The prediction of condom use intention among South African university students

Cultural Consensus Modeling to Understand South African Adolescent Girls' Attitudes, Awareness, and Uptake of Dual Protection Strategies

PURPOSE

This study used cultural consensus modeling to elucidate culturally relevant factors associated with dual protection use (strategies to prevent both pregnancy and sexually transmitted infection [STI]/HIV) among South African adolescent girls aged 14-17 years.

METHODS

In Phase 1, participants (N = 50) completed a free-listing survey assessing pregnancy and STI/HIV methods used by peers. In Phase 2, participants (N = 100) completed a rating survey to examine perceived peer acceptability of Phase 1 pregnancy and STI/HIV prevention methods. In Phase 3, qualitative individual interviews (N = 25) gathered in-depth information regarding the cultural acceptability of pregnancy and STI/HIV prevention strategies. In Phase 4, participants (N = 300) completed the Phase 2 rating survey for individual beliefs regarding the acceptability of pregnancy and STI/HIV prevention methods.

RESULTS

In Phase 1, 41 pregnancy and 29 STI/HIV prevention strategies, along with 16 factors influencing pregnancy prevention method acceptability were endorsed; male condoms were the most commonly endorsed pregnancy and STI/HIV prevention method. In Phase 2, using cultural consensus analysis, participants were consistent in the perceived acceptability of pregnancy and STI/HIV prevention methods (73.4% variance accounted for in single cultural model). In Phase 3, qualitative findings provided in-depth information regarding factors influencing commonly used pregnancy (e.g., injectable contraception) and STI/HIV (e.g., condoms) prevention methods. In Phase 4, a single cultural model was identified (56.3% variance accounted for), with similar acceptability ratings as Phase 2.

CONCLUSIONS

A singular cultural model of pregnancy and STI/HIV prevention method acceptability was observed, with little awareness of dual protection. The findings highlight cultural factors for future culturally tailored dual protection interventions for South African adolescent girls.

Structural Equation Modeling Test of an Integrated Model of Spanish Youth's Condom Use

Heterosexual transmission represents 26 % of newly diagnosed infection in Spanish youth. Behavioral change models have emphasized the influence of multiple variables to predict condom use behavior. The aim of this study is to examine how those variables are organized and which theory explains the condom use behavior better. A sample of 424 young heterosexuals (M _age  = 20.62; SD = 2.16) filled out a battery of self-report questionnaires for assessing AIDS-related variables, personality traits and clinical variables (general, sexuality-related and health-related). A structural model was specified that included perceived pleasure and condom use self-efficacy as predictive variables. Depression and sexual compulsivity indirectly influence behavior. The final model accounted for 65.9 % of the variance in behavior. These results highlight the importance of cognitive and emotional variables as predictors of behavior (ex. expectations of pleasure and self-efficacy beliefs). This is important information for designing effective psychological interventions.

Continuity and Change in Reproductive Attitudes of Teenage Women, Their Mothers, and Maternal Grandmothers in South Africa

During the past couple of decades, as South Africa has undergone a political and social transformation, conditions for reproduction and reproductive health have changed. Against the backdrop of these societal changes, the objectives of this cross-sectional study were to trace continuity and change in reproductive attitudes on an individual level, through three generations of women linked to each other by kin in the Limpopo Province, South Africa. This study is defined within the psychological theoretical framework called Values of Children, and the specific aims for this study were to explore the three generations of women's preferred timing of their first childbirth, their desired number of children and sex of the offspring, and the women's deeper motivations behind the wish for children. Participants ( n = 516) were chosen using a multi-stage cluster sampling procedure, and face-to-face structured interviews were conducted. Factor analysis indicated that the women have two main motivations to have children, namely Social/Emotional values of children and Traditional/ Utilitarian values of children. However, the motivations to bear children seemed to be less emphasised by the teenage women as compared to their mothers and maternal grandmothers. Likewise, the data revealed a change in reproductive attitudes in that teenage women wished to have fewer children later in their lives than the older generations. Stronger daughter preferences than son preferences were presented in one-child scenarios in all generations, yet the strongest emphasis on a daughter was found in the young generation. In the light of the huge social changes in the country, such as the explosion of HIV infections and the abolishment of the apartheid regime including its racial family planning programmes, we expected more dramatic changes in reproductive attitudes in three generations of women than those which we found.

