Explaining utilization of HIV prevention and testing services among university students in Mozambique: results from a mixed methods study

Abstract

Background In Mozambique, HIV infection disproportionately affects young adults, particularly women. Despite awareness and knowledge of HIV transmission, many university students have not received HIV testing and continue to engage in high-risk sexual behaviors, including inconsistent condom use. Further understanding of patterns of engagement with HIV prevention and testing is key to reducing HIV transmission in this at-risk population. Methods This study used a sequential mixed methods approach to examine patterns of engagement and perceptions of HIV prevention and testing services among higher education students in Mozambique. Survey data were collected from a representative sample of 501 students from Universidade Eduardo Mondlane (UEM) in Maputo, Mozambique to assess the primary outcomes of 1) HIV testing within the last 12 months; and 2) condom use during last sexual encounter. We employed univariate and multivariate regression models. The survey was followed by qualitative interviews with 70 survey participants which were analyzed using an inductive, content-focused analysis to further explain and contextualize survey findings. Results Over 85% of students reported to be sexually active, among these 74% reported condom use during their last sexual encounter, and 64.2% reported an HIV test within the past 12 months. Females were more likely to have had HIV testing in the past 12 months in comparison to their male peers (aOR 1.82, 95% CI 1.11, 2.99), but were half as likely to have used a condom with their last sexual encounter (aOR 0.52, 95% CI 0.33, 0.83), when controlling for other factors. Qualitative data suggests that these discrepancies may be explained by differential perceptions in risk and trust/mistrust, with women being more concerned about infidelity by their male partner(s) and assuming more responsibility for knowing their own serostatus. Women were also subject to negative stereotypes for possessing condoms in comparison to men, which could explain lower propensity for use. Conclusion Given gendered differences in uptake of condom use and HIV testing, and perceived HIV risk, interventions tailored specifically to male and female students may impact engagement with HIV prevention and testing and empower informed choices about sexual behaviors.

Determinants of Community HIV Index Testing among HIV Index Clients in Yirol West County, South Sudan

“…Lack of privacy when handling sensitive information has been considered to be a glitch of privacy. These research findings were consistent with two other studies done in Nigeria and Mozambique [17,18]. Study respondents who reported being counseled to bring families for HIV testing were 1.9 times more expected to utilize community HIV index testing as linked to their colleagues.…”

Assessing Condom Use and Views on HIV Counselling and Testing among TVET College Students in Limpopo Province, South Africa

“…Compared with a study conducted in a similar setting in TVET colleges in a rural and urban province in South Africa, 72% of students indicated that they have been previously tested for HIV which is comparable to our findings [21]. This result is higher than that found by studies conducted among university students in other countries [25,27,37]. Additionally, our quantitative results show that there are differences in perceived use of HCT services between females and males.…”

“…Moreover, HIV testing remains the most critical intervention to HIV prevention and entry into continuum of care for those who test positive. Although previous studies argue that higher education is protective, and students are more likely to have been tested for HIV [22,23], this is in contrast to similar studies conducted in the region were the majority of students reported that they were sexually active and most of their sexual encounters were unprotected [18,19,24,25]. Additionally, previous studies conducted revealed that university students engage in sexual encounters while intoxicated [22,26] and often do not take precautionary measures to reduce HIV infections such as using condoms correctly and consistently [27][28][29].…”

“…The study among university students in sub-Saharan Africa reported that 50.5% of the students used a condom during their last sexual intercourse [33]. Additionally, the study among sexually active university students in Mozambique revealed that 74% of the study participants used condoms during their last sexual encounter [25]. Another study showed that 80% of students in a Ugandan university used a condom in their last sex act [34].…”

“…Previous studies demonstrated mixed findings. [25] found that over 85% of students reported to be sexually active. In another study conducted among students in institutions of higher education, it was found that 61% were in a sexual relationship [14].…”