Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE (Open Access)

Condoms in sub-Saharan Africa

Eleanor Maticka-Tyndale
+ Author Affiliations
- Author Affiliations

Department of Sociology, Anthropology and Criminology, University of Windsor, 401 Sunset Avenue, Windsor, Ontario N9B 3P4, Canada. Email: maticka@uwindsor.ca

Sexual Health 9(1) 59-72 https://doi.org/10.1071/SH11033
Submitted: 28 February 2011  Accepted: 16 November 2011   Published: 17 February 2012

Journal Compilation © CSIRO Publishing 2012 Open Access CC BY-NC-ND

Abstract

Sub-Saharan Africa (SSA) is the region with the world’s highest rates of HIV and other sexually transmissible infections (STIs), yet numerous studies show that condom use is generally rare. This suggests a need for a better understanding of how condoms fit within sexual practices and relationships in SSA. This paper seeks to address this need by reviewing research published between the late 1980s and 2011 on use and factors influencing use of male condoms in SSA. What is evident from this research is that condom use involves complex social and interpersonal dynamics, with structural and cultural conditions exerting an influence through framing social cognitions and setting boundaries on autonomy that make the apparently irrational choice of eschewing condoms a rational decision. The influences of poverty; relationships with parents, peers and partners; limited, insufficient or absent information especially in rural areas and among men who have sex with men; gender and sexual norms, and the dynamics of gendered power; and beliefs and attitudes about HIV, condoms and sexuality all have been shown to work against condom use for a large proportion of Africa’s people. However, promising results are shown in trends towards increased condom use among single women in numerous countries, increasing acceptance and use of condoms among some university students, successes in producing potentially sustainable condom use resulting from select interventions, and resistance to succumbing to the dominant gender–power dynamics and structural–cultural impediments that women in groups have mobilised.

Additional keywords: AIDS, beliefs, cultural influence, gender, HIV, social dynamics.


References

[1]  United Nations Development Program (UNDP). Human development report 2003 on millennium development goals. New York, NY: United Nations; 2003.

[2]  UNAIDS. AIDS epidemic update. Geneva: UNAIDS; 2009.

[3]  Gallant M, Maticka-Tyndale E. School-based HIV prevention programmes for African youths. Soc Sci Med 2004; 58 1337–51.
School-based HIV prevention programmes for African youths.Crossref | GoogleScholarGoogle Scholar |

[4]  Kirby DB, Laris BA, Rolleri LA. Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world. J Adolesc Health 2007; 40 206–17.
Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world.Crossref | GoogleScholarGoogle Scholar |

[5]  Magnussen L, Ehiri J, Ejere H, Jolly P. Interventions to prevent HIV/AIDS among adolescents in less developed countries: are they effective? Int J Adolesc Med Health 2004; 16 303–24.
Interventions to prevent HIV/AIDS among adolescents in less developed countries: are they effective?Crossref | GoogleScholarGoogle Scholar |

[6]  Maticka-Tyndale E, Barnett JP. Peer educators: a synthesis of the research. Eval Program Plann 2010; 33 98–112.
Peer educators: a synthesis of the research.Crossref | GoogleScholarGoogle Scholar |

[7]  Maticka-Tyndale E, Brouillard-Coyle C. The effectiveness of community interventions targeting HIV and AIDS prevention at young people in developing countries. In Ross DA, Dick B, Ferguson J, editors. Preventing HIV/AIDS in young people: a systematic review of the evidence from developing countries. Geneva: WHO; 2006. 243–285.

[8]  United Nations Statistical Division of the UN Department of Economic and Social Affairs (DESA). Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings : DESA. Available online at: http://unstats.un.org/unsd/methods/m49/m49regin.htm#africa [verified June 2011].

[9]  Lagarde E, Aubert B, Chege J, Sukwa T, Glynn JR, Weiss HA, et al Condom use and its association with HIV/sexually transmitted diseases n four urban communities of sub-Saharan Africa. AIDS 2001; 15 S71–78.
Condom use and its association with HIV/sexually transmitted diseases n four urban communities of sub-Saharan Africa.Crossref | GoogleScholarGoogle Scholar |

[10]  Glick P, Sahn DE. Are Africans practicing safer sex? Evidence from Demographic and Health Surveys for eight countries. Econ Dev Cult Change 2008; 56 397–439.
Are Africans practicing safer sex? Evidence from Demographic and Health Surveys for eight countries.Crossref | GoogleScholarGoogle Scholar |

[11]  Adetunji J, Meekers D. Consistency in condom use in the context of HIV/AIDS in Zimbabwe. J Biosoc Sci 2001; 33 121–38.
Consistency in condom use in the context of HIV/AIDS in Zimbabwe.Crossref | GoogleScholarGoogle Scholar |

[12]  Mnyika KS, Klepp K-I, Kvale G, Ole-Kingori N. Determinants of high-risk sexual behaviour and condom use among adults in the Arusha region, Tanzania. Int J STD AIDS 1997; 8 176–83.
Determinants of high-risk sexual behaviour and condom use among adults in the Arusha region, Tanzania.Crossref | GoogleScholarGoogle Scholar |

[13]  Lagarde E, Pison G, Enel C. Knowledge, attitudes and perception of AIDS in rural Senegal: relationship to sexual behaviour and behaviour change. AIDS 1996; 10 327–34.
Knowledge, attitudes and perception of AIDS in rural Senegal: relationship to sexual behaviour and behaviour change.Crossref | GoogleScholarGoogle Scholar |

[14]  Waithaka M, Bessinger R. Sexual behavior and condom use in the context of HIV prevention in Kenya. Population Services International, Kenya; 2001.

