1
|
Kwena ZA, Bukusi EA, Turan JM, Darbes L, Farquhar C, Makokha C, Baeten JM. Effects of the Waya Intervention on Marital Satisfaction and HIV Risk Behaviors in Western Kenya: A Pre-Post Study Design. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3689-3701. [PMID: 35338399 DOI: 10.1007/s10508-021-02180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/29/2021] [Accepted: 10/07/2021] [Indexed: 06/14/2023]
Abstract
Poor marital satisfaction is associated with high-risk sexual behavior and HIV transmission. We tested whether a counselor-led couple education and counseling intervention dubbed Waya (paternal aunt) would improve marital satisfaction and reduce HIV risk behavior among married couples in Kisumu County, western Kenya. In a pre-post design, we enrolled 60 heterosexual married couples at high risk for HIV to undergo five 1-h couple education and counseling sessions over 56 days. We collected self-reported data on marital satisfaction, the number of sex partners, and condom use with extramarital partners at pre- and post-intervention visits. We used Wilcoxon and McNemar tests to examine the association of our intervention with marital relationship satisfaction and reduction in HIV risk sexual behavior. The intervention was associated with marital relationship satisfaction score improvement from a median of 5 (interquartile range [IQR], 4-5) to 6 (IQR, 6-7) among men and 4 (IQR, 3-5) to 6 (IQR, 5-6) among women (p < .01). The intervention was also associated with reducing HIV risk sexual behaviors depicted by a reduction in the number of sex partners in the past one month and an increase in consistent extramarital condom use. The number of sex partners reduced from a median of 2 (IQR, 1-2) to 1 (IQR, 1-2) and consistent extramarital condom use increased from 4% at baseline to 56% among men. Our intervention was associated with improvements in marital relationship satisfaction and reductions in HIV high-risk behaviors necessary for achieving epidemic control in HIV hotspots such as fishing communities in western Kenya.
Collapse
Affiliation(s)
- Zachary Arochi Kwena
- Center for Microbiology Research, Research Care & Training Program, Kenya Medical Research Institute, Box 614, Kisumu, 40100, Kenya.
| | - Elizabeth A Bukusi
- Center for Microbiology Research, Research Care & Training Program, Kenya Medical Research Institute, Box 614, Kisumu, 40100, Kenya
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lynae Darbes
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Carey Farquhar
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Catherine Makokha
- Center for Microbiology Research, Research Care & Training Program, Kenya Medical Research Institute, Box 614, Kisumu, 40100, Kenya
| | - Jared M Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
2
|
Achen D, Nyakato VN, Akatukwasa C, Kemigisha E, Mlahagwa W, Kaziga R, Ruzaaza GN, Rukundo GZ, Michielsen K, Neema S, Coene G. Gendered Experiences of Parent-Child Communication on Sexual and Reproductive Health Issues: A Qualitative Study Employing Community-Based Participatory Methods among Primary Caregivers and Community Stakeholders in Rural South-Western Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095052. [PMID: 35564447 PMCID: PMC9104466 DOI: 10.3390/ijerph19095052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 12/10/2022]
Abstract
Open and positive parent–child communication about sexual and reproductive health (SRH) is known to reduce negative SRH outcomes for young people. However, socio-cultural influences can inhibit meaningful SRH communication. Restrictive gender norms threaten the SRH of adolescents, as they make adolescent boys more likely to engage in risky sexual behavior and make girls more vulnerable to negative SRH outcomes. This study intended to critically understand the impact of gender norms and expectations on parent–child SRH communication in rural south-western Uganda. Methods: The study adopted a community-based participatory approach using community stakeholder engagement meetings (n = 2), in-depth interviews (n = 12), and three focus group discussions with parents (n = 18). The study considered biological parents, step-parents, grandparents, uncles and aunties, as long as they were primary caregivers of adolescents aged 10–14. Results: Participants elaborated on the socio-cultural aspects that shaped their experiences of parent–child SRH communication such as cultural gender norms, religion, and media influences. They also referred to socio-economic challenges, lack of knowledge, and the role of peers and schools. Conclusions: There is need for community-based interventions to improve parent–child SRH communication to address the deeply rooted cultural and gender contexts in rural south-western Uganda.
