Health providers' perceptions of adolescent sexual and reproductive health care in Swaziland.

AIM: To explore health providers' perceptions of adolescent sexual and reproductive healthcare services in Swaziland. METHODS: Fifty-six healthcare providers, working in 11 health clinics in Swaziland in 2005, were surveyed using a semi-structured questionnaire. The data were analysed by descriptive statistics and content analysis to identify key themes. FINDINGS: Most participants were women with a mean age of 36 years and a mean number of 6 years in the profession. Services provided included STIs/HIV/AIDS advice, pre- and post-test counselling and testing on HIV, contraceptives and condom use. Half of the nurses/midwives had no continued education and lacked supervision on adolescent sexual and reproductive health care. The majority had unresolved moral doubts, negative attitudes, values and ethical dilemmas towards abortion care between the law, which is against abortion, and the reality of the adolescents' situation. Forty-four wanted to be trained on post-abortion care while eight on how to perform abortions. Twenty-six wanted the government to support adolescent-friendly services and to train heathcare providers in adolescent sexual and reproductive health services. CONCLUSION: The curricula within nursing and midwifery preservice education need to be reviewed to incorporate comprehensive services for adolescents. There is need for provision of comprehensive services for adolescents in Swaziland and appropriate youth-friendly services at all levels. There is need for nurse/midwifery participation, advocacy and leadership in policy development.

Traditional healers in Zambia and their care for patients with urethral/vaginal discharge.

OBJECTIVE: The aim of this study was to describe the knowledge and practices of traditional healers in relation to the management of patients with urethral/vaginal discharge. SUBJECTS AND METHOD: Eighty (80) traditional healers, 54 from an urban and 26 from a rural setting in Zambia, who attend to patients with urethral/vaginal discharge, were interviewed using a semistructured questionnaire. RESULT: All of the traditional healers had knowledge of urethral/vaginal discharge being a symptom of a sexually transmitted disease (STD) and that individuals get the infection through sexual relations with infected persons. The healers were all able to cite other symptoms associated with urethral/vaginal discharge. The treatment the healers used was mostly herbal preparations in the form of roots or powders administered orally to induce diarrhea, vomiting, and diuresis. Patients were not allowed to combine traditional and biomedical therapies. Almost half of the healers did apply some biomedical practices in the management of patients with urethral/vaginal discharge, such as history taking and examination of patients before diagnosis and prescription. The healers also advised patients to avoid sex while on treatment and to avoid reinfection by remaining with one partner and using condoms. Some healers advised their patients to bring their sexual partners for consultation. CONCLUSION: Because traditional healers attend to patients with STDs, both in rural and urban areas, efforts should be made to promote cooperation between traditional and biomedical health care providers, so that treatment of patients and their partners could be improved. Traditional management that concurs with biomedical practices could thus be a starting point for discussion and cooperation.

Psycho-social determinants for sexual partner referral in Uganda: quantitative results.

The purpose of this study was to investigate the factors influencing sexual partner referral using the Attitude-Social influence self-Efficacy model as a guiding theoretical framework. The data was collected in an interview survey with 236 women and 190 men attending a sexually transmitted disease clinic in Kampala, Uganda. Intention, attitude, subjective norm, self-efficacy, and past behaviour in relation to partner referral as well as partner type were collected at time 1. At time 2 (1 month later), sexual partner referral was assessed. Intention, self-efficacy, and previous behaviour predicted partner referral for women whereas intention, partner type and previous behaviour predicted partner referral for men. For the women the strongest predictors for intention were self-efficacy followed by attitude and partner type. For the men the strongest predictor was attitude followed by partner type and self-efficacy. Social influence was a better predictor of intention for women than for men. An analysis of underlying cognitive beliefs discriminating those who referred and those who did not refer the sexual partner showed that attitudinal beliefs were the most important for men whereas self-efficacy beliefs were the most important for women. The targeting of the gender-based discriminatory beliefs in intervention may improve compliance with sexual partner referral.

Efficacy of patient-delivered partner medication in the treatment of sexual partners in Uganda.

