Why don’t urban youth in Zambia use condoms? The influence of gender and marriage on non-use of male condoms among young adults

Abstract

BackgroundZambia experiences high unmet need for family planning and high rates of HIV, particularly among youth. While male condoms are widely available and 95% of adults have heard of them, self-reported use in the past 12 months is low among young adults (45%). This study describes factors associated with non-use of male condoms among urban young adults in Zambia.MethodsA household cross-sectional survey in four urban districts was conducted from November 2015 to January 2016 among sexually active young adults ages 18–24 years. A random walk strategy was implemented in urban areas; eligible, enrolled participants were administered a survey on household characteristics, health access, and knowledge, attitudes and practices related to contraception. Relative risk regression models were built to determine factors associated with the decision to not use a male condom (non-use) at most recent sexual intercourse.ResultsA total of 2,388 individuals were interviewed; 69% were female, 35% were married, and average lifetime sex partners was 3.45 (SD±6.15). Non-use of male condoms was 59% at most recent sexual intercourse. In a multivariate model, women were more likely to report non-use of a male condom compared with men (aRR = 1.24 [95% CI: 1.11, 1.38]), married individuals were more likely to report non-use compared with unmarried individuals (aRR = 1.59 [1.46, 1.73]), and those residing in the highest poverty wards were more likely to report non-use compared with those in the lowest poverty wards (aRR = 1.31 [1.16, 1.48]). Those with more negative perceptions of male condom use were 6% more likely to report non-use (aRR = 1.06 [1.03, 1.09]). Discussion regarding contraception with a partner decreased non-use 13% (aRR = 0.87 [0.80, 0.95]) and agreement regarding male condom use with a partner decreased non-use 16% (aRR = 0.84 [0.77, 0.91)]).DiscussionNon-use of male condoms is high among young, married adults, particularly women, who may be interested in contraception for family planning but remain at risk of STI infection. Effective marketing strategy of dual protection methods to this population is critical.

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

“…In 2015, 226 million young people aged 15-24 lived in Africa, accounting for 19% of the global youth population [1]. Data from sub-Saharan Africa suggest that, while a significant number of adolescents have their first sexual experience at an early age (ranging from 2.0 to 27.0% of adolescents under age 15) [2], in many cases they do not use any form of protection to prevent pregnancy or sexually transmitted infections [3,4]. In addition, not all sexual experiences among adolescents are consensual, since the prevalence of coerced sex and sexual abuse at this age remains high (approximately 16% in Zambia) [5,6].…”

Perceived Risk of Contracting HIV and AIDS among Sexually Active Unmarried Young People in Zambia

“…In a number of studies, trust in a sex partner was mentioned as a reason for not using condoms. Although a number of studies have looked at young people's perceptions of condoms, there is little data on the extent to which these perceptions may mitigate condom use [12].…”

“…According to Pincoff urban Zambia is an important context for the development of effective condom promotion strategies [12]. Zambia has a high rate of unmet need for FP (27%) and the capital city, Lusaka has high poverty levels and high HIV prevalence rates of 19.4 per cent [16].…”

Exploring gender and partner communication: Theory of planned behavior predictors for condom use among urban youth in Zambia

“…The survey methods have been described previously . A cross‐sectional survey of young, sexually active adults (aged 18–24 years), residing in 40 urban wards in Lusaka, Chilanga, Kafue, and Chongwe districts, was conducted between November 2015 and January 2016 as a baseline for a larger impact evaluation of a female condom intervention conducted through the USAID Expanding Effective Contraceptive Options project (AEA ID: AEARCTR‐0000899) . We calculated a geographical centroid for each census enumeration area in 40 wards.…”

“…Negative perceptions of the use of condoms are associated with marital status; women report better adherence and greater ease using condoms with transactional partners compared to steady partners, reflecting issues of trust in partner relationships. Poor perceptions (and lower use of condoms) are linked with early marriage, which deprive young women of economic empowerment and self‐efficacy . Lastly, the evidence is mixed regarding the link between the TPB predictor of knowledge and the behavior outcome of the use of contraception .…”