Explaining the increase in condom use among South African young females

Population-level impact of information sources on HIV testing uptake in South Africa: gender and age disparities

In South Africa, mass media and interpersonal communication sources have been used extensively to increase awareness of human immunodeficiency virus (HIV)/AIDS. A sub-population of 10,565 black Africans who participated in the 2011–2012 household survey was analysed. Overall compared to men, a higher proportion of women had ever been tested for HIV (76% versus 60%). In age-specific analysis, men and women aged 25–49 years were more likely to be ever been tested compared to the youngest (<25 years) and the oldest age groups (50+ years). More than 80% of the study population was exposed to mass media tools, while exposure to interpersonal information sources was less common (16–72%). Among adolescents, 37% (men) and 41% (women) of the HIV tests were collectively associated with exposure to interpersonal programmes, while mass media tools had substantial contributions on HIV testing rates among the older individuals. Information sources to promote HIV/AIDS awareness should be tailored to reduce age–gender disparities.

Influence of Access to HIV/AIDS Information on the Knowledge of Federal University Undergraduates in Nigeria

Information and knowledge are the foremost tools in fighting the scourge of HIV/AIDS. Previous studies have focused more on HIV/AIDS and Nigerian undergraduates’ attitudes, beliefs and protective practices than how information factors influence their knowledge of the pandemic. This study, therefore, investigated the influence of access to HIV/AIDS information on its knowledge among undergraduates of federal universities in Nigeria. The study adopted the descriptive survey research design, with a combination of the purposive, proportionate and stratified random sampling technique used to select 1,679 undergraduates from five universities across five geopolitical zones of Nigeria. Questionnaire was the instrument used for collecting data, which were analyzed using Pearson’s product moment correlation and multiple regression. The most accessible sources of HIV/AIDS information among undergraduates were television (94.5 %), radio (93.0 %) and the Internet/ICT centers (90.5 %). The types of HIV/AIDS information frequently assessed were information on how to refuse sex (Mean=3.15), how to be faithful to one partner (Mean=3.12), sharing of sharp objects (Mean=3.12), blood transfusion (Mean=3.11), unprotected sexual intercourse (Mean=3.10) and how to use condoms correctly (Mean=3.09). Access to HIV/AIDS information (r=0.15) resulted in positive significant relationships with HIV/AIDS knowledge, thus access to HIV/AIDS information has a positive influence on the promotion of knowledge of HIV/AIDS among undergraduates. The level of study was also a predictor of HIV/AIDS knowledge, which was not the case for factors of age, discipline, gender, marital status, tribe and religion. The AIDS service organizations and program developers should come up with strategies that would strengthen and improve the content, accuracy and ease of understanding of HIV/AIDS information that students have access to in order to facilitate its use.

The Role of Condom Use Self-Efficacy on Intended and Actual Condom Use Among University Students in Ghana

Little attention has been paid to the dimensions that help to predict and understand condom use among university students within an African context. A cross-sectional study involving 518 university students in Accra, Ghana was conducted to determine how the Condom Use self-Efficacy Scale-Ghana (CUSES-G) can predict both actual condom use and future condom use. Of all the participants, 84% were sexually active but less than half of the sample (48%) reported to have used condom during their last sexual intercourse. A hierarchical regression analysis showed that components of the Condom Use Self-Efficacy Scale (CUESE-G) such as appropriation, assertiveness, pleasure and intoxication, and STDs predicted condom use and condom use intentions. Behavioural change campaigns targeting university students should encourage condom use self-efficacy, as this would strengthen condom use, which is economically cheap and practically effective means of preventing STIs including HIV.

The role of communication inequality in mediating the impacts of socioecological and socioeconomic disparities on HIV/AIDS knowledge and risk perception

INTRODUCTION

Although the link between social factors and health-related outcomes has long been widely acknowledged, the mechanisms characterizing this link are relatively less known and remain a subject of continued investigation across disciplines. In this study, drawing on the structural influence model of health communication, the hypothesis that differences in concern about and information needs on HIV/AIDS, HIV/AIDS-related media use, and perceived salience of HIV/AIDS-related information, characterized as communication inequality, can at least partially mediate the impacts of socioecological (urban vs. rural) and socioeconomic (education) disparities on inequalities in HIV/AIDS knowledge and risk perception was tested.

METHODS

Data were collected from a random sample of 986 urban and rural respondents in northwest Ethiopia. Structural equation modeling, using the maximum likelihood method, was used to test the mediation models.

