The purpose of this study was to systematically review the literature regarding factors influencing contraceptive use in sub-Saharan Africa between 2005 and 2015. A total of 58 studies from twelve Sub-Saharan African countries were reviewed. Keywords were grouped using the PEN-3 cultural model. Negative factors prohibiting or reducing contraceptive use were women's misconceptions of contraceptive side-effects, male partner disapproval, and social/cultural norms surrounding fertility. Positive factors included education, employment, and communication with male partner. Increasing modern contraceptive use in Sub-Saharan Africa is a multi-faceted problem that will require community and systems wide interventions that aim to counteract negative perceptions and misinformation.

IntroductionIn spite of a high prevalence of HIV infection among adolescents and young adults in sub-Saharan Africa, uptake of HIV testing and counseling among youth in the region remains sub-optimal. The objective of this study was to assess factors that influence uptake of HIV testing and counseling among youth aged 15–24 years in sub-Saharan Africa.MethodsThis study used the Demographic and Health Survey (DHS) data from countries that represent four geographic regions of sub-Saharan Africa: Congo (Brazzaville), representing central Africa (DHS 2011–2012); Mozambique, representing southern Africa (DHS 2011); Nigeria, representing western Africa (DHS 2013); and Uganda, representing eastern Africa (DHS 2011). Analyses were restricted to 23,367 male and female respondents aged 15–24 years with complete data on the variables of interest. Chi-square tests and logistic regression models were used to assess predictors of HIV testing. Statistical significance was set at p< 0.01.ResultsThe analysis revealed that a majority of the respondents were female (78.1%) and aged 20-24-years (60.7%). Only a limited proportion of respondents (36.5%) had ever tested for HIV and even fewer (25.7%) demonstrated comprehensive knowledge of HIV/AIDS. There was a significant association between HIV testing and respondents’ gender, age, age at sexual debut, and comprehensive knowledge of HIV in the pooled sample. Older youth (adjusted OR (aOR) = 2.19; 99% CI = 1.99–2.40) and those with comprehensive knowledge of HIV (aOR = 1.98; 1.76–2.22) had significantly higher odds of ever being tested for HIV than younger respondents and those with limited HIV/AIDS knowledge respectively. Furthermore, men had lower odds of HIV testing than women (aOR = 0.32; 0.28–0.37).ConclusionsReaching youth in sub-Saharan Africa for HIV testing continues to be a challenge. Public health programs that seek to increase HIV counseling and testing among youth should pay particular attention to efforts that target high-risk subpopulations of youth. The results further suggest that these initiatives would be strengthened by including strategies to increase HIV comprehensive knowledge.

Objective This paper reviews available studies that applied the PEN-3 cultural model to address the impact of culture on health behaviors. Methods We search electronic databases and conducted a thematic analysis of empirical studies that applied the PEN-3 cultural model to address the impact of culture on health behaviors. Studies were mapped to describe their methods, target population and the health behaviors or health outcomes studied. Forty-five studies met the inclusion criteria. Results The studies reviewed used the PEN-3 model as a theoretical framework to centralize culture in the study of health behaviors and to integrate culturally relevant factors in the development of interventions. The model was also used as an analysis tool, to sift through text and data in order to separate, define and delineate emerging themes. PEN-3 model was also significant with exploring not only how cultural context shapes health beliefs and practices, but also how family systems play a critical role in enabling or nurturing positive health behaviors and health outcomes. Finally, the studies reviewed highlighted the utility of the model with examining cultural practices that are critical to positive health behaviors, unique practices that have a neutral impact on health and the negative factors that are likely to have an adverse influence on health. Discussion The limitations of model and the role for future studies are discussed relative to the importance of using PEN-3 cultural model to explore the influence of culture in promoting positive health behaviors, eliminating health disparities and designing and implementing sustainable public health interventions.

This study examines the role of family in the care and support of people living with HIV/AIDS (PLWHA) as a way of reducing the burden of stigma in the family. The PEN-3 model provided the cultural framework for this study. Data were drawn from participants' responses in 27 focus groups interviews conducted in South Africa. Participants were asked to discuss experiences of people living with HIV and AIDS in the family. The results highlight the positive and supportive aspects of the family, acknowledge the existential and unique aspects, and discuss the negative experiences shared by participants. This study's findings stress the need to take into account families' experiences with HIV and AIDS in the development of interventions aimed at reducing the burden of the disease on family systems and improving care and support for PLWHA.

