Factors associated with self-efficacy for condom use and sexual negotiation among South african youth

The Effect of Stigma on Family Planning and HIV Pre-exposure Prophylaxis Decisions of Young Women Accessing Post-Abortion Care in Kenya

Adolescent girls and young women (AGYW) in Eastern and Southern Africa face parallel epidemics of unintended pregnancy and HIV. Their sexual health decisions are often dominated by intersecting stigmas. In an implementation science project integrating delivery of daily, oral pre-exposure prophylaxis (PrEP) for HIV prevention into 14 post-abortion care (PAC) clinics in Kenya, we enrolled a subset of PrEP initiating AGYW (aged 15 to 30 years) into a research cohort. Utilizing log binomial models, we estimated the effect of PrEP stigma on PrEP continuation (measured via self-report and urine assay for tenofovir) and abortion stigma on contraceptive initiation. Between April 2022 and February 2023, 401 AGYW were enrolled after initiating PrEP through their PAC provider, of which 120 (29.9%) initiated highly-effective contraception. Overall, abortion and PrEP stigmas were high in this cohort. Abortion stigma was more prevalent among those that were adolescents, unmarried, and reported social harm. Among 114 AGYW returning for the month 1 follow-up visit, 83.5% reported continuing PrEP and 52.5% had tenofovir detected. In this subset, higher levels of PrEP stigma were significantly associated with greater likelihood of PrEP adherence, but not PrEP continuation. For abortion stigma, greater scores in the subdomain of isolation were significantly associated with greater likelihood of initiating a highly-effective contraception, while greater scores in the subdomain of community condemnation were significantly associated with reduced likelihood of initiating a highly-effective contraception. Given the burden of stigma documented by our work, PAC settings are a pivotal space to integrate stigma-informed counseling and to empower young women to optimize contraceptive and PrEP decisions.

Investigating factors affecting HIV/AIDS knowledge among women in low and middle-income countries in Asia

Sustainable Development Goal 3 focuses on reducing HIV/AIDS spread, for which disseminating correct information on the disease is required. This study investigated factors associated with HIV/AIDS knowledge among women in several Asian LMICs. Global Multiple Indicator Cluster Survey-6 (MICS-6) for Bangladesh, Lao, Mongolia and Nepal were assessed. Bivariate analysis and generalised linear regression models were fitted. Overall, 60% of the respondents were aware or heard of the existence of HIV/AIDS, with 63.2% having transmission knowledge and 80.4% misconception knowledge. Results revealed that several demographic factors such as wealth index, education and access to information had a significant association with HIV/AIDS knowledge. Mongolia and Nepal have formal programmes in place that may provide policy and implementation advantages compared to Bangladesh and Lao.

Prevalence of Good Condom Usage and Its Association with Condom Use Self-Efficacy among Youth Attending HIV/STDs Clinics in Primary-Care Settings in Malaysia

The low prevalence of condom usage among youth with Human Immunodeficiency Virus/Sexually Transmitted Diseases (HIV/STDs) is a concern. Condom use self-efficacy has been identified as a significant predictor of condom usage. This cross-sectional study examines the prevalence of good condom usage and its association with condom use self-efficacy among Malaysian urban youth, aged between 18 to 24 years old attending HIV/STDs clinics in primary-care settings, Selangor. Utilising the Harmonised Malay version of Condom Use Self-Efficacy Scale (CUSES M-H) questionnaire, the data from 218 responders were analysed using univariate and multiple logistic regression. The prevalence of good condom usage was 61% (95% CI: 54%, 68%). The average mean score of condom use self-efficacy was 3.07. Condom use self-efficacy was divided into four subscales of mechanics, perceived barriers, assertiveness and intoxicants. The assertiveness subscale had the highest average mean score of 3.42, while the intoxicant subscale score had the lowest average mean score of 2.24. Good condom usage was significantly associated with condom use during first sexual intercourse (aOR = 5.81, 95% CI: 1.97, 17.14), duration diagnosis of HIV/STDs of more than 12 months (aOR = 6.40, 95% CI: 2.30, 17.86) and the high assertiveness subscale score (aOR = 1.19, 95% CI: 1.03, 1.36). A behavioural change campaign that targets high-risk youth in primary care settings could promote condom use self-efficacy particularly assertiveness to increase condom usage among the youth.

Effectiveness of a Safe Sex Education Module in Improving Condom Use among People Living with HIV: A Randomised Controlled Trial

The Human Immunodeficiency Virus (HIV) epidemic in Malaysia has transitioned to occurring through more sexual transmission than injecting drugs in 2018. According to reports, the increase was caused by poor condom compliance and a lack of health programmes to prevent sexually transmitted infections (STIs) among people living with HIV (PLWH). The purpose of the study was to create, implement, and evaluate the impact of a safe sex education module on condom use among PLWH. A single-blinded, parallel randomised controlled trial was conducted at Seremban district. The intervention group received additional health information geared toward safe sex education based on Social Cognitive Theory (SCT). The study primary analysis was the intention to treat, and the overall effects of the intervention were assessed using a generalised linear mixed model (GLMM). There was no significant difference between groups in terms of sociodemographics, sexual history, mean condom usage frequency score, or STI incidence at the study baseline. Receiving the module was linked to increased condom usage frequency (β = 1.228, % CI = 0.850, 1.606). When compared to conventional treatment provided in Seremban health clinics, this module effectively increases condom usage frequency among PLWH.

Gender, Power, and Health: Measuring and Assessing Sexual Relationship Power Equity Among Young Sub-Saharan African Women and Men, a Systematic Review

Gender inequity, including low sexual relationship power (SRP), is an important determinant of intimate partner violence (IPV) and negative sexual, reproductive, and mental health. Different versions of the Sexual Relationship Power Scale (SRPS) are commonly used within youth studies to examine how gender inequities, including controlling behaviors, in heterosexual relationships impact the lives of young people in sub-Saharan Africa. This review aims to (1) describe definitions and measures of SRP within sub-Saharan African youth studies and (2) review and summarize associations between SRP equity, IPV, and sexual, reproductive, and mental health. After searching Pubmed, Ovid Med, Psych info, Web of Science, Google Scholar, and relevant research forums, 304 papers were identified, of which 29 papers based on 15 distinct studies (published 2004-2019) met our criteria for being youth-specific, conducted in sub-Saharan Africa, and including a quantitative measure of SRP. Details of each SRPS are described, including any adaptations and psychometric properties, as well as associations with IPV, sexual, reproductive, and mental health behaviors and outcomes. Results indicate that there are variations to the SRPS, and a paucity of evidence has detailed the psychometric properties of such measures within sub-Saharan African youth studies. Measures of SRP equity are associated with experiences (among women) and perpetration of (among men) IPV as numerous pathways to HIV risk; however, the evidence remains mixed. In order to address overlapping epidemics of violence against women and HIV, efforts are needed to ensure that measures, including the SRPS, are valid and reliable among highly affected populations.

Role of Schooling and Comprehensive Sexuality Education in Reducing HIV and Pregnancy Among Adolescents in South Africa

BACKGROUND

Comprehensive sexuality education (CSE) seeks to reduce risky sexual behaviour and subsequent incidence of unintended pregnancy and HIV among schoolgoing adolescents. This study estimates the association between exposure to CSE and key biomedical and behavioural indicators among adolescent girls in South Africa.

