CHAPTER 6: CONDOM KNOWLEDGE, ATTITUDE AND USE
6.3 Beliefs about Condoms Efficacy
fact that the use of condoms is controlled by men. But, on the other hand, it may reflect the lack of power of women in determining condom use. As expected, men were more likely than women to show higher levels of confidence on how to use a condom correctly and effectively. Thus, the results indicate that about 76 percent of men reported that they were very confident that they knew how to use a condom correctely and effectively compared with 38 percent of women who also reported having proper skills to use a condom correctly and effectively. In addition, 23 percent of men reported that they were somewhat confident on how to use a condom correctly and effectively compared with 14 percent of women. Notewhorthy is that a significant number of women, 35 percent, reported that they were not confident on how to use a condom correctly and effectively. Particularly worrying, 19 percent reported that they have never used a condom at all.
Table 6.3: Percentage of respondents who agree with specific statements about the effectiveness of condoms in preventing either unwanted pregnancy or HIV/AIDS
Men Women Statements % %
Using condoms is an effective way of preventing
HIV/AIDS
Agree 83.7 79.2 Mixed/no opinion 8.2 11.6 Disagree 8.2 9.3
Using Condoms is an effective way to prevent pregnancy
Agree 87.0 71.8**
Mixed/no opinion 7.7 8.8 Disagree 5.3 19.4
Total 208 216 Note: ** Significant P < 0.01 percent
Overall, respondents of both sexes hold positive beliefs about the effectiveness of condoms in preventing both HIV/AIDS and unwanted pregnancies. However men were more likely than women to report high levels of positive beliefs on the effectiveness of condoms. In this regard, 84 percent of men reported that using condoms is an effective way of preventing HIV/AIDS compared with 79 percent of women.
Accordingly, 87 percent of men believe that using condoms is an effective way to prevent pregnancy compared with 72 percent of women. However, the same cannot be said for women.
Women were less confident about obtaining condoms. In addition, women were less likely to report that they knew how to use condoms effectively. This may suggest that women lack consistent experience in using condoms, a finding consistent with another study (de Walque and Kline, 2009)
Both the focus group discussions and in-depth interviews show high levels of awareness about condoms and their role in preventing STIs (including the risk of HIV infection) and unwanted pregnancies. The issue of condoms was recurrent in nearly all the interviews even when the topics of debate were related to other aspects of sexual behaviour such as multiple partnerships
and infidelity. In this regard, during the interviews almost all respondents have shown that they knew about condoms. They also acknowledged that condoms are an effective protective tool against sexually transmitted infections (including HIV) as well as unwanted pregnancies.
However, there is greater awareness of condoms as a strategy for disease rather than pregnancy prevention as the quote below illustrates.
“I think that everybody is aware of HIV/AIDS here. AIDS is a reality and we are all aware of that. That is why there is a total demand for the use of condoms.
(Urban non-married male, IDI # 17)
In the interviews it became clear that some respondents associate condoms with disease prevention rather than pregnancy prevention. This may result from the fact that condom use is generally perceived as indicating promiscuity and an absence of cleanness. In addition, as a result of the negative meaning attached to condoms, men and women who carry them are also perceived as diseased and unclean. Studies have recognized that it is unfortunate that current HIV prevention campaigns have also reinforced these stereotypes (Bond and Dover, 1997). In an in- depth interview, a male respondent explained why the use of condoms is so difficult in relationships. The respondent stated that broaching the topic of condoms is likely to lead to suspicions that the person has AIDS.
“When we use condoms people think that we have AIDS. I think that people are afraid of being seen as already infected with HIV/AIDS. Besides, a woman is afraid of losing her partner if she asks him to use a condom because he will think she has got AIDS.”
(Urban married male, IDI # 18)
In this quote, some of the dilemmas surrounding the use of condoms in relationships are clear.
First, it seems that both men and women are afraid of being perceived as living with HIV/AIDS since condoms are associated with diseases. Secondly, women are in a more fragile position because if she proposes the use of a condom she may lose the support of her partner as a direct consequence of broaching the topic.
A number of studies have found that condoms are more likely to be used for the prevention of disease (Varga, 2000; Preston-Whyte, 1999). This is largely because condoms are associated with illicit sex and promiscuity. This is aptly captured by the statement of a woman in another study who proclaimed: ‘I have never seen a condom. Why should I use a condom? Condoms are only used by prostitutes’ (Bond and Dover, 1997:384-5)
The awareness of condoms was also highlighted when respondents raised their concerns and fears of being infected by HIV/AIDS. According to some respondents, the fear of acquiring the virus was behind the growing demand for condoms in the study areas. It would seem that the HIV/AIDS epidemic is impacting on condom use among both men and women.
“For me the major problem is AIDS. I am afraid to die even if I know I will die anyway and everyone else will die. But I will not look for death by myself. Now that I know that there is this disease called AIDS, I would rather die because of another disease or by a car accident not because of AIDS. That is why I insist on the use of condoms”.
(Urban non-married female, IDI # 06)
Other reasons why the demand for condoms has increased included, for instance, the lack of trust among partners. It seems that the perception that a partner posed a risk was one of the motivating reasons for the increasing demand for condom use. According to some respondents, condoms are the most effective strategy against the risk of HIV infection. They felt that trust does not provide protection against sexually transmitted infections, including HIV infection.
“You cannot trust anybody nowadays. People just do not trust one another anymore and even if you are a faithful to your partner, you can still be infected by the disease. So before they stop using condoms, they should do a test”.
(Rural married female, IDI # 05)
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).