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1 TRaC SUMMARY REPORT PSI DASHBOARD LESOTHO (2012): HIV/AIDS TRaC Study Evaluating HIV Counseling and Testing Uptake, Consistent Condom Use, and Concurrent Sexual Partnerships among Men and Women aged 15 to 35 years in Lesotho FIRST ROUND Sponsored by: PSI s Four Pillars Bottom Line Health Impact Private Sector Speed and Efficiency Decentralization, Innovation, and Entrepreneurship Long-term Commitment to the People We Serve

2 Research & Metrics Population Services International 1120 Nineteenth Street NW, Suite 600 Washington, D.C Lesotho (2012): HIV/AIDS TRaC Study Evaluating HIV Testing and Counseling Uptake, Consistent Condom Use, and Concurrent Sexual Partnerships among Men and Women aged 15 to 35 years in Lesotho FIRST ROUND PSI Research Division 2012 This study is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Population Services International and do not necessarily reflect the views of USAID or the United States Government. This document may be freely reviewed, quoted, reproduced or translated, in part or in full, provided the source is acknowledged. PSI Research & Metrics HIV/AIDS TRaC Study Evaluating HIV Testing and Counseling Uptake, Consistent Condom Use, and Concurrent Sexual Partnerships among Men and Women aged 15 to 35 years in Lesotho. Washington, DC: Population Services International. Available at: PSI shares its study results with interested individuals and organizations, except when prohibited by a donor or host country government. Please note that this summary report contains a limited analysis to support programmatic decision-making at PSI and is written with a non-research audience in mind. If you are interested in learning more about this study, please get in touch with the contacts named below. Population Services International, 2012 PSI Lesotho, 2012 Page 2

3 Contacts: Makhahliso Jubilee Research, Monitoring and Evaluation Manager Population Services International 138 Moshoeshoe Road, Industrial Area Maseru, Lesotho Tel : , Fax : , mjubilee@psi.co.ls Brian Pedersen, Technical Services Advisor Population Services International 138 Moshoeshoe Road, Industrial Area Maseru, Lesotho Tel : , Fax : , bpedersen@psi.co.ls Please note that the analysis described in this summary report was conducted with aggregated data. Additional analyses, with more specific disaggregation, are available and encouraged to support better programming decisions. Please contact PSI/Lesotho s Research Department should additional analyses be required for other purposes. Acknowledgments We would like to express our gratitude to the President s Plan for AIDS Relief (PEPFAR) and USAID for funding this TRaC behavioral study and to the Ministry of Health (MoH) for supporting the effort and approving the study. We are also grateful to the Lesotho Bureau of Statistics for their support in assisting with sampling frame and geographical maps. Finally, gratitude is expressed to PSI s Regional Researcher, Dr. Noah Taruberekera, for overseeing this research from study design to final report. Suggested citation of this work PSI Research & Metrics, Lesotho (2012): HIV/AIDS TRaC Study Evaluating HIV Testing and Counseling uptake, Consistent condom use and Concurrent Sexual Partnerships among Men and Women ages 15 to 35 years in Lesotho. First Round. PSI Social Marketing Research Series, (2012) PSI Lesotho, 2012 Page 3

4 TABLE OF CONTENTS SUMMARY... 5 METHODOLOGY... 6 MAIN FINDINGS... 6 PROGRAMMATIC RECOMMENDATIONS... 9 HIV TESTING AND COUNSELING TABLES CONSISTENT CONDOM USE TABLES CONCURRENT SEXUAL PARTNERSHIPS TABLES ANNEXES PSI Lesotho, 2012 Page 4

