Multi-Country Study on Trusted Partners among Youth: Eritrea, Tanzania, Zambia, and Zimbabwe

ObjectivesExplore youth's definitions of "trust"Establish criteria youth use to determine the trustworthiness of partnersIdentify types of individuals youth believe they can and cannot "trust"Examine trust's influence on sexual decision-making and STI/HIV risk perceptionIdentify how sexual partners violate trust and the effects on sexual decision-makingStudy designData were collected in October 2001 as part of a regional Behavior Change Communication (BCC) strategy in East and Southern Africa. Country programs chose to participate in research based on project priorities and levels of interest in participating in a regional BCC strategy. Four county programs agreed to collect and share data, Eritrea, Tanzania, Zambia, and Zimbabwe.A total of 33 focus groups were conducted. Research teams in each country used the same discussion guide and pretested the guide prior to data collection. Discussion groups lasted between an hour and an hour and a half, were audiotaped, and transcribed into English. Each research team conducted two discussion groups in the major urban area composed of the following strata: males 15-19 years, females 15-19 years, males 20-24 years, and females 20-24 years. The Zambia program conducted one additional focus group with males aged 15-19.FindingsExplore youth's definition of "trust" and criteria used to determine trustworthinessThe major components of trust did not vary greatly across countries. Youth in all countries placed a high value on sexual fidelity and its role in trusted partnerships. Youth believed that partners met through family or friends are more trustworthy than those met in bars or nightclubs. In addition, youth in all countries expressed that trusted partners must pass informal assessments, dress appropriately, demonstrate appropriate social conduct, talk sweetly to each other, come from the right neighborhood, meet one another's family, be punctual for appointments/dates, and remain emotionally committed to one another. Eritrean youth appeared to place greater importance on the roles that religion, virginity, and marriage (or intent to marry) play in establishing trust than youth from other countries.Differences in criteria for trust were more apparent by gender. In terms of testing partners' trustworthiness, females discussed passive ways of questioning partners, while males discussed elaborate methods for entrapping females in lies. Males were concerned with partners' sexual reputation and appearance. Females were primarily concerned with partners' emotional commitment, willingness to accept responsibility for pregnancies, and ability to display affection in public in order to demonstrate intimacy and trust.Identify types of individuals youth believe they can and cannot "trust"Across countries, youth place prospective partners into groups that can and cannot be trusted according to key attributes and behaviors. Similar to the findings above, most participants said that youth that come from good families, are well respected in the community, are religious, do not drink, avoid bars and nightclubs, and are faithful can be trusted. Youth believe that they cannot trust anyone outside of committed, monogamous relationships. Male participants added that virgins can be trusted.Examine trust's influence on sexual decision-making and STI/HIV risk perceptionYouth do not appear to take effective preventive measures with trusted partners. Trust can blind them to their risk for STIs/HIV and render them unwilling to explore partners' sexual histories. Sex usually occurs early in relationships and condom use remains low. When youth use condoms, they are more likely to incorporate them into casual than trusted relationships, or use them for pregnancy prevention rather than protection from STIs/HIV. Condoms are usually abandoned once relationships appear to be serious and partners fail to show signs or symptoms of STIs or HIV infection. There were few differences in risk perception and risk behavior across countries; however, male participants in Zambia reported that they discuss their sexual histories, while participants from other countries said that couples rarely discuss their sexual histories.Identify how sexual partners violate trust and the effects on sexual decision-makingInfidelity represents the most serious violation of trust and usually results in the end of relationships. A common theme across all countries was youth's refusal to learn from past experiences and apply them to future sexual decision-making. Even when trust is broken, youth fail to apply lessons learned to new relationships, repeating the same scenarios of trust, infidelity and exposure to STIs/HIV.Programmatic implicationsYouth must understand that partners' trustworthiness and character are independent of their risk for STIs/HIV. Although a checklist may help youth select a good partner, unprotected sex with this or any other person must be perceived as risky. Youth must also personalize their risk for STIs/HIV and avoid thinking that only people outside of their community are at risk for infection. It is likely that interpersonal communication campaigns or other community-level activities will help achieve an improved risk perception. Finally, in order to communicate new and appropriate levels of personal risk assessment, programs should strive to achieve broad social support, if not pressure for, consistent condom use, knowledge of one's own HIV status as well as that of all partners, and delay of sexual activity where possible

