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Analysis of predictors of consistent condom use among adolescent girls in Ivory Coast: implication for preventions interventions


par Metahan TRAORE
Pennsylvania State University  - Master of Public Health 2016
  

sommaire suivant

Title: Analysis of predictors of consistent condom use among adolescent girls in Ivory coast: implication for preventions interventions

By TraoreMetahan, Demographer, MPH

September 2016

Key words

Africa, Adolescentgirls, HIV /AIDS, condomuse, behavioral model, risky behavior, prevention

Abstract

Background

In sub-Saharan Africa, new infections among adults (15 and older) touch 56% of women; and the proportion was higher among young women aged 15-24, who made up 66 per cent of new infections among young people.

Ivory Coast is the one of the most contaminated country of west Africa with a rate of 3.7% in 2012 to 2.7% in 2014 (UNAIDS, 2015). HIV/AIDS rates have fallen from 14 to 12, 4.7% in 2005 in 2014 is 3.2%. despite a slight improvement of HIV rate, AIDS is still the main cause of death in West Africa. In fact, the context in which young women live has a negative influence on their behaviors.

Objective

This study objective is to examine relevant predictors associated with condom use amongadolescent girls in Ivory Coast.

Results

The main predictors from the multiple regression, are place of residence, matrimonial status, education level, the fact that the condom reduces HIV risk and the multiple sexual behavior and the contraceptive methodof condom use. The matrimonial status, the education level and the household wealth are statistically significant. These variables show significant differences for the condom use. Single young girls are 9.03 times more likely to use condom (p=0.000). Adolescent girls witha primary education level are 1.91 times more likely to use condom compared to those with no education. those with secondary and plus education level are 3.54 times more likely to use condom. For the factors of needs The fact that the condom can reduce the HIV is statistically significant. Indeed, adolescent are 1.51 times more likely to use condom during sexual intercourses. Young girls involved in multiple sexual behavior are 0.55 times less likely to use condom. Also, adolescent girls using contraceptive method are 5.71 times more likely to use condom than those who do not use condom.

Conclusions

The context in which young women live has a negative influence on their behaviors. Awareness campaign must focusparticularly for their message in condom use of adolescentgirls.

Background

Since the 20thcentury, of human immunodeficiency virus/acquired immunedeficiency syndrome (HIV/AIDS) continues to be one of the current challenges on the prevention and control faced worldwide is a category of population face a lot of issues among youths of age 15 to 24 years.

According to UNAIDS in 2015, there is a total of 36.7 million of people living with HIV and 1.1 million people died of HIV/AIDS. The number of infected is 2.5 million every year during the last ten years (UNAIDS, 2015). Since the discover of the AIDS, 30 million people are dead (UNAIDS, 2013). In Africa there's a reduction of 32% during the last decade and the mortality rate decrease to more than 32% since its pic of 2005. But the number of infected people is still high comparing the population growth.More than35millionpeople are infected in the world by HIV with 1.5 million of deathsand high proportions of women and children.The official statistics reported that almost 60% of adults living with HIV are women, and 75% of young people infected are girls (UNAIDS, 2012). Young women and adolescent girls of 15-24 group age aredrastically affected and infected. Globally, in 2015 there werean estimated 2.3 million adolescent girls and young women living with HIV, that constitute 60 per cent of all young people living with HIV (15-24).

In 2015, women represent 47 per cent of the 1.9 million new HIV infections. It is noticed that young persons aged 15-24 there is 58% of new HIV infections occurred among adolescent girls and young women in 2015(Unaids, 2015)

In sub-Saharan Africa, women comprised 56 per cent of new infections among adults (15 and older); and the proportion was higher among young women aged 15-24, who made up 66 per cent of new infections among young people. Women are more vulnerable and more exposed to HIV/AIDS than men (Rwenge, 2002). The biological make-up of the female genitalia coupled with the gender/structural constraints within which sex takes place thus exposes sexually active women to contracting the disease more than their male counterparts. because of (WHO, 1999). In fact, some studies found strong and consistent relationships between poverty economic insecurity and multiple high risk sexual behaviors among women (Phaladze & Weiser, 2007).

Sexual activities during adolescence have been characterized as dynamic and constantly changing, with potential impact on reproductive life and a 5.8% increase in fertility rates in the 15-to-19-year age group observed in Ivory Coast from 1994 to 2012. Another important health dimension relates to the increased susceptibility to HIV transmission when such activities are unprotected or performed under coercion.

Ivory Coast is the one of the most contaminated country of west Africa. With a rate of 3.7% in 2012 to 2.7% in 2014 (UNAIDS, 2015). HIV rates have fallen from 14 to 12, 4.7% in 2005 in 2014 is 3.2%. despite a slight improvement of HIV rate, AIDS is still the main cause of death in west Africa. The national report of Côte d'Ivoire aboutAIDS published in 2008 shows that the prevalence of AIDS varies among age groups, gradually increasing by about 1% in the 15 to 19 years to almost 14% in 30-34 years. There are different reasons thathave been advanced to explain this meteoric rise of HIV / AIDS within the Ivorian population in general and youth in particular. First ofall, the socioeconomic, socio cultural andinstitutional contexthas influenced young people live in a negative way on their attitudes about sexuality.