5 SUMMARY Background & Research objectives With 23.2% of the Basotho population infected, Lesotho faces a generalized and highly entrenched HIV epidemic spread primarily through heterosexual contract. 1 In all districts, and among both sexes and most age groups older than 15 years, HIV prevalence is above 15%. 2 No matter the demographic group, becoming sexually-active in Lesotho poses a high risk of HIV infection. HIV prevalence increases dramatically from 3% among year olds to over 40% among year olds. 3 Women are disproportionately affected with 40% more likely to be HIV-positive than men, and 57% of people living with HIV (PLHIV) are women. 4 HIV prevalence among women peaks in their twenties and thirties, while HIV prevalence among men peaks after the age of HIV transmission in Lesotho occurs primarily through heterosexual sex, in both those reporting multiple and single sexual partners. 6 In 2009, the percentage of men and women aged who reported two or more sexual partners in the last 12 months was 45% and 25.9%, respectively. 7 The goal of the present study was to provide actionable evidence for social marketing decision making and help to measure the impact of existing HIV prevention interventions. Data collection focused on HIV testing and counseling, consistent condom use, and concurrent sexual partnerships and underlying factors for these behaviors. This information will be used to develop interventions and communications for HIV prevention programs in Lesotho. Description of Intervention PSI has been implementing HIV programming in Lesotho since 2001 with funding from the US Centers for Disease Control (CDC), US Agency for International Development, Royal Dutch embassy and other private donors. PSI s mission in Lesotho is to increase the adoption of safer sexual behaviors among adults focusing on increasing knowledge of HIV status, condom use, and reduction of concurrent sexual partnerships. The program uses interpersonal communication (IPC) and mass media activities to promote the benefits of correct and consistent condom use, risk of concurrent sexual partnerships, and to create demand creation for HIV testing and counseling (HTC) services. Currently, the program offers HTC services in targeted districts through two (2) static sites and mobile service delivery teams. Beginning in 2011, PSI/Lesotho launched a five-year USAID-funded program in partnership with the Lesotho Network of AIDS Service Organizations (LENASO), Kick4Life, Apparel Lesotho Alliance to Fight AIDS (ALAFA), Phela Health and Development Communications, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), and Johns Hopkins University Center for Communication Programs (JHUCCP). The goal of this program is to reduce HIV incidence in Lesotho by increasing the adoption and use of HIV prevention products and services amongst youth and adults aged 15 to Ministry of Health and Social Welfare and ICF Macro (2010). Lesotho Demographic and Health Survey Ibid. 3 Ibid. 4 Ibid. 5 Lesotho National AIDS Commission, The World Bank, UNAIDS (2009), Lesotho HIV Prevention Response and Modes of Transmission Study. 6 Ibid. 7 Ibid. PSI Lesotho, 2012 Page 5

6 METHODOLOGY A two stage cluster sampling was used to provide a nationally representative sample of 1,810 individuals. In the first stage, enumeration areas (EAs) within each district were randomly selected using probability proportionate to size. EAs are geographic areas used for sampling purposes. In the second stage, households within the selected EAs were selected using simple random sampling. In households where more than one eligible respondent was available, a respondent was randomly selected using the Kish grid method. Analyses consisted of logistic regression, and cross tabulations to ascertain which correlates are correlated with key behaviors, and establish program baselines. In addition, Coarsened Exact Matching (CEM) was applied for evaluation analysis to improve estimation of the effects of existing interventions. Respondents were matched on place of residence and on radio and television ownership. MAIN FINDINGS Findings in this study are presented by intervention area as follows: HIV Counseling and Testing Highlights from the monitoring analysis for HIV testing and counseling among all respondents include: 55.1% of respondents reported having undergone HIV testing in the past 12 months. More women (63.5%) reported testing for HIV in the past 12 months than men (44.2%) (p<0.001). Overall, only 20.8% of individuals who tested for HIV in the past 12 months were tested at a New Start service (fixed site and mobile). More men (33.9%) than women (13.9%) reported being tested at a New Start service. A majority of respondents (72.9%) reported that it is acceptable to go for HIV testing in their community. More women reported this belief than men (75.3% vs. 69.7%; p<0.01). 54.9% of respondents reported that their families and friends would support them to go for HIV testing. More women than men reported social support for HIV testing (57.7% vs. 51.5%; p<0.001). Perceived self-efficacy to undergo an HIV test was high. As many as 82.4% of respondents reported high self-efficacy to go for HIV testing. More women (86.9%) than men (76.5%) reported high self-efficacy for HIV testing (p<0.001). 94.2% of respondents reported that HIV testing is beneficial although more women than men believe that HIV testing is beneficial (95.8% vs. 94.2%; p<0.001). Only 45.6% of respondents reported positive outcome expectations if they were to test positive for HIV. More women than men had positive outcome expectations (50.7% vs. 39%; p<0.001). Highlights from the segmentation analysis for HIV testing and counseling among all respondents include: Availability of HIV testing facilities: Individuals who perceived high availability of HIV testing services were more likely to test for HIV than those who perceived low availability (58.2% among those who tested for HIV vs. 52.0% among those who did not test; p<0.001). Social support for HIV testing: Respondents who perceived support for HIV testing from people close to them were more likely to test for HIV than those who perceived less support (68.6% for testers and 49% for non-testers; p<0.001). PSI Lesotho, 2012 Page 6