SETTING

Four DREAMS implementation districts in Gauteng and KwaZulu-Natal provinces in South Africa.

METHODS

Data from a household-based representative sample of adolescent girls (between the ages 12-18 years) (n = 9673) was collected. Independent variables included school attendance and exposure to CSE, with outcome variables measuring prevalence of HIV, pregnancy, and sexual risky behaviour, including condom use, incidence of age-disparate relationships, and transactional sex.

RESULTS

Adolescent girls in school and who had attended CSE classes in the previous 12 months were associated with reduced adjusted odds of being HIV-positive [full sample: adjusted odds ratios (AOR): 0.76, 95% confidence interval [CI]: 0.61 to 0.95, P < 0.05; sexually active sample: AOR: 0.62, 95% CI: 0.40 to 0.96, P < 0.05]. Those in school who attended CSE in the previous 12 months were also more likely to get tested for HIV (AOR: 1.48, 95% CI: 1.32 to 1.65, P < 0.001).

CONCLUSIONS

The results indicate that school attendance and exposure to CSE is associated with a reduction in risky sexual behaviour. Exposure to CSE is also associated with increased access to HIV testing for adolescent girls both in and out of school. Keeping adolescent girls in school produces the greatest positive sexual behavioural effect; this, coupled with the delivery of quality CSE, is a key strategy for reducing HIV risk.

A structural equation modeling of reproductive health promoting behaviors among female adolescents in the Philippines

AIMS

Integrated reproductive health promoting behaviors, including safe sexual intercourse, preventing sexually transmitted diseases, sexual responsibility, and genital health management, are essential for adolescents in developing countries. The Philippines is currently facing several reproductive health threats. The aim of this study was to identify factors affecting reproductive health promoting behaviors based on a theoretical model using structural equation modeling.

METHODS

In this cross-sectional study and a structural equation modeling, a total of 227 female adolescents in the Philippines participated in a self-reported questionnaire survey.

RESULTS

The results indicated that reproductive health knowledge (β = .14, p = .033), attitudes regarding reproductive health behaviors (β = .31, p = .027), and reproductive health self-efficacy (β = .31, p = .002) influenced participants' reproductive health promoting behaviors. Social norms (β = .31, p = .021) influenced reproductive health self-efficacy and indirectly influenced reproductive health promoting behaviors. Attitude toward gender roles (β = .20, p = .020) was associated with reproductive health knowledge.

CONCLUSIONS

This study confirmed the direct effect of reproductive health knowledge, attitudes regarding reproductive behaviors, and reproductive health self-efficacy, as well as the indirect effect of social norms, on reproductive health promoting behaviors using structural equation modeling.

Between a Rock and a Hard Place: How poverty and lack of agency affect HIV risk behaviors among married women in 25 African countries: A cross-sectional study

Background

Gender inequality and poverty exacerbate the burden of HIV/AIDS among women in Africa. AIDS awareness and educational campaigns have been inadequate in many countries and rates of HIV testing and adherence to condom use remains considerably low, especially among married women. We investigate whether higher HIV knowledge is equally effective in lowering risky behaviors among groups of women with different levels of wealth and agency.

Methods

Pooled data on 113 151 adult married women from Demographic and Health Surveys (DHS) in 25 African countries was used (2010 to 2016). Agency was defined as women’s ability to refuse sex and ask her partner to use a condom, plus have a role in decision making in household spending and health-related issues. The lowest tertile of DHS wealth index defined poverty. Questions about HIV prevention and mother-to-child transmission were used to create a scale for knowledge (0-5). Use of condom, HIV testing, absence of sexually transmitted disease (STD), and having one partner were dependent variables. Regression models investigated the effect of agency and knowledge as predictors of behaviors. Separate additional models were run to measure associations of each behavior with knowledge scores on groups of women divided by agency and poverty. Analyses were adjusted for demographic factors, history of pregnancy, wife-beating attitude, and country dummies.

Results

Significantly higher risk and lower level of protective factors exist for poor women who lack agency. Knowledge had positive associations with a better score in behavior, higher rate of condom use and testing for HIV both among poor and not poor women. When examining compound effects of agency and poverty, absence of agency reduces the positive effect of knowledge on lowering STD rate and overall behavior score among poor women. It also nullifies the effect of knowledge on condom use in both wealth groups.

Conclusion

Knowledge of HIV does not exert its potential protective effect when women live in poverty compounded with lack of agency. Success of anti-HIV programs should be tailored to dynamics of risk and sociocultural and economic context of target populations.

Social and Behavioral Correlates of Adolescent Sexual Experience and Intention to Use Condoms in Northwestern Botswana

Adolescent sexual behavior is shaped by individual, social, and structural factors that can increase HIV-risk, unwanted pregnancy, and sexually transmitted disease. To inform the development of a comprehensive sexuality education program, 239 secondary school adolescents ages 14–19 in Maun, Botswana, completed a survey of sexual and reproductive health knowledge, attitudes, and behaviors in February–March 2020. Bivariate and multivariate analyses examined factors associated with sexual experience and perceived ability to insist on condoms. Approximately 21% of respondents reported having had sexual intercourse. More than half felt able to insist on condoms. Sources of information about human reproduction, alcohol use, attitudes about when sex is acceptable, and perceived sexual activity by one’s peers were predictive of sexual experience. Age, confidence in correct condom use, perceived acceptability of adolescent sex with condoms, and endorsement of prevailing gender norms were significantly associated with perceived ability to insist on condom use.

Psychosocial Experiences of Adolescent Girls and Young Women Subsequent to an Abortion in Sub-saharan Africa and Globally: A Systematic Review

Introduction: Unmet need for contraception, unintended pregnancy, and access to safe abortion remain global challenges preventing adolescent girls and young women (AGYW) from achieving optimal reproductive health. Furthermore, AGYW face difficulties navigating sexual autonomy, lack of agency or experience negotiating sexual acts, and challenges accessing sexual health information and services. The aim of this systematic review is to assess the psychosocial outcomes of AGYW who have experienced an abortion with particular focus on sub-Saharan Africa, which bears the global burden of unintended pregnancy and risk of death due to unsafe abortion.

Materials and Methods: The systematic review was registered and used search terms to identify peer-reviewed articles relevant to “post-abortion,” “psychosocial,” “adolescent girls,” and “young women” from PubMed, Embase, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature. Examples of psychosocial experiences include quality of life, stigma, and mental health outcomes. Rayyan software (Qatar, 2020) was used by two reviewers to assess the relevance of each article to psychosocial outcomes of AGYW any time after an abortion or accessing post-abortion services. Analysis was conducted with a focus on data from Africa and comparisons are made to non-African settings.

Results: A total of 2,406 articles were identified and 38 articles fit the criteria. Six selected articles were from Africa, including Ghana, Kenya, Uganda, and Zambia, and the remaining articles were from other regions. Themes around stigma, shame, and abandonment associated with the experience of abortion were prevalent in all regions. Studies of psychosocial outcomes of AGYW in sub-Saharan Africa highlight social isolation as well as learned resilience among young women who abort.

