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Gender & Behaviour, 10(2), December 2012
Copyright © Ife Center for Psychological Studies/Services, Ile-Ife, Nigeria
- 4627 -
Correlates of Condom Use among Male and Female aged 18-24
Years in South Africa*
Gladys Matseke1, Karl Peltzer1,2, Gugu Mchunu,1 and Julia Louw1
1HIV/AIDS, STIs and TB (HAST) Research Programme, Human
Sciences Research Council, Pretoria and Durban
2Department of Psychology, University of Limpopo, Turfloop
Abstract
Condom use is one of the effective means of HIV
prevention among sexually active people. Even though HIV
incidence has slightly decreased among the youth in
South Africa, many young people still expose themselves
to sexual risk behaviours. The aim of the study was to
investigate factors that are associated with condom use
and exposure to loveLife programmes among young people
aged 18 to 24 years in South Africa. A cross-sectional
population-based household survey in selected provinces
in South Africa was conducted using a multi-stage
disproportionate stratified cluster sampling approach. The
sample (N=2138) used in the analysis for this paper only
includes sexually active youth (18-24 years). Among the
sexually active youth surveyed it was found that 78.9%
reported using a condom at their last sexual intercourse;
this was significantly higher among men (85.4%) than
women (72.0%). In multivariate analysis, condom use
among males was significantly associated with having not
agreed with the statement ―It is acceptable to have sex
with my sex partner even though my partner does not
want to‖, having partner risk reduction self-efficacy,
having talked with their partner about condoms in past 12
months, having had two or more sexual partners in the
past year and loveLife programme exposure. Among
females, condom use was significantly associated with
partner risk reduction self-efficacy, and having talked with
* Address correspondence to Professor Karl Peltzer, HIV/AIDS, STIs and TB (HAST) Research
Programme, Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Af rica. Email:
kpeltzer@hsrc.ac.za
Gender & Behaviour, 10(2), 2012
- 4628 -
their partner about condoms in the past 12 months. The
findings indicate higher condom use at last sex among
young men when compared to women in South Africa.
Condom use with non-regular partners is generally high
and even higher among men compared to women.
However, condom use with transactional partners is very
low. Of concern are young mens‘ reported risk behaviours
in having multiple partners. loveLife programme exposure
has had a positive effect on condom use among young
men. Therefore strategies are needed to improve regular
condom use among youth with regular and transactional
partners and reinforcing regular condom use with non-
regular partners.
Key words: Condom use, loveLife, multiple partners,
youth, gender, South Africa
Background
Condom use as a means for preventing HIV infection has significantly
increased over the past years among the youth in South Africa,
which is likely to have contributed to an HIV incidence reduction in
this population (Shisana & Simbayi, 2002; Shisana et al., 2005;
Shisana et al., 2009). Condom use at last sexual intercourse has
been used in previous studies as a measure to illustrate uptake of
condom use (Shisana et al., 2009; Hendriksen et al., 2004; Sheeran
& Abraham, 1994). According to the 2008 South African National HIV
survey (Shisana et al. 2009), reported condom use at last sex
increased dramatically from 57% in 2002 to 87% in 2008 among
young males (15-24 years), and correspondingly from 46% to 73%
among young females (15-24 years). This is supported by the
statistically significant decreases in HIV prevalence among the South
African youth aged 15-24 over the years in the same survey from
9.3% in 2002 to 8.7% in 2008. Analysis of data from the 2008
National HIV survey (Shisana et al., 2009) has shown that among
young people aged 18-24 years 86.5% reported ever using a condom
while only 64.5% reported using condoms in the last sexual
intercourse. According to the National Youth Survey conducted by
the Reproductive Health Research Unit among 15–24 year olds in
2003, about 57%f young men and 48% of young women reported
having used a condom during their most recent sexual intercourse
(Hendriksen, Pettifor, Lee, Coates, & Rees, 2007). The results from a
national survey conducted by the Kaiser Family Foundation and the
Matseke, G. et al.: Correlates of Condom Use
- 4629 -
South African Broadcasting Corporation (2007) showed that 62%
sexually experienced young people reported that they used a condom
the last time they had sex.
