Zolani Ngwane

Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa.

Abstract HIV/AIDS is taking a heavy toll on South African youth. Reducing their risk for HIV requires an understanding of the determinants of their HIV risk behaviours that are amendable to intervention-induced change. This study draws upon the theory of planned behaviour to identify the modifiable determinants of the intention to use condoms among Xhosa-speaking South African adolescents. The participants were 390 Xhosa-speaking 6th grade students (mean age = 12.1 years) in public schools in the township of Mdantsane, South Africa who completed an anonymous questionnaire. Multiple regression revealed that attitude and perceived behavioural control were significantly related to the intention to use condoms, whereas subjective norm was not, controlling for sexual experience, gender, and language preference. Consistent with this were additional analyses using beliefs as predictors: Hedonistic behavioural beliefs and control beliefs about condom-use negotiation and technical skills predicted intention, whereas normative beliefs did not. The theory of planned behaviour may be a useful model of condom use among Xhosa-speaking South African adolescents. An emphasis on beliefs about the adverse effects of condom use on sexual enjoyment, the ability to negotiate condom use, and the ability to use condoms correctly might improve the efficacy of HIV/STD interventions for such adolescents.

Cognitive-behavioural health-promotion intervention increases fruit and vegetable consumption and physical activity among South African adolescents: a cluster-randomised controlled trial.

Rates of chronic diseases are high among Black South Africans but few studies have tested cognitive-behavioural health-promotion interventions to reduce this problem. We tested the efficacy of such an intervention among adolescents in a cluster-randomised controlled trial. We randomly selected 9 of 17 matched pairs of schools and randomised one school in each pair to the cognitive-behavioural health-promotion intervention designed to encourage health-related behaviours and the other to a human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk-reduction intervention that served as the control. Interventions were based on social cognitive theory, the theory of planned behaviour and qualitative data from the target population. Data collectors, blind to participants’ intervention, administered confidential assessments at baseline and 3, 6 and 12 months post-intervention. Primary outcomes were fruit and vegetable consumption and physical activity. Participants were 1057 grade 6 learners (mean age = 12.4 years), with 96.7% retained at 12-month follow-up. Generalised estimating equations revealed that averaged over the follow-ups, a greater percentage of health-promotion intervention participants than HIV/STD control participants met 5-a-Day fruit and vegetable and physical activity guidelines. The intervention also increased health-promotion knowledge, attitude and intention, but did not decrease substance use or substance-use attitude and intention. The findings suggest that theory based and contextually appropriate interventions may increase health behaviours among young adolescents in sub-Saharan Africa.

‘Christmas Time’ and the Struggles for the Household in the Countryside: Rethinking the Cultural Geography of Migrant Labour in South Africa

In this paper, I take advantage of a space of interdisciplinary research that has emerged at the intersection of human and social sciences since the advent of radical revisionist scholarship in South African Studies in the 1980s. Within this space, I argue for a rethinking of the geography of cultures of migrancy. By focusing attention on rural (rather than urban) contexts of the cultures of mobility that accrue with migrancy, I argue that we can look at migrant labour as a constellation of cultural arguments in much the same way that recent scholarship has analysed media such as radio, newspapers and schooling, all of which similarly connect the ‘local’ with the national and the global. In particular, I look at how a gendered culture of migrancy, reflected discursively, materially and performatively, orchestrates struggles over the household.

'REAL MEN REAWAKEN THEIR FATHERS' HOMESTEADS, THE EDUCATED LEAVE THEM IN RUINS': THE POLITICS OF DOMESTIC REPRODUCTION IN POST-APARTHEID RURAL SOUTH AFRICA'

An historical ethnography of generational conflicts in a rural community in the Eastern Cape province of South Africa, this paper engages debates on the consequences of global neo-liberalism in local contexts. Through cash from migrant labor, rural household heads exercised power over domestic economics. Ideologically this power translated into the symbolic articulation of two institutions of social reproduction-the school and initiation rite such that the educated and potentially alienated subjects yielded by the former were resocialized through the latter into local subjects of the chief and sons of their fathers. With rising unemployment rates since the 1980s, however, the older men lost the material base for their monopoly over this symbolic structure. The generational conflicts that ensued reflected at once the attendant contradictions in social consciousness and consequent struggles to renegotiate the symbolic purchase of the relations between schooling and initiation.

