Ecological Association between HIV and Concurrency Point-Prevalence in South Africa's Ethnic Groups

HIV prevalence between different ethnic groups within South Africa exhibits considerable variation. Numerous authors believe that elevated sexual partner concurrency rates are important in the spread of HIV. Few studies have; however; investigated if differential concurrency rates could explain differential HIV spread within ethnic groups in South Africa. This ecological analysis; explores how much of the variation in HIV prevalence by ethnic group is explained by differential concurrency rates. Using a nationally representative survey (the South African National HIV Prevalence; HIV Incidence; Behaviour and Communication Survey; 2005) the HIV prevalence in each of eight major ethnic groups was calculated. Linear regression analysis was used to assess the association between an ethnic group's HIV prevalence and the point-prevalence of concurrency. Results showed that HIV prevalence rates varied considerably between South Africa's ethnic groups. This applied to both different racial groups and to different ethnic groups within the black group. The point-prevalence of concurrency by ethnic group was strongly associated with HIV prevalence (R2 = 0.83; p = 0.001). Tackling the key drivers of high HIV transmission in this population may benefit from more emphasis on partner reduction interventions

Reproductive behaviour among women on antiretroviral therapy in Botswana: mismatched pregnancy plans and contraceptive use

Understanding pregnancy planning and contraceptive use is important in preventing unplanned/unwanted pregnancies among women on antiretroviral therapy (ART). Through a cross-sectional survey of 155 women living with HIV on ART in Botswana (mean age = 36); bivariate/multivariate analyses were used to identify and understand pregnancy planning and contraceptive use. Women who did not plan to have a child (n = 85) were older; less educated; had more children and worried about stigmatisation from family and healthcare workers (HCWs). Multivariate analyses found age (OR:3.41; CI:1.57-7.45; p = 0.002); perceived stigmatisation from family and healthcare workers (OR:3.62; CI:1.47-8.96; p = 0.005); and believing it is irresponsible for women living with HIV to want a child (OR:2.40; CI:1.10-5.24; p = 0.028) to be significantly associated with not planning to have a child. Although reported condom use among 85 women who did not plan to have a child was nearly 90; a total of 26 of these women (34) believed they did not have control over condom use. Lack of contraception was reported by 6 women who did not plan a child; this; coupled with the lack of control over condom use; puts unmet need for contraception at 38 Most women reported feeling comfortable talking with HCWs about contraceptives. However; almost a quarter of the women indicated they were infrequently advised about contraceptives at ART clinics. This study found discordance between pregnancy planning and contraceptive use among women on ART. Lack of control over condom use coupled with low hormonal contraceptive use creates unmet need for contraception and increases the risk of unwanted pregnancies. Regular clinic visits for women on ART present excellent opportunities to address contraceptive needs in a considerate and comprehensive manner

Coital Frequency and Condom Use in Monogamous and Concurrent Sexual Relationships in Cape Town; South Africa

The importance of concurrency (overlapping sexual partnerships in which sexual intercourse with one partner occurs between two acts of intercourse with another partner) in driving HIV transmission in hyperendemic settings remains controversial. A modelling study concluded that the role of concurrency in accelerating the spread of HIV is dramatically reduced by coital dilution (the reduction in frequency of sex acts per sexual partner; as a result of acquiring additional partners). We recently examined self-reported data on coital frequency and condom use during monogamous and concurrent relationship episodes from a survey in three communities with a high HIV prevalence. A key question in our analysis was if there is evidence for coital dilution and/or increased condom use during episodes of concurrency

Perceptions of youth on the use of condoms for HIV prevention in Capricorn District, Limpopo Province, South Africa

Despite the fact that condoms are very effective against Sexually Transmitted Infections (STIs) and Human Immunodeficiency Virus transmission (HIV); many people who are at risk do not use them. Latex condoms provide an essentially impermeable barrier to particles the size of HIV and other STI pathogens. The primary aim of this study was to determine the perceptions of youth on the use of condoms for HIV prevention in the Capricorn District of the Limpopo Province; South Africa. A qualitative; exploratory and descriptive design was used. The population included all youth from the ages of 15 to 19 years who attended two primary health care clinics in the Capricorn District. A non-probability purposive sampling method was used. Purposive sampling was used to include participants to participate in the study. Data were collected through unstructured interviews from 15 participants. Interviews were conducted until data saturation was reached; after which the data obtained were analysed qualitatively by open-coding method. Findings revealed four themes; namely; paradoxical attitudes towards consistent condom use related to fear of sexual intercourse and a need to prevent HIV transmission; casual usage of condoms perceived as having positive and negative results; responsibilities of youth to insist on condom use during sexual intercourse; and programme available to help youth with consistent use of condoms. Health education themes that should be included in the programme for educating the youth on the use of condoms for HIV prevention were recommended

