5.4 Knowledge and comprehension of HIV/AIDS: A focus on prevention
5.4.3 Condom literacy
Condoms are the first choice for preventing the sexual transmission of HIV (Bailey et al., 2010). Given that southern-Africa’s epidemic is heterosexual (Bailey et al., 2001; GoZ, 2015), it is therefore imperative that if HIV prevention interventions that include condom promotion are to be successful, condom users must be “literate”. The phrase condom literacy refers to a state of being accomplished with regards to knowledge and skill required to ensure that the efficacy of condoms in HIV prevention is not compromised.
In the preliminary stages of the data collection process, one key informant interview (KII) participant made an important eye-opening contribution. She viewed important developments such as Zimbabwe’s unveiling of the teen condom in 2015 against a backdrop of reverberating calls to increase condom access, especially among in-school adolescents as positive steps towards reversing the impact of the epidemic. She said:
How? Ummmm... The how aspect is yet another critical issue! I once volunteered at one of the NGOs where we were targeting school leavers. Iii, it’s not that people don’t want to use condoms; they want. But using it, how to use it, aaah, thus the problem- thus the major issue. Even for adults, some of them don’t know how to use it (KII participant: De Beauvoir – a female teacher, Zvishavane).
The above testimony triggered the researcher’s quest to further explore this issue in-depth. The researcher expressed his conviction that knowledge or information on its own is not adequate if one doesn’t have the requisite practical skills to use a condom, not least because if condoms are to be used in HIV prevention, users must have knowledge, beliefs and required skills. In response, the same participant said:
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You are right. Apparently, our kids do not know how to use a condom. If you want to check, even if you leave these schools today, go to the adults. At church for example, I am a counsellor, I talk to people. They don’t know how to use a condom. Some of them will have the condoms in their pockets but when it comes to action, they just feel uncomfortable; what if I fail in front of this lady, what will happen? What if, what if?
And they won’t use it [she laughs]. They end up not using it (KII participant: De Beauvoir – a female teacher, Zvishavane).
In one focus group discussion (FGD), participants were exploring condom use with consideration of the twin challenges of high STI prevalence and incidence (including HIV/AIDS), and teenage unplanned pregnancies. One participant made the following contribution:
The youth should be informed that condoms are not completely perfect for preventing HIV and pregnancy. However, despite that they are not perfect; they should be provided for free in school toilets and other health corners to help prevent unplanned pregnancies. We shouldn’t however forget that demanding that he use a condom is not easy. Contrary to the previous proposal that pupils be given oral contraceptives, they should not be given these because they will be reluctant to prevent STIs/HIV, and the pills have side-effects (FGD: 1G, Zvishavane).
Having such an in-depth understanding among adolescents that condoms are not 100% efficient is quite promising to the fight against HIV incidence. Although condoms significantly reduce the risk of HIV infection if constantly and correctly used, the stark reality that they are not a
‘magic-bullet’ against infection is critical. Jackson (2002) refers to this clarity of understanding as being ‘sex and AIDS competent’.
What I discovered is that, there is no product which is 100% efficient. That’s why they even say that no machine is 100% efficient and similarly, no product is completely safe…condoms are 98 point something percent efficient, they can either break or slide.
That being the case, perhaps abstinence is the only way to go (FGD: 2B, Zvishavane).
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In another different, but related focus group interview, the following was uttered by one of the participants;
I think it is important that such skills be imparted. There are some of our friends whom we are not with here because they made mistakes in using condoms and they are parents as we speak. They became parents before completing school. Therefore, it is my opinion that such knowledge should be shared with young people. Someone may have a condom but fail to put it on due to fear that they may fail to use it, which leads to humiliation in front of a girl (FGD: 3B, Mberengwa).
It became clearer that condom literacy might be a real challenge to HIV prevention efforts among the youth in general and in-school adolescents. This prompted the researcher to probe further. It emerged that the bulk of knowledge on sex and sexuality school adolescents have is socially generated as they discuss as friends. The following responses were given in separate FGDs:
The arguments would centre on issues such as the use of one versus two [condoms].
Using two simultaneously means that you are double protected. However, others claim that despite being totally protected, it defeats the purpose as it reduces the amount of pleasure; sex won’t be pleasurable. It’s like you are not doing anything. But I feel that using two or three condoms at the same is important since it is not possible for all the three to break at the same time (FGD: 2B, Zvishavane).
As friends, we always discuss issues of dating and of course sex and stuff. There are debates we always engage in, e.g. condoms and their efficiency in preventing STIs.
Apparently, condoms easily break, especially the free ones, many friends have shared this (FGD: 4B, Mberengwa).
This was further probed to encourage participants to provide more detail. Amplification probes were used (Harding, 2013). Responses to the probe were related to a common myth that most participants had alluded to, that condom use reduces sexual pleasure. The participant shared that:
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Condoms have issues. Like circumcision, they make sex dull. Sex with a condom is different from sex without a condom; without a condom, sex is nice. Friends share that when circumcised, it feels as if the penis is not yours (FGD: 2A, Zvishavane).
The issue of ‘super pleasure’ will come later, when the opportune time comes. Now, what is more critical is experience, so by putting on two condoms at the same time; it’s being less pleasurable is not a concern. Pleasurable sex awaits us in marriage, and for now it’s the experience that matters (FGD: 4B, Mberengwa).
It did not only become apparent that condom education is important to ensuring that the opportunities offered by increased condom access are not wasted, but also that young people understand the unwritten sex education scripts which they socially co-author with their peers.
Although not stated directly in the excerpt, the undercurrents of the desire for experimentation are discernible, something which is commonly associated with adolescence (Mbotho et al., 2011; Sumter, Bokhorst, Steinberg, & Westenberg, 2009). The implication is that experimentation should occur while the adolescent is empowered with both knowledge about HIV transmission and skill to negotiate and practise safer sex.