Condom use has been linked to various factors including
socio-demographic, social, behavioural, and others factors in a
number of studies worldwide (Calazans, Araujo, Venturi, Franca,
2005; Cobat, Halfen, & Gremy, 2008; Glick, Randriamamonjy, &
Sahn, 2009; Hendriksen et al., 2007; Msamanga, et al. 2009;
Onayede, Abiona, Ugbala, Alozie, Adetuyi, 2008; Rahamefy, Rivard,
Ravaoarinono, Ranaivoharisoa, Rasamindrakotroka, & Morriset,
2009). Studies examining condom use among South African youths
by selected populations have shown that condom use is affected -
either negatively or positively, by factors such as self-efficacy and
perceived risk of HIV infection among others (Hendriksen et al.,
2007). A strong positive association was found between perception of
personal risk of HIV and a high level of condom use (Adik &
Alexander, 1999; Meekers & Klein, 2002; Myer et al. 2001). In a
study conducted by Meekers et al. (2006), male respondents were
significantly more likely to ever have used a condom if they had a
high perceived risk of sexually transmitted infections, they perceived
condoms as an effective form of family planning, knew a condom
source within 10 minutes walking distance and had perceived high
levels of parental and peer support for condom use. Condom use
was found to be positively associated with the level of education in
various studies (Glick et al., 2009; Lane, 2004; Meekers et al., 2006;
Msamanga et al., 2009; Myer et al. 2001; Prata et al. 2006; Rahamefy
et al., 2009). Consistent with this hypothesis, other studies showed
that lower levels of education were associated with less frequent
condom use (Calazans et al., 2005; Cobat et al., 2008). Studies on
links between condom use and the number of sexual partners reveal
mixed results in different countries. Condom use among people with
multiple partners has generally increased especially in the areas
most affected by the HIV epidemic (Adentunji & Meekers, 2001;
Meekers et al., 2006; Msamanga et al., 2009; Myer et al., 2001;
Onayede et al., 2008; UNAIDS; 2008). However, in Tanzania a study
revealed the opposite trend by showing that having only one sex
partner was associated with increased condom use (Volk & Koopman,
2001).
loveLife is the largest HIV prevention and youth development
programme in South Africa. It was established in late 1999 and
combines loveLife combines a nationwide multimedia campaign with
Gender & Behaviour, 10(2), 2012
- 4630 -
programmatic face to face engagements, community-level outreach,
systems strengthening and clinical and psychosocial services.
loveLife recognises that youth leadership is critical in transforming
South African society, and has based its approach on addressing the
individual, social and structural factors driving high risk tolerance
and leading to a perception of scant opportunity among young
people.
Every year loveLife recruits a national corps of over 1,200 full-time
young leaders known as groundBREAKERS, who volunteer for a
period of 12 months to drive HIV prevention within their
communities. These young people, aged between 18 and 25, go
through a series of training programmes to equip them with sexual
health counselling skills and techniques for effective outreach to
other young people. groundBREAKERS recruit over 6,000 volunteers
per year called mpintshis (vernacular for ‗friend‘ or ‗buddy‘).
Together, groundBREAKERS and mpintshis work in more than 6,500
schools across South Africa from almost 900 hubs, which include
loveLife Y-Centres, youth-friendly clinics, social franchises and
loveLife outlets.
For the purposes of this paper it would be imperative to
determine factors associated with condom use among this group of
youth to assist in strengthening and sustaining already existing
interventions for the prevention of further HIV infections such as
loveLife, among young people in South Africa. Therefore this study
aims to explore factors that are associated with condom use and
exposure to loveLife programmes among young people aged 18 to 24
years in South Africa. This research was conducted as part of an
evaluation of the impact of loveLife, South Africa‘s national HIV
prevention campaign for young people, on HIV and related risk
behaviours.
Method
Sample and procedures
A cross-sectional population-based household survey was conducted
using a multi-stage stratified cluster sampling approach. In each
household all eligible household members were invited to participate
and interviewed. The survey included persons of ages 18 to 24 years
living in South African households of the four (out of nine) selected
provinces, KwaZulu-Natal, Mpumalanga, Eastern Cape and Gauteng
Matseke, G. et al.: Correlates of Condom Use
- 4631 -
Province, providing an urban-rural representation of South Africa.
The selection of the provinces were guided by the selecting two
provinces with the highest HIV prevalence in the country, KwaZulu-
Natal and Mpumalanga, and one most urban province (Gauteng) and
one rural province (Eastern Cape). Ethical approval for the study was
obtained from the HSRC Research Ethics Committee. Participants
signed informed consent forms.