Collapse
Affiliation(s)
- Dorcus Achen
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, 1090 Brussels, Belgium;
- Correspondence:
| | - Viola N. Nyakato
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda; (V.N.N.); (E.K.); (W.M.)
| | - Cecilia Akatukwasa
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (C.A.); (R.K.); (K.M.)
| | - Elizabeth Kemigisha
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda; (V.N.N.); (E.K.); (W.M.)
| | - Wendo Mlahagwa
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda; (V.N.N.); (E.K.); (W.M.)
| | - Ruth Kaziga
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (C.A.); (R.K.); (K.M.)
| | - Gad Ndaruhutse Ruzaaza
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda;
| | - Godfrey Z. Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda;
| | - Kristien Michielsen
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (C.A.); (R.K.); (K.M.)
| | - Stella Neema
- College of Humanities, Makerere University, Kampala P.O. Box 7062, Uganda;
| | - Gily Coene
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, 1090 Brussels, Belgium;
| |
Collapse
|
3
|
de Vries DH, Bruggeman J, Benoni TE, Rwemisisi JT, Kashaija LM, Muhangi D, Kaawa-Mafigiri D, Pool R. Social networks for health communication in rural Uganda: A mixed-method analysis of Dekabusa Trading Centre, Luwero County. Glob Public Health 2020; 15:1674-1688. [PMID: 32493119 DOI: 10.1080/17441692.2020.1775870] [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: 10/24/2022]
Abstract
To reach the most vulnerable individuals in under-resourced countries, health communication interventions increasingly move towards the community level. However, little is known about how health information spreads through local social networks. This paper maps the health information network of a rural trading centre in Uganda. As part of a five-year ethnographic study of sustainable community health resources, ego networks were obtained for 231 village residents in March 2014. Using both ethnographic and social network data, we analyze how the village social network is structured, and how this structure may influence the transmission of health information. Results show a network with low average proximity, with a small number of individuals, notably key administrative officials, much closer connected to many other community members than average. However, because of social partitioning in the village network, a number of people are outside the social clusters in which the top influencers are located.
Collapse
Affiliation(s)
- Daniel H de Vries
- Department of Anthropology, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeroen Bruggeman
- Department of Sociology, University of Amsterdam, Amsterdam, the Netherlands
| | - Turinawe E Benoni
- Department of Social Work & Social Administration, Makerere University, Kampala, Uganda
| | - Jude T Rwemisisi
- Uganda Management Institute, Institute Research Centre, Kampala, Uganda
| | - Laban M Kashaija
- Department of Social Work & Social Administration, Makerere University, Kampala, Uganda
| | - Denis Muhangi
- Department of Social Work & Social Administration, Makerere University, Kampala, Uganda
| | - David Kaawa-Mafigiri
- Department of Social Work & Social Administration, Makerere University, Kampala, Uganda
| | - Robert Pool
- Department of Anthropology, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Ninsiima AB, Leye E, Michielsen K, Kemigisha E, Nyakato VN, Coene G. "Girls Have More Challenges; They Need to Be Locked Up": A Qualitative Study of Gender Norms and the Sexuality of Young Adolescents in Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020193. [PMID: 29364192 PMCID: PMC5858264 DOI: 10.3390/ijerph15020193] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/15/2018] [Accepted: 01/19/2018] [Indexed: 11/16/2022]
Abstract
Unequal power and gender norms expose adolescent girls to higher risks of HIV, early marriages, pregnancies and coerced sex. In Uganda, almost half of the girls below the age of 18 are already married or pregnant, which poses a danger to the lives of young girls. This study explores the social construction of gender norms from early childhood, and how it influences adolescents' agency. Contrary to the mainstream theory of agency, which focuses on the ability to make informed choices, adolescents' agency appears constrained by context-specific obstacles. This study adopted qualitative research approaches involving 132 participants. Of these, 44 were in-depth interviews and 11 were focus group discussions, parcelled out into separate groups of adolescents (12-14 years), teachers, and parents (n = 88), in Western Uganda. Data were analysed manually using open and axial codes, and conclusions were inductive. Results show that gender norms are established early in life, and have a very substantial impact on the agency of young adolescents. There were stereotypical gender norms depicting boys as sexually active and girls as restrained; girls' movements were restricted; their sexual agency constrained; and prevention of pregnancy was perceived as a girl's responsibility. Programs targeting behavioural change need to begin early in the lives of young children. They should target teachers and parents about the values of gender equality and strengthen the legal system to create an enabling environment to address the health and wellbeing of adolescents.
