Correlates of Sexual Faithfulness among Low-Literate Rural Males in the Amhara Region of Ethiopia

HIV is a major threat to the people of the rural Amhara Region; northwest Ethiopia. To date; numerous studies have focused on condom use for HIV prevention. Using the theory of planned behaviour; this study investigates the psychosocial determinants of intended sexual faithfulness among rural males in the Amhara Region. In February 2008; we conducted a cross-sectional study with 100 males; with an age range of 20-50 years (mean age 38 years); in Dejen Woreda. The participants were illiterate or had a low level of literacy and all were rural farmers. Consequently; 10 literate male data collectors were recruited from the same community to assist in collecting data by means of a structured questionnaire. In the analysis of social cognitions as determinants of sexual faithfulness; attitude to faithfulness emerged as the best predictor of intended faithfulness; with significant contributions from self-efficacy and social norm for faithfulness. Thus; balanced and comprehensive HIV interventions focusing on attitudes; self-efficacy and social norms pertaining to faithfulness; sexual abstinence and condom use are needed to halt the spread of HIV among low-literate males in rural Amhara

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

Military Men and Sexual Practices: Discourses of `Othering' in Safer Sex in the Light of HIV/AIDS

Despite recent reports that there is increasing condom use; generally resistance to condom use is still high. This paper focuses on factors inhibiting condom use and explores issues of responsibility for safe sex practices to prevent infection among a group of 14 South African male soldiers. Military men are particularly vulnerable to HIV because of their working conditions; for example; working far from home and being among communities where they have greater economic and political power; as well as in relation to their identities and sexualities as men; and how that is exaggerated by the institutional framework of the military. The data in this paper were drawn from a larger qualitative study exploring a group of military men's narratives on their masculinity; sexuality; sexual relationships and HIV/AIDS. Semi-structured interviews were the main data collection method; and the interview transcripts were analysed primarily through interpretive discourse analysis. Findings of this study show that most participants used the socially desirable discourse that safe sex practices (specifically condom use) should be everybody's responsibility. However; there was also the discourse of the `other' responsible person; which was linked to gender; race; ethnicity; education and rank. The paper concludes with a recommendation that tackling HIV in the military needs to involve the rigorous examination of social factors such as gender; race and ethnicity