Psychosocial determinants of consistent condom use among university students in Sudan: findings from a study using the Integrated Change Model.

Unprotected sex is common among university students in Sudan, thus increasing risks for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). As little is known about the psychosocial determinants of consistent condom use among this population, this study was designed to identify them. The Integrated Change Model (ICM) was applied in a cross-sectional design to identify in 218 students (aged 18-25 years) from Khartoum which items distinguish condom users from non-condom users. Condom users differed significantly from non-condom users in having more HIV and condom use-related knowledge, higher perception of susceptibility to HIV, reporting more exposure to condom use cues, having a less negative attitude towards condom use (attitude cons), experiencing social support and norms favouring condom use and having higher condom use self-efficacy. Binary logistic regression showed that peer norms favouring condom use in addition to HIV-related knowledge, condom use cues, negative attitude and self-efficacy were the factors uniquely associated with consistent condom use among university students in Sudan. Interventions seeking to promote consistent condom use among sexually active students could benefit from increasing knowledge about HIV transmission and prevention, raising HIV-risk perception, using condom use cues, addressing perceived condom disadvantages and enhancing students` self-efficacy to avoid unprotected sex. Moreover, such interventions should raise students` perceptions of their peers` beliefs and behaviours favouring condom use and seek health care professionals` and religious scholars` support for condom use.

Assessing sexual practices and beliefs among university students in Khartoum, Sudan; a qualitative study.

University students in Sudan are more at risk of contracting HIV than the general population, due to a high rate of sexual activity and low uptake of preventive measures such as condoms. Hence, they are considered an important target for HIV prevention programmes. This study explored students` beliefs about abstinence and pre-marital sex. Thirty semi-structured individual interviews were conducted, based on constructs from the Integrated Change (I-Change) Model. The study sample included 16 (53%) male and 14 (47%) female university students. Their average age was 21.2 years (Range 18-27 and SD 2.5). Both sexual abstainers (N = 19) and sexually active students (N = 11) perceived HIV severity and susceptibility. Most of the participants had a positive attitude towards abstinence. However, sexually active students also perceived some advantages of engaging in sexual practices, such as sexual pleasure and proving adulthood. Sexually active students more often mentioned being influenced in their sexual practices by their peers than by their families. Sexually active students reported lower self-efficacy to refrain from sex than abstainers. Interventions that seek to promote abstinence among those willing to achieve this should stress the advantages of abstinence from sex until marriage, offer tools to resist peer pressure and enhance self-efficacy to abstain. These findings can be used to develop comprehensive HIV prevention programmes that primarily promote abstinence among university students who are not yet sexually active but also consider promoting condom use and other safer-sex practices among those who are sexually active. These interventions should also be gender-sensitive to address the needs of both male and female students.

Exploring Determinants of Condom Use among University Students in Sudan.

Increasing numbers of university students in Sudan are at risk of contracting HIV because of their engagement in condomless sex. A comprehensive and culturally accepted condom promotion program could potentially reduce this threat substantially. However, little is known about the sociocognitive determinants of condom use in this population: information that is required to develop such HIV prevention programs. Therefore, in August 2014, we conducted 30 semi-structured individual interviews with male and female students (both currently sexually active and nonactive) to explore determinants of condom use based on the I-Change model. Data were analyzed using Nvivo 10. The results suggest that barriers to condom use among university students include misconceptions about condom use, negative attitudes toward condom use, lack of social support, low self-efficacy to use condoms, and poor action planning. Sexual health promotion should, therefore, address these aspects to successfully promote condom use among sexually active students and subsequently reduce the risk of HIV transmission.