Factors Contributing to the Risk of HIV Infection in Rural School-Going Adolescents
Abstract
:1. Introduction
2. Methodology
2.1. Study Setting and Population
2.2. Study Design and Sample
2.3. Sample Size
2.4. Operational Definitions
2.5. Research Instrument
2.5.1. Demographic Information
2.5.2. Sources of Information on HIV/AIDS and Sex Communication with Parents
2.5.3. HIV Knowledge Questionnaire (HIV-KQ-18)
2.5.4. Sexual Behaviors
2.5.5. Sexual Communication and Negotiation Skills
2.5.6. Self-Efficacy to Refuse Sex
2.5.7. Peer Norms about Sexual Intercourse (Peer Influence)
2.5.8. Time Perspective Scale
2.6. Procedures
2.6.1. Reliability of the Research Instrument
Variables | Range of Scores | No. of Items | Mean (SD) | Cronbach Alpha |
---|---|---|---|---|
HIV knowledge | 0–18 | 18 | 8.37 (3.06) | 0.73 |
Self-efficacy | 1–5 | 4 | 3.42 (1.23) | 0.82 |
Communication | 1–5 | 4 | 4.28 (0.86) | 0.81 |
Peer influence | 1–5 | 4 | 2.41 (0.91) | 0.70 |
Negotiation | 1–5 | 7 | 3.39 (0.83) | 0.70 |
FPT | 1–5 | 5 | 2.72 (0.78) | |
HPT | 1–5 | 10 | 2.80 (0.61) | 0.73 |
Future Time | 1–5 | 11 | 3.42 (0.69) | 0.75 |
2.6.2. School-Level Permission
2.6.3. Parents’ Informed Consent and Learners’ Informed Assent
2.6.4. Ethics Approval
2.7. Data Management and Analysis
3. Results
3.1. Demographic Characteristics of Study Sample
Characteristics | Total Population N (%) | Boys N (%) | Girls N (%) | p-value |
---|---|---|---|---|
Age | ||||
<15 years | 117 (28.4%) | 55(28.8%) | 62 (28.1%) | 0.87 |
≥15 years | 295 (71.6%) | 136 (71.2%) | 159 (71.9%) | |
Population group | ||||
Mixed | 386 (94.4%) | 184 (92.9%) | 202 (95.7%) | 0.52 |
Black | 10 (2.4%) | 5 (2.5%) | 5 (2.4%) | |
White | 8 (2.0%) | 5 (2.5%) | 3 (1.4%) | |
Indian | 3 (0.7%) | 2 (1.0%) | 1 (0.5%) | |
Others | 2 (0.5%) | 2 (1.0 %) | 0 | |
Grade | ||||
10 | 114 (26.6%) | 59 (28.9%) | 55 (24.4%) | 0.41 |
9 | 160 (37.3%) | 70 (34.3%) | 90 (40.0%) | |
8 | 155 (36.1%) | 75 (36.8%) | 80 (35.6%) | |
SES | ||||
Low | 159 (38.2%) | 79 (39.5%) | 80 (37.0%) | 0.56 |
Middle | 202 (48.6%) | 92 (46.0%) | 110 (50.9%) | |
High | 55 (13.2%) | 29 (14.5%) | 26 (12.1%) | |
Communication (General) | ||||
Easy | 207 (49.3%) | 114 (57.0%) | 93 (42.3%) | 0.003 |
Difficult | 213 (50.7%) | 86 (43.0%) | 127 (57.7%) | |
Communication (Sexuality) | ||||
Easy | 135 (32.1%) | 53 (26.6%) | 82 (37.1%) | 0.02 |
Difficult | 285 (67.9%) | 146 (73.4%) | 139 (62.9%) | |
How often did you discuss sexuality communication? | ||||
Always | 55 (14.4%) | 23 (12.3%) | 32 (16.4%) | 0.25 |
Rarely | 327 (85.6%) | 164 (87.7%) | 163 (83.6%) | |
Sources of information on HIV/AIDS * | ||||
Teachers | 261 (60.0%) | 116 (57.7%) | 144 (63.7%) | - |
Mothers | 127 (29.6%) | 52 (26.0%) | 74 (32.9%) | |
Preferred sources of info on HIV/AIDS * | ||||
Mothers | 233 (53.6%) | 103 (55.1%) | 130 (60.5%) | - |
Teachers | 194 (44.6%) | 80 (43.0%) | 112 (52.1%) |
3.2. Prevalence of Risky Sexual Behaviors
