Intervention Targets: Summary

Transcription

1 Integrated Behavioral Model, Montaño & Kasprzyk, 2008

2 Intervention Targets: Summary Protective Behavior Condom use Spousal Partner Condom use Steady Partner Condom use Casual Partner Condom use CS Partner Attitude M F Norm M F PBC SE M F M F

3 CONVERSATION GUIDE STEP 1: a) Initiate the conversation b) Assess current HIV/AIDS knowledge If necessary, present practical, accurate information to: - Fill gaps in knowledge - Correct myths and misconceptions STEP 2: a) Identify the current high risk behaviour: -Having sex without a condom -Not sticking to one sexual partner -Having casual sex after drinking alcohol b) Identify the safe sex behaviours to promote: -Talk honestly about sex with your partner -Abstain or delay sex until marriage -Know your status; get an HIV test -Use a condom with all partners, all the time -Stick to one sexual partner, but if you are unable, use a condom -No casual sex after drinking alcohol, but if so, use a condom STEP 3: Identify issues to target by using the elicitation questions for the safe sex behaviour you are promoting: a. How do you feel about? What makes you feel that way? b. What do you think about? c. What are some of the advantages and disadvantages of? d. Who might be most supportive or not supportive of? e. What makes it easy or hard to? STEP 4: Create a targeted response: a) Acknowledge feelings; validate or reinforce positive beliefs, social support, facilitators b) Counter negative feelings, negative beliefs, lack of social support; help reduce barriers c) Discuss and plan for commitment

4 CONDOM USE STEADY PARTNER

5 Behavioral Beliefs: Rs with Condom Use Motivation (Steady Partner) Behavioral Beliefs: Motivation Make partner angry -.37 Show lack of respect for partner -.40 Show you think partner is unclean/diseased -.37 Show that you are unclean/diseased -.37 Be embarrassing -.29 Make partner think you don t love her/him -.37 Spoil the relationship -.36 Show you don t trust her/him -.38 You would get less pleasure -.21 Make partner think you have other partners -.39 Unnecessary - partner has no other partners -.31 You will not have sexual release -.24 Encourage promiscuity in partner -.29 All correlations significant with p < 0.001

6 Normative Beliefs: R with Condom Use Motivation (Steady Partner) Normative Beliefs: Motivation Your family.25 Your closest friends.29 Radio shows or radio dramas.20 Your partner.56 All correlations significant with p < 0.001

7 Efficacy Beliefs: Rs with Condom Use Motivation (Steady Partner) Efficacy Beliefs: Motivation Carried away and can t wait to have sex.57 You drink before sex.52 Partner drinks before sex.53 Use another method of birth control.59 Partner doesn t want to use condom.56 Believe AIDS will affect you.43 Having condom with you.57 Know how to use a condom.59 Condom availability in community.60 Had to talk about it with her.56 You think she had other partners.45 All correlations significant with p < 0.001

8 STICKING TO ONE PARTNER - MONOGAMY

9 Behavioral Beliefs: Rs with Monogamy Motivation Behavioral Beliefs: Motivation means you would not get the variety in sexual partners you need -.12 means you would not be sexually satisfied -.28 does not fit into our culture -.09 is difficult because you have a high sex drive -.32 is difficult since it is traditional for men to have multiple partners -.20 makes men less manly -.12 means you will not have HIV.05 is something that you cannot commit to -.30 means men would get sick -.12 means men would lose prestige or standing in the community -.13 means women will not get ahead in their jobs -.12 All correlations significant with p < 0.004

10 Normative Beliefs: R with Monogamy Motivation Normative Beliefs: your spouse or steady partner.21 your family.15 your closest friends.20 your culture.20 your church.12 radio shows or radio dramas.13 Intention All correlations significant with p < 0.001

11 Efficacy Beliefs: Rs with Monogamy Intention Efficacy Beliefs: If you could talk about it with your partner.55 If you trusted that your partner was also monogamous.46 If you and your partner were a part a lot.41 If your partner didn t want sex as often as you did.40 MEN ONLY: If you spot a beautiful girl.44 MEN ONLY: If commercial sex workers entice you.39 MEN ONLY: If wife, main or steady partner was pregnant.48 WOMEN ONLY: If men offer you gifts or money.48 All correlations significant with p < Intention

12 Sub-sample Analysis All sexually active men IBM Comparisons for attitudinal, normative, personal agency beliefs Comparisons made between: - those with concurrent partners -to those without concurrent partners

13 Monogamy: Behavioral Expectations/Motivations Monogamy % strongly agree Expectations Motivation to stick to one partner Expectation main partner is monogamous Non Concurrent r 95% 65%* Concurrent 76% 66%* Spouse expects monogamy Your self standard re: monogamy w spouse Your spouse has other partners besides you Steady partner (SP) expects monogamy Your self standard re: monogamy w SP 98%* 96%* 98% 85% 23% 13% 96% 90% 96% 79% Your SP has other partners besides you 18% * Non Significant 22%