Discussion: Navigating abortion as an AGYW involves managing internalized and perceived stigma, fear of violence, secrecy, and growing resilient in order to overcome the significant barriers that society and culture place on access to an essential service in sexual and reproductive health. Post-abortion psychosocial outcomes highlight the need for support services and investigation of contexts that perpetuate and necessitate unsafe abortion. Empowerment of AGYW may present an important opportunity to build self-agency and positive coping mechanisms to withstand social pressures during stigmatizing circumstances associated with abortion.

Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, "Passing" Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil

This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, "passing" concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher "passing" concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and "passing" concerns in transgender populations.

Factors Associated with Condom Use Self-Efficacy Among Preparatory School Students in Sodo Town, Southern Ethiopia 2020: A Cross-Sectional Study

BACKGROUND

Condoms are playing a central role in the prevention of sexually transmitted infections, human immune virus, and unintended pregnancy particularly among young peoples. Therefore, this study aimed to assess factors associated with condom use self-efficacy among preparatory school youths in Sodo town, Ethiopia.

METHODS

This institution-based cross-sectional study was conducted among 424 study participants from January 25 to February 20, 2020. Data were collected using a validated pretested structured questionnaire. Descriptive analysis was done and results were presented in texts and tables. Those variables at bivariate analysis with p-value <0.2 at 95% confidence level were moved to a multivariate logistic regression model to control potential confounding variables. Odds ratio with 95% confidence interval was computed to ascertain association during multivariate analysis model. Statistical tests at P-value <0.05 were considered as cutoff point to determine statistical significance.

RESULTS

Out of a total of 424 youths, only 416 had participated in the study yielding a response rate of 98.1%. The prevalence of higher self-efficacy among respondents was 70%. Factors that were independently associated with condom use self-efficacy in multivariate analysis were having sexual experience (AOR=2.047,95% CI:1.141-3.675), having life goals (AOR=1.736, 95% CI: 1.021-2.951), having social support (AOR=2.395,95% CI:1.501-5.458), and having good knowledge about condoms (AOR=2.535,95% CI:1.499-4.282).

CONCLUSION

The finding of this study showed that participants who had sexual experience, social support, knowledge of the human immune virus, and having life goals were found to be significantly associated with condom use self-efficacy. These results suggest ways to increase self-efficacy for condom use among youth that can increase the effectiveness of future interventions for youth.

Prevalence and Factors Associated with Depression among HIV/AIDS-Infected Patients Attending ART Clinic at Jimma University Medical Center, Jimma, Southwest Ethiopia

Background

HIV is a chronic life-threatening illness and, like other similar chronic and stigmatizing illnesses, can be stressful to manage. Depression is a common mental health problem that deteriorates the quality of life of people with HIV/AIDS and found to be a strong predictor for noncompliance to antiretroviral therapy treatment. Therefore, epidemiological evidence on the factors associated with depression among patients with HIV/AIDS can contribute towards effective and efficient preventive health care strategies for this population.

Objectives

To assess the prevalence and factors associated with depression among HIV/AIDS-infected patients attending ART clinic at Jimma University Medical Center, Jimma, Southwest Ethiopia, in 2018.

Methods

This study followed an institution-based cross-sectional quantitative study design. A simple random sampling method yielded 303 participants who were interviewed from April to May 2018, using a pretested questionnaire, followed by their card review. The SPSS version 23 was used for bivariate analysis which was used to find out the significance of association. Variables that showed association in bivariate analysis at p value < 0.25 were entered to multivariable logistic regressions to control for confounders, and the significance of association was determined by 95% confidence interval and p value < 0.05.

Results

The point prevalence of depression was 94 (31%). Variables like sex (AOR = 0.510 (95%CI = 0.264‐0.986)), marital status (AOR = 3.610 (95%CI = 1.649‐7.901)), opportunistic infection (AOR = 3.122 (95%CI = 1.700‐5.733)), and medication adherence (AOR = 0.470 (95%CI = 0.266‐0.831)) were significantly associated with depression. Conclusion and Recommendation. From the findings of this study, it is possible to conclude that depression was highly prevalent among people living with HIV/ADS. Sex, marital status, opportunistic infection, and medication adherence were found to be associated with depression and need attention from the health professional working in the ART clinic.

Psychosocial correlates of safe sex self-efficacy among in-school adolescent girls in Lagos, Nigeria

BACKGROUND

Adolescent girls in Nigeria are at heightened risk for HIV and other sexually transmitted infections. However, there are limited studies on psychosocial factors that are associated with safe sex intentions among this population. Self-efficacy has been established as an important correlate of behavioral intentions and the actual behavior. The objective of this research was to examine how key psychosocial factors such as social support, parental monitoring, and future orientation influence perceived safe sex self-efficacy among in-school adolescent girls in Nigeria. Furthermore, we assessed the associations between these psychosocial factors and HIV-related knowledge and safe sex self-efficacy.

METHODS

A self-administered questionnaire was distributed to 426 adolescent girls attending public and private school systems in Lagos, Nigeria. Multiple linear regression was used to evaluate the influence of psychosocial and demographic factors on safe sex self-efficacy. Further, stratified analysis was conducted to compare the estimates between participants attending public schools (n = 272) and those attending private schools (n = 154).

FINDINGS

Results from the study show that future orientation (β = 0.17; p < 0.05), participants age (β = 0.14; p < 0.05), and HIV knowledge accuracy (β = 0.17; p < 0.05) were associated with safe sex self-efficacy. Future orientation remained statistically significant in the sub-group analysis among participants attending public (β = 0.13; p < 0.05) and private schools (β = 0.24; p < 0.05). Among participants attending public schools, HIV accuracy (β = 0.2; p < 0.05) remained a significant correlate of safe sex self-efficacy while this association dissipated among private school attendees.

CONCLUSIONS

These findings point to the importance of including future orientation strategies in interventions developed for in-school adolescent girls in Nigeria. School-based interventions that increase positive future orientation outcomes may be beneficial to improve safe sex intentions among adolescent girls in Nigeria.

Qualitative characterizations of relationships among South African adolescent girls and young women and male partners: implications for engagement across HIV self-testing and pre-exposure prophylaxis prevention cascades

INTRODUCTION

Adolescent girls and young women (AGYW) in sub-Saharan Africa have emerged as a priority population in need of HIV prevention interventions. Secondary distribution of home-based HIV self-test kits by AGYW to male partners (MP) is a novel prevention strategy that complements pre-exposure prophylaxis (PrEP), a female-controlled prevention intervention. The objective of this analysis was to qualitatively operationalize two HIV prevention cascades through the lens of relationship dynamics for secondary distribution of HIV self-tests to MP and PrEP for AGYW.

METHODS

From April 2018 to December 2018, 2200 HIV-negative AGYW aged 16-24 years were enrolled into an HIV prevention intervention which involved secondary distribution of self-tests to MP and PrEP for AGYW; of these women, 91 participants or MP were sampled for in-depth interviews based on their degree of completion of the two HIV prevention cascades. A grounded theory approach was used to characterize participants' relationship profiles, which were mapped to participants' engagement with the interventions.

