Decline in Sexual Risk Behaviours among Young People in Zambia (2000–2009): Do Neighbourhood Contextual Effects Play a Role?

<div><p>Objective</p><p>This study examined trends in premarital sex, multiple partnership and condom use among young people (15–24 years) in Zambia from 2000 to 2009, and assessed the effects of individual and neighbourhood variables on these sexual behaviour indicators in 2000 and 2009.</p><p>Methodology</p><p>We analysed data from the Zambia Sexual Behaviour Survey, conducted in 2000, 2003, 2005 and 2009. Multi-stage cluster sampling was used to select 385 neighbourhoods, giving a population sample of 6,500 young people. Using linear-by-linear trend test, trends in the three indicators were examined. Multilevel logistic regression was used to assess the effects of individual and neighbourhood variables on the indicators.</p><p>Results</p><p>Premarital sex among young people decreased significantly from 51 to 42% between 2000 and 2009. Multiple partnerships of men also decreased from 26 to 14% during the same period. The use of condoms by young people remained stable during this period. Full multilevel regression models explained 29 and 34% of the neighbourhood variance of premarital sex in 2000 and 2009. For multiple partnerships and condom use, the explained variance was 29 and 18% in 2000; whereas in 2009 it was extremely low. Urban residence and living in neighbourhood with higher average duration of residence were associated with low premarital sex and higher condom use. Living in a neighbourhood with higher average level of comprehensive knowledge of HIV was associated with less risky sexual behaviour.</p><p>Conclusion</p><p>Declining trends in premarital sex and multiple partnerships are among the factors that might explain the decrease in HIV incidence in Zambia among young people. However, condom use among young people has remained low and stable over the years. The results also suggest that behaviour change interventions should take stock of the social context when introducing individual-level programmes because neighbourhood factors play a considerable role in influencing sexual behaviour.</p></div

HIV prevalence among young people (15–24 year) for ANC sites with data from 1994 to 2008 by location of sites.

<p><i>X²</i> linear trend tests. The highlighted p-values are statistically significant at 0.05 level. “n” is number, % is percent. Rural/urban refers to the location of the sites.</p

HIV prevalence and incidence among young women and men aged 15–24 years from surveys in Zambia by residence between 1994 and 2008.

<p>HIV prevalence estimated based on assumed stable incidence between age 15 and 24.</p>**<p>Ndola PBS age range used is 15–29 years.</p>#<p>HIV Incidence was measured per 1000 person years. Blank spaces - no HIV data</p

HIV prevalence and age-adjusted risk ratios estimates for ANC (2002 and 2008) and ZDHS (2001–2002 and 2007) by age-group and province.

β<p>A total of 600 women recorded as rural residents attending ANC sites in Lusaka were excluded from the analysis because all the sites in Lusaka were urban and Lusaka is predominantly an urban district. The highlighted p-values are statistically significant at 0.05 level, n is number and % is percentage, aRR is age- adjusted risk ratio. The dash (–) represent missing cases.</p

ANC-based trends in HIV prevalence by educational attainment 1994–2008.

<p>ANC-based trends in HIV prevalence by educational attainment 1994–2008.</p

ANC HIV prevalence and age-adjusted risk ratios for changes in HIV prevalence by province and residence (urban/rural) among young women 15–24 years.

β<p>A total of 600 women recorded as rural residents attending ANC sites in Lusaka were excluded from the analysis because all the sites in Lusaka were urban and Lusaka is predominantly an urban district. Age adjustment was done using a continuous age variable. The highlighted p-values are statistically significant at 0.05 level, n is number, % is percentage, aRR is age-adjusted risk ratio.</p