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Aboagye RG, Ahinkorah BO, Seidu AA, Frimpong JB, Adu C, Hagan JE, Ahmed SAE, Yaya S. Female genital mutilation and safer sex negotiation among women in sexual unions in sub-Saharan Africa: Analysis of demographic and health survey data. PLoS One 2024; 19:e0299034. [PMID: 38758930 PMCID: PMC11101093 DOI: 10.1371/journal.pone.0299034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/02/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The practice of female genital mutilation is associated with harmful social norms promoting violence against girls and women. Various studies have been conducted to examine the prevalence of female genital mutilation and its associated factors. However, there has been limited studies conducted to assess the association between female genital mutilation and markers of women's autonomy, such as their ability to negotiate for safer sex. In this study, we examined the association between female genital mutilation and women's ability to negotiate for safer sex in sub-Saharan Africa (SSA). METHODS We pooled data from the most recent Demographic and Health Surveys (DHS) conducted from 2010 to 2020. Data from a sample of 50,337 currently married and cohabiting women from eleven sub-Saharan African countries were included in the study. A multilevel binary logistic regression analysis was used to examine the association between female genital mutilation and women's ability to refuse sex and ask their partners to use condom. Adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings of the logistic regression analysis. Statistical significance was set at p<0.05. RESULTS Female genital mutilation was performed on 56.1% of women included in our study. The highest and lowest prevalence of female genital mutilation were found among women from Guinea (96.3%) and Togo (6.9%), respectively. We found that women who had undergone female genital mutilation were less likely to refuse sex from their partners (aOR = 0.91, 95% CI = 0.86, 0.96) and ask their partners to use condoms (aOR = 0.82, 95% CI = 0.78, 0.86) compared to those who had not undergone female genital mutilation. CONCLUSION Female genital mutilation hinders women's ability to negotiate for safer sex. It is necessary to implement health education and promotion interventions (e.g., decision making skills) that assist women who have experienced female genital mutilation to negotiate for safer sex. These interventions are crucial to enhance sexual health outcomes for these women. Further, strict enforcement of policies and laws aimed at eradicating the practice of female genital mutilation are encouraged to help contribute to the improvement of women's reproductive health.
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Affiliation(s)
- Richard Gyan Aboagye
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Bright Opoku Ahinkorah
- School of Clinical Medicine, University of New South Wales Sydney, Sydney, Australia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western Region, Ghana
| | - Abdul-Aziz Seidu
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western Region, Ghana
- College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Queensland, Australia
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
| | - James Boadu Frimpong
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Department of Kinesiology, New Mexico State University, Las Cruces, NM, United States of America
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Centre for Social Research in Health, University of New South Wales Sydney, Sydney, NSW, Australia
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Salma A. E. Ahmed
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Saaka SA, Pienaah CKA, Stampp Z, Antabe R. Safe sex negotiation and HIV risk reduction among women: A cross-sectional analysis of Burkina Faso 2021 Demographic and Health Survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003134. [PMID: 38656996 PMCID: PMC11042694 DOI: 10.1371/journal.pgph.0003134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
Women are biologically more susceptible to the Human Immunodeficiency Virus (HIV) and other sexually transmitted Infections (STIs) because receptive sex is riskier than insertive. Despite condom use being the staple preventive method for HIV infection (over 80% efficacy), in Sub-Saharan African countries like Burkina Faso, a high burden of HIV and the unmet need for condom use coexist. Moreover, even though women in SSA are disproportionately HIV positive, they are reportedly less capable of negotiating condom use for HIV risk reduction. Thus, using the Health Believe Model (HBM), this study explored the factors that influence condom use among women within the context of HIV prevention, with a key interest in condom use negotiation. Using the women's dataset of the 2021 Burkina Faso Demographic and Health Survey and applying logistic regression models, this study examined the factors associated with condom use for HIV risk reduction. Women who had confidence to negotiate condom use with their partners (OR = 1.57, P<0.001, 95%CI: 1.29, 1.91), those with secondary education (OR = 1.38, P<0.05, 95%CI: 1.07 1.77), from richest households (OR = 1.64, P<0.05, 95%CI: 1.08, 2.47), the employed (OR = 1.23, P<0.05, 95%CI: 1.02, 1.49), women with knowledge of sexually transmitted infections (OR = 1.58, P<0.001, 95%CI: 1.26, 1.97), those who have ever been tested for HIV (OR = 1.85, P<0.001, 95%CI: 1.52 2.24), as well as those who knew that a healthy-looking person can have HIV (OR = 2.64, P<0.001, 95%CI: 2.15, 3.24) were all significantly more likely to practice condom use for HIV risk reduction. Also, religion and geographical location of participants significantly predicted condom use for HIV risk reduction in the study context. The ability to negotiate condom use, knowledge of HIV and STIs, the socioeconomic status of women, as well as their geographical location, influence their practice of safer sex for HIV risk reduction in Burkina Faso.
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Affiliation(s)
| | | | - Zakara Stampp
- Department of Geography and Environment, University of Western Ontario, London, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
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Friedland BA, Mgodi NM, Palanee-Phillips T, Mathur S, Plagianos MG, Bruce IV, Lansiaux M, Murombedzi C, Musara P, Dandadzi A, Reddy K, Ndlovu N, Zulu SK, Shale LR, Zieman B, Haddad LB. Assessing the acceptability of, adherence to and preference for a dual prevention pill (DPP) for HIV and pregnancy prevention compared to oral pre-exposure prophylaxis (PrEP) and oral contraception taken separately: protocols for two randomised, controlled, cross-over studies in South Africa and Zimbabwe. BMJ Open 2024; 14:e075381. [PMID: 38479746 PMCID: PMC10936506 DOI: 10.1136/bmjopen-2023-075381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Oral pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention method; however, uptake and persistence have been low among southern African women. A dual prevention pill (DPP) that combines PrEP with oral contraception (OC) may increase PrEP use and better meet women's sexual and reproductive health needs. We will gauge the DPP's acceptability in two cross-over clinical trials. METHODS AND ANALYSIS PC952 (Zimbabwe) and PC953 (South Africa) will compare acceptability, adherence and preference for an over-encapsulated DPP versus PrEP and OCs taken separately. HIV-negative, non-pregnant cisgender females in Johannesburg, South Africa (n=96, 16-40 years) and Harare, Zimbabwe (n=30, 16-24 years) will be randomised 1:1 to the order of regimens-DPP or two separate tablets-each used for three 28-day cycles, followed by a 6-month choice period in South Africa. Monthly clinic visits include HIV and pregnancy testing; safety assessments and risk reduction and adherence counselling. We will assess adherence (monthly) based on tenofovir diphosphate drug levels in dried blood spots and by self-report. We will evaluate acceptability (monthly) and preference (end of cross-over) via computer-assisted self-interviewing and in-depth interviews with a subset of participants. Data collection started in September 2022 and ended in January 2024. ETHICS AND DISSEMINATION PC952 was approved by the Ministry of Health and Child Care, Medical Research Council, Research Council and Medicines Control Authority of Zimbabwe; the Chitungwiza City Health Ethics Committee; and the Joint Research Ethics Committee for the University of Zimbabwe Faculty of Medicine and Health Sciences and Parirenyatwa Group of Hospitals. PC953 was approved by the South African Health Products Regulatory Authority and the University of the Witwatersrand's Human Research Ethics Committee. The Population Council IRB approved both studies. We will disseminate results in open-access journals, clinical trials registries, and at local and international meetings and conferences. TRIAL REGISTRATION NUMBERS NCT04778514, NCT04778527.
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Affiliation(s)
| | - Nyaradzo M Mgodi
- University of Zimbabwe - Clinical Trials Research Centre, Harare, Zimbabwe
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, Johannesburg, South Africa
- University of Washington, Department of Epidemiology, School of Public Health, Seattle, Washington, USA
| | | | | | - Irene V Bruce
- Population Council, Center for Biomedical Research, New York, New York, USA
| | - Maud Lansiaux
- Population Council, Center for Biomedical Research, New York, New York, USA
| | | | - Petina Musara
- University of Zimbabwe - Clinical Trials Research Centre, Harare, Zimbabwe
| | - Adlight Dandadzi
- University of Zimbabwe - Clinical Trials Research Centre, Harare, Zimbabwe
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, Johannesburg, South Africa
| | - Nkosiphile Ndlovu
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, Johannesburg, South Africa
| | - Sihle K Zulu
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, Johannesburg, South Africa
| | - Lerato R Shale
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, Johannesburg, South Africa
| | - Brady Zieman
- Population Council, Center for Biomedical Research, New York, New York, USA
| | - Lisa B Haddad
- Population Council, Center for Biomedical Research, New York, New York, USA
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Hensen B, Phiri MM, Sigande L, Schaap A, Simuyaba M, Zulu-Phiri R, Mwape L, Floyd S, Fidler S, Hayes R, Simwinga M, Ayles H. Self-reported uptake of STI testing services among adolescents and young people aged 15-24 years: Findings from the Yathu Yathu cluster randomized trial in Lusaka, Zambia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002491. [PMID: 38437238 PMCID: PMC10911628 DOI: 10.1371/journal.pgph.0002491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/18/2023] [Indexed: 03/06/2024]
Abstract
There is little evidence regarding community-based delivery of STI testing and treatment for youth aged 15-24 (AYP) in Zambia. In a cluster-randomised trial, we evaluated whether offering syndromic STI screening through community-based, peer-led sexual and reproductive health services (Yathu Yathu) with referral to a local health facility for testing, increased self-reported testing for STIs (other than HIV) among AYP. Two communities in Lusaka were divided into 10 zones each (20 zones in total); by community, zones were randomly allocated (1:1) to Yathu Yathu or control. Monitoring data were used to describe syndromic STI screening through Yathu Yathu and an endline cross-sectional survey used to evaluate the impact of Yathu Yathu on self-reported ever and recent (last 12 months) STI testing. 10,974 AYP accessed Yathu Yathu; 66.6% (females-67.7%; males-64.7%) were screened for STIs, 6.2% reported any STI symptoms. In the endline survey, 23.3% (n = 350/1501) of AYP who ever had sex ever STI tested; 13.5% (n = 174/1498) who had sex in the last 12 months recently STI tested. By trial arm, there was no difference in self-reported ever or recent STI testing among all AYP. Among men aged 20-24, there was evidence that ever STI testing was higher in the Yathu Yathu compared to control arm (24.1% vs 16.1%; adjPR = 1.67 95%CI = 1.02, 2.74; p = 0.04). Among AYP who ever STI tested, 6.6% (n = 23) reported ever being diagnosed with an STI. Syndromic STI management through community-based, peer-led services showed no impact on self-reported STI testing among AYP. Research on community-based delivery of (near) point-of-care diagnostics is needed. Trial registration number(s): NCT04060420 https://clinicaltrials.gov/ct2/show/NCT04060420; and ISRCTN75609016; https://doi.org/10.1186/ISRCTN75609016.
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Affiliation(s)
- Bernadette Hensen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Ab Schaap
- Zambart, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Helen Ayles
- Zambart, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Sithole MZ, Batidzirai JM, Yirga AA, Musekiwa A. Prevalence and factors associated with condom use among women aged 15-49 years in Rwanda using a survey logistic regression model: evidence from the 2019/20 Rwanda Demographic and Health Survey. Pan Afr Med J 2023; 46:121. [PMID: 38465006 PMCID: PMC10924606 DOI: 10.11604/pamj.2023.46.121.41640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/02/2023] [Indexed: 03/12/2024] Open
Abstract
Introduction although Rwanda's HIV prevalence has declined, many people are still acquiring or living with it. Among other methods of HIV prevention, condoms are a safe and reliable method in addition to preventing pregnancy and other sexually transmitted infections, especially when used properly. This study aimed to determine the prevalence and determinants of condom use during last sexual intercourse among reproductive-aged women in Rwanda. Methods using data from the cross-sectional, nationally representative Rwanda Demographic and Health Survey (RDHS) conducted in 2019/2020, we carried out secondary data analysis. A multivariable logistic regression model was applied to determine the factors associated with condom use. All analyses from the model were adjusted for unequal sampling probabilities using survey weights. Results results showed a 10.8% prevalence of condom use. The odds of condom use during last sex were significantly lower for women who lived with a man (adjusted odds ratio [aOR]= 0.10, CI=0.08: 0.13) and those from the Southern region (aOR=0.69, CI= 0.52 to 0.92) but were significantly higher for those with primary education (aOR=1.38, CI= 1.00: 1.88). Also, the rich were more significantly associated with condom use compared to the poor (aOR=1.53, 95% CI= 1.20: 1.93). Those who had three or more sexual partners had higher odds of condom use than those with one partner (aOR=3.12, CI= 2.50: 3.89). Conclusion based on the results, health promotion interventions aimed at raising awareness on HIV prevention should, therefore, target the groups that were found to have a high risk of not using condoms.