HIV/AIDS related knowledge and perceived risk associated with condom use among adolescents in Uganda

While considerable attention has been paid to sexual behaviors among HIV high-risk populations in Africa, few studies have looked at the adolescent population. Using data from the 2004 National Survey of Adolescents in Uganda, logistic regression models were fitted to examine the odds that HIV/AIDS related knowledge and perceived risk of HIV infection are associated with condom use among adolescents. After including demographic measures, findings indicated that correct knowledge of condom use, as well as positive attitudes towards the use of condoms are associated with the likelihood that adolescents used condoms. Self assessment of the risk of HIV infection was not predictive of condom use, nor was knowing someone with AIDS. These findings further emphasize the need to encourage condom use and help protect adolescents at risk of HIV infection (Afr J Reprod Health 2011; 15[1]: 57-63)

HIV/AIDS Misconceptions may be Associated with Condom Use among Black South Africans: an Exploratory Analysis

In South Africa; approximately 20of 15-49-year-olds are infected with HIV. Among black South Africans; high levels of HIV/AIDS misconceptions (e.g. HIV is manufactured by whites to reduce the black African population; AIDS is caused by supernatural forces or witchcraft) may be barriers to HIV prevention. We conducted a cross-sectional study of 150 young black adults (aged 18-26; 56males) visiting a public clinic for sexually transmitted infections; to investigate whether HIV/AIDS misconceptions were related to low condom use in main partner relationships. We assessed agreement with HIV/AIDS misconceptions relating to the supernatural (e.g. witchcraft as a cause of HIV) and to genocide (e.g. the withholding of a cure). In multivariate models; agreement that `Witchcraft plays a role in HIV transmission' was significantly related to less positive attitudes about condoms; less belief in condom effectiveness for HIV prevention; and lower intentions to use condoms among men. The belief that `Vitamins and fresh fruits and vegetables can cure AIDS' was associated with lower intentions among men to use condoms. Women who endorsed the belief linking HIV to witchcraft had a higher likelihood of unprotected sex with a main partner; whereas women who endorsed the belief that a cure for AIDS was being withheld had a lower likelihood of having had unprotected sex. Knowledge about distinct types of HIV/AIDS misconceptions and their correlates can help in the design of culturally appropriate HIV-prevention messages that address such beliefs

Fertility desires and condom use among HIV-positive women at an antiretroviral roll-out program in Zimbabwe

As access to anti-retroviral therapy (ART) increases in sub-Saharan Africa, fertility and contraception patterns are likely to change. Two hundred HIV-positive women at an ART roll-out site in Zimbabwe responded to a questionnaire on fertility desires and condom use. Ten women (5%) reported planning a pregnancy in the next year, comprising 0% of women not yet eligible for ART, 8.22% of women on the waitlist for ART, and 4.17% of women on ART. Younger age, fewer living children, and higher quality of life were individually associated with intended pregnancy in the next year; however in multivariate analysis only the association with higher quality of life remained significant. Reported ever use of condoms was relatively low (46.5%) and condom use varied by neither ART status nor by fertility desires. In conclusion, our data demonstrates fertility desires among HIV-positive women in Zimbabwe correlate with higher perceived quality of life (Afr. J. Reprod. Health 2010; 14[2]: 27-35)

Influence of independent and proximate variables on condom use in selected states in Nigeria

The study examined the influence of individual and proximate factors in determining condom use. Current use of condom and condom use during last sex were used as proxies for consistent condom use. Data on 3,797 sexually active respondents of reproductive age was analyzed from the 2007 USAID-COMPASS midline evaluation on basic family planning and reproductive health outcomes in five Nigerian states. About 9% of respondents were current users, while 11% used a condom during last sex. Younger and more educated respondents were more likely to report condom use. Of the 23 variables, four were statistically significant (p<0.05) in predicting current use for females, and five for males; six were statistically significant in predicting condom use during last sex for females and seven for males. The paper concluded that understanding the determinants and predictors of condom use is critical to improving family planning and reproductive health indicators in Nigeria (Afr J Reprod Health 2010; 14[4]: 53-62)

