Motivating Factors and Psychosocial Barriers to Condom Use among out-of-School Youths in Dar es Salaam, Tanzania: A Cross Sectional Survey Using the Health Belief Model
Condoms remain a cost-effective and relatively simple intervention to prevent HIV infection. However, condom use is still very low, particularly among youths aged 15 to 24. 348 individuals (186 males and 162 females) completed a pre-tested questionnaire. Logistic regression analysis was used to identify factors associated with condom use. Out of 348 respondents, 296 (85.0%) were sexually experienced, and 260 (87.8%) reported noncondom use in the past 3 months prior to the study. Among men, noncondom use was independently associated with feeling shy to buy condoms (AOR = 1.16; 95% CI 1.12–1.34), condoms reducing sexual pleasure (AOR = 8.19; 95% CI 3.98–17.01), and HIV is a serious and deadly disease (AOR = 0.36; 95% CI 0.28–0.46). Among women, experiencing forced sex (AOR = 1.16; 95% CI 1.10–2.78), condoms reduce sexual pleasure (AOR = 8.29; 95% CI 3.36–20.73), and inability to convince a partner to use condoms (AOR = 1.14; 95% CI 1.04–1.28) were predictors of noncondom use. In conclusion, sexually active youths in this population practice risky sexual behaviours, with low condom use practices. Strategies to improve condom use should address these psychosocial barriers associated with noncondom use. 1. Background One of the current challenges on the prevention and control of HIV/AIDS faced worldwide is among youths aged 15–24 years. In fact, the global population of adolescents has reached over one billion, the largest in human history [1]. In Tanzania, almost two-thirds (65%) of the population is under the age of 24 and almost 20% are aged 15 to 24 [2, 3]. In fact, these young women and men are the future of Tanzania, and thus, an important age group for the growth and prosperity of the country. Globally, it is estimated that 5.4 million young people aged 15 to 24 are living with HIV, 3.2 million of whom live in Sub-Saharan Africa [4]. In sub-Saharan Africa (SSA), youth lack access to HIV prevention education programes. For example, only 8 percent of out-of-school youth, have access to prevention education programes [5]. Overall HIV prevalence of 7.9% among youth aged 15 to 24 in Tanzania indicates that the HIV infection is two to three times higher among females than males (7% versus 3%), particularly in urban populations [2, 3]. Indicators of sexual activity among young people in Tanzania have revealed that a substantial proportion (46%) of unmarried youths aged 15–24 years is sexually experienced [2, 3]. A host of environmental, economic, and legal factors, together with social norms, are likely to influence early sexual debut and tendency for
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