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AIDS Care. 2009 Aug;21(8):1014-24. doi: 10.1080/09540120802626162.

Gender differences in unsafe sexual behavior among young people in urban Mali.

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Institute for Health and Social Policy, McGill University, Montreal, QC, Canada.


We developed gender-specific explanatory models for unsafe sexual behavior among unmarried young people living in urban West Africa using a culturally adapted instrument which addresses personal, relational and socio-cognitive factors. Data were collected on condom use and number of sexual partners, and on their potential determinants, using in-person interviews on a heterogeneous sample of in-school and out-of-school young women (n=185) and (n=214) men who reported ever having had sexual intercourse. Recruitment was done at various sites in 21 randomly selected neighborhoods in Bamako. Bivariate analysis and multivariate logistic regressions were conducted to identify determinants of lack of condom at last sex and having more than one partner in the last six months and to test for interactions with gender. Similar percentages of men (40%) and women (46%) reported not using a condom at last sex. However, more men (64%) reported multiple partnering in the last six months than women (32%). Our findings suggest that the context of sexual debut, social status, relation to peers and family as well as attitudinal, normative and behavioral control constructs may influence young men and women's sexual behavior, but that pathways leading to unsafe sex are different across genders. Our findings also show that factors associated with condom use and sexual partnering are distinct. Earlier sexual debut seems to be risk-inducing in women while risk-reducing in men. Poor communication with peers and receiving money from sexual partner were associated with lack of condom use in women. High behavioral control was associated with fewer sexual partners in men. Determinants of unsafe sexual behavior were found at the social, interpersonal and individual levels for both men and women, but notable gender differentials existed. These findings underscore the importance of addressing gender as a crucial factor shaping HIV-risk profiles.

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