[15]  Zellner SL. Condom use and accuracy of AIDS knowledge in Cote’ D’Ivoire. Int Fam Plan Perspect 2003; 29 41–7.
Condom use and accuracy of AIDS knowledge in Cote’ D’Ivoire.Crossref | GoogleScholarGoogle Scholar |

[16]  Ukwuani FA, Amy OT, Chirayath MS. Condom use for preventing HIV infection/AIDS in sub-Saharan Africa: a comparative multilevel analysis of Uganda and Tanzania. J Acquir Immune Defic Syndr 2003; 34 203–13.
Condom use for preventing HIV infection/AIDS in sub-Saharan Africa: a comparative multilevel analysis of Uganda and Tanzania.Crossref | GoogleScholarGoogle Scholar |

[17]  Agha S. Sexual activity and condom use in Lusaka, Zambia. Int Fam Plan Perspect 1998; 24 32–7.
Sexual activity and condom use in Lusaka, Zambia.Crossref | GoogleScholarGoogle Scholar |

[18]  Glick P, Randriamamonjy J, Sahn DE. Determinants of HIV knowledge and condom use among women in Madagascar: an analysis using matched household and community data. Afr Dev Rev 2009; 21 147–79.
Determinants of HIV knowledge and condom use among women in Madagascar: an analysis using matched household and community data.Crossref | GoogleScholarGoogle Scholar |

[19]  Prata N, Vahidnia F, Fraser A. Gender and relationship differences in condom use among 15–24 year olds in Angola. Int Fam Plan Perspect 2005; 31 192–9.
Gender and relationship differences in condom use among 15–24 year olds in Angola.Crossref | GoogleScholarGoogle Scholar |

[20]  Cherutich P, Brentlinger P, Nduati R, Kiarie JN, Farquhar C. Condom use among sexually active Kenyan female adolescents at risk for HIV-1 infection. AIDS Behav 2008; 12 923–9.
Condom use among sexually active Kenyan female adolescents at risk for HIV-1 infection.Crossref | GoogleScholarGoogle Scholar |

[21]  Kabiru CW, Orpinas P. Correlates of condom use among male high school students in Nairobi, Kenya. J Sch Health 2009; 79 425–32.
Correlates of condom use among male high school students in Nairobi, Kenya.Crossref | GoogleScholarGoogle Scholar |

[22]  Betts SC, Peterson DJ, Huebner AJ. Zimbabwean adolescents’ condom use: what makes a difference? Implications for intervention. J Adolesc Health 2003; 33 165–71.
Zimbabwean adolescents’ condom use: what makes a difference? Implications for intervention.Crossref | GoogleScholarGoogle Scholar |

[23]  Babalola S, Awasum D, Quenum-Renaud B. The correlates of safe sex practices among Rwandan youth: a positive deviance approach. Afr J AIDS Res 2002; 1 11–21.
The correlates of safe sex practices among Rwandan youth: a positive deviance approach.Crossref | GoogleScholarGoogle Scholar |

[24]  Meekers D, Klein M, Foyet L. Patterns of HIV risk behavior and condom use among youth in Yaound’e and Douala, Cameroon. AIDS Behav 2003; 7 413–20.
Patterns of HIV risk behavior and condom use among youth in Yaound’e and Douala, Cameroon.Crossref | GoogleScholarGoogle Scholar |

[25]  Maticka-Tyndale E, Tenkorang E. A multi-level model of condom use among upper primary school students in Nyanza, Kenya. Soc Sci Med 2010; 71 616–25.
A multi-level model of condom use among upper primary school students in Nyanza, Kenya.Crossref | GoogleScholarGoogle Scholar |

[26]  Agha S, Hutchinson P, Kusanthan T. The effects of religious affiliation on sexual initiation and condom use in Zambia. J Adolesc Health 2006; 38 550–5.
The effects of religious affiliation on sexual initiation and condom use in Zambia.Crossref | GoogleScholarGoogle Scholar |

[27]  Trinitapoli J. Religious teachings and influences on the ABCs of HIV prevention in Malawi. Soc Sci Med 2009; 69 199–209.
Religious teachings and influences on the ABCs of HIV prevention in Malawi.Crossref | GoogleScholarGoogle Scholar |

[28]  Takyi BK. Religion and women’s health in Ghana: insights into HIV/AIDS preventive and protective behavior. Soc Sci Med 2003; 56 1221–34.
Religion and women’s health in Ghana: insights into HIV/AIDS preventive and protective behavior.Crossref | GoogleScholarGoogle Scholar |

[29]  Muula AS. Marriage, not religion, is associated with HIV infection among women in rural Malawi. AIDS Behav 2010; 14 125–31.
Marriage, not religion, is associated with HIV infection among women in rural Malawi.Crossref | GoogleScholarGoogle Scholar |

[30]  Gilbert S. The influence of Islam on AIDS prevention among Senegalese university students. AIDS Educ Prev 2008; 20 399–407.
The influence of Islam on AIDS prevention among Senegalese university students.Crossref | GoogleScholarGoogle Scholar |

[31]  Leclerc-Madlala S. Youth, HIV/AIDS and the importance of sexual culture and context. Cape Town: South Africa: Centre for Social Science Research; 2002.

[32]  Ulin P. African women and AIIDS: negotiating behavioural change. Soc Sci Med 1992; 34 63–73.
African women and AIIDS: negotiating behavioural change.Crossref | GoogleScholarGoogle Scholar |

[33]  Karim QA, Karim SSA, Soldan K, Zondi M. Reducing the risk of HIV infection among South African sex workers: socioeconomic and gender barriers. Am J Public Health 1995; 85 1521–5.
Reducing the risk of HIV infection among South African sex workers: socioeconomic and gender barriers.Crossref | GoogleScholarGoogle Scholar |

[34]  Baylies C, Bujra J. AIDS, sexuality and gender in Africa: collective strategies and struggles in Tanzania and Zambia. London: Routledge; 2000.

