University of Zambia Medical Library

Socio-Behavioural Aspects: Health-Seeking Behaviour (AIDS in Zambia Bibliography #129-40)

(#129) "Focus Group Research on Condom Use for AIDS Prevention"
Kapumba, S., Manda, V., Zambezi, R. (1991) unpublished
Geographical area: Ndola, Mansa; Keywords: KAPB, condoms; Location: PPAZ, UNZA, Institute of African Studies

The purpose of this study was to increase understanding of communities' knowledge, attitudes and behaviour related to HIV transmission and AIDS with a view of influencing them to developing a positive attitude towards the use of condoms. Among the objectives of the study were to demonstrate the use of focus group discussion methodology and techniques in studies that investigate sensitive areas of sexual behaviour and to identify strategies for making condoms available, accessible and affordable to all eligible members of the community. This study was conducted using qualitative research methodologies. It utilised both the key informant approach and the focus groups. The first approach was used during a situational/community analysis prior to the actual implementation of the focus groups. A total of 12 Focus Groups Discussions were conducted, 6 in Ndola and 6 in Mansa, comprising of female student nurses, male industrial workers, female marketeers, male out-of-school youths, a mixed group of male and female teachers and another mixed group of male and female bar users. The raw data which comprised of the researcher's notes and the recorded tapes were analysed at PPAZ Head Office by the principal investigator and the chief collaborator with the help of other programme staff.

(#130) "Condom use Among Soldiers in Tug-Argan and Arakan Barracks, Zambia"
Musonda, J. (1992) unpublished
Geographical area: Lusaka; Keywords: Condoms, military, high risk situation; Location: UNZA Medical Library

The study seeks to determine patterns of condom use among soldiers in the Tug-Argan and Arakan Barracks. The general objective was to establish factors that influence condom use among soldiers and to identify condom distribution patterns. This was a descriptive, qualitative and quantitative study. It was qualitative because variables were only concerned with exploring and giving an insight in the nature and causes of the factors that influence condom use among soldiers, and because some variables such as opinions could not be measured quantitatively. Most respondents were aged between 20-30 years, followed by 31-40 years.

Results:

• 99.5 per cent of the respondents had adequate knowledge of AIDS.
• Only 56 per cent of those were using condoms during casual sex.
• Most respondents (81.5 per cent) were aware that condoms were available for free distribution at the military health centre.
• Of the 112 condom users only 18 per cent used condoms always during casual sex while the majority used them only sometimes.
• The majority of the junior non commissioned officers (56 per cent) found access to free condom supplies difficult because they are issued by a senior person and 26 per cent found access difficult because condoms are issued by the opposite sex.
• The majority (53 per cent) of the condom users considered condom supplies inadequate.
• Not liking' condoms was the largest single reason for their non-use.
• Condom use declined when the men were drunk.
• Marital status and religious affiliation did not affect condom use.

(#131) "Contraceptive Prevalence among Women who are Seropositive in Zambia"
Mulundu, M.B. (1993) unpublished
Geographical area: Lusaka; Keywords: KAPB; Location: UNZA Medical Library

A descriptive and explorative survey conducted in Lusaka, determined contraceptive prevalence among women aged 13-45 years who are seropositive and being followed up to HIV/AIDS counsellors. A sample size of 50 seropositive sexually active women was selected randomly at University Teaching Hospital. Study subjects were interviewed using an interview schedule to obtain information on contraceptive utilisation. Research results revealed that prevalence of contraceptives was merely for child spacing (80 per cent) and not to prevent prenatal transmission. Reasons for non-use of contraceptives include infertility; loss of sexual partners due to divorce or death; loss of interest in men; the subordinate position of women in fertility decision making, and viability to comprehend and retain HIV/AIDS information given during counselling. AIDS prevention programmes deal with change of attitudes toward sexual behaviour. Lessons can be learnt from family planning programmes which seem to be successful. Therefore integration of family planning with HIV/AIDS prevention is appropriate.

(#132) "Health Seeking Behaviour Patterns in Relation to Sexually Transmitted Diseases (STD) Among the Youth in Lusaka Urban"
Kalonga, E. (1993) unpublished
Geographical area: Lusaka; Keywords: Health seeking behaviour, cost; Location: UNZA Medical Library

Studies indicate that STDs are recognised as a public health problem and therefore require attention in terms of their choice of treatment and sexual behaviour. A descriptive, qualitative and quantitative non-experimental design was chosen to seek information on health seeking behaviour in relation to STD. Questionnaires were used to collect data. A sample size of 100 comprising 53 male and 45 female in Lusaka urban. The findings elicited were that those with STD related problems do utilise other available health services such as traditional healers, private doctors and street vendors for antibiotics. The majority of the patients (59.3 per cent) resorted to government health clinics after first attempting to get cures from the various sources; factors found to be contributing to the delay in seeking treatment from appropriate health services include the low standard of quality of services offered at the government health centres and attitude of the public which tend to stigmatise those with STD; those factors identified to be associated positively to health seeking behaviour were the cost of treatment and comprehensive management.