Measures
Despite numerous studies that measure condom use, there is no
agreed ―gold standard‖ in terms of the best way to assess condom use
(Noar, Cole, & Carlyle, 2006). In the present study, we asked only a
single standard question ―Did you use a condom the last time you
had sex?‖ Hence the main outcome variable was condom use at last
sex.
Using a social-ecological model the following variables were assessed:
individual variables (HIV knowledge, self-esteem, sense of future, and
partner risk reduction self-efficacy), social variables (peer pressure,
sexual attitudes, HIV communication, HIV/AIDS stigma) and
structural variables (poverty, formal education, accessibility to
condoms and relationship control).
HIV knowledge was assessed with two items: 1) How many people
living with HIV do you personally know? and 2) How many people
have you personally known (in your lifetime) that have died from
AIDS? The responses to these two questions were summed and coded
as 0 if the interviewee did not know anyone in either category, 1 if the
interviewee knew at least one person living with HIV (PLHIV) or who
has died from AIDS, and 2 if the interviewee knew at least one PLHIV
and at least one person who has died from AIDS. Cronbach alpha for
this 2-item HIV knowledge index was 0.73 in this sample.
Self-esteem was assessed with the 10-item Rosenberg self-esteem
scale (Rosenberg, 1965), with a score of 14 or less indicating low-self-
esteem. A sample item is, ―All in all, I am inclined to feel that I am a
failure.‖ Response options ranged from 0=strongly disagree to
3=strongly agree. Cronbach alpha for the Rosenberg self-esteem scale
was 0.64 in this sample.
“Sense of future‖ was assessed with 6 items such as ―I have a plan
for the future‖; response options were ‗agree‘ or ‗disagree‘. Sense of
future was classified as those who indicated to all 6 items to have
any sense of future. Cronbach alpha for this ―sense of future‖ index
was 0.63 in this sample.
Partner risk reduction self-efficacy was assessed with 4 items such
Gender & Behaviour, 10(2), 2012
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as ―Would you be able to avoid sex any time you didn‘t want it?‖
Response options were: ―No‖, ―Probably no‖, ―Probably yes‖, and
―Yes‖. Cronbach alpha for this partner risk reduction self-efficacy
index was 0.73 in this sample.
Peer pressure was assessed with 2 items; 1) ―How much pressure you
get from your friends to have sexual intercourse, would you say...?‖
(Response options ranged from 1=―No pressure at all‖ to 4=―A lot of
pressure‖) and 2) ―I feel pressure from friends to do things I don‘t
want to.‖ (Response options ranged from 1=―Very often‖ to 4=―Never‖).
Low peer pressure was coded 2, medium 3-5 and high 6-8. Cronbach
alpha for this peer pressure index was 0.61 in this sample.
HIV/AIDS stigma was assessed with four items, e.g. ―If you knew a
shopkeeper or food seller had HIV, would you buy food from them?‖
Response options were ―yes‖ or ―no‖. Cronbach alpha for this
HIV/AIDS stigma index was 0.58. Responses were summed up, and
if any of the 4 questions were affirmative for stigma it was coded =1,
against =0.
HIV communication was assessed with 10 items, specifying 10
different source persons or institutions, e.g., ―Have you ever talked to
your mother or female primary care giver/guardian about HIV/AIDS
issues‖ Responses options were 1= ―Yes‖ or 2= ―No‖. Cronbach alpha
for this HIV communication index was 0.75 in this sample. Further,
1 item assessed ―Did you talk about using a condom with your latest
sexual partner in the last 12 months?‖ Responses options were 1=
―Yes‖ or 2= ―No‖.
Poverty was assessed with 6 items on the availability or non-
availability of shelter, fuel or electricity, clean water, medicines or
medical treatment, food and cash income in the past week. Response
options ranged from 1= ―Not one day‖ to 4= ―Every day of the week‖.
Poverty was defined as higher scores on non-availability of essential
items. Cronbach alpha for this poverty index was 0.70 in this sample.
Accessibility of condoms was assessed with the question, ―How easy
is it for you to get condoms if you needed or wanted them?‖ Response
options ranged from 1= ―very easy‖ to 4= ―very difficult‖. This was
coded 2-4=1 (difficult) 1=0, very easy.
