Masculinities and condom use patterns among young rural South Africa men: a cross-sectional baseline survey

BMC Public Health

K Dunkle⁴  M Nduna²  R Jewkes³  N Jama Shai¹ 

[1]Gender & Health Research Unit, Medical Research Council (MRC), Pretoria, South Africa

[2]Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa

[3]School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

[4]Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA

关键词: South Africa;    Young men;    Sexual behaviour;    Masculinities;    Condom use;   

Others  :  1163513
DOI  :  10.1186/1471-2458-12-462

 received in 2012-03-27, accepted in 2012-05-25,  发布年份 2012

【 摘 要 】

Background

Notions of ideal manhood in South Africa are potentially prescriptive of male sexuality thus accounting for the behaviors which may lead to men being at greater HIV risk. We tested the hypothesis that gender and relationship constructs are associated with condom use among young men living in rural South Africa.

Methods

1219 men aged 15–26 years completed a cross-sectional baseline survey from an IsiXhosa questionnaire asking about sexual behaviour and relationships. Univariate and bivariate analyses described condom use patterns and explanatory variables, and multinomial regression modeling assessed the factors associated with inconsistent versus consistent and non-condom use.

Results

47.7% of men never used condoms, when 36.9% were inconsistent and 15.4% were consistent with any partner in the past year. Condom use patterns differed in association with gender relations attitudes: never users were significantly more conservative than inconsistent or consistent users. Three gender positions emerged indicating that inconsistent users were most physically/sexually violent and sexually risky; never users had more conservative gender attitudes but were less violent and sexually risky; and consistent users were less conservative, less violent and sexually risky with notably fewer sexual partners than inconsistent users.

Conclusions

The confluence of conservative gender attitudes, perpetration of violence against women and sexual risk taking distinguished inconsistent condom users as the most risky compared to never condom users, and rendered inconsistent use one of the basic negative attributes of dominant masculinities in the Eastern Cape, South Africa. This finding is important for the design of HIV prevention and gender equity interventions and emphasizes the need for a wider roll-out of interventions that promote progressive and healthy masculine practices in the country.

