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Sexual Risk Behavior, Alcohol Use, and Social Media Use Among Secondary School Students in Informal Settlements in Cape Town and Port Elizabeth, South Africa

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Abstract

South Africa’s HIV prevalence among young people remains among the highest in the world. A cross-sectional study was carried out in 2012 to estimate prevalences of sexual risk behavior and hazardous alcohol use (HAU) (via the Alcohol Use Disorder Identification Test) as well as to investigate potential associations between these outcomes and social media use. In all, 4485 students (mean age 15.66 years, SD 1.39) at 46 secondary schools in informal settlements in Cape Town and Port Elizabeth completed mobile-phone-assisted, self-administered baseline questionnaires within a cluster-randomized trial. In all, 312 females (12.5 %) and 468 males (23.5 %) screened positive for HAU (AOR = 1.98, 95 % CI 1.69–2.34). 730 males (39.9 %) and 268 females (11.8 %) reported having had two or more partners in the last year (AOR = 3.46, 95 % CI 2.87–4.16). Among females, having a Facebook account was associated with reported multiple partnerships in the last year (AOR = 1.81, 95 % CI 1.19–2.74), age-disparate sex in the last year (AOR = 1.96, 95 % CI 1.16–3.32) and HAU (AOR = 1.97, 95 % CI 1.41–2.74). Using Mxit—a popular mobile instant messaging application—was associated with higher odds of reported multiple partnerships in the last year among both males (AOR = 1.70, 95 % CI 1.35–2.14) and females (AOR = 1.45, 95 % CI 1.07–1.96) and with HAU among both males (AOR = 1.47, 95 % CI 1.14–1.90) and females (AOR = 1.50, 95 % CI 1.18–1.90). Further longitudinal and qualitative research should explore in more depth the observed links between social media and risk behavior.

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References

  1. UNAIDS. Global Report: UNAIDS report on the global AIDS epidemic 2013. Geneva: Joint United Nations Programme on HIV/AIDS; 2013.

  2. Shisana O. Plenary Session 3, 20 June 2013: HIV/AIDS in South Africa: at last the glass is half full. SA AIDS. Durban; 2013.

  3. Shisana O, Rehle T, Simbayi LC, et al. South African national HIV prevalence, incidence, behaviour and communication survey 2008: a turning tide among teenagers?. Cape Town: HSRC Press; 2009.

    Google Scholar 

  4. WHO. Global update on HIV treatment 2013: results, impact and opportunities. Geneva: World Health Organization; 2013.

  5. Kagee A, Remien RH, Berkman A, Hoffman S, Campos L, Swartz L. Structural barriers to ART adherence in Southern Africa: challenges and potential ways forward. Global Public Health. 2011;6:83–97.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings. Prev Sci. 2007;8:141–51.

    Article  PubMed  Google Scholar 

  7. Morojele NK, Nkosi S, Kekwaletswe CT, Saban A, Parry C. Review of research on alcohol and HIV in sub-Saharan Africa: South African Medical Research Council; 2013.

  8. Fisher JC, Bang H, Kapiga SH. The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies. Sex Transm Dis. 2007;34:856–63.

    Article  PubMed  Google Scholar 

  9. Thurman TR, Brown L, Richter L, Maharaj P, Magnani R. Sexual risk behavior among South African adolescents: is orphan status a factor? AIDS Behav. 2006;10:627–35.

    Article  PubMed  Google Scholar 

  10. Gregson S, Nyamukapa CA, Garnett GP, et al. Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. Lancet. 2002;359:1896–903.

    Article  PubMed  Google Scholar 

  11. Laga M, Schwartlander B, Pisani E, Sow PS, Carael M. To stem HIV in Africa, prevent transmission to young women. AIDS. 2001;15:931–4.

    Article  CAS  PubMed  Google Scholar 

  12. Kelly RJ, Gray RH, Sewankambo NK, et al. Age differences in sexual partners and risk of HIV-1 infection in rural Uganda. J Acquir Immune Defic Syndr. 2003;32:446–51.

    Article  PubMed  Google Scholar 

  13. Leclerc-Madlala S. Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability. AIDS. 2008;22(Suppl 4):S17–25.

    Article  PubMed  Google Scholar 

  14. Jewkes RKDK, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010;376:41–8.

    Article  PubMed  Google Scholar 

  15. Peacock D, Redpath J, Weston M, Evans K, Daub A, Greig A. Literature review on men, gender, health and HIV and AIDS in South Africa. Cape Town: Sonke Gender Justice Network; 2008.

  16. Mantell JE, Needham SL, Smit JA, et al. Gender norms in South Africa: implications for HIV and pregnancy prevention among African and Indian women students at a South African tertiary institution. Cult Health Sex. 2009;11:139–57.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Vearey J, Thomas L, Nunez L, Bezuidenhout J, Drimie S. Informal settlements and HIV in South Africa: the need for a developmental local response. SAHARA Conference. Johannesburg; 2009.

  18. African Mobile Factbook 2012: Blycroft Publishing; 2012.

  19. Foundation KF. Young South Africans, broadcast media, and HIV/AIDS awareness: results of a national survey. Washington DC; 2007.

  20. Kreutzer T. Generation mobile: online and digital media usage on mobile phones among low-income urban youth in South Africa University of Cape Town; 2009.

  21. Subrahmanyam K, Greenfield P. Online communication and adolescent relationships. The Future of children/Center for the Future of Children, the David and Lucile Packard Foundation 2008;18:119–46.

  22. Beger G, Kounkou Hoveyda P, Sinha A. From ‘What’s your ASLR’ to ‘Do You Wanna Go Private?’: UNICEF; 2011.

  23. McFarlane M, Bull SS, Rietmeijer CA. The Internet as a newly emerging risk environment for sexually transmitted diseases. JAMA, J Am Med Assoc. 2000;284:443–6.

