Progress and challenges to male and female condom use in South Africa
Mags E. Beksinska A C , Jennifer A. Smit A and Joanne E. Mantell B
+ Author Affiliations
- Author Affiliations
A MatCH Maternal, Adolescent and Child Health, Department of Obstetrics and Gynaecology, University of the Witwatersrand, 151 Juniper Road, Overport, Durban 4091, South Africa.
B HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, 10032, USA.
C Corresponding author. Email: mbeksinska@match.org.za
Sexual Health 9(1) 51-58 https://doi.org/10.1071/SH11011
Submitted: 29 January 2011 Accepted: 3 May 2011 Published: 21 October 2011
Abstract
South Africa has responded to the sexually transmissible infection and HIV epidemic with a rapid expansion of its national-level public sector condom program. Male condoms are available widely at no cost in the public sector, with expanded access via social marketing and the private sector. The female condom program is one of the largest and best established globally. National surveys show progressive increases in rates of condom use at last sex. However, inconsistent and incorrect condom use and the likelihood that condoms are discontinued in longer-term partnerships are some of the challenges impeding the condom program’s successes in the fight against sexually transmissible infections and HIV. This article reviews the current condom program, related guidelines and policies, and the existing data on male and female condom use, including distribution and uptake. We discuss the main challenges to condom use, including both user and service-related issues and finally how these challenges could be addressed.
Additional keywords: AIDS, contraception, HIV, sexually transmissible infections.
References
[1] Coovadia H, Jewkes R, Barron P, Sanders D, McIntryre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet 2009; 374 817–34.| The health and health system of South Africa: historical roots of current public health challenges.Crossref | GoogleScholarGoogle Scholar |
[2] Harrison A, Cleland J, Frohlich J. Young people’s sexual partnerships in KwaZulu-Natal, South Africa: patterns, contextual influences, and HIV risk. Stud Fam Plann 2008; 39 295–308.
| Young people’s sexual partnerships in KwaZulu-Natal, South Africa: patterns, contextual influences, and HIV risk.Crossref | GoogleScholarGoogle Scholar |
[3] Chersich MF, Rees HV. Causal links between binge drinking patterns, unsafe sex and HIV in South Africa: it’s time to intervene. Int J STD AIDS 2010; 21 2–7.
| Causal links between binge drinking patterns, unsafe sex and HIV in South Africa: it’s time to intervene.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MfktVeksg%3D%3D&md5=62d196e30291b981bf4d1673854abab8CAS |
[4] Shisana O, Rice K, Zungu N, Zuma K. Gender and poverty in South Africa in the era of HIV/AIDS: a qualitative study. J Womens Health (Larchmt) 2010; 19 39–46.
| Gender and poverty in South Africa in the era of HIV/AIDS: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[5] Jewkes R, Dunkle K, Nduna M, Shai N. Relationship power inequity and incidence of HIV infection in young women in South Africa: a cohort study. Lancet 2010; 376 41–8.
| Relationship power inequity and incidence of HIV infection in young women in South Africa: a cohort study.Crossref | GoogleScholarGoogle Scholar |
[6] Shisana O, Rehle T, Simbayi LC, Zuma K, Josste S, Pillay-van-Wyk V, et al. South African national HIV prevalence, incidence, behaviour and communication survey 2008: a turning tide among teenagers? Cape Town: Human Science Research Council Press; 2009.
[7] Department of Health. Medical Research Council, OrcMacro. South Africa Demographic and Health Survey 2003. Pretoria: South Africa Department of Health; 2007.
[8] Morroni C, Tibazarwa K, Myer L. Combined condom and contraceptive use among South African women. S Afr Med J 2006; 96 620–2.
[9] Jewkes R, Morrell R, Christofides N. Empowering teenagers to prevent pregnancy: lessons from South Africa. Cult Health Sex 2009; 11 675–88.
| Empowering teenagers to prevent pregnancy: lessons from South Africa.Crossref | GoogleScholarGoogle Scholar |
[10] Department of Health. HIV and AIDS and STI national strategic plan for South Africa, 2007–2011. Pretoria: South Africa Department of Health; 2007.
[11] Johnson S, Kincaid L, Laurence S, Chikwava F, Delate R, Mahlasela L. Second national HIV communication survey 2009. Pretoria: John Hopkins Health Education South Africa; 2010.