[35]  Campbell T, Kelley M. Women and AIDS in Zambia: a review of the psychosocial factors implicated in the transmission of HIV. AIDS Care 1995; 7 365–74.
Women and AIDS in Zambia: a review of the psychosocial factors implicated in the transmission of HIV.Crossref | GoogleScholarGoogle Scholar |

[36]  Wojcicki JM, Malala J. Condom use, power and HIV/AIDS risk: sex-workers bargain for survival in Hillbrow/Joubert Park/Berea, Johannesburg. Soc Sci Med 2001; 53 99–121.
Condom use, power and HIV/AIDS risk: sex-workers bargain for survival in Hillbrow/Joubert Park/Berea, Johannesburg.Crossref | GoogleScholarGoogle Scholar |

[37]  Wood K, Jewkes R. Violence, rape and sexual coercion: everyday love in a South African township. Gend Dev 1997; 5 41–6.
Violence, rape and sexual coercion: everyday love in a South African township.Crossref | GoogleScholarGoogle Scholar |

[38]  Amuyunzu-Nyamongo M, Okeng’o L, Wagura A, Mwenzwa E. Putting on a brave face: the experiences of women living with HIV and AIDS in informal settlements of Nairobi, Kenya. AIDS Care 2007; 19 25–34.
Putting on a brave face: the experiences of women living with HIV and AIDS in informal settlements of Nairobi, Kenya.Crossref | GoogleScholarGoogle Scholar |

[39]  Terry P, Mhloyi M, Masvaure T, Adlis S. Gender equity and HIV/AIDs prevention: comparing gender differences in sexual practice and beliefs among Zimbabwe university students. Int Q Community Health Educ 2005–2006; 24 29–43.
Gender equity and HIV/AIDs prevention: comparing gender differences in sexual practice and beliefs among Zimbabwe university students.Crossref | GoogleScholarGoogle Scholar |

[40]  Orubuloye IO, Caldwell JC, Caldwell P. African women’s control over their sexuality in an era of AIDS. Soc Sci Med 1993; 37 859–72.
African women’s control over their sexuality in an era of AIDS.Crossref | GoogleScholarGoogle Scholar |

[41]  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 |

[42]  Greig F, Koopman C. Multilevel analysis of women’s empowerment and HIV prevention: quantitative survey results from a preliminary study in Botswana. AIDS Behav 2003; 7 195–208.
Multilevel analysis of women’s empowerment and HIV prevention: quantitative survey results from a preliminary study in Botswana.Crossref | GoogleScholarGoogle Scholar |

[43]  Clark S, Bruce J, Dude A. Protecting young women from HIV/AIDS: the case against child and adolescent marriage. Int Fam Plan Perspect 2006; 32 79–88.
Protecting young women from HIV/AIDS: the case against child and adolescent marriage.Crossref | GoogleScholarGoogle Scholar |

[44]  Ahmed S, Lutalo T, Wawer M, Serwadda D, Sewankambo NK, Nalugoda F, et al HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda. AIDS 2001; 15 2171–9.
HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda.Crossref | GoogleScholarGoogle Scholar |

[45]  Stewart TJ, Richter DL. Perceived barriers to HIV prevention among university students in Sierra Leone, West Africa. Int Q Community Health Educ 1994; 15 253–66.
Perceived barriers to HIV prevention among university students in Sierra Leone, West Africa.Crossref | GoogleScholarGoogle Scholar |

[46]  Heeren GA, Jemmott JB, Mandeya A, Tyler JC. Sub-Saharan African university students’ beliefs about condoms, condom-use intention, and subsequent condom use: a prospective study. AIDS Behav 2009; 13 268–76.
Sub-Saharan African university students’ beliefs about condoms, condom-use intention, and subsequent condom use: a prospective study.Crossref | GoogleScholarGoogle Scholar |

[47]  Gysels M, Pool R, Nnalusiba B. Women who sell sex in a Ugandan trading town: life histories, survival strategies and risk. Soc Sci Med 2002; 54 179–92.
Women who sell sex in a Ugandan trading town: life histories, survival strategies and risk.Crossref | GoogleScholarGoogle Scholar |

[48]  Stephenson R. Community influences on young people’s sexual behavior in 3 African countries. Am J Public Health 2009; 99 102–9.
Community influences on young people’s sexual behavior in 3 African countries.Crossref | GoogleScholarGoogle Scholar |

[49]  Katz I. Explaining the increase in condom use among South African young females. J Health Commun 2006; 11 737–53.
Explaining the increase in condom use among South African young females.Crossref | GoogleScholarGoogle Scholar |

[50]  Maticka-Tyndale E. Can we? Have we? Prevention of sexual transmission of HIV. Can J Hum Sex 1995; 4 79–102.

[51]  Airhihenbuwa C, Obregon R. A critical assessment of theories/models used in health communication for HIV/AIDS. J Health Commun 2000; 5 5–15.
A critical assessment of theories/models used in health communication for HIV/AIDS.Crossref | GoogleScholarGoogle Scholar |

[52]  Adih W, Alexander C. Determinants of condom use to prevent HIV infection among youth in Ghana. J Adolesc Health 1999; 24 63–72.
Determinants of condom use to prevent HIV infection among youth in Ghana.Crossref | GoogleScholarGoogle Scholar |

[53]  Bosompra K. Determinants of condom use intentions of university students in Ghana: an application of the theory of reasoned action. Soc Sci Med 2001; 52 1057–69.
Determinants of condom use intentions of university students in Ghana: an application of the theory of reasoned action.Crossref | GoogleScholarGoogle Scholar |

[54]  Hendriksen ES, Pettifor A, Lee S, Coates TJ, Rees HV. Predictors of condom use among young adults in South Africa: the reproductive health and HIV research unit national youth survey. Am J Public Health 2007; 97 1241–8.
Predictors of condom use among young adults in South Africa: the reproductive health and HIV research unit national youth survey.Crossref | GoogleScholarGoogle Scholar |

[55]  Bryan A, Kagee A, Broaddus MR. Condom use among South African adolescents: developing and testing theoretical models of intentions and behavior. AIDS Behav 2006; 10 387–97.
Condom use among South African adolescents: developing and testing theoretical models of intentions and behavior.Crossref | GoogleScholarGoogle Scholar |

[56]  Peltzer K. Factors affecting behaviours that address HIV risk among a sample of junior secondary school students in the northern province, South Africa. Psychological Reports 2001; 89 51–56.