Although more than 93% of Ivorian's youths know that consistent condom use could prevent HIV infection (DHS, 2012), only 47% female youths used them at their previous high risk sexual encounters. This indicates a gap between knowledge and behaviors. Many Ivorian youths engage in risky sexual behaviors such as having unprotected sexual intercourse which may lead to sexually transmissible infections (STIs), including HIV/AIDS (Arcand & Wouabe, 2010; Kongnyuy et al., 2008; Mosoko et al., 2009). Despite the risks, consistent condom use has remained fairly low (Van Rossem and Meekers, 2000).

The explanation of this situation is caused by the poverty and misery whom face population in Côte d'Ivoire. As in most developing countries, young people, especially girls, are forced to sell their charms to survive. In Abidjan, prostitution is highly practiced so that it is become a society issue. Since the 90 where governments seem unable to limit the spread AIDS. Several studies showed argue that in the Ivorian capital, the rich and the middle class men display marital infidelity. For young people, multiple sexual partners andhaving multiple sexual partners is a phenomenon in fashion.It is very important to understand why some people use condomduring sexualintercourse and others not, request to take into consideration several parameters. It must take into account individual susceptibility and characteristics of the potential users, the context in which he lives, etc.

This study objective is to examine relevant factors associated with condom use amongadolescent girls in Ivory Coast.

Two specific objectives are addressed in this paper.

· Identify the profile of adolescent girls using condom

· Determine thepredictors influencing the high risk sexual behavior in Cote d'Ivoire

Synthetic literature review

This literature review presents the different explanatory approaches in relation to condom use in order to identify determinants of condom use. It is noticed that there is a deficiency in the explanatory approaches sexual behavior of women in African context. To do so, we present the differentapproaches to sexual behavior of young women and see their relevance in men.

The Socio-Cultural Approach

The cultural approach plays a central role in the social construction and cultural (Foucault, 1984, cited by Rwenge, 1991). Thus according to these authors, the circumstances in which occurs the sexual activity is a function of socio-cultural norms and values(ABEGA, 1999). Since they are dynamic it is important to highlight how they influence the sexual behavior of individuals in the traditional society.

According to the literature, the sociocultural approach about women is based on the socio-cultural norms and values ??of the individual and society in terms of sexuality. Sexual morals are not uniform in all the societies. The sexual behavior of women depends on the degree of permissiveness of social groups considered(Bah 1995). In permissive societies sexual mores and sexual behavior are reflected in the low importance given to virginity, encouragement of sexuality and adultery for men (Orubuloye et al., 1994, Caldwell et al. 1994 quoted by Rwenge, 2002). In societies where sexual morals are rigid women behave according to strict social control in sexual matters (BONGAARTS, 2000).

In these societies there are the abandonment of traditional values ??and conservative social standards, in favor of mores liberal attitudes. These often include an increase in sexual promiscuity due to decreased of social control. Urbanization appears as a cause of the reduction of social control of women's sexuality and behavior.(Bajos,2001)

Standards and socio-cultural values ??of the sexuality of men in traditional society. Traditionally, there exists a set of standards and more or less binding legal obligations that regulate sexual behavior(Caldwellet al. 1989). The sexual behavior of man depends on the traditional context. The sociocultural system model representations and directs individuals practices from the perspective of normative stability and maintenance of cultural models (Songue, 1994). Traditional African society is one where traditional norms and values ??have a strong influence on the behavior of individuals, or social control is the most important. Unlike women's sexuality, that of men is less controlled and less brigaded by the communities which they serve. A man is often accused of adultery in case of sexual intercourse with a married woman. (Tarkang, 2013). Furthermore, sexual experiences before marriage are more valued among men and infidelity is better tolerated. But the sexual mores are not uniform in all societies. In contrary, according to social groups considered, there is more or less significant differences, particularly in terms of their permissiveness (Rwenge, 2002).

Traditionally, there are societies with permissive sexual mores and other are non-permissive. In societies or are permissive sexual mores, the man has a great tolerance for premarital sexuality and fertility and tolerance of adultery (Orubuloye et al, 1994; Caldwell et al, 1994 cited by Rwenge 2002). By cons, in societies where sexual norms are not permissive, although undergoing a low social control than women, the sexual behavior of men are characterized by low promotion of premarital sex and adultery tolerance of man(Uchudi et al, 2010).. These situations lead to differences in the use of condoms. Traditionally, marriage and fertility have an important social value (Muula 2011). These two phenomena are social norms. It also important to point out that in traditional society, marriage main objective is a social obligation which no man and women can escape. If not no man has no right to dispose of his wife's body. The sexual act is considered in the African context, as a conjugal duty that every woman should do. So to enable it to achieve its desired goal of fertility, the company him, attaches great sexual freedom (Rwenge, 2002) considering the fact that the goal of sex is fertility, so all decisions on sexuality are held by men. In such circumstances all voluntary contraception methods (condoms, for example) are banned. In these societies, we see more and more to an upset conservative social norms, for more liberal attitudes (Uchudi, 2010). These often include increased individual liberty corollary of social control reduction.