Disclosure of HIV Diagnosis to HIV-Infected Children in South Africa: Focus Groups for Intervention Development

Worldwide about 2.5 million children younger than 15 years of age are living with HIV, and more than 2.3 million of them live in sub-Saharan Africa. Antiretroviral therapy (ART) has reduced mortality among HIV-infected children, and as they survive into adolescence, disclosing to them their diagnosis has emerged as a difficult issue, with many adolescents unaware of their diagnosis. There is a need to build an empirical foundation for strategies to appropriately inform infected children of their diagnosis, particularly in South Africa, which has the largest number of HIV-positive people in the world. As a step toward developing such strategies, we conducted a study in Eastern Cape Province, South Africa, to identify beliefs about disclosing HIV diagnosis to HIV-infected children among caregivers, health-care providers, and HIV-positive children who knew their diagnosis. We implemented seven focus groups with 80 participants: 51 caregivers in four groups, 24 health-care providers in two groups, and 5 HIV-positive children in one group. We found that although the participants believed that children from age five should begin to learn about their illness, with full disclosure by age 12, they suggested that many caregivers fail to fully inform their children. The participants said that the primary caregiver was the best person to disclose. The main reasons cited for failing to disclose were (a) lack of knowledge about HIV and its treatment; (b) the concern that the children might react negatively; and (c) the fear that the children might inappropriately disclose to others, which would occasion gossip, stigmatization, and discrimination toward them and the family. We discuss the implications for developing interventions to help caregivers appropriately disclose HIV status to HIV-infected children and, more generally, communicate effectively with the children to improve their health outcomes.

Moderation and mediation of an effective HIV risk-reduction intervention for South African adolescents.

Background“Let Us Protect Our Future” is a sexual risk-reduction intervention for sixth-grade adolescents in South Africa. Tested in a cluster-randomized controlled trial, the intervention significantly reduced self-reported intercourse and unprotected intercourse during a 12-month follow-up period.PurposeThe present analyses were conducted to identify moderators of the intervention’s efficacy as well as, which theory-based variables mediated the intervention’s effects.MethodsIntervention efficacy over the 3-, 6-, and 12-month follow-up was tested using generalized estimating equation models.ResultsLiving with their father in the home, parental strictness, and religiosity moderated the efficacy of the intervention in reducing unprotected intercourse. Self-efficacy to avoid risky situations and expected parental disapproval of their having intercourse, derived from Social Cognitive Theory, significantly mediated the intervention’s effect on abstinence.ConclusionsThis is the first study to demonstrate that Social Cognitive variables mediate the efficacy of a sexual risk-reduction intervention among South African adolescents.

Cluster-randomized controlled trial of an HIV/sexually transmitted infection risk-reduction intervention for South African men.

OBJECTIVES We tested the efficacy of a sexual risk-reduction intervention for men in South Africa, where heterosexual exposure is the main mode of HIV transmission. METHODS Matched-pairs of neighborhoods in Eastern Cape Province, South Africa, were randomly selected and within pairs randomized to 1 of 2 interventions based on social cognitive theory and qualitative research: HIV/sexually transmitted infection (STI) risk-reduction, targeting condom use, or attention-matched control, targeting health issues unrelated to sexual risks. Sexually active men aged 18 to 45 years were eligible. The primary outcome was consistent condom use in the past 3 months. RESULTS Of 1181 participants, 1106 (93.6%) completed the 12-month follow-up. HIV and STI risk-reduction participants had higher odds of reporting consistent condom use (odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.03, 1.71) and condom use at last vaginal intercourse (OR = 1.40; 95% CI = 1.08, 1.82) than did attention-control participants, adjusting for baseline prevalence. No differences were observed on unprotected intercourse or multiple partnerships. Findings did not differ for sex with steady as opposed to casual partners. CONCLUSIONS Behavioral interventions specifically targeting men can contribute to efforts to reduce sexual risk behaviors in South Africa.

