CHAPTER 6: CONDOM KNOWLEDGE, ATTITUDE AND USE
6.4 Attitudes towards Condoms
The above quote confirms the high levels of awareness of HIV/AIDS and the risks associated with unprotected sexual intercourse as well as the strategies to adopt in order to protect against the risk of HIV infection. On the other hand, the quote seems to contradict the discourses on trust, which is used by both men and women as the main reason for not using condoms (see Longfield et al., 2002; and Agha et al., 2002). In this regard, it seems that people use “trust” more for moral reasons rather than because they are fully convinced of the faithfulness of their partners, because it may appear somehow contradictory to stay with a partner they do not trust, which may cause them embarrassment. This interpretation seems to be in line with the model developed by Eaton et al. (2003) which states that people with a poor sexual self-concept may rely on others for self- affirmation. But more importantly, precisely because of their poor sexual self-concept such people are more likely to think that proposing the use of condoms is immoral or offensive to their partners. For example, Longfield and his colleagues (2002) conclude that the use of trust which was the focus of youth sexual relationships hampered them to explore partners’s sexual history or to adopt protective practices including the use of condoms. In addition, they noted that “youth appear to repeat a cycle of trust and broken trust, without adopting sustainable risk reduction methods” (Longfield et al., 2002: 17). In this study, respondents stressed that is not sufficient for one partner to be faithful, because even in such circumstances, one can become infected by an unfaithful partner. This seems particularly true for women who still have expectations that their partners are faithful, but at the same time they suspect that they are not. Furthermore, studies have shown that negative connotations associated with condoms prevent both men and women from protecting themselves against sexually transmitted infections including HIV (Parikh, 2007;
Smith, 2007; Hirsch, 2002; de Zoysa, Sweat and Denison, 1996).
about condoms. The findings presented in Table 6.4 suggest that in general respondents hold relatively negative attitudes towards condoms despite their awareness of the efficacy of condoms in protecting against HIV infection. One striking finding to note is that there is huge disagreement between men and women in most of the statements. In this regard, men were more likely than women to hold negative attitudes towards condoms use.
Table 6.4: Percentage of respondents who agree with specific statements about condoms use
Men Woman
% % Statements
Using condoms reduces sexual pleasure 47.3 13.9**
A women loses a man’s respect if she asks him
to use a condom 29.5 26. 9 The man has greater influence than the woman
over whether or not to use a condom 73.1 53.2**
Condoms encourage promiscuous behaviour 43.3 31.9**
The only reason to use condoms is because you
don’t trust your partner 58.2 33.3**
It is acceptable for married couple to use a
condom 36.1 51.9**
It is acceptable for a married woman to ask her
husband to use a condom 38.9 47.7**
It is acceptable for a woman who is not married
to ask her partner to use a condom 94.2 84.3*
It is acceptable to use a condom with someone at
the beginning of a relationship 92.3 82.9*
Total 208 216 Note: * Significant P ≤ 0.05 percent;**Significant P ≤ 0.01 percent
For instance, while about a half of interviewed men, 47 percent, agreed with the statement that using condoms reduces sexual pleasure, only 14 percent of women held the same view. On the other hand it is of interest to note that 73 percent of men and 53 percent of women agreed with
the statement that the man has greater influence than the woman over whether or not to use a condom. Similarly, while 44 percent of men thought that condoms encouraged promiscuous behaviour, only 32 percent of women shared the same view. Furthermore, about 59 percent of men and 33 percent of women agreed that the only reason for use of condom is lack of trust.
As observed earlier, the belief that using condoms is an effective method to prevent HIV/AIDS and unwanted pregnancy hardly translates into condom use particularly in long-term relationships. In this regard, men were less likely than women to accept condom use within marriage or in long-term relationships. The findings show that only about 36 percent men thought that it was acceptable for a married couple to use a condom compared with almost 52 percent of women who perceived no problem in a married couple using a condom. Women (48 percent) were more likely than men (39 percent) to agree that it is acceptable for a married woman to ask her husband to use a condom.