BACKGROUND: Patient-based partner referral (PBPR), which is the main method for treating sexual partners of patients with sexually transmitted diseases (STDs), has limited effectiveness. GOAL: The authors compared the efficacy of PBPR with patient-delivered partner medication (PDPM) among patients attending the Mulago STD clinic in Kampala, Uganda. STUDY DESIGN: A total of 383 patients (187 women, 196 men) with STDs were randomized to the PBPR or PDPM group. The proportion of sexual partners treated in either group was compared using the chi-square statistic by intention to treat for partners whose follow-up status was unknown. RESULTS: The two groups had similar background characteristics. Of the 237 partners elicited, 176 (74%) were reported treated in the PDPM group. In the PBPR group, in which 234 partners were elicited, 79 (34%) were referred to the treatment clinic. This difference was statistically significant (risk ratio [RR], 2.44; 95% CI, 1.95-3.07; P < 0.001). Furthermore, PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult. For women, 86 of 103 partners in the PDPM group were reported treated, compared with 23 of 104 partners in the PBPR group (RR, 4.55; 95% CI, 2.92-7.08; P < 0.001). For casual partners, 18 of 51 (34%) were reported treated in the PDPM group, compared with only three of 45 partners (7%) who were referred in the PBPR group (RR, 1.43; 95% CI, 1.40-2.65; P < 0.01). CONCLUSION: Patient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners.

"Shopping" for sexually transmitted disease treatment: focus group discussions among lay persons in rural and urban Zambia.

BACKGROUND: In Zambia, persons use different types of services when seeking treatment for sexually transmitted diseases (STDs). GOAL: To gain insight into the rationale behind the selection of treatment sources by investigating perceptions of STDs and by identifying STD treatment sources used. STUDY DESIGN: Focus group discussions were held with 57 men and 44 women in one urban and one rural area in Zambia between May 1997 and June 1997. The focus group discussions were audiotaped and analyzed qualitatively. RESULTS: Participants combined traditional and modern treatment. The main reason given was that even when biomedical medicine was effective, STDs could only be totally cured if the patient was cleansed by traditional herbs. Factors influencing health-seeking behavior were the person's perception, how the diagnosis was determined, type and cost of treatment, demand for sexual partners, and attitudes of health workers, parents, and the church. CONCLUSION: Barriers and enabling factors for the use of treatment sources were identified. Interventions to improve services and cooperation between the health sectors need to consider these factors.

Psychosocial determinants for sexual partner referral in Uganda: qualitative results.

In order to understand and elicit the psychosocial factors influencing compliance with sexual partner referral, 10 focus group discussions (FGDs) and 40 individual interviews based on the attitude-social influence-self efficacy (ASE) model were held in Mbarara District of Uganda. The focus groups were derived from both rural and urban areas. Informal interviews were held with 20 men and 20 women presenting with symptoms of a sexually transmitted disease (STD) at the outpatient department of Mbarara Hospital. The emerging outcome of attitudinal beliefs regarding health consequences of partner referral were mainly positive. However, outcome beliefs relating to the relationship with the partners were mainly negative. Social influence for sexual partner referral was from health-care providers, partner(s), friends and relatives. The self-efficacy beliefs were mainly negative especially among women. Barriers hampering sexual partner referral were related to poor quality of health care, gender relations and type of sexual partners. There is a need to target these beliefs and self-efficacy expectations in health education and STD counselling and for more research to evaluate the psychosocial determinants of sexual partner referral quantitatively.

Lay people's perceptions of sexually transmitted infections in Uganda.

In order to understand lay people's perceptions of sexually transmitted infections (STIs) focus group discussions and semi-structured interviews were held with community members and patients with STIs in Mbarara and Kampala, Uganda. Symptoms of common STIs and the modes of transmission methods were known. STIs were perceived as naturalistic diseases caused by a tiny insect called akakoko or akawutka, although female infertility, one of the common complications of STIs, was perceived as a supernatural ailment. There was no stigma towards people with AIDS, although stigma towards people with other STIs was high. There were also strong negative attitudes towards the use of condoms. More than 60% of the patients interviewed had received treatment from the informal sector which included self-treatment and traditional healers. To reduce the incidence and complications of STIs, there may be a need to collaborate with the informal sector, to further evaluate the beliefs and practices identified in this study and to target them for health education.