Cross-Generational Relationships in Kenya: Couples' Motivations, Risk Perception for STIs/HIV and Condom Use

Objectives: To understand women's and men's motivations for entering into cross-generational relationships and to examine how their risk perception for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) affects sexual decision-making and condom use.Methods: A total of eight focus groups were conducted with women aged 15 -- 19 and 28 indepth interviews were carried out with men aged 30 years and older in Nairobi, Mombasa, Kisumu, and Meru. Participants discussed motivations for entering into non-marital, crossgenerational relationships, perceived risks, relationship dynamics, and circumstances under which older men and younger women meet. Data analysis highlighted common and divergent themes on cross-generational relationships and the risks associated with them. Results: According to study participants, Kenyan men who pursue younger women do not fit a "sugar daddy" stereotype; rather they come from a variety of social and professional backgrounds. Young women actively seek partners who are willing to spend money on them whereas men look for partners who are well mannered, need money and have certain physical attributes. Women's primary incentive for engaging in cross-generational relationships is financial and material gain while men seek younger partners for sexual gratification. Pressure from peers to fit in and some family members to secure financial assistance from older partners can compel women to engage in cross-generational relationships. Although some peer groups support and encourage such relationships, other groups, especially wives, same-aged boyfriends and parents, disapprove of them. As a result, cross-generational couples are often preoccupied by the threat of discovery. Risk perception for STIs/HIV is low and couples rarely use condoms.Conclusions: Most cross-generational couples underestimate their risk for infection from STIs/ HIV. Young women believe that older men are low-risk partners because they are less likely to be promiscuous and more likely to remain faithful to younger partners and wives. Men believe that young partners are innocent and sexually inexperienced. Material gain, emotional factors, sexual gratification, and recognition from peers override the risk for STIs and HIV infection. Condom use is low and young women's ability to negotiate use is compromised by age disparities and economic dependence. Study findings suggest several programmatic strategies for targeting young women and older men. Behavior change communication campaigns should educate women and men about the increased risk of STIs/HIV associated with cross-generational relationships. Programs should also promote safer sexual practices, such as consistent condom use, within relationships. Campaigns could employ positive role models to encourage young women to seek safer alternatives to cross-generational relationships and decrease peer pressure among men to pursue such relationships. Long-term interventions include improving young women's access to educational and career opportunities, and working with communities to determine the best approach for changing social norms and the acceptability of cross-generational relationships

Reasons for Non-use of Condoms in Eight Countries in Sub-Saharan Africa

Objective: To determine why sexually experienced males and females from multiple countries in sub-Saharan Africa do not use condoms.Methods: We used data from sample surveys conducted in eight countries in sub-Saharan Africa. Respondents were asked about their use of condoms and their reasons for not using a condom in last sex with a marital, a regular (non-marital) or a casual partner. Respondents' reasons for not using a condom are shown by type of partner and by gender. Results: Males and females most frequently reported trusting their partner as the main reason for not using a condom in last sex with a marital or a regular (non-marital) partner. This suggests that low personal risk perception is the most important reason for not using a condom with a marital or a regular partner. A dislike of condoms is the most frequently cited reason for not using a condom with a casual partner. Respondents rarely cited the price of condoms as a barrier to condom use. Lack of condom availability was also rarely cited as a reason for not using a condom, except to some degree by males in casual partnerships. The latter may be because of the unplanned nature of casual sex activity, rather than because condoms are not available. Conclusions: Behavior change campaigns encouraging sexually experienced people to accurately assess their personal risk of acquiring HIV should be complemented with marketing campaigns emphasizing the positive attributes of condoms

Qualitative Research for Social Marketing: One Organization’s Journey to Improved Consumer Insight

