A Multilevel Analysis of the Determinants of High-Risk Sexual Behaviour in Sub-Saharan Africa

Abstract

A number of authors have identified multiple concurrent sexual partnerships by both men and women to lie at the root of the HIV/AIDS epidemic in sub-Saharan Africa. This study applies multilevel models to Demographic and Health Survey data collected during 2003-2008 in 20 sub-Saharan African countries to examine the influence of social and cultural context on involvement with multiple sexual partnerships in the region, above and beyond the effects of individual characteristics. The findings provide support for the ecological argument that health behaviours are shaped and determined by societal conditions, in addition to the effects of individual and household characteristics. Involvement with multiple sex partners is most prevalent in societies in which sexual norms are widely permissive and where polygyny is common. Individual autonomy is substantial and attitudes towards sexuality are more liberal among men and women who live in communities in which sexual norms are widely permissive. Men and women who are most likely to have multiple sex partners in the sub-Saharan region are those who initiated sexual activity earlier and those who have the individual attributes (e.g. young age, urban residence, education, media exposure and working for cash and away from home) that bring to them more rights and/or decision-making autonomy, but not necessarily more financial resources and economic security (mostly among women). On the other hand, involvement with multiple partners is determined by cultural norms (i.e. permissive sexual norms) and social change (i.e. mass education, expansion of cash employment). The findings suggest a number of opportunities for more effective policy and programmatic responses to curb the prevalence of multiple partnerships in sub-Saharan Africa.

Sexual Risk Behaviors among Club Drug Users in Shanghai, China: Prevalence and Correlates

“…The association between having multiple sex partners and being male are similar to findings from other studies [35]. Our findings indicated that club drug users 35 years or older were more likely to report having multiple sex partners in the past month than those younger than 25 years, regardless of marital status, which was contrary to the findings from previous studies in which younger people were more likely to have multiple sex partners [36,37]. The reason is unknown, but it is possible that compared to other populations, club drugs influence users’ sexual practices, or that middle-aged persons with multiple sex partners are more likely to report use of club drugs and were thus included in our study.…”

Preschool attendance: a multilevel analysis of individual and community factors in 21 low and middle-income countries

“…DHS data for comparative (multilevel) analysis on how community characteristics affect specific outcomes has mainly been used in studies of health (Adekanmbi et al, 2013;Corsi et al, 2012;Uchudi, 2012;Uthman, 2010). By contrast, for education measures and especially for preschool attendance, evidence related to community is non-existent.…”

Substance Use and Risky Sexual Behaviors Among Young Men Working at a Rural Roadside Market in Malawi

“…They described HIV as the outcome of societal, neighborhood, interpersonal, and individual level factors. When applied to substance use and sexual behaviors at a rural market, societal norms and national policies and laws provide a broad context in which opportunities for substance use and risky sex are made available for young people (Wagenaar, Tobler, & Komro, 2010;Xu & Chaloupka, 2011). The next level of influence is the neighborhood, which includes the market as an alcohol environment as well as the communities surrounding the market.…”

“…Introduction to alcohol at an early age may have lifelong consequences, while higher educational achievement may motivate people to think optimistically about the future and reduce the risk of substance use (Baker, Collins, & Leon, 2008;Edstrom & Khan, 2009;Uchidi, Magadi, & Mostazir, 2012). Understanding how factors at each of these levels influence young men's substance use and risky sexual behaviors may aid in the reduction of these risks.…”