RESULTS

In cases where AGYW had a MP with multiple partners, AGYW perceived both interventions as inviting distrust into the relationship and insinuating non-monogamy. Many chose not to accept either intervention, while others accepted and attempted to deliver the self-test kit but received a negative reaction from their MP. In the few cases where AGYW held multiple partnerships, both interventions were viewed as mechanisms for protecting one's health, and these AGYW exhibited confidence in accepting and delivering the self-test kits and initiating PrEP. Women who indicated intimate partner violence experiences chose not to accept either intervention because they feared it would elicit a violent reaction from their MP. For AGYW in relationships described as committed and emotionally open, self-test kit delivery was completed with ease, but PrEP was viewed as unnecessary. MP experience with the cascade corroborated AGYW perspectives and demonstrated how men can perceive female-initiated HIV prevention options as beneficial for AGYW and a threat to MP masculinity.

CONCLUSIONS

Screening to identify AGYW relationship dynamics can support tailoring prevention services to relationship-driven barriers and facilitators. HIV prevention counseling for AGYW should address relationship goals or partner's influence, and engage with MP around female-controlled prevention interventions.

Sexual Relationship Power and Socio-demographic Factors Predicting Contraceptive Use, Antenatal Visits and Sick Child Health Service Use in Northern Togo

INTRODUCTION

Implementation of community-based healthcare services offering effective contraception, antenatal care (ANC), and treatment for symptomatic children under five has reduced maternal and child mortality in Togo. However, understanding if women are utilizing these services differentially based on social or demographic factors is important. This study identifies whether sexual relationship and socio-demographic factors are associated with healthcare utilization in four health facility catchment areas.

METHODS

We conducted a cross-sectional household survey of women aged 15-49 in four health facility catchment areas in 2016 (three rural sites, one urban site). We used multivariable Poisson regression to test whether socio-demographic factors and a validated sexual relationship power scale were associated with contraceptive use, ANC visits, and seeking treatment for symptomatic children under five.

RESULTS

Among women not pregnant or desiring pregnancy, older age, lower education, and single relationship status were associated with lower use of effective contraception. Among women who gave birth in two years preceding survey, low relationship power and low wealth quintile were associated with being less likely to attend at least four ANC visits. Women in rural sites were slightly more likely than women in the urban site to report seeking treatment for child under five with malaria, pneumonia, and/or diarrhea symptoms in last 2 weeks.

DISCUSSION

Interventions in low-resource settings should explore ways to reach women with low health-service utilization to improve contraceptive use, ANC visits, and treatment for sick children. Furthermore, age, education, marital status, wealth status and sexual relationship power must be considered when targeting maternal health behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03773913; Date of registration: 12 Dec. 2018.

Sexual Relationship Power and Socio-demographic Factors Predicting Contraceptive Use, Antenatal Visits and Sick Child Health Service Use in Northern Togo

INTRODUCTION

Implementation of community-based healthcare services offering effective contraception, antenatal care (ANC), and treatment for symptomatic children under five has reduced maternal and child mortality in Togo. However, understanding if women are utilizing these services differentially based on social or demographic factors is important. This study identifies whether sexual relationship and socio-demographic factors are associated with healthcare utilization in four health facility catchment areas.

METHODS

We conducted a cross-sectional household survey of women aged 15-49 in four health facility catchment areas in 2016 (three rural sites, one urban site). We used multivariable Poisson regression to test whether socio-demographic factors and a validated sexual relationship power scale were associated with contraceptive use, ANC visits, and seeking treatment for symptomatic children under five.

RESULTS

Among women not pregnant or desiring pregnancy, older age, lower education, and single relationship status were associated with lower use of effective contraception. Among women who gave birth in two years preceding survey, low relationship power and low wealth quintile were associated with being less likely to attend at least four ANC visits. Women in rural sites were slightly more likely than women in the urban site to report seeking treatment for child under five with malaria, pneumonia, and/or diarrhea symptoms in last 2 weeks.

DISCUSSION

Interventions in low-resource settings should explore ways to reach women with low health-service utilization to improve contraceptive use, ANC visits, and treatment for sick children. Furthermore, age, education, marital status, wealth status and sexual relationship power must be considered when targeting maternal health behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03773913; Date of registration: 12 Dec. 2018.

Piloting an evidence-based intervention for HIV prevention among street youth in Eldoret, Kenya

OBJECTIVES

This study presents findings from piloting an adapted evidence-based intervention, Stepping Stones and Creating Futures, to change street-connected young people's HIV knowledge, condom-use self-efficacy, and sexual practices.

METHODS

Eighty street-connected young people participated in a pre- and post-test mixed methods design in Eldoret, Kenya. The primary outcome of interest was HIV knowledge. Secondary outcomes included condom-use self-efficacy and sexual practices. Multiple linear regression models for change scores with adjustment for socio-demographic variables were fitted. Qualitative and quantitative findings are presented together, where integration confirms, expands on, or uncovers discordant findings.

RESULTS

Participants had a significant increase in HIV knowledge from pre- to post-intervention. The median HIV knowledge score pre-intervention was 11 (IQR 8-13) and post-intervention 14 (IQR 12-16). Attendance was significantly associated with HIV knowledge change scores. Qualitatively participants reported increased HIV and condom-use knowledge and improved condom-use self-efficacy and health-seeking practices.

CONCLUSIONS

Our findings support the potential for further testing with a rigorous study design to investigate how best to tailor the intervention, particularly by gender, and increase the overall effectiveness of the program.

Sexual Relationship Power and Periconception HIV-Risk Behavior Among HIV-Infected Men in Serodifferent Relationships

Gender norms affect HIV risk within serodifferent partnerships. We assessed how the sexual relationship power described by men living with HIV (MLWH) associates with periconception HIV-transmission risk behavior. Quantitative surveys were conducted with 82 MLWH reporting a recent pregnancy with an HIV-negative or unknown-serostatus partner in KwaZulu-Natal, South Africa. Surveys assessed decision-making dominance (DMD) using the Pulerwitz et al. sexual relationship power scale; partnership characteristics; and HIV-risk behaviors. Multivariable logistic regression models evaluated associations between DMD score and HIV-risk behaviors. Higher male decision-making dominance was associated with non-disclosure of HIV-serostatus to pregnancy partner (aRR 2.00, 95% CI 1.52, 2.64), not knowing partner's HIV-serostatus (aRR 1.64, 95% CI 1.27, 2.13), condomless sex since pregnancy (aRR 1.92, 95% CI 1.08, 3.43), and concurrent relationships (aRR 1.50, 95% CI 1.20, 1.88). Efforts to minimize periconception HIV-risk behavior must address gender norms and power inequities.

What predicts self-efficacy? Understanding the role of sociodemographic, behavioural and parental factors on condom use self-efficacy among university students in Nigeria

BACKGROUND

Risky sexual behaviours are not uncommon among young adults particularly those in the higher levels of education. It is known that higher self-efficacy could contribute to better sexual and reproductive health outcomes including the use of condoms. However, there is limited research on the role of socio-demographic, behavioural and parental factors as predictors of condom-use self-efficacy. As a result, this exploratory study was designed to assess the predictors of self-efficacy for condom use among university students in Nigeria.

METHODS

A cross-sectional survey was conducted with 755 university students in Nigeria from February to April 2018. Self-efficacy for condom use was assessed by combining responses to 11-items measures of condom self-efficacy drawn from the work of Barkley and colleagues. We fitted a structural equation model to identify the pathways through which socio-demographic, behavioural and parental factors predict two constructs of condom-use self-efficacy (self-efficacy for condom purchase and use and partner communication self-efficacy) in the sample.