Population Services International (PSI) is an international NGO working to improve outcomes in developing countries through behavior change communications and the social marketing of health products and services. Consumer insight is central to PSI\u27s social marketing strategy because it informs which messages to promote and which products and services to offer to make the concept of healthy behavior change attractive to consumers. Qualitative research provides rich insight by exploring consumers\u27 values, feelings, thoughts, intentions, barriers, motivators, culture, and social norms that affect their behaviors and use of products and services. In this paper, we describe how PSI\u27s qualitative research program developed from 2003 to 2013, and how using an interpretive approach and more appropriate data collection methods improved our consumer insight and marketing planning process

Brand equity and willingness to pay for condoms in zimbabwe

<p>Abstract</p> <p>Background</p> <p>Zimbabwe suffers from one of the greatest burdens of HIV/AIDS in the world that has been compounded by social and economic instability in the past decade. However, from 2001 to 2009 HIV prevalence among 15-49 year olds declined from 26% to approximately 14%. Behavior change and condom use may in part explain this decline.</p> <p>PSI-Zimbabwe socially markets the Protector Plus (P+) branded line of condoms. When Zimbabwe converted to a dollar-based economy in 2009, the price of condoms was greatly increased and new marketing efforts were undertaken. This paper evaluates the role of condom marketing, a multi-dimensional scale of brand peceptions (brand equity), and price in condom use behavior.</p> <p>Methods</p> <p>We randomly sampled sexually active men age 15-49 from 3 groups - current P+ users, former users, and free condom users. We compared their brand equity and willingness to pay based on survey results. We estimated multivariable logistic regression models to compare the 3 groups.</p> <p>Results</p> <p>We found that the brand equity scale was positive correlated with willingness to pay and with condom use. Former users also indicated a high willingness to pay for condoms. We found differences in brand equity between the 3 groups, with current P+ users having the highest P+ brand equity. As observed in previous studies, higher brand equity was associated with more of the targeted health behavior, in this case and more consistent condom use.</p> <p>Conclusions</p> <p>Zimbabwe men have highly positive brand perceptions of P+. There is an opportunity to grow the total condom market in Zimbabwe by increasing brand equity across user groups. Some former users may resume using condoms through more effective marketing. Some free users may be willing to pay for condoms. Achieving these objectives will expand the total condom market and reduce HIV risk behaviors.</p

The Bulletin, Off-Campus Courses and Extension Services 1964-1966, Volume 64, Number 4, June (1964)

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Vietnam (2006): HIV/AIDS TRaC Study among Injecting Drug Users in Mong Cai, Uong Bi, and Thai Nguyen City Second Round

Tracking surveys serve as tools to inform programming by routinely collecting data from cross-sections of populations at risk for HIV/AIDS and other adverse health outcomes. This survey among injecting drug users (IDUs)aimed to: 1) identify and describe segments of the population in terms of needle-sharing in the three months prior to the survey; 2) explore injecting practices, sexual behaviors and condom use of IDUs; 3) monitor trends in condom use, injecting behaviors, and use of VCT services by IDUs; 4) determine whether exposure to PSI program activities is associated with changes in key indicators; and 5) apply study findings to interventions designed for reducing the risk of HIV transmission among IDUs. Respondent-Driven Sampling (RDS) was used to recruit 398 male IDUs aged 15 to 45 who live in Uong Bi and Mong Cai towns in Quang Ninh province and Thai Nguyen City in Thai Nguyen province. All IDUs refered for an interview were screened for eligibility and to prevent duplicate participation. The questionnaire collected information on socio-demographic characteristics, drug use and needle-sharing behaviors, opinions about needlesharing practices, beliefs and knowledge about HIV, sexual activity and condom use, and exposure to harm reduction services. In addition, a section on voluntary counseling and testing for HIV (VCT) was added to the questionnaire for the second round of the tracking survey. Multivariate analyses were performed t o identify significant factors associated with needlesharing, condom use, and use of VCT services. For project monitoring, analysis of variance (UNIANOVA) was conducted to generate adjusted proportions and means for key project indicators by survey round and to identify significant changes in behaviors and behavioral determinants. To evaluate the effet of exposure to PSI's outreach activities, indicators that were significant on the monitoring table were tested with UNIANOVAs to identify differences in indicators by degree of exposure to PSI's outreach activities