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With an official HIV infection rate of 18.5%, approximately one in five South Africans are HIV positive. Despite this prevalence, stigma and discrimination associated with being HIV positive is widespread. HIV-related stigma emanates from the fact that HIV is associated with risky behaviors such as drug use, sexual promiscuity, homosexuality and transactional sex. Participants were recruited through announcements in classrooms and during community meetings. Participants were selected if they knew someone who was discriminated against HIV as a result of being affected by HIV. The status of the participants was irrelevant. Seven focus group sessions were conducted with 62 participants. The results show that stigma is seen as a result of lack of HIV knowledge, with participants from rural areas showing more knowledge regarding HIV transmission and care as compared to urban participants. Most participants agreed that disclosure leads to more voluntary HIV testing, obtaining treatment and preventing further transmission of HIV. The results of this study provide indications that stigma can be mitigated by increasing knowledge of HIV prevention, targeted information campaigns in urban areas, and encouraging discussion about stigma and discrimination against the disease. Programmes should apply the Theory of Planned Behavior for the development of such interventions, take culture, creed, and other social affiliation into consideration. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of a health-promotion intervention in increasing self-reported physical activity among university students in Sub-Saharan Africa. Randomly selected second-year students at a university in South Africa were randomized to an intervention based on social cognitive theory: health-promotion, targeting physical activity and fruit, vegetable, and fat consumption; or HIV risk-reduction, targeting sexual-risk behaviors. Participants completed assessments via audio computer-assisted self-interviewing pre-intervention and 6 and 12 months post-intervention. A total of 176 were randomized with 171 (97.2%) retained 12 months post-intervention. Generalized-estimating-equations analyses indicated that the health-promotion-intervention participants were more likely to meet physical-activity guidelines than were control participants, post-intervention, adjusting for pre-intervention physical activity (odds ratio [OR] = 3.35; 95% CI: 1.33-8.41). Health-promotion participants reported a greater number of days they did vigorous-intensity (risk ratio [RR] = 2.01; 95% CI: 1.43-2.83) and moderate-intensity (RR = 1.40; 95% CI: 1.01-1.95) aerobic activity, but not strength-building activity (RR = 1.37; 95% CI: 0.091-2.07). The intervention reduced self-reported servings of fried foods (mean difference = −0.31; 95% CI: −0.60, −0.02). The findings suggest that theory-based, contextually appropriate interventions may increase physical activity among university students in Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Objective:: To develop targeted interventions for high-risk drinkers among South African men, we assessed whether sociodemographic factors and history of childhood sexual abuse predicted binge drinking at six-month follow-up assessment and their psychological pathways according to the extended Theory of Reasoned Action (TRA). Design:: Survey responses with a sample of 1181 South African men from randomly selected neighbourhoods in Eastern Cape Province were collected at baseline and six-month follow-up. Multiple logistic regression analysis examined the baseline predictors of binge drinking. Serial multiple mediation analysis examined the psychological pathways. Main outcome measurements:: Binge drinking at six-month follow-up. Results:: Age (OR = 1.03, 95% CI: 1.01, 1.05), religious participation (OR = .73, CI:.65,.82) and history of childhood sexual abuse (OR = 1.82, CI: 1.32, 2.51) were significant predictors of binge drinking. Predictions of religious participation and history of childhood sexual abuse were partially mediated through attitude, subjective norm, descriptive norm and intention to binge drinking. Conclusion:: South African men with childhood sexual abuse experience and low religious participation were at higher risk for binge drinking. The extended TRA model explains the associations of these factors to binge drinking and can contribute to the design and evaluation of interventions. [ABSTRACT FROM AUTHOR]

Given the high risk of HIV infection among university students in sub-Saharan Africa, there is a need for culturally appropriate risk-reduction interventions specifically targeting this population. Efforts to reduce the risk require an understanding of the modifiable antecedents of sexual-risk behaviors. We report the results of a semi-structured elicitation survey based on the reasoned action approach to identify behavioral, normative, and control beliefs regarding abstinence, condom use, and limiting sexual partners. Two coders classified into 64 belief categories the written responses of 96 sub-Saharan African university students. Most students believed each behavior could reduce risk of HIV infection. The students reported that peer pressure and being in a risky environment made it harder to practice abstinence. Good communication made it easier to use condoms and to limit partners; however, unstable relationships made practicing these protective behaviors harder. The identified beliefs help to inform the development of theory-based HIV risk-reduction interventions. [ABSTRACT FROM AUTHOR]