Construction and Validation of a Self-Efficacy Scale for Latex Barrier Use

Some studies have concluded there is a relationship between perceived self-efficacy and behaviors that prevent HIV transmission. This paper presents the construction and validation of the latex barrier use self-efficacy scale (LBSS), which 480 participants filled out. Exploratory factor analysis yielded two components: positive expectations of self-efficacy (ES-POS) and negative expectations of self-efficacy (ES-NEG), which together accounted for 65.59% of total variance. That structure was later verified through confirmatory factor analysis. Internal consistency was .80 for the total scale, and .78 for each of the two factors. Moreover, the instrument had adequate convergent validity and was positively related with condom use self-efficacy, attitudes toward condom and latex barrier use, and ability to refuse sex if the partner refuses to use preventive methods. In conclusion, this instrument is a useful measure of self-efficacy in latex barrier use.

Consistent condom use in HIV/AIDS patients receiving antiretroviral therapy in northwestern Ethiopia: implication to reduce transmission and multiple infections

Background

Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is one of the greatest public health problems of sub-Saharan African countries. Consistent condom use, among others, remains the most effective barrier method against HIV transmission. However, existing reports on frequency of consistent condom use have targeted the general public, rather than HIV/AIDS patients due, to the assumption that condom use is not important in HIV-infected persons. Since consistent condom use among HIV/AIDS patients is vital, to prevent the virus transmission from the infected to noninfected as well as to prevent multiple infections among already infected persons, its frequency and determining factors need to be investigated.

Methods

A cross-sectional study was conducted from April 2013 to May 2013 among 317 randomly selected patients who were currently taking antiretroviral therapy (ART). Logistic regressions were performed to examine predictors of consistent condom use.

Results

A total of 317 HIV/AIDS patients who were currently receiving ART participated in the study, and the mean age of the study population was 31.4 (standard deviation [SD] 10.5) years. Overall, 250 (78.9%) participants reported consistent condom use in the past 6 months. Of these, 140 (88.6%) were males and 110 (69.1%) females. Multivariate analysis indicated that respondents with an advanced level of education were more likely to report regular use of condoms (odds ratio [OR] 8.98; 95% confidence interval [CI] 5.06–14.45) compared with illiterate participants. Being male (OR 6.87; 95% CI 3.84–11.22), living in or around a town (OR 4.65; 95% CI 3.09–9.11), and taking ART for longer time (OR 3.91; 95% CI 2.07–6.25) were also positively associated with consistent condom use.

Conclusion

Females, patients living in rural areas, uneducated groups, and new ART users were less likely to use condoms consistently. The importance of consistent condom use should be well-addressed in HIV/AIDS patients, to prevent transmission and multiple infections of HIV.

Conundrum of Sexual Decision Making in Marital Relationships: Safer-Sex Knowledge, Behavior, and Attitudes of Married Women in Zambia

Recent research suggests that Zambian women face an increasing risk of contracting human immunodeficiency virus (HIV) within marital relationships. Married women's perceived ability to negotiate safer sex or adopt self-efficacy practices is recognized as critical in preventing new infections within marriage. Yet women's self-efficacy practices, such as requesting condom use or refusing sex within marriage, are influenced by individual and context-specific factors. Using the 2007 Zambia Demographic and Health Survey data from 4,306 married women, this article examines the association between married women's perceived ability to negotiate safer sex and a range of attitudinal, knowledge, and sociodemographic variables. Results from complementary log-log regression models reveal that married women who have factual knowledge about HIV transmission and prevention, as well as those who have been tested for their HIV serostatus, were more likely to report they can request that their husbands use a condom. Rural married women were more likely to report they can refuse their husbands sex compared to woman in urban areas. Likewise, married women who agree that a wife is justified in refusing her husband sex if he sleeps with other women were more likely to report they can negotiate safer sex compared to women who disagree. These findings suggest that married women are able to negotiate safer sex if they have correct factual knowledge about HIV transmission and are aware of their rights within marital relations.

Inconsistent condom use among Ugandan university students from a gender perspective: a cross-sectional study

Background

Feminization of the HIV/AIDS epidemic has been a prominent phenomenon in sub-Saharan Africa. Inconsistent condom use among young people is one of the major risk factors in the continued propagation of the epidemic. Therefore, it is of importance to increase knowledge of gender aspects of condom use among young people.

