Pranitha Maharaj

Sexual Risk Behavior among South African Adolescents: Is Orphan Status a Factor?

There is concern that orphans may be at particular risk of HIV infection due to earlier age of sexual onset and higher likelihood of sexual exploitation or abuse; however, there is limited empirical evidence examining this phenomenon. Utilizing data from 1694 Black South African youth aged 14–18, of whom 31% are classified as orphaned, this analysis explores the relationship between orphan status and sexual risk. The analysis found both male and female orphans significantly more likely to have engaged in sex as compared to non-orphans (49% vs. 39%). After adjusting for socio-demographic variables, orphans were nearly one and half times more likely than non-orphans to have had sex. Among sexually active youth, orphans reported younger age of sexual intercourse with 23% of orphans having had sex by age 13 or younger compared to 15% of non-orphans. Programmatic implications of these findings for the care and protection of orphans are discussed.

Reasons for condom use among young people in KwaZulu-Natal: prevention of HIV pregnancy or both?

CONTEXT High levels of HIV/AIDS and unwanted pregnancy among young people are urgent public health problems in South Africa. Studies among youth have generally focused on protection against one or the other of these risks, but not both. METHODS Data collected in 2001 from 2,067 sexually active men and women aged 15-24 in KwaZulu-Natal were examined in bivariate and multivariate analyses to assess reasons for condom use, and levels and determinants of use. RESULTS Overall, 59% of respondents said that they used condoms at last sexual intercourse, including 6% who used them with another method. The main reason for use (cited by 64% of users) was protection against both pregnancy and HIV infection. Two-thirds of respondents thought that becoming or making someone pregnant in the next few weeks would be a big problem; fewer than one in five viewed their risk of HIV infection as medium or high. Among both sexes, young people who would consider a pregnancy highly problematic were more likely to use condoms than their counterparts who would view a pregnancy as no problem (odds ratios, 1.4-2.3). In sharp contrast, young men and women who perceived themselves as having a medium to high risk of HIV infection were less likely to use condoms than their counterparts who perceived themselves as being at no risk (0.2-0.3). CONCLUSION Prevention programs could increase condom use in this population by increasing awareness of the twin risks of pregnancy and HIV infection, and by promoting condoms for protection against these dual risks.

Barriers to HIV/AIDS protective Behaviour among African adolescent males in township secondary schools in Durban, South Africa

Abstract This exploratory qualitative study investigates possible barriers to HIV preventive behaviour amongst Zulu-speaking, black adolescent males, aged 15–23, in township secondary schools in Durban, South Africa. Perceptions, attitudes, beliefs, and practices concerning HIV prevention and transmission are elicited using semi-structured focus groups and mixed open-ended and closed-ended questionnaires. Thematic analysis of the data is used to identify possible barriers to protection. Issues specifically investigated are condom use and multiple sexual partners. Belief in the ability to choose uninfected girlfriends, a distrust of and misperceptions about condoms, the importance of trust to a sexual relationship, false optimism engendered by fast-spreading myths about cures, and skewed risk perception engendered by conspiracy theory narratives and overestimatlon of the severity of the epidemic were found to be possible barriers to protection amongst males and controlling the spread of HIV. A discussion of these barriers Is presented.

Interpersonal Relations Between Health Care Workers and Young Clients: Barriers to Accessing Sexual and Reproductive Health Care

Interpersonal relations between health care providers and young clients have long being cited as an important element for improving client up take of services, satisfaction and overall health outcomes. In an era of HIV and AIDS this forms a critical determinant to young people accessing sexual and reproductive health care. This study explores to what extent interpersonal relations form a barrier to young peoples access to and satisfaction of health services. The study draws on data from 200 client exit interviews and four in-depth interviews conducted with university students and university health care staff in Kwazulu-Natal, South Africa. While young people are aware of the importance of utilising STI, HIV and family planning services they experienced barriers in their relationship with providers. This served as a deterrent to their use of the health facility. Adequate training in interpersonal relations for youth-friendly service provision is essential in helping overcome communication problems and enabling providers to interact with young clients at a more personal level.

