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Ryan JH, Young A, Musara P, Reddy K, Macagna N, Guma V, Seyama L, Piper J, van der Straten A. Sexual Attitudes, Beliefs, Practices, and HIV Risk During Pregnancy and Post-delivery: A Qualitative Study in Malawi, South Africa, Uganda, and Zimbabwe. AIDS Behav 2022; 26:996-1005. [PMID: 34907478 PMCID: PMC8840901 DOI: 10.1007/s10461-021-03454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 12/03/2022]
Abstract
Women who acquire HIV during the pregnancy and breastfeeding periods have a higher risk of transmitting the virus to their child than women who become infected with HIV before pregnancy. We explore the context of sexual beliefs and practices that may shape both HIV risk and willingness to use HIV prevention products during pregnancy and postpartum in Malawi, South Africa, Uganda and Zimbabwe. Twenty-three single sex focus group discussions and 36 in-depth interviews took place between May and November 2018 with recently pregnant or breastfeeding women, men, mothers and mothers-in-law of pregnant or breastfeeding women, and key informants. Participants across study groups and sites (N = 232) reported various perceived benefits and harms of sex during pregnancy and postpartum. Participants discussed reasons why men might seek sex outside of the relationship. There is a critical need for alternative prevention options to protect pregnant and breastfeeding women from HIV.
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Affiliation(s)
- Julia H. Ryan
- Women’s Global Health Imperative (WGHI), RTI International, Berkeley, CA USA
| | - Alinda Young
- Women’s Global Health Imperative (WGHI), RTI International, Berkeley, CA USA
| | - Petina Musara
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | | | - Victor Guma
- Makerere University – Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Linly Seyama
- Johns Hopkins Project-College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Ariane van der Straten
- Women’s Global Health Imperative (WGHI), RTI International, Berkeley, CA USA
- Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA USA
| | - the MTN-
041/MAMMA Study Team
- Women’s Global Health Imperative (WGHI), RTI International, Berkeley, CA USA
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
- FHI 360, Durham, NC USA
- Makerere University – Johns Hopkins University Research Collaboration, Kampala, Uganda
- Johns Hopkins Project-College of Medicine, University of Malawi, Blantyre, Malawi
- DAIDS, NIH/NIAID, Bethesda, MD USA
- Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA USA
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Shabangu Z, Madiba S. The Role of Culture in Maintaining Post-Partum Sexual Abstinence of Swazi Women. Int J Environ Res Public Health 2019; 16:ijerph16142590. [PMID: 31330772 PMCID: PMC6678937 DOI: 10.3390/ijerph16142590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/13/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022]
Abstract
Eswatini is one of the countries in the African continent where post-partum sexual abstinence is practiced. Beside scarcity of research exploring sexual abstinence in Eswatini, there are only a few studies that explore post-partum abstinence across HIV-positive and negative women in sub-Saharan Africa. The study explored the practice of post-partum sexual abstinence in Swazi women and examined how cultural beliefs influence and promotes the perpetuation of the practice. The study population consisted of post-partum women who were selected, using purposive sampling. Thematic approach was used for data analysis. Despite feeling that the period for post-partum, sexual abstinence was long; the participants adhered to the practice as prescribed by their culture. Nevertheless, they felt that the practice is imposed on women only because while they are observing post-partum abstinence, their partners get to sleep with other sexual partners. They raised concerns that the practice increases the risk of acquiring HIV and sexually transmitted infections. There is an element of coercion to the practice of post-partum abstinence, the myths and misconceptions around the early resumption of sexual intercourse forces the practice on women. At the family and community level, the discussions to change the way sexual abstinence is viewed and practiced are crucial.
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Affiliation(s)
- Zinhle Shabangu
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa
| | - Sphiwe Madiba
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa.
