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Kitonsa J, Kansiime S, Kusemererwa S, Onyango M, Nayiga B, Kabarambi A, Mugisha JO, Kaleebu P, Ruzagira E. Changes in self-reported risky sexual behaviour indicators among adults receiving regular risk reduction counselling and optional initiation of pre-exposure prophylaxis in an HIV vaccine preparedness study in Masaka, Uganda. Glob Health Action 2023; 16:2242672. [PMID: 37548558 PMCID: PMC10408567 DOI: 10.1080/16549716.2023.2242672] [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] [Received: 03/20/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND HIV risk reduction counselling may reduce risk-taking behaviours. Yet, concerns remain about risk compensation among individuals initiating pre-exposure prophylaxis (PrEP). OBJECTIVE We assessed changes in risky sexual behaviour indicators among HIV vaccine preparedness study participants who received regular risk reduction counselling and referral for PrEP in Masaka, Uganda. METHODS Adults (18-39 years) at high risk of HIV infection were enrolled in the study between July 2018 and December 2021. Data were collected on socio-demographic factors (baseline) and self-reported sexual risk behaviours (baseline, six monthly). HIV testing and risk-reduction counselling and referral for PrEP were done quarterly. Participants who had completed at least 1 year of follow-up were included in the analysis. Proportional differences and McNemar chi-square tests were used to assess changes in the prevalence of self-reported risky sexual behaviour indicators between baseline and 1 year. Logistic regression was used to assess the predictors of unchanged/increased HIV risk at 1 year. RESULTS Three hundred participants [132 (44%) females, 152 (51%) aged ≤24 years] were included in this analysis. Eighty-one (27%) participants initiated PrEP at 1 year. Compared to baseline, there were significant reductions in the prevalence of the following self-reported HIV risk indicators at 1 year (overall, among non-PrEP initiators, and among PrEP initiators): transactional sex, ≥6 sexual partners, unprotected sex with ≥3 partners, sex while drunk, and sexually transmitted infection diagnosis/treatment. Percentage differences ranged from 10% for individuals reporting at least six sexual partners to 30% for those reporting unprotected sex with three or fewer sexual partners. There was weak evidence of association between female gender and unchanged/increased HIV risk at 1 year (adjusted OR: 1.35, 95% CI (0.84-2.17)). No other indicators, including PrEP use, were associated with unchanged/increased HIV risk at 1 year. CONCLUSION Regular risk-reduction counselling may reduce risky sexual behaviour, while PrEP initiation may not lead to risk compensation.
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Affiliation(s)
- Jonathan Kitonsa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Sheila Kansiime
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Sylvia Kusemererwa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Martin Onyango
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Berna Nayiga
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Anita Kabarambi
- Research, International Centre for Child Health and Development (ICHAD), Masaka, Uganda
| | - Joseph O Mugisha
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
- Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Eugene Ruzagira
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
- Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Bryant J, Ward J, Worth H, Hull P, Solar S, Bailey S. Safer sex and condom use: a convenience sample of Aboriginal young people in New South Wales. Sex Health 2011; 8:378-83. [PMID: 21851779 DOI: 10.1071/sh10138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 03/28/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND This paper examines condom use in a sample of Aboriginal young people in New South Wales (NSW) aged 16-30 years. METHODS Cross-sectional data were collected using hand-held computer devices from 293 Aboriginal people attending two Aboriginal events in NSW. RESULTS Almost two-thirds of respondents reported having had a casual sex partner in the previous 6 months. Of these, 39.2% reported always using a condom with casual partners. Having always used a condom with casual partners varied among respondents, and was more likely among younger respondents (adjusted odds ratio (AOR): 2.7, 95% confidence interval (CI): 1.2-6.1) and less likely among those who used illicit drugs (AOR: 0.2, 95% CI: 0.1-0.7). CONCLUSIONS In comparison to published studies of other Australians, casual sex appears to be more common among this sample of Aboriginal young people; however, the proportion who report having always used condoms with casual partners is very similar. This suggests that although casual sex is more common, Aboriginal young people do not engage in risky behaviour any more often than other young Australians. Further work should be conducted with those who do not always use condoms, such as those who are older and who use illicit drugs, particularly with regards to how abstinence from drug use supports protective behaviours such as condom use among this population of Aboriginal young people.
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Affiliation(s)
- Joanne Bryant
- National Centre in HIV Social Research, University of New South Wales, Sydney, NSW 2052, Australia.
