kumba, Cameroon.
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Harper GW, Riplinger AJ, Neubauer LC, Murphy AG, Velcoff J, Bangi AK. Ecological factors influencing HIV sexual risk and resilience among young people in rural Kenya: implications for prevention. HEALTH EDUCATION RESEARCH 2014; 29:131-146. [PMID: 23969629 DOI: 10.1093/her/cyt081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Most new HIV infections in Kenya occur among young people. The purpose of this study was to understand ecological factors that influence HIV-related sexual risk and resilience among young people in rural Kenya and to elicit their ideas for HIV prevention interventions. Nine focus groups (N = 199) were conducted with both female (55%) and male (45%) participants (ages 14-24 years) living in rural communities in Kenya. Findings were organized into thematic areas related to the following systems of influence: (i) intrapersonal (substance use, HIV knowledge), (ii) interpersonal (peer pressure, lack of parent-child communication, interpersonal sexual violence), (iii) institutional/community (pornography, transactional sex, 'idleness', lack of role models) and (iv) socio-cultural/policy (Kikuyu culture, Western influence, religious beliefs, HIV-related stigma and gendered sexual scripts). Results regarding the types of HIV prevention programs that participants believed should be developed for young people in rural Kenya revealed seven primary themes, including (i) HIV prevention community/group workshops, (ii) condom distribution, (iii) job skills trainings, (iv) athletic and social clubs, (v) HIV-related stigma reduction campaigns, (vi) community-wide demonstrations and (vii) other HIV/AIDS activities led by young people. Implications for the development of culturally and developmentally appropriate HIV prevention interventions for young people in rural Kenya are discussed.
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Affiliation(s)
- Gary W Harper
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA, Master of Public Health Program, DePaul University, Chicago, IL 60614, USA, College of Communication, DePaul University, Chicago, IL 60614, USA, HIV Clinical Research, New Orleans, LA 70117, USA and Harder + Company Community Research, San Francisco, CA 94103, USA
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Woodward A, Howard N, Kollie S, Souare Y, von Roenne A, Borchert M. HIV knowledge, risk perception and avoidant behaviour change among Sierra Leonean refugees in Guinea. Int J STD AIDS 2014; 25:817-26. [PMID: 24480849 DOI: 10.1177/0956462414521163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A common assumption underpinning health communications design in humanitarian settings is that increasing knowledge and risk perception will lead to appropriate behaviour change. This study compares associations of HIV knowledge and perceived risk with reported HIV-avoidant behaviour changes and sexual health choices from a community survey of 698 sexually experienced male and female Sierra Leonean refugees in Guinea. HIV knowledge was not significantly associated with reported HIV-avoidant changes (OR 1.25; adjusted for gender; 95%CI 0.76-2.04), while perceived HIV risk was negatively associated (OR 0.38, adjusted for age at sexual debut; 95%CI 0.22-0.66). Trying to conceive was the main reason reported for not using condoms or other contraception (28%; 138/498), followed by current pregnancy/lactation (19%; 93/498). Results suggest contextual factors (e.g. desire for children) can be as important as knowledge and risk-perception, and HIV prevention initiatives in stable and chronic humanitarian settings should account for these.
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Affiliation(s)
- Aniek Woodward
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK King's International Development Institute and King's Centre for Global Health, King's College London, London, UK
| | - Natasha Howard
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Sarah Kollie
- Reproductive Health Group (RHG), Gueckedou, Guinea
| | - Yaya Souare
- Reproductive Health Group (RHG), Gueckedou, Guinea
| | - Anna von Roenne
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Berlin, Germany
| | - Matthias Borchert
- Institute of Tropical Medicine and International Health (ITMIH), Charité - Universitätsmedizin, Berlin, Germany Institute of Tropical Medicine (ITM), Berlin, Belgium
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Brawner BM, Teitelman AM, Bevilacqua AW, Jemmott LS. Personalized Biobehavioral HIV Prevention for Women and Adolescent Girls. Glob Adv Health Med 2014; 2:100-8. [PMID: 24416702 PMCID: PMC3833571 DOI: 10.7453/gahmj.2013.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Women and adolescent girls bear a significant burden of the global HIV pandemic. Both behavioral and biomedical prevention approaches have been shown to be effective. In order to foster the most effective combination HIV-prevention approaches for women and girls, it is imperative to understand the unique biological, social, and structural considerations that increase vulnerability to acquiring HIV within this population. Primary Study Objective: The purpose of this article is to propose novel ideas for personalized biobehavioral HIV prevention for women and adolescent girls. The central argument is that we must transcend unilevel solutions for HIV prevention toward comprehensive, multilevel combination HIV prevention packages to actualize personalized biobehavioral HIV prevention. Our hope is to foster transnational dialogue among researchers, practitioners, educators, and policy makers toward the actualization of the proposed recommendations. Methods: We present a commentary organized to review biological, social, and structural factors that increase vulnerability to HIV acquisition among women and adolescent girls. The overview is followed by recommendations to curb HIV rates in the target population in a sustainable manner. Results: The physiology of the lower female reproductive system biologically increases HIV risk among women and girls. Social (eg, intimate partner violence) and structural (eg, gender inequality) factors exacerbate this risk by increasing the likelihood of viral exposure. Our recommendations for personalized biobehavioral HIV prevention are to (1) create innovative mechanisms for personalized HIV risk—reduction assessments; (2) develop mathematical models of local epidemics; (3) prepare personalized, evidence-based combination HIV risk—reduction packages; (4) structure gender equity into society; and (5) eliminate violence (both physical and structural) against women and girls. Conclusions: Generalized programs and interventions may not have universal, transnational, and crosscultural implications. Personalized biobehavioral strategies are needed to comprehensively address vulnerabilities at biological, social, and structural levels.
