Academic journal article Bulletin of the World Health Organization

Developing a Scale for Measuring the Barriers to Condom Use in Nigeria. (Research)

Academic journal article Bulletin of the World Health Organization

Developing a Scale for Measuring the Barriers to Condom Use in Nigeria. (Research)

Article excerpt

Voir page 931 le resume en francais. En la pagina 931 figura un resumen en espanol.

Introduction

Any obstacles to the use of condoms in heterosexual relationships can interfere with their frequent and consistent employment as a means of preventing acquired immunodeficiency syndrome (AIDS) and sexually transmitted diseases (STDs), and for family planning purposes (1-4). Although some of the specific barriers to condom use in Africa have been elucidated (5-11), a method of measuring an individual's barriers to their use has still to be identified. Measuring and explicating the potential barriers to condom use represents an important step in promoting the effectiveness of a strategy for improving their use (12). This paper examines how such a method, with a scale for assessment, contributes to the understanding and measurement of the barriers in Nigeria. The findings are of relevance also for other African countries.

Need for condom use and its promotion in Nigeria

Heterosexual intercourse is the leading means of transmitting human immunodeficiency virus (HIV) in Nigeria. The first case of HIV/AIDS involving a sexually active teenage girl was identified in the country in 1984 (13). About 10 years later, close to 1000 cases had been identified and some 500 000 people were estimated to be HIV positive (13, 14). It was thus believed that a major HIV/AIDS epidemic might be under way in the country. In Nigeria, heterosexual contacts with long distance truck drivers (15) and commercial sex workers (16) are the major vector for the spread of the AIDS virus through diverse population groups. There are severe implications of a large-scale HIV/AIDS epidemic in the country, including the likelihood of demographic changes due to deaths, resulting in a reduction in the productive workforce. Furthermore, national budgets may be confronted with having to allocate more funds for health to cope with the increase in HIV/ AIDS cases. This may worsen the current levels of national poverty and adversely affect the basic welfare of the population.

Greater attention needs to be directed towards measures that will reduce the risk of HIV infection in Nigeria, and since 1984 several approaches have been used by various governmental and nongovernmental agencies to protect the public from HIV/AIDS infection. The major focus of the efforts to encourage condom use has been advocacy through radio and television broadcasts, as well as other popular media channels, and within counselling relationships. Rational and self-evident as these messages may be, most Nigerians are only aware of condom use as birth control and sexual diseases protective measures. These efforts have not produced significant practical use of condoms in sexual relationships (16-20). (a)

Prospects for the measurement of barriers to condom use

One reason for the minimal effects of the existing advocacy methods for condom use in Nigeria is that most interventions do not incorporate mechanisms to control the barriers that inhibit condom use in sexual relationships. In so far as some knowledge of the nature of such barriers exists (5, 17, 21-24), interventions should commence by identifying these barriers and proceed to controlling them through use of an appropriate strategy.

The method of measurement that was used in the present study includes identifying the adverse experiences associated with condom use in sexual relationships. Furthermore, the measurement identifies individuals who give and do not give priority to using condoms and the type of condom use intervention. Finally, the measurement scale employed is suitable for addressing critical issues that surround low rates of condom use, and facilitates their increased use in various populations. For example, in sub-Saharan Africa condom use is reported by only 1% of women in the reproductive age group and by a slightly higher percentage of men (25). One suggestion for this is that condom use interferes with the sexual functioning of these groups of people (26), perhaps because sexual intercourse is not so enjoyable when a condom is used or because some guilt feelings are experienced. …

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