Patterns of sexual behaviour of male patients before testing HIV-positive in a Cambodian hospital, Phnom Penh

The Magnitude and Associated Factors of Consistent Condom Utilization Among ART Users in Hawassa City, Sidama, Ethiopia

BACKGROUND

Antiretroviral therapy (ART) introduction has sharply decreased mortality and morbidity rates among HIV-infected patients and resulted in longer and healthier lives among people living with HIV. Hence, the aim of this study is to determine the level of consistent condom use and associated factors among ART users in Hawassa City.

METHODS

Cross-sectional study design triangulated with qualitative phenomenology was used. One hospital and one health center were selected by simple random sampling and proportional to size allocation was used to assign participants to each health facility. Accordingly, 358 study subjects were selected. Adjusted odds ratio (AOR) with 95% confidence interval was used to implicate significant factors. Thematic content analysis was used and narrative report writing with a quote was used to present qualitative data.

RESULTS

The prevalence of consistent condom utilization in this study was 51.4%. Sex (AOR= 4.20, 95% CI: 2.386, 7.41), residence (AOR=3.55, 95% CI: 1.81, 6.99) educational status (AOR=0.4, 95% CI: 0.196, 0.946), perception on ART's does not reduction of HIV transmission (AOR=1.96, 95% CI: 1.12, 3.43), rate of counseling (AOR=0.37, 95% CI: 0.17, 0.84) and use condom to prevent pregnancy (AOR=4.53, 95% CI: 2.11, 9.73) were found to be independent predictors of consistent condom utilization among ART users. Refusal by husbands, decrement in satisfaction, gender difference with more women than men willing to use consistently and religious reasons were factors associated with inconsistent condom utilization in the qualitative study.

CONCLUSION AND RECOMMENDATION

Consistent condom utilization among ART users was low. Sex, residence, educational status, perception towards ART were significantly associated with consistent condom utilization. Moreover, husband refusal, religious reason, decrement in satisfaction on the qualitative study were associated with non-consistent use of a condom. The importance of consistent condom use should be well addressed in HIV/AIDS patients, to prevent transmission and multiple infections of HIV.

Perceptions of Sexual Infidelity in Rural Cambodia: A Qualitative Study of Adolescent Men

Sexual infidelity plays a significant role in the high rate of spousal transmission of HIV in Cambodia. The sexual beliefs and attitudes of a person begin in childhood and are developed through multiple chains in early adolescence, affecting his or her future sexual behavior and future incidence of HIV. A deeper understanding of the perspectives of adolescents regarding infidelity is critical to effective HIV prevention efforts during adulthood. Using a descriptive qualitative approach, this study explored the perceptions of male adolescents regarding male infidelity. Through the thematic analysis method, themes and subcategories were developed from the responses of 48 male high school students from three provinces. Majority of the participants ( n = 33) were found to have liberal attitudes not only toward male infidelity but also toward the high possibility of their own future infidelity ( n = 14). Almost 45% ( n = 21) of the participants explained that men would fulfill their sexual desires outside, such as in karaoke, when their wives are unable to have sex with them. Participants believed it annoying for men to disclose their extramarital activities to their wives. The study concluded that the participants hold accepting perceptions about infidelity; they are part of the HIV problem and must be part of the solution. Educators and counselors need to deliver age-appropriate, scientifically correct, and culturally relevant messages about sexual health and HIV prevention to growing adolescents.

Sociocultural Influences on the Transmission of HIV From Husbands to Wives in Cambodia: The Male Point of View

