Exploring condom use decision-making among adolescents: the synergistic role of affective and rational processes

HIV and sexual risk behaviours by 18-25-year-old youth at Nyandeni Municipality in the Eastern Cape

Background

The human immunodeficiency virus (HIV) epidemic in South Africa is among the worst in the world; in 2017, 38% of new infections were among young people aged 15-24 years. Estimates for HIV infection in 2020 worldwide indicate that there will be 1.5 million new cases, 10.2 million untreated cases (out of 37.7 million), and 680 000 deaths from acquired immunodeficiency syndrome (AIDS). Despite a 46% decline in new HIV infections among adolescents and youth over the previous 10 years, two of the seven new HIV infections in 2019 occurred in people between the ages of 15 and 24. HIV prevalence among young people has remained unchanged since 2008. This consistent pattern among people under 30 years of age indicates a failure in HIV prevention.

Aim

The study aimed to explore HIV and sexual risk behaviours by 18-25-year-old youth at Nyandeni Municipality in the Eastern Cape province.

Setting

The investigation was conducted Nyandeni Municipality in the Eastern Cape province.

Methods

Qualitative approach was used to explore, describe and investigate the knowledge and attitudes about HIV among the 18-25 years old youth.

Results

The findings are based on three themes namely, knowledge and attitudes about HIV and AIDS in youth, sexual risk behaviour among youth, and HIV prevention strategies.

Conclusion

This exploratory investigation confirms that the participants' knowledge is limited by showing that most of them knew very little about HIV and AIDS infection and prevention. Ongoing educational initiatives are required.

Contribution

Youth experience high HIV incidence because of their knowledge gaps.

Adolescent girls' perceptions regarding the use of contraceptives in Ekurhuleni District, Gauteng

Background

Unintended pregnancies pose various challenges for adolescent girls and can be prevented through contraceptive use. However, contraceptive use among adolescents is lower compared to among older women.

Aim

To describe adolescent girls' perceptions of the use of contraceptives.

Setting

Two high schools in Tembisa were selected as the study setting.

Methods

Purposive sampling was used to select adolescent girls who had reached menarche and were willing to participate. Data collection involved narrative writing for girls under 16 and interviews for older adolescents. Braun and Clark's six-step method was used for data analysis.

Results

A total of 35 adolescent girls were identified, and the final sample size was N = 33 adolescent girls whose ages ranged from 13 to 18 years. Two main themes emerged. Theme 1 was positive perceptions of contraceptives. Theme 1 was supported by two subthemes: the first was the influence of the male partner; the second was financial constraints in families. The second theme was negative perceptions of contraceptives. Four subthemes supported the second main theme, which were: myths and misconceptions, influence of parents, healthcare worker attitudes and negative attitudes of community members.

Conclusion

Addressing the low contraceptive uptake among adolescent girls requires understanding their perceptions to tailor interventions accordingly.

Contribution

The study contributes by highlighting the negative perceptions of contraceptive use, including family financial constraints and the influence of male partners. These findings can inform reproductive health initiatives aimed at increasing contraceptive use among adolescents.

Predictors of Condom Use among College Students

Consistent condom use is recognized as one of the most effective strategies to prevent unwanted pregnancies and sexually transmitted infections. Despite their effectiveness, condoms remain fairly well used among younger people. The conception of appropriate measures to change behaviors needs a deep understanding of the factors underlying poor adherence to condom use. This study aims to identify the predictors of condom use among college students. A cross-sectional, correlational, and predictive study was conducted involving a convenience sample of 1946 university students, with an average age of 21 years (20.74 ± 2.32). Pender's Health Promotion Model (HPM) was used as a conceptual and methodological framework to understand the relationship between the predictors of condom use. An explanatory theoretical model of condom use behavior was established using path analysis. Condom use among young people is infrequent, with only 39.4% of respondents reporting consistent use. Perceived benefits, positive feelings, and interpersonal influences emerged as variables with the most explicitly positive influence on the commitment to condom use, a trend confirmed for both sexes. Commitment was the strongest predictor of condom use behavior (β = 0.580; p < 0.001). Pender's HPM is effective in explaining the relationships between the predictors of condom use.

Creating allies: qualitative exploration of young women's preferences for PrEP methods and parents' role in PrEP uptake and user support in urban and rural Zambia

BACKGROUND

Zambian adolescent girls and young women (AGYW) have high HIV incidence and face barriers to the use of pre-exposure prophylaxis (PrEP). Parental support improves PrEP use and adherence in some settings, but negative parental attitudes toward HIV prevention may inhibit engagement with AGYW. We explored perceptions of future PrEP methods among AGYW and parents and parent-youth engagement on HIV prevention and PrEP use.

METHODS

We conducted a qualitative descriptive study among AGYW and parents of AGYW in five provinces in Zambia in September-October 2021. We conducted 10 focus group discussions (FGDs) and four in-depth interviews (IDIs) with AGYW participants (n = 87) and seven FGDs and four IDIs among parents of AGYW (n = 62). All FGDs and IDIs were audio-recorded, transcribed verbatim, and analyzed to identify qualitative themes.

