Behavioral Mechanisms in HIV Epidemiology and Prevention: Past, Present, and Future Roles

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72261/1/j.1728-4465.2009.00202.x.pd

Factors Associated with Early Sexual Debut among Ghanaian Women from the Manya – Krobo District, – Ghana, 2011

Affiliation: Department of Epidemiology and Biostatistics GW, School of Public Health and Health Services Title: Factors associated with early sexual debut among Ghanaian women from the Manya – Krobo district, – Ghana, 2011 Background: The dipo, a Krobo puberty initiation rite practiced annually among an estimated 2,000 Ghanaian females ages 2–20, is a cultural rite of passage into womanhood that is intended to promote abstinence from sexual activity until marriage. Objectives: This study examined the risk of early sexual debut among dipo-initiated Krobo females versus uninitiated Krobo females. This study also assessed Manya–Krobo societal opinions regarding the sexual health outcomes of initiates and existing modifications of the rite. Methods: Mixed-methods. Utilizing a retrospective cohort study design, we surveyed 306 unwed Krobo females from Agormanya ages 13–20. We employed Cox proportional hazard regressions assessing the effects of model covariates upon sexual debut and age at sexual debut. Qualitative analysis included nine interviews conducted among Manya–Krobo district community members who either supported or opposed the dipo. Responses were analyzed using Dedoose QDA software to determine patterns in attitudes and opinions regarding initiates’ sexual behaviors and to identify current ceremonial changes. Results: Dipo initiated participants had a 1.8 increased hazard rate of early sexual debut as compared to uninitiated participants after adjusting for covariates, however, results were not statistically significant (aHR: 1.8, 95% C.I: 0.8–4.0). Qualitative data indicated that some dipo opponents stated participation promotes promiscuity and teen pregnancy while select supporters asserted the rite protects participants from these outcomes. Key ceremonial changes included a reduction in age eligibility and length of dipo preparatory period. Conclusions: These study findings do not offer conclusive evidence that participation in the dipo increases the risk of early sexual debut among initiated versus uninitiated Krobo females. Study findings suggest the reduction in age of dipo eligibility may increase the likelihood of sexual debut following the ceremony. Participants who received the rite as toddlers had a greater length of time between the dipo and adulthood to become sexually active post-initiation than females who were initiated during their late teens/early twenties

Adolescents and parents\u27 perceptions of best time for sex and sexual communications from two communities in the Eastern and Volta Regions of Ghana: Implications for HIV and AIDS education

Background Adolescents and parents’ differ in their perceptions regarding engaging in sexual activity and protecting themselves from pregnancy and sexually transmitted infections (STIs). The views of adolescents and parents from two south-eastern communities in Ghana regarding best time for sex and sexual communications were examined. Methods Focus Group interviews were conducted with parents and adolescents (both In-school and Out-of school) from two communities (Somanya and Adidome) in the Eastern and Volta regions of Ghana with epidemiological differentials in HIV infection. Results Findings showed parents and adolescents agree that the best timing for sexual activity amongst adolescents is determined by socioeconomic viability. In practice however, there were tensions between adolescents and parents crystallized by spoilt generation and physiological drive ideologies. Whilst one community relied on a more communal approach in controlling their children; the other relied on a confrontational approach. Sex-talk is examined as a measure to reduce these tensions, and children in both communities were ambivalent over sexual communication between their parents and themselves. Parents from the two communities however differed in their perceptions. Whilst parents in one community attributed reduced teenage pregnancies to sex education, those in the other community indicated a generalized adolescents’ sexual activeness manifested in the perceived widespread delinquency in the community. Conclusion Parents in both communities reported significant barriers to parents-adolescents sexual communication. Parents in both communities should be educated to discuss the broader issues on sexuality that affects adolescents and their reproductive health needs

Differences in the delivery of health education to patients with chronic disease by provider type, 2005-2009