7 Self Efficacy about going for an HIV testing and counseling: Individuals with higher perceived self-efficacy to go for HIV testing were more likely to test than those who had lower perceived self-efficacy (OR=6.06; p<0.001) Marital status: Ever married people were more likely to test than never married people (OR=2.79; p<0.001) Occupation: Unemployed people were more likely to test than employed people (OR=1.28; p<0.001) Sex: Men were less likely to test for HIV than women (OR= 0.68; p<0.001) The segmentation analysis for HIV testing and counseling among men indicates that: HIV testing among men increases with the same behavioral correlates as discussed above (availability, social support and self-efficacy). Ever married men were likely to test for HIV compared to never married men (OR=1.87; p<0.001) and men with higher education were more likely to test than those with less education (OR=1.57; p<0.01). The segmentation analysis for HIV testing and counseling among women indicates that: HIV testing among women increases with the same behavioral correlates as discussed above with the exception of availability (social support and self-efficacy). Ever married women were more likely to test for HIV compared to never married (OR=3.56; p< and unemployed women were more likely to test compared to employed women (OR=1.37; p<0.01). Highlights from the evaluation analysis for HIV testing and counseling among all respondents include: Of respondent who reported testing for HIV in the past 12 months, 59.4% were exposed to PSI messages/interventions compared to 47% who were not exposed (p<0.001). Exposure to PSI interventions was associated with: o Increased perceived self-efficacy to go for HIV testing (p<0.05); o Increased perceived social support to go for HIV testing (p<0.05); o Increased outcome expectations for HIV testing (p<0.01); and, o Increased perceived social norms for disclosing HIV status (p<0.05). Consistent Condom use Highlights from the monitoring analysis for consistent condom use among all respondents include: Reported consistent condom use varied by partner type. o The proportion of respondents who reported always using a condom with marital and/or cohabiting partners was 18.7% and 57.3% with regular partners. No significant difference in condom use with marital/co-habiting and regular partners between genders was found. o 56.6% of respondents reported consistent condom use with non-regular partners with more men than women reporting consistent condom use (61.2% vs. 38.7%; p<0.01). Perceived ability to initiate condom use (self-efficacy) with partner was high. 83.4% of adults reported high self-efficacy to initiate condom use with no significant difference between genders. Perceived availability of condoms was low (32.5%) and there was no significant different between genders. 53.7% of respondents reported high perceived partner support for using condom with men reporting higher perceived partner support than women (64.2% vs. 45.6%; p<0.001). PSI Lesotho, 2012 Page 7

8 Only 43.6% of respondents reported high perceived social support with men again reporting higher perceived social support (49.9%) than women (38.7%) (p<0.001). Other correlates for consistent condom use (brand appeal, attitudes, and beliefs) were consistently weak. Highlights from the segmentation analysis for consistent condom use among all respondents with regular partners include: Social support for condom use: Individuals with higher perceived partner support were more likely to report consistent condom use (OR=5.04; p<0.001). Attitudes towards condom use: Individuals with positive attitudes toward condom use were more likely to report consistent condom use compared to those with negative attitudes (OR=2.00; p<0.001). Marital status: Ever married respondent with regular partners were more likely to report consistent condom use than never married respondent (OR=1.98, p<0.001). Highlights from the segmentation analysis for consistent condom use among all respondents with non-regular partners include: Respondents with higher education levels were more likely to report consistent condom use with non-regular partners than those with less education (OR=2.51; p<0.01). Unemployed respondents were less likely to report consistent condom use with non-regular partners than those who were employed (OR=0.28; p<0.01). Highlights from the evaluation analysis for consistent condom use among all respondents include: Consistent condom use with regular and non-regular relationships were significantly associated with exposure to PSI interventions, (66.3% vs. 57.2%; p<0.05) and (77.5% vs. 51.9%; p<0.01), respectfully. Exposure to PSI interventions was further associated with: o Increased perceived availability of condoms (p<0.01); o Increased perceived partner support to condom use (p<0.001); o Increased perceived self-efficacy to initiate condom use (p<0.05) o Increased perceived positive belief towards condoms (p<0.001); and, o Increased perceived positive attitudes towards condom use (p<0.001) Concurrent sexual partnerships Highlights from the monitoring analysis for concurrent sexual partnerships among all respondents indicate: 33.8% of respondents reported concurrent sexual partnerships. More men than women reported concurrent sexual partnerships (57.7% vs. 15.5%; p<0.001). Perceived positive outcome expectations to engage in concurrent relationships are high at 82.5%. There was no gender difference in perceived positive outcome expectations. Highlights from the segmentation analysis for concurrency sexual partnerships among all respondents include Attitudes towards concurrent sexual partnerships: Individuals with higher negative attitudes towards concurrent sexual partnerships were less likely to report engaging in concurrent sexual partnerships (OR= 0.45; p<0.001). Sex: Men were more likely to report concurrent sexual partnerships than women (OR=4.42; p<0.001). Occupation: Unemployed respondents were less likely to report concurrent sexual partnerships that employed respondents (OR= 0.69; p<0.001). PSI Lesotho, 2012 Page 8