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Affiliation(s)
- Mkhombiseni Zamani Sithole
- School of Mathematics, Statistics and Computer Science, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Jesca Mercy Batidzirai
- School of Mathematics, Statistics and Computer Science, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Ashenafi Argaw Yirga
- School of Mathematics, Statistics and Computer Science, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Kgoele M, Rammopo M, Oguntibeju OO. Condom Use among HIV-Positive Postnatal Women in Primary Health Care Facilities in Tshwane Sub-District 1, Gauteng Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6877. [PMID: 37835147 PMCID: PMC10572944 DOI: 10.3390/ijerph20196877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
Condoms have been and are still an important part of HIV preventative measures worldwide, and many countries have designed programmes that encourage their use. Consistent and correct condom use among HIV-positive individuals is important in preventing multiple infections. Hence, the uptake and determining factors associated with condom use were investigated in this study. This study was aimed at determining the level of, and factors associated with, condom use among HIV-positive postnatal women in primary health care facilities in Tshwane sub-district 1, Gauteng Province, South Africa. A descriptive cross-sectional study was conducted among 326 HIV-positive postnatal women aged between 15 and 50 years who were conveniently selected and voluntarily participated in the study. A self-developed pretested questionnaire was used to collect data on level of condom use and factors associated with its use from the selected participants. Statistical tests of correlation were then used to determine the association between frequency of condom use during sexual encounter and condom use at last sexual encounter with the independent variables. Regular condom use during sexual encounters was reported by 63.2% of the participants while 83% of the participants reported using a condom at their last sexual encounter. Frequency of condom use during sexual encounter was found to be associated with employment status (p < 0.05), residence (p < 0.001), number of children (p < 0.05), first HIV diagnosis (p < 0.05) and disclosure of HIV status to partner (p < 0.05). Condom use at last sexual encounter was also found to have a significant statistical association with level of education (p < 0.05) and the ability to negotiate condom use (p < 0.001). A good proportion of the participants used condoms regularly. Interventions to improve condom use among this population should focus on female empowerment by investing in their education, and economic empowerment to improve their economic status, which, in turn, would help the women to better negotiate condom use. The other factors mentioned above should also be considered when developing health education policies and programmes about condom use amongst HIV-positive postnatal women.
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Affiliation(s)
- Mpho Kgoele
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (M.K.); (M.R.)
| | - Modikwe Rammopo
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (M.K.); (M.R.)
| | - Oluwafemi O. Oguntibeju
- Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville 7535, South Africa
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Jean Simon D, Paul B, Kiragu A, Olorunsaiye CZ, Joseph F, Joseph G, N'Gou MD. Prevalence and factors associated with condom use among sexually active young women in Haiti: evidence from the 2016/17 Haiti demographic and health survey. BMC Womens Health 2023; 23:146. [PMID: 36991441 PMCID: PMC10061838 DOI: 10.1186/s12905-023-02295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Young women in Haiti remain vulnerable to sexually transmitted infections and unintended pregnancy. However, little is known about condom use among this population. This study examined the prevalence and the factors associated with condom use among sexually active young women in Haiti. METHODS Data from the 2016/17 Haiti demographic and health survey were used. The prevalence and the factors associated with condom use among sexually active young women in Haiti were assessed using descriptive statistics and binary logistic regression model. RESULTS The prevalence of condom use was 15.4% (95% CI 14.0-16.8). Being teenage (AOR = 1.34; 95% CI: 1.04-1.74), living in urban areas (AOR = 1.41; 95% CI = 1.04-1.90), having higher education level (AOR = 2.39; 95% CI: 1.44-4.00), being in the middle or rich category of household wealth index (AOR = 2.32; 95% CI: 1.53-3.53 and AOR = 2.93; 95% CI: 1.90-4.52), having correct knowledge of ovulatory cycle (AOR = 1.65; 95% CI: 1.30-2.10), having 2-3 lifetime sexual partners and one lifetime sexual partner (AOR = 2.04; 95% CI: 1.36-3.06 and AOR = 2.07; 95% CI: 1.35-3.17) had significantly higher odds of using condom. In addition, sexually active young women whose last partner was their boyfriend (AOR = 4.38; 95% CI: 2.82-6.81), and those whose last partner was a friend/casual acquaintance/commercial sex worker (AOR = 5.29; 95% CI: 2.18-12.85) were associated with increased likelihood of using condom compared with their counterparts whose partner was their spouse. CONCLUSION The Haitian government as well as institutions involved in sexual health should consider these factors when designing sexual and reproductive health interventions targeting young women. More specifically, to increase condom use and reduce risky sexual behaviors, they should combine efforts to raise awareness and induce sexual behavioral changes at two levels. In the education system, they should reinforce sexual education in primary and secondary schools while paying special attention to rural areas. In the whole society, it is important to deepen efforts toward increased awareness on family planning and condom use, through mass media and local organizations including religious ones. Priority should be given to the poorer households, young people and women, and rural areas, in order to maximize reduction in early and unintended pregnancy, and sexually transmitted infections. Interventions should include a condom price subsidy and a campaign to destigmatize condom use which is actually a "male affair".
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Affiliation(s)
- David Jean Simon
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
| | - Bénédique Paul
- Department of Agro-socio-economics, Chibas, Université Quisqueya, Port-au-Prince, Haiti.
- Groupe d'Etude sur les Sciences de la Durabilité, Université Quisqueya, Port-au-Prince, Haiti.
| | - Ann Kiragu
- Department of Law and Political and Social Sciences, University of Sorbonne Paris Nord, Paris, France
| | | | - Fanor Joseph
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
- Doctoral School of Social and Human Sciences, University of Antananarivo, Antananarivo, Madagascar
| | - Ghislaine Joseph
- Centre de Recherche Cultures Arts Sociétés (CELAT), University of Laval, Quebec, Canada
| | - M'Boh Delphin N'Gou
- Centre de Recherche de l'Institut de Démographie de l'Université de Paris (CRIDUP), Paris 1 Pantheon Sorbonne University, Paris, France
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Friedland BA, Plagianos M, Savel C, Kallianes V, Martinez C, Begg L, Guthrie KM, Venkatasetty D, Pickett J, Haddad LB. Women Want Choices: Opinions from the Share.Learn.Shape Global Internet Survey About Multipurpose Prevention Technology (MPT) Products in Development. AIDS Behav 2023; 27:2190-2204. [PMID: 36881183 DOI: 10.1007/s10461-022-03951-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 03/08/2023]
Abstract
Women need multipurpose prevention technologies (MPTs) to simultaneously prevent sexually transmitted infections (STIs), including HIV, with or without contraception. User feedback early in product development is critical for maximizing uptake and continuation. Our global online survey (April 2017-December 2018) explored women's opinions about MPT formulations in development (e.g., fast-dissolving vaginal inserts, vaginal films, intravaginal rings, injectables, implants), preferences for long-acting or "on-demand" methods, and interest in a contraceptive MPT versus products for HIV/STI prevention alone. Of the 630 women in our final analysis (mean 30 years old; range 18-49), 68% were monogamous, 79% completed secondary education, 58% had ≥ 1 child, 56% were from sub-Saharan Africa and 82% preferred a cMPT versus HIV/STI prevention alone. There were no clear preferences for any specific product or product type (long-acting, on-demand, daily). No single product will appeal everyone, however, adding contraception is likely to increase uptake of HIV/STI prevention methods for most women.
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Affiliation(s)
- B A Friedland
- Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY, 10065, USA.
| | - M Plagianos
- Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY, 10065, USA
| | - C Savel
- Information Technology, Population Council, New York, NY, USA
| | - V Kallianes
- Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY, 10065, USA
| | - C Martinez
- Borough of Manhattan Community College, New York, NY, USA
| | - L Begg
- Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY, 10065, USA
| | - K M Guthrie
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - D Venkatasetty
- Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY, 10065, USA
| | - J Pickett
- Independent Consultant, Chicago, IL, USA
| | - L B Haddad
- Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY, 10065, USA
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Abstract
Women's ability to negotiate for safer sex has effects on their sexual and reproductive health. This study investigated the association between safer sex negotiation and parity among women in sub-Saharan Africa. The data were sourced from the Demographic and Health Surveys of 28 sub-Saharan African countries conducted from 2010 to 2019. A total of 215,397 women aged 15-49 were included in the study. Multilevel logistic analysis was conducted to examine the association between safer sex negotiation and parity among women in sub-Saharan Africa. The results were presented as adjusted odds ratios (aOR) and the significance level set at p<0.05. The overall prevalences of safer sex negotiation and high parity among women in sub-Saharan Africa were 82.7% and 52.1%, respectively. The prevalence of high parity ranged from 32.3% in Chad to 72.1% in Lesotho. The lowest prevalence of safer sex negotiation was in Chad (16.8%) while the highest prevalence was recorded in Rwanda (99.7%). Women who had the capacity to negotiate for safer sex were less likely to have high parity compared with those who had no capacity to negotiate for safer sex (aOR = 0.78, CI: 0.75-0.81). Other factors that were associated with high parity were age, educational level, marital status, exposure to media, contraceptive use, religion, wealth quintile, sex of household head, and place of residence. The study identified significant association between safer sex negotiation and high parity among women of reproductive age in sub-Saharan Africa. It is worth noting that women's ability to negotiate for safer sex could reduce high parity among women in sub-Saharan Africa. Therefore, policies and programmes aimed at birth control or reducing high parity among women could be targeted at improving their capacity to negotiate for safer sex through education.
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Phiri M, Lemba M, Chomba C, Kanyamuna V. Examining differentials in HIV transmission risk behaviour and its associated factors among men in Southern African countries. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2022; 9:295. [PMID: 36060615 PMCID: PMC9419142 DOI: 10.1057/s41599-022-01312-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Sub-Saharan Africa (SSA), particularly Southern and East Africa, has the highest AIDS deaths and HIV-infected people in the world. Even though considerable effort has been made over the years to study HIV transmission risk behaviours of different population groups in SSA, there is little evidence of studies that have looked at pooled effects of associated HIV risk factors among men, particularly in Southern Africa. Thus, this study sought to fill this gap in knowledge by investigating the variations in HIV risk behaviours among men in the region. The study analysed cross-sectional data based on the most recent country Demographic and Health Survey (DHS) for six countries, namely Lesotho, Mozambique, Namibia, South Africa, Zambia and Zimbabwe. The study employed multivariate logistic regression models on a pooled dataset and individual country data to examine the relative risk of education and other factors on HIV risk behaviour indicators. It considered: (i) condom use during high risk-sex, (ii) multiple sexual partnerships, and (iii) HIV testing among men aged 15-59 years. Findings show that the proportion of men who engaged in HIV transmission risk behaviour was high in Southern Africa. Two-thirds of men reported non-use of a condom during last sex with most recent partners while 22% engaged in multiple sexual partnerships. The percentage of men who used condoms during sex with most recent partners ranged from 18% in Mozambique to 58% in Namibia. Age, residence, marital status and household wealth status were associated with HIV risk factors in the region. The study has established country variations in terms of how individual factors influence HIV transmission risk behaviour among men. Results show that the level of education was associated with increased use of condoms, only in Zambia and Mozambique. Delay in starting a sexual debut was associated with reduced odds of having multiple sexual partnerships in the region. Suggesting the need to strengthen comprehensive sexuality education among young men in school, to promote social behaviour change during adolescence age. The study presents important results to inform direct health policy, programme and government action to address HIV prevalence in the Southern region of Africa.
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Affiliation(s)
- Million Phiri
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
- Department of Demography and Population Studies, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Musonda Lemba
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Chrispin Chomba
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Vincent Kanyamuna
- Department of Development Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
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Costa ECV, Barbosa T, Soares M, McIntyre T, Pereira MG. Factors Associated with Sexually Transmitted Infections among Users of Voluntary HIV Counseling and Testing Centers in Portugal. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:432-449. [PMID: 38596277 PMCID: PMC10903659 DOI: 10.1080/19317611.2022.2032527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 04/11/2024]
Abstract
Objective: Users of publicly funded voluntary HIV Counseling and Testing Centers (VCT C) in the Portuguese National Service have been found to have higher rates of HIV risk behavior than the general population, but data concerning the relationship between socio-demographic, behavioral, and cognitive variables, and Sexually Transmitted Infections (ST Is) in this specific population are limited. This study tests the impact of socio-demographic, behavioral and cognitive variables on ST Is in a sample of 168 users of VCT C. Methods: A cross-sectional study using structured questionnaires was conducted. Results: Being older, being gay or bisexual, and having more barriers towards safer sex (e.g., negative attitudes toward safer sex behavior) were associated with increased odds of having had a ST I diagnosis. We found significant differences between heterosexual and gay men for number of sexual partners, frequency of anal sex, exchanging sex for money or drugs, history of ST Is, AIDS knowledge, and risk beliefs about the partner, with gay men showing higher rates. Conclusions: ST Is education should target older, gay or bisexual individuals, and focus on information as well as on changing barriers towards safer sex and associated health beliefs.
