High Risk Sexual Behaviors for HIV among In-School Youth in Swaziland: Using the Theory of Planned Behavior (TPB) to Predict the Intention to Engage in Protective Sexual Behaviors

Abstract

Background: Global efforts in response to the rise of HIV prevalence are mainly aimed at reducing high risk sexual behaviors among youth. However, knowledge regarding the intention for the youth to engage in protective sexual behaviors is still lacking in many countries around the world, especially those in Sub-Saharan Africa where the prevalence of HIV is highest. Objectives: The first objective was to test the efficacy of the Theory of Planned Behavior in predicting factors associated with protective sexual behaviors, specifically; sexual abstinence and condom use among the in-school youth aged 15 to 19 years in Swaziland. The second objective was to examine gender differences in factors underlying protective sexual behaviors among such population. Design: This was a cross sectional survey conducted using a cross-cultural annoymous questionnaire. Setting: Four high schools located in rural and urban areas within the northern region of Swaziand. Participants: About one hundred pupils per school responded to the study thus yielding a total sample of 403 pupils of which 369 were ultimately included in data analysis. The response rate was 98%. Methods: Structural Equation Modelling was used to analyse hypothesized paths. All research hypothesis were based on the Theory of Planned behavior (TPB), which contextually asserts that, the exogenous variables; attitude, subjective norm and percieved behavioral control will jointly predict the intention to engage in protective sexual behaviors; abstinence and condom use. Results: The TPB models used in this study demonstrated good fit with data. Abstinence and condom use intentions were predicted by all hypothesized constructs of the final TPB model, however there were gender differences evidenced by male and female TPB models. Even though subjective norms were the strongest predictors of the intention to abstain across genders (effect coefficients .45, p<0.01 and .39, p<0.01 among males and females respectively); the strongest predictors of the intentions to use condoms were perceived condom use controls among males effect coefficient .55, p<0.01 and subjective norms of condom use among females, effect coefficient .36, p<0.01. Conclusion: Findings support applicability of the TPB in predicting determinants of condom use and abstinence intentions among Swazi in-school youth.