[57]  Jemmott JB, Heeren GA, Ngwane Z, Hewitt N, Jemmott LS, Shell R, et al Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa. AIDS Care 2007; 19 677–84.
Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa.Crossref | GoogleScholarGoogle Scholar |

[58]  Schaalma H, Aaro LE, Flisher AJ, Matthews C, Kaaya S, Onya H, et al Correlates of intention to use condoms among sub-Saharan African youth: the applicability of the theory of planned behaviour. Scand J Public Health 2009; 37 87–91.
Correlates of intention to use condoms among sub-Saharan African youth: the applicability of the theory of planned behaviour.Crossref | GoogleScholarGoogle Scholar |

[59]  Sheeran P, Abraham C, Orbell S. Psychosocial correlates of heterosexual condom use: a meta-analysis. Psychol Bull 1999; 125 90–132.
Psychosocial correlates of heterosexual condom use: a meta-analysis.Crossref | GoogleScholarGoogle Scholar |

[60]  Benefo KD. Determinants of condom use in Zambia: a multilevel analysis. Stud Fam Plann 2010; 41 19–30.
Determinants of condom use in Zambia: a multilevel analysis.Crossref | GoogleScholarGoogle Scholar |

[61]  Bogale GW, Boer H, Seydel ER. Condom use among low-literate, rural females in Ethiopia: the role of vulnerability to HIV infection, condom attitude, and self-efficacy. AIDS Care 2010; 22 851–7.
Condom use among low-literate, rural females in Ethiopia: the role of vulnerability to HIV infection, condom attitude, and self-efficacy.Crossref | GoogleScholarGoogle Scholar |

[62]  Boileau C, Zunzunegui MV, Rashed S. Gender differences in unsafe sexual behavior among young people in urban Mali. AIDS Care 2009; 21 1014–24.
Gender differences in unsafe sexual behavior among young people in urban Mali.Crossref | GoogleScholarGoogle Scholar |

[63]  Eaton L, Flisher A, Aaro L. Unsafe sexual behaviour in South African youth. Soc Sci Med 2003; 56 149–65.
Unsafe sexual behaviour in South African youth.Crossref | GoogleScholarGoogle Scholar |

[64]  Lugoe WL, Biswalo PM. Self-restraining and condom use behaviours: the HIV/AIDS prevention challenges in Tanzanian schools. Int J Adolesc Youth 1997; 7 67–81.

[65]  Reddy P, Meyer-Weitz A, van den Borne B, Kok G. Determinants of condom-use behaviour among STD clinic attenders in South Africa. Int J STD AIDS 2000; 11 521–30.
Determinants of condom-use behaviour among STD clinic attenders in South Africa.Crossref | GoogleScholarGoogle Scholar |

[66]  Taylor M, Dlamini SB, Nyawo N, Huver R, Jinabhai CC, deVries 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 |

[67]  Meekers D, Klein M. Determinants of condom use among young people in urban Cameroon. Stud Fam Plann 2002; 33 335–46.
Determinants of condom use among young people in urban Cameroon.Crossref | GoogleScholarGoogle Scholar |

[68]  Akwara A, Madise J, Hinde A. Perception of risk of HIV/AIDS and sexual behaviour in Kenya. J Biosoc Sci 2003; 35 385–411.
Perception of risk of HIV/AIDS and sexual behaviour in Kenya.Crossref | GoogleScholarGoogle Scholar |

[69]  Crentsil P. Deaths, ancestors, and HIV/AIDS among the Akan of Ghana. Suomen Antropologiety 2007; 32 54–62.

[70]  Yankah K. Narrative in times of crisis: AIDS stories in Ghana. Journal of Folklore Research 2004; 41 181–98.
Narrative in times of crisis: AIDS stories in Ghana.Crossref | GoogleScholarGoogle Scholar |

[71]  Behrend H. The rise of occult powers, AIDS and the Roman Catholic Church in western Uganda. J Relig Afr 2007; 37 41–58.
The rise of occult powers, AIDS and the Roman Catholic Church in western Uganda.Crossref | GoogleScholarGoogle Scholar |

[72]  Yamba BC. Cosmologies in turmoil: witchfinding and AIDS in Chiawa, Zambia. Journal of International African Institute 1997; 67 200–23.
Cosmologies in turmoil: witchfinding and AIDS in Chiawa, Zambia.Crossref | GoogleScholarGoogle Scholar |

[73]  Maticka-Tyndale E, Kyeremeh C. The trouble with condoms: norms and meanings of sexuality and condom use among school-going youth in Kenya. Int J Sex Health 2010; 22 234–47.
The trouble with condoms: norms and meanings of sexuality and condom use among school-going youth in Kenya.Crossref | GoogleScholarGoogle Scholar |

[74]  Nzioka C. Perspectives of adolescent boys on the risks of unwanted pregnancy and sexually transmitted infections: Kenya. Reprod Health 2001; 9 108–17.
Perspectives of adolescent boys on the risks of unwanted pregnancy and sexually transmitted infections: Kenya.Crossref | GoogleScholarGoogle Scholar |

[75]  MacPhail C, Campbell C. ‘I think condoms are good but, aai, I hate those things’: condom use among adolescents and young people in a Southern African township. Soc Sci Med 2001; 52 1613–27.
‘I think condoms are good but, aai, I hate those things’: condom use among adolescents and young people in a Southern African township.Crossref | GoogleScholarGoogle Scholar |

[76]  Maharaj P, Cleland J. Condom use within marital and cohabiting partnerships in KwaZulu-Natal, South Africa. Stud Fam Plann 2004; 35 116–24.
Condom use within marital and cohabiting partnerships in KwaZulu-Natal, South Africa.Crossref | GoogleScholarGoogle Scholar |