Patterns of Knowledge and Condom Use among Population Groups: Results from the 2005 Ethiopian Behavioral Surveillance Surveys on HIV

Background:Behavioral surveys help interpret the magnitude of HIV/AIDS. We analyzed indicators of knowledge on HIV/AIDS and condom use among different groups of populations selected for behavioral surveillance in Ethiopia.Methods: We used HIV/AIDS Behavioural Surveillance Surveys (BSS) data collected from ten target groups in Ethiopia. These were female sex workers; military personnel; police force; pastoralists; long distance truck drivers; intercity bus drivers; road construction workers; teachers; factory workers and ANC catchment populations. Results: Data from 14;524 individuals were analyzed. The majority were male (63.6). Knowledge of the three preventive methods (abstinence; faithfulness and consistent condom use); misconceptions and comprehensive knowledge was 57; 75and 18.5; respectively. Female sex workers and the defence force showed positive results in using condom during last sexual encounter and did so consistently with non regular sexual partners and paying partners. Women; pastoralists and the illiterate were negatively impacted. Conclusion: Inadequate and incorrect knowledge on HIV/AIDS was observed with special deficiency among the underserved groups such as pastoralists. Women and the older age group were found to be at a disadvantage. The findings indicate the need to expand prevention activities to hard-to-reach groups and such a certain specific population segments. Population groups such as female sex workers and the defense force that were known to be severely affected by the epidemic and are focus of HIV/AIDS interventions showed positive behaviors. Although this is encouraging; considerable proportion of the study groups did not use condom during sex with non regular partners. This underscores the importance of intensifying interventions across all groups and extended to their localities

"""I Don't Use a Condom (with my Regular Partner) because I Know that I'm Faithful; but with everyone else I do"": The Cultural and Socioeconomic Determinants of Sexual Partner Concurrency in Young South Africans"

Finding ways to reduce the high rates of sexual partner concurrency is increasingly believed to be vital to controlling HIV spread in southern Africa. We describe the frequency and correlates of sexual partner concurrency in a representative sample of 3 324 young South Africans aged 14-25. Of the 2 468 individuals who were sexually active 21had engaged in concurrent sexual partnerships. Multivariate analysis revealed that concurrency was more common with males; Africans; those who knew their partner had another partner; early age of sexual debut; four or more lifetime sexual partners; alcohol consumption; and self-perception of being at high risk for acquisition of HIV. If the respondent's partner knew his or her friends (termed high structural embeddedness) this was associated with a 52reduction in concurrency rates. There are significant differences in both the rates of concurrency and the risk factors underpinning these in the different racial/ethnic groups. Analysis of these underlying determinants suggests that cultural rather than socioeconomic factors predominate; which has important implications for the design and targeting of prevention efforts

Perception of Undergraduates of University of Port Harcourt towards Use of Condom

Background: Unintended pregnancy and sexually transmitted infection especially human immunodeficiency virus pose major challenges to the reproductive health of young adults in developing countries. Appropriate use of contraceptives such as condom may play a significant role in reducing the problems. Aim: To assess the perception of undergraduates in University of Port Harcourt towards the use of condom. Methods: A cross-sectional questionnaire survey on the knowledge and use of condom among undergraduates of University of Port Harcourt. A systematic random sampling method was employed. Data collected was analyzed using SPSS version 11. Results: Of the 601 respondents involved in the study; 319 (53.1) were males and 282 (46.9) were females. While 98.9respondents displayed high level of knowledge of condoms; only 59.3of respondents use condoms. Similarly electronic media and peer group provided the major sources of information about condom. Unmarried people use the condom more than married ones. (p= 0.001). The main reasons for condom use for all age groups were prevention of unwanted pregnancies and sexually transmitted infections (STI).While most unmarried respondents purchased their condoms from patent medicine stores and pharmacy; the married ones procured theirs from clinics and hospitals. Conclusion: The perception of these undergraduates towards use of condom is good. Prevention of STI and unwanted pregnancies were the major reasons for condom use among them while peer group and electronic media were important sources of information

