Individual and contextual socioeconomic determinants of knowledge of the ABC approach of preventing the sexual transmission of HIV in Nigeria: a multilevel analysis
Olalekan A. Uthman A B E , Gbenga A. Kayode C D and Victor.T. Adekanmbi C
+ Author Affiliations
- Author Affiliations
A Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK.
B Liverpool School of Tropical Medicine, International Health Group, Pembroke Place, Liverpool, L3 5QA, UK.
C Centre for Evidence-based Global Health, Ilorin, 240001, Kwara State, Nigeria.
D Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
E Corresponding author. Email: olalekan.uthman@warwick.ac.uk
Sexual Health 10(6) 522-529 https://doi.org/10.1071/SH13065
Submitted: 30 April 2013 Accepted: 9 August 2013 Published: 25 October 2013
Abstract
Background: Nigeria has the highest number of people living with HIV/AIDS in the world after India and South Africa. HIV/AIDS places a considerable burden on society’s resources, and its prevention is a cost-beneficial solution to address these consequences. To the best of our knowledge, there has been no multilevel study performed to date that examined the separate and independent associations of individual and community socioeconomic status (SES) with HIV prevention knowledge in Nigeria. Methods: Multilevel linear regression models were applied to the 2008 Nigeria Demographic and Health Survey on 48 871 respondents (Level 1) nested within 886 communities (Level 2) from 37 districts (Level 3). Results: Approximately one-fifth (20%) of respondents were not aware of any of the Abstinence, Being faithful and Condom use (ABC) approach of preventing the sexual transmission of HIV. However, the likelihood of being aware of the ABC approach of preventing the sexual transmission of HIV increased with older age, male gender, greater education attainment, a higher wealth index, living in an urban area and being from least socioeconomically disadvantaged communities. There were significant community and district variations in respondents’ knowledge of the ABC approach of preventing the sexual transmission of HIV. Conclusion: The present study provides evidence that both individual- and community-level SES factors are important predictors of knowledge of the ABC approach of preventing the sexual transmission of HIV in Nigeria. The findings underscore the need to implement public health prevention strategies not only at the individual level, but also at the community level.
Additional keywords: behavioural approach, contextual factors, social determinant.
References
[1] Joint United Nations Programme on HIV/AIDS (UNAIDS). Report on the global AIDS epidemic 2010. Geneva: UNAIDS; 2010.[2] World Bank. Intensifying action against HIV/AIDS in Africa: responding to a development crisis. Washington, DC: The World Bank; 2000.
[3] United Nations Organizations. United Nations declaration of commitment on HIV/AIDS, special session on HIV/AIDS, United Nations General Assembly. Geneva: United Nations Organizations; 2001.
[4] Ratzan SC. AIDS: when can the world rest? J Health Commun 2000; 5 193–4.
| AIDS: when can the world rest?Crossref | GoogleScholarGoogle Scholar |
[5] Livingston IL. HIV/AIDS control in Africa: the importance of epidemiological and health promotion approaches. Health Promot Int 1993; 8 189–98.
| HIV/AIDS control in Africa: the importance of epidemiological and health promotion approaches.Crossref | GoogleScholarGoogle Scholar |
[6] Assefa Y, Jerene D, Lulseged S, Ooms G, Van Damme W. Rapid scale-up of antiretroviral treatment in Ethiopia: successes and system-wide effects. PLoS Med 2009; 6 e1000056
| Rapid scale-up of antiretroviral treatment in Ethiopia: successes and system-wide effects.Crossref | GoogleScholarGoogle Scholar |
[7] Baggaley RF, Garnett GP, Ferguson NM. Modelling the impact of antiretroviral use in resource-poor settings. PLoS Med 2006; 3 e124
| Modelling the impact of antiretroviral use in resource-poor settings.Crossref | GoogleScholarGoogle Scholar |
[8] Tanser F, Barnighausen T, Grapsa E, Zaidi J, Newell ML. High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa. Science 2013; 339 966–71.
| High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa.Crossref | GoogleScholarGoogle Scholar |
[9] Siegfried N, Muller M, Deeks JJ, Volmink J. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database Syst Rev 2009; CD003362
[10] Cremin I, Alsallaq R, Dybul M, Piot P, Garnett G, Hallett TB. The new role of antiretrovirals in combination HIV prevention: a mathematical modelling analysis. AIDS 2013; 27 447–58.
| The new role of antiretrovirals in combination HIV prevention: a mathematical modelling analysis.Crossref | GoogleScholarGoogle Scholar |
[11] Eaton JW, Johnson LF, Salomon JA, Barnighausen T, Bendavid E, Bershteyn A, et al HIV treatment as prevention: systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa. PLoS Med 2012; 9 e1001245
| HIV treatment as prevention: systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa.Crossref | GoogleScholarGoogle Scholar |
[12] McNairy ML, Cohen M, El-Sadr WM. Antiretroviral therapy for prevention is a combination strategy. Curr HIV/AIDS Rep 2013; 10 152–8.
| Antiretroviral therapy for prevention is a combination strategy.Crossref | GoogleScholarGoogle Scholar |
[13] McNairy ML, Howard AA, El-Sadr WM. Antiretroviral therapy for prevention of HIV and tuberculosis: a promising intervention but not a panacea. J Acquir Immune Defic Syndr 2013; 63 S200–7.