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Affiliation(s)
- Bridgette M Brawner
- Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, United States
| | - Anne M Teitelman
- Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, United States
| | - Amanda W Bevilacqua
- Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, United States
| | - Loretta Sweet Jemmott
- Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, United States
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Condom use and sexuality communication with adults: a study among high school students in South Africa and Tanzania. BMC Public Health 2013; 13:874. [PMID: 24053420 PMCID: PMC4016546 DOI: 10.1186/1471-2458-13-874] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 09/17/2013] [Indexed: 11/23/2022] Open
Abstract
Background Fostering adolescents’ communication on sexuality issues with their parents and other significant adults is often assumed to be an important component of intervention programmes aimed at promoting healthy adolescent sexual practices. However, there are few studies describing the relationship between such communication and sexual practices, particularly in sub-Saharan Africa. This study examined the relationships between adolescents’ communication with significant adults and their condom use in three sites in this region. Methods Data stem from a multi-site randomized controlled trial of a school-based HIV prevention intervention implemented in Cape Town and Mankweng, South Africa and Dar es Salaam, Tanzania. Only data from comparison schools were used. The design is therefore a prospective panel study with three waves of data collections. Data were collected in 2004 from 6,251 participants in 40 schools. Associations between adolescents’ communication with adults about sexuality issues and their use of condoms were analysed cross-sectionally using analysis of variance, as well as prospectively using multiple ordinal logistic regression analysis. Results Cross-sectional analyses showed that consistent condom users had significantly higher mean scores on communication (across topics and communication partners) than both occasional users and never-users, who had the lowest scores. After controlling for condom use at the first data collection occasion in each model as well as for possible confounders, communication scores significantly predicted consistent condom use prospectively in all three ordinal logistic regression models (Model R2 = .23 to .31). Conclusion The findings are consistent with the assertion that communication on sexuality issues between adolescents and significant adults results in safer sexual practices, as reflected by condom use, among in-school adolescents. The associations between communication variables and condom use might have been stronger if we had measured additional aspects of communication such as whether or not it was initiated by the adolescents themselves, the quality of advice provided by adults, and if it took place in a context of positive adult-adolescent interaction. Studies with experimental designs are needed in order to provide stronger evidence of causality.
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Tenkorang EY, Maticka-Tyndale E. Individual- and school-level correlates of HIV testing among secondary school students in Kenya. Stud Fam Plann 2013; 44:169-87. [PMID: 23720001 DOI: 10.1111/j.1728-4465.2013.00351.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The policy framework guiding Kenya's response to the AIDS epidemic identifies voluntary counseling and testing as crucial to risk reduction and HIV-preventive activities. Yet in Kenya, as in most sub-Saharan countries, voluntary testing rates are low, especially among young people. Using hierarchical linear models, we identify both individual- and teacher/school-level factors that affect voluntary HIV testing among secondary school students in Kenya. Results indicate that adolescents are more likely to test for HIV serostatus when they are knowledgeable about testing, have been involved in HIV/AIDS activities in primary school, have been provided with HIV information in secondary school, perceive themselves as at high risk of contracting HIV or know of someone infected with or who has died from HIV/AIDS, and have ever engaged in sexual intercourse. Barriers include fear of going to testing centers and being perceived as HIV-positive. Teacher/school-level characteristics are relevant for explaining rates of HIV testing, especially among girls. To encourage testing, policymakers should attend to teacher/school-level factors as well as individual characteristics of students.