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Reuben Mahiti G, Mbekenga CK, Dennis Kiwara A, Hurtig AK, Goicolea I. Perceptions about the cultural practices of male partners during postpartum care in rural Tanzania: a qualitative study. Glob Health Action 2018; 10:1361184. [PMID: 28882101 PMCID: PMC5645690 DOI: 10.1080/16549716.2017.1361184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Men play an important role in maternal health. The postpartum period is a critical stage, yet there is a scarcity of research that explores men’s involvement during this stage. Objective: The aim of the study was to explore male partners’ perceptions of the cultural practices during postpartum care in rural Tanzania. Methods: Fourteen focus group discussions were conducted with 93 men, with an age range of 19–65 years, in August 2013. The study was conducted in the Kongwa District, located in the Dodoma region in central Tanzania. Qualitative data were digitally recorded, transcribed verbatim and analyzed using content analysis. Results: Four categories emerged, namely: ‘Men as providers and, occasionally, care takers’, ‘Men as decision makers’, ‘Diverse perceptions of sexual abstinence’ and ‘Barriers for men in using/accompanying partners to use reproductive and child healthcare services’. The cross-category theme ‘Men during postpartum: remaining powerful but excluded’ refers to how men are in a powerful position above women in different aspects of life. Elderly women played an important role in caring for postpartum mothers and their newborns, but men were the ones making the final decision about where to seek care. Traditional practices isolated men from their partners for a certain period, and enforced sexual abstinence for the women during the postpartum period. However, cultural norms permitted men to engage in extramarital relations. Reproductive and child healthcare services were perceived by men as not welcoming the male partners, and local gender norms discouraged men from accompanying their partners to seek services. Conclusions: In this study, we found that men perceived their role during the postpartum period as financial providers, decision makers and, occasionally, care givers. Men also held diverse perceptions with regard to sexual abstinence and felt excluded from participating in maternal healthcare services.
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Affiliation(s)
- Gladys Reuben Mahiti
- a Department of Development Studies, School of Public Health and Social Sciences , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Columba K Mbekenga
- b School of Nursing and Midwifery , Agakhan University , Dar es Salaam , Tanzania
| | - Angwara Dennis Kiwara
- a Department of Development Studies, School of Public Health and Social Sciences , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Anna-Karin Hurtig
- c Division of Epidemiology and Global Health, Faculty of Medicine , Umeå University , Umeå , Sweden
| | - Isabel Goicolea
- c Division of Epidemiology and Global Health, Faculty of Medicine , Umeå University , Umeå , Sweden
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Limaye RJ, Berman A, Brown J, Kakhobwe T. Perceptions of why Malawians engage in concurrent sexual partnerships among a select population of radio listeners: findings from an exploratory study. Afr J AIDS Res 2018; 17:1-8. [PMID: 29471730 DOI: 10.2989/16085906.2017.1362014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Concurrent sexual partnerships have been identified as a potential driver in the HIV epidemic in Southern Africa. This study utilised an innovative approach to explore perceptions of why Malawians may engage in these relationships, and their suggestions for reducing the practice among a select population of radio listeners. Using radio listener feedback in the form of text messages, we analysed approximately 1 000 text messages sent by individuals who listened to a reality radio programme that included real stories, told by Malawians, on topics related to HIV/AIDS. Listeners suggested that lack of satisfaction with one's partner was the overarching reason why individuals had concurrent sexual partnerships. Within the context of lack of satisfaction, listeners cited alcohol use, poor communication and gendered norms as factors related to satisfaction. Listeners suggested that couple communication could increase satisfaction, which, in turn, could reduce concurrent sexual partnerships. Prevention efforts should consider how to utilise couple communication to improve satisfaction as an approach to reduce HIV risk in Southern Africa.
