Condom use at last sex by young men in Ethiopia: the effect of descriptive and injunctive norms

Condom use increased after a peer group intervention implemented by community volunteers in Malawi

BACKGROUND

HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi.

METHODS

Three communities sequentially rolled out the program. Effectiveness was evaluated using a stepped wedge design. Repeated surveys 11-13 months apart were conducted between 2016 and 2019. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 771) and condom use at last sex (N = 880). The analytical sample included all sexually active persons answering that question at one or more time points. Mixed-effects cumulative logit and Generalized Estimating Equation (GEE) models were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication.

RESULTS

This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final adjusted models with non-significant factors removed, condom use in the last two months increased for the intervention group vs. control group [Time 2: Adjusted Odds Ratio (AOR) = 1.59 (1.15, 2.21); Time 3: AOR 2.01 (1.23, 3.30)]. Similarly, condom use at last sex increased for the intervention group vs. control group [Time 2: AOR = 1.48 (1.08, 2.03); Time 3: AOR 1.81 (1.13, 2.90)]. Other significant predictors of greater condom use were also described. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use.

CONCLUSIONS

In this community-engaged implementation study, an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Community ownership and program delivery by trained volunteers offer an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening healthcare systems in sub-Saharan Africa.

TRIAL REGISTRATION

Clinical Trials.gov NCT02765659 Registered May 6, 2016.

The Role of Collective Group Orientation and Social Norms on Physical Distancing Behaviors for Disease Prevention

To reduce the impact of communicable diseases like COVID-19, collective action is required and likely to be susceptible to normative influence as well as whether people are more or less collectively oriented. We extend the theory of normative social behavior (TNSB) to account for group orientation and predict the relationships between social norms and physical distancing behaviors. Using a rolling cross-sectional design during 17 weeks of the pandemic, a national sample of US residents from 20 states (N = 8,778) participated in the study. The findings show that perceived descriptive norms, injunctive norms, and group orientation are significantly associated with physical distancing. The descriptive norm-behavior relationship and injunctive norm-behavior relationship are moderated by group orientation and the other predicted moderators in the TNSB. The findings extend the TNSB and highlight the need to understand social norms and group orientation in formative research for health communication campaigns designed to promote prevention behaviors.

Condom use increased after a peer group intervention implemented by community volunteers in Malawi

Background

HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi.

Methods

Three communities sequentially rolled out the program. Effectiveness was evaluated using repeated surveys. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 776) and condom use at last sex (N = 880). For each indicator, the sample included all sexually active persons answering that question at one or more time points. Regression analyses were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication.

Results

This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final regression models. Other predictors of greater condom use for at least one condom use indicator included younger age group (13-19), male gender, not married/cohabiting, high involvement in religiously affiliated activities, higher safer sex self-efficacy, and greater partner communication. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use.

Conclusions

This community engaged implementation study found that an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Leveraging community strengths and human capital resources facilitated implementation of this effective HIV prevention program in rural Malawi. Community ownership and program delivery by trained local volunteers offers an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening heathcare systems in sub.

Trial registration

Clinical Trials.gov NCT02765659 Registered May 6, 2016.

Predictors of Condom Use Among Youth of the Rural Tigray, Northern Ethiopia: Community-Based Cross-Sectional Study

Background

Condom is one of the most commonly used and cost-effective HIV preventive measures, particularly in low-income countries. Despite the proven effect of condoms for STI/HIV prevention, there are limited data on its utilization. Hence, this community-based study aimed to assess the level and determinant factors of condom utilization among the youth of the rural Tigray.

Methods

This study was part of a large community-based cross-sectional study conducted to assess the utilization of adolescent and youth-friendly health services among randomly selected 631 youth aged 15-24 years from May 23 to June 30, 2018. We used 273 youth who reported having a history of sexual activity during the study period. The data were collected using an interviewer-administered structured questionnaire. Logistic regression analysis was used to determine the independent predictors of the outcome variable and the level of significance was declared at a P-value of <0.05.

Results

A total of 273 participants were included in the study. The mean age (+SD) of the respondents was 19.14 (±2.74) years. Only one-third (35.2%) of the respondents used a condom during their last sexual encounter and 51 (53.1%) of them used it consistently. Being married (AOR = 0.17; 95% CI: 0.04, 0.60), respondent's partner attained primary education (AOR = 0.14; 95% CI: 0.04, 0.50), and having multiple sexual partners (AOR = 6.97; 95% CI: 2.09, 23.20) were found to be the determinants of condom utilization.