9 Marital: Ever married respondents were less likely to report concurrent sexual partnerships than never married respondents (OR=0.64; p<0.001). Religion: Pentecostal believers were less likely to reporting engaging in concurrent sexual relationships than other religions (OR=0.65; p<0.01). PROGRAMMATIC RECOMMENDATIONS The implications of these results might include: Implementing strategies to reach lesser educated men. The results indicate that men with lower education were less likely to report testing for HIV in the past 12 months. Strategies to identify and reach these men are critical as other data suggest that these men are also are increased risk of HIV infection. Scale-up messaging to address stigma and barriers to disclosure. The results indicate that perceived acceptance for disclosure of HIV status is low amongst both testers and nontesters. This might indicate that fear of stigma is still high and may serve as a barrier to further update of HIV testing and hamper efforts to strength prevention with positives programs. Communication activities must be scaled-up and sustained. Low recall of communication activities amongst respondents might indicate that communication activities have not been adequately scaled up. Because evaluation data suggests that exposure to communication activities is associated with key behaviors, it is important to scale-up and further sustain communication activities to increase exposure amongst targeted audiences. Creating social support for key behaviors should remain a central objective of all activities. Across nearly all groups, social support for promoted behaviors was a significant contributing factor for adoption of the behavior. Programs should continue to create social support for both condom use and HIV testing to contribute to the development of new social norms around these behaviors. PSI Lesotho, 2012 Page 9

10 HIV TESTING AND COUNSELING TABLES Monitoring Table 1: Uptake of HIV testing and counseling and underlying factors among adult males and females aged 15 to 35 years in Lesotho 2012 Risk Group: Men and women aged 15 to 35 years in Lesotho Behaviors: Uptake of HIV testing and counseling INDICATORS Male [N = 788] Female [N = 1022] [ %] Total [N = 1810] Sig. *, **, or *** BEHAVIOR/USE Tested for HIV in the past 12 months (n=997) *** OPPORTUNITY Availability NS Social norms Going for HIV testing: Percentage of sexually active men and women who report that most people in their community go for an HIV test ** Social norms Disclosing status: Percentage of sexually active men and women who report that most people disclose their status to their partner NS ABILITY Social support: Percentage of sexually active men and women who believe that their friends and family would support them in *** utilizing HTC services Self-efficacy Going for HIV testing *** MOTIVATION Outcome Expectation *** Beliefs *** ADDITIONAL LOGICAL FRAMEWORK INDICATORS Percentage of sexually active men and women who report that they know their partner(s) has undergone HIV testing ** Proportion of adults who self-report as HIV-positive (n=85) *** Tested at New Start fixed or mobile service *** Proportion of adults who report: Received counseling before and after HIV test Received counseling only before HIV test Received counseling only after HIV test Did not receive counseling Proportion of men who self-report as circumcised Circumcised by medical provider at health center Circumcised by traditional circumciser as part of initiation NOTES: NS=not significant, *= p<0.05, **= p<0.01, ***=p<0.001 Scale values range from 1-4 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements PSI Lesotho, 2012 Page 10

11 Monitoring graph 1: Key percentage results Uptake of HIV testing and counseling in past 12 months (%) among men and women aged 15 to 35 years in Lesotho, 2012 (N=1810) Tested for HIV in the past 12 months Males Females Tested at New start centers Males Females Monitoring graph 2: Key percentage results Portion of respondents with high/positive contributing factors for uptake of HIV testing and counseling among adult males and females aged 15 to 35 years in Lesotho, 2012 (N=1810) Social norm: Going for HIV testing Social norm: Disclosing status Social support: Friends and families Self efficacy: Going for HIV testing Outcome expectation Beliefs PSI Lesotho, 2012 Page 11

12 Segmentation Table 1: Contributing factors for uptake of HIV testing and counseling among men and women aged 15 to 35 years, Lesotho 2012 Risk: Men and women aged 15 to 35 years in Lesotho Behavior: Uptake of HIV testing and counseling INDICATORS Tested for HIV in past 12 months [N=997] Did not test [N=813] OR Sig. *, **, or *** OPPORTUNITY Availability *** Social norms Going for HIV testing NS Social norms Disclosing status NS ABILITY Social support Friends and families *** Self-efficacy Going for HIV testing *** MOTIVATION Outcome Expectation NS Beliefs NS POPULATION CHARACTERISTICS Region (Rural vs. urban) NS Sex (Males vs. women) *** Age (Young vs. older 25+) NS Marital Status (ever married vs. never married) *** Religion (Pentecostal vs. others) NS Education (Secondary or above vs. below secondary) NS Occupation (Unemployed vs. employed) *** NOTES: NS=not significant, *=p<0.05, **=p<0.01, ***=p<0.001 Scale values range from 1-4 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements Adjusted for religion, sex, age, marital status, religion, education and occupation OR: Odds Ratio Omnibus Test: χ 2 = , significance = p<0.001*** Hosmer and Lemeshow test: χ 2 = 3.877, p=0.868 PSI Lesotho, 2012 Page 12

