Abstract
BackgroundThis study investigated the extent and predictors of condom use and condom refusal in the Free State province in South Africa.MethodsThrough a household survey conducted in the Free Sate province of South Africa, 5,837 adults were interviewed. Univariate and multivariate survey logistic regressions and classification trees (CT) were used for analysing two response variables ‘ever used condom’ and ‘ever refused condom’.ResultsEighty-three per cent of the respondents had ever used condoms, of which 38% always used them; 61% used them during the last sexual intercourse and 9% had ever refused to use them. The univariate logistic regression models and CT analysis indicated that a strong predictor of condom use was its perceived need. In the CT analysis, this variable was followed in importance by ‘knowledge of correct use of condom’, condom availability, young age, being single and higher education. ‘Perceived need’ for condoms did not remain significant in the multivariate analysis after controlling for other variables. The strongest predictor of condom refusal, as shown by the CT, was shame associated with condoms followed by the presence of sexual risk behaviour, knowing one’s HIV status, older age and lacking knowledge of condoms (i.e., ability to prevent sexually transmitted diseases and pregnancy, availability, correct and consistent use and existence of female condoms). In the multivariate logistic regression, age was not significant for condom refusal while affordability and perceived need were additional significant variables.ConclusionsThe use of complementary modelling techniques such as CT in addition to logistic regressions adds to a better understanding of condom use and refusal. Further improvement in correct and consistent use of condoms will require targeted interventions. In addition to existing social marketing campaigns, tailored approaches should focus on establishing the perceived need for condom-use and improving skills for correct use. They should also incorporate interventions to reduce the shame associated with condoms and individual counselling of those likely to refuse condoms.
Highlights
This study investigated the extent and predictors of condom use and condom refusal in the Free State province in South Africa
There were 57% women and 91% Africans compared to 52% and 87% respectively in the population of the Free State province
The importance of the perceived need for condoms found in this study stresses the need for tailored approaches delivered in addition to broadly based social marketing campaigns for condoms [37]
Summary
The number of people living with HIV and AIDS has been increasing, while the number of new infections and AIDS related deaths has declined slightly [1]. Sub-Saharan Africa, where 67% of the global 33.4 million people living with HIV and AIDS reside, continues to be the worst affected region of the world. In South Africa, more than five million people are living with HIV and AIDS [2]. There is evidence that condoms are highly effective in reducing sexual transmission of HIV [5]. While they are the most widely available prevention means they are currently not used to their full potential as a low cost prevention technology
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