Condoms become the norm in the sexual culture of college students in Durban, South Africa.

Résumé The aim of this study was to examine the factors contributing to the increase in condom use among college students in Durban, KwaZulu-Natal, South Africa, and some of the barriers to consistent condom use. The data were drawn from six focus group discussions with male and female students aged 18–24 in three public tertiary education institutions, supplemented by a survey of 3,000 students aged 17–24. Condoms had become “part of sex” and highly acceptable to the great majority, and were easily accessible. They were primarily being used for preventing pregnancy; many students liked not having to go to a health facility for supplies. Less than half of male and only a third of female students thought male partners had greater influence over the decision whether a condom was used. If a woman requested condoms, men and women agreed the man must comply. Some men were suspicious of women who agreed to have unprotected sex. Almost 75% of sexually active students surveyed reported condom use at last sexual intercourse, but consistent condom use, reported by only a quarter, remains the main challenge. It may be more effective to promote condoms for contraception among sexually active young people than for HIV prevention. Condoms have become the most commonly used contraceptive method among students, and this trend should be reinforced. Resumen Une étude a examiné les facteurs de l’accroissement de l’utilisation des préservatifs chez des étudiants de Durban, KwaZulu-Natal, Afrique du Sud, et les obstacles à une utilisation suivie. Les données recueillies pendant six discussions avec des étudiants et des étudiantes de 18 à 24 ans dans trois institutions publiques d’enseignement supérieur ont été complétées par une enquête auprès de 3000 étudiants de 17 à 24 ans. Les préservatifs faisaient « partie de la sexualité », étaient bien acceptés par la grande majorité et faciles à trouver. Ils servaient principalement à éviter les grossesses ; de nombreux étudiants appréciaient de pouvoir les obtenir sans se rendre dans un centre de santé. Moins de la moitié des garçons et un tiers seulement des filles pensaient que les partenaires masculins influençaient davantage la décision d’utiliser ou non un préservatif. Si une fille demandait un préservatif, les garçons et les filles jugeaient que le garçon devait accepter. Certains garçons se méfiaient des femmes acceptant d’avoir des rapports non protégés. Près de 75% des étudiants sexuellement actifs ont indiqué qu’ils avaient utilisé un préservatif lors de leur dernier rapport, mais l’utilisation suivie de préservatifs, rapportée par seulement un quart, demeure le principal enjeu. Il peut être plus efficace de promouvoir les préservatifs pour la contraception que pour la prévention du VIH chez les jeunes sexuellement actifs. Les préservatifs sont devenus la méthode contraceptive la plus utilisée par les étudiants et cette tendance devrait être renforcée. El objetivo de este estudio fue examinar los factores que contribuyen al aumento en el uso del condón entre los estudiantes universitarios en Durban, KwaZulu-Natal, Sudáfrica, así como algunos de los obstáculos al uso habitual del condón. Se recolectaron datos por medio de seis discusiones en grupos focales con estudiantes de sexo masculino y femenino, de 18 a 24 años de edad, en tres instituciones escolares públicas de tercer nivel, suplementados por una encuesta entre 3,000 estudiantes de 17 a 24 años. El condón, fácil de adquirir, había pasado a ser “parte del sexo” y muy aceptado por la gran mayoría. Se utilizaba principalmente para la prevención del embarazo; a muchos de los estudiantes les gustaba el no tener que acudir a un servicio de salud para obtener suministros. Menos de la mitad de los hombres y sólo una tercera parte de las mujeres pensaban que las parejas de sexo masculino tienen mayor influencia sobre la decisión de usar un condón. Ambos sexos convinieron en que, si una mujer solicita el uso del condón, el hombre debe acceder. Algunos hombres sospechaban de las mujeres que aceptan tener relaciones sexuales sin protección. Casi el 75% de los estudiantes sexualmente activos encuestados informaron haber usado un condón en su última relación sexual, pero el uso habitual del condón, practicado por sólo una cuarta parte, continúa siendo el gran reto. Quizás sea más eficaz promover este método para la anticoncepción entre los jóvenes sexualmente activos que para la prevención del VIH. Dado que es el anticonceptivo más comúnmente usado entre los estudiantes, esta tendencia debe reforzarse.

