Going underground and going after women: trends in sexual risk behaviour among gold miners in South Africa

This paper examines trends in risk behaviour among South African gold miners, a population with an estimated HIV prevalence of 10-20%. The study is based on a 1995 and 1997 survey of a random sample gold miners in the town of Welkom, South Africa. The results show that the percentage of miners who perceived they were likely to contract HIV increased from 33% in 1995 to 35% in 1997 (P<0.01). The percentage who had 4 or more partners in the past year decreased from 25% to 13% (P < 0.01), and the percentage whose last sexual partner was their spouse increased from 56% to 70% (P<0.01). Condom use in last intercourse with a spouse increased from 18% to 26% (P < 0.05). Condom use with other partners was considerably higher (67%), but did not increase significantly from 1995. The most likely contributors to this behaviour change were the AIDS awareness programmes implemented by the mining industry and the behaviour change communications of a condom social marketing campaign targeted at miners and commercial sex workers in the mining community.

Reproductive health in males with cystic fibrosis: knowledge, attitudes, and experiences of patients and parents

Males with cystic fibrosis (CF) are generally infertile as a result of aberrant development of Wolffian duct derivitives. The personal significance of this and related reproductive and sexual health (RSH) issues is unknown. We set out to describe the knowledge, attitudes, and experiences regarding RSH in a group of adolescent and adult males with CF, as well as the knowledge and attitudes of parents. This descriptive study was based on a semi-structured interview utilizing in-depth interview techniques. Questions included aspects of knowledge, attitudes, and experiences. Adolescent (aged 14-17 years) and adult (at least 18 years) males attending the Children's Hospital Cystic Fibrosis Clinic, Boston, MA, USA, or hospitalized at the Children's Hospital over that period were eligible; the accompanying parent of the adolescent was also interviewed. Consecutive eligible males were interviewed over a 3 month period. Summary data are presented, attitudinal data are analyzed qualitatively, and a selection of representative transcript data are reported to describe the range of opinions. Fifty males (10 adolescents, 40 adults) participated; this constituted a consecutive sample of 44% of the eligible clinic population. Ninety percent of adults, 60% of adolescents, and 50% of parents knew of male infertility. The mean age (+/-SD) at which adults recalled first hearing this was 16.0 +/- 4.7 years and 13.9 +/- 1.6 years for those adolescents who knew of infertility. Nineteen (48%) of adults and 5 (83%) of adolescents first heard about infertility from their health care providers. Ninety percent reported no major distress upon first hearing about infertility during adolescence. Increasing significance of infertility with maturity was reported by 12 men (30%); only 4 adults (10%) reported that infertility was not a significant aspect of CF. Forty percent knew that males with CF have a small volume ejaculate, but none had been told this by a health care provider. Thirty percent of men had semen analysis performed and all were azoospermic. We conclude that the majority of males with CF know of likely infertility. The significance of this knowledge changes with time. Poor knowledge and confusion surround a range of RSH issues in males with CF.

Condom use with casual partners by men in Kampala, Uganda

OBJECTIVE

To estimate the prevalence and correlates of condom use with casual sex partners by men in urban Uganda and to identify barriers to condom use that are amenable to intervention.

DESIGN

Cross-sectional, door-to-door survey of men residing in a poor area of Kampala, Uganda.

SUBJECTS AND METHODS

A multistage, probability sample was approximated by recruiting participants within randomly selected neighborhoods. A total of 301 men between the ages of 18 and 45 years answered questions about condom knowledge, attitudes, beliefs and practices. The respondents also provided demographic and HIV risk-related information.

RESULTS

Condom use was higher than previously found in studies in Uganda: 46% of men reported using a condom at the last casual sexual encounter; 31% reported always using condoms with casual partners. In multivariate analysis, independent correlates of condom use included higher condom self-efficacy (4-item scale, odds ratio 1.3 per scale point), lower embarrassment around condoms (3-item scale, odds ratio 0.44 per scale point), knowing where to buy a condom (odds ratio 3.9), knowing how to use a condom (8-item scale, odds ratio 1.4 per scale point), and increasing number of casual sex partners (odds ratio 1.4 per partner).

CONCLUSIONS

These data suggest that condom use may be further increased in this population by conducting demonstrations of condom use skills, preparing individuals to anticipate circumstances that make using condoms difficult and using a variety of outlets to dispense condoms.

