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Ugwu NH, Odimegwu CO. Contextual determinants of multiple sexual partnerships amongst young people in South Africa: a multilevel analysis. BMC Public Health 2024; 24:1533. [PMID: 38849818 PMCID: PMC11157945 DOI: 10.1186/s12889-024-18872-5] [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: 02/13/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Risky sexual behaviour (RSB), particularly multiple sexual partnerships (MSP) continues to be a major public health concern and has been linked to the increasing STIs, including HIV/AIDS in many parts of sub-Saharan Africa (SSA), suggesting that there is an association between contextual factors and multiple sexual partnering. However, in South Africa, this association is not well established in recent literature. Hence, this study examined the contextual factors contributing to multiple sexual partnerships among young people in South Africa. MATERIALS AND METHODS Data was extracted from the 2016 South Africa Demographics and Health Survey (2016 SADHS). A cross-sectional study of 3889 never-married young people. Descriptive and inferential statistics as well as multilevel logistic regression were used to analyse the data on never-married young people aged 15 to 24 years. RESULTS The results indicated that at the individual level, young males (61.7%) were significantly more likely than their female counterparts (56.1%) to engage in multiple sexual partners, although, the difference was not as significant as expected. At the community level clustering, the likelihood of exposure to multiple sexual partnerships significantly increased among females (OR = 1.47; 95% CI: 1.25-1.73) but decreased among their male counterparts (OR = 0.73; 95% CI: 0.58-0.92), in particular, family disruption, residential instability, and ethnic diversity led young people to engage in multiple sexual partnerships. CONCLUSIONS There is a need to intensify programmes aimed at considering appropriate policy options to reduce the prevalence of multiple sexual partnerships. Adopting the implications of these findings is essential for a developmental strategy towards achieving the sustainable development goal of ending STIs among young people in South Africa.
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Affiliation(s)
- Nebechukwu H Ugwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Institute for Development Studies, University of Nigeria, Enugu Campus, Enugu, Nigeria.
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Buhendwa M, Sliep Y, Mchunu GG, Nxumalo CT. Exploring the Influence of Social Capital on HIV Prevention with Migrants from the Democratic Republic of Congo (DRC) Living in Durban, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:618. [PMID: 36612938 PMCID: PMC9819981 DOI: 10.3390/ijerph20010618] [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: 10/17/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Background: Research shows a growing attentiveness to the role of social and environmental influences on HIV risk behaviours. Moreover, the understanding of HIV risk behaviours has moved from an earlier consideration of individual risk, to ecological models, with the understanding that behaviours are rooted in the economic, environmental and social structure. Aim: To explore how social capital, specifically on a social bonding level, operates as a risk or protective factor for the spread of HIV among French-speaking migrants from the Democratic Republic of Congo (DRC), living in Durban, South Africa. Methods: A qualitative approach using a case study design was used to conduct the study. Data were collected through focus group discussions and individual in-depth interviews from a purposive sample of French-speaking migrants from DRC, living in Durban, South Africa. Ethical approval to conduct the study was obtained from the University of KwaZulu-Natal's Human and Social Science Research Ethics' Committee. Data were analysed thematically using Creswell's steps of data analysis. Results: This study found that social capital can act as both a protective factor in certain circumstances, and a risk factor in others. Trust, norms, reciprocity and social networks are complex elements in the refugee community and are influenced by a myriad of factors including the past and present stressors that are prevalent within this community. Conclusions: The findings confirm the complexity of issues related to HIV prevention which necessitate policy and practice interventions to mitigate consequences that may result from the higher risks of HIV transmission in this community.
