HIV prevention among Zambian adolescents: Developing a value utilization norm change model

University of Miami, كورال غيبلز، فلوريدا, Florida, United States
Social Science & Medicine (Impact Factor: 2.89). 03/1997; 44(4):455-68. DOI: 10.1016/S0277-9536(96)00164-5
Source: PubMed


Peer-led interventions are effective in reducing risk for HIV among adolescents. A pre-intervention study was conducted to determine how to successfully carry out a possible future intervention to reduce HIV risk among adolescents in urban Zambia. Ethnographic and sexual data were collected on 276 males and females both attending and not attending secondary school during a 14-month period in 1992-1993. Additionally, several focus groups were conducted. This paper reviews the cultural background of Zambian adolescents and presents an overview of the study results. Among the findings, it was learned that most of the male and female adolescents (average age of 17) are sexually active, very few routinely use condoms, less than half of sexually active adolescents have ever used a condom, AIDS is omnipresent in Zambia, the threat of HIV infection is a very real concern for most of the adolescents, there is a strong desire to protect themselves from HIV infection during sex (but condoms are often seen as ineffective and other forms of safer sex are not discussed), nearly all of the sexually active females and some of the males have received money or gifts for sex, and some of the out-of-school females are engaging in very risky sex (e.g., unprotected anal intercourse, and anilingus) with adult men. The ethnographic data, including a brief trial risk reduction workshop, suggests that the core values and social norms of the adolescents may shape behavioral change. A value utilization/norm change (VUNC) model is developed, which is intended to provide a conceptual framework for understanding how to utilize selected core values of the adolescents to strengthen or alter norms within the social networks in order to elicit desired HIV risk reduction.

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    • "This age differential contributes to young women being less able to refuse sex or negotiate condom use (Dancy, 1999; MacPhail & Campbell, 2001; UNFPA, 2003). Further, girls have less access to even minimal education and may be pressured into early marriage or transactional sex to reduce family economic burden (MacPhail & Campbell, 2001; Feldman et al., 1997; Rankin, Lindgren, N'goma, & Rankin, 2005; UNFPA, 2003; UNICEF, 2006). Additionally, young women report difficulties with using condoms, including becoming the target for community gossip and negative interactions with clinic staff when requesting condoms (MacPhail & Campbell, 2001). "
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    ABSTRACT: To examine the impact of 2 mitigating social institutions, religious organizations, and the state, on Malawi women's vulnerability to HIV. In-depth interviews with a purposive sample of 40 central leaders from 5 faith-based organizations in Malawi were recorded and transcribed as part of an on-going larger study. Qualitative description was used to identify themes and categories. Primarily urban and periurban areas of south-central Malawi. A minimum of 6 leaders from each faith-based organization were interviewed; the mean age of the primarily male (68%) participants was 44 years (range 26-74). Analysis of religious leaders' messages about HIV produced an overarching theme, the condom divide, which conceptualized the divergence between faith-based organizations and the state's prevention messages related to HIV prevention strategies. Faith-based organizations have "demonized" state messages about condoms as promoting sin. The faith-based organizations' insistence on abstinence and faithfulness leaves women with few options to protect themselves. As socially conscious citizens of the world, nurses can increase the responsiveness to the disparate levels of suffering and death in countries like Malawi.
    Full-text · Article · Sep 2008 · Journal of Obstetric Gynecologic & Neonatal Nursing
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    • "In Zambia, admittance to public secondary school is highly competitive. Less than 30 per cent of those who take the test to enter the first year there (grade 8) pass (Baggaley, Sulwe, Chilala, & Mashambe, 1999) and only 15 per cent of those who take the test to enter grade 10 pass (Feldman et al., 1997). Thus people take these tests repeatedly. "
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    ABSTRACT: This study explores shared thinking about HIV/AIDS among Zambian adolescents. With high numbers affected, the question is how this group represents its risk. Social representations of the origin, spread and risk of HIV/AIDS were gleaned via 60 semistructured interviews with urban 15 to 20 year olds. A systematic analysis revealed a shared picture: AIDS was linked to the West, God and teenage girls; its spread lay beyond the control of adolescent boys and men; and the personal sense of vulnerability was low. The results are discussed in light of their corroboration of the finding that social representations of danger can be identity protective, yet also system justifying. The potential transfer of such findings to psychological theory and to health campaigns is considered.
    Full-text · Article · Oct 2003 · Journal of Health Psychology
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    • "One important way to address the problem of STDs is to raise awareness about transmission and prevention in the general population, especially among the young people. Studies conducted mostly in the urban areas of Zambia show that the majority of young people engage in risky sexual behaviour despite evidence suggesting widespread awareness about STDs (Mkumba and Edwards 1992; Feldman et al. 1997). In Zambia, as in much of sub-Saharan Africa, urbanization, with its attendant social and cultural disruptions, has been identified as the main cause of risky sexual practices among urban young men (WHO 1989). "
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    ABSTRACT: Sexually transmitted diseases (STDs) are an increasing public health problem in Zambia. About 200 000 cases of STDs are treated annually in the formal health sector. Young people are the most affected by STDs. High-risk sexual behaviour has been identified as the major risk factor for STDs among young people. We conducted interviews and focus group discussions with a purposely selected sample of 126 young men aged between 16 and 26 in Chiawa, rural Zambia. The aim of the interviews and focus group discussions was to explore views about sexual practices and attitudes towards STD. Fifty-eight (59%) young men reported having had pre-marital or extra-marital sexual partners during the past year. The maximum number was five partners for six individuals. Forty-two (43%) had pre-marital or extra-marital sexual partners at the time of the interviews. Focus group discussions revealed that perceptions of manhood encouraged multiple sexual relationships. Twenty-two (23%) reported having suffered from an STD in the past. Seventy-nine (81%) said they were likely to inform their sexual partners if they had an STD. Although condoms were believed to give protection against STDs by the majority (94%), only 6% said they always used condoms. The data suggest that condoms were perceived to affect male potency. These results show that STDs, multiple sexual relationships and unprotected sex are common among the young men of Chiawa. Perceptions that emphasize manhood are widespread and these may negatively affect efforts for positive behavioural change. Health messages that target the young men should take into account the local perceptions and values that seem to sustain risky sexual behaviour.
    Preview · Article · Apr 2001 · Health Policy and Planning
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