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Affiliation(s)
- Rupali J Limaye
- a Johns Hopkins Center for Communication Programs , Baltimore , Maryland
| | - Amanda Berman
- a Johns Hopkins Center for Communication Programs , Baltimore , Maryland
| | - Jane Brown
- a Johns Hopkins Center for Communication Programs , Baltimore , Maryland
| | - Triza Kakhobwe
- b Johns Hopkins Center for Communication Programs , Lilongwe , Malawi
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de Pierrepont C, Polomeno V, Bouchard L, Reissing E. [What do we know about perinatal sexuality? A scoping review on sexoperinatality - part 1]. ACTA ACUST UNITED AC 2016; 45:796-808. [PMID: 27388468 DOI: 10.1016/j.jgyn.2016.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 05/12/2016] [Accepted: 06/07/2016] [Indexed: 11/22/2022]
Abstract
The intimate and sexual dimension of future and new parenting couples' relationship is the most affected and the most vulnerable during the transition to parenthood; couples must adapt to support their relationship and their families. The purpose of this scoping review is to identify the literature that has been published on perinatal sexuality in the last 15 years. A total of 123 empirical articles were selected. This first article of a series of two is about sexuality during pregnancy. In addition to painting a picture from the chosen articles, 23 prenatal sexual variables were analyzed. The combined data present a diversified portrait of perinatal sexuality during pregnancy: the intimate and sexual experience varies during this period. Despite some exceptions, a certain tendency towards a gradual and progressive decline in most sexual behaviors and overall sexual expression during pregnancy was noted, with a marked decrease in early pregnancy and during the third trimester. Women are particularly affected by a greater number of sexual changes, but men are too. Many simultaneous physiological and psychological factors affect the sexual expression of the couples. Sexual fluctuations are a natural phenomenon during the transition to parenthood; couples must adjust to the new conditions and to the changes associated with sexuality during pregnancy, which are considered temporary. Sexoperinatal interventions should be a part of holistic perinatal health care in order to help couples maintain an intimate relationship and a healthy and positive sexual life.
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de Pierrepont C, Polomeno V, Bouchard L, Reissing E. [What do we know about perinatal sexuality? A scoping review on sexoperinatality - Part 2]. ACTA ACUST UNITED AC 2016; 45:809-20. [PMID: 26989006 DOI: 10.1016/j.jgyn.2015.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/30/2015] [Accepted: 11/04/2015] [Indexed: 02/04/2023]
Abstract
The intimate and sexual dimension of future and new parenting couples' relationship is the most affected and the most vulnerable during the transition to parenthood. The purpose of this scoping review is to present the portrait of perinatal sexuality through 123 empirical articles published in the last 15 years. This second article in a series of two is about sexuality during labor and birth, during the postpartum, and in relation to breastfeeding. A total of 29 sexual variables were analyzed. Sexuality during the intrapartal and postnatal periods is very diversified. Some recurring items, however, can be identified: a period of non-sexuality in the first postnatal months, followed by a gradual return of sexuality from 3 to 6 months postpartum and continuing until 12 months or more. Sexuality during the intrapartum is considered taboo and couples' experiences can be at opposite ends: some couples' experiences are sensual and erotic during childbirth, while others experience birth trauma with a negative sexual impact postnatally. Sexuality during breastfeeding is also taboo with a negative impact on women's sexuality. In all of these circumstances, women's and men's sexuality are affected and a multitude of simultaneous physiological and psychological factors affect their experiences. Fluctuations in the intimate and sexual dimensions of the conjugal relationship are considered as a natural phenomenon but temporary. Sexoperinatal interventions should be part of holistic perinatal health care in order to help couples maintain a positive intimate and sexual relationship.