Theory-Based Behavioral Intervention Increases Self-Reported Physical Activity in South African Men: A Cluster-Randomized Controlled Trial

OBJECTIVE To determine whether a health-promotion intervention increases South African mens adherence to physical-activity guidelines. METHOD We utilized a cluster-randomized controlled trial design. Eligible clusters, residential neighborhoods near East London, South Africa, were matched in pairs. Within randomly selected pairs, neighborhoods were randomized to theory-based, culturally congruent health-promotion intervention encouraging physical activity or attention-matched HIV/STI risk-reduction control intervention. Men residing in the neighborhoods and reporting coitus in the previous 3 months were eligible. Primary outcome was self-reported individual-level adherence to physical-activity guidelines averaged over 6-month and 12-month post-intervention assessments. Data were collected in 2007-2010. Data collectors, but not facilitators or participants, were blind to group assignment. RESULTS Primary outcome intention-to-treat analysis included 22 of 22 clusters and 537 of 572 men in the health-promotion intervention and 22 of 22 clusters and 569 of 609 men in the attention-control intervention. Model-estimated probability of meeting physical-activity guidelines was 51.0% in the health-promotion intervention and 44.7% in attention-matched control (OR=1.34; 95% CI, 1.09-1.63), adjusting for baseline prevalence and clustering from 44 neighborhoods. CONCLUSION A theory-based culturally congruent intervention increased South African mens self-reported physical activity, a key contributor to deaths from non-communicable diseases in South Africa. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01490359.

Associations between psychosocial factors and incidence of sexually transmitted disease among South African adolescents

Background Adolescents living in South Africa are at high risk for HIV and other sexually transmitted diseases (STDs). The present study sought to identify correlates of curable STD incidence among a cohort of adolescents in Eastern Cape Province, South Africa. Methods Data were collected in conjunction with an HIV/STD prevention intervention randomized controlled trial.1 At 54 months postintervention, curable STD incidence (gonorrhea, chlamydial infection, and trichomoniasis) was assayed and self-report measures of potential correlates of STD incidence were collected. Results Participants were adolescents reporting at least 1 sexual partner in the past 3 months (n = 659). As expected, univariate analyses revealed that girls were more likely than boys to have an STD. In addition, intimate partner violence, unprotected sex, and having older partners were associated with incident STD. In Poisson multiple regression analyses, sex (risk ratio [RR], 4.00; 95% confidence interval [CI], 2.51–6.39), intimate partner violence (RR, 1.23; 95% CI, 1.12–1.35), unprotected sex (RR, 1.42; 95% CI, 1.09–2.01), and multiple partners (RR, 1.70; 95% CI, 1.11–2.61), but not partner’s age (RR, 1.00; 95% CI, 0.94–1.07) were associated with incident STD, adjusting for 42-month STD prevalence. Binge drinking, forced sex, and age were unrelated to STD incidence in both analyses. Interactions between sex and the hypothesized correlates were nonsignificant, suggesting that sex did not modify these relationships. Conclusions Interventions to reduce HIV/STD incidence among adolescents in South Africa should address the risk associated with sex, unprotected sex, intimate partner violence, and multiple partnerships.

Cattle for Wives and Extramarital Trysts for Husbands? Lobola, Men, and HIV/STD Risk Behavior in Southern Africa

Lobola is in many Southern African countries a tradition, which is expected to be adhered by anyone who is part of the community. It is paying respect to the elders, and the community. In order to determine how much the actual fact of payment of lobola would influence the behavior of husbands and wives, we conducted several focus groups. Many participants see lobola as part of their African culture, although they wished that they would not actually have to pay lobola. There is no difference in the husbands behavior, whether they had paid lobola or not and having extramarital affairs.