HIV-1 risk and vaccine acceptability in the Ugandan military

Between July and October 1993, 570 19- to 22-year-old volunteers were screened for HIV-1, with a resulting seroprevalence rate of 18.3% (95% CI: 14.0%, 22.6%). A cohort of 249 HIV-1-noninfected military recruits in the Ugandan Peoples' Defense Forces was followed prospectively for up to 18 months to document rates of HIV-1 seroprevalence, seroconversion, and knowledge and attitudes related to vaccine acceptability. The HIV-1 seroincidence rate was 3.56 per 100 person-years (95% CI: 1.49, 5.62) over 309 person-years of observation. At the 3- and 12-month visits, subjects were interviewed on issues of acceptance and knowledge about vaccines, including anti-HIV vaccines in particular. More than 90% believe that HIV vaccines will not cause HIV infection, and if offered, 88% report that they would take the vaccine if they were not already infected. Nonvaccine prevention methods were considered less reliable; monogamy and condom use were considered effective by only 33.5% and 69.3% of the cohort respectively. After completing the vaccine acceptability questionnaire at the 12-month visit, subjects were offered an approved polyvalent meningococcal vaccine as an indicator of general vaccine acceptance. All subjects reported receiving at least one previous vaccination, and 95% willingly accepted the meningococcal vaccination. The Ugandan military is a stable population at substantial risk for HIV-1 infection and may be a suitable population for vaccine efficacy trials.

Dimensions of AIDS knowledge and risky sexual practices: a study of northern Thai males

The relation between AIDS-related knowledge and sexual risk-taking for a sample of young men living in northern Thailand was examined. Data were collected during the fall of 1991. The sample of 1472 men includes university students, soldiers, store clerks, and laborers. Recent commercial sex patronage was variable among the subgroups, and consistent condom use among these recent patrons was far from universal. Several important misunderstandings among our respondents regarding the AIDS virus were identified. These misconceptions were most common among men of relatively low socioeconomic status (laborers and soldiers). Factor analysis identified four distinct domains of AIDS knowledge among the student and soldier groups: knowledge about the mechanics of contagion, knowledge about the consequences of infection, knowledge about appropriate strategies for avoiding the virus, and knowledge regarding inappropriate strategies for avoiding the virus. In multivariate logistic regression, knowledge about inappropriate strategies and knowledge about contagion were the only two domains predictive of recent commercial sex patronage: Men with a relatively good understanding regarding the inefficacy of inappropriate strategies and the mechanics of contagion had lower odds of recent commercial sex patronage compared with men who had a relatively poor understanding of these domains of AIDS knowledge. In the condom use analysis, knowledge about both appropriate and inappropriate strategies was predictive of consistent condom use among recent commercial sex patrons. Thus programs should attempt to improve knowledge about strategies for avoiding the virus and the mechanics of contagion. Special efforts should be made to debunk existing myths about the perceived effectiveness of inappropriate strategies.

Characteristics of risk-taking behaviors, HIV and AIDS knowledge, and risk perception among young males in southwest China

A cross-sectional survey was undertaken to describe risk-taking behaviors and to assess the knowledge and risk perception of HIV and AIDS among young males aged 18 to 29 years in 82 villages in Longchuan, Yunnan, China, in 1994. Information on demographic, behavioral, and drug-using factors, and knowledge of HIV transmission and prevention, and risk perception was collected using an interviewer-administered anonymous questionnaire. A total of 1,548 individuals were interviewed and 433 drug users, including 52 nonsharing injectors and 140 sharing injectors, were identified. Over half the individuals scored 0 on HIV knowledge, but knowledge was greater among nonsharing drug injectors. Most drug injectors had initiated drug injection after 1990. The reported incidence continues to increase in all three major ethnic groups. Sharing of equipment was common (73%) among injectors. Drug users were four times more likely to have had premarital or extramarital sex, but condoms were used by only 2.5%. Thus, factors promoting spreading of HIV are common in this area. We recommend that a community-based intervention program, targeting both young men and women, be implemented and evaluated in Longchuan as soon as possible.

Knowledge, attitude and beliefs amongst inhabitants of high density informal settlements with regard to sexuality and AIDS in Alexandra township

OBJECTIVE

The main purpose of this study was to gain information on the knowledge that people living in squatter conditions have about AIDS, their attitude towards this disease and their sexual practices.

METHOD

The study had two parts, in-depth interviews and a survey. The in-depth interviews were held with 68 male informal settlement dwellers to obtain information on the type of questions to ask in the quantitative part of the study, taking into account the sensitivity of the information we were seeking, and how best to phrase these questions. For the survey, the 300 male informal settlement residents who were interviewed, were located by means of systematic sampling techniques.

RESULTS

The results of the survey showed that most of the respondents were living in squalid conditions, without recreation facilities. They were also likely to have had more than one partner (54%). Most of the respondents (90%) had heard about AIDS as a disease. Even though they were aware of AIDS as an epidemic in the country as a whole, they were not convinced that the disease exists in their community, the main reason being that they have never heard about nor seen a person with AIDS in the township.

CONCLUSION

There is an urgent need for AIDS education. But this education cannot take place as a separate activity from other upliftment activities in squatter areas.