Characteristics | N | Total (%) | Boys (%) | Girls (%) | χ2 | p-value |
---|---|---|---|---|---|---|
Sexually active | ||||||
Yes | 113 | 27.2 | 33.8 | 21.3 | 8.29 | 0.004 |
No | 303 | 72.8 | 66.2 | 78.7 | ||
Early sex debut * | ||||||
Before 15 years | 55 | 48.7 | 60.6 | 31.9 | 9.05 | 0.003 |
After 15 years | 58 | 51.3 | 39.4 | 68.1 | ||
Multiple partner * | ||||||
One | 59 | 57.8 | 50 | 68.2 | 3.39 | 0.07 |
More than one | 43 | 42.2 | 50 | 31.8 | ||
Condom use for last sexual intercourse * | ||||||
Yes | 57 | 53.3 | 50.8 | 41.3 | 0.95 | 0.33 |
No | 50 | 46.7 | 49.2 | 58.7 | ||
Regular condom use * | ||||||
Irregular | 53 | 55.2 | 52.8 | 58.1 | 0.27 | 0.60 |
Always | 43 | 44.8 | 47.2 | 41.9 | ||
HIV testing * | ||||||
Yes | 54 | 13 | 13.4 | 12.7 | 0.04 | 0.84 |
No | 360 | 87 | 86.6 | 87.3 |
3.3. Selected Predictors of Sexual Behaviors in Boys and Girls
Factors | N | Boys M (SD) | Girls M (SD) | t-test scores | p-value |
---|---|---|---|---|---|
HIV knowledge | 431 | 8.34 (3.03) | 8.39 (3.11) | 0.16 | 0.87 |
Self-efficacy | 396 | 3.25 (1.22) | 3.55 (1.24) | 2.42 | 0.02 |
Communication | 383 | 4.29 (0.94) | 4.35 (0.79) | 1.83 | 0.07 |
Peer influence | 402 | 2.60 (0.94) | 2.25 (0.90) | 4.00 | 0.000 |
Negotiation | 339 | 3.23 (0.77) | 3.54 (0.86) | 3.43 | 0.001 |
Fatalistic Present Time | 350 | 2.75 (0.83) | 2.69 (0.73) | 0.70 | 0.49 |
Hedonic Present Time | 323 | 2.77 (0.68) | 2.82 (0.54) | 0.83 | 0.41 |
Future Time | 317 | 3.35 (0.74) | 3.48 (0.64) | 1.65 | 0.10 |
3.4. Associations between Sexual Behavior Outcomes and Selected Predictors
Predictors | Reporting Sexual Activity | Reporting Early Sex | Reporting Condom Use | ||||||
---|---|---|---|---|---|---|---|---|---|
B | ORs | 95% ORs | B | ORs | 95% ORs | B | ORs | 95% ORs | |
Gender (Boys) | −0.39 | 1.48 | 0.78–2.00 | 1.89 a | 6.60 b | 1.62–26.84 b | −0.54 | 0.58 | 0.21–1.62 |
HIV knowledge | −0.04 | 1.04 | 0.93–1.15 | −0.09 | 0.91 | 0.74–1.11 | 0.20 a | 1.22 a | 1.03–1.44 a |
Self-efficacy | 0.12 | 1.13 | 0.85–1.50 | 0.22 | 1.25 | 0.72–2.18 | −0.21 | 0.81 | 0.52–1.26 |
Peer influence | 1.10 a | 3.01 a | 1.97–4.60 a | 0.64 | 0.53 | 0.23–1.20 | 0.38 | 1.47 | 0.76–2.82 |
Negotiation | −0.23 | 1.25 | 0.82–1.91 | 0.72 | 2.06 | 0.88–4.81 | 0.05 | 1.05 | 0.55–1.99 |
Communication 1 | 0.57 | 1.77 | 0.94–3.29 | −1.30 a | 0.27 a | 0.08–0.91 a | −0.25 | 0.77 | 0.25–2.41 |
Fatalistic | −0.30 | 0.97 | 0.49–1.89 | 0.28 | 1.32 | 0.38–4.49 | −0.32 | 0.73 | 0.22–2.41 |
Future | 0.12 | 1.23 | 0.57–2.22 | −0.47 | 0.62 | 0.17–2.19 | 0.48 | 1.62 | 0.48–5.48 |
Communication 2 | −0.21 | 1.24 | 0.82–1.87 | 0.31 | 1.36 | 0.66–2.81 | 0.27 | 0.81 | 0.52–1.26 |
4. Discussion
5. Implications
6. Limitation of the Study
7. Conclusions
Acknowledgements
Author Contributions
Conflicts of Interest
References
- Doyle, M.; Mavedzenge, S.; Plummer, M.; Ross, D. The sexual behaviour of adolescents in sub-Saharan Africa: Patterns and trends from the national surveys. Trop. Med. Int. Health 2012, 17, 796–807. [Google Scholar] [CrossRef] [PubMed]
