Abstract
Two of the most effective health behaviours with regard to HIV prevention are condom use and sexual abstinence. While determinants of condom use among sub-Saharan African adolescents have been studied extensively, factors related to abstinence have received far less attention. This study identified socio-cognitive determinants of primary and secondary abstinence intentions and of early sexual activity. This study also assessed whether these factors had a direct or indirect association with intentions to abstain from sex. A longitudinal design was used in which 1670 students (age 12–16) of non-private South African high schools filled in a questionnaire, with a follow-up after 6 months, concerning sexual abstinence, attitudes, social norms, self-efficacy, risk perception and knowledge. Logistic and linear regression analysis with latent factors was used to assess determinants of intentions and abstinence, and structural equation modelling was used to assess indirect effects. Results showed that among sexually inactive students, social norms predicted the intention to abstain from sex in the next 6 months. Among sexually active students, reporting less disadvantages of abstinence predicted the intention to abstain. Sexual activity at follow-up was predicted by attitudes and intention among sexually inactive girls, and by knowledge among sexually inactive boys. No predictors were found for sexually active adolescents. Structural equation modelling further showed that risk perception was indirectly related to intentions to abstain from sexual intercourse. We conclude that addressing socio-cognitive factors in order to motivate adolescents to delay sex is more likely to be successful before they experience sexual debut. In addition, this study shows that the effect of increasing risk perceptions, a strategy often applied by parents and HIV prevention programmes, is to a large extent mediated by more proximal cognitive factors such as attitude. Research is needed to identify factors that influence the execution of intentions to abstain from sex.
Highlights
In South Africa, approximately 5.7 million people are living with HIV and incidence rates range from 0.5 % in the Western Cape till 2.3 % in Kwazulu-Natal [1]
A longitudinal design was used in which 1670 students of non-private South African high schools filled in a questionnaire, with a follow-up after 6 months, concerning sexual abstinence, attitudes, social norms, self-efficacy, risk perception and knowledge
We will use structural equation modeling to assess whether the socio-cognitive factors knowledge and risk perception are directly or indirectly longitudinally associated with intentions to abstain from sex
Summary
In South Africa, approximately 5.7 million people are living with HIV and incidence rates range from 0.5 % in the Western Cape till 2.3 % in Kwazulu-Natal [1]. One of the four key strategic objectives mentioned is the prevention of new HIV and STI infections by at least 50 %. To reach this objective, the National Strategic Plan emphasises the importance of targeting behavioural and socio-cognitive factors such as early sexual debut, condom use, knowledge and risk perception, in addition to more structural barriers such as poverty and access to sexual and reproductive health services. An extensive worldwide review of the effectiveness of sexual and HIV education programmes by Kirby et al [3] concludes that more research is needed into the mediating role of socio-cognitive factors, such as risk perception, to broaden our understanding of motivational processes. As such, detailed knowledge of motivational pathways could lead to more effective interventions and the development of more informative socio-cognitive theories
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