13 Segmentation graph 1: Key percentage results Significant contributing factors for uptake of HIV testing and counseling among men and women aged 15 to 35 years, Lesotho Availability*** Social support: Friends and families*** Self efficacy: Going for HIV testing*** Tested for HIV in the past 12 months (N=997) Did not test for HIV int he past 12 months (N=813) Note: NS=not significant *=p<0.05 **=p<0.01 ***=p<0.001 Segmentation Table 2: Contributing factors for uptake of HIV testing and counseling among men aged 15 to 35 years, Lesotho 2012 Risk: Men aged 15 to 35 years in Lesotho Behavior: Uptake of HIV testing and counseling INDICATORS Tested for HIV in the past 12 months [N=348] Did not test [N=440] OPPORTUNITY Availability ** Social norms Going for HIV testing NS Social norms Disclosing status NS ABILITY Social support Friends and families *** Self-efficacy Going for HIV testing *** MOTIVATION Outcome Expectation NS Beliefs NS POPULATION CHARACTERISTICS Region (Rural vs. urban) NS Age (Young vs. older 25+) NS Marital status (ever married vs. never married) *** Religion (Pentecostal vs. others) NS Education (secondary or above vs. below secondary) ** Occupation (Unemployed vs. employed) NS OR Sig. *, **, or *** PSI Lesotho, 2012 Page 13

14 NOTES: NS= not significant, *=p<0.05, **=p<0.01, ***=p<0.001 Scale values range from 1-4 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements Adjusted for religion, age, marital status, religion education and occupation OR: Odds Ratio Omnibus Test of Model coefficients: χ 2 = , significance =p<0.001 *** Hosmer and Lemeshow test: χ 2 = 3.974, p=0.859 Segmentation graph 2: Key percentage results Contributing factors for uptake of HIV testing and counseling among men aged 15 to 35 years, Lesotho Tested for HIV in the past 12 months (N=314) Did not test for HIV in the past 12 months (N=349) Availability*** Social support: Friends and families*** Self efficacy: Going for HIV testing*** Note: NS=not significant *=p<0.05 **=p<0.01 ***=p<0.001 PSI Lesotho, 2012 Page 14

15 Segmentation Table 3: Contributing factors for uptake of HIV testing and counseling among women aged 15 to 35 years, Lesotho 2012 Risk: Women aged years in Lesotho Behavior: Uptake of HIV testing and counseling INDICATORS OPPORTUNITY Tested for HIV in the past 12 months [N=649] Did not test [N=373] Availability NS Social norms Going for HIV testing NS Social norms Disclosing status NS ABILITY OR Sig. *, **, or *** Social support Friends and families *** Self-efficacy Going for HIV testing *** MOTIVATION Outcome Expectation NS Beliefs NS POPULATION CHARACTERISTICS Region (Rural vs. urban) NS Age (Young vs. older 25+) NS Marital Status (Ever married vs. never married) *** Religion (Pentecostal vs. others) NS Education (Secondary or above vs. below secondary) NS Occupation (Unemployed vs. employed) ** NOTES: NS= not significant, *=p<0.05, **=p<0.01, ***=p<0.001 Scale values range from 1-4 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements Adjusted for religion, age, marital status, religion education and occupation OR: Odds Ratio Omnibus Test of Model coefficients: χ 2 = , significance =p<0.001 Hosmer and Lemeshow test: χ 2 = 4.625, p=0.745 PSI Lesotho, 2012 Page 15

16 Segmentation graph 3: Key percentage results Significant contributing factors for uptake of HIV testing and counseling among women aged 15 to 35 years, Lesotho Social support: Friends and families*** 79.9 Self efficacy: Going for HIV testing*** Tested for HIV in the past 12 months (N=649) Did not test for HIV in the past 12 months (N=373) Note: NS=not significant *=p<0.05 **=p<0.01 ***=p<0.001 Evaluation Table 1: Exposure to PSI interventions and uptake of HIV testing and related contributing factors among men and women aged 15 to 35 years in Lesotho, 2012 Risk: Men and women aged 15 to 35 years in Lesotho Behavior: Uptake of HIV testing and counseling % Sig. INDICATORS *, **, or Un-Exposed [N=1398] Exposed [N=412] *** Tested for HIV in the past 12 months *** CONTRIBUTING FACTORS Positive beliefs towards HIV testing NS Outcome expectation about HIV testing ** Self-efficacy to go for HIV testing * Social support from close individuals to go for HIV testing * Perceived availability of HIV testing facilities NS Social norms for HV testing NS Social norms for disclosing status * NOTES: NS= not significant, *= p<0.05, **= p<0.01, ***= p<0.001 Scale values range from 1-4 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements Analysis controlled for Radio and TV ownership, age, gender, education, place of residence, occupation and other non-psi HCT messages Treatment (Exposure) is based on all PSI campaigns on HIV testing and counseling while matching for demographics and amenities ownership for radio and TV. Matching L1= PSI Lesotho, 2012 Page 16

