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"I would rather do, practice the sex, even if it's without a condom": A qualitative reinvestigation of barriers and facilitators to condom use in Cape Town, South Africa

Shrader, Cho Hee (2015)
Master's Thesis (98 pages)
Committee Chair / Thesis Adviser: Siegler, Aaron J
Committee Members: Rochat, Roger
Research Fields: Health Sciences, Public Health; Health Sciences, General; Gender Studies
Partnering Agencies: Non-US governmental agency (e.g., Minister of Health in Haiti) ; Emory University schools, faculty or affiliated programs
Keywords: Sexual Health; Condom; South Africa; Barriers to condom use; Contraception; Reproductive health; Africa; Sexual Violence; Gender power; Gender relations; Alcohol; HSRC; GHI; Condomless sex; Choice
Program: Rollins School of Public Health, Hubert Department of Global Health
Permanent url: http://pid.emory.edu/ark:/25593/pkmfh

Abstract

South Africa recently experienced a surge in the HIV/AIDS prevalence with 1.2 new million infections from 2008 to 2012. This thesis aims to reinvestigate barriers and facilitators to condom use in Cape Town, South Africa. The study was a mixed-methods cross-sectional design consisting of seven focus group discussions with 40 men, 20 in-depth interviews with both men and women, and an electronically self-administered survey of 200 men and women. Data analysis focused on emergent themes of barriers to condom use such as an increase in the availability of alcohol, a decrease in communication surrounding sexual health, and an increase in dissatisfaction with the currently available free condoms. Participants also suggested several static barriers and challenges to condom use previously identified in the literature, including an imbalance in sexual negotiation between genders, condoms serving as a symbol of mistrust within relationships, violent and nonconsensual sexual behavior, and issues of pleasure and partner-perceived pleasure with condom use. The findings of this reinvestigation indicate several areas where further evidence-based intervention research would be beneficial. Future research should focus on methods to increase condom use, examine the effects of alcohol on risky sexual health behavior and its potential modification of biological HIV/AIDS transmission pathways during sex, assess how to best make available and distribute a larger variety of condom types that men and women prefer to use, increase conversations surrounding condom use within society, and explore the role of gender norms in the context of sexual violence.

Table of Contents

Chapter 1: Introduction................................................................................. 1

HIV/AIDS in South Africa............................................................................... 1

Barriers to correct and consistent use of condoms............................................. 2

Problem Statement....................................................................................... 3

Research question........................................................................................ 5

Significance Statement.................................................................................. 6

Chapter 2: Comprehensive Review of the Literature........................................... 7

Section A: Background and HSRC Research Findings.......................................... 7

Section B: Decrease in condom use in longitudinal studies................................. 11

Section C: Barriers to correct and consistent condom use.................................. 16

Gaps in the Literature................................................................................... 25

Chapter 3: Manuscript................................................................................... 26

Contribution of student................................................................................. 27

Abstract...................................................................................................... 28

Introduction................................................................................................. 29

Methods....................................................................................................... 30

Focus groups................................................................................................ 30

In-depth interviews....................................................................................... 31

Surveys....................................................................................................... 31

Ethical Review:............................................................................................. 32

Data Analysis of Focus Group Discussion and In-depth Interviews:....................... 32

Data Analysis of Survey.................................................................................. 33

Results......................................................................................................... 34

Exploration of condom use decrease from 2008 to 2012...................................... 36

Reinvestigation of condom nonuse in 2014: emerging themes............................. 42

Discussion.................................................................................................... 52

Chapter 4: Conclusions and Public Health Recommendations............................... 54

Alcohol........................................................................................................ 55

"No Choice Condom"...................................................................................... 59

Condom Fatigue............................................................................................ 61

Condom Conversation.................................................................................... 63

Sexual Violence............................................................................................ 64

References.................................................................................................... 66

Appendices................................................................................................... 71

Appendix A: Focus Group Guide....................................................................... 71

Appendix B: In-depth Interview Guide.............................................................. 75

Appendix C: Focus Group Discussion Consent Form............................................ 78

Appendix D: In-depth Interview Consent Form.................................................. 82

Appendix E: Survey Consent Forms................................................................. 85

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