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Ménard AD, MacIntosh HB. Childhood Sexual Abuse and Adult Sexual Risk Behavior: A Review and Critique. JOURNAL OF CHILD SEXUAL ABUSE 2021; 30:298-331. [PMID: 33403939 DOI: 10.1080/10538712.2020.1869878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 09/14/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
Childhood sexual abuse (CSA) is a global problem with serious repercussions for survivors in various domains of adult interpersonal functioning, including sexual risk behavior. This review aimed to summarize findings from the recent literature on the connections between CSA and later adult sexual risk behaviors (e.g., unprotected intercourse, sexually transmitted infection [STSI] diagnosis). The sexual risk behaviors consistently associated with CSA were having sex under the influence of alcohol/substances and reports of concurrent sexual partners/infidelity. Notably, studies investigating the links between CSA and history of STI diagnosis and CSA and reports of unprotected sex (with the exception of samples comprised men who have sex with men) produced inconsistent findings. The methodological limitations of existing studies are considered and suggestions for future research are offered.
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Belus JM, Baucom DH, Wechsberg WM. Individual and Relationship Predictors of Couple-Level Sexual Concurrency in Heterosexual South African Couples. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:999-1015. [PMID: 31552573 PMCID: PMC7060824 DOI: 10.1007/s10508-019-1444-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/27/2019] [Accepted: 03/21/2019] [Indexed: 05/11/2023]
Abstract
One of the major goals of couple-based HIV prevention programs in sub-Saharan Africa is to reduce outside sex partners, known as sexual concurrency. This cross-sectional study examined sexual concurrency at the couple-level and differentiated couples based on whether neither, one, or both partners engaged in sexual concurrency over the past 6 months. Individual predictors (alcohol use and lifetime history of physical or sexual trauma) and relationship predictors (mistrust, relationship inequity, relationship satisfaction, and sexual satisfaction) were used as predictors of couple-level sexual concurrency. A quantitative investigation using path analysis was carried out with data collected from 286 South African heterosexual couples. Results showed that alcohol use for both sexes, relationship dissatisfaction for women, and mistrust among women were predictive of different types of sexual concurrency. Findings suggest that consideration of the experiences and behavior of both partners may be useful in understanding different reasons for engagement in sexual concurrency.
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Affiliation(s)
- Jennifer M Belus
- Department of Psychology, University of Maryland, College Park, MD, 20740, USA.
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wendee M Wechsberg
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, USA
- Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA
- Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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Zhang J, Jemmott JB, Icard LD, Heeren GA, Ngwane Z, Makiwane M, O'Leary A. Predictors and psychological pathways for binge drinking among South African men. Psychol Health 2018; 33:810-826. [PMID: 29415576 DOI: 10.1080/08870446.2018.1429613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To develop targeted interventions for high-risk drinkers among South African men, we assessed whether sociodemographic factors and history of childhood sexual abuse predicted binge drinking at six-month follow-up assessment and their psychological pathways according to the extended Theory of Reasoned Action (TRA). DESIGN Survey responses with a sample of 1181 South African men from randomly selected neighbourhoods in Eastern Cape Province were collected at baseline and six-month follow-up. Multiple logistic regression analysis examined the baseline predictors of binge drinking. Serial multiple mediation analysis examined the psychological pathways. MAIN OUTCOME MEASUREMENTS Binge drinking at six-month follow-up. RESULTS Age (OR = 1.03, 95% CI: 1.01, 1.05), religious participation (OR = .73, CI: .65, .82) and history of childhood sexual abuse (OR = 1.82, CI: 1.32, 2.51) were significant predictors of binge drinking. Predictions of religious participation and history of childhood sexual abuse were partially mediated through attitude, subjective norm, descriptive norm and intention to binge drinking. CONCLUSION South African men with childhood sexual abuse experience and low religious participation were at higher risk for binge drinking. The extended TRA model explains the associations of these factors to binge drinking and can contribute to the design and evaluation of interventions.