17 CONSISTENT CONDOM USE TABLES Monitoring Table 2: Consistent condom use and contributing factors among sexually active men and women aged 15 to 35 years in Lesotho, 2012 Risk Group: Sexually active men and women aged 15 to 35 years in Lesotho Behaviors: Consistent condom use INDICATORS Male [N=788] Female [N=1022] Total [N=1810] Sig. *, **, or *** BEHAVIOR/USE Consistent condom use with spouse/cohabiting partner (n=732) NS Consistent condom use with regular partner (n=750) NS Consistent condom use with non-regular partner (n=152) * OPPORTUNITY Availability NS Brand appeal *** ABILITY Self-efficacy NS Social support Friends *** Social support Partner *** MOTIVATION Attitudes ** Beliefs NS ADDITIONAL LOGICAL FRAMEWORK INDICATORS Percentage of men and women who believe that using condoms can be pleasurable NS Percentage of men who believe that, even if they drink alcohol, they are capable of negotiating condom use 41.5 Percentage of sexually active men and women who report using a condom at last sex with their partner(s) [n = 1510] *** Age at first sex (MEAN) NS NOTES: NS=not significant, *= p<0.05, **= p<0.01, *** = p<0.001 Scale values range from 1-4 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements PSI Lesotho, 2012 Page 17

18 Monitoring graph 3: Key percentage results Consistent condom use (%) by partner type among sexually active men and women aged 15 to 35 years in Lesotho, 2012 (N=1810) Spouse/cohabiting Regular Non-regualr Males Females Total Monitoring graph 4: Key percentage results Contributing factors for consistent condom use among men and women aged 15 to 35 years, Lesotho 2012 (N=1810) Availabilty Brand appeal Self efficacy 43.6 Social support: Friends 53.7 Social support: Partner 34.6 Attitudes 47.1 Beliefs PSI Lesotho, 2012 Page 18

19 Segmentation Table 4: Contributing factors for consistent condom use with regular partnerships, Lesotho 2012 Risk: Sexually active men and women aged 15 to 35 years with regular partners in Lesotho Behavior: Consistent condom use INDICATORS Consistent condom users N = [450] Non users N=[320] OR Sig. *, ** or *** OPPORTUNITY Availability NS Brand appeal NS ABILITY Social support Friends Social support Partner Self-efficacy to use condom MOTIVATION Attitudes *** Beliefs NS POPULATION CHARACTERISTICS Region (Rural Vs Urban) NS Sex (Male Vs Female) NS Age (Young vs. older 25+) NS Marital Status (Ever married vs. never married) *** Religion (Pentecostal vs. others) NS Education (Secondary or above vs. below secondary) NS Occupation (Unemployed vs. employed) NS NOTES: NS= not significant, *= p<0.05, **= p<0.01, ***= p<0.001 Scale values range from 1-4 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements Adjusted for religion, age, marital status, religion education and occupation OR: Odds Ratio Omnibus Test of Model coefficients: χ 2 = , significance =p<0.001*** Hosmer and Lemeshow test: χ 2 = 4.66, p= NS *** *** PSI Lesotho, 2012 Page 19

20 Segmentation graph 4: Key percentage results Significant contributing factors for consistent condom use (%) with regular partners among sexually active men and women aged 15 to 35 years, Lesotho Consistent condom users (N=450) Non-consistent condom users (N=320) Social support: Partner*** Self-efficacy*** Attitudes*** Note: NS=not significant *=p<0.05 **=p<0.01 ***=p<0.001 Segmentation Table 5: Contributing factors for consistent condom use with non-regular partnerships, Lesotho 2012 Risk: Sexually active men and women aged 15 to 35 years with non-regular partners, in Lesotho Behavior: Consistent condom use INDICATORS Consistent condom users [N=90] Non-Users [N=57] OR Sig. *, ** or *** OPPORTUNITY Availability NS Brand appeal NS ABILITY Social support Friends Social support Partner Self-efficacy MOTIVATION Attitudes NS Beliefs NS POPULATION CHARACTERISTICS Region (Rural vs. urban) NS Sex (Male vs. female) NS Age (Young vs. older 25+) NS Marital Status (Ever married vs. never married) NS Religion (Pentecostal vs. others) NS Education (Secondary or above vs. less than secondary) ** Occupation (Unemployed vs. employed) ** NS ** *** PSI Lesotho, 2012 Page 20