- Udry, J.; Billy, J.; Morris, N.; Groff, T.; Raj, M. Serum androgenic hormones motivate sexual behaviour in boys. Fert. Steril. 1985, 43, 90–94. [Google Scholar]
- Peltzer, K. Early sexual debut and associated factors among in-school adolescents in eight African countries. Acta Paediat. 2010, 99, 1242–1247. [Google Scholar] [CrossRef] [PubMed]
- Shisana, O.; Rehle, T.; Simbayi, L.; Zuma, K.; Jooste, S.; van Wyk, V.P.; Mbelle, N.; van Zyl, J.; Parker, W.; Zungu, N.; et al. South African National HIV Prevalence, Incidence, Behaviour and Communication Survey 2008: A Turning Tide among Teenagers? HSRC Press: Cape Town, South Africa, 2009. [Google Scholar]
- Gregson, S.; Nyamukapa, C.; Garnet, G.; Mason, R.; Zhuwau, T; Carael, M.; Chandiwana, S. Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. Lancet 2002, 359, 1896–1903. [Google Scholar] [CrossRef]
- Gardener, M.; Steinberg, L. Peer influence on risk taking, risk preference, and risk decision making in adolescence and adulthood: An experimental study. Develop. Psychol. 2005, 41, 625–635. [Google Scholar] [CrossRef]
- UNICEF. Opportunity in Crisis: Preventing HIV from Early Adolescence to Young Adulthood; United Nations Children’s Fund: New York, NY, USA, 2011. [Google Scholar]
- Sneed, C.; Strachman, A.; Nguyen, C.; Morisky, D. The influence of parental monitoring and communication on adolescent’s sexual behaviour and intentions. Vulnerable Child. Youth Stud. 2009, 4, 27–47. [Google Scholar] [CrossRef]
- Dilorio, C.; Dudley, W.; Soet, J.; McCarty, F. Sexual possibility situations and sexual behaviours among young adolescents: The moderating role of protective factors. J. Adolescent Health 2004, 35, 11–20. [Google Scholar]
- Sieverding, J.; Adler, N.; Witt, S.; Ellen, J. The influence of parental monitoring on adolescent initiation. Arch. Pediatr. Adolesc. Med. 2005, 159, 724–729. [Google Scholar] [CrossRef] [PubMed]
- Collazo, A. Theory-based predictors of intention to engage in precautionary sexual behaviour among Puerto Rican high school adolescents. J. HIV/AIDS Prevent. Child. Youth 2004, 6, 91–120. [Google Scholar] [CrossRef]
- Nahom, D.; Wells, E.; Gillmore, M.; Hoppe, M.; Morrison, D.; Archibald, M.; Murowwchick, E. Differences by gender and sexual experiences in adolescent’s sexual behaviours: Implication for education and HIV prevention. J. Sch. Health 2001, 71, 153–158. [Google Scholar] [CrossRef] [PubMed]
- Villarruel, A.; Jemmott, J.; Jemmott, L.; Ronis, D. Predictors of sexual intercourse and condom use intention among Spanish dominant Latino youth: A test of the planned behaviour theory. Nurs. Res. 2004, 53, 172–181. [Google Scholar] [CrossRef] [PubMed]
- Rucibwa, N.; Modeste, N.; Montgomery, S.; Fox, C. Exploring family factors and sexual behaviours in a group of black and Hispanic adolescent males. Amer. J. Health Behav. 2003, 27, 63–74. [Google Scholar] [CrossRef]
