Use of Western-based HIV risk-reduction interventions targeting adolescents in an African setting.

PURPOSE: To evaluate an intervention (based on one which had previously been successful in reducing adolescent human immunodeficiency virus (HIV) risk behaviors in the United States) among adolescents residing in Namibia, a country located in sub-Saharan Africa. METHODS: A randomized trial of a 14-session face-to-face intervention emphasizing abstinence and safer sex was conducted among 515 youth (median age 17 years; median grade 11) attending 10 secondary schools located in two districts in Namibia. Knowledge, attitudes, intentions, and HIV risk behaviors were assessed at baseline and in the immediate postintervention period. RESULTS: Knowledge increased significantly among intervention compared to control youth (88% vs. 82%; correct responses, p < .0001). At postintervention follow-up, more intervention than control youth believed that they could be intimate without having sex, could have a girlfriend or boyfriend for a long time without having sex, could explain the process of impregnation, knew how to use a condom, and could ask for condoms in a clinic. Fewer intervention than control youth believed that if a girl refused to have sex with her boyfriend it was permissible for him to strike her, and that condoms took away a boy's pleasure. More intervention than control youth anticipated using a condom when they did have sex, and fewer expected to drink alcohol. Finally, after intervention, there was a trend for increased condom use. There were significant gender-related differences at baseline, although intervention impact was generally equivalent. CONCLUSIONS: These findings provide support for the judicious adaptation of successful Western HIV prevention programs in other cultural settings. A single intervention approach appears to be effective in short-term follow-up with both genders.

HIV risk behaviors, intentions, and perceptions among Namibian youth as assessed by a theory-based questionnaire.

Considerable progress has been made in the United States and Europe regarding HIV risk prevention efforts targeting adolescents. However, in Africa less progress has been made to date. This article address three questions: Can risk assessment questionnaires developed in Western countries be modified so as to be appropriate for use in African countries? Are social cognitive models appropriate in African settings? Does covariation among risk behaviors occur among youth residing in African countries? The data was obtained from a cross-sectional survey conducted among 922 youth ages 12 to 18 years living in school-based hostels in Namibia. Data were collected using a theory-based risk assessment questionnaire. One third of the youth were sexually experienced, three quarters of whom had engaged in sexual intercourse in the previous 6 months. Over one third of these youth had had more that one sexual partner in the previous 6 months and over one half had not used a condom at last episode of intercourse. The psychometric properties of the questionnaire and the relationship between perceptions and behaviors provide evidence that theory-based questionnaires developed in Western countries can be modified for use in different cultural settings. The data also provide strong evidence of covariation between risk behaviors among Namibian youth.

PIP: Findings are presented from an investigation into whether risk assessment questionnaires developed in Western countries can be modified to be used appropriately in African countries. The authors also explored whether covariation among risk behaviors occurs among youth living in African countries. Data were obtained from a cross-sectional survey conducted among 922 individuals aged 12-18 years, of median age 15 years, living in school-based hostels in Namibia. 49% of the subjects were male. 37% overall and 56% of the boys had ever had sexual intercourse, of whom 70% had experienced such intercourse during the preceding 6 months. 29% of those who were sexually experienced reported having more than 1 sex partner in the previous 6 months and 50% used a condom during their most recent intercourse. Study findings suggest that theory-based questionnaires developed in Western countries can be modified for use in different cultural settings. Study data also provide strong evidence of covariation between risk behaviors among Namibian youth.

Increased protected sex and abstinence among Namibian youth following a HIV risk-reduction intervention: a randomized, longitudinal study.

OBJECTIVE: To evaluate an HIV risk-reduction intervention among Namibian adolescents. METHODS: A randomized trial of a 14-session face-to-face intervention emphasizing abstinence and safer sexual practices conducted among 515 youths (median age 17 years and median grade 11) attending 10 secondary schools located in two districts in Namibia. Youths were randomly assigned to the intervention or control condition at the level of the individual. HIV risk behaviours, intentions and perceptions were assessed at baseline, immediately post-intervention and at 6 and 12 months post-intervention. RESULTS: Among all 515 youths who enrolled in the programme, rates of either abstinence or sex with a condom were not different between control and intervention youths at baseline or in the follow-up period. However, analyses conducted among the subset of youths who were sexually inexperienced at baseline (n = 255) revealed that a higher percentage of intervention youths (17%) than control youths (9%, P<0.05) remained sexually inexperienced one year later. Moreover, in the immediate post-intervention period, among baseline virgins who subsequently initiated sex, intervention youths were more likely than control youths to use a condom (18 versus 10%, P<0.05). Additional HIV-related risk behaviours (failure to discuss previous HIV risk exposure with one's sexual partner and alcohol use), intentions to use condoms, and perceptions of the ability to use condoms were positively affected by the intervention. CONCLUSIONS: There is evidence that the 'My Future is My Choice' (MFMC) intervention is reducing HIV risk behaviours among sexually inexperienced participants aged 15-18. Related risk behaviours and perceptions are also positively impacted by the intervention.