Individual and Relationship Predictors of Couple-Level Sexual Concurrency in Heterosexual South African Couples

One of the major goals of couple-based HIV prevention programs in sub-Saharan Africa is to reduce outside sex partners, known as sexual concurrency. This cross-sectional study examined sexual concurrency at the couple-level and differentiated couples based on whether neither, one, or both partners engaged in sexual concurrency over the past 6 months. Individual predictors (alcohol use and lifetime history of physical or sexual trauma) and relationship predictors (mistrust, relationship inequity, relationship satisfaction, and sexual satisfaction) were used as predictors of couple-level sexual concurrency. A quantitative investigation using path analysis was carried out with data collected from 286 South African heterosexual couples. Results showed that alcohol use for both sexes, relationship dissatisfaction for women, and mistrust among women were predictive of different types of sexual concurrency. Findings suggest that consideration of the experiences and behavior of both partners may be useful in understanding different reasons for engagement in sexual concurrency.

HIV prevention: mapping Mozambican people's views on the acceptability of the widow's sexual cleansing ritual called pita-kufa

BACKGROUND

In Mozambique, the widow is traditionally required to undergo a cleansing ritual called pita-kufa, which generally involves several sessions of unprotected sexual intercourse with the brother of her deceased husband. This ritual may play a role in the spread of HIV and reveals, to some degree, the subordinate position to which women are subjected in Mozambican society. Thus, this study's aim was to map Mozambicans' views on the acceptability of this ritual, given the gender and public health concerns linked to it.

METHODS

A total of 359 Mozambicans participated in the study. The data collection instrument consisted of 18 vignettes describing realistic pita-kufa situations, varying as a function of three factors: a widow's willingness or not to perform the ritual, the perceived effectiveness of the ritual, and the risk level of HIV infection linked to the practice. For each pita-kufa situation presented in the vignettes, the participants were asked to rate its acceptability on an 11-point scale. In addition, the participants wrote comments giving their general views on the ritual. A cluster analysis using the K-means procedure was applied to the quantitative raw data to capture different perspectives, and the participants' written comments were subjected to thematic and frequency content analysis.

RESULTS

From the data gathered though the vignettes, three different perspectives were found: total unacceptability (55% of the participants), conditional acceptability (29% of the participants) and unconditional acceptability (16% of the participants). From the data gathered though the participants' written comments, it emerged that they thought that the practice of this ritual should evolve (61%), stop (27%) and be kept as it is (12%).

CONCLUSION

According to the main results, it seems that a large majority of study participants think that this ritual is outdated and needs to evolve in order to minimize the risk of HIV transmission and respect women's rights.

Assessing Mozambicans' willingness and determinants to use pre-exposure prophylactic HIV medication

In anticipation of the introduction of the pre-exposure prophylaxis drugs as an additional HIV prevention tool, we mapped the different positions of Mozambicans' willingness to use it. Overall, 507 adults indicated willingness to use under different conditions varying as a function of perceived susceptibility to and severity of infection, side effects, administration protocol, and cost. Three qualitatively different positions were found: Unwillingness irrespective of conditions (4%), depend on circumstances (76%), and unconditional willingness (8%). A large majority of participants were willing to use pre-exposure prophylaxis drugs, provided that the administration is not too constraining, and the adverse side effects can be minimized.

The Impact of Face Skin Tone vs. Face Symmetry on Perceived Facial Attractiveness

The purpose of this study was to assess and compare the relative contribution of skin tone and symmetry on judgment of attractiveness regarding female faces. Two hundred and fifteen Mozambican adults were presented with a set of faces, and instructed to rate their degree of attractiveness along a continuous scale. Chi-square, factorial weight analyses and ANOVA were used to analyze the data. Face skin tone had a significant impact on the participants' attractiveness judgment of target faces. However, the target face skin tone contribution to the participants' attractiveness judgment (5% of the total variance) was much weaker than the contribution of the target face symmetry (85% of the total variance). These results imply that skin bleaching, common among Black people across sub-Saharan African countries, is not only dangerous to the health of those who practice it, but it is unlikely to make them appear much more attractive.

Regarding realities: Using photo-based projective techniques to elicit normative and alternative discourses on gender, relationships, and sexuality in Mozambique

This paper argues for the methodological merit of photo-based projective techniques (PT) in formative HIV communication research. We used this technique in Mozambique to study multiple sexual partnerships (MSPs) and the roles of social and gender norms in promoting or discouraging these behaviours. Facilitators used ambiguous photographs and vignettes to ease adult men and women into discussions of sexual risk behaviour and HIV transmission. Visuals upheld a third-person perspective in discussions, enabling participants to safely project their worldviews onto the photographed characters, and indirectly share their attitudes, normative environments, personal and peer experiences, perceived risks and benefits, and theories about motivations for extramarital sex. Visually grounded storylines contained rich detail about the circumstances and interpersonal conversations that contextualise MSP behaviour and norms. The research yielded findings about conflicting social practices of public encouragement and private disapproval. Despite concerns around the verifiability of PTs, the repetition and convergence in the elicited conversations - and confirmation through subsequent campaign design and evaluation - suggest these techniques can reliably elicit information for formative public health and communication research on psychosocial and normative factors.

The impact of face skin tone on perceived facial attractiveness: A study realized with an innovative methodology

This study aimed to assess the impact of target faces' skin tone and perceivers' skin tone on the participants' attractiveness judgment regarding a symmetrical representative range of target faces as stimuli. Presented with a set of facial features, 240 Mozambican adults rated their attractiveness along a continuous scale. ANOVA and Chi-square were used to analyze the data. The results revealed that the skin tone of the target faces had an impact on the participants' attractiveness judgment. Overall, participants preferred light-skinned faces over dark-skinned ones. This finding is not only consistent with previous results on skin tone preferences, but it is even more powerful because it demonstrates that the light skin tone preference occurs regardless of the symmetry and baseline attractiveness of the stimuli.

A flexible method to model HIV serodiscordance among couples in Mozambique

Whereas the number of people newly infected by HIV is continuing to decline globally, the epidemic continues to expand in many parts of the world. As the HIV/AIDS epidemic has matured in many countries, it is believed that the proportion of new infections occurring within couples has risen. Across countries, including Mozambique, a sizeable proportion of couples with HIV infection are discordant. A serodiscordant couple is a couple in which one partner has tested positive for HIV and the other has not. To describe the HIV serodiscordance among couples, a variety of association measures can be used. In this paper, we propose the serodiscordance measure (SDM) as a new alternative measure. Focus is on the specification of flexible marginal and random effects models for multivariate correlated binary data together with a full-likelihood estimation method, to adequately and directly describe the measure of interest. Fitting joint models allows examining the effects of different risk factors and other covariates on the probability to be HIV positive for each member within a couple, and estimating common effects for both probabilities more efficiently, while accounting for the association between their infection status. Moreover, the interpretation of the proposed association parameter SDM is more direct and relevant and effects of covariates can be studied as well. Results show that the HIV prevalence for the province where a couple was located as well as the union number for the woman within a couple are factors associated with HIV serodiscordance. These findings are important for the Mozambican public health policy makers to design national prevention plans, which include policies to stimulate regular HIV testing for couples as well as adolescents and young adults, prior to getting married or living together as a couple.