The purpose of the study was to explore, within cultural and societal contexts, the factors of spousal HIV transmission as described by the experiences of HIV-positive Cambodian men. Using qualitative research methods, the researchers collected data from in-depth interviews with 15 HIV-positive Cambodian men of seroconcordant couples recruited from an HIV/AIDS clinic in Phnom Penh. Using a model of HIV transmission from husbands to wives, the questions were designed to elicit the men’s perspectives on the topics of promiscuity, masculinity, condom use in marriage, the image of the ideal Cambodian woman, and attitudes toward sex and marriage. Directed content analysis was used to analyze the interview data. The main results were as follows: (a) men involved with sex workers perceived this as a natural behavior and a necessary part of being an approved member in a male peer group, (b) married men never used condoms during sex with their wives prior to their HIV diagnosis, (c) men perceived a good wife as one who is diligent and loyal to her husband, and (4) men’s attitudes toward sex and marriage (e.g., sex perceived as a part of life pleasure) differed from those of their wives. Promoting honest spousal communication about sexuality, maintaining men’s marital fidelity, and increasing women’s comfort in the use of sexual techniques are suggested as strategies for reducing HIV transmission within marriage in Cambodia. Future interventions should focus on reshaping men’s behaviors and changing cultural norms to protect them and their spouses from HIV infection.

High prevalence of unhealthy alcohol use and comparison of self-reported alcohol consumption to phosphatidylethanol among women engaged in sex work and their male clients in Cambodia

BACKGROUND

In Cambodia, most of the female sex workers (FSW) work in venues where unhealthy alcohol use is ubiquitous and potentially contributing to the HIV epidemic. However, no accurate data exists. We compare self-reported unhealthy alcohol consumption to a biomarker of alcohol intake in Cambodian FSW and male clients, and determine factors associated with unhealthy alcohol use.

METHODS

A cross-sectional study was conducted among FSW (n=100) and male clients (n=100) in entertainment and sex work venues in Cambodia. Self-reported unhealthy alcohol use (AUDIT-C) was compared to phosphatidylethanol (PEth) positive (≥50ng/ml), a biomarker of alcohol intake. Sociodemographics data was collected. Correlates of self-reported unhealthy alcohol use and PEth positive were determined.

RESULTS

The prevalence of PEth positive in FSW was 60.0%. Self-reported unhealthy alcohol consumption was reported by 85.0% of the women. Almost all women (95.0%) testing PEth positive also reported unhealthy alcohol use. Prevalence of unhealthy alcohol consumption (self-report and PEth positive) was higher in FSW working in entertainment establishments compared to other sex work venues (p<0.01). Among male clients, 47.0% reported unhealthy alcohol consumption and 42.0% had a PEth positive. However, only 57.1% of male clients with PEth positive reported unhealthy alcohol use.

CONCLUSIONS

Unhealthy alcohol consumption is prevalent in Cambodian sex work settings. Self-reported unhealthy alcohol use is well reported by FSW, but less by male clients. These findings highlight the urgency of using accurate measures of unhealthy alcohol consumption and integrating this health issue into HIV prevention interventions.

Determinants of Heterosexual Adolescents Having Sex with Female Sex Workers in Singapore

Objectives

We assessed the proportion of and socio-ecological factors associated with ever having had sex with female sex workers (FSWs) among heterosexual adolescents. We also described the characteristics of the adolescents who reported inconsistent condom use with FSWs.

Methods

This is a cross-sectional study (response rate: 73%) of 300 heterosexually active male adolescents of 16 to 19 years attending a national STI clinic in Singapore between 2009 and 2014. We assessed the ecological factors (individual, parental, peer, school and medial influences) and sexual risk behaviors using a self-reported questionnaire. Poisson regression was used to obtain the adjusted prevalence ratios (aPR) and confidence intervals (CI).

Results

The proportion of heterosexual male adolescents who had ever had sex with FSWs was 39%. Multivariate analysis showed that significant factors associated with ever having had sex with FSWs were sex initiation before 16 years old (aPR 1.79 CI: 1.30–2.46), never had a sexually active girlfriend (aPR 1.75 CI 1.28–2.38), reported lower self-esteem score (aPR 0.96 CI: 0.93–0.98), higher rebelliousness score (aPR 1.03 CI: 1.00–1.07) and more frequent viewing of pornography (aPR 1.47 CI: 1.04–2.09). Lifetime inconsistent condom use with FSWs was 30%.

Conclusions

A significant proportion of heterosexual male adolescents attending the public STI clinic had ever had sex with FSWs. A targeted intervention that addresses different levels of influence to this behavior is needed. This is even more so because a considerable proportion of adolescents reported inconsistent condom use with FSWs, who may serve as a bridge of STI transmission to the community. National surveys on adolescent health should include the assessment of frequency of commercial sex visits and condom use with FSWs for long-term monitoring and surveillance.