RESULTS

Most AGYW participants preferred the discreet nature and longer duration of injectable PrEP compared to the PrEP ring and oral PrEP. Many AGYWs reported inability to disclose PrEP use to their parents due to lack of parental support based on cultural taboos against premarital sex. Nevertheless, AGYW participants said they would like to talk to their parents about PrEP so their parents could support their use. Many parents also described difficulties discussing PrEP with their daughters because of cultural and religious beliefs about abstinence from sex before marriage. However, parents acknowledged that the threat of HIV is real and said they need PrEP knowledge and guidance on speaking with their children about HIV prevention and PrEP.

CONCLUSIONS

Although many parents are currently not playing a role in daughters' decisions about PrEP use, both parents and AGYW are willing to engage with each other on HIV prevention issues. To foster parent-child engagement, HIV prevention programs should not only provide information about PrEP but also address social norms that impede discussion of HIV prevention and equip both parents and AGYW with skills and support for such conversations. Community sensitization is also needed as new PrEP products are introduced, to create an enabling environment for parent-child engagement by increasing awareness, countering misconceptions, and reducing stigma.

Long-acting reversible contraception and condom use: A cohort study of female adolescents and young adults in New York City

OBJECTIVES

This study aimed to determine whether condom use varied between adolescents and young women using long-acting reversible contraception (LARC) vs non-LARC hormonal methods and assess if the initiation of LARC was associated with lower condom use.

STUDY DESIGN

This study used data from a large longitudinal study of sexually active females aged 13-25 years. Questionnaires assessed contraception, condom use, sexual history, and partner characteristics at the baseline visit and every 6 months. Log-binomial regression analyses examined associations between hormonal contraceptive methods and condom use, and the moderating effects of age and number of sexual partners. Exploratory analyses compared condom use based on partner characteristics.

RESULTS

Of 1512 participants, 1116 reported LARC or non-LARC hormonal method use during any study visit. Among baseline and new LARC users, 75.7% and 84.7% reported intrauterine device (IUD) use, respectively. Condom use at baseline among hormonal non-LARC users (37.5%) was significantly higher (p < 0.01) than LARC users (23.5%). Condom use among LARC vs non-LARC users was moderated by age in that LARC was associated with lower condom use among participants aged 13-18 years, but not those aged 19-25 years. Number of sexual partners was not a significant moderator. Among participants with increased sexually transmitted infection (STI) risk based on partner characteristics, LARC users had lower condom use compared to non-LARC users.

CONCLUSIONS

Condom discontinuation was common following initiation of LARC and hormonal non-LARC methods. However, condom use was lower in LARC users at baseline, among younger adolescents, and if partners had risk factors for STIs.

IMPLICATIONS

Condom discontinuation following initiation of highly effective contraception increases the risk of STI. Young women using LARC may be at greater risk than non-LARC users given lower condom use despite having partners with risk factors for STIs. Condom use counseling for STI protection is critical for adolescents.

Motivators and Influencers of Adolescent Girls' Decision Making Regarding Contraceptive Use in Four Districts of Zambia

Low contraceptive use in sub-Saharan Africa, and Zambia specifically, negates the potential benefits of contraception in preventing unwanted and early pregnancies. This study aimed to explore and understand the motivators and influencers of adolescent girls' contraceptive decision making. Using thematic analysis, we analysed qualitative data from seven focus group discussions and three key informant interviews with adolescent girls aged 15 to 19 years in four Zambian districts. The data were managed and organised using NVivo version 12 pro (QSR International). Fear of pregnancy, fear of diseases, fear of having more children, and spacing of children (especially among married adolescents) were key motivators for adolescents' contraceptive use. Friends and peers motivated them to use contraceptives while fear of side effects and fear of infertility drove non-use. Peer pressure and fear of mocking by their friends were important deterrents to contraceptive use. Parents, peers and friends, family members, partners, churches, and religious groups influenced adolescent girls' contraceptive decisions. Mixed messages from these influencers, with some in favour and others against contraceptives, make adolescents' decisions to use contraceptives complex. Therefore, interventions targeting increased contraceptive use should be all-inclusive, incorporating multiple influencers, including at institutional and policy levels, to empower adolescents and give them autonomy to make contraceptive decisions.

Perceived motivators, knowledge, attitude, self-reported and intentional practice of female condom use among female students in higher training institutions in Dodoma, Tanzania

BACKGROUND

Unplanned pregnancies and sexually transmitted infections (STIs) Human Immunodeficiency Virus (HIV) inclusive, have remained to be a significant public health challenges among young people, especially across middle and low-income countries. Self-efficacy on the right ways of using condoms appears to be effective against the aforementioned health-related problems. However, most women of reproductive age tend not to use them when they are using highly effective contraceptives such as implants, and/or injectable hormones. It is unknown whether the uptake of female condoms among young girls is significantly high or not. Examining female students' perceived motivators, knowledge, attitudes, and self-reported and intentional female condom practice in training institutions seems to be a key precursor in addressing the challenge.