Relationship control was assessed with 4 items (for those never in a
relationship, they were asked imagine to be) such as ―Your partner
has more control than you do in important decisions that affect your
relationship.‖ Response options ranged from 1=―Strongly disagree‖ to
4=―Strongly agree.‖ Higher scores on lack of relationship power were
defined as lack of relationship control. Cronbach alpha for this
relationship control index was 0.81 in this sample.
Matseke, G. et al.: Correlates of Condom Use
- 4633 -
HIV risk behaviour. Various questions were asked to assess HIV/STI
risk behaviour. These included condom use at last sex, having stayed
away from home for more than one month in the past year, having
had two or more sexual partners in the past year, early sex (less than
15 years), coercive sex, self-reported HIV status, history of sexually
transmitted infection (STI), lifetime number of transactional sexual
partners, history of HIV testing, alcohol and drug use in the context
of sex. Alcohol use was assessed with the Alcohol Use Disorder
Identification Test (AUDIT-C) questionnaire (11), a measure of
consumption of alcohol (i.e., the frequency of drinking, the quantity
consumed at a typical occasion), and the frequency of heavy episodic
drinking (i.e., consumption of five standard drinks, 60 gram alcohol,
or more on a single occasion). Because AUDIT is reported to be less
sensitive at identifying risk drinking in women (12), the cut-off points
of binge drinking for women (4 units) were reduced by one unit as
compared with men (5 units), as recommended by Freeborn et al.
(13). Using a cut off score of 5 or more hazardous or harmful
drinking was defined (14,15). Cronbach alpha reliability coefficient
was in this study for the AUDIT-C 0.91.
HIV prevention programme exposure was assessed with the following
items. Exposure to ever loveLife face to face programmes was
assessed with 24 items, e.g., Gone to a loveLife clinic, Participated in
a loveLife Community Dialogue, or Gone to a loveLife Youth Centre.
LoveLife exposure to face-to-face programmes was summed up and
coded as 0, 1-2, 3-4 or 5 or more programme exposures. Further,
longer term participation was assessed with having participated in
loveLife programmes for at least one year. In addition, loveLife multi-
media exposure was assessed with 9 items, e.g., ―Have you ever
watched a loveLife television show?‖ ―Contacted loveLife on facebook‖
―Heard a loveLife advert on radio.‖ ―Read UNCUT (loveLife) youth
magazine.‖ Response options were 1=Yes or 2=No. The 9 multi-media
programmes were summed up and coded as 1=0-1 media exposures,
2=2-4, and 3=5-9 media exposures.
Data analysis
In this analysis only the sample (N=2138) which had ever had sexual
intercourse was included. Data analysis consisted of both descriptive
and inferential statistics. After the datasets were edited, programs
were written to calculate the sample weights. Weighted data was
analysed using STATA software, taking into account the complex
multi-level sampling design. STATA software (svy methods) was used
to obtain the estimates of key indicators, significance values (p-
Gender & Behaviour, 10(2), 2012
- 4634 -
values) and confidence intervals (95% CI) that take into account the
complex design and individual sample weights. Computed estimates
and odds ratios are reported with 95% confidence intervals and a
two-side p-value of 0.05 used as the cut-off point for statistical
significance. Data were checked for normality distribution and
outliers. For non-normal distribution non-parametric tests were
used. Associations between key outcomes of condom use at last sex,
and individual, social and structural variables and HIV programme
exposure were evaluated calculating odds ratios (OR). Unconditional
multivariable logistic regression was used for evaluation of the
impact of explanatory variables for key outcome of condom use at
last sex (binary dependent variables). All variables statistically
significant at the P < .05 level in bivariate analyses were included in
the multivariable models.
Results
Sample characteristics
Overall, just over 3 quarters (78.9%) of the participants reported
using a condom at their last sexual intercourse, this was significantly
(P<001) higher among men (85.4%) than women (72.0%).
Furthermore with regard to risky sexual behaviour, more males
reported early age of sexual debut (17.8%), alcohol before sex in past
3 months (20.7 %%), hazardous or harmful alcohol use (34%), and
having had two or more sexual partners in past year (43.6%),
compared to their female counterparts (6.9%, 5.6%, 16.4%, and
20.8%, respectively). More males showed slightly higher partner risk
reduction self-efficacy (2.7%) compared to females (2.6%). Most
participants reported having talked with their partner about condoms
in past 12 months, with males reporting slightly (91.9%) higher rates
of communication than females (90.7%) (see Table 1).