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RamaRao S, Ishaku S, Liambila W, Mane B. Enhancing contraceptive choice for postpartum women in sub-Saharan Africa with the progesterone vaginal ring: a review of the evidence. Open Access J Contracept 2015; 6:117-123. [PMID: 29386929 PMCID: PMC5683135 DOI: 10.2147/oajc.s55033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
It is increasingly recognized that women who have just given birth have a high unmet need and require contraceptive protection in the first year postpartum. A majority of women in developing countries do breastfeed exclusively but for short durations, hence they may be sometimes unknowingly exposed to the risk of pregnancy if they are relying on nursing for contraceptive protection. The WHO’s Medical Eligibility Criteria for Contraceptive Use recommends the use of different contraceptives in the first year postpartum depending on whether the woman is nursing or not and the time since delivery. Some of the options available for breastfeeding women include implants, IUDs and injectables, which can be obtained only from a trained family planning provider. Since 2013, Population Council has been carrying out a study in Senegal, Nigeria, and Kenya to assess the acceptability of progesterone vaginal ring (PVR) as a new contraceptive option designed specifically for use by breastfeeding women to extend the period of lactational amenorrhea and promote birth spacing. Breastfeeding in sub-Saharan Africa is near universal with fairly long durations, a situation that increases the effectiveness of PVR. Each ring delivers a daily dose of 10 mg of progesterone and can be used continuously up to 3 months with a woman being able to continue with its use up to 1 year (four rings used consecutively). Preliminary results indicate that many women who had used the method found it acceptable and their partners supported its use. Activities aimed at having PVR registered and made available in focal countries are ongoing. Integration of family planning and immunization services for mothers and their newborns will be a key strategy in introducing PVR into targeted health care markets. Given that the use of PVR does not require extensive clinical training, it will be easier to integrate it at all levels of the health system from tertiary health facilities to community-based services. The PVR has been recently included in the WHO Model List of Essential Medicines and the WHO’s fifth edition of the Medical Eligibility Criteria for Contraceptive Use which should facilitate its introduction into the public and private sectors.
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Affiliation(s)
- Saumya RamaRao
- Population Council, Reproductive Health Program, New York, NY, USA
| | - Salisu Ishaku
- Population Council, Reproductive Health Program, Abuja, Nigeria
| | - Wilson Liambila
- Population Council, Reproductive Health Program, Nairobi, Kenya
| | - Babacar Mane
- Population Council, Reproductive Health Program, Dakar, Senegal
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Abstract
OBJECTIVE Concurrent sexual partnerships (CP) have been identified as a potential driver in the HIV epidemic in southern Africa, making it essential to understand motivating factors for engagement in CP. We aimed to assess community attitudes and beliefs about relationship factors that influence men and women in stable relationships to engage in CP in Tanzania. Social exchange theory was used for interpreting the data. DESIGN Qualitative study with focus group discussions (FGDs). SETTING Semiurban/rural communities in four regions across Tanzania (Dar es Salaam, Shinyanga, Iringa and Mbeya). PARTICIPANTS 120 women aged 17-45 years and 111 men aged 18-49 years from four study areas participated in 32 FGDs. OUTCOME MEASURES FGD participants were asked the following questions about CP: definitions and types, motivations and justifications for engaging or not engaging, cultural factors, gender and socialisation, and local resources and efforts available for addressing CP. Our analysis focused specifically on beliefs about how relationship factors influence engagement in CP. RESULTS Dissatisfaction with a stable relationship was believed to be a contributing factor for engagement in CP for both men and women. Participants more commonly reported financial dissatisfaction as a contributing factor for women engaging in CP within stable relationships, whereas emotional and sexual dissatisfaction were reported as contributing factors for men and women. Furthermore, participants described how potential outside partners are often evaluated based on what they are able to offer compared with stable partners. CONCLUSIONS Efforts to reach men and women in stable relationships with HIV prevention messages must consider the various dimensions of motivation for engaging in CP, including relationship dynamics.
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Affiliation(s)
| | - Stella Babalola
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deanna Kerrigan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Kisa S, Zeyneloğlu S, Yilmaz D, Güner T. Quality of sexual life and its effect on marital adjustment of Turkish women in pregnancy. J Sex Marital Ther 2013; 40:309-322. [PMID: 24102194 DOI: 10.1080/0092623x.2012.751071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pregnancy is an important period of a woman's life that can affect marital relationships because of decrease in the sexual function. This study aimed to examine the effect of sexual life on the marital adjustment of 607 healthy, pregnant women using the self-administered Sexual Quality of Life Questionnaire-Female and the Marital Adjustment Scale. Results showed that 30% of the pregnant women experienced problems during sexual intercourse and 50% had painful intercourse. The median total score of the Sexual Quality of Life Questionnaire-Female for pregnant women was 35.5, and the median total score of the Marital Adjustment Scale was 41.0. The authors found a positive moderate level correlation between the sexual quality of life for women and their marital adjustment for being pregnant (r = 0.468, p =.001). The results imply that the variance in the sexual activity during the childbearing period does occur and pregnant women need to be assessed regularly with regards to their sexuality by health care providers in a professional atmosphere.
