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Dhillon S, Amoak D, Chidimbah Munthali GN, Sano Y, Antabe R, Luginaah I. Polygamy and safe sex negotiation among married women: evidence from Cameroon. BMC Infect Dis 2023; 23:817. [PMID: 37993765 PMCID: PMC10664310 DOI: 10.1186/s12879-023-08826-4] [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: 07/02/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Research indicates that women in polygamous relationships may be exposed to unique sexual and reproductive health challenges. However, there are very few studies that examine whether polygamy is associated with safe sex negotiation among married women in sub-Saharan Africa, including Cameroon. METHODS Using the 2018 Cameroon Demographic and Health Survey, we apply logistic regression analysis to compare two indicators of safe sex negotiation (i.e., the ability to ask for condom use and refuse sex against their partner) between polygamous (n = 1,628) and monogamous (n = 5,686) women aged 15-49 years old. RESULTS We find that 67% and 50% of married women can ask for condom use and refuse sex against their partner, respectively. Multivariate analysis further reveals that women in polygamous relationships are less likely to report they can ask for condom use (OR = 0.71, p < 0.001) and refuse sex (OR = 0.64, p < 0.001) in comparison to their monogamous counterparts. CONCLUSIONS Our analysis found that in Cameroon, women in polygamous relationships, Muslim women, married women with inadequate HIV knowledge, those who had never been tested for HIV and women with lower socioeconomic status are less likely to negotiate for safe sex. Based on these findings, we discuss several implications for policymakers, including the establishment of a comprehensive family planning educational program and the deployment of community health workers to disseminate educational initiatives pertaining to safe sex negotiation to community members.
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Affiliation(s)
- Satveer Dhillon
- Department of Geography and Environment, Western University, 1151 Richmond St, London, ON, N6A 5C2, Canada
| | - Daniel Amoak
- Department of Geography and Environment, Western University, 1151 Richmond St, London, ON, N6A 5C2, Canada
| | | | - Yujiro Sano
- Department of Sociology and Anthropology, Nipissing University, 100 College Dr, North Bay, ON, P1B 8L7, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, Scarborough, ON, M1C 1A4, Canada
| | - Isaac Luginaah
- Department of Geography and Environment, Western University, 1151 Richmond St, London, ON, N6A 5C2, Canada
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Solanke BL, Kupoluyi JA, Awoleye AF, Adewole OE, Babalola OB. Women's ability to negotiate safer sex with partners by contraceptive status among a nationally representative sample of married women in Nigeria. Contracept Reprod Med 2023; 8:17. [PMID: 36855163 PMCID: PMC9976491 DOI: 10.1186/s40834-023-00214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Existing studies established that safer sex negotiation influences contraceptive use, and women who are able to negotiate safer sex were expected to be contraceptive users. However, it is not certain that all contraceptive users have the ability to negotiate safer sex. Likewise, there is no evidence that all non-users are not able to negotiate safer sex with partners. The study assesses the prevalence of women's ability to negotiate safer sex and examines the determinants of women's ability to negotiate safer sex among contraceptive users and non-users. METHODS The comparative cross-sectional research design was adopted. Data were extracted from the 2018 Nigeria Demographic and Health Survey. The study analyzed a sample of 2,765 contraceptive users and 20,304 non-users. The outcome variable was women's ability to negotiate safer sex with partners. The explanatory variables examined are eight socio-demographic characteristics (age, child marriage, education, parity, media exposure, religion, work status, and experience of female genital mutilation), six relational characteristics (healthcare autonomy, financial autonomy, household wealth quintile, partners' education, ownership of assets, and type of marriage). Attitude to wife-beating, male controlling behavior, place of residence, and geo-political zone of residence were included as control variables. Multivariable regression models were estimated. RESULTS Findings showed that 6.2% of women who were not able to negotiate safer sex were contraceptive users, while 15.9% of women who were able to negotiate safer sex were contraceptive users. Among non-users, the significant determinants were child marriage, education, parity, mass media exposure, religion, work status, healthcare autonomy, financial autonomy, household wealth, partner education, type of marriage, geo-political zone, attitude to wife-beating, and male controlling behavior. Regarding contraceptive users, the significant determinants were parity, religion, the experience of female genital mutilation, financial autonomy, partner education, type of marriage, and the geo-political zone of residence. CONCLUSION The ability to negotiate safer sex differs among contraceptive users and non-users. Also, the determinants of the ability to negotiate safer sex differ among contraceptive users and non-users. While existing strategies may continue to focus on women not using contraceptives, new strategies promoting reproductive autonomy are required among contraceptive users.