RESULTS

Demographic factors such as age (β = -0.29, p<0.05) and sex (β = 0.42, p<0.05), as well as ratings on religious importance (β = -0.08, p<0.05) were directly associated with self-efficacy for condom purchase and use. These factors showed significantly mediated effects through sexual experience which also had a direct positive relationship (β = 0.73, p<0.05) with self-efficacy for condom purchase and use. The receipt of parental support, on the other hand, was directly associated with higher partner communication efficacy for condom use (β = 0.07, p<0.05). We found no evidence that the level of partner communication efficacy was directly associated with any of the behavioural, demographic or parental factors.

CONCLUSION

The findings of this study affirm that sex, or age or having higher ratings on religious importance alone does not increases self-efficacy but also exposure to sexual activity through which these factors affect self-efficacy for condom purchase and use. These findings also highlight the need to address and strengthen condom use self-efficacy among young adults, particularly the sexually inexperienced, highly religious and young adults with limited support from their parent.

Exploratory Factor Analysis of Two Sexual Health Scales for Transgender People: Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) and Trans-Specific Sexual Body Image Worries (T-Worries)

Few sexual health measures have been validated for transgender (trans) populations. Condom/barrier self-efficacy and sexual body image worries are interrelated constructs that may contribute to enhanced and poor sexual health, respectively. We report on the development and initial validation of trans-specific scales designed to measure these constructs. Trans people in Ontario, Canada, who had ever had sex completed these scales as a part of a larger Trans PULSE survey (n = 323). Using exploratory factor analysis, a one-factor solution fit the 8-item Condom/Barrier Negotiation Self-Efficacy Scale (T-Barrier). Two factors were identified for the 7-item Sexual Body Image Worries Scale (T-Worries): "general body image worries" and "trans-related image worries," while two items were recommended for deletion. The scales demonstrated convergent validity with measures such as self-esteem, sexual anxiety, sexual satisfaction, sexual fear, and experiences of transphobia. Further evaluation to confirm these structures within an independent trans sample would be valuable. We recommend the use of these scales for studies of sexual health within trans populations, to enhance our ability to better understand and promote sexual health within trans communities.

Frequent residential mobility among American Indians and early indications of sexual risk among young adolescents

American Indian and Alaska Native (AI/AN) youth are more likely to ever have had sex, and to have engaged in sexual activity prior to age 13 compared to all other race groups. It is essential to understand the development of skills to refuse sexual experience in early adolescence in order to reduce disparities associated with early sexual debut among AI/AN youth. Familial, social, and individual factors can act as protective influences on adolescent sexual experience; however, in other settings, research has shown that frequent residential mobility disrupts these protective influences and may increase the likelihood of adolescent sexual activity. AI/AN youth are highly mobile, and, as a result, may be especially vulnerable to increased sexual risk. To date, no prior study has considered the impact of residential mobility on AI/AN youth sexual experience, nor the influence on precursors that reduce initiation of sex. We used data from a longitudinal study of AI/AN youth attending all middle schools from a Northern Plains reservation from 2006-2009 to estimate a structural equation model based on a cultural and age adapted theoretical framework. The tested model included frequent residential mobility as the independent variable and sex refusal self-efficacy as the dependent variable. Mediating variables included factors related to individual risks, psychological well-being, and social supports. Results indicate a direct association between residential mobility and sex refusal self-efficacy (-.29, p = 0.05) and an indirect association mediated by deviant peers (-.08, p = .05). Other mediating variables did not provide insight on the mechanism by which residential mobility influences skills to refuse sexual intercourse among AI/AN youth in early adolescence. Findings provide evidence for an association between residential mobility and precursors to sexual experience suggesting augmenting sexual health interventions for highly mobile youth.

Condom Use and its Associated Factors Among Iranian Youth: Results From a Population-Based Study

Background: Given the young structure of Iran’s population and the fact that extramarital sexual relationships are both prohibited by legislation and shunned by society and religion, examining condom use practices among Iranian youth is highly important. The aim of this study was to explore condom use and its correlates among Iranian young adults.

Methods: In a sample of 3,045 individuals aged 19-29 who were recruited from a nation-wide study, we analyzed data from 633 participants who reported a history of extramarital sex. Subjects were asked about their condom use practices during their last penetrative sex. Data were collected through a self-administered questionnaire where the respondents completed the survey on their own and passed it to trained gender-matched interviewers. Multivariable regression models were constructed to report adjusted odds ratios (AOR) along with 95% CI.

Results: Of the 633 participants, 222 (35.1%) reported condom use at last sex. Men reported significantly higher condom use than women (38.5% vs. 25.7%). Having a stable job (AOR = 1.86, 95% CI: 1.01, 3.43), higher knowledge of condom use (AOR = 1.57, 95% CI: 1.03, 2.37) and sexual transmission of HIV (AOR = 1.83, 95% CI: 1.18, 2.85) were positively associated with condom use at last sex. Conversely, experience of sex under the influence of substances (AOR = 0.66, 95% CI: 0.45, 0.94) was significantly associated with reduced odds of condom use at last sex.

Conclusion: This study shows that only one out of every three young adults reported using condoms at last sex. While educational programs are helpful, multi-sectoral approaches (eg, individual-, community-, and structural-level interventions) are required to change sexual behaviours towards safe sex practices and reinforce negotiating condom use among youth.

Motivated Reasoning and HIV Risk? Views on Relationships, Trust, and Risk from Young Women in Cape Town, South Africa, and Implications for Oral PrEP

In high prevalence environments relationship characteristics are likely to be associated with HIV risk, yet evidence indicates general underestimation of risk. Furthermore uncertainty about partner's risk may challenge PrEP demand among young African women. We conducted quantitative and qualitative interviews with women before and after HIV discussions with partners, to explore how partner's behavior affected risk perceptions and interest in PrEP. Twenty-three women were interviewed once; twelve had a follow-up interview after speaking to their partners. Fourteen women were willing to have their partner contacted; yet two men participated. Several themes related to relationships and risk were identified. These highlighted that young women's romantic feelings and expectations influenced their perceptions of risk within their relationships, consistent with the concept of motivated reasoning. Findings emphasize challenges in using risk to promote HIV prevention among young women. Framing PrEP in a positive empowering way that avoids linking it to relationship risk may ultimately encourage greater uptake.

How empowered are girls/young women in their sexual relationships? Relationship power, HIV risk, and partner violence in Kenya

BACKGROUND

Gendered power dynamics within couple relationships can constrain women from achieving positive sexual and reproductive health outcomes. But little is known about relationship power among adolescents, and tools to measure it are rarely validated among adolescents. We tested the Sexual Relationship Power Scale (SRPS) among adolescent girls and young women (AGYW) and examined associations with select health outcomes.

METHODS

A 16-item adaptation of the SRPS was administered to AGYW aged 15-24 in Kenya (n = 1,101). Confirmatory factor analysis (CFA) and theta coefficients assessed scale performance for three age bands: 15-17, 18-20, and 21-24 years old. Relationship power levels were examined and multivariate logistic regressions assessed the relationship between power, and partner violence and HIV risk outcomes.

