Page 126 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 9 Original Research

TB 2012–2016 is to reduce new HIV infections by at least 50%, Methods
using a combination of prevention approaches combining
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biomedical and behavioural interventions. In 2012, the South We analysed secondary data from the Third National HIV
African government made a commitment to address issues Communication Survey (NCS) conducted in all nine
related to social and structural factors that influence HIV provinces in SA between February and May 2012. This survey
through scaling up accessibility of services including ART, was designed to be representative of 16–55 years old. The
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rolling out the HIV counselling and testing campaign, methodology has been previously published, but briefly a
expanding medical male circumcision programmes and multi-stage, cluster sampling approach was first used to
provision of basic needs grants. 6,7,9 To reduce new HIV draw a sample of 400 primary sampling units. Secondly, a
infections, a combination of biomedical, behavioural, social systematic sampling interval was calculated by probability
and structural interventions have been set in place and are proportional to size techniques. The third stage of the
being constantly improved for better alignment. 8 sampling focused on randomly selected households,
followed by individuals.
Multiple and concurrent partnerships, low and inconsistent
condom use, alcohol abuse (together termed risky sexual Measurements and variables
behaviours) and low levels of male circumcision have been
shown to be the key drivers of the epidemic. 10,11 While HIV An interviewer-administered structured questionnaire
risky behaviours are known to be drivers of the spread of HIV, was used to collect data, including socio-demographic
cognitive factors including perceived susceptibility to HIV, characteristics, exposure to television and radio
perceived monetary or material benefits of having sex for communication messages or programmes on HIV and AIDS,
material gain, self-efficacy and attitudes play a significant role perception of risk and indicators on knowledge, attitude
in influencing risky sexual behaviours. 12,13,14 Based on the and behaviour related to HIV and AIDS.
health belief model, an individual’s personal belief influences
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their behaviour. Despite the large number of research studies Five constructs were created to measure psychosocial and
carried out on risk factors of HIV in SA, which include age of cognitive determinants. Responses to the questions that
sexual debut, age disparate or intergenerational relationships made up the constructs were graded on a five-point Likert
(5 year age difference), multiple sexual partnerships (MSPs) scale, ranging from strongly disagree to strongly agree.
and condom use, there have been limited studies of cognitive Cronbach’s alpha coefficient for internal consistency
behaviours that influence risky sexual behaviours. Cognitive reliability was used to assess the correlations between the
behaviours include a perceived lack of susceptibility to HIV,
perceived benefits, personal beliefs surrounding risky sexual items that made up each construct. Values of 60% or higher
behaviours, condom self-efficacy, social norms and the impact were considered to indicate acceptable internal consistency.
self-esteem has on engaging in risky sexual behaviours. A composite score was obtained for each construct by
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A study conducted by Tarkang in Cameroon in 2013 revealed calculating an average score of the responses to all the
that only 39% of the sexually active secondary school learners questions that made up the construct. We calculated the
had a high HIV risk perception. A study conducted by average scores in percentages. The composite score was
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Pettifor et al. in SA reported that only 14.0% of school learners used to create a dichotomous variable for the construct,
had high HIV risk perception. Perceptions, ideas and which was graded as either high if the composite score
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behaviours that determine people’s actions need to be explored was above 65% or low if the composite score was 65% or
further in order to better understand the drivers of risky sexual lower. This cut-off number was used to accommodate the
behaviours in SA. small number of questions used on other constructs
because we used questions from a survey that was
There are a number of psychological concepts that show how intended to measure communication programmes in SA.
ideational and cognitive factors can have an impact on behaviour Box 1 shows single-item questions that were used for each
modification. The acquired immune deficiency syndrome behavioural construct.
(AIDS) risk reduction model states that knowledge of HIV and
AIDS is a prerequisite that will enable an individual to take Definitions
action and change their behaviour. This model links HIV
knowledge to behaviour change. However, findings regarding The perceived benefits construct was defined as beliefs that
the correlation between knowledge and behaviour have been there are positive outcomes related to engaging in a specific
inconsistent. Other theories and models of health risk behaviour. The self-efficacy construct was defined as beliefs
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perception assert that cognitive ideational factors that are related that one is capable of completing a certain task on their own.
to attitudes, beliefs, knowledge, intentions and perceived self- Perceived susceptibility was defined as the individual’s
efficacy are sufficient to foster safer sex behaviour. 3,12 belief that they would acquire HIV infection. Social norms
are beliefs of how the society thinks people should perform
This study sought to investigate personal beliefs, perceptions or how the society views things. Personal beliefs are intrinsic
and other ideas, thoughts and actions that are associated cognitive beliefs that people have on their own. Multiple
with MSP and non-condom use (nCU) among the South sexual partnerships (MSP) refers to having had more than
African population aged 16–55 years. one sexual partner in the past 12 months and nCU is defined

http://www.sajhivmed.org.za 119 Open Access