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Affiliation(s)
- Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Joseph Ayodeji Kupoluyi
- grid.10824.3f0000 0001 2183 9444Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Abayomi Folorunso Awoleye
- grid.10824.3f0000 0001 2183 9444Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusola Esther Adewole
- grid.10824.3f0000 0001 2183 9444Department of Sociology and Anthropology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Oyeyemi Bukola Babalola
- grid.10824.3f0000 0001 2183 9444Department of Psychology, Obafemi Awolowo University, Ile-Ife, Nigeria
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Broderick K, Aristide C, Bullington BW, Mwanga-Amumpaire J, Downs JA, Sundararajan R. Stigma of infidelity associated with condom use explains low rates of condom uptake: qualitative data from Uganda and Tanzania. Reprod Health 2023; 20:12. [PMID: 36631809 PMCID: PMC9832812 DOI: 10.1186/s12978-023-01563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
Despite widespread messaging supporting male (external) condom use to prevent HIV in endemic settings, utilization of condoms is low across sub-Saharan Africa. A thorough understanding of barriers to condom use as a form of HIV prevention is necessary to reduce HIV transmission. Here, we present qualitative data from rural eastern Africa to explain low utilization of condoms among heterosexual adults. Focus groups and interviews were conducted in Tanzania and Uganda between 2016 and 2019. A content analysis approach was used to identify attitudes about condoms and factors related to use/non-use. We found that strategies such as abstinence and being faithful to one's partner are perceived as ideal but rarely achievable methods of HIV prevention. Condoms are used in the setting of "failure" to abstain or be faithful and are therefore stigmatized as markers of infidelity. As such, use within cohabiting and long-term relationships is low. Our data suggest that negative perceptions of condoms may stem from persistent effects of the formerly applied "ABC" HIV prevention approach, a public health messaging strategy that described A-abstinence, B-be faithful, and C-use a condom as tiered prevention tools. Condom uptake could increase if HIV prevention messaging acknowledges existing stigma and reframes condom use for proactive health prevention. These studies were approved by Weill Cornell Medicine (Protocols 1803019105 and 1604017171), Mbarara University of Science and Technology (Protocol 16/0117), Uganda National Council of Science and Technology (Protocol SS-4338), and the Tanzania National Institute for Medical Research (Protocol NIMR/HQ/R.8c/Vol.I/1330).
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Affiliation(s)
- Kathryn Broderick
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Christine Aristide
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Brooke W Bullington
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
- Burlington Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Jennifer A Downs
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
- Weill Cornell Medicine, Center for Global Health, New York, USA
- Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Radhika Sundararajan
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA.
- Weill Cornell Medicine, Center for Global Health, New York, USA.
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Awoleye AF, Solanke BL, Kupoluyi JA, Adetutu OM. Exploring the perception and socio-cultural barriers to safer sex negotiation among married women in Northwest Nigeria. BMC Womens Health 2022; 22:411. [PMID: 36209114 PMCID: PMC9547432 DOI: 10.1186/s12905-022-01989-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Background Safer sex negotiation refers to the means through which partners in sexual relationships agree to have intercourse that protects both partners from adverse sexual health outcomes. Evidence is sparse on the socio-cultural barriers to safer sex negotiation, especially in Northwest Nigeria where almost every aspect of women’s lives is influenced by religious and cultural norms. Understanding the socio-cultural barriers requires having knowledge of the perspectives of community stakeholders such as religious leaders, and community leaders. Thus, from the perspectives of community stakeholders, this study explored the perception and socio-cultural barriers to safer sex negotiation of married women in Northwest Nigeria. Method A qualitative research design was adopted. Participants were purposively selected across six states, namely, Kano, Katsina, Jigawa, Kebbi, Kaduna, and Zamfara. Data were collected through Key Informant Interview (KII). A total of 24 KIIs were conducted using the in-depth interview guide developed for the study. The selection of the participants was stratified between rural and urban areas. The interviews were tape-recorded, transcribed, and translated from the Hausa language into the English language. Verbal and written informed consent were obtained from participants prior to the interviews. Data were analyzed using inductive thematic content analysis. Results Safer sex negotiation was well-understood by community stakeholders. Men dominate women in sexual relationships through the suppression of women’s agency to negotiate safer sex. Married women endured domination by males in sexual relationships to sustain conjugal harmony. The practice of complying with traditional, cultural, and religious norms in marital relationships deters women from negotiating safer sex. Other socio-cultural causes of the inability to negotiate safer sex are child marriage, poverty, poor education, and polygyny. Conclusion Community stakeholders have a clear understanding of safer sex negotiation in Northwest Nigeria but this has not translated into a widespread practice of safer sex negotiation by married women due to diverse socio-cultural barriers. Strategies that will empower women not only to gain more access to relevant sexual and reproductive health information and services but also to encourage women’s assertiveness in family reproductive health decisions are imperative in Northwest Nigeria.