RESULTS

CFAs confirmed a one factor structure for each subgroup, and thetas for final 15-item scales were robust (>.82). Most respondents reported limited power in their sexual relationships, however older respondents consistently reported lower levels of power. Relationship power was strongly associated with several outcomes, even when controlling for socioeconomic status and schooling. For example, AGYW who reported more relationship power were 12, 6, and 7 times less likely (ages 21-24, 18-20, and 15-17, respectively) to experience sexual violence (p<0.001). Significant relationships were also found in multivariate analyses for physical partner violence (all three age bands), using a condom at last sex (18-20-year-olds), and increased knowledge of partner's HIV status (21-24-year-olds).

CONCLUSIONS

The SRPS is a good measure of relationship power for several age bands within AGYW, and power is experienced differently by older and younger AGYW. Low relationship power was a consistent predictor of partner violence, as well as an important predictor of HIV risk. Interventions seeking to address HIV and violence should also explicitly address relationship power and utilize validated tools (like the SRPS) to evaluate impacts.

Socio-demographic, Marital, and Psychosocial Factors Associated with Condom Use Negotiation Self-Efficacy Among Mozambican Women at Risk for HIV Infection

PURPOSE

In Mozambique, women are the most affected by HIV/AIDS. Self-efficacy is one of the main predictors of effective use of a condom. Therefore, it is essential to identify the factors that influence condom-use negotiation self-efficacy in vulnerable women. The aim of this paper is to identify socio-demographic, marital, and psychosocial factors associated with condom-use negotiation self-efficacy among Mozambican women at risk for HIV infection.

METHODS

Participants were women (173) who were patients at the Gynecology Department of the Central Hospital of Beira, Mozambique, and at risk for HIV infection. Women completed measures of condom-use negotiation self-efficacy, HIV prevention knowledge, and perceived barriers against safer sex.

RESULTS

The results showed that demographic and marital variables are associated with condom-use negotiation self-efficacy, namely, those having more than 9 years of education, who are younger and not living with a partner, and who talk about AIDS with partners report higher condom-use negotiation self-efficacy. Regarding psychosocial factors, higher HIV prevention knowledge and fewer perceived barriers to safer sex predict higher condom-use negotiation self-efficacy.

CONCLUSION

These results can contribute to sexual health promotion and HIV/AIDS prevention in Mozambican women because they identify at-risk groups and marital and psychosocial malleable factors that can be targeted in AIDS prevention among at-risk Mozambican women.

Sexual Self-Efficacy and Gender: A Review of Condom Use and Sexual Negotiation Among Young Men and Women in Sub-Saharan Africa

Sexual self-efficacy (SSE), one's perceived control of or confidence in the ability to perform a given sexual outcome, predicts sexual behavior; however, important questions remain regarding whether gender modifies observed associations. In a comprehensive review of peer-reviewed HIV-prevention literature focusing on youth (ages 10 to 25) in sub-Saharan Africa, we measured and assessed the influence of SSE on condom use and sexual refusal, overall and by gender. Our results, after reviewing 63 publications, show that SSE is inconsistently measured. Most studies measured condom use self-efficacy (CUSE) (96.8%) and/or sexual refusal self-efficacy (SRSE) (63.5%). On average, young men had higher CUSE than young women, while young women had higher SRSE than young men. While cross-sectional studies reported an association between high SSE and sexual behaviors, this association was not observed in interventions, particularly among young women who face a disproportionate risk of HIV acquisition. In all, 25% of intervention studies demonstrated that fostering CUSE increased condom use among young men only, and one of two studies demonstrated that higher SRSE led to reduced frequency of sexual activity for both men and women. Future research and HIV-prevention interventions must be gender targeted, consider improving CUSE for young men, and move beyond limited individual-level sexual behavior change frameworks.

Gender, Sexual Self-Efficacy and Consistent Condom Use Among Adolescents Living in the HIV Hyper-Endemic Setting of Soweto, South Africa

Within HIV-endemic settings, few studies have examined gendered associations between sexual self-efficacy (SSE), one's confidence or perceived control over sexual behavior, and uptake of HIV prevention behaviors. Using cross-sectional survey data from 417 sexually-experienced adolescents (aged 14-19, median age = 18, 60% female) in Soweto, South Africa, we measured SSE using a 6-item scale (range:0-6) with 'high-SSE' = score > 3 (study alpha = 0.75). Gender-stratified logistic regression models assessed associations between high-SSE and lifetime consistent condom use. A higher proportion of women reported high-SSE (68.7%) than men (49.5%, p < 0.001). We observed no difference in reported consistent condom use by gender (45.5% among women, 45.8% among men; p = 0.943). In confounder models, high-SSE was associated with consistent condom use among men (aOR = 3.51, 95%CI = 1.86-6.64), but not women (aOR = 1.43, 95%CI = 0.74-2.77). Findings highlight that individual-level psychosocial factors are insufficient for understanding condom use and must be considered alongside the relational, social, and structural environments within which young women navigate their sexual lives.

Theory-based interventions in STIs/HIV Prevention: A systematic review of the literature in Iran

Background: Various theory-based interventions (TBIs) have been done to prevent STI/HIV. The current study aimed at reviewing the TBIs for STI/HIV prevention in Iran. Methods: We systematically searched 6 English and Persian electronic databases to identify TBIs conducted for STI/HIV prevention in Iran. General searches were conducted using PubMed MeSH terms. Articles were included if they were interventional and conducted using models and theories, aimed at reducing the risk of STIs, were quasi-experimental or experimental, and if their full text was available. Results: Overall, 1042 studies were found. Finally, 13 original studies met our inclusion criteria. The findings indicated that HBM and TPB were the most frequently used theory/models. High school students and drug abusers were the most common target groups in the included studies. Conclusion: The results revealed that the majority of the conducted TBIs contained a methodological weakness. Conducting randomized controlled trials is needed to evaluate the effectiveness of the TBIs.

Gender differences in prevalence and correlates of high sexual self-efficacy among adolescents in Soweto, South Africa: implications for gender-sensitive research and programming

Sexual self-efficacy (SSE) - one's confidence in their ability to perform given sexual behaviours, has been shown to predict adolescents' HIV-prevention practices (e.g., Condom use). Few studies within sub-Saharan Africa, where HIV incidence and prevalence disproportionately affects young women, have examined gendered differences in SSE. We used multivariable logistic regression to identify correlates of high-SSE separately among adolescent men and women (aged 14-19) in Soweto, South Africa using a previously validated SSE scale (high-SSE [>3/6 items]; study-alpha = 0.75). SSE scale items assessed self-efficacy related to sexual refusal and condom use. Adolescent women were significantly more likely to report high-SSE than adolescent men (72.3% versus 49.5%; p < 0.01). High-SSE among adolescent men was associated with more positive beliefs about sexual relationships and negatively associated with probable depression. High-SSE among adolescent women was associated with increased HIV knowledge, more positive beliefs about condom use and sexual relationships, having an adult in the home, and negatively associated with being an older adolescent (16-17 versus ≤15), and ever experiencing physical violence. Differences in prevalence and correlates of SSE among adolescent men and women in South Africa highlight important areas for gender-sensitive interventions. Targeted efforts to reduce negative sexual beliefs, improve HIV knowledge and mental well-being may improve SSE and thus the uptake of HIV-prevention practices among adolescent men. For adolescent women, findings indicate programming should move beyond individual-levels determinants of behaviour to focus on improving enabling environments (e.g., Reduced violence and improved family relationships) in which sexual agency can be enacted.