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Affiliation(s)
- Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St. John's NL, A1C 5S7, Canada.
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Nguyen HV, Dunne MP, Debattista J. Predictors of recent HIV testing among male street laborers in urban Vietnam. J Health Psychol 2013; 19:1066-78. [PMID: 23682063 DOI: 10.1177/1359105313483645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study assessed the prevalence of and factors associated with HIV testing among male street laborers. In a cross-sectional survey, social mapping was done to recruit and interview 450 men aged 18-59 years in Hanoi. Although many of these men engaged in multiple risk behaviors for HIV, only 19.8 percent had been tested for HIV. A modified theoretical model provided better fit than the conventional Information-Motivation-Behavioral Skills model, as it explained much more variance in HIV testing. This model included three Information-Motivation-Behavioral components and four additional factors, namely, the origin of residence, sexual orientation, the number of sexual partners, and the status of condom use.
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Nguyen VH, Dunne MP, Debattista J. Modeling predictors of risky drug use behavior among male street laborers in urban Vietnam. BMC Public Health 2013; 13:453. [PMID: 23651704 PMCID: PMC3681656 DOI: 10.1186/1471-2458-13-453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 05/02/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The application of theoretical frameworks for modeling predictors of drug risk among male street laborers remains limited. The objective of this study was to test a modified version of the IMB (Information-Motivation-Behavioral Skills Model), which includes psychosocial stress, and compare this modified version with the original IMB model in terms of goodness-of-fit to predict risky drug use behavior among this population. METHODS In a cross-sectional study, social mapping technique was conducted to recruit 450 male street laborers from 135 street venues across 13 districts of Hanoi city, Vietnam, for face-to-face interviews. Structural equation modeling (SEM) was used to analyze data from interviews. RESULTS Overall measures of fit via SEM indicated that the original IMB model provided a better fit to the data than the modified version. Although the former model was able to predict a lesser variance than the latter (55% vs. 62%), it was of better fit. The findings suggest that men who are better informed and motivated for HIV prevention are more likely to report higher behavioral skills, which, in turn, are less likely to be engaged in risky drug use behavior. CONCLUSIONS This was the first application of the modified IMB model for drug use in men who were unskilled, unregistered laborers in urban settings. An AIDS prevention program for these men should not only distribute information and enhance motivations for HIV prevention, but consider interventions that could improve self-efficacy for preventing HIV infection. Future public health research and action may also consider broader factors such as structural social capital and social policy to alter the conditions that drive risky drug use among these men.
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Affiliation(s)
- Van Huy Nguyen
- Department of Health Management and Organization, Institute for Preventive Medicine and Public Health, Hanoi Medical University, 01 Ton That Tung Str., Dong Da Dist., Hanoi, Vietnam
| | - Michael P Dunne
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Joseph Debattista
- Brisbane Sexual Health and HIV Service, MetroNorth Hospital and Health Service, Brisbane, Australia
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Ybarra ML, Korchmaros J, Kiwanuka J, Bangsberg DR, Bull S. Examining the applicability of the IMB model in predicting condom use among sexually active secondary school students in Mbarara, Uganda. AIDS Behav 2013; 17:1116-28. [PMID: 22350827 PMCID: PMC3425669 DOI: 10.1007/s10461-012-0137-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The applicability of the IMB model in predicting condom use was tested among 390 sexually active secondary school students in Mbarara, Uganda. Adolescents across five secondary schools completed a self-report survey about their health and sexual experiences. Based upon results from structural equation modeling, the IMB model partially predicts condom use. Condom use was directly predicted by HIV prevention information and behavioral skills regarding having and using condoms. It was indirectly predicted (through behavioral skills regarding having and using condoms) by behavioral intentions regarding using condoms and talking to one's partner about safer sex. Aspects of one's first sexual experience (i.e., age at first sex, having discussed using condoms with first sex partner, willingness at first sex) were strongly influential in predicting current condom use; this was especially true for discussing condoms with one's first sex partner. Findings highlight the importance of providing clear and comprehensive condom use training in HIV prevention programs aimed at Ugandan adolescents. They also underscore the importance of targeting abstinent youth before they become sexually active to positively affect their HIV preventive behavior at their first sexual experience.
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Affiliation(s)
- Michele L Ybarra
- Center for Innovative Public Health Research, Inc, San Clemente, CA, USA.