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Affiliation(s)
- Jingwen Zhang
- a Department of Communication , University of California , Davis , CA , USA
| | - John B Jemmott
- b Department of Psychiatry , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA.,c Annenberg School for Communication , University of Pennsylvania , Philadelphia , PA , USA
| | - Larry D Icard
- d College of Health Professions and Social Work , Temple University , Philadelphia , PA , USA
| | - G Anita Heeren
- b Department of Psychiatry , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Zolani Ngwane
- e Department of Anthropology , Haverford College , Haverford , PA , USA
| | - Monde Makiwane
- f Human Sciences Research Council , Pretoria , South Africa
| | - Ann O'Leary
- g Centers for Disease Control and Prevention , Atlanta , GA , USA
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Harris T, Rice E, Rhoades H, Winetrobe H, Wenzel S. Gender Differences in the Path From Sexual Victimization to HIV Risk Behavior Among Homeless Youth. JOURNAL OF CHILD SEXUAL ABUSE 2017; 26:334-351. [PMID: 28471336 PMCID: PMC6178948 DOI: 10.1080/10538712.2017.1287146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Experiencing sexual victimization prior to becoming homeless is common among homeless youth and is associated with increased HIV risk behavior. This study examined mediating variables that underlie this association, adding to the understanding of gender differences in these paths. Participants were homeless youth in Los Angeles recruited through service access centers who completed a computerized self-administered interview in English or Spanish using an iPad. Findings indicate a high presence of sexual victimization across both genders. Female participants experienced posttraumatic stress disorder and subsequent engagement with exchange sex, whereas male participants were primarily involved in substance use risk pathways. Results indicate paths in the association between sexual victimization and HIV risk behavior differ between male and female homeless youth. Gender-specific, mental-health-informed interventions targeting sexual risk reduction are warranted.
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Affiliation(s)
- Taylor Harris
- School of Social Work, University of Southern California, 669 W. 34 St., Los Angeles, CA 90089
| | - Eric Rice
- School of Social Work, University of Southern California, 669 W. 34 St., Los Angeles, CA 90089
| | - Harmony Rhoades
- School of Social Work, University of Southern California, 669 W. 34 St., Los Angeles, CA 90089
| | - Hailey Winetrobe
- School of Social Work, University of Southern California, 669 W. 34 St., Los Angeles, CA 90089
| | - Suzanne Wenzel
- School of Social Work, University of Southern California, 669 W. 34 St., Los Angeles, CA 90089
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5
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Manyaapelo T, Ruiter RAC, Nyembezi A, van den Borne B, Sifunda S, Reddy P. The psychosocial determinants of the intention to avoid sexual engagement when intoxicated among young men in KwaZulu-Natal, South Africa. BMC Public Health 2016; 16:562. [PMID: 27411913 PMCID: PMC4944248 DOI: 10.1186/s12889-016-3219-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/23/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND A cross sectional study was conducted among 350 sexually active, mainly unemployed men between the ages of 18 and 35 in KwaZulu-Natal. This study examined the psychosocial determinants of the intention to be sexually active after having used marijuana or alcohol personally or in instances when the sexual partner is intoxicated. The theory of planned behaviour and cultural notions of responsible manhood were used in developing the measures. METHODS Correlation and hierarchical stepwise linear regression analyses tested determinants of the intention to avoid having sex when personally intoxicated and the intention to avoid sex when the sexual partner is intoxicated. RESULTS About 78 % of the participants reported regular use of alcohol and 39 % indicated ever-using marijuana. A total of 36.3 % used both alcohol and marijuana, and 73 % said that they engaged in multiple sexual partner behaviour. The intention to avoid sex when personally intoxicated as well as the intention to avoid sex when the sexual partner is intoxicated were significantly associated with subjective norms and perceptions of perceived behavioural control towards the respective behaviours, and less with attitudes towards the respective behaviours. CONCLUSIONS These findings imply that health education interventions should focus on changing the normative beliefs as well as control beliefs of the target population either directly through education and training or indirectly by creating physical and social environments that facilitate safe sexual practices, for example by organizing positive peer support for risk prevention and by making condoms freely available in community alcohol serving establishments.
