HIV This Week

Norman LR, Figueroa JP, Wedderburn M, Byfield L, Bourne D, Gebre Y. Trends in HIV risk perception, condom use and sexual history among Jamaican youth, 1996-2004. Int J Adolesc Med Health. 2007 Apr-Jun;19(2):199-207.

As the number of HIV cases continues to increase among youth, aged 15-24 years, it becomes critically important to identify the factors that are contributing to this increase. Trends in perceived risk and risk behaviours were examined among youth by sex and age in an attempt to address this concern. National-level cross-sectional data across three time periods (1996, 2000, 2004) gathered from youths, aged 15-24 years in Jamaica for six outcomes were examined (perceived risk, ever had sex, initiation of sex before age 14, multiple sexual partnerships, condom use at last sex with regular and non-regular partners). Trend analyses were employed for each outcome for the total sample and separately by sex and age. A significant positive increase in condom use emerged; males reported higher levels of condom use at last sex with most recent regular partner (55.7% in 1996, 67.9% in 2004, p < 0.01). Condom use by females with regular and non-regular partners did not increase. There was no significant change in the percent of youths reporting multiple partnerships, the percent initiating sex or age at first sex. Youths did perceive themselves to be at greater risk for HIV in 2004 than in 1996 (40.0% vs. 17.6%, p < 0.001). These analyses revealed inadequate protective behaviour adoption by Jamaican youths. Prevention programs targeting youths need to be expanded significantly, be culturally relevant, and also address social vulnerability.

Editors’ note: Cross-sectional studies such as these four years apart are measuring characteristics of different cohorts of young people aged 15-24 years rather than changes in one group of individuals followed over time. Some of the trends noted here are positive but much needs to be done in Jamaica, particularly on condom use by young women, age at first sex, and multiple partnerships.

Plummer ML, Wight D, Wamoyi J, Nyalali K, Ingall T, Mshana G, Shigongo ZS, Obasi AI, Ross D A. Are schools a good setting for adolescent sexual health promotion in rural Africa? A qualitative assessment from Tanzania. Health Educ Res. 2007 Aug;22(4):483-99.

African adolescents are at high risk of poor sexual health. School-based interventions could reach many adolescents in a sustainable and replicable way, if enrolment, funding, and infrastructure are adequate. This study examined pupils', recent school leavers', parents', and teachers' views and experiences of rural Tanzanian primary schools, focusing on the implications for potential sexual health programmes. From 1999 to 2002, participant observation was conducted in nine villages for 158 person-weeks. Half of Year 7 pupils were 15-17 years old, and few went on to secondary school, suggesting that primary schools may be a good venue for such programmes. However, serious challenges include low enrolment and attendance rates, limited teacher training, little access to teaching resources, and official and unofficial practices that may alienate pupils and their parents, e.g. corporal punishment, pupils being made to do unpaid work, forced pregnancy examinations, and some teachers' alcohol or sexual abuse. At a national level, improved teacher training and supervision are critical, as well as policies that better prevent, identify, and correct undesired practices. At a programme level, intervention developers need to simplify the subject matter, introduce alternative teaching methods, help improve teacher-pupil and teacher-community relationships, and closely supervise and appropriately respond to undesired practices.

Editors’ note: Substantial long-term efforts to improve infrastructure, resources, and teacher capacity and supervision are required in many low-income countries. Nonetheless, primary school-based adolescent and sexual health programmes may be the best way to reach adolescents in cost-effective, large-scale, and fairly in-depth ways.

Stulhofer A, Graham C, Bozicevic I, Kufrin K, Ajdukovic D. HIV/AIDS-Related Knowledge, Attitudes And Sexual Behaviors as Predictors of Condom Use Among Young Adults in Croatia. Int Fam Plan Perspect. 2007 Jun;33(2):58-65.

Although Croatia is still in an early stage of HIV infection, the rising rates of infection in other central and eastern European countries suggest the need to understand HIV knowledge, attitudes and sexual behaviours among young adults in Croatia. Data from a multistage probability sample of 1,093 Croatians aged 18-24 surveyed in 2005 were used in regression models that examined the associations between HIV-related knowledge, attitudes, and sexual behaviour, and predictors of condom use at first and last sexual intercourse and condom use consistency. For both men and women, condom use at first intercourse and positive attitudes toward condom use were the most robust predictors of condom use at last intercourse and consistent condom use. In addition, for women, having peers with less traditional attitudes regarding sexuality was associated with consistent condom use (odds ratio, 1.3). Risky sexual behaviours are common among young adults in Croatia. Pragmatic and comprehensive sex education programs should target young people before they become sexually active.

Editors’ note: In Croatia, as elsewhere, using a condom the first time one has sex predicts consistent condom use. Rather than questioning “when do you have to use a condom” young people need to be asking “when will it be time to stop using condoms”. In Croatia, where only one-fifth of respondents reported consistent condom use in the last 12 months there is clearly a lot of ground to cover.