Condom Use and its Associated Factors Among Iranian Youth: Results From a Population-Based Study

Gender differences and factors affecting opinions on condom use and sexual experiences among adolescents in a high teenage pregnancy setting in the Volta Region, Ghana

BACKGROUND

Gender is crucial in understanding the sexual behaviour of adolescents regarding their condom use and sexual experiences. However, not much is known about the role gender plays in adolescents' opinions on condom use and their sexual experiences and other factors that influence these opinions in high-adolescent pregnancy settings in rural Ghana. This study sought to examine the gendered dynamics and factors that shape the opinions of adolescent girls and boys on condom use and how that affects their sexual experiences in the high teenage pregnancy setting of Adaklu District, in the Volta region of Ghana.

METHODS

Data for this study were extracted from a larger primary baseline cross-sectional study among 188 adolescents (109 girls and 79 boys) aged 10-19 years in 30 communities. Data from a semi-structured questionnaire were analyzed using a bivariate analysis and binary logistic regression.

RESULTS

The results indicate adolescent girls were less likely (aOR = 0.16, CI 0.06-0.43) to agree to the opinion that condoms are an effective way of preventing HIV compared to boys. Adolescent girls are less likely to agree to the opinion that they have been pressured into sex (aOR = 0.15; CI 0.06-0.39), but have higher odds (aOR = 2.58; CI 1.33-1.64) to agree that purchasing condoms is embarrassing for them compared to males. Regarding age, adolescents 10-14 years are less likely (aOR = 0.43; CI 0.19-0.99) to agree that condoms are an effective in preventing HIV compared to those aged 15-19 years. Adolescents aged 10-14 years had higher odds (aOR = 2.91; CI 1.28-6.63) to agree that purchasing condoms is embarrassing for them to compared to the 15-19 year olds. Employment status of adolescents significantly influences their opinion on condom use, where adolescents who are currently employed are more likely to agree to the opinion that it would be embarrassing for them to go and purchase condoms compared to the unemployed ones.

CONCLUSIONS

Gender, age and employment status of adolescents are critical to their sexual and reproductive health and wellbeing, as the study findings show distinct sexual experiences of adolescent boys and girls. These important factors should be considered when formulating sexual and reproductive health policies and programs for adolescents to meet their needs.

Prevalence and predictors of HIV testing among young men in Papua New Guinea: A cross-sectional analysis of a nationally representative sample

BACKGROUND

HIV testing is an important component of HIV prevention and serves as a gateway to other HIV-related services. However, the uptake remains suboptimal among young people, particularly in highly prevalent settings such as Papua New Guinea (PNG). This study aimed to assess the prevalence and determine the predictors of HIV testing uptake among young men aged 15-24 years in PNG.

METHODS

The 2016-2018 PNG Demographic and Health Survey (DHS) data was used. A total of 1,275 young men aged 15-24 years were included in the final analysis. Descriptive, bivariate, and multivariable logistic regression analyses were performed to determine independent predictors of HIV testing. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. All analyses were adjusted using survey weights to account for unequal sampling probabilities.

RESULTS

The overall prevalence of HIV testing among young men was 17.1% (95% CI: 15-19). Of those who were tested for HIV, about one-third (32.9%) had experienced a sexual debut at age <15 years, and 33.9% inconsistently used condoms during sex. In multivariable analysis, men aged 20-24 years (AOR 1.18, 95% CI: 1.00-2.31), who owned mobile phones (AOR 1.43, 95% CI: 1.00-2.55), who were aware that consistent condom use during sex can reduce HIV risk (AOR 2.18, 95% CI: 1.18-4.04), who had paid for sex (AOR 1.75, 95% CI: 1.01-5.83), and who had two or more sexual partners (AOR 1.37, 95% CI: 1.01-3.14) had increased odds of HIV testing. However, decreased odds of HIV testing were found among men who were never married (AOR 0.51, 95% CI: 0.29-0.88), lived in rural areas (AOR 0.54, 95% CI: 0.32-0.92), and consistently used condoms during sex (AOR 0.59, 95% CI: 0.34-1.01).