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Affiliation(s)
- Mulumeoderhwa Buhendwa
- Faculty of Health Sciences, Durban University of Technology, Ritson Campus, Durban 4000, South Africa
| | - Yvonne Sliep
- School of Applied Human Sciences, Department of Psychology, University of KwaZulu-Natal, Durban 4140, South Africa
| | - Gugu Gladness Mchunu
- Faculty of Health Sciences, Durban University of Technology, Ritson Campus, Durban 4000, South Africa
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Teshale AB, Worku MG, Tesema GA. Spatial Distribution and Factors Associated with Multiple Sexual Partnerships among Reproductive-Aged Men in Ethiopia: A Spatial and Mixed-Effect Analysis of the 2016 Ethiopian Demographic and Health Survey. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:593-604. [PMID: 34104001 PMCID: PMC8178613 DOI: 10.2147/hiv.s311020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022]
Abstract
Background Though multiple sexual partnerships (MSPs) increase the risk of acquiring sexually transmitted diseases, such as HIV/AIDS, they are still common in sub-Saharan Africa, particularly in Ethiopia. Therefore, this study aimed to investigate spatial distribution and factors associated with MSPs among reproductive-age men in Ethiopia. Methods This study was based on Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 12,688 men aged 15–59 years was included. Spatial analysis was conducted using Arc GIS 10.3 and SaTScan 9.6 statistical software. Mixed-effect logistic regression analysis was used to estimate the association between MSPs and independent variables. Variables with p<0.05 on multivariable mixed-effect analysis were considered significant predictors of MSPs. Results MSPs had significant variations across the country (global Moran’s I=0.109, p<0.001). The primary-cluster spatial window was located in the southwest Oromia and Somalia regions, withrelative risk of 3 and log-likelihood ratio of 24.49 (P<0.001). Age 20–29 years (AOR 2.79, 95% CI 1.83–4.26), 30–39 years (AOR 4.04, 95% CI 2.48–6.58), and 40–59 years (AOR 7.13, 95% CI 4.36–11.68), never married (AOR 1.54, 95% CI 1.13–2.08), femle-headed household (AOR 1.90, 95% CI 1.48–2.44), Internet usage (AOR 1.62, 95% CI 1.21–2.17), ever chewing khat (AOR 1.72, 95% CI 1.37–2.18), ever drinking alcohol (AOR 2.31, 95% CI 1.74–3.08), and being from regions other than Tigray, Harari, and Dire Dawa were significant factors associated with increased odds of MSPs. Conclusion MSPs showed significant variations across the country, with the primary-cluster spatial window located in Oromia and Somalia regions. Therefore, special attention should be paid to high-risk regions and groups, particularly those who are unmarried and substance users, to decrease MSPs and their serious consequences, such as HIV and other sexually transmitted infections.
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Affiliation(s)
- Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Njiru R. Social networks, gender and HIV within marriages in Kenya. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:224-233. [PMID: 31575342 DOI: 10.2989/16085906.2019.1653331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Gender inequalities drive the HIV risk within marriages in Kenya, yet strategies to combat the spread of HIV are limited by their emphasis on the individual or dyadic relationship rather than the wider social-cultural relations that shape gender relations within marriage. This study explores how couples' social networks and spaces of interactions are implicated in the (re)production of gender and gender relations and how this, consequently, shapes HIV risks within marriage. It draws on qualitative data from 14 relatively poor couples from rural eastern Kenya and 13 middle-class couples from the capital city of Nairobi. The data describe couples' networks and address three broad themes: kin relations and gender (re)production; informal financial networks and gender hierarchies; and gender segregation of networks and spaces of interaction. Overall, findings show that much social interaction serves to reinforce gender identities, ideologies and realities that already exist though gender relations might differ among poor rural and middle-class city couples. Therefore, for public health, incorporating couples' wider social and gender relations in HIV interventions in marriage is imperative. Moreover, an intersectional perspective that considers how gender mutually interacts with class, space/geography, religion, age, and other axes of difference to produce particular forms of gender and gender relations in networks is crucial in informing HIV interventions in addressing gender power relationships that shape HIV risk in marriages.
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Affiliation(s)
- Roseanne Njiru
- Department of Sociology and Social Work, University of Nairobi , Kenya
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Abstract
Despite the large interest in economic interventions to reduce HIV risk, little research has been done to show whether there are economic gains of these interventions for younger women and what intermediary role economic resources play in changing participants' sexual behavior. This paper contributes to this gap by examining the impacts of a conditional cash transfer (CCT) for young women in South Africa on young women's economic resources and the extent to which they play a role in young women's health and behavior. We used data from HIV Prevention Trials Network 068 study, which provided transfers to young women (in addition to their parents) conditional on the young woman attending at least 80% of school days in the previous month. We found that the CCT increased young women's economic wellbeing in terms of having savings, spending money, being unindebted, and food secure. We also investigated heterogeneous effects of the program by household economic status at baseline because the program was not specifically poverty targeted and found that the results were driven by young women from the poorest families. From these results, we examined heterogeneity by baseline poverty for other outcomes related to HIV risk including sexual behavior and psychosocial well-being. We found psychosocial well-being benefits in young women from the poorest families and that economic wellbeing gains explained much these impacts.