[14] Williams B, Wood R, Dukay V, Delva W, Ginsburg D, Hargrove J, et al Treatment as prevention: preparing the way. J Int AIDS Soc 2011; 14 S1–6.
| Treatment as prevention: preparing the way.Crossref | GoogleScholarGoogle Scholar |
[15] Baeten JM, Haberer JE, Liu AY, Sista N. Preexposure prophylaxis for HIV prevention: where have we been and where are we going? J Acquir Immune Defic Syndr 2013; 63 S122–9.
[16] Okwundu CI, Uthman OA, Okoromah CA. Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals. Cochrane Database Syst Rev 2012; 7 CD007189
[17] Cassell MM, Halperin DT, Shelton JD, Stanton D. Risk compensation: the Achilles’ heel of innovations in HIV prevention? BMJ 2006; 332 605–7.
| Risk compensation: the Achilles’ heel of innovations in HIV prevention?Crossref | GoogleScholarGoogle Scholar |
[18] Okware S, Kinsman J, Onyango S, Opio A, Kaggwa P. Revisiting the ABC strategy: HIV prevention in Uganda in the era of antiretroviral therapy. Postgrad Med J 2005; 81 625–8.
| Revisiting the ABC strategy: HIV prevention in Uganda in the era of antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |
[19] Stoneburner RL, Low-Beer D. Population-level HIV declines and behavioral risk avoidance in Uganda. Science 2004; 304 714–18.
| Population-level HIV declines and behavioral risk avoidance in Uganda.Crossref | GoogleScholarGoogle Scholar |
[20] Green EC, Halperin DT, Nantulya V, Hogle JA. Uganda’s HIV prevention success: the role of sexual behavior change and the national response. AIDS Behav 2006; 10 335–46, discussion 47–50.
| Uganda’s HIV prevention success: the role of sexual behavior change and the national response.Crossref | GoogleScholarGoogle Scholar |
[21] Murphy EM, Greene ME, Mihailovic A, Olupot-Olupot P. Was the ‘ABC’ approach (abstinence, being faithful, using condoms) responsible for Uganda’s decline in HIV? PLoS Med 2006; 3 e379
| Was the ‘ABC’ approach (abstinence, being faithful, using condoms) responsible for Uganda’s decline in HIV?Crossref | GoogleScholarGoogle Scholar |
[22] Slutkin G, Okware S, Naamara W, Sutherland D, Flanagan D, Carael M, et al How Uganda reversed its HIV epidemic. AIDS Behav 2006; 10 351–60.
| How Uganda reversed its HIV epidemic.Crossref | GoogleScholarGoogle Scholar |
[23] Green EC, Conde A. Sexual partner reduction and HIV infection. Sex Transm Infect 2000; 76 145a
| Sexual partner reduction and HIV infection.Crossref | GoogleScholarGoogle Scholar |
[24] Fylkesnes K, Musonda RM, Sichone M, Ndhlovu Z, Tembo F, Monze M. Declining HIV prevalence and risk behaviours in Zambia: evidence from surveillance and population-based surveys. AIDS 2001; 15 907–16.
| Declining HIV prevalence and risk behaviours in Zambia: evidence from surveillance and population-based surveys.Crossref | GoogleScholarGoogle Scholar |
[25] Shelton JD, Halperin DT, Nantulya V, Potts M, Gayle HD, Holmes KK. Partner reduction is crucial for balanced ‘ABC’ approach to HIV prevention. BMJ 2004; 328 891–3.
| Partner reduction is crucial for balanced ‘ABC’ approach to HIV prevention.Crossref | GoogleScholarGoogle Scholar |
[26] Aphichat C. ABC program for HIV prevention in Thailand: Empirical evidences and policy implications. Nakhon Pathom: Institute for Population and Social Research, Mahidol University; 2009.