CONCLUSION

The findings show that HIV testing is low among young men in PNG. To increase HIV testing uptake among young men, it is crucial to implement comprehensive youth-friendly HIV/STI education and tailored sensitization programs and enable more accessible and affordable HIV testing services. Also, outreach and community-based testing programs for young men in rural and prioritized areas requiring urgent prevention interventions are feasible options in PNG.

Prevalence of risk factors for human immunodeficiency virus among sexually active women in Rwanda: a nationwide survey

BACKGROUND

The Human Immunodeficiency Virus (HIV) remains a global health burden, and despite the advancements in antiretroviral therapy and various strategies employed to curb HIV infections, the incidence of HIV remains disproportionately high among women. Therefore, this study aimed to determine the prevalence of the risk factors for the acquisition of HIV among sexually active women in Rwanda.

METHODS

Secondary data from the 2020 Rwanda Demographic Health Survey, comprising 10,684 sexually active women, was used. Multistage stratified sampling was employed to select the study participants. Multivariable logistic regression was conducted to determine the associated risk factors using the SPSS (version 25).

RESULTS

Of the 10,684 sexually active women, 28.7% (95% confidence interval (CI): 27.5-29.4) had at least one risk factor for HIV acquisition. Having no education (AOR = 3.65, 95%CI: 2.16-6.16), being unmarried (AOR = 4.50, 95%CI: 2.47-8.21), being from female-headed households (AOR = 1.75, 95%CI: 1.42-2.15), not having health insurance (AOR = 1.34, 95%CI: 1.09-1.65), no HIV test history (AOR = 1.44, 95%CI: 1.01-2.08), being from the poorest wealth quintile (AOR = 1.61, 95%CI: 1.14-2.27) and lack of exposure to mass media (AOR = 1.30, 95%CI: 1.07-1.58) were associated with higher odds of exposure to at least one HIV acquisition risk factor. In contrast, age groups of 25-34 (AOR = 0.56, 95%CI: 0.44-0.71) and 35-44 years (AOR = 0.62, 95%CI: 0.48-0.80), rural residence (AOR = 0.63, 95%CI: 0.49-0.81) and being from the western region (AOR = 0.67, 95%CI: 0.48-0.94) were associated with less odds of exposure to at least one HIV acquisition risk factor.

CONCLUSION

More than a quarter of sexually active women in Rwanda had exposure to at least one risk factor for HIV acquisition. There is a need to maximize the use of mass media in disseminating HIV prevention and behavioral change messages. Engagement of religious leaders and promotion of HIV testing, especially among the never-testers, may be vital strategies in successful HIV prevention programs.

Knowledge and practice of high school students regarding HIV/AIDS prevention and transmission: Results from a cross-sectional study in an Iranian less-developed, high-risk region

BACKGROUND

Some residents of the Persian Gulf Coastline (PGC) areas are circular migrants due to geo-commercial issues. They have a higher risk of HIV infection and non-disclosure of their HIV/AIDS status. These people who live with HIV (PLHIV) are considered as the bridge population for HIV transmission to general population, especially adolescents. This study sought to investigate the knowledge and behavior of adolescents regarding HIV/AIDS prevention and transmission in a less-developed, high-risk area located along the PGC.

MATERIALS AND METHODS

In this cross-sectional study, using multistage cluster random sampling, 1450 students were invited to complete a standardized questionnaire previously used in a 2013 Iranian national high-risk behaviors survey. The prevalence of adequate knowledge, condom use, and stigmatization of HIV/AIDS and their 95% confidence intervals (CIs) were estimated. Adjusted odds ratios (ORs) were estimated using ordinal logistic regression.

RESULTS

Totally, 17.09% (CI: 15.0-19.3) of the students had adequate knowledge. Social networks and the internet were the most important sources of information (20.9%, CI: 18.6-23.3). Socioeconomic status (OR: 2.0, 95% CI: 1.7-2.3), gender (0.6, CI: 0.5-0.8), residential area (0.08, CI: 0.05-0.1), and using social networks and the internet as the main sources of information (1.5, CI: 1.1-1.9) were correlated to the level of knowledge. Furthermore, 29.8% (CI: 27.2-32.5) of the students respected the social rights of PLHIV, and 12.6% (CI: 10.7-14.6) reported condom use.