Culture and tradition influence behavior. Multiple-partner and concurrent relationships are held responsible for the increase of HIV infection in Sub-Saharan Africa. A contextualized “theory of planned behavior” is used in this article to identify predictors of intention to practice monogamy. A mixed method design using qualitative data from focus groups, stories, and a survey is analyzed for quantitative data. The qualitative data add to the behavioral beliefs a sociocultural belief domain, as well as attitudes and subjective norms. Perceived behavioral control predicts the intention to practice monogamy. Adolescents show a tendency toward having more than one sexual partner. The normative beliefs and the sociocultural beliefs also predict intentions, while hedonistic beliefs and partner’s reaction do not. In contextualizing theory-based interventions, it is important to draw from stories and the language that circulate in a community about a given behavior. More studies are needed on ways to combine qualitative approaches with quantitative approaches to inform the development of theory-based, culturally appropriate, and context-specific intervention strategies to reduce the risk of HIV. [ABSTRACT FROM PUBLISHER]

The prevalence of HIV in sub-Saharan Africa is the highest in the world. Young people, including university students, are at risk. Many sexually active young people have multiple partners, but little is known about how university students who have multiple partners differ from those who do not. This study examined such differences among randomly selected first-year students at a university in the Eastern Cape Province, South Africa, who completed a confidential questionnaire via audio computer-assisted self-interviewing. Of 201 participants, 93 (46.3%) reported sexual intercourse in the previous 3 months. Of those, 52 (55.91%) reported sexual intercourse with more than one partner in the past 3 months. Controlling for gender, students who reported multiple partners were younger at first coitus, had a greater number of lifetime coital partners, and reported more frequent coitus and unprotected coitus but a lower proportion of condom-protected coital acts in the past 3 months than did those reporting only one partner. However, those reporting multiple partners and one partner did not differ in religiosity, drinking problems, or victimization by childhood sexual abuse. HIV/sexually transmitted disease risk reduction interventions must address unprotected coitus and failure to use condoms among university students reporting multiple partners. [ABSTRACT FROM AUTHOR]

Globally, chronic diseases place a tremendous burden on health care systems all over the world. The increased prevalence of chronic diseases is mainly influenced by industrialization and decreased levels of physical activity. A cross-sectional qualitative and quantitative pilot survey, using a self-administered questionnaire and focus group discussions, was conducted with 73 students to assess the need for and feasibility of a health promotion program for university students at a rural South African university. The results of this survey suggest that there is a need for a health promotion program aimed at young adults who attend university. [ABSTRACT FROM AUTHOR]

The purpose of the study was to describe the premarital sexual behaviors of Botswana adolescents and examine the factors associated with premarital sex intentions. An anonymous self-reported questionnaire was administered to 1,054 pupils ages 10 to 18 years in school and out of school. The findings indicate that the theory of planned behavior provides a model for developing interventions to reduce the risk behavior in regard to HIV/AIDS through premarital sex. The findings in the study indicate factors that influence adolescent intentions to engage in premarital sexual intercourse and the need to address these when designing effective interventions. [ABSTRACT FROM AUTHOR]

A cross sectional qualitative and quantitative pilot survey, using self-administered questionnaire and focus group discussions, was conducted to assess the feasibility of a health promotion programme implemented at the university. About 73 students participated in the survey and the discussion. We examined gender and cultural differences on sexual attitude and behaviour. There was a strong belief that unprotected sex can lead to pregnancy and STIs. Overall participants were not sure if condom use had any negative effects, although female respondents felt that condoms affect the pleasure of sexual intercourse. The results suggest that there is a need for health promotion programmes aimed at young adults, who attend university. The programme should improve general health knowledge, targeting health promotion and sexual risk behaviour among university students. Such a programme would have to consider gender, socio-economic circumstances as well as national and cultural background of the target population. [ABSTRACT FROM AUTHOR]

Worldwide about 2.5 million children younger than 15 years of age are living with HIV, and more than 2.3 million of them live in sub-Saharan Africa. Antiretroviral therapy (ART) has reduced mortality among HIV-infected children, and as they survive into adolescence, disclosing to them their diagnosis has emerged as a difficult issue, with many adolescents unaware of their diagnosis. There is a need to build an empirical foundation for strategies to appropriately inform infected children of their diagnosis, particularly in South Africa, which has the largest number of HIV-positive people in the world. As a step toward developing such strategies, we conducted a study in Eastern Cape Province, South Africa, to identify beliefs about disclosing HIV diagnosis to HIV-infected children among caregivers, health-care providers, and HIV-positive children who knew their diagnosis. We implemented seven focus groups with 80 participants: 51 caregivers in four groups, 24 health-care providers in two groups, and 5 HIV-positive children in one group. We found that although the participants believed that children from age five should begin to learn about their illness, with full disclosure by age 12, they suggested that many caregivers fail to fully inform their children. The participants said that the primary caregiver was the best person to disclose. The main reasons cited for failing to disclose were (a) lack of knowledge about HIV and its treatment; (b) the concern that the children might react negatively; and (c) the fear that the children might inappropriately disclose to others, which would occasion gossip, stigmatization, and discrimination toward them and the family. We discuss the implications for developing interventions to help caregivers appropriately disclose HIV status to HIV-infected children and, more generally, communicate effectively with the children to improve their health outcomes. [ABSTRACT FROM PUBLISHER]