PIP: This article aims to understand the perception of lay people in Uganda towards sexually transmitted infections (STIs). Focus group discussions and semi-structured interviews were conducted in the communities and statistical analysis through the Chi-square test was used to treat the data. Results showed that causes and modes of transmission of STIs were known to the people. An STI was perceived as a natural disease from an agent called "akakoko or akawuka," although female infertility, one of the common STI complications, was perceived as a supernatural ailment. People infected with HIV/AIDS were accepted by the society, but a person with another STI was stigmatized, in the sense that, they are infecting themselves when they already knew of AIDS. For STI prevention, avoiding and preventing sexual promiscuity was the most common method, but the people demonstrated a strong negative attitude towards the use of condom. Common among the respondents is the use of traditional healers for treating STIs and self-treatment of the disease.

Predictors of condom use among patients with sexually transmitted diseases in Uganda.

BACKGROUND AND OBJECTIVE: Patients with sexually transmitted diseases (STDs) are at an increased risk of HIV infection and they must be targeted for increased condom use. GOAL: To identify predictors of condom use among patients with STDs. STUDY DESIGN: In a cross-sectional survey, an interview-administered questionnaire was administered to 138 patients at the STD clinic, Mulago, and the outpatients department, Mbarara Hospital, in Uganda. Data were collected on socio-demographic situations, STD symptoms, type of sexual partners, and use of condoms. Multivariate logistic regression models were used to identify independent predictors of condom use. RESULTS: Of the 138 patients, 87 (66%) knew how to use condoms, 81 (59%) ever used a condom, 34 (25%) used a condom at least once in the previous 3 months, 20 (15%) used a condom during the last sexual intercourse, and 80 (58%) accepted a free supply of condoms. Reasons for not using condoms among the 57 who had never were: having a regular partner or spouse (28, 49%), partner does not approve (17, 30%), reduced sexual pleasure (5, 9%), and no answer (7, 12%). The independent predictors of condom use were: being a man, not having a regular partner, having had sex with a casual partner, being able to read English, having at least secondary education, and using electricity for lighting. CONCLUSION: Providing health promotion messages in local languages may improve condom use in this population. There is a need for complementary HIV prevention strategies for women and for regular sexual partnerships.

PIP: A cross-sectional survey was undertaken among 138 sexually transmitted disease (STD) patients in Mbarara Hospital, Uganda, to understand the predictors of condom use among patients with STDs with a view of suggesting measures for increased condom use. Data were collected on sociodemographic situations, STD symptoms, type of sexual partners, and use of condoms. Multivariate logistic regression models were used to identify independent predictors of condom use. Results showed that of the 138 patients (58 men, 80 women), 87 (42 men, 45 women) knew how to use a condom; 81 had ever used a condom, 34 had used a condom at least once in the previous 3 months, 20 had used one during the last intercourse, and 80 had accepted a free supply of condoms. Reasons among the 57 patients for not using condoms were: having a regular partner or spouse (28.49%); partner does not approve (30%); reduced sexual pleasure (9%); and no answer (12%). The results also showed that the predictors of condom use were: being a man; not having a regular partner; having had sex with a casual partner; able to read English; having a secondary education; and using electricity for lighting. Therefore, the results suggested that providing health promotion in local languages would improve condom use in the area. Furthermore, a complementary HIV prevention strategy is needed for women and regular sexual partners.

Health-seeking behaviour of patients with sexually transmitted diseases in Zambia.

The aim of this paper is to describe health-seeking behaviour, time with symptoms and sexual activity during symptom period among patients attending the public health sector in urban and rural Zambia for treatment of an STD. The study was conducted at two urban health centres and at one rural mission hospital during four months in 1994 and 1995. Four hundred and seventy nine patients seeking health care for STD symptoms were interviewed. The patients had experienced STD symptoms for one to two weeks before they came to the clinic. During this period two thirds in the urban and one third in the rural setting had had sex. Sixty per cent of the patients in the urban and 50% in the rural setting had taken some kind of medicine before they came to the clinic. More people had used modern compared to traditional medicine, especially in the urban area. Market places, other clinics and doctors, friends, and relatives were common treatment sources. Ten per cent had received medicine from a traditional healer. Thus, a majority of the patients had received medication from other sources before they came to the clinic. Sex during periods with STD symptoms was common. This has serious implications for STD as well as HIV transmission.