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Affiliation(s)
- Abayomi Folorunso Awoleye
- grid.10824.3f0000 0001 2183 9444Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Bola Lukman Solanke
- grid.10824.3f0000 0001 2183 9444Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Joseph Ayodeji Kupoluyi
- grid.10824.3f0000 0001 2183 9444Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olufemi Mayowa Adetutu
- grid.10824.3f0000 0001 2183 9444Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Imo CK, Odimegwu CO, De Wet-Billings N. Women's attitudes towards negotiating safe sexual practices in Nigeria: Do family structure and decision-making autonomy play a role? BMC Womens Health 2022; 22:16. [PMID: 35065648 PMCID: PMC8783474 DOI: 10.1186/s12905-022-01602-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk of contracting sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) is related to women's sexual attitudes, beliefs, and power dynamics within marriages in developing countries. Despite the interventions towards improving women's sexual health and well-being, women are disproportionately affected by the risk of STIs transmission compared with their male counterparts in most sub-Saharan African countries including Nigeria. This study examined the roles of family structure and decision-making autonomy on women's attitudes towards negotiating safe sexual practices in Nigeria. METHODS The study involved analyses of data from a nationally representative and weighted sample size of 28,219 ever-married/cohabiting women aged 15-49 years from the 2018 Nigeria Demographic and Health Survey. Descriptive and statistical analyses were carried out, including frequency tables, Pearson's chi-square test, and multivariable binary logistic regression model. RESULTS The overall prevalence of having positive attitudes towards negotiating safe sexual practices were 76.7% and 69.6% for a wife justified in asking the husband to use a condom if he has an STI and refusing to have sex with the husband if he had sex with other women, respectively. The results further showed that polygamous unions negatively influenced urban and rural women's attitudes towards negotiating safe sexual practices, but women's decision-making autonomy on how to spend their earnings was found to be a protective factor for having positive attitudes towards negotiating safe sexual practices with partners. Surprisingly, there were significant variations in attitudes towards negotiating safe sexual practices among urban and rural women who enjoyed decision-making autonomy on their healthcare (aOR 1.70; CI 1.32-2.18 and aOR 0.52; CI 0.44-0.62, respectively). Plausibly, such women might have constrained them to compromise their sexual relationships for fear of being neglected by partners. CONCLUSION The outcomes of this study have some policy implications for both maternal and child health. There is the need to intensify programmes aimed at improving women's sexual health and rights towards achieving sustainable development goals of preventing deaths of newborns, ending STIs and creating gender in Nigeria.
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Affiliation(s)
- Chukwuechefulam Kingsley Imo
- Department of Sociology, Faculty of the Social Sciences, Adekunle Ajasin University, P. M. B. 001, Akoko-Akungba, Ondo State, Nigeria.
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole De Wet-Billings
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Solanke BL, Awoleye AF, Ikotun FF, Ogunjuyigbe PO. Timing of first marriage and women’s ability to negotiate safer sex in Nigeria. SEXUAL AND RELATIONSHIP THERAPY 2021. [DOI: 10.1080/14681994.2021.1900559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Bola Lukman Solanke
- Faculty of Social Sciences, Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Abayomi Folorunso Awoleye
- Faculty of Social Sciences, Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Florence Folake Ikotun
- Faculty of Social Sciences, Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Peter Olasupo Ogunjuyigbe
- Faculty of Social Sciences, Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Vyas S. Women's economic status and sexual negotiation: re-evaluation of the 'normative precedent' in Tanzania. CULTURE, HEALTH & SEXUALITY 2020; 22:1097-1111. [PMID: 31429378 DOI: 10.1080/13691058.2019.1652933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
Women's ability to negotiate the conditions and circumstances of sexual relations is central to their sexual and reproductive health, including mitigating HIV risk. In Africa, gender-based power imbalances constrain women's sexual agency. Research has suggested that among couples in sub-Saharan African countries, such as Uganda and Nigeria, sexual decision making is defined by a 'normative precedent' in the form of a set of rules and practices conferring sexual authority on men. Using qualitative data among women in paid work and among men, this study explored interpersonal relations and sexual negotiation in Tanzania. Data were collected in two sites, Dar es Salaam and Mbeya. The normative precedent for sexual decision making was universally understood by men and women. Women did not perceive paid work as giving them greater bargaining power in the domain of sex. In Mbeya, a high-HIV area, some women perceived that refusing sex would encourage men to have additional sexual partners, thus increasing their susceptibility to HIV. Other women, however, believed that suspicions about men's behaviour combined with accurate HIV knowledge, provided leverage for women to refuse sex. In both sites, challenges to the normative precedent were evident, particularly among younger men. Both men and women expressed a preference for equality in sexual decision making.
