ANALYSIS OF SEXUAL AND REPRODUCTIVE HEALTH RISK PREFERENCES OF ZIMBABWE UNIVERSITY STUDENTS

  • Lazarus Muchabaiwa Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
  • Josue Mbonigaba Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
Keywords: Adolescence sexual and reproductive health, Prospect theory, Risk aversion, Loss aversion

Abstract

Although the Zimbabwean government launched an Adolescent and Youth Sexual and Reproductive Health policy in 2010, HIV prevalence and incidence among youth remains amongst the highest in sub-Saharan Africa. Zimbabwean Youths in tertiary education institutions exhibit high-risk sexual behaviours. The study aimed to estimate the risk preference parameters of youths in a tertiary education setting to understand their risky behaviour better using prospect theory. It involved 250 students completing a socioeconomic questionnaire and making a choice from over three series of pairwise lottery questions framed around sexual and reproductive health prevention interventions. The study used bivariate techniques to examine differences in risk-taking behaviour. Ordinary least squares and interval regression techniques determined the socioeconomic determinants of the risk behaviour function. The study established an average risk aversion parameter of 0.7 and a probability weighting parameter of 0.8. The probability weighting parameter implies that the participants were more focused on the outcomes with less concern for their likelihood. The study estimated the loss aversion parameter at 2.26, which indicates the need to reduce loss-framed messages in favour of positively framed awareness campaigns. Bivariate and multivariate regression analyses showed that income, prior sexual and reproductive health knowledge and alcoholism were associated with risk and loss aversion. We recommend positive framing of youth sexual and reproductive health awareness campaigns. We also recommend youth economic emancipation to increase economic prospects which in turn improves reference points which changes the viewing of health interventions and outcomes from the loss domain to gain domain.

Author Biography

Josue Mbonigaba, Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa

Professor

Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa

References

Lawless L, Drichoutis AC, Nayga RM. Time preferences and health behaviour: a review. Agricultural and Food Economics. 2013; 1(1):17.

Gonese E, Musuka G, Ruangtragool L, et al. Comparison Of HIV Incidence In The Zimbabwe Population-Based HIV Impact Assessment Survey (2015–2016), With Modeled Estimates: Progress Toward Epidemic Control. AIDS Research and Human Retroviruses. 2020; (ja).

Blower S, Okano JT. Precision public health and HIV in Africa. The Lancet Infectious Diseases. 2019; 19(10):1050-2.

Bulstra CA, Hontelez JA, Giardina F, et al. Mapping and characterising areas with high levels of HIV transmission in sub-Saharan Africa: A geospatial analysis of national survey data. PLoS medicine. 2020; 17(3):e1003042.

Zimbabwe Go. Zimbabwe national HIV and AIDS strategic plan III (ZNASP), 2015-2018: Commitment towards fast tracking 90.90.90 targets by 2020 and ending AIDS by 2030.: National AIDS Council of Zimbabwe; 2015.

WHO. Report on global sexually transmitted infection surveillance 2018. World Health Organization; 2018. Report No.: 9241565691.

Blum RW, Mmari K, Alfonso NY, et al. ASRH Strategic Plan Review. Johns Hopkins School of Public Health; 2015.

(MOHCC) MoHaCC. Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2015-16: First Report. Harare: MOHCC; 2017 July 2017.

Musizvingoza R, Wekwete NN. Factors facilitating risky sexual behaviour among youths in Mufakose, Harare, Zimbabwe. African Population Studies. 2018; 32(1).

Busisiwe M. Factors associated with sexually transmitted infections among youths in Umguza district [Masters Thesis]. Harare: University of Zimbabwe; 2014.

Akande A. AIDS-related beliefs and behaviours of students: evidence from two countries (Zimbabwe and Nigeria). International Journal of Adolescence and Youth. 1994; 4(3-4):285-303.