CONCLUSION

HIV/AIDS-related education is needed in the PGC. Such education should be focused on males, students from marginalized areas, and people with lower socioeconomic status. Social networks and the internet may be the most effective way to improve people's knowledge about HIV/AIDS.

Psychosocial determinants of consistent condom use among university students in Sudan: findings from a study using the Integrated Change Model

Unprotected sex is common among university students in Sudan, thus increasing risks for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). As little is known about the psychosocial determinants of consistent condom use among this population, this study was designed to identify them. The Integrated Change Model (ICM) was applied in a cross-sectional design to identify in 218 students (aged 18-25 years) from Khartoum which items distinguish condom users from non-condom users. Condom users differed significantly from non-condom users in having more HIV and condom use-related knowledge, higher perception of susceptibility to HIV, reporting more exposure to condom use cues, having a less negative attitude towards condom use (attitude cons), experiencing social support and norms favouring condom use and having higher condom use self-efficacy. Binary logistic regression showed that peer norms favouring condom use in addition to HIV-related knowledge, condom use cues, negative attitude and self-efficacy were the factors uniquely associated with consistent condom use among university students in Sudan. Interventions seeking to promote consistent condom use among sexually active students could benefit from increasing knowledge about HIV transmission and prevention, raising HIV-risk perception, using condom use cues, addressing perceived condom disadvantages and enhancing students` self-efficacy to avoid unprotected sex. Moreover, such interventions should raise students` perceptions of their peers` beliefs and behaviours favouring condom use and seek health care professionals` and religious scholars` support for condom use.

Prevalence of risk factors for human immunodeficiency virus among women of reproductive age in Sierra Leone: a 2019 nationwide survey

Background and aim

For over 40 years of the HIV/AIDS global epidemic, no effective cure nor vaccine is yet available, making the current control strategies focused on curbing new infections through risk reduction. The study aimed to determine the prevalence of HIV risk factors and their associated socio-demographics among women of reproductive age in Sierra Leone.

Methods

We used weighted data from the Sierra Leone Demographic and Health Survey (SLDHS) of 2019 for 12,005 women aged 15–49 years. Multistage sampling was used to select study participants. Exposure to HIV risk factors was considered if a woman reported at least one of the following; having multiple sexual partners, transactional sex, non-condom use for the unmarried, and having other sexually transmitted infections (STIs). We, then, conducted multivariable logistic regression to explore the associated socio-demographics. All the analyses were done using SPSS (version 25).

Results

Of the 12,005 women, 38.1% (4577/12005) (95% confidence interval (CI) 37.3–39.0) had at least one of the four risk factors. Women of 15 to 19 years (adjusted odds ratio (AOR) = 1.34, 95% CI 1.00–1.80) and 20 to 34 years (AOR = 1.25, 95% CI 1.05–1.49) had more odds of having HIV risk factors compared to those of 35 to 49 years. Urban residents (AOR = 1.49, 95% CI 1.17–1.89) and those from the Northwestern region (AOR = 1.81, 95% CI 1.26–2.60) were also more likely to encounter HIV risk factors compared to their respective counterparts. Moreover, unmarried women (AOR = 111.17, 95% CI 87.55–141.18) and those working (AOR = 1.38, 95% CI 1.14–1.67) also had higher odds of having HIV risk factors, compared to their respective counterparts. Sex of household head and parity were also significant associates.

Conclusions

More than a third of women in Sierra Leone had encountered at least one HIV risk factor, and this was associated with age, place of residence, region, marital status, working status, household head and parity. There is a need for strengthening HIV/AIDS education programs, laws and policies targeting the young, working, unmarried and urban-resident women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07037-7.

Understanding the epidemiological HIV risk factors and underlying risk context for youth residing in or originating from the Middle East and North Africa (MENA) region: A scoping review of the literature

INTRODUCTION

HIV is the second leading cause of death among young people globally, and adolescents are the only group where HIV mortality is not declining. Middle East and North Africa (MENA) is one of few regions seeing rapid increase of HIV infections (31.0%) since 2001. MENA youth are at particular risk of HIV due to dearth of research and challenges in accessing services.