Objective

To investigate whether gender differences regarding individual and social factors determine the association between condom efficacy and inconsistent condom use with a new sex partner, among Ugandan university students.

Design

In 2010, 1954 Ugandan students participated in a cross-sectional survey, conducted at Mbarara University of Science and Technology in southwestern Uganda. A self-administered questionnaire assessed socio-demographic factors, alcohol consumption, sexual behaviors (including condom use and condom efficacy), and peer norms. The data were stratified by sex and examined by multivariate logistic regression analysis.

Results

A total of 1,179 (60.3%) students reported having had their sexual debut. Of these, 231 (37.4%) males and 209 (49.2%) females reported inconsistent condom use with a new sex partner. Students with low condom efficacy had a higher risk of inconsistent condom use with a new sex partner, even after adjusting for the potential confounders. A synergistic effect was observed between being a female and low condom efficacy with inconsistent condom use.

Conclusion

The association between inconsistent condom use and low condom efficacy was found among both males and females, but females were found to be at a higher risk of inconsistent condom use compared to their male counterparts. Therefore, gender power relations should be addressed in policies and interventions aiming at increasing condom use among young people in sub-Saharan settings. Programs could be designed with intervention strategies that focus on interactive and participatory educational activities and youth-friendly counseling of young people, which in turn may improve their interpersonal communication and condom negotiation skills with their partners.

The prevalence of condom use among university students in zimbabwe: implications for planning and policy

Young people, especially university students, are at high risk of HIV infections because of little or no parental or administrative prohibitions in campus environments. The aim of this study was to ascertain the level of condom use among university students in Zimbabwe; that is, condom use at last sex and consistent condom use among both regular and casual partners. The study draws on self-completed questionnaires administered to university students. The results reveal that, while 78.3% of sexually active respondents had used condoms in penetrative sexual encounters before, only 56.2% had used condoms at their last sexual encounter. As expected, consistent condom use was lower in regular sexual partnerships than it was in casual partnerships (30.6% versus 54.6%). Condom use at first sex and high personal HIV risk perception were found to be the most important factors in explaining condom use at last sex and consistent condom use with casual partners. Condom use intentions were high, as 75% of respondents indicated that they would use condoms at their next sexual encounters. Whilst this is commendable, use rates should ideally be higher still. Campus HIV/AIDS programmers should endeavour to ensure that condoms are available at all times in order to help translate these intentions into actual condom use. In addition, promotional programmes should encourage those who have not yet initiated sexual intercourse to use condoms at their first sex and also to improve personal HIV risk perceptions in order to trigger initiation of protective sexual behaviours.

Knowledge, attitudes and practice of secondary school girls towards contraception in Limpopo Province

Unplanned teenage pregnancy constitutes an important health problem, whilst contraceptive services are free throughout South Africa and the number of Termination of Pregnancy (TOP) services is increasing. The purpose of this study was to assess the knowledge, attitudes and practices of secondary school girls towards contraception in Thulamela Municipality of Limpopo Province, South Africa. A quantitative descriptive study design was used and respondents were selected by convenience sampling from a population of secondary school girls, the sample consisting of 273 girls in Grades 10-12. A self-administered questionnaire was used to collect data and analysed by computing frequencies and percentages using the Statistical Package for Social Sciences. Findings showed that respondents were aware of different contraceptive methods that can prevent pregnancy. However, most did not have knowledge of the emergency contraceptive, intra-uterine device and female condom. Pressure from male partners, fear of parental reaction to the use of contraceptives, reluctance to use contraceptives, poor contraceptive education and lack of counselling were seen as the main causes of ineffective contraceptive use and non-utilisation. Possible modalities of intervention deal with providing contraceptive counselling and care to empower these school girls to make informed choices on reproductive health. 