Collapse
Affiliation(s)
- Anna B Ninsiima
- RHEA Centre for Gender, Diversity and Intersectionality, Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium.
- School of Women and Gender Studies, Makerere University, 7062 Kampala, Uganda.
| | - Els Leye
- International Centre for Reproductive Health, Ghent University, 10 UZ-P114, 9000 Ghent, Belgium.
| | - Kristien Michielsen
- International Centre for Reproductive Health, Ghent University, 10 UZ-P114, 9000 Ghent, Belgium.
| | - Elizabeth Kemigisha
- International Centre for Reproductive Health, Ghent University, 10 UZ-P114, 9000 Ghent, Belgium.
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara, Uganda.
| | - Viola N Nyakato
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara, Uganda.
| | - Gily Coene
- RHEA Centre for Gender, Diversity and Intersectionality, Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium.
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
- Michele L Ybarra
- Center for Innovative Public Health Research, San Clemente, CA, USA,
| | | | | | | |
Collapse
|
6
|
Emeka-Nwabunnia I, Ibeh BO, Ogbulie TE. High HIV sero-prevalence among students of institutions of higher education in Southeast Nigeria. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60334-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
7
|
Martínez Pérez G, Namulondo H, Tomás Aznar C. Labia minora elongation as understood by Baganda male and female adolescents in Uganda. CULTURE, HEALTH & SEXUALITY 2013; 15:1191-1205. [PMID: 23905946 DOI: 10.1080/13691058.2013.811613] [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
Labia minora elongation is a common traditional female genital modification practice among the members of the Baganda ethnic group in Uganda. In 2002, a study carried out by the Padua Working Group on Female Genital Mutilation analysed how Baganda girls residing in Wakiso District graphically represented their experiences of labia minora elongation. In the present study, using the same methodology and in the same geographic setting 10 years later, we asked young men and women to prepare graphical representations of this rite. The purpose was to learn about how the practice is perceived and represented, describing the differences found in their testimonies, and comparing the findings with the former study. A total of 36 respondents (21 male and 15 female), aged between 9 and 15 years old participated in the study. The drawings were analysed using a three-themes analysis frame with a focus on setting, subject and operator. Differences were detected between how young women and men represented this practice. Educational interventions may be helpful to address the doubts, concerns, anxieties and misconceptions that Baganda youth may have concerning traditional genital practices.