Shumba A, Mapfumo J, Chademana J. The Prevalence of Concurrent Sexual Partnerships among Students in Institutions of Higher Education in Zimbabwe. Journal of Human Ecology. 2011; 34(1):53-65.

McGillen JB, Stover J, Klein DJ, et al. The emerging health impact of voluntary medical male circumcision in Zimbabwe: An evaluation using three epidemiological models. PloS one. 2018; 13(7):e0199453-e.

ZIMSTAT, ICFI. Zimbabwe Demographic and Health Survey 2015: Final Report. Rockville, Maryland, USA: Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International.

Morris BJ, Hankins CA. Effect of male circumcision on risk of sexually transmitted infections and cervical cancer in women. The Lancet Global Health. 2017; 5(11):e1054-e5.

Morris BJ, Hankins CA, Banerjee J, et al. Does Male Circumcision Reduce Women's Risk of Sexually Transmitted Infections, Cervical Cancer, and Associated Conditions? Front Public Health. 2019; 7:4-.

Kuguyo O, Matimba A, Tsikai N, et al. Cervical cancer in Zimbabwe: a situation analysis. Pan Afr Med J. 2017; 27:215-.

CDC. Human Papillomavirus (HPV)- Treatment and Care: Centers for Disease Control and Prevention; 2016 [Available from: https://www.cdc.gov/std/hpv/treatment.htm.

WHO. Human papillomavirus (HPV) and cervical cancer: World Health Organization; 2019 [updated 24 January 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer.

Gabaza C, Chonzi P, Chadambuka A, et al. Utilization and outcomes of cervical cancer screening services in Harare City, 2012–2016: a secondary data analysis. BMC health services research. 2019; 19(1):454.

Looker KJ, Rönn MM, Brock PM, et al. Evidence of synergistic relationships between HIV and Human Papillomavirus (HPV): systematic reviews and meta‐analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status. Journal of the international AIDS Society. 2018; 21(6):e25110.

Averbach SH, Gravitt PE, Nowak RG, et al. The association between cervical HPV infection and HIV acquisition among women in Zimbabwe. AIDS (London, England). 2010; 24(7):1035.

Bendor J. Bounded rationality. In: Smelser NJ, Baltes B, editors. International Encyclopedia of the Social and Behavioral Sciences2001. p. 1303--7.

Nguyen Q, Leung P. Do fishermen have different attitudes toward risk? An application of prospect theory to the study of Vietnamese fishermen. Journal of Agricultural and Resource Economics. 2009:518-38.

Abdellaoui M, Bleichrodt H, Paraschiv C. Loss aversion under prospect theory: A parameter-free measurement. Management Science. 2007; 53(10):1659-74.

Writing Group for C-C, Simianu VV, Grounds MA, et al. Understanding clinical and non-clinical decisions under uncertainty: a scenario-based survey. BMC Med Inform Decis Mak. 2016; 16(1):153-.

Abellan-Perpinan JM, Bleichrodt H, Pinto-Prades JL. The predictive validity of prospect theory versus expected utility in health utility measurement. Journal of Health Economics. 2009; 28(6):1039-47.

Bleichrodt H, Abellan-Perpiñan JM, Pinto-Prades JL, et al. Resolving inconsistencies in utility measurement under risk: Tests of generalizations of expected utility. Management Science. 2007; 53(3):469-82.

Attema AE, Brouwer WB, l’Haridon O, et al. An elicitation of utility for quality of life under prospect theory. Journal of health economics. 2016; 48:121-34.

Lim S-L, Bruce AS. Prospect theory and body mass: characterizing psychological parameters for weight-related risk attitudes and weight-gain aversion. Frontiers in psychology. 2015; 6:330.

Tversky A, Kahneman D. Advances in prospect theory: Cumulative representation of uncertainty. Journal of Risk and uncertainty. 1992; 5(4):297-323.

Bleichrodt H, Pinto JL. A parameter-free elicitation of the probability weighting function in medical decision analysis. Management science. 2000; 46(11):1485-96.