RESULTS

The models showed an adequate fit of the data and hence supported the hypothesis that communication inequality can at least partially explain the causal mechanism linking socioeconomic and socioecological factors with HIV/AIDS knowledge and risk perception. Both urbanity versus rurality and education were found to have significant mediated effects on HIV/AIDS knowledge (urbanity vs. rurality: β = 0.28, p = .001; education: β = 0.08, p = .001) and HIV/AIDS risk perception (urbanity vs. rurality: β = 0.30, p = .001; education: β = 0.09, p = .001).

CONCLUSIONS

It was concluded that communication inequality might form part of the socioecologically and socioeconomically embedded processes that affect HIV/AIDS-related outcomes. The findings suggest that the media and message effects that are related to HIV/AIDS behavior change communication can be viewed from a structural perspective that moves beyond the more reductionist behavioral approaches upon which most present-day HIV/AIDS communication campaigns seem to be based.

Educating women for HIV prevention: does exposure to mass media make them more knowledgeable?

Mass media is an important vehicle for health promotion in developing countries. In Bangladesh multiple media campaigns are being carried out to educate people about HIV/AIDS. We examined the extent of HIV/AIDS knowledge and the association of exposure to mass media among women in Bangladesh. The Bangladesh Demographic and Health Survey (BDHS) provides data for this article. We found that media exposure (combined index of television, radio, and newspaper) was a highly significant predictor of women's knowledge about HIV and AIDS. Other significant predictors of HIV knowledge include women's education, age, employment, and urban residence.

Determinants of HIV/AIDS-related information needs and media use: beyond individual-level factors

Despite the centrality of information and communication in the fight against HIV/AIDS, little research has investigated the factors associated with HIV/AIDS-related information needs and media use in hard-hit Sub-Saharan Africa. This study explored individual-level and socioecological determinants among urban and rural residents in northwest Ethiopia. Urbanity versus rurality, education, direct experience with HIV/AIDS, perceived salience of HIV/AIDS-related information, and personal health concern were tested as predictors. Regression analyses showed that urbanity versus rurality and education are the major determinants of HIV/AIDS-related information needs and media use. Being urbanite and educated were associated with high concern about and information needs on HIV/AIDS and HIV/AIDS-related mass media use. Moreover, urbanity versus rurality and education significantly predicted preferences for specific types of HIV/AIDS-related information. While rurality and low education were associated with a preference for basic HIV transmission and prevention information, urbanity was associated with a preference for information on HIV/AIDS-related care and support. In most cases, urbanity versus rurality emerged as a substantial predictor and also significantly moderated the effects of other variables. Given the evolving nature of the pandemic and its expansion to rural areas, ruralites' low information needs and media use deserve due attention. Equally, communication interventions targeting urban contexts need to move beyond providing only the ABCs of HIV transmission and prevention and should attend to urbanites' progressive information needs, which seem to have now become more on care and support so as to live and deal with the pandemic.

Newspaper coverage of HIV/AIDS in China from 2000 to 2010

Mass media in China play a significant role in the dissemination of HIV/AIDS knowledge to the general public. Previous studies have described how the Chinese mass media portray HIV/AIDS in general, but no study has yet to examine changes in patterns of HIV/AIDS reporting over time. This study aims to describe and examine newspaper coverage of HIV/AIDS in China from 2000 to 2010. A systematic search of the China Core Newspapers Database was conducted to identify HIV/AIDS-focused news articles; we found 3648 articles. Results show that coverage rates of HIV/AIDS in newspapers remained low, with only about three articles published per newspaper per year between 2000 and 2010. The sources focused primarily on prevention methods (23.7%), development of a cure or vaccine (21.2%), and education and awareness (17.2%). The HIV/AIDS-related topic covered in an article varied significantly depending on scope (national vs. local) of the newspaper (χ(2)=130.37, p<0.001) and article type (χ(2)=455.72, p<0.001). Totally, more articles were classified as positive than negative from 2002 to 2010. Findings indicate that the HIV/AIDS news-reporting pattern has shifted in the past decade, with more news stories disclosing information about prevention or treatment. However, coverage of HIV/AIDS remains insufficient. Enhancing collaboration between health educators and media sources can be an important strategy in disseminating HIV/AIDS knowledge.