PIP: A number of factors influence which treatment sources people seek when symptoms of morbidity occur and a person alone, or with the advice of others, decides that the condition warrants additional attention. Some such factors are related to social structures such as kinship, social networks, gender, and economic status, while others are related to belief systems which define how people conceptualize the etiology of disease. Service quality, the introduction of user fees, and the cost of treatment can also affect health-seeking behavior (HSB). One highly important factor affecting HSB for sexually transmitted diseases (STD) is social stigma. For example, in Zambia, where STDs are a major public health problem, it is considered highly shameful to have an STD, especially for women. This paper describes the HSB, time with symptoms, and sexual activity during symptom period among patients attending 2 urban public health centers and 1 rural mission hospital in Zambia during 4 months in 1994 and 1995 to receive treatment for their STDs. 479 patients seeking health care for STD symptoms were interviewed. The patients had experienced STD symptoms for 1-2 weeks before coming to the clinic. During that period, two-thirds in the urban and one-third in the rural areas had had sexual intercourse. 60% of the patients in the urban and 50% in the rural settings had taken some kind of medicine before coming to the clinic. However, more people had used modern rather than traditional medicine, especially in the urban area. Marketplaces, other clinics, physicians, friends, and relatives were common treatment sources, although 10% had received medicine from a traditional healer.

Quality of STD care in Zambia. Impact of training in STD management.

STUDY OBJECTIVE: To assess quality of care of sexually transmitted diseases (STDs) and evaluate interactive training methods aimed at improving providers' performance. DESIGN AND SETTING: This comparative study, with a baseline, intervention, and evaluation phases was conducted at two urban health centers in Zambia. The personnel at one health center were trained in STD management using interactive training methods. The other health center acted as a control. SUBJECTS AND METHODS: Two-hundred patients with STD were interviewed and their interaction with health care providers observed before and after the training. Another 200 interviews and observations were conducted at the control health center. RESULTS: The proportion of patients being examined, given health education and informed about partner notification increased significantly after the intervention. The proportion of patients who had complaints about the health care did not decrease. Long waiting time and lack of time to discuss the disease were the main complaints. CONCLUSION: The training solved some, but not all, problems of poor case management. This indicates the need for a more process-oriented approach for improving quality of care.

Partner notification in context: Swedish and Zambian experiences.

Partner notification is a public health strategy in which sexual partners of persons with a sexually transmitted disease (STD) are notified, counselled and offered services. According to recommendations published by the World Health Organization, partner notification should be voluntary, confidential and only undertaken when appropriate services are available. This paper communicates experiences from studies on partner notification in Sweden and Zambia and emphasizes the need for a contextualized approach to partner notification. In Sweden as well as in Zambia partner notification is an acknowledged strategy to prevent STDs. Methods must, however, be adjusted to the practical and cultural context in each country.

Quality of STD care in an urban Zambian setting: the providers' perspective.

The aim of this paper is to analyse obstacles to optimal STD care in an urban setting in Zambia. Eight-two health professionals answered a questionnaire with closed and open-ended questions. More than 50% were not satisfied with their working conditions, due to heavy workload, lack of equipment/drugs, poor salary, and lack of continuing education. Negative opinions about STD patients were common. Treatment and preventive activities were considered important but most respondents found patient compliance poor--especially for partner notification. To improve the quality of STD care, training in STD management should be combined with improved working conditions.

PIP: Improvement of the quality of care is a major goal of the Government of Zambia's health reform program. A questionnaire administered to 82 health professionals from two health centers in Lusaka, Zambia, sought to identify obstacles to high-quality sexually transmitted disease (STD) care. Both health centers had an antenatal and general outpatient department, a maternity ward, and a laboratory. Respondents, who were primarily enrolled nurses (n = 41) and midwives (n = 22), had a median of 11 years of working experience. The questionnaire had both closed and open-ended items. Negative opinions about STD clients (e.g., they risk other people's lives, they are difficult patients, they are bad people) were common. The most frequently cited components of high-quality STD care were diagnosis, treatment, prevention, and interpersonal relationships. Shortages of equipment and drugs, lack of patient compliance with clinic instructions (especially regarding partner notification), inadequate staff training, and lack of time for patient care were the major obstacles identified. Of the 78 health workers who answered this question, 34 were satisfied with their current working conditions, 25 were partly satisfied, and 19 were dissatisfied. Reasons for dissatisfaction included the heavy workload, lack of equipment and drugs in the clinic, poor staff salaries, lack of transport and housing allowances, absence of continuing education, no team work, and professional isolation. To improve the quality of STD care at the health center, respondents suggested a separate room for STD patients to ensure privacy, specialized training for staff in STD management, regular clinical meetings where staff can raise suggestions, staff seminars, and purchase of equipment and drugs with money from the user fees.

