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. 2017 May;21(5):1417-1428.
doi: 10.1007/s10461-016-1438-2.

Predicting Primary and Secondary Abstinence Among Adolescent Boys and Girls in the Western Cape, South Africa

Sander M Eggers  1 , Catherine Mathews  2   3   4 , Leif E Aarø  5   6 , Tracy McClinton-Appollis  2   3   4 , Arjan E R Bos  7 , Hein de Vries  8
Affiliations

Predicting Primary and Secondary Abstinence Among Adolescent Boys and Girls in the Western Cape, South Africa

Sander M Eggers et al. AIDS Behav. 2017 May.

Abstract

Two of the most effective health behaviours with regard to HIV prevention are condom use and sexual abstinence. While determinants of condom use among sub-Saharan African adolescents have been studied extensively, factors related to abstinence have received far less attention. This study identified socio-cognitive determinants of primary and secondary abstinence intentions and of early sexual activity. This study also assessed whether these factors had a direct or indirect association with intentions to abstain from sex. A longitudinal design was used in which 1670 students (age 12-16) of non-private South African high schools filled in a questionnaire, with a follow-up after 6 months, concerning sexual abstinence, attitudes, social norms, self-efficacy, risk perception and knowledge. Logistic and linear regression analysis with latent factors was used to assess determinants of intentions and abstinence, and structural equation modelling was used to assess indirect effects. Results showed that among sexually inactive students, social norms predicted the intention to abstain from sex in the next 6 months. Among sexually active students, reporting less disadvantages of abstinence predicted the intention to abstain. Sexual activity at follow-up was predicted by attitudes and intention among sexually inactive girls, and by knowledge among sexually inactive boys. No predictors were found for sexually active adolescents. Structural equation modelling further showed that risk perception was indirectly related to intentions to abstain from sexual intercourse. We conclude that addressing socio-cognitive factors in order to motivate adolescents to delay sex is more likely to be successful before they experience sexual debut. In addition, this study shows that the effect of increasing risk perceptions, a strategy often applied by parents and HIV prevention programmes, is to a large extent mediated by more proximal cognitive factors such as attitude. Research is needed to identify factors that influence the execution of intentions to abstain from sex.

Keywords: Adolescents; HIV; I-Change Model; Prevention; Sexual abstinence; South Africa.

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Conflict of interest statement

Conflict of Interest

Sander M. Eggers, Catherine Mathews, Leif E. Aarø, Tracy McClinton-Appollis, Arjan E.R. Bos, and Hein de Vries declare no conflict of interest.

Informed Consent

Informed consent was obtained from all participants and school authorities.

Research Involving Human Participants and/or Animals

The study was approved by the Human Research Ethics Committee, Faculty of Health Sciences, University of Cape Town (REC Ref: 268/2010), and the Western Norway Regional Committee for Medical and Health Research Ethics. Permission for the research was granted by the Western Cape Education Department and the Western Cape Department of Health. All procedures were in accordance with the 1964 Helsinki declaration and its later amendments.

Figures

Fig. 1
Fig. 1
Cross-lagged socio-cognitive model predicting primary abstinence intentions (non-sign pathways are not shown). Results are shown separately for males (first) and females (secondly)
Fig. 2
Fig. 2
Cross-lagged socio-cognitive model predicting secondary abstinence intentions (non-sign pathways are not shown)
See this image and copyright information in PMC

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