Standards and socio-cultural values ??of men's sexuality in modern society. The reduction of social control would be caused in part by urbanization and modernization. This is accompanied not only an ethnic, cultural and social with the anonymity of individuals but also of family control over the sexuality of young people (Mekers, 1991). Thus attitudes toward sexuality are much more permissive in urban and semi-urban. The degradation of morals values and mores consecutive to the abandonment of traditional values ?? (due to modernism) would encourage and increase women risk sexual behavior. To explain the evolution of sexuality, we focus to the loosening of social control paradigm of "social disorganization".

The relaxation of social controls on sexuality, due to urbanization, sex education and changes in modes of production in African societies not only increased decision-making power of men to rigid sexual morals but also young people have the capacityof decision-making power of men to rigid sexual mores but also young people who have decision-making capacity on when, with whom and why getting sex (Mekers 1991a).This social disorganization of sociocultural mores on sexuality has led women to certain Western practices, including sexual libertinism shown by multiple partners, casual sex leading to the spread of STI/AIDS. They appear as the villages are beginning to be affected by the change of lifestyle. The fact that people living in cities come to visit the village playing an important role in the rural spread of new practices (Balde, 2003). It isin the sense that Rwenge (2002) attributes the change in the vision of the meaning of sex in modern society where the main objective of this activity is reflected in modern society by the unbridled pursuit of sexual pleasure. Much importance is given here in the sexual performance of man passes. The gender issues are no longer taboo and premarital sex becomes a common practice considered normal and sexual inexperience show damaging failure (Ngondo, 1994; Njikam, 1998; Songue 1998; Evina, 1998).

Christian religions have also contributed to the destabilization of African traditions. (Gugler, 1981). The dynamics of sexual behavior is explained by many researches as a consequence of the accession of individuals in Western religion, modernization factors and the urban economy. Moreover, the consideration of marriage and fertility has changed. Marriage is becoming less and less a social control strategy in fertility (Kaplan, 2001). Theseresults are expressed through divorces, separations between spouses. The fundamental purpose of marriage is no longer so tied to fertility effect this marriage is gradually losing its importance as a social institution. So, infidelity is become a common practice even in societies with rigid sexual mores that marriage devaluation is a manifestation of little interest that African societies are paying increasingly high fertility (Ibara, 2008).Therefore, sexuality objective is not more essentially fertility, but forsexual satisfaction. Such consideration given to the sexuality of women determines their attitude to modern contraceptive methods and sexual risk behaviors(Rwenge 2002). Therefore, the sexual risk behaviors are amplified. Despite the mostly urban population experiencing STI / AIDS and it is the mode of transmission, the rate of condom use is low (Caldwell, 2000). Thus, this approach argues that modern values ??in marriage and fertility rates in Africa also contribute to the attitudes and behavior of individuals on contraception and thus condom (Carlos Mendes 2009).

The socio-cultural approach is based on the value placed on sexuality to highlight the factors that explain the use of condoms as the context of traditional society and the context of modern society in this case traditional society where sexuality a reproductive purpose, it is considered as ataboo (Caldwell, 1989). The condom is a contraceptive method goes against the aspiration of many people. So, in such societies the sexual mores are in favor of condom use. There is a change in sexual behavior of individuals due to an erosion of standards and socio-cultural values ?? (Meekers, 1993; CERPOD, 1996; Rwenge, 1999; Delauny et al. 2001) and causing social disorganization and a crumbling sexual mores often unfavorable to prevention behaviors. However, the socio-economic approach helps explain the sexual behavior of men and women associated with condom use factors.

Socioeconomic Approach

This approach is based on the relationship between personality and the adoption of healthy sexual behavior that approach considers individuals as rational actors. This approach is thus based on the thesis of "wise adaptation" that women would engage in sex to achieve well-defined goals, specific economic or social difficulties.

As the study of the sexual behavior of men is recent, we will present the content of the studies in women and then examine their relevance in men. In women, sexual behavior depends on their socioeconomic status. Material dependence of women to men because they have multiple sexual partners and lack the power to control their sexual behavior(Kaltsam, 2008). Similarly, economic constraints mean that girls have sex with older men and thus more likely to have STIs / AIDS. Furthermore, an educated woman can challenge the internalized representations of gender roles. That situation can have a great mastery over his sex life and effectively negotiate the terms of the relationships in which they engage (Rwenge, 2002).