Individual counseling of patients with sexually transmitted diseases. A way to improve partner notification in a Zambian setting?

BACKGROUND: Sexually transmitted diseases (STD) are a major health problem in Zambia. Partner notification, which is a recommended strategy to decrease STD, must be improved. GOAL: To assess whether individual counseling of patients with STD, combined with contact slip(s), had any impact on the proportion of sex partners traced in an urban setting in Zambia. STUDY DESIGN: A randomized trial comprised of 94 women and 302 men with STD. RESULTS: Women and men in the intervention group informed more partners than did those in the control group. In the intervention group, 1.8 partners per man was treated compared to 1.2 in the control group (P < 0.001). There was no difference between the two groups of women. There was a gradual decline from numbers of partners informed to numbers of partners treated according to the patient to number of contact slips filed. CONCLUSIONS: Individual counseling of men with STD improved partner notification.

PIP: In Lusaka, Zambia at an urban health center, researchers randomly allocated 302 male sexually transmitted disease (STD) patients and 94 female STD patients to receive or not receive individual counseling combined with written information to sex partners (i.e., contact slips). They aimed to determine whether or not this intervention improved partner notification. This study was conducted during October 1992-March 1993. The most common STD for men was chancroid, followed by gonorrhea and syphilis. For women, it was syphilis, followed by gonorrhea. Men and women in the intervention group were more likely to bring at least one sex partner to the clinic than those in the control group (100% vs. 93% and 72% vs. 56%, respectively). Men in the intervention group brought more partners from the last three months to the clinic than those in the control group (1.8 vs. 1.2; p 0.001), while women in both groups brought the same number of partners (0.7). In the intervention group, more partners of the men received treatment based on contact slips than partners of the women (1.6 vs. 0.4). For both sexes, based on the number of contact slips filed, the numbers of partners informed fell gradually with the numbers of partners treated. Men in the intervention group were less likely than those in the control group not to tell all partners from the last three months to come for treatment (19% vs. 48%). Among controls, the reasons were health staff failed to tell them to bring more than one partner and the men could not afford the medicines for their partners. Among cases, the leading reason was that the partners were unknown or out of town. Quarrels that prevented partners from seeking treatment occurred equally in both groups of women. They occurred more often among male cases than male controls, however (p = 0.0008). Yet partners of male controls who had experienced quarrels were less likely to seek treatment than those of male cases (p = 0.0015). The quarrels-related findings suggest the need for counseling to emphasize partners' emotional reactions and how to deal with these reactions. Overall findings show that individual counseling of men improved STD partner notification.

Quality of care in sexually transmitted diseases in Zambia: patients' perspective.

The aims of this study were to describe Zambian STD patients response to treatment, compliance with partner notification, and further to measure patients' satisfaction with the health care received. The majority of 179 STD patients (92 men, 87 women) interviewed twice at an urban health centre were not satisfied with the care received. Their response to treatment and compliance with partner notification were not satisfactory. Thirteen patients had not been able to buy medicines, since they had no money. One hundred and twenty-five patients had asked 134 sexual partners to come for treatment but only 60 percent of them had received treatment. To get free medicines, to have privacy, to get injections instead of tablets, to be examined before treatment, and to be informed about the diagnosis were judged most important for good quality STD care. Health workers must improve their communication and counselling skills to understand the needs of their patients, who are the ultimate evaluators of the quality of care.

PIP: Sexually transmitted diseases (STD) are the most common infectious diseases in Zambia, affecting mainly adolescents and young adults across society. Zambia, with a total population of about 8 million people, experiences approximately 125,000 cases of STD annually. Findings are reported from a study conducted to describe Zambian STD patients' response to treatment and compliance with partner notification, as well as their satisfaction with health care received. 92 male and 87 female patients were interviewed twice at an urban health center 5 km outside of Lusaka. The men and women were aged 17-55 and 15-37 years, respectively, of mean ages 26 and 23. 48% of the men and 78% of women were married. Most of the patients were unsatisfied with the care received. Their response to treatment and compliance with partner notification were unsatisfactory. For example, lack of funds prevented 13 patients from buying medicines, and 125 patients had asked 134 sex partners to come for treatment, but only 60% of them had actually done so and been treated. The most important factors defining good quality STD care noted by study participants were the provision of free medicines, privacy, injections rather than tablets, pre-treatment examinations, and information about their diagnoses. Health care providers must improve their communication and counseling skills to better understand patients' needs.