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Affiliation(s)
- Eleonora C. V. Costa
- Faculty of Philosophy and Social Sciences, Centre for Philosophical and Humanistic Studies, Universidade Católica Portuguesa, Braga, Portugal
- North Regional Health Administration, Ministry of Health, Braga, Portugal
| | - Tânia Barbosa
- Faculty of Philosophy and Social Sciences, Centre for Philosophical and Humanistic Studies, Universidade Católica Portuguesa, Braga, Portugal
| | - M. Soares
- North Regional Health Administration, Ministry of Health, Braga, Portugal
| | - Teresa McIntyre
- College of Nursing and Institute for Measurement, Evaluation and Statistics, University of Houston, Houston, TX, USA
| | - M. Graça Pereira
- Applied Psychology Department, School of Psychology, University of Minho, Braga, Portugal
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12
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Johnson MW, Strickland JC, Herrmann ES, Dolan SB, Cox DJ, Berry MS. Sexual discounting: A systematic review of discounting processes and sexual behavior. Exp Clin Psychopharmacol 2021; 29:711-738. [PMID: 33001694 PMCID: PMC8977071 DOI: 10.1037/pha0000402] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral processes underlying sexual behavior are important for understanding normal human functioning and risk behavior leading to sexually transmitted infections (STIs). This systematic review examines delay and probability discounting in human sexual behavior through synthesis of 50 peer-reviewed, original research articles. Sixteen studies focusing exclusively on monetary delay discounting found small effect size positive correlations with sexual risk behaviors. Eleven studies examined delay or probability discounting of sexual behavior itself using tasks that varied duration, frequency, or quality of sex to determine value. Results show delay and uncertainty of sex causes systematic decreases in value. These studies also show consistent medium effect size relationships between sexual discounting measures and sexual health and substance use, supporting utility above and beyond monetary discounting. Twenty-three studies have modeled clinically relevant decision-making, examining effects of delay until condom availability and STI contraction probability on condom use. Observational and experimental designs found condom-use discounting is elevated in high-risk substance use populations, is sensitive to context (e.g., partner desirability), and is more robustly related to sexual risk compared with monetary discounting or condom use decisions when no delay/uncertainty was involved. Administering cocaine, alcohol, and, for some participants, methamphetamine increased condom-use discounting with minimal effect on monetary discounting or condom use when no delay/uncertainty was involved. Reviewed studies robustly support that sexual behavior is highly dependent on delay and probability discounting, and that these processes strongly contribute to sexual risk. Future research should exploit these systematic relationships to design behavioral and pharmacological approaches to decrease sexual risk behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Matthew W. Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Justin C. Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Sean B. Dolan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David J. Cox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Meredith S. Berry
- Human Behavioral Pharmacology and Decision-Making Laboratory, Department of Health Education and Behavior, University of Florida, Gainesville, FL, United States
- Department of Psychology, University of Florida, Gainesville, FL, United States
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Comprehensive HIV/AIDS knowledge and safer sex negotiation among adolescent girls and young women in sub-Saharan Africa. J Biosoc Sci 2021; 54:991-1003. [PMID: 34558397 DOI: 10.1017/s0021932021000493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Globally, HIV/AIDS remains a public health issue, especially in sub-Saharan Africa (SSA). Despite the increased advocacy and dissemination of comprehensive HIV/AIDS information in SSA, it appears that little progress has been made to reduce the incidence of HIV/AIDS in the sub-region. This study, therefore, examined the association between comprehensive HIV/AIDS knowledge and safer sex negotiation among adolescent girls and young women in SSA. Data were taken from the Demographic and Health Surveys conducted between 2010 and 2019 in 30 countries in SSA. The study sample comprised 37,364 adolescent girls and young women aged 15-24. A multivariable binary logistic regression analysis was done to test the hypothesis that there is a positive association between comprehensive HIV/AIDS knowledge and safer sex negotiation. Adolescent girls and young women who had comprehensive knowledge on HIV/AIDS were more likely to negotiate for safer sex compared with those who had no comprehensive knowledge on HIV/AIDS (AOR=1.31, 95% CI: 1.22-1.41). At the country level, the positive association between comprehensive knowledge on HIV/AIDS and safer sex negotiation was significant in Chad, Congo DR, Gambia, Guinea, Liberia, Ethiopia and Malawi. On the other hand, in Togo, adolescent girls and young women who had comprehensive HIV/AIDS knowledge were less likely to negotiate for safer sex. These findings can inform policies and programmes on the crucial role of comprehensive HIV/AIDS education and knowledge in increasing safer sex negotiation among adolescent girls and young women in SSA. The study recommends that Togo needs to address certain practices such as intimate partner violence against adolescent girls and young women, which prevent them from negotiating for safer sex, despite their higher knowledge on comprehensive HIV/AIDS. Lessons can be learnt from Chad, Congo DR, Gambia, Guinea, Liberia, Ethiopia and Malawi about the scale-up of programmes and interventions targeted at young women.
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Cele LP, Vuyani S, Huma M. Determining the level of condom use and associated factors among married people in Tshwane District of South Africa. Pan Afr Med J 2021; 40:11. [PMID: 34733379 PMCID: PMC8531972 DOI: 10.11604/pamj.2021.40.11.26681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/15/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION despite the wide availability of free male condoms in South Africa, high rates of new HIV transmissions are reported to occur among married couples. The aim of this study was to determine the level of condom use among the married people and to assess the factors associated with condom use in the Tshwane district of the Gauteng province. METHODS a cross-sectional study was conducted among 325 clients accessing health care services at the Steve Biko Academic Hospital. A self- administered questionnaire was used to collect data, which were entered onto an Excel spreadsheet and imported into Epi info version 7 for analysis. A logistic regression model was used to investigate the association between condom use and the explanatory variables. The odds ratio was used to measure the strength of the associations. The 95% CI and a cut-off point of 0.05 for the p-value were used to indicate statistical significance. RESULTS the mean age of the participants was 41.6 years (SD=7.7). Two hundred and seventy-six (276; 85%) of the 325 participants reported not using condoms. Trust, doing regular HIV testing, and refusal by the husband were among the reasons given for not using condoms. In this study it was found that, the level of education, age and employment status were the determinants of condom use. CONCLUSION the level of condom use was low and sero-discordance was found to be the primary motivator for condom use. This study recommends the strengthening of and the widespread implementation of the CVCT service.
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Affiliation(s)
- Lindiwe Priscilla Cele
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Setati Vuyani
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Mmampedi Huma
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Friedland BA, Mathur S, Haddad LB. The Promise of the Dual Prevention Pill: A Framework for Development and Introduction. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3. [PMID: 34318291 PMCID: PMC8312733 DOI: 10.3389/frph.2021.682689] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Women of reproductive age need multipurpose prevention technology (MPT) products to address two overlapping health risks: unintended pregnancy and HIV. Currently, condoms are the only available MPT, however male condoms are not within the control of a woman, and the use of female condoms has been limited by low acceptability and cost. Oral pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, yet uptake and adherence among women have been low to date. Women globally need more options for HIV and pregnancy prevention. Several MPTs for simultaneous HIV and pregnancy prevention are in various stages of development and clinical testing, although most are many years away from market launch. A dual prevention pill (DPP), a daily oral pill combining oral contraceptives and PrEP, both of which are licensed, approved products in many low- and middle-income countries (LMIC), is likely to be the fastest route to getting an MPT product into the hands of women. The DPP is one option that could enhance method choice, particularly for women who are already using oral contraceptives. By leveraging the oral contraceptive market and reaching women currently using condoms or with an unmet need for contraception, the DPP has the potential to increase the uptake of PrEP. The successful rollout of the DPP will require careful consideration of user-, provider-, and product-centered factors during product development and introduction. Early attention to these interrelated factors can help ensure that the DPP has the ideal characteristics for maximum product acceptability, that effective and quality services are designed and implemented, and that users can make informed choices, demand the product, and use it effectively. The proposed framework outlines key considerations for the effective development and introduction of the DPP, which could also facilitate integration models for future MPTs.
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Affiliation(s)
- Barbara A Friedland
- Population Council, Center for Biomedical Research, New York, NY, United States
| | - Sanyukta Mathur
- Population Council, HIV and AIDS Program, Washington, DC, United States
| | - Lisa B Haddad
- Population Council, Center for Biomedical Research, New York, NY, United States
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Khumaidi K, Yona S, Waluyo A. Condom-use negotiation, alcohol consumption, and HIV-risk sexual behavior among female sex workers in Kupang, East Nusa Tenggara, Indonesia: A cross-sectional study. J Public Health Res 2021; 10. [PMID: 34060741 PMCID: PMC9309626 DOI: 10.4081/jphr.2021.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background Female Sex Workers (FSW) play a crucial part in HIV transmission. Having
unprotective condom during sexual activity can lead to HIV infection. Having
lower power in condom negotiation with client can lead FSW not to using
condoms during the sexual act. Alcohol consumption was also mediated HIV
risk behavior among FSW. This study aimed to evaluate the relationship
between condom use-negotiation, alcohol consumption and HIV-risk sexual
behavior among female sex workers (FSW) in Kupang. Design and Methods A cross-sectional study was conducted with 125 FSWs aged 18 to 60 years
recruited from Yayasan Tanpa Batas Kupang with consecutive sampling. The
data were analyzed using univariate and the Chi-square test. Results The majority of FSWs (61.6%) reported had low negotiation condom use with
their clients, about 77.6% reported high levels of alcohol consumption and
64.8% had high-risk sexual behavior. Condom-use negotiation (p-value: 0.003)
and alcohol consumption (p-value: 0.037) were found to be significantly
associated with HIV-risk sexual behavior. Conclusions Future interventions on HIV prevention should focus on empowering young FSWs
with condom negotation skills in order to increase condum use. It is also
recommended to include information about alcohol consumption and it's
relationship wit HIV-risk behavior in order to have better health outcomes
for FSW.
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Affiliation(s)
| | - Sri Yona
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java.
| | - Agung Waluyo
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java.
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Mass Media Exposure and Safer Sex Negotiation among Women in Sexual Unions in Sub-Saharan Africa: Analysis of Demographic and Health Survey Data. Behav Sci (Basel) 2021; 11:bs11050063. [PMID: 33925022 PMCID: PMC8145045 DOI: 10.3390/bs11050063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Improving sexual autonomy among women in sexual unions comes with various benefits, including the reduction of sexually transmitted and blood-borne infections. We examined the relationship between mass media exposure and safer sex negotiation among women in sub-Saharan Africa (SSA). (2) Methods: The study involved a cross-sectional analysis of Demographic and Health Survey (DHS) data of 29 sub-Saharan African countries. A total of 224,647 women aged 15–49 were included in our analyses. We examined the association between mass media exposure and safer sex negotiation using binary logistic regression analysis. The results are presented using a crude odds ratio (cOR) and adjusted odds ratio (aOR), with their respective confidence intervals (CIs). Statistical significance was set at p < 0.05. (3) Results: The overall prevalence of safer sex negotiation among women in sexual unions in SSA was 71.6% (71.4–71.8). Women exposed to mass media had higher odds of negotiating for safer sex compared with those who had no exposure (aOR = 1.94; 95% CI = 1.86–2.02), and this persisted after controlling for covariates (maternal age, wealth index, maternal educational level, partner’s age, partner’s educational level, sex of household head, religion, place of residence, and marital status) (aOR = 1.40; 95% CI = 1.35–1.46). The disaggregated results showed higher odds of safer sex negotiation among women exposed to mass media in all the individual countries, except Ghana, Comoros, Rwanda, and Namibia. (4) Conclusions: The findings could inform policies (e.g., transformative mass media educational seminars) and interventions (e.g., face-to-face counselling; small group sensitization sessions) in SSA on the crucial role of mass media in increasing safer sex practice among women in sexual unions. To accelerate progress towards the achievement of the Sustainable Development Goal five’s targets on empowering all women and safeguarding their reproductive rights, the study recommends that countries such as Ghana, Comoros, Rwanda, and Namibia need to intensify their efforts (e.g., regular sensitization campaigns) in increasing safer sex negotiation among women to counter power imbalances in sexual behaviour.
