Male Participation in Reproductive Health Interventions in Sub-Saharan Africa: A Scoping Review.

CONTEXT: Despite improvements in reproductive health indicators among women living in Sub-Saharan Africa, the persistence of poor outcomes underscores the need to examine recent interventions to inform future research, programming and policy. Because men in this context have an outsize role in reproductive decision making, assessing their involvement in reproductive health programs is an important step in meeting men's needs, supporting women's health and improving family health. METHODS: A scoping review was conducted to identify relevant literature and assess evidence of the impact of male involvement in reproductive health interventions. Seven databases were searched using terms related to male involvement and reproductive health; searches were limited to research conducted in Sub-Saharan Africa and published in English between 2007 and 2018. Remaining studies were assessed by participant characteristics, settings, research design, theoretical frameworks, outcome measures and findings. RESULTS: Searches identified 18 studies conducted in eight countries. Interventions engaged participants by using such strategies as community health workers, written invitation, peers, community or religious leaders and media campaigns. Results show that men are willing to participate in reproductive health programs and that their involvement is associated with increased uptake of family planning services, and HIV counseling and testing; reduction in risk behaviors; and improved maternal health and spousal communication. CONCLUSIONS: Given the findings that male involvement is positively associated with improved reproductive health outcomes in Sub-Saharan Africa, health providers and program planners should consider including men in reproductive health interventions, when feasible.

RESUMEN Contexto: A pesar de las mejoras observadas en los indicadores de salud reproductiva en las mujeres que viven en África subsahariana, la persistencia de malos resultados subraya la necesidad de examinar intervenciones recientes para sustentar futuras investigaciones, programas y políticas. Debido a que los hombres en este contexto tienen un papel enorme en la toma de decisiones reproductivas, evaluar su participación en los programas de salud reproductiva es un paso importante para responder a las necesidades de los hombres, apoyar la salud de las mujeres y mejorar la salud familiar. Métodos: Se realizó una revisión de alcance para identificar bibliografía relevante y evaluar la evidencia del impacto de la participación masculina en las intervenciones de salud reproductiva. Se realizaron búsquedas en siete bases de datos utilizando términos relacionados con la participación masculina y la salud reproductiva; las búsquedas se limitaron a investigaciones realizadas en África subsahariana y que fueron publicadas en inglés entre 2007 y 2018. Los estudios restantes se evaluaron según las características de los participantes, los entornos, el diseño de la investigación, los marcos teóricos, las medidas de resultado y los hallazgos. Resultados: Las búsquedas identificaron 18 estudios conducidos en ocho países. Las intervenciones involucraron a los participantes mediante estrategias tales como la labor de trabajadores de salud comunitarios, invitaciones por escrito, interacción con pares, líderes comunitarios o religiosos y campañas en los medios. Los resultados muestran que los hombres están dispuestos a participar en programas de salud reproductiva y que su participación está asociada con una mayor aceptación de los servicios de planificación familiar, así como de consejería y pruebas de VIH, reducción de comportamientos de riesgo, y mejor salud materna y comunicación conyugal. Conclusiones: Con base en los hallazgos que indican que la participación masculina se asocia positivamente con mejores resultados de salud reproductiva en el África subsahariana, los proveedores de servicios de salud y los planificadores de programas deberían considerar incluir a los hombres en las intervenciones de salud reproductiva cuando sea posible.

