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Click to edit Master title style If they know how to talk about them Click to edit Master text styles they will use them: Second level Determinants of Condom Use Among Third level Women in Mozambique Fourth level Fifth level Valeriana


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Second level

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Fourth level Fifth level

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If they know how to talk about them they will use them: Determinants of Condom Use Among Women in Mozambique

Valeriana Rufino, High Risk Group Manager, PSI/Mozambique Co-Authors: Filipe Bila, Jennifer Wheeler, Fatima Mussa, Dvora Joseph, Arild Drivdal, Brian Smith

HIV Implementer’s Meeting Namibia, June, 2009

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OUTLINE

  • Background and Implementation approach
  • Analysis design and methods
  • Determinants of condom use among women
  • Way forward
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BACKGROUND AND IMPLEMENTATION APPROACH

  • Since 1994, PSI/Mozambique in

collaboration with the Ministry of Health and the National AIDS Council, has implemented HIV prevention programs, including condom social marketing.

  • In 2008, PSI conducted a population-

based survey on HIV attitudes, knowledge and behaviors in selected districts of Gaza, Sofala and Zambézia.

  • Survey used to identify the

determinants of condom use in women and men with non-marital non- cohabitating partners (NMNC) as well as primary partners.

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ANALYSIS DESIGN AND METHODS

  • The total sample size included 4,075 women and men

aged 15 to 35.

  • 2/3 of the sample were women
  • Women were over sampled to capture a sufficient

number of respondents with NMNC partners.

  • The survey used a multi-stage cluster sampling design

to select households to be interviewed.

  • Data was analyzed using ANOVA and logistic

regression procedures in SPSS.

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Why do we focus on women?

  • Condom use among women was significantly

lower than men in the study

  • Women have less power to negotiate condom

use in Mozambique, hence we wanted to analyze determinants to improve women’s ability to negotiate and USE condoms

  • Using results to develop targeted programs to

increase condom use among women

Focus of Analysis on Women

WHY FOCUS ON WOMEN?

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USE OF MALE CONDOMS BY WOMEN

  • Condom use is significantly lower with primary

partner than with NMNC partners and remains significantly lower than male reporting

  • f condom use

PROVINCES NMNC PARTNERS PRIMARY PARTNERS GAZA 31% 21%* SOFALA 53% 30%* ZAMBEZIA 54% 33%*

* p<.05

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DETERMINANTS OF CONDOM USE (Cont.)

  • Self efficacy around condom use was the most

significant determinant of condom use for women with primary partners in all provinces.

  • Strong confidence and “know how” about

condom use – including negotiation skills

  • E.g.: “I am able to talk to all of my partners about

the importance of condom use even if we have already had sex”

DETERMINANTS OF MALE CONDOM USE AMONG WOMEN

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DETERMINANTS OF CONDOM USE (Cont.)

  • Positive attitudes towards condoms were

determinants of condom use among women with both primary and NMNC partners in all study sites.

  • Disagreement with phrases such as “condoms

reduce pleasure” or “condoms are not comfortable”

  • Availability of condoms was related to

condom use among women in Gaza only. DETERMINANTS OF CONDOM USE AMONG WOMEN, cont.

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DETERMINANTS OF CONDOM USE (Cont.)

  • Community social support was significantly

associated with condom use with both NMNC and primary partners in Sofala and Gaza.

  • E.g.: “In my community, it is OK to be seen buying

condoms”

  • However, men in Zambézia were more likely to use

condoms if they had support from friends

DETERMINANTS OF CONDOM USE AMONG WOMEN, cont.

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CONCLUSIONS AND RECOMENDATIONS

  • Improved interpersonal communication through

network of community agents, peer educators and theater groups

– Target sexually active women to improve self efficacy around condom use by providing

  • pportunities to demonstrate, touch condoms and

ask questions

  • Condoms are still highly stigmatized because
  • f focus on HIV prevention in Mozambique,

which could be the cause of low use with primary partners or use for family planning

WAY FORWARD

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WAY FORWARD, cont.

  • Increase accessibility of condoms through free

distribution in partnership with local NGOs specially in Gaza Province

  • Results of the study were incorporated into the

Government of Mozambique’s condom promotion strategy

  • E.g. A national condom campaign will be launched in 2009 to

address self efficacy around condom use among women

  • PSI has launched a male condom (Confianca) marketed

specifically for family planning with primary partners

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CONCLUSIONS AND RECOMENDATIONS

  • KANIMAMBO
  • OBRIGADA
  • THANK YOU