[12] Harrison A, Newell ML, Imrie J, Hoddinott G. HIV prevention for South African youth: which interventions work? A systematic review of current evidence. BMC Public Health; 2010. Available online at: http://www.biomedcentral.com/1471-2458/10/102 [accessed December 2010].
[13] Department of Health. National contraception policy guidelines. Pretoria: Department of Health; 2001.
[14] Ramkissoon A, Kleinschmidt I, Beksinska M, Smit J, Hlazo J, Mabude Z. National baseline assessment of sexually transmitted infection and HIV services in South African public sector health facilities 2002/2003: summary report 2004. Durban: Reproductive Health & HIV Research Unit; 2004. Available online at: http://www.hst.org.za/indicators/ReproHealth/STI_baselinesurvey.pdf [verified June 2011].
[15] Day C, Monticelli F, Barron P, Haynes R, Smith J, Sello E, eds. The district health barometer 2008/2009. Durban: Health Systems Trust; 2010. Available online at: http://www.hst.org.za/publications/864 [accessed December 2010].
[16] UNAIDS. Country Progress Report On The Declaration of Commitment on HIV/AIDS. Final Report, Republic of South Africa 2010. Available online at: www.unaids.org/en/dataanalysis/monitoringcountryprogress/2010progressreportssubmittedby countries/southafrica_2010_country_progress_report_en.pdf [verified June 2011].
[17] Myer L, Matthews C, Little F, Karim SS. The fate of free male condoms distributed to the public in South Africa. AIDS 2001; 15 789–93.
| The fate of free male condoms distributed to the public in South Africa.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mzis1egsA%3D%3D&md5=348ad41cb2ea7784e95c1ecb289f6934CAS |
[18] Republic of South Africa. Children’s Act 38 of 2005. Cape Town: Republic of South Africa Government Gazette; 2006. Available online at: http://www.info.gov.za/gazette/acts/2005/a38-05.pdf [verified December 2010].
[19] Han J, Bennish ML. Condom access in South African schools: law, policy, and practice. PLoS Med 2009; 6 e6
| Condom access in South African schools: law, policy, and practice.Crossref | GoogleScholarGoogle Scholar |
[20] Human Sciences Research Council (HSRC). South African national HIV prevalence, HIV incidence, behaviour change and communications survey, 2002. Cape Town: HSRC Press; 2002.
[21] Shisana O, Rehle T, Simbayi L, Parker W, Bhana A, Zuma K, et al. South African national HIV prevalence, incidence, behaviour and communications survey, 2005. Cape Town: HSRC Press; 2005.
[22] Kleinschmidt I, Maggwa BN, Smit J, Beksinska ME, Rees H. Dual protection in sexually active women. S Afr Med J 2003; 93 854–7.
[23] MacPhail C, Pettifor AE, Pascoe S, Rees HV. Contraception use and pregnancy among 15–24 year old South African women: a nationally representative cross-sectional survey. BMC Med 2007; 5 31
| Contraception use and pregnancy among 15–24 year old South African women: a nationally representative cross-sectional survey.Crossref | GoogleScholarGoogle Scholar |
[24] Hubacher D, Raymond ER, Beksinska M, Delaney-Moretlwe S, Smit J, Hylton-Kong T, et al Hormonal contraception and the risks of STI acquisition: results of a feasibility study to plan a future randomized trial. Contraception 2008; 77 366–70.
| Hormonal contraception and the risks of STI acquisition: results of a feasibility study to plan a future randomized trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXks12htrY%3D&md5=bb0ec8b7b517f662f34aad7fe2396d78CAS |
[25] Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health 2004; 82 454–61.
[26] Gafos M, Ndlovu H, Mzimela M, and the MDP Team. How many women really achieve consistent condom use over the course of a year? Evidence from rural KwaZulu-Natal. 2010 International Microbicides Conference, Pittsburgh, PA; 2010 May 22–24; Abstract 193.