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Tenkorang EY. Myths and misconceptions about HIV transmission in Ghana: what are the drivers? CULTURE, HEALTH & SEXUALITY 2012; 15:296-310. [PMID: 23240740 DOI: 10.1080/13691058.2012.752107] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Biomedical and social cognitive models driving HIV preventive activities in sub-Saharan Africa are mostly premised on factual and accurate knowledge of the disease. While knowledge about HIV exists in most parts of Africa, there is widespread belief in myths that often contradict and undermine preventive efforts. Using the 2008 Demographic and Health Survey and applying logit models, we examined what influences belief in myths and misconceptions surrounding HIV transmission among Ghanaian men and women. Results indicate that respondents with high knowledge of how HIV may be transmitted had lower odds of endorsing myths about the disease. Compared to the less educated and poorer Ghanaians, educated and wealthier Ghanaians were less likely to endorse myths about HIV. Also, compared to the Akan people, respondents identifying with other ethnic groups were significantly less likely to endorse myths. The findings suggest that policy makers provide accurate information about how the disease is spread to counter myths surrounding HIV transmission.
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Affiliation(s)
- Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St. John's, Canada.
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Tenkorang EY. Negotiating safer sex among married women in Ghana. ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:1353-62. [PMID: 22552707 DOI: 10.1007/s10508-012-9960-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 12/15/2011] [Accepted: 02/04/2012] [Indexed: 05/10/2023]
Abstract
Recent evidence across sub-Saharan Africa shows married women face heightened risks of contracting HIV compared to the never-married. Vulnerability of married women to HIV infection is linked to a number of factors including their inability to negotiate safer sex, inter alia, asking their husbands to use condoms or refusing sexual intercourse even in high risk situations. This study examined what influences married women's ability to say they can ask their sexual partners to use condoms or refuse sexual intercourse. Demographic and Health Survey data from 2,950 married women were analyzed using complementary log-log models. Married women in Ghana were more likely to say they can ask their husbands to use condoms when they know condoms can protect against HIV transmission and had been tested for their HIV serostatus. Also, women who know sexual abstinence can protect against HIV transmission were more likely to say they can refuse sex. Wealthier and highly educated women were more likely to say they can refuse to have sex with their husbands or ask them to use condoms, compared to poorer and less educated women. It is recommended that policy makers promote specific knowledge related to HIV prevention (condom use, HIV testing), while improving the social and economic circumstances of married women in Ghana.
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Affiliation(s)
- Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
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Kaufman MR, Harman JJ, Shrestha DK. Let's talk about sex: development of a sexual health program for Nepali women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:327-338. [PMID: 22827902 DOI: 10.1521/aeap.2012.24.4.327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to develop and test the feasibility of conducting a sexual health intervention for women in Nepal, a country with high political and economic instability and strong patriarchal systems. Of the 88 women enrolled, 100% retention was obtained over three sessions, and 85% completed a 1-month follow-up. Recruitment was so effective that some women were placed on a waitlist. All participants embraced the content and actively engaged in the intervention. Baseline results indicate HIV knowledge of the sample of educated women was low, and they did not often speak to other women about sex. Low knowledge about HIV and being comfortable discussing sex were associated with less frequent communication with others about sex. This study identified a great need for sexual health programs for women in Nepal, and we were able to effectively develop and implement an intervention to target this need.
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Affiliation(s)
- Michelle R Kaufman
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD 21202, 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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Dynes M, Stephenson R, Rubardt M, Bartel D. The influence of perceptions of community norms on current contraceptive use among men and women in Ethiopia and Kenya. Health Place 2012; 18:766-73. [PMID: 22579117 DOI: 10.1016/j.healthplace.2012.04.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 04/13/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
Abstract
The paper uses data from Ethiopia and Kenya to examine how perceptions of community norms differentially shape contraceptive use among men and women. Women whose current number of sons is lower than their perception of the community ideal had lower odds of reporting contraceptive use, while women whose own personal ideal number of sons is lower than the community ideal had greater odds of reporting contraceptive use. Men and women in Kenya were influenced more by their perception of their social network's approval of family planning than by their own approval of family planning. Results highlight the importance of place, conceptualized as the place-specific perceptions of fertility ideals, when conducting reproductive health research. Identification of people who use contraception in the face of pervasive pronatalist community norms presents a point for future intervention.
