Lwakatare Mark, Thompson Gretchen, Msofe Joseph, Nyoni Waziri, Gillum Claire, Tureski Kara
Family Health International (FHI 360), Dar es Salaam, United Republic of Tanzania.
Family Health International (FHI 360), Durham, North Carolina, United States of America.
PLoS One. 2025 Jul 2;20(7):e0326878. doi: 10.1371/journal.pone.0326878. eCollection 2025.
HIV and unplanned pregnancies are significant public health concerns for youth in Sub-Saharan Africa. Consistent condom use is an effective behavioral method in preventing both health outcomes; however, it remains low and is declining among this population. Evidence indicates that preventive health behaviors are influenced by a range of specific factors relevant to their contexts. This study aimed to assess factors associated with condom use among sexually active youth in communities where social and behavior change (SBC) interventions were implemented in Tanzania. A cross-sectional study was conducted among 1,959 youths aged 15-24 years, selected using a multi-stage sampling approach from three regions (Iringa, Mwanza, and Tabora) where SBC interventions were implemented. Of these, 1,265 participants (64.6%) reported sexual activity within the six months preceding the study and were included in the analysis. Multivariable logistic regression was employed to determine the significant factors associated with condom use at last sex. P-values of ≤ 0.05 were considered statistically significant. Overall, 46.9% (95% CI: 44.0-50.0) of sexually active youth reported condom use at last sex, with higher prevalences observed among those exposed to condom use messaging through social media (70.4%), and who discussed condom use with their sexual partners (63.6%) and parents (62.2%). Significant predictors of condom use included residing in Tabora (AOR = 1.609; 95% CI: 1.155-2.241), having no children (AOR = 1.844; 95% CI: 1.095-3.106), delayed sexual debut (AOR = 1.591; 95% CI: 1.027-2.464), having multiple sexual partners (AOR = 1.667; 95% CI: 1.280-2.171), having a partner tested for HIV (AOR = 1.671; 95% CI: 1.138-2.455), self-efficacy to convince partner on condom use (AOR = 1.653; 95% CI: 1.233-2.215), discussing condom use with parents (AOR = 1.902; 95% CI: 1.430-2.532), and perceived parental support in HIV prevention (AOR = 1.585; 95% CI: 1.200-2.095). Condom use among sexually active youth in Tanzania is influenced by a range of sociodemographic, behavioral, and ideational (emotional and social) factors. This indicates the continued need for tailored multi-level interventions that address the contextual needs of target audiences to improve condom use. Further research is also needed to examine the causal pathways and underlying factors influencing condom use among sexually active youth.
在撒哈拉以南非洲地区，艾滋病毒和意外怀孕是困扰青少年的重大公共卫生问题。坚持使用避孕套是预防这两种健康问题的有效行为方式；然而，该人群中避孕套的使用率依然很低且呈下降趋势。有证据表明，预防性健康行为会受到一系列与其所处环境相关的具体因素的影响。本研究旨在评估在坦桑尼亚实施了社会和行为改变（SBC）干预措施的社区中，性活跃青少年使用避孕套的相关因素。我们采用多阶段抽样方法，从实施了SBC干预措施的三个地区（伊林加、姆万扎和塔博拉）选取了1959名15 - 24岁的青少年进行横断面研究。其中，1265名参与者（64.6%）报告在研究前六个月内有过性行为，并被纳入分析。我们采用多变量逻辑回归来确定与最近一次性行为时使用避孕套相关的显著因素。P值≤0.05被视为具有统计学意义。总体而言，46.9%（95%置信区间：44.0 - 50.0）的性活跃青少年报告在最近一次性行为时使用了避孕套，在那些通过社交媒体接触到避孕套使用信息的人群中（70.4%）、与性伴侣讨论过避孕套使用的人群中（63.6%）以及与父母讨论过避孕套使用的人群中（62.2%），避孕套使用率更高。使用避孕套的显著预测因素包括居住在塔博拉地区（比值比[AOR]=1.609；95%置信区间：1.155 - 2.241）、没有孩子（AOR = 1.844；95%置信区间：1.095 - 3.106）、初次性行为较晚（AOR = 1.591；95%置信区间：1.027 - 2.464）、有多个性伴侣（AOR = 1.667；95%置信区间：1.280 - 2.171）、伴侣接受过艾滋病毒检测（AOR = 1.671；95%置信区间：1.138 - 2.455）、说服伴侣使用避孕套的自我效能感（AOR = 1.653；95%置信区间：1.233 - 2.215）、与父母讨论避孕套使用（AOR = 1.902；95%置信区间：1.430 - 2.532）以及感受到父母在预防艾滋病毒方面的支持（AOR = 1.585；95%置信区间：1.200 - 2.095）。坦桑尼亚性活跃青少年的避孕套使用受到一系列社会人口学、行为以及观念（情感和社会）因素的影响。这表明持续需要开展有针对性的多层次干预措施，以满足目标受众的具体需求，从而提高避孕套的使用率。还需要进一步研究来探究影响性活跃青少年避孕套使用的因果路径和潜在因素。
