We investigated alcohol-related sexual risk behavior from the perspective of social norms theory. Adults (N = 895, 62% men) residing in a South African township completed street-intercept surveys that assessed risk and protective behaviors (e.g., multiple partners, drinking before sex, meeting sex partners in shebeens, condom use) and corresponding norms. Men consistently overestimated the actual frequency of risky behaviors, as reported by the sample, and underestimated the frequency of condom use. Relative to actual attitudes, men believed that other men were more approving of risk behavior and less approving of condom use. Both behavioral and attitudinal norms predicted the respondents' self-reported risk behavior. These findings indicate that correcting inaccurate norms in HIV-risk reduction efforts is worthwhile.Sub-Saharan Africa is in the midst of an HIV/AIDS epidemic. Southern Africa is home to two-thirds of people living with HIV/AIDS in the world; although only 10% of the world's population lives in southern Africa, more than 85% of the world's AIDS-related deaths have occurred in this region (UNAIDS, 2006). In the Republic of South Africa, 7.9% of men and 13.6% of women are infected with HIV (Shisana, et al., 2009). Like elsewhere in the world, the AIDS epidemic in South Africa is linked, in part, to substance use. Alcohol serving establishments are often the very places that link drinking with risks for HIV infection. Informal alcohol serving establishments, such as small bars and private homes where alcoholic beverages are sold and served which are popularly known as shebeens are often places where sex partners meet (Morojele, et al., 2004). Research conducted in South Africa suggests a close association between patronizing shebeens and engaging in HIV risk behaviors such as unprotected sex and concurrent partners (Kalichman, Simbayi, Vermaakk, Jooste, & Cain, 2008;Morojele, et al., 2006). Shebeens sometimes provide venues for sex between new or casual partners (Morojele, et al., 2006). The co-occurrence of these behavioral risk factors suggests the importance of social determinants of health behaviors, including social norms.Social norms play an explanatory role in theories of health behavior in general (Godin & Kok, 1996) and HIV risk behavior in particular (Albarracin, Johnson, Fishbein, & Muellerleile, 2001;Auerbach, Parkhurst, Caceres, & Keller, 2009). Perceived norms are a form of internalized social influence (Oostveen, Knibbe, & de Vries, 1996). Norms predict behavioral intentions and behavior in part because they signal what will be accepted/ approved by the group; failure to conform to social norms invites disapproval and/or social sanction (Cialdini & Trost, 1998 Distinction has been made between behavioral (descriptive) and attitudinal (injunctive) norms (Cialdini, Reno, & Kallgren, 1990). Behavioral norms refer to perceptions of how the group behaves, and attitudinal norms refer to perceptions of what the group finds acceptable. Although conceptually similar, these two types of ...
BackgroundIn South Africa, there are limited nationally representative data on the prevalence and factors associated with psychological distress. This study used a 2012 nationally representative population-based household survey to investigate factors associated with psychological distress in South Africa.MethodsThe survey is based on a multistage stratified cross-sectional design. Univariate and multivariate logistic regression models were fitted to identify factors associated with psychological distress.ResultsOut of a total 25860 participants, 23.9% reported psychological distress. Higher likelihood of reporting psychological distress was significantly associated with being female [OR = 1.68 (95% CI: 1.34–2.10), p < 0.001], aged 25 to 49 years [OR = 1.35 (95% CI: 1.08–1.70), p = 0.010] and 50 years and older [OR = 1.44 (95% CI: 1.06–1.97), p = 0.023)], Black Africans [OR = 1.61 (95% CI: 1.24–2.10), p < 0.001)], a high risk drinker [OR = 1.37 (95% CI: 1.02–1.83), p = 0.037], a hazardous drinker [OR = 4.76 (95% CI: 2.69–8.42), p < 0.001] and HIV positive, [OR = 1.79 (95% CI:1.55–2.08) p < 0.001], while lower likelihood of reporting psychological distress was significantly associated with being married [OR = 0.78 (95% CI: 0.62–0.98), p = 0.031), employed [OR = 0.71 (95% CI: 0.57–0.88), p = 0.002], and living in a rural formal area [OR = 0.73 (95% CI: 0.55–0.97), p = 0.033].ConclusionThere is a need to develop strategies to alleviate psychological distress in the general population, with a particular focus on those who may be more vulnerable to distress such as females, the aged, excessive alcohol users, the unemployed, people living with HIV and those residing in urban areas as identified in the current findings.