Non Castigat Ridendo Mores: evaluating the effectiveness of humor appeal in printed advertisements for HIV/AIDS prevention in Italy

This article investigates the effects of different emotional appeals in HIV/AIDS prevention campaigns using printed advertisements. More specifically, it examines the effectiveness of humor appeal compared with shock and fear appeals. The authors experimentally test the level of attention drawn and the spontaneous recall arising when young Italian adults are shown different HIV/AIDS prevention campaigns. Findings show that humor appeals are less effective than fear and shock appeals, evidencing the failures in HIV/AIDS prevention campaigns in Italy, a country where the former communication strategy has been used in substantive ways. The results also indicate the higher effectiveness of fear appeals (over shock and humor) in printed HIV/AIDS advertising campaigns. The implications of these results for further studies and for improving the design, implementation, and evaluation of HIV/AIDS campaign efforts are also discussed.

Advancing HIV/AIDS Combination Prevention through mass media: a review of practices in sub-Saharan Africa

This paper presents an assessment of the literature on the use of mass media campaigns to advance biomedical, structural and behavioural approaches to HIV/AIDS prevention in sub-Saharan Africa over the past decade (2000–2010). Studies on the use of mass media in HIV/AIDS prevention efforts were searched from two main electronic databases – Web of Science and PubMed. Studies meeting selection criteria were examined for the themes of the mass media programs studied in a content analytic approach. The findings suggest that while there are several biomedical and structural issues which the mass media could well have been instrumental for, their utilization in sub-Saharan Africa seems to be limited to behavioural interventions. It is concluded that at a time when recommendations for Combination Prevention are prevailing, the utilization of the mass media largely limited to a certain domain of HIV/AIDS prevention appears to be worthy of attention.

Condoms in sub-Saharan Africa

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.

The impact of education on sexual behavior in sub-Saharan Africa: a review of the evidence

Many studies have attempted to determine the relationship between education and HIV status. However, a complete and causal understanding of this relationship requires analysis of its mediating pathways, focusing on sexual behaviors. We developed a series of hypotheses based on the differential effect of educational attainment on three sexual behaviors. We tested our predictions in a systematic literature review including 65 articles reporting associations between three specific sexual behaviors -- sexual initiation, number of partners, and condom use -- and educational attainment or school enrollment in sub-Saharan Africa. The patterns of associations varied by behavior. The findings for condom use were particularly convergent; none of the 44 studies using educational attainment as a predictor reviewed found that more educated people were significantly less likely to use condoms. Findings for sexual initiation and number of partners were more complex. The contrast between findings for condom use on the one hand and sexual initiation and number of partners on the other supports predictions based on our theoretical framework.

Making sense of condoms: social representations in young people's HIV-related narratives from six African countries

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.

Are Nepali students at risk of HIV? A cross-sectional study of condom use at first sexual intercourse among college students in Kathmandu

BACKGROUND

Condoms offer the best protection against unintended pregnancies and sexually transmitted infections. Little research has been conducted to determine the prevalence and investigate the influencing factors of condom use at first sexual intercourse among college students.

METHODS

A self-administered questionnaire was completed by 1137 college students (573 male and 564 female) in the Kathmandu Valley. Analyses were confined to 428 students who reported that they have ever had sexual intercourse. The association between condom use at first sexual intercourse and the explanatory variables was assessed in bivariate analysis using Chi-square tests. The associations were further explored using multivariate logistic analysis in order to identify the significant predictors after controlling for other variables.

RESULTS

Among the sexually active students, less than half (48%) had used condoms during first sexual intercourse. The results from the logistic regression analysis revealed that age, caste and/or ethnicity, age at first sexual intercourse, types of first sex partner, alcohol consumption and mass media exposure are significant predictors for condom use at first sexual intercourse among the college students. Students in the older age groups who had first sex were about four times (16 to 19 years old) (OR = 3.5) more likely and nine times (20 or older) (OR = 8.9) more likely than the students who had sex before 16 years of age to use condoms at first sexual intercourse.Moreover, those students who had first sex with commercial sex worker were five times (OR = 4.9) more likely than those who had first sex with their spouse to use condoms at first sex. Furthermore, students who had higher exposure to both print and electronic media were about twice (OR = 1.75) as likely as those who had lower media exposure to use condoms. On the other hand, students who frequently consumed alcohol were 54% (OR = 0.46) less likely to use condoms at first sexual intercourse than those who never or rarely consumed alcohol.

CONCLUSIONS

The rate of condom use at first sexual intercourse is low among the students. It indicates students are exposed to health hazards through their sexual behaviour. If low use of condom at first sex continues, vulnerable sexual networks will grow among them that allow quicker spreading of sexually transmitted diseases and HIV. Findings from this study point to areas that policy and programmes can address to provide youth with access to the kinds of information and services they need to achieve healthy sexual and reproductive lives.