The human level, socio-economic approaches is based on two assumptions; the assumption of economic rationality and the economic constraints. Two categories of men who get sex can be distinguished: (1) those for whom sexual activity meets both an economic purpose and is a marriage strategy (Cherlin &Riley 1986 quoted by Rwenge, 2002). In the first case, found mostly young boys contracting the profit reports. This is the marketing phenomenon by young girls who want to earn money necessary to meet their needs. The economic conditions of women may also influence on their sexual behavior. These young people are usually victims of sexual services of old men or engage them in casual sex because of the poverty of their families(Dedy, 1995). However, in case of favorable economic situation, some of them may engage in multiple partnerships. In consequence, they enjoy the material difficulties of some young girls to satisfy their sexual desires maximum. In the case of economic difficult situation, many young women tend to engage intensively in sexual relationships and even get into prostitution(Baral, 2012).

In the second case, the sexuality of women is an economic objective than asocial purpose (Rwenge 1999). The purpose of sexual activity can also be fertility. This being a necessary strategy is the culmination of marriage. Studies have shown that this trend is much more pronounced among young people in urban areas where the monetization of sex is amplified and current (Calvès, 1996).

In addition, men who have a higher socioeconomic status and those with a higher socioeconomic status allows these men to have multiple sexual partners with old men. Thus,they take advantage of that status supplies to meet their maximum sexual desire. In such a context. The man is needed in the way of doing sex with these partners. Condom use often returns to man alone, since the woman has a low condom negotiation power (Rwengé, 2002).

Institutional Approach.

As the institutional approach is characterized by a deficiency, it will be presented the content of this approach in terms of sexual behavior among women and then examine their relevance in men. The institutional approach in women is one that gives great importance to policy, program and legislation on sexuality and marriage in sexual behavior explaining of women.

In general, public policy, attitude and involvement of authorities in the fight against STDs and AIDS can affect the spread of these diseases in the population. These policies can allow the adoption of safer sexual behavior prevention through condom availability and favorable preventive information to improve sexual behavior of women (Rwenge 1999 b). Unfortunately, in many African countries, few STI prevention programs for a change in sexual behavior. Moreover, if prostitution is in many countries represent a phenomenon reducing the efforts of the fight against STDs and AIDS, it should be noted the strategies implemented by some governments for better control of this activity. In Senegal, for example, prostitution islegalized for people over 20 years. One advantage is related to the legalization of prostitutionactivities in Senegal where condoms are freelydistributed to prostitutes in STI centers (United Nations, 1992). Regarding the marriage, in many African countries, the marriage of women is regulated by texts on the organization of civil status and various provisions relating to the physical condition of those people remains the "customary" (Rwenge 1999). In Cameroon the age of consent is 15 years for girls, while in Togo, that age is 18 years.

The adoption of healthy sexual behavior is keen to legal and political contexts, as well as the availability of condoms and prevention information (Rwenge ,2002). For example, cooperation between government and grassroots organizations, to that change some certain sexual standards, can lead to the improvement of the sexual behavior of men and particularly of women. It is the same for the implementation of information dissemination systems, means of prevention of STI / AIDS among women and campaigns to systematic use of condoms in risky sex.

Given that in modern societies the traditional considerations of the child are not observed, people have a real desire to reduce their fertility, among others by using condoms. In the same company's individuals have a high level of knowledge of HIV / ADS, modes of transmission, etc. But condom use rates are low. It's that there are institutional factors affecting the accessibility, the quality of services of reproductive health. The real problem is the psychosocial level regarding awareness of the risk association with sexuality. The Information Education and Communication via the media does not convey messages emphasizing the perceived risk of infection. And the level of service quality of the RH, the level of information. It is not often adapted and more women are often overlooked during awareness campaigns. (Dodo, 2003)

Governments are often helped in the fight against STI / AIDS by religious institutions, especially in the moralization of manners, for example by advocating monogamy (in the case of Christian institutions), fidelity or abstinence. But the "dogmatic" position of religions is not without creating difficulties for NAP (National Program for the Fight against AIDS) that being engaged in the field of condoms, in open contradiction with religious messages, sometimes causing confusion among the recipients (Beat S., 1993; Dozon 1994).

With the marriage rate among men in many African countries, new legislation codifying the family organization were adopted in the years following independence. Some like Guinea in 1962 and Ivory Coast in 1964, forbade polygamy (Thirat,2000). On the other have chosen a compromise between Western and African traditions legislation. Thus, the family codes of Cameroon and Congo, for example, allow a choice in a marriage contract between a union weakness to be only little apply, among other things because the marriages registered with the civil state remains low numerous. In Côte d'Ivoire and Guinea, the abolition of polygamy did not stop the practice: according to the 1994 DHS and the first 1998 of the second 30% and 54% of married women living in polygamous union (Ivory coast 1995, Guinea, 2000). Finally, the marriage of adolescents is regulated in most countries by various text and law. In Cameroon, as in the Ivory Coast official marriage is 18 years(Sylla, 2002).

In summary, the sociocultural, economical and institutional approaches have influences on women sexuality in term of high sexual risk behavior.

Method

The data for this study come from Demographic and Health Survey (DHS)

conducted in 2012 in Ivory Coast. The access to these data has been authorized by ORCMacro, an organization based in the United States.

