A multi-level model of condom use among male and female upper primary school students in Nyanza, Kenya.

Although several studies have emphasized the relevance of community level variables to AIDS prevention among young people in sub-Saharan Africa, few have tested the empirical connections between such variables and sexual behaviors. Using data from 3645 sexually experienced grade 6 and 7 students from 160 schools, modeled on Fisher and Fisher's information-motivation-behavioral skills (IMB) model (2000, 1993) and Campbell's identification of community influences (2003), this study applies hierarchical linear models to estimate the effects of individual and community level variables on condom use among youth in Nyanza Province, Kenya. Four separate models were fit for both males and females. Results show significant differences across schools and communities regarding condom use. The predictors of reported condom use at last intercourse for both males and females were ethnicity, pressure to engage in sexual intercourse, and condom self efficacy. While age, religion, rejecting myths about the spread of HIV, and talking to male relatives about HIV/AIDS were all positively related to condom use for males, risk perception, socio-economic status of the school and school sponsorship by a religious group were negatively related to the outcome variable. For females, abstinence self efficacy and HIV prevention programming in community festivals were additional significant predictors, both increasing the odds of condom use. Our results suggest that there are marked differences in factors influencing reported condom use among males and females in Nyanza, Kenya. While some of these factors exist at the individual level, others exist at the school/community level. Based on our findings, we recommend that AIDS prevention interventions take account not only of individual-level factors, but also school/community influences on the sexual behaviors of youth. Copyright 2010 Elsevier Ltd. All rights reserved.