An assessment of sex work in Swaziland: barriers to and opportunities for HIV prevention among sex workers

The HIV situation in virtually all southern African countries is a generalised epidemic. Despite the fact that almost all adult age and social groups have high HIV prevalence estimates, sex workers are disproportionally affected, with prevalence estimates higher than the general population. In a qualitative study of 61 male and female sex workers in Swaziland, we found that while poverty drove many into sex work, others reported motivations of pleasure or "sensation seeking", and freedoms from the burden of marriage as perceived benefits of sex work. We also found that penile-vaginal sex was not universal in male-female sexual encounters; and motivation by sex workers for non-condom use included intention to earn more money from unprotected sex, desire for sexual pleasure, and not having time to use condoms. Many sex workers expressed doubts over an alternative lifestyle, even if that change afforded them money to meet their daily necessities. The findings from this study suggest that treating sex workers as a homogenous group that is driven into, or maintain sex work only because of poverty may be problematic, and could hamper HIV-relevant interventions aimed at reducing their vulnerability to sexually transmitted infections.

Social and cognitive variables predicting voluntary HIV counseling and testing among Tanzanian medical students

OBJECTIVE

The present study aimed to predict Tanzanian medical students' Voluntary Counseling and Testing (VCT) participation intention using the Health Belief Model (HBM) as a theoretical framework. Further, differences between respondents who had previously participated in VCT and respondents who had not were assessed.

METHODS

Cross-sectional data were gathered from 186 Tanzanian medical students using a self-administered questionnaire.

RESULTS

Almost half of the respondents (43.3%) reported having been tested for HIV. A prediction model containing HBM and demographic variables explained 31% of the variance in VCT-participation intention. Self-efficacy, fear of being HIV-positive, and perceived susceptibility contributed significantly to the final regression model. In addition, respondents who had previously participated in VCT expressed less fear of being stigmatized and being HIV-positive than respondents who had not.

CONCLUSION

Fear of being HIV-positive, self-efficacy, perceived susceptibility and fear of being stigmatized were associated with either VCT-participation intention or previous participation. Further, the HBM accounted for a limited proportion of the explained variance in Tanzanian students' intention to participate in VCT. This suggests that the validity of the HBM in explaining HIV-preventive behavior in Sub-Saharan Africa should be questioned.

PRACTICE IMPLICATIONS

Interventions promoting VCT should incorporate program elements targeting self-efficacy, fear of being HIV-positive, perceived susceptibility and fear of being stigmatized.

Sub-Saharan African university students' beliefs about condoms, condom-use intention, and subsequent condom use: a prospective study

Whether certain behavioral beliefs, normative beliefs, and control beliefs predict the intention to use condoms and subsequent condom use was examined among 320 undergraduates at a university in South Africa who completed confidential questionnaires on two occasions separated by 3 months. Participants' mean age was 23.4 years, 47.8% were women, 48.9% were South Africans, and 51.1% were from other sub-Saharan African countries. Multiple regression revealed that condom-use intention was predicted by hedonistic behavioral beliefs, normative beliefs regarding sexual partners and peers, and control beliefs regarding condom-use technical skill and impulse control. Logistic regression revealed that baseline condom-use intention predicted consistent condom use and condom use during most recent intercourse at 3-month follow-up. HIV/STI risk-reduction interventions for undergraduates in South Africa should target their condom-use hedonistic beliefs, normative beliefs regarding partners and peers, and control beliefs regarding technical skill and impulse control.

Correlates of the intention to remain sexually inactive among male adolescents in an Islamic country: case of the Republic of Iran

BACKGROUND

There are very few studies that have examined sexual intentions and behaviors of adolescents in Islamic countries. This study employs the Health Belief Model to assess the correlates of the intention to remain sexually inactive among male adolescents in the Republic of Iran.

METHODS

This cross-sectional study was performed with a sample of 314 adolescents recruited from 3 high schools from Tehran, Iran.

RESULTS

Fifty-seven percent of this sample planned to remain abstinent until marriage. Another 23% rejected the notion of remaining abstinent and 20% were uncertain. Multinomial logistic regression revealed that students whose mothers were employed and who received a higher daily allowance were more likely to report that they would not remain abstinent. No significant independent relationship between human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome-related knowledge and an intention to remain abstinent was detected. However, consistent with previous studies conducted in Asia, Africa, and in Western countries, we documented that (1) perceived subjective norms, (2) self-efficacy, (3) and perceived susceptibility to contracting the HIV virus all are associated with the intention to remain sexually inactive among adolescents.

CONCLUSIONS

It seems abstinence until marriage is more likely to be practiced in traditional families. However, Iranian society is changing rapidly and traditional family structures, values, and norms may not sufficiently protect adolescents from HIV infection. The data from this study support previous studies conducted in Western countries, which found that intervention programs that focus on knowledge alone are ineffective in their ability to alter adolescents' intentions to postpone sexual activity.