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Affiliation(s)
- Sezer Kisa
- a Department of Nursing, Faculty of Health Sciences , Gazi University , Besevler , Ankara , Turkey
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Abstract
Despite the centrality of information and communication in the fight against HIV/AIDS, little research has investigated the factors associated with HIV/AIDS-related information needs and media use in hard-hit Sub-Saharan Africa. This study explored individual-level and socioecological determinants among urban and rural residents in northwest Ethiopia. Urbanity versus rurality, education, direct experience with HIV/AIDS, perceived salience of HIV/AIDS-related information, and personal health concern were tested as predictors. Regression analyses showed that urbanity versus rurality and education are the major determinants of HIV/AIDS-related information needs and media use. Being urbanite and educated were associated with high concern about and information needs on HIV/AIDS and HIV/AIDS-related mass media use. Moreover, urbanity versus rurality and education significantly predicted preferences for specific types of HIV/AIDS-related information. While rurality and low education were associated with a preference for basic HIV transmission and prevention information, urbanity was associated with a preference for information on HIV/AIDS-related care and support. In most cases, urbanity versus rurality emerged as a substantial predictor and also significantly moderated the effects of other variables. Given the evolving nature of the pandemic and its expansion to rural areas, ruralites' low information needs and media use deserve due attention. Equally, communication interventions targeting urban contexts need to move beyond providing only the ABCs of HIV transmission and prevention and should attend to urbanites' progressive information needs, which seem to have now become more on care and support so as to live and deal with the pandemic.
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Affiliation(s)
- Mesfin Awoke Bekalu
- Leuven School for Mass Communication Research Katholieke Universiteit, Leuven, Belgium.
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Mbekenga CK, Pembe AB, Darj E, Christensson K, Olsson P. Prolonged sexual abstinence after childbirth: gendered norms and perceived family health risks. Focus group discussions in a Tanzanian suburb. BMC Int Health Hum Rights 2013; 13:4. [PMID: 23316932 PMCID: PMC3626895 DOI: 10.1186/1472-698x-13-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 01/09/2013] [Indexed: 11/10/2022]
Abstract
Background Prolonged sexual abstinence after childbirth is a socio-cultural practice with health implications, and is described in several African countries, including Tanzania. This study explored discourses on prolonged postpartum sexual abstinence in relation to family health after childbirth in low-income suburbs of Dar es Salaam, Tanzania. Methods Data for the discourse analysis were collected through focus group discussions with first-time mothers and fathers and their support people in Ilala, Dar es Salaam, Tanzania. Results In this setting, prolonged sexual abstinence intended at promoting child health was the dominant discourse in the period after childbirth. Sexual relations after childbirth involved the control of sexuality for ensuring family health and avoiding the social implications of non-adherence to sexual abstinence norms. Both abstinence and control were emphasised more with regard to women than to men. Although the traditional discourse on prolonged sexual abstinence for protecting child health was reproduced in Ilala, some modern aspects such as the use of condoms and other contraceptives prevailed in the discussion. Conclusion Discourses on sexuality after childbirth are instrumental in reproducing gender-power inequalities, with women being subjected to more restrictions and control than men are. Thus, interventions that create openness in discussing sexual relations and health-related matters after childbirth and mitigate gendered norms suppressing women and perpetuating harmful behaviours are needed. The involvement of males in the interventions would benefit men, women, and children through improving the gender relations that promote family health.
