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Johnson MJ, Darbes LA, Hosegood V, Johnson MO, Fritz K, Ngubane T, van Rooyen H, McGrath N. Social Influence and Uptake of Couples HIV Testing and Counselling in KwaZulu-Natal, South Africa. AIDS Behav 2022; 26:764-774. [PMID: 34417920 PMCID: PMC8840905 DOI: 10.1007/s10461-021-03435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
Social influences may create a barrier to couples HIV testing and counselling (CHTC) uptake in sub-Saharan Africa. This secondary analysis of data collected in the 'Uthando Lwethu' randomised controlled trial used discrete-time survival models to evaluate the association between within-couple average 'peer support' score and uptake of CHTC by the end of nine months' follow-up. Peer support was conceptualised by self-rated strength of agreement with two statements describing friendships outside of the primary partnership. Eighty-eight couples (26.9%) took up CHTC. Results tended towards a dichotomous trend in models adjusted only for trial arm, with uptake significantly less likely amongst couples in the higher of four peer support score categories (OR 0.34, 95% CI 0.18, 0.68 [7-10 points]; OR 0.53, 95% CI 0.28, 0.99 [≥ 11 points]). A similar trend remained in the final multivariable model, but was no longer significant (AOR 0.59, 95% CI 0.25, 1.42 [7-10 points]; AOR 0.88, 95% CI 0.36, 2.10 [≥ 11 points]). Accounting for social influences in the design of couples-focused interventions may increase their success.
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Affiliation(s)
- Matthew J. Johnson
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Mailpoint 95, Tremona Road, Southampton, SO16 6YD UK
- NIHR ARC Wessex Data Science Hub, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK
| | - Lynae A. Darbes
- Center for AIDS Prevention Studies, Division of Prevention Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA USA
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, USA
| | - Victoria Hosegood
- Department of Social Statistics and Demography, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies, Division of Prevention Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Katherine Fritz
- International Center for Research on Women, Washington, DC USA
| | | | - Heidi van Rooyen
- Human Sciences Research Council, Durban, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nuala McGrath
- Department of Social Statistics and Demography, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Alabi TA, Ramsden MJ. Gender differences in the acceptance of wife-beating in Nigeria: evidence from the 2018 Demographic and Health Survey. Heliyon 2021; 7:e08191. [PMID: 34746466 PMCID: PMC8554140 DOI: 10.1016/j.heliyon.2021.e08191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
The world over, more than one-third of women have been victims of either physical or sexual violence, or both, most of which are perpetrated by intimate partners. Intimate partner violence (IPV) has negative consequences for women's health, socio-economic and psychological wellbeing. Similarly, acceptance of IPV has negative implications for its spread, sympathy for victims, and utilisation of antenatal and postnatal healthcare services among women. This study investigates the influence of age, education, location, religion, marriage type, employment, wealth level, extramarital sex, smoking, internet use, media exposure and decision making on the justification of IPV, and how the associations vary between men and women. The study utilised the 2018 Nigeria's Demographic and Health Survey. The data analysed was comprised of 8,018 men and 28,888 women who were married or living with a partner. It was found that women are more likely to accept IPV than men (AOR: 1.627). Educational difference between spouses influences women's experience of and acceptance of IPV. Overall, being young, being uneducated, living in the north, being Muslim, being polygamous, being employed, being poor, having extra-marital sex, being a smoker, not having access to internet, and not being exposed to the media increased the odds of IPV justification. However, while Muslim women had higher odds of accepting IPV than Christians (AOR: 1.587), Muslim men have lower likelihood of IPV justification than Christian men (AOR: 0.759). Gender differences also exist in the influence of age, marriage type, employment, extra-marital sex, smoking, media exposure and decision making. This study underscores the importance of applying differing intervention programmes to men and women where necessary.
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Affiliation(s)
- Tunde A Alabi
- Department of Sociology, Faculty of Social Sciences, University of Lagos, Nigeria.,Department of Sociology, Faculty of Humanities, University of Cape Town, South Africa
| | - Mark J Ramsden
- Faculty of Education, University of Cambridge, United Kingdom
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Thapa R, Yang Y, Nget M. Perceptions of Sexual Infidelity in Rural Cambodia: A Qualitative Study of Adolescent Men. Am J Mens Health 2019; 13:1557988319848576. [PMID: 31055984 PMCID: PMC6505243 DOI: 10.1177/1557988319848576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 11/21/2022] Open
Abstract
Sexual infidelity plays a significant role in the high rate of spousal transmission of HIV in Cambodia. The sexual beliefs and attitudes of a person begin in childhood and are developed through multiple chains in early adolescence, affecting his or her future sexual behavior and future incidence of HIV. A deeper understanding of the perspectives of adolescents regarding infidelity is critical to effective HIV prevention efforts during adulthood. Using a descriptive qualitative approach, this study explored the perceptions of male adolescents regarding male infidelity. Through the thematic analysis method, themes and subcategories were developed from the responses of 48 male high school students from three provinces. Majority of the participants ( n = 33) were found to have liberal attitudes not only toward male infidelity but also toward the high possibility of their own future infidelity ( n = 14). Almost 45% ( n = 21) of the participants explained that men would fulfill their sexual desires outside, such as in karaoke, when their wives are unable to have sex with them. Participants believed it annoying for men to disclose their extramarital activities to their wives. The study concluded that the participants hold accepting perceptions about infidelity; they are part of the HIV problem and must be part of the solution. Educators and counselors need to deliver age-appropriate, scientifically correct, and culturally relevant messages about sexual health and HIV prevention to growing adolescents.