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Crankshaw TL, Voce A, Butler LM, Darbes L. Expanding the relationship context for couple-based HIV prevention: Elucidating women's perspectives on non-traditional sexual partnerships. Soc Sci Med 2016; 166:169-176. [PMID: 27566046 DOI: 10.1016/j.socscimed.2016.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 07/17/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION HIV prevention interventions targeting couples are efficacious, cost-effective and a key strategy for preventing HIV transmission. Awareness of the full spectrum of relationship types and underlying complexities, as well as available support mechanisms in a given context, are critical to the design of effective couple-based interventions. OBJECTIVE This paper is based on a sub-analysis of a qualitative research study investigating HIV disclosure dynamics amongst pregnant women living with HIV in Durban, South Africa. The sub-analysis explored the nature of participants' social and relationship contexts and consequences of these dynamics on women's feelings of trust towards partners and perceptions of partner commitment. METHODS Between June and August 2008, we conducted in-depth interviews with 62 pregnant women living with HIV and accessing Prevention of Mother-to-Child Transmission (PMTCT) services in Durban, South Africa. Transcripts were coded for emergent themes and categories using a grounded theoretical approach. RESULTS The median age of participants was 26 years (interquartile range: 22-29 years). Three major themes with accompanying sub themes were identified: 1) relationship types (sub themes included unmarried status, minimal cohabitation with partners, presence of concurrent relationships), 2) relationship quality/functioning (sub themes included low trust and expectation of partner commitment, relationship turbulence, and lack of communication/ability to negotiate protective behaviours), and 3) factors underlying the relationship functioning (sub themes included dynamics of concurrent relationships coinciding with concurrent pregnancies, gender roles and unequal relationship power, intimate partner violence or threat thereof, and lack of social support). CONCLUSIONS Our research findings indicate a lack of many of the dyadic relationship elements underlying couple-counselling frameworks for successful risk reduction coordination. Understanding sexual behaviour and the accompanying relationship dynamics within different types of partnerships is crucial for the optimal design of couple-based HIV prevention interventions.
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Affiliation(s)
- T L Crankshaw
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal 236 George Campbell Building, Howard College Campus, King George V Avenue, Durban 4041, South Africa; Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa.
| | - A Voce
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal 236 George Campbell Building, Howard College Campus, King George V Avenue, Durban 4041, South Africa
| | - L M Butler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248, USA
| | - L Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48109, USA
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Swartz A, Colvin C, Harrison A. The Cape Town boyfriend and the Joburg boyfriend: women's sexual partnerships and social networks in Khayelitsha, Cape Town. SOCIAL DYNAMICS 2016; 42:237-252. [PMID: 28366972 PMCID: PMC5371405 DOI: 10.1080/02533952.2016.1194591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In South Africa, young people's "multiple" or "concurrent" partnerships have been increasingly prominent in public health discourses - as drivers of HIV transmission. Multiple partnerships are typically framed in moralising, negative terms and depicted primarily as male-driven, within a broader framework of women's vulnerability and use of sex for survival and material gain. Based on ethnographic fieldwork with adolescents and young adults in Khayelitsha township near Cape Town, this article investigates young women's partnerships by exploring their complex interpersonal and social dynamics. We unpack women's multiple motivations for, and careful management strategies of, both sexual and social relationships in a broader context of socioeconomic exclusion, threats to health and wellbeing, social obligations and relationships of care. The meanings and practices associated with young people's relationships are more than the sum of individual sexual behaviours, rigid cultural scripts or simply a locus of "risk." The data presented here highlight some of the limitations of "prevention" approaches that do not take into account this nuanced and multilayered view of such relationships. The affective and empathetic dimensions of young peoples' relationships, as well as the socioeconomic contexts in which they occur should also be considered. Without accounting for this context, standard "prevention" approaches are less likely to succeed.
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Affiliation(s)
- Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, International Health Institute, School of Public Health, Brown University, Providence, RI, USA
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Mlambo MG, Peltzer K, Chirinda W. Predictors of multiple concurrent and multiple sexual partnerships among male and female youth aged 18–24 in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2016. [DOI: 10.1080/14330237.2016.1163901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Motlatso Gladys Mlambo
- Centre for Rural Health, Family Medicine Department, University of the Witwatersrand, South Africa
| | - Karl Peltzer
- HIV/AIDS/STIs and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
- Department of Research and Innovation, University of Limpopo, Turfloop Campus, South Africa
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
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Bulled NL. Social models of HIV risk among young adults in Lesotho. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 14:239-54. [PMID: 26284999 DOI: 10.2989/16085906.2015.1054295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Extensive research over the past 30 years has revealed that individual and social determinants impact HIV risk. Even so, prevention efforts focus primarily on individual behaviour change, with little recognition of the dynamic interplay of individual and social environment factors that further exacerbate risk engagement. Drawing on long-term research with young adults in Lesotho, I examine how social environment factors contribute to HIV risk. During preliminary ethnographic analysis, I developed novel scales to measure social control, adoption of modernity, and HIV knowledge. In survey research, I examined the effects of individual characteristics (i.e., socioeconomic status, HIV knowledge, adoption of modernity) and social environment (i.e., social control) on HIV risk behaviours. In addition, I measured the impact of altered environments by taking advantage of an existing situation whereby young adults attending a national college are assigned to either a main campus in a metropolitan setting or a satellite campus in a remote setting, irrespective of the environment in which they were socialised as youth. This arbitrary assignment process generates four distinct groups of young adults with altered or constant environments. Regression models show that lower levels of perceived social control and greater adoption of modernity are associated with HIV risk, controlling for other factors. The impact of social control and modernity varies with environment dynamics.