(#133) "A Community-Based Intervention to Increased Condom use Among Sexually Active Population in an Urban Setting of Lusaka"
Macwang'i, M. (1993) unpublished
Geographical area: Lusaka; Keywords: KAPB, adolescents, condoms; Location: Institute of African Studies

A community-based intervention to increase condom use among sexually active population in an urban setting was conducted in 1992. The objectives were to determine whether community based intervention and inter personal communication were effective in disseminating condom promotion information and changing behaviour; assessing the role of friendship groups and their networks as a strategy for disseminating AIDS and condom promotion information; to determine most appropriate communication channels for distributing condoms and availability of condoms in the community will increase condom use. Data for this study were collected using eleven focus group discussions with female and male youths living in Kaunda Square. In addition two focus group discussions with teachers and health providers in the community were conducted. The study results indicated consistency with current literature which shows a big gap between knowledge and behaviour. The study also found that inter-personnel communication channels were predominant over mass media. None of the youths mentioned newspapers as a source of information and only one female group mentioned radio. Misconceptions about HIV/AIDS were common and general youths did not personalise the risk of HIV/AIDS. These findings imply that more innovative inter-personal communication strategies should be developed to supplement mass media communication efforts and dispel existing misconceptions about HIV/AIDS.

(#134) "Effectiveness of Condom Promotion in Lusaka"
Ebrahim, S., Hira, S.K., Chinikima, K., (1993) Paper presented at the IXth International Conference on AIDS, Berlin, 1993.
Geographical area: Lusaka; Keywords: Condoms; Location: unknown

Objective:
To evaluate the effectiveness of condoms in reducing STD episodes; to evaluate the impact of condom promotion in Lusaka among STD clients.

Methods:
500 consecutive STD patients (PT) at the OPD followed up for six months with condom intervention.

Results:
Male (M): Female (F) is 3:1. 40 per cent (M) and 50 per cent (F) married. PT acquiring STD outside their normal residence doubled among (M) (79 per cent) and (F) (47 per cent). A third of females were unemployed housewives. Though 79 per cent had never used a condom, 95 per cent accepted condoms. 65 per cent of condom refusers were females. 30 per cent came for return visits (12 per cent in '89) and all took more supply of condoms, compared only to 1/3 in '89. During 14.5 PT years of follow up 38 per cent acquired a new STD, i.e., 4.2 new episodes per PT year. Significantly, those who used condoms regularly (18 per cent) had no new STD episodes, while refusers and irregular users had 5-7 new STD per year. Conclusions: There are some changes in the socio-demographic determinants of STD in Lusaka. Initial condom acceptability is very high and increased from last year. Condoms are very effective in reducing new STD episodes if used during all sexual contacts. However the percentage of persistent condom users is very low. Preventative counselling and education is to be strengthened.

(#135) "Assessment of Condom Promotion in Zambia"
Chirwa, B.U., Chimba, R., Freund, P., Macwan'gi, M., Kakoma, C., (1993) Paper presented to the VIIIth International Conference on AIDS in Africa, Marrakech, 1993.
Geographical area: National; Keywords: Condoms, KAPB; Location: unknown

While condom promotion is critical to the success of the prevention and control of AIDS, it is also important to assess clients' knowledge, attitudes and use of the condom in order to plan an effective condom promotion programme. A Rapid Assessment Procedure (RAP) on condom promotion was conducted in 1992 in six (of nine) randomly selected provinces in Zambia. A total of 485 men and 350 women participated in the study. Consistent with other results this study shows a high knowledge (75 per cent) of condoms. Many (75 per cent) had seen a condom. Most (95 per cent) stated that condoms were used for family planning. Only 13 per cent stated that they would use condoms. A total of 196 participated in 24 focus group discussions. Of those who had used condoms most of them had a positive attitude towards the condom. "I have used a condom and I have not come across any problems. The satisfaction was the same". About half (48.8 per cent) of 150 condom outlets had condoms. The study recommends improved distribution and creation of non-traditional outlets for the distribution of condoms. Social Marketing to reduce inhibition to access has been one result of the study.

