CONTEXT: High levels of HIV/AIDS and unwanted pregnancy among young people are urgent public health problems in South Africa. Studies among youth have generally focused on protection against one or the other of these risks, but not both.
METHODS: Data collected in 2001 from 2,067 sexually active men and women aged 15-24 in KwaZulu-Natal were examined in bivariate and multivariate analyses to assess reasons for condom use, and levels and determinants of use.
RESULTS: Overall, 59% of respondents said that they used condoms at last sexual intercourse, including 6% who used them with another method. The main reason for use (cited by 64% of users) was protection against both pregnancy and HIV infection. Two-thirds of respondents thought that becoming or making someone pregnant in the next few weeks would be a big problem; fewer than one in five viewed their risk of HIV infection as medium or high. Among both sexes, young people who would consider a pregnancy highly problematic were more likely to use condoms than their counterparts who would view a pregnancy as no problem (odds ratios, 1.4-2.3). In sharp contrast, young men and women who perceived themselves as having a medium to high risk of HIV infection were less likely to use condoms than their counterparts who perceived themselves as being at no risk (0.2-0.3).
CONCLUSION: Prevention programs could increase condom use in this population by increasing awareness of the twin risks of pregnancy and HIV infection, and by promoting condoms for protection against these dual risks.
International Family Planning Perspectives, 2006, 32(1):28-34
Young people in South Africa face high levels of unwanted pregnancy and HIV/AIDS. The South African government has cited the high incidence of unwanted pregnancy among youth as one of the major challenges facing the country. (1) More than one-third of women nationally have their first child before age 20. (2) The overwhelming majority of these pregnancies occur outside marriage, and most of them are either unwanted or unplanned. (3) Evidence from the 1990s suggested that many young women become pregnant intentionally, to demonstrate their fertility, and return to school after the birth of their child. (4) However, more recent studies have found that young women often want to avoid pregnancy at an early age. (5)
South Africa has one of the largest numbers of people living with HIV/AIDS of any country in the world--an estimated 4-6 million. (6) The incidence of new HIV infections is highest among young people; more than half of all infected adults acquired the virus before the age of 25. (7) Surveillance surveys using blood samples from women attending antenatal clinics have shown that HIV prevalence in this population increased from less than 1% in 1990 to almost 28% in 2003. (8) However, the level of infection differs notably across racial groups. In a population-based survey conducted in 2002. HIV prevalence was significantly higher among blacks than among other racial groups. (9) That survey also found that the estimated HIV seroprevalence among young people aged 15-24 years in South Africa was 9%; it was 13% among women and 6% among men this age. (10) As in other parts of Africa, young women in South Africa are at particularly increased risk of HIV infection. They often become infected at a younger age and at a higher rate than their male counterparts. (11)
In this context, the promotion of dual protection--simultaneous protection against unwanted pregnancy and against HIV and other sexually transmitted infections (STIs)--plays an important role in public health interventions. (12) Apart from sexual abstinence and nonpenetrative sex, dual protection may be achieved in one of three ways: by correct and consistent use of condoms alone, by simultaneous use of condoms with another method of contraception or by use of a contraceptive method other than condoms in the context of a long-term, mutually monogamous relationship in which both partners are known to be HIV-negative (although this option may not be feasible in many settings (13)).
Among countries of Sub-Saharan Africa, South Africa has a high level of contraceptive use. According to the 1998 Demographic and Health Survey, injectables are the most commonly used method of contraception in South Africa; 30% of sexually active women use this method. (14) Almost two-thirds of sexually active women aged 15-24 years use a modern contraceptive method. However, only small proportions use condoms--21% of those aged 15-19 and 17% of 20-24-year-olds. Hormonal implants and injectables, IUDs and sterilization are highly effective for preventing pregnancy, but condoms, if used correctly and consistently, are the only known method that protects sexually active individuals against the twin risks of pregnancy and HIV infection. (15) The role of hormonal methods in protecting against transmission of the virus remains unclear. (16) Therefore, although use of modern contraceptives in South Africa is high, current levels of HIV infection warrant greater emphasis on protection against both risks.
Some studies in South Africa have found that condom use is highly correlated with social and demographic characteristics such as age, education and race. (17) In addition, research in other African settings has documented that individuals who have multiple sexual partners are more likely than others to report high levels of condom use. (18) A study in Zimbabwe found that condom use increased with number of sexual partners. (19) Use of this method is also highly influenced by the length and intensity of relationships: The longer a relationship lasts, the greater the likelihood that condom use will be discontinued. (20) Men and women in committed relationships may prefer methods that are more effective at preventing pregnancy. However, a study in the United States found that women who perceived themselves to be at greater risk of STIs acted to protect themselves from disease as well as from pregnancy by using condoms with another method …