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Affiliation(s)
- Thabang Manyaapelo
- />Human Sciences Research Council, Population Health, Health Systems and Innovation, Private Bag X41, Pretoria, 0001 South Africa
| | - Robert A. C. Ruiter
- />Department of Work & Social Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Anam Nyembezi
- />Human Sciences Research Council, Population Health, Health Systems and Innovation, Private Bag X9182, Cape Town, 8000 South Africa
| | - Bart van den Borne
- />Department of Health Education & Health Promotion, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Sibusiso Sifunda
- />Human Sciences Research Council, HIV/AIDS, STIs and TB, Private Bag X41, Pretoria, 0001 South Africa
| | - Priscilla Reddy
- />Human Sciences Research Council, Population Health, Health Systems and Innovation, Private Bag X9182, Cape Town, 8000 South Africa
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Cook MC, Morisky DE, Williams JK, Ford CL, Gee GC. Sexual Risk Behaviors and Substance Use Among Men Sexually Victimized by Women. Am J Public Health 2016; 106:1263-9. [PMID: 27077345 PMCID: PMC4984784 DOI: 10.2105/ajph.2016.303136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate whether forced sex of men by women was associated with sexual risk behaviors, and whether this association was mediated by substance use. METHODS Data from US men aged 18 years or older at interview in the National Survey of Family Growth 2006-2010 (n = 8108) who reported sexual behavior history. Outcome variables were condom use at most recent sex and number of lifetime sexual partners. Sexual activity covariates included age at first consensual sex and treatment of sexually transmitted infections. Alcohol and drug use were the mediating factors. RESULTS Six percent of men reported forced sex by a woman at a mean age of 18 years. On average, victimized men had 3 more lifetime sexual partners than nonvictimized men (P < .01). Furthermore, victimized men who reported drug use had, on average, 4 more female sexual partners (P < .01) than nonvictimized men. Marijuana (P < .05) and crack cocaine use (P < .05) partially mediated the association between forced sex and number of female partners. Neither condom use nor number of male partners differed between victimized and nonvictimized men. CONCLUSIONS A nontrivial fraction of men experience forced sex by women; some of them have elevated sexual risk behaviors.
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Affiliation(s)
- Mekeila C Cook
- Mekeila C. Cook is with the University of California, Los Angeles (UCLA) Integrated Substance Abuse Programs, Los Angeles, CA. Donald E. Morisky, Chandra L. Ford, and Gilbert C. Gee are with the UCLA Fielding School of Public Health, Department of Community Health Sciences. John K. Williams is with the UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior
| | - Donald E Morisky
- Mekeila C. Cook is with the University of California, Los Angeles (UCLA) Integrated Substance Abuse Programs, Los Angeles, CA. Donald E. Morisky, Chandra L. Ford, and Gilbert C. Gee are with the UCLA Fielding School of Public Health, Department of Community Health Sciences. John K. Williams is with the UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior
| | - John K Williams
- Mekeila C. Cook is with the University of California, Los Angeles (UCLA) Integrated Substance Abuse Programs, Los Angeles, CA. Donald E. Morisky, Chandra L. Ford, and Gilbert C. Gee are with the UCLA Fielding School of Public Health, Department of Community Health Sciences. John K. Williams is with the UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior
| | - Chandra L Ford
- Mekeila C. Cook is with the University of California, Los Angeles (UCLA) Integrated Substance Abuse Programs, Los Angeles, CA. Donald E. Morisky, Chandra L. Ford, and Gilbert C. Gee are with the UCLA Fielding School of Public Health, Department of Community Health Sciences. John K. Williams is with the UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior
| | - Gilbert C Gee
- Mekeila C. Cook is with the University of California, Los Angeles (UCLA) Integrated Substance Abuse Programs, Los Angeles, CA. Donald E. Morisky, Chandra L. Ford, and Gilbert C. Gee are with the UCLA Fielding School of Public Health, Department of Community Health Sciences. John K. Williams is with the UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior
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Vaillancourt-Morel MP, Godbout N, Sabourin S, Briere J, Lussier Y, Runtz M. Adult Sexual Outcomes of Child Sexual Abuse Vary According to Relationship Status. JOURNAL OF MARITAL AND FAMILY THERAPY 2016; 42:341-356. [PMID: 26804731 DOI: 10.1111/jmft.12154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study tested a moderation model in which the association between child sexual abuse severity and negative sexual outcomes (i.e., sexual avoidance and compulsivity) differed as a function of relationships status (i.e., single, cohabiting, and married individuals). A sample of 1,033 adults completed self-report questionnaires online, and 21.5% reported childhood sexual abuse. Path analyses indicated that child sexual abuse severity was associated with higher sexual compulsivity in single individuals, both higher sexual avoidance and compulsivity in cohabiting individuals, and higher sexual avoidance in married individuals. The moderation model was invariant across men and women. These results suggest that the time course of negative sexual outcomes associated with child sexual abuse may follow distinct patterns of expression according to relationship status.