Behaviour, knowledge and reactions concerning sexually transmitted diseases: implications for partner notification in Lusaka.

Available data show that STDs and their consequences are a major health problem in Zambia. This study focuses on factors which could have implications for partner notification, as a tool for prevention. Fifty women and fifty men with STD were interviewed at two outpatient clinics in Lusaka, where partner notification is not functioning optimally. A majority of the sexual partners during the last three months were known by the patients who also stated a willingness to bring more partners than they were asked to do. Women had symptoms for a longer period than men before they came for treatment. They were less aware of symptoms connected with STD and a majority of them did not know that they were receiving treatment for STD. The communication between the health care provider and the patients about disease, treatment and partner notification needs to be improved especially for women.

PIP: Sexually/transmitted diseases (STD) and their consequences are a major health problem in Zambia. Partner notification is a strategy to find, counsel, and treat the sex partners of STD patients in the attempt to control the spread of STDs. The authors describe existing health care for STD patients in two urban health centers in Lusaka where partner notification is not functioning optimally with focus upon issues with implications for partner notification such as the number of sex partners identifiable and patients knowledge of and reactions to having an STD. 50 men of mean age 28.9 years and 50 women of mean age 23.7 years with STDs were interviewed at the clinics. 52% were married and 32% were unmarried. The men and women had had symptoms for medians of 5 and 14 days, respectively. STD patients are usually asked to bring their sex partners to the clinic for evaluation and treatment. This study found, however, that some patients were not asked to bring their partners. A majority of the sexual partners during the last three months were known by the patients who were also willing to bring more partners than they were asked to by health personnel. Partners of STD patients in Zambia could therefore be found and treated more extensively than is now the case. The research also found women to be less aware of symptoms connected with STDs and a majority did not know that they were receiving treatment for STD. It is concluded that communication between the health care provider and patients about disease, treatment, and partner notification needs to be improved, especially for women.

Experiences of disease and treatment among Chlamydia patients.

Chlamydia trachomatis infection is a common sexually transmitted disease in Sweden, where counselling and partner notification are tools for prevention. Fifty infected patients (27 women, 23 men) were interviewed at an outpatient department. A majority of the patients felt that they were to blame for getting the disease and had the responsibility to inform partners. Women reacted more strongly against the disease and felt more negatively treated by the health care personnel. Chlamydia was considered a serious disease and 40% expressed fear for HIV/AIDS. Only eight per cent used condoms regularly. The concept 'causal contact' was very differently defined by the patients. Health personnel has to be more aware of the difficulties with ambiguous concepts and information need to be improved. More attention should be paid to women and their reactions.

Predictors of condom use among patients with sexually transmitted disease in Uganda

Background and objective: Patients with sexually transmitted diseases (STDs) are at an increased risk of HIV infection and they must be targeted for increased condom use. goal : to identify predictors of condom use among patients with STDs. Study Design : in a cross-sectional survey; an interview-ad-ministered questionnaire was administered to 138 patients at the STD clinic; Mulago; and the outpatients department; Mbarara Hospital; in Uganda. Data were collected on socio-demographic situations; STD symptoms; type of sexual partners; and use of condoms. Multivariate logistic regression models were used to identify independent predictors of condomuse. Results: of the 138 patients; 87(66) knew how to use condoms; 81(59) every used a condom; 34(25) used a condom at least once in the previous 3 months; 20(15) used a condom at least once in the previous 3 months; 20(15) used a condom during the last sexual intercourse; and 80 (58) accepted a free supply of condoms. Reasons for not using condoms among the 57 who had never were: having a regular partner or spouse (28; 49) accepted a free supply of condoms. Reasons for not using condoms among the 57 who had never were: having a regular partner or spouse (28; 49);partner does not approve (17;30); reduced sexual pleasure (5;9); and no answer (7;12). The independent predictors of condom use were: being a man; not having a regular partner; having had sex with a casual partner; being able to read eng; having at least secondary education; and using electricity for lighting. Conclusion: Providing health promotion measures in local languages may improve condom use in this population. There is a need for complementary HIV prevention strategies for women and for regular sexual partnerships