Stigma of infidelity associated with condom use explains low rates of condom uptake: qualitative data from Uganda and Tanzania

Abstract

Despite widespread messaging supporting male (external) condom use to prevent HIV in endemic settings, utilization of condoms is low across sub-Saharan Africa. A thorough understanding of barriers to condom use as a form of HIV prevention is necessary to reduce HIV transmission. Here, we present qualitative data from rural eastern Africa to explain low utilization of condoms among heterosexual adults. Focus groups and interviews were conducted in Tanzania and Uganda between 2016 and 2019. A content analysis approach was used to identify attitudes about condoms and factors related to use/non-use. We found that strategies such as abstinence and being faithful to one’s partner are perceived as ideal but rarely achievable methods of HIV prevention. Condoms are used in the setting of “failure” to abstain or be faithful and are therefore stigmatized as markers of infidelity. As such, use within cohabiting and long-term relationships is low. Our data suggest that negative perceptions of condoms may stem from persistent effects of the formerly applied “ABC” HIV prevention approach, a public health messaging strategy that described A—abstinence, B—be faithful, and C—use a condom as tiered prevention tools. Condom uptake could increase if HIV prevention messaging acknowledges existing stigma and reframes condom use for proactive health prevention. These studies were approved by Weill Cornell Medicine (Protocols 1803019105 and 1604017171), Mbarara University of Science and Technology (Protocol 16/0117), Uganda National Council of Science and Technology (Protocol SS-4338), and the Tanzania National Institute for Medical Research (Protocol NIMR/HQ/R.8c/Vol.I/1330).

Knowledge, Attitudes, and Practices of Family Planning among Mothers attending Antenatal Care in Rural Uganda: Implications for Maternal Health and Population Growth

“…, number of living children and desire for additional children play an important role in determining the use of family planning. The study also showed that when mothers were asked if the condom would disappear into the vagina, the majority 129(93.5%) thought that the condom could not disappear into the vagina, and only 9(6.5%) of the mothers thought it could, the study shows a good attitude on mothers on condom use, since most of them are aware the condom doesn't disappear during intercourse, this would build in confidence in mothers to utilize a condom as a family planning method, when this study is compared with other studies, the study shows a difference from a study by Broderick et al, [31] who showed that in Uganda, 4 in 50 cohort group members believed that it was potentially dangerous to use condoms because it could get stuck in the vagina cause damage. A negative attitude toward family planning is associated with rumours and myths about family planning methods and can prevent young people from seeking family planning.…”

‘It depends on who is asking and why they will use it’: Access to male condoms in Timor-Leste

“…The narrow and overall negative focus on sexual relations and condom use found within our study highlights the stigma and discrimination associated with condom use both within the Timorese health system and broader society. Stigma and discrimination associated with condom use has also been described in other contexts, with similar associations identified between condom use and infidelity, promiscuity and lack of love or trust in a relationship [ 34 – 36 ]. Numerous social harms, such as reputational damage, associated with condom use have been described in other contexts as especially impacting young people and women [ 35 , 36 ].…”

Perceptions of Antenatal Attendees on Prevention of Mother-to-Child Transmission of Human Immunodeficiency Virus (HIV) Services in the Central Region of Ghana.

“…This implies that condom use is widely recognized as an effective barrier method to reduce the risk of sexually transmitted infections, including HIV. In contrast, [49] uncovered that condom use has been stigmatized as indicators of unfaithfulness. Additionally, the study conducted by [50] indicated that healthcare workers believed the absence of female condoms played a role in insu cient utilization.…”