Department of Health Behavior, UNC Chapel Hill, CB #7440, Chapel Hill, NC 27599, United States.
Department of Sociology, Duke University, Box 90088, Durham, NC 27708, United States; Department of Sociology, King Abdulaziz University, Jeddah, Saudi Arabia.
Soc Sci Med. 2018 Jan;196:77-85. doi: 10.1016/j.socscimed.2017.10.030. Epub 2017 Nov 4.
BACKGROUND: Young men living in Dar es Salaam's informal settlements face environmental stressors that may expose them to multiple determinants of HIV risk including poor mental health and risky sexual behavior norms. We aimed to understand how these co-occurring risk factors not only independently affect men's condom use and sexual partner concurrency, but also how they interact to shape these risk behaviors. METHODS: Participants in the study were male members of 59 social groups known as "camps" in Dar es Salaam, Tanzania. We assessed moderation by changes in peer norms of the association between changes in symptoms of anxiety and depression and sexual risk behaviors (condom use and sexual partner concurrency) among 1113 sexually active men. Participants nominated their three closest friends in their camp and reported their perceptions of these friends' behaviors, attitudes, and encouragement of condom use and concurrency. Anxiety and depression were measured using the HSCL-25, and condom use and sexual partner concurrency were assessed through self-report. RESULTS: Perceptions of decreasing condom use among friends (descriptive norms) and decreasing encouragement of condom use were associated with lower levels of condom use. Perceptions of increasing partner concurrency and acceptability of partner concurrency (injunctive norms) among friends were associated with higher odds of concurrency. Changes in perceived condom use norms (descriptive norms and encouragement) interacted with changes in anxiety symptoms in association with condom use such that the negative relationship was amplified by norms less favorable for condom use, and attenuated by more favorable norms for condom use. CONCLUSIONS: These results provide novel evidence of the interacting effects of poor mental health and risky sexual behavior norms among a hard to reach population of marginalized young men in Dar es Salaam. Our findings provide important information for future norms-based and mental health promotion interventions targeting HIV prevention in this key population.
背景：生活在达累斯萨拉姆非正规住区的年轻男性面临着环境压力因素，这些因素可能使他们面临多种 HIV 风险决定因素，包括心理健康状况不佳和危险的性行为规范。我们旨在了解这些同时存在的风险因素不仅如何独立影响男性使用避孕套和性伴侣同时发生性行为，还了解它们如何相互作用来影响这些风险行为。
方法：本研究的参与者是坦桑尼亚达累斯萨拉姆的 59 个社会群体（称为“营地”）中的男性成员。我们评估了同伴规范变化对焦虑和抑郁症状变化与性风险行为（避孕套使用和性伴侣同时发生性行为）之间关联的调节作用，共纳入了 1113 名有性行为的男性。参与者在他们的营地中提名了他们三个最亲密的朋友，并报告了他们对这些朋友的行为、态度和对避孕套使用和同时发生性行为的鼓励的看法。使用 HSCL-25 评估焦虑和抑郁，通过自我报告评估避孕套使用和性伴侣同时发生性行为。
结果：朋友中减少避孕套使用的看法（描述性规范）和减少对避孕套使用的鼓励与避孕套使用水平降低有关。朋友中增加性伴侣同时发生性行为和接受性伴侣同时发生性行为的看法（规范性规范）与更高的同时发生性行为的几率有关。对避孕套使用规范的看法变化（描述性规范和鼓励）与焦虑症状变化相互作用与避孕套使用有关，即不利的规范会放大负面关系，有利的规范则会减弱负面关系。
结论：这些结果为达累斯萨拉姆边缘化年轻男性这一难以接触的人群中，心理健康状况不佳和危险性行为规范相互作用的影响提供了新的证据。我们的研究结果为针对该关键人群的基于规范和心理健康促进的 HIV 预防干预措施提供了重要信息。
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