[27] Chopra M, Townsend L, Johnston L, Mathews C, Tomlinson M, O’bra H, et al Estimating HIV prevalence and risk behaviours among high-risk heterosexual men with multiple sex partners: use of respondent-driven sampling. J Acquir Immune Defic Syndr 2009; 51 72–7.
| Estimating HIV prevalence and risk behaviours among high-risk heterosexual men with multiple sex partners: use of respondent-driven sampling.Crossref | GoogleScholarGoogle Scholar |
[28] Pettifor A, Rees H, Kleinschmidt I, Steffenson AE, MacPhail C, Hlongwa-Madikizela L, et al Young people’s sexual health in South Africa: HIV prevalence and sexual behaviours from a nationally representative household survey. AIDS 2005; 19 1525–34.
| Young people’s sexual health in South Africa: HIV prevalence and sexual behaviours from a nationally representative household survey.Crossref | GoogleScholarGoogle Scholar |
[29] Taylor M, Dlamini SB, Nyawo N, Huver R, Jinabhai CC, de Vries H. Reasons for inconsistent condom use by rural South African high school students. Acta Paediatr 2007; 96 287–91.
| Reasons for inconsistent condom use by rural South African high school students.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s3itVOisg%3D%3D&md5=123d9621684d4c6c897370d4943dfb05CAS |
[30] Lurie M, Pronyk P, de Moor E, Heyer A, de Bruyn G, Struthers H, et al Sexual behaviour and reproductive health among HIV-infected patients in urban and rural South Africa. J Acquir Immune Defic Syndr 2008; 47 484–93.
| Sexual behaviour and reproductive health among HIV-infected patients in urban and rural South Africa.Crossref | GoogleScholarGoogle Scholar |
[31] Maharaj P, Cleland J. Condoms become the norm in the sexual culture of college students in Durban, South Africa. Reprod Health Matters 2006; 14 104–12.
| Condoms become the norm in the sexual culture of college students in Durban, South Africa.Crossref | GoogleScholarGoogle Scholar |
[32] Moyo W, Levandowski BA, MacPhail C, Rees H, Pettifor A. Consistent condom use in South African youth’s most recent sexual relationships. AIDS Behav 2008; 12 431–40.
| Consistent condom use in South African youth’s most recent sexual relationships.Crossref | GoogleScholarGoogle Scholar |
[33] Chimbindi NZ, McGrath N, Herbst K, San Tint K, Newell ML. Socio-demographic determinants of condom use among sexually active young adults in rural KwaZulu-Natal, South Africa. Open AIDS J 2010; 4 88–95.
| Socio-demographic determinants of condom use among sexually active young adults in rural KwaZulu-Natal, South Africa.Crossref | GoogleScholarGoogle Scholar |
[34] Shai NJ, Jewkes R, Levin J, Dunkle K, Nduma M. Factors associated with consistent condom use among rural young women in South Africa. AIDS Care 2010; 22 1379–85.
| Factors associated with consistent condom use among rural young women in South Africa.Crossref | GoogleScholarGoogle Scholar |
[35] Maharaj P, Cleland J. Risk perception and condom use among married or cohabiting couples in KwaZulu-Natal, South Africa. Int Fam Plan Perspect 2005; 31 24–9.
| Risk perception and condom use among married or cohabiting couples in KwaZulu-Natal, South Africa.Crossref | GoogleScholarGoogle Scholar |
[36] Khumalo NP. How common is condom failure? S Afr Med J 2007; 97 143
[37] Simbayi LC, Kalichman SC. Condom failure in South Africa. S Afr Med J 2007; 97 476
[38] Kalichman SC, Simbayi LC, Cain D, Jooste S. Condom failure among men receiving sexually transmissible infection clinic services, Cape Town, South Africa. Sex Health 2009; 6 300–4.
| Condom failure among men receiving sexually transmissible infection clinic services, Cape Town, South Africa.Crossref | GoogleScholarGoogle Scholar |
[39] Beksinska M, Smit J, Mabude Z, Vijayakumar G, Joanis C. Performance of the Reality polyurethane female condom and a synthetic latex prototype: a randomized cross-over trial among South African women. Contraception 2006; 73 386–93.
| Performance of the Reality polyurethane female condom and a synthetic latex prototype: a randomized cross-over trial among South African women.Crossref | GoogleScholarGoogle Scholar |
[40] Beksinska ME, Rees VH, McIntyre JA, Wilkinson D. Acceptability of the female condom in different groups of women in South Africa – a multicentred study to inform the national female condom introductory strategy. S Afr Med J 2001; 91 672–8.
