How can psychological theory help to promote condom use in sub-Saharan African developing countries?

Reasons for inconsistent condom use by young adults in Mahalapye, Botswana

BACKGROUND

Botswana is one of the countries significantly affected by the HIV and AIDS epidemic. Despite an extensive preventive campaign, the incidence of HIV remains high.Condoms are an important contributor to prevention of new HIV infections, although they are not consistently used by young adults.

AIM

The aim of this study was to explore the reasons why condoms are not consistently usedby young adults.

SETTING

Mahalapye District Hospital and Airstrip Clinic, Botswana.

METHOD

This was a phenomenological qualitative study using individual in-depth interviews.Eleven participants were purposively selected, including six males and five females. Data were transcribed and analysed using the framework method.

RESULTS

All participants acknowledged the importance of utilising condoms to prevent unplanned pregnancies and sexually transmitted infections. Reasons not to use condoms were a need to have a child,implied lack of trust or faithfulness, long-term relationships need toplease the partner and decreased pleasure. Other contributing factors were lack of knowledge of benefits, less fear of contracting HIV and AIDS as it can now be controlled with medication,influence of tradition, alcohol and drug abuse, peer pressure, power and gender issues and the refusal of the partner. The female condom was largely rejected by young adults in general and by women in particular because of its size and the perception that it is complicated to insert.

CONCLUSION

The current preventive campaign against HIV and AIDS needs to take cognisance of the factors affecting decisions on the use of condoms by young adults and the obstacles to their use, particularly the new belief that HIV and AIDS is no longer a significant concern.

Role of condom negotiation on condom use among women of reproductive age in three districts in Tanzania

Background

HIV/AIDS remains being a disease of great public health concern worldwide. In regions such as sub-Saharan Africa (SSA) where women are disproportionately infected with HIV, women are reportedly less likely capable of negotiating condom use. However, while knowledge of condom use for HIV prevention is extensive among men and women in many countries including Tanzania, evidence is limited about the role of condom negotiation on condom use among women in rural Tanzania.

Methods

Data originate from a cross-sectional survey of random households conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania. The survey assessed health-seeking behaviour among women and children using a structured interviewer-administered questionnaire. A total of 2,614 women who were sexually experienced and aged 15-49 years were extracted from the main database for the current analysis. Linkage between condom negotiation and condom use at the last sexual intercourse was assessed using multivariate logistic regression.

Results

Prevalence of condom use at the last sexual intercourse was 22.2% overall, ranging from12.2% among married women to 54.9% among unmarried (single) women. Majority of the women (73.4%) reported being confident to negotiate condom use, and these women were significantly more likely than those who were not confident to have used a condom at the last sexual intercourse (OR = 3.13, 95% CI 2.22-4.41). This effect was controlled for marital status, age, education, religion, number of sexual partners, household wealth and knowledge of HIV prevention by condom use.

Conclusion

Confidence to negotiate condom use is a significant predictor of actual condom use among women in rural Tanzania. Women, especially unmarried ones, those in multiple partnerships or anyone needing protection should be empowered with condom negotiation skills for increased use of condoms in order to enhance their sexual and reproductive health outcomes.

Swazi men's contraceptive knowledge, attitudes, and practices

This study investigated Swazi men's contraceptive knowledge, attitudes, and practices. Thirty adolescent men, aged from 16 to 18, and 86 adult men from urban and rural areas participated in focus group interviews. Adult Swazi men indicated that men were the sole decision makers about sexual and reproductive issues. The number and gender of children remains socially significant in Swaziland. Adolescent men expressed contradictory notions in expecting girls to refuse unprotected sex but maintaining that men were the sole decision makers about sexual matters. They agreed that women should commence childbearing activities at the age of 21 or later. This finding holds some promise for enabling more Swazi women to use contraceptives at least until they have completed their schooling. Contraceptive services were not readily accessible to men in Swaziland.