[27] Uwakwe CB. Systematized HIV/AIDS education for student nurses at the University of Ibadan, Nigeria: impact on knowledge, attitudes and compliance with universal precautions. J Adv Nurs 2000; 32 416–24.
| Systematized HIV/AIDS education for student nurses at the University of Ibadan, Nigeria: impact on knowledge, attitudes and compliance with universal precautions.Crossref | GoogleScholarGoogle Scholar |
[28] Akpabio II, Asuzu MC, Fajemilehin BR, Ofi B. Effects of parental involvement in HIV/AIDS preventive education on secondary student knowledge about transmission and prevention in Akwa Ibom State, Nigeria. Int Q Community Health Educ 2008; 29 71–87.
| Effects of parental involvement in HIV/AIDS preventive education on secondary student knowledge about transmission and prevention in Akwa Ibom State, Nigeria.Crossref | GoogleScholarGoogle Scholar |
[29] Essien EJ, Mgbere O, Monjok E, Ekong E, Holstad MM, Kalichman SC. Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for female military personnel. Soc Sci Med 2011; 72 63–71.
| Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for female military personnel.Crossref | GoogleScholarGoogle Scholar |
[30] Arnold R, Maticka-Tyndale E, Tenkorang E, Holland D, Gaspard A, Luginaah I. Evaluation of school- and community-based HIV prevention interventions with junior secondary school students in Edo State, Nigeria. Afr J Reprod Health 2012; 16 103–25.
[31] Adebiyi AO, Asuzu MC. Condom use amongst out of school youths in a local government area in Nigeria. Afr Health Sci 2009; 9 92–7.
[32] Adedimeji AA, Heard NJ, Odutolu O, Omololu FO. Social factors, social support and condom use behavior among young urban slum inhabitants in southwest Nigeria. East Afr J Public Health 2008; 5 215–22.
[33] Iyaniwura CA, Mautin G. Sexual activity and other related practices among youth corpers in Nigeria. West Afr J Med 2008; 27 13–9.
[34] Onayade AA, Abiona TC, Ugbala C, Alozie G, Adetuyi O. Determinants of consistent condom use among adolescents and young adults attending a tertiary educational institution in Ile-Ife, Nigeria. Niger Postgrad Med J 2008; 15 185–91.
[35] Owoaje ET, Uchendu OC. Sexual risk behaviour of street youths in south west Nigeria. East Afr J Public Health 2009; 6 274–9.
[36] Sabitu K, Iliyasu Z, Baba SE. Sexual behaviour and predictors of condom use among students of a Nigerian tertiary institution. Niger J Med 2007; 16 338–43.
[37] National Population Commission (NPC) Nigeria and ICF Macro. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro; 2009.
[38] Filmer D, Pritchett LH. Estimating wealth effects without expenditure data–or tears: an application to educational enrollments in states of India. Demography 2001; 38 115–32.
[39] Montgomery MR, Gragnolati M, Burke KA, Paredes E. Measuring living standards with proxy variables. Demography 2000; 37 155–74.
| Measuring living standards with proxy variables.Crossref | GoogleScholarGoogle Scholar |
[40] Tu YK, Clerehugh V, Gilthorpe MS. Collinearity in linear regression is a serious problem in oral health research. Eur J Oral Sci 2004; 112 389–97.
| Collinearity in linear regression is a serious problem in oral health research.Crossref | GoogleScholarGoogle Scholar |
[41] Tu YK, Kellett M, Clerehugh V, Gilthorpe MS. Problems of correlations between explanatory variables in multiple regression analyses in the dental literature. Br Dent J 2005; 199 457–61.
| Problems of correlations between explanatory variables in multiple regression analyses in the dental literature.Crossref | GoogleScholarGoogle Scholar |
[42] Hocking RR. Methods and applications of linear models. New York: Wiley; 1996.
[43] Schroeder MA. Diagnosing and dealing with multicollinearity. West J Nurs Res 1990; 12 175–84.
[44] Rasbash J, Charlton C, Jones K, Pillinger R. Manual supplement for MLwiN version 2.26. Bristol: Centre for Multilevel Modelling, University of Bristol; 2012.
[45] Rahman MM, Kabir M, Shahidullah M. Adolescent knowledge and awareness about AIDS/HIV and factors affecting them in Bangladesh. J Ayub Med Coll Abbottabad 2009; 21 3–6.
[46] Sabitu K, Iliyasu Z, Joshua IA. An assessment of knowledge of HIV/AIDS and associated risky behavior among inmates of Kaduna convict prison: the implications for prevention programmes in Nigerian prisons. Niger J Med 2009; 18 52–8.
[47] Wilson D, Greenspan R, Wilson C. Knowledge about AIDS and self-reported behaviour among Zimbabwean secondary school pupils. Soc Sci Med 1989; 28 957–61.
| Knowledge about AIDS and self-reported behaviour among Zimbabwean secondary school pupils.Crossref | GoogleScholarGoogle Scholar |
[48] Campbell B, Mbizvo MT. Sexual behaviour and HIV knowledge among adolescent boys in Zimbabwe. Cent Afr J Med 1994; 40 245–50.
[49] Chimbindi NZ, McGrath N, Herbst K, San TK, Newell ML. Socio-demographic determinants of condom use among sexually active young adults in rural KwaZulu-Natal, South Africa. OpenAIDS J. 2010; 4 88–95.
