Monitoring HIV risk and evaluating interventions among young people in urban West Africa: development and validation of an instrument

Psychometric Properties of the Colombian Version of the HIV Attitudes Scale for Adolescents

The HIV Attitudes Scale (HIV-AS) evaluates attitudes towards different aspects of HIV. In view of the lack of scales measuring this construct in Colombia, this study sought to validate the HIV-AS test for adolescents from Colombia. A total of 867 Colombian students, aged between 14 and 19 years (M = 15.97 years; SD = 1.37) were evaluated. Participants responded to the HIV-AS test and a set of scales used to assess external validity. Content validity analyses reflected good adequacy indices for the items. Exploratory factor analyses revealed a four-factor structure and reliability indices were satisfactory. The structural equation model showed good levels of fit. Most of the items presented a discrimination index above 0.30 and contributed to the reliability of the scale, except for item 9, which was eliminated. Concurrent validity showed significant correlations among the HIV-AS and other similar constructs. A reliable measurement of attitudes toward HIV allows for an improved assessment of the risk associated with exposure to sexually transmitted infections in adolescent populations.

Portuguese Version of the HIV-Related Attitudes Scale (HIV-AS) for Adolescents

Abstract. The HIV-related Attitudes Scale (HIV-AS) is a brief, valid, and reliable instrument, widely used in Spain. Because of the high risk of HIV in adolescents in Portugal and the scarcity of multidimensional measures to assess attitudes toward HIV-related aspects, reliable and valid instruments are essential for understanding sexual risk behaviors in this population. The aim of this study was to adapt and validate the Spanish version of the HIV-AS into Portuguese. Factor structure, internal consistency, temporal stability, and measurement equivalence with the Spanish version were examined. Analyses were conducted based on a sample of 1,618 adolescents aged 15–18 years (Portugal N = 624, and Spain N = 994). This study confirmed the four-factor structure of HIV-AS, including attitudes toward obstacles to safe sex, HIV testing, condom use, and people living with HIV/AIDS. Reliability was excellent (α = .82) and temporal stability was moderate ( r = .51). Results provided good initial support for the invariance at a strict level for Portuguese and Spanish samples. The Portuguese version of the HIV-AS is a valid and reliable tool for assessing relevant dimensions of attitudes toward HIV-related aspects in adolescents. Future research is needed to consolidate these findings and to generalize them to other populations and countries.

Sexual Behavior With Noncommercial Partners: A Concurrent Partnership Study Among Middle-Aged Female Sex Workers in China

Female sex workers (FSWs) often engage in concurrent partnerships, meaning they have multiple sexual relationships at the same time. The objective of this study was to investigate sexual concurrency and its associations with condom use and syphilitic infections among FSWs over age 35. Respondent-driven sampling was used to recruit 1,245 FSWs in Nanning, Hefei, and Qingdao, China. FSWs were asked to report whether they had concurrent partners in the past six months. Concurrency was defined as engagement in sex with commercial clients and (1) husbands and boyfriends (n = 167); (2) husbands only (n = 301); or (3) boyfriends only (n = 469). FSWs with only commercial clients were used as the comparison group (n = 308). Across all groups, the percentage of FSWs with prevalent and active syphilis ranged from 19.6% to 25.6% and 9.1% to 11.5%, respectively. Condom use was low with noncommercial sexual partners and was more likely to be used when FSWs' boyfriends had other partners. Three components of the theory of planned behavior were significantly associated with consistent condom use. Concurrent relationships may lead to increased transmission of syphilis at the workplace and family levels. Effective interventions should target concurrency with both commercial and noncommercial partners.

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

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

Chowa G. HIV risk among young Ghanaians in high school: validation of a multidimensional attitude towards condom use scale

Condom use remains low among sexually active youth in sub-Saharan Africa. Theoretical and empirical evidence suggests that attitudes towards condom use are important predictors of actual condom use. However, few attempts have been made to systematically develop a valid scale that measures attitudes towards condom use among youth, particularly high school students in sub-Saharan Africa. Using the health belief model, we developed an instrument that measures such attitudes. We analysed survey data collected from 6252 Ghanaian junior high school students. We assessed construct validity using confirmatory factor analysis. Results indicate that attitudes towards condom use among young Ghanaians are best represented by a multidimensional construct. Young Ghanaians differentiate constructs related to perception of benefits and barriers to condom use, as well as perception of severity and susceptibility to HIV. This instrument offers a valid tool for assessing high school students' attitudes towards condom use and their HIV risk.