【 授权许可】

   
2012 Jama Shai et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Harrison A, Cleland J, Gouws E, Frohlich J: Early sexual debut among young men in rural South Africa: heightened vulnerability to sexual risk? Sex Transm Infect 2005, 81:259-261.
• [2]Pettifor AE, Rees HV, Steffenson A, Hlongwa-Madikizela L, MacPhail C, Vermaak K, Kleinschmidt I: HIV and Sexual Behaviour Among Young South Africans : A National Survey of 15–24 year olds. In Book HIV and Sexual Behaviour Among Young South Africans : A National Survey of 15–24 year olds. (Editor ed.^eds.). Reproductive Health Research Unit, University of Witwatersrand, ; 2004. http://www.lovelife.org.za/research/studies.php webcite
• [3]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, 12:431-440.
• [4]Harrison A, O’Sullivan LF, Hoffman S, Dolezal C, Morrell R: Gender Role and Relationship Norms among Young Adults in South Africa: Measuring the Context of Masculinity and HIV Risk. J Urban Health 2006, 83:709-722.
• [5]Jewkes RK, Levin JB, Penn-Kekana LA: Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med 2003, 56:125-134.
• [6]Jewkes R, Morrell R: Sexuality and the limits of agency among South African teenage women: Theorising femininities and their connections to HIV risk practises. Soc Sci Med 2012, 74:1729-1737.
• [7]Pettifor AE, Measham DM, Rees HV, Padian NS: Sexual power and HIV risk, South Africa. Emerg Infect Dis 2004, 10:1996-2004.
• [8]Noar S, Webb E, Van Stee S, Feist-Price S, Crosby R, Willoughby J, Troutman A: Sexual Partnerships, Risk Behaviors, and Condom Use Among Low-Income Heterosexual African Americans: A Qualitative Study. Arch Sex Behav 2011, 1-12. https://springerlink3.metapress.com/content/3gng11072127h972/resource-secured/?target=fulltext.html&sid=goz10yoi4orr4u35fomzpox4&sh=www.springerlink.com webcite
• [9]Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD: Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet 2004, 363:1415-1421.
• [10]Jewkes R, Dunkle K, Nduna M, Shai N: Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet 2010, 376:41-48.
• [11]Sallis JF, Owen N, Fisher EB: Ecological Models of Health Behavior. In Health Behavior and Health Education: Theory, Research and Practice. 4th edition. Edited by Glanz K, Rimer BK, Viswanath K. San Francisco, CA: Jossey-Bass, A Wiley Imprint; 2008.
• [12]Sales JM, Lang DL, DiClemente RJ, Latham TP, Wingood GM, Hardin JW, Rose ES: The mediating role of partner communication frequency on condom use among African American adolescent females participating in an HIV prevention intervention. Heal Psychol 2012, 31:63-69.
• [13]Varga CA: Sexual decision-making and negotiation in the midst of AIDS: youth in KwaZulu-Natal, South Africa. Health Transit Rev 1997, 7:45-67.
• [14]Ragnarsson A, Townsend L, Thorson A, Chopra M, Ekstrom AM: Social networks and concurrent sexual relationships–a qualitative study among men in an urban South African community. AIDS Care 2009, 21:1253-1258.
• [15]Kenyon C, Boulle A, Badri M, Asselman V: “I don’t use a condom (with my regular partner) because I know that I’m faithful, but with everyone else I do”: The cultural and socioeconomic determinants of sexual partner concurrency in young South Africans. J Soc Aspects HIV/AIDS 2010, 7:35-43.
• [16]Santana MC, Raj A, Decker MR, La Marche A, Silverman JG: Masculine gender roles associated with increased sexual risk and intimate partner violence perpetration among young adult men. J Urban Health 2006, 83:575-585.
• [17]Jama Shai N, Jewkes R, Levin J, Dunkle K, Nduna M: Factors associated with consistent condom use among rural young women in South Africa. AIDS Care 2010, 22:1379-1385.
• [18]Pettifor AE, Rees HV, Kleinschmidt I, Steffenson EA, MacPhail C, Hlongwa-Madikizela L, Vermaak K, Padian NS: Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS 2005, 19:1525.
• [19]Jewkes R, Sikweyiya Y, Morrell R, Dunkle K: Understanding men’s health and use of violence: interface of rape and HIV in South Africa. Technical Report. Pretoria: Medical Research Council; 2009. http://www.mrc.ac.za/gender/projects.htm webcite
• [20]Jewkes R, Morrell R: Sexuality and the limits of agency among South African teenage women: Theorising femininities and their connections to HIV risk practises. Soc Sci Med 2012, 74(11):1729-37. Epub 2011 May 31
• [21]Jewkes R, Sikweyiya Y, Morrell R, Dunkle K: The Relationship between Intimate Partner Violence, Rape and HIV amongst South African Men: A Cross-Sectional Study. PLoS One 2011, 6:e24256.
• [22]Silverman JG, Decker MR, Saggurti N, Balaiah D, Raj A: Intimate partner violence and HIV infection among married Indian women. Jama 2008, 300:703-710.
• [23]Dunkle KL, Jewkes RK, Nduna M, Levin J, Jama N, Khuzwayo N, Koss MP, Duvvury N: Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa. AIDS 2006, 20:2107-2114. 2110.1097/2101.aids.0000247582.0000200826.0000247552
• [24]Townsend L, Rosenthal SR, Parry CD, Zembe Y, Mathews C, Flisher AJ: Associations between alcohol misuse and risks for HIV infection among men who have multiple female sexual partners in Cape Town, South Africa. AIDS Care 2010, 22:1544-1554.
• [25]Silverman JG, Decker MR, Kapur NA, Gupta J, Raj A: Violence against wives, sexual risk and sexually transmitted infection among Bangladeshi men. Sex Transm Infect 2007, 83:211-215.
• [26]Jewkes R, Dunkle K, Koss MP, Levin JB, Nduna M, Jama N, Sikweyiya Y: Rape perpetration by young, rural South African men: Prevalence, patterns and risk factors. Soc Sci Med 2006, 63:2949-2961.
• [27]Stephenson R: Community-Level Gender Equity and Extramarital Sexual Risk-Taking AmongMarriedMen in Eight African Countries. Int Perspect Sex Reprod Heal 2010, 36:178-188.
• [28]Connell RW: Gender and power: society, the person, and sexual politics. Stanford, California, USA: Stanford University Press; 1987. annotated, reprint
• [29]Connell RW: Hegemonic Masculinity: Rethinking the Concept. Gend Soc 2005, 19:829-859.
• [30]Jewkes R, Morrell R: Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. J Int AIDS Soc 2010, 13:1-11. BioMed Central Full Text
• [31]Jewkes R, Nduna M, Jama PN: Stepping Stones, South African Adaptation. In Book Stepping Stones, South African Adaptation. (Editor ed.^eds.). 2nd edition. South Africa: Medical Research Council; 2002.
• [32]Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Khuzwayo N, Koss M, Puren A, Wood K, Duvvury N: A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Trop Med Int Health 2006, 11:3-16.
• [33]Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, Duvvury N: Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. British Med J 2008, 337:a506.
• [34]WHO Multi-Country Study on Women’s Health and Domestic Violence: Core Questionnaire and WHO Instrument. Version 9. Geneva, Switzerland: World Health Organisation; 2000.
• [35]Barker G: Gender equitable boys in a gender inequitable world: reflections from qualitative research and programme development in Rio de Janeiro. Sex Relationsh Ther 2000, 15:263-282.
• [36]Weller SC, Davis-Beaty K: Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev 2002.
• [37]Peacock D, Levack A: The Men as Partners Program in South Africa: Reaching Men to End Gender-Based Violence and Promote Sexual and Reproductive Health. Int J Men’s Health 2004, 3:173-188.
• [38]Varga CA: How Gender Roles Influence Sexual and Reproductive Health Among South African Adolescents. Stud Fam Plan 2003, 34:160-172.
• [39]Courtenay WH: Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med 2000, 50:1385-1401.
• [40]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, 52:1613-1627.