RÉSUMÉ Contexte: Malgré l'amélioration des indicateurs de santé reproductive chez les femmes d'Afrique subsaharienne, la persistance de résultats défavorables souligne la nécessité d'examiner les interventions récentes en vue d'éclairer la recherche, la programmation et les politiques futures. Étant donné, dans ce contexte, l'immense rôle des hommes dans les décisions ayant trait à la reproduction, l'évaluation de leur participation aux programmes de santé reproductive représente une étape importante en termes de réponse aux besoins des hommes, de soutien de la santé des femmes et d'amélioration de la santé des familles. Méthodes: Un examen de portée a été effectué pour identifier la littérature pertinente et évaluer les signes de l'impact de la participation masculine aux interventions de santé reproductive. La recherche a été menée dans sept bases de données au moyen de termes associés à la participation masculine et à la santé reproductive; elle s'est limitée aux études effectuées en Afrique subsaharienne et publiées en anglais entre 2007 et 2018. Les études restantes ont été évaluées d'après les caractéristiques des participants, les contextes, le plan de recherche, les cadres théoriques, les mesures de résultat et les observations. Résultats: La recherche a identifé 18 études menées dans huit pays. Les interventions engageaient les participants au moyen de stratégies recourant, notamment, aux agents de santé communautaire, aux invitations écrites, aux pairs, aux dirigeants communautaires ou religieux et aux campagnes médiatiques. Les résultats montrent que les hommes sont disposés à participer aux programmes de santé reproductive et que leur participation est associée à une adoption accrue des services de planification familiale et du conseil et dépistage du VIH, à la réduction des comportements à risques et à l'amélioration de la santé maternelle et de la communication au sein du couple. Conclusions: Face au constat de l'association positive entre la participation masculine et l'amélioration des résultats de santé reproductive en Afrique subsaharienne, il convient que les prestataires de santé et les planificateurs de programmes incluent si possible les hommes dans les interventions de santé reproductive.

Adaptaçao portuguesa e validaçao da versao reduzida da Condom Use Self-efficacy Scale / Portuguese adaptation and validation of the brief version of Condom Use Self-efficacy Scale

Introdução. O preservativo é o método mais eficaz na prevenção de infeções sexualmente transmissíveis. É reconhecido o papel da autoeficácia na predição de comportamentos de saúde e a autoeficácia para usar preservativo tem‐se mostrado um constructo‐chave relacionado com o uso efetivo do preservativo. Objetivos. Proceder à adaptação e validação da versão reduzida da Condom Use Self‐efficacy Scale (CUSES) para estudantes do ensino superior português. Material e métodos. Foi realizado um estudo quantitativo, descritivo‐correlacional numa amostra de conveniência de 1.946 estudantes do ensino superior, 64% raparigas e 36% rapazes, com idade média de 21 anos (20,74±2,32). Resultados. A análise das características psicométricas da escala foi avaliada com recurso à análise fatorial exploratória (AFE) e confirmatória (AFC), realizada em 2 subgrupos aleatorizados da amostra inicial. Os resultados da AFE revelaram uma estrutura com 4 fatores, semelhante à escala original, que explicam 70,6% da variância e uma boa consistência interna (alpha=0,86). A AFC revelou a necessidade de ajustamento do modelo aos dados, apresentando o modelo modificado índices aceitáveis de ajustamento. A versão modificada revelou valores adequados de fiabilidade, validade fatorial e validade concorrente e discriminante. Conclusões. As propriedades psicométricas avaliadas permitem considerar a utilização deste instrumento no desenvolvimento de programas de saúde sexual e reprodutiva para estudantes do ensino superior português, pois permite determinar os domínios relevantes da perceção da autoeficácia para usar o preservativo (AU)

Introduction. Condoms are the most effective method to prevent sexually transmitted infections. The role of self‐efficacy in predicting health behaviors and self‐efficacy to use condoms has been shown to be a key related construct to the effective use of condoms. Objectives. Adaptation and validation of the reduced version of Condom Use Self‐efficacy Scale (CUSES) for Portuguese college students. Material and methods. We conducted a quantitative, descriptive and correlational in a convenience sample of 1946 university students study, 64% girls and 36% boys, mean age 21 years (20.74±2.32). Results. The analysis of the psychometric characteristics of the scale was carried using exploratory (EFA) and confirmatory factor analysis (EFC), held in 2 randomized subgroups of the original sample. The results of EFA revealed a structure with four factors, which explains 70.6% of variance and have a good values of internal consistency (alpha=0.86). The AFC revealed the need to adjust the model to the data, presenting acceptable levels of adjustment. The modified version had good reliability, factorial validity and concurrent and discriminant validity. Conclusions. The psychometric properties assessed allow considering the use of this instrument in the development of sexual and reproductive health programs for students of Portuguese higher education as it allows determining the relevant fields of self‐efficacy perception to use condom (AU)

Lights, camera, condoms! Assessing college men's attitudes toward condom use in pornography.