Alcohol Use Disorder and Heavy Episodic Drinking in Rural Communities in Cambodia

Alcohol misuse is increasing in Southeast Asia. We investigated the extent of and risk factors for alcohol use disorder (AUD) and heavy episodic drinking (HED) in a rural community in Cambodia. We also attempted to explore the communities’ perception of alcohol misuse and elicited potential community-based strategies to address the alcohol problem. A mixed-methods study design was used, combining a cross-sectional questionnaire survey with qualitative interviews (focus group discussions and key informant interviews). AUD and HED were measured using the AUDs Identification Test Alcohol Consumption questionnaire. The prevalence of AUD and HED was high: 25% and 31%, respectively. Male sex, younger age, and increasing income were significant risk factors. The communities were well aware of the harmful effects of alcohol, expressed the importance of implementing community-based measures, and proposed various community-led solutions. Evidence-based strategies that are culturally appropriate, accepted, and driven by communities are urgently needed.

Becoming a person with HIV: experiences of Cambodian women infected by their spouses

We conducted an interpretive phenomenological investigation in order to understand, within a Cambodian sociocultural context, the lived experiences of women infected with HIV by their husbands as they navigated the tasks of discovering, disclosing and dealing with the diagnosis. Using an open-ended interview protocol and an interpretive phenomenological approach, data were analysed from 15 women (aged 28-42 years) who self-identified the HIV transmission as coming from their spouses. Using qualitative inductive analysis, we were able to identify three main themes: (1) finding oneself to be HIV-positive, (2) encountering HIV--accepting an unwelcomed guest and (3) going public--dealing with the fear of discrimination. Participants consistently delayed testing for HIV and, after receiving an HIV-positive diagnosis, had to deal with painful emotions and discrimination within their social network. The complexity of gender roles and the sociocultural status of the women acted as behavioural determinants of their responses to HIV transmission from their spouses.

HIV transmission from husbands to wives in Cambodia: a systematic review of the literature

HIV transmission in Cambodia has declined considerably in recent years, yet new incidents of HIV transmission within marital relationships have increased. Evidence suggests that the cause of this is transmission from HIV-positive men to their HIV-negative spouses. The objective of this paper is to develop an evidence-based model of HIV transmission from husbands to wives in Cambodia in a context of culture and society, drawing from the published literature. A critical analysis of peer reviewed literature, professional papers, policy reports and reference books identified four plausible factors influencing inter-spousal HIV transmission: (1) a hierarchical male-dominated society, (2) husbands' involvement with sex workers, (3) cultural values concerning the ideal Khmer woman and (4) unprotected sex between an HIV-infected husband and his uninfected wife. This evidence-based explanatory model can be used to inform future culturally appropriate HIV-education and prevention programmes.

Social capital and risk and protective behaviors: a global health perspective

Social capital and health research has emerged as a focus of contemporary behavioral epidemiology, while intervention research is seeking more effective measures to increase health protective behaviors and decrease health-risk behaviors. In this review we explored current literature on social capital and health outcomes at the micro-, mesa-, and macro-levels with a particular emphasis on research that incorporates a social capital framework, and adolescent and young adult engagement in risk behaviors. These data indicate that across a broad range of socio-cultural and economic contexts, social capital can affect individuals’ risk for negative health outcomes and their engagement in risk behaviors. Further research is needed which should focus on differentiating and measuring positive and negative social capital within both mainstream and alternative social networks, assessing how social constructions of gender, ethnicity, and race – within specific cultural contexts – mediate the relationship between social capital and risk and/or protective behaviors. This new research should integrate the existing research within historical socioeconomic and political conditions. In addition, social capital scales need to be developed to be both culturally and developmentally appropriate for use with adolescents living in a diversity of settings. Despite the proliferation of social capital research, the concept remains underutilized in both assessment and intervention development for adolescents’ and young adults’ engagement in risk behaviors and their associated short- and long-term poor health outcomes.