[77]  Kalichman SC, Simbayi L. Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa. AIDS Care 2004; 16 572–80.
Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa.Crossref | GoogleScholarGoogle Scholar |

[78]  Maharaj P. Reasons for condom use among young people in Kwazulu-Natal: prevention of HIV, Pregnancy or Both? Int Fam Plan Perspect 2006; 32 28–34.
Reasons for condom use among young people in Kwazulu-Natal: prevention of HIV, Pregnancy or Both?Crossref | GoogleScholarGoogle Scholar |

[79]  Plummer ML, Wight D, Wamoyi J, Mshana G, Hayes RJ, Ross DA. Farming with your hoe in a sack: condom attitudes, access, and use in rural Tanzania. Stud Fam Plann 2006; 37 29–40.
Farming with your hoe in a sack: condom attitudes, access, and use in rural Tanzania.Crossref | GoogleScholarGoogle Scholar |

[80]  Chimbiri AM. The condom is an ‘intruder’ in marriage: evidence from rural Malawi. Soc Sci Med 2007; 64 1102–15.
The condom is an ‘intruder’ in marriage: evidence from rural Malawi.Crossref | GoogleScholarGoogle Scholar |

[81]  Maticka-Tyndale E, Gallant M, Brouillard-Coyle C, Holland D, Metcalfe K, Wildish J, et al The sexual scripts of Kenyan young people and HIV prevention. Cult Health Sex 2005; 7 27–41.
The sexual scripts of Kenyan young people and HIV prevention.Crossref | GoogleScholarGoogle Scholar |

[82]  Caldwell JC, Caldwell P, Quiggin P. The social context of AIDS in sub-Saharan Africa. In Orubuloy IO, Caldwell JC, Caldwell P, Santow G, editors. Sexual networking and AIDS in sub-Saharan Africa: behavioural research and the social context. Health Transition Series No. 4. Canberra: Australian National University; 1994. pp. 129–161.

[83]  Moffett H. “These women, they force us to rape them”: rape as narrative of social control in post-apartheid South Africa. J South Afr Stud 2006; 32 129–44.
“These women, they force us to rape them”: rape as narrative of social control in post-apartheid South Africa.Crossref | GoogleScholarGoogle Scholar |

[84]  Schoepf BG. Women at risk: case studies from Zaire. In Herdt G, Lindenbaum S, editors. In the time of AIDS: social analysis, theory and method. London: Sage; 1993. pp. 259–86.

[85]  Barnett J, Maticka-Tyndale E. The gift of agency: sexual exchange scripts among Nigerian youth. J Sex Res 2010; 47 1–11.

[86]  Meyer-Weitz A, Reddy P, Weijtz W, van den Borne B, Kok G. The socio-cultural contexts of sexually transmited diseases in South Africa: implications for health education programmes. AIDS Care 1998; 10 39–55.
The socio-cultural contexts of sexually transmited diseases in South Africa: implications for health education programmes.Crossref | GoogleScholarGoogle Scholar |

[87]  Silberschmidt M. Men, male sexuality and HIV/AIDS: reflections from studies in rural and urban East Africa. Transformation 2004; 54 42–58.

[88]  Jewkes R, Vundule C, Maforah F, Jordaan E. Relationship dynamics and teenage pregnancy in South Africa. Soc Sci Med 2001; 52 733–44.
Relationship dynamics and teenage pregnancy in South Africa.Crossref | GoogleScholarGoogle Scholar |

[89]  Wood K, Maforah F, Jewkes R. “He forced me to love him”: putting violence on adolescent sexual health agendas. Soc Sci Med 1998; 47 233–42.
“He forced me to love him”: putting violence on adolescent sexual health agendas.Crossref | GoogleScholarGoogle Scholar |

[90]  van der Straten A, King R, Grinstead O, Vittinghoff E, Serufilira A, Allen S. Sexual coercion, physical violence, and HIV infection among women in steady relationships in Kigali, Rwanda. AIDS Behav 1998; 2 61–73.
Sexual coercion, physical violence, and HIV infection among women in steady relationships in Kigali, Rwanda.Crossref | GoogleScholarGoogle Scholar |

[91]  Caldwell J. Rethinking the African AIDS epidemic. Population and Development Review. 2002; 26 117–135.

[92]  Caldwell J, Orubuloye I, Caldwell P. Obstacles to behavioural change to lessen the risk of HIV infection in the African AIDS epidemic: Nigerian research. In Caldwell JC, editor. Resistance of behavioural change to reduce HIV/AIDS infection. Canberra: Health Transition Centre; 1999. pp. 113–24.

[93]  Preston-Whyte E. Reproductive health and the condom dilemma: identifying situational barriers to HIV protection in South Africa. In Caldwell JC, Caldwell P, Anarfi J, Awusabo-Asare K, Ntozi J, Orubuloye IO, Marck J, Cosford W, Colombo R, Hollings E, editors. Resistances to Behavioural Change to Reduce HIV/AIDS Infection in Predominantly Heterosexual Epidemics in Third World Countries. Canberra:Australian National University. 1999. pp. 139–155.

[94]  Karim SSA, Karim QA, Preston-Whyte E, Sankar N. Reasons for lack of condom use among high school students. S Afr Med J 1992; 82 107–10.

[95]  Coast E. Wasting semen: context and condom use among the Maasai. Cult Health Sex 2007; 9 387–401.
Wasting semen: context and condom use among the Maasai.Crossref | GoogleScholarGoogle Scholar |

[96]  Bond V, Dover P. Men, women and the trouble with condoms: problems associated with condom use by migrant workers in rural Zambia. Health Transit Rev 1997; 377–91.

