Condom Use Young people who had had their sexual

Condom Use

Young people who had had their sexual debut at an early age or whose first partner had ever forced them to have sex were more likely than other respondents to report not having used condoms at their first sexual experience. However, among young women, the association between early debut and condom use varied according to whether they had had forced sex. Specifically, compared with young women who had had a later debut and whose partner had not forced them to have sex, those who had had a later debut and had had forced sex, and those who had had an early debut but had not had forced sex, were more likely to not have used condoms the first time they had sex. Surprisingly, nonuse of condoms was no higher among young women who had had an early debut and had had forced sex than among those who had had a later debut and had not had forced sex. The lack of an association may be attributable in part to the small proportion of women (1% of sexually experienced females) who had had both an early debut and forced sex. Other studies have documented an association between early debut and lack of contraceptive (including condom) use at debut;^15,34 associations have also been observed between forced and unwanted first sex and lack of contraceptive (including condom) use at first sex.^29,30

For all measures of condom use, women in the younger age-group were more likely to report use than those aged 20–24. Our findings suggest that condom use may be increasing in South Africa (the prevalence of condom use at last sex among women aged 15–24 in the 1998 Demographic and Health Survey was only 17%¹⁴); nevertheless, fewer than one-third of young people in this study reported consistent condom use with their first partner. Thus, a substantial proportion of young people had not been protected against HIV infection in their first sexual relationship. Previous work using this sample showed that the prevalence of condom use was lower among women with less gender power in their relationship and those whose partner had forced them to have sex than among those who had more power or who had not had forced sex.³⁵ Thus, it is important that prevention programs continue to address gender norms that discourage youth from using condoms and to help develop supportive environments that facilitate condom use.

Talking to a partner about condom use is an important predictor of actual use, especially within a first sexual relationship.^36,37 Qualitative research conducted with South African youth in the 1990s revealed minimal communication concerning condom use.^17,20 Young women reported that they were afraid to mention condoms to their partners for fear of violent reactions.^17,19 Interestingly, 75% of 15–19-year-old women in our study reported that they had talked to their first sexual partner about condom use. This finding is encouraging and may be an indication that gender norms concerning condom communication have begun to change. Since 1999, a number of campaigns in South Africa have encouraged youth to talk about sex; the most notable of these is the loveLife HIV prevention campaign, whose tag line is "talk about it"—the "it" being sex and HIV prevention. Unfortunately, previous analyses of data from our survey found that young women who reported not having talked to their partner about condom use were significantly more likely than other women to be inconsistent condom users.³⁶ Prevention programs must continue to provide young people with the skills they need to communicate effectively with their partner about safer sex, and must continue striving to change social norms about sexual communication.

Studies of South African adolescents have found that contraceptives are rarely used at sexual initiation.²¹ In this study, approximately half of young people reported that they had used a method of pregnancy prevention with their first partner; similarly, 44% of young women in a previous study reported having used a contraceptive method the first time they had sex.¹² Again, respondents aged 15–19 were more likely than those in the older age-group to report that they had used a condom as their method of pregnancy prevention. Reproductive health organizations in South Africa have worked to promote dual method use, and to reframe the male condom as a pregnancy prevention method and not solely a means of STI and HIV prevention. Given the high rates of HIV and pregnancy among young women, there is a tremendous need for prevention programs that emphasize the importance of dual protection.

Our study has several limitations. Recall error is likely for first sexual experiences, particularly for individuals whose sexual debut occurred long before their interview. In addition, as with all surveys of self-reported sensitive behavior, this survey likely suffers from underreporting and social desirability bias.