247771 Exploring the complex paradigms regarding concurrent sexual partnerships, condom use, and HIV among youth in Malawi: Lessons learned from qualitative formative research

Tuesday, November 1, 2011

Tilly A. Gurman, DrPH , School of Public Health and Health Services, Dept. of Global Health, The George Washington University, Washington, DC, Malawi
Stacy Romero , School of Public Health and Health Services, Dept. of Global Health, The George Washington University, Washington, DC
Amy Ellis, PhD , Research & Metrics Division, Population Services International, Nairobi, Kenya
Background: In Malawi, as in other parts of Sub-Saharan Africa, concurrent sexual partnerships (CP) play a central role in HIV risk among youth. Less is known, however, about the paradigms through which Malawian youth view condom use and CP and assess their personal risk. The current study—conducted as formative research for an HIV prevention program—explores these concepts. Methods: Malawian youth (ages 18 to 22) were interviewed about their sexual relationships and behavior, as well as their perceptions and knowledge regarding condom use and CP. In order to ensure that youth engaged in CP were oversampled, the recruitment process asked potential respondents to self-identify whether they currently participated n CP. Of the total sample (N=19), 13 self-identified as engaging in CP. Data was analyzed using a Grounded Theory approach.

Results: Findings revealed discordance between respondents' personal HIV risk assessment and their knowledge and attitudes regarding condom use and CP. For example, although respondents engaged in CP knew that condoms can reduce one's HIV risk, the majority reported inconsistent condom use. As respondents rationalized their behavior, factors such as partner trust and communication influence their decision-making more than did CP or condom use knowledge.

Conclusions: The current study suggests that youth may not personalize their HIV risk and may rationalize their behavior in spite of their safer sex knowledge. Furthermore, HIV prevention programs in Malawi, and elsewhere in Sub-Saharan Africa, should stress factors such as evaluating partner trust and personalizing risk in order to reach youth with more credible and persuasive messages.

Learning Areas:
Assessment of individual and community needs for health education
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
(1) Describe the complex role of concurrent sexual partnerships and condom use in HIV prevention among youth in Malawi; (2) Explain the discordance that between youth’s perceptions regarding condoms and CP and their personalization of sexual risk; (3) Identify at least two implications for youth-specific HIV prevention programming

Keywords: Adolescents, International, HIV Risk Behavior

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My professional and academic expertise is in sexual health, evaluation research for health communication programs, and adolescent health. I have also published qualitative research, with similar methodology to the formative research that is reported in the current study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.