Table 1: Sample characteristics (N=2138) of sexually active youth
Men
(1129, 52.8%)
Women
(N=1009, 47.2%)
Individual
N (%) or M (SD)
N (%) or M (SD)
Knows person living with HIV and/or
died from AIDS
0
1=knows PLHIV or died from AIDS
2=knows PLHIV and died from AIDS
393 (40.0)
252 (23.5)
475 (36.6)
272 (36.3)
215 (18.2)
514 (45.5)
Normal self-esteem
1035 (93.5)
926 (96.1)
Sense of future
728 (72.4)
628 (63.6)
Partner risk reduction self-efficacy
(range 4-16)
13.9 (2.7)
14.0 (2.6)
Matseke, G. et al.: Correlates of Condom Use
- 4635 -
Social
Peer pressure
Low
Medium
High
350 (41.0)
547 (42.3)
206 (16.6)
465 (54.6)
398 (37.6)
121 (7.9)
HIV communication index (range 0-10)
5.4 (2.6)
5.6 (2.2)
Talked with partner about condoms in
past 12 months
903 (91.9)
769 (90.7)
Length of relationship with most recent
partner longer than 3 mo (vs. ≤3 mo)
811 (87.3)
740 (75.4)
HIV/AIDS stigma
118 (5.5)
75 (3.8)
Believed using condoms is a sign of not
trusting your partner
259 (15.9)
229 (17.5)
Agreed with statement ―It is okay for
men to have multiple sexual partners.‖
268 (19.8)
36 (2.4)
Agreed with statement ―It is acceptable
to have sex with my sex partner even
though my partner does not want to.‖
60 (4.0)
43 (2.9)
Structural
Poverty index (range 6-22)
8.1 (2.9)
8.0 (2.8)
Education
Low (≤Grade 10)
Medium (Grade 11)
High (Grade 12 or more)
218 (14.7)
233 (17.3)
670 (68.0)
171 (18.0)
201 (18.5)
632 (63.5)
Student
Employed
Unemployed
459 (42.3)
217 (23.0)
370 (34.8)
361 (44.0)
114 (11.1)
440 (45.0)
Difficulty of getting condoms
132 (11.1)
106 (9.3)
Lack of relationship control (range 4-16)
8.5 (2.3)
8.3 (2.5)
Away from home for more than one
months in past12 months
298 (27.5)
281 (21.2)
HIV/STI risk behavior
Age at sexual debut < 15 years
145 (17.8)
65 (6.9)
Ever had forced sex
---
58 (7.3)
Ever tested for HIV
556 (48.9)
779 (80.4)
HIV positive
35 (2.8)
64 (7.1)
HIV negative
493 (38.5)
654 (66.9)
Ever STI
125 (7.8)
108 (8.7)
Two or more sexual partners in past
year
525 (43.6)
200 (20.8)
Ever transactional sex partner
103 (7.8)
50 (5.0)
Hazardous or harmful alcohol use
430 (34.0)
160 (16.4)
Alcohol before sex in past 3 months
215 (20.7)
71 (5.6)
Drugs before sex in past 3 months
79 (4.8)
12 (2.0)
Condom use at last sex
902 (85.4)
668 (72.0)
Programme exposure
One year or more loveLife participation
315 (22.4)
250 (21.5)
loveLife face-to-face participation
0
1-2
3-4
5 or more
700 (70.4)
219 (12.2)
100 (8.0)
98 (9.3)
639 (62.6)
193 (22.1)
71 (4.3)
101 (11.0)
loveLife multi media exposure
0-1
2-4
5-9
173 (18.1)
566 (50.8)
341 (31.0)
180 (20.7)
458 (48.2)
331 (31.0)
***P<.001; **P<.01; *P<.05
Gender & Behaviour, 10(2), 2012
- 4636 -
Association between condom use and various characteristics
Table 2 shows both the bivariate and multivariate analyses,
conducted separately among male and females, reporting the
unadjusted and adjusted odds ratios of possible predictors of condom
use at last sexual intercourse. The bivariate analyses among males
showed that normal self-esteem, peer pressure, the belief that using
condoms is a sign of not trusting your partner, HIV negative status,
two or more sexual partners in the past year, educational level, the
ease of getting condoms, having been away from home for more than
one month in past12 months, having not agreed with statement ―It is
acceptable to have sex with my sex partner even though my partner
does not want to‖, partner risk reduction self-efficacy, having talked
with partner about condoms in past 12 months, having had one year
or more loveLife participation, loveLife face-to-face programme
exposure and/or accessed loveLife resources, and loveLife multi
media exposure, were significantly associated with condom use at
last sexual intercourse.