HIV- and AIDS-related stigma has been reported to be a major factor contributing to the spread of HIV. In this study, the authors explore the meaning of stigma and its impact on HIV and AIDS in South African families and health care centers. They conducted focus group and key informant interviews among African and Colored populations in Khayelitsha, Gugulethu, and Mitchell’s Plain in the Western Cape province. The audio-recorded interviews were transcribed and coded using NVivo. Using the PEN-3 cultural model, the authors analyzed results showing that participants’ shared experiences ranged from positive/nonstigmatizing, to existential/unique to the contexts, to negative/stigmatizing. Families and health care centers were found to have both positive nonstigmatizing values and negative stigmatizing characteristics in addressing HIV/AIDS-related stigma. The authors conclude that a culture-centered analysis, relative to identity, is central to understanding the nature and contexts of HIV/AIDS-related stigma in South Africa.

BackgroundDespite the growing body of evidence on use of modern contraceptives among women in sub-Saharan African countries, little is known about the broader context in which female decision-making concerning contraceptive use occurs, particularly the role of their male partners’ awareness and support of modern contraceptives.MethodsWe conducted a cross-sectional survey of 2468 pregnant women and their male partners enrolled in the Healthy Beginning Initiative (HBI), an intervention to increase HIV testing among pregnant women in Enugu, southeast Nigeria. The aims of this study were to determine: 1) male partners’ awareness of, and support for, female contraceptive methods, and 2) influence of male partners’ contraceptive awareness and support on pregnant women’s expressed desire to use contraception. We used logistic regression models to examine the association between male partners’ awareness and support of modern contraceptives on their spouses’ desire to use contraceptives.ResultsMen’s awareness of, and support for, use of modern contraceptives were significantly associated with their female partners’ desire to use contraception. A majority of the men who were aware of modern contraceptives (66.5 %) and those who supported their spouses’ use of contraception (72.5 %) had partners who expressed a desire to use contraception. Men who were aware of female contraception were 3 times more likely to have spouses who desired to use contraception (AOR = 3.17, 95 % C.I: 2.70–3.75). In addition, men who showed support for their spouses’ use of contraception were over 5 times more likely to have spouses who indicated a desire to use contraception (AOR = 5.76, 95 % C.I: 4.82–6.88). Living in a household of 5 or more people (AOR = 1.45, 95 % C.I: 1.23–1.72) and residing in an urban area (AOR = 0.81, 95 % C.I: 0.67–0.97) were also significantly associated with women’s expressed desire to use modern contraception.ConclusionMen’s awareness of, and support for, use of modern contraceptives were markedly associated with their spouses’ desire to use contraception. This underscores the need for men’s involvement in programs that seek to address women’s uptake of contraception in low and middle income countries.

BackgroundNigeria remains a focus for increasing contraceptive use, as it is one of the most populous countries in Sub-Saharan Africa. The objective of the current study was to investigate determinants of contraceptive use in Nigeria couples.MethodsUsing the 2013 Nigeria Demographic and Health Survey, we estimated the likelihood of contraceptive use based on concordance with male partner desire for family size, male and female fertility preferences, female decision making power, and male partner attitudes toward contraceptive use.ResultsMale partner perception that decisions regarding health should be made jointly or primarily by women was positively associated with use. Women were less likely to use contraceptives in couples in which male partners had greater earning power. Finally, men who viewed contraceptives as an enabler for promiscuity had female partners less likely to use contraceptives.ConclusionsThese findings highlight the importance of male partners in women’s contraceptive decision making.

This qualitative study explored whether motherhood plays a role in influencing decisions to conceal or reveal knowledge of seropositive status among women living with HIV/AIDS in 2 South African communities: Gugulethu and Mitchell’s Plain. Using the PEN-3 cultural model, we explored how HIV-positive women disclose their status to their mothers and how HIV-positive mothers make decisions about disclosure of their seropositive status. Our findings revealed 3 themes: the positive consequences of disclosing to mothers, how being a mother influences disclosure (existential role of motherhood), and the cost of disclosing to mothers (negative consequences). The findings highlight the importance of motherhood in shaping decisions to reveal or conceal knowledge of seropositive status. Implications for interventions on HIV/AIDS prevention, care, and support are discussed.