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Faini D, Munseri P, Bakari M, Sandström E, Faxelid E, Hanson C. "I did not plan to have a baby. This is the outcome of our work": a qualitative study exploring unintended pregnancy among female sex workers. BMC Womens Health 2020; 20:267. [PMID: 33261591 PMCID: PMC7709442 DOI: 10.1186/s12905-020-01137-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND High number of unintended pregnancies-often leading to induced abortions-are reported among female sex workers (FSWs), highlighting a major unmet need for contraception. To better understand barriers to contraceptive use, we explored FSW's pregnancy perceptions and experiences of unintended pregnancy. We hypothesized that sex work exacerbates barriers to contraceptive use and that FSW's pregnancy perceptions and experiences of unintended pregnancy influence future commitment to contraceptive use. METHODS We conducted in-depth interviews with 11 FSWs (January-June 2019) in Dar es Salaam, Tanzania. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy. All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software. RESULTS FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol. FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Financial hardships related to childrearing or painful abortion experiences influenced FSWs' commitment to good contraceptive practices. CONCLUSION Our results demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience. Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work.
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Affiliation(s)
- Diana Faini
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), 9 United Nations Road, Dar es Salaam, Tanzania.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Muhammad Bakari
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Eric Sandström
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Carroll A, Kapilashrami A. Barriers to uptake of reproductive information and contraceptives in rural Tanzania: an intersectionality informed qualitative enquiry. BMJ Open 2020; 10:e036600. [PMID: 33039990 PMCID: PMC7549473 DOI: 10.1136/bmjopen-2019-036600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Access to reproductive information and contraception (RIC) continues to be a critical unmet need in Tanzania and impedes the realisation of reproductive health rights. This study examined key sources of RIC and the factors influencing their uptake by women in Mbeya region of Tanzania. SETTING This qualitative study was undertaken in a rural ward in a district in the south of the Mbeya region PARTICIPANTS: In-depth interviews were undertaken with 48 women users and 2 nurses working in a public health facility, and focus group discussions with 16 home-based care workers in the district. Participants were recruited through a local non-governmental organisation (NGO) in the region, and via snowball sampling. All interactions were recorded, translated and transcribed and sought to identify the available resources and barriers in using them. RESULTS Participants reported six main sources of reproductive information and contraceptives: public health facilities, NGO mobile clinics, other women, Mganga wa Asili (witchdoctors/traditional doctors) and Duka la Dawa (pharmacy). Women users and healthcare workers identified a range of individual (age, marital status and geography) and health system-wide factors shaping women's reproductive choices and preventing uptake of contraceptives. The study also revealed structural factors such as gender, ethnicity, indigeneity as key determinants of access and health seeking, placing women from Sukuma and Maasai communities is the most disadvantageous position. Historical social disadvantage, patriarchal social controls and the pressure to preserve sociocultural traditions that women experience in the Maasai and Sukuma tribes underpin their disconnect from mainstream services. CONCLUSION Women's reproductive choices and their uptake of contraceptives are shaped by the interaction of a range of individual, household, institutional and structural factors. An intersectional lens enables examination of the ways in which these factors interact and mutually constitute disadvantage and privilege.
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Affiliation(s)
- Allison Carroll
- School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | - Anuj Kapilashrami
- School of Health & Social Care, University of Essex, Colchester, Essex
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20
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Hlongwa M, Peltzer K, Hlongwana K. Risky sexual behaviours among women of reproductive age in a high HIV burdened township in KwaZulu-Natal, South Africa. BMC Infect Dis 2020; 20:563. [PMID: 32738895 PMCID: PMC7395408 DOI: 10.1186/s12879-020-05302-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite several intervention programmes in South Africa, risky sexual behaviours among women of reproductive age remain a public health concern, making them vulnerable to unintended pregnancies and/or sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection. The aim of this study was to investigate the predictors of risky sexual behaviours among women of reproductive age in a high HIV-burden township in KwaZulu-Natal, South Africa. METHODS In a cross-sectional study, 471 women of reproductive age (18-49 years, mean: 25.83) in 10 public health clinics in Umlazi Township, responded to a structured questionnaire. Data were coded, entered into Epi Data Manager and exported to Stata for analysis. A Pearson Chi-square tests and logistic regression models (bivariate and multivariate) were employed to assess the level of the association between the predictor and outcome variables and the p-value < 0.05 was considered statistically significant. RESULTS More than half (51.80%) of the women were aged 18-24 years and only a handful (18.26%) had a tertiary qualification. The majority were single (88.96%) and the unemployed accounted for 53.50%. This study found that women who had talked about condoms with their partner in the past 12 months were more likely (p = < 0.0001) to have used condoms during their last sexual intercourse. Older women (p = 0.035) were more likely to have used a condom at last sex, compared to younger women. However, women who were exposed to physical partner violence (hitting and/or slapping), those who had been diagnosed with HIV and those whose sexual partners were diagnosed with HIV, did not show a significant association with condom use at last sex. CONCLUSION Exposure to physical partner violence and poor partner discussions about condoms are key deterrents to condom usage. Holistic interventions are required in order to address the risky behaviours, and consequently reduce sexually transmitted infections and/or unintended pregnancies.
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Affiliation(s)
- Mbuzeleni Hlongwa
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Karl Peltzer
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, Cape Town, South Africa
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Khumbulani Hlongwana
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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21
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Mchunu GG, Naidoo JR, Ncama BP. Condom use: a less travelled route among minibus taxi drivers and their taxi queens in KwaZulu-Natal, South Africa. Afr Health Sci 2020; 20:658-665. [PMID: 33163028 PMCID: PMC7609093 DOI: 10.4314/ahs.v20i2.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Despite significant gains in the HIV epidemic in South Africa, with reduction in mortality and elimination of vertical transmission, national HIV prevalence remains high, with women rather than men continuing to bear higher burden of the disease. Population subgroups, through ignorance, disbelief or recklessness, continue to engage in risky sexual behaviour. A substantial proportion of minibus taxi drivers engage in risky sex, seldom seeing themselves at risk for STIs or HIV/AIDS. These taxi drivers have been linked with so-called taxi queens, with whom they engage in transactional and intergenerational relationships. Objectives The study explored condom use and condom negotiation strategies among taxi drivers and taxi queens in Kwa- Zulu-Natal, South Africa. Methods Applying explorative qualitative design, we conducted focus group discussion and individual interviews among participants who were purposively recruited in KwaZulu-Natal. Result Qualitative data analysis revealed that condom use and negotiation are sources of conflict for the participants. In addition, the strategies employed by participants to ensure condom usage are not always sustainable and are likely to be problematic due to a variety of complex factors. Conclusion Our study concludes by recommending a nested public health response that takes cognizance of factors that promote sustainable condom use strategies among this population subgroup.
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Affiliation(s)
- Gugu G Mchunu
- School of Nursing and Public Health, University of Kwazulu-Natal, South Africa
- Corresponding author: Gugu G Mchunu, School of Nursing and Public Health, University of Kwazulu-Natal, South Africa. 5th Floor, Desmond Clarence Building, Howard College Campus, University of Kwazulu-Natal, Durban. 4041.
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22
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Woolfork MN, Fox A, Swartzendruber A, Rathbun S, Lee J, Mutanga JN, Ezeamama AE. Empowerment and HIV Risk Behaviors in Couples: Modeling the Theory of Gender and Power in an African Context. WOMEN'S HEALTH REPORTS 2020; 1:89-101. [PMID: 33786478 PMCID: PMC7784798 DOI: 10.1089/whr.2019.0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Young women and girls in Eastern and Southern Africa are at elevated risk of acquiring human immunodeficiency virus (HIV) compared with men, largely due to power dynamics within heterosexual relationships that contribute to HIV risk behaviors. Few studies employ a comprehensive framework to examine divisions between men and women and HIV risk behaviors in an African context. Thus, we examined associations between levels of women's empowerment and HIV risk behaviors applying the Theory of Gender and Power. Methods: We used logistic regression (adjusted odds ratios or AORs) to assess associations between women's empowerment indicators and HIV risk behaviors (multiple sexual partners) and self-efficacy (ability to negotiate sex/sex refusal) with couples data (n = 12,670) from Malawi, Namibia, Zambia, and Zimbabwe. Results: Specifically, key drivers of high levels of empowerment among women were household decision-making involvement, female economic independence, and rejecting all reasons for wife-beating. Furthermore, higher levels of women's empowerment in coupled relationships was associated with safer sex negotiation in Malawi (AOR = 1.57, p < 0.05) and Zambia (AOR = 1.60, p < 0.0001) and sex refusal in Malawi (AOR = 1.62, p < 0.0001) and Zimbabwe (AOR = 1.29, p < 0.05). However, empowerment was not associated with the likelihood of the male partner having multiple sexual partners across all countries studied. Conclusions: These findings provide evidence that high levels of women's empowerment were associated with safer sex practices, although this varied by country. Policymakers should incorporate empowerment indicators to address women's empowerment and HIV prevention within African couples.
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Affiliation(s)
- Makhabele Nolana Woolfork
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Ashley Fox
- Department of Public Administration, University at Albany SUNY, Albany, New York, USA
| | - Andrea Swartzendruber
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Stephen Rathbun
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Joel Lee
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Jane N Mutanga
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Amara E Ezeamama
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
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23
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Consistent Condom Use and Dual Protection Among Female Sex Workers: Surveillance Findings from a Large-Scale, Community-Based Combination HIV Prevention Program in Tanzania. AIDS Behav 2020; 24:802-811. [PMID: 31444713 PMCID: PMC7018834 DOI: 10.1007/s10461-019-02642-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In Tanzania, HIV infection remains much higher among female sex workers (FSWs) than among other adult women. In addition to HIV, sexually transmitted infections (STIs) and pregnancy prevention are major concerns for FSWs in Tanzania. This study used a programmatic surveillance approach to examine protection against STIs/HIV and unintended pregnancy (dual method use) among FSWs in an outreach-based HIV prevention, care, and treatment program in Tanzania. 119,728 FSWs made a first visit to services served by the Sauti Project from January 2016 to September 2017. Of these 79,774 were current contraceptive users—of those, 4548 (5.7%) took a contraceptive as well as condoms, the study measure of dual family planning (FP) method use. Ninety-one percent (n = 4139) of FSWs taking dual FP methods were provided with an injectable in addition to condoms. Dual method use was lower in this study than in research studies in the region, highlighting potential differences between findings from research studies and evidence from a routine service provision setting. Self-reported consistent condom use among FSWs was 16.1%. The findings call for further research and programs to address FSW agency to increase dual protection against STIs/HIV and unintended pregnancy.
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24
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Aloni M, Mbago MC, Sichona FJ. Understanding The Combined Effects Of The Knowledge Of HIV/AIDS Prevention Methods On Condom Use: A Case Of Njombe And Tanga Regions Of Mainland Tanzania. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:265-274. [PMID: 31807082 PMCID: PMC6826185 DOI: 10.2147/hiv.s210758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/16/2019] [Indexed: 11/23/2022]
Abstract
Aim This study assesses how the combined effects of knowledge of the HIV/AIDS prevention methods (ie, abstinence (A), being faithful (B), condom use (C), and diagnosis or testing (D)) influence behavioral change in terms of condom use. Methods The study employed a cross-sectional design. Data were collected using a household survey conducted in 2017 in the Tanga and Njombe Regions of Tanzania through a structured questionnaire. The dependent variable was condom use during the last sexual intercourse. The main independent variable was knowledge of HIV prevention methods, referred to in this study as "knowledge of ABCD of HIV/AIDS prevention". A respondent with knowledge of three or more of the ABCD was classified as having good knowledge of HIV prevention. Those with knowledge of two, one, or none of the ABCD were classified as having average, fair, and poor knowledge of HIV prevention methods, respectively. Data analysis included univariate analysis, bivariate analysis, and multivariate logistic regression analysis. The study included 660 respondents aged 15-64 years. Results The study indicates that the majority (52.2%) of the respondents had average knowledge of the HIV prevention methods. That is, they were knowledgeable of any two of the A, B, C, and D of HIV prevention methods. Condom use during the last sexual intercourse was reported by 46.5% of respondents. Multivariate analysis showed that condom use was 1.48-times more likely among respondents with good knowledge of ABCD of HIV/AIDS prevention than those with poor knowledge. Conclusion The predictive effect of knowledge of the HIV prevention methods on condom use was more visible when assessed in combination than when treated at A, B, C, and D in isolation. This suggests that successful behavioral change towards HIV/AIDS aversion requires dedicated efforts that promote comprehensive knowledge of all the methods through which the epidemic can be transmitted.