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Affiliation(s)
- Columba K Mbekenga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Stephenson R. Community-level gender equity and extramarital sexual risk-taking among married men in eight African countries. Int Perspect Sex Reprod Health 2011; 36:178-88. [PMID: 21245024 DOI: 10.1363/3617810] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT In many parts of Africa, women are most likely to become infected with HIV by having unprotected sex with their husbands, who may have acquired the virus through extramarital sex. However, the ways in which aspects of community environments-particularly those related to gender equity-shape men's extramarital sexual risk-taking are not well understood. METHODS Demographic and Health Survey data from eight African countries (Chad, Ghana, Malawi, Nigeria, Tanzania, Uganda, Zambia and Zimbabwe) were used to examine associations between married men's engaging in risky extramarital sex (i.e., having had both unprotected sex and extramarital sex) and indicators of gender equity and other community characteristics. Separate multilevel logistic regression models that incorporated individual, household and community measures were created for each country. RESULTS In five countries, men who lived in communities with more equal ratios of women to men with at least a primary education were less likely to report risky extramarital sexual activity (odds ratios, 0.4-0.6). A similar relationship was found in four countries for the ratio of women to men who were employed (0.4-0.5). In three countries, men who lived in communities with more conservative attitudes toward wife-beating or male decision making had elevated odds of extramarital sexual risk-taking (1.1-1.5). CONCLUSIONS While HIV prevention programs should focus on reducing gender inequities, they also need to recognize the conservative cultural factors that influence the formation of men's masculine identities and, in turn, affect their sexual behavior.
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Affiliation(s)
- Rob Stephenson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Abstract
Extra-marital sexual partnerships (EMSPs) are a major route of HIV/AIDS transmission in sub-Saharan Africa. In this paper, we investigate the roles of two types of male friendships - best friends and friends with whom they talk about AIDS - in determining whether men have EMSPs. Using data from men in rural Malawi, we find that men's current extra-marital sexual behavior is most closely correlated with their best friends', but that the behaviors of both types of friends are associated with men's subsequent EMSPs. These findings suggest that men's friendships could be used to help combat the AIDS epidemic.
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Oyediran K, Isiugo-Abanihe UC, Feyisetan BJ, Ishola GP. Prevalence of and factors associated with extramarital sex among Nigerian men. Am J Mens Health 2009; 4:124-34. [PMID: 19477757 DOI: 10.1177/1557988308330772] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study used data on currently married and cohabiting men aged 15 to 64 years from the 2003 Nigeria Demographic and Health Survey to examine the prevalence of and factors associated with extramarital sex. The results show that 16% engaged in extramarital sex in the 12 months preceding the survey and had an average of 1.82 partners. The results also show statistically significant association between extramarital sex and ethnicity, religion, age, age at sexual debut, education, occupation, and place of residence. Based on the study results, it could be concluded that significant proportions of Nigerians are exposed to HIV infection through extramarital sex. A fundamental behavioral change expected in the era of HIV/AIDS is the inculcation of marital fidelity and emotional bonding between marital partners. The promotion of condom use among married couples should be intensified to protect women, a large number of whom are exposed to HIV infection from their spouses who engage in unprotected extramarital sex. And, because of gender-based power imbalances within the family, a large number of the women are unable to negotiate consistent condom use by their partners.
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Affiliation(s)
- Kola Oyediran
- MEASURE Evaluation/JSI, Asokoro Distirct, Abuja Federal Capital Territory NGR, Nigeria.