Collapse
Affiliation(s)
- Guillermo Martínez Pérez
- a Department of Physiatrist and Nursing, Faculty of Health Sciences , University of Zaragoza , Zaragoza , Spain
| | | | | |
Collapse
|
8
|
Sidze EM, Defo BK. Effects of parenting practices on sexual risk-taking among young people in Cameroon. BMC Public Health 2013; 13:616. [PMID: 23809373 PMCID: PMC3703286 DOI: 10.1186/1471-2458-13-616] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 06/26/2013] [Indexed: 11/26/2022] Open
Abstract
Background There is scanty evidence regarding the impact of parenting practices on young people’s sexual risk-taking in sub-Saharan Africa. Moreover, the extent to which such practices have enduring consequences on adolescents and young adults is little documented. This study uses repeated measures of parent–child relationships, parental monitoring, and parent–child communication about sexual matters to shed some light in these two areas. Methods The analysis is based on time-dependent retrospective data on parenting practices which were retrieved from the Cameroon Family and Health Survey (CFHS). The study sample includes 447 sexually active and unmarried individuals aged 15–24 years old. Correlation analysis and multivariate logistic regressions are used. Results Young males and females reported high levels of parental monitoring, moderate quality of parent–child relationships and low levels of parent–child communication on sexual matters. This study substantiates that the higher the quality of parent–child relationships, the lower the odds of young males having multiple sexual partners (0.63, p < 0.05), and the lower the odds of young females being sexually active (0.52, p < 0.10) or of having multiple sexual partners (0.64, p < 0.10) or of having occasional sexual partners (0.51, p < 0.05). Living with the biological father only was associated with higher odds of having multiple sexual partners (3.21, p < 0.10) and higher odds of occasional concurrent sexual partners (3.26, p < 0.10) among young males. Compared with their out-of-school counterparts, young males still enrolled in school were less likely to be sexually active in the last 12 months (0.33, p < 0.05) and less likely to have occasional concurrent sexual partners (0.57, p < 0.10), whereas young females still enrolled in school were more likely to be sexually active (2.25, p < 0.10) and less likely to use contraceptive consistently (0.36, p < 0.001). Conclusions Reproductive health programs and interventions for preventing young people’s risky sexual behaviors in sub-Saharan African settings must take into account the protective effects of parent–child relationships and the significance of parental monitoring over time.
Collapse
Affiliation(s)
- Estelle M Sidze
- African Population and Health Research Center, PO Box 10787-00100, Nairobi, Kenya.
| | | |
Collapse
|
9
|
|
10
|
Katz IT, Ybarra ML, Wyatt MA, Kiwanuka JP, Bangsberg DR, Ware NC. Socio-cultural and economic antecedents of adolescent sexual decision-making and HIV-risk in rural Uganda. AIDS Care 2012; 25:258-64. [PMID: 22835224 DOI: 10.1080/09540121.2012.701718] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
With more than half of new infections occurring among youth, HIV/AIDS remains a major contributor to morbidity and mortality in Uganda. Semi-structured interviews were performed with 48 adolescents and 15 adult key informants in a rural Ugandan community to identify influences on adolescent sexual decision-making. Inductive data analytic methods revealed five thematic influences: (1) social pressure, (2) decline of the Senga (a familial figure who traditionally taught female adolescents about how to run a household), (3) cultural barriers to condom use, (4) knowledge of HIV transmission and modes of prevention, and (5) a moral injunction against sex before marriage. Influences were classified as HIV/AIDS risk and protective factors and organized to form an explanatory framework of adolescent sexual risk-taking. Risk factors pull youth toward risky behavior, while protective factors push them away. Predominance of risk over protective influences explains persistent sexual risk-taking by Ugandan youth. HIV prevention programs designed for Ugandan adolescents should take competing factors and sociocultural and economic influences into account.
Collapse
Affiliation(s)
- Ingrid T Katz
- Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA.