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Affiliation(s)
- Mbwiga Aloni
- Department of Mathematics, Physics and Information Technology, Mkwawa University College of Education (MUCE), Iringa, Tanzania
| | - Maurice Cy Mbago
- Department of Statistics, University of Dar es Salaam (UDSM), Dar es Salaam, Tanzania
| | - Francis J Sichona
- Department of Statistics, University of Dar es Salaam (UDSM), Dar es Salaam, Tanzania
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25
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Chakalisa U, Wirth K, Bennett K, Kadima E, Manyake K, Gaolathe T, Bachanas P, Marukutira T, Lebelonyane R, Dryden-Peterson S, Butler L, Mmalane M, Makhema J, Roland ME, Pretorius-Holme M, Essex M, Lockman S, Powis KM. Self-reported risky sexual practices among adolescents and young adults in Botswana. South Afr J HIV Med 2019; 20:899. [PMID: 31308965 PMCID: PMC6620511 DOI: 10.4102/sajhivmed.v20i1.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/25/2019] [Indexed: 12/05/2022] Open
Abstract
Background Adolescents and young adults account for more than one-third of incident Human Immunodeficiency Virus (HIV) infections globally. Understanding sexual practices of this high-risk group is critical in designing HIV targeted prevention programming. Objectives To describe self-reported risky sexual practices of adolescents and young adults aged 16–24 years from 30 Botswana communities. Methods Cross-sectional, self-reported age at sexual debut; number of sexual partners; condom and alcohol use during sex; intergenerational sex; and transactional sex data were collected. Modified Poisson estimating equations were used to obtain univariate and multivariate-adjusted prevalence ratios (PR) and 95% confidence intervals (CI) comparing engagement in different sexual practices according to gender, accounting for the clustered design of the study. Results Among the 3380 participants, 2311 reported being sexually active with more females reporting being sexually active compared to males (65% vs. 35%, respectively; p < 0.0001). In univariate analyses, female participants were more likely to report inconsistent condom use (PR 1.61; 95% CI 1.44–1.80), intergenerational sex (PR 9.00; 95% CI 5.84–13.88) and transactional sex (PR 3.46; 95% CI 2.07–5.77) than males, yet less likely to report engaging in sex before age 15 years (PR 0.59; 95% CI: 0.41–0.85), using alcohol around the time of intercourse (PR: 0.59; 95% CI 0.45–0.76) or having ≥ two partners in the last 12 months (PR 0.65; 95% CI 0.57–0.74). Conclusions Self-reported risky sexual practices of adolescents and young adults in Botswana differed significantly between males and females. Gender-specific risky sexual practices highlight the importance of developing tailored HIV prevention programming.
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Affiliation(s)
- Unoda Chakalisa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kathleen Wirth
- Harvard T.H. Chan School of Public Health, Boston, United States
| | - Kara Bennett
- Bennett Statistical Consulting, Ballston Lake, United States
| | - Etienne Kadima
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kutlo Manyake
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Pam Bachanas
- Centers for Disease Control and Prevention, Division of Global HIV/AIDS and TB, Atlanta, United States
| | | | | | | | - Lisa Butler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, United States
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | - Max Essex
- Harvard T.H. Chan School of Public Health, Boston, United States
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26
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Mangombe K, Kalule-Sabiti I. Knowledge about male circumcision and perception of risk for HIV among youth in Harare, Zimbabwe. South Afr J HIV Med 2019; 20:855. [PMID: 31205776 PMCID: PMC6556916 DOI: 10.4102/sajhivmed.v20i1.855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 02/05/2019] [Indexed: 01/21/2023] Open
Abstract
Background Male circumcision will require high uptake among previously non-circumcising countries to realise the impact of circumcising in preventing HIV. Little is known about whether youths are knowledgeable about male circumcision and its relationship with HIV prevention and their perception of risk of HIV infection. Objective This article aimed to ascertain youth’s knowledge about male circumcision and perception of risk of HIV infection. Methods A quantitative study on 784 youth (men aged 15–35 years) was conducted in Harare, Zimbabwe, after obtaining their consent. Multivariate analysis examined the associations between background characteristics and knowledge about male circumcision and the perception of risk of HIV infection. Results The results revealed that age was a significant predictor of knowledge about male circumcision among youth in Harare, as was educational attainment and ever having tested for HIV. In addition, youth who had heard of voluntary medical male circumcision were more likely to have high knowledge of male circumcision compared to those who had never heard of it. The results also showed that male circumcision status was associated with higher knowledge about male circumcision compared to those who were not circumcised. The study also found that educational attainment, belonging to the Shona ethnic group, never having tested for HIV and disapproval of voluntary counselling and testing prior to male circumcision were associated with the perception of risk of HIV infection. Conclusion The study provides two recommendations: the need to strengthen perceived susceptibility to HIV among the youth and the need for advocacy on the health benefits of male circumcision.
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Affiliation(s)
- Kudzaishe Mangombe
- Department of Sociology and Social Anthropology, Faculty of Social Sciences, Great Zimbabwe University, Masvingo, Zimbabwe
| | - Ishmael Kalule-Sabiti
- Department of Population Studies and Demography, Faculty of Humanities, North-West University, Mmabatho, South Africa
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27
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Colombe S, Beard J, Mtenga B, Lutonja P, Mngara J, de Dood CJ, van Dam GJ, Corstjens PLAM, Kalluvya S, Urassa M, Todd J, Downs JA. HIV-seroconversion among HIV-1 serodiscordant married couples in Tanzania: a cohort study. BMC Infect Dis 2019; 19:518. [PMID: 31195994 PMCID: PMC6567663 DOI: 10.1186/s12879-019-4151-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/31/2019] [Indexed: 01/20/2023] Open
Abstract
Background Heterosexual transmission is the main driver of the HIV epidemic in Tanzania. Only one estimate of the incidence rate of intra-marital HIV seroconversion in Tanzania has been reported and was derived from data collected between 1991 and 1995. Moreover, little is known about the specific risk factors for intra-marital seroconversion in Tanzania. Improved evidence around factors that increase the risk of HIV transmission to a serodiscordant spouse is needed to develop and improve evidence-based interventions. We sought to investigate the rate of intra-marital HIV seroconversion among HIV sero-discordant couples in Tanzania as well as its associated risk factors. Methods We identified all HIV positive individuals in the TAZAMA HIV-serosurvey cohort and followed up their serodiscordant spouse from 2006 to 2016. The rate of seroconversion was analyzed by survival analysis using non-parametric regressions with exponential distribution. Results We found 105 serodiscordant couples, 14 of which had a seroconverting spouse. The overall HIV-1 incidence rate among spouses of people with HIV-1 infection was 38.0 per 1000 person/years [22.5–64.1]. Notably, the HIV-1 incidence rate among HIV-1 seronegative male spouses was 6.7[0.9–47.5] per 1000 person/years, compared to 59.3 [34.4–102.1] per 1000 person/years among female spouses. Sex of the serodiscordant spouse was the only significant variable, even after adjusting for other variables (Hazard rate = 8.86[1.16–67.70], p = 0.036). Conclusions Our study suggests that rates of HIV-1 seroconversion of sero-discordant partners are much higher within marriage than in the general population in Tanzania. The major risk factor for HIV-1 seroconversion is sex of the serodiscordant spouse, with female spouses being at very high risk of acquiring HIV infection. This suggests that future programs that target serodiscordant couples could be a novel and effective means of preventing HIV-1 transmission in Tanzania.
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Affiliation(s)
- Soledad Colombe
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, 402 East 67th Street, 2nd Floor, New York, NY, 10065, USA.
| | - James Beard
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Baltazar Mtenga
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Peter Lutonja
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Julius Mngara
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Claudia J de Dood
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Samuel Kalluvya
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Mark Urassa
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, 402 East 67th Street, 2nd Floor, New York, NY, 10065, USA.,Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
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28
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Qiao J, Guo Y, Zhu Y, Hong YA, Xu Z, Zeng C, Zhang H, Cai W, Li L, Liu C, Kellstedt DK. Gender differences in the relationship of sexual partnership characteristics and inconsistent condom use among people living with HIV in China. AIDS Care 2019; 32:128-135. [PMID: 31181956 DOI: 10.1080/09540121.2019.1622632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Few studies have examined the relationship between inconsistent condom use and sexual partnership characteristics among people living with HIV (PLWH). The current study focused on such association and its gender differences. The study was conducted in a large hospital in South China in 2013. A total of 320 dyads (PLWH indexes and their sexual partners) were recruited from an outpatient clinic using convenience sampling. The proportion of inconsistent condom use in the last six months among female indexes was higher than that among male indexes (52.4% vs. 43.6%). Of sexual partnership characteristics, HIV seropositive status was a risk factor for inconsistent condom use for both male and female indexes (aOR = 2.32, 95%CI = 1.15∼4.66, aOR = 3.09, 95%CI = 1.10∼8.67, respectively). For male indexes, lower educational level was also a risk factor (aOR = 2.39, 95%CI = 1.23∼4.67); while having had emotionally intimate relationships was a protective factor (aOR = 0.40, 95%CI = 0.21∼0.77). For female indexes, receiving material support was a risk factor (aOR = 10.17, 95%CI = 2.13∼48.61) and receiving health-related advice was a protective factor (aOR = 0.11, 95%CI = 0.02∼0.55). Future HIV interventions for PLWH need to be gender-sensitive and include their sexual partners.
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Affiliation(s)
- Jiaying Qiao
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yan Guo
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yajing Zhu
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Y Alicia Hong
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Zhimeng Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Chengbo Zeng
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hanxi Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Weiping Cai
- Department of Infectious Disease, Guangzhou Number Eight People's Hospital, Guangzhou, People's Republic of China
| | - Linghua Li
- Department of Infectious Disease, Guangzhou Number Eight People's Hospital, Guangzhou, People's Republic of China
| | - Cong Liu
- Department of Infectious Disease, Guangzhou Number Eight People's Hospital, Guangzhou, People's Republic of China
| | - Debra K Kellstedt
- School of Public Health, Texas A&M University, College Station, TX, USA
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29
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Kangmennaang J, Mkandawire P, Luginaah I. Determinants of risky sexual behaviours among adolescents in Central African Republic, Eswatini and Ghana: evidence from multi-indicator cluster surveys. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:38-50. [PMID: 30880582 DOI: 10.2989/16085906.2018.1552600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite the declining HIV/AIDS prevalence globally, nearly half of all new HIV infections still occur among youth, especially in sub-Saharan Africa. While determinants of risky sexual behaviour have received copious attention in the literature, we still lack multi-country studies that track regional changes in sexual risk among youth in sub-Saharan Africa. This study seeks to fill part of this gap by identifying the determinants of risky sexual behaviours among adolescents in Ghana, Central African Republic (CAR) and Eswatini (formerly Swaziland). We used nationally representative sample data from the Multi Indicator Cluster survey, round four (MICS4). Results of the descriptive analysis show that overall consistent condom use is still extremely low in sub-Saharan Africa. In Ghana, only 8.5% of male youth and 7% of female youth consistently use condoms. In CAR this figure is 8% and 4% in male youth and female youth respectively. In Eswatini, with one of highest HIV prevalence in the world, the prevalence of consistent condom use is at 29% in males and 20% in females, higher than both in Ghana and CAR. Results of hierarchical models show that age at first sex does not predict risky sexual behaviour in Ghana, but it does predict risky sexual behaviour in CAR although only among young males. In Swaziland, age at first sex predicts risky sexual behaviour in both male and female youth but the relationship is not in the expected direction. Low socio-economic status predicts inconsistent condom use in all the three countries, but only among young females. This paper provides relevant policy lessons and recommendations.
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Affiliation(s)
- Joseph Kangmennaang
- a Department of Geography and Environment , University of Waterloo , Ontario , Canada
| | - Paul Mkandawire
- b Institute of Interdisciplinary Studies, Human Rights Program, Carleton University , Ottawa , Canada
| | - Isaac Luginaah
- c Department of Geography , Western University , Ontario , Canada
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30
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Gutierrez EB, Pinto VM, Basso CR, Spiassi AL, Lopes MEDBR, Barros CRDS. Factors associated with condom use inyoung people-A population-based survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190034. [PMID: 31038615 DOI: 10.1590/1980-549720190034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 09/01/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION This study aimed to identify the factors associated with condom use in the last sexual intercourse. METHODS A population-based survey with young people aged 15-24, in the city of São Paulo, which collected sociodemographic data referring to knowledge about sex and sexual behavior. RESULTS Among 821 sexually active young people interviewed in the last year, condom use in their last sexual intercourse was positively associated with: 1) not being married; 2) use of condom at sexual onset; and 3) receiving free condoms; additionally, among men: 4) casual partners in the previous year; and 5) partner of the same sex; and, amongwomen: 6) sexual onset after the age of 15. Having been tested for HIV was a negative association among women. Condoms are widely acknowledged, and there is a pattern of use for the first and last sexual intercourse. Access to free condoms is an important factor for use, and people use condoms according to standards that configure risk management. CONCLUSIONS The strategy of primary prevention with the use of condoms is not yet exhausted. Based on this study, the city of São Paulo takes prevention as a public policy and allocates large condoms dispensers in 26 urban bus terminals, where 6million people circulate daily. In 2016, 75,546,720 free condoms were distributed, 30% in bus terminals alone.