OBJECTIVE: Investigate male college students' attitudes toward actors' use of condoms in pornography. PARTICIPANTS: Two hundred thirteen undergraduate males attending a large, state-supported midwestern university in the fall semester, 2012. METHODS: Using a Web-based procedure, participants completed questionnaires assessing their pornography use, sexual history characteristics, and their attitudes toward condom use by adult performers. RESULTS: Factor analysis of the 11-item condom use attitudes questionnaire supported 2 distinct subscales: Condom Supportive Attitudes and Condom Critical Attitudes. Although participants typically agreed with statements supportive of condom use and generally disagreed with statements critical of condom use in pornography, gay men had significantly higher condom supportive subscale scores than did heterosexual men. Neither subscale was correlated with weekly viewing of pornography. CONCLUSIONS: Although some producers of adult films argue that actors wearing condoms will displease many viewers, current findings suggest that young men express support for use of condoms by pornographic film actors.

Men's involvement in family planning in rural Bangladesh.

Contraceptive prevalence has risen markedly in rural Bangladesh due in part to a doorstep-delivery system initiated by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). This study investigates effects of residence in the Matlab MCH-FP treatment area on men's involvement in family planning. The analysis compares for treatment and comparison areas knowledge of and attitudes toward contraception, as well as levels of contraceptive use, among 413 married men interviewed at the baseline of an ICDDR,B men's involvement project. Although residence in the MCH-FP area is associated with a higher overall contraceptive prevalence, it also is associated with a lower adjusted ratio of male-to-female method use, and lower odds of other indicators of men's involvement in family planning. Historical decisions to exclude men from contraceptive decision-making may place the 'burden' of contraception on women and may preclude the productive involvement of men. These and other implications and strategies for increased men's involvement are discussed.

Knowledge of correct condom use and consistency of use among adolescents in four countries in sub-Saharan Africa.

Using data from the 2004 National Adolescent Surveys, this paper undertook a detail analysis of knowledge of correct condom use and consistency of use, as well as their covariates, among adolescents in Burkina Faso, Ghana, Malawi and Uganda. The strongest predictor of knowledge of correct condom use among both male and female adolescents is exposure to a condom use demonstration. In Burkina Faso, Ghana and Uganda, adolescents who have seen a condom demonstration are 2 to 5 times as likely as those who have not to have good knowledge of correct condom use. Age, ever received sex education in school, ever attended school and exposure to the radio are also significant predictors of knowledge of correct use, particularly among men. As indicated by behavior among young men, the extent to which adolescents use the condom consistently varies across countries. Yet, it is nowhere near the required 100% level. The proportion reporting consistent use of the method in the 3 months preceding the survey is 38% in Burkina Faso, 47% in Ghana, 20% in Malawi and 36% in Uganda. Age difference between partners is a major determinant of consistent use of condoms: young men whose partner is 0-4 years younger are about two and a half times more likely to use condoms consistently than those who whose partner is 5-9 years younger. Other important predictors of consistent condom use are residence, education, living arrangement and exposure to mass media, specifically the radio and newspaper. Findings from this study point to areas that policy and program can address to provide adolescents access to the kinds of information and service they need to achieve healthy sexual and reproductive lives.

Unprotected anal intercourse in HIV-positive and HIV-negative gay men: the relevance of sexual arousability, mood, sensation seeking, and erectile problems.

Reduction of unprotected anal intercourse (UAI) in gay men infected with HIV is important in preventing further spread of this infection. In previous studies, personality trait measures relevant to sexual arousability and the effects of anxiety have been shown to relate to UAI in both gay and heterosexual men. Are HIV+ gay men similar in these respects or are there other personality-related factors that influence their sexual risk taking? This question was addressed using a convenience sample of 156 HIV+ gay men and 155 HIV- gay men, matched for age and UAI risk. There were no significant differences between these two groups on measures of sexual arousability, inhibition of sexual arousal in risky situations, sensation seeking, depression and anxiety proneness, or tendency to increased sexual interest in negative mood states. HIV+ men were, however, more likely to report erectile problems and higher scores on an associated trait measure, inhibition of arousal due to threat of performance failure. As this association was not anticipated, questions about whether erectile problems preceded the seroconversion were not asked. Such problems could be associated with reluctance to use condoms, thus increasing the likelihood of seroconversion and/or disease transmission. Alternatively, erectile problems could be a consequence of HIV infection. In each case, this has implications for prevention. The associations among HIV status, erectile problems, and UAI need to be specifically addressed in future research.

