Predictors of Self-efficacy in HIV Prevention among People Living with HIV and AIDS in Thika District, Kiambu County, Kenya
Kieru, Jane Njeri
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It has been shown that PLWHA are living longer due to increasing availability and uptake of antiretroviral therapy (ART). There has been limited research on whether PLWHA adopt safer sexual and reproductive practices as focus has been primarily on HIV negative persons. The purpose of this study was to determine predictors of self-efficacy in HIV prevention among PLWHA in Thika district, Kiambu County; „a case of prevention with positives‟. Specific objectives included: to assess socio-demographic characteristics of PLWHA, determine attitude towards sexual and reproductive behaviour, establish sexual and reproductive practices, identify barriers to safe sexual and reproductive behaviour and to analyze the decision making patterns on sexual and reproductive behaviour and determine the predictors of self-efficacy in HIV prevention. The study was guided by Health Belief Model and General Systems Theory. The study employed a cross-sectional survey research design. Three divisions of Thika district were chosen purposively namely: Ruiru, Thika Municipality and Kamwangi. The sample size comprised 239 PLWHA. The data were collected using interview guides, focus group discussions and key informant interviews. Both qualitative and quantitative data analyses were used. Chi-square results yielded significant relationship between self-efficacy in HIV prevention and gender (p=0.000), marital status (p=0. 001), monthly income (p=0. 043), employment status (p=0. 037), attitude towards HIV-negative people (p=0.002), attitude towards reproductive behaviour (p=0. 049), number of sexual partners (p=0.000), type of sexual partner (p=0.000), awareness of HIV-status of sexual partner (p=0.025), HIV disclosure (p=0.003), number of children born after testing HIV positive (p=0.034), partner‟s condom refusal (p=0.028), alcohol and drug abuse (p=0.000), financial constraints (p=0.000), condom fatigue (p=0.002), decision on whether to use condoms (p=0.050), and which type of condoms used (p=0.010). Further analysis by use of Binary Logistic Regression showed positive predictors of self-efficacy in HIV prevention namely: gender (p=0.050), monthly income (p=0.002), attitude towards reproductive behaviour (p=0.007), number of children born after testing sero-positive (p=0.0.029), financial constraints and condom fatigue (p=0.046). Negative predictors were number of sexual partners (p=0.001) and alcohol and drug abuse (p=0.021). It was concluded that females, middle income earners, positive attitude towards reproductive behaviour, having more than one child after testing sero-positive and those not facing challenges condom fatigue and financial constraints predicted high self-efficacy in HIV prevention. On the contrary, having multiple partners and indulging in alcohol and drug abuse predicted low self-efficacy in HIV prevention. It was recommended that there was need to promote inclusion of both men and women in HIV and AIDS programs, ensure sustainable income generating activities, promote sexual behaviour change programmes within the community targeting PLWHA, ensure effective provision of alcohol and drug abuse counselling sessions among PLWHA and strengthen consistent use of condoms. These might increase self-efficacy in HIV prevention among PLWHA thus reducing the number of new HIV cases.