More than 30 years after the first discovery of the deadly HIV virus, and in the wake of increased knowledge of transmission, treatment and behavioral intervention development, parents are still faced with the difficult task of whether, when and how to inform their child about her or his HIV status. Except for some general ethical considerations, there are no national or international guidelines available for handling HIV status disclosure to a child by parents and health professionals. Most studies on disclosure address the problem of stigma and the barriers to disclosure of HIV-positive status by adults to their sexual partners, caretakers, families and communities, but very few studies focus on disclosure to HIV-positive children. The majority of the studies that address disclosure to children limit themselves to stipulating reasons for barriers to such disclosure instead of the skills and knowledge necessary for effective disclosure to a child. Increasing availability of therapy for HIV across the world presses the issue of disclosure to the child. Even so, disclosure for children who are HIV-positive due to vertical transmission continues to be very difficult. There is a lack of interventions that consider guidelines for healthcare professionals, parents or persons involved with taking care of HIV-positive children. These interventions should be designed in an understanding manner towards the culture where they might be implemented and be as appropriate in the view of integrating different family structures and the child's development. [ABSTRACT FROM AUTHOR]

Rates of chronic diseases are high among Black South Africans but few studies have tested cognitive-behavioural health-promotion interventions to reduce this problem. We tested the efficacy of such an intervention among adolescents in a cluster-randomised controlled trial. We randomly selected 9 of 17 matched pairs of schools and randomised one school in each pair to the cognitive-behavioural health-promotion intervention designed to encourage health-related behaviours and the other to a human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk-reduction intervention that served as the control. Interventions were based on social cognitive theory, the theory of planned behaviour and qualitative data from the target population. Data collectors, blind to participants' intervention, administered confidential assessments at baseline and 3, 6 and 12 months post-intervention. Primary outcomes were fruit and vegetable consumption and physical activity. Participants were 1057 grade 6 learners (mean age = 12.4 years), with 96.7% retained at 12-month follow-up. Generalised estimating equations revealed that averaged over the follow-ups, a greater percentage of health-promotion intervention participants than HIV/STD control participants met 5-a-Day fruit and vegetable and physical activity guidelines. The intervention also increased health-promotion knowledge, attitude and intention, but did not decrease substance use or substance-use attitude and intention. The findings suggest that theory based and contextually appropriate interventions may increase health behaviours among young adolescents in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

HIV/AIDS is taking a heavy toll on South African youth. Reducing their risk for HIV requires an understanding of the determinants of their HIV risk behaviours that are amendable to intervention-induced change. This study draws upon the theory of planned behaviour to identify the modifiable determinants of the intention to use condoms among Xhosa-speaking South African adolescents. The participants were 390 Xhosa-speaking 6th grade students (mean age = 12.1 years) in public schools in the township of Mdantsane, South Africa who completed an anonymous questionnaire. Multiple regression revealed that attitude and perceived behavioural control were significantly related to the intention to use condoms, whereas subjective norm was not, controlling for sexual experience, gender, and language preference. Consistent with this were additional analyses using beliefs as predictors: Hedonistic behavioural beliefs and control beliefs about condom-use negotiation and technical skills predicted intention, whereas normative beliefs did not. The theory of planned behaviour may be a useful model of condom use among Xhosa-speaking South African adolescents. An emphasis on beliefs about the adverse effects of condom use on sexual enjoyment, the ability to negotiate condom use, and the ability to use condoms correctly might improve the efficacy of HIV/STD interventions for such adolescents. [ABSTRACT FROM AUTHOR]

Purpose: Using the theory of reasoned action (TRA), this research examined predictors of sexual intercourse among first- and second-year college women.Methods: Participants completed a confidential self-administered questionnaire on their attitude, subjective norm, and intention regarding sexual intercourse and their behavioral beliefs about the consequences of abstinence and sexual intercourse.Results: At baseline, 58 (34%) of the 172 participants (mean age = 18.2; SD = 0.56) reported ever having sexual intercourse, and 41 (24%) reported having sexual intercourse within the last three months. Proportional-odds analysis on baseline data revealed that attitude and subjective norm were associated with a greater intention to have intercourse, as was relationship status (i.e. being in a relationship), a variable external to the TRA. Three-month follow-up questionnaires were completed by 165 (96%) of the participants. Logistic regression indicated that baseline intention and relationship status predicted self-reported sexual intercourse three months later. Examination of the relation of behavioral beliefs to attitude revealed that beliefs about the positive consequences of abstinence were associated with a negative attitude toward intercourse, whereas beliefs about the negative consequences of intercourse were unrelated to attitude toward intercourse. Being in a relationship and alcohol use were also related to positive attitude toward intercourse.Conclusions: These results suggest that, for college women, the TRA is a useful model of sexual behavior and that abstinence interventions may be a viable risk-reduction approach if the abstinence message is framed to emphasize the positive consequences of abstinence rather than the negative consequences of sexual intercourse. [ABSTRACT FROM AUTHOR]