21 NOTES: NS= not significant, *= p<0.05, **= p<0.01, ***= p<0.001 Scale values range from 1-4 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements Adjusted for religion, age, marital status, religion education and occupation OR: Odds Ratio Omnibus Test of Model coefficients: χ 2 = , significance =p<0.001 *** Hosmer and Lemeshow test: χ 2 = 2.86, p=0.898 Evaluation Table 2: Exposure to PSI interventions and consistent condom use and related contributing factors among men and women aged 15 to 35 years in Lesotho, 2012 Risk: Sexually active men and women ages 15 to 35 years in Lesotho Behavior: Consistent condom use INDICATORS Exposed [N=365] Non-exposed [N=1445] Sig. *, **, or *** Consistent condom use with regular partner * Consistent condom use with non-regular partner ** Consistent condom use with spouse CONTRIBUTING FACTORS Social support from partner to use condom *** Perceived availability of condoms * Condom brand appeal NS Self-efficacy to negotiate condom use with partner * Positive beliefs towards condom use *** Positive attitudes towards condom use *** NOTES: NS= not significant, *= p<0.05, **= p<0.01, ***= p<0.001 Scale values range from 1-4: 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements Analysis controlled for Radio and TV ownership, age, gender, education, place of residence and occupation - Number of respondents too small for analysis Treatment (exposure) is based on all PSI campaigns on condoms while matching for demographics and amenities ownership, such as radio and TV; matching, L1= PSI Lesotho, 2012 Page 21

22 CONCURRENT SEXUAL PARTNERSHIPS TABLES Monitoring Table 3: Practice of concurrent sexual partnerships and contributing factors among sexually active men and women aged 15 to 35 years in Lesotho, 2012 Risk Group: Sexually active men and women in concurrent sexual partnerships aged 15 to 35 years in Lesotho Behavior: Concurrent sexual partnerships INDICATORS Male [N = 587] Female [N = 750] Total [N = 1337] Sig. *, **, or *** BEHAVIOR/USE Proportion of sexually active respondents who reported being currently engaged in 2 or more sexual partnerships at *** the same time [n =452] OPPORTUNITY n/a n/a n/a MOTIVATION Attitudes *** Outcome expectation NS Social pressure *** Support for survival ** Wants/Status ** Positive Expectation *** ADDITIONAL LOGICAL FRAMEWORK INDICATORS Percentage of men and women who say having sex with someone who is 10 years older increases risk of contracting *** HIV Percentage of men and women who say having sex with someone in order to get money, gifts, work, or other favours increases risk of contracting HIV NS NOTES: NS=not significant, *= p<0.05, **= p<0.01, ***=p<0.001 Scale values range from 1-4 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements Monitoring graph 5: Key percentage results 100 Portion of men and women aged 15 to 35 years in Lesotho reporting current engagement in concurrent sexual partnerships, 2012 (N=1810) Males Females Total PSI Lesotho, 2012 Page 22

23 Segmentation Table 6: Contributing factors for engaging in concurrent sexual partnerships, Lesotho 2012 Risk: Sexually active men and women ages 15 to 35 years engaged in concurrent sexual partnerships in Lesotho Behavior: Concurrent sexual partnerships INDICATORS Engaged in CSP [N=452] % Not engaged in CSP [N=1358] % OR Sig. *, ** or *** OPPORTUNITY Social norms NS MOTIVATION Attitudes *** Outcome expectation NS Social pressure NS Support for survival NS Wants/Status NS Positive Expectation NS POPULATION CHARACTERISTICS Region (Rural vs. urban) NS Sex (Males vs. women) *** Age (Young vs. Older 25+) NS Marital Status (Ever married vs. never married) *** Religion (Pentecostal vs. others) ** Education (Secondary or above vs. below secondary) NS Occupation (Unemployed vs. employed) ** NOTES: NS= not significant, *= p<0.05, **= p<0.01, ***= p<0.001 Scale values range from 1-4 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree Percentages represent portion of respondents who agree or strongly agree with measure statements Adjusted for religion, sex, age, marital status, religion education and occupation OR: Odds Ratio Omnibus Test of Model coefficients: χ 2 = , significance =p<0.001 Hosmer and Lemeshow test: χ 2 = 5.75, p=0.675 PSI Lesotho, 2012 Page 23

24 ANNEXES Population Characteristics Frequency Percent Region Rural Urban Employment Unemployed Education (level attained) Employed Below Secondary Secondary and above Marital status Never married Ever married Sex Females Males Age Total Reliability Analysis Correlates of HIV Counseling and Testing, Consistent condom use and Concurrent Sexual Partnerships, Lesotho 2012 HCT Composite Variables Cronbach s Alpha ABILITY Self Efficacy to go for HIV testing (1-strongly disagree; 4=strongly agree) -I am confident that I could go and get tested for HIV if I needed/wanted to -I am not scared to go for HIV testing -Going to get tested for HIV would be an easy thing for me to do MOTIVATION Outcome Expectation (1-strongly disagree; 4=strongly agree) -Getting tested for HIV will make it easier to change risky sexual behaviour -Getting tested will allow me to prevent spreading HIV to my partner if I test positive -Getting tested for HIV will give me peace of mind and freedom from worries -I would want to know my status in order to prevent spreading HIV during my (partner s) pregnancy -Going for VCT will help me decrease chances of contracting HIV Beliefs (1-strongly disagree; 4=strongly agree) -If I test positive for HIV, I could never have any new sexual partners (r) -If I test positive for HIV, I could no longer cook for my family (r) -If I test positive for HIV, I could still have sex -If I test positive for HIV, I would lose my job (r) -If I test positive for HIV, my boyfriend/girlfriend/partner would leave me (r) -If I test positive for HIV, my family would still support me -If I test positive for HIV, my friends would still want to be my friend CONDOM USE SCALES Composite Variables OPPORTUNITY Cronbach s Alpha PSI Lesotho, 2012 Page 24

