Abstract #81  -  Choice disability and HIV prevention knowledge, attitudes and practices in Botswana
Authors:   Presenting Author:   Mr Ari Ho-Foster - CIET Trust
Additional Authors:  Prof Neil Andersson, Dr Anne Cockcroft, Mr Mokgweetsi Masisi, Ms Ditiro Laetsang, Mr Leagajang Kgakole,
Aim: Botswana has among the highest HIV rates in the world. Services for diagnosis and treatment of those with HIV infection in Botswana have made progress, but there remains the serious challenge of preventing new infections. Many prevention programmes motivate for condom use and reduction of multiple sexual partnerships. But some people cannot implement decisions to protect themselves: the choice-disabled. It is necessary to learn more about choice-disability and how it relates to HIV prevention knowledge, attitudes and practices.
Method / Issue: We analysed data from household respondents (16-60 years old) in a 2007 nationally representative stratified random sample of communities across Botswana. We considered individuals as choice-disabled if they thought their partner was at risk of HIV, but said they would have sex if their partner refused to use a condom. A step-down logistic regression approach examined associations between choice disability and outcomes of self-reported HIV prevention knowledge, attitudes and practices, taking into account the possible effects of other individual and community level factors, and including terms for prior levels of the outcomes in a 2002 survey. We report associations from the final models as the Odds Ratio and 95% confidence intervals, adjusted for clustering.
Results / Comments: Of the 768 men and 1784 women participating in the survey, 12% were choice disabled according to our definition. The choice-disabled of both sexes were more likely to hold certain unhelpful beliefs and attitudes. They were more likely not to believe condoms prevent AIDS (OR 2.89 95% CI 1.66-5.03), and more likely to think women sometimes deserve to be beaten (OR 1.61 95% CI 1.07-2.41). The choice-disabled also reported less positive practices than other people. They were more likely not to have gone for an HIV test in the previous 12 months (OR 2.01 95% CI 1.29-3.14), more likely to report more than one sexual partner in the past month (OR 3.88 95% CI 2.06-7.32), and more likely to report not always using a condom with a non-regular partner (OR 2.36 95% CI 1.39-4.00).
Discussion: Choice-disability in Botswana is associated with unhelpful HIV prevention attitudes and practices. This will undermine the effectiveness of HIV prevention efforts until programmes take into account choice-disability, reducing the number of people affected or supporting them to implement prevention in other ways. Trials of potentially effective interventions to support HIV prevention in the choice-disabled are a priority.
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