Condom use and sexuality communication with adults: a study among high school students in South Africa and Tanzania.

BACKGROUND: Fostering adolescents' communication on sexuality issues with their parents and other significant adults is often assumed to be an important component of intervention programmes aimed at promoting healthy adolescent sexual practices. However, there are few studies describing the relationship between such communication and sexual practices, particularly in sub-Saharan Africa. This study examined the relationships between adolescents' communication with significant adults and their condom use in three sites in this region. METHODS: Data stem from a multi-site randomized controlled trial of a school-based HIV prevention intervention implemented in Cape Town and Mankweng, South Africa and Dar es Salaam, Tanzania. Only data from comparison schools were used. The design is therefore a prospective panel study with three waves of data collections. Data were collected in 2004 from 6,251 participants in 40 schools. Associations between adolescents' communication with adults about sexuality issues and their use of condoms were analysed cross-sectionally using analysis of variance, as well as prospectively using multiple ordinal logistic regression analysis. RESULTS: Cross-sectional analyses showed that consistent condom users had significantly higher mean scores on communication (across topics and communication partners) than both occasional users and never-users, who had the lowest scores. After controlling for condom use at the first data collection occasion in each model as well as for possible confounders, communication scores significantly predicted consistent condom use prospectively in all three ordinal logistic regression models (Model R(2) = .23 to .31). CONCLUSION: The findings are consistent with the assertion that communication on sexuality issues between adolescents and significant adults results in safer sexual practices, as reflected by condom use, among in-school adolescents. The associations between communication variables and condom use might have been stronger if we had measured additional aspects of communication such as whether or not it was initiated by the adolescents themselves, the quality of advice provided by adults, and if it took place in a context of positive adult-adolescent interaction. Studies with experimental designs are needed in order to provide stronger evidence of causality.

Associations between attitudes toward violence and intimate partner violence in South Africa and Tanzania.

Attitude change approaches are common in the prevention of intimate partner violence (IPV) among adolescents. This study examined associations between perpetration or victimization and attitudes toward IPV with data from a longitudinal randomized controlled trial (RCT) of an HIV prevention intervention among school students in three sites in South Africa and Tanzania. Data analyses were confined to students from the control group only, and to those with experience with romantic relationships. Boys and those more involved with violence reported more violence-supportive attitudes. For Cape Town (and to some extent Mankweng), the results of prospective prediction are consistent with the notion of a bidirectional attitudes-behavior interrelationship. For Dar es Salaam attitudes predicted behavior prospectively; however, prediction in the opposite direction was not confirmed. These results indicate that attitude change strategies may be useful complementary to structural approaches also in global South settings, although their effectiveness may vary.

An HIV/AIDS knowledge scale for adolescents: item response theory analyses based on data from a study in South Africa and Tanzania.

A 14-item human immunodeficiency virus/acquired immunodeficiency syndrome knowledge scale was used among school students in 80 schools in 3 sites in Sub-Saharan Africa (Cape Town and Mankweng, South Africa, and Dar es Salaam, Tanzania). For each item, an incorrect or don't know response was coded as 0 and correct response as 1. Exploratory factor analyses based on polychoric correlations showed two separate factors for all sites. Two-parameter item response theory (IRT) analysis (bifactorial multiple indicators multiple causes confirmatory factor analysis models) consistently showed a general first factor and a second 'method' factor. One single global latent variable seemed to sufficiently well capture most of the systematic variation in knowledge. Some items did not discriminate well between levels of the underlying knowledge latent variable and information values were highest for low levels of knowledge. The scale might be improved by adding items, in particular items that are more difficult to answer. Some differential item functioning effects related to site and socioeconomic status were identified. Scores on the latent knowledge variable were particularly low among females in Dar es Salaam and Mankweng, and were negatively associated with socioeconomic status. This study illustrates advantages of using IRT analysis instead of more conventional approaches to examining psychometric properties of knowledge scales.

Dating violence among school students in Tanzania and South Africa: prevalence and socio-demographic variations.

AIMS: Widespread adolescent dating violence (DV) in Sub-Saharan Africa calls for immediate action, particularly since it is linked to the spread of HIV/AIDS. This article presents prevalence and demographic correlates of DV among school students in Cape Town and Mankweng (South Africa) and Dar es Salaam (Tanzania). METHODS: Data were derived from the baseline data collection of a multi-site randomized controlled trial of an HIV prevention intervention among young adolescents. The results were confined to students who reported previously or currently being in a relationship (n = 6,979). Multiple logistic regression analysis with demographic predictors was employed, controlled for cluster effect. RESULTS: Within our sample 10.2%-37.8% had been victims, 3.1%-21.8% had been perpetrators, and 8.6%-42.8% had been both (percentages dependent on site and gender). Before controlling for other factors, religion was a protective factor against violence in Cape Town. After controlling for other factors, a higher age and lower socioeconomic status were associated with belonging to any of the three groups of violence. Being male in all sites was associated with perpetration; being female with victimization (except in Cape Town where the converse finding was obtained). Higher parental education in Cape Town was protective against all types of violence. Ethnicity and living with biological parents were not associated with violence. CONCLUSIONS: DV is prevalent and widespread in the study sites. Violence control policies and interventions should target young adolescents. Since there was not one clearly defined subgroup identified as being at high risk, such programmes should not be limited to high risk groups only.