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Affiliation(s)
| | | | | | - John Briere
- Keck School of Medicine, University of Southern California
| | - Yvan Lussier
- Département de psychologie, Université du Québec à Trois-Rivières
| | - Marsha Runtz
- Department of Psychology, University of Victoria
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Traumatic stress and the mediating role of alcohol use on HIV-related sexual risk behavior: results from a longitudinal cohort of South African women who attend alcohol-serving venues. J Acquir Immune Defic Syndr 2015; 68:322-8. [PMID: 25394191 DOI: 10.1097/qai.0000000000000433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND In South Africa, alcohol contributes to the HIV epidemic, in part, by influencing sexual behaviors. For some, high levels of alcohol consumption may be driven by previous traumatic experiences that result in traumatic stress. The purpose of this study was to quantify the longitudinal association between traumatic stress and unprotected sex among women who attend drinking venues and to assess whether this association was explained by mediation through alcohol use. METHODS Data were collected in 4 waves over a year from a prospective cohort of 560 women who regularly attended alcohol-serving venues in a Cape Town township. Longitudinal mixed models examined (1) the relationship between traumatic stress and counts of unprotected sex and (2) whether alcohol use mediated the association between traumatic stress and unprotected sex. RESULTS Most women reported elevated traumatic stress (80%) and hazardous alcohol use (88%) at least once during the study period. In models adjusted for covariates, traumatic stress was associated with unprotected sex (b = 0.28, SE = 0.06, t = 4.82, P < 0.001). In addition, traumatic stress was associated with alcohol use (b = 0.27, SE = 0.02, t = 14.25, P < 0.001) and was also associated with unprotected sex (b = 0.20, SE = 0.06, t = 3.27, P < 0.01) while controlling for alcohol use (b = 0.28, SE = 0.07, t = 4.25, P < 0.001). The test for the mediated effect established that alcohol use was a significant mediator, accounting for 27% of the total effect of traumatic stress on unprotected sex. CONCLUSIONS These results highlight the need to address traumatic stress among female venue patrons as an important precursor of HIV risk due to alcohol use.
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Jemmott JB, Stephens-Shields A, O'Leary A, Jemmott LS, Teitelman A, Ngwane Z, Mtose X. Mediation of effects of a theory-based behavioral intervention on self-reported physical activity in South African men. Prev Med 2015; 72:1-7. [PMID: 25565482 PMCID: PMC4351128 DOI: 10.1016/j.ypmed.2014.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 12/22/2014] [Accepted: 12/26/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Increasing physical activity is an important public-health goal worldwide, but there are few published mediation analyses of physical-activity interventions in low-to-middle-income countries like South Africa undergoing a health transition involving markedly increased mortality from non-communicable diseases. This article reports secondary analyses on the mediation of a theory-of-planned-behavior-based behavioral intervention that increased self-reported physical activity in a trial with 1181 men in Eastern Cape Province, South Africa. METHOD Twenty-two matched-pairs of neighborhoods were randomly selected. Within pairs, neighborhoods were randomized to a health-promotion intervention or an attention-matched control intervention with baseline, immediate-post, and 6- and 12-month post-intervention assessments. Theory-of-planned-behavior constructs measured immediately post-intervention were tested as potential mediators of the primary outcome, self-reported physical activity averaged over the 6- and 12-month post-intervention assessments, using a product-of-coefficients approach in a generalized-estimating-equations framework. Data were collected in 2007-2010. RESULTS Attitude, subjective norm, self-efficacy, and intention were significant mediators of intervention-induced increases in self-reported physical activity. The descriptive norm, not affected by the intervention, was not a mediator, but predicted increased self-reported physical activity. CONCLUSION The results suggest that interventions targeting theory-of-planned-behavior constructs may contribute to efforts to increase physical activity to reduce the burden of non-communicable diseases among South African men.