The bivariate analyses among females showed that partner risk
reduction self-efficacy, peer pressure, having talked with my partner
about condoms in past 12 months, length of relationship with most
recent partner longer than 4 months, HIV/AIDS stigma, ease of
getting condoms, HIV negative status, loveLife face-to-face
participation, and loveLife multi media exposure, were significantly
associated with condom use at last sexual intercourse.
Finally, in the multivariate analysis, condom use among males was
significantly associated with having not agreed with the statement ―It
is acceptable to have sex with my sex partner even though my
partner does not want to‖, partner risk reduction self-efficacy, having
talked with their partner about condoms in past 12 months, having
had two or more sexual partners in the past year and loveLife face-to-
face programme exposure and/or accessed loveLife resources.
Condom use among females was significantly associated with partner
risk reduction self-efficacy, and having talked with their partner
about condoms in the past 12 months (see Table 2).
Matseke, G. et al.: Correlates of Condom Use
- 4637 -
Table 2: Association between individual, social, structural, risk behaviour variables, loveLife programme exposure and condom use at last sex by
gender
Men
Women
OR (95% CI)
AOR (95% CI)
OR (95% CI)
AOR (95% CI)
Individual
Knows person living with HIV and/or died from
AIDS
0
1=knows PLHIV or died from AIDS
2=knows PLHIV and died from AIDS
1.00
1.57 (0.74-3.33)
0.95 (0.45-2.00)
---
1.00
0.78 (0.33-1.84)
0.84 (0.46-1.51)
---
Normal self-esteem
4.86 (1.82-12.95)**
1.32 (0.13-14.00)
1.33 (0.55-3.18)
---
Sense of future
0.78 (0.45-1.37)
0.97 (0.53-1.75)
---
Partner risk reduction self-efficacy
2.74 (1.49-5.04)***
3.74 (1.71-8.19)***
1.20 (1.10-1.31)***
1.24 (1.10-1.39)***
Social
Peer pressure
Low
Medium
High
1.00
0.36 (0.16-0.86)*
0.66 (0.27-1.60)
1.00
1.44 (0.58-3.54)
3.72 (1.16-11.94)
1.00
0.47 (0.23-0.97)*
0.72 (0.27-1.94)
1.00
0.36 (0.13-0.95)
0.53 (0.14-2.06)
HIV communication index
1.04 (0.94-1.14)
---
1.11 (0.95-1.29)
---
Talked with partner about condoms in past 12 ms
7.34 (2.96-
18.15)***
8.05 (2.62-24.76)***
8.89 (4.25-18.39)***
9.15 (3.00-27.91)***
Length of relationship with most recent partner
longer than 4 mo (vs. ≤4 mo)
0.42 (0.16-1.11)
---
0.34 (0.13-0.88)*
0.92 (0.29-2.99)
HIV/AIDS stigma
1.01 (0.43-2.37)
---
0.40 (0.17-0.95)*
1.94 (0.62-6.05)
Believed using condoms is a sign of not trusting
your partner
0.42 (0.20-0.88)*
0.89 (0.32-2.45)
0.63 (0.32-1.25)
---
Agreed with statement ―It is okay for men to have
multiple sexual partners.‖
1.61 (0.86-3.02)
---
2.46 (0.75-8.10)
---
Agreed with statement ―It is acceptable to have
sex with my sex partner even though my partner
does not want to.‖
0.14 (0.05-0.43)***
0.13 (0.04-0.45)**
2.35 (0.71-7.81)
---
Structural
Poverty index
0.94 (0.86-1.04)
---
0.96 (0.83-1.11)
---
Education
Low (≤Grade 10)
Medium (Grade 11)
High (Grade 12 or more)
1.00
1.47 (0.71-3.07)
3.56 (1.71-7.42)***
1.00
2.03 (0.50-8.28)
1.71 (0.48-6.03)
1.00
1.39 (0.52-3.69)
2.02 (0.99-4.12)
---
Student
Employed
Unemployed
1.00
1.21 (0.55-2.64)
0.79 (0.37-1.67)
---
1.00
0.49 (0.21-1.15)
0.73 (0.43-1.23)
---
Gender & Behaviour, 10(2), 2012
- 4638 -
Difficulty of getting condoms
0.38 (0.24-0.58)***
0.55 (0.29-1.03)
0.40 (0.25-0.64)***
0.65 (0.39-1.08)
Relationship control
0.81 (0.40-1.65)
---
1.49 (0.50-4.01)
---
Away from home for more than one months in
past12 months
2.41 (1.24-4.67)**
0.97 (0.39-2.44)
1.01 (0.49-2.09)
---
HIV/STI risk behavior
Age at sexual debut < 15 years