The fact that women in general presented more positive attitudes to condoms than men also deserves particular attention. As expected, both men and women thought that it was acceptable for a woman who is not married to ask her partner to use a condom, with about 94 percent of men agreeing with the statement compared with 84 percent of women. Accordingly, while almost 92 percent of men felt that it is acceptable to use a condom at the beginning of a relationship, fewer women (83 percent) felt that this was acceptable.
Very often condoms became a controversial and disputed topic during the qualitative interviews.
Although condoms are well known as a method of preventing sexually transmitted diseases including HIV infection, as well as unwanted pregnancies, use of condoms seem to be very selective and dependent upon the nature of relationships, a finding consistent with other studies (Maharaj and Cleland, 2004; Adetunji, 2000; Preston-Whyte, 1999). During the interviews, respondents outlined a number of barriers to condom use including fear of partner’s reaction; the nature of relationships; lack of confidence in the product; lack of trust between partners;
reduction in sexual pleasure and discomfort during sexual intercourse.
In the interviews, a number of negative attitudes to condoms emerged. Some associate condoms with a lack of trust within relationships. Because condoms are largely perceived as sending lack of trust messages and superficiality within relationships, many respondents showed reluctance to use them. Some men in focus group discussions, for example, did not hesitate to establish a direct link between condoms use and lack of trust. They even argued that a woman would be entitled to demand condoms from her partner when she found out that her partner had other sexual partners.
They argued that only in relationships were there was a lack of trust was it justifiable to use condoms.
“Well, if she finds out that he has a lover over there, then it is her right to force him to use condoms, because she has lost all the trust she had for him”.
(Rural non-married males, FGD # 18)
“I think that for married people it is not acceptable to use condoms unless they do not trust each other. But if they trust each other and they feel no danger they should not”.
(Rural married male, FGD # 12)
Resistance to condoms in marital and cohabiting unions or even in long-lasting relationships was not only a male phenomenon. Some women also were opposed to condoms within these unions.
During both rural and urban focus group discussions and in-depth interviews some women argued that marriage was a place of trust; mutual belonging and intimacy. This therefore meant that there was no need to use condoms. For some women, it was absurd that married and cohabiting couples, who are supposedly committed to each other, use condoms.
“Wait! If he is my husband, I am with him because I trust him. We are married; I think he should trust me too. I think we should not use condoms”.
(Urban non-married females, FGD # 09)
“If they are married and trust each other there is no point in using condoms. Your husband!? If I find a condom in my husband’s pocket he has to explain to me why he has got that condom because, to me, that is a sign that he betrays me because we do not use condoms here at home”
(Urban non-married females, FGD # 03)
Once more, the above quote clearly confirms that the topic of condoms is a very emotive topic within marriage. Studies have reported that condoms are almost always associated with either illicit sex or diseased people (Varga, 2000; Bond and Dover, 1997). For example, some respondents are more concerned about accusations of lack of trust than protecting themselves against the risk of HIV infection. In the above quote, it is clear that the female respondent prefers to obtain an explanation from her husband regarding his infidelity rather than protect her health by demanding condom use. The consequence of such attitudes is that, in reality, both men and women may have extramarital relationships and some do not use condoms to avoid moral judgements. This, of course, may have serious negative health consequences for their sexual reproductive health.
Meanwhile a large number of women in both focus group discussions and in-depth interviews showed positive attitudes to condoms even in long-lasting relationships. Health concerns were the reasons behind such attitudes. They argued that this was because men are unfaithful and they did not know whether or not their extramarital partners have sexually transmitted infections including HIV/AIDS. This clearly shows that women not only are upset about their partners’ infidelity but also about the negative impact on their sexual and reproductive health.
“Men do not know if their lovers are sick or not, and they will never tell them that they are sick. When my husband goes out, he always takes condoms with him, but even then it might happen that his lovers will not accept to use them and he may infect me with her diseases.”
