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ASSOCIATION BETWEEN HIV AWARENESS FACTORS, HEALTH FACILITY CHARACTERISTICS AND RISKY SEXUAL BEHAVIOUR AMONG YOUNG WOMEN IN ZOMBA DISTRICT, MALAWI

Published online by Cambridge University Press:  30 January 2018

Melissa Ward-Peterson Open the ORCID record for Melissa Ward-Peterson [Opens in a new window] ,
Kristopher Fennie ,
Sarah Baird ,
Stefany Coxe ,
Mary Jo Trepka  and
Purnima Madhivanan
Melissa Ward-Peterson*
Affiliation:
Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
Kristopher Fennie
Affiliation:
Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
Sarah Baird
Affiliation:
Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
Stefany Coxe
Affiliation:
Department of Psychology, School of Integrated Science and Humanity, College of Arts, Sciences, and Education, Florida International University, Miami, FL, USA
Mary Jo Trepka
Affiliation:
Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
Purnima Madhivanan
Affiliation:
Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA Public Health Research Institute of India, Mysore, India
*
1Corresponding author. Email: mward001@fiu.edu
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Summary

The objective of this study was to examine the association between multilevel factors related to HIV awareness and risky sexual behaviour among young women in Zomba district, Malawi. Secondary analyses of the Schooling, Income, and Health Risk (SIHR) study were undertaken. Four outcomes related to risky sexual behaviour were examined among young women: if participants had ever had sex, consistent condom use and two scores measuring risk related to partner history and age during sexual activity. Independent variables included individual-level factors such as education and rural/urban residence, as well as higher-level factors such as household’s highest level of education and health facility characteristics. Regression models with cluster-robust standard errors and multilevel regression models were used to estimate associations; analyses were stratified into two strata by school enrolment status, i.e. whether the women were in school (N=1407) or had dropped out of school (N=407) at baseline of the SIHR study. For both strata, increasing age and residing within 16 km of an urban centre (‘near rural’ residence) increased the odds of ever having sex; lower educational achievement was associated with lower age during sexual activity. A history of pregnancy was associated with lower odds of condom use and riskier partner history. For women in school at baseline, lower household education was associated with higher odds of ever having sex (OR=1.48; 95% CI: 1.06, 2.07); near-rural and far-rural (≤16 km and >16km from urban centre, respectively) residence were associated with decreased odds of condom use (OR=0.47; 95% CI: 0.28, 0.78; and OR=0.27; 95% CI: 0.11, 0.65, respectively). For those not in school at baseline, lower household education was associated with lower age during sexual activity (β=0.31, 95% CI: 0.05, 0.58). Also for women not in school, the use of private or non-governmental health facilities was associated with decreased odds of condom use (OR=0.51, 95% CI: 0.39, 0.67) and higher age during sexual activity (β=−0.30, 95% CI: −0.52, −0.09). While individual factors were associated with risky sexual behaviour in both strata, contextual factors differed.

Type
Research Article
Information
Journal of Biosocial Science , Volume 50 , Issue 6 , November 2018 , pp. 853 - 867
Copyright
© Cambridge University Press, 2018 