Alcohol use has been closely linked with HIV risk behaviors in South Africa. The places where people drink are often the same settings in which they meet new sex partners and may contribute independently to sexual risk. This current study examines the independent effects of patronizing alcohol serving establishments (shebeens) and alcohol use in predicting HIV risk behaviors. Men (n= 981) and women (n= 492) were recruited from inside shebeens and surrounding areas proximal to shebeens in 8 separate neighborhoods in a Township in Cape Town, South Africa. Anonymous community surveys measured demographic characteristics, alcohol use, shebeen attendance, and sexual risk behaviors. Comparisons of 1210 (82%) participants who patronized shebeens in the past month with 263 (18%) participants who did not patronize shebeens demonstrated higher rates of alcohol use frequency and quantity, more sexual partners, and higher rates of vaginal intercourse without condoms for the patrons. Multiple linear regression analysis found shebeen attendance in the past month predicted greater sexual risk for HIV beyond demographic characteristics and alcohol use. Social influences and environmental factors in shebeens could be contributing to sexual risk behavior independently of alcohol consumption. Further research is needed to understand the environmental factors of shebeens that promote and influence HIV risk behaviors.
Objectives The South African Government recently launched a national campaign to test 15 million South Africans for HIV by 2011. Little is known about how receipt of HIV testing might influence interpersonal communication. To explore these questions, we examine the effects of prior HIV testing on sexual health communication among South Africans. Methods Adults (N = 1,284; 98% Black, 36% women, mean age = 31) residing in a South African township completed street-intercept surveys. Results Of the 1,284 participants, 811 (63%) had been tested for HIV. Among those who had been tested, 77% tested negative, 12% tested positive, and 11% did not know their test result or refused to answer. Compared to those who had not been tested, participants who had been tested for HIV were more likely to communicate with community members about (a) HIV/AIDS, (b) getting tested for HIV, and (c) using condoms. Testing positive for HIV was associated with communication with sexual partners about condom use. Among participants who had been tested for HIV, exploratory analyses revealed that those who had engaged in sexual health communication with community members or sexual partners reported more condom-protected sex than those who had not engaged in sexual health communication. Conclusions HIV testing is associated with sexual health communication among South African community members and sexual partners. Offering HIV testing to all South Africans may increase communication and lead to reductions in sexual risk.
Background Evidence indicate that intimate partner violence (IPV) is disturbingly high among South African adolescent girls and young women (AGYW). Understanding prevalence and risk factors for IPV among these emerging adults is critical for developing appropriate interventions to prevent adverse health outcomes later in life. This study investigates the prevalence and factors associated with lifetime physical IPV experience among AGYW, aged 15–24 years, using the South African national HIV prevalence, incidence, behaviour and communication survey conducted in 2017. Methods The data used in this secondary analysis was obtained from a cross-sectional, population-based household survey data, conducted using a multi-stage stratified random cluster sampling approach. Multivariate stepwise backward logistic regression modelling was used to determine factors associated with IPV. Results Of 716 AGYW that responded to the two commonly answered questions on IPV, 13.1% (95% CI: 9.6–17.6) indicated that they experienced IPV. The odds of reporting experiences of IPV were significantly lower among AGYW residing in high SES households [AOR = 0.09 (95% CI: 0.02–0.47), p = 0.004] than low SES households, and those residing in rural informal/tribal areas [AOR = 0.01 (95% CI: 0.00–0.22), p = 0.004] than urban areas. AGYW experiencing IPV had higher odds of reporting psychological distress compared to their counterparts [AOR = 4.37 (95% CI, 0.97–19.72), p = 0.054]. Conclusion The findings highlight the need for targeted structural and psychosocial interventions in low SES households and especially in urban areas.
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