[97]  Gausset Q. AIDS and cultural practices in Africa: the case of the Tonga (Zambia). Soc Sci Med 2001; 52 509–18.
AIDS and cultural practices in Africa: the case of the Tonga (Zambia).Crossref | GoogleScholarGoogle Scholar |

[98]  Undie CC, Zirabaa A, Madisex N, Kebasoa J, Kimani-Murage E. “If you start thinking positively, you won’t miss sex”: narratives of sexual (in)activity among people living with HIV in Nairobi’s informal settlements. Cult Health Sex 2009; 11 767–82.
“If you start thinking positively, you won’t miss sex”: narratives of sexual (in)activity among people living with HIV in Nairobi’s informal settlements.Crossref | GoogleScholarGoogle Scholar |

[99]  Moore AR, Oppong J. Sexual risk behavior among people living with HIV/AIDS in Togo. Soc Sci Med 2007; 64 1057–66.
Sexual risk behavior among people living with HIV/AIDS in Togo.Crossref | GoogleScholarGoogle Scholar |

[100]  Kaler A. The moral lens of population control: condoms and controversies in Southern Malawi. Stud Fam Plann 2004; 35 105–15.
The moral lens of population control: condoms and controversies in Southern Malawi.Crossref | GoogleScholarGoogle Scholar |

[101]  Mbugua N. Factors inhibiting educated mothers in Kenya from giving meaningful sex-education to their daughters. Soc Sci Med 2007; 64 1079–89.
Factors inhibiting educated mothers in Kenya from giving meaningful sex-education to their daughters.Crossref | GoogleScholarGoogle Scholar |

[102]  Muyinda H, Kengeya J, Pool R, Whitworth J. Traditional sex counseling and STI/HIV among young women in rural Uganda. Cult Health Sex 2001; 3 353–61.
Traditional sex counseling and STI/HIV among young women in rural Uganda.Crossref | GoogleScholarGoogle Scholar |

[103]  Muyinda H, Nakuya J, Pool R, Whitworth J. Harnessing the senga institution of adolescent sex education for the control of HIV and STDs in rural Uganda. AIDS Care 2003; 15 159–67.
Harnessing the senga institution of adolescent sex education for the control of HIV and STDs in rural Uganda.Crossref | GoogleScholarGoogle Scholar |

[104]  Wood K, Maepa J, Jewkes R. Adolescent sex and contraceptive experiences: perspectives of teenagers and clinic nurses in the northern province. Pretoria: Centre for Epidemiological Research in Southern Africa; 1997.

[105]  Nyanzi S, Pool R, Kinsman J. The negotiation of sexual relationships among school pupils in South-Western Uganda. AIDS Care 2001; 13 83–98.
The negotiation of sexual relationships among school pupils in South-Western Uganda.Crossref | GoogleScholarGoogle Scholar |

[106]  Buhler C, Kohler H-P. Talking about AIDS: the influence of communication networks on individual risk perceptions of HIV/AIDS infection and protective behaviors in South Nyanza district, Kenya. Rostock, Germany: Max Planck Institute for Demographic Research; 2002.

[107]  Maticka-Tyndale E. Sustaining gains made in a primary school HIV prevention program in Kenya into the secondary school years. J Adolesc 2010; 33 563–73.
Sustaining gains made in a primary school HIV prevention program in Kenya into the secondary school years.Crossref | GoogleScholarGoogle Scholar |

[108]  Maticka-Tyndale E, Wildish J, Gichuru M. Quasi-experimental evaluation of a national primary school HIV intervention in Kenya. Eval Program Plann 2007; 30 172–86.
Quasi-experimental evaluation of a national primary school HIV intervention in Kenya.Crossref | GoogleScholarGoogle Scholar |

[109]  Maticka-Tyndale E, Wildish J, Gichuru M. Thirty-month quasi-experimental evaluation follow-up of a national primary school HIV intervention in Kenya. Sex Educ 2010; 10 113–30.
Thirty-month quasi-experimental evaluation follow-up of a national primary school HIV intervention in Kenya.Crossref | GoogleScholarGoogle Scholar |

[110]  Adetunji J. Condom use in marital and nonmarital relationships in Zimbabwe. Int Fam Plan Perspect 2000; 26 196–200.
Condom use in marital and nonmarital relationships in Zimbabwe.Crossref | GoogleScholarGoogle Scholar |

[111]  Boer H, Mashamba MT. Psychosocial correlates of HIV protection motivation among black adolescents in Venda, South Africa. AIDS Educ Prev 2005; 17 590–602.
Psychosocial correlates of HIV protection motivation among black adolescents in Venda, South Africa.Crossref | GoogleScholarGoogle Scholar |

[112]  Stoskopf C, Kim YK, Richter D. Factors related to condom use among young people in Kenya. Int Q Community Health Educ 2001; 20 193–208.
Factors related to condom use among young people in Kenya.Crossref | GoogleScholarGoogle Scholar |

[113]  Agha S, Kusanthan T, Longfield K, Klein M, Berman J. Reasons for non-use of condoms in eight countries in sub-Saharan Africa. Washington, DC: Population Services International; 2002.

[114]  Van Rossem R, Meekers D, Akinyemi Z. Consistent condom use with different types of partners: evidence from two Nigerian surveys. AIDS Educ Prev 2001; 13 252–67.
Consistent condom use with different types of partners: evidence from two Nigerian surveys.Crossref | GoogleScholarGoogle Scholar |

[115]  Montgomery CM, Lees S, Stadler J, Morar NS, Ssali A, Mwanzaf B, et al The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care 2008; 20 733–40.
The role of partnership dynamics in determining the acceptability of condoms and microbicides.Crossref | GoogleScholarGoogle Scholar |

[116]  Tavory I, Swidler A. Condom semiotics: meaning and condom use in rural Malawi. Am Sociol Rev 2009; 74 171–89.
Condom semiotics: meaning and condom use in rural Malawi.Crossref | GoogleScholarGoogle Scholar |

[117]  Ghosh J, Kalipeni E. Women in Chinsapo, Malawi: vulnerability and risk to HIV/AIDS. Journal of Social Aspects of HIV/AIDS 2005; 2 320–332.