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Affiliation(s)
- John B Jemmott
- Department of Psychiatry, Perelman School of Medicine and Annenberg School for Communication, University of PA, USA.
| | - Alisa Stephens-Shields
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of PA, USA
| | - Ann O'Leary
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, USA
| | | | | | | | - Xoliswa Mtose
- Faculty of Education, University of Fort Hare, Alice, South Africa
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Toska E, Cluver LD, Boyes M, Pantelic M, Kuo C. From 'sugar daddies' to 'sugar babies': exploring a pathway among age-disparate sexual relationships, condom use and adolescent pregnancy in South Africa. Sex Health 2015; 12:59-66. [PMID: 25702156 DOI: 10.1071/sh14089] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 01/05/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Adolescent pregnancy has been linked to adverse outcomes. Most studies proposing risk pathways for adolescent pregnancy in South Africa are qualitative, hypothesising links among age-disparate relationships, reduced condom use and higher pregnancy rates. No known South African studies have quantitatively explored pathways to adolescent pregnancy. OBJECTIVES This study aimed to: (i) identify the factors associated with adolescent pregnancy and (ii) explore a pathway of risk by assessing whether condom use mediated the relationship between age-disparate sexual relationships and adolescent pregnancy. METHODS A cross-sectional survey of 447 sexually active girls aged 10-19 years was undertaken in six health districts of South Africa. Multivariate logistic regressions controlled for confounders. Mediation tests used bootstrapping. RESULTS Consistent condom use (β=-2.148, odds ratio (OR)=8.566, P≤0.001) and school enrolment (β=-1.600, OR=0.202, P≤0.001) were associated with lower pregnancy rates. Age-disparate sex (β=1.093, OR=2.982, P≤0.001) and long-term school absences (β=1.402, OR=4.061, P≤0.001) were associated with higher pregnancy rates. The indirect effect of age-disparate sex on adolescent pregnancy through condom use was significant, irrespective of age, age at sexual initiation, poverty and residential environment (B=0.4466, s.d.=0.1303, confidence interval: 0.2323-0.7428). CONCLUSION This survey supports hypotheses that inability to negotiate condom use in age-disparate sexual relationships may drive adolescent pregnancy. Interventions addressing these relationships, facilitating condom use and increasing access to sexual health services among adolescents might avert unwanted pregnancies.
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Affiliation(s)
- Elona Toska
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 23R, UK
| | - Lucie D Cluver
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 23R, UK
| | - Mark Boyes
- School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Marija Pantelic
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 23R, UK
| | - Caroline Kuo
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa
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Heeren GA, Icard LD, O'Leary A, Jemmott JB, Ngwane Z, Mtose X. Protective factors and HIV risk behavior among South African men. AIDS Behav 2014; 18:1991-7. [PMID: 24722765 DOI: 10.1007/s10461-014-0767-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary mode of HIV transmission in South Africa is heterosexual sexual behavior. HIV prevention research specifically focusing on men in South Africa is limited. We assessed self-reported HIV risk behaviors in 1,181 men ages 18 to 45 years in randomly selected neighborhoods in Eastern Cape Province, South Africa. Older men were less likely to report having multiple partners. Religiosity was a protective factor for condom use and unprotected sex with steady partners. Discussing using condoms was a protective factor for condom use and unprotected sex with both steady and casual partners. Having a child was associated with decreased condom use with steady partners and employment was associated with decreased condom use with casual partners. The findings suggest the need for HIV risk-reduction behavioral interventions tailored for South African men with regard to age, religiosity, and types of sexual partners. Implications for the development of such interventions are discussed.
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Affiliation(s)
- G Anita Heeren
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, PA, 19104-3309, USA
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