Botswana 2009 Botswana 2009  

Abstract #86  -  Characteristics and attitudes of the choice-disabled in Namibia
  Presenting Author:   Mr Gert Van Rooy - University of Namibia
  Additional Authors:  Mr Steve Mitchell, Mr Mokgweetsi Masisi, Dr Anne Cockcroft, Dr Neil Andersson,  
Namibia continues to have a serious AIDS epidemic. National efforts to control the epidemic include encouraging people to use condoms or limit their sexual partners. However, some people are unable to implement decisions to protect themselves – the choice-disabled. This study examined the characteristics of the choice-disabled in Namibia, and explored associations between choice disability and attitudes about sex and gender issues.
  Method / Issue:
In 2007 trained field teams interviewed adults aged 16-60 years in a national random cluster sample. We categorised people as choice disabled if they said they would have sex if their partner refused to use a condom and they believed their partner could be at risk of HIV. We examined associations between a number of factors and choice disability, in bivariate then multivariate analysis, with an adjustment for clustering. We report on associations in the final models, with the adjusted Odds Ratio and cluster-adjusted 95% confidence intervals. The variables we examined included: age, sex, marital status, education, urban or rural residence, household income, earnings compared with partner, sources of information about HIV/AIDS, discussion about HIV/AIDS, and experience of intimate partner violence. We also examined the association between choice disability and several attitudes about sex and gender, taking into account other variables.
  Results / Comments:
Some 739 men and 1426 women provided information. A quarter 26% said they would have sex if their partner refused to use a condom. Some16% would have sex if their partner refused to use a condom and believed their partner could be at risk of HIV: the choice-disabled. Certain groups were more likely to be choice-disabled: women (OR1.52, 95%CI 1.04-2.21), those who were married or co-habiting (OR 2.07, 95%CI 1.57-2.73); those who earned less than their partner (OR 1.61, 95%CI 1.14-2.25); those who had experienced partner violence (OR 1.89, 95%CI 1.35-2.65); and those who did not talk often about HIV/AIDS (OR 1.68, 95%CI 1.22-2.31). Choice disability was associated with several unhelpful attitudes. The choice disabled were more likely to think it is okay for a man to expect sex without a condom (OR 1.62, 95%CI 1.19-2.21); they were less likely to believe that condoms can prevent HIV (OR 0.36, 95%CI 0.18-0.70). Among men only, the choice disabled were more likely to agree “women sometimes deserve to be beaten” (OR 2.43, 95%CI 1.17-5.03). In addition, the choice-disabled were more likely to believe they were at risk of getting HIV (OR 4.28, 95%CI 2.36-7.77).
By our definition, one sixth of people aged 16-60 in Namibia are choice-disabled, more in some subgroups. They are more likely to hold unhelpful attitudes about sex and gender. Better understanding of the characteristics of the choice-disabled can help to devise strategies to reach them effectively with HIV prevention programmes.
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