25 Availability (1-strongly disagree; 4=strongly agree) -I know a place where I can get condoms -I have easy access to condoms -It is easy to procure a condom within 10 minutes walk -I know a place where I can get condoms even after 9 PM -Condoms are available when I need them Brand Appeal (1-strongly disagree; 4=strongly agree) -Some condoms are better than others -Lovers Plus is better than any other condom brand -Trust is better than any other condom brand -Lovers Plus is a quality brand that I would feel comfortable using -Trust is a quality brand that I would feel comfortable using ABILITY Self Efficacy (1-strongly disagree; 4=strongly agree) -I can say no to sex with a partner if we don t have a condom even if I want to have a relationship -I can say no to sex if my partner insists we do not use a condom even if we have not used one in the past -I can talk to every new partner about the importance of using condoms Social support (1-strongly disagree; 4=strongly agree) -Among my close friends, we are comfortable discussing condom use -When I think that one of my friends might have sex on a date, I usually ask them if they have condoms - If my friend knew that I might have sex on a date, s/he would ask me if I am carrying a condom MOTIVATION Attitude (1-strongly disagree; 4=strongly agree) -Condoms are pleasant to use -I don t think condoms interfere with the enjoyment of sex -Then idea of using condoms doesn t appeal to me (r) -Condoms are uncomfortable (r) CONCURRENT SEXUAL PARTNERSHIPS SCALES Composite Variables MOTIVATION Outcome Expectations (1-strongly disagree; 4=strongly agree) -Being in a mutually faithful relationship with one partner reduces one s chances of HIV infection -Having fewer partners at the same reduces the chances of getting HIV -Having only one sexual partner reduces my chances of HIV/AIDS infection -Having sex with someone in order to get money, gifts, work, or other favours increases my risk of contracting HIV OPPORTUNITY Social Pressure (1-strongly disagree; 4=strongly agree) -My friends are more accepting if I have multiple partners at the same time (r) -My friends will think I am fashionable if I have more than one partner at the same time (r) -I will not be popular among my friends if I only have one partner at the same time (r) -I will be lagging behind my friends if I don t have multiple partners at the same time (r) -My friends will think I am sexually inexperienced if I have only one partner (r) Attitudes (1-strongly disagree; 4=strongly agree) -Sex becomes boring with the same person over time (r) -Being in a monogamous relationship is healthy -Life is too short to only have one partner at a time (r) -If I have sex with someone, it does not mean that I love that person (r) -One should not have sex until that person is in love (r) -Sex without any commitment is more fun (r) -Sex has no value so I can have it with anybody (r) Perceived Benefits: Support for survival (1-strongly disagree; 4=strongly agree) -If I have more than one sexual partner at the same time will allow me to get basic groceries(r) -If I have more than one sexual partner at the same time I will be guaranteed of enough cash all the time(r) -Having more than one sexual partner ensures that I get/keep my job(r) -Having more than one sexual partner at the same time will meet my needs for accommodation/transport/school tuition (r) Cronbach s Alpha PSI Lesotho, 2012 Page 25

26 Perceived Benefits: Wants/Status (1-strongly disagree; 4=strongly agree) -Having more partners at the same time will help meet my entertainment needs (such as night clubs, restaurants, stadiums etc) (r) -I will obtain fashionable goods (clothing, makeup, hairdo etc) if I have partners at the same time (r) -Taking on multiple partners at the same time helps me to get a promotion at work (r) -Taking on multiple partners at the same time ensures me of preferential treatment from people in powers positions (r) -Having more partners at the same time will give me access to car/cell phone/cash (r) Perceived Benefits: Positive Expectation (1-strongly disagree; 4=strongly agree) -Having more than one sexual partner at the same time ensures that I have company all the time (r) -If I have more partner at the same time I have someone else to fall back on if something goes wrong with one relationship (r) -Having more than one sexual partner at the same time will increase my chances of having a boy child (r) -Having more than one sexual partner at the same time will give a proof of my fertility (r) NOTES: Cronbach s Alpha determines whether or not a scale is reliable based on the following criterion: <0.60 = unacceptable = undesirable = minimally acceptable = acceptable = very good (r) stands for reverse coded scale items. PSI Lesotho, 2012 Page 26