Effects of the SATZ teacher-led school HIV prevention programmes on adolescent sexual behaviour: cluster randomised controlled trials in three sub-Saharan African sites.

In this study, the effects on young adolescent sexual risk behaviour of teacher-led school HIV prevention programmes were examined in two sites in South Africa (Cape Town and Mankweng) and one site in Tanzania (Dar es Salaam). In Cape Town, Dar es Salaam and Mankweng, 26, 24 and 30 schools, respectively, were randomly allocated to intervention or comparison groups. Primary outcomes were delayed sexual debut and condom use among adolescents aged 12-14 years (grade 8 in South Africa and grades 5 and 6 in Tanzania). In total, 5352, 4197 and 2590 students participated at baseline in 2004 in Cape Town, Dar es Salaam and Mankweng, respectively, and 73% (n = 3926), 88% (n = 3693) and 83% (n = 2142) were retained 12-15 months later. At baseline, 13% (n = 224), 5% (n = 100) and 17% (n = 164) had had their sexual debut, and 44% (n = 122), 20% (n = 17) and 37% (n = 57) of these used a condom at last sex, respectively. In Dar es Salaam, students in the intervention were less likely to have their sexual debut during the study (OR 0.65, 95% CI 0.48-0.87). In Cape Town and Mankweng, the intervention had no impact. The current interventions were effective at delaying sexual debut in Dar es Salaam but not in South Africa, where they need to be supplemented with programmes to change the environment in which adolescents make decisions about sexual behaviour.

Concurrent partnerships and sexual risk taking among African and Caribbean migrant populations in the Netherlands.

Concurrent partnerships have been recognized as a determinant for the spread of HIV and sexually transmitted infections (STIs). We studied the association of concurrent partnerships with sexual behaviour among heterosexual Caribbean and African migrants, who account for a disproportionate burden of STIs and HIV in the Netherlands. Of 1792 migrants, 15% reported concurrent sexual partners in the previous six months. In multivariate multinomial analyses, women were less likely to have concurrent partners than men and they were less likely than men to use condoms with concurrent partners. We could not identify an association with the observed HIV prevalence; however, migrants with concurrent partners were less likely to be tested for HIV. Of migrants tested for STIs, one in three migrants with concurrent partners was diagnosed with an STI. Prevention targeting migrants should address the promotion of HIV/STI testing and stress the potential acceleration of HIV and STI epidemics due to concurrency.

Socio-economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in Dar es Salaam, Tanzania.

Depression during pregnancy may negatively influence social functioning, birth outcomes and postnatal mental health. A cross-sectional analysis of the baseline survey of a prospective study was undertaken with an objective of determining the prevalence and socio-demographic factors associated with depressive morbidity during pregnancy in a Tanzanian peri-urban setting. Seven hundred and eighty seven second to third trimester pregnant women were recruited at booking for antenatal care at two primary health care clinics. Prenatal structured interviews assessed socio-economic, quality of partner relationships and selected physical health measures. Depressive symptoms were measured at recruitment and three and eight months postpartum using the Kiswahili version of the Hopkins Symptom Checklist. Completed antenatal measures available for 76.2% participants, showed a 39.5% prevalence of depression. Having a previous depressive episode (OR 4.35, P<0.01), low (OR 2.18, P<0.01) or moderate (OR 1.86, P=0.04) satisfaction with ability to access basic needs, conflicts with the current partner (OR 1.89, P<0.01), or booking earlier for antenatal care (OR 1.87, P=0.02) were independent predictors of antenatal depression in the logistic regression model; together explaining 21% of variance in depression scores. Attenuation of strength of multivariate associations suggests confounding between the independent risk factors and socio-demographic and economic measures. In conclusion, clinically significant depressive symptoms are common in mid and late trimester antenatal clinic attendees. Interventions for early recognition of depression should target women with a history of previous depressive episodes or low satisfaction with ability to access basic needs, conflict in partner relationships and relatively earlier booking for antenatal care. Findings support a recommendation that antenatal services consider integrating screening for depression in routine antenatal care.

Understanding women's experiences of distress during pregnancy in Dar es Salaam, Tanzania.

Several studies show depression is common during pregnancy. However, there is limited information in Tanzania on the magnitude of perceived distress during pregnancy and meanings ascribed to such distress. A descriptive survey collected data using unstructured interviews from 12 traditional practitioners and 10 peri-urban women with previous pregnancy related mental health concerns identified using a depression vignette. The objectives were to describe the sources and characteristics of distress during pregnancy, and idioms of distress that could inform cultural adaptation of depression screening tools. Narrative analysis showed an emergent category of "problematic pregnancies" framed women's recollections of prolonged periods of sadness. This experience was qualified using various idioms of distress that were differentially emphasized depending on informant's perceived causes of health concern. The idiom kusononeka was consistently used to describe extreme sadness across causal categories and clustered with at least two typical features of major depression. This suggested existence of a construct with similarities to biomedical criteria for depression. "Thinking too much" emerged as a distinctive expression associated with prolonged sadness. Distinctive expressions of social functioning impairments were identified that can inform depression severity assessments. In conclusion, contextual inquiry into experiences of psychological distress showed distinct local idioms that clustered in patterns similar to symptoms of biomedical depressive episodes. Further studies to assess the utility of local idioms of distress and distress related functional impairment in depression assessment tools are warranted.

Community vs. facility-based directly observed treatment for tuberculosis in Tanzania's Kilimanjaro Region.

SETTING: Kilimanjaro Region, northern Tanzania. OBJECTIVE: To assess the effect of the introduction of the patient-centred tuberculosis treatment (PCT) approach-which allows tuberculosis (TB) patients to choose between community and facility-based directly observed treatment (DOT)-on treatment outcomes, and to analyse factors that contribute to opting for community DOT. DESIGN: Retrospective analysis of treatment outcomes of TB patients registered in the Kilimanjaro Region in 2007, differentiating between patients under community vs. facility-based DOT and taking into account demographic factors, disease classification, TB diagnosis and human immunodeficiency virus (HIV) status. RESULTS: Data from 2769 TB patients were analysed. Treatment success rates were respectively 81% and 70% in patients under community vs. facility-based DOT (P < 0.001). Cure rates were respectively 73% and 72% in smear-positive pulmonary TB patients under community vs. facility-based DOT (P = 0.62). Women, children, patients residing in districts other than Hai, patients with newly diagnosed TB and patients with smear-negative pulmonary TB were most likely to be under community DOT. CONCLUSION: The PCT approach was shown to be effective in terms of treatment outcomes. Treatment success rates were higher in patients who opted for community DOT than in patients who chose facility-based DOT (all cases), and were similar in smear-positive pulmonary TB patients under community or facility-based DOT.

Modelling antecedents of blood donation motivation among non-donors of varying age and education.

Understanding blood donation motivation among non-donors is prerequisite to effective recruitment. Two studies explored the psychological antecedents of blood donation motivation and the generalisability of a model of donation motivation across groups differing in age and educational level. An older well-educated population and a younger less well-educated population were sampled. The studies assessed the role of altruism, fear of blood/needles and donation-specific cognitions including attitudes and normative beliefs derived from an extended theory of planned behaviour (TPB). Across both samples, results showed that affective attitude, subjective norm, descriptive norm, and moral norm were the most important correlates of blood donation intentions. Self-efficacy was more important among the younger less well-educated group. Altruism was related to donation motivation but only indirectly through moral norm. Similarly, fear of blood/needles only had an indirect effect on motivation through affective attitude and self-efficacy. Additional analyses with the combined data set found no age or education moderation effects, suggesting that this core model of donation-specific cognitions can be used to inform future practical interventions recruiting new blood donors in the general population.

Identifying blood donors willing to help with recruitment.

BACKGROUND AND OBJECTIVES: Social influence shapes behaviour and donors are ambassadors for blood banks. Donors are role models for family and friends and, therefore, so may be able to help with donor recruitment. MATERIALS AND METHODS: A questionnaire was used to assess donors' willingness to engage in donor recruitment. Measures included willingness to recruit new donors and antecedents of recruitment motivation based on the theory of planned behaviour (TPB). RESULTS: More than half of our participants were willing to try to recruit friends and family (57%). Self-efficacy was the most important correlate of intention to recruit as were cognitive attitude and experience with the blood bank. The findings suggest that the TPB provides a good basis for understanding cognitive antecedents of donors' willingness to recruit other donors. CONCLUSION: Results suggest that using existing donors to recruit new donors could be an efficient and cost-effective way to recruit additional donors. This approach warrants further investigation.

Factors associated with teachers' implementation of HIV/AIDS education in secondary schools in Cape Town, South Africa.

This study investigated the factors influencing whether high school teachers implemented HIV/AIDS education. The independent variables included constructs derived from expectancy value theories, teachers' generic dispositions, their training experience, characteristics of their interactive context and the school climate. We conducted a postal survey of 579 teachers responsible for AIDS education in all 193 public high schools in Cape Town. Questionnaires were completed and returned by 324 teachers (56% response rate) from 125 schools. Many teachers (222; 70%) had implemented HIV/AIDS education during 2003, and female teachers were more likely to have implemented than males (74% vs. 58%). The teacher characteristics associated with teaching HIV/AIDS were previous training, self-efficacy, student-centeredness, beliefs about controllability and the outcome of HIV/AIDS education, and their responsibility. The existence of a school HIV/AIDS policy, a climate of equity and fairness, and good school-community relations were the school characteristics associated with teaching HIV/AIDS. These findings demonstrate the value of teacher training and school policy formulation. They also demonstrate the value and importance of interventions that go beyond a sexual health agenda, focussing on broader school development to improve school functioning and school climate.

The relevance of cultural factors in predicting condom-use intentions among immigrants from the Netherlands Antilles.

A study into the relevance of cultural factors in predicting condom-use intentions among Antillean migrants in the Netherlands is described in this article. The association between the intention to use condoms with a new sexual partner and a perceived taboo on discussing sex, beliefs about sex education and machismo beliefs on gender and power relationships is addressed. The study was conducted among 346 Dutch Antilleans from a random sample of an Antillean population aged 15-50 years. The response rate was 37.8%. The results showed that condom-use intentions were primarily determined by perceived subjective norms, the perceived taboo on discussing sex, machismo attitudes, gender, age and educational background. Moreover, the respondent's opinion regarding machismo was an effect modificator for the association between condom-use intentions and subjective social norm. It is concluded that, in predicting condom-use intentions, factors specific to the culture of a population contribute significantly to the determinants drawn from the general social-cognition models. It is recommended that future research should use measurement instruments that are adapted to culture-specific beliefs, and should explore the influence of cultural factors on actual condom use. Moreover, interventions promoting condom use among migrant populations should target the cultural correlates of condom use.

Why don't young people volunteer to give blood? An investigation of the correlates of donation intentions among young nondonors.

BACKGROUND: In the past decade, the number of blood donors has steadily declined in the Netherlands, and young adults are underrepresented among registered donors. An understanding of the correlates of donation intentions among nondonors could facilitate targeting psychological prerequisites of donation decisions in recruitment campaigns. STUDY DESIGN AND METHODS. A cross-sectional study with self-administered questionnaires based on an extension of the Theory of Planned Behavior (TPB; a social cognition model to study the determinants of volitional behavior) was conducted to assess potential cognitive determinants of willingness to donate blood in a student sample. A response rate of 50.5 percent yielded a sample of 311. RESULTS: Just over 7 percent of participants were registered blood donors but most (61.7%) had never seriously considered becoming donors. Self-efficacy (confidence in performing the behavior), attitude (the overall evaluation of the behavior), and personal moral norm (the perceived personal responsibility to perform the behavior) regarding blood donation were the most important correlates of the intention to become a blood donor. In total, 43 percent of the variance in the intentions toward blood donation could be explained by a TPB-based model. CONCLUSION: Among students, determinants of the intention to become a blood donor include self-efficacy, attitude, personal moral norm regarding blood donation, and subjective norm (perceived social support). Future research could establish whether campaigns targeting these psychological prerequisites would be more effective than current strategies.

Predicting condom use with casual and steady sex partners among drug users.

In many Western societies, drug users are accountable for heterosexual transmission of HIV. Although various studies have shown that safe sex is not a common practice among drug users, we still have little understanding of the factors that determine their use of condoms in their sexual relationships with steady or casual partners. The objective of this study is to gain more insight into the determinants of drug users' condom use with steady and casual sex partners. In a study conducted among 103 Dutch drug users, the participants indicated their intentions, vulnerability, attitude, personal norms, subjective norms, descriptive norms, self-efficacy and response efficacy regarding condom use with steady and casual partners. The results showed that some drug users had borrowed used syringes and that most drug users practise unsafe sex, especially with steady partners. Most drug users were hardly motivated to start using condoms. The study further showed that antecedents of condom use differ with regard to steady sex partners and casual sex partners. Self-efficacy and subjective norms were predictors of intentions to use condoms with steady partners; intention to use condoms with casual partners was only predicted by self-efficacy. These differences should be taken into account when designing AIDS prevention interventions to encourage use of condoms.

Physical exercise habit: on the conceptualization and formation of habitual health behaviours.

An observation one can make when reviewing the literature on physical activity is that health-enhancing exercise habits tend to wear off as soon as individuals enter adolescence. Therefore, exercise habits should be promoted and preserved early in life. This article focuses on the formation of physical exercise habits. First, the literature on motivational determinants of habitual exercise and related behaviours is discussed, and the concept of habit is further explored. Based on this literature, a theoretical model of exercise habit formation is proposed. More specifically, expanding on the idea that habits are the result of automated cognitive processes, it is argued that physical exercise habits are capable of being automatically activated by the situational features that normally precede these behaviours. These habits may enhance health as a result of consistent performance over a long period of time. Subsequently, obstacles to the formation of exercise habits are discussed and interventions that may anticipate these obstacles are presented. Finally, implications for theory and practice are briefly discussed.

Planned development and evaluation of AIDS/STD education for secondary school students in The Netherlands: short-term effects.

This study evaluated the effects of an AIDS/STD curriculum for 9th- and 10th-grade students in the Netherlands. Curriculum development was based on (1) theory-based need assessments among students and teachers, (2) pilot testing of data-based and theory-based methods and materials, and (3) cooperation between researchers and students, teachers, and gatekeepers within the school system. Using a quasi-experimental design, program effects on students' attitudes, beliefs, and sexual behavior were compared with those of current AIDS/STD education practice. The results indicated that the experimental curriculum had a stronger favorable impact on students' attitudes and beliefs regarding using condoms consistently. Regarding sexual risk behavior, a differential curriculum effect could be demonstrated. These findings support the contention that current AIDS/STD education can be improved by (1) using empirical data, (2) applying multiple theories from the social sciences, and (3) involving representatives within the school system in the development process.

Diffusion of AIDS curricula among Dutch secondary school teachers.

This study reports data from a sample of 698 Dutch secondary school teachers intending to provide classroom AIDS education. The study addresses determinants of awareness knowledge about and adoption of four nationally disseminated AIDS curricula. The results indicated that knowledge acquisition was largely dependent on diffusion networks within schools. Transition from awareness knowledge to adoption appeared to be mediated by perceived instrumentality, subjective norms, perceived colleague behavior, and teachers' sexual morality. Preferences for using one curriculum rather than another were related to the same variables, although financial costs became slightly more important. It is concluded that effective dissemination strategies should combine (1) development of validated materials with clear instruction for implementation, (2) focused mass media communication, (3) close collaboration of curriculum designers, linking agents, and teachers, and (4) access to in-person assistance.

Public reactions towards people with AIDS: an attributional analysis.

This article addresses the issue of stigmatization and discrimination towards people with AIDS (PWAs) using Weiner's attributional theory of motivation and emotion. In a field experiment, subjects responded to vignettes describing patients with AIDS, syphilis, lung cancer or tuberculosis. In these vignettes, the onset of the diseases was either described as personally controllable or as uncontrollable. Results show that although attributional variables do account for a significant amount of variance in helping behavior and emotions towards PWAs, other variables such as the incurability of the disease, the risk of infection and associations with (homo)sexuality, may be more useful in explaining reactions to PWAs. Implications for education tailored at the prevention of the stigmatization of PWAs are discussed.

Reactions among Dutch youth toward people with AIDS.

AIDS education emphasizing personal responsibility toward AIDS-inducing behavior might enhance negative reactions to people with AIDS. This study, based on Weiner's attributional theory of motivation and emotion, addressed this dilemma by reporting data from a sample of 1,018 Dutch secondary school students. Results support the reasoning that emphasizing personal responsibility, and consequently personal controllability, increases negative reactions to people with AIDS. In addition to causal attributions, however, AIDS knowledge and attitudes toward homosexuality also related significantly to reactions to people with AIDS. To prevent negative reactions to people with AIDS, the subject of homosexuality should be dealt with before AIDS education is provided. AIDS education should address the impossibility of HIV infection by daily interactions, and the meaning and consequences of being seropositive.