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Affiliation(s)
- Eliana Battaggia Gutierrez
- Programa Municipal de DST/AIDS de São Paulo - São Paulo (SP), Brasil.,Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Valdir Monteiro Pinto
- Programa Municipal de DST/AIDS de São Paulo - São Paulo (SP), Brasil.,Programa Estadual de DST/AIDS de São Paulo - São Paulo (SP), Brasil
| | | | - Ana Lucia Spiassi
- Programa Municipal de DST/AIDS de São Paulo - São Paulo (SP), Brasil
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31
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Siril H, Kaale A, Minja A, Kilewo J, Mugusi F, Sunguya B, Todd J, Kaaya S, Smith Fawzi MC. Improving communication about HIV prevention among people living with HIV and their at-risk social network members in Dar es Salaam, Tanzania. COGENT MEDICINE 2019; 6. [PMID: 31355302 PMCID: PMC6660010 DOI: 10.1080/2331205x.2019.1600230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Although a number of HIV prevention programs have been implemented, such as mass media campaigns, high rates of unprotected and concurrent sexual partnerships, as well as low uptake HIV testing and limited HIV knowledge, persist in Tanzania. We examined the effect and predicting factors of HIV prevention communication among people living with HIV (PLH) exposed to NAMWEZA intervention, and their at-risk social network members (NMs) Quantitative data were collected from 326 participants at baseline and 24 months of follow-up. In-depth interviews with 20 PLH were conducted at follow-up. Results indicated specific communication about condom use and HIV testing increased; (mean increase of 0.28 (SD = 0.14) scores, P = 0.012 and 0.42 (SD = 0.11) scores, p < 0.001 respectively while general discussion about protecting other people from HIV did not change significantly; mean increase was 0.01 scores (SD = 0.005), p = 0.890. Positive predictors of communication included being single; OR = 1.10, p = 0.01, female; OR = 1.15, p = 0.03, aged 30 years or older; OR = 1.23, p < 0.01, HIV knowledge, dose of NAMWEZA participation; OR = 1.01, p < 0.001, and high self-efficacy for condom use; OR = 1.4, p < 0.001. Stigma demonstrated a significant but negative association with communication for condom use; OR = 1.01, p < 0.01.Qualitative data reflected perceived possession of more individual skills and ability to address some personal/cultural obstacles to communicating about HIV prevention including those observed in the quantitative data. NAMWEZA improved communication about HIV prevention among PLH with their at-risk-NMs. The approach is a promising complement to media campaigns in similar populations. Future research and program evaluation efforts should explore how communities perceive and communicate about protecting others from HIV.
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Affiliation(s)
- Hellen Siril
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Public Health Evaluations and Quality Improvement, Management and Development for Health, Dar es Salaam, Tanzania
| | - Anna Kaale
- Department of Healthy Options, Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Anna Minja
- Department of Healthy Options, Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Japheth Kilewo
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jim Todd
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Darteh EKM, Dickson KS, Doku DT. Women's reproductive health decision-making: A multi-country analysis of demographic and health surveys in sub-Saharan Africa. PLoS One 2019; 14:e0209985. [PMID: 30625212 PMCID: PMC6326492 DOI: 10.1371/journal.pone.0209985] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Women's ability to make decisions regarding their reproductive health has important implications for their health and well-being. We studied the socio-demographic factors affecting reproductive health decision-making among women in 27 sub-Sahara African countries. MATERIALS AND METHODS The study made use of pooled data from current Demographic and Health Survey (DHS) conducted from January 1, 2010 and December 31, 2016 in 27 countries in sub-Sahara African. Binary and multivariate logistic regression models were used to investigate the associations of women's socio-demographic factors with decision-making regarding sexual reproductive health. RESULTS The proportion of women who can ask their partners to use a condom during sexual intercourse ranged from lowest in Mali (16.6%) to highest in Namibia (93.4%). Furthermore, the proportion of women who can refuse sex ranged from 18.3% in Mali to 92.4% in Namibia. Overall, approximately every five out of ten women can ask their partners to use a condom, six out ten women could refuse their partners sex and seven out of ten women could make at least 1 decision. Women from rural areas (OR = 0.51, CI = 0.48-0.54), those with no education (OR = 0.11, CI = 0.10-0.12), Muslim women (OR = 0.29, CI = 0.27-0.31), women not working (OR = 0.53, CI = 0.51-0.56) and women whose partners had no education (OR = 0.17, CI = 0.16-0.19) were less likely to make a decision on their reproductive health. CONCLUSION Residence, age, level of education, religion, occupation and partner's education were found to be associated with women's decision-making about sexual intercourse, condom use and reproductive health decision-making index. This study contributes to the discourse on reproductive health decision-making in Africa. Policies and intervention targeted at improving women's autonomy and empowering them to take charge of their sexual and reproductive health issues should be focused on these factors.
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Affiliation(s)
| | | | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Ghost, Ghana
- University of Tampere, Faculty of Social Sciences, Health Sciences and PERLA (Tampere Centre for Childhood, Youth and Family Research), University of Tampere, Tampere, Finland
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Protogerou C, Johnson BT, Hagger MS. An integrated model of condom use in Sub-Saharan African youth: A meta-analysis. Health Psychol 2018; 37:586-602. [PMID: 29708390 DOI: 10.1037/hea0000604] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We tested an integrated social-cognitive model derived from multiple theories of the determinants of young people's condom use in Sub-Saharan Africa. The model comprised seven social-cognitive antecedents of condom use: Attitudes, norms, control, risk perceptions, barriers, intentions, and previous condom use. METHOD We conducted a systematic search of studies including effects between at least one model construct and intended or actual condom use in young people from sub-Saharan African countries. Fifty-five studies comprising 72 independent data sets were included and subjected to random-effects meta-analysis. Demographic and methodological variables were coded as moderators. Hypotheses of the integrated model were tested using meta-analytic structural equation modeling. RESULTS The meta-analysis revealed significant nontrivial sample-weighted correlations among most model constructs. Moderator analyses revealed differences in six correlations for studies that included a formative research component relative to studies that did not. There was little evidence of systematic moderation of relations among model constructs by other candidate moderators. Meta-analytic structural equation models revealed significant direct effects of attitudes, norms, and control on condom use intentions, and of intention, control, and barriers on condom use. Including past condom use increased explained variance in condom use intentions and behavior but did not attenuate model effects. There were also significant indirect effects of attitudes, norms, and control on condom use through intentions. CONCLUSIONS Findings provide preliminary evidence to support the integrated condom use model in sub-Saharan African youth. The model provides guidance on potential targets for improving the effectiveness of condom promotion interventions. (PsycINFO Database Record
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Affiliation(s)
| | - Blair T Johnson
- Department of Psychological Sciences, University of Connecticut
| | - Martin S Hagger
- Faculty of Sport and Health Sciences, University of Jyväskylä
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Abstract
The question of youth sexual behaviour has been widely debated, with researchers such as Berhan and Berhan (2015) arguing that young adults aged 15-24 are more likely to engage in risky behaviours. However, research has not adequately addressed the issue of positive sexual behaviours, in particular among young people in sub-Saharan Africa. Adapting the compensatory model of risk and resiliency theory, this study examined the determinants of positive sexual behaviours among youth in sub-Saharan Africa. Using recent data from Demographic and Health Surveys of sixteen countries representative of each African region (East, West, Southern and Central), it was hypothesized that positive sexual behaviours of youth (condom use at last sex and single sexual partnership) would be most strengthened by protective factors at the individual and family levels, and that these behaviours would differ by region due to regional variation in socio-cultural practices. Delayed age at sexual debut (first sex after the age of 15) was found to be the strongest protective factor for positive sexual behaviours among males and females in sub-Saharan Africa. Certain socioeconomic variables were found to be positively associated with positive sexual behaviours and the associations differed by gender.
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Musalia J. Household Decision Making Among Married Women in Kenya: A Latent Class Analysis. SEX ROLES 2018. [DOI: 10.1007/s11199-017-0788-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Budambula V, Matoka C, Ouma J, Ahmed AA, Otieno MF, Were T. Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users. BMC Public Health 2018; 18:193. [PMID: 29378631 PMCID: PMC5789578 DOI: 10.1186/s12889-018-5100-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
Background Substance use is increasingly becoming prevalent on the African continent, fueling the spread of HIV infection. Although socio-demographic factors influence substance consumption and risk of HIV infection, the association of these factors with HIV infection is poorly understood among substance users on the African continent. The objective of the study was to assess socio-demographic and sexual practices that are associated with HIV infection among injection drug users (IDUs), non-IDUs, and non-drug users (DUs) at an urban setting of coastal Kenya. Methods A cross-sectional descriptive study was conducted among 451 adults comprising HIV-infected and -uninfected IDUs (n = 157 and 39); non-IDUs (n = 17 and 48); and non-DUs (n = 55 and 135); respectively at coastal, Kenya. Respondent driven sampling, snowball and makeshift methods were used to enroll IDUs and non-IDUs. Convenience and purposive sampling were used to enroll non-DUs from the hospital’s voluntary HIV testing unit. Participant assisted questionnaire was used in collecting socio-demographic data and sexual practices. Results Binary logistic regression analysis indicated that higher likelihood of HIV infection was associated with sex for police protection (OR, 9.526; 95% CI, 1.156-78.528; P = 0.036) and history of sexually transmitted infection (OR, 5.117; 95% CI, 1.924-13.485; P = 0.001) in IDUs; divorced, separated or widowed marital status (OR, 6.315; 95% CI, 1.334-29.898; P = 0.020) in non-IDUs; and unemployment (OR, 2.724; 95% CI, 1.049-7.070; P = 0.040) in non-drug users. However, never married (single) marital status (OR, 0.140; 95% CI, 0.030-0.649; P = 0.012) was associated with lower odds for HIV infection in non-drug users. Conclusion Altogether, these results suggest that socio-demographic and sexual risk factors for HIV transmission differ with drug use status, suggesting targeted preventive measures for drug users.
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Affiliation(s)
- Valentine Budambula
- Department of Environment and Health Sciences, Technical University of Mombasa, P. O. Box 90420-80100, Mombasa, Kenya.
| | - Charles Matoka
- Department of Applied Sciences, Technical University of Mombasa, P. O. Box 90420-80100, Mombasa, Kenya
| | - James Ouma
- Department of Environmental Health, University of Kabianga, P. O. Box 2030-20200, Kericho, Kenya
| | | | - Michael F Otieno
- Department of Medical Laboratory Sciences, Kenyatta University, P. O. Box 43844-00100, Nairobi, Kenya
| | - Tom Were
- Department of Medical Laboratory Sciences, Masinde Muliro University of Science and Technology, P.O. Box 190-50100, Kakamega, Kenya.
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Osuafor GN, Maputle S, Ayiga N, Mturi AJ. Condom use among married and cohabiting women and its implications for HIV infection in Mahikeng, South Africa. JOURNAL OF POPULATION RESEARCH 2017. [DOI: 10.1007/s12546-017-9195-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Predictors of Health Care Seeking Behavior During Pregnancy, Delivery, and the Postnatal Period in Rural Tanzania. Matern Child Health J 2017; 20:1726-34. [PMID: 27194528 DOI: 10.1007/s10995-016-1976-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives Four antenatal visits, delivery in a health facility, and three postnatal visits are the World Health Organization recommendations for women to optimize maternal health outcomes. This study examines maternal compliance with the full recommended maternal health visits in rural Tanzania with the goal of illuminating interventions to reduce inequalities in maternal health. Methods Analysis included 907 women who had given birth within two years preceding a survey of women of reproductive age. Multinomial logistic regression was used to assess the influence of maternal, household, and community-level characteristics on four alternative classes defining relative compliance with optimal configuration of maternal health care seeking behavior. Results Parity, wealth index, timeliness of ANC initiation, nearest health facility type, religion, and district of residence were significant predictors of maternal health care seeking when adjusted for other factors. Multiparous women compared to primiparous were less likely to seek care at the high level [RRR 0.16, 95 % confidence interval (CI) 0.06-0.46], at the mid-level (RRR 0.22, 95 % CI 0.09-0.58), and the mid-low level (RRR 0.27, 95 % CI 0.09-0.80). Women in the highest wealth index compared to those in the poorest group were almost three times more likely to seek the highest two levels of care versus the lowest level (high RRR 2.92, 95 % CI 1.27-6.71, mid-level RRR 2.71, 95 % 1.31-5.62). Conclusion Results suggest that efforts to improve the overall impact of services on the continuum of care in rural Tanzania would derive particular benefit from strategies that improve maternal health coverage among multiparous and low socioeconomic status women.