| | | | | | | | | | | |
Collapse
|
11
|
A review of studies of parent-child communication about sexuality and HIV/AIDS in sub-Saharan Africa. Reprod Health 2011; 8:25. [PMID: 21943095 PMCID: PMC3192730 DOI: 10.1186/1742-4755-8-25] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/24/2011] [Indexed: 11/26/2022] Open
Abstract
Parent-child sexuality communication has been identified as a protective factor for adolescent sexual and reproductive health, including HIV infection. The available literature on this topic in sub-Saharan Africa is increasing; however a systematic review of studies has not been conducted. This article reviews the literature in the area of parental or caregiver and child communication about sexuality and HIV/AIDS in sub-Saharan Africa. A review of peer reviewed literature published between 1980 and April 2011 was conducted. Communication process studies investigating the frequency, content, style, tone of discussions, preferences, as well as associations with and barriers to sexuality communication are reviewed. In addition, studies which examine behavioral associations with parent-child sexuality communication, and intervention studies to improve parent-child sexuality communication are examined. The findings from process studies suggest wide variation in terms of frequency of discussions, with a range of socio-demographic and other factors associated with sexuality communication. Overall, findings demonstrate that discussions tend to be authoritarian and uni-directional, characterized by vague warnings rather than direct, open discussion. Moreover, parents and young people report a number of barriers to open dialogue, including lack of knowledge and skills, as well as cultural norms and taboos. Findings are less clear when it comes to associations between parental communication and adolescent sexual activity and contraception use. However, nascent indications from intervention research suggest positive findings with increases in frequency and comfort of discussions, among other outcomes. Gaps in the research are identified and discussed with implications for future studies.
Collapse
|
12
|
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.
Collapse
Affiliation(s)
- Ann-Maree Nobelius
- School of Rural Health, Centre for Medical and Health Sciences Education, Monash University.
| | | | | | | | | | | |
Collapse
|
13
|
Vandenhoudt H, Miller KS, Ochura J, Wyckoff SC, Obong'o CO, Otwoma NJ, Poulsen MN, Menten J, Marum E, Buvé A. Evaluation of a U.S. evidence-based parenting intervention in rural Western Kenya: from parents matter! To families matter! AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2010; 22:328-343. [PMID: 20707693 DOI: 10.1521/aeap.2010.22.4.328] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We evaluated Families Matter! Program (FMP), an intervention designed to improve parent-child communication about sexual risk reduction and parenting skills. Parents of 10- to 12-year-olds were recruited in western Kenya. We aimed to assess community acceptability and FMP's effect on parenting practices and effective parent-child communication. Data were collected from parents and their children at baseline and 1 year postintervention. The intervention's effect was measured on six parenting and parent-child communication composite scores reported separately for parents and children. Of 375 parents, 351 (94%) attended all five intervention sessions. Parents' attitudes regarding sexuality education changed positively. Five of the six composite parenting scores reported by parents, and six of six reported by children, increased significantly at 1 year postintervention. Through careful adaptation of this U.S. intervention, FMP was well accepted in rural Kenya and enhanced parenting skills and parent-child sexuality communication. Parents are in a unique position to deliver primary prevention to youth before their sexual debut as shown in this Kenyan program.
Collapse
|
14
|
Wilcken A, Miiro-Nakayima F, Hizaamu RNB, Keil T, Balaba-Byansi D. Male circumcision for HIV prevention--a cross-sectional study on awareness among young people and adults in rural Uganda. BMC Public Health 2010; 10:209. [PMID: 20420701 PMCID: PMC2880292 DOI: 10.1186/1471-2458-10-209] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 04/26/2010] [Indexed: 11/28/2022] Open
Abstract
Background Medical male circumcision is now part of a comprehensive approach to HIV prevention. It has been shown that awareness of the protective effect of male circumcision leads to high acceptability towards the introduction of medical male circumcision services within countries. The objective of this survey was to identify factors determining awareness of male circumcision for HIV prevention. Methods We interviewed 452 participants (267 adults >24 years of age; 185 youths 14-24 years) living in three rural Ugandan districts in 2008. Using a standardized questionnaire, we assessed socio-demographic parameters, awareness of MC for HIV prevention, general beliefs/attitudes regarding MC and MC status. Determinants for awareness of MC for HIV prevention were examined with multiple logistic regression models. Results Out of all adults, 52.1% were male (mean ± SD age 39.8 ± 11 years), of whom 39.1% reported to be circumcised. Out of all youths, 58.4% were male (18.4 ± 2.5), 35.0% circumcised. Adults were more aware of MC for HIV prevention than youths (87.1% vs. 76.5%; p = 0.004). In adults, awareness was increased with higher educational level compared to no school: primary school (adjusted OR 9.32; 95%CI 1.80-48.11), secondary (5.04; 1.01-25.25), tertiary (9.91; 0.76-129.18), university education (8.03; 0.59-109.95). Younger age and male sex were further significant determinants of increased awareness, but not marital status, religion, district, ethnicity, employment status, and circumcision status. In youths, we found a borderline statistically significant decrease of awareness of MC for HIV prevention with higher educational level, but not with any other socio-demographic factors. Conclusions Particularly Ugandans with low education, youths, and women, playing an important role in decision-making of MC for their partners and sons, should be increasingly targeted by information campaigns about positive health effects of MC.
