Meekers Dominique, Silva Martha, Klein Megan
Department of International Health and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
J Biosoc Sci. 2006 May;38(3):365-80. doi: 10.1017/S0021932005007200.
The objective of this study was to identify the key determinants of condom use with regular and casual partners among youth in Madagascar. Data stem from a reproductive health survey conducted in October-December 2000 among a representative sample of 2440 youth aged 15-24 living in Toamasina province. Following theoretical models of behaviour change, logistic regression was used to assess the effect of AIDS awareness,personal risk perception, condom access, perceived condom effectiveness,self-efficacy and social support on condom use. Among sexually experienced youth, only about four in ten males and two in ten females have ever used condoms. Fewer than 15% of youth used a condom in last intercourse with their regular partner. Whether youth will try condoms appears to depend largely on the perceived effectiveness of condoms for family planning, access to a nearby condom source, parental support for condom use, and patterns of risky sexual behaviour. Young males' likelihood of using a condom with a regular partner increases significantly if they perceive condoms to be effective for family planning (OR=11.4; p=0.019). For females, it increases with level of self-efficacy (OR=2 1; p=0.042) and having discussed HIV prevention with someone in the last year (OR=2.8; p=0.022). Among males,condom use with casual partners is significantly higher among those who perceive themselves to be at high risk of sexually transmitted infections(OR=2.3; p=0.014), who believe condoms are effective for family planning(OR=2.8; p=0.048), who have good access to condoms (OR=2.9; p=0.002)and who perceive their parents support condom use (OR=1-7; p=0.048). In conclusion, very few youth in Toamasina are using condoms, highlighting the need to continue and expand adolescent reproductive health interventions. In this low HIV prevalence setting, it is important for these programmes to emphasize that condoms are effective for both pregnancy prevention and STI/HIV prevention.
本研究的目的是确定马达加斯加青年在与固定伴侣和临时伴侣发生性行为时使用避孕套的关键决定因素。数据来源于2000年10月至12月在图阿马西纳省对2440名15至24岁青年进行的具有代表性的生殖健康调查。根据行为改变的理论模型，采用逻辑回归分析来评估艾滋病认知、个人风险认知、避孕套的可及性、对避孕套有效性的认知、自我效能感和社会支持对避孕套使用的影响。在有过性经历的青年中，每十名男性中只有约四名、每十名女性中只有约两名使用过避孕套。与固定伴侣的上一次性行为中，使用避孕套的青年不到15%。青年是否会尝试使用避孕套似乎很大程度上取决于对避孕套在计划生育方面有效性的认知、附近是否有避孕套供应源、父母对使用避孕套的支持以及危险性行为模式。如果青年认为避孕套对计划生育有效，那么他们与固定伴侣使用避孕套的可能性会显著增加（比值比=11.4；p=0.019）。对于女性而言，使用避孕套的可能性会随着自我效能感的提高（比值比=2.1；p=0.042）以及在过去一年中与他人讨论过艾滋病毒预防问题而增加（比值比=2.8；p=0.022）。在男性中，那些认为自己感染性传播感染风险高（比值比=2.3；p=0.014）、认为避孕套对计划生育有效（比值比=2.8；p=0.048）、容易获得避孕套（比值比=2.9；p=0.002）以及认为父母支持使用避孕套（比值比=1.7；p=0.048）的人，与临时伴侣使用避孕套的比例显著更高。总之，图阿马西纳很少有青年使用避孕套，这突出表明需要继续并扩大青少年生殖健康干预措施。在这种艾滋病毒感染率较低的情况下，这些项目强调避孕套对预防怀孕和性传播感染/艾滋病毒均有效非常重要。
