Barriers to consistent and correct condom use among heterosexual serodiscordant couples in Zambia and Rwanda Open Access
Hageman, Kathy Marie (2010)
Abstract
Background: An estimated 43-93% of new HIV infections in
Africa occur within
cohabiting adults. The negative partner in a sexually active
heterosexual serodiscordant
couple is at risk for HIV infection unless safe sex practices are
applied; specifically,
consistent and correct condom use (CCCU). The aim of this study was
three-fold: to
explore the behavioral influences upon the successful management of
CCCU; to assess
the prevalence of supportiveness towards condom use and identify
predictors for couple-
level supportiveness; and to investigate the desire for children
and attempted pregnancy
techniques.
Methods: A mixed-method study was conducted. First, a
qualitative study was
conducted from June to August 2006 in Lusaka, Zambia. Eight focus
groups were
conducted by sex and serostatus. The modified constant comparison
method guided the
data analyses. Next, a cross-sectional study was conducted from
April to August 2009
among couples in Kigali, Rwanda (n=198) and Lusaka, Zambia (n=485).
Men and
women were interviewed separately. Data analyses included
descriptive, bivariate, and
multivariate logistic regression analysis along with
Cohen‟s kappa and p-value, and
conditional probability.
Results: The most common barrier to CCCU identified in the
qualitative study was the
husband‟s forced unprotected sex with his wife.
The most common reported supportive
influence was assertiveness by the wife. For the second-phase of
the study, only 67.4%
of Rwandan couples and 54.0% of Zambian couples had two
supportive partners.
Predictors for couple-level supportiveness included individual,
couple, and socio-cultural
factors. The desire for children was reported by up to one-third of
individuals and current
condom use interruption for pregnancy attempts was reported by up
to one-third of
desiring couples yet couples‟ knowledge of a
woman‟s fertility cycle was extremely low.
Conclusions: The investigation of individual, couple, and
socio-cultural factors that
disrupt CCCU is a critical next step in the development of HIV
prevention.
Consideration is needed to develop problem-solving strategies and
safer sex hierarchies.
Likewise, reproductive counseling for HIV-affected couples
continues to be a critical
unmet need. A systematic and theory-driven investigation of
couple-level prevention
strategies for CCCU is needed to develop sustainable techniques and
the establishment of
sero-specific norms for this unique population.
Table of Contents
Table of Contents
CHAPTER 1:
Introductory literature review
1
Sub-Saharan Africa continues to bear a disproportionate
burden
of the AIDS epidemic, particularly among urban populations
2
Cohabiting couples are the largest risk group for HIV
infection
in sub-Saharan Africa
3
Consistent and correct condom use is the primary behavioral
option
for sexually active HIV serodiscordant couples yet use
is not guaranteed
4
Greater understanding is needed regarding the behavioral gap
between HIV serostatus knowledge and long-term consistent
condom use among HIV serodiscordant couples
5
Significance of study
7
Conceptual framework
8
References
11
CHAPTER 2: Understanding behavioral influences upon
consistent condom use:
qualitative study among serodiscordant couples in Lusaka,
Zambia
Abstract
23
Introduction
25
Methods
27
Results
30
Discussion
41
References
49
CHAPTER 3: Prevalence and predictors of supportiveness
towards condom use among
heterosexual serodiscordant couples in Zambia and Rwanda
Abstract
59
Introduction
61
Methods
62
Results
68
Discussion
75
References
82
CHAPTER 4: Desire for children and its impact upon condom
use among heterosexual
serodiscordant couples in Zambia and Rwanda
Abstract
97
Introduction
99
Methods
101
Results
105
Discussion
115
References
126
CHAPTER 5: Summary and Conclusions
142
References
146
About this Dissertation
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