| 1:STN:280:DC%2BD3Mrjsl2qsg%3D%3D&md5=1e1e7e4cb91a0b99cd2756c0ec4ca5a5CAS |
[41] Smit J, Beksinska ME, Vijayakumar G, Mabude Z. Short-term acceptability of the Reality® polyurethane female condom and a synthetic latex prototype: a randomised crossover trial among South African women. Contraception 2006; 73 394–8.
| Short-term acceptability of the Reality® polyurethane female condom and a synthetic latex prototype: a randomised crossover trial among South African women.Crossref | GoogleScholarGoogle Scholar |
[42] Turner AN, De Kock AE, Meehan-Ritter , Blanchard K, Sebola MH, Hoosen AA, et al Many vaginal microbicide trial participants acknowledged they had misreported sensitive sexual behaviour in face-to-face interviews. J Clin Epidemiol 2009; 62 759–65.
| Many vaginal microbicide trial participants acknowledged they had misreported sensitive sexual behaviour in face-to-face interviews.Crossref | GoogleScholarGoogle Scholar |
[43] Smit J, Chersich M, Beksinska M, Kunene B, Manzini N, Martin Hilber A, et al Prevalence and self-reported health consequences of vaginal practices in KwaZulu-Natal, South Africa: findings from a household survey. Trop Med Int Health 2011; 16 245–56.
| Prevalence and self-reported health consequences of vaginal practices in KwaZulu-Natal, South Africa: findings from a household survey.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MvisVCjtA%3D%3D&md5=19eb3debeba66d7a39011ea899ff34f4CAS |
[44] Bagnol B, Mariano E. Vaginal practices: eroticism and implications for women’s health and condom use in Mozambique. Cult Health Sex 2008; 10 573–85.
| Vaginal practices: eroticism and implications for women’s health and condom use in Mozambique.Crossref | GoogleScholarGoogle Scholar |
[45] Civic D, Wilson D. Dry sex in Zimbabwe and implications for condom use. Soc Sci Med 1996; 42 91–8.
| Dry sex in Zimbabwe and implications for condom use.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28zkt1Ogsw%3D%3D&md5=5cdb8a39a4d916a09794de6fc728b05bCAS |
[46] Scorgie F, Smit J, Kunene B, Martin Hilber A, Beksinska M, Chersich M. Predictors of vaginal practices for sex and hygiene in KwaZulu-Natal, South Africa: findings of a household survey and qualitative inquiry. Cult Health Sex 2011; 13 381–98.
| Predictors of vaginal practices for sex and hygiene in KwaZulu-Natal, South Africa: findings of a household survey and qualitative inquiry.Crossref | GoogleScholarGoogle Scholar |
[47] Abdool Karim SS, Abdool Karim Q, Preston-Whyte E, Sankar N. Reasons for lack of condom use among high school students. S Afr Med J 1992; 82 107–10.
| 1:STN:280:DyaK38zns1KmsA%3D%3D&md5=b2cb7d8d08fc301fdbd4540d5784e945CAS |
[48] Mantell JE, Needham SL, Smit JA, Hoffman S, Cebekhulu Q, Adams-Skinner J, et al Gender norms in South Africa: implications for HIV and pregnancy prevention among Black and Indian women students at a South African university. Cult Health Sex 2009; 11 139–57.
| Gender norms in South Africa: implications for HIV and pregnancy prevention among Black and Indian women students at a South African university.Crossref | GoogleScholarGoogle Scholar |
[49] Higher Education HIV/AIDS Programme (HEAIDS). HIV prevalence and related factors-higher education sector study, South Africa, 2008–2009. Pretoria: Higher Education South Africa; 2010. Available online at: http://www.heaids.org.za/resources/HEAIDS%20Conference/4936%20HESA%20HIV%20and%20AIDS%20in%20the%20Higher%20Education%20Sectori.pdf [verified March 2010].
[50] Mulwo AK, Tomaselli KG, Dalrymple L. Condom brands, perceptions of condom efficacy and HIV prevention among university students in KwaZulu-Natal, South Africa. Afr J AIDS Res 2009; 8 311–20.
| Condom brands, perceptions of condom efficacy and HIV prevention among university students in KwaZulu-Natal, South Africa.Crossref | GoogleScholarGoogle Scholar |
[51] Dunkle KL, Jewkes R, Brown H, Gray G, McIntryre J, Harlow S. Gender-based violence, relationship power and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet 2004; 363 1415–21.
| Gender-based violence, relationship power and risk of HIV infection in women attending antenatal clinics in South Africa.Crossref | GoogleScholarGoogle Scholar |
[52] Pettifor AE, Measham DM, Rees HV, Padian N. Sexual power and HIV risk, South Africa. Emerg Infect Dis 2004; 11 1996–2004.