Collapse
Affiliation(s)
- Andrea Wilcken
- Traditional and Modern Health Practitioners Together against AIDS (THETA), Kampala, Uganda.
| | | | | | | | | |
Collapse
|
15
|
Majumdar B, Guenter D, Browne G. HIV prevention in an aboriginal community in Canada. J Assoc Nurses AIDS Care 2010; 21:449-54. [PMID: 20347345 DOI: 10.1016/j.jana.2010.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Basanti Majumdar
- School of Nursing and Department of Family Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | | | | |
Collapse
|
16
|
Action research: developing a pediatric cancer pain program in jordan. J Pain Symptom Manage 2008; 35:447-54. [PMID: 18258410 DOI: 10.1016/j.jpainsymman.2007.05.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 05/22/2007] [Accepted: 05/23/2007] [Indexed: 10/22/2022]
Abstract
Children's pain is undertreated worldwide. Using a model of pediatric cancer pain management in Amman, Jordan, the authors demonstrated that an action research approach to pain service development resulted in a sustainable program of pain control. Barriers to care were due more often to health professionals' misconceptions concerning pain and opioid use than to concerns related to cultural, religious, or societal beliefs. Successful implementation of a pain management program requires education, policy development, and support from several levels of hospital administration. Role-modeling and mentorship are important factors. Established knowledge translation theories explained some but not all of the findings. Outcomes included consistent pain assessment and documentation by nursing staff, increased consultation for pain management, and increased use of intravenous opioids.
Collapse
|
17
|
Paul-Ebhohimhen VA, Poobalan A, van Teijlingen ER. A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa. BMC Public Health 2008; 8:4. [PMID: 18179703 PMCID: PMC2248569 DOI: 10.1186/1471-2458-8-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 01/07/2008] [Indexed: 11/10/2022] Open
Abstract
Background The HIV/AIDS epidemic remains of global significance and there is a need to target (a) the adolescent age-groups in which most new infections occur; and (b) sub-Saharan Africa where the greatest burden of the epidemic lies. A focused systematic review of school-based sexual health interventions in sub-Saharan Africa to prevent HIV/AIDS and Sexually Transmitted Infections (STI) in this age group was therefore conducted. Methods Searches were conducted in Medline, Embase, Cinahl and PsychINFO according to agreed a priori criteria for studies published between 1986 and 2006. Further searches were conducted in UNAIDS and WHO (World Health Organization) websites, and 'Google'. Relevant journals were hand-searched and references cited in identified articles were followed up. Data extraction and quality assessment was carried out on studies selected for full text appraisal, and results were analysed and presented in narrative format. Results Some 1,020 possible titles and abstracts were found, 23 full text articles were critically appraised, and 12 articles (10 studies) reviewed, reflecting the paucity of published studies conducted relative to the magnitude of the HIV epidemic in sub-Saharan Africa. Knowledge and attitude-related outcomes were the most associated with statistically significant change. Behavioural intentions were more difficult to change and actual behaviour change was least likely to occur. Behaviour change in favour of abstinence and condom use appeared to be greatly influenced by pre-intervention sexual history. Conclusion There is a great need in sub-Saharan Africa for well-evaluated and effective school-based sexual health interventions.
Collapse
|