- De Bruin, W.B.; Downs, J.; Fischhoff, B.; Palmgren, C. Development and evaluation of an HIV/AIDS knowledge measure for adolescents focusing on misconceptions. J. HIV/AIDS Prevent. Child. Youth 2007, 8, 35–57. [Google Scholar] [CrossRef]
- Haile, B.; Chambers, J.; Garrison, J. Correlates of HIV knowledge and testing: Results of a 2003 South African survey. J. Black Stud. 2007, 38, 194–208. [Google Scholar] [CrossRef]
- Phillips, J.; Malcolm, C. Sexual risk behaviour among adolescent school girls in a local community in the Western Cape. Afr. J. Phys. Health Recreat. Dance 2006, 12, 426–437. [Google Scholar]
- Dudley, C.; O’Sullivan, L.; Moreau, D. Does familiarity breed complacency: HIV knowledge, personal contact, and sexual risk behaviour of psychiatrically-referred Latino adolescent girls? Hispan. J. Behav. Sci. 2002, 24, 353–368. [Google Scholar]
- Jemmott, J.; Jemmott, S.; O’Leary, A.; Ngwane, Z.; Icard, L.; Bellamy, S.; Jones, S.; Landis, J.; Heeren, G.; Tyler, J.; et al. School-based randomized controlled trial of an HIV/STD risk reduction intervention for South African adolescents. Arch. Pediatr. Adolesc. Med. 2010, 164, 923–929. [Google Scholar] [PubMed]
- Regional Development Profile West Coast District 2011 Working Paper. Western Cape Goverment Provincial District. Available online: www.westerncape.gov.za (accessed on 14 November 2014).
- Morojele, N.; Myers, B.; Townsend, L.; Lombard, C.; Pluddemann, A.; Carney, T.; Williams, P.P.; Padayachee, T.; Nel, E.; Nkosi, S. Survey on Substance Use, Risk Behaviour and Mental Health among Grade 8–10 Learners in Western Cape Provincial Schools, 2011; South Africa Medical Research Council: Cape Town, South Africa, 2013. [Google Scholar]
- Browner, W.S.; Newman, T.B.; Hulley, S.B. Estimating sample size and power: applications and examples. In Designing Clinical Research, 3rd ed.; Hulley, S.B., Cummings, S.R., Browner, W.S., Grady, D.G., Newman, T.B., Eds.; Lippincolt Willaims & Wilkins: Philadelphia, PA, USA, 2007; pp. 3–367. [Google Scholar]
- Boyce, W.; Torsheim, T.; Currie, C.; Zambon, A. The family affluence scale as a measure of national wealth: Validation of an adolescent self-report measure. Soc. Indic. Res. 2006, 78. [Google Scholar] [CrossRef]
- Carey, M.; Schroder, K. Development and psychometric evaluation of the brief HIV knowledge questionnaire. AIDS Educ. Prev. 2002, 14, 172–182. [Google Scholar] [CrossRef] [PubMed]
- Reddy, P.; James, S.; McCauley, A. Programming for HIV Prevention in South African Schools; Population Council: Washington, DC, USA, 2003. [Google Scholar]
- Deiter, P.J. Sexual Assertiveness Training for College Women: An Intervention Study. Dissertations and Master’s Theses. (Campus Access, 1994). Available online: http://digitalcommons.uri.edu/dissertations/AAI9507062 (accessed on 14 November 2014).