Factors associated with sexual problems in HIV-positive gay men.

Our objective was to determine factors associated with sexual problems in a sample of HIV-seropositive gay male clinic patients. Using a cross-sectional survey design a volunteer sample of 78 outpatient HIV-seropositive gay male service users completed a self-report questionnaire. This examined sexual problems, their perceived causes and associated factors including demographics, health status, sexual behaviour, self-justifications for sexual risk-taking and mood state (Hospital Anxiety and Depression Scale). Fifty (69%) of 78 HIV-positive gay men reported one or more sexual problems. Erectile dysfunction (ED) was reported by 38% rising to 51% in the context of trying to use condoms. Loss of interest in sex was reported by 41% and 24% experienced delayed ejaculation. The presence of sexual problems affected condom use in that 33 (90%) of the 37 gay men who had ED associated with condom use were inconsistent condom users in insertive sex compared to 28% of those not having this type of ED (P < 0.001). The presence of ED did not reduce the frequency of anal intercourse but those with ED associated with condoms were significantly more likely to have had receptive anal sex in the past three months (62%) compared to men without ED with condoms (38%) (P = 0.05). Risk cognitions such as wanting to lose oneself in sex, leaving responsibility for condom use to the active partner and perceptions that condoms interfere with pleasure were significantly more likely to be endorsed by those who report ED with condoms. Other factors associated with sexual problems included low T-cell counts (i.e. < 200). Psychological explanations were the most frequently cited causes of sexual problems, whether alone or in interaction with HIV disease itself, and combination therapy. A high incidence of sexual problems was found amongst this sample of HIV-positive gay men. Untreated sexual dysfunctions may contribute to sexual risk-taking and therefore HIV clinics need to address both issues. Further research is required to better understand the role of psychological factors, HIV disease itself and combination therapy in the incidence and treatment of sexual problems.

Male contraception-a topic with many facets.

In addition to the scientific issues associated with male contraception, there are a variety of other concerns that must be addressed before new male contraceptives reach the market. Cultural attitudes toward contraception will play a role both in the acceptability of any contraceptive and in compliance and usage. Delivery methods must also be considered; different methods are favored depending on the social context. Prevention of sexually transmitted diseases by a combined contraceptive/microbicidal treatment is a laudable goal, and may enhance public acceptance of a male contraceptive. This review is the result of a workshop that was convened to address these topics.

[Male participation in contraceptive methods use]. / Participação masculina no uso de métodos contraceptivos.

This study aimed to evaluate male participation in the use of contraceptive methods and to identify relevant variables. A secondary data analysis was conducted, and the sample size was estimated at 175 men using contraceptives methods that require male participation. The study used the qui-square test to evaluate differences between groups, as well as multiple logistic regression analysis. Some 38% of interviewees used some birth control method that required male participation. Higher level of schooling was associated with the use of some form of contraception requiring male participation, i.e., condom use or vasectomy. Considering the sample's characteristics, the study concluded that it is possible for important changes to take place in Brazilian society with regard to the male perspective on contraception. For these changes to be possible it is necessary to invest in education for both men and women, shown to be an important factor for a balance in gender relations.

Current status of fertility control methods in India.

