南非多性伴关系和避孕套使用的认知与行为决定因素：一项全国性调查的结果
Cognitive and behavioural determinants of multiple sexual partnerships and condom use in South Africa: Results of a national survey.
作者信息
Manjengwa Patience G, Mangold Kerry, Musekiwa Alfred, Kuonza Lazarus R
机构信息
South African Field Epidemiology Training Programme, National Institute of Communicable Diseases, Johannesburg, South Africa.
School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
出版信息
South Afr J HIV Med. 2019 Jun 10;20(1):868. doi: 10.4102/sajhivmed.v20i1.868. eCollection 2019.
BACKGROUND
Human immunodeficiency virus (HIV) risky behaviours including multiple sexual partnership (MSP) and non-condom use (nCU) are known to be drivers of the spread of HIV; cognitive factors including perceived susceptibility of HIV, self-efficacy and attitudes play a significant role in influencing risky sexual behaviours.
OBJECTIVES
We sought to investigate personal beliefs, perceptions, thoughts and actions that are associated with MSP and nCU in South Africa.
METHODS
We analysed nationally representative data from the 2012 National HIV Communication Survey (NCS) that included about 10 000 participants aged 16-55 years. Five constructs were created to measure psychosocial and cognitive determinants. Cronbach's alpha coefficient for internal consistency reliability was calculated. Multivariable logistic regression was used to determine factors associated with MSP and nCU.
RESULTS
Of the 6061 sexually active respondents, 13% (95% CI: 11.47-13.12) reported MSP and 52.7% ( = 3158 of 6039) (95% CI: 51.0-53.55) nCU at last sex. Factors associated with MSP included perceived benefits, adjusted odds ratio (aOR) = 2.16 (95% CI: 1.80-2.58), perceived susceptibility to HIV, aOR = 2.22 (95% CI: 1.83-2.69) and engaging in intergenerational sex, aOR = 2.14 (95% CI: 1.78-2.56). Predictors of nCU were perceived benefits, aOR = 1.25 (95% CI: 1.09-1.43); perceived susceptibility to HIV, aOR = 1.6 (95% CI: 1.39-1.83); and personal beliefs, aOR = 1.35 (95% CI: 1.13-1.62).
CONCLUSION
Cognitive and behavioural factors were found to be predictors of risky sexual behaviours for HIV. This highlights the importance of considering personal perception and reasoning when attempting to understand and influence an individual's sexual behaviour. This could be done through enhancing awareness of HIV risk in the general population and by influencing cognitive behaviour change through community mobilisation, advocacy and creating activities to improve self-esteem.
背景
已知包括多性伴关系（MSP）和不使用避孕套（nCU）在内的人类免疫缺陷病毒（HIV）危险行为是HIV传播的驱动因素；认知因素，包括对HIV易感性的认知、自我效能感和态度，在影响危险性行为方面发挥着重要作用。
目的
我们试图调查在南非与多性伴关系和不使用避孕套相关的个人信念、认知、想法及行为。
方法
我们分析了来自2012年全国HIV传播调查（NCS）的具有全国代表性的数据，该调查纳入了约10000名年龄在16 - 55岁的参与者。创建了五个结构来测量心理社会和认知决定因素。计算了内部一致性信度的克朗巴哈α系数。采用多变量逻辑回归来确定与多性伴关系和不使用避孕套相关的因素。
结果
在6061名有性行为的受访者中，13%（95%置信区间：11.47 - 13.12）报告有多性伴关系，在最后一次性行为中有52.7%（6039人中的3158人）（95%置信区间：51.0 - 53.55）未使用避孕套。与多性伴关系相关的因素包括感知到的益处，调整后的优势比（aOR） = 2.16（95%置信区间：1.80 - 2.58），对HIV易感性的认知，aOR = 2.22（95%置信区间：1.83 - 2.69）以及发生代际性行为，aOR = 2.14（95%置信区间：1.78 - 2.56）。未使用避孕套的预测因素为感知到的益处，aOR = 1.25（95%置信区间：1.09 - 1.43）；对HIV易感性的认知，aOR = 1.6（95%置信区间：1.39 - 1.83）；以及个人信念，aOR = 1.35（95%置信区间：1.13 - 1.62）。
结论
发现认知和行为因素是HIV危险性行为的预测因素。这凸显了在试图理解和影响个体性行为时考虑个人认知和推理的重要性。这可以通过提高普通人群对HIV风险的认识以及通过社区动员、宣传和开展提高自尊的活动来影响认知行为改变来实现。
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