The survey was conducted among 10060women (8,109 men and 1,577 women)

aged between 15 and 49 years. The ORC Macro uses stratified sampling in order to provide adequate representation of environments urban and rural.

In this study, we limited our sample to women whose age ranges between 15 and 19 and who are mostat risk for infection with STIs HIV/AIDS included. This gives us a sample of 2124 people. We will use the behavioral model developed in 1968 by Ronald Andersen study the determinants of the use of condoms among adolescent girls in Côte d'Ivoire (Figure 1).

Under this model, the use of condom takes place:

1. The individual must be predisposed to accept the condom,

2. Certain conditions are necessary to facilitate its use and,

3. The individual must feel the need to use the condom.

In summary, facilitators factors, predisposing factors and factors ofneed are used to achieve condom use.

Data analysis

Data Analysis Data were analyzed using the software SAS 9.2 Windows [16, 17]. Univariate descriptive were used to inspect the distribution of frequencies.Par Thereafter, bivariate analyzesallow us to evaluate the association betweenevery independentand condom use. The chi-square test with a significance level of 5%, odds Ratio (OR) and a95% confidence interval were used to examine the magnitude and degree of significance between the main dependent value and each independent variable. For the final modeling, multivariate logistic regression was used based on the behavioral model of Andersen for the inclusion of explanatory variables. Three models were estimated. First, we have introduced only the predisposing variables in the second model, we added the facilitating variables. The latest model includes all three groups of variables (predisposing, facilitative and needs).

Figure1: Conceptual Diagram of the analysis of determinant

Predisposing factors

Multiple partnership

Condom prevent HIV

Risk perception

Having STI

Getting AIDS by Witchcraft

Facilitating factors

Religion

Matrimonial status

Education

Household wealth

Employment status

Predisposing factors

Age

Place of residency

Region

Cultural model of sexuality and fertility

Contraceptive method

Condom use

Principal dependent Variable

The dependent variable is condom use occurred during the last sexual intercourse whatever casual or regular. The variable is dichotomous and the responses are 1 for «yes» or 0 for «No» or «don't know»

Independent variable

The independent variables are constituted of predisposing factors, facilitating factors and the need factors

Results

Table 2:Sociodemographics Characteristics andbehavioral of respondents

Variables

Frequency (n)

Proportion (%) of adolescent girls aged 15 to 19, who reported using condom

Probability of CHI2

Predisposing factors

 
 
 

Region

Centre

North

West

South

Abidjan

105

87

59

50

56

34.88

31.64

27.83

24.39

42.75

0.004***

Facilitating factors

 
 
 

Religion

Muslim

Christian

Animist

Total

118

214

25

357

27.25

39.85

16.23

31.76

0.000***

Matrimonial status

Married

Single

21

336

5.50

45.28

0.000***

Place of residence

Urban

Rural

248

109

44.93

19.06

0.000***

Education level

No education

Primary

Secondary

Total

64

94

199

357

13.64

30.62

57.35

31.76

0.000***

Occupation

Working

No working

201

156

36.28

27.37

0.001***

Household Wealth

Poor

Middle

Rich

72

63

222

17.43

27.27

46.25

0.000***

Condom reduce risk of HIV

No

Yes

85

267

23.48

39.50

0.000***

Multiple partnership

No

Yes

328

29

31.66

32.95

0.000***

Had Sexually transmissible disease

No

Yes

707

60

31.23

37.50

0.207

Get HIV by Witchcraft

No

Yes

231

340

40.03

26.25

0.000***

Tested for HIV

No

Yes

578

189

29.68

37.42

0.014

Contraception use

No

Yes

95

201

12.39

56.30

0.000***

***: Significant to á=0.01

**: Significant to á=0.05

Almost all the variables have a strong relationship with the use of condom. Except the variable of having STI, the fact that the respondent got a Sexually Transmitted Disease (STD).

The Region is statistically significant linked with the condom of girls at 1% with a p-value of 0.004 Centreregion have 34.88 respondent reported to use condom with their partners. In the North, 31.64% of adolescent girls use condom and 27.83% for the West region use condom. There is 24.39% of the participants in the South Regionusing condom and participant living in Abidjan (the capitol) are 42.75% to use condom.There is a strong significant relationship between the religion and the condom use at 1% (p-value =0.000). Adolescent girls who are Muslim constitute 27.25% using condom. 39.85% of participants are Christians using condom. The animist is 31.76% using condom.The matrimonial status is statistically significant with the condom use (p=0.000) at 1%. The participant who are married represent 5.50% using condom and those who are single are 45.28% using condom during sexual intercourse.The place of residence is statically significant with the adolescent girls' condom use (p=0.000) at 1%. Young girls with no education represent 13.64% who reported using condom with their partner. For the primary education level, 30.62% use condom. The secondary and plus represent 57.35% of respondents using condom.