[53] El-Bassel N, Gilbert L, Rajah V, Foleno A, Frye V. Fear and violence: raising the HIV stakes. AIDS Educ Prev 2000; 12 154–70.
| 1:STN:280:DC%2BD3cvjt1Ohsg%3D%3D&md5=46a463917ec30f3a27cb8bd572bd3cadCAS |
[54] Morwane O. Take a stand against HIV/AIDS; Ms Mkhize. Pretoria: SA Corrections Today; 2010. Available online at: http://www.dcs.gov.za/Publications/SA%20Corrections%20Today/SA%20Corrections%20June%202010.pdf [verified December 2010].
[55] Scott R, Harrison D. A gauge of HIV prevention in South Africa, 2009. Johannesburg: LoveLife; 2009. Available online at: www.lovelife.org.za/preventiongauge [verified December 2010].
[56] Negin J, Cumming RG. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health 2010; 88 847–53.
| HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data.Crossref | GoogleScholarGoogle Scholar |
[57] The Johannesburg/eThekwini Men’s Study (JEMS). A rapid assessment of the HIV epidemic among men who have sex with men (MSM) information leaflet. Durban: JEMS; 2009. Available onnline at: http://www.hsrc.ac.za/Document-3166.phtml [verified December 2010].
[58] Lane T, Raymond HF, Dladla S, Rasethe J, Struthers H, McFarland W, et al High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto Men’s Study. AIDS Behav 2011; 15 626–34.
| High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto Men’s Study.Crossref | GoogleScholarGoogle Scholar |
[59] Knox J, Yi H, Reddy V, Maimane S, Sandfort T. The fallacy of intimacy: sexual risk behaviour and beliefs about trust and condom use among men who have sex with men in South Africa. Psychol Health Med 2010; 15 660–71.
| The fallacy of intimacy: sexual risk behaviour and beliefs about trust and condom use among men who have sex with men in South Africa.Crossref | GoogleScholarGoogle Scholar |
[60] Statistics South Africa. Census 2001. Prevalence of disability in South Africa. Pretoria: Statistics South Africa; 2001. Available online at: http://www.statssa.gov.za/census01/HTML/Disability.pdf [verified December 2010].
[61] Wazakili M, Mpofu R, Devlieger P. Should issues of sexuality and HIV and AIDS be a rehabilitation concern? The voices of young South Africans with physical disabilities. Disabil Rehabil 2009; 31 32–41.
| Should issues of sexuality and HIV and AIDS be a rehabilitation concern? The voices of young South Africans with physical disabilities.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1M7itVeruw%3D%3D&md5=972a602777902ff329e486c4fff4a8beCAS |
[62] Maart S, Jelsma J. The sexual behaviour of physically disabled adolescents. Disabil Rehabil 2010; 32 438–43.
| The sexual behaviour of physically disabled adolescents.Crossref | GoogleScholarGoogle Scholar |
[63] De Vincenzi I. A longitudinal study of human immnodeficiency virus transmission by heterosexual partners. N Engl J Med 1994; 331 341–6.
| A longitudinal study of human immnodeficiency virus transmission by heterosexual partners.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2czgtFentw%3D%3D&md5=14980a17863a340a53031d267785e651CAS |
[64] Vijayakumar G, Mabude Z, Smit J, Beksinska M, Lurie M. A review of female-condom effectiveness: patterns of use and impact on protected sex acts and STI incidence. Int J STD AIDS 2006; 17 652–9.
| A review of female-condom effectiveness: patterns of use and impact on protected sex acts and STI incidence.Crossref | GoogleScholarGoogle Scholar |
[65] Parker F. Hunt is on for elusive female condom. Johannesburg: Mail & Guardian Online; 2010. Available online at: http://www.mg.co.za/article/2010-08-05-hunt-is-on-for-elusive-female-condom [verified January 2010].