IntroductionHealth education provided to patients can reduce mortality and morbidity of chronic disease. Although some studies describe the provision of health education by physicians, few studies have examined how physicians, physician assistants, and nurse practitioners differ in the provision of health education. The objective of our study was to evaluate the rate of health education provision by physicians, physician assistants, and nurse practitioners/certified midwives. MethodsWe analyzed 5 years of data (2005–2009) from the outpatient department subset of the National Hospital Ambulatory Medical Care Survey. We abstracted data on 136,432 adult patient visits for the following chronic conditions: asthma, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, ischemic heart disease, and obesity. ResultsHealth education was not routinely provided to patients who had a chronic condition. The percentage of patients who received education on their chronic condition ranged from 13.0% (patients with COPD or asthma who were provided education on smoking cessation by nurse practitioners) to 42.2% (patients with diabetes or obesity who were provided education on exercise by physician assistants). For all conditions assessed, rates of health education were higher among physician assistants and nurse practitioners than among physicians. ConclusionPhysician assistants and nurse practitioners provided health education to patients with chronic illness more regularly than did physicians, although none of the 3 types of clinicians routinely provided health education. Possible explanations include training differences, differing roles within a clinic by provider type, or increased clinical demands on physicians. More research is needed to understand the causes of these differences and potential opportunities to increase the delivery of condition-specific education to patients

Faith and HIV prevention: The conceptual framing of HIV prevention among Pentecostal Botswana teenagers

Background There is a huge interest by faith-based organizations (FBOs) in sub-Saharan Africa and elsewhere in HIV prevention interventions that build on the religious aspects of being. Successful partnerships between the public health services and FBOs will require a better understanding of the conceptual framing of HIV prevention by FBOS to access for prevention intervention, those concepts the churches of various denominations and their members would support or endorse. This study investigated the conceptual framing of HIV prevention among church youths in Botswana; - a country with one of the highest HIV prevalence in the world. Method Participants were 213 Pentecostal church members (67% female; age range 12 to 23?years; median age?=?19?years). We engaged the participants in a mixed-method inductive process to collect data on their implicit framing of HIV prevention concepts, taking into account the centrality of religion concepts to them and the moderating influences of age, gender and sexual experience. After, we analysed the data using multi-dimensional scaling (MDS) and hierarchical cluster analysis (HCA) to map the ways the church youths framed HIV prevention. Results The findings suggest the church youth to conceptually frame their HIV prevention from both faith-oriented and secular-oriented perspectives, while prioritizing the faith-oriented concepts based on biblical teachings and future focus. In their secular-oriented framing of HIV prevention, the church youths endorsed the importance to learn the facts about HIV and AIDS, understanding of community norms that increased risk for HIV and prevention education. However, components of secular-oriented framing of HIV prevention concepts were comparatively less was well differentiated among the youths than with faith-oriented framing, suggesting latent influences of the church knowledge environment to undervalue secular oriented concepts. Older and sexually experienced church youths in their framing of HIV prevention valued future focus and prevention education less than contrasting peer cohorts, suggesting their greater relative risk for HIV infection. Conclusion A prospective HIV prevention intervention with the Pentecostal church youths would combine both faith and secular informed concepts. It also would need to take into account the ways in which these youth interpret secular-oriented health concepts in the context of their religious beliefs

Natural Mentors and Adolescent Resiliency: A Study with Urban Youth

Natural mentors may play an important role in the lives of adolescents. We interviewed 770 adolescents from a large Midwestern city. Fifty-two percent reported having a natural mentor. Those with natural mentors were less likely to smoke marijuana or be involved in nonviolent delinquency, and had more positive attitudes toward school. Natural mentors had no apparent effect on anxiety or depression. Using the resiliency theory framework, natural mentors were found to have compensatory but not protective effects on problem behaviors, and both compensatory and protective effects on school attitudes. Direct and indirect (mediated) effects of natural mentors are explored for problem behaviors and school attitudes. The potential importance of natural mentors is supported, and implications for future research are considered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44059/1/10464_2004_Article_368417.pd

They Destroy the Reproductive System : Exploring the Belief that Modern Contraceptive Use Causes Infertility

© 2018 The Authors. Studies in Family Planning published by John Wiley & Sons Ltd. on behalf of The Population Council, Inc. A common reason for nonuse of modern contraceptives is concern about side effects and health complications. This article provides a detailed characterization of the belief that modern contraceptives cause infertility, and an examination of how this belief arises and spreads, and why it is so salient. We conducted focus group discussions and key informant interviews in three rural communities along Kenya\u27s eastern coast, and identified the following themes: (1) the belief that using modern contraception at a young age or before childbirth can make women infertile is widespread; (2) according to this belief, the most commonly used methods in the community were linked to infertility; (3) when women observe other women who cannot get pregnant after using modern contraceptives, they attribute the infertility to the use of contraception; (4) within the communities, the primary goal of marriage is childbirth and thus community approval is rigidly tied to childbearing; and, therefore (5) the social consequences of infertility are devastating. These findings may help inform the design of programs to address this belief and reduce unmet need