Conclusion

The study participants had a low level of condom utilization. Social and sexual related factors were the major predictors of condom use among the youth. Therefore, focused interventions need to be designed specifically to strengthen condom promotion campaigns.

A systematic review and meta-analysis of sexually transmitted infection prevention practices among Ethiopian young people

Objective

Approximately 178.5 million new cases of treatable sexually transmitted infections are thought to be diagnosed each year among young people worldwide who are between the ages of 15 and 24 years. The results regarding sexually transmitted infection prevention studies in Ethiopia are not consistent. Therefore, the objective of this systematic review and meta-analysis was to determine the pooled prevalence of sexually transmitted infection prevention methods among young people in Ethiopia.

Methods

The systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Between 5 January and 18 May 2022, published studies were searched using online databases such as PubMed, CINAHL, African Online Journal, and Google Scholar. The quality of the study was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. A random-effects model was used for the statistical analysis using STATA version 14 software.

Results

A total of 3331 studies were searched, and five studies with a total of 1925 participants were included in the final meta-analysis. The pooled prevalence of preventive practice toward sexually transmitted infections was 54% (95% confidence interval: 44, 64). According to a subgroup analysis based on regional state, the prevalence was highest in the southern region, at 66% (95% CI: 59, 73), and lowest in the Amhara region, at 42% (95% confidence interval: 38, 45). Institution-based studies had high heterogeneity, according to a subgroup analysis based on study setting (I ² = 95.39%, p value 0.001).

Conclusion

Almost one in every two young people is engaged in preventive practices. This is lower than the World Health Organization global health sector strategy target (70%) for sexually transmitted infections. A subgroup analysis based on regional state and study setting showed a variation in the prevalence of preventive practices and significant heterogeneity among the regions.

Using structural equation modeling to examine the influence of family planning social norms on modern contraceptive use in Nigeria

Despite high knowledge of family planning (FP) among Nigerian women, use of modern contraceptives remains low. While FP investments in Nigeria have been ongoing for decades, relatively little emphasis on contextual and structural factors may have contributed to low demand for and use of contraception. From 2009 to 2014, the Bill & Melinda Gates Foundation (BMGF) supported the Nigerian Urban Reproductive Health Initiative (NURHI) with the aim of increasing voluntary use of contraceptives among women ages 15-49 years in six Nigerian cities. A subsequent phase of NURHI was implemented in three states for the next 3 to 5 years. Using cross-sectional survey data from three cities (two exposed to NURHI, one not exposed), this study examines whether social norms around FP were related to women's use of modern contraception, and whether the relationship differed by varying levels of exposure to the program (i.e., by city). We identified three distinct FP social norms through factor analysis: norms around delaying first pregnancy; spacing or limiting pregnancies; and using contraception when the husband disagrees. Using structural equation modeling, we found that FP social norms are related to use of modern contraceptive methods, and the relationship varies by city and norm type. The observed differences suggest that this relationship depends on numerous factors at the individual, interpersonal and societal level, and this may include malleable factors influenced by the NURHI program.

Validation and Assessment of a Tool to Measure Psychosocial Readiness to Use Modern Contraceptives among Women in Tigray, Ethiopia

Social norms, beliefs, and attitudes around modern contraception (MC) use can influence the decision to take up a method, but susceptibility to these factors varies between individuals. The effect of psychosocial readiness to use MC at the individual level is not established for women in Ethiopia. Data from 349 women were used for validity and reliability testing of a 12-item MC psychosocial readiness scale. A rating-scale Rasch model tested for unidimensionality, rating scale functioning, and construct and content validity. Multiple linear regression assessed the effect of respondent characteristics on MC psychosocial readiness scores. The psychometric properties of the univariate MC psychosocial readiness scale were satisfactory after the stepwise removal of two items. Prior MC use, socioeconomic status, geographic zone, and education were significantly associated with increased endorsement of MC psychosocial readiness. The 10-item scale measures the extent of endorsement of MC psychosocial readiness for childbearing women in Tigray, Ethiopia. Further research should qualitatively explore the identified influence of education on MC psychosocial readiness.