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Affiliation(s)
- Nicola L Bulled
- a Center for Global Health , University of Virginia , Charlottesville , Virginia , USA
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Abstract
Southern African traditional healers often generalize too broadly from discrete ('accidental') instances of success, partly to recruit a clientele, while biomedicine frequently reasons incorrectly from the general to the specific. Both logics are based on empirical observations, but are inversions of each other; these I characterize as 'magical empiricism.' 'Magic' functions as a metapragmatic discourse to recruit a clientele from a skeptical public that doubts the efficacy of any therapeutic interventions, and it acts in parallel with other practical (and efficacious) healing acts. I introduce the concept of 'exposed beings' to describe locally specific constructions of the person as patient and healer. This helps to explain the existence and enduring appeal of many different medical practices and beliefs in South Africa, but I suggest that 'medical parallelism' rather than 'pluralism' might be more accurate.
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Amin I. Social Capital and Sexual Risk-Taking Behaviors Among Older Adults in the United States. J Appl Gerontol 2014; 35:982-99. [PMID: 25245384 DOI: 10.1177/0733464814547048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 07/20/2014] [Indexed: 11/15/2022] Open
Abstract
Using the General Social Survey (GSS) 2012, a national household-based probability sample of non-institutionalized U.S. adults, this study examined the association of social capital and sexual risk behaviors among older adults aged 55 years and older. Of the 547 respondents, 87% reported not using condoms during their last intercourse, and nearly 15% reported engaging in sexual risk behaviors, such as casual sex, paid sex, male to male sex, and drug use. Binary logistic regression results showed that age, gender, marital status, education, race, sexual orientation, and sexual frequencies were significant predictors of older adults' unprotected sex. Social capital was not a predictor of unprotected sex but was positively associated with other human immunodeficiency virus/sexually transmitted disease (HIV/STD) risk behaviors such as sex with strangers, having multiple sex partners, injecting drugs, and having male to male sex. Findings of this study highlight the importance of HIV/STD prevention programs for older adults.
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Cruz GV, Maússe L. Multiple and Concurrent Sexual Partnerships among Mozambican Women from High Socio-Economic Status and with High Education Degrees: Involvement Motives. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/psych.2014.510138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nyembezi A, Funani I, Sifunda S, Ruiter RA, van den Borne B, Reddy P. The psychosocial determinants of the intention to reduce the number of sexual partners among recent traditionally initiated and circumcized men in the Eastern Cape Province, South Africa. J Health Psychol 2011; 17:664-75. [DOI: 10.1177/1359105311424469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study focuses on the factors associated with the intention to reduce the number of sexual partners. An individual face-to-face interview was used to collect data amongst 2337 traditionally initiated and circumcized men in the rural areas of Eastern Cape Province, South Africa. About 55.5% reported having a main sexual partner and of those 41.4% indicated having other sexual partners. The strongest association with intention was found for self-efficacy towards having one sexual partner, which accounted for almost 49% of the variance. These findings provide specific information for the development of a focused cultural sensitive STI/HIV prevention programme in sexually active young men, which can be integrated into the initiation and health education practices.
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Affiliation(s)
- Anam Nyembezi
- Medical Research Council, Health Promotion Research & Development Unit, Tygerberg, South Africa
| | - Itumeleng Funani
- Medical Research Council, Health Promotion Research & Development Unit, Tygerberg, South Africa
| | - Sibusiso Sifunda
- Medical Research Council, Health Promotion Research & Development Unit, Tygerberg, South Africa
| | | | | | - Priscilla Reddy
- Medical Research Council, Health Promotion Research & Development Unit, Tygerberg, South Africa
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