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Affiliation(s)
- Seema Vyas
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Persson A, Kelly-Hanku A, Mek A, Mitchell E, Nake Trumb R, Worth H, Bell S. Polygyny, Serodiscordance and HIV Prevention in Papua New Guinea: A Qualitative Exploration of Diverse Configurations. THE ASIA PACIFIC JOURNAL OF ANTHROPOLOGY 2020. [DOI: 10.1080/14442213.2020.1758202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Esmaeili A, Shokoohi M, Danesh A, Sharifi H, Karamouzian M, Haghdoost A, Shahesmaeili A, Akbarpour S, Morris MD, Mirzazadeh A. Dual Unsafe Injection and Sexual Behaviors for HIV Infection Among People Who Inject Drugs in Iran. AIDS Behav 2019; 23:1594-1603. [PMID: 30460664 DOI: 10.1007/s10461-018-2345-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We used two national surveys (2010: N = 1597; 2013: N = 1057) of people who inject drugs (PWID) in past-month to assess the prevalence and population size of PWID with either safe or unsafe injection and sex behaviors, overall and by HIV status. In 2013, only 27.0% (vs. 32.3% in 2010) had safe injection and sex, 24.6% (vs. 23.3% in 2010) had unsafe injection and sex, 26.4% (vs. 26.5% in 2010) had only unsafe injection, and 22.0% (vs. 18.0% in 2010) had unsafe sex only. Among HIV-positive PWID in 2013, only 22.1% (~ 2200 persons) had safe injection and sex, 14.2% (~ 1400 persons) had unsafe injection and sex, 53.1% (~ 5200 persons) had unsafe injection, and 10.6% had unsafe sex (~ 1100 persons). Among HIV-negative PWID in 2013, only 27.5% (~ 22,200 persons) had safe injection and sex, 25.9% (~ 20,900 PWID) had unsafe injection and sex, 23.2% (~ 18,700 persons) had unsafe injection, and 23.3% (~ 18,800 persons) had unsafe sex. HIV-positive and -negative PWID in Iran continue to be at risk of HIV acquisition or transmission which calls for targeted preventions services.
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Affiliation(s)
- Aryan Esmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Ahmad Danesh
- Golestan Research Center of Psychiatry, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - AliAkbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samaneh Akbarpour
- Center for Disease Control (CDC), Ministry of Health and Medical Education, Tehran, Iran
| | - Meghan D Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
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Siril H, Kaale A, Minja A, Kilewo J, Mugusi F, Sunguya B, Todd J, Kaaya S, Smith Fawzi MC. Improving communication about HIV prevention among people living with HIV and their at-risk social network members in Dar es Salaam, Tanzania. COGENT MEDICINE 2019; 6. [PMID: 31355302 PMCID: PMC6660010 DOI: 10.1080/2331205x.2019.1600230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Although a number of HIV prevention programs have been implemented, such as mass media campaigns, high rates of unprotected and concurrent sexual partnerships, as well as low uptake HIV testing and limited HIV knowledge, persist in Tanzania. We examined the effect and predicting factors of HIV prevention communication among people living with HIV (PLH) exposed to NAMWEZA intervention, and their at-risk social network members (NMs) Quantitative data were collected from 326 participants at baseline and 24 months of follow-up. In-depth interviews with 20 PLH were conducted at follow-up. Results indicated specific communication about condom use and HIV testing increased; (mean increase of 0.28 (SD = 0.14) scores, P = 0.012 and 0.42 (SD = 0.11) scores, p < 0.001 respectively while general discussion about protecting other people from HIV did not change significantly; mean increase was 0.01 scores (SD = 0.005), p = 0.890. Positive predictors of communication included being single; OR = 1.10, p = 0.01, female; OR = 1.15, p = 0.03, aged 30 years or older; OR = 1.23, p < 0.01, HIV knowledge, dose of NAMWEZA participation; OR = 1.01, p < 0.001, and high self-efficacy for condom use; OR = 1.4, p < 0.001. Stigma demonstrated a significant but negative association with communication for condom use; OR = 1.01, p < 0.01.Qualitative data reflected perceived possession of more individual skills and ability to address some personal/cultural obstacles to communicating about HIV prevention including those observed in the quantitative data. NAMWEZA improved communication about HIV prevention among PLH with their at-risk-NMs. The approach is a promising complement to media campaigns in similar populations. Future research and program evaluation efforts should explore how communities perceive and communicate about protecting others from HIV.