[118]  King R, Lifshay J, Nakayiwa W, Katuntu D, Lindkvist P, Bunnell R. The virus stops with me: HIV-infected Ugandans’ motivations in preventing HIV transmission. Soc Sci Med 2009; 68 749–57.
The virus stops with me: HIV-infected Ugandans’ motivations in preventing HIV transmission.Crossref | GoogleScholarGoogle Scholar |

[119]  Luginaah I, Elkins D, Maticka-Tyndale E, Landry R, Muthui M. Challenges of a pandemic: HIV/AIDS-related problems affecting Kenyan widows. Soc Sci Med 2005; 60 1219–28.
Challenges of a pandemic: HIV/AIDS-related problems affecting Kenyan widows.Crossref | GoogleScholarGoogle Scholar |

[120]  Harrison A, Xaba N, Kunene P. Understanding safe sex: gender narratives of HIV and pregnancy prevention by rural South African school-going youth. Reprod Health Matters 2001; 9 63–71.
Understanding safe sex: gender narratives of HIV and pregnancy prevention by rural South African school-going youth.Crossref | GoogleScholarGoogle Scholar |

[121]  Hart GJ, Pool R, Green G, Harrison S, Nyanzi S, Whitworth JAG. Women’s attitudes to condoms and female-controlled means of protection against HIV and STDs in South-Western Uganda. AIDS Care 1999; 11 687–98.
Women’s attitudes to condoms and female-controlled means of protection against HIV and STDs in South-Western Uganda.Crossref | GoogleScholarGoogle Scholar |

[122]  Blanc A. The effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. Stud Fam Plann 2001; 32 189–213.
The effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence.Crossref | GoogleScholarGoogle Scholar |

[123]  Campbell C. Selling sex in the time of AIDS: the psycho-social context of condom use by sex workers on a Southern African mine. Soc Sci Med 2000; 50 479–94.
Selling sex in the time of AIDS: the psycho-social context of condom use by sex workers on a Southern African mine.Crossref | GoogleScholarGoogle Scholar |

[124]  Ray S, van de Wijgert J, Mason P, Ndowa F, Maposhere C. Constraints faced by sex workers in use of female and male condoms for safer sex in urban Zimbabwe. J Urban Health 2001; 78 581–92.
Constraints faced by sex workers in use of female and male condoms for safer sex in urban Zimbabwe.Crossref | GoogleScholarGoogle Scholar |

[125]  Ntumbanzondo M, Dubrow R, Niccolai L, Mwandagalirwa K, Mersoni M. Unprotected intercourse for extra money among commercial sex workers in Kinshasa, Democratic Republic of Congo. AIDS Care 2006; 18 777–85.
Unprotected intercourse for extra money among commercial sex workers in Kinshasa, Democratic Republic of Congo.Crossref | GoogleScholarGoogle Scholar |

[126]  Gomes do Espirito Santo M, Etheredge G. HIV prevalence and sexual behaviour of male clients of brothels’ prostitutes in Dakar, Senegal. AIDS Care 2003; 15 53–62.
HIV prevalence and sexual behaviour of male clients of brothels’ prostitutes in Dakar, Senegal.Crossref | GoogleScholarGoogle Scholar |

[127]  Pickering H, Todd J, Dunn D, Pepin J, Wilkins A. Prostitutes and their clients: a Gambian survey. Soc Sci Med 1992; 34 75–88.
Prostitutes and their clients: a Gambian survey.Crossref | GoogleScholarGoogle Scholar |

[128]  Vuylsteke BL, Ghys PD, Traore M, Konan Y, Mah-Bi G, Maurice C, et al HIV prevalence and risk behavior among clients of female sex workers in Abidjan, Cote d’Ivoire. AIDS 2003; 17 1691–4.
HIV prevalence and risk behavior among clients of female sex workers in Abidjan, Cote d’Ivoire.Crossref | GoogleScholarGoogle Scholar |

[129]  Wechsberg WM, Luseno WK, Lama WK. Violence against substance-abusing South African sex workers: intersection with culture and HIV risk. AIDS Care 2005; 17 S55–S64.
Violence against substance-abusing South African sex workers: intersection with culture and HIV risk.Crossref | GoogleScholarGoogle Scholar |

[130]  Adu-Oppong A, Grimes R, Ross M, Risser J, Kessie G. Social and behavioral determinants of consistent condom use among female commercial sex workers in Ghana. AIDS Educ Prev 2007; 19 160–72.
Social and behavioral determinants of consistent condom use among female commercial sex workers in Ghana.Crossref | GoogleScholarGoogle Scholar |

[131]  Needle R, Kroeger K, Belani H, Achrekar A, Parry CD, Dewing S. Sex, drugs, and HIV: rapid assessment of HIV risk behaviors among street-based drug using sex workers in Durban, South Africa. Soc Sci Med 2008; 67 1447–1455.
Sex, drugs, and HIV: rapid assessment of HIV risk behaviors among street-based drug using sex workers in Durban, South Africa.Crossref | GoogleScholarGoogle Scholar |

[132]  Mgalla Z, Pool R. Sexual relationships, condom use and risk perception among female bar workers in north-west Tanzania. AIDS Care 1997; 9 407–16.
Sexual relationships, condom use and risk perception among female bar workers in north-west Tanzania.Crossref | GoogleScholarGoogle Scholar |

[133]  Sunmola M. Sexual practices, barriers to condom use and its consistent use among long distance truck drivers in Nigeria. AIDS Care 2005; 17 208–21.
Sexual practices, barriers to condom use and its consistent use among long distance truck drivers in Nigeria.Crossref | GoogleScholarGoogle Scholar |

[134]  Krishnan S, Dunbar M, Minnis M, Medlin CA, Gerdts CE, Padian N. Poverty, gender inequities and women’s risk of human immunodeficiency virus/AIDS. Ann N Y Acad Sci 2008; 1136 101–10.
Poverty, gender inequities and women’s risk of human immunodeficiency virus/AIDS.Crossref | GoogleScholarGoogle Scholar |