    Article  CAS  Google Scholar 

  24. McFarlane M, Bull SS, Rietmeijer CA. Young adults on the Internet: risk behaviors for sexually transmitted diseases and HIV(1). J Adolesc Health. 2002;31:11–6.

    Article  PubMed  Google Scholar 

  25. O’Keeffe GS, Clarke-Pearson K, Council on C, Media. The impact of social media on children, adolescents, and families. Pediatrics 2011;127:800–4.

  26. Young SD, Rice E. Online social networking technologies, HIV knowledge, and sexual risk and testing behaviors among homeless youth. AIDS Behav. 2011;15:253–60.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Anderson P, de Bruijn A, Angus K, Gordon R, Hastings G. Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies. Alcohol Alcohol. 2009;44:229–43.

    Article  PubMed  Google Scholar 

  28. Winpenny EM, Marteau TM, Nolte E. Exposure of children and adolescents to alcohol marketing on social media websites. Alcohol Alcohol. 2014;49:154–9.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Moreno MA, Briner LR, Williams A, Brockman L, Walker L, Christakis DA. A content analysis of displayed alcohol references on a social networking web site. J Adolesc Health. 2010;47:168–75.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Bandura A. Social learning theory. New York: General Learning Press; 1977.

    Google Scholar 

  31. Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26:224–7.

    Article  CAS  PubMed  Google Scholar 

  32. Open Data Kit. 2011. http://www.opendatakit.org. Accessed 14 May 2011.

  33. Hartung C, Anokwa Y, Brunette W, Lerer A, Tseng C, Borriello G. OpenData Kit: open source mobile data collection tools for community health workers. In: ACM, editor. International Conference on Information and Communication Technologies and Development. New York; 2010.

  34. Kaufman ZA, Hershow R, DeCelles J, et al. Acceptability of data collection on mobile phones using ODK software for self-administered sexual behavior questionnaires. STI & AIDS World Congress. Vienna 2013.

  35. Langhaug LF, Sherr L, Cowan FM. How to improve the validity of sexual behaviour reporting: systematic review of questionnaire delivery modes in developing countries. Trop Med Int Health. 2010;15:362–81.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: the alcohol use disorders identification test: World Health Organization; 2001.

  37. Peltzer K, Davids A, Njuho P. Alcohol use and problem drinking in South Africa: findings from a national population-based survey. Afr J Psychiatry (Johannesbg). 2011;14(1):30–7.

    CAS  Google Scholar 

  38. Daeppen JB, Yersin B, Landry U, Pecoud A, Decrey H. Reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) imbedded within a general health risk screening questionnaire: results of a survey in 332 primary care patients. Alcohol Clin Exp Res. 2000;24:659–65.

    Article  CAS  PubMed  Google Scholar 

  39. Peltzer KSL, Kalichman S, Jooste S, Cloete A, Mbelle N. Alcohol use in three different inner cities in South Africa: AUDIT-C and CAGE. J Psychol Afr. 2007;17:99–104.

    Google Scholar 

  40. Gevers A, Mathews C, Cupp P, Russell M, Jewkes R. Illegal yet developmentally normative: a descriptive analysis of young, urban adolescents’ dating and sexual behaviour in Cape Town, South Africa. BMC Int Health Hum Rights. 2013;13:31.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Mchunu G, Peltzer K, Tutshana B, Seutlwadi L. Adolescent pregnancy and associated factors in South African youth. Afr Health Sci. 2012;12:426–34.

    CAS  PubMed Central  PubMed  Google Scholar 

  42. Moreno MA, Vanderstoep A, Parks MR, Zimmerman FJ, Kurth A, Christakis DA. Reducing at-risk adolescents’ display of risk behavior on a social networking web site: a randomized controlled pilot intervention trial. Arch Pediatr Adolesc Med. 2009;163:35–41.

    Article  PubMed  Google Scholar 

  43. Brook DW, Morojele NK, Zhang C, Brook JS. South African adolescents: pathways to risky sexual behavior. AIDS Educ Prev. 2006;18:259–72.

    Article  PubMed  Google Scholar 

  44. Biddlecom A, Awusabo-Asare K, Bankole A. Role of parents in adolescent sexual activity and contraceptive use in four African countries. Int Perspect Sex Reprod Health. 2009;35:72–81.

    Article  PubMed  Google Scholar 

  45. Bettinger JA, Celentano DD, Curriero FC, Adler NE, Millstein SG, Ellen JM. Does parental involvement predict new sexually transmitted diseases in female adolescents? Arch Pediatr Adolesc Med. 2004;158:666–70.

    Article  PubMed  Google Scholar 

  46. Beauclair R, Meng F, Deprez N, et al. Evaluating audio computer assisted self-interviews in urban South African communities: evidence for good suitability and reduced social desirability bias of a cross-sectional survey on sexual behaviour. BMC Med Res Methodol. 2013;13:11.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This study was carried out as part of the GOAL Trial, which is a collaboration between the London School of Hygiene and Tropical Medicine, the Wits Reproductive Health and HIV Institute, and Grassroot Soccer, jointly funded by Comic Relief and the MAC AIDS Fund. We would like to thank the Western Cape and Eastern Cape Departments of Education, along with the teachers and students at the 46 participating schools for their cooperation.

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Correspondence to Z. A. Kaufman.

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Kaufman, Z.A., Braunschweig, E.N., Feeney, J. et al. Sexual Risk Behavior, Alcohol Use, and Social Media Use Among Secondary School Students in Informal Settlements in Cape Town and Port Elizabeth, South Africa. AIDS Behav 18, 1661–1674 (2014). https://doi.org/10.1007/s10461-014-0816-x

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