Approximately 48.2% of couples of 15 to 49 years of age practice family planning methods in India. Female sterilization accounts for 34.2%, with male sterilization declining from 3.4% in 1992-93 to 1.9% in 1998-99. Use of the condom increased to 3.1% from 2.4%. There is an urgent need for research to develop new contraceptive modalities especially for men and also for women and to make existing methods more safe, affordable and acceptable. Current efforts in India to develop a male contraceptive are mainly directed towards (i) development of antispermatogenic agents to suppress sperm production, (ii) prevention of sperm maturation, (iii) prevention of sperm transport through vas deferens or rendering these sperm infertile and (iv) prevention of sperm deposition. Research work in the field of prevention of sperm transport through vas deferens has made significant advances. Styrene maleic anhydride (SMA) disturbed the electrical charge of spermatozoa leading to acrosome rupture and consequent loss in fertilizing ability of sperm. A multicentre phase-III clinical trial using SMA is continuing and it is hoped that the SMA approach would be available in the near future as an indigenously developed injectable intra-vasal male contraceptive. The safety and efficacy of available oral contraceptives were evaluated. An indigenously developed oral contraceptive 'Centchorman', which is a nonsteroidal, weakly estrogenic but potently antiestrogenic, was found to be safe and effective and is now being marketed in India since 1991 as a 'once a week' pill. Cyclofem and Mesigyna have been recommended as injectable contraceptives with proper counselling and service delivery by Indian studies. It has been recommended that these injectable contraceptives be added to the existing range of contraceptive methods available in the National Family Planning Programme. Based on the Indian studies CuT 200 was also recommended. Studies have indicated the advantage of intrauterine devices (IUD); they are long acting, relatively easily removed and fertility returns rapidly after their removal. Recent studies have recommended CuT 200 for use up to 5 years. The combination of some plant products i.e. Embelia ribes, Borax and Piper longum has been found to be safe and effective as a female contraceptive and the results of phase-I clinical trials are encouraging. Research work is going on in the country in various areas with special reference to hormonal contraceptive - a three monthly injectable contraceptive, immuno-contraceptives, antiprogestins, etc.

Sexo seguro: ¿qué saben y qué hacen los adolescentes escolarizados de la ciudad de Buenos Aires / Safe sex: adolescents from Buenos Aires high schools, what do they know?

Objetivo: analizar los conocimientos, actitudes y conductas de los adolescentes en relación con el preservativo. Población: adolescentes escolarizados de la ciudad de Buenos Aires, entre 15 y 18 años. Muestra: aleatoria representativa de escuelas, integrada por 952 adolescentes. Métodos: cuestionario autoadministrado de 72 preguntas. Análisis uni y bivariado de datos. Resultados: el preservativo aparece como el método anticonceptivo más reconocido entre los adolescentes estudiados. Si bien la difusión acerca del papel preventivo del preservativo frente al SIDA, ha crecido en los últimos años, es preocupante el alto porcentaje de adolescentes que no saben cómo usarlo y que no lo usan en su debut sexual y en su vida sexual posterior. Las mujeres, que tienen que vencer más barreras culturales, aparecen más desprotegidas, tanto frente a un embarazo no planeado como frente al riesgo de una enfermedad como el SIDA. Y lo mismo ocurre con los hijos de padres menos educados

Sexo seguro: ¿qué saben y qué hacen los adolescentes escolarizados de la ciudad de Buenos Aires / Safe sex: adolescents from Buenos Aires high schools, what do they know?

Objetivo: analizar los conocimientos, actitudes y conductas de los adolescentes en relación con el preservativo. Población: adolescentes escolarizados de la ciudad de Buenos Aires, entre 15 y 18 años. Muestra: aleatoria representativa de escuelas, integrada por 952 adolescentes. Métodos: cuestionario autoadministrado de 72 preguntas. Análisis uni y bivariado de datos. Resultados: el preservativo aparece como el método anticonceptivo más reconocido entre los adolescentes estudiados. Si bien la difusión acerca del papel preventivo del preservativo frente al SIDA, ha crecido en los últimos años, es preocupante el alto porcentaje de adolescentes que no saben cómo usarlo y que no lo usan en su debut sexual y en su vida sexual posterior. Las mujeres, que tienen que vencer más barreras culturales, aparecen más desprotegidas, tanto frente a un embarazo no planeado como frente al riesgo de una enfermedad como el SIDA. Y lo mismo ocurre con los hijos de padres menos educados (AU)

Influence of HIV positive status on sexual behavior among males.

OBJECTIVE: To compare HIV seronegative (HIV-) and HIV seropositive (HIV+) males in terms of sexual behavior with female and male partners of different types. METHOD: Cross-sectional study. From August 1994 to February 1995, a sample of 236 respondents (150 HIV- and 86 HIV+) recruited from public health centers in the State of S. Paulo (Brazil), answered a questionnaire, including questions on demographic aspects, HIV and AIDS related knowledge, sexual orientation, use of alcohol and other drugs, sexual behavior with regular and casual female and male partners, and perceived risk of HIV infection. Sexual behavior with regular and casual female and male partners within the previous three months, was investigated. RESULTS: A lower proportion of HIV+ engaged in sexual contact with regular female partners (p < .01) and in vaginal intercourse with this type of partner (p < .01). A lower proportion of HIV+ engaged in overall sexual activity (p < .001) and reported lower frequency of penetrative sexual practices (p < .05). A high level of condom use with female and male partners was identified with no significant differences being found between the two serostatus groups. Some risky sexual behavior was identified, however, especially with regular partners, suggesting that some men were continuing to practice unsafe sex. CONCLUSIONS: The high level of condom use identified suggests that safer sex advice has been taken up. Condom use was not universal, however, and some men continue to place themselves at risk, especially with regular partners. Prevention programs should strive not only to encourage HIV- to practice safer sex, but also to encourage HIV+ to do so in order to prevent further transmission of the virus.