Attitudes of males on contraception: a KAPE survey

Acceptance of Family Planning services has been at a very slow pace in Africa. It was generally believed that the African male, due to his conservatism, was an obstacle to the acceptance of contraception by the African female. The study however showed that this was not true. The attitude of the African male towards contraception has changed drastically during the last thirty years, from ultra-conservatism during the 60s to very liberal in the 80s and 90s. Further it can be said that the African male is as well informed and has the same degree of Family Planning and child spacing acceptance-level as his counterpart in the developed world. However the African male does not accompany his partner for Family Planning Counselling. The study showed that most African men associate Family Planning with the use of condoms and not other methods such as the pill or the intrauterine devices.

Men and family planning in Zambia

This paper examines the sociodemographic factors which influence familiarity with methods of family planning among 85 males holding low paying jobs in the University of Zambia, Lusaka. The results showed that wife's education had a significant and positive effect on husband's familiarity with family planning methods. In the longer term, female education is likely to emerge as an important factor in the onset of fertility decline in Zambia.

Family planning knowledge, attitudes, and practices of men in Zimbabwe

The purpose of this report is to describe knowledge, attitudes, and practices in family planning among male Zimbabweans. Understanding the role of men in inhibiting or promoting contraceptive adoption could affect the design of family planning promotion programs and program success in Zimbabwe and other African countries. Data from the 1988 Male Fertility Survey, a representative sample of 711 currently married men aged 20 and over, showed that men have a major role in the decision to use family planning methods and in determining the number of children a couple should have. Male knowledge of various family planning methods was high, as was approval and ever-use of family planning. Attitudes toward family planning information, obtaining methods, couple communication, and family size were also investigated. It was concluded that men should be included in information, education, and communication programs, without delay. Program efforts should move beyond emphasis on child spacing to stress family size limitation in order to increase contraceptive prevalence, resulting in a commensurate decline in the level of fertility.

Male knowledge of and attitudes and practices towards AIDS in Zimbabwe

This paper presents findings from a survey on knowledge of and attitudes and practices towards AIDS among currently married Zimbabwean men conducted between April and June 1988. Findings indicated that knowledge was reasonably high: 89.7% reported having heard of AIDS. The young and middle-aged groups, the most educated, and the urban men were the most knowledgeable in identifying routes of transmission. However, 22% did not know that there could be asymptomatic carriers of the virus capable of transmitting the virus and infecting others. Furthermore, 38% did not know that all those affected with AIDS eventually die as a result, and only 55% knew that there is no cure for AIDS. Behavioral change in order to avoid contracting AIDS seems relatively low given this sample's history of sexually transmitted diseases and extramarital sexual relations during the year prior to the survey. Although condom use was the lowest percentage of the behavioral change categories, a high percentage reported ever using a condom.

A direct mailing to teenage males about condom use: its impact on knowledge, attitudes and sexual behavior

In August 1987, a letter, informational pamphlet and order coupon for free mail-order condoms were sent to an experimental group of teenage males 16-17 years of age. An experimental design was used to measure the impact of the mailing on teenagers' knowledge, attitudes and behavior. Approximately five weeks after the mailing, 985 members of this group and 1,033 members of the control group (who received no mailing) were interviewed by telephone. About seven months after the mailing, members of the experimental group who claimed they had ordered the free condoms were reinterviewed by phone. The results of the initial interviews revealed that about three-fourths of the teenagers in the experimental group had received the materials, and about two-thirds had read them. Moreover, males in the experimental group, particularly those who reported having received and read the pamphlet, were slightly but statistically significantly more knowledgeable about sexually transmitted diseases (STDs), pregnancy and contraceptives. On the other hand, there were no differences between males in the experimental and control groups in attitudes toward STDs or birth control, nor were there differences in actual sexual activity or in the use of birth control. However, the experimental group was significantly more likely to have ordered condoms by mail, presumably as a result of having received the free mail-order condom offer. Many of those who ordered condoms had previously had sex and had used condoms. However, a sizeable portion of those who ordered condoms did so prior to first intercourse, suggesting a possibly important early intervention.

Male attitudes towards family planning in Khartoum, Sudan

In a 1982 survey of 250 men living in Khartoum, knowledge of, attitudes towards and use of contraception among Sudanese men were explored. Particular attention was given to attitudes towards male and female sterilization. Although most of the men expressed a desire to have large families, several findings suggest that they felt that they may have to be satisfied with a lower number for economic reasons. Three-fifths of the men with wives of reproductive age wished to use family planning services now but only about one-fifth were currently using an effective method. Almost 60% of the men were interested in learning more about female sterilization and about 50%, more about male sterilization. In general, attitudes towards family planning were more favourable than previously believed by providers of these services. Only 2·8% of these men had obtained services from a family planning clinic, suggesting that the demand currently exceeds the supply.