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.1991 Jul;37(7):196-202.

Psychosocial predictors of reported HIV-preventive behaviour change among adults in Bulawayo, Zimbabwe

Affiliations
  • PMID:1811902

Psychosocial predictors of reported HIV-preventive behaviour change among adults in Bulawayo, Zimbabwe

D Wilson et al. Cent Afr J Med.1991 Jul.

Abstract

In order to reduce HIV transmission, improved understanding of factors that motivate safer sexual behaviour is needed. The Health Belief Model attempts to explain health-related behaviour, including HIV-preventive behaviour. The association of six elements of this model--AIDS knowledge, perceived susceptibility to HIV infection, perceived effectiveness of HIV-preventive measures, self-efficacy, barriers to behaviour change, accessibility of health care/advice and social support for safer sexual behaviour--to three indices of HIV-related behavioural risk reduction--reduced number of sexual partners, increased consistency of condom use and (among males only) reduced prostitute contact--was examined by self-report inventory among 202 men and 100 women in Bulawayo, Zimbabwe. Multiple logistic regression identified social support for behaviour change, followed by accessibility of health care/advice, as the most consistent predictors of risk reduction across sex and outcome measures. The remaining predictors were not consistently associated with behaviour change. It is concluded that AIDS campaigns must foster the perception that there is concerted normative support for HIV-related behaviour change and that community and small group, face-to-face AIDS education, which may have more impact on perceived social support than mass media campaigns, must be emphasised.

PIP: A national AIDS prevention campaign exists in Zimbabwe which stresses the need to practice safer sex in order to reduce the transmission of HIV. Alternative campaigns have been mounted internationally in other countries which emphasize increasing knowledge on HIV within the target community. Experiences from such campaigns, however, indicate that knowledge alone will not provoke people to adopt safer sex practices. Researchers must therefore seek to identify and understand which factors motivate behavioral change. The following data were obtained from 202 men and 100 women of mean age 26 interviewed in 1989: 72.55% of men and 47.83% of women had 2 or more sex partners during their lifetime; 24.31% of men and 1.04% of women had 2 or more sex partners within the previous month;l 40.23% of males had ever had sex with a prostitute; and 24.39% had sex with a prostitute within the previous month. These data were obtained and submitted to multiple logistic regression within an Health Belief Model attempting to explain HIV-preventive behavior. Perceived susceptibility to HIV infection, perceived effectiveness of HIV-preventive measures, self-efficacy, barriers to behavior change, accessibility of health care/advice, and social support for safer sex behavior were associated with reduced number of sexual partners, increased consistency of condom use, and reduced prostitute contact among males. While some HIV-preventive behavioral change may have occurred, respondents remain at risk for HIV infection. Many misconceptions exists about HIV transmission and the role of asymptomatic individuals, with many men and over 50% of women thinking that they are not at risk of HIV infection. These results suggest that efforts must be taken to increase the preparedness of men to engage in safer versus riskier sex. Furthermore, social support for behavioral change, followed by accessibility of health care/advice, was the most consistent predictor of risk reduction across sex and outcome measures; other predictors were not consistently associated with behavioral change. AIDS campaigns should therefore foster the perception that concerted normative support exists for HIV-related behavior change. Community and small group face-to-face AIDS education interventions may help achieve these program objectives.

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