Employment status is statistically significant with the condom use at 1% (p=0.001). the participants who are working are 36.28% using condom and those who are not working are 27.37% using condom.Household wealth is statistically significant with the condom use of adolescent girls at 1% (p=0.000). Poor women use less condom with 17.43% of respondents. In contrary the percentage of condom use increases with the education level. In fact, 27.27% of primary education use condom and 46.25% of secondary and plus use condom.

Condom reduce risk of HIV is statically significant with the condom use at 1% (p=0.000). In fact, 23.48% of participant reported that condom does not reducesHIV and 39.50 % think that condom is do reduces the riskof HIV. There is a strong relationship between the multiple sexual partnership and the condom use at 1% (p=0.000). There is 31.66% of participants in who are not involved in multiple sexual behaviors and those involved in multiple sexual behaviors are 32.95% using condom during sexual intercourses.The fact of having Sexually Transmitted Infection during the last 12 months is not significantly associated with the condom use of adolescent girls (p value =0.207).

There is a strong association between the getting HIV bywitchcraft at 1% (p=0.000). Infact,adolescent girls represent40.03% whoreported HIVcannot be got through witchcraft use compared to 26.25% who answered that HIV can be got by witchcraft use condom.There is an association condomuse with HIV test is statically significant at 5% (0.014). participants who had not ever been tested are 29.68% using condom while those who had ever been tested represent 37.42% using condom.The contraceptive use is statistically associated with condom use of adolescent girls at 1% (p=0.000). For this variable 12.39% reporting not using contraceptive method use condom and there is a proportion of 56.30% who use contraceptive method are currently involved in use condom.

Bivariate association

Table 2: Bivariate analysis to assess the association of the sociodemographic and behavioral and condom use

Variables

O.R

95% I.C.

P value

Predisposing factors

 
 
 

Place of residence

Urban

Rural

3.46

1.00

2.65-4.53

0.000***

Region

Centre

North

West

South

Abidjan

1.00

0.86

0.72

0.60

1.39

0.61-1.22

0.49-1.05

0.40-0.90

0.92-2.12

0.0043***

Facilitating factors

 
 
 

Religion

Muslim

Christian

Animist

Total

1.93

3.42

1.00

1.20-3.12

2.15-5.43

0.000***

Matrimonial status

Married

Single

1.00

14.22

8.95-22.60

0.000***

Education level

No education

Primary

Secondary

Total

1.00

2.80

8.53

1.96-4.01

6.08-11.97

0.000***

Occupation

No Working

Working

1.51

1.00

1.17-1.95

0.0013***

Household Wealth

Poor

Middle

Rich

1.00

1.77

4.08

1.21-2.61

2.99-5.56

0.000***

Factors of Needs

 
 
 

Condom reduce risk of HIV

No

Yes

1.00

2.13

1.60-1.84

0.000***

Multiple partnership

No

Yes

1.00

1.06

0.67-1.69

0.802

Risk perception

No

Yes

1.00

3.34

2.24-4.98

0.000

Had STI

No

Yes

1.00

1.32

 

0.2126

Get HIV by Witchcraft

No

Yes

1.00

0.53

0.41-0.70

0.000***

Tested for HIV

No

Yes

1.00

1.42

1.07-1.87

0.0144**

Contraception use

No

Yes

1.00

9.11

6.73-12.30

0.000***

The results show that allthe independent variables are associated with the condom use except ever had STI variable.

Adolescent girls from the North region have 0.86 times less likely to use condom compared to those from Centre. Those coming from West have 0.72 times less likely to use condom compare to those from Centre. Adolescent from the South are 0.60 times less likely than those from the Centre. Girls from Abidjan have 1.39 times more likely to use condom compared to those from the Centre. Adolescent of urban zone are 3.46 times to use condom (p=0.000). For the religion, Muslim are 1.93 times more likely and Christians have 3.452 timesmore likely to use condom compared to animist. For the marital status, adolescent girls who are single have 14.22 times more likely to use condom compared to singleadolescent girls during sexual intercourse with their partners.

The odds ratio increases with the education level. In fact, girls with and primary and those with second&plus and plus education level are respectively 2.80 and 8.53 times more likely to use condom compared to those with no education level.Employment status, is significantly associated with the condom use. In fact, girls who don't work have 1.51 timeslikely to use condom compared to those who don't work.The fact of using condom is function with the wealth. Women in the middle are 1.77 times more likely using condom than those who are poor and the rich are 4.08 times likely to use condom than the poor.

Girls who reported that condom can reduce HIV are 2.13 time likely to use condom than those who reported the negative. But for the multiple sexual behavior there is significant difference with the condom use. In fact, adolescent girls who are involved in multiple sexual behavior are 1.06 times more likely to use condom than those who are not. The risk perception showsa significant difference for the condom use at 1%. Girls are 3.34 timemore likely to use condom than those who don't have any risk perception.Girls supposing the AIDS can bet got by witchcraft are 0.53 times less likely to use condom than those stated the contrary.Adolescent girls using condom are 9.11 times more likely to use condom compared to those who do not use any contraceptive method. But the variable of tested of HIV is not statistically different.