The Dilemma of Safe Sex and Having Children: Challenges Facing HIV Sero-Discordant Couples in Uganda

Background: Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda; we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus; we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples. Methods: A cross-sectional survey of 114 HIV discordant couples in Kampala; and in-depth interviews with 15 purposively selected couples. Quantitative data were analysed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2. Results: Participants wanting children and those with multiple sexual partners were less likely to use condoms (Adj OR 0.51; and 0.36 respectively). Three of the five types of sexual practices used by couples do not allow pregnancy to occur. Main reasons for wanting a child included: ensuring lineage continuity and posterity; securing relationships and pressure from relatives to reproduce. Challenges included: risk of HIV transmission to partner and child; lack of negotiating power for safer sex; failure of health systems to offer safe methods of reproduction. Conclusions: HIV sero-discordant couples with strong desire for childbearing have a dilemma of risking HIV infection or infecting their spouse. Some risk transmission of HIV infection to reproduce. We need to address gender issues; risky behaviour and reproductive health services for HIV sero-discordant couples

Correlates of Condom use among Sexually Experienced Secondary School Male Students in Nairobi; Kenya

This study aimed to examine perceptual factors associated with condom use; and the relationship between condom use and the timing of sexual debut among male secondary school students in Nairobi; Kenya. Data are from the TeenWeb study; a school-based project that used the World Wide Web to assess the health needs of secondary school students; and tested the web's utility as a teaching and research modality. Analyses are based on 214 sexually experienced males aged 14 - 20 years who completed web-based questionnaires about their sexual attitudes and behaviour. Results indicate that students did not see themselves as susceptible to HIV/AIDS and believed condom effectiveness in preventing HIV to be low. Consequently; only a marginal association was found between agreeing that buying condoms is embarrassing and condom use at first sexual intercourse. However; contrary to expectation; agreeing that condoms often break (almost half of participants) was associated with a higher likelihood of condom use at first sex. Each year of delay in sexual debut increased the likelihood of using a condom at first sex by 1.44 times. In turn; having used a condom at first sex increased the likelihood of using one at the most recent sex by 4.81 times; and elevated general condom use (`most or all the time') by 8.76 times. Interventions to increase awareness about the role of condoms in preventing HIV; delay sexual initiation; and teach proper condom use among secondary-school students in Nairobi are needed

A Critical Look on Condoms

Background: To protect the public health; the practice ofsafer sex; promoted in a sex-positive way; is necessary. It includes saying no to unwanted sex; being faithful; havingfewer partners; having sex that does not includeintercourse; and using condoms. This is not just to preventHIV and Sexually transmitted infections (STIs); but also to prevent unwanted pregnancy; STI-related infertility and negative pregnancy outcomes; and cervical cancer- andmost importantly to protect children and for partners to protect each other. Couples in stable relationships are now changing their sexual behavior due to increasing awareness on HIV and other STIs. While some are abstaining from premarital sex; others are being faithful to their partners. However; large numbers of people are yet to adopt safer sexual behavior through correct condom use. Since the beginning of the AIDS epidemics; condom distribution has greatly increased. Methodology: Literature review on the topic was done usiong Pubmed. Relevant journals and topics were also reviewed. Textbooks on relevant topics were also searched. Results The consistent use of male latex condoms significantly reduces the risk of HIV infection in men and women.Consistent use of male latex condoms reduces the risk of gonorrhea in men. Laboratory studies have proved that latex condom is impermeable to the infectious agents in genitalsecretions; including the smallest viruses. Male condoms may be less effective in protecting against STIs that are transmitted by skin-to-skin contact; if that area is not covered by the condom Conclusion: Condoms are currently the only available means of preventing the sexual transmission of HIV and some other STIs. Condoms exist for both men and women

Social factors, social support and condom use behavior among young urban slum inhabitants in southwest Nigeria