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Nobelius AM, Kalina B, Pool R, Whitworth J, Chesters J, Power R. "The young ones are the condom generation": condom use amongst out-of-school adolescents in rural southwest Uganda. JOURNAL OF SEX RESEARCH 2011; 49:88-102. [PMID: 21516591 DOI: 10.1080/00224499.2011.568126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This article reports on factors influencing condom use among out-of-school adolescents in rural southwest Uganda. Despite an abundance of negative discourses and myths about condoms in the community, these adolescents believe condoms protect them from sexually transmitted infections, HIV, and premarital pregnancies. Girls want partners to use condoms, but most lack the confidence to insist. Girls aged 13 to 14 reported the least difficulty asking for condoms; older girls attributed this to coming-of-age in the era of AIDS when condom use is the norm. Boys under 16 years want to use condoms, but lack confidence in application skills. Boys over 17 years always use condoms with casual partners, but only occasionally for pregnancy prevention with steady partners. Girls need skills training to improve confidence in negotiating condom use. Younger boys require training to improve confidence in skills with condom application. These findings are compared with studies conducted with in-school adolescents in the same study area. Health promotions that provide this skills training and focus on the need to think of the health of future family would be most effective for out-of-school adolescents. This study shows that it is self-confidence, rather than years of schooling, that has the greatest impact on condom use in this cohort.
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Affiliation(s)
- Ann-Maree Nobelius
- School of Rural Health, Centre for Medical and Health Sciences Education, Monash University.
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Muñoz FA, Pollini RA, Zúñiga ML, Strathdee SA, Lozada R, Martínez GA, Valles-Medina AM, Sirotin N, Patterson TL. Condom access: Associations with consistent condom use among female sex workers in two northern border cities of Mexico. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2010; 22:455-465. [PMID: 20973665 PMCID: PMC3069917 DOI: 10.1521/aeap.2010.22.5.455] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
To determine whether condom access is associated with consistent condom use among female sex workers (FSWs) in Tijuana and Ciudad Juarez, between 2004 and 2006 we administered a questionnaire to 924 FSWs who reported unprotected sex with a client in the past 2 months. Of these women, 43% reported consistent ("often" or "always") condom use, 74% said condoms were available, and 38% reported having access to free condoms. In a logistic regression, factors positively associated with consistent condom use were condom availability (adjusted odds ratio [AOR] = 2.00; 95% confidence interval [CI]: 1.32-3.03), condom affordability (AOR = 1.72; 95% CI: 1.25-2.38) and self-efficacy (AOR = 2.16; 95% CI: 1.54-3.04). Factors inversely associated with consistent condom use included poor financial status (AOR = 0.65; 95% CI: 0.47-0.90), methamphetamine use (AOR = 0.58; 95% CI: 0.40-0.83), alcohol use (AOR = 0.68; 95% CI: 0.49-0.96), and recent injection drug use (AOR = 0.62; 95% CI: 0.39-0.97). While increased condom availability may improve condom use among FSWs in general, interventions to broaden condom use among lower income and drug-using FSWs are critically needed.
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Affiliation(s)
- Fátima A. Muñoz
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | - Robin A. Pollini
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | - María Luisa Zúñiga
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | - Steffanie A. Strathdee
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | | | - Gustavo A. Martínez
- Community Health & Development of Ciudad Juarez (SADEC) and Mexican Federation of Private Associations (FEMAP), Ciudad Juarez, Chihuahua, Mexico
| | - Ana M. Valles-Medina
- Master in Public Health Program, Autonomous University of Baja California, Tijuana, Mexico
| | - Nicole Sirotin
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | - Thomas L. Patterson
- Department of Psychiatry University of California, San Diego and MIRECC, VA Medical Center, San Diego, California
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Renaud TC, Bocour A, Irvine MK, Bernstein KT, Begier EM, Sepkowitz KA, Kellerman SE, Weglein D. The free condom initiative: promoting condom availability and use in New York City. Public Health Rep 2009; 124:481-9. [PMID: 19618784 DOI: 10.1177/003335490912400404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In 2005, the New York City Department of Health and Mental Hygiene (DOHMH) made free condoms available to organizations through a Web-based ordering system. In 2006, we interviewed managers and patrons about free condom availability, acquisition, and use in venues where people at high risk for human immunodeficiency virus congregate. DOHMH condom distribution increased from 5.8 million in 2004 to 17.3 million in 2006. Overall, managers reported making condoms available at 76% (309/409) of high-priority venues, but only at 40% of gay bars. Among patrons who saw free condoms, 80% (280/351) reported taking them; 73% (205/280) of those who reported taking them also reported using them. A simple, Web-based ordering system dramatically increased condom distribution. In the venues we sampled, the majority of patrons acquired and used free condoms when available and visible, suggesting that increasing free condom availability may increase use. Special efforts are needed to ensure availability at gay bars.