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

We developed an instrument for HIV/AIDS behavioral surveillance applicable to youth living in urban West Africa. The instrument includes a comprehensive set of constructs borrowed from the sociocognitive theory of planned behavior as well as measures of parental and peer communication An exploratory (n=189) and validation sample (n=342) of young men and women living in Bamako were interviewed. Scale construct validity was assessed via factor analysis and multiple linear regressions and internal consistency was assessed using Cronbach's coefficient. All constructs had high internal consistency, scales' structure was relatively stable, and associations between different components of the questionnaire were in the predicted directions. Gender, sexual experience and education were significantly associated with attitudes and perception of control. Furthermore, attitudes, perceived behavioral control, perceived norms, and peer communication significantly predicted condom use. This questionnaire offers a valid and reliable tool for assessing young people's sexual behavior in an urban West African setting.

[Sexual behaviour among adolescents in Brazzaville, Congo]

AIM

Estimate sexual activity among Congolese adolescents in Brazzaville and appreciate the influence of sociocultural and economic factors on sexual behaviour.

METHODS

Data were collected from 900 adolescents (389 males and 511 females) aged 10-19 years in the seven urban areas of Brazzaville. These subjects were randomly recruited by a two stage sampling. The data were gathered by an anonymous face-to-face questionnaire. Relative risk estimations were calculated for early or first sexual intercourse, multiple sexual partnerness and safe sex.

RESULTS

A total of 474 respondents indicated that they were sexually active. Females were more sexually active, 270 compared with 204 males (p<0.05). The mean early age of coital debut was 14.6 years (S.D.=1.7 years). Early intercourse (before 14 years) was found in 73 males and 39 females (p<0.001). Multiple sexual partnerness was found in 81.3% of males, while the frequency of females was 51.1%. Risk factors for pregnancy and multiple sexual partnerness were unemployment mother, non school situation, early puberty and non sexual education. In contrast, regular religious activity was recognized as factor that had significant protection impact on sexual activity. The total use ratio of the condom was estimated at 42.2% in males. More females (41.7%) were using Ogino method of contraception. In addition, 102 females (36.8%) claimed to have already a pregnancy and the mean age was 16.1 years (S.D.=1.2 years). In 64.7% of these cases, teenagers chose the abortion as solution of an unwanted pregnancy. After the birth of a child, it was reported that 82.4% of adolescents gave up with school.

CONCLUSION

Our results show the importance of problems associated to sexual activity among Congolese adolescents in Middle Africa. These data should be taken into account when planning the prevention of risk of sexual behaviours among adolescents.

Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa

HIV/AIDS is taking a heavy toll on South African youth. Reducing their risk for HIV requires an understanding of the determinants of their HIV risk behaviours that are amendable to intervention-induced change. This study draws upon the theory of planned behaviour to identify the modifiable determinants of the intention to use condoms among Xhosa-speaking South African adolescents. The participants were 390 Xhosa-speaking 6th grade students (mean age = 12.1 years) in public schools in the township of Mdantsane, South Africa who completed an anonymous questionnaire. Multiple regression revealed that attitude and perceived behavioural control were significantly related to the intention to use condoms, whereas subjective norm was not, controlling for sexual experience, gender, and language preference. Consistent with this were additional analyses using beliefs as predictors: Hedonistic behavioural beliefs and control beliefs about condom-use negotiation and technical skills predicted intention, whereas normative beliefs did not. The theory of planned behaviour may be a useful model of condom use among Xhosa-speaking South African adolescents. An emphasis on beliefs about the adverse effects of condom use on sexual enjoyment, the ability to negotiate condom use, and the ability to use condoms correctly might improve the efficacy of HIV/STD interventions for such adolescents.

Predictors of condom use among young adults in South Africa: the Reproductive Health and HIV Research Unit National Youth Survey

OBJECTIVES

We examined correlates of condom use among a national random probability sample of sexually experienced young adults aged 15 to 24 years (n = 7686) in South Africa.

METHODS

Using data from the Reproductive Health and HIV Research Unit National Youth Survey, we conducted gender-stratified bivariate and multivariate logistic regression analyses to determine predictors of whether respondents had used a condom during their most recent sexual intercourse.

