Condom Use among Urban Adolescents in Nairobi, Kenya: Findings from a Web-Based Survey

Tilda Farhat, University of North Carolina at Chapel Hill
Carolyn Tucker Halpern, University of North Carolina at Chapel Hill
Ellen M.H. Mitchell, Ipas
Sarah Onyango, Ipas

The prevalence of HIV/AIDS is increasing worldwide, mainly in developing countries and more particularly in sub-Saharan Africa. Kenya is one of the countries in this region most devastated by the HIV pandemic and adolescents, who constitute a significant portion of Kenya's population, are at high risk of HIV infection. Many Kenyan youth are sexually active, yet the proportion of sexually active youth who report using condoms in the last 12 months with non-marital, non-cohabiting partners is quite low, particularly for females (14%) (UNAIDS report, 2002). This paper examines attitudes and perceptions about condom use in the context of perceived personal susceptibility to HIV/AIDS among a large sample of high school students in Nairobi, Kenya who are participating in a series of Web-based surveys. More specifically this paper will examine the following questions: 1. What proportion of adolescents perceive HIV/AIDS to be a serious problem in Nairobi, and what proportion see themselves as susceptible? 2. What proportion of adolescents perceive condoms to be useful in preventing HIV infection and pregnancy? 3. What proportion of adolescents perceive multiple barriers to condom use? 4. In which sexual contexts do adolescents believe condom use is necessary? 5. Do perceptions and attitudes about condom use vary according to the adolescent's age, biological sex, socioeconomic status, sexual status, or perceived susceptibility to HIV/AIDS? Methods Study Design We use data collected through TeenWeb, a research-practice collaborative project conducted by the Carolina Population Center and Ipas. TeenWeb is a school-based, longitudinal research study that is testing the feasibility of the Web as a mechanism to collect repeated measures of the reproductive health, attitudes, and behavior of urban adolescents in Nairobi and Rio de Janeiro. This paper focuses on data collected from adolescents in Nairobi (data collection in Rio de Janeiro has not yet begun). We recruited five secondary schools in Nairobi to serve either as "Web" schools or "control" schools. At study entry, students in all schools reported perceptions and attitudes about condom use. Sample The sample includes 896 boys and 565 girls who range in age from 12 to 22 years with a mean of 16.04 years. Almost all respondents are single (93%); 5% live with a boyfriend/girlfriend and 2% are married. The majority of students reported that their parents/guardians pay their school fees (94%); 3% are on a governmental scholarship and 2% have other relatives pay for their school fees. With respect to their socioeconomic status, most students reported that they have electricity at home (83%), running water (65%), and an indoor bathroom (60%); slightly less than half (49%) have a refrigerator in their home. Measures I. Outcome variables: 1. Perceived benefits of condom use. Respondents were asked to rate their agreement with two statements on a 5-point Likert scale (ranging from Strongly Agree to Strongly Disagree). The statements were: "condoms are useful to prevent pregnancy" and "condoms are useful to prevent infections like HIV." A mean score will be computed from these two statements. 2. Perceived barriers to condom use: Respondents were asked to rate their agreement with 6 statements intended to tap difficulty in use, anticipated embarrassment, and cost. The statements were: "condoms are difficult to use," "condoms often break," "talking about condoms is embarrassing," "buying condoms is embarrassing," "using condoms is embarrassing," and "condoms are too expensive to buy." Answer categories reflect a 5-point Likert scale with answers ranging from Strongly Agree to Strongly Disagree. If analyses indicate the items constitute a homogeneous group, a mean score will be computed for the five statements. If not, analyses will be conducted separately for the 3 dimensions noted above. 3. Condom access for adolescents. This construct is measured by the single statement "If someone your age wanted to buy condoms, how hard would it be for him or her to get a condom at a low cost?" Students responded on a four point scale, ranging from Very Hard to Very Easy. 4. Attitudes about sexual contexts in which condom use is necessary. These attitudes are measured by the following statements: "When someone trusts their partner, they do not need to use a condom," "Only people with many partners need to use condoms," "Condoms are used by responsible partners," "It is fine to say no to sex if there is no condom," and "It is alright for a woman to ask her partner to wear a condom." Students indicated their agreement on a five point scale ranging from Strongly Agree to Strongly Disagree. A mean score will be computed for these five statements. II. Sociodemographic variables: Age and gender are self-reported. Socioeconomic status (SES) will reflect a summary variable indicating the number of the following facilities present in the student's home: electricity, running water, indoor bathroom, refrigerator, stove, metal bed, bicycle, car, newspapers, dictionary, telephone, cell phone, stereo and computer. III. Sexual status is measured by the following question: "Have you ever had sexual intercourse?" IV. Perceptions about HIV/AIDS and personal susceptibility. These perceptions are measured by two items: "Is HIV/AIDS a problem in Nairobi" (answer categories range from Not a Problem at All to Very Serious Problem), and "What do you think the chances are that you will ever get HIV/AIDS" (answer categories range from Almost no Chance to Almost Certain). Analysis Plan & Discussion Descriptive statistics will be presented for all analysis variables, including alpha coefficients for composite measures. Main effects models will be run in which outcome measures are regressed on respondents' age, sex, SES, sexual status, perceptions about HIV/AIDS, and perceived personal susceptibility. Next, models including interactions among predictors will be tested. Results will be compared to other studies conducted in Kenya that have looked at attitudes about condom use, with an evaluation of figures relative to sample construction and interview methodology across studies. Reference Young people and HIV/AIDS: Opportunity in Crisis. Joint report of UNICEF, UNAID, WHO, 2002.