[135]  Kim J, Ferrari G, Abramsky T, Watts C, Hargreaves J, Morison L, et al Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa. Bull World Health Organ 2009; 87 824–32.
Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa.Crossref | GoogleScholarGoogle Scholar |

[136]  Bankole A, Ahmed F, Neema S, Ouedraogo C, Konyani S. Knowledge of correct condom use and consistency of use among adolescents in four countries in sub-Saharan Africa. Afr J Reprod Health 2007; 11 197–220.
Knowledge of correct condom use and consistency of use among adolescents in four countries in sub-Saharan Africa.Crossref | GoogleScholarGoogle Scholar |

[137]  Shelton JD, Johnston B. Condom gap in Africa: evidence from donor agencies and key informants. BMJ 2001; 323 139
Condom gap in Africa: evidence from donor agencies and key informants.Crossref | GoogleScholarGoogle Scholar |

[138]  Meekers D, Ahmed G, Molatlheg M. Understanding constraints to adolescent condom procurement: the case of urban Botswana. AIDS Care 2001; 13 297–302.
Understanding constraints to adolescent condom procurement: the case of urban Botswana.Crossref | GoogleScholarGoogle Scholar |

[139]  Kelley M, Parker W. Communities of practice: contextual mediators of youth response to HIV/AIDS. Beyond Awareness campaign report. Pretoria: Department of Health; 2000.

[140]  Greif M, Doodoo N, Jayaraman A. Urbanisation, poverty and sexual behaviour: the tale of five African cities. Urban Stud 2011; 48 947–57.
Urbanisation, poverty and sexual behaviour: the tale of five African cities.Crossref | GoogleScholarGoogle Scholar |

[141]  Nobelius A, Kalina B, Pool R, Whitworth J, Chesters J, Power R. “You still need to give her a token of appreciation”: the meaning of the exchange of money in the sexual relationships of out-of-school adolescents in rural southwest Uganda. J Sex Res 2010; 47 490–503.
“You still need to give her a token of appreciation”: the meaning of the exchange of money in the sexual relationships of out-of-school adolescents in rural southwest Uganda.Crossref | GoogleScholarGoogle Scholar |

[142]  Wojcicki J. Commerical sexwork or ukuphanda? Sex-for-money exchange in Soweto and Hammanskraal area, South Africa. Cult Med Psychiatry 2002; 26 339–70.
Commerical sexwork or ukuphanda? Sex-for-money exchange in Soweto and Hammanskraal area, South Africa.Crossref | GoogleScholarGoogle Scholar |

[143]  Silberschmidt M, Rasch V. Adolescent girls, illegal abortions and ‘‘sugar-daddies’’ in Dar es Salaam: vulnerable victims and active social agent. Soc Sci Med 2001; 52 1815–26.
Adolescent girls, illegal abortions and ‘‘sugar-daddies’’ in Dar es Salaam: vulnerable victims and active social agent.Crossref | GoogleScholarGoogle Scholar |

[144]  Wyrod R, Fritz K, Woelk G, Jain S, Kellogg T, Chirowodza A, et al Beyond sugar daddies: intergenerational sex and AIDS in urban Zimbabwe. AIDS Behav 2011; 15 1275–82.
Beyond sugar daddies: intergenerational sex and AIDS in urban Zimbabwe.Crossref | GoogleScholarGoogle Scholar |

[145]  Cleland J, Ali MM, Shah I. Trends in protective behaviour among single vs. married young women in Sub-Saharan Africa: the big picture. Reprod Health Matters 2006; 14 17–22.
Trends in protective behaviour among single vs. married young women in Sub-Saharan Africa: the big picture.Crossref | GoogleScholarGoogle Scholar |

[146]  Cleland J, Ali MM. Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data. Lancet 2006; 368 1788–93.
Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data.Crossref | GoogleScholarGoogle Scholar |

[147]  Adair T. Men’s condom use in higher-risk sex: trends in five sub-Saharan African countries. J Popul Res 2008; 25 51–62.
Men’s condom use in higher-risk sex: trends in five sub-Saharan African countries.Crossref | GoogleScholarGoogle Scholar |

[148]  Dunkle KL, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, et al New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: an analysis of survey and clinical data. Lancet 2008; 371 2183–91.
New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: an analysis of survey and clinical data.Crossref | GoogleScholarGoogle Scholar |

[149]  Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, et al Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomized controlled trial. BMJ 2008; 337 A506
Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |

[150]  Erulkar AS, Ettayang O, Hyagah M. Behaviour change evaluation of a culturally consistent reproductive health program for young Kenyans. Int Fam Plan Perspect 2004; 30 58–67.
Behaviour change evaluation of a culturally consistent reproductive health program for young Kenyans.Crossref | GoogleScholarGoogle Scholar |

[151]  Esu-Williams E, Schenk K, Motsepe J, Geibel S, Zulu A. Involving young people in the care and support of people living with HIV and AIDS in Zambia. Washington, DC: Population Council; 2004.

[152]  Ross D, Changalucha J, Obasi A, Todd J, Plummer M, Cleophas-Mazige B, et al Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial. AIDS 2007; 21 1943–55.
Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial.Crossref | GoogleScholarGoogle Scholar |

[153]  Ngugi E, Simonsen JN, Bosire M, Ronald AR, Plummer FA, Cameron DW, et al Prevention of transmission of human immunodeficiency virus in Africa: effectiveness of condom promotion and health education among prostitutes. Lancet 1988; 332 887–90.
Prevention of transmission of human immunodeficiency virus in Africa: effectiveness of condom promotion and health education among prostitutes.Crossref | GoogleScholarGoogle Scholar |

[154]  Williams E, Lamson N, Efem S, Weir S. Implementation of an AIDS prevention program among prostitutes in the Cross River State of Nigeria. AIDS 1992; 6 229–30.
Implementation of an AIDS prevention program among prostitutes in the Cross River State of Nigeria.Crossref | GoogleScholarGoogle Scholar |