Nkomazana N, Maharaj P. Perception of risk of HIV infections and sexual behaviour of the sexually active university students in Zimbabwe. SAHARA-J: Journal of Social Aspects of HIV/AIDS. 2014; 11(1):42-50.

Gwede CK, McDermott RJ, Westhoff WW, et al. Health Risk Behavior of Rural Secondary School Students in Zimbabwe. Health Education & Behavior. 2001; 28(5):608-23.

Mapfumo J, Shumba A, Zvimba R, et al. Sexual Activity and Prevalence of Multiple Sexual Relationships among Female Students at a University Campus in Zimbabwe. The Anthropologist. 2012; 14(5):383-91.

Jia Y, Li S, Yang R, et al. Knowledge about cervical cancer and barriers of screening program among women in Wufeng County, a high-incidence region of cervical cancer in China. PloS one. 2013; 8(7):e67005.

Tanaka T, Camerer CF, Nguyen Q. Risk and time preferences: Linking experimental and household survey data from Vietnam. American Economic Review. 2010; 100(1):557-71.

Presser S, Couper MP, Lessler JT, et al. Methods for testing and evaluating survey questions. Public opinion quarterly. 2004; 68(1):109-30.

Tversky A, Kahneman D. Prospect theory: an analysis of decision under risk. Econometrica. 1979; 47(2):263-92.

Lobel RE, Klotzle MC, Silva PVJDG, et al. Prospect theory: a parametric analysis of functional forms in Brazil. Revista de Administração de Empresas. 2017; 57(5):495-509.

Attema AE, Brouwer WB, l’Haridon O. Prospect theory in the health domain: A quantitative assessment. Journal of health economics. 2013; 32(6):1057-65.

Francis JM, Myers B, Nkosi S, et al. The prevalence of religiosity and association between religiosity and alcohol use, other drug use, and risky sexual behaviours among grade 8-10 learners in Western Cape, South Africa. PloS one. 2019; 14(2):e0211322.

Orihuela CA, Mrug S, Davies S, et al. Neighborhood Disorder, Family Functioning, and Risky Sexual Behaviors in Adolescence. Journal of Youth and Adolescence. 2020:1-14.

Ganle JK, Amoako D, Baatiema L, et al. Risky sexual behaviour and contraceptive use in contexts of displacement: insights from a cross-sectional survey of female adolescent refugees in Ghana. International journal for equity in health. 2019; 18(1):127.

Rusvingo SL. The Zimbabwe soaring unemployment rate of 85%: A ticking time bomb not only for Zimbabwe but the entire SADC region (2014). Global Journal of Management and Business Research. 2015.

McDermott R. Adolescent HIV prevention and intervention: A prospect theory analysis. Psychology, Health & Medicine. 1998; 3(4):371-85.

Hallett TB, Singh K, Smith JA, et al. Understanding the Impact of Male Circumcision Interventions on the Spread of HIV in Southern Africa. PLOS ONE. 2008; 3(5):e2212.

Skolnik L, Tsui S, Ashengo TA, et al. A cross-sectional study describing motivations and barriers to voluntary medical male circumcision in Lesotho. BMC public health. 2014; 14(1):1119.

George G, Strauss M, Chirawu P, et al. Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu–Natal, South Africa. African Journal of AIDS Research. 2014; 13(2):179-87.

Ackerson K, Preston SD. A decision theory perspective on why women do or do not decide to have cancer screening: systematic review. Journal of advanced nursing. 2009; 65(6):1130-40.

Published
2021-04-24
How to Cite
Muchabaiwa, L., & Mbonigaba , J. (2021). ANALYSIS OF SEXUAL AND REPRODUCTIVE HEALTH RISK PREFERENCES OF ZIMBABWE UNIVERSITY STUDENTS. Malaysian Journal of Public Health Medicine, 21(1), 37-45. https://doi.org/10.37268/mjphm/vol.21/no.1/art.489