OBJECTIVE

The purpose of this scoping review is to establish the epidemiological HIV risk factors and underlying risk context for youth residing in or originating from the MENA region.

METHODS

Online database searches were conducted using combination of search terms. Screening 5,853 citations, published between 1990-2019 with age groups 16 to 29, resulted in 57 studies included across 18 MENA countries.

RESULTS

'Key populations' engage in risky behaviors, including: overlapping risky behaviors among youth who inject drugs (PWID); lack of access to HIV testing, condomless sex, and multiple sex partners among young men who have sex with men (MSM); and high and overlapping risk behaviors among young sex workers. Challenges facing other youth groups and bridging populations include: peer pressure, inhibition about discussing sexual health, lack of credible sex education sources, low condom use, and lack of access to HIV protection/prevention services, especially testing.

CONCLUSION

Poor surveillance coupled with scarcity of rigorous studies limit what is known about epidemiology of HIV among youth in MENA. Homophobia, stigma around PWID, and illegal status of sex work promote non-disclosure of risk behaviors among youth and curtail serving this population.

Prevalence of STIs, sexual practices and substance use among 2083 sexually active unmarried women in Lebanon

Access to sexual and reproductive health in conservative communities and in the MENA region are particularly limited and, as such, increase women's vulnerability to unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STIs). The aim was to assess the prevalence of STIs, sexual practices, recreational drug-use and their possible associations among cisgender unmarried women residing in Lebanon. Data on demographics, sexual practices and substance-use were collected from 2083 unmarried cisgender women who voluntarily attended a sexual health clinic in Lebanon between 2015 and 2019. They tested for HIV, Hepatitis B, Hepatitis C and Syphilis through rapid testing. Other infections (genital warts, Neisseria gonorrhea/Chlamydia trachomatis) were screened for. Regression models were computed between variables. There were two cases of HIV, one of Hepatitis B and syphilis, and no cases of Hepatitis C. Genital warts were present in 15% and symptoms indicative of Neisseria gonorrhea/Chlamydia trachomatis in 14%. Inconsistent condom-use (81%) was significantly associated with number of partners (adj. OR: 0.4). Inconsistent condom-use discussion with partners (33%) was significantly associated with unemployment (adj OR: 1.7), recreational drug-use (adj. OR: 1.4), and number of partners (adj. ORs 3.7-4.4). Unwanted pregnancies (11%) were significantly associated with age (adj. ORs 0.1-0.37), recreational drug-use (adj. OR: 2), using intrauterine device (adj. OR:2.9) and natural birth control methods (adj. OR: 2.4). Recreational drug-use (33%) was significantly associated with age (adj ORs 1.9-2.2), and smoking status (adj. OR: 0.6). The results indicate an urgent need for: (1) Accessible, non-stigmatizing, and inclusive sexual health services dedicated to women's sexual health; (2) Comprehensive and non-stigmatizing sexual health education for all, but especially women, in order to promote safer sexual practices and effective decision making with regards to contraception and condom-use.

Adolescents and Young People's Sexual and Reproductive Health in Iran: A Conceptual Review

This paper reviews the evidence on the sexual and reproductive health (SRH) of young people in Iran from 2001 to 2019 and maps needs, challenges, and opportunities in this area. From among 125 papers, 43 articles were examined for this review. Findings indicated that although the majority of youth abstain from sex before marriage, significant minorities are sexually active before marriage, with a huge heterogeneity based on gender and geographical region. A gender disparity is apparent in high-risk sexual behaviors. Multiple partners, inconsistent condom use, and younger age at sexual debut were more prevalent among men than women. There is a need to narrow gender disparities that expose young women to greater risks, expand health awareness and relevant skills, and enable access to SRH services. While the government has reaffirmed many commitments for young people's wellbeing, policy development falls far short of realizing these commitments. Future success requires increased evidence on the SRH of youth as well as political will and strategic commitment to SRH for young people. The challenge is to develop comprehensive and culturally appropriate SRH education and confidential and nonjudgmental youth services. Due to the importance of families and parents, such programs need to engage families.