RESULTS

Condom use at sexual debut and talking with one's first sexual partner about condoms were the most significant predictors of condom use at most recent intercourse. Other significant predictors included high condom use self-efficacy, optimism about the future, and reported behavior change attributable to HIV/AIDS. Young adults who were married or had been involved in a relationship for 6 months or more were significantly less likely to have used a condom during their most recent sexual intercourse.

CONCLUSIONS

Our findings point to the importance of exposing youths to sexuality education before their sexual debut as well as voluntary counseling and testing and programming that supports young adults, particularly young women, in making informed decisions about sexual intercourse and condoms.

Health beliefs among African American women regarding genetic testing and counseling for sickle cell disease

PURPOSE

The Health Belief Model can help in understanding low acceptance of disease prevention and screening. We studied health beliefs of African American women to determine causes of low acceptance of genetic testing and counseling despite high prevalence of sickle cell disease and heterozygotes in this population.

METHODS

An anonymous questionnaire using a 12-question measure with a 5-point Likert scale response was administered to 101 African American women attending an obstetrics and gynecology clinic to determine knowledge of sickle cell disease, perception of risk, severity, likelihood of benefit and barriers to counseling.

RESULTS

The cumulative mean perceived scores on the 5-point Likert scale were 4.22 +/- 0.88 for severity of sickle cell disease, 4.10 +/- 1.03 for benefit of genetic testing, 2.28 +/- 1.00 for barriers to testing, and 2.62 +/- 1.06 for risk of having a child with sickle cell disease. High average level knowledge was associated with high perception of severity and benefit to screening (P < 0.05).

CONCLUSION

African American women have a relatively high belief of the severity of sickle cell disease and benefits of genetic counseling but frequently do not appear to believe that they are at risk of having a child with the disease. This should be taken into account in the design of educational and counseling strategies.

Factors associated with self-efficacy for condom use and sexual negotiation among South african youth

OBJECTIVES

To use logistic regression modeling to identify factors associated with high self-efficacy for sexual negotiation and condom use in a sample of South African youth.

METHODS

The Reproductive Health and HIV Research Unit (RHRU) National Youth Survey examined a nationally representative sample of 7409 sexually active South African youth aged 15 to 24 years. We used logistic regression modeling in this sample to identify factors associated with the main outcome of high self-efficacy.

RESULTS

Among female respondents (n = 3890), factors associated with high self-efficacy in the adjusted model were knowing how to avoid HIV (odds ratio [OR] = 2.30, 95% confidence interval [CI]: 1.05 to 5.00), having spoken with someone other than a parent or guardian about HIV/AIDS (OR = 1.46, 95% CI: 1.01 to 2.10), and having life goals (OR = 1.28, 95% CI: 1.10 to 1.48). Not using condoms during their first sexual encounter (OR = 0.61, 95% CI: 0.50 to 0.76), a history of unwanted sex (OR = 0.66, 95% CI: 0.51 to 0.86), and believing that condom use implies distrust in one's partner (OR = 0.57, 95% CI: 0.51 to 0.86) were factors associated with low self-efficacy among female respondents. Male respondents (n = 3519) with high self-efficacy were more likely to take HIV seriously (OR = 4.03, 95% CI: 1.55 to 10.52), to believe they are not at risk for HIV (OR = 1.38, 95% CI: 1.12 to 1.70), to report that getting condoms is easy (OR = 1.85, 95% CI: 1.23 to 2.77), and to have life goals (OR = 1.30, 95% CI: 1.10 to 1.54). Not using condoms during their first sexual experience (OR = 0.51, 95% CI: 0.39 to 0.67), a history of having unwanted sex (OR = 0.47, 95% CI: 0.34 to 0.64), believing condom use is a sign of not trusting one's partner (OR = 0.63, 95% CI: 0.46 to 0.87), and refusing to be friends with HIV-infected persons (OR = 0.52, 95% CI: 0.32 to 0.85) were factors associated with low self-efficacy among male respondents in the fully adjusted model.

CONCLUSIONS

We used the social cognitive model (SCM) to identify factors associated with self-efficacy for condom use and sexual negotiation. Many of these factors are modifiable and suggest potential ways to improve self-efficacy and reduce HIV sexual risk behavior in South African youth.