[50] Kaufman CE, Clark S, Manzini N, May J. Communities, opportunities, and adolescents’ sexual behavior in KwaZulu-Natal, South Africa. Stud Fam Plann 2004; 35 261–74.
| Communities, opportunities, and adolescents’ sexual behavior in KwaZulu-Natal, South Africa.Crossref | GoogleScholarGoogle Scholar |
[51] Esiet AO, Esiet U, Philliber S, Philliber WW. Changes in knowledge and attitudes among junior secondary students exposed to the family life and HIV education curriculum in Lagos State, Nigeria. Afr J Reprod Health 2009; 13 37–46.
[52] Jodati AR, Nourabadi GR, Hassanzadeh S, Dastgiri S, Sedaghat K. Impact of education in promoting the knowledge of and attitude to HIV/AIDS prevention: a trial on 17,000 Iranian students. Int J STD AIDS 2007; 18 407–9.
| Impact of education in promoting the knowledge of and attitude to HIV/AIDS prevention: a trial on 17,000 Iranian students.Crossref | GoogleScholarGoogle Scholar |
[53] Calazans G, Araujo TW, Venturi G, Franca JI. Factors associated with condom use among youth aged 15–24 years in Brazil in 2003. AIDS 2005; 19 S42–50.
| Factors associated with condom use among youth aged 15–24 years in Brazil in 2003.Crossref | GoogleScholarGoogle Scholar |
[54] Camlin CS, Chimbwete CE. Does knowing someone with AIDS affect condom use? An analysis from South Africa. AIDS Educ Prev 2003; 15 231–44.
| Does knowing someone with AIDS affect condom use? An analysis from South Africa.Crossref | GoogleScholarGoogle Scholar |
[55] Douthwaite MR, Saroun L. Sexual behaviour and condom use among unmarried young men in Cambodia. AIDS Care 2006; 18 505–13.
| Sexual behaviour and condom use among unmarried young men in Cambodia.Crossref | GoogleScholarGoogle Scholar |
[56] Gregson S, Garnett GP, Nyamukapa CA, Hallett TB, Lewis JJ, Mason PR, et al HIV decline associated with behavior change in eastern Zimbabwe. Science 2006; 311 664–6.
| HIV decline associated with behavior change in eastern Zimbabwe.Crossref | GoogleScholarGoogle Scholar |
[57] Koffi AK, Kawahara K. Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Cote d’Ivoire AIDS indicator survey. BMC Public Health 2008; 8 408
| Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Cote d’Ivoire AIDS indicator survey.Crossref | GoogleScholarGoogle Scholar |
[58] Sambisa W, Curtis SL, Stokes CS. Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe. J Biosoc Sci 2010; 42 1–25.
| Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe.Crossref | GoogleScholarGoogle Scholar |
[59] Merlo J, Chaix B, Yang M, Lynch J, Rastam L. A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon. J Epidemiol Community Health 2005; 59 443–9.
| A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon.Crossref | GoogleScholarGoogle Scholar |
[60] Braverman M. Sources of survey error: implication for evaluation studies. New Dir Eval 1996; 70 17–28.
| Sources of survey error: implication for evaluation studies.Crossref | GoogleScholarGoogle Scholar |
[61] Knox D, Zusman ME, McGinty K, Gescheidler J. Deception of parents during adolescence. Adolescence 2001; 36 611–14.
[62] Kupek E. Bias and heteroscedastic memory error in self-reported health behavior: an investigation using covariance structure analysis. BMC Med Res Methodol 2002; 2 14
| Bias and heteroscedastic memory error in self-reported health behavior: an investigation using covariance structure analysis.Crossref | GoogleScholarGoogle Scholar |
[63] Wellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel D, et al Sexual behaviour in context: a global perspective. Lancet 2006; 368 1706–28.
| Sexual behaviour in context: a global perspective.Crossref | GoogleScholarGoogle Scholar |
[64] Nnko S, Boerma JT, Urassa M, Mwaluko G, Zaba B. Secretive females or swaggering males? An assessment of the quality of sexual partnership reporting in rural Tanzania. Soc Sci Med 2004; 59 299–310.
| Secretive females or swaggering males? An assessment of the quality of sexual partnership reporting in rural Tanzania.Crossref | GoogleScholarGoogle Scholar |
[65] Curtis SL, Sutherland EG. Measuring sexual behaviour in the era of HIV/AIDS: the experience of demographic and health surveys and similar enquiries. Sex Transm Infect 2004; 80 ii22–7.
| Measuring sexual behaviour in the era of HIV/AIDS: the experience of demographic and health surveys and similar enquiries.Crossref | GoogleScholarGoogle Scholar |
[66] Cleland J, Ferry B. Sexual behaviour and AIDS in the developing world. Geneva: World Health Organization; 1995.