1.49 (0.52-4.31)
---
0.62 (0.17-2.28)
---
Ever had forced sex
---
---
0.47 (0.21-1.05)
---
Ever tested for HIV
0.87 (0.57-1.34)
---
1.23 (0.62-2.45)
---
HIV positive (vs. negative)
0.19 (0.06-.59)**
0.19 (0.02-1.86)
0.42 (0.18-0.95)*
1.75 (0.31-9.96)
Ever STI
0.64 (0.26-1.57)
---
0.48 (0.21-1.05)
---
Two or more sexual partners in past year
1.74 (1.06-2.86)*
2.42 (1.12-5.21)*
1.01 (0.47-2.19)
---
Ever transactional sex partner
0.84 (0.36-1.93)
---
0.61 (0.21-1.84)
---
Hazardous or harmful alcohol use
1.61 (0.87-2.96)
---
1.53 (0.73-3.21)
---
Alcohol before sex in past 3 months
1.15 (0.45-2.97)
---
0.61 (0.24-1.55)
---
Drugs before sex in past 3 months
0.84 (0.31-2.32)
---
0.47 (0.03-8.02)
---
Programme exposure
One year or more loveLife participation
2.04 (1.12-3.73)*
3.15 (0.85-11.61)
1.25 (0.58-2.70)
---
loveLife face-to-face participation
0
1-2
3-4
5 or more
1.00
1.00 (0.44-2.31)
1.30 (0.45-3.78)
3.40 (1.45-7.97)**
1.00
0.15 (0.05-0.46)***
0.16 (0.04-0.57)**
0.10 (0.02-0.52)**
1.00
1.04 (0.63-1.69)
4.20 (1.66-10.60)**
0.99 (0.40-2.46)
1.00
0.76 (0.29-1.99)
3.00 (0.65-13.73)
0.77 (0.24-2.51)
loveLife multi media exposure
0-1
2-4
5-9
1.00
3.77 (1.58-9.01)**
3.94 (1.41-11.02)**
1.00
1.82 (0.25-13.24)
1.31 (0.16-10.63)
1.00
2.72 (1.54-4.82)***
3.16 (1.36-7.32)**
1.00
1.01 (0.23-4.46)
0.90 (0.20-4.08)
***P<.001; **P<.01; *P<.05
Matseke, G. et al.: Correlates of Condom Use
- 4639 -
Discussion
This study among young people (18-24 years) in South Africa found
that 78.9% reported having used a condom at last sexual
intercourse. Similar to what has been reported in the previous
studies (Shisana et al., 2009; Rahamefy et al., 2009; Boer &
Mashaba, 2007; Leclerc-Madlala et al., 2009), more males in this
study (96.6%) reported ever using a condom compared to females
(91.8%). Lower condom use by females is the result of deeply
embedded culturally-sanctioned sexual behavioural norms reflecting
gender inequality that allow only men to decide when, where and how
to have sex and in particular also including deciding when or with
whom to use condoms. However, it is of great importance to have
noted that a large number of women (90.7%) reported having talked
with their partners about condoms in past 12 months. These shows a
gradual shift in gender dynamics where women are able to
communicate to their partners about condoms and as a result
negotiate safe sex with their sexual partners.
It was, however, a concern that a majority of male respondents
(60%), agreed with the statement ―It is acceptable to have sex with
my sex partner even though my partner does not want to‖. Although
a positive finding was that more male respondents have ―talked to the
partner about condoms in the past 12 months‖, it was however a
concern that more male respondents were still engaging in risky
sexual behaviour by having multiple sexual partners compared to
their female counterparts. For example, more than a quarter (43.6%)
of males compared to 20.8% of females had had two or more sexual
partners in the past year. Similarly, while 80.4% of female
respondents reported ever tested for HIV, less than half (48.9%) of
male respondents had done so, as such 2.8% reported to be HIV
positive. These results may be an indication that many male
respondents were not aware of their HIV status. Also more women
are likely to test for HIV and receive their test results because of
stronger patterns of health care seeking behaviour as compared to
men, for example, women are more likely to access clinics because of
programs related to pregnancy and immunization.
