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Factors Associated With Self-Efficacy for Condom Use and Sexual Negotiation Among South African Youth

Sayles, Jennifer N MD*; Pettifor, Audrey PhD; Wong, Mitchell D MD, PhD*; MacPhail, Catherine PhD; Lee, Sung-Jae PhD§; Hendriksen, Ellen BA; Rees, Helen V MD; Coates, Thomas PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2006 - Volume 43 - Issue 2 - p 226-233
doi: 10.1097/01.qai.0000230527.17459.5c
Epidemiology and Social Science

Objectives: To use logistic regression modeling to identify factors associated with high self-efficacy for sexual negotiation and condom use in a sample of South African youth.

Methods: The Reproductive Health and HIV Research Unit (RHRU) National Youth Survey examined a nationally representative sample of 7409 sexually active South African youth aged 15 to 24 years. We used logistic regression modeling in this sample to identify factors associated with the main outcome of high self-efficacy.

Results: Among female respondents (n = 3890), factors associated with high self-efficacy in the adjusted model were knowing how to avoid HIV (odds ratio [OR] = 2.30, 95% confidence interval [CI]: 1.05 to 5.00), having spoken with someone other than a parent or guardian about HIV/AIDS (OR = 1.46, 95% CI: 1.01 to 2.10), and having life goals (OR = 1.28, 95% CI: 1.10 to 1.48). Not using condoms during their first sexual encounter (OR = 0.61, 95% CI: 0.50 to 0.76), a history of unwanted sex (OR = 0.66, 95% CI: 0.51 to 0.86), and believing that condom use implies distrust in one's partner (OR = 0.57, 95% CI: 0.51 to 0.86) were factors associated with low self-efficacy among female respondents. Male respondents (n = 3519) with high self-efficacy were more likely to take HIV seriously (OR = 4.03, 95% CI: 1.55 to 10.52), to believe they are not at risk for HIV (OR = 1.38, 95% CI: 1.12 to 1.70), to report that getting condoms is easy (OR = 1.85, 95% CI: 1.23 to 2.77), and to have life goals (OR = 1.30, 95% CI: 1.10 to 1.54). Not using condoms during their first sexual experience (OR = 0.51, 95% CI: 0.39 to 0.67), a history of having unwanted sex (OR = 0.47, 95% CI: 0.34 to 0.64), believing condom use is a sign of not trusting one's partner (OR = 0.63, 95% CI: 0.46 to 0.87), and refusing to be friends with HIV-infected persons (OR = 0.52, 95% CI: 0.32 to 0.85) were factors associated with low self-efficacy among male respondents in the fully adjusted model.

Conclusions: We used the social cognitive model (SCM) to identify factors associated with self-efficacy for condom use and sexual negotiation. Many of these factors are modifiable and suggest potential ways to improve self-efficacy and reduce HIV sexual risk behavior in South African youth.

Received for publication September 16, 2005; accepted May 19, 2006.

From the *Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, Los Angeles, CA; †Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡Reproductive Health and HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa; ‡Neuropsychiatric Institute, Center for Community Health, University of California, Los Angeles, Los Angeles, CA; ‖Department of Psychology, University of California, Los Angeles, Los Angeles, CA; and the ¶Division of Infectious Disease, Department of Medicine, University of California, Los Angeles, Los Angeles, CA.

Funding for the National Youth Survey was provided by the Kaiser Family Foundation. J. N. Sayles is a National Research Service Award Fellow in the Division of General Internal Medicine and Health Services Research, UCLA, and was partially supported by the UCLA Primary Care Research Fellowship Program.

Reprints: Jennifer N. Sayles, MD, UCLA Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, PO Box 951736, Los Angeles, CA 90095-1736 (e-mail: jsayles@mednet.ucla.edu).

© 2006 Lippincott Williams & Wilkins, Inc.