High Risk Sexual Behaviors for HIV among the In-School Youth in Swaziland: A Structural Equation Modeling Approach

Hlengiwe Nokuthula Sacolo,Lu-I Chang,Chiung-Hua Chen,Hsin Chu,Kuei-Ru Chou,Min-Huey Chung,Keng-Liang Ou,Yuan-Mei Liao,Jeremy Miles

doi:10.1371/journal.pone.0067289

Abstract

BackgroundGlobal efforts in response to the increased prevalence of the human immunodeficiency virus (HIV) are mainly aimed at reducing high risk sexual behaviors among young people. However, knowledge regarding intentions of young people to engage in protective sexual behaviors is still lacking in many countries around the world, especially in Sub-Saharan Africa where prevalence of human immunodeficiency virus is the highest. The objective of this study was to test the theory of planned behavior (TPB) for predicting factors associated with protective sexual behaviors, including sexual abstinence and condom use, among in-school youths aged between 15 and 19 years in Swaziland.MethodsThis cross-sectional survey was conducted using a anonymous questionnaire. A two-stage stratified and cluster random sampling method was used. Approximately one hundred pupils from each of four schools agreed to participate in the study, providing a total sample size of 403 pupils of which 369 were ultimately included for data analysis. The response rate was 98%. Structural equation modeling was used to analyse hypothesized paths.ResultsThe TPB model used in this study was effective in predicting protective sexual behavior among Swazi in-school youths, as shown by model fit indices. All hypothesized constructs significantly predicted intentions for abstinence and condom use, except perceived abstinence controls. Subjective norms were the strongest predictors of intention for premarital sexual abstinence; however, perceived controls for condom use were the strongest predictors of intention for condom use.ConclusionsOur findings support application of the model in predicting determinants of condom use and abstinence intentions among Swazi in-school youths.

Highlights

Human immunodeficiency virus (HIV) infection is a global crisis that represents a serious health threat, among younger people
Descriptions of the Sample and Sexual Behaviors The proportions of participants were almost equivalent in terms of gender (53.1% male and 46.9% female), area of residence (49.6% urban and 50.4% rural) and Grade level (55.8% junior high school and 44.2% senior high school)
Major Socio-demographic Findings In Swaziland, the prevalence of human immunodeficiency virus (HIV) varies depending on rural or urban location, such variation among in-school youths may be off-set by the homogeneous nature of government schools and the proximity of urban and rural areas in specific regions

Summary

Introduction

Human immunodeficiency virus (HIV) infection is a global crisis that represents a serious health threat, among younger people. Most countries with generalized epidemics report that major declines in HIV infection rates are associated with changes in adolescent sexual behaviors, mainly including delayed sexual debut, consistent condom use and reduced number of sexual partners [2]. It is concerning, that young people in most countries continue to engage in high risk sexual behaviors despite the presence of robust HIV prevention strategies aimed at reducing such behaviors [3]. Global efforts in response to the increased prevalence of the human immunodeficiency virus (HIV) are mainly aimed at reducing high risk sexual behaviors among young people. The objective of this study was to test the theory of planned behavior (TPB) for predicting factors associated with protective sexual behaviors, including sexual abstinence and condom use, among in-school youths aged between 15 and 19 years in Swaziland

Objectives

Methods

Results

Discussion

Conclusion