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An integrated model of condom use in Sub-Saharan African youth: A meta-analysis.

ABSTRACT: OBJECTIVE:We tested an integrated social-cognitive model derived from multiple theories of the determinants of young people's condom use in Sub-Saharan Africa. The model comprised seven social-cognitive antecedents of condom use: Attitudes, norms, control, risk perceptions, barriers, intentions, and previous condom use. METHOD:We conducted a systematic search of studies including effects between at least one model construct and intended or actual condom use in young people from sub-Saharan African countries. Fifty-five studies comprising 72 independent data sets were included and subjected to random-effects meta-analysis. Demographic and methodological variables were coded as moderators. Hypotheses of the integrated model were tested using meta-analytic structural equation modeling. RESULTS:The meta-analysis revealed significant nontrivial sample-weighted correlations among most model constructs. Moderator analyses revealed differences in six correlations for studies that included a formative research component relative to studies that did not. There was little evidence of systematic moderation of relations among model constructs by other candidate moderators. Meta-analytic structural equation models revealed significant direct effects of attitudes, norms, and control on condom use intentions, and of intention, control, and barriers on condom use. Including past condom use increased explained variance in condom use intentions and behavior but did not attenuate model effects. There were also significant indirect effects of attitudes, norms, and control on condom use through intentions. CONCLUSIONS:Findings provide preliminary evidence to support the integrated condom use model in sub-Saharan African youth. The model provides guidance on potential targets for improving the effectiveness of condom promotion interventions. (PsycINFO Database Record

SUBMITTER: Protogerou C

PROVIDER: S-EPMC6549692 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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An integrated model of condom use in Sub-Saharan African youth: A meta-analysis.

Protogerou Cleo C Johnson Blair T BT Hagger Martin S MS

Health psychology : official journal of the Division of Health Psychology, American Psychological Association 20180430 6

<h4>Objective</h4>We tested an integrated social-cognitive model derived from multiple theories of the determinants of young people's condom use in Sub-Saharan Africa. The model comprised seven social-cognitive antecedents of condom use: Attitudes, norms, control, risk perceptions, barriers, intentions, and previous condom use.<h4>Method</h4>We conducted a systematic search of studies including effects between at least one model construct and intended or actual condom use in young people from su ...[more]

PMID: 29708390

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Project description:IntroductionIn an HIV/AIDS epidemic driven primarily by heterosexual transmission, it is important to have an understanding of the human sexual behaviour patterns that influence transmission. We analysed the distribution and predictors of within-partnership sexual behaviour and condom use in rural Zimbabwe and generated parameters for use in future modelling analyses.MethodsA population-based cohort was recruited from a household census in 12 communities. A baseline survey was carried out in 1998-2000 with follow-up surveys after 3 and 5 years. Statistical distributions were fitted to reported within-partnership numbers of total, unprotected and protected sex acts in the past two weeks. Multilevel linear and logistic regression models were constructed to assess predictors of the frequency of unprotected sex and consistent condom use.ResultsA normal distribution of ln(sex acts+1) provided the best fit for total and unprotected sex acts for men and women. A negative binomial distribution applied to the untransformed data provided the best fit for protected sex acts. Condom use within partnerships was predominantly bimodal with at least 88% reporting zero or 100% use. Both men and women reported fewer unprotected sex acts with non-regular compared to regular partners (men: 0.26 fewer every two weeks (95% confidence interval 0.18-0.34); women: 0.16 (0.07-0.23)). Never and previously married individuals reported fewer unprotected sex acts than currently married individuals (never married men: 0.64 (0.60-0.67); previously married men: 0.59 (0.50-0.67); never married women: 0.51 (0.45-0.57); previously married women: 0.42 (0.37-0.47)). These variables were also associated with more consistent condom use.DiscussionWe generated parameters that will be useful for defining transmission models of HIV and other STIs, which rely on a valid representation of the underlying sexual network that determines spread of an infection. This will enable a better understanding of the spread of HIV and other STDs in this rural sub-Saharan population.

Project description:Despite improved availability of simple, relatively inexpensive, and highly effective antiretroviral treatment for HIV/AIDS, the disease remains a major public health challenge for women in sub-Saharan Africa (SSA). Given the numerous barriers in access to care for women in this region, every health issue that brings them into contact with the health system should be optimized as an opportunity to integrate HIV/AIDS prevention. Because most non-condom forms of modern contraception require a clinical appointment for use, contraception appointments could provide a confidential opportunity for access to HIV counseling, testing, and referral to care. This study sought to investigate the relationship between contraceptive methods and HIV testing among women in SSA. Data from the Demographic and Health Survey from four African countries-Congo, Mozambique, Nigeria, and Uganda-was used to examine whether modern (e.g., pills, condom) or traditional (e.g., periodic abstinence, withdrawal) forms of contraception were associated with uptake of HIV testing. Data for the current analyses were restricted to 35,748 women with complete information on the variables of interest. Chi-square tests and logistic regression models were used to assess the relationship between uptake of HIV testing and respondents' baseline characteristics and contraceptive methods. In the total sample and in Mozambique, women who used modern forms of contraception were more likely to be tested for HIV compared to those who did not use contraception. This positive association was not demonstrated in Congo, Nigeria, or Uganda. That many women who access modern contraception are not tested for HIV in high HIV burden areas highlights a missed opportunity to deliver an important intervention to promote maternal and child health. Given the increasing popularity of hormonal contraception methods in low-income countries, there is an urgent need to integrate HIV counseling, testing, and treatment into family planning programs. Women on hormonal contraceptives should be encouraged to continue to use condoms for HIV-prevention.