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References

Andersson, N., Paredes-Solís, S., Milne, D., Omer, K., Marokoane, N., Laetsang, D. & Cockcroft, A. (2012) Prevalence and risk factors for forced or coerced sex among school-going youth: national cross-sectional studies in 10 southern African countries in 2003 and 2007. BMJ Open 2, e000754.Google Scholar
Baird, S. J., Garfein, R. S., McIntosh, C. T. & Özler, B. (2012) Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. The Lancet 379, 1320–1329.Google Scholar
Barnett, T. & Whiteside, A. (2006) AIDS in the Twenty-First Century: Disease and Globalization, 2nd edition. Palgrave Macmillan, Basingstoke, UK.Google Scholar
Benefo, K. D. (2010) Determinants of condom use in Zambia: a multilevel analysis. Studies in Family Planning 41, 19–30.Google Scholar
Bunnell, R., Ekwaru, J. P., Solberg, P., Wamai, N., Bikaako-Kajura, W., Were, W. et al. (2006) Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS 20, 85–92.Google Scholar
Cataldo, F., Chiwaula, L., Nkhata, M., van Lettow, M., Kasende, F., Rosenberg, N. E. et al. (2017) Exploring the experiences of women and health care workers in the context of PMTCT Option B Plus in Malawi. Journal of Acquired Immune Deficiency Syndrome 74, 517–522.Google Scholar
Chiao, C. (2010) Community context and the prevalence of premarital sex among young women in Kenya and the Philippines: trends and differences from 1993 to 2003. Health & Place 16, 512–522.Google Scholar
DiStefano, C., Zhu, M. & Mîndrilă, D. (2009) Understanding and using factor scores: considerations for the applied researcher. Practical Assessment, Research & Evaluation 14.Google Scholar
Dodoo, F. N., Zulu, E. M. & Ezeh, A. C. (2007) Urban–rural differences in the socioeconomic deprivation–sexual behavior link in Kenya. Social Science & Medicine 64, 1019–1031.Google Scholar
Grice, J. W. (2001) Computing and evaluating factor scores. Psychological.Methods 6, 430–450.Google Scholar
Hung, K. J., Scott, J., Ricciotti, H. A., Johnson, T. R. & Tsai, A. C. (2012) Community-level and individual-level influences of intimate partner violence on birth spacing in sub-Saharan Africa. Obstetrics & Gynecology 119, 975–982.Google Scholar
Kamndaya, M., Kazembe, L. N., Vearey, J., Kabiru, C. W. & Thomas, L. (2015) Material deprivation and unemployment affect coercive sex among young people in the urban slums of Blantyre, Malawi: a multi-level approach. Health & Place 33, 90–100.Google Scholar
McNeish, D., Stapleton, L. M. & Silverman, R. D. (2017) On the unnecessary ubiquity of hierarchical linear modeling. Psychological Methods 22, 114–140.Google Scholar
Magadi, M. A. & Uchudi, J. (2015) Onset of sexual activity among adolescents in HIV/AIDS-affected households in sub-Saharan Africa. Journal of Biosocial Science 47, 238–257.Google Scholar
Mugo, N. R., Heffron, R., Donnell, D., Wald, A., Were, E. O., Rees, H. et al. (2011) Increased risk of HIV-1 transmission in pregnancy: a prospective study among African HIV-1-serodiscordant couples. AIDS 25, 1887–1895.Google Scholar
NSO & ICF Macro. (2011) Malawi Demographic and Health Survey 2010. National Statistical Office and ICF Macro, Zomba and Calverton, MD.Google Scholar
NSO & ICF Macro. (2017) Malawi Demographic and Health Survey 2015–16. National Statistical Office and ICF Macro, Zomba and Rockville.Google Scholar
Ngome, E. & Odimegwu, C. (2014) The social context of adolescent women’s use of modern contraceptives in Zimbabwe: a multilevel analysis. Reproductive Health 11, 64.Google Scholar
Okware, S., Kinsman, J., Onyango, S., Opio, A. & Kaggwa, P. (2005) Revisiting the ABC strategy: HIV prevention in Uganda in the era of antiretroviral therapy. Postgraduate Medical Journal 81, 625–628.Google Scholar
Painter, T. M. (2001) Voluntary counseling and testing for couples: a high-leverage intervention for HIV/AIDS prevention in sub-Saharan Africa. Social Science & Medicine 53, 1397–1411.Google Scholar
Robertson, L., Gregson, S. & Garnett, G. P. (2010) Sexual risk among orphaned adolescents: is country-level HIV prevalence an important factor? AIDS Care 22, 927–938.Google Scholar
Santelli, J. S., Speizer, I. S. & Edelstein, Z. R. (2013) Abstinence promotion under PEPFAR: the shifting focus of HIV prevention for youth. Global Public Health 8, 1–12.Google Scholar
Stephenson, R. (2009) Community influences on young people’s sexual behavior in 3 African countries. American Journal of Public Health 99, 102–109.Google Scholar
Stephenson, R. (2010) Community-level gender equity and extramarital sexual risk-taking among married men in eight African countries. International Perspectives on Sexual and Reproductive Health 36, 178–188.Google Scholar
Sweat, M. D. & Denison, J. A. (1995) Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS 9 (Supplement A), S251–S257.Google Scholar
Uchudi, J., Magadi, M. & Mostazir, M. (2012) A multilevel analysis of the determinants of high-risk sexual behaviour in sub-Saharan Africa. Journal of Biosocial Science 44, 289–311.Google Scholar
Ukwuani, F. A., Tsui, A. O. & Suchindran, C. M. (2003) Condom use for preventing HIV infection/AIDS in sub-Saharan Africa: a comparative multilevel analysis of Uganda and Tanzania. Journal of Acquired Immune Deficiency Syndromes 34, 203–213.Google Scholar
Uthman, O.A., Lawoko, S. & Moradi, T. (2010) The role of individual, community and societal gender inequality in forming women’s attitudes toward intimate-partner violence against women: a multilevel analysis. World Health & Population 12, 5–17.Google Scholar
Uthman, O. A., Moradi, T. & Lawoko, S. (2009) The independent contribution of individual-, neighbourhood-, and country-level socioeconomic position on attitudes towards intimate partner violence against women in sub-Saharan Africa: a multilevel model of direct and moderating effects. Social Science & Medicine 68, 1801–1809.Google Scholar
van Lettow, M., Bedell, R., Landes, M., Gawa, L., Gatto, S., Mayuni, I. et al. (2011) Uptake and outcomes of a prevention-of mother-to-child transmission (PMTCT) program in Zomba district, Malawi. BMC Public Health 11, 426.Google Scholar
Van Stam, M. A, Michielsen, K., Stroeken, K. & Zijlstra, B. J. (2014) The impact of education and globalization on sexual and reproductive health: retrospective evidence from eastern and southern Africa. AIDS Care 26, 379–386.Google Scholar
Voeten, H. A., Egesah, O. B. & Habbema, J. D. (2004) Sexual behavior is more risky in rural than in urban areas among young women in Nyanza Province, Kenya. Sexually Transmitted Diseases 31, 481–487.Google Scholar
Zuilkowski, S. S. & Jukes, M. C. (2012) The impact of education on sexual behavior in sub-Saharan Africa: a review of the evidence. AIDS Care 24, 562–576.Google Scholar