- Basen-Engquist, K.; Masse, L.; Coyle, K.; Kirby, D.; Parcel, G.; Banspach, S.; Nodora, J. Validity of scales measuring the psychosocial determinants of HIV/STD-related risk behaviour in adolescents. Health Educ. Res. 1999, 14, 25–38. [Google Scholar] [CrossRef] [PubMed]
- Zimbardo, P.; Boyd, J. Putting time in perspective: A valid, reliable, individual-differences metric. J. Personal. Soc. Psychol. 1999, 77, 1271–1288. [Google Scholar] [CrossRef]
- DeVellis, R. Scale Development: Theory and Application, 2nd ed.; Sage: Thousand Oaks, CA, USA, 2003. [Google Scholar]
- Mavedzenge, S.; Olson, R.; Doyle, M.; Changalucha, J.; Ross, D. The epidemiology of HIV among young people in sub-Saharan Africa: Know your local epidemic and its implication for prevention. J. Adolescent Health 2011, 49, 559–567. [Google Scholar] [CrossRef]
- Moodley, C.; Phillips, J. HIV/AIDS-related knowledge and behaviour of FET college students: Implication for sexual health promotion. Afr. J. Phy. Health Educ. Recreat. Dance 2011, 6, S49–S60. [Google Scholar]
- Kirby, D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases; National Campaign to Prevent Teen and Unplanned Pregnancy: Washington, DC, USA, 2007. [Google Scholar]
- Exavery, A.; Lutambi, A.; Mubyazi, M.; Kweka, K.; Mbaruku, G.; Masanja, H. Multiple sexual partners and condom use among 10–19 years-old in four districts in Tanzania: What do we learn? BMC Public Health 2011, 11. [Google Scholar] [CrossRef] [Green Version]
- Doyle, M.; Ross, D.; Maganja, K.; Baisely, K.; Masesa, C.; Andreasen, A.; Plummer, M. Long-term biological and behavioural impact of an adolescent sexual health intervention in Tanzania: Follow-up survey of the community-based MEMA KwaVijana trial. PLoS Med. 2010. [Google Scholar] [CrossRef] [Green Version]
- Global Guidance Briefs on HIV Prevention for Young People; WHO: Geneva, Switzerland, 2008.
- Harrison, A.; Cleland, J.; Gouws, E.; Frohlich, J. Early sexual debut among young men in South Africa: Heightened vulnerability to sexual risk. Sex. Transm. Infect. 2005, 81, 259–261. [Google Scholar] [CrossRef] [PubMed]
- Coley, R.; Votruba-Drzal, E.; Schindler, H. Father’s and mother’s parenting practices and responding to adolescent sexual risk behaviours. Child Develop. 2009, 80. [Google Scholar] [CrossRef]
- Ream, G.; Savin-Williams, R. Reciprocal associations between adolescent’s sexual activity and quality of youth-parent interactions. J. Family Psychology 2005, 19, 171–179. [Google Scholar] [CrossRef]
- Brown, B.; Baronowski, M. Searching for the Majic Johnson effect: AIDS, adolescents and celebrity disclosure. Adolescence 1996, 31, 253–264. [Google Scholar] [PubMed]
- Rose, A.; Koo, H.; Bhaskar, B.; Anderson, K.; White, G.; Jenkins, P. The influence of primary caregivers on the sexual behaviour of early adolescents. J. Adolescent Health 2005, 37, 135–144. [Google Scholar] [CrossRef]
- Swenson, R.; Rizzo, C.; Brown, L.; Vanable, P.; Carey, M.; Valois, R.; DiClemente, R. HIV knowledge and it contribution to sexual health behaviours of low-income African-American adolescents. J. Natl. Med. Assn. 2010, 102, 1173–1182. [Google Scholar]
- Shuey, D.; Babishangire, B.; Omiat, S.; Bangarukayo, H. Increased sexual abstinence among in-school adolescents as a result of school health education in Soroti district, Uganda. Health Educ. Res. 1999, 14, 411–419. [Google Scholar] [CrossRef] [PubMed]
© 2014 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Awotidebe, A.; Phillips, J.; Lens, W. Factors Contributing to the Risk of HIV Infection in Rural School-Going Adolescents. Int. J. Environ. Res. Public Health 2014, 11, 11805-11821. https://doi.org/10.3390/ijerph111111805
Awotidebe A, Phillips J, Lens W. Factors Contributing to the Risk of HIV Infection in Rural School-Going Adolescents. International Journal of Environmental Research and Public Health. 2014; 11(11):11805-11821. https://doi.org/10.3390/ijerph111111805
Chicago/Turabian StyleAwotidebe, Adedapo, Julie Phillips, and Willy Lens. 2014. "Factors Contributing to the Risk of HIV Infection in Rural School-Going Adolescents" International Journal of Environmental Research and Public Health 11, no. 11: 11805-11821. https://doi.org/10.3390/ijerph111111805