Masculinity and male sexual behaviour in Mozambique

Like many countries in sub-Saharan Africa, Mozambique is facing a severe HIV epidemic. Evidence suggests that male sexual behaviour is one of the driving forces behind the epidemic. Yet, there is limited understanding of how notions of masculinity influence such behaviour in the context of HIV. Using data collected through focus group discussions and in-depth interviews with sexually active men and women, this paper investigates how notions of masculinity influence the risk of HIV infection among men. The study findings suggest that traditional norms of masculinity, the man as the main provider and figure of authority, continue to exert a strong influence on male attitudes and behaviour. Alternative approaches are urgently needed in HIV programming that take into consideration notions of masculinity in order to reduce risky sexual behaviour.

Obstacles to negotiating dual protection: perspectives of men and women.

This article presents findings from a qualitative study on the perspectives of sexually active men and women about the risks of unwanted pregnancy and HIV/AIDS. The study found that there is a high level of awareness of the risk of unwanted pregnancy and HIV/AIDS. Knowledge of condoms as a method of preventing pregnancy and HIV/AIDS is also relatively good. However, there are many real and perceived barriers to condom use especially in stable sexual relationships. In stable long-term relationships, resistance to condom use was found to be strongly related to its association with STIs (including HIV/AIDS). Men and women do not see the need for condoms in stable, ongoing sexual relationships if a more effective method is used for pregnancy prevention. Condom use in such relationships may be seen as a clear sign of infidelity. These attitudes represent a major obstacle to the use of condoms as a dual method of protection.

Women on top: the relative influence of wives and husbands on contraceptive use in KwaZulu-Natal.

ABSTRACT Objectives: The purpose of this paper is to examine the relative influence of husband and wife on contraceptive practice. Methods: A cross-sectional survey was conducted among adult men and women in KwaZulu-Natal, South Africa. A matched file for 238 married or cohabiting couples was created. Results: Knowledge of methods of contraception was virtually universal and attitudes to contraception were favorable both in men and women. A substantial proportion of men and women reported using a method of contraception. The wifes desire to stop childbearing was the most powerful predictor of contraceptive use among couples, after adjustment for possible confounders. The husbands approval (or not) of family planning and his preference for future childbearing were not significantly related to contraceptive use. Conclusion: Contraceptive use within marital and cohabiting unions is high and the wifes fertility preference was found to be a key determinant of use. This conclusion challenges conventional wisdom that men are the dominant decision-makers in fertility and family planning decisions.

Challenges with couples, serodiscordance and HIV disclosure: healthcare provider perspectives on delivering safer conception services for HIV-affected couples, South Africa

Introduction Safer conception interventions should ideally involve both members of an HIV‐affected couple. With serodiscordant couples, healthcare providers will need to manage periconception risk behaviour as well tailor safer conception strategies according to available resources and the HIV status of each partner. Prior to widespread implementation of safer conception services, it is crucial to better understand provider perspectives regarding provision of care since they will be pivotal to the successful delivery of safer conception. This paper reports on findings from a qualitative study exploring the viewpoints and experiences of doctors, nurses, and lay counsellors on safer conception care in a rural and in an urban setting in Durban, South Africa.

Growing Old in the Era of a High Prevalence of HIV/AIDS: The Impact of AIDS on Older Men and Women in KwaZulu-Natal, South Africa

Despite the important consequences that HIV/AIDS is likely to have for older people in South Africa, little empirical work has focused directly on this issue. However, emerging evidence suggests that older people are increasingly affected by the AIDS pandemic. In many households, older people often assume responsibility for the care of those who are sick and/ or dying and for children orphaned by AIDS. This study uses qualitative and quantitative methods to provide insights into the multiple impacts of the HIV/AIDS pandemic on the lives of older men and women. The results show that some older men and women feel at risk of HIV infection because of their caregiving activities. Almost 17% of respondents report that they have ever cared for someone with HIV/AIDS, with the percentage somewhat higher in rural areas. The study found that the impact of HIV/AIDS is substantial and is compounded greatly by gender dynamics in the household.