(Rural married female, IDI # 04)
“If you have lovers at least use condoms. In doing so there is a lower risk of infecting your husband and your husband infecting you”
(Rural married female, IDI # 02)
Lack of trust in the effectiveness of condoms seems to play a significant role in discouraging people from using them more frequently. Stories of condoms tearing during sexual intercourse have been used as justification for the distrust of the effectiveness of condoms, therefore, rendering them dispensable in some circumstances. During the interviews some respondents highlighted that condoms were not a reliable product and they were somewhat doubtful about their efficacy, as is illustrated in the following comments:
“I do not rely that much on condoms. For me it is 50 percent condoms and 50 percent of faithfulness. Condoms can get torn. They are not 100 percent safe. I have a cousin who told me that once he was having sex with his girlfriend and the condom broke and he did not feel this happening. Then he did not tell his girlfriend to avoid an argument.”
(Rural non-married males, FGD # 18)
As this quote shows, defective condoms which sometimes result from incorrect use may occur from negative messages spread about condoms, particularly from the Catholic Church, which has spread the message that “condom are not a hundred percent safe”, thus exacerbating the lack of trust in the product (Bosmans et al., 2006). Of interest here is that there is scientific evidence which suggest that condoms are not 100 percent effective (Holmes et al. 2004), which is also used by some to argue that condoms are not completely reliable, therefore, there is no need for condoms. Such beliefs are used as an excuse for not using condoms is well illustrated in the quote below.
“Others say that girls have pimples during puberty because they have not had sex yet. I think that condoms get damaged when you have sex with a virgin”.
(Rural non-married males, FGD # 18)
It could be seen in the quote that this respondent is trying to argue that sexual intercourse with a virgin does not need any protection with a condom because it is useless, since the condom is going to be damaged during the sexual act. If a man is already sexually active he is likely to put the young girl with whom he engages in sexual intercourse at risk of acquiring a sexually transmitted infection including HIV/AIDS.
A common complaint during the interviews was that related to the interference of condoms with sexual pleasure. Men and women during focus group discussions and in-depth interviews both in rural and urban areas said that condoms reduce sexual pleasure, disrupt sexual excitement and cause discomfort. The perceptions that condoms prevent pleasure and cause discomfort are viewed as the reasons behind the low use of condoms in some communities. This can be seen in the quotes below:
“Well, I think that condoms here in our neighbourhood are not respected. Many see condoms as causing discomfort and few young people use them. That is why the rate of positive people here is high. ”
(Urban married males, FGD # 17)
“You avoid AIDS by using condoms, but as I said earlier, there are some people who do not like to use them. They say that they do not feel anything with it.”
(Urban non-married male, IDI # 16)
Some women in focus group discussions were surprised when the interviewer raised the question of condoms use within marriages. On the one hand this is because there is a widespread understanding that in marriage there should be complete intimacy between a man and a woman without any restrictions. In other words, it is understood that sex within marriage is not only legitimate and expresses intimacy but also a duty that husband and wife owe to each other. On the other hand it is because condoms are perceived as a barrier preventing the pleasure of flesh- to-flesh sex.
“It is not acceptable for married people to use condoms. No! Things do not go well with Jeito[brand name for Mozambique male condom]! It is not acceptable. You do not feel anything with those small plastics!”
(Rural non-married females, FGD # 06)
The views that condoms constitute an obstacle to sexual pleasure were also highlighted by some men in rural focus group discussions. Unanimously, they voiced the concern that the reduction of sexual pleasure was the main reason for the resistance to condoms.
“Many people say that condoms inhibit sexual pleasure. For me, the first thing she or he is looking to achieve is pleasure.
(Rural non-married males, FGD # 18)
The perception that condoms prevent sexual pleasure and intimacy raised a hot debate in one urban female focus group discussions. Respondents argued that the use of condoms in the context of marriage was a violation of their sexual rights. For these women, the use of condoms in marital unions deprived them of their right to sexual pleasure and intimacy and, apart from that; they viewed flesh-to-flesh sex as a way to compensate for their hard work in the household.
“Look, I work so hard as a housewife. I usually do farming and I cannot suffer from work and then not get anything there [in the bed]. I need to feel him. I cannot sweat while he is inside the condom, what about me?”
(Urban married females, FGD # 03)