Factors Affecting Condom Use in Primary Sexual Relationships in Sub-Saharan Africa

Thomas W. Pullum, University of Texas at Austin
John G. Cleland, London School of Hygiene and Tropical Medicine
Iqbal H. Shah, World Health Organization (WHO)

This paper uses data collected in Kenya, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe about 1999, as part of a WHO initiative to investigate how couples perceive and manage the dual risks of unwanted pregnancy and STD/HIV prevention. In permanent relationships, factors that hypothetically should favor condom use include the desire to stop childbearing, a sense of subjective risk of HIV infection, positive attitudes toward family planning in general and condoms in particular, and several kinds of discussion with the partner. We find that condoms are not highly favored as a family planning method and their family planning function is often an important reason for NOT using them for HIV protection. Condom use is also not strongly associated with the perceived risk of HIV infection. Ironically, the greatest obstacles to condom use in permanent relationships are negative attitudes derived from the association with HIV, as well as suspicions of infidelity.