It was of interest to learn that over 90% of respondents among both
young men and women in this study reported having talked with a
partner about condoms in the past 12 months. As a result, people
who reported having talked with a partner about condoms in past 12
months were more likely to report having used condom during the
last sexual intercourse. These shows a gradual shift in gender
Gender & Behaviour, 10(2), 2012
- 4640 -
dynamics where both men and women are able to communicate
about condoms and as a result negotiate safe sex with their sexual
partners. However, it of a great concern to note that condom use with
transactional partners is very low in this study, with 61% of young
people reporting never condoms when having transactional sex.
In the multivariate analysis, the study found among men and
women that partner risk reduction self-efficacy and having talked
with their partner about condoms in past 12 months were associated
with condom use. This finding is consistent with previous studies
(Hendriksen et al., 2007) and studies have also shown that self-
efficacy is a strong predictor of condom use intentions (Taffa, Klepp,
Sundby, & Bjune, 2002). Furthermore, among male youth in the
study, condom use was significantly associated with having not
agreed with statement ―It is acceptable to have sex with my sex
partner even though my partner does not want to‖, having had two or
more sexual partners in the past year and loveLife face-to-face
programme exposure. This finding seems to show that participants
with multiple sexual partners were more likely to use a condom. In
Shisana et al. (2009), it was noted that male youth who have multiple
sexual partners also report more condom use. The findings suggest
that those with multiple sex partners compensated for their risky
lifestyles by using condoms.
loveLife face-to-face programme exposure was associated with
increased condom use among men. loveLife face-to-face participation
(such as ever going to a loveLife clinic or loveLife Youth Centre, and
participated in a loveLife Community Dialogue) and loveLife multi
media exposure (such as ever watched a loveLife television show,
heard a loveLife advert on radio, read UNCUT magazine) had a
positive effect on condom use for young men. This is in line with
loveLife‘s approach and programme model, which promotes risk
reduction and safe sex behaviour. Three quarters of young people
reported that loveLife encouraged them to use condoms more
regularly (74%) and that their participation in loveLife made them
reduce the number of their sexual partners (76%). Four out of five
young people said that loveLife saved them from getting HIV (85%).
This might also mean that young men find the services at loveLife
clinics more friendly and acceptable as compared to those in public
health clinics and would be more likely to go to any loveLife site
where they can easily get services that they need and have access to
condoms.
Matseke, G. et al.: Correlates of Condom Use
- 4641 -
Limitations
One of the limitations of this study was that it was a cross-sectional
study. Furthermore, it was only done in four provinces thus the
results cannot be generalized.
Conclusion
The findings indicate a higher percentage of condom use among
young men than women in South Africa. Lower condom use by young
women results from deeply embedded culturally-sanctioned sexual
behavioural norms reflecting gender inequality that allow only men to
make decisions related to having sex. However, it is of great
importance to have noted that a large number of women (90.7%)
reported having talked with their partners about condoms in past 12
months. These shows a gradual shift in gender dynamics where
women are able to communicate to their partners about condoms
and as a result negotiate safe sex with their sexual partners. Of
continuing concern are young men‘s‘ reported risk behaviours in
having multiple partners. However, it is encouraging to see that
young people report that three quarters of sexual encounters with a
non-regular partner are always protected. Condom use at last sex
even stood at 98%. loveLife face-to-face participation and loveLife
multi media exposure had a positive effect on condom use for young
men and reduced the number of their sexual partners. The data
suggest that strategies for increased condom use should focus on
improving regular condom use with regular partners, significantly
increasing condom use with transactional partners and reinforcing
regular condom use with non-regular partners. This maybe done
through expanding and improving access to loveLife programmes
that promote condom use and the reduction of sexual partners and
loveLife sites such as youth friendly clinics and Y-Centres, where
condoms are readily available, to all youth communities.
Acknowledgement
This research was a collaborative project between loveLife and the
HSRC and was made possible by the Henry J. Kaiser Family
Foundation. We would like to acknowledge loveLife and the
anonymous review committee for their comments and
suggestions. We would also like to thank the research participants
who took part in the study.
Gender & Behaviour, 10(2), 2012
- 4642 -
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