Mduma RM, Mawanda MN.

Int Conf AIDS. 2004 Jul 11-16; 15: abstract no. C11867.


Background: With an estimated HIV prevalence rate of 30%,Lesothois among the worst affected countries. Practising safer sex through correct and consistent use of condoms is among the recommended HIV risk reduction strategies. We conducted a rapid condom assessment among our peer students at theLesothoNationalUniversityin May 2003. Objectives: a) To assess students’ condom awareness. b) To estimate prevalence of condom usage, consistency, negotiation of use and reasons for non- use among the sexually active. Methods: A pre-tested questionnaire was self-administered by 120 students randomly selected from the residence halls. Analysis was done using SPSS. Results: The age ranged from 18-24 years, 54.2% males and 45.8% females. 95% were single. 99% were aware about condoms and 78.5% were sexually active out of which 76.7% had ever used a condom. During the last sexual intercourse more condom use was reported by those with steady partners (50.8%) as compared to those engaging in casual sex (31.7%). More males (54.6%) than females (12.3%) used condoms for casual sex. Males used condoms more consistently (58.2%) than females (33.8%). Regarding negotiation of use 44.2% with steady partners would refuse to have sex if the partner objected to using a condom. For both sexes the main reason for using condoms was avoidance of pregnancy and STIs. Most of those that did not use a condom did so because of their unavailability.

Conclusions: Although condom awareness was universal, the prevalence of condom use was sub-optimal especially among female students. Non-use was attributed to condom unavailability.

Recommendations: In a combined HIV risk reduction/risk avoidance continuum among sexually active youth, condoms need to be available and used consistently by both sexes. Abstinence and fidelity should also be promoted especially where the culturally submissive role of women might disadvantage them in negotiating for safer sex.

Although the female condom has been introduced into over 90 countries since 1997, it has only been accepted in sexual and reproductive health programmes as a mainstream method in a few. This paper describes introductory strategies developed by Ministries of Health and non-governmental organisations in Brazil, Ghana, Zimbabwe and South Africa, supported by UNAIDS, and the manufacturers of the female condom, which have significantly expanded the number of female condoms being used. These projects have several key similarities: a focus on training for providers and peer educators, face-to-face communication with potential users to equip them with information and skills, an identified target audience, a consistent supply, a long assessment period to gauge actual use beyond the initial novelty phase, and a mix of public and private sector distribution. Female condom programmes require the sanction, leadership and funding of governments and donors. However, the non-governmental and private sectors have also played a major role in programme implementation. To ensure successful introduction of the female condom, it is crucial to involve a range of decision-makers, programme managers, service providers, community leaders and women’s and youth groups. The rising cost of inaction and unprotected sex in the spread of HIV and AIDS force us to recognise the high cost of not providing female condoms alongside male condoms in family planning and AIDS prevention programmes.

Structural factors affecting women’s HIV risk: a life-course example.

Structural Factors in HIV Prevention

AIDS. 14 Supplement 1:S68-S72, June 2000.
O’Leary, Ann; Martins, Patricia

AIDS and HIV incidence among women continues to escalate in theUnited States and globally. While several behavior-change interventions have shown promise in helping some women to reduce their risk of HIV infection, numerous barriers continue to prevent many at-risk women from protecting themselves effectively. This paper explores structural interventions that may influence women’s HIV risk directly or indirectly. We present the life course of Bobbie, a quasi-hypothetical woman whose circumstances and behaviors are based on those of a woman with whom the first author worked in an HIV risk-reduction program. Her circumstances also reflect those of numerous women who have become infected with HIV. Bobbie’s risk-enhancing life events are presented chronologically and, at each step, structural interventions are described that might have had the potential to prevent movement to the next stage. Thus, each stage represents a ‘missed opportunity’ for employing social and societal interventions to prevent movement along the trajectory leading to HIV infection.

Socio-cultural factors

Social taboos

Issues around sex and sexuality are taboo in many cultures, and perceived stigma and embarrassment can lead to a reluctance to discuss and address sexual health issues. Taboos are even more pronounced for people who do not conform to socially accepted norms of behaviour such as adolescents who have sex before marriage and men who have sex with men (MSM). Unmarried adolescent girls are routinely denied or have limited access to SRH services even though they are vulnerable to violence and sexual abuse, and the consequences of early sexual experiences including unwanted pregnancy, STIs and unsafe abortions. InWest Africa, some donors are apprehensive to fund research and support the service needs of MSM for fear that these activities might fuel anger in some communities and restrict progress made on less sensitive reproductive health programmes.


Gender roles

Gender norms in many societies tend to make men macho, women passive, and marginalise transgender people – making all of them vulnerable in different ways to SRH problems, and inhibiting access to services. For example, men may associate masculinity with taking risks in their sexual relations which expose them to HIV and STIs, and may be reluctant or too embarrassed to seek out appropriate health information and care (these are often focussed on women).

Women who are financially, materially or socially dependent on men may have limited power to exercise control in relationships, such as negotiating the use of condoms during sex. Social expectations about how women should behave can place women in subordinate roles and increase their risk of being sexually assaulted, contracting STIs and having unwanted pregnancies, and also limit their access to SRH services. InZanzibar, unmarried women are denied contraceptives from health professionals, while inBotswana andSenegal married women are restricted from using contraceptives without the permission of their husbands. In many societies, women’s health concerns are often considered less important than those of men and children, and household responsibilities can prevent them from spending time visiting a clinic.


Religious conservatism

Religious fundamentalisms expressed through policy and funding decisions undermine progress towards achieving universal access to SRH services. Conservative Christian attitudes towards sexuality in the United Stateshave led to government funding restrictions on services for sex workers, and the promotion of narrow sex education programmes for young people which focus only on abstinence as a means of STI prevention. These policies limit access to and information about contraceptives and safe abortions, and neglect the complexities and realities of peoples’ lives, for example the prevalence of rape (including marital rape) and sexual coercion of unmarried girls. Similarly, the Vatican’s stance against contraception has compromised the promotion of condoms for STI/HIV prevention, and “pro-life” movements linked to both have hampered efforts to reduce unsafe abortions, for instance by blocking access to emergency contraception.

Conversely, some religious groups have taken action to improve access to SRH services and information. Catholics for a Free Choice advocate the use of condoms (; and Christian Aid has adopted an approach to HIV prevention which promotes safer practices, available medications, voluntary counselling and testing, and empowerment as an alternative to abstinence strategies.


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