A Decade Later: Follow-Up Review of South African Research on the Consequences of and Contributory Factors in Teen-Aged Pregnancy

In this paper, we review South African research conducted in the last 10 years on the consequences of and contributory factors in teen-aged pregnancy. We discuss research into the rates of teen-aged pregnancy, the intentionality and wantedness of pregnancy, the disruption of schooling, health issues, consequences for the children, welfare concerns, knowledge and use of contraception, timing of sexual debut, age of partner, coercive sexual relations, cultural factors and health service provision. We compare this discussion to the reviews on the same topic appearing in the South African Journal of Psychology a decade ago. We find that there are several changes in focus in the research on pregnancy amongst young women. We conclude that, in general, there has been an improvement in the breadth of data available, mostly as a result of representative national and local surveys. A better teasing out of nuances around particular issues and a grappling with theoretical issues are also evident in recent research.

An assessment of global Internet-based HIV/AIDS media coverage: implications for United Nations Programme on HIV/AIDS' Global Media HIV/AIDS Initiative

No studies to date have assessed the quantity of HIV/AIDS-related media on the Internet. We assessed the quantity of language-specific HIV/AIDS Internet-based news coverage, and the correlation between country-specific HIV/AIDS news coverage and HIV/AIDS prevalence. Internet-based HIV/AIDS news articles were queried from Google News Archives for 168 countries, for the year 2007, in the nine most commonly spoken languages worldwide. English, French and Spanish sources had the greatest number of HIV/AIDS-related articles, representing 134,000 (0.70%), 11,200 (0.65%) and 24,300 (0.49%) of all news articles, respectively. A strong association between country-specific HIV/AIDS news coverage and HIV/AIDS prevalence was found, Spearman's rank correlation: 0.6 ( P < 0.001). Among countries with elevated HIV/AIDS prevalence (≥10%), the volume of HIV/AIDS-specific media was highest in Swaziland (15.9%) and Malawi (13.2%), and lowest in South Africa (4.8%) and Namibia (4.9%). Increased media attention should be placed on countries with high HIV/AIDS prevalence and limited HIV/AIDS-specific news coverage.

Why has HIV stabilized in South Africa, yet not declined further? Age and sexual behavior patterns among youth

OBJECTIVES

To understand the stabilization in HIV prevalence in South Africa, and why HIV prevalence has not declined further, despite behavior change and apparently moderate risk behaviors.

STUDY DESIGN

HIV prevalence and 4 HIV-related sexual behaviors in 15- to 24-year old South Africans and Ugandans were compared, before and during HIV prevalence stabilization and decrease, respectively.

RESULTS

According to standard indicators, 15- to 24-year-old South Africans have shown behavior change and have moderate risk behaviors. Yet, the HIV prevalence of South African youth is more than twice the prevalence among Ugandan youth, despite 2 times greater reported condom use and an increase in secondary abstinence among young females. We observed inconsistent use of condoms and an extended age distribution of risk together with age and partner mixing. These increase the cumulative risk beyond indicators which are based on sexual behavior in the last year and condom use at last sexual act. In addition, the extended age distribution of risk together with age and partner mixing, increase the cumulative risk beyond standard indicators which are based on sexual behavior in the last year and condom use at last sexual act.

CONCLUSIONS

Comprehensive HIV prevention in South Africa needs to be intensified beyond individual age groups for example youth, clearly promote consistent condom use and reduction in sexual partners, and focus on the transmission dynamics including older age groups. This should be based on careful behavioral analysis of the epidemic, which goes beyond standard indicators. This study shows the significant risks beyond apparently improving behavioral indicators in Southern Africa, and helps explains the seriousness of the epidemics in this region.

Predictors of sexual behaviors among Thai young adults

To identify correlates of sexual behaviors among Thai young adults between 18 and 24 years, the authors used a cross-sectional survey of 405 young adults from eight randomly selected Thai urban and rural vocational schools. The young adults completed self-report questionnaires. Logistic regressions were used to determine the correlates between a Thai young adult's ever having had sexual intercourse and the correlates of the number of sexual partners and consistent condom use among those who were sexually active. The independent variables were age, gender, socioeconomic status, geographic residence, parental residence, parental-young adult communication, HIV knowledge, and negotiation for safer sex. The results showed that geographic residence and negotiation for safer sex were related to a young adult's ever having had sexual intercourse; gender, HIV knowledge, and negotiation for safer sex were related to the number of sexual partners; and geographic residence was related to condom use. HIV prevention programs should incorporate HIV knowledge and negotiation skills for both genders and for all geographical areas.