Risk Perception and Condom Use Among Married Or Cohabiting Couples in KwaZulu-Natal, South Africa

Excerpts from the report

A household survey was conducted in an urban and a rural area in KwaZulu-Natal, South Africa, in 1999–2000. From this survey, matched partners in 238 marital or cohabiting relationships were independently interviewed about condom use and attitudes toward condoms, knowledge of AIDS/HIV risk and self-efficacy in preventing HIV infection. Logistic regression analysis was used to assess relationships between condom use and selected demographic and HIV prevention characteristics.

Although couples' knowledge of condoms and where to obtain them was very high, only 15% of men and 18% of women reported consistent or occasional use. The level of use was 8% and 11% among men and women, respectively, in rural, less educated couples, and 29% and 34% among men and women in urban, more educated couples. A majority of urban women had favorable attitudes toward condoms, and they also reported higher self-efficacy regarding HIV prevention than did rural women. A woman's perceived risk of HIV infection from her partner was the most powerful predictor of condom use (odds ratio, 4.0).

The common belief that men's resistance to condom use within stable relationships cannot be overcome may be exaggerated. HIV prevention programmes should address the reproductive health needs of these couples.

Most HIV prevention efforts focus on premarital and extramarital sexual behaviour, but in areas with high HIV prevalence the protective needs of married and cohabiting couples are just as great and often go unmet. Condom use by these couples is generally low, with resistance from men and cultural norms commonly cited as barriers to increased use.

According to the document, the results of this study confirm that some married and cohabiting couples are willing to use condoms at least some of the time if they perceive the risk of HIV infection. The promotion of condoms within such relationships has been a neglected component in HIV prevention programs, largely because of the widely held belief that resistance against condom use is too strong to overcome. By showing that modification of sexual behaviour in response to HIV risk has actually begun in KwaZulu-Natal-an area with a high incidence of HIV-we hope that prevention programs will be encouraged to broaden their focus and strengthen efforts to meet the needs of married and cohabiting couples.