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Appiah AB, Tenkorang EY, Maticka-Tyndale E. Modeling Beliefs, Attitudes, and Intentions of Condom Use Among Secondary School Students in Kenya. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1949-1960. [PMID: 28451836 DOI: 10.1007/s10508-017-0966-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 02/06/2017] [Accepted: 02/17/2017] [Indexed: 06/07/2023]
Abstract
As in other parts of sub-Saharan Africa, youth in Kenya report low rates of condom use. Although several studies have explored reasons for the low condom use among Kenyan youth, not many have established linkages between lack of use and normative beliefs and attitudes around condoms. Using the Theory of Planned Behavior (TPB), this article examined whether beliefs and attitudes around condoms influenced intentions and actual condom use. Data for the study were restricted to 1453 sexually active youth during the last school break. Path analysis was used to examine the relationship between the TPB constructs and condom use among Kenyan youth. Results indicated a direct relationship between attitudes and condom use for male respondents and an indirect relationship between these two variables for females. Both males and females who expressed greater intentions to use condoms were significantly more likely to report they used condoms consistently. Also, male and female youth with higher perceived behavioral control were significantly more likely to have used condoms consistently. Males with friends who used condoms were significantly more likely to use condoms consistently. The findings suggest the importance of examining young people's attitudes toward condoms-in particular, those deeply rooted in misconceptions that serve to discourage safer sexual behaviors.
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Affiliation(s)
- Anna B Appiah
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
| | - Eleanor Maticka-Tyndale
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON, Canada
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Carlos S, Lopez-Del Burgo C, Burgueño E, Martinez-Gonzalez MA, Osorio A, Ndarabu A, Passabosc C, de Irala J. Male condom use, multiple sexual partners and HIV: a prospective case-control study in Kinshasa (DRC). AIDS Care 2016; 29:772-781. [PMID: 27852108 DOI: 10.1080/09540121.2016.1258450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the Democratic Republic of Congo no previous studies have assessed the factors associated with different patterns of condom use and with multiple sexual partners, and the association between condom use simultaneously taking into account multiple sexual partnerships, and HIV infection. We carried out a prospective case-control study. From December 2010 until June 2012, 1630 participants aged 15-49 getting HIV Voluntary Counseling and Testing in a hospital in Kinshasa were selected. Cases were new HIV diagnosis and controls were HIV-negative participants detected along the study period. We recruited 274 cases and 1340 controls that were interviewed about HIV-related knowledge, attitudes and behaviours. Among cases there was a high prevalence of multiple lifetime and concurrent sexual partnerships (89.8% and 20.4%, respectively) and most cases never used condoms with only 1.5% using them consistently. Condom use and multiple partnerships were associated with male, single and high-educated participants. An association was found between multiple lifetime partners and 'any condom use' (OR = 2.99; 95%CI: 2.14-4.19) but not with consistent use. Both having two or more multiple concurrent sexual partners or not using condoms were variables similarly and highly associated to HIV risk. The association found between having two or more concurrent sexual partners and HIV was slightly higher (OR = 3.58, 95%CI:2.31-5.56) than the association found between never condom use and HIV (OR = 3.38, 95%CI:1.15-9.93). We found a high prevalence of multiple lifetime sexual partners and an extremely high prevalence of inconsistent condom use, both strongly associated with HIV seropositivity. Local programmes would benefit from comprehensive interventions targeting all behavioural and sociocultural determinants.
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Affiliation(s)
- Silvia Carlos
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain
| | - Cristina Lopez-Del Burgo
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain
| | - Eduardo Burgueño
- d CEFA-Monkole , Kinshasa , Democratic Republic of the Congo.,e Department of Family Medicine and Primary Health Care , UPC - Protestant University in Congo, Kinshasa , Democratic Republic of the Congo
| | - Miguel Angel Martinez-Gonzalez
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,f CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Spanish Government (ISCIII) , Madrid , Spain
| | - Alfonso Osorio
- b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain.,g School of Education and Psychology , University of Navarra , Pamplona , Spain
| | - Adolphe Ndarabu
- h Monkole Hospital , Kinshasa, Democratic Republic of the Congo
| | - Clément Passabosc
- i Department of Ophthalmology , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Jokin de Irala
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain
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Tani K, Exavery A, Baynes CD, Pemba S, Hingora A, Manzi F, Phillips JF, Kanté AM. Unit cost analysis of training and deploying paid community health workers in three rural districts of Tanzania. BMC Health Serv Res 2016; 16:237. [PMID: 27391368 PMCID: PMC4938973 DOI: 10.1186/s12913-016-1476-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 06/24/2016] [Indexed: 11/18/2022] Open
Abstract
Background Tanzania, like other African countries, faces significant health workforce shortages. With advisory and partnership from Columbia University, the Ifakara Health Institute and the Tanzanian Training Centre for International Health (TTCIH) developed and implemented the Connect Project as a randomized cluster experimental trial of the childhood survival impact of recruiting, training, and deploying of a new cadre of paid community health workers (CHW), named “Wawazesha wa afya ya Jamii” (WAJA). This paper presents an estimation of the cost of training and deploying WAJA in three rural districts of Tanzania. Methods Costing data were collected by tracking project activity expenditure records and conducting in-depth interviews of TTCIH staff who have led the training and deployment of WAJA, as well as their counterparts at Public Clinical Training Centres who have responsibility for scaling up the WAJA training program. The trial is registered with the International Standard Randomized Controlled Trial Register number (ISRCTN96819844). Results The Connect training cost was US$ 2,489.3 per WAJA, of which 40.1 % was for meals, 20.2 % for accommodation 10.2 % for tuition fees and the remaining 29.5 % for other costs including instruction and training facilities and field allowance. A comparable training program estimated unit cost for scaling-up this training via regional/district clinical training centres would be US$ 833.5 per WAJA. Of this unit cost, 50.3 % would involve the cost of meals, 27.4 % training fees, 13.7 % for field allowances, 9 % for accommodation and medical insurance. The annual running cost of WAJA in a village will cost US$ 1.16 per capita. Conclusion Costs estimated by this study are likely to be sustainable on a large scale, particularly if existing regional/district institutions are utilized for this program.
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Affiliation(s)
- Kassimu Tani
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.
| | - Amon Exavery
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
| | - Colin D Baynes
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.,Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue (B2), New York, NY, 10032, USA
| | - Senga Pemba
- Tanzanian Training Centre for International Health, P.O. BOX 39, Ifakara, Tanzania
| | - Ahmed Hingora
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
| | - James F Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue (B2), New York, NY, 10032, USA
| | - Almamy Malick Kanté
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.,Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue (B2), New York, NY, 10032, USA
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McLellan-Lemal E, Gust DA, Gvetadze R, Furtado M, Otieno FO, Desai M, Zeh C, Samandari T, Nyagol B, Makanga EM. Characteristics of women screened for a contraceptive intravaginal ring study in Kisumu, Kenya, 2014. RESEARCH JOURNAL OF WOMEN'S HEALTH 2016; 3:1. [PMID: 27441094 PMCID: PMC4946642 DOI: 10.7243/2054-9865-3-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/30/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND HIV antiretroviral-based intravaginal rings with and without co-formulated contraception hold promise for increasing HIV prevention options for women. Acceptance of and ability to correctly and consistently use this technology may create challenges for future ring-based microbicide trials in settings where this technology has not been introduced. We examined baseline factors associated with enrolling in a contraceptive intravaginal ring study in Kisumu, Kenya and describe notional acceptability (willingness to switch to a contraceptive ring based solely on information received about it). METHODS Demographic, psychosocial, and behavioral eligibility screening of women 18-34 years was undertaken. Testing for pregnancy, HIV, and other sexually transmitted infections (STIs) was also conducted. We compared enrollment status across groups of categorical predictors using prevalence ratios (PR) and 95% confidence interval (CI) estimates obtained from a log-binomial regression model. RESULTS Out of 692 women pre-screened April to November 2014, 463 completed screening, and 302 women were enrolled. Approximately 97% of pre-screened women were willing to switch from their current contraceptive method to use the intravaginal ring exclusively for the 6-month intervention period. Pregnancy, HIV, and STI prevalence were 1.7%, 14.5%, and 70.4% respectively for the 463 women screened. Women 18-24 (PR=1.47, CI 1.15-1.88) were more likely to be enrolled than those 30-34 years of age, as were married/cohabitating women (PR=1.62, CI 1.22-2.16) compared to those separated, divorced, or widowed. In adjusted analyses, sexual debut at less than 17 years of age, one lifetime sexual partner, abnormal vaginal bleeding in the past 12 months, condomless vaginal or anal sex in the past 3 months, and not having a sexual partner of unknown HIV status in the past 3 months were predictive of enrollment. CONCLUSION High notional acceptability suggests feasibility for contraceptive intravaginal ring use. Factors associated with ring use initiation and 6-month use will need to be assessed.
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Affiliation(s)
- Eleanor McLellan-Lemal
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Deborah A. Gust
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Roman Gvetadze
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Melissa Furtado
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
- Engility Corporation, Atlanta, GA, USA
| | | | - Mitesh Desai
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Clement Zeh
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Kisumu, Kenya
| | - Taraz Samandari
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
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Kanté AM, Exavery A, Phillips JF, Jackson EF. Why women bypass front-line health facility services in pursuit of obstetric care provided elsewhere: a case study in three rural districts of Tanzania. Trop Med Int Health 2016; 21:504-14. [PMID: 26806479 DOI: 10.1111/tmi.12672] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In the Tanzanian health system, women are expected to first visit their nearest front-line health facility (FLF) for delivery. However, women frequently bypass these FLF. Our study estimates the extent of bypassing for childbirth and assesses factors associated with this behaviour. METHODS Data describing the experiences of 597 women who recently delivered at a facility and the EmONC service capability at 107 health facilities were collected in 2011. Women who did not deliver at their nearest FLF were considered 'bypassers'. Factors associated with bypassing were assessed using multivariate logistic regression models. Three sets of analyses were conducted: among 597 women who delivered at the first facility they visited, among 521 women with no previous complications, and among 407 women not primigravida and without previous complications. RESULTS More than 75.4% of women bypassed. In the fully adjusted model of all 597 women those who had experienced complications were more likely to bypass for delivery [OR = 6.31 (2.36, 16.86)]. In the fully adjusted model excluding women with previous complications, primigravida women were more likely to bypass [OR = 3.70 (1.71, 8.01)]. Fully adjusted models for each set of analysis found that, for each additional emergency obstetric and newborn care signal function (EmONC SF) available at the nearest FLF, women's odds of bypassing almost halved. CONCLUSIONS Bypassing is highly associated with EmONC SF score at nearest FLF, controlling for individual and community-level factors.
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Affiliation(s)
- A M Kanté
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.,Ifakara Health Institute, Dar-Es-Salaam, Tanzania
| | - A Exavery
- Ifakara Health Institute, Dar-Es-Salaam, Tanzania
| | - J F Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - E F Jackson
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Kanté AM, Chung CE, Larsen AM, Exavery A, Tani K, Phillips JF. Factors associated with compliance with the recommended frequency of postnatal care services in three rural districts of Tanzania. BMC Pregnancy Childbirth 2015; 15:341. [PMID: 26689723 PMCID: PMC4687308 DOI: 10.1186/s12884-015-0769-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 12/02/2015] [Indexed: 11/16/2022] Open
Abstract
Background High neonatal mortality persists in Tanzania. Rates of decline are slow, in part because postnatal care (PNC) services for addressing this problem remain severely underutilized. This study assesses factors associated with utilization of PNC among mothers in rural Tanzania. Methods This study analyzed household survey data collected in 2011 to understand health service utilization patterns among women of reproductive age and children less than 5 years of age in the Rufiji, Kilombero, and Ulanga districts of Tanzania. A total of 889 mothers were eligible for the current analysis. Multinomial logistic regression was used to determine factors associated with the likelihood of mothers seeking the WHO recommended PNC visits. Results The percent of newborns and their mothers with full PNC was low (10.4 %). Factors explaining PNC completion were district of residence, ethnic group, pregnancy wantedness, ANC attendance, place of delivery, and any incidence of newborn. Mothers of unwanted pregnancies were less likely to attend PNC services compared to mothers of wanted pregnancies [for at least two PNC: aRRR = 0.57, 95 % CI 0.35–0.94]. Sick newborns were more likely to receive PNC than newborns who were not sick during the first month after childbirth [for at least two PNC, aRRR = 3.52, 95 % CI 2.12–5.86]. Mothers who attended ANC services more frequently were more likely to receive PNC services compared to those who had attended fewer than 2 ANC services [for 1 PNC, aRRR = 1.89, 95 % CI 1.23–2.90]. Mothers who delivered at a health facility were less likely to attend PNC services compared to mothers who delivered outside a facility [for at least 2 PNC: aRRR = 0.42, 95 % CI 0.26–0.76]. Model with interactions between ANC attendance and place of delivery shown that only ANC attendance had a positive and statistically significant effect on PNC visit. Conclusion To achieve the WHO recommended number of PNC in rural Tanzania, our findings suggest the need to provide PNC through the community-based primary health care. Efforts to improve coverage of PNC should include expanding health education and counseling during childbirth and neonatal period to more effectively advocate PNC for newborns perceived to be healthy.