14 Behavioral Beliefs with Monogamy Behavior Monogamy Behavioral Beliefs Not get variety in sex partners you need 13% % strongly agree Non concurrent Concurrent 22% Not be sexually satisfied Does not fit into our culture 3% 9% 6% 10% Difficult because you have high sex drive Difficult since traditional for multiple partners 3% 9% 10% 14% Makes men less manly You will not get HIV Something you cannot commit to Would get sick Would lose prestige or standing in community 6% 10% 61%* 63%* 9% 22% 4% 7% 4% 7% * Non Significant

15 Normative Beliefs with Monogamy Behavior Monogamy % strongly agree Normative Influence Beliefs Non concurrent Concurrent Your family 96% 92% Your closest friends Your church Your culture Radio shows or dramas Spouse 95% 97% 97% 96%* 98%* 88% 86% 94% 94%* 96%* * Non Significant

16 Self-Efficacy with Monogamy Behavior Monogamy % strongly agree Self-Efficacy Beliefs Talking about it with partner Trust partner is also monogamous You and partner being apart a lot Non concurrency 90% 88% 80% Concurrency 76% 77% 63% Partner did not want sex as often as you 82% 61% You spot a beautiful girl CSWs entice you Wife or steady partner being pregnant 81% 86% 85% 66% 79% 74%

17 Survey Results - Highlights: MEN AGE 18-30

18 Behavioral Beliefs - Men Beliefs about getting circumcised: % Agree/Disagree Not Intend MC Strongly Intend MC Will help encourage friends to get circumcised 26% 76% Will give you peace of mind 10% 56% Is something that you are too old for now 40% 7% Will give you sense of achievement 14% 58% Might not heal properly, cause disfigurement 50% 10% Enhance sexual pleasure for you 12% 48% Would be against your religion 30% 5% Will result in a slowdown of HIV in Zimbabwe 20% 69% Will make it easier to have sons circumcised 31% 76% Will cause women to shun you 55% (D) 79% (D) Wife/girlfriend may think you will seek pleasure elsewhere 33% 6% Will protect you from STIs 17% 59%

19 Normative Beliefs - Men Beliefs about who would encourage you to get circumcised: % Agree Encourages Not Intend MC Strongly Intend MC Your Brothers 17% 72% Your Closest Friends 14% 68% Your Culture 16% 70% People in your community 7% 51% Your Wife 4% 72% Your Girlfriend 12% 59% Health care workers in your community 44% 87%

20 Efficacy Beliefs - Men How certain you can get circumcised if: MC is new and has not been offered before in community % Certain Could Get MC Not Intend MC Strongly Intend MC 4% 46% MC is available in local including rural - clinics 22% 74% Your culture is against it 7% 51% Your wife/girlfriend is against it 10% 52% You cannot have it done privately, so others might know about it Worried about whether there are adequate supplies in clinics 7% 46% 2% 18%

21 Control Beliefs - Men Facilitators/ Barriers to getting circumcised: % Easy to get MC Not Intend MC Strongly Intend MC Availability of equipment and materials 30% 82% People describe MC as painful 5% 36% If you don t know how MC prevents HIV 0% 24% If local chiefs / village heads support MC 23% 73% MC is new, not offered before in community 2% 32% If circumcision is not free to you 3% 21% If MC available in local (including rural) clinics 22% 70% If MC promoted on TV and radio 26% 74% If you cannot do it privately, so others know 9% 38% If you did not know where to go for MC 3% 13%

22 Complete Model Adult Men IBM Construct Behavioral Beliefs Normative Beliefs Efficacy Beliefs Control Beliefs Belief Will give you peace of mind Something you are too old for now Will enhance your sexual pleasure/enjoyment Cause women to shun you Might not heal properly cause disfigurement Brothers encourage Closest friends encourage Wife/girlfriend encourage If culture is against MC If MC is new not offered before in community If wife/girlfriend is against MC Availability of equipment and materials (B) If MC available in local (including rural) clinics (F)

23 Survey Results - Highlights: CLINICIANS

24 Behavioral Beliefs - Clinicians Beliefs about Recommending MC to Men: Will result in patients accusing you of promoting alien practice Helps you see clients have a healthy life Result in complications, side effects, infections Helps person with tight foreskin Should be done, as most are affected by HIV/AIDS Difficult to convince adults afraid of pain Result in women not liking circumcised men Healing may take too long Conflicts with being faithful, abstinence which are more effective Is recommending method that is not completely protective Promotes personal hygiene keep penis clean, prevent infections Would be against culture Recommends method that can only play supporting role Protects women by reducing his chance of getting HIV even if unfaithful Would be against religion

25 Normative Beliefs - Clinicians Beliefs who would encourage you to recommend MC to Men: Your closest friends Your adult male patients Your religion / church Teachers and schools

26 Control Beliefs - Clinicians Facilitators/Barriers to Recommending MC to Men: Awareness through schools and churches If men are afraid of infection and healing process If community is informed about benefits of MC If MC is only available at central city clinics or hospitals If patients are aware of HIV being in the community If you were not trained in providing MC If MC is new and has not been offered before in community Facil. Barrier Facil. Barrier Facil. Barrier Barrier