Multivariate association

Table 3. Multiple regression logisticof adolescent use of condom

 
 
 

Model1

Model2

Model3

Variables

Bivariate

 

OR

95% I.C.

OR

95% I.C.

OR

95% I.C.

Predisposing factors

 
 
 
 
 
 
 
 

Place of residence

Urban

Rural

3.46

1.00

 

3.50***

1.00

2.63-4.65

1.10

1.00

0.68-1.80

1.03

1.00

0.63-1.71

Region

Centre

North

West

South

Abidjan

1.00

0.86

0.72

0.60

1.39

 

1.00

1.01

0.82

0.72

0.81

0.70-1.45

0.55-1.23

0.47-1.09

0.52-1.26

1.00

1.21

1.19

0.74

0.76

0.80-1.85

0.75-1.88

0.46-1.16

0.46-1.26

1.00

1.19

1.22

0.70

0.75

0.76-1.84

0.76-1.96

0.44-1.11

0.45-1.24

Facilitating factors

 
 
 
 
 
 
 
 

Religion

Muslim

Christian

Animist

1.93

3.42

1.00

 
 
 

1.73

1.66

1.00

0.99-3.02

0.97-2.83

1.52

1.47

1.00

0.85-2.71

0.85-2.56

Matrimonial status

Married

Single

1.00

14.22

 
 
 

1.00

9.03***

5.50-14.8

1.00

9.16***

5.47-15.34

Education level

No education

Primary

Secondary

1.00

2.80

8.53

 
 
 

1.00

1.91***

3.54***

1.28-2.85

2.34-5.35

1.00

1.84***

3.16***

1.21-2.80

2.04-4.88

Occupation

No Working

Working

1.51

1.00

 
 
 

0.96

1.00

0.70-1.31

0.95

1.00

0.69-1.32

Household Wealth

Poor

Middle

Rich

1.00

1.77

4.08

 
 
 

1.00

1.31

2.61***

0.78-2.21

1.52-4.47

1.00

1.38

2.68

0.80-2.38

1.54-4.68

Factors of Needs

 
 
 
 
 
 
 
 

Condom reduce risk of HIV

No

Yes

1.00

2.13

 
 
 
 
 

1.00

1.51**

1.08-2.12

Multiple partnership

No

Yes

1.00

1.06

 
 
 
 
 

1.00

0.55**

0.32-0.92

Risk perception

No

Yes

1.00

3.34

 
 
 
 
 

1.00

1.01

0.61-1.66

Had STI

No

Yes

1.00

1.32

 
 
 
 
 

1.00

0.94

0.57-1.58

Get HIV by Witchcraft

No

Yes

1.00

0.53

 
 
 
 
 

1.00

0.85

0.62-1.72

Tested for HIV

No

Yes

1.00

1.42

 
 
 
 
 

1.00

1.05

0.74-1.48

Contraception use

No

Yes

1.00

9.11

 
 
 
 
 

1.00

5.71***

3.98-8.20

The results of table 3 show the final model of the condom using among the adolescent girls after adjusting for all the variables. The model 1 present the predisposing factors without the influences of the others types of factors. The place of residence is statistically significant at 1%. In fact, adolescent girls from urban zone are 3.50 times more likely to condom compared to those from the rural zone.

In the model 2, the matrimonial status, the education level and the household wealth are statistically significant. These variablesshow significant differences for the condom use. Single young girls are9.16 times more likely to use condom. Adolescent girls with primary education level are 1.84 times more likely to use condom compared to those with no education. those with secondary and plus education level are 3.16 times more likely to use condom.Even if the religion does not have influence but it is very important to reveal its influence in African socio cultural context of HIV spread. The Christian religion is spread everywhere almost in urban. This religion vehicles eastern and modern values and education. Thus, in urban area, the traditional, cultural values and values of sexuality are less severe and with a certain degree of freedom contrary in rural area the traditional values and norms in term of sexuality. That situation is an explanation of thefact that young girls are more likely to use condom in opposition to the those of rural zones.

In the model 3, the matrimonial status, the education level and the household wealth are statistically significant. These variables show significant differences for the condom use. Single young girls are 9.03 times more likely to use condom (p=0.000). Adolescent girls with primary education level are 1.91 times more likely to use condom compared to those with no education. those with secondary and plus education level are 3.54 times more likely to use condom. For the factors of needs The fact that the condom can reduce the HIV is statistically significant. Indeed, adolescent are 1.51 times more likely to use condom during sexual intercourses. Young girls involved in multiple sexual behavior are 0.55 times less likely to use condom. Also, adolescent girls using contraceptive method are 5.71 times more likely to use condom than those who do not use condom.

Discussion

The main predictors from the multiple regression, are place of residence, matrimonial status, education level, the fact that Condon reduce HIV risk and the multiple sexual behavior and the contraceptive method condom use.

