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BackgroundEmergency contraception (EC) is widely available free of charge at public sector clinics in South Africa. At the same time, rates of teenage and unintended pregnancy in South Africa remain high, and there are few data on knowledge of EC in the general population in South Africa, as in other resource-limited settings.MethodsWe conducted a cross-sectional, interviewer-administered survey among 831 sexually active women at 26 randomly selected public sector clinics in the Western Cape province.ResultsOverall, 30% of the women had ever heard of EC when asked directly, after the method was described to them. Only 15% mentioned EC by name or description spontaneously. Knowledge of EC was independently associated with higher education, being married, and living in an urban setting. Four percent of women had ever used EC.DiscussionThese data suggest that knowledge of EC in this setting is more common among women of higher socioeconomic status living in urban areas. For EC to play a role in decreasing unintended pregnancy in South Africa, specific interventions are necessary to increase knowledge of the method, where to get it, and the appropriate time interval for its use before the need for EC arises. Future health promotion campaigns should target rural and low socioeconomic status communities.

We investigated alcohol-related sexual risk behavior from the perspective of social norms theory. Adults (N = 895, 62% men) residing in a South African township completed street-intercept surveys that assessed risk and protective behaviors (e.g., multiple partners, drinking before sex, meeting sex partners in shebeens, condom use) and corresponding norms. Men consistently overestimated the actual frequency of risky behaviors, as reported by the sample, and underestimated the frequency of condom use. Relative to actual attitudes, men believed that other men were more approving of risk behavior and less approving of condom use. Both behavioral and attitudinal norms predicted the respondents' self-reported risk behavior. These findings indicate that correcting inaccurate norms in HIV-risk reduction efforts is worthwhile.Sub-Saharan Africa is in the midst of an HIV/AIDS epidemic. Southern Africa is home to two-thirds of people living with HIV/AIDS in the world; although only 10% of the world's population lives in southern Africa, more than 85% of the world's AIDS-related deaths have occurred in this region (UNAIDS, 2006). In the Republic of South Africa, 7.9% of men and 13.6% of women are infected with HIV (Shisana, et al., 2009). Like elsewhere in the world, the AIDS epidemic in South Africa is linked, in part, to substance use. Alcohol serving establishments are often the very places that link drinking with risks for HIV infection. Informal alcohol serving establishments, such as small bars and private homes where alcoholic beverages are sold and served which are popularly known as shebeens are often places where sex partners meet (Morojele, et al., 2004). Research conducted in South Africa suggests a close association between patronizing shebeens and engaging in HIV risk behaviors such as unprotected sex and concurrent partners (Kalichman, Simbayi, Vermaakk, Jooste, & Cain, 2008;Morojele, et al., 2006). Shebeens sometimes provide venues for sex between new or casual partners (Morojele, et al., 2006). The co-occurrence of these behavioral risk factors suggests the importance of social determinants of health behaviors, including social norms.Social norms play an explanatory role in theories of health behavior in general (Godin & Kok, 1996) and HIV risk behavior in particular (Albarracin, Johnson, Fishbein, & Muellerleile, 2001;Auerbach, Parkhurst, Caceres, & Keller, 2009). Perceived norms are a form of internalized social influence (Oostveen, Knibbe, & de Vries, 1996). Norms predict behavioral intentions and behavior in part because they signal what will be accepted/ approved by the group; failure to conform to social norms invites disapproval and/or social sanction (Cialdini & Trost, 1998 Distinction has been made between behavioral (descriptive) and attitudinal (injunctive) norms (Cialdini, Reno, & Kallgren, 1990). Behavioral norms refer to perceptions of how the group behaves, and attitudinal norms refer to perceptions of what the group finds acceptable. Although conceptually similar, these two types of ...

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Arriving late for scheduled contraceptive reinjections is common in many countries and contributes to discontinuation when providers are unsure how to manage such clients. A clinic-randomized cohort and cross-sectional study with more than 5,000 clients using injectable contraceptives was conducted in the Eastern Cape province of South Africa to test the effectiveness of a provider job aid for managing late-returning clients and promoting continued use of the method. A marginally significant difference in reinjection rates between intervention and control groups was found for those up to two weeks late, and reanalysis excluding one clinic that experienced stockout issues revealed a significant difference. The difference in reinjection rates for those 2-12 weeks late was also found to be significant. The one-reinjection cycle continuation rate for the intervention group was higher than that for the control group, but the difference was not statistically significant. Appropriate management of late-returning clients is critical, and this study illustrates that reinjection rates can be significantly increased with a low-resource provider job aid.