Sexual risk behavior among people living with HIV/AIDS in Togo

Since HIV in Africa is spread primarily through unprotected sex, safe sex practices such as condom use can reduce HIV spread significantly. Nevertheless, because sexual behavior involves complex dynamics, condom use is not an easy option for many people in Africa despite years of condom distribution intervention. In fact, the complex nature of sexuality complicates efforts to combat HIV spread and limits the effectiveness of many prevention efforts. This paper uses theoretical explanations--social representation theory, situated rationality theory, and social action theory--to examine the patterns of sexual risk behavior and the underlying reasons and rationalization among people living with HIV/AIDS in Lomé, Togo. Qualitative interviews were conducted with 151 people living with HIV/AIDS, recruited from 3 HIV/AIDS centers. The results of this in-depth study suggest that although people living with HIV/AIDS may be aware of the risk of infecting their sexual partners, they deliberately ignore the risk because other considerations, such as wanting a baby, take precedence. Consequently, condom access is inadequate to change risky sexual behavior that spreads HIV. It must be supplemented with adequate empowerment.

AIDS-related knowledge and behaviors in Mozambique

BACKGROUND

The objective of this study was to describe attitudes and knowledge about AIDS among the population aged 15 to 49 in Chókwè (Mozambique) during the period from March to May 2004, and to study associated factors.

METHODS

Cross-sectional study conducted by interviewing 1,055 people aged 15 to 49, of both sexes, residents in Chókwè (68,698 inhabitants). The questionnaires employed are known as the Behavior Surveillance Survey. Dependent variables were: knowledge about transmission routes and preventive methods, use of condoms and having had sexual relations with an irregular partner during the past 12 months. Odds ratios were calculated for the association between these variables and age, sex, educational level, neighborhood of residence, number of relations in the last 30 days, and whether AIDS tested, by fitting Logistic Regression models (bivariate and multivariate).

RESULTS

Over 99% of the sexually active population of Chókwè knew about AIDS and condoms. More than half of the population of Chókwè has a good knowledge of preventive methods and of transmission routes. 72.9% of men and 91.3% of women did not use the condom when having sexual relationships. It was observed that a low educational level implied a lower degree of knowledge about preventive methods (OR=2.48, 95% CI: 1.60-3.84) and about transmission routes (OR=2.49, 95% CI: 1.37-4.52), less condom use and less relations with irregular or sporadic partners. The probability of not using condoms was higher among females, among people living in less privileged districts, with no education (OR=3.79; 95% CI: 1.80-7.99), with regular partners (OR=4.36; 95% CI: 1.93-9.84) and among people who have not had an AIDS test.

CONCLUSION

Knowledge of preventive methods and transmission routes is good in more than half of the population of Chókwè. The majority of men and women do not use the condom when having sexual intercourse. Moreover, inequalities may be observed as a function of educational level and district socioeconomic level. Knowledge of preventive practices, mainly among socio-economically disadvantaged groups, must be improved and strategies designed to broaden access to use of condoms by everyone should be implemented.

HIV risk environment for Ghanaian women: challenges to prevention

Ghana is experiencing high rates of HIV transmission and women have been identified as a group with increased vulnerability to infection. Women's vulnerability may be influenced by factors such as gender, unequal power relationships and poverty. Research was undertaken in Ghana from January to May 1999 to examine the experiences of HIV sero-positive women. Thirty-one women were interviewed to explore the broad context of disease transmission and to identify factors that mediated women's ability to protect themselves from infection. The poverty experienced by many of the women during their childhood years, coupled with a societal belief that favored the education of males, restricted the participants' educational and vocational opportunities. With limited education and few vocational skills, many of the women took boyfriends to assist them with the purchase of food, clothing and shelter, as a strategy for survival. For most women, the use of condoms with sexual partners was restricted by the high value placed on fertility, the negative association of condoms with prostitution, and the women's limited ability to influence decision-making in this area. The women's narratives provide a compelling description of the context of HIV transmission in Ghana. Strategies to expand and intensify the response to HIV prevention are presented and critiqued.