Barriers to acceptance of personal digital assistants for HIV/AIDS data collection in Angola.

PURPOSE: Handheld computers have potential to improve HIV/AIDS programs in healthcare settings in low-resource countries, by improving the speed and accuracy of collecting data. However, the acceptability of the technology (i.e., user attitude and reaction) is critical for its successful implementation. Acceptability is particularly critical for HIV/AIDS behavioral data, as it depends on respondents giving accurate information about a highly sensitive topic - sexual behavior. METHODS: To explore the acceptability of handheld computers for HIV/AIDS data collection and to identify potential barriers to acceptance, five focus groups of 8-10 participants each were conducted in Luanda, Angola. Facilitators presented Palm Tungsten E handhelds to the focus groups, probed participants' perceptions of the handheld computer, and asked how they felt about disclosing intimate sexual behavior to an interviewer using a handheld computer. Discussions were conducted in Portuguese, the official language of Angola, and audio-taped. They were then transcribed and translated into English for analysis. RESULTS: In total, 49 people participated in the focus groups. PDAs were understood through the lens of social and cultural beliefs. Themes that emerged were suspicion of outsiders, concern with longevity, views on progress and development, and concern about social status. CONCLUSIONS: The findings from this study suggest that personal and cultural beliefs influence participant acceptance of PDAs in Angola. While PDAs provide great advantages in terms of speed and efficiency of data collection, these barriers, if left unaddressed, may lead to biased reporting of HIV/AIDS risk data. An understanding of the barriers and why they are relevant in Angola may help researchers and practitioners to reduce the impact of these barriers on HIV/AIDS data collection.

Evaluation of a prevention intervention to reduce HIV Risk among Angolan soldiers.

We developed and evaluated a military-focused HIV prevention intervention to enhance HIV risk-reduction knowledge, motivation, and behaviors among Angolan soldiers. Twelve bases were randomly assigned to HIV prevention or control conditions, yielding 568 participants. HIV prevention participants received training in preventing HIV (4.5 days) and malaria (0.5 days). Control participants received the reverse. Monthly booster sessions were available after each intervention. We assessed participants at baseline, 3 and 6 months after the training. HIV prevention participants reported greater condom use and less unprotected anal sex at 3 months, as well as greater HIV-related knowledge and perceived vulnerability at 3 and 6 months. Within-group analyses showed HIV prevention participants increased condom use, reduced unprotected vaginal sex, and reduced numbers of partners at both follow-ups, while control participants improved on some outcomes at 3 months only. A military-focused HIV prevention intervention may increase HIV-related knowledge, motivation, and risk reduction among African soldiers.

HIV/AIDS behavioral surveillance among Angolan military men.

To assess HIV-related risk behavior among military men in a post-conflict sub-Saharan African country with low HIV prevalence this study evaluated sexual risk taking and related behaviors among a stratified random sample of 1,710 military personnel in four regions of Angola. Over 90% were sexually active and 60% had two or more sexual partners within the past year. Condom use varied depending on partner type, from a low of 10% to a high of 54%. Factors independently predicting the number of sexual partners included younger age, younger age of sexual debut, being away from home, being in the eastern part of the country, higher military rank, higher education, alcohol before sex, and problem alcohol use. Independent predictors of sexually transmitted infection symptoms included age of sexual debut, lower education, higher rank, and having had sex with a casual partner or a commercial sex worker in the previous 12 months. These findings indicate high rates of HIV risk-taking behaviors among military personnel and the need for aggressive prevention campaigns to reduce HIV risk among military personnel and the populations they serve.