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Affiliation(s)
- Hellen Siril
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Public Health Evaluations and Quality Improvement, Management and Development for Health, Dar es Salaam, Tanzania
| | - Anna Kaale
- Department of Healthy Options, Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Anna Minja
- Department of Healthy Options, Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Japheth Kilewo
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jim Todd
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Rutagumirwa SK, Bailey A. "I Have to Listen to This Old Body": Femininity and the Aging Body. THE GERONTOLOGIST 2019; 59:368-377. [PMID: 29045614 PMCID: PMC6417766 DOI: 10.1093/geront/gnx161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study explores how older women with low socioeconomic status living in rural Tanzania give meaning to their (aging) body in relation to the ideals of femininity. RESEARCH DESIGN AND METHODS Ten qualitative in-depth interviews and 10 focus group discussions (N = 60) were conducted among women aged 60 and older. RESULTS The findings reveal that older women perceive their aging body as "a burden." This characterization of the body is linked to the inability of the aging body to live up to the women's gendered lives. The conflict between their physical limitations and the desire to perform gendered tasks (internalized feminine habitus) affect the women's process of self-identification. This led to emotional distress and subsequently threatened their survival and well-being. DISCUSSION AND IMPLICATIONS The results suggest that older women need to be supported through interventions that are tailored to their cultural and socioeconomic context.
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Affiliation(s)
| | - Ajay Bailey
- Department of Demography, Faculty of Spatial Sciences, University of Groningen, The Netherlands
- Transdisciplinary Center of Qualitative Methods, Manipal University, India
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Goicolea I, Öhman A, Vives-Cases C. Intersections between gender and other relevant social determinants of health inequalities. Glob Health Action 2018; 10:1397909. [PMID: 29168436 PMCID: PMC5727427 DOI: 10.1080/16549716.2017.1397909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Isabel Goicolea
- a Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Ann Öhman
- b Umeå Center for Gender Studies , Umeå University , Umeå , Sweden
| | - Carmen Vives-Cases
- c Department of Community Nursing, Preventive Medicine and Public Health and History of Science , Alicante University , Alicante , Spain.,d CIBER of Epidemiology and Public Health , Barcelona , Spain
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Mtenga SM, Pfeiffer C, Tanner M, Geubbels E, Merten S. Linking gender, extramarital affairs, and HIV: a mixed methods study on contextual determinants of extramarital affairs in rural Tanzania. AIDS Res Ther 2018; 15:12. [PMID: 29880001 PMCID: PMC5991469 DOI: 10.1186/s12981-018-0199-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extramarital sex is a potential driver of human immunodeficiency virus (HIV) transmission for long-term couples in sub-Saharan Africa. It is increasingly recognized that preventing sexual risk behaviours requires an understanding and adjustment of sexual relationship factors beyond the individual level. We investigated the association between extramarital affairs and HIV status, factors associated with extramarital affairs, and created insights in the context and pathways for married men and women in rural Tanzania who engage in extramarital affairs. METHODS A cross-sectional sequential explanatory mixed method design was employed. The WHO-Social determinants of health perspective guided the study. Using logistic regression, we analysed the MZIMA project community surveillance representative sample of 3884 married partners aged 15+ residing in Ifakara town, Tanzania (2012-2013). Multinomial logistic regression analysis established the relative risk ratio (RRR) of different social and economic factors with lifetime (proxy) and recent (12 months prior to survey) extramarital affairs. Logistic regression analysis determined the association between extramarital affairs and HIV status. Semi-structured interviews and focus group discussions explored the quantitative findings, capturing the experiences and norms regarding extramarital affairs. RESULTS We found a significant association between lifetime (proxy) extramarital affairs and HIV infection among women only. The RRR of having extramarital affairs (lifetime proxy) was significantly higher among Village Community Bank (VICOBA) members, the re-married, consumers of