Is 80% a passing grade? Meanings attached to condom use in an abstinence-plus HIV prevention programme in South Africa

AIDS Care. 2011 Feb;23(2):213-20. doi: 10.1080/09540121.2010.498875.

Abstract

This study represents the first qualitative exploration of how condoms are perceived by at-risk youth, their parents, their teachers and HIV prevention programme staff in an abstinence-plus HIV prevention programme. Behavioural interventions for HIV prevention with youth may be divided into three categories, each with a different approach to condoms: abstinence-only, abstinence-plus and comprehensive approaches. Research has highlighted the limitations of abstinence-only approaches and the emergence of early support for abstinence-plus interventions as HIV prevention strategies. Furthermore, research consistently demonstrates that condoms are socially mediated, reflecting diverse norms. However, there is a gap in the literature in terms of how condom use is framed, understood and represented by those delivering and receiving an abstinence-plus programme. This is critically important because advocates of a comprehensive approach to HIV prevention have flagged concern with the degree to which abstinence-plus programming may undermine confidence in condom use. Therefore, this study analyses meanings attached to condom use by stakeholders in an abstinence-plus HIV prevention programme in South Africa. Results demonstrate diverse meanings attached to condom use, including: condoms as second best to abstinence; condoms as a gendered response to HIV; condoms as a source of mockery; condoms as futile in a high-prevalence setting; condoms as part of conspiracy beliefs along racial and colonial lines; and, condoms as popular in HIV prevention because they can be counted. These findings have particular bearing for abstinence-plus HIV prevention programmes, which face the double challenge of (1) engaging with condom promotion in a way that takes into account their diverse social meanings, and (2) promoting condoms within their hierarchical framework of options in a way that does not inadvertently discourage their use.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Condoms / statistics & numerical data*
  • Faculty
  • Female
  • Focus Groups
  • HIV Infections / prevention & control*
  • HIV Infections / psychology
  • Humans
  • Male
  • Parents
  • Qualitative Research
  • Safe Sex / psychology*
  • Sexual Abstinence / psychology*
  • South Africa
  • Young Adult