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Dr Philippe CG Adam Centre for Social Research in Health UNSW Australia, Sydney

Assessing social-cognitive indicators of barriers to using condoms and testing for HIV and STI among young people in NSW, Australia. Dr Philippe CG Adam Centre for Social Research in Health UNSW Australia, Sydney. Acknowledgements.

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Dr Philippe CG Adam Centre for Social Research in Health UNSW Australia, Sydney

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  1. Assessing social-cognitive indicators of barriers to using condoms and testing for HIV and STI among young people in NSW, Australia Dr Philippe CG Adam Centre for Social Research in Health UNSW Australia, Sydney

  2. Acknowledgements • John de Wit, Carla Treloar, Joanne Bryant, Toby Lea, Paul Byron • Chris Bourne, Brooke Shepherd, Carolyn Murray • Jo Holden, Tim Duck Study funded by the Centre for Population Health, New South Wales Ministry of Health

  3. Background • STI notifications continue to increase among young people in Australia • Reducing the prevalence of STIs through the promotion of condom use and testing for STIs is a public health priority

  4. Background • Uptake of condom use and testing for STI/HIV, remains limited among young people in Australia • A more comprehensive understanding of barriers and facilitators of using condoms and testing for STI/HIV is needed to inform the development of sexual health promotion campaigns and interventions

  5. Review of literature • Abundant literature on STI/HIV testing but knowledge on barriers and facilitators of testing remains fragmented… • De Wit & Adam, To test or not to test, HIV Medicine, 2008 • Most studies on determinants focus on a few factors • Range of possible individual, social and structural factors not comprehensively assessed • Difficult to tell which factors should be addressed with priority by sexual health programs • Literature on barriers facilitators of condom use presents similar gaps

  6. Comprehensive approach to barriers to testing • Two online surveys on indicators of potential individual, social and structural barriers and facilitators of HIV/STI testing in NSW, Australia • ‘Getting Down to It Study’ among young people in 2010 • ‘How much do you care? Study’ among gay men in 2012 • Adam, de Wit et al., Promoting regular testing, AIDS and Behavior, 2014 • Relative contribution of a range of social-cognitive indicators of potential barriers and facilitators, derived from health behaviour theory: • Knowledge of HIV/STI • Perceived severity and vulnerability • Fears and worries • Attitude, perceived advantages (‘pros’) and disadvantages (‘cons’) • Perceived behavioural control • Subjective norm • Stigma and shame

  7. Implications of previous research findings • Multivariate analyses of data from survey of young people • Limited influence of STI/HIV knowledge and perceived vulnerability on testing behaviours; no association with perceived severity or stigma and shame • A range of other social-cognitive factors together play an important role in explaining testing behaviours: fears and worries, perceived advantages and disadvantages of testing, perceived behavioural control, subjective norms of testing; marginal association with attitude • Findings inform sexual health promotion activities with young people in NSW • Online intervention ‘Play Safe’ produced by NSW STI Programs Unit, for NSW Ministry of Health

  8. The present study aims at… • Extending previous research on social-cognitive indicators of potential barriers and facilitators of testing using short measures that can be easily used in brief (periodic) surveys • Using the same framework and methods to also examine social-cognitive indicators of potential barriers and facilitators of condom use • Appraising the extent to which sexual health promotion with young people in NSW, Australia may contribute to reducing barriers and promoting facilitators of STI/HIV testing and condom use

  9. Methods

  10. Recruitment and procedures • Self-report quantitative survey conducted online between July and November 2013 (www.project1626.csrh.org) • Facebook advertisements used as main recruitment channel • To be eligible, individuals had to be aged 16-26 years old, live in NSW, Australia and provide informed consent • Of the 900 individuals who met the eligibility criteria, 754 participants completed the survey • Analyses are based on 502 sexually active participants

  11. Sample characteristics

  12. Survey instrument • Sexual practices, condom use, risk • Testing for STI and HIV • STI/HIV knowledge was measured with 16 questions (extracted from a 32 item-scale used in previous research) • Multi-item scales used to measure social-cognitive indicators of potential barriers and facilitators of testing in previous research were replaced by single items; answers were provided on 5 point scale (Totally disagree – Totally agree) • Mirrored questions were used to measure social-cognitive indicators of potential barriers and facilitators of condom use

  13. Short measures of social-cognitive barriers and facilitators to condom use or testing for STIs Note: *Answers to each question were provided on a 5 point scale (Totally disagree – Totally agree)

  14. Results

  15. STI/HIV knowledge

  16. Sexual risk and STI/HIV testing

  17. Testing for STIs Extent and contribution of social-cognitive correlates

  18. Extent of potential barriers/facilitators of STI/HIV testing Note: *Answers to each question were provided on a 5 point scale (Totally disagree – Totally agree) • † Somewhat agree and totally agree combined.

  19. Extent of potential barriers/facilitators of STI/HIV testing Note: *Answers to each question were provided on a 5 point scale (Totally disagree – Totally agree) • † Somewhat agree and totally agree combined.

  20. Contribution of social-cognitive correlates to STI/HIV testing Note: * Controlling for socio-behavioural factors associated with STI testing (age, gender, sexual identity, unprotected intercourse with casual partners); ns = non-significant.

  21. Testing for STIs Impact of campaigns on practices, intentions and social-cognitive correlates

  22. Exposure to STI testingcampaigns

  23. Association of frequency of exposure to STI testing campaigns with prior STI/HIV testing and intention to test

  24. Association of frequency of exposure to STI/HIV testing campaigns with social-cognitive correlates of testing Campaigns impact on all 3 social-cognitive barriers/facilitators associated with STI/HIV testing in previous multivariate analyses

  25. Condom use Extent and contribution of social-cognitive correlates

  26. Extent of potential barriers/facilitators of condom use Note: *Answers to each question were provided on a 5 point scale (Totally disagree – Totally agree) • † Somewhat agree and totally agree combined

  27. Contribution of social-cognitive correlates to condomless sex • Note: * Controlling for socio-behavioural factors associated with engaging in unprotected sex (reporting regular partner(s), casual partners, and being ever tested for STIs); ns = non-significant.

  28. Condom use Impact of campaigns on practices, intentions and social-cognitive correlates

  29. Exposure to condom use campaigns

  30. Association of frequency of exposure to STI testing campaigns with prior condomless sex and intention to use condoms Note: * ns = non-significant.

  31. Association of frequency of exposure to condom use campaigns with social-cognitive correlates Note: * ns = non-significant. Campaigns impact on 1 of the 3 social-cognitive barriers/facilitators (subjective norms) associated with condomless sex in previous multivariate +analyses

  32. Conclusion • The present study confirms and expands previous research • Social-cognitive factors individually are moderately associated but together significantly explain STI/HIV testing and condom use behaviours among young people • Sexual health promotion programs face the challenge of having to address a range of small hurdles rather than a single major barrier • More than increasing knowledge and raising risk awareness • Promoting positive attitudes and perceived advantages of sexual health behaviours and addressing perceived disadvantages • Increasing young people’s sense of control over sexual health behaviours and stimulating positive social norms

  33. Conclusion • Recent campaigns to promote STI/HIV testing among young people in NSW by directly addressing relevant social-cognitive barriers/facilitators, are showing promising effects • Association with behaviour and intention • Through influence on social-cognitive correlates • A similar sexual health promotion framework could be used to promote condom use • Collaboration between research and practice has the potential to considerably increase the effectiveness of sexual health promotion programs

  34. Thank you! philippe.adam@unsw.edu.au

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