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Affiliation(s)
- Tamar C Renaud
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
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Jukes M, Simmons S, Bundy D. Education and vulnerability: the role of schools in protecting young women and girls from HIV in southern Africa. AIDS 2008; 22 Suppl 4:S41-56. [PMID: 19033754 DOI: 10.1097/01.aids.0000341776.71253.04] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Education has a potentially important role to play in tackling the spread of HIV, but is there evidence that this potential is realized? This analysis combines the results of previous literature reviews and updates them with the findings of recent randomized controlled trials and a discussion of possible mechanisms for the effect of schooling on vulnerability to HIV infection. There is a growing body of evidence that keeping girls in school reduces their risk of contracting HIV. The relationship between educational attainment and HIV has changed over time, with educational attainment now more likely to be associated with a lower risk of HIV infection than earlier in the epidemic. Educational attainment cannot, however, be isolated from other socioeconomic factors as the cause of HIV risk reduction. The findings of this analysis suggest that the equitable expansion of primary and secondary schooling for girls in southern Africa will help reduce their vulnerability to HIV. Evidence of ineffective HIV prevention education in schools underlines the need for careful evidence-based programme design. Despite the challenges, recent provisional evidence suggests that highly targeted programmes promoting realistic options for young adults may lead to safer sexual behaviour. Targeted education programmes have also been successful in changing students' attitudes to people living with HIV and AIDS, which is associated with testing and treatment decisions. This reduction in stigma may be crucial in encouraging the uptake of voluntary counselling and testing, a central strategy in the control of the epidemic. Expansions of carefully designed and evaluated school-based HIV prevention programmes can help to reduce stigma and have the potential to promote safe sexual behaviour.
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Moore SG, Dahl DW, Gorn GJ, Weinberg CB, Park J, Jiang Y. Condom embarrassment: coping and consequences for condom use in three countries. AIDS Care 2008; 20:553-9. [DOI: 10.1080/09540120701867214] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Darren W. Dahl
- b Marketing , UBC , Vancouver , British Columbia , Canada
| | | | | | - Jongwon Park
- d Marketing , Korea University , Seoul , Republic of Korea
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Plummer ML, Wight D, Wamoyi J, Mshana G, Hayes RJ, Ross DA. Farming with your hoe in a sack: condom attitudes, access, and use in rural Tanzania. Stud Fam Plann 2006; 37:29-40. [PMID: 16570728 DOI: 10.1111/j.1728-4465.2006.00081.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examines condom knowledge, attitudes, access, and practices in rural Mwanza, Tanzania. From 1999-2002, six researchers carried out participant observation in nine villagesfor a total of 158 person-weeks. Many villagers perceived condoms negatively for multiple reasons, for example, the method's association with infection or promiscuity, reduced male sexual pleasure, and cultural understandings of meaningful sex. Men controlled the terms of sexual encounters and reported that they would use condoms only with risky partners, but few perceived their partners as such. Use of condoms appeared to be very low, primarily as a result of limited demand, although barriers to access also existed. These qualitative findings contrast with inconsistent survey reports of relatively high condom use in the same population. Intervention efforts should address the tradeoff between possible short- and long-term consequences of condom use, particularly for men, for example, reduced pleasure versus reduced HIV risk. If possible, surveys should assess the validity of reported condom use through comparison with other data, including qualitative findings and distribution/sales records.
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Affiliation(s)
- Mary L Plummer
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Latkin CA, Knowlton AR. Micro-social structural approaches to HIV prevention: a social ecological perspective. AIDS Care 2005; 17 Suppl 1:S102-13. [PMID: 16096122 DOI: 10.1080/09540120500121185] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To be effective and sustainable, HIV-prevention interventions need to be sufficiently powerful to counteract prevailing social norms and diffuse through the targeted community to provide social reinforcement for behaviour change. Social structural and environmental factors are major influences on HIV-related behaviours yet the dearth of conceptualization and operationalization of these factors impede progress in intervention development. In this paper we propose a social ecological perspective to intervention and highlight relevant theories from social psychology and organizational behaviour literatures. We examine social networks and social settings as micro-structural and environmental influences on HIV risk behaviours, social identities and norms, and as important targets for HIV-prevention intervention. Intervention approaches are proposed that target networks and behavioural settings and provide participants with socially meaningful and rewarding behavioural options that are consistent with valued prosocial identities or roles. Examples are presented on how such an approach has been utilized in prior HIV prevention interventions, including our social network-oriented intervention that trained disadvantaged former and current illicit drug users to conduct peer outreach. We describe how behavioural interventions may enhance or introduce new prosocial identities and social roles, and that network members may confer social approval to reinforce these identities and roles, leading to sustained behavioural risk reduction and changes in risk behaviour norms.
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Affiliation(s)
- C A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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