Young people's understanding of HIV: a qualitative study among school students in Mankweng, South Africa.

AIMS: This article describes young people's interpretation of HIV, AIDS and sexually transmitted illness in a rural South African community in Mankweng, Limpopo Province. METHOD: The study was based on 19 focus group discussions with adolescents aged 12-14 years. RESULTS: Our participants had limited knowledge about HIV from a biomedical perspective. Their understanding and interpretations of HIV and other sexually transmitted diseases were largely informed by traditional and religious belief systems that explain how and why people contract an illness via sexual intercourse. Based on these interpretations, they also expressed distrust towards the medical health system, and where to go for care, support and treatment. Local traditional healers were often mentioned as the only people who could cure several of the sexually transmitted diseases described by our informants. CONCLUSIONS: The ways of understanding HIV, AIDS and other sexually transmitted illnesses may weaken efforts of health education interventions based solely on a medical and modern notion of disease. The authors emphasise the importance of exploring traditional and religious belief systems and taking these into account when planning and designing behaviour change interventions.

Health promotion competency building in Africa: a call for action.

The 26 leading authorities in competency-based and accreditation movements in global health promotion, health education, and public health identified eight domains of core competency that are required to engage in effective health promotion practice. The conference held in Galway, Ireland, issued a statement on building competency of health education and health promotion practitioners. Almost all the countries in the African region have structures for health education and/or health promotion that will benefit from the outcome of this conference, a first of its kind. Countries such as South Africa, Botswana and Nigeria have policies that support health education and health promotion development, and capacity building will be encouraged by the Consensus Statement to concentrate on identifying and building capacity within existing infrastructures across government and community sectors. South Africa attempted to establish a Standard Generating Board (SGB) for Health Promotion that envisaged the development of standards and qualifications for part of the second learner category, who hold the National Qualification Framework (NQF) level 5 certificate in health promotion. The author of this commentary joins other colleagues in congratulating the Galway conference participants for identifying the eight domains of core competency that are necessary if health promotion and health education are to develop into a distinct discipline, particularly in the African region.

Fear of stigmatization as barrier to voluntary HIV counselling and testing in South Africa.

OBJECTIVE: The objective of this qualitative study was to identify psychosocial correlates of HIV voluntary counselling and testing (VCT), with an emphasis on the association between fear of AIDS-related stigma and willingness to have an HIV test. METHODS: The study was executed in Limpopo Province at University of Limpopo, Polokwane, South Africa. Focus group interviews were held among 72 students, divided over 10 groups. RESULTS: Results showed that participants had different levels of knowledge about HIV/AIDS and VCT, and that AIDS was still strongly associated with 'death'. Results further demonstrate that HIV/AIDS related stigma is still a very serious problem in South Africa. Lack of HIV/AIDS related knowledge, blaming persons with HIV/AIDS for their infection, and the life-threatening character of the disease were seen as the most important determinants of AIDS-related stigma. The main benefit to go for VCT was 'knowing your HIV status', whereas main barriers for testing were 'fear of being stigmatised' and 'fear of knowing your HIV positive status'. CONCLUSION: Fear of stigmatization is an important barrier to HIV testing and has negative consequences for AIDS prevention and treatment. Interventions to reduce HIV-related stigma are needed in order to foster voluntary HIV counselling and testing in South Africa

Young males' gendered sexuality in the era of HIV and AIDS in Limpopo Province, South Africa.

This article is focused on young males' sexual identity and behaviors in rural South Africa. The study comprised 19 focus group discussions with adolescents aged 12 to 14 years. The informants depict male sexuality as biologically predetermined, where physical needs and practices such as circumcision legitimize early sexual debut. Furthermore, the construction of male sexual identity and power imbalances in relationships are already evident at an early age, and age and economics are pertinent factors affecting social relations. Violent behavior and sexual abuse are supported by constructed gender inequalities forming an often negative and nonsupportive environment for young people. We stress the importance of planned HIV and sexuality education for young adolescents with support structures that can help endorse individual actions and informed choices. This is especially important in resource-poor settings where young people are likely to be less empowered than is the case in more affluent settings.