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Affiliation(s)
- Almamy M Kanté
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA. .,Ifakara Health Institute, PO Box 78373, Mikocheni, Dar es Salaam, Tanzania.
| | - Christine E Chung
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
| | - Anna M Larsen
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
| | - Amon Exavery
- Ifakara Health Institute, PO Box 78373, Mikocheni, Dar es Salaam, Tanzania.
| | - Kassimu Tani
- Ifakara Health Institute, PO Box 78373, Mikocheni, Dar es Salaam, Tanzania.
| | - James F Phillips
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
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Abstract
OBJECTIVES To examine levels, trends and correlates of childbearing in childhood (CiC) in the Rufiji district of Tanzania from 2002 to 2010. METHODS Using longitudinal data collected in, and by, the Rufiji health and demographic surveillance system in Tanzania from 2002 to 2010, all women who initiated childbearing in this period (n = 5491) were selected for analysis. CiC was defined as childbearing initiation before age 18. Data analysis involved one-way tabulations of each variable-most of which were socio-demographic-to obtain frequency distributions, cross-tabulations of CiC and each of the independent variables with a Chi square test for associations, and multivariate analysis using multilevel logistic regression to examine covariates of CiC. RESULTS CiC was 44 % and remained constant over the 2002-2010 period (P = 0.623). The relative odds of CiC was significantly reduced by 83 percent among women with secondary or higher educational attainment relative to CiC among uneducated women (OR = 0.17, CI 0.12-0.23). Moreover, the odds of CiC significantly declines monotonically as relative household wealth increases by quintile (OR = 0.70, CI 0.57-0.86). CiC also declines significantly with employment and marital status of the respondent. CONCLUSIONS CiC represents a challenging social and health problem. Forty-four percent of first time mothers in Rufiji district of Tanzania are of childhood age, and this has not changed over the past 9 years since 2002. Prioritizing girls' formal education-especially up to secondary level or higher-as well as devising some economic empowerment modalities, may be worthwhile measures towards curbing CiC in the study area.
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Exavery A, Kanté AM, Hingora A, Phillips JF. Determinants of early initiation of breastfeeding in rural Tanzania. Int Breastfeed J 2015; 10:27. [PMID: 26413139 PMCID: PMC4582933 DOI: 10.1186/s13006-015-0052-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/17/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Breastfeeding is widely known for its imperative contribution in improving maternal and newborn health outcomes. However, evidence regarding timing of initiation of breastfeeding is limited in Tanzania. This study examines the extent of and factors associated with early initiation of breastfeeding in three rural districts of Tanzania. METHODS Data were collected in 2011 in a cross-sectional survey of random households in Rufiji, Kilombero and Ulanga districts of Tanzania. From the survey, 889 women who had given birth within 2 years preceding the survey were analyzed. Both descriptive and inferential statistical analyses were conducted. Associations between the outcome variable and each of the independent variables were tested using chi-square. Logistic regression was used for multivariate analysis. RESULTS Early initiation of breastfeeding (i.e. breastfeeding initiation within 1 h of birth) stood at 51 %. The odds of early initiation of breastfeeding was significantly 78 % lower following childbirth by caesarean section than vaginal birth (adjusted odds ratio (OR) = 0.22; 95 % confidence interval (CI) 0.14, 0.36). However, this was almost twice as high for women who gave birth in health facilities as for those who gave birth at home (OR = 1.75; 95 % CI 1.25, 2.45). Furthermore, maternal knowledge of newborn danger signs was negatively associated with early initiation of breastfeeding (moderate vs. high: OR = 1.73; 95 % CI 1.23, 2.42; low vs. high: OR = 2.06; 95 % CI 1.43, 2.96). The study found also that early initiation of breastfeeding was less likely in Rufiji compared to Kilombero (OR = 0.52; 95 % CI 0.31, 0.89), as well as among ever married than currently married women (OR = 0.46; 95 % CI 0.25, 0.87). CONCLUSIONS To enhance early initiation of breastfeeding, using health facilities for childbirth must be emphasized and facilitated among women in rural Tanzania. Further, interventions to promote and enforce early initiation of breastfeeding should be devised especially for caesarean births. Women residing in rural locations and women who are not currently married should be specifically targeted with interventions aimed at enhancing early initiation of breastfeeding to ensure healthy outcomes for newborns.
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Affiliation(s)
- Amon Exavery
- />Ifakara Health Institute, Plot 463, Kiko Avenue, P.O. Box 78373, Mikocheni, Dar es Salaam Tanzania
| | - Almamy Malick Kanté
- />Ifakara Health Institute, Plot 463, Kiko Avenue, P.O. Box 78373, Mikocheni, Dar es Salaam Tanzania
- />Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA
| | - Ahmed Hingora
- />Ifakara Health Institute, Plot 463, Kiko Avenue, P.O. Box 78373, Mikocheni, Dar es Salaam Tanzania
| | - James F. Phillips
- />Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA
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Kanté AM, Gutierrez HR, Larsen AM, Jackson EF, Helleringer S, Exavery A, Tani K, Phillips JF. Childhood Illness Prevalence and Health Seeking Behavior Patterns in Rural Tanzania. BMC Public Health 2015; 15:951. [PMID: 26399915 PMCID: PMC4581421 DOI: 10.1186/s12889-015-2264-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 09/13/2015] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION This paper identifies factors influencing differences in the prevalence of diarrhea, fever and acute respiratory infection (ARI), and health seeking behavior among caregivers of children under age five in rural Tanzania. METHODS Using cross-sectional survey data collected in Kilombero, Ulanga, and Rufiji districts, the analysis included 1,643 caregivers who lived with 2,077 children under five years old. Logistic multivariate and multinomial regressions were used to analyze factors related to disease prevalence and to health seeking behavior. RESULTS One quarter of the children had experienced fever in the past two weeks, 12.0 % had diarrhea and 6.7 % experienced ARI. Children two years of age and older were less likely to experience morbidity than children under one year [ORfever = 0.77, 95 % CI 0.61-0.96; ORdiarrhea = 0.26, 95 % CI 0.18-0.37; ORARI = 0.60 95 % CI 0.41-0.89]. Children aged two and older were more likely than children under one to receive no care or to receive care at home, rather than to receive care at a facility [RRRdiarrhea = 3.47, 95 % CI 1.19-10.17 for "No care"]. Children living with an educated caregiver were less likely to receive no care or home care rather than care at a facility as compared to those who lived with an uneducated caregiver [RRRdiarrhea = 0.28, 95 % CI 1.10-0.79 for "No care"]. Children living in the wealthiest households were less likely to receive no care or home care for fever as compared to those who lived poorest households. Children living more than 1 km from health facility were more likely to receive no care or to receive home care for diarrhea rather than care at a facility as compared to those living less than 1 km from a facility [RRRdiarrhea = 3.50, 95 % CI 1.13-10.82 for "No care"]. Finally, caregivers who lived with more than one child under age five were more likely to provide no care or home care rather than to seek treatment at a facility as compared to those living with only one child under five. CONCLUSIONS Our results suggest that child age, caregiver education attainment, and household wealth and location may be associated with childhood illness and care seeking behavior patterns. Interventions should be explored that target children and caregivers according to these factors, thereby better addressing barriers and optimizing health outcomes especially for children at risk of dying before the age of five.
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Affiliation(s)
- Almamy M Kanté
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA. .,Ifakara Health Institute, PO Box 78373, Dar es Salaam, Mikocheni, Tanzania. .,Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, CH-4002, Switzerland. .,University of Basel, Petersplatz 1, Basel, CH-4003, Switzerland.
| | - Hialy R Gutierrez
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
| | - Anna M Larsen
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
| | - Elizabeth F Jackson
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
| | - Stéphane Helleringer
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Amon Exavery
- Ifakara Health Institute, PO Box 78373, Dar es Salaam, Mikocheni, Tanzania.
| | - Kassimu Tani
- Ifakara Health Institute, PO Box 78373, Dar es Salaam, Mikocheni, Tanzania.
| | - James F Phillips
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
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Exavery A, Kanté AM, Tani K, Hingora A, Phillips JF. Sociodemographic drivers of multiple sexual partnerships among women in three rural districts of Tanzania. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2015; 7:105-13. [PMID: 25914557 PMCID: PMC4399694 DOI: 10.2147/hiv.s76694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background This study examines prevalence and correlates of multiple sexual partnerships (MSP) among women aged 15+ years in Rufiji, Kilombero, and Ulanga districts of Tanzania. Materials and methods Data were collected in a cross-sectional household survey in Rufiji, Kilombero, and Ulanga districts in Tanzania in 2011. From the survey, a total of 2,643 sexually active women ages 15+ years were selected for this analysis. While the chi-square test was used for testing association between MSP and each of the independent variables, logistic regression was used for multivariate analysis. Results Number of sexual partners reported ranged from 1 to 7, with 7.8% of the women reporting multiple sexual partners (2+) in the past year. MSP was more likely among both ever married women (adjusted odds ratio [AOR] =3.83, 95% confidence interval [CI] 1.40–10.49) and single women (AOR =6.13, 95% CI 2.45–15.34) than currently married women. There was an interaction between marital status and education, whereby MSP was 85% less likely among single women with secondary or higher education compared to married women with no education (AOR =0.15, 95% CI 0.03–0.61). Furthermore, women aged 40+ years were 56% less likely compared to the youngest women (<20 years) to report MSP (AOR =0.44, 95% CI 0.24–0.80). The odds of MSP among Muslim women was 1.56 times as high as that for Christians women (AOR =1.56, 95% CI 1.11–2.21). Ndengereko women were 67% less likely to report MSP compared to Pogoro women (AOR =0.33, 95% CI 0.18–0.59). Conclusion Eight percent of the women aged 15+ in Rufiji, Kilombero, and Ulanga districts of Tanzania are engaged in MSP. Encouraging achievement of formal education, especially at secondary level or beyond, may be a viable strategy toward partner reduction among unmarried women. Age, religion, and ethnicity are also important dimensions for partner reduction efforts.
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Affiliation(s)
- Amon Exavery
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Almamy Malick Kanté
- Ifakara Health Institute, Dar es Salaam, Tanzania ; Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, new York, NY, USA ; Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - James F Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, new York, NY, USA
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Saenz Soto NE, Benavides-Torres RA, Dimmitt Champion J. Attachment and associated sexual health behaviors of heterosexual Mexican housewives. Issues Ment Health Nurs 2015; 36:258-65. [PMID: 25988376 DOI: 10.3109/01612840.2014.978423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sexually transmitted infections including human immunodeficiency virus are international public health concerns. Heterosexual women who are in steady relationships have been described as a particularly vulnerable population at risk for sexually transmitted infections acquired from their male partners. In this pilot study, we describe associations identified via cross-sectional survey among demographic variables, attachment style, and condom use in Mexican heterosexual women (ages 20-44 years, n = 50) who self-reported current steady partner relationships. Descriptive, bivariate, and correlation analyses were conducted. Secure attachment and condom use were positively correlated with education level. Limited sexual risk prevention knowledge and contraception use, low risk perception within male partner relationships and misconception about proper condom use were identified as sources of elevated risk for sexually transmitted infections via male partners. Implications of findings include sexual health intervention modification to include dialogue concerning the context of steady relationship and sexual risk among Mexican heterosexual women.
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Affiliation(s)
- Norma Elva Saenz Soto
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Monterrey, Mexico
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Sankoh O, Arthur S, Nyide B, Weston M. Prevention, treatment and future challenges of HIV/AIDS: A decade of INDEPTH research. HIV & AIDS REVIEW 2015. [DOI: 10.1016/j.hivar.2014.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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