Primary prevention of sexually transmitted disease: applying the ABC strategy

Creation of Sexually Transmitted Diseases Education Program for Young Adults in Rural Cambodia

Introduction: Globally, adolescents and young adults aged from 15 to 24 years accounted for 25% of the sexually active population. They also took up almost 50% of all newly acquired sexually transmitted diseases (STDs) worldwide. In developing countries/ regions, there have been more unreported cases due to the limited resources and availability of data. This project aimed to enhance sexual health knowledge and encourage behavioral change in sexual practice in rural Cambodia by educational interventions. Methods: A multi-prong project used the Theory of Planned Behavior (TPB) as framework to guide the implementation, which involved carrying out educational talks, group discussion sessions. The educational health talks described the signs and symptoms of STDs and preventive measures including the Abstinence-Be faithful- Condom (ABC) strategy. Pre- and post-intervention assessments were conducted on 111 villagers aged between 18 and 30 years who lived in Peaksneng Thyme Village, Cambodia. Special materials were prepared that highlighted such information were also given to all participants. This was followed by discussion sessions that aimed to strengthen an appropriate attitude toward STDs. A pilot trial was done to prepare and build a constructive, realistic atmosphere and facilitated in-depth spread of main messages. A 20-item assessment of STD knowledge was used as pre- and post-intervention evaluation tool. Individual participant scores were compared to determine the effectiveness of interventions. Conclusion: This comprehensive program was effective in enhancing sexual knowledge in high-risk groups of both sexes as well as general public in rural Cambodia. With experiences gained, this could be replicated in nearby communities, possibly motivating community behavioral change in future. Alternatively, this approach could be further developed, or using other behavioral theories, and applied to other health issues in this country.

A tale of two countries: rethinking sexual risk for HIV among young people in South Africa and the United States

PURPOSE

To compare the sexual behaviors of young people in South Africa (SA) and the United States (US) with the aim to better understand the potential role of sexual behavior in HIV transmission in these two countries that have strikingly different HIV epidemics.

METHODS

Nationally representative, population-based surveys of young people aged 18-24 years from SA (n = 7,548) and the US (n = 13,451) were used for the present study.

RESULTS

The prevalence of HIV was 10.2% in SA and <1% in the US. Young women and men in the US reported an earlier age of first sex than those in SA (mean age of coital debut for women: US [16.5], SA [17.4]; for men: US [16.4], SA [16.7]). The median number of lifetime partners is higher in the US than in SA: women: US (4), SA (2); men: US (4), SA (3). The use of condom at last sex is reported to be lower in the US than in SA: women: US (36.1%), SA (45.4%); men: US (48%), SA (58%). On average, young women in SA report greater age differences with their sex partners than young women in the US.

CONCLUSION

Young people in the US report riskier sexual behaviors than young people in SA, despite the much higher prevalence of HIV infection in SA. Factors above and beyond sexual behavior likely play a key role in the ongoing transmission of HIV in South African youth, and thus should be urgently uncovered to develop maximally effective prevention strategies.

HIV protective strategies among college students in Durban, South Africa

There is growing concern about the high level of HIV infection among young people in South Africa. The aim of the study is to examine the HIV protective strategies used by college students with specific emphasis on variations by race group. The data for the study come from a self-administrated survey that was conducted with 3 000 college students in Durban in order to understand the strategies they use to protect themselves against the risk of HIV infection. Overall, students perceived a far greater risk of pregnancy than HIV infection. The results show that abstinence is the most common protective factor among Indian and White students. Among African students, there is great concern about HIV but abstinence is less common. Among sexually active men and women, the majority report having more than one sexual partner (with the exception of Indian females). Female students among all groups were more likely than male students to report that they were faithful to their partners. In Africans the contrast is stark: 25% for women versus 6% for men. Condoms are the most commonly used method by students but are not used in every sexual encounter. Consistent condom use was highest among Indian males (46%) and lowest among White females (13.7%). More effort needs to be directed at promoting correct and consistent condom use in order to avoid the negative consequences associated with unprotected sexual intercourse including unwanted pregnancy and HIV/AIDS.

Aboriginal women's stories of sexually transmissible infection transmission and condom use in remote central Australia

BACKGROUND

Sexually transmissible infection (STI) rates are persistently high in central Australia, creating conditions for a potential HIV pandemic in the area. There is a shortage of qualitative research examining the underlying factors affecting STI transmission in this region. The present study investigates Aboriginal women's current levels of knowledge regarding STI and their transmission, perception of risk for STI, patterns of condom use, access to condoms and experiences of condom negotiation with their partners. It also explores the sociocultural context of their sexual health.

METHODS

The present study used qualitative methods with a semistructured questionnaire. Twenty-four women aged 18-35 years from one remote central-Australian Aboriginal community were recruited.

RESULTS

The results revealed poor understandings of STI transmission, limited access to condoms and low levels of condom use despite a high perception of risk to STI. They also identified specific issues facing these women regarding the sociocultural context of their condom use, their access to condoms and the transmission of STI. The perceived effects of alcohol abuse, infidelity, sexual assault and shame on the acquisition of STI were significant issues for the women.

CONCLUSION

This research has identified an urgent need for further qualitative research into the sociocultural factors that facilitate the spread of STI among Aboriginal people of remote central Australia. Implications include the need to increase their knowledge regarding STI and STI transmission, to increase women's access to condoms and to incorporate the teaching of skills to deal with sexual assault and violence into sexual-health education.