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Benefo KD. Determinants of Zambian men's extra-marital sex: a multi-level analysis. Arch Sex Behav 2008; 37:517-529. [PMID: 17999170 DOI: 10.1007/s10508-007-9243-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 09/13/2006] [Accepted: 05/22/2007] [Indexed: 05/25/2023]
Abstract
Research interest in extra-marital sex has increased as scholars have become aware of its role in sustaining epidemics of STDs in sub-Saharan Africa and elsewhere. While most research has used the socioeconomic and demographic features of individuals as determinants of extra-marital sexual behavior, this study examined the role played by community characteristics. Using data from the 2003 Zambian Sexual Behavior Survey for a sample of 1,118 men aged 15-59 and multilevel logistic regression techniques, the study analyzed the effects of community social and demographic characteristics on involvement in extra-marital sex while controlling for the men's individual-level characteristics. Men's involvement in extra-marital sex was found to vary with the characteristics of communities. The chances of men's involvement in extra-marital sex increased with community-level ethnic heterogeneity and urbanization, decreased in commercial centers, and in communities with a demographic surplus of males, health workers active in AIDS prevention, and access to the mass media. These results show that scholars trying to understand the motivations for extra-marital sex must pay attention to the characteristics of both individuals and communities.
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Affiliation(s)
- Kofi D Benefo
- Department of Sociology and Social Work, Lehman College, City University of New York, 250 Bedford Park Blvd. West, Bronx, NY 10468-1589, USA.
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Kongnyuy EJ, Wiysonge CS. Alcohol use and extramarital sex among men in Cameroon. BMC Int Health Hum Rights 2007; 7:6. [PMID: 17683541 PMCID: PMC1959248 DOI: 10.1186/1472-698x-7-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 08/03/2007] [Indexed: 11/10/2022]
Abstract
Background The spread of HIV in sub-Saharan Africa is believed to be driven by unsafe sex, and identification of modifiable risk factors of the latter is needed for comprehensive HIV prevention programming in the region. Some previous studies suggest an association between alcohol abuse and unsafe sexual behaviour, such as multiple concurrent sexual partnerships and inconsistent condom use in sex with non-spousal non-cohabiting partners. However, most of these studies were conducted in developed countries and the few studies in Africa were conducted among well-defined social groups such as men attending beer halls or sexually transmitted infection clinics. We therefore examined the association between alcohol and extramarital sex (a sign of multiple concurrent sexual partnerships) among men in a population-based survey in Cameroon; a low-income country in sub-Saharan Africa with a high rate of alcohol abuse and a generalised HIV epidemic. Methods We analyzed data from 2678 formally married or cohabiting men aged 15 to 59 years, who participated in the 2004 Cameroon Demographic and Health Survey, using a multivariate regression model. Results A quarter of the men (25.8%) declared having taken alcohol before their last sexual intercourse and 21% indicated that the last sex was with a woman other than their wife or cohabiting partner. After controlling for possible confounding by other socio-demographic characteristics, alcohol use was significantly associated with having extramarital sex: adjusted odds ratio (OR) 1.70, 95% confidence intervals (CI) 1.40 to 2.05. Older age (30–44 years: OR 3.06, 95%CI 2.16–4.27 and 45–59 years: OR 4.10, 95%CI 2.16–4.27), higher education (OR 1.25, 95%CI 1.10–1.45), and wealth (OR 1.71, 95%CI 1.50–1.98) were also significantly associated with higher odds of having extramarital sex. The men were more likely to have used a condom in their last sex if it was extramarital (OR 10.50, 95%CI 8.10–13.66). Older age at first sex (16–19 years: OR 0.81, 95%CI 0.72–0.90 and > 19 years: OR 0.74, 95% CI 0.65–0.87) and being the head of a household (OR 0.17, 95%CI 0.14–0.22) significantly decreased the odds of having sex outside of marriage. Religion and place of residence (whether urban or rural) were not significantly associated with extramarital sex. Conclusion Alcohol use is associated with having multiple concurrent non-spousal sexual partnerships among married men in Cameroon. We cannot infer a causal relationship between alcohol abuse and unsafe sex from this cross-sectional study, as both alcohol use and unsafe sexual behaviour may have a common set of causal personal and social factors. However, given the consistency with results of studies in other settings and the biologic plausibility of the link between alcohol intake and unsafe sex, our findings underscore the need for integrating alcohol abuse and HIV prevention efforts in Cameroon and other African countries with similar social profiles.