The Botsha Bophelo Adolescent Health Study: A profile of adolescents in Soweto, South Africa

Background

Youth between the ages of 15 years to 24 years account for almost half of new HIV infections in South Africa.

Objectives

To describe the study details of the Botsha Bophelo Adolescent Health Study (BBAHS) which was an investigation of HIV risk among adolescents living in Soweto, South Africa.

Methods

Eligibility criteria for the BBAHS included being 14 years – 19 years old and living in one of the 41 identified formal and informal areas in the township of Soweto. A cross-sectional survey was developed between investigators and an adolescent community advisory board consisting of previously validated scales and original questions including demographics, sexual and reproductive health, health service utilisation and psychosocial behaviours.

Results

Between 2010 and 2012, interviewers administered surveys among 830 adolescents (57% females), whose median age was 17 years (Q1, Q3: 16, 18), and found that 43% of participants identified their ethnicity as Zulu, 52% reported high food insecurity, 37% reported at least one parent had died, 15% reported living in a shack and 83% identified as heterosexual. Over half of the participants (55%) reported ever having sex (49% of females and 64% of males), 11% of whom initiated sex at < 15 years of age (3% females and 21% males). Almost half (47%) reported ever testing for HIV, 3% (n = 12) of whom self-reported being HIV-positive and 33% (n = 4) were on antiretroviral therapy.

Conclusion

Our study highlights important individual, relational and structural level determinants of HIV risk for adolescent men and women growing up within HIV hyperendemic settings.

Factors Associated with HIV Discussion and Condom Use with Sexual Partners in an Underserved Community in South Africa

We examined factors associated with discussing HIV and condom use with a sexual partner. Two cross-sectional surveys were conducted in 2004 prior to the implementation of an HIV awareness campaign in a South African community and in 2008 after a three-year education program. Overall, the proportion of individuals who had discussed HIV with a sexual partner increased from 76% in 2004 to 89% in 2008 (p < .001). Among respondents who had sex six months before completing the surveys, condom use significantly increased from 64% in 2004 to 79% in 2008 (p < .05). Respondents who discussed HIV with a sexual partner were more likely to use condoms than respondents who had not discussed HIV with a sexual partner (OR=2.08, 95% CI=1.16, 3.72). These findings indicate the importance of interventions aimed at promoting HIV awareness and discussion of HIV in communities with individuals at risk of acquiring HIV.

Beyond love: a qualitative analysis of factors associated with teenage pregnancy among young women with pregnancy experience in Bolgatanga, Ghana

Globally, an estimated 16 million young women aged 15 to 19 years give birth every year. Most teenage pregnancies are unintended and being pregnant or delivering a baby as a teenager can have serious adverse consequences. Knowledge of the environmental factors and social cognitive determinants influencing young women's failure to protect against unintended pregnancy is necessary to address the high rate of teenage pregnancies. We conducted semi-structured in-depth interviews with 21 young women, who had experience of pregnancy, in Bolgatanga, Ghana. The interview protocol included themes (relationships, sex, pregnancy, family planning) and determinants (knowledge, attitudes, self-efficacy, norms, risk perceptions) derived from empirical studies and theories related to sexuality behaviour. Findings show that young women's motivations for sexual relationships are mostly 'beyond love' and seem to focus on economic factors. The main means of sexual protection seems to be condom use. Other forms of contraception were believed to be linked to infertility. Sexuality remains a largely taboo topic for open discussion and sex education in schools seems limited to abstinence-only messages. The need for more open communication on matters of sexuality with young people and the provision of a more comprehensive sexuality education in school to address teenage pregnancies in Ghana, is discussed.

Errors and Predictors of Confidence in Condom Use amongst Young Australians Attending a Music Festival

Objectives. To determine the confidence and ability to use condoms correctly and consistently and the predictors of confidence in young Australians attending a festival. Methods. 288 young people aged 18 to 29 attending a mixed-genre music festival completed a survey measuring demographics, self-reported confidence using condoms, ability to use condoms, and issues experienced when using condoms in the past 12 months. Results. Self-reported confidence using condoms was high (77%). Multivariate analyses showed confidence was associated with being male (P < 0.001) and having had five or more lifetime sexual partners (P = 0.038). Reading packet instructions was associated with increased condom use confidence (P = 0.011). Amongst participants who had used a condom in the last year, 37% had experienced the condom breaking and 48% had experienced the condom slipping off during intercourse and 51% when withdrawing the penis after sex. Conclusion. This population of young people are experiencing high rates of condom failures and are using them inconsistently or incorrectly, demonstrating the need to improve attitudes, behaviour, and knowledge about correct and consistent condom usage. There is a need to empower young Australians, particularly females, with knowledge and confidence in order to improve condom use self-efficacy.

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.

Factors associated with general self-efficacy and resilience among youth heads of households in Kenya

This study assesses resilience and general self-efficacy among Kenyan orphans and vulnerable children ( n = 1060) active in a community-based program combining economic household strengthening with psychosocial support. Quantile regression analyses modeled associations between the 25th, 50th, and 75th percentiles of resilience and general self-efficacy and multiple covariates. Program participation positively predicted increased general self-efficacy at all levels. Program participation predicted increased resilience at the 25th percentile but decreased resilience at the 75th percentile. Other significant predictors included economic, educational, sexual behavior and other demographic factors. This study suggests support for an integrated approach to economic and psychosocial empowerment.

Positive Youth Development and Contraceptive Use Consistency

INTRODUCTION

Understanding protective factors associated with adolescent contraceptive use can guide strategies to prevent unprotected sex and its consequences. The current study investigated associations between a set of protective factors, specifically indicators of positive youth development, and consistency of contraceptive use.

METHOD

This cross-sectional study examined relationships between positive youth development indicators and consistency of contraceptive use among sexually active adolescent girls at elevated risk for pregnancy. Multivariate models assessed whether measures of individual attributes, social attachments, and social norms were associated with consistent condom and hormonal contraceptive use.

RESULTS

Adolescents with higher self-esteem and greater family connectedness reported more consistent hormonal contraceptive use. Two factors, stress management skills and perceived peer prosocial norms, were protective for consistent condom use. In contrast, steady partnership status was associated with less consistent condom use.

DISCUSSION

Findings suggest that interventions targeting protective factors may influence adolescents' contraceptive use, in addition to promoting their healthy development.

Sexual communication self-efficacy, hegemonic masculine norms and condom use among heterosexual couples in South Africa

Hegemonic masculine norms (HMN), which promote sexual risk-taking among males and the subordination of women, are believed to play a key role in the HIV epidemic among heterosexual couples in South Africa (SA). Sexual communication self-efficacy (SCSE) (i.e., a couple's confidence in their ability to communicate about HIV prevention) may be a key leverage point for increasing HIV prevention behaviors among this population. We interviewed 163 sexually active heterosexual couples in Soweto, SA to investigate the association between SCSE, HMN, and consistent condom use. We collected information on demographics, relationship dynamics, and sexual activity. We utilized the SCSE scale to measure couples' SCSE, and a subscale of the Gender Equitable Men scale to measure HMN among males. We performed bivariate and multivariable analyses to determine the association of consistent condom use with couples' SCSE as well as the male partner's endorsement of HMN. We found that couples with higher SCSE have greater odds of consistent condom use (adjusted odds ratio [AOR] = 1.30, 95% CI: 1.15-1.47). Furthermore, male endorsement of HMN was found to be negatively associated with consistent condom use among couples (AOR = 0.47, 95% CI: 0.24-0.89). Joint HIV serostatus was not significantly associated with the outcome. Future interventions that equip heterosexual couples with sexual communication skills, while simultaneously promoting more gender equitable norms, may increase consistent condom use and thereby reduce the transmission of HIV among this at-risk population.

