Abstract
BackgroundAdolescent HIV and pregnancy rates in Southern Africa are amongst the highest in the world. Despite decades of sexual and reproductive health (SRH) programming targeting adolescents, recent trends suggest there is a continued need for interventions targeting condom use for this age group.MethodsThis review synthesises evidence from qualitative studies that describe the determinants of condom use among adolescents in Southern Africa. We conducted systematic searches in four databases. Data were extracted, appraised for quality and analysed using a ‘best-fit’ framework synthesis approach.ResultsWe coded deductively findings from 23 original studies using an a priori framework and subsequently conducted thematic analysis. Synthesised findings produced six key themes relating to: 1) pervasive unequal gender norms and restrictive masculinities favouring male sexual decision-making and stigmatising condom use in committed relationships; 2) other social norms reflecting negative constructions of adolescent sexuality and non-traditional family planning; 3) economic and political barriers including poverty and a lack of policy support for condom use; 4) service-level barriers including a lack of youth-friendly SRH services and comprehensive sex education in schools; 5) interpersonal barriers and facilitators including unequal power dynamics in sexual partnerships, peer influences and encouraging condoning condom use, and inadequate communication about SRH from parents/caregivers; and 6) negative attitudes and beliefs about condoms and condom use among adolescents. A conceptual model was generated to describe determinants of condom use, illustrating individual-, interpersonal- and structural-level barriers and facilitating factors.ConclusionSRH programming targeting barriers and facilitators of condom use at multiple levels is recommended in Southern Africa. We present a multilevel integrated model of barriers and facilitators to guide adolescent SRH decision-making, programme planning and evaluation. Given the existence of multilevel barriers and facilitators, interventions should, likewise, take a multilevel approach that incorporates locally relevant understanding of the individual-, interpersonal- and structural-level barriers and facilitators to condom use among adolescents in the region.
Highlights
Adolescent HIV and pregnancy rates in Southern Africa are amongst the highest in the world
Synthesis of the evidence The findings provided evidence to support all 12 a priori themes in the original ‘best-fit’ model depicting the multi-level determinants of condom use among adolescents in Southern Africa
We identified and mapped relevant qualitative literature onto an a priori framework incorporating three theoretical models – the social ecological model [31, 32]; an integrated model of condom use among young people in sub-Saharan Africa [20]; and the If Were Jack theory of change [28,29,30] – and used inductive thematic analysis to identify the key barriers and facilitators of condom use which we incorporated into a new conceptual model (Fig. 2)
Summary
Adolescent HIV and pregnancy rates in Southern Africa are amongst the highest in the world. Despite decades of sexual and reproductive health (SRH) programming targeting adolescents, recent trends suggest there is a continued need for interventions targeting condom use for this age group. In sub-Saharan Africa, consistent use of condoms among adolescents is low [1]. This is likely a contributory factor for the high prevalence of sexually transmitted infections (STIs), including HIV, and adolescent pregnancy in the region [1,2,3,4], which has persisted despite more than two decades of research and programming. In the Southern African region in particular, there are stark gender disparities in relation to HIV risk: risk among adolescent girls aged 15–19 is six times higher than among their male counterparts [8]. A recent systematic review has identified persistent perceived and experienced barriers to STI services for adolescents [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
