Determinants of condom use and HIV prevention among East African immigrants in Minnesota.

摘要

African-born immigrants are at increased risk of HIV infection in the U.S. (Minnesota Department of Health, n. d.; Washington State Department of Health, 2010). In Minnesota, from 2006-2010, the number of new HIV cases per 100,000 persons were the highest among the African-born black population, accounting for 10-15% of all HIV infections in the state while representing only 1.5% of the state’s population (Migration Policy Institute, n. d; Minnesota Department of Health, n. d.). The main transmission route for HIV among immigrant population is unprotected heterosexual contact (Beckwith et al., 2009; Johnson, Hu, & Dean, 2010; Washington State Department of Health, 2010). With 80% of new HIV infections transmitted sexually worldwide, correct and consistent condom use is critical element in preventing HIV infections (UNAIDS, 2009). A thorough review of the literature indicates a lack of research that specifically examines psychosocial determinants affecting the use of condoms under the framework of behavioral models in East-African population in the U.S.;This study examined potential correlates of consistent condom use in steady heterosexual relationships among East-African immigrants in Minnesota in two sequential phases: the elicitation (Phase I) and the cross-sectional quantitative survey (Phase II). Information from Phase I conducted (April-May, 2012) was used to develop the survey instrument for Phase II conducted (August-October, 2012). In Phase II, East-African immigrants in Minnesota (n=205) responded to questions on demographic characteristics, attitudes, norms, perceived behavioral control, self-efficacy, intention, acculturation, habit, and social desirable responding based on the Balanced Inventory of Desirable Responding (BIDR). Hierarchical regression models were used to assess the relationship between the main independent variables (attitude, norms, perceived behavioral control, self-efficacy, acculturation, and habit) and the dependent variables (behavioral intention and self-reported condom use). Mediational analyses were conducted to examine the mediating roles of self-efficacy and attitude in acculturation-intention relationship. Finally, structural equation modeling was used to test the hypothesized model. Self-efficacy emerged as the factor with the strongest and direct influence on intention to use condoms (β=.68, p <.001). In turn, intention was a significant predictor of self-reported condom use (β=.62, p < .001). Behavioral intention accounted for 38% of variance in self-reported condom use (R2 =.38, p <.001). Together, attitude, norms, perceived behavioral control, and self-efficacy explained 54% of the variation in behavioral intention (R2=.54, p <.001). Attitude and self-efficacy and did not mediate the association between acculturation and behavioral intention. However, acculturation directly and significantly (β=.16, p <.05) influenced condom use. Thus, interventions to increase condom use among immigrants should not ignore the role of acculturation. Measures to enhance integration through expanded English language training and sexual health education for adults should be tailored to the unique cultural and religious values of the immigrants. Furthermore, strengthening condom use self-efficacy among East-African immigrants is suggested as a main component of public health intervention seeking to curb the spread of HIV and other STIs in Minnesota.