(#136) "Zambia AIDS Awareness and Condom Consumer Usage Survey"
Olson, D., Chaganti, S., Phiri, D., (1994) Paper presented to the Xth International Conference on AIDS, Yokohama, 1994.
Geographical area: National; Keywords: Condoms, KAPB, awareness; Location: unknown

Objectives:
To evaluate the programmatic impact of the Zambia Condom Social Marketing (CSM) project through assessment of marketing efforts to date and to develop new strategies to increase usage of Maximum condoms.

Method:
A survey was conducted of a stratified random sample of 1056 respondents chosen from three high-risk groups - adolescent males, adolescent females, and adult males - which constitute the primary target markets for Maximum condoms. Data on issues relating to AIDS awareness, condom purchase and usage, sexual behaviour and media exposure were obtained.

Results:
The Zambia CSM project was launched in December 1992. Maximum has quickly become the most popular and ubiquitous condom brand in Zambia in the nine months since its launch. Unaided brand recall for Maximum at around 50 per cent is significantly higher than for the next most popular brand. The introduction of Maximum has coincided with overall increase in condom use, with about 50 per cent of the sexually active adolescents reporting first usage in the period following the launch of Maximum. Conclusions: The constant availability, high quality, and low price of Maximum condoms have resulted in impressive sales (4.6 million condoms) in the first year of operation. The condom use survey demonstrates the need to:

• address the extensive misconceptions about AIDS that continue to persist,
• develop effective communication campaigns to encourage increased condom use and purchase among low-use groups; and
• open more non-pharmaceutical retail outlets.

(#137) "Attitudes towards condom use: a survey of CMAZ Institutions"
Plourde, P.,J., Banda, M., Sichinga, K. (1994) Paper presented to the 4th National AIDS Conference, Lusaka, 1994
Geographical area: National; Keywords: Condoms, churches; Location: Family Health Trust

Objectives:
To determine the attitudes of the STD/HIV Programme Coordinators in mission hospitals regarding the use of condoms.

Methods:
A pretested questionnaire was distributed to all 86 CMAZ member institutions coordinators (32 hospitals and 54 rural health centres). Data were collected pertaining to outpatient clinic facilities, laboratory facilities, counselling practices, STD treatment practices, and attitudes pertaining to HIV testing and the use of condoms. The results presented are in answer to the question In which of these situations would you recommend that condoms be made available?'

Results:
43 (50 per cent) individuals responded to the questionnaire. 33 (77 per cent) mentioned that condoms were distributed to patients at their institution. Only 2 of 31 (6 per cent) admitted to a shortage of condoms. All respondents (90 per cent) felt that condoms should be made available to discordant couples regardless of which partner is positive. About two thirds would provide condoms to sex workers (67 per cent) in bars. Just over half felt that condoms should be available to street youth, but only one third would make them available to school youth.

Conclusions:
There is a wide spread support in mission hospitals for the use of condoms to prevent the transmission of HIV between discordant couples. Support outside of marriage is significantly less. Some respondents wrote that they would not recommend the use of condoms other than for discordant couples as they did not wish to encourage sex outside of marriage. There is a need to continue dialogue with the churches concerning the medical and ethical implications regarding the use of condoms for the prevention of HIV transmission.

(#138) "Traditional Healing and Practices in Central Province of Zambia"
Mushanga, M., Hanson, S., Kamanga, J (1995). Paper presented to the Fifth National AIDS Conference, 8-10 May 1995, Lusaka. Unpublished.
Geographical area: Central Province; Keywords: Traditional medicine, condoms; Location: Family Health Trust

The paper presents the results of an exploratory study on the prevention and control of STD/HIV which was conducted in Central Province of Zambia. One of the aims of the study was identify risk factors or groups in health seeking behaviour of the community and how diseases are perceived with particular reference to prevention and control of STD/HIV.

Qualitative research methods were used and data collection was based on two approaches; the clinical group reviewed records at the health facility, interviewed health personnel and observed the management of STD cases. The other group, consisting of social workers, set about preparing sketch maps and collecting community statistics (catchment area, bars, shops/markets etc). Key informants were identified (which included traditional healers) and interviewed. In addition, focus group discussions were conducted.

Findings showed that patients first seek care at the health institution, whereas the opinions of key informants and traditional healers indicate the patients first seek care at the traditional healers because they do not ask the patient to bring the partner in cases of STDs. Most of the people interviewed saw STDs as a major problem in their area, and that it is contracted after contacts have been taken to bars or other beer drinking places, and when the couple is under the influence of alcohol. Although they are aware of the connection between alcohol and casual sex, they usually do not like to use the condom although they know about its usefulness.

The knowledge in the community about STD/HIV/AIDS is reasonably high but there is little evidence to show that behaviour is changing accordingly. Hence, the need for community health workers in conjunction with NGOs and traditional healers to facilitate the education and training of the communities to improve their skills and modify beliefs in an acceptable way.