METHODS

The institutional-based analytical cross-sectional survey in a quantitative research approach was adopted to study 384 randomly selected female students from higher training institutions, in Tanzania. Interviewer-administered structured questionnaires from previous studies were the main data collection tools. Data analysis was done using a statistical package for social science (SPSS) with the strength of statistical limits set at a 95% confidence interval and a 5% significance level.

RESULTS

The response rate of the study was 100% with 24 ± 2.122 years respondents' mean age while and 32.7% of them were in the third year of their studies. Only 6.2% of the respondents reported having used female condoms while 26.3% of them have not ever seen packages of female condoms. The minority of the respondents (21.7%, 23.3%, and 9.4%) demonstrated good knowledge, positive attitude, and intention to use female condoms respectively. Their age, accommodation, marital status, peer groups, previous training, knowledge, and attitude related significantly to their intentional practices of female condom use (p < 0.05).

CONCLUSION

Given the existing governmental and non-governmental efforts that advocate awareness creation and the uptake of various contraceptives, this study has found that knowledge, attitude, self-reported and intentional practices of female students admitted in higher training institutions within Dodoma region, Tanzania is low. Institutionalized educational programs on sexual and reproductive health matters may need to be prioritized to increase the availability, accessibility, and uptake of female condoms among female students in higher training institutions.

Sexual abstinence as a reproductive health-promoting behavior for women: A perspective

This article is intended to provide an appropriate context for adopting sexual abstinence from a health-promoting behavioral perspective that can be applied to women of reproductive age worldwide to improve reproductive health, maintain well-being, and prevent health problems in women. The topics related to women's health status, sexual abstinence definitions, benefits, and application, as well as sexual autonomy and efficacy, including family collaboration, are discussed. This article will provide health care providers, especially nurses and midwives, with new ideas for integrating sexual abstinence into nursing and midwifery practice.

The Interaction between Basic Psychological Needs, Decision-Making and Life Goals among Emerging Adults in South Africa

The interaction between emerging adult psychological well-being and decision-making, in South Africa, has not been explicitly explored in Self-Determination Theory. Life goals have been thought to play a role in the interaction between basic psychological needs and decision-making to promote psychological well-being. The current study, therefore, aimed to examine whether the decision-making styles employed, and the life goals which were deemed important, contribute to the understanding of the satisfaction or frustration of the basic psychological needs of emerging adults in South Africa. Data were collected cross-sectionally, using a secure, online survey among 1411 participants. The interaction between decision-making, life goals and basic psychological needs variables were examined using descriptive statistics, Pearson correlations and hierarchical regression analyses. The results in the study suggest that adaptive (vigilant) decision-making and intrinsic life goals were significant predictors for the satisfaction of the basic psychological needs. Some forms of maladaptive decision-making and extrinsic goals were predictors of the frustration of basic psychological needs. The variance explained by the various models were between 15.6–32.6%, with the results suggesting all models were significant. The results provide a novel contribution to emerging adult well-being in South Africa and Self-Determination Theory, with the implications for society, research and practice discussed.

“Compared to COVID, HIV Is Nothing”: Exploring How Onshore East Asian and Sub-Saharan African International Students in Sydney Navigate COVID-19 versus BBVs/STIs Risk Spectrum

Background: While a large body of evidence indicates changes in alcohol and other drug use among young people as a result of the COVID-19 pandemic, there is a lack of evidence around changes in sexual practices and how the pandemic may be impacting the potential spread of blood-borne viruses and sexually transmissible infections (BBVs/STIs). Most of what we know about sex during COVID-19 lockdowns is largely based on solitary sexual practices, which may not answer the critical question around how the pandemic may be shaping sexual practices among young people. Against this backdrop, this study explored how the COVID-19 pandemic may be shaping BBVs/STIs risk and protective practices among a sample of onshore African and Asian international students in Sydney, Australia. Methods: This phenomenological qualitative study involved semi-structured telephone and face-to-face interviews with 16 international university students in Sydney, between September 2020–March 2021. Generated data were coded using NVivo and analysis was guided by reflexive thematic analysis. Results: Participants reported elevated mental health distress because of the COVID-19 pandemic. Some participants reported engaging in casual sexual hook-ups as a strategy to mitigate the mental health distress they were experiencing. Some of these sexual hook-ups were condomless partly because COVID-related disruptions impacted condom accessibility. Additionally, the preventive practices of some participants who were sexually active during the lockdowns were focused on preventing COVID-19, while the risk of BBVs/STIs were downplayed. Conclusions: This study indicates a need for a comprehensive public health response to the evolving and near-endemic COVID-19 situation. Such a comprehensive approach should focus on empowering young people to prevent both SARS-CoV-2 and BBVs/STIs.