Socio-cultural and behavioral determinants of condom use among youths in Limpopo Province, South Africa

[摘要] IntroductionSouth Africa is one of the countries hardest hit by HIV/AIDS. Of particular concern, newinfections among young people, especially young women and girls are on the rise. Despitewidespread awareness and prevention campaigns, the prevalence of HIV and deaths causedby AIDS are still on the increase, whereas condom use particularly in rural areas remainslow. Consistent condom use is central to the prevention of unwanted pregnancies, HIV andother STIs, yet young men and women alike are hesitant to use condoms because of threats totheir relationships, cultural roles and at times economic survival.PurposeThe purpose of this study is to identify socio-cultural and behavioral factors that influencecondom use among youths in Limpopo province, South Africa. This adds to a growing bodyof knowledge on the determinants of condom use and how they might shape effective HIVprevention programs.Objectives1. To conduct a secondary data analysis that examines the determinants of condom use, formen and women separately in relation to the following factors:Socio-demographic characteristics- age, education, marital status, migration and ivsocio-economic statusSexual behavior characteristics- partnership type (spousal, non spousal, or both), ageat sexual debut, number of lifetime sexual partners, contraceptive use (females only)and HIV-statusSocio-cultural characteristics - perceived risk of HIV infection, condom self efficacy(males only), partner communication on sex, condoms, HIV and other STI’s, beliefson gender norms, attitudes towards gender violence, knowledge on HIV/AIDS andHIV/AIDS related stigmaTo compare the results of this analysis to other national studies on condom use amongyoung people.To use the results of this analysis to make recommendations to improve HIV control inrural South Africa.MethodsThis study is a secondary analysis of data collected from a sample of 2236 sexually activeyoung people aged between 14-35 years in Limpopo province, South Africa. The data used inthis study is part of a wider public health intervention, the Intervention with Micro-financefor AIDS and Gender Equity (IMAGE) study. STATA 8.0 was used to analyze data inbivariate and multivariate analyses to assess determinants of consistent condom use andcondom use at last sex for males and females separately as the patterns of associations arelikely to differ between them.ResultsOverall condom use in this population was low: less than a quarter of respondents usedcondoms consistently and less than one third of men and women used condoms at last sex.This is especially true of females, married couples and those who have multiple partners. Inmultivariate analysis, significant predictors of consistent condom use for both sexes includedgood communication, older age at sexual debut, low risk perception of HIV infection,progressive attitudes towards gender violence and high HIV-related stigma. High condomself-efficacy, defined as the intention to pick up or purchase condoms with the intention ofuse, was the most powerful predictor of both condom use indices among males. Amongfemales only, having fewer than three lifetime sexual partners was positively associated with using condoms consistently. Lastly, females who used condoms as their main method ofcontraception were up to 20 times more likely to use them consistently and at last sex.ConclusionsHIV prevention programmes in this population should focus on delaying sexual debut,increasing perceived risk of HIV infection, encouraging partner communication, makingcondoms more easily accessible to young men and addressing gender inequalities.Furthermore, the dual protection offered by condoms against unwanted pregnancies andagainst HIV and other STI’s should be emphasized in this population as it plays an importantrole in the prevention of HIV.

[发布机构] University of the Witwatersrand