FAMILIES' RESPONSE TO AIDS: NEW INSIGHTS INTO PARENTAL ROLES IN FOSTERING HIV/AIDS KNOWLEDGE

Worldwide, there is a consensus that parents must be involved in children's HIV/AIDS education. However, there is little evidence that speaks to this advocacy for improving adolescent health. This study developed and tested four hypotheses about (i) the relationship between parents' and adolescents' knowledge of HIV/AIDS transmission routes and prevention strategies conditional upon (ii) parents' gender, (iii) communication about sexuality, and (iv) the parent-adolescent education gap. The sample consisted of 306 parent-adolescent dyads from the 2002 Cameroon Family and Health Survey. Adolescents were aged 12-19 years. Overall, fifteen items about HIV/AIDS transmission routes and prevention strategies were analysed. Descriptive results showed that parents fared better than adolescents regardless of the AIDS fact considered. An exception was the correct use of condoms (parents 57% vs adolescents 61%). The generation gap probably explains this result: parents are more conservative, reluctant and distant from condoms compared with adolescents, who are more receptive and open to discussing sex with peers. Multivariate ordered logistic regressions showed a significant positive effect of parents' HIV/AIDS knowledge on adolescents' HIV/AIDS knowledge, thus supporting the main hypothesis of direct parental influences. Parent-adolescent communication about sexuality showed positive and significant effects on adolescents' HIV/AIDS knowledge, suggesting an 'enhancing effect' when combined with the effect of parents' HIV/AIDS knowledge. Against the background that parents in sub-Saharan Africa do not teach their children about sexuality, the study demonstrated that families can play an important role in HIV/AIDS education. These findings have major implications for HIV/AIDS interventions involving adolescents, parents or both, in fostering accurate HIV/AIDS knowledge among adolescents, which could lead to protective sexual behaviours.

Quality assessment of TPB-based questionnaires: a systematic review

Objective

This review is aimed at assessing the quality of questionnaires and their development process based on the theory of planned behavior (TPB) change model.

Methods

A systematic literature search for studies with the primary aim of TPB-based questionnaire development was conducted in relevant databases between 2002 and 2012 using selected search terms. Ten of 1,034 screened abstracts met the inclusion criteria and were assessed for methodological quality using two different appraisal tools: one for the overall methodological quality of each study and the other developed for the appraisal of the questionnaire content and development process. Both appraisal tools consisted of items regarding the likelihood of bias in each study and were eventually combined to give the overall quality score for each included study.

Results

8 of the 10 included studies showed low risk of bias in the overall quality assessment of each study, while 9 of the studies were of high quality based on the quality appraisal of questionnaire content and development process.

Conclusion

Quality appraisal of the questionnaires in the 10 reviewed studies was successfully conducted, highlighting the top problem areas (including: sample size estimation; inclusion of direct and indirect measures; and inclusion of questions on demographics) in the development of TPB-based questionnaires and the need for researchers to provide a more detailed account of their development process.

Mediation effect of perceived behavioural control on intended condom use: applicability of the theory of planned behaviour to money boys in China

BACKGROUND

Money boys (MBs) are male sex workers who sell sex to men who have sex with men. The objectives of this study were to assess (a) the sexual HIV risk of MBs; (b) the ability of the theory of planned behaviour (TPB) to predict MBs' intentions to use condoms; and (c) the manner in which TPB constructs (attitudes towards condom use, subjective norms and perceived behavioural control) combine to influence condom use intentions.

METHODS

Participants came from 10 MB-frequented clubs in two cities in China. Multiple regression and path analytic models were used to test inter-relationships among the TPB constructs.

RESULTS

Seventy-eight percent of the 122 MB participants reported having used condoms for every anal sex act. About one-third reported having had female sexual partners in the past 2 months; of these MBs, half (53%) used condoms for every sex act. A revised model using TPB constructs accounted for 52% of the variance of condom use intentions and revealed that perceived behavioural control was a mediator in pathways beginning with attitudes and ending with condom use intentions, and beginning with subjective norms and ending with intentions.

CONCLUSIONS

The findings suggest that a revised model of TPB applies to condom use intentions among Chinese MBs. It may be appropriate to adapt HIV interventions that are grounded in TPB and that have been shown to be effective elsewhere for use with Chinese MBs. HIV interventions for this population should give perceived behavioural control and its predictors special consideration.