Objectives: Despite widespread knowledge that condoms offer protection against STIs/HIV when used correctly and consistently; many young people do not regularly use condoms; thus leading to new sexually transmitted infections; including HIV and AIDS. This study explored condom use behaviour; specifically the extent to which beliefs; self efficacy; risk perception and perceived social support act as predictors of use or non-use of condoms among sexually active young people aged 15-24 years. Methods: Data was obtained from sexually active 448 boys and 338 girls; who were selected through multistage sampling techniques. Analysis of data; which was done with EPI Info and SPSS version 12; focused on predictors of condom use or non-use. Result: Generally; there is widespread knowledge and low levels of condoms use; despite high levels of risky sexual behaviour. Although; half of boys and one third of girls report ever using condoms; a considerably lower proportion of male and female adolescents regularly use condoms. Logistic regression models show that among girls; those who perceived social support from peers and non-parental figures were more likely to use condoms while among boys; earning an income; high risk perception and self efficacy were associated with higher odds of condom use. Conclusions: Programs aiming to increase condom use among young people need to address these factors through community-based strategies

Knowledge of HIV and AIDS in women in sub-Saharan Africa

Although most African people have heard of HIV and AIDS, there is still widespread misunderstanding about how HIV is spread, the consequences of infection, and how to protect against infection. The most vulnerable groups are poorly educated women, those from rural backgrounds, and women who are economically dependent on men. Lower levels of education, taboos associated with the discussion of sexuality and sexual health, the submissive role of women in a relationship, and male control of decision-making regarding sexual relations might explain why African women are less knowledgeable about HIV/AIDS than men. Although most African men and women are aware of the protective benefits of condoms, negative attitudes towards the acceptability and safety of condom use are widespread. More sexual health campaigns tailored to women, especially those with low education levels and those from rural areas, are needed to reduce the spread of HIV in Africa. (Afr J Reprod Health 2008; 12[2]:14-31)

Epidemiologic and behavioral characterization of knowledge of condom use and modeling among military personnel

How accurately condoms are being used vary across populations and knowledge of the factors determining its proper use remains unclear. Knowledge of such differentials and determinants would aid in evaluating the contributions of condom use to HIV epidemic reduction. Baseline data from the Situationally Focused Individual HIV/AIDS intervention to promote HIV protective behavior among 2,213 Nigerian Military Personnel were analyzed. Educational status as a predictor variable was assessed using univariable and multivariable logistic regression model. Compared to those with less than high school education, those with high school and some college education were two times more likely to demonstrate knowledge of condom use and modeling, prevalence odds ratio (POR), 2.32, 95% Confidence Interval (CI)=1.60-3.37. After adjustment for the relevant covariates, higher education attainment was associated with nonsignificant 62% increase in knowledge and modeling, POR, 1.62, 95% CI=0.78-3.38. This study is indicative of low knowledge of condom use and modeling among the Nigerian military personnel; as well as a direct correlation between education attainment and knowledge of condom use and modeling

Condom Use amongst Oil Workers in Niger Delta Region of Nigeria

Background: Spread of sexually transmitted diseases (STDs) amongst oil workers in the Niger Delta region even with the use of condom is worrisome. To ascertain the awareness of the mode of transmission of STDs and commitment to prevention amongst oil workers in the Niger Delta region; the level of use of condom was studied. Method: A cross-sectional study using questionnaires administered to 180 oil workers over a period of three months (January to March 2006) was carried out. Result: A total of 165 respondents questionnaires from 138 males and 27 females were analyzed. Of this number; 144 were married and 21 single. Sixty - five (39.4) respondents used the condom occasionally. Respondents in the 35 44 years bracket used condom most [68 (41.2)]. Extra marital relationship was the reason given by most of the respondents [43 (26.1)] for using the condom. Most of the participants purchased their condoms from the chemist shops [106 (64.2)]. Condom accident [82 (49.7)] accounted for the high risk of infection. Rupture/bursting was responsible for most [70 (85.4)]. Conclusion: There is increased awareness of condom use within the educated sexually active oil workers. About 70of purchased condom is from Chemist shops. National agency for food and drug administration and control therefore should ensure that good quality condoms are dispensed in these outlets

Acceptability of the female condom among high-risk population in Cameroon

The rapid spread of sexually transmitted diseases (STDs); including Acquired Immune Deficiency Syndrome (AIDS); has generated renewed interest in condoms in recent years. The female condom represents a new and potentially important addition to the existing choice of condoms. A female could potentially empower women by giving them a barrier method under their control; offering protection against the spread of AIDS and other STDs as well as unintended pregnancy