Click to edit Master title style If they know how to talk about them Click to edit Master text styles they will use them: Second level Determinants of Condom Use Among Third level Women in Mozambique Fourth level Fifth level Valeriana Rufino, High Risk Group Manager, PSI/Mozambique Co-Authors: Filipe Bila, Jennifer Wheeler, Fatima Mussa, Dvora Joseph, Arild Drivdal, Brian Smith HIV Implementer’s Meeting Namibia, June, 2009 1
OUTLINE • Background and Implementation approach • Analysis design and methods • Determinants of condom use among women • Way forward
BACKGROUND AND IMPLEMENTATION APPROACH • Since 1994, PSI/Mozambique in collaboration with the Ministry of Health and the National AIDS Council, has implemented HIV prevention programs, including condom social marketing. • In 2008, PSI conducted a population- based survey on HIV attitudes, knowledge and behaviors in selected districts of Gaza, Sofala and Zambézia. • Survey used to identify the determinants of condom use in women and men with non-marital non- cohabitating partners (NMNC) as well as primary partners.
ANALYSIS DESIGN AND METHODS • The total sample size included 4,075 women and men aged 15 to 35. • 2/3 of the sample were women • Women were over sampled to capture a sufficient number of respondents with NMNC partners. • The survey used a multi-stage cluster sampling design to select households to be interviewed. • Data was analyzed using ANOVA and logistic regression procedures in SPSS.
Focus of Analysis on Women Why do we focus on women? WHY FOCUS ON WOMEN? • Condom use among women was significantly lower than men in the study • Women have less power to negotiate condom use in Mozambique, hence we wanted to analyze determinants to improve women’s ability to negotiate and USE condoms • Using results to develop targeted programs to increase condom use among women
USE OF MALE CONDOMS BY WOMEN PROVINCES NMNC PARTNERS PRIMARY PARTNERS GAZA 31% 21%* SOFALA 53% 30%* ZAMBEZIA 54% 33%* •Condom use is significantly lower with primary partner than with NMNC partners and remains significantly lower than male reporting of condom use * p<.05
DETERMINANTS OF MALE CONDOM USE DETERMINANTS OF CONDOM USE (Cont.) AMONG WOMEN • Self efficacy around condom use was the most significant determinant of condom use for women with primary partners in all provinces. • Strong confidence and “know how” about condom use – including negotiation skills • E.g.: “I am able to talk to all of my partners about the importance of condom use even if we have already had sex”
DETERMINANTS OF CONDOM USE DETERMINANTS OF CONDOM USE (Cont.) AMONG WOMEN, cont. • Positive attitudes towards condoms were determinants of condom use among women with both primary and NMNC partners in all study sites. • Disagreement with phrases such as “ condoms reduce pleasure ” or “ condoms are not comfortable ” • Availability of condoms was related to condom use among women in Gaza only.
DETERMINANTS OF CONDOM USE DETERMINANTS OF CONDOM USE (Cont.) AMONG WOMEN, cont. • Community social support was significantly associated with condom use with both NMNC and primary partners in Sofala and Gaza. • E.g.: “In my community, it is OK to be seen buying condoms” • However, men in Zambézia were more likely to use condoms if they had support from friends
WAY FORWARD CONCLUSIONS AND RECOMENDATIONS • Improved interpersonal communication through network of community agents, peer educators and theater groups – Target sexually active women to improve self efficacy around condom use by providing opportunities to demonstrate, touch condoms and ask questions • Condoms are still highly stigmatized because of focus on HIV prevention in Mozambique, which could be the cause of low use with primary partners or use for family planning
WAY FORWARD, cont. • Increase accessibility of condoms through free distribution in partnership with local NGOs specially in Gaza Province • Results of the study were incorporated into the Government of Mozambique’s condom promotion strategy • E.g. A national condom campaign will be launched in 2009 to address self efficacy around condom use among women • PSI has launched a male condom ( Confianca) marketed specifically for family planning with primary partners
CONCLUSIONS AND RECOMENDATIONS • KANIMAMBO • OBRIGADA • THANK YOU
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