Correlates of inconsistent condom use among youth aged 18-24 years in South Africa

This paper examines the correlates of inconsistent condom use with most recent sexual partner among sexually experienced youth (N = 2 138) in South Africa. A cross-sectional population based survey with youth aged 18 to 24 years was conducted in 4 provinces (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). More women than men (57.7% vs. 25.8%) reported inconsistent condom use with their most recent partner. Multivariate analysis indicated that for males, not having talked with a partner about condoms in the past 12 months, having 2 or more sexual partners in the past 12 months, having ever had a transactional sex partner and alcohol use before sex in the past 3 months were associated with inconsistent condom use with their most recent sexual partner. In females multivariate analysis showed that lack of self-efficacy, not having talked with a partner about condoms in the past 12 months, having ever had or been subjected to forced sex and hazardous or harmful alcohol use were found to be associated with inconsistent condom use with their most recent sexual partner in multivariate analysis.

Exposure to information and communication about HIV/AIDS and perceived credibility of information sources among young people in northern Tanzania

Young people in sub-Saharan Africa constitute an important group for HIV prevention efforts. Determining their exposure to HIV/AIDS information and communication and their perceived credibility of information sources is imperative to the development of interventions. However, the majority of studies on this topic have been conducted among school-based populations, with few focused on those out of school or on comparing the two groups. A structured face-to-face interview was completed by 993 young people out of school, between the ages of 13 and 18, in Kilimanjaro, Tanzania; additionally, the questionnaire was self-administered by 1 007 students attending either their last year of primary or first year of secondary school. Significant factors associated with the frequency of exposure to HIV/AIDS information and frequency of communication about HIV/AIDS included urban/rural location, sex, socio-economic status, and educational attainment. Both groups ranked the radio as the most frequent source of HIV/AIDS information. The in-school group reported significantly more frequent exposure to all sources of HIV/ AIDS information and they communicated more frequently about the topic than did the out-of-school group. Among both groups, exposure to HIV/AIDS information occurred more frequently than discussing the topic. The in-school group gave high credibility ratings to medical doctors, the radio and parents as sources of information, while the out-of-school group attributed the most credibility to the mass media. Irrespective of school attendance, the young people ranked friends, parents and doctors as preferred communicators of sexual and reproductive health information. Interventions that address the determinants of educational attainment are needed, as well as ones specifically intended to reach girls or those out of school. The preferences and credibility rankings for sources of HIV/AIDS information suggest the need for evidence-based programmes that utilise peers and promote the involvement of parents or doctors. Particularly needed are interventions that explicitly aim to stimulate discussion among young people about HIV/AIDS and that foster the development of interpersonal skills.

Individual, Interpersonal, and Structural Power: Associations With Condom Use in a Sample of Young Adult Latinos

Interviews were conducted with 480 sexually active Latino young adults from four rural counties in Oregon. We examined relationships between three levels of power (individual, interpersonal, and structural) and consistent condom use. Condom use self-efficacy and sexual decision-making, examples of individual and interpersonal measures of power, respectively, were associated with increased odds of consistent condom use among both men and women. Among men only, increasing relationship control, an interpersonal measure of power, was associated with lower odds of consistent condom use. Among women only, increasing medical mistrust, a structural measure of power, was associated with increased odds of consistent condom use.

A systematic review of the psychometric properties of the Sexual Relationship Power Scale in HIV/AIDS research

The Sexual Relationship Power Scale (SRPS) was developed over a decade ago to address the lack of reliable and valid measures of relationship power in social, behavioral and medical research. The SRPS and its two subscales (relationship control [RC], decision-making dominance [DMD]) have been used extensively in the field of HIV prevention and sexual risk behavior. We performed a systematic review of the psychometric properties of the SRPS and subscales as reported in the HIV/AIDS literature from 2000 to 2012. A total of 54 published articles were identified, which reported reliability or construct validity estimates of the scales. Description of the psychometric properties of the SRPS and subscales is reported according to study population, and several cross-population trends were identified. In general, the SRPS and RC subscale exhibited sound psychometric properties across multiple study populations and research settings. By contrast, the DMD subscale had relatively weak psychometric properties, especially when used with specific populations and research settings. Factors that influenced the psychometric properties of the various scales and subscales included the study population, mean age of the sample, number of items retained in the scale, and modifications to the original scales. We conclude with recommendations for (1) the application and use of the SRPS and subscales, (2) reporting of psychometric properties of the scales in the literature, and (3) areas for future research.

Adolescent experiences of HIV and sexual health communication with parents and caregivers in Soweto, South Africa

Communication about sexual health between parents and adolescents has been shown to have a protective influence on behaviours that reduce the risk of HIV transmission. This study explored experiences of HIV and sexual health (HSH) communication between parents and/or caregivers and adolescents in an urban HIV-endemic community in Southern Africa. Adolescents (aged 14-19 years) were recruited from the Kganya Motsha Adolescent Centre and the Kliptown community between June and August 2009. Qualitative data were collected through focus group discussions (n=10 adolescents) and semi-structured interviews (n=31 adolescents). In total, 41 adolescents (56% female, 44% male, mean age=17.2) participated in the study. Adolescent participants identified emotional, physical and sociocultural barriers to initiating HSH communication with parents and caregivers including fear of verbal warnings, threats and physical assault. Adolescents also expressed a desire for mentorship around HSH communication beyond abstinence and peer-based information. Public health interventions need to support adolescents' access to bi-directional HSH information from adult mentors that address the lived realities of adolescents beyond expectations of abstinence.

Conundrum of Sexual Decision Making in Marital Relationships: Safer-Sex Knowledge, Behavior, and Attitudes of Married Women in Zambia

Recent research suggests that Zambian women face an increasing risk of contracting human immunodeficiency virus (HIV) within marital relationships. Married women's perceived ability to negotiate safer sex or adopt self-efficacy practices is recognized as critical in preventing new infections within marriage. Yet women's self-efficacy practices, such as requesting condom use or refusing sex within marriage, are influenced by individual and context-specific factors. Using the 2007 Zambia Demographic and Health Survey data from 4,306 married women, this article examines the association between married women's perceived ability to negotiate safer sex and a range of attitudinal, knowledge, and sociodemographic variables. Results from complementary log-log regression models reveal that married women who have factual knowledge about HIV transmission and prevention, as well as those who have been tested for their HIV serostatus, were more likely to report they can request that their husbands use a condom. Rural married women were more likely to report they can refuse their husbands sex compared to woman in urban areas. Likewise, married women who agree that a wife is justified in refusing her husband sex if he sleeps with other women were more likely to report they can negotiate safer sex compared to women who disagree. These findings suggest that married women are able to negotiate safer sex if they have correct factual knowledge about HIV transmission and are aware of their rights within marital relations.