PIP: Findings are presented from a cross-sectional study comparing the sexual behavior of HIV-seronegative and HIV-seropositive men with male and female sex partners, with particular focus upon the practice of safer sex in both groups of men. The 150 HIV-seronegative and 86 HIV-seropositive participating males were recruited between August 1994 and February 1995 from public health centers in the state of Sao Paulo, Brazil, where they responded to a questionnaire. The men were 15-69 years old, of mean age 30 years. 78% were single, 14.4% were married/living together, 6.4% were separated/divorced, and 1.3% were widowers. 36% defined themselves as heterosexuals, 11.4% as bisexuals, and 36.4% as homosexuals, while 16.1% used other expressions. Compared to HIV-seronegative men, a smaller proportion of HIV-seropositive men had sexual contact with regular female partners and engaged in vaginal intercourse with that type of partner. Similarly, a smaller proportion of HIV-seropositive men engaged in overall sexual activity and reported a lower frequency of penetrative sexual practices. A high level of condom use with male and female sex partners was identified with no significant differences being found between the 2 serostatus groups. However, some risky sexual behavior was identified, especially with regular partners, suggesting that some men were continuing to have unsafe sex. HIV prevention programs should encourage both HIV-seronegative and HIV-seropositive men to practice safer sex.

Groups push for specific discussion of HIV risk.

AIDS: The American Medical Association (AMA) is pushing physicians to discuss HIV risk factors more openly with their patients. With an estimated 40,000 new cases of HIV infection occurring annually in the United States, prevention must be stressed more strongly. The AMA is developing a guidebook for physicians to more easily discuss topics such as sexually risky behavior and the implications of drug use with their patients.^ieng

Increasing the use of bleach and condoms among injecting drug users in Denver: outcomes of a targeted, community-level HIV prevention program.

OBJECTIVE: To evaluate the impact of an HIV risk-reduction program among injecting drug users (IDU) in Denver, Colorado. DESIGN: A targeted, community-level intervention study with multiple, time-phased, cross-sectional measurements assessing HIV high-risk behaviors among IDU in intervention and comparison sites. SETTING: Neighborhoods with high IDU prevalence in Denver, Colorado (intervention site) and Long Beach, California (non-intervention comparison site). PARTICIPANTS: Street-recruited IDU who had injected drugs in the previous 30 days and shared injection equipment in the previous 60 days to evaluate the use of bleach to clean injection equipment; or had sexual intercourse in the previous 30 days, to evaluate condom use. INTERVENTION: A prevention program in which peer volunteers were recruited and trained to distribute and discuss intervention kits that included condoms, bleach bottles and role model stories. MAIN OUTCOME MEASURES: Multiple cross-sectional surveys were conducted in the intervention and comparison sites to assess the impact of the intervention on the consistent use of bleach before sharing injection equipment and the consistent use of condoms for vaginal intercourse with steady and occasional partners. RESULTS: Between February 1991 and December 1993, 1997 IDU were interviewed, 890 at the intervention site and 1107 at the comparison site. In contrast to the comparison site, subjects from the intervention site reported significant increases in consistent use of bleach [odds ratio (OR), 2.6; 95% confidence interval (CI), 1.3-5.1; P < 0.001], and consistent use of condoms with occasional partners (OR, 13.6; 95% CI, 3.2-58.0; P < 0.001). CONCLUSION: This targeted, peer-based intervention was associated with significant HIV risk reduction among IDU in Denver and may be useful in other communities at risk for HIV infection.

Knowledge, attitudes and perception of AIDS in rural Senegal: relationship to sexual behaviour and behaviour change.