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Affiliation(s)
- Michelle Dynes
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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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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Tenkorang EY, Gyimah SO, Maticka-Tyndale E, Adjei J. Superstition, witchcraft and HIV prevention in sub-Saharan Africa: the case of Ghana. CULTURE, HEALTH & SEXUALITY 2011; 13:1001-1014. [PMID: 21714753 DOI: 10.1080/13691058.2011.592218] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Belief in superstition and witchcraft is central to many African conceptions of illness, disease causation and etiology. While a number of anthropological studies have alluded to a theoretical link between such beliefs and HIV prevention in particular, there is limited empirical assessment of the association. Using data from the 2008 Ghana Demographic and Health Survey and applying random-effects logit models, we investigate whether the belief that AIDS can spread through witchcraft associates with the sexual decision making of never-married men and women. The results show that men who believed AIDS can spread through witchcraft and other supernatural means were less likely to have used condoms at last sexual intercourse, controlling for other socioeconomic and cultural variables. Women with similar beliefs were more likely to have experienced sexual intercourse but less likely to have used condoms at last sex. For women, however, the relationship between such superstitious beliefs and condom use was somewhat attenuated after controlling for ethnicity and region of residence. From a policy perspective, the findings suggest that local beliefs regarding AIDS causation must be considered in designing HIV/AIDS programmes and interventions.
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Affiliation(s)
- Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St. John's, Canada.
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Van Rossem R, Meekers D. Perceived social approval and condom use with casual partners among youth in urban Cameroon. BMC Public Health 2011; 11:632. [PMID: 21819611 PMCID: PMC3170619 DOI: 10.1186/1471-2458-11-632] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 08/06/2011] [Indexed: 05/26/2023] Open
Abstract
Background HIV prevention programs targeting youth often emphasize the role of peers, and assume that youths will model their behavior after their peers'. We challenge this view; we argue that adopting a given behavior requires social approval, and that youths do not necessarily turn to peers for such approval. This study analyzes survey data on youths in urban Cameroon to 1) identify which type of persons youths look to for social approval, and 2) establish how important social approval by these persons is for condom use among youths. Methods We analyzed data from three survey waves (2000, 2002, and 2003) of a reproductive health survey conducted among urban Cameroonian youth (aged 15-24). Only respondents who reported having at least one casual partner in the past year were retained for the analysis. Bivariate analyses and structural equation modeling were used to examine relationships among perceived social approval, attitudes towards condoms and condom use. Results The data show that only 3% of youths named their friends as people whose opinion they valued, while 93% mentioned family members. The perceived approval of condom use by these persons had a significant positive effect on the frequency of condom use among youths. The frequency of condom use was also affected by the respondents' attitudes toward condom use, the range of persons with whom they discussed reproductive health matters, whether they were enrolled in school, socioeconomic status, their self-efficacy, perceived severity of AIDS, risk perception and sexual risk behavior. The perceived social approval of condom use and the respondents' own condom attitudes were correlated. Conclusions Our analysis demonstrates that perceived social approval facilitates the adoption of condom use among urban Cameroonian youth. However, youths tend to value the opinions of family members much more than the opinions of their peers. These results suggest that interventions targeting youths should not focus exclusively on peers but should also include other groups, such as parents and community leaders.
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Affiliation(s)
- Ronan Van Rossem
- Department of Sociology, Universiteit Gent, Korte Meer 3-5, 9000 Gent, Belgium.
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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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Tenkorang EY, Maticka-Tyndale E, Rajulton F. A multi-level analysis of risk perception, poverty and sexual risk-taking among young people in Cape Town, South Africa. Health Place 2010; 17:525-35. [PMID: 21195013 DOI: 10.1016/j.healthplace.2010.12.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 11/22/2010] [Accepted: 12/09/2010] [Indexed: 10/18/2022]
Abstract
Various studies have underscored the relevance of community-level factors to sexual behavior and HIV/AIDS prevention efforts in Africa. However, there is a paucity of research and theorizing in this area compared to the preponderance of prevention models that focus solely on individual-level factors. Using data from the Cape Area Panel Survey and hierarchical linear models, this study examines the effects of a combination of individual-level factors and community-level poverty on sexual behaviors. Male and female respondents who perceived themselves to be at great risk of HIV infection were less likely to indulge in risky sexual behaviors. For females, race and community-level poverty were confounded such that race mediated the effects of community-level poverty. Results from this study indicate that multiple rationalities affect sexual behaviors in Cape Town, South Africa and that there is a need to consider both the social embeddedness of sexual behaviors and the rational components of decision making when designing HIV/AIDS prevention programs.
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Affiliation(s)
- Eric Y Tenkorang
- Population Studies Centre, University of Western Ontario, 1151 Richmond Street, London, Ontario, Canada N6A 5C2.
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