Men's Condom Use in Higher-Risk Sex: Trends and Determinants in Five Sub-Saharan Countries

This 29-page paper, produced by Measure DHS for review by the United States Agency for International Development (USAID), examines men's condom use at last higher-risk sex (i.e. non-marital, non-cohabiting partner) in five sub-Saharan countries: Burkina Faso, Cameroon, Kenya, Tanzania, and Zambia. The two most recent Demographic and Health Surveys (DHS) in each country are analysed to show trends in various indicators. According to the report, use of condoms has increased substantially in Burkina Faso, Cameroon, and Tanzania, with smaller increases in Kenya and Zambia.

The report also states that levels of higher-risk sex have declined in four of the five countries, although use of a condom at last higher-risk sex remains below 50% in Kenya and Zambia. Multivariate analysis shows that higher education is a consistently strong, positive predictor of condom use at last higher-risk sex, whereas higher wealth status is not significant in most surveys. Knowledge that use of condoms can reduce the risk of HIV transmission is a consistently strong, positive predictor of condom use, but urban-rural residence and region are significant only in some surveys. However, there is evidence of widening gaps in condom use by level of education in Cameroon and by urban-rural residence in Kenya. One important policy finding that emerged from this study is that low wealth status is not a barrier to condom use in most countries, but lack of education is.

The study found that older men have lower levels of condom use than younger men, and that while many condom programmes are designed for youth, the condom needs of older men should also be given programmatic consideration. The study also found that residence in a rural area reduces the likelihood of condom use compared with residence in an urban area; therefore, future programming should deal with this differential. The study suggests that one way to increase condom use among men is to improve their knowledge of condoms, particularly the knowledge that condoms can reduce the risk of HIV transmission. However, the study admits that future increases in knowledge about condoms will not be great because, in all five countries, at least 70% of the men in the study were already aware of the effectiveness of condoms in reducing the risk of HIV transmission.

The report also states that while there is some evidence that knowledge of condoms contributes to increased use of condoms, this does not appear to be the case with attitudes toward people with HIV. Having a positive attitude toward people with HIV, or believing that information about condoms should be taught in schools, has no clear relationship with condom use.

The report states that the use of some of these findings by programmes can be enhanced by reviewing the effectiveness of interventions designed to increase condom use. Of particular importance is increased condom use among men who engage in higher-risk sex, especially in Kenya and Zambia, where the increases have so far been small. Increased condom use is also important in countries that have a high level of HIV infection, such as Zambia. According to the report, with much of the HIV-prevention effort focused on other ways to reduce the transmission of HIV, including circumcision, abstinence, and being faithful to one uninfected partner, it is important that policymakers recognise that condoms remain an important resource in the fight against HIV/AIDS.