alcohol, those from southern regions, non-Muslims, and those with older age. In the case of recent extramarital affairs (12 months prior to survey), associations were significant for the same variables except for religion, having an income was also associated with the outcome. Qualitative narratives reflected that, desire to prove manhood (masculinity) supported by societal normative beliefs such as; 'it is not realistic for a man to stay without extramarital partner' and religious beliefs; 'a man shall dominate a woman' encouraged men's extramarital affairs. For women, striving for financial autonomy, obligations to pay back debts borrowed from several VICOBA, and limited support from their husbands encouraged their engagement in extramarital affairs. Low relationship quality (conflict and sexual dissatisfaction) were reported to encourage both men and women's extramarital affairs. CONCLUSIONS The findings show that the link between extramarital affairs and HIV has a gender dimension in which women are more likely to acquire HIV through extramarital affairs (case of recent extramarital affairs (12 months prior to survey). Future programs seeking to address risk sexual behaviors in Tanzanian marriages can consider context-sensitive interventions which address aspects beyond 'individual risk' and women's financial uncertainties, and include couple's relationship quality, excessive alcohol behaviors, normative masculinity ideology and societal norms, that encourage women's economic dependence and men's engagement in multiple sexual partnerships. Microfinance projects (e.g. VICOBA) could be a platform for gender-transformative approaches, combining economic empowerment and HIV risk protection strategies.
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Pinchoff J, Boyer CB, Mutombo N, Chowdhuri RN, Ngo TD. Why don't urban youth in Zambia use condoms? The influence of gender and marriage on non-use of male condoms among young adults. PLoS One 2017; 12:e0172062. [PMID: 28333963 PMCID: PMC5363807 DOI: 10.1371/journal.pone.0172062] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Zambia experiences high unmet need for family planning and high rates of HIV, particularly among youth. While male condoms are widely available and 95% of adults have heard of them, self-reported use in the past 12 months is low among young adults (45%). This study describes factors associated with non-use of male condoms among urban young adults in Zambia. METHODS A household cross-sectional survey in four urban districts was conducted from November 2015 to January 2016 among sexually active young adults ages 18-24 years. A random walk strategy was implemented in urban areas; eligible, enrolled participants were administered a survey on household characteristics, health access, and knowledge, attitudes and practices related to contraception. Relative risk regression models were built to determine factors associated with the decision to not use a male condom (non-use) at most recent sexual intercourse. RESULTS A total of 2,388 individuals were interviewed; 69% were female, 35% were married, and average lifetime sex partners was 3.45 (SD±6.15). Non-use of male condoms was 59% at most recent sexual intercourse. In a multivariate model, women were more likely to report non-use of a male condom compared with men (aRR = 1.24 [95% CI: 1.11, 1.38]), married individuals were more likely to report non-use compared with unmarried individuals (aRR = 1.59 [1.46, 1.73]), and those residing in the highest poverty wards were more likely to report non-use compared with those in the lowest poverty wards (aRR = 1.31 [1.16, 1.48]). Those with more negative perceptions of male condom use were 6% more likely to report non-use (aRR = 1.06 [1.03, 1.09]). Discussion regarding contraception with a partner decreased non-use 13% (aRR = 0.87 [0.80, 0.95]) and agreement regarding male condom use with a partner decreased non-use 16% (aRR = 0.84 [0.77, 0.91)]). DISCUSSION Non-use of male condoms is high among young, married adults, particularly women, who may be interested in contraception for family planning but remain at risk of STI infection. Effective marketing strategy of dual protection methods to this population is critical.
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Affiliation(s)
- Jessie Pinchoff
- Research Department, Innovations for Poverty Action, New Haven, Connecticut, United States of America
| | - Christopher B. Boyer
- Research Department, Innovations for Poverty Action, New Haven, Connecticut, United States of America
| | | | | | - Thoai D. Ngo
- Poverty, Gender and Youth Program, Population Council, One Dag Hammarskjold Plaza, New York, New York, United States of America
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