(#139) "Knowledge, attitudes and practices about traditional healers (THs) and formal health workers (FHWs) in Lusaka, Zambia "
Ndovi-Macmillan, M., Sulwe, J., Burnett, A., Bennett, J., Baggaley, R., et al., (1995) Paper presented the IInd International Conference on Home and Community care for Persons Living with HIV/AIDS, Montreal, 1995.
Geographical area: Lusaka, Monze; Keywords: KAPB, counselling, traditional healers; Location: Kara Counselling

Objectives:
To determine the knowledge, attitudes and practices about HIV among THs and FHWs, and see how these influence their care, health education and HIV counselling.

Method:
A sample of 37 THs and 27 FHWs were interviewed in vernacular or English. The interviews were semi-structured. They were tape recorded, transcribed and then translated into English. Quantitative results were analysed using Epiinfo 5.1 and qualitative data using standard techniques. Results: There is good basic knowledge about symptoms and transmission in both groups, although there are still some misconceptions, particularly by THs. 18 THs claim that there is a cure for AIDS. All THs interviewed expressed difficulties discussing the diagnosis of HIV directly with patients, mainly due to fear of the patient becoming depressed and suicidal. Most THs and FHWs want more training and most were interested in supplying condoms. Almost all THs were keen to collaborate with FHWs in training and patient care and half of the FHWs felt positive about collaboration with THs.

Conclusion:
THs have good knowledge about HIV, but they have difficulty in openly discussing it with patients. All workers are keen for more training in the field of HIV and many are keen for collaboration between THs and FHWs.

(#140) "Factors determining health seeking behaviour patterns in Lusaka, Zambia - with particular relevance to sexually transmitted diseases"
NASTLP, Ministry of Health (1995) Applied Health Research Series Report 1.
Geographical area: Lusaka; Keywords: KABP, commercial sex work, STD, health seeking behaviour, health care delivery, traditional medicine, policy, condoms.; Location: NASTLP, UNICEF

STDs represent the third most common reported cause of hospital attendance in adults in Zambia. The objective of this study was to determine health seeking behaviour patterns of STD patients in selected communities in Lusaka. A rapid assessment procedure was developed, and the study was conducted during early 1995. A combination of 20 informal conversations, 12 FGDs and participant observation elicited information on lay referral mechanisms, sources of STD drugs, names used to describe illness, traditional treatment, preventative practices, beliefs, community knowledge, attitudes and perceptions related to STD care seeking behaviour.

Results:

• The high profile of illnesses such as TB, malaria, AIDS, cholera and dysentery were predominant in most of the FGDs.
• Exploring health seeking behaviour in relation to STDs revealed two main patterns: one centred on traditional healers being the most common (self diagnosis, peer consultation, traditional healers and health centre) and the less common pattern centred on formal medical health care.
• Peer consultation emerged as an important source of information for the young on STDs. Due to stigmatisation, young people find it difficult to consult with elders once afflicted with STDs.
• STDs are highly stigmatised: the main mode of expression is through offensive labels.
• Social cost is higher for women than for men. Although women prefer to be treated by a woman staff member, they are still being examined by men. Other concerns related to the bringing of partners before getting treatment, too many questions from staff, and the lack of privacy in relation to facilities. The use of traditional healers was mentioned as a way of reducing social cost.
• With gender and stigmatisation, labels for women were more offensive than for men: dustbins', toilets', prostitutes' compared to kubunkinsa' ( accident') for men. Girls considered suffering from STD worse than having a child out of wedlock.
• STD drugs are available in markets, stores and pharmacies: septrin, tetracycline, ampicillin and injectable penicillin.
• Hinderance to the use of formal health care in relation to STDs were: shortage of drugs, lack of privacy, long queues, being examined by a member of the opposite sex, high fees, poor attitudes of staff, and demanding that one should bring a partner before treatment.
• The taking of antibiotics before intercourse is believed to prevent STDs. Condoms were considered dangerous by elderly women: as they can block the fallopian tubes'. Some believed that menstrual flow cleansed women of STDs.
• Reasons for indulging in sexual activity included adventure, peer pressure and economic activity. It is possible for a boy or a girl to have sex with someone of the same age for pleasure and sex with an elderly man or woman for money.
• Sex work occurs all over Lusaka. Charges range from 300ZK to 25,000ZK. Charges are higher for sex without a condom, and their use is not strictly enforced. Sex with sex workers occurs in cars, rented rooms, toilets, hotels, homes and ditches.

Policy recommendations are made in relation to the above findings.

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