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Affiliation(s)
- Eugene J Kongnyuy
- Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK
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17
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Abstract
The AIDS epidemic in Nigeria is generalized, with infection primarily occurring through heterosexual transmission. It is important to understand patterns of sexual behavior to assess their impact on the epidemic and to design appropriate intervention strategies. This study examined risk factors for extramarital sex among Nigerian men, with a particular focus on polygyny and peri- and postpartum abstinence. Data from the 2003 Nigeria Demographic and Health Survey were analyzed for 1153 men and their wives. Eleven percent of men reported extramarital sex in the previous year. Logistic regression models showed that men with 3 or more wives were at the greatest risk for extramarital sex, followed by monogamous men, when compared with men with 2 wives. Other significant predictors included region, religion, wealth, age at sexual debut, and self-perceived risk of HIV infection. Peri- and postpartum abstinence was not significant. Based on these findings, HIV prevention programs should include men with 3 or more wives and those living in the southwest region, in addition to activities targeting men of all ages. Given the heterogeneity within Nigeria, further in-depth studies should be undertaken to explore the relation between number of wives, peri- and postpartum abstinence, and extramarital sex within specific communities.
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Affiliation(s)
- Tisha M Mitsunaga
- AIDS Prevention Initiative Nigeria, Harvard School of Public Health, Boston, MA 02115, USA
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18
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Abstract
This study was designed to identify sociodemographic characteristics of HIV-positive mother-child pairs in the southwest of Nigeria. The aim was to identify factors that will be helpful in designing initiatives for preventing mother to child transmission (MTCT) of the virus. It was a hospital-based, case-control study carried out at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria from August 2000 to July 2002. Eligible mother-child pairs identified at the paediatric department, who consented to participate in the study, were interviewed using semi-structured questionnaires and screened for HIV seropositivity. Ninety-three (46.7%) of 199 mother-child pairs were HIV-positive. When compared with the 106 HIV-negative mothers, the HIV-positive mothers were younger, unemployed, had earlier sexual exposure, lower education and were married to polygynous spouses. It is recommended that initiatives designed to reduce MTCT of the HIV virus in the southwest of Nigeria should include education and improvement of the economic status of female adolescents; promotion of cultural practices such as virginity until marriage while discouraging polygyny and early marriage. Health education on prevention of HIV infection should target potential mothers and their partners.
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Affiliation(s)
- E A Adejuyigbe
- Obfemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
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19
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Abstract
OBJECTIVES To examine new evidence from studies on the estimates of the fertility rate ratio comparing HIV-infected and uninfected women, of the population change in total fertility attributable to HIV, and to review the evidence of changes in fertility in HIV-uninfected women. DESIGN A review and analysis of data from the many individual studies that have examined the associations between HIV/AIDS and fertility. METHODS Data from sub-Saharan Africa were collected from published studies, personal communications and the Demographic and Health Surveys. A mathematical model was used to demonstrate the impact of the HIV/AIDS epidemic on the number of births in Uganda. RESULTS Fertility was lower among HIV-infected women than HIV-uninfected women, with the exception of those aged 15-19 years, in whom the selective pressure of sexual debut on pregnancy and HIV infection led to higher fertility rates among the HIV infected. This fertility differential resulted in a population-attributable decline in total fertility of 0.37% (95% confidence interval 0.30%, 0.44%) for each percentage point of HIV prevalence. The evidence for fertility changes in HIV-uninfected women was ambiguous. An estimated reduction of 700 000 births occurred in Uganda, as a result of the reduced fertility in HIV-infected women and premature mortality among reproductive age women. CONCLUSION Large fertility differentials existed between HIV-infected and uninfected women, with substantial variation by age. The extent to which these could be attributed to the direct impact of the epidemic on both infected and uninfected women, as opposed to pre-existing differences in their fertility, merits further study.
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Affiliation(s)
- James J C Lewis
- Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, University of London, Norfolk Place, W2 1PG, UK
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