OBJECTIVES: To describe the determinants of 'at risk' sexual behaviour and perception of AIDS-related prevention messages in rural Africa. SETTING: A rural area in Southern Senegal. DESIGN: Cross-sectional study using a standardized questionnaire administered by local interviewers to 240 men and 242 women aged 15-59 years, randomly selected among the general population. RESULTS: Twenty-eight per cent of the sexually active men and 27% of the sexually active women declared at least one casual sexual partner in the 12 months preceding the interview. Among these, 27% of men and 30% of women declared having used a condom in most acts of casual intercourse. Seasonal migrants and divorced or widowed women were more likely to declare casual sex. Causal sex was motivated by material needs for 66% of the women who experienced it, and those of the women who reported casual sexual intercourse were less likely to feel at risk of AIDS [odds ratio (OR), 3.9; P = 0.01] and were more optimistic about their future (OR, 3.6; P = 0.03). For men, the motivations explaining a change in sexual behaviour in order to avoid HIV infection included the perception of AIDS as a health problem (OR, 11; P = 0.004), the perception of the disease as serious (OR, 5.4; P = 0.001) and the feeling of personal risk of becoming HIV-infected (OR, 3.2; P = 0.02). Perceived skill in changing one's behaviour was strongly associated with declaration of past behaviour change for both men and women (men: OR, 3.4; P = 0.02; women: OR, 6.3; P = 0.0001). CONCLUSION: Men and women exhibit two different patterns regarding their behaviour and perception towards AIDS. Material needs appear to be of importance for women, whereas perception of a real threat lead men to adopt protective behaviours. In the very area of this study, widowed and divorced women as well as male seasonal migrants are particularly exposed to HIV infection. They are characterized by a higher risk behaviour, a low rate of condom use and seldom declared any protective measures to avoid HIV infection.

PIP: 240 men and 242 women, randomly selected, aged 15-59 years were questioned by local interviewers about their sexual behavior in this study on the determinants of risky sexual behavior and the perception of AIDS-related prevention messages in rural Africa. 28% of the sexually active men and 27% of the sexually active women reported having at least one casual sex partner during the 12 months preceding the interview. Among these, 27% of men and 30% of women reported having used a condom in most acts of sexual intercourse with casual partners. Male seasonal migrant workers and widowed and divorced women were more likely to report engaging in casual sex. These individuals in the area of study are particularly at risk for exposure to HIV infection. Casual sex was motivated by material needs among 66% of women who experienced it. Women who reported engaging in such behavior were less likely to feel at risk of AIDS. The perception of a real threat of personal vulnerability to contracting HIV lead men to adopt protective behaviors.

NICHD researches women's attitudes, behavior. National Institute of Child Health and Human Development.

AIDS: The National Institutes of Health (NIH) reports study results on women's attitudes and behavior that impact HIV transmission. Among the findings are the following: low-income women put bearing and raising children, not cultivating relationships with their partners or the communities, as their top priorities; black women who are properly taught about condom use and who practice proper negotiation skills increase consistent condom use; school success is the most important factor affecting sexual behavior; and little straightforward communication about sex-related topics is received by adolescents from either doctors or mothers.^ieng

Supreme Court refuses to hear appeal of 'hot and sexy' program.

AIDS: The U.S. Supreme Court refused to consider an appeal of a lower court's decision regarding a school-based safer-sex education program. Parents and students from the Chelmsord High School in Falmouth, MA, claim that the Hot, Sexy, and Safer AIDS awareness program violated religious beliefs and was humiliating and intimidating. The Supreme Court's refusal to hear the appeal leaves intact the First U.S. Circuit Court of Appeals ruling that parents do not have a constitutional right to dictate a school curriculum.^ieng

Air Force court affirms assault conviction of major.

AIDS: The Air Force Court of Criminal Appeals upheld the conviction and sentencing of [name removed], who had vaginal intercourse with two women without warning them that he was HIV-positive. [Name removed] was ordered not to engage in sexual intercourse unless he first informed his partner that he was infected. He was also ordered to use condoms. According to the court martial, both of these orders were disobeyed. Both women have tested negative for HIV antibodies. On appeal, [name removed] argued that evidence was insufficient to establish that he posed a risk of transmitting the virus. The three-judge appeals panel found in favor of the Air Force.^ieng