The variable place of residence which is significant in the model1 becomenon-significant in the model 2. The adjusting for the facilitating variables make disappear the influence of the predisposing factors such as place of residency. In the urban place of residence,adolescent girls are exposed to the massmedia (TV, radio,etc.). The sensitive campaigns are more frequent than in the rural zone. In fact, in urban zone the presence of health facilities, reproductive health services and HIV/ AIDS care Programs, screening test where counsels are given to people. Thus they have access more to the family planning services. Thus girls of the urban area benefitsof important sensitive and awareness campaign. This results showed there are gaps between urban andrural zone in terms of HIV /AIDS intervention and programs.The place of residence may discriminate through the employment status where people work in intellectual area and women got an education level are able to negotiate the condom use with their partner during the sexual intercourses.

In the model2, the facilitating factors such as matrimonial status, education and household wealth are the main predictors. The propensity increases with the education level. The girls with primary and secondary and plus are more likely to use condom. Several studies have shown the same results (Rwenge, 2002; Dodo, 2003). The same for the marital status. In fact, single women are more likely to use condom than those who are married. Many researchers found out the same outcomes.The fact that women living in cities got good education level facilitate conduct to adopt preventive behavior. The low condom for education is caused bythe factthat many of these women work in rural area where there is not enough health infrastructures and family planning program. Also women are nor exposed to media (Television, radio, magazine,Newsweek).Household wealth represents a main predictor. Women oh rich household are more likely to use condom.

The introduction of factors of needs maintain the action of facilitating action from model 2 to the final model (model3).For the factors of needs, multiple sexual behavior and the fact that condom prevent HIV are main predictors. Many results are shown from many studies. In fact, condom is used a double protection for a contraceptive and HIV/AIDS.The risk perception can be explained by the spread of the disease in the communities. Almost people gotfriends,relatives or colleagues suffering or dead of HIV/AIDS. The fact that women using contraceptive have a high propensity to use condom is due to the fact that condom is used for it double protection against unintended pregnancies and HIV/AIDS at the same time.

These young women are student and the condom is a contraceptive method to avoid unintended pregnancies. Women living in rural zone are often excluded of awarenesscampaign about HIV/AIDS. Traditional sexual norms values mores and fertility are highly and anchored in mentality and collective unconscious and mores. The perception of traditional value of children is still present in mentality and in mores. People are living in natality environment. People want to get many children because children represent a wealth in term of workforce to work in farms and contraceptive method to limit the number of children is poorly perceived. The condom use in traditional area is poorly viewed in conservative norms. In addition, those living in rural zone think that they don't have high risk to be contaminated by HIV are not exposed enough to the risk. This variable influence directly the condom use. The variable is a pertinent predictor because manyfactors action for condom use pass through that variable.

Study limitations

The study has taken place during post electoral crisis in Cote d'Ivoire. Therefore, this situation can be factor of bias. For the case of HIV/AIDS it is very important to set up a qualitative study in order to understand the socio economic, psychological and anthropologic, culture influence on HIV spread in Africa context. In addition, because most of the items in the questionnaire elicit self-reported information on sensitive issues such as condom use and HIV/AIDS, the respondent might have been bias in responding to these items. However, assurance of confidentiality and anonymity might have minimized this problem.

The lack of qualitative survey overshadows the research because, the qualitative study gives a better understanding of and comprehension of the high risk sexual behavior in terms of the non-use of condom and the multiple sexual behavior and the relationship with the social norms, values and stereotype. Many answers may be double with bias because of the factthat sexuality is still taboo in many African society, so people don't give real information concerning condom use.

Recommendations

· It will be high appreciated if awareness campaign be focused on abstainingfrom sexualintercourse for young men and adolescent girls. Adolescent shouldbe encouraged and counselled in order to prevent STDs, including HIV infection, and pregnancy. Adolescents who have been sexually active previously should also be counseled regarding the benefits of postponing future sexual relationships.

· It must be encouraged the double protection of condom for contraception and against HIV/AIDS are urged to actively support and encourage the correct and consistent use of reliable contraception and condoms by adolescents who are sexually active or contemplating sexual activity. The responsibility of males as well as females in preventing unwanted pregnancies and STDs should be emphasized.

· Decision makers must be actively involved all the community leaders in all the HIV/AIDS mostly the religious leaders in order to adapt their religious law for sexuality to the reality of the situation

· In the interest of public health, restrictions and barriers to condom availability should be removed.

· It is very useful to activate the school committee to fight HIV/AIDS in every Schools I order to decrease rates of unintended pregnancy and acquisition of STDs and HIV infection.

· Should be considered appropriate sites for the availability of condoms, because they contain large adolescent populations and may potentially provide a comprehensive array of related educational and health care resources.

· To be most effective, condom availability programs should be developed through a collaborative community process and accompanied by comprehensive sequential sexuality education, with parental involvement, counseling, and positive peer support.

· It is urge to encourage research focus on qualitative method in order to increase consistent condom use by sexually active adolescents. These researchesmust evaluate andenhance effectiveness of strategies to promote condom use, through condom education information and communication of behavioral change.

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