Family environment and premarital intercourse in Bandjoun (West Cameroon)

Family environment is one of the most influential factors on youth sexual behavior but has received little investigation in sub-Saharan Africa. Yet, a comprehensive understanding of family influences could improve the efficiency of reproductive health (RH) interventions. Using retrospective data from a population-based survey, life-table analysis was utilized to compute the median age at premarital intercourse among 1,182 youth aged 12-24 years. Discrete-time hazard models were used in multivariate analysis to estimate the effects of family structures and parent-child interactions on premarital intercourse. Overall, 42% of participants had a premarital intercourse, and the median age at first sex was 16.9 years. Participants in nuclear two-parent families had the highest median (17.7) compared with those in nuclear one-(16.7), extended one-(16.5), extended two-parent families (16.9) or other relatives (16.8). Youth from monogamous families had the highest median (16.9) compared to those from polygamous (16.3) and other families (16.0). Orphans and youth reporting family transitions were more likely to initiate first sex at an earlier age compared with non-orphans and non-movers, with a median of 16.1 and 16.9 years, respectively. Multivariate results showed that living in extended families, being orphaned, and family transitions significantly increased the risk of premarital intercourse. Polygamy showed marginal effects. Stronger parent-child relationships and higher levels of parental control decreased the risk of premarital intercourse. Unexpectedly, parent-child communication was significantly associated with a higher risk of sexual debut. Programmatically, family environment is an important resource that needs to be promoted when designing RH interventions in sub-Saharan Africa.

Fostering accurate HIV/AIDS knowledge among unmarried youths in Cameroon: do family environment and peers matter?

BACKGROUND

The last three decades have seen a series of HIV interventions in sub-Saharan Africa. However, youths still have a mixture of correct and incorrect HIV/AIDS knowledge of transmission routes and prevention strategies. Previous studies have identified parents and peers as the most important socializing agents for youths. This paper assesses the relationships between family structure, family/peer communication about sexuality and accurate knowledge of transmission routes and prevention strategies.

METHODS

Data were drawn from the Cameroon Family Life and Health Survey (CFHS) conducted in 2002. The CFHS collected information on a representative sample of 4950 people aged 10 years and over nested within 1765 selected households from the 75 localities forming the administrative prefecture of Bandjoun, using detailed questionnaires about family, HIV/AIDS/STDs knowledge, sexual behaviors, contraception, health, media exposure, household assets and neighborhood characteristics. The survey cooperation rates were high (97%). For the purpose of this study, a sub-sample of 2028 unmarried youths aged 12-29 years was utilized.

RESULTS

Overall, 42% of respondents reported accurate knowledge of documented HIV transmission routes whereas 21% of them had inaccurate knowledge such as AIDS can be transmitted through mosquito bites or casual contact with an infected person. Only 9% of respondents were knowledgeable about all HIV prevention strategies. Multivariate analyses showed that family structure, communication with parents/guardians and peers about sexual topics were significantly associated with accurate HIV knowledge. Additionally, age, education, sexual experience and migration had significant effects on accurate knowledge. Finally, living in poor households and disadvantaged neighborhoods significantly increased inaccurate knowledge of HIV transmission modes and prevention strategies.

CONCLUSIONS

This paper evidenced the limited effects of HIV interventions/programmes in sub-Saharan Africa. Indeed, few respondents reported accurate knowledge about HIV transmission routes and prevention strategies. Findings showed that the role of family environment as source of accurate HIV knowledge transmission routes and prevention strategies is of paramount significance; however, families have been poorly integrated in the design and implementation of the first generation of HIV interventions. There is an urgent need that policymakers work together with families to improve the efficiency of these interventions. Peer influences is likely controversial because of the double positive effect of peer-to-peer communication on both accurate and inaccurate knowledge of HIV transmission routes.

HIV screening: beliefs and intentions of the homeless

HIV screening is the first step in identifying HIV infection; however, the HIV screening rates remain low. Homeless people in the United States are at risk for HIV infection, yet their acceptance of HIV screening remains poorly understood. The purpose of this study was to investigate beliefs and intentions of the homeless toward HIV screening. Using a survey design, this study applied the Theory of Planned Behavior to investigate attitudes, social norms, and perceived behavioral control and their relationship to intention to screen for HIV. Homeless people (N = 323) from 12 different shelters participated in this study. The final path analysis explained 60% of homeless people's intentions to screen for HIV. Significant predictors included: attitude toward HIV screening, prior screening, age, and subjective norms. Implications include health provider recommendations for screening and increasing awareness of HIV risk behaviors for this vulnerable population.