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Affiliation(s)
- Roshna Thapa
- School of Nursing, Research Institute of
Nursing Science, Chonbuk National University, Jeonju, Baekje-daero, Republic of
Korea
| | - Youngran Yang
- School of Nursing, Research Institute of
Nursing Science, Chonbuk National University, Jeonju, Baekje-daero, Republic of
Korea
| | - Manndy Nget
- School of Nursing, Thammasat University,
Bangkok, Thailand
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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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Mugweni E, Omar M, Pearson S. Understanding barriers to safer sex practice in Zimbabwean marriages: implications for future HIV prevention interventions. HEALTH EDUCATION RESEARCH 2015; 30:388-399. [PMID: 25503579 DOI: 10.1093/her/cyu073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
Against the backdrop of high human immunodeficiency virus (HIV) prevalence in stable relationships in Southern Africa, our study presents sociocultural barriers to safer sex practice in Zimbabwean marriages. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008. Our aim was to identify barriers faced by married women when negotiating for safer sex. Participants identified individual, relational and community-level barriers. Individual level barriers made women voiceless to negotiate for safer sex. Being voiceless emanated from lack sexual decision-making power, economic dependence, low self-efficacy or fear of actual or perceived consequences of negotiating for safer sex. Relational barriers included trust and self-disclosure. At the community level, extended family members and religious leaders were said to explicitly or implicitly discourage women's safer sex negotiation. Given the complexity and multi-levelled nature of barriers affecting sexual behaviour in marriage, our findings suggest that HIV prevention interventions targeted at married women would benefit from empowering individual women, couples and also addressing the wider community.
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Affiliation(s)
- Esther Mugweni
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Mayeh Omar
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Stephen Pearson
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
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Kwena Z, Mwanzo I, Shisanya C, Camlin C, Turan J, Achiro L, Bukusi E. Predictors of extra-marital partnerships among women married to fishermen along Lake Victoria in Kisumu County, Kenya. PLoS One 2014; 9:e95298. [PMID: 24747951 PMCID: PMC3991629 DOI: 10.1371/journal.pone.0095298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 03/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The vulnerability of women to HIV infection makes establishing predictors of women's involvement in extra-marital partnerships critical. We investigated the predictors of extra-marital partnerships among women married to fishermen. METHODS The current analyses are part of a mixed methods cross-sectional survey of 1090 gender-matched interviews with 545 couples and 12 focus group discussions (FGDs) with 59 couples. Using a proportional to size simple random sample of fishermen as our index participants, we asked them to enrol in the study with their spouses. The consenting couples were interviewed simultaneously in separate private rooms. In addition to socio-economic and demographic data, we collected information on sexual behaviour including extra-marital sexual partnerships. We analysed these data using descriptive statistics and multivariate logistic regression. For FGDs, couples willing to participate were invited, consented and separated for simultaneous FGDs by gender-matched moderators. The resultant audiofiles were transcribed verbatim and translated into English for coding and thematic content analysis using NVivo 9. RESULTS The prevalence of extra-marital partnerships among women was 6.2% within a reference time of six months. Factors that were independently associated with increased likelihood of extra-marital partnerships were domestic violence (aOR, 1.45; 95% CI 1.09-1.92), women reporting being denied a preferred sex position (aOR, 3.34; 95% CI 1.26-8.84) and spouse longer erect penis (aOR, 1.34; 95% CI 1.00-1.78). Conversely, women's age--more than 24 years (aOR, 0.33; 95% CI 0.14-0.78) and women's increased sexual satisfaction (aOR, 0.92; 95% CI 0.87-0.96) were associated with reduced likelihood of extra-marital partnerships. CONCLUSION Domestic violence, denial of a preferred sex positions, longer erect penis, younger age and increased sexual satisfaction were the main predictors of women's involvement in extra-marital partnerships. Integration of sex education, counselling and life skills training in couple HIV prevention programs might help in risk reduction.
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Affiliation(s)
- Zachary Kwena
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
- * E-mail:
| | - Isaac Mwanzo
- Department of Community Health, Kenyatta University, Nairobi, Kenya
| | - Chris Shisanya
- Department of Geography, Kenyatta University, Nairobi, Kenya
| | - Carol Camlin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, San Francisco, California, United States of America
| | - Janet Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lilian Achiro
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
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