Determinants of condom use during last sexual intercourse among male college youth of Kaski, Nepal: A cross-sectional survey

Background

The National Family Planning program of Nepal has introduced the condom as an important family planning method. Despite the continuous effort from the public and private sectors at various levels, its use among youth remains low. Therefore, this study aimed to assess the factors associated with condom use during the last sexual intercourse among male college youth.

Methods

We conducted a cross-sectional study and analyzed the responses of 361 male college youth (aged 19 to 24 years who reported being sexually active preceding six months of the survey), among the 903 participants who reported being involved in vaginal and anal sexual intercourse. The chi-square test was primarily used to find the associated factors and then, stepwise logistic regression was performed by selecting the covariates after the multicollinearity test followed by adjustment of confounders.

Results

We found that more than one-fourth (27.4%) of the sexually active male youth had used the condoms during their last sexual intercourse. Postgraduate male youth were four times more likely to use the condoms during the last sexual intercourse than undergraduate male youth (AOR = 4.09, 95% CI; 2.08–8.06). Similarly, married youth were less likely to use the condoms during the last sexual intercourse with 95% lower odds than their counterparts (AOR = 0.05, 95% CI; 0.01–0.38). Male youth with adequate knowledge about the condoms were 8 times more likely to use them compared to those with inadequate knowledge (AOR = 8.42, 95% CI; 4.34–16.33). Likewise, male youth with favorable attitude towards the condoms were 2.5 times more likely to use them compared to their counterparts (AOR = 2.58, 95% CI; 1.23–5.42). Similarly, male youth having two or more sex partners were 4.5 times more likely to use the condoms than the youth having only a sex partner (AOR = 4.57, 95% CI; 2.38–8.76).

Conclusion

The study concluded that slightly more than one-fourth (27.4%) of male college youth in Kaski district used the condoms during their last sexual intercourse. Level of education, marital status, knowledge about condoms, attitude toward condoms, and number of sex partners are the determinants of condom use among male college youth so recommended for early behavioral interventions, especially in knowledge and attitude. Further studies focusing on including the rural youth and larger geography may help to reach a firmer conclusion.

Predicting intentions to practice COVID-19 preventative behaviors in the United States: A test of the risk perception attitude framework and the theory of normative social behavior

This study examined risk perceptions, efficacy beliefs, social norms, and their interactions as predictors of people's intention to practice four COVID-19 preventative behaviors among a U.S. sample with quotas on age, sex, ethnicity, and region (N = 336). This online survey found that perceived injunctive norms predicted intentions to clean and disinfect (β = 0.20), practice social distancing (β = 0.14), and wear a face mask (β = 0.24). Additionally, efficacy beliefs were found to attenuate the association between descriptive norm perceptions and intention to wash hands (B = -0.15) and wear a face mask(B = -0.12). The results revealed the importance of considering both psychological and social factors to promote COVID-19 preventative behaviors.

HIV/AIDS prevention practices among military personnel in Northwest Ethiopia

The spread of HIV/AIDS is a major public health problem in military personnel in Africa. However, the epidemiological evidence regarding HIV/AIDS prevention practices among military personnel in Ethiopia remains unclear. The aim of this study was to investigate HIV/AIDS prevention practices among military personnel in Northwest Ethiopia. A cross-sectional study among military personnel (n = 410) was conducted in Northwest Ethiopia in 2015. Data were collected using a pre-tested questionnaire. Multivariable logistic regression model was fitted to ascertain factors influencing participation in HIV/AIDS prevention programs. About one-fourth (24.6%) of the military personnel had multiple sexual partners, of whom 24.7% failed to use condoms regularly when having sex with non-regular sexual partners. Majority of the sample (n = 355, 86.6%) participated in HIV/AIDS prevention programs. Military personnel who had multiple sexual partners were 6.3 times more likely to report history of non-participation in HIV/AIDS prevention programs (AOR = 6.3, CI₉₅ = 3.5-11.54). A considerable proportion of military personnel had multiple sexual partners with lower levels of condom utilization with non-regular sexual partners. The study further demonstrated misconceptions about HIV/AIDS in Ethiopian military personnel, which reduce their likelihood of participation in HIV/AIDS prevention programs. Health authorities need to strengthen and accelerate HIV/AIDS prevention programs focusing towards military personnel.