Project description:BACKGROUND:As high stigmatization of HIV and relatively low knowledge of HIV transmission and prevention measures persist in Sub-Saharan Africa, the improvement of HIV-related knowledge, and the evaluation of which types of interventions are most effective in this regard, is an important aspect of further prevention efforts. In addition, it is of interest to assess whether improvements in HIV-related knowledge may actually lead to increased engagement in preventive behaviours and ultimately lower HIV transmission. This study therefore aims to systematically review and meta-analyse the evidence for the effect of HIV-related knowledge interventions on 1) the improvement of HIV-related knowledge, 2) subsequent risk reduction behaviour (condom use), 3) lower incidence of HIV infection. METHODS:A literature search was conducted using the Embase and Medline databases, returning 746 after duplicate removal. Following abstract and full-text screening, 36 studies were ultimately included in the final review. Meta-analyses were conducted in R, using random-effects models, for the HIV-related knowledge, condom use, and HIV incidence outcomes, where sufficient data were available. RESULTS:Interventions assessed in the reviewed studies varied, including computer-based interventions, mass media campaigns, and peer education interventions. The interventions were generally found to be effective at improving HIV-related knowledge in the target population, with 10 studies reporting improved knowledge of risk reduction through condom use in the intervention group (out of 11 studies reporting data for this outcome), with 6 reporting these differences as significant (p?<?0.05). Regarding knowledge of transmission routes, studies assessing peer education interventions often reported significant improvements in the intervention group. Meta-analysis results showed significantly higher odds among the intervention groups of correct knowledge of: risk reduction through condom use (OR: 3.09, 95%CI: 1.83-5.22, p?<?0.0001), sexual transmission of HIV (OR: 5.86, 95%CI: 2.65-12.97, p <?0.001) and transmission through sharps (OR: 4.35, 95%CI?=?3.21-5.90, p?<?0.001), but non-significantly lower odds of HIV infection (OR: 0.97, 95%CI: 0.66-1.41, p?=?0.854). CONCLUSION:Peer-education-based interventions appear to be particularly effective in facilitating the uptake of HIV-related knowledge, particularly pertaining to transmission routes. There is some evidence that improved knowledge of HIV transmission and prevention facilitates increased subsequent engagement in preventive measures, although this requires further exploration. TRIAL REGISTRATION:PROSPERO Number: CRD42018090600.

Project description:BACKGROUND:Paying for sex has often been associated with risky sexual behavior among heterosexual men, and men who pay for sex are considered as a bridging population for sexually transmitted infections. Consistent condom use during paid sex is essential for reducing sexually transmitted infections, including HIV/AIDS. In this study, we assessed the prevalence and predictors of consistent condom use among men who pay for sex in sub-Saharan Africa. MATERIALS AND METHODS:We pooled data from 29 sub-Saharan African countries' Demographic and Health Surveys. A total of 3,353 men in sub-Saharan Africa who had paid for sex in the last 12 months preceding the surveys and had complete information on all the variables of interest were used in this study. The outcome variable for the study was consistent condom use for every paid sex in the last 12 months. Both bivariate and multivariable logistic regression analyses were carried out. Results were presented as adjusted odds ratios with their corresponding 95% confidence intervals. Statistical significance was declared at p< 0.05. RESULTS:Overall, the prevalence of consistent condom use during paid sex in sub-Saharan Africa was 83.96% (CI = 80.35-87.56), ranging from 48.70% in Benin to 98% in Burkina Faso. Men aged 35-44 [AOR, 1.39 CI = 1.04-1.49], men in the richest wealth quintile [AOR, 1.96 CI = 1.30-3.00], men with secondary level of education [AOR, 1.69 CI = 1.17-2.44], and men in Burkina Faso [AOR = 67.59, CI = 8.72-523.9] had higher odds of consistent condom use during paid sex, compared to men aged 15-19, those in the poorest wealth quintile, those with no formal education, and men in Benin respectively. Conversely, Muslim men had lower odds [AOR = 0.71, CI = 0.53-0.95] of using condom consistently during paid sex, compared to Christian men. CONCLUSION:Empirical evidence from this study suggests that consistent condom use during paid sex encompasses complex social and demographic characteristics. The study also revealed that demographic characteristics such as age, wealth quintile, education, and religion were independently related to consistent condom use for paid sex among men. With sub-Saharan Africa having the highest sexual and reproductive health burden in the world, continuous application of evidence-based interventions (e.g., educational and entrepreneurial training) that account for behavioural and social vulnerabilities are required.

Dataset Information

An integrated model